Takayasu’s arteritis associated with Crohn’s disease

Takayasu’s arteritis (TA), also known as the “pulseless disease,” is a chronic vasculitis of the aorta and aortic branches. TA with Crohn’s disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu’s arteritis associated with concurrent Crohn’s disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autologous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn’s disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn’s disease may be associated with immune disorders, especially autoimmunity.      

Is adult celiac disease really uncommon in Chinese?

Celiac disease (CD) is a type of intestinal malabsorption syndrome, in which the patients are intolerant to the gliadin in dietary gluten, resulting in chronic diarrhea and secondary malnutrition. The disease is common in Europe and the United States, but only sporadic reports are found in East Asia including China. Is CD really rare in China? We examined 62 patients by capsule endoscopy for chronic diarrhea from June 2003 to March 2008. Four patients with chronic diarrhea and weight loss were diagnosed to have CD. Under the capsule endoscopy, we observed that the villi of the proximal small bowel became short, and that the mucous membrane became atrophied in these four patients. Duodenal biopsies were performed during gastroscopy and the pathological changes of mucosa were confirmed to be Marsh 3 stage of CD. A gluten free diet significantly improved the conditions of the four patients. We suspect that in China, especially in the northern area where wheat is the main food, CD might not be uncommon, and its under-diagnosis could be caused by its clinical manifestations that could be easily covered by the symptoms from other clinical situations, particularly when it came to subclinical patients without obvious symptom or to patients with extraintestinal symptoms as the initial manifestations.     

ORS和思密达治疗急性腹泻病疗效观察

为进一步探讨ORS(口服补液盐)和思密达对成人急性腹泻病的疗效与应用价值,作者对1996年7～9月间,急性腹泻病208例,随机分为oRS加思密达75例。并与单用抗生素66例和联合用药67例作对照,观察结果ORS加思密达显效率明显优于单用抗生索(p<0.05),建议ORS加思密达可作为急性腹泻病病因诊断前的首选疗法。     

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.     

Off-pump coronary artery bypass grafting versus on-pumpcoronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

INTRODUCTION Conventional coronary artery bypass graftin(CCABG) with cardiopulmonary bypass (CPB) habeen accepted as an effective and safe treatment fomulti-vessel coronary heat disease. CPB may stilcontribute to the operation field because of threlatively easier technical requirement; but it alscauses a serious systematic inflammatory reactiowhich will lead to dysfunction of important organand higher cost for the patients. Off-pump coronarartery bypass grafting (OPCABG) has r…     

Musculoskeletal ultrasound training encourages self-directed learning and increases confidence for clinical and anatomical appreciation of first-year medical students

Best-practice guidelines have incorporated ultrasound in diagnostic and procedural medicine. Due to this demand, the Arizona College of Osteopathic Medicine initiated a comprehensive integration of ultrasound into its first-year anatomy course attended by more than 280 students. Ultrasound workshops were developed to enhance student conceptualization of musculoskeletal (MSK) anatomy through visualizing clinically important anatomical relationships, a simulated lumbar puncture during the back unit, carpal tunnel and shoulder evaluations during the upper limb unit, and plantar fascia, calcaneal tendon, and tarsal tunnel evaluations during the lower limb unit. A 5-point Likert scale survey evaluated if ultrasound improved students' self-perceived anatomical and clinical comprehension of relevant anatomy, improved students' ability to orient to ultrasound imagery, and prompted further independent investigation of the anatomical area. Ultrasound examination questions were added to the anatomy examinations. Two-tailed one-sample t-tests for the back, upper limb, and lower limb units were found to be significant across all Likert survey categories (P < 0.001). Positive student responses to the Likert survey in conjunction with examination question average of 84.3% (±10.3) demonstrated that the ultrasound workshops are beneficial to student education. Ultrasound enhances medical students' clinical and anatomical comprehension and ability to orient to ultrasound imagery for MSK anatomy. This study supports early ultrasound education as a mechanism to encourage students' independent learning as evidenced by many undertaking voluntary investigation of clinical concerns associated with MSK anatomy. This study establishes the successful integration of MSK ultrasound into a large medical school program and its benefit to student clinical education.     

足底静脉泵预防脊柱创伤术后DVT的有效性评价

目的：探讨足底静脉泵在预防脊柱创伤术后深静脉血栓形成的有效性和安全性。方法：将2011年6月至2012年7月收治的脊柱损伤患者86例,随机分为观察组和对照组,每组各43例。术后均给予常规药物预防和护理干预,观察组在此基础上增加给予足底静脉泵物理干预。分别于术前和术后7d行下肢彩色多普勒超声检查,比较两组患者DVT发生率、下肢肿胀和D-二聚体含量。结果：术后7d,两组患者下肢肿胀明显缓解,其中观察组下肢周径差值仅为（1．3±0．3）cm,显著小于对照组（P〈0.05）,且D-二聚体含量呈下降趋势,仅为（0．6±0．1）ng／L,显著低于对照组（P〈0．01）。两组患者术后7d深静脉血栓发生率分别为2．3％和18．6％,观察组较低（P〈0．05）,两组在治疗过程中均未出现明显的不良反应。结论：足底静脉泵在预防脊柱创伤术后深静脉血栓形成中具有较好的临床效果且能够安全、够快速缓解腿部肿胀,值得临床推广。     

系统性血管炎的诊治进展

系统性血管炎是以血管壁炎症和纤维素样坏死为病理特征,具有多种临床表现的一组疾病。可分为原发性和继发性,常见原发性血管炎有巨细胞动脉炎、大动脉炎、结节性多动脉炎、川崎病、变应性肉芽肿性血管炎、韦格纳肿、显微镜下多血管炎等。近几年,有关原发性系统性血管炎的诊断标准和治疗方面已取得不少的进展,本文综述了诊断与治疗该病的最新进展,有一定临床参考价值。     

Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery bypass grafting with radial arteries on long-term patency and mortality.     

PCI术后AGI-1067应用综述

评价抗氧化剂succinobucol(AGI-1067)与安慰剂治疗冠状动脉疾病经皮冠状动脉介入治疗后血管内超声(IVUS)、血浆脂蛋白、心血管事件、腹泻及心电图QT-间期.方法计算机检索数据库PubMed、Embase、Cochrane图书馆、SCI、CBM、CNKI、维普和万方,手工检索专业相关期刊,由两人独立筛选和提取资料,根据Cochrane系统评价手册5.0标准评价纳入文献质量,用RevMan5.0软件进行数据分析.结果共纳入3个随机对照试验,包括6914例患者.Meta-分析结果显示:斑块体积[OR-1.93,95%Cl(-5.36,1.50)]、HDL[OR-0.16,95%Cl(-0.21,-0.11)、LDL[OR0.29,95%Cl(0.02,0.56)]、死亡率[OR1.10,95%Cl(0.84,1.44)]、急性心肌梗死[OR0.84,95%Cl(0.67,1.06)]、腹泻[OR3.54,95%Cl(3.03,4.13)]两组差异无统计学意义;与安慰剂对比,AGI-1067不能显著增加冠状动脉血管腔体积(p>0.01)和延长QT间期(p>0.01)结论抗氧化剂AGI-1067预防PCI术后血管再狭窄,降低血浆脂蛋白,远期疗效及安全性方面优于安慰剂,尚缺乏证据.     

冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床研究

目的：研究冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床意义。方法：采用高频超声测量冠心病组和对照组颈动脉斑块积分、斑块数、颈动脉内-中膜厚度（IMT）及血管内皮舒张功能（EDD％），并进行对比分析。结果：1．冠心病组颈动脉IMT、斑块积分及斑块数明显高于对照组，多支冠脉血管病变组明显高于单支病变组；2．冠心病组内皮舒张功能明显低于对照组，单支、双支病变组间无显著性差异。3．冠状动脉造影与颈动脉超声结果比较，以斑块存在为预测冠脉病变的阳性指标，敏感性为83％、特异性75％。结论：冠心病患者多合并血管舒张功能受损及颈动脉粥样硬化，高频超声探查颈动脉可预测冠状动脉病变的存在及严重程度。     

冠状动脉三支病变心电图特征

目的：通过冠状动脉造影术与常规心电图比较，分析冠状动脉三支病变的心电图特征。方法：选择68例冠状动脉造影冠状动脉三支病变的患者，进行常规12导联心电图特点分析，预测心电图对冠状动脉三支病变的临床意义。结果：心电图对冠状动脉三支病变的诊断缺乏特异性。结论：冠状动脉造影术是诊断冠状动脉三支病变的金标准。     

Living AnatoME: Teaching and learning musculoskeletal anatomy through yoga and pilates

Living AnatoME, a program designed in 2004 by two medical students in conjunction with the Director of Anatomy, teaches musculoskeletal anatomy through yoga and Pilates. Previously offered as an adjunct to the Gross Anatomy course in 2007, Living AnatoME became an official part of the curriculum. Previous research conducted on the program demonstrated its efficacy in providing relaxation and well-being to students who attended. In 2007, with all 144 gross anatomy students required to participate in a 1.5 hour Living AnatoME session on the upper and lower limbs, the impact of the program on students' comprehension of musculoskeletal anatomy was analyzed through the administration of 25-question pre- and post-tests, gauging knowledge in the following domains: upper limb, lower limb, muscle function, palpation, attachment/location, clinical correlate, and control (i.e., material not emphasized during the intervention). Analysis of postintervention tests revealed significant improvement in total Living AnatoME scores as well as in the domains of upper limb, muscle function, and palpation, indicating the possible efficacy of Living AnatoME in teaching anatomy. Performance on control questions also improved, although not significantly, which may indicate the role of other variables (e.g., additional study time) in increased performance.     

Association between TaqIB polymorphism of cholesteryl ester transfer protein and coronary artery disease in the Chinese population

Objective  

To assess whether the TaqIB polymorphism of cholesteryl ester transfer protein (CETP) is associated with coronary artery disease (CAD) in Chinese population, we performed a meta-analysis in this paper.     

冠心病介入治疗的临床分析

目的 :观察冠心病介入治疗的有效性和安全性。方法 :2 0 0 1.6～ 2 0 0 2 .5月 ,我院共对112例冠心病患者实施了经皮冠脉成形术 (PTCA)和冠脉内支架置入术 (CASI) ,其中 ,包括 4 3例紧急冠状动脉内支架术。结果 :本组行PTCA成功 15 0处 ,失败 4处 ,成功率 97.0 %。其中A、B型病变成功率均为 10 0 % ,C型病变成功率为 87.5 %。失败者为 4例冠脉完全闭塞 ,1例不稳定型心绞痛 ,1例急性心肌梗塞 ,2例陈旧心梗。其中 2处病变导丝不能通过 ,1处病变导丝通过后球囊不能通过 ,病变扩张前目测平均狭窄是 87.9%。PTCA后置入支架及直接支架置入共 112例 (15 4处病变 ) ,其中病变A型 6 8处 ,B型 6 0处 ,C型 2 8处 ,置入支架 15 4支 ,平均 1.1支 /处 ,即刻成功率 10 0 %。因病变较长或两支以上病变 ,有 2 4例患者置入 2只支架 ,7例置入 3只支架。急诊PTCA4 3例 ,直接PTCA4 2例 ,挽救PTCA1例 ,成功率 97.6 %。结论 :PTCA及支架植入术治疗冠心病是安全有效的。     

清营活血汤辅助治疗小儿川崎病32例临床观察

目的:探讨减少川崎病发生冠状动脉病变的治疗方法.方法:用清营活血汤(自拟)结合西药治疗川崎病32例.观察临床表现的消失时间和冠状动脉病变的发生率.结果:清营活血汤结合西药治疗川崎病,冠状动脉病变发生率为15.6%,纯西药组50%,有显著差异(P＜0.05),而临床表现的消退时间无明显差异性.结论:清营活血汤对减少川崎病发生冠状动脉病变有显著的治疗和预防作用.     

The Continuous Learning Journey of a Certified Performance Technologist

In this article the author, a certified performance technologist (CPT), explains what led him to pursue the CPT designation and what he has learned since then. His learning journey is framed by the three phases of Shu‐Ha‐Ri, a martial arts concept. He tells of how he developed a foundational proficiency with the CPT performance standards before truly understanding the principles and foundational concepts behind the practices associated with the standards. In his early days, he studied the work of performance improvement masters and practiced their techniques, both interpersonal and analytical. In the years after earning the CPT designation, he strove for true mastery in applying hybrid techniques or ones of his own invention, all grounded in the CPT principles.     

Real-Time Arm Animation with Natural Collision Avoidance

A novel approach to realistic collision-free animation of the upper limb was proposed.According to the obstacle-avoidance strategy of human hand,the movement trajectory was computed by manipulability model and minimum-jerk based interpolation.In each key frame,an improved in～verse kinematics method was adopted to obtain a believable posture of the upper limb.By comparing with the real movement data obtained from the motion capture device,the resultant animation was testified to be natural.This method can be performed in interactive time,and therefore is applicable in animation edit and control of virtual humans.     

宁南山区外科治疗甲状腺疾病227例疗效分析

用统计学方法对宁夏回族自治区固原市医院227例甲状腺手术病人进行分析,探讨甲状腺疾病手术治疗的效果.甲状腺疾病的手术治疗有增多趋势,其疾病谱也有明显的变化,应引起广大医务工作者的关注.     

Students' misconceptions about U.S. westward migration

Fifth-grade students with learning disabilities (LD) and their typically achieving (TA) peers participated in an 8-week investigation about 19th-century U.S. westward migration. During their investigations, the students analyzed primary and secondary sources to understand the experiences of these emigrants and Native peoples. The analysis of source material was preceded by teacher-led discussions about the possibility of bias in evidence that affects the trustworthiness of historical documentation. Quantitative analyses showed that these investigations were associated with gains in students' knowledge about the period of westward expansion and a better understanding of historical content and historical inquiry; however, these gains were not always comparable for students with LD and their TA peers. Furthermore, misconceptions about this historical period and the processes of historical investigation were evident in students' responses before and after instruction. We discuss how design features of the instruction and its implementation may have contributed to the development and persistence of these misconceptions.