耐多药肺结核患者疾病不确定感与社会支持的相关性

［摘要］　目的　探讨耐多药肺结核患者疾病不确定感的水平以及与社会支持之间的相关性。方法　采用由Mishel设计的住院患者疾病不确定感量表（MUIS）和由肖水源设计社会支持评定量表（SSRS）,以随机抽样的方法对72例符合耐多药肺结核诊断的患者进行入院后疾病不确定感和社会支持的测量。结果　72例耐多药肺结核患者的疾病不确定感总得分（87.04±12.04）分,其中不明确性（37.58±8.10）分,复杂性(16.13±3.45)分,信息缺乏性(18.14±4.10)分,不可预测性（15.19±3.03）分。耐多药肺结核患者的疾病不确定感属于中等程度的占86.1%。不明确性与客观支持、主观支持及社会支持总分呈负相关（r=-0.258,P=0.029;r=-0.278,P=0.018;r=-0.335,P=0.004）。信息缺乏则与客观支持、对支持的利用度及社会支持总分呈负相关（r=-0.311,P=0.008;r=-0.262,P=0.026;r=-0.305,P=0.009）。未发现复杂性和不可预测性与社会支持有相关性（P均>0.05）。结论　耐多药肺结核患者存在着中等程度的疾病不确定感,疾病不确定感与社会支持存在着负相关。临床护理工作中应重视患者的疾病不确定感和患者社会支持系统的作用,以降低疾病不确定感,提高耐多药肺结核治愈率。     

水飞蓟宾缓解油酸诱导的HepG2细胞脂质沉积的机制探讨

［摘要］　目的　构建油酸诱导的HepG2细胞脂肪变性模型,探索水飞蓟宾调节HepG2细胞脂质沉积的作用机制。方法　通过0.4 mM油酸刺激HepG2细胞24 h构建脂肪变性模型。根据实验目的设置对照组、油酸组（OA组）、油酸+水飞蓟宾组（OA+S组）、油酸+氯喹组（OA+CQ组）和油酸+氯喹+水飞蓟宾组（OA+CQ+S组）。每组4样本。通过油红O染色以及甘油三酯(TG)检测评估各干预组细胞脂质沉积情况。通过Western blot检测各干预组自噬标志蛋白LC3B的表达情况。结果　OA组HepG2细胞胞内染色脂滴数量明显多于对照组,且TG含量高于对照组,差异有统计学意义（P<0.05）。OA+S组经水飞蓟宾干预后胞内染色脂滴数量减少,TG含量下降,与OA组比较差异有统计学意义（P<0.05）。OA+CQ+S组在油酸刺激后,用自噬抑制剂氯喹预处理1 h,再加水飞蓟宾干预24 h,HepG2细胞内出现显著脂质沉积,TG含量上升,与OA+S组比较差异有统计学意义（P<0.05）,而与OA组水平相当（P>0.05）。Western blot检测结果显示,OA组LC3BⅡ/LC3BⅠ水平较对照组降低（P<0.05）;OA+S组LC3BⅡ/LC3BⅠ水平显著高于OA组,与对照组比较差异无统计学意义（P>0.05）;OA+CQ组、OA+CQ+S组的LC3BⅡ/LC3BⅠ水平显著高于OA组和OA+S组（P<0.05）。结论　0.4 mM油酸可引起HepG2细胞脂肪变性。水飞蓟宾通过增强HepG2细胞自噬而改善油酸引起的脂质沉积。     

正常范围内CD4+ T细胞水平对2型糖尿病患者胰岛素抵抗的影响

［摘要］　目的　探讨正常范围内CD4⁺ T细胞水平对2型糖尿病（T2DM）患者胰岛素抵抗的影响。方法　招募2021年9月至2022年6月徐州医科大学附属医院收治的T2DM患者269例,依据正常范围内的CD4⁺ T细胞水平将其分为4组：A组58例,414～670个/μl;B组78例,671～927个/μl;C组74例,928～1 183个/μl;D组59例,1 184～1 440个/μl。对研究对象的干扰素-γ（INF-γ）、白细胞介素-17(IL-17)、总胆固醇（TC）、甘油三酯（TG）、C反应蛋白（CRP）等指标进行检测。行口服葡萄糖耐量试验（OGTT）及胰岛素释放试验,计算稳态模型胰岛β细胞分泌指数（HOMA-β）,胰岛素抵抗指数（HOMA-IR）和Matsuda指数评估胰岛素敏感性IS（ISI_M）,分析各指标间的关联性。结果　四组CRP、INF-γ、IL-17、糖化血红蛋白（HbA_1c）、空腹血糖（FPG）、HOMA-IR、ISI_M比较差异有统计学意义（P<0.05),且CRP、INF-γ、IL-17、HbA_1c、FPG、HOMA-IR与CD4⁺ T细胞水平呈正关联,ISI_M与CD4⁺ T细胞水平呈负关联。Spearman秩相关性分析结果显示,HOMA-IR与CD4⁺ T细胞、CRP、HbA_1c、FBG、IL-17、INF-γ呈显著正相关（P<0.05）,与ISI_M呈显著负相关（P<0.05）。多元线性回归分析结果显示,CD4⁺ T细胞、FBG、IL-17、INF-γ水平与HOMA-IR水平呈正关联（P<0.05）。控制FPG及其他混杂因素（CRP、HbA_1c、IL-17、INF-γ）后,偏相关分析结果显示,HOMA-IR与CD4⁺ T细胞呈正相关（r=0.343,P<0.05）。结论　在CD4⁺ T细胞正常水平范围内,T2DM患者的CD4⁺ T细胞水平越高,其胰岛素抵抗越重,外周组织对胰岛素的敏感性也更低。     

黄连素逆转人结肠癌细胞奥沙利铂耐药性的作用及机制

［摘要］　目的　探究黄连素（Ber）逆转人结肠癌细胞奥沙利铂(OXA)耐药性的作用及机制。方法　选用人结肠癌耐OXA细胞THC-8307/OXA进行实验,分为对照组、OXA组和Ber（5、10、20 μg/ml）+OXA组。采用倒置相差显微镜观察细胞形态,MTT法检测细胞存活率,流式细胞术检测细胞凋亡率,RT-qPCR检测MDR-1 mRNA的表达,Western blot检测P-gp、PI3K、Akt和p-Akt蛋白的表达。结果　与OXA组比较,Ber（5、10、20 μg/ml）+OXA组的细胞存活率显著降低（P<0.05）,凋亡率显著升高（P<0.05）;MDR-1 mRNA、P-gp蛋白、p-Akt蛋白、PI3K蛋白的表达水平及p-Akt/Akt值均显著降低（P<0.05）。其中Ber（10、20 μg/ml）+OXA组的效应显著高于Ber（5 μg/ml）+OXA组,Ber（20 μg/ml）+OXA组的效应显著高于Ber（10 μg/ml）+OXA组。OXA组与对照组的检测结果比较差异无统计学意义（P>0.05）。结论　Ber可显著逆转THC-8307/OXA细胞对OXA的耐药性,其作用机制可能与PI3K/Akt信号通路抑制,P-gp蛋白表达下调有关。     

癌-睾丸抗原NY-SAR-35在结直肠癌组织中的表达情况及其临床意义

［摘要］　目的　探讨癌-睾丸抗原NY-SAR-35在结直肠癌（CRC）组织中的表达情况及其临床意义。方法　选择2009年10月至2012年5月于广西医科大学第一附属医院普外科接受手术治疗的CRC患者59例。男42例,女17例;年龄30～86（55.55±14.36）岁;TNM分期为Ⅰ～Ⅱ期38例,Ⅲ～Ⅳ期21例。均经手术取癌组织及配对的癌旁组织。采用逆转录聚合酶链反应（RT-PCR）检测组织NY-SAR-35 mRNA的表达情况。分析CRC组织NY-SAR-35 mRNA表达情况与患者临床特征及预后的关联性。结果　CRC组织中NY-SAR-35 mRNA阳性表达率显著高于癌旁组织（35.59% vs 13.56%,P<0.05）。CRC组织NY-SAR-35 mRNA阳性组肿瘤直径≥5 cm的人数比例显著大于阴性组（P<0.05）,但两组在性别、年龄、肿瘤位置、癌胚抗原（CEA）水平、T分期、N分期、M分期、TNM分期、组织学类型和分化程度方面比较差异无统计学意义（P>0.05）。NY-SAR-35 mRNA阴性组的生存预后优于阳性组（生存期：57.24个月 vs 40.71个月;log-rank检验： χ²=4.356,P=0.037）。Cox回归分析结果显示,T分期为T_3～4期、N分期为N_1～3期、M分期为M₁期以及NY-SAR-35 mRNA阳性表达是影响CRC患者生存预后的独立危险因素（P<0.05）。结论　NY-SAR-35 mRNA在CRC组织中高表达,且与患者不良预后具有相关性,具有作为CRC治疗靶点的潜在价值。     

ADC值及rADC鉴别诊断低危和中高危前列腺癌的效能分析

［摘要］　目的　分析磁共振表观扩散系数（ADC）值、ADC比值（rADC）鉴别诊断低危和中高危前列腺癌的效能。方法　选择2018年1月至2021年12月郑州市第七人民医院收治的前列腺癌患者62例,均经病理检查确诊。依据Gleason评分将其分为中高危组（Gleason评分≥7分,37例）和低危组（Gleason评分≤6分,25例）。测量所有患者癌灶ADC值,并以癌灶对侧、膀胱内尿液和臀大肌为参考,计算相应的rADC。采用Spearman秩相关分析探讨癌灶ADC值、rADC与Gleason分级的关系。采用受试者工作特征（ROC）曲线评价ADC值、rADC鉴别诊断低危和中高危前列腺癌的效能。结果　与低危组比较,中高危组的ADC值、rADC均较低,差异有统计学意义（P<0.05）。Spearman秩相关分析结果显示,前列腺癌患者ADC值与Gleason分级呈负相关（r_s=-0.639,P=0.000）,rADC_癌灶对侧、rADC_膀胱、rADC_膀胱与Gleason分级均呈负相关（r_s=-0.578,P=0.000;r_s=-0.640,P=0.000;r_s=-0.603,P=0.000）。ROC曲线分析结果显示,ADC值、rADC_癌灶对侧、rADC_膀胱、rADC_膀胱均可用于鉴别低危与中高危前列腺癌（P<0.05）,其中以rADC_膀胱的诊断效能最高（AUC=0.815）。结论　ADC值、rADC可应用于鉴别低危与中高危前列腺癌,有助于术前评估前列腺癌的生物学特性。     

CLCA1在结直肠癌中的表达及其基因集富集分析

［摘要］　目的　探讨钙激活的氯离子通道辅助蛋白1（CLCA1）在结直肠癌（CRC）中的表达及其与临床病理特征和预后的关系,分析其基因集富集情况。方法　通过肿瘤基因组图谱（TCGA）数据库下载CLCA1 mRNA表达数据,应用GSEA软件进行CLCA1不同表型的基因集富集分析。分析CLCA1 mRNA在CRC组织与癌旁组织中的差异表达,并分析其与临床病理特征的关联性。采用免疫组织化学染色法分析CLCA1在CRC组织和癌旁组织中的差异。结果　CRC组织中CLCA1表达较癌旁组织明显降低。CRC组织的免疫组织化学染色评分显著低于癌旁组织［（2.46±1.09）分 vs （5.65±0.49）分;t=6.458,P=0.000］。癌旁组织的CLCA1 mRNA表达水平显著高于临床Ⅰ～Ⅱ期CRC组织和临床Ⅲ～Ⅳ期CRC组织（P<0.05）,临床Ⅰ～Ⅱ期CRC组织的CLCA1 mRNA表达水平显著高于临床Ⅲ～Ⅳ期CRC组织（P<0.05）。CLCA1高表达组临床分期为Ⅰ～Ⅱ期、N分期为N₀期以及M分期为M₀期的人数比例显著大于CLCA1低表达组（P<0.05）。CLCA1高表达组的生存预后显著优于CLCA1低表达组（χ²=8.200,P=0.004）。基因集富集分析结果显示,有19个基因集显著富集于CLCA1高表达表型,未发现有基因集显著富集于CLCA1低表达表型。结论　CLCA1在CRC组织中表达下调,并且与患者的临床病理特征及预后有关,具有作为CRC诊断、治疗和预后预测标志物的潜力。     

全身型重症肌无力患者胸腺切除术后肌无力危象的影响因素分析

［摘要］　目的　分析全身型重症肌无力（MG）患者胸腺切除术后肌无力危象（POMC）的影响因素。方法　回顾性分析2018年1月至2022年6月于首都医科大学宣武医院胸外科接受胸腺切除术的116例全身型MG患者的临床资料，根据术后是否出现POMC分为POMC组38例和非POMC组78例。对其临床特点进行单因素和多因素分析，确定POMC的影响因素。结果　POMC组的机械通气时间、住ICU时间显著长于非POMC组（P<0.001）。POMC组和非POMC组在改良Osserman分型、合并胸腺瘤、手术方式、用力肺活量（FVC）、第一秒用力呼气容积（FEV₁）以及血清白蛋白与球蛋白比值（AGR）等方面比较差异均有统计学意义（P<0.05）。多因素logistic回归分析结果显示，Osserman分型、FVC、FEV₁以及AGR是POMC发生的影响因素（P<0.05）。结论　术前Osserman分型、FVC、FEV₁以及AGR是全身型MG患者发生POMC的影响因素，可为临床工作提供参考。     

甲亢患者血清miR-133a水平变化与甲状腺激素及脂质代谢的关联性研究

［摘要］　目的　探讨甲亢患者血清miR-133a水平变化与甲状腺激素及脂质代谢的关联性。方法　招募2020年10月至2022年8月中国人民解放军联勤保障部队第九八三医院收治的新发显性甲亢患者100例（甲亢组）,其中28例患者接受标准甲巯咪唑治疗;另选择同期健康体检者100名作为对照组。收集研究对象的性别、年龄、甲状腺激素、肝功能及其他生化指标等临床资料。采用实时荧光定量聚合酶链式反应（PCR）法检测血清miR-133a水平,分析其与甲状腺激素及脂质代谢水平的相关性。结果　与对照组相比,甲亢组游离甲状腺素(FT₄)、游离三碘甲状腺原氨酸(FT₃)、促甲状腺激素受体抗体(TRAb)、舒张压、丙氨酸转氨酶(ALT)、总胆红素(TBIL)和直接胆红素(DBIL)水平较高,体质量指数(BMI)、腰围、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、促甲状腺激素(TSH)水平较低,差异有统计学意义（P<0.05）。甲亢组血清miR-133a水平显著低于对照组（Z=9.796,P<0.001）。甲亢组血清miR-133a水平与ALT、FT₃、FT₄水平呈负相关（P<0.05）,与TC、LDL-C和TSH水平呈正相关（P<0.05）。在接受甲巯咪唑治疗后,甲亢患者FT₃和FT₄水平显著降低（P<0.05）,TC、LDL-C、TSH及血清miR-133a水平显著升高（P<0.05）。治疗前后血清miR-133a水平变化值与FT₃（r_s=-0.728,P<0.001）、FT₄（r_s=-0.377,P=0.048）水平变化值呈负相关,但与TC、TG、LDL-C和TSH水平变化值相关性不显著（P>0.05）。结论　甲亢患者血清miR-133a水平下调,这可能与甲状腺激素升高导致的脂质代谢紊乱有关。     

头孢哌酮钠舒巴坦钠联合左氧氟沙星治疗医院获得性肺炎的临床疗效观察

［摘要］　目的　探讨头孢哌酮钠舒巴坦钠联合左氧氟沙星治疗医院获得性肺炎（hospital acquired pneumonia,HAP）的临床疗效和不良反应。方法　将42例HAP确诊病例随机分为治疗组和对照组,每组21例。治疗组用头孢哌酮钠舒巴坦钠联合左氧氟沙星治疗,对照组用头孢哌酮钠舒巴坦钠治疗,疗程均为7～8 d。 结果　治疗组症状、体征恢复正常的时间为（48.24±7.54）h,对照组为（72.36±10.24）h,两组比较差异有统计学意义（P<0.01）;治疗组的临床疗效优于对照组（P<0.05);两组不良反应发生率比较差异无统计学意义（P>0.05)。结论　头孢哌酮钠舒巴坦钠联合左氧氟沙星治疗HAP的疗效明显优于单用头孢哌酮钠舒巴坦钠,值得临床推广应用。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.