15kg以下小儿体外循环的管理体会

目的探讨15kg以下小儿体外循环的管理措施。方法回顾性分析112例体重15kg以下小儿体外循环的管理经验。结果平均体外循环转流时间(49.13±22.45)min,105例在开放升主动脉后自动复跳,无一例术中死亡。结论预充、术中超滤的应用、术中维持合适的温度、完善的术中管理是15kg以下小儿体外循环管理的重要环节。     

Drug-eluting stenting for femoropopliteal lesions,followed by cilostazol treatment,reduces stent restenosis in patients with symptomatic peripheral artery disease

Background

Cilostazol improves clinical endovascular therapy outcomes for femoropopliteal (FP) lesions in patients with symptomatic peripheral arterial disease, but whether it also has clinical benefits for patients after drug-eluting stent implantation remains unclear.

伤口呈色显影用于预测重症肢体缺血患者血管腔内治疗后溃疡愈合的价值初探

目的 探讨伤口呈色显影预测重症肢体缺血患者血运重建术后溃疡愈合的价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2011年6月1日-2014年6月30日收治成功实施Angiosome概念指导腔内血运重建的重症肢体缺血的缺血性溃疡患者临床资料.根据血管腔内血运重建术后伤口呈色显影情况分组,其中伤口呈色(+)组109例,伤口呈色(-)组64例,分别比较患者保肢率,溃疡愈合时间的差异,试分析其作为重症肢体缺血的缺血性溃疡愈合预测因子的价值.采用SPSS 19.0软件进行统计学分析.正态分布计量资料以均数±标准差(x±s)表示,两组比较采用t检验.计数资料以频数和百分比表示,两组比较采用Pearson x2检验或Fisher确切概率法.结果 纳入研究患者共173例(173条患肢),两组患者年龄、性别比例、吸烟史、冠心病、糖尿病、慢性肾功能不全、术前踝肱指数、术后踝肱指数差异均无统计学意义,溃疡愈合时间:伤口呈色(+)组(3.9±1.9)个月低于伤口呈色(-)组(7.9±2.6)个月,差异有统计学意义(P＜0.05).累积保肢率:伤口呈色(+)组(90.2％)高于伤口呈色(-)组(78.0％),差异有统计学意义(P＜0.05).通过Logistic回归分析,校正年龄、性别、吸烟史、高血压异常等因素后,伤口呈色(-)(OR=4.5,P＜0.05)、IRc(间接血供有侧支)血运重建(OR =2.6,P＜0.05)均是溃疡难愈合的独立危险因素.结论 伤口呈色显影阳性显示足部循环较好,可以作为重症肢体缺血的缺血性溃疡愈合的预测因子,而伤口呈色显影阴性是溃疡难愈合的独立危险因素.     

Molecular pathology quality control in Southeast Asia: Results of a multiregional quality assurance study from MASTER KEY Asia

Tissue specimen quality assurance is a major issue of precision medicine for rare cancers. However, the laboratory standards and quality of pathological specimens prepared in Asian hospitals remain unknown. To understand the methods in Southeast Asian oncology hospitals and to clarify how pre-analytics affect the quality of formalin-fixed paraffin-embedded (FFPE) specimens, a questionnaire surveying pre-analytical procedures (Part I) was administered, quality assessment of immunohistochemistry (IHC) staining and DNA/RNA extracted from the representative FFPE specimens from each hospital (Part II) was conducted, and the quality of DNA/RNA extracted from FFPE of rare-cancer patients for genomic sequencing (Part III) was examined. Quality measurements for DNA/RNA included ΔΔCt, DV200, and cDNA yield. Six major cancer hospitals from Malaysia, Philippines, and Vietnam participated. One hospital showed unacceptable quality for the DNA/RNA assessment, but improved by revising laboratory procedures. Only 57% (n = 73) of the 128 rare-cancer patients' specimens met both DNA and RNA quality criteria for next-generation sequencing. Median DV200 was 80.7% and 64.3% for qualified and failed RNA, respectively. Median ΔΔCt was 1.25 for qualified and 4.89 for failed DNA. Longer storage period was significantly associated with poor DNA (fail to qualify ratio = 1579:321 days, p < 0.001) and RNA (fail to qualify ratio = 1070:280 days, p < 0.001). After improvement of pre-analytical factors, the qualification rate increased for hospitals A and E from 41.5% to 70.5% and 62.5% to 86%, respectively. This is the first report to elucidate the pre-analytical laboratory procedures of main Southeast Asian oncology hospitals. An external quality assessment program may improve factors associated with tumor FFPE specimen quality.     

Heavy metal concentrations in water and soil along the Hun River,Liaoning, China

Water and soil samples were collected along the Hun River to study the concentrations of Cr, Cu and Zn during the dry season, medium season and wet season in 2013. The concentrations of Cr, Cu, and Zn in Hun River were 0.0010 to 0.1298, 0.0057 to 0.1533 and 0.0162 to 0.5004 mg/L, respectively. The concentrations of Cr, Cu, and Zn in soil from around the Dahuofang reservoir were 0.0033 to 0.2149, 0.0054 to 0.2218 and 0.0135 to 0.3544 mg/g, respectively. The results indicated that the concentrations of Cr, Cu and Zn in water from the Hun River and soil from around the Dahuofang reservoir were significantly different at different sample stations and seasons. The pollution indexes of Cr, Cu and Zn in water and soil along the Hun River were calculated using principal component analysis in order to enact future measures against heavy metal pollution. According to the pollution characteristics of heavy metals along the Hun River, a treatment strategy was formulated to provide a scientific basis for the prevention and control of heavy metal pollution along the Hun River.     

新生儿重症监护室患儿肠道内定植的大肠埃希菌和肠球菌耐药分析

目的 了解新生儿重症监护室（NICU）患儿肠道菌定植和耐药情况,为临床用药及合理治疗提供依据。方法 2014年5月至2015年5月对北京妇幼保健院NICU新生儿采集的572份粪便样本进行肠道菌分离培养,采用VITEK-2系统进行菌株鉴定和抗生素敏感性检测,并对耐药情况进行统计分析。结果 分离得到328株大肠埃希菌和243株肠球菌。选取的199株大肠埃希菌对亚胺培南、厄他培南、阿米卡星、呋喃妥因较敏感（耐药率为0.50%~3.52%）;对氨苄西林、四环素、复方甲基异恶唑、头孢唑啉耐药率较高（耐药率为54.27%~84.92%）,未发现对美罗培南耐药菌株;产ESBL的菌株占45%;多重耐药情况统计结果显示对4类抗生素耐药性的菌株数量最多（34.6%）;有3株大肠埃希菌对7类抗生素表现耐药性。肠球菌对链阳霉素、呋喃妥因、链霉素较敏感（耐药率为0.41%~4.53%）;对氨苄西林、青霉素、环丙沙星、四环素、庆大霉素、红霉素耐药率较高（耐药率为70.78%~91.77%）,未发现对替加环素、万古霉素、利奈唑胺耐药的肠球菌;多重耐药情况统计结果显示,对5类抗生素表现耐药性的菌株数量最多（86.5%）。结论 NICU新生儿肠道定植的大肠埃希菌和肠球菌对抗生素耐药情况较严重,呈现多重耐药性,临床用药应结合药敏实验结果,合理选择抗菌药物。     

Laparoscopic complete mesocolic excision via combined medial and cranial approaches for transverse colon cancer

Purpose

To evaluate the safety and feasibility of laparoscopic complete mesocolic excision via combined medial and cranial approaches with three-dimensional visualization around the gastrocolic trunk and middle colic vessels for transverse colon cancer.

Methods

We evaluated prospectively collected data of 30 consecutive patients who underwent laparoscopic complete mesocolic excision between January 2010 and December 2015, 6 of whom we excluded, leaving 24 for the analysis. We assessed the completeness of excision, operative data, pathological findings, length of large bowel resected, complications, length of hospital stay, and oncological outcomes.

Results

Complete mesocolic excision completeness was graded as the mesocolic and intramesocolic planes in 21 and 3 patients, respectively. Eleven, two, eight, and three patients had T1, T2, T3, and T4a tumors, respectively; none had lymph node metastases. A mean of 18.3 lymph nodes was retrieved, and a mean of 5.4 lymph nodes was retrieved around the origin of the MCV. The mean large bowel length was 21.9 cm, operative time 274 min, intraoperative blood loss 41 mL, and length of hospital stay 15 days. There were no intraoperative and two postoperative complications.

Conclusion

Our procedure for laparoscopic complete mesocolic excision via combined medial and cranial approaches is safe and feasible for transverse colon cancer.

     

伤寒沙门菌致感染性腹主动脉瘤1例

目的 探讨伤寒沙门菌致感染性腹主动脉瘤的手术治疗方法.方法 回顾收住入院并实施外科干预的1例伤寒沙门菌属致感染性腹主动脉瘤的临床资料,对手术方式及术后治疗方案进行分析.结果 病人痊愈出院.结论 感染性腹主动脉瘤是一种少见且危险的主动脉疾病,治疗棘手,病死率高,充分的术前评估及选择适合病人的手术方案,是手术治疗成功的基础.根据手术方式选择不同的抗生素疗程,预防感染复发,为今后诊治伤寒沙门菌致感染性腹主动脉瘤提供一定的参考意义.     

Renal simplicity denervation reduces blood pressure and renal injuries in an obesity‐induced hypertension dog model

This study aimed to investigate the effects of renal sympathetic denervation (RDN) on blood pressure, renal function, and renal tissue pathological changes in obesity‐induced hypertensive dogs. Thirty‐two beagle dogs (10‐12 months) were randomized to the control (n=10) and model groups (n=22). High‐fat diet (HFD) was used to establish the obesity‐induced hypertensive model. After 3 months of HFD, 20 animals with successfully induced hypertension were randomized to the RDN (n=10) and sham groups (n=10). Renal artery angiography, body weight, blood pressure, heart rate (HR), and blood and urine biochemistry were determined 1, 3 and 6 months after surgery. Models were killed 6 months after surgery. Pathological changes in the renal artery and renal tissue were assessed. The HFD group had significantly (P<.05) increased body weight, HR, and blood pressure, and higher levels of urine albumin, serum noradrenaline, and angiotensin II compared with controls. After RDN, blood pressure was decreased compared with baseline and the sham group (P<.05). In the RDN group, examination of the renal artery and renal tissue showed intact intima of renal artery in the surgical area, renal sympathetic nerve degeneration, necrosis, and dissolution, and widened space between nerve fibres. Hypertension‐induced renal pathological changes were mild to moderate in the RDN group, but severe in the sham group. The control group had normal glomerular structure. In conclusion, RDN can effectively lower blood pressure in obesity‐induced hypertensive dogs, as well as hypertension‐induced renal pathological changes.