特应质与儿童肺炎支原体肺炎严重程度及肺外表现相关性研究

目的探讨特应质在肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)儿童病情严重程度和肺外并发症中的作用,并阐明IL-17在其中的作用机制。方法回顾性纳入了2017年2月至2019年2月期间就诊于本院的221例MPP儿童,所有患者均行过敏原检测。采用相关性分析探索特应质和IL-17与病情及肺外并发症等相关性。结果221例MPP患儿中71例合并特应质,44例出现肺外并发症,其中以皮肤表现(36.4%)最为常见。有特应质MPP患者哮喘发作(P<0.001)和既往哮喘病史(P<0.001)比例、总IgE(P<0.001)显著高于无特应质患者,而IL-17(P<0.001)显著低于无特应质患者。有特应质MPP患者中更易出现重症肺炎(48/71 vs 17/150,P<0.001)。有特应质MPP患者出现胸腔积液(P=0.045)、呼吸急促(P<0.001)的比例、需氧疗(P<0.001)、糖皮质激素治疗的比例(P=0.008)以及糖皮质激素治疗时间(P=0.002)显著高于无特应质患者。合并肺外并发症MPP患者血浆IL-17(P=0.009)显著低于无肺外并发症患者,而总IgE水平(P=0.009)和特应质比例(P<0.001)显著高于无肺外并发症患者。结论特应质是导致MPP患儿病情严重和肺外并发症的危险因素之一,可能与IgE释放和IL-17降低相关。     

Polymeric immunoglobulin receptor (PIGR) exerts oncogenic functions via activating ribosome pathway in hepatocellular carcinoma

Objective: This report aimed to investigate the potential mechanism of polymeric immunoglobulin receptor (PIGR) in promoting cancer development in hepatocellular carcinoma (HCC).Methods: PIGR expression was investigated in Gene Expression Omnibus (GEO), Oncomine, The Cancer Genome Atlas (TCGA) and The Human Protein Atlas (HPA) databases. Relationships between PIGR and HCC survival and clinico-pathological features were conducted in TCGA. RNAseq of PIGR overexpression and knockdown samples in Bel-7404 cells were performed for identifying potential mechanisms.Results: PIGR was significantly overexpressed in tumors compared to nontumors and in HCC serum peripheral blood mononuclear cells (PBMC) than in healthy individuals (all p < 0.05). In TCGA, PIGR was highly altered in 14% HCC patients. PIGR upregulation was significantly associated with poor disease-free survival (p < 0.05). More patients recurred/progressed in PIGR altered group compared to unaltered group (p < 0.01). PIGR was significantly higher in HCC patients with incomplete cirrhosis (p < 0.001) and established cirrhosis (p < 0.05). Fewer patients had N₀ lymph node stage in PIGR altered group than those in the unaltered group (p < 0.05). PIGR RNAseq revealed that ribosome signaling was the common pathway in PIGR overexpression and PIGR knockdown samples. RNAseq analysis indicated that RPL10, RPL10A, RPL12, RPL19, RPL36, RPL38, RPL41, RPL6, RPL8, RPS12, RPS14, RPS15A, RPS2, RPS27A and RPSA were significantly upregulated in PIGR overexpression group and downregulated in PIGR underexpression group (all p < 0.05).Conclusions: Aberrant PIGR was associated with HCC recurrence, and PIGR stimulated ribosome pathway might be a potential mechanism.     

凝胶体位垫在手术患者预防压疮中的应用

目的:观察凝胶体位垫在预防手术患者压疮中的应用。方法:将需要安放特殊体位,3 h以上手术时间的60例患者按住院号的单双数分成试验组30例与对照组30例。试验组患者在手术开始前在骨隆突处垫凝胶体位垫,对照组则垫传统的软枕体位垫,手术结束后观察受压部位的皮肤情况,是否出现压痕,红肿,水泡及皮肤破溃等情况。结果:试验组患者皮肤情况好于对照组患者的皮肤。结论:凝胶体位垫的使用在手术患者压疮的预防中起到了很好的效果,从而提高了手术护理质量。     

Antibiotic cement-coated intramedullary nail is cost-effective for the initial treatment of GAⅢ open tibia fractures

ObjectiveTo evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type Ⅲ (GAIII) open tibia fractures.MethodsA break-even equation was used to analyze the costs associated with antibiotic cement-coated IMN and postoperative infection following GAⅢ open tibia fractures. This equation produced a new infection rate, which defines what percentage the antibiotic coated IMN needs to decrease the initial infection rate for its prophylactic use to be cost-effective. The postoperative infection rate used for calculations was 30%, a value established in current literature for these fracture types (6–33%). The institutional costs associated with a single operative debridement and resultant inpatient stay and treatment were determined. A sensitivity analysis was conducted to demonstrate how various total costs of infection and different infection rates affected the break-even rate, the absolute risk reduction (ARR), and the number needed to treat (NNT).ResultsFinancial review yielded an average institutional cost of treating a postoperative infection to be $13,282.85. This number was inclusive of all procedures during an inpatient stay. The added cost of the antibiotic coated implant to the hospital is $743.42. Utilizing the break-even formula with these costs and a 30% initial infection rate, antibiotic coated IMN was economically viable if it decreased infection rate by 0.056% (NNT = 1,785.714).ConclusionThis break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAⅢ open tibia fractures is cost-effective.     

Proximal avulsion of five ligaments and revised diagonal principle in tibial plateau fractures

PurposeThe aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures.MethodsComputed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed.ResultsIn total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified.ConclusionsAmong the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.     

Natural YMDD-motif mutants affect clinical course of lamivudine in chronic hepatitis B

AIM:To investigate the prevalence of nature tyrosinemethionine-aspartic acid-aspartic acid motif mutations in chronic hepatitis B(CHB)patients and to evaluate the efficacy of lamivudine.METHODS:A total of 1268 CHB patients were recruited from the outpatient and inpatient departments of six centers.Tyrosine-methionine-aspartic acid-aspartic acid(YMDD)mutations were analyzed using the hepatitis B virus(HBV)drug resistance line probe assay.Forty voluntary patients were selected from those with positive or negative natural YMDD mutations to undergo treatment with lamivudine.RESULTS:YMDD mutations were detected in 288(22.71%)of the 1268 CHB patients.Multivariate analysis revealed that the patients’HBV DNA level(P=0.0282)and hepatitis B e antigen status(P=0.0133)were also associated with natural YMDD mutations.The rates of normalization of alanine aminotransferase levels and HBV DNA nondetection at 6,24,36,and 48 wk were compared between the patients with natural YMDD mutations and those without,and the differences were not significant.However,there was a significant difference in the cumulative emergence rates of virological breakthrough at 48 wk in the patients with natural YMDD mutations and those without(32.5%vs 12.5%,P=0.032).CONCLUSION:Naturally occurring YMDD mutationsare detectable in a large proportion of CHB patients;breakthrough hepatitis tended to occur in patients with natural YMDD mutations.     

双钢板治疗肱骨髁间骨折3种内固定方式的载荷-应变与位移

背景：很多临床报道认为“双钢板”方法治疗肱骨髁间骨折是较为理想的方法,但对于放置方式一直存在争议。 目的：比较肱骨髁间骨折应用双钢板固定时,3种不同放置方式的生物力学特性。 方法：18具防腐肱骨标本,制成肱骨远端“T”型髁间骨折模型,在髁间骨折线两侧各贴2个(共4个)应变片。随机予以背侧双钢板固定、垂直双钢板固定、平行双钢板固定,在压缩载荷下,对3种内固定方式进行应变、位移、刚度的测试。 结果与结论：①从载荷-位移数据中可以看到：当载荷低于500 N时,3种内固定方式位移差异无显著性意义;在500 N时,平行双钢板压缩位移小于背侧双钢板固定、垂直双钢板固定(P < 0.05)。②3种内固定应变较小的是平行双钢板固定,另两种钢板固定方式应变较大,前者与后两者差异有显著性意义(P < 0.05)。内外髁的应变大于髁间应变,外髁的应变最大。当载荷低于300 N时,3种内固定方式的刚度差异无显著性意义。在300~500 N外力的载荷下轴向压缩刚度以平行双钢板内固定最高,背侧双钢板和垂直双钢板较低,前者与后两者比较差异有显著性意义(P < 0.05)。由此可见,同等载荷下,平行钢板固定效果最佳,垂直钢板固定和背侧钢板固定之间无差异。     

Siewert Ⅱ-Ⅲ型食管胃结合部腺癌行近端胃切除后双通道吻合术的疗效评估

[摘要]：目的: 探讨根治性近端胃切除间置空肠残胃-空肠双通道吻合术在SiewertⅡ～Ⅲ型食管胃结合部腺癌病人中的临床疗效。方法: 采用回顾性队列研究，将2017年12月到2020年3月南通大学附属丹阳医院胃肠外科专业组收治SiewertⅡ～Ⅲ型食管胃结合部腺癌病人纳入研究，行根治性近端胃切除间置空肠残胃-空肠双通道吻合术的30例病人为观察组；行根治性全胃切除Roux-en-Y消化道重建术的30例病人为对照组。比较2组病人术中、术后及随访的相关指标。结果: 两组病人总手术时间、消化道重建时间、术后第3天腹腔引流液淀粉酶值相比较，差异有统计学意义（均P<0.05）。两组病人的术中出血量、淋巴结清扫个数、术后首次下床时间、术后肛门首次排气时间、术后进食时间、术后并发症发生率、术后住院时间比较，差异均无统计学意义（均P>0.05）。观察组术后6月、12月、24月血清胃泌素、血红蛋白、白蛋白、体质量增加均高于对照组，差异有统计学意义（均P<0.05），但是单次进食量、术后消化系统症状（烧心、反酸、胃食管反流）的比较，差异无统计学意义（均P>0.05）。结论: SiewertⅡ～Ⅲ型食管胃结合部腺癌病人切除近端胃后，采用间置空肠残胃-空肠双通道吻合术保留了十二指肠路径，胃及十二指肠的有关生理功能得到了保留，病人的长期营养状况较好，安全可行，值得临床推广应用。