Treatment and outcomes of endoscopic surgery and traditional open resection in sinonasal mucosal melanoma

Objective: The optimal surgical approach for sinonasal mucosal melanoma (SNM) remains under debate. We aimed to compare the therapeutic efficacy of traditional open resection and endoscopic surgery for patients with SNM treated at a single center.

Methods: Thirty-three patients diagnosed with SNM who underwent surgery between January 1995 and June 2014 at a single institution were retrospectively analyzed; 18 patients were treated using an open resection approach and 15 using an endoscopic resection approach for the primary tumor. The associations between open resection and endoscopic resection with treatment-related survival outcomes were assessed using the Kaplan–Meier method and log-rank test.

Results: The most common presenting symptoms were epistaxis and abstraction; the nasal cavity was the most common anatomic location. The open resection and endoscopic resection groups did not have significantly different demographic or tumor characteristics. Overall survival (p?=?.66) and disease-free survival (p?=?.73) were modest and did not differ significantly between the open resection and endoscopic resection groups.

Conclusions: This retrospective study indicates that the endoscopic endonasal approach is an effective treatment for SNM in selected cases and, when performed by a skilled surgeon, can enable successful radical resection with a similar efficacy as traditional open resection.     

实验室血样保存条件对降钙素原浓度测定的影响

目的:探讨实验室血样保存类型、温度、时间、密封状态对降钙素原(procalcitonin,PCT)浓度测定的影响。方法:采用高敏免疫化学发光法检测10位脓毒血症患者的血样PCT浓度,分析比较保存不同时间血清与全血、4℃与25℃、密封与非密封PCT值的变化。结果:密封组与非密封组PCT值差异无统计学意义(P>0.05);全血4℃保存4h、25℃保存2h、血清25℃保存4h后,PCT值均较基线值下降,下降具有统计学意义(P<0.05);而血清4℃保存2h时其PCT值较基线值升高,有统计学意义(P<0.05),保存4～8h较基线值升高,但无统计学意义(P>0.05),保存24h后PCT较基线值下降有统计学意义(P<0.05);四组保存24h时PCT值较基线值下降了4.3%～16.8%。结论:检测PCT的血样标本以血清室温下保存最好,全血标本宜于冷藏保存,为提高检测的准确性和稳定性,建议采血后2h内完成检测,或制定规范的检测流程,确保采血与检测的时间间隔相对恒定,以利于PCT值的动态稳定性。     

适应性支持通气在体外循环下心脏手术患者脱机中的研究

目的:通过比较ASV和SIMV+PSV模式在体外循环下心脏手术后患者脱机中的研究,为临床寻找一个更合适的脱机模式。方法:将我院2010年1月-2011年12月期间体外循环下行非复杂心脏外科手术者(包括房间隔缺损、室间隔缺损、二尖瓣置换术、主动脉瓣置换术)纳入研究。体外循环心脏手术后患者常规转入ICU,使用随机数字表随机分为两组(ASV组和SIMV+PSV组),分别给予ASV和SIMV+PSV两种通气模式,并按标准的脱机程序脱机。术后比较两组患者机械通气时间、住ICU时间、血气分析、呼吸力学指标、血流动力学指标、呼吸机报警次数、人工操作次数、生命体征等指标。结果:共31例患者完成该研究,其中ASV组16例,SIMV+PSV组15例。ASV组与SIMV+PSV组相比,机械通气时间[(223.9±22.1)min VS(302.9±30.2)min]、呼吸机报警次数[(2.0±1.3)bpmVS(4.0±1.8)bpm]人工操作次数[(4.8±1.4)bpm VS(8.2±3.4)bpm],两组相比具有统计学差异。呼吸力学指标:ASV组与SIMV+PSV组相比,气道峰值压力[(15.8±1.4)cmH2O VS(20.4±1.3)cmH2O],两组相比具有统计学差异。而血流动力学以及血气分析结果相比无统计学差异。结论:ASV模式能加速气管插管的拔除,简化操作,ASV模式作为一个脱机模式安全有效。     

CircRNAs在骨质疏松症中的研究进展

骨质疏松症是最常见的与年龄相关的骨骼退化型疾病,常常无临床症状,一般骨折发生后才被确诊。通过骨密度和常规骨标志物难以判断骨质疏松症患者的骨质量及预测其骨折风险。Circular RNAs(circRNAs)即环状RNA,是真核生物中具有组织特异及细胞特异表达模式的一类内源性闭合环状非编码RNA,其稳定性高、保守性好,在基因调控中发挥复杂作用。研究发现circRNAs作为miRNA海绵,调控基因表达和蛋白相互作用,参与骨质疏松症的发生和发展。本文将对circRNAs在骨质疏松症中调控作用的最新研究进行综述,并探讨circRNAs作为骨质疏松症新型标志物的可能性。     

乳头肌切开术在合并十二指肠乳头旁憩室的 特发性胰腺炎中的应用价值

目的评价乳头肌切开术(EST)在合并十二指肠乳头旁憩室的特发性胰腺炎中的诊治价值。方法对该院7年来收治的18例合并十二指肠乳头旁憩室的特发性胰腺炎进行回顾性研究。结果 18例患者成功17例,成功率94.44%,EST 17例,其中中切开9例,小切开+柱状气囊扩张8例,胆管支架置入3例,鼻胆管引流14例,无严重的出血、穿孔等并发症。结论 EST对于合并十二指肠乳头旁憩室的特发性胰腺炎,安全有效,能够进一步明确病因、有效地控制并预防复发,值得临床推广。     

授权教育对类风湿关节炎病人治疗依从性及生活质量的影响

[目的]探讨授权教育对类风湿关节炎(rheumatoid arthritis,RA)病人治疗依从性及生活质量的影响。[方法]选择RA病人80例随机分为两组,对照组采用传统健康教育模式;干预组采用授权教育模式,干预前后采用自制的RA病人治疗依从性调查表、简明生活质量量表(SF-36)、健康状况评定量表(HAQ)进行调查,比较两组病人干预后治疗依从性、生活质量及健康状况。[结果]两组干预前一般资料、治疗依从性、SF-36评分、HAQ评分比较差异无统计学意义(P>0.05),干预后两组病人治疗依从性、SF-36评分、HAQ评分比较差异均有统计学意义(P<0.05)。[结论]授权教育可以提高RA病人治疗依从性,进而提高病人的生活质量和健康状况。     

临床护理路径在中西医结合治疗顺铂致胃肠道反应中的应用

[目的]临床护理路径在中西医结合治疗顺铂致胃肠道反应中的效果。[方法]将108例顺铂联合化疗病人随机分为对照组57例和观察组51例。对照组予以常规西医治疗,进行传统健康教育方法,观察组采用临床护理路径模式,制订中西医结合治疗对顺铂致胃肠道反应效果临床护理路径表,根据病人特定群体的实际情况,有针对、有计划、有预见性地制订并实施病人的健康教育,并加用艾灸配合穴位按压。[结果]观察组胃肠道反应、健康教育知识掌握情况及护理满意度均优于对照组(P0.05)。[结论]临床护理路径在中西医结合治疗顺铂致胃肠道反应中起到良好的作用。     

Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs

Purpose

To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA).

Methods

RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA.

Result

Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p?=?0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p?=?0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p?=?0.005), which was not statistically different in adults (p?>?0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay.

Conclusion

SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.     

基因芯片法检测21例耳聋患者基因突变的研究

目的探讨基因芯片在耳聋基因筛查中的应用价值。方法对扬州市聋哑学校21例8～18岁的耳聋患者中4个耳聋相关基因上的9个热点突变进行检测,包括GJB2(35 delG、176 del16、235 delC及299 delAT)、GJB3(C538 T)、SLC26 A4(IVS7-2 A>G、A2168 G)以及线粒体12 S rRNA(A1555G、C1494T)。结果 SLC26A4突变阳性率为38%(8/21),其中IVS7-2A>G杂合突变7例,IVS 7-2 A>G与A 2 1 6 8 G杂合突变1例;GJB 2突变阳性率为1 9%(4/2 1),其中1 7 6 del 1 6杂合突变1例,299 delAT杂合突变1例,176 del 16与235 del C杂合突变1例,235 del C纯合突变1例。结论基因芯片是一种筛查耳聋基因的高效、经济、简便、灵敏及特异性方法。