Circulating adhesion molecules in patients with Keshan disease and their relationship with Coxsackie B virus infection

This study determined the levels of serum soluble intercellular adhesion molecule-1 （sI-CAM-l） and soluble vascular cell adhesion molecular-1 （sVCAM-1） in patients with different types of Keshan disease （KD）, examined the relationship between Coxsackie B virus-specific IgM antibody （CBV-IgM） and slCAM-1 or sVCAM-1 in KD patients, and investigated the role of these adhesion molecules in the pathogenesis of KD and their clinical implications. The levels of serum slCAM-1, sVCAM-1 and CBV-IgM were measured by using enzyme-linked immunosorbent assay in 22 patients with chronic Keshan disease （CKD）, 27 with latent Keshan disease （LKD） and 28 healthy controis. The subjects in different groups were adjusted for sex and age. Echocardiography was adopted to determine left ventricular ejection fraction （LVEF） in 22 patients with CKD. The results showed that CKD patients had significantly higher levels of slCAM-1 and sVCAM-1 than LKD patients and healthy controls （P〈0.01 for all）. And there was significant difference in the levels of the 2 adhesion molecules between LKD patients and healthy controls （P〈0.05）. A negative correlation was found between LVEF and slCAM-1 or sVCAM-1 in CKD patients. The percentage of CBV-specific IgM positive individuals in KD patients was significantly higher than that of healthy controls. In CVB-specific IgM positive patients, the levels of serum slCAM-1 and sVCAM-1 were significantly greater than those in CBV-specific IgM negative counterpart. It was concluded that the increase in the levels of slCAM-1 and sVCAM-1 suggests the progression of inflammation in KD. slCAM-1 and sVCAM-1 can promote the development of myocardial pathology and lead to poor myocardial function. The increased serum slCAM-1 and sVCAM-1 in KD patients may be related to CBV infection.     

胃癌全胃切除术后不置胃管的可行性和安全性研究

目的探讨胃癌全胃切除术后不置胃管的安全性和可行性。方法120例胃癌患者随机分成置胃管组和不置胃管组，对两组术后肠功能恢复时间、进食时间、下床活动时间、腹胀、呼吸道感染、吻合口漏等进行比较分析。结果不置胃管组肠功能恢复时间短、术后进食时间早，差异具有统计学意义（P〈0．05）；不置胃管组术后咽喉疼痛、恶心呕吐、肺部感染发生率低，差异具有统计学意义（P〈0．01）；两组术后吻合口漏、腹胀发生的差异无统计学意义（P〉0．05）。结论胃癌全胃切除术后不置胃管是安全可行的，不置胃管可减少术后并发症，有利于术后恢复。     

3种方法对于控制急性牙髓炎疼痛的比较研究

目的比较3种不同方法在急性牙髓炎治疗过程中控制疼痛的效果。方法急性牙髓炎患者120例120颗患牙随机分成3组:A组(开髓引流组)、B组(冠髓去除组)和C组(冠髓-根髓去除组),每组40颗牙。3组皆在局麻下进行手术,A组仅行开随处理,B组去除冠髓组织,C组彻底去除全部牙髓组织,以0.9%氯化钠和2%H2O2液反复冲洗,然后髓腔内置樟脑酚棉球,24 h后观察和比较疼痛缓解情况。结果 B组和C组在疼痛缓解方面明显优于A组(P0.01和P0.05),B组和C组之间差异无统计学意义(P0.05),但B组在治疗程序上较C组更为简便。结论冠髓去除对于急性牙髓炎患者控制疼痛是一种简单、有效、可靠的治疗方法。     

pT4aN0M0期胃癌预后的影响因素分析

目的 探讨影响pT_4aN₀M₀期胃癌预后的相关因素。方法 回顾性分析57例行根治性手术治疗且术后病理分期为pT_4aN₀M₀的胃癌患者临床病理资料，比较病理特征与临床预后的关系。结果 pT_4aN₀M₀期胃癌患者发病年龄多≥60岁，男性多于女性，BMI多低于24 kg/m²，肿瘤部位多位于胃中上部；肿瘤大小≥5 cm、阴性淋巴结数目≥15个、术后辅助化疗、肿瘤分化程度与pT_4aN₀M₀期胃癌预后相关（r=0.266，0.478，0.971，0.515，P<0.05，）；COX模型多因素分析显示，肿瘤大小、阴性淋巴结数目、术后辅助化疗、肿瘤分化程度是影响其预后的独立危险因素（P<0.05）。结论 肿瘤大小、阴性淋巴结数目、术后辅助化疗、肿瘤分化程度可能与pT_4aN₀M₀期胃癌患者预后有关，其中术后辅助化疗是最重要因素。     

德国口腔颌面肿瘤外科临床技术管窥

介绍作者在德国工作期间所见德国口腔颌面肿瘤外科技术和经验,并将德国经验与国内做法进行比较,分析了德国经验的优点.     

牙支持式种植导板指引下种植体植入的围手术期护理

目的 探讨牙支持式种植导板指引下种植体植入的围手术期护理方法。方法 回顾性分析2015年8月至2017年3月安徽省合肥市某医院15例病人在牙支持式种植导板指引下行种植体植入的围手术期护理方法。结果 15例种植牙病人成功植入植体23枚,无一例发生术后并发症,病人满意。结论 加强牙支持式种植导板指引下种植体植入的围手术期护理,可减少术中、术后并发症,消除病人焦虑,并提高种植修复的成功率。     

Efficacy and safety of different dosages of rituximab for refractory generalized AChR myasthenia gravis: A meta-analysis

BackgroundRituximab (RTX) is a mouse-human chimeric anti-CD20 monoclonal antibody and has been increasingly used for preventing relapses in myasthenia gravis (MG). However, the appropriate dose for maximizing the beneficial effects in refractory MG with acetylcholine receptor (AChR) autoantibody is a long-standing and critical debating question.MethodsWe performed a meta-analysis to evaluate the efficacy and safety of the different doses of RTX in 260 refractory AChR-MG patients.ResultsThe AChR-MG patients were divided into low or routine RTX dose groups. An overall proportion of 77% (p = 0.000) AChR-MG patients demonstrated improved clinical status as indicated by the Myasthenia Gravis Foundation of America post-intervention scale (MGFA-PIS). There were 77.1% patients showed improved clinical status in lower dose of RTX group (p = 0.000) and 76.8% in routine protocol group (p = 0.000). Although we found there was no significant difference in the proportion of AChR-MG patients with improved clinical status or adverse reactions between the two groups, adverse reactions might be lower in the lower dose RTX group.ConclusionMost of refractory MG patients with anti-AChR autoantibody were well responsive and tolerated to RTX treatment. Repeated application of lower dose of RTX was effective and might be more appropriate for refractory AChR-MG patients with potential lower side effects.     

Increased Plasma Interleukin-32 Expression in Patients with Neuromyelitis Optica

Purpose

Neuromyelitis optica (NMO) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). The pathogenesis of NMO remains unclear. IL-32 is emerging as a critical molecule in the pathophysiology of immune-mediated chronic inflammatory diseases. Whether IL-32 levels are elevated in NMO patients is unclear. We aimed to determine whether IL-32 levels are elevated in NMO patients and explore its relationship with IL-6, IL-17, and Expanded Disability Status Scale (EDSS) scores.

Methods

Plasma IL-32α, IL-6 and IL-17A were measured by enzyme-linked immunosorbent assay in NMO (n?=?26), MS (n?=?23) and 22 healthy controls.

Results

We found IL-32α levels were higher in NMO patients compared with MS (p?=?0.020) and healthy controls (p?=?0.00001). IL-32α levels were increased in MS patients compared with controls (p?=?0.009). IL-32α positively correlated with IL-6 and IL-17A levels and EDSS scores in NMO patients.

Conclusions

In summary, plasma IL-32α levels are associated with inflammatory responses in NMO patients.     

胰十二指肠切除术后早期并发症的分析及处理

目的探讨胰十二指肠切除术(PD)后早期并发症的原因及其防治方法。方法回顾性分析我院2007年3月～2012年9月间实施胰十二指肠切除术30例患者的临床资料。结果术后发生早期并发症9例(30.0%),包括腹腔内出血2例(6.7%),胰瘘5例(16.7%),胆瘘2例(6.7%),腹腔内感染1例(3.3%),围手术期死亡1例(3.3%)。统计学分析显示:术前血清胆红素水平≥171 mmol/L,血清白蛋白水平<35 g/L,术中失血量≥600 ml术后并发症发生率显著增高。结论出血、胰瘘、胆瘘和腹腔内感染等是PD术后主要的早期并发症,围手术期恰当的处理,术中仔细操作并采用合适的吻合方法,术后密切观察和及时积极的处理是减少PD术后并发症和病死率的关键。     

医养结合型养老机构的老年人久坐行为及影响因素分析

目的 调查合肥市医养结合型养老机构入驻老人久坐行为情况,并探讨其影响因素。方法 2021年5—8月便利抽取合肥市3所医养结合型养老机构中的210名老年人为研究对象,使用一般资料调查表、害怕跌倒评估、简易衰弱量表（FRAIL）、中文版老年抑郁量表（GDS-30）、国际体力活动短问卷（IPAQ-SF）进行调查,并采用多元线性回归分析机构内老年人久坐行为的影响因素。结果 合肥市医养结合型养老机构老年人平均每日总久坐时间为（7.09±1.66）h/d,久坐时间≥6 h/d 的老年人为153名（72.9%）。多元线性回归分析结果显示,性别、年龄、有无久坐爱好、衰弱状态、害怕跌倒、健康自评、抑郁程度是医养结合型养老机构老年人久坐行为的影响因素（均P<0.05）,共解释 62.2%的变异量。结论 医养结合型养老机构老年人久坐行为现状不容忽视。今后应重点关注男性、高龄、有久坐爱好、衰弱、害怕跌倒、健康自评差、中重度抑郁的老年人,并制定针对性强、可行性高的久坐行为干预策略改善其久坐行为现状,达到改善晚年生活质量、促进健康老龄化的目的。