306例荨麻疹患者过敏原血清特异性IgE检测分析

目的分析荨麻疹患者血清中过敏原特异性IgE和总IgE水平,为更好地诊断和防治荨麻疹提供科学依据。方法采用免疫印迹技术对荨麻疹患者进行血清特异性IgE和总IgE水平的检测。结果 306例荨麻疹患者中总IgE阳性为302例(98.7%),其主要过敏原为吸入性的尘螨(46.4%)、蟑螂(22.5%)、兽毛(15.0%)和食物性的花生及腰果和黄豆(12.4%)、牛奶(10.8%)等。此外,儿童食物致敏主要为牛奶和牛、羊肉。结论检测荨麻疹患者血清中总IgE和特异性IgE对荨麻疹的预防、诊断和治疗有重要指导意义。     

Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing

Emergomyces is a newly described dimorphic fungus genus; it may cause fatal infections in immunocompromised patients, but diagnosis is often delayed. We report a case of disseminated emergomycosis caused by the novel species Emergomyces orientalis in a kidney transplant recipient from Tibet. Infection was diagnosed early by metagenomic next-generation sequencing.     

基于ITS2序列对藏药材植物的分子鉴定

目的选用ITS2序列作为条形码来鉴定44种藏药材植物。方法用高盐低pH法提取藏药材植物的基因组DNA,通过PCR扩增藏药材植物的ITS2序列,共得到ITS2序列145条,分属于24科,39属,44种。在GenBank数据库中通过序列比对选取了部分藏药材的同源序列。将ITS2序列在Bioedit软件中进行序列比对,在MEGA软件中计算双参数(K2P)种内和种间遗传距离,并基于邻接法构建系统进化树来分析物种的系统发育关系。结果 ITS2区域有显著的种内、种间差异,基于ITS2区域的系统进化分析与形态学结果一致,并可以反映物种之间的亲缘关系。此外,藏药材的ITS2序列二级结构各有不同,为物种鉴定提供了另一种方法。结论 ITS2序列是藏药材植物鉴定和系统发育研究的非常有效的单条形码,为藏药材植物资源的利用和保护提供了科学依据。     

蒙特卡洛模拟评价中国成人持续静脉输注万古霉素治疗开颅术后MRSA脑膜炎感染的给药方案

目的 应用蒙特卡洛模拟(MCs)评价中国成人开颅术后脑膜炎患者持续静脉输注万古霉素(VAN)治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的给药方案。方法 搜集我国开颅术后脑膜炎感染患者的群体药动学参数，以及成都区域VAN对MRSA的最低抑菌浓度(minimal inhibitory concentration, MIC)值和其分布频率，MCs 10000例次后得到对应的目标获得概率(PTA)与累计反应分数(CFR)。结果 当MIC为0.03mg/L时予1g/d VAN即可达到满意的抗菌活性；当MIC为0.06mg/L时予1.5g/d VAN即可达到满意的抗菌活性；当MIC为0.12mg/L时予3g/d VAN可达到相对满意的抗菌活性(PTA＞90%)；但当MIC为0.25~2mg/L时即使予3g/d也不能达到满意的抗菌活性；各给药方案的CFR均小于90%。结论 开颅术后治疗MRSA脑膜炎感染采用持续静脉输注常规给药剂量(2g/d)的VAN可能偏低，经验性持续静脉输注VAN可考虑联合用药或改用其他给药途径方式。     

From McKeown to Ivor Lewis,the learning curve for thoracic lymphadenectomy over the first 100 robotic esophagectomy cases: a retrospective study

BackgroundLymphadenectomy is an essential but challenging part of the surgical treatment for esophageal cancer. However, the previously reported learning curve for robotic esophagectomy primarily focused on only one surgical approach (McKeown or Ivor Lewis). However, both approaches must be mastered by a mature robotic surgical team to deal with different clinical conditions and satisfy patients’ needs. This study aimed to show how an experienced esophageal surgical team became proficient in both McKeown and Ivor Lewis robotic esophagectomy.MethodsA retrospective review of the first 100 cases of robot-assisted minimally invasive esophagectomy (RAMIE) by a single surgical team was performed. The cumulative sum (CUSUM) analysis was used to distinguish the change point during the learning course. A subgroup analysis was performed according to a surgical approach (McKeown or Ivor Lewis) to determine the effect of experience from one surgical approach on learning the other RAMIE technique.ResultsAccording to the tendency of the CUSUM plot, the learning curve was divided into four phases. The subgroup analysis indicated the decline of the CUSUM plot in the 3rd phase originated from the start of the Ivor Lewis approach. The attending surgeon took 23 cases to achieve a significant improvement in the number of harvested thoracic lymph nodes using the McKeown approach. Regardless of the acquired experience of McKeown RAMIE, it took another 18 cases for the surgical team to achieve significant improvement in harvesting thoracic lymph nodes using the Ivor Lewis approach.ConclusionsTwenty-three cases were needed for an experienced surgical team to improve thoracic lymphadenectomy results using McKeown RAMIE. There was another learning phase during the transition from McKeown to Ivor Lewis esophagectomy. Importantly, the acquired experience from performing McKeown RAMIE could shorten how long it takes to learn Ivor Lewis RAMIE.     

Incidence of Skeletal-related Events Over Time from Solid Tumour Bone Metastases Reported in Randomised Trials Using Bone-modifying Agents

AimsSkeletal-related events (SREs) in patients with bone metastases decrease a patient's quality of life and functional status. Although bone-modifying agents have been found to reduce the time to first on-trial SRE and decrease the total incidence of SREs in randomised clinical trials, standard practice in the management of bone metastases has changed concurrently. The purpose of this study was to investigate if advances in bone-targeted therapies have decreased the incidence of individual types of SREs and to delineate the trend of SREs.Materials and methodsA literature review was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to identify phase III, randomised bisphosphonate and other bone-targeted therapy trials from 1980 to September 2011. For all studies, a mean year of enrolment ([start of enrolment + end of enrolment]/2) was calculated. The incidences of SREs were tabulated and expressed as percentages of on-trial patients. Generalised linear mixed models were used to search for the trends of SREs over time for all placebo and intervention arms. Regression coefficients were interpreted as the odds ratio, which was calculated using the exponential of the slope. Ninety-five per cent confidence intervals were also calculated.ResultsIn total, 20 eligible studies were identified that reported SRE data from phase III trials, of which 11 were suitable for the quantitative analysis. Most of the articles included patients with breast cancer and the remaining involved patients with prostate, renal cell, bladder and lung cancer or other solid tumours. Enrolment periods for all included data ranged from 1990 to 2009. Statistically significant overall downward trends in pathological fractures and the need for surgery were seen over time. Also significant differences between intervention and placebo were seen with all SREs.ConclusionThe decrease in SREs over time may not only be a result of the development of new generation bone-targeted agents, but also due to better systemic management and awareness of events associated with bone metastases.     

高原慢性阻塞性肺疾病稳定期血清SP-D水平与肺功能及炎症因子的临床意义

目的探讨高原慢性阻塞性肺疾病(COPD)稳定期患者血清肺泡表面活性蛋白D(SP-D)的水平及与肺功能、炎症因子的临床意义。 方法收集2016年5月至2017年12月在华西医院就诊的世居高原COPD稳定期的患者150例及健康对照组67例，收集两组的临床资料包括年龄、性别、体质指数(BMI)、吸烟指数及肺功能指标，包括FEV₁(第1 s用力呼出气容积)、FEV₁%(第1 s用力呼出气容积占预计值百分比)、FEV₁/FVC%(第1 s用力呼出气容积/用力肺活量比值)，抽取静脉血测定SP-D、CRP(C反应蛋白)、IL-6(白介素6)、TNF-α(肿瘤坏死因子α)。比较两组之间及COPD稳定期的汉、藏族之间的血清SP-D、CRP、IL-6、TNF-α的浓度差异；并将血清SP-D与COPD稳定期患者的肺功能、全身炎症、CAT(COPD测试评分)、mMRC(改良英国医学研究学会呼吸困难指数)作相关性分析；作SP-D在COPD稳定期的多因素回归分析，并作SP-D在COPD稳定期的ROC分析。 结果COPD稳定组的SP-D高于对照组[(12 524±8 796)vs.(9 288±5 640 ng/L)，P<0.05]、COPD稳定组的炎症指标如CRP[0.5(2.3)比2(2.5)，P<0.05]、IL-6[2.3(2.2)vs. 1.1(1.4)，P<0.05]、TNF-α[(5.5±2.7)vs.(7.8±6.7)，P<0.05]，均显著高于对照组。COPD稳定组的SP-D与CAT、mMRC评分呈正相关(r＝0.498，P<0.05；r＝0.512，P<0.05)，与炎症因子CRP、IL-6、TNF-α的水平呈正相关(r＝0.369，P<0.05；r＝0.454，P<0.05；r＝0.529，P<0.05)，与肺功能指标FEV₁%、FEV₁/FVC%呈负相关(r＝-0.404，P<0.05；r＝-0.171，P<0.05)。对COPD稳定期患者，汉、藏族在血清SP-D及炎症因子CRP、IL-6、TNF-α之间的浓度水平均无统计学差异(P>0.05)。对SP-D在COPD稳定期的多因素回归分析，没有发现与稳定期相关的指标，均P>0.05。在ROC统计中，SP-D的阈值为9 303.5，敏感度为0.576，特异度为0.616，SP-D对诊断COPD稳定期有一定诊断价值。 结论血清SP-D升高可反应全身炎症水平，有助于评估高原COPD患者的肺功能程度及病情变化。对高原COPD病情的预测与评估有一定临床意义。     

Comparison of closed reduction and expert tibial nailing with open reduction and plate and screw fixation in the treatment of two segmental tibial fractures

Purpose: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods: This study included 53 cases of two segmental fractures of the tibial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN (ETN group, n=31) or open reduction fixation with plate and screws (PS group, n=22). The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference (p>0.05). To compare the therapeutic effects between two groups, the intraoperative condition, postoperative function and related complications were investigated. Results: All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% (5/22), much higher than that in ETN group (p<0.05). Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs'' criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group (100% excellent-good rate). While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases (77.3% excellent-good rate). The comparison was insignificant (p>0.05). Conclusion: Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.