Disposable circumcision suture device： clinical effect and patient satisfaction

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.     

Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closu...     

肺超声在心源性肺水肿诊疗中的应用价值

目的探讨肺超声检查在发生心力衰竭患者心源性肺水肿的诊断及治疗监测中的应用价值。方法纳入2014年7月~2015年1月临床诊断为心力衰竭患者61例为研究对象。所有患者均接受超声心动图、肺超声及胸部CT检查,比较分析肺超声与胸部CT对心源性肺水肿的诊断价值;同时,对比分析患者治疗前后肺超声检查肺部B线数量与左心室射血分数的变化,并对B线数量和左心室射血分数进行Pearson相关分析。结果CT诊断心源性肺水肿52例,肺超声诊断心源性肺水肿50例,Kappa值为0.642,两者比较差异无统计学意义(P>0.05);治疗后患者肺部B线数量与左心室射血分数较治疗前显著改善(P<0.05);相关分析表明,治疗前后B线数量与射血分数两者之间在P=0.05水平均呈显著负相关(r_治疗前=-0.907,P<0.01;r_治疗后=-0.783,P<0.01)。结论肺超声可以作为诊断心力衰竭患者心源性肺水肿的可靠辅助检查方法之一,并可用于心源性肺水肿的治疗评价,具有重要临床应用价值。     

下肢全长负重位X线检查在膝关节炎内外翻畸形中的临床价值

目的:探讨膝关节炎患者下肢全长负重位X线片对膝内、外翻畸形诊断的临床价值。方法:选取32例临床诊断为膝关节炎51膝分别拍摄下肢全长负重X线片,测量下肢力线和机械轴偏距(mechanical axis offset distance,MAD),解剖学股胫骨角(anatomical femor-tibial angle,aFTA),股骨远端力学外侧角(mechanical lateral distal femoral angle,mLDFA),胫骨近端力学内侧角(mechanical medial proximal tibial angle,mMPTA),对图像数据进行分析,对膝关节炎进行X线K/L分级,通过SPSS 17.0统计对下肢力线各参数与关节炎的相关性进行分析。结果:①膝关节下肢全长负重位X线片显示,关节有不同程度骨质增生,关节间隙变窄。②51膝骨关节炎中确诊膝内翻畸形38膝(74.51.%)和膝外翻畸形8膝(10.42%),5膝均无内外翻畸形。③膝关节炎X线K/L分级显示,0级:5膝(9.8%),I级:12膝(23.5%),II级:22膝(43.1%);III级:9膝(17.6%);IV级:3膝(59%)。④膝内翻组中股骨内翻7膝(18.42%),胫骨内翻18膝(47.36%),股骨、胫骨均内翻13膝(34.21%);膝外翻组中股骨外翻6膝,股骨、胫骨均外翻2膝。⑤在膝内翻组中,aFTA与骨关节炎X线K/L分级呈正相关(B值=0.132,t=2.648,P=0.012,P<0.05)。结论:下肢全长负重X线显示下肢结构清晰、完整,通过测量下肢力线参数评估,可全面诊断膝关节炎的内翻畸形或外翻畸形,膝内翻中以胫骨内翻显著,膝外翻中则以股骨外翻显著。因此,膝关节骨性关节炎的下肢全长负重X线检查具有较高的临床价值。     

Autophagy is involved in regulating the immune response of dendritic cells to influenza A (H1N1) pdm09 infection

Autophagy can mediate antiviral immunity. However, it remains unknown whether autophagy regulates the immune response of dendritic cells (DCs) to influenza A (H1N1) pdm09 infection. In this study, we found that infection with the H1N1 virus induced DC autophagy in an endocytosis‐dependent manner. Compared with autophagy‐deficient Beclin‐1^+/? mice, we found that bone‐marrow‐derived DCs from wild‐type mice (WT BMDCs) presented a more mature phenotype on H1N1 infection. Wild‐type BMDCs secreted higher levels of interleukin‐6 (IL‐6), tumour necrosis factor‐ α (TNF‐α), interferon‐β (IFN‐β), IL‐12p70 and IFN‐γ than did Beclin‐1^+/? BMDCs. In contrast to Beclin‐1^+/? BMDCs, H1N1‐infected WT BMDCs exhibited increased activation of extracellular signal‐regulated kinase, Jun N‐terminal kinase, p38, and nuclear factor‐κB as well as IFN regulatory factor 7 nuclear translocation. Blockade of autophagosomal and lysosomal fusion by bafilomycin A1 decreased the co‐localization of H1N1 viruses, autophagosomes and lysosomes as well as the secretion of IL‐6, TNF‐α and IFN‐β in H1N1‐infected BMDCs. In contrast to Beclin‐1^+/? BMDCs, H1N1‐infected WT BMDCs were more efficient in inducing allogeneic CD4⁺ T‐cell proliferation and driving T helper type 1, 2 and 17 cell differentiation while inhibiting CD4⁺ Foxp3⁺ regulatory T‐cell differentiation. Moreover, WT BMDCs were more efficient at cross‐presenting the ovalbumin antigen to CD8⁺ T cells. We consistently found that Beclin‐1^+/? BMDCs were inferior in their inhibition of H1N1 virus replication and their induction of H1N1‐specific CD4⁺ and CD8⁺ T‐cell responses, which produced lower levels of IL‐6, TNF‐α and IFN‐β in vivo. Our data indicate that autophagy is important in the regulation of the DC immune response to H1N1 infection, thereby extending our understanding of host immune responses to the virus.     

25-羟维生素D与儿童1型糖尿病及酮症酸中毒的相关性研究

目的探讨血清25-羟维生素D[25-(OH)D]水平与儿童1型糖尿病(T1DM)及酮症酸中毒(DKA)的相关性。方法选取2006年1月—2009年12月期间152例住院患儿,其中52例为首次发病的T1DM患儿,包括酮症酸中毒(DKA组)21例,以及非酮症酸中毒(非DKA组)31例,其余100例为非T1DM组。检测并比较三组患儿的血清25-(OH)D水平,分析血清25-(OH)D水平与儿童T1DM及DKA的相关性。结果 DKA组患儿的血清25-(OH)D平均为(53.6±27.8)nmol/L,显著低于非DKA组的(69.7±27.9)nmol/L和非T1DM组的(81.8±28.3)nmol/L(P<0.05);非DKA组患儿的血清25-(OH)D水平显著低于非T1DM组(P<0.05)。结论 T1DM患儿的血清25-(OH)D水平低,尤以DKA患儿最为明显,维生素D在儿童T1DM发病中的潜在保护效应值得关注。     

血管紧张素Ⅱ受体拮抗剂洛沙坦对脓毒症大鼠多脏器的保护作用

目的探讨血管紧张素Ⅱ受体（AT1型）特异性拮抗剂洛沙坦（losartan）对脓毒症大鼠心、肝、肾、肺、小肠等多脏器的保护作用及对预后的影响。方法sD清洁级大鼠120只,雌雄不拘,随机分为4组,即假手术组（30只）、脓毒症组（30只）和脓毒症大鼠30mg／kg剂量的洛沙组在制模前预给药、制模后给药造成处理组（各30只）。采用改良盲肠结扎穿孔方法（CLP）建立大鼠脓毒症模型。观测各组动物心、肝、肾、肺、小肠等脏器功能指标。各组剩15只大鼠计算5d累计死亡率。结果与假手术组比较,脓毒症组大鼠心、肝、肾、肺、小肠等功能指标有显著变化（P〈0．05）,病理损害较严重,死亡率显著升高（P〈0．05）;与脓毒症组比较,给予洛沙组处理的两组大鼠心、肝、肾、肺、小肠等功能指标与脓毒症组比较显著好转（P〈0．05）,病理损害较轻,死亡率显著下降（P〈0．05）。两洛沙坦处理组无明显差异（P〉0．05）。结论洛沙坦对脓毒症大鼠心、肝、肾、肺、小肠等多脏器具有保护作用,并能改善预后。     

压力性损伤护理评估智能决策系统的研发与应用

目的 研发压力性损伤护理评估智能决策系统,探讨其在临床压力性损伤患者中的应用效果。方法 成立研发小组,以参考预防和治疗压力性损伤：快速参考指南2019为指导蓝本,设置智能决策规则。以医院临床信息系统为基础,依托计算机信息技术,对系统的界面布局、分区、模块结构、内容和功能进行整体构架,多角度、多方位研发压力性损伤护理评估智能决策系统,实现智能决策、健康教育推送双路径、质量控制指标监测等,落实入院8 h内风险评估及时率、院内PI发生率等指标。结果 应用压力性损伤护理评估智能决策的系统后,PI入院8 h内风险评估及时率由84.7%上升至95.7%,Braden评估漏评率由8.7%下降至3.7%,Braden评估准确率由75.5%上升84.4%,创面评估准确率由77.2%上升至87.3%, 创面处理准确率由68.3%上升至79.3%,压力性损伤转归率由56.6%上升86.7%,差异均有统计学意义（P<0.05）。院内PI发生率由0.7‰降至0.3‰。结论 压力性损伤护理评估智能决策系统是一个自动化、智能化、信息化的智能决策平台,能为护理人员提供准确、客观的决策依据,能智能决策压力性损伤患者的分期,提高护理质量及管理效能。