扁桃体部分切除术对OSAHS患儿的临床效果观察

目的　探讨扁桃体部分切除术对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apner hypopnea syndrome，OSAHS）患儿的临床效果。 方法　对中山大学附属第一医院耳鼻咽喉医院2016年8月~2019年1月收治的138例扁桃体肥大合并腺样体肥大的儿童，行扁桃体部分切除术（TT组，69例）和扁桃体全切除术（TE组，69例），比较患儿术后疼痛指数、术中出血量、手术时间、术后出血、术后发热、术后再发上呼吸道炎症、住院时间、术后呼吸暂停低通气指数、术后进食等方面的差异。 结果　TE组患儿相比TT组，术中出血量明显较多，手术时间较长，术后疼痛指数较高，但术后发热更少见。TT组患儿住院时间短于TE组，术后更快恢复进普食。两组患儿术后呼吸暂停低通气指数均较术前明显下降。术后再发上呼吸道炎症两组大致相同。 结论　对于OSAHS患儿，扁桃体部分切除术手术时间短、术中出血更少、术后出血机会更低，且同样达到缓解患儿上呼吸道阻塞的目的，值得临床应用推广。     

Development and validation of a risk-based algorithm for preoperative type and screen testing in spine surgery

BACKGROUND CONTEXTWith improvements in surgical techniques and perioperative management, transfusion rates after spine surgery have decreased over time. Given this trend, routine preoperative ABO/Rh type and antibody screen (T&S) laboratory testing may not be warranted in all patients undergoing spine surgery.PURPOSEThe aim of the current study is to evaluate risk factors for intra/postoperative transfusion in patients undergoing a variety of spine procedures and to develop an algorithm for selectively ordering preoperative T&S testing in appropriate patients.STUDY DESIGN/SETTINGThis is a single institution, retrospective observational study of patients undergoing emergent or elective spine surgery. External validation of the algorithm was performed on a national sample of patients undergoing spine surgery from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) national database.PATIENT SAMPLEA total of 5,947 surgeries from January 1, 2016 to December 31, 2019 at a single institution, and 166,113 surgeries from the 2016 to 2018 ACS-NSQIP database.OUTCOME MEASURESThe primary outcome measure was performance of intraoperative or postoperative transfusion.METHODSUsing the institutional sample, univariate statistics (chi-square tests, fisher's exact test, 2-sided independent sample tests) were performed to compare demographics, comorbidities, and surgical details (case type, number of levels treated, etc.) between patients who did and did not require intra- or postoperative transfusion. Transfusion rates were calculated and compared across procedure types. Multivariate logistic regression was performed to identify independent predictors of transfusion and the model's accuracy was evaluated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. A risk-based algorithm suggesting no preoperative T&S in low transfusion risk procedures, routine preoperative T&S in high-risk procedures, and further assessment in medium risk thoracolumbar fusion procedures was created. The algorithm's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated when it was applied to both the institutional and national samples. Potential cost savings from reducing T&S orders were calculated.RESULTSIn the institutional sample, 120 patients (2.0%) required intraoperative or postoperative transfusion. The highest rates of transfusion were found in corpectomy (10.5%) and anterior/posterior cervical fusion (6.9%) procedures. In the multivariate logistic regression model, the presence of a preoperative coagulation defect or hemorrhagic condition (OR: 7.149, p<.001) and 6+ level surgery (OR: 7.511, p<.001) were the strongest predictors of transfusion. Overall, the model generated an AUC of 0.882, indicating excellent predictive accuracy. When applied to the institutional cohort, the risk-based algorithm had a sensitivity of 78.3%, specificity of 80.5%, PPV of 7.6%, and NPV of 99.4% for evaluating likelihood of transfusion. Using the algorithm 4,717 T&S tests would have been eliminated (79.3%), resulting in a cost savings of $179,246. Application of the model to the ACS-NSQIP cohort resulted in a sensitivity of 61.9%, specificity of 84.6%, PPV of 15.6%, and NPV of 98.0%.CONCLUSIONSThe routine use of preoperative ABO/Rh type and antibody screen testing does not appear to be warranted in patients undergoing spine surgery. A risk-based approach to preoperative type and screen testing may eliminate unnecessary tests and generate significant cost savings with minimal disruption to clinical care.     

Relationship between patients in hospital affects recovery from total knee arthroplasty (TKA)–A prospective study

Background

The interaction between patients is rather important source of information about surgery and recovery. Patients always prefer particularly to compare themselves with others of relatively similar ability, opinion and situation. Exploration of patients' dyads, however, is rare and needs further elaboration as to the significance of fellow patients. This study was designed to determine in whether and how preoperative assignment affects TKA's results.

腹腔镜术后Ⅰ～Ⅱ期盆腔子宫内膜异位症不孕患者的临床治疗观察

目的寻找Ⅰ～Ⅱ期盆腔子宫内膜异位症不孕症患者腹腔镜术后最合适的助孕方案。方法收集2009年3月至2011年3月间在本院住院行腹腔镜手术的子宫内膜异位症不孕患者共437例,其中298例Ⅰ~Ⅱ期患者纳入本研究,并且区分为原发不孕组和继发不孕组。腹腔镜术后按照不同尝试怀孕方式分为自然周期、促排卵周期以及人工授精周期组。汇总资料后分别比较两种类型不孕患者采取三种助孕方式临床治疗效果。另外还研究比较两种不孕类型子宫内膜异位症术后1年累积妊娠情况。结果原发和继发不孕患者术后采用三组不同助孕方式间周期临床妊娠率差异有统计学意义(P=0.032和P=0.034),均为人工授精组最高,自然周期组最低。而周期妊娠率、早期流产率、异位妊娠率及双胎妊娠率在三组间比较,差别无统计学意义(P>0.05)。但人工授精周期妊娠率相对有明显增高趋势。原发不孕与继发不孕的子宫内膜异位症比较,累积妊娠率(64%vs.81.2%)与累积临床妊娠率(53.8%vs.69.3%)均较低,差别有统计学意义(P<0.05)。而此两组间早期流产率、异位妊娠率以及双胎妊娠率差异均无统计学意义(P>0.05)。结论Ⅰ、Ⅱ期子宫内膜异位症患者在腹腔镜术后妊娠结果是良好的,结合促排卵方案人工授精技术可以得到更高的临床妊娠结局。     

The protective effects of incadronate on inflammation and joint destruction in established rat adjuvant arthritis

The effects of a new generation bisphosphonate, incadronate, in established adjuvant arthritis rats were evaluated according to the arthritis index, hind paw volume, and radiological and histopathological examinations. Incadronate suppressed the radiological and histopathological changes of hind paws, as well as the joint swelling in a dose-dependent manner. In contrast, the arthritis control rats showed drastic joint inflammation, marked destruction of bone and articular cartilage. The remains of articular cartilage lost Safranin O staining, and were attached with numerous TRAP-positive multinuclear cells. Some of resorption lacunas could be seen at the cartilage matrix nearby the TRAP-positive multinuclear cells. As regards the chondroprotective effects of bisphosphonates, we speculate that it is probably concerned with the inhibition of the chondroclasts. These data indicate that bisphosphonates may be a class of effective agent that can be considered for treatment of various arthritic conditions, including human rheumatoid arthritis.     

Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor

In order to further promote the standardization of diagnosis and treatment of gastrointestinal stromal tumor (GIST) in China,the members of Chinese Society of Clinical Oncology (CSCO) Expert Committee on GIST thoroughly discussed the key contents of the consensus guidelines,and voted on the controversial issue.In final,the Chinese consensus guidelines for the diagnosis and management of GIST (2017 edition) was formed on the basis of 2013 edition consensus guidelines,which is hereby announced.The consensus included the pathological diagnosis,recurrence risk classification evaluation,targeted agent therapy,surgery and principles of surveillance of GIST.     

心脏术后急性肾损伤的危险因素

目的探讨用急性肾损伤网络(acute kidney injury network,AKIN)标准诊断心脏术后AKI的危险因素.方法回顾性收集昆明医科大学第一附属医院心外科2012年6月至2013年6月期间所有行心脏手术的住院患者资料,根据AKIN诊断标准,对心脏术后AKI患者的发病率及危险因素进行统计学分析.结果 548例心脏手术患者中,用AKIN标准诊断心脏术后AKI的发生,其中81例发生AKI,发病率为14.78%,死亡患者3例;统计学分析表明:年龄、左室射血分数、高血压、术中甘露醇使用量、CPB时间、主动脉阻断时间、心脏停跳时间、机械通气时间、监护室停留时间、术前Scr、术前尿酸是心脏术后AKI发生的相关危险因素,而术前血肌酐(P<0.01)、年龄(P<0.01)、CPB时间(P<0.01)、机械通气时间(P=0.026)是心脏术后AKI发生的独立危险因素.结论 AKI是心脏手术后严重的并发症,术前血肌酐、年龄、CPB时间、机械通气时间是心脏术后AKI的独立危险因素.