乳突鼓室再手术中钛听骨假体位置状态及相关因素分析

目的 回顾性研究中耳乳突再次手术病例中已植入的钛听骨假体存在状态、临床特征、影响听骨位置状态的相关因素,以期为鼓室成形术中听骨植入提供临床经验和教训。 方法 总结2013—2020年行乳突鼓室成形术中植入钛听骨后6个月以上因各种原因再手术的病例,回顾分析钛听骨的位置情况、听骨位置异常的原因、处理方法。 结果 在485例应用了钛听骨听力重建的鼓室成形术中,有30例再手术,其中钛听骨位置良好9例,鼓膜(TM)内陷钛听骨突出2例,TM穿孔钛听骨顶出7例,脱离TM或倾角6例,脱离镫骨患者6例。再手术原因术后感染8例,复发15例,单纯听力下降7例,术后感染均发生在术后1个月之内,而复发和单纯听力下降中位数发生时间分别为19个月(5~54个月)、30个月(4~49个月)。复发和感染中钛听骨位置良好占1/3、1/2,而单纯听力下降者钛听骨位置均异常。 结论 使用钛假体的听骨成形术是一种安全有效的重建方法,再手术率较低,咽鼓管功能不良、TM内陷是钛听骨异常的主要原因,术后复发、感染为再手术的主要原因,再手术中发现前次听骨植入失败包括脱位、倒伏、突出、脱落、异物刺激反应、肉芽包裹等状态。     

Risk Prediction Model for Survival of Wait-List Patients on Axial CF-LVAD: A UNOS Database Analysis

BackgroundContinuous flow left ventricular assist devices (CF-LVADs) have become a viable option for patients with end-stage heart failure as a bridge to transplantation or the destination therapy.MethodsAdult patients listed for heart transplantation (2010-2015) with an axial CF-LVAD on the wait list were obtained from the UNOS database. The multivariate Cox regression model was used to predict the probability of survival after listing. Patients were divided into derivation (80%) and validation (20%) groups. Receiver operating characteristics curves and area under curves were used to define the strength of the model.ResultsRisk factors on multivariate analyses were diabetes type I (hazard ratio [HR], 2.5; P = .018), presence of inotropes (HR, 1.6; P = .005), creatinine at listing (HR, 1.2; P < .001). No significant differences were observed between the derivation and validation groups for any of the variables. The area under the curve at 3, 6, and 12 months on the wait list was 0.69, 0.65, 0.63, respectively in the training set and 0.71, 0.65, 0.60, respectively in the validation set. Survival analyses showed that patients implanted with Heartmate II before listing had a better survival than those who were implanted after being on the wait list (HR, 0.78; P = .048).ConclusionTo our knowledge, this was the first time a risk prediction model was generated for wait-list survival of Heartmate II patients. A significant difference in survival was noted between patients who received their Heartmate II before being put on a wait list vs those who were implanted while on the list.     

Tenofovir Alafenamide for Pregnant Chinese Women With Active Chronic Hepatitis B: A Multicenter Prospective Study

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空肠穿刺造瘘术在食管癌外科治疗中的应用：258例分析

目的探讨食管癌外科治疗中行空肠穿刺造瘘术的安全性和有效性。方法回顾性分析2015年8月—2019年12月在解放军总医院第六医学中心胸外科接受食管癌切除术并行空肠穿刺造瘘术的258例患者临床资料,统计分析术中空肠穿刺造瘘术手术时间、术后并发症和造瘘管留置时间。结果258例食管癌患者均在术中行空肠穿刺造瘘术,手术时间6~12(8.2±2.4)min,造瘘管带管时间1~382(97.4±21.3)d。术后出现造瘘口相关并发症19例,其中穿刺口周围浅表皮肤感染10例,造瘘管阻塞5例,自行脱管2例,拔管困难2例,未出现非计划再次手术和死亡等严重并发症。结论空肠穿刺造瘘术操作简便、并发症少、耐受性好、带管时间长,值得在食管癌外科术后营养支持中进一步推广应用。     

长期意识障碍患者PICC导管相关性感染分析及干预措施

目的探讨长期意识障碍患者经外周置入中心静脉导管(PICC)后导管相关性感染的危险因素,并提出相关护理措施。方法回顾性分析2018年1月至2019年12月解放军总医院第六医学中心高压氧科220例行PICC置管术意识障碍患者的临床资料,根据是否发生导管相关性感染分为感染组和非感染组,对其危险因素进行统计学分析。结果 220例患者中42例发生PICC术后导管相关性感染(CRI),发生率为19.1%。感染组和非感染组患者在年龄、昏迷程度、基础病、卧床时间、单次置管穿刺次数、导管留置时间比较差异有统计学意义(P<0.05)。结论年龄≥60岁、意识障碍程度深、患糖尿病(基础病)、卧床时间>3个月、单次置管反复穿刺及导管留置时间>3个月为发生PICC术后相关性感染的危险因素,临床工作中对上述危险因素进行必要的护理干预,有助于降低感染发生率。     

超声引导下针刺联合功能康复治疗运动训练所致鹅足滑囊炎的临床疗效

目的　观察超声引导下针刺联合功能康复治疗运动训练引起的鹅足滑囊炎的临床疗效。方法：　纳入康复医学科门诊2019年5月至2020年5月收治的运动训练所致膝关节鹅足滑囊炎患者50例，分为观察组（25例）和对照组（25例），其中观察组患者采用超声引导下针刺联合功能康复治疗，对照组采用盲法穿刺局部封闭联合功能康复治疗。采用视觉模拟量表（VAS）评价患者治疗前后疼痛情况，采用国际通用膝关节评分（Lysholm评分）量表评价膝关节功能，采用生活质量测定量表（QOL）评估生活质量，通过超声影像及远红外线热成像观察治疗前后病变区域炎症反应变化情况。结果　治疗前两组患者性别、年龄、病程等一般资料及VAS、Lysholm、QOL评分差异均无统计学意义（P均＞0.05）。治疗后两组VAS评分均较治疗前降低（P均<0.05），Lysholm、QOL评分均较治疗前升高（P均<0.05）。治疗后观察组VAS评分低于对照组（P<0.05），Lysholm和QOL评分均优于对照组（P均<0.05）。治疗后声像图可见观察组病变区血流信号明显减少或消失，远红外线热成像显示胫骨内髁处体表温度恢复正常。观察组总有效率为96%（24/25），高于对照组的68%（17/25），差异有统计学意义（P＜0.05）。结论　对于运动训练所致鹅足滑囊炎患者，超声引导下针刺联合功能康复治疗能有效减轻患者疼痛、促进膝关节功能恢复，且临床可行性、安全性好。     

The use of angiotensin system inhibitors correlates with longer survival in resected pancreatic adenocarcinoma patients

BackgroundActivities and inhibition of the Renin-Angiotensin-Aldosterone System (RAAS) may affect the survival of resected pancreatic ductal adenocarcinoma (PDAC) patientsMethodA single-institution retrospective analysis of resected PDAC patients between 2010 and 2019. To estimate the effect of angiotensin system inhibitors (ASIs) on patient survival, we performed Kaplan Meier analysis, Cox Proportional Hazards model, Propensity Score Matching (PSM), and inverse probability weighting (IPW) analysis.Results742 patients were included in the analysis. The average age was 67.0 years, with a median follow-up of 24.1 months. The use of ASI was associated with significantly longer overall survival in univariate (p = 0.004) and multivariable (HR = 0.70 [0.56–0.88],p = 0.003) adjusted analysis. In a propensity score-matched cohort of 400 patients, ASI use was again associated with longer overall survival (p = 0.039). Lastly, inverse probability weighting (IPW) analysis suggested that the use of ASI was associated with an average treatment effect on the treated (ATT) of HR = 0.68 [0.53–0.86],p = 0.002) for overall survival.ConclusionIn this single-institution retrospective study focusing on resected PDAC patients, the use of ASI was associated with longer overall survival in multiple statistical models. Prospective clinical trials are needed before routine clinical implementation of ASI as an adjuvant to existing therapy can be recommended.