综合性康复介入辅助早期营养支持策略对早产儿营养状况及生长发育的影响

目的探讨综合性康复介入辅助早期营养支持策略治疗对早产儿营养状况及生长发育的影响。方法选取2015年1月～2018年8月在我院妇产科出生的早产儿120例。将其分为观察组与对照组,每组60例。两组早产儿均予以早期营养支持策略,对照组予以婴儿常规体检并采用常规育儿方式进行养育;观察组在对照组基础上予以综合性康复介入辅助治疗。观察并比较两组早产儿2周内营养状况及生长发育指标变化情况。结果治疗2周后,两组早产儿血清PA和ALB水平均较出生时明显上升(P0.05或P0.01),且观察组早产儿上升幅度较对照组更明显(P0.05);同时观察组早产儿体质量、头围增加速度和身长增长速率明显快于对照组(P0.05)。结论综合性康复介入辅助早期营养支持策略治疗用于早产儿不仅可显著提高血清PA和ALB水平,改善其营养状况;而且可加快早产儿的生长速率,促进其生长发育,降低生长迟缓发生率。     

全髋关节置换术后早期引流管夹闭的临床疗效比较

目的 探讨一种既能减少THA术后失血,又不影响其髋关节功能恢复的有效引流方式。方法 将2017年8月～2019年5月在我科首次行单侧全髋关节置换术的120例股骨头无菌性坏死患者随机分成4组,每组30例;实验组:切口引流管夹闭2 h(A组)、4 h(B组)和6 h(C组)后开放,对照组(D组)持续负压引流。记录各组术后0～8 h、9～12 h、13～18 h、19～24 h的切口引流量;术前与术后24 h血红蛋白含量(Hb)差值;各组异体血输血例数;换药次数;术后第1、3天的VAS评分;切口并发症发生率及出院日、术后1个月及术后3个月的髋关节功能Harris评分。结果 实验组术后前8 h切口流量、术前与术后24 h的Hb差值、异体血输血人数及部分切口并发症均较对照组明显减少(P0.05);术后9～12 h、13～18 h、19～24 h四组切口引流量差异无统计学意义(P0.05)。术后第1、3天VAS评分对照组高于实验组,差异有统计学意义(P0.05);四组术后不同时间节点髋关节功能Harris评分差异无统计学意义(P0.05)。结论 全髋关节置换术后早期引流管夹闭能有效减少THA术后失血,减轻患者疼痛、且不影响术后髋关节功能快速康复,有一定的临床应用价值,且术后夹闭4 h效果优于2 h、6 h。     

早期综合性康复干预在调节早产儿胃肠道功能、营养状态及免疫功能中的作用

目的探讨早期综合性康复干预在调节早产儿胃肠道功能、营养状态及免疫功能中的作用。方法选取2017年1月～2018年12月在我院住院早产儿90例,随机分为干预组与对照组各45例。对照组均予以保暖、感染防控及早期肠内营养支持治疗。干预组在对照组基础上予以早期综合性康复干预。两组早产儿均干预8周。观察并比较两组干预前后胃肠道功能、营养状态及免疫功能指标的变化。结果干预组早产儿胎便初排时间、胎便转黄时间和达全肠道喂养时间明显短于对照组,日排便次数明显高于对照组(P0.05)。干预8周后,两组早产儿血清ALB、PA及RBP水平均较干预前明显上升(P0.05或P0.01),且干预组上升幅度较对照组更显著(P0.05);同时两组早产儿血清CD4~+及CD4~+/CD8~+比值较前明显上升,CD8~+较前明显下降(P0.05或P0.01),且干预组上升或下降幅度较对照组更显著(P0.05)。结论早期综合性康复干预不仅可改善早产儿胃肠道功能,促进胃肠蠕动,提升其营养状况,而且可纠正早产儿外周血T淋巴细胞亚群紊乱,增强细胞免疫功能。     

经腹超声和经阴道超声对早期鉴别诊断子宫切口妊娠的价值比较

目的 探究经腹超声和经阴道超声对早期鉴别诊断子宫切口妊娠的实际诊断价值。方法 选取2016年2月～2019年2月我院产科收治的60例子宫切口妊娠孕妇作为研究对象,依据入院先后时间分为两组,每组30例。对照组采取经腹多普勒超声检测,观察组采取经阴道多普勒超声检测,与病理诊断结果相比较,分析经腹部与经阴道超声对子宫切口妊娠的分型诊断结果、符合率、特异性、灵敏度。结果 观察组诊断符合率达83.33%,灵敏度达84.62%,特异度达75.00%,高于对照组的诊断符合率60.00%、灵敏度68.42%、特异度45.45%(P0.05);观察组胚囊型符合率为68.75%(11/16),对照组为72.22%(13/18);早孕型符合率为60.00%(3/5),对照组为50.00%(2/4);不均质包块为88.89%(8/9),对照组为75.00%(6/8),两组三项符合率均无差异(P0.05)。结论 经阴道超声在对子宫切口妊娠的早期鉴别中相较经腹超声虽分型诊断结果无差异,但其具备符合率、特异性及灵敏度更高,因此诊断价值更高。     

Immunomodulatory aspects in the progression and treatment of oral malignancy

Inflammation substantially affects the risk of oral malignancy. Pro-inflammatory cytokine, interferon (IFN)-γ, confers anti-tumor activity using several different mechanisms. Conversely, higher expression of interleukin (IL)-17 is associated with worse prognosis. Monocyte chemotactic protein (MCP)-1 correlates positively with poor long-term survival of head and neck squamous cell carcinoma (HNSCC) patients. IL-1α affects cancer associated fibroblasts and macrophages, and promote several malignant phenotypes including immune suppression. Some anti-inflammatory cytokines, including IL-10 and transforming growth factor (TGF)-β, relate to pro-tumoral activities.Among immune checkpoint modulators, programmed death (PD-)1 and PD-ligand (L)1 facilitate oral squamous cell carcinoma (OSCC) cell evasion from immune surveillance, and the expression status of these has a prognostic value.OSCCs contain tumor associated macrophages (TAMs) as major stromal cells of their tumor microenvironment. Among the two distinctive states, M2 macrophages support tumor invasion, metastasis and immune suppression. Crosstalk between TAMs and OSCC or cancer-associated fibroblasts (CAF) plays an important role in the progression of OSCC.Clinical trials with blocking antibodies against IL-1α or melanoma-associated antigens have been reported as therapeutic approaches against OSCCs. The most promising approach activating antitumor immunity is the blockade of PD-1/PD-L1 axis. Manipulating the polarization of pro-tumorigenic macrophages has been reported as a novel therapeutic approach.     

Advances in Sudden Death Prevention: The Emerging Role of a Fully Subcutaneous Defibrillator

Randomized clinical trials support the use of implantable defibrillators for mortality reduction in specific populations at high risk for sudden cardiac death. Conventional transvenous defibrillator systems are limited by implantation-associated complications, infection, and lead failure, which may lead to delivery of inappropriate shocks and diminish survival. The development of a fully subcutaneous defibrillator may represent a valuable addition to therapies targeted at sudden death prevention. The PubMed database was searched to identify all clinical reports of the subcutaneous defibrillator from 2000 to the present. We reviewed all case series, cohort analyses, and randomized trials evaluating the safety and efficacy of subcutaneous defibrillators. The subcutaneous defibrillator is a feasible development in sudden cardiac death therapy and may be useful particularly to extend defibrillator therapy to patients with complicated anatomy, limited vascular access, and congenital disease. The subcutaneous defibrillator should not be considered in patients with an indication for cardiac pacing or who have ventricular tachycardia responsive to antitachycardia pacing. Further investigation is needed to compare long-term, head-to-head performance of subcutaneous defibrillators and conventional transvenous defibrillator systems.     

Acute promyelocytic leukaemia is characterized by stable incidence and improved survival that is restricted to patients managed in leukaemia referral centres: a pan‐Canadian epidemiological study

Timely diagnosis and care are major determinants of the outcome in acute promyelocytic leukaemia (APL), a malignancy whose incidence may be increasing. The Canadian Cancer Registry (CCR) and health system represent valuable settings to study APL epidemiology. We analysed the CCR, which contains data on all Canadians with APL. To provide clinical information lacking in the CCR, we obtained data from five leukaemia referral centres during a similar time period. Between 1993 and 2007, there were 399 APL in Canada. Age‐standardized incidence was 0·083/100 000 and was stable over time. The early death (ED) rate was 21·8% (10·6% in patients <50 years old and 35·5% for those aged >50 years), with no improvement over time. Five‐year overall survival (OS) was 54·6% (73·3% in patients <50 years; 29·1% older patients). In the referral cohort, 131 patients were diagnosed between 1999 and 2010. ED was 14·6% and 2‐year OS was 76·5%. Within this cohort, ED and OS improved over time, although advanced patient age remained an adverse determinant of OS. In Canada, APL incidence is unexpectedly low and temporally stable. ED was higher than reported in clinical trials, but similar to reports from other registries. In contrast, ED was lower in referral centres and improved with time.