Topical tacrolimus therapy in the management of lower extremity ulcers due to prolidase deficiency

Prolidase deficiency is a rare autosomal recessive disorder characterized by cutaneous ulcers, facial dysmorphism, recurrent infections, and intellectual disability. We report a unique case of a 6‐year‐old boy with prolidase deficiency and Crohn's disease who presented with lower extremity ulcers. Cutaneous ulcers due to prolidase deficiency are historically resistant to treatment, and we report success with the novel use of topical tacrolimus.     

紫杉醇联合卡铂化疗治疗卵巢癌的效果分析

目的探讨紫杉醇联合卡铂化疗治疗卵巢癌的效果分析。方法选自2018年5月-2019年5月132名符合入组以及排除标准的患者,随后研究人员将患者分为对照组以及研究组,分组应按照科学、合理、随机的标准,两组患者分别均有67例,对照组患者按照研究要求,接受卡铂化疗治疗,研究组患者按照研究要求,接受紫杉醇联合卡铂化疗治疗,两组患者分别接受不同的治疗,评估患者的临床效果,对比两组患者的观察指标,如:T细胞亚群、临床疗效。结果治疗后,CD8、CD4、CD3、CD4/CD8,研究组高于对照组;研究组中,CR+PR+SD人数多于对照组患者,且治疗总有效率高于对照组患者(P<0.05)。结论紫杉醇联合卡铂化疗治疗卵巢癌,能够提升患者自身的免疫功能,促进疾病的好转。     

老年人股骨粗隆间骨折手术时机对预后影响的临床研究

目的：探讨老年股骨粗隆间骨折手术时机对临床预后结局的影响。方法整群选取2015年1月—2016年1月该院收治的老年股骨粗隆间骨折患者68例为研究对象。根据患者手术时间将其分为A组与B组, A组32例,B组36例,观察两组患者不同年龄术后30 d、1年的死亡情况。结果两组患者术后30d、1年死亡率比较差异无统计学意义,P>0.05；但A组、B组患者中超过80岁的患者术后1年死亡率明显低于80岁以下年龄患者,P<0.05,差异具有统计学意义。结论年龄超过80岁的老年股骨粗隆间骨折患者术后1年死亡率相对较高。     

围手术期外科之家模式在肝移植中的应用

围手术期外科之家（PSH）是一种以病人为中心的创新性围手术期管理模式，强调以医生为主导、以多学科团队为基础，基于循证医学证据，协调医疗资源，促进病人接受不同专业处理时平稳过渡，围手术期始终获得正确的处理方案，尤其适合存在器官功能障碍的外科病人。肝移植病人大多病情危重，手术复杂，围手术期管理困难。将PSH引入肝移植，可以为这类高手术风险的特殊病人群体提供一种全新的围手术期管理方式。     

A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury

IntroductionThe liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma.MethodsPubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates.ResultsThe electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11).ConclusionNon-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.     

溃疡性结肠炎32例手术治疗分析

目的探讨溃疡性结肠炎(UC)手术治疗的指征、时机、方式及转归。方法回顾性分析32例接受手术治疗的UC患者的住院病历资料,记录患者的临床表现、诊疗过程、手术方式及转归,并对患者术后情况进行随访。结果 71.9%(23/32)手术病例为重型UC;初发型占21.9%(7/32),慢性复发型78.1%(25/32);广泛结肠病变占93.8%(30/32),其中全结肠受累占81.3%(26/32)。手术原因:药物治疗不能达到或维持缓解26例(81.3%);UC相关结直肠癌(UC-CRC)/上皮内瘤变(IEN)5例(15.6%);并发肠穿孔1例(3.1%)。手术方式:全结直肠切除、回肠储袋肛管吻合术(IPAA)19例(59.4%),回肠永久造瘘术或长期保留造瘘口7例(21.9%),全结肠或次全结肠切除、肠吻合术6例(18.8%)。术后并发症发生率69.6%(16/23),分别为肠梗阻9例、吻合口狭窄2例、盆腔感染2例、直肠阴道瘘1例、切口疝1例、储袋炎2例、残余直肠UC复发2例。25例(78.1%)患者接受随访2个月~22年,21例UC治愈,2例因残余直肠UC复发继续药物治疗,2例因UC-CRC广泛转移死亡。结论手术是药物难治性及出现并发症UC的治疗选择,多数患者手术效果满意,术后并发症发生率较高,手术时机、术式及术后并发症的预防及随访有待进一步规范。