睾丸扭转评分法及标准化流程在提高诊治效率的应用

目的提高基层医院对睾丸扭转的诊治效率。方法收集2011年9月至2017年4月确诊的睾丸扭转患者31例(A组),回顾分析诊治效率;前瞻性纳入2017年5月至2019年1月按标准化流程收治的急诊急性阴囊疼痛患者43例(B组),并采用五要素七分评分法诊断睾丸扭转和采用与中山大学附属第一医院教学平台共建的区域"三基"培训体系的标准化诊治流程,对比两组的诊治效率。结果A组睾丸扭转病例从就诊至临床确诊时间为20~60 min,从入院后至急诊手术时间60~160 min,其中70%患者行睾丸切除,30%行睾丸固定;B组中睾丸扭转确诊时间为5~25 min,入院至手术室45~60 min,B组的诊治效率较高(P<0.001),其中56%患者行睾丸切除,44%为睾丸固定,两组睾丸切除率比较差异无统计学意义(P>0.05)。结论睾丸扭转评分法可快速有效诊断,标准化救治流程可有效缩短患者救治时间,可操作性强,二者联合可以提高基层医院对青少年睾丸扭转的诊治效率。     

弯刀综合征14例外科治疗结果分析

目的 探讨小儿弯刀综合征的诊断、外科治疗方法及治疗后的近、中期结果。方法 回顾性分析2010年1月到2017年12月手术治疗的14例弯刀综合征的临床资料。其中,男7例,女7例;年龄(18.23±28.55)个月,范围在23 d至9岁。合并其他心血管畸形10例,中位心8例,右肺发育不良7例,有侧支循环8例,合并肺动脉高压10例。用SPSS 16.0软件的寿命表(Life Table)做出本组患儿术后生存曲线,评估其近、中期生存状况。结果 9例异常肺静脉(scimitar vein,SV)从下腔静脉切下,端-侧吻合于左心房;SV分成2支2例,1例采用2支SV连同部分下腔静脉壁切下,另1例2支SV从下腔静脉从根部切下侧-侧吻合形成单根SV,均吻合于左心房;SV离左心房距离过大3例,2例将SV吻合在右心房右侧壁,再重建心房间隔,1例SV与自体心包卷管道连接再吻合于左心房。其他心血管畸形同期手术矫治。8例有侧支循环,3例心导管检查时被封堵,5例手术时切断缝合。本组14例手术死亡2例(14.29%),另有1例于术后1年2个月因肺炎、呼吸衰竭死亡。本组术后1、3、5年累积生存率分别为86%、73%和73%。术后出院时有1例移植的SV开口狭窄,血流速度为1.9 m/s;有3例随访期间发现移植SV狭窄,血流速度超过1.6 m/s。结论 弯刀综合征可合并其他心血管畸形、中位心、右肺发育不良等。一般将SV与左心房吻合;SV离左心房距离大或多条SV时,可采用个性化办法将SV吻合于左心房。侧支循环心导管检查时可封堵,或术中切断缝合。     

Suppression of PRDX4 inhibits cell proliferation and invasion of ectopic endometrial stromal cells in endometriosis

Abstract

Oxidative stress (OS) has been proposed to play a role in the development of EMs. Peroxiredoxins are a family of antioxidant proteins that exhibit peroxidase activity in a thioredoxin-dependent manner, protecting cells against OS. The Western blotting results showed that the relative expression of PRDX4 was significantly increased in ectopic endometria compared with the normal endometria of EMs-free (p?<?.05). The H₂O₂ concentration was also significantly higher in the ectopic endometrium. PRDX4 siRNA was transfected into primary ectopic endometrial stromal cells (EESCs). The viability of the transfected EESCs was measured by CCK-8 assay, and the results showed significantly decreased cell viability. Furthermore, the apoptosis rate and ROS generation in flow cytometry assays were significantly increased after the knockdown of PRDX4 expression (p?<?.05). Scratch assays and transwell assays revealed that decreased expression of PRDX4 mediated by siRNA inhibited EESC migration and invasion. In conclusion, these findings indicate the potential role of PRDX4 in the development of EMs and PRDX4 as a possible therapeutic target for EMs treatment.     

Iliopsoas Abscess Due to Brenner Tumor Malignancy: A Case Report

@@     

苏州科技城医院:科技与生态同步建设六部曲

苏州科技城医院坐落于苏州高新区太湖之滨,由苏州高新区政府投资新建,是一所集医疗、科研、康复、预防于一体的三级综合性公立医院。医院占地面积140亩,总建筑面积180000m~2,总投资额16亿,设计床位1200张。医院于2013年9月29日奠基,2014年12月28日主体封顶,2016年4月正式投入使用,比预定日期提前了将近1年!     

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

IntroductionThis meta-analysis evaluated the safety and efficacy of fast track surgery (FTS) for patients with gastric cancer undergoing gastrectomy.MethodsRandomised controlled trials (RCTs) published between 1 January 1995 and 21 June 2013 comparing FTS with conventional perioperative care for patients with gastric cancer undergoing gastrectomy were identified in the PubMed, Embase™ and Cochrane Library databases, and were analysed systematically using RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark).ResultsSeven RCTs (524 patients) were analysed. Compared with conventional perioperative care, FTS treatment with/without laparoscopy was associated with shorter postoperative hospitalisation, less hospitalisation expenditure (both p<0.00001), less pain and better quality of life. Short-term morbidity and readmission rates did not differ between treatments. No incidents of death occurred during the short-term follow-up period.ConclusionsIn patients with gastric cancer undergoing gastrectomy, the FTS pathway reduces the length and cost of postoperative hospitalisation while maintaining short-term morbidity, readmission and mortality rates comparable with those of conventional care.