The Outcomes and Quality of Life of Patients with Achalasia after Peroral Endoscopic Myotomy in the Short-Term

Purpose: To assess the short-term efficacy and quality of life (QOL) of patients with achalasia after peroral endoscopic myotomy (POEM).Methods: Thirty-five achalasia patients underwent POEM from May 2013 to December 2013. The data on clinical evaluation and QOL before therapy, at 1 month and 6 months postoperation were collected and analyzed.Results: All the thirty-five patients underwent POEM successfully. By comparing the data of the preoperative with that of 1 month and 6 months after POEM respectively, we found that: mean Eckardt score decreased (6.83 vs 0.51, 6.83 vs 0.46, all P <0.05), esophagus diameter reduced (47.97 mm vs 32.00 mm, 47.97 mm vs 28.50 mm, all P <0.05), and esophageal manometry declined (29.5 mmHg vs 11.5 mmHg, 29.5 mmHg vs 10.3 mmHg, all P <0.05). Complications occurred in 14.3% (5/35) of the cases, and no recurrence was observed. At each time point, postoperative QOL scores were higher than those of preoperative (P <0.05).Conclusions: POEM is safe and effective for treating achalasia in the short-term, it can relieve clinic symptoms as well as improve patients’ QOL.     

Postoperative Acute Pulmonary Embolism Following Pulmonary Resections

Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism.Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections.     

腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效观察

【摘要】〓目的〓评价腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效。方法〓回顾性分析2012年1月至2014年9月在广东医学院附属福田医院治疗的195例胆总管结石患者,按照术式分为腹腔镜联合术中胆道镜经胆囊管胆道探查取石术(LTCBDE)组(43例)、腹腔镜胆道探查“T”管引流(LCBDE)组(65例)和剖腹胆囊切除、胆总管探查取石、“T”管引流术(OCBD)组(87例)。比较三组患者手术时间、术中出血量、术后肛门排气时间、视觉模拟评分法(VAS)评分、并发症发生率,以及三组治疗前后CRP、PA、TBIL和ALT水平的变化。结果〓3组患者均成功进行手术,LTCBDE组除手术时间比OCBD组长外,术中出血量、术后VAS评分、肛门排气时间、术后住院时间和并发症明显少于LCBDE和OCBD组(P<0.001)。LTCBDE组的并发症发生率为4.7%,明显低于LCBDE组的15.4%和OCBD组的23.0%,差异有统计学意义(P<0.05)。治疗后,三组的CRP、TBIL和ALT水平比治疗前明显降低(P<0.001),而PA水平比治疗前明显升高(P<0.001)。LTCBDE组的降低和升高水平比其余两组更为明显(P<0.001)。结论〓LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,是一种有效、安全及经济的术式。     

关节镜下滑膜切除术治疗局限型膝关节色素沉着绒毛结节性滑膜炎的临床分析

【摘要】 目的 探讨关节镜下治疗局限型膝关节色素沉着绒毛结节性滑膜炎(PVNS)的方法及疗效。方法 回顾性分析2008年9月~2014年5月在我院术前行MRI检查、术后经病理证实的10例色素着绒毛结节性滑膜炎患者的临床资料及治疗方法,并对患者进行跟踪随访9~68个月,采用Lysholm膝关节功能评分了解患者术后患膝疼痛、肿胀及活动度等功能恢复情况。结果 10例患者在术后随访期均无并发症发生,复发2例,Lysholm 膝关节功能评分为91.80±5.28分,明显高于术前(P<0.01)。结论〓关节镜下对局限型色素沉着绒毛结节性滑膜炎的患者实施滑膜切除术,手术创伤小,术后膝关节功能恢复好,是一种安全有效的治疗膝关节局限型色素沉着绒毛结节性滑膜炎的方法。     

29例脑死亡器官移植供体的维护体会

【摘要】 目的 探讨脑死亡器官移植供体在ICU的维护要点。方法〓回顾性分析我科2012年1月~2013年12月间完成的29例脑死亡供体器官捐献资料,分析脑死亡供体器官获取前情况,移植肾、移植肝受者情况及急性肾损伤(AKI)供肾的移植效果,总结脑死亡患者作为潜在供体的维护要点。结果〓维护脑死亡供体29例,共捐献肾脏40个、肝脏27个、心脏4个、角膜21对。6例(15%)移植肾受者发生移植物功能延迟恢复,1例(2.5%)发生急性排斥反应、1例(2.5%)发生髂内动脉假性动脉瘤出血切除移植肾,1例(2.5%)发生重症肺炎术后死亡;AKI供肾与非AKI供肾的受者在术后7天、2月肌酐恢复情况及不良事件发生率比较无明显差异;1例(4%)移植肝受者发生多脏器功能衰竭术后死亡。余受者随访至今均恢复顺利,器官功能良好。结论〓经过ICU内积极管理后的潜在器官移植供体能够获得较高质量的移植器官,有较好的移植效果。     

IL-25 Elicits Innate Lymphoid Cells and Multipotent Progenitor Type 2 Cells That Reduce Renal Ischemic/Reperfusion Injury

IL-25 is an important immune regulator that can promote Th2 immune response-dependent immunity, inflammation, and tissue repair in asthma, intestinal infection, and autoimmune diseases. In this study, we examined the effects of IL-25 in renal ischemic/reperfusion injury (IRI). Treating IRI mice with IL-25 significantly improved renal function and reduced renal injury. Furthermore, IL-25 treatment increased the levels of IL-4, IL-5, and IL-13 in serum and kidney and promoted induction of alternatively activated (M2) macrophages in kidney. Notably, IL-25 treatment also increased the frequency of type 2 innate lymphoid cells (ILC2s) and multipotent progenitor type 2 (MPP^type2) cells in kidney. IL-25–responsive ILC2 and MPP^type2 cells produced greater amounts of Th2 cytokines that associated with the induction of M2 macrophages and suppression of classically activated (M1) macrophages in vitro. Finally, adoptive transfer of ILC2s or MPP^type2 cells not only reduced renal functional and histologic injury in IRI mice but also induced M2 macrophages in kidney. In conclusion, our data identify a mechanism whereby IL-25-elicited ILC2 and MPP^type2 cells regulate macrophage phenotype in kidney and prevent renal IRI.     

Variation of plantar pressure in Chinese diabetes mellitus

To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross‐sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 “normal” Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75‐g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one‐step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure‐time integrals and force‐time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers.     

Autologous platelet‐rich gel for treatment of diabetic chronic refractory cutaneous ulcers: A prospective,randomized clinical trial

The purpose of the study is to examine the safety and effectiveness of topical autologous platelet‐rich gel (APG) application on facilitating the healing of diabetic chronic refractory cutaneous ulcers. The study was designed as a prospective, randomized controlled trial between January 1, 2007 and December 31, 2011. Eligible inpatients at the Diabetic Foot Care Center of West China Hospital, Sichuan University (China) were randomly prescribed with a 12‐week standard treatment of ulcers (the control group) or standard treatment plus topical application APG (the APG group). The wound healing grades (primary endpoint), time to complete healing, and healing velocity within 12 weeks were monitored as short‐term effectiveness measurements, while side effects were documented safety endpoints. The rates of survival and recurrence within the follow up were recorded as long‐term effectiveness endpoints. Analysis on total diabetic ulcers (DUs) (n = 117) and subgroup analysis on diabetic foot ulcers (DFUs) (n = 103) were both conducted. Standard treatment plus APG treatment was statistically more effective than standard treatment (p < 0.05 in both total DUs and subgroup of DFUs). The subjects defined as healing grade 1 were 50/59 (84.8%) in total DUs and 41/48 (85.4%) in DFUs in the APG group compared with 40/58 (69.0%) and 37/55 (67.3%) in the control group from intent to treat population. The Kaplan‐Meier time‐to‐healing were significantly different between the two groups (p < 0.05 in both total DUs and subgroup of DFUs). No side effects were identified after topical APG application. The long‐term survival and recurrence rates were comparative between groups (p > 0.05). This study shows that topical APG application plus standard treatment is safe and quite effective on diabetic chronic refractory cutaneous ulcers, compared with standard treatment.