女性膀胱颈部梗阻的诊断与治疗

为探讨女性膀胱颈部梗阻的病因、诊断及治疗方法。总结１９８１年５月～１９９６年６月收治女性膀胱颈部梗阻病例３２例。２９例经手术治疗，其中２例行膀胱颈ＹＶ成形术，２７例经尿道膀胱颈部后唇切除术，效果满意。结果认为，女性膀胱颈部梗阻病因为纤维组织增生和慢性炎症所致；尿流率检查是客观评价排尿状况的指标；膀胱镜检查为可靠的诊断手段；经尿道膀胱颈部后唇切除为有效的治疗方法。     

并发肺动脉高压患者血清OPG水平的变化及临床意义

观察慢性阻塞性肺疾病（COPD）并发肺动脉高压（PH）患者血清骨保护素（OPG）水平的变化,探究其临床应用价值。方法 选取2020年12月~2021年12月于我院住院治疗的COPD患者120例作为观察组,依据超声心动图结果,将患者分为COPD组、COPD并发PH（COPD-PH）组,COPD-PH组分为轻度、中度及重度PH组,选取同期健康体检者49例作为对照组。检测并比较各组血清OPG水平。结果COPD PH组患者血清OPG水平高于COPD组,且两组均高于对照组,差异有统计学意义（P＜0.05）;重度PH组患者血清OPG水平高于中度PH组,且两组均高于轻度PH组,差异有统计学意义（P＜0.05）;相关性分析结果显示,血清OPG水平与PASP、PLR、NLR、CRP、NT-Pro BNP呈正相关（rs＝0.463,0.278,0.396,0.285,0.273,P＜0.05）,与氧合指数呈负相关（rs＝-0.415,P＜0.001）。结论 慢阻肺并发肺动脉高压患者血清OPG水平升高,且与肺动脉高压程度相关,动态观察该指标或可监测慢阻肺患者肺动脉高压的发生、发展     

脂联素、直接胆红素及甘油三酯对2型糖尿病患者大血管病变的诊断价值

目的 探讨脂联素（APN）、直接胆红素（DB）、甘油三酯（TG）及三者联合对 2 型糖尿病（T2DM）患者大血管病变的诊断价值。方法 选取120例T2DM患者,根据是否合并大血管病变将其分为T2DM组（62 例）和 T2DM+大血管病变组（58 例）。比较两组的临床资料;采用非条件多因素逐步Logistic回归分析T2DM患者合并大血管病变的风险因素;绘制受试者工作特征（ROC）曲线评估APN、DB、TG及三者联合对T2DM患者合并大血管病变的诊断效能。结果 非条件多因素逐步Logistic回归分析结果显示,■是T2DM患者合并大血管病变的危险因素（P <0.05);■是T2DM患者合并大血管病变的保护因素（P <0.05）。ROC曲线分析结果显示,当APN ≤ 5.870 nmol/mL时,诊断T2DM患者合并大血管病变的曲线下面积（AUC）为0.718,敏感性为70.7%(95% CI:0.571,0.815）,特异性为61.3%(95% CI:0.480,0.713）;当DB ≤ 14.205 mol/L 时,AUC 为 0.772,敏感性为 74.1% (95% C...     

肝外胆道系统管道异常扩张1例

在解剖一成年男性尸体时发现肝外胆道系统(除胆囊外)异常扩张。报道如下:肝脏外形形态正常,肝外胆道各管径变粗,与周围组织无粘连,肝左管、肝右管、肝总管、胆囊管、胆总管的管径异常扩张(表1,图1)。     

选择腰椎椎弓根螺钉长度的放射解剖学研究

目的 :探讨在腰椎侧位片及CT片上推算椎弓根螺钉长度的方法 ,为临床提供参考。方法 :随机在 3 0个腰椎骨标本上用 1mm软钢丝在椎弓根最狭窄处缠绕 ,按人字嵴进钉方法打入椎弓根直钢丝 ,拍正侧位片、横断面片及椎弓根CT扫描 ,分别在标本、CT及侧位片上测量椎弓根螺钉长度 ,三组数据比较。结果 :腰椎侧位片上测量的自关节突关节间隙下缘至椎体前缘距离乘以 0 .83即是螺钉长度 ,椎弓根CT扫描测量其长度更为准确。结论 :正常拍照条件下 ,用腰椎侧位片和椎弓根CT片可准确地推算螺钉长度 ,具有临床实用意义。     

2016—2019年河北省儿童血培养检出病原菌及其耐药性变迁

 目的 了解河北省细菌耐药监测网74所医院2016—2019年儿童患者血培养病原菌的分布及耐药性变迁。方法 应用WHONET软件回顾性分析45所三级医院、29所二级医院儿童患者血培养病原菌分布及药敏特点;应用SPSS 19.0软件进行统计分析。结果 剔除重复菌株后,2016—2019年儿童住院患者血培养分离菌株共7 591株,革兰阳性菌占71.7%,革兰阴性菌占28.3%。在本研究定义的4个年龄段内,金黄色葡萄球菌、嗜麦芽窄食单胞菌所占比率随年龄增加而增多。肺炎克雷伯菌对亚胺培南、美罗培南的耐药率为7.8%~35.5%。4年间,耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率呈上升趋势（由12.9%上升至30.1%）,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率呈下降趋势（由81.7%下降至75.2%）。结论 河北省儿童住院患者血培养病原菌以革兰阳性菌为主,与成人血培养病原菌分布不同,病原菌存在年龄分布差异,临床经验性治疗儿童血流感染时应注意儿童血培养的特点。     

超声清创联合重组人表皮生长因子治疗肛周脓肿合并感染的效果

目的探讨超声清创联合重组人表皮生长因子对肛周脓肿合并感染患者表皮细胞生长因子(Epidermal growth factor,EGF)、激活素A(Activin A,ACTA)水平及创面血流量的影响。方法选取2018年2月-2020年1月承德医学院附属医院肛周脓肿合并感染患者117例,依据随机数字表法分为对照A组(n=39)、对照B组(n=39)、联合组(n=39)。常规干预基础上对照A组采取超声清创,对照B组采取重组人表皮生长因子,联合组采取超声清创及重组人表皮生长因子。统计三组治疗情况、治疗前后疼痛程度评分、创面血流量及经皮氧分压、EGF、转化生长因子-β(Transforming growth factor-β,TGF-β)、ACTA、C-反应蛋白(C-reactive protein,CRP)水平及临床疗效。结果联合组创面愈合时间、感染控制时间、住院时间分别为(12.39±2.01)d、(5.22±1.56)d、(13.91±2.51)d短于对照A组、对照B组,创面细菌清除率为(89.13±4.64)%高于对照A组、对照B组(P<0.001);治疗后1 d、3 d、7 d、14 d三组VAS评分较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);治疗后1 d联合组创面血流量及经皮氧分压分别为(0.92±0.25)PU、(35.69±3.20)mmHg大于对照A组、对照B组(P<0.05);治疗后1 d联合组血清EGF、TGF-β分别为(0.70±0.11)μg/L、(0.68±0.12)μg/L高于对照A组、对照B组(P<0.05);治疗后1 d联合组血清ACTA、CRP分别为(9.45±3.58)μg/L、(5.71±2.68)mg/L低于对照A组、对照B组(P<0.05);联合组疗效优于A组和B组(P<0.05)。结论联合采取超声清创及重组人表皮生长因子治疗肛周脓肿合并感染,可改善创面愈合及感染控制情况,缓解疼痛程度,增加创面血流量及经皮氧分压,调节EGF、ACTA等水平,提高整体治疗效果。     

Hyperglycemia is associated with lower levels of urokinase-type plasminogen activator and urokinase-type plasminogen activator receptor in wound fluid

AimsWounds in patients with hyperglycemia show impaired healing. Plasminogen activation is crucial in several overlapping phases of wound healing process. In this study, we aimed i) to compare acute wound fluid in patients with hyperglycemia and normoglycemia, ii) to focus on the elements of plasminogen activation in the wound fluid, and iii) to determine if the acute wound fluid characteristics are associated with surgical site infections.MethodsIn a cohort of 54 patients, a closed suction drain was placed in the wound above the anterior abdominal wall fascia under the skin in order to collect postoperative acute wound fluid samples for 3 following days after colorectal surgery. Patients were classified as normoglycemic (n = 25) or hyperglycemic (n = 29; 17 with type 2 diabetes and 12 with stress induced hyperglycemia). Surgical site infection was defined according to the Centers for Disease Control criteria. The levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAr), plasminogen activator inhibitor-1 (PAI-1), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and fibroblast growth factor-1 (FGF-1) were measured in the wound fluid.ResultsCompared to normoglycemic subjects, patients with hyperglycemia had significantly lower levels of uPA and uPAr in the wound fluid despite similar or even higher circulating levels. There was no significant difference in IL-1β, TNF-α, PAI-1 and FGF-1 levels. In the whole study population, the wound fluid levels of uPA and uPAr were negatively correlated with circulating glucose levels. No difference was detected in the wound fluid characteristics of patients with and without surgical site infection.ConclusionPatients with hyperglycemia exhibit decreased levels of uPA and uPAr in the wound fluid, suggesting a local failure in plasminogen activation at the wound site.     

Left ventricular pseudoaneurysm complicating a ruptured isolated congenital diverticulum

We report a case of 41-year-old woman who presented with chest tightness and shortness of breath. Transthoracic echocardiogram (TTE) showed left ventricular (LV) pseudoaneurysm of the inferior wall with preserved LV systolic function. Coronary angiogram was normal. Surgical repair of the pseudoaneurysm with a pericardial patch was performed, and pathological results confirmed rupture of an isolated congenital LV diverticulum, as the most likely etiology.     

Is the pepsin immunohistochemical staining of laryngeal lesions an available way for diagnosing laryngopharyngeal reflux

Abstract

Backgound: Pepsin immunohistochemical (IHC) staining is a promising diagnostic approach of laryngopharyngeal reflux (LPR). The interarytenoid mucosa has been proved to be an effective biopsy area.

Objectives: To investigate whether positive result of pepsin IHC staining in laryngeal lesions can predict LPR.

Methods: The study included 136 patients with laryngeal cancer or vocal cord leukoplakia. 24?h multichannel intraluminal impedance-pH (MII-pH) was performed before operation, and pepsin IHC staining was performed on pathological sections after operation. The results of the two methods were compared.

Results: Among the 136 patients, 101 with at least one LPR event were regarded as MII-pH positive group, and another 35 were negative. The positive rate of pepsin IHC staining was 93.1% in MII-pH positive group and 54.1% in MII-pH negative group (p?<?.05). If the MII-pH results were used as a reference, the sensitivity and specificity of pepsin IHC staining in the diagnosis of LPR were 93.1 and 45.7%, respectively. The consistency of pepsin IHC and MII-pH was moderate (Kappa value = 0.452).

Conclusions: The sensitivity of pepsin IHC staining in laryngeal lesions for diagnosing LPR is satisfactory. The existence of false negative of MII-pH may be the main reason for the low specificity.