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BackgroundAim of study is to report our preliminary experience with magnetic anastomosis (magnamosis) treating long-gap esophageal atresia (LGEA), the most challenging condition of esophageal atresia continuum. Magnamosis has been reported in 20 patients worldwide as an innovative and marginally invasive option.MethodsProspective evaluation of all LGEA patients treated with magnamosis was performed (study registration number: 2535/2021). Main outcomes considered were demographic and surgical features, postoperative complications and feeding within 6-month of follow-up.ResultsBetween June 2020 and January 2021, 5 LGEA patients (Type A, Gross classification) were treated. Median preoperative gap was 5 vertebral bodies. Magnetic bullets were placed at an average age of 81 days of life, leading to successful magnamosis in all cases: 4 infants had primary magnetic repair (one after thoracoscopic mobilization of the pouches), 1 patient had a delayed magnamosis after Foker's procedure.Esophageal anastomosis was achieved after an average of 8 days. No anastomotic leak was found. All patients developed anastomotic stenosis at 6-month follow-up, requiring a mean of 6 dilations each. Full oral feeding was achieved in 3 patients, while 2 were still on oral-gastrostomy feeding. One patient experienced small esophageal perforation after dilation (3 months after magnamosis), distal to the anastomotic stricture and subsequently developed oral aversion.ConclusionsOur preliminary results suggest magnamosis a safe and effective minimally invasive option in patients with LGEA. Absence of postoperative esophageal leaks may represent a major advantage of magnamosis over conventional surgery, although possible high rate of esophageal stenosis should be further evaluated.Levels of EvidenceIV (Case series with no comparison group)  相似文献   
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《Injury》2023,54(5):1246-1256
IntroductionDelayed diagnosis of abdominal injuries and hemorrhagic shock leads to secondary complications and high late mortality in severely traumatized patients. The liver fatty acid-binding protein (L-FABP) is expressed in intestine, liver and kidney; the neutrophil gelatinase-associated lipocalin (NGAL) in colon and kidney. We hypothesized that l-FABP is an early biomarker for abdominal injury and hemorrhagic shock and that l-FABP and NGAL are specific markers for detection of liver and/or kidney injuries.Patients and MethodsTraumatized patients with an age ≥18 years and an abdominal injury (AISabd≥2), independently from Injury Severity Score (ISS), were prospectively included from 04/2018 to 05/2021. 68 patients had an abdominal injury (“Abd”) and 10 patients had an abdominal injury with hemorrhagic shock (“HS Abd”). 41 patients without abdominal injury and hemorrhagic shock but with an ISS ≥ 25 (“noAbd”) were included as control group. Four abdominal subgroups with isolated organ injuries were defined. Plasma l-FABP and NGAL levels were measured at admission (ER) and up to two days post-trauma.ResultsAll patient groups had a median ISS≥25. In ER, median l-FABP levels were significantly higher in “HS Abd” group (1209.2 ng/ml [IQR=575.2–1780.3]) compared to “noAbd” group (36.4 ng/ml [IQR=14.8–88.5]), and to “Abd” group (41.4 ng/ml [IQR=18.0–235.5]), p<0.001. In matched-pair-analysis l-FABP levels in the group “Abd” were significantly higher (108.3 ng/ml [IQR=31.4–540.9]) compared to “noAbd” (26.4 ng/ml [IQR=15.5–88.8]), p = 0.0016. l-FABP correlated significantly with clinical parameters of hemorrhagic shock; the optimal cut-off level of l-FABP for detection was 334.3 ng/ml (sensitivity: 90%, specificity: 78%). Median l-FABP-levels were significantly higher in patients with isolated liver or kidney injuries and correlated significantly with AST, ALT and creatinine value. Median NGAL levels in the ER were significantly higher in “HS Abd” group (115.9 ng/ml [IQR=90.6–163.8]) compared to “noAbd” group (58.5 ng/ml [IQR=41.0–89.6],p<0.001) and “Abd” group (70.5 ng/ml [IQR=53.3–115.5], p<0.05). The group “Abd” showed significant higher median NGAL levels compared to “noAbd”, p = 0.019. NGAL levels correlated significantly with clinical parameters of hemorrhagic shock.Conclusion:L-FABP and NGAL are novel biomarkers for detection of abdominal trauma and hemorrhagic shock. l-FABP may be a useful and promising parameter in diagnosis of liver and kidney injuries, NGAL failed to achieve the same.  相似文献   
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《Injury》2023,54(7):110754
IntroductionDistal femur fractures are common injuries that remain difficult for orthopedic surgeons to treat. High complication rates, including nonunion rates as high as 24% and infection rates of 8%, can lead to increased morbidity for these patients. Allogenic blood transfusions have previously been identified as risk factors for infection in total joint arthroplasty and spinal fusion surgeries. No studies have explored the relationship between blood transfusions and fracture related infection (FRI) or nonunion in distal femur fractures.Methods418 patients with operatively treated distal femur fractures at two level I trauma centers were retrospectively reviewed. Patient demographics were collected including age, gender, BMI, medical comorbidities, and smoking. Injury and treatment information was also collected including open fracture, polytrauma status, implant, perioperative transfusions, FRI, and nonunion. Patients with less than three months of follow up were excluded.Results366 patients were included in final analysis. One hundred thirty-nine (38%) patients received a perioperative blood transfusion. Forty-seven (13%) nonunions and 30 (8%) FRI were identified. Allogenic blood transfusion was not associated with nonunion (13% vs 12%, P = 0.87), but was associated with FRI (15% vs 4%, P<0.001). Binary logistic regression analysis identified a dose dependent relationship between number of perioperative blood transfusions and FRI: total transfusion ≥2 U PRBC RR= 3.47(1.29, 8.10, P = 0.02), ≥3 RR= 6.99 (3.01, 12.40, P<0.001), and ≥4 RR= 8.94 (4.03, 14.42, P<0.001).DiscussionIn patients undergoing operative treatment of distal femur fractures, perioperative blood transfusions are associated with increased risk of fracture related infection, but not the development of a nonunion. This risk association increases in a dose-dependent relationship with increasing total blood transfusions received.  相似文献   
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《Injury》2023,54(2):409-415
BackgroundWe aim to review and describe the proportion of patients with co-existing gout amongst patients with surgical treated septic arthritis, characterize their clinical presentation, outcomes and complications compared to patients with native joint septic arthritis.MethodsSixty-one patients with surgically treated primary joint septic arthritis were identified from the period of January 2011 to December 2016. There were 13 (21.3%) patients with co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics, comorbidities, clinical features on presentation, infection markers, number of surgeries, length of stay (LOS) in general and individual LOS in supportive care units, limb amputations, readmissions and mortality were reviewed. Multiple linear and logistic regression models were used to control for confounders during analysis.ResultsThe average age of patients was 60.8 years (range: 23–87 years). The patients with gout are associated with comorbidities such as being hypertensive, hyperlipidemia and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%; p = 0.004) while septic arthritis patients without gout tend to present with knee joint involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5% vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant increase in LOS by an additional 12.6 days on average (95% CI: 2.11 – 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%; p = 0.008) on univariate analysis.ConclusionGout accompanying septic arthritis in the same joint is potentially associated with major systemic and joint related sequela, complications in terms of prolonged hospital stay, need for complex care and risk for limb amputation. Our findings further indicate the value and need for well-designed prospective controlled cohort studies to explore the relationship between gout and septic arthritis  相似文献   
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目的 观察埃克替尼联合抗血管药物一线治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)突变晚期肺腺癌的治疗效果和不良反应。方法 选取首都医科大学宣武医院胸科2018年6月1日至2019年12月31日期间,37例EGFR突变晚期肺腺癌的患者。采用埃克替尼(125 mg/次,3 次/d)联合贝伐单抗(7.5 mg/kg,1次/3周);或埃克替尼(125 mg/次,3 次/d)联合安罗替尼(10~12 mg 1次/d,第1~14天),均21 d为1个周期,至疾病进展或出现严重的不良反应后终止。中位随访时间14.5(9.2~30.8)个月。结果 本组患者中,62.2%(23/37)达到部分缓解,37.8% (14/37) 达到疾病稳定。客观有效率为62.2%(23/37),疾病控制率为100%(37/37)。中位疾病无进展时间为17.9个月(95% CI:10.292~25.508)个月。1年生存率为83.8%,18个月生存率为81.1%。多因素Cox回归分析结果显示,肝转移和脑转移对患者的PFS有明显影响(P<0.05)。最常见不良反应为皮疹(43.2%, 16/37)和腹泻(21.6%, 8/37)。结论 埃克替尼联合抗血管药物是一种有效且安全的一线治疗EGFR突变晚期肺腺癌的方案。  相似文献   
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随着低剂量螺旋电子计算机断层扫描(computed tomography,CT)应用于肺癌高危人群中的筛查越来越普及,肺外周病变(peripheral pulmonary lesions,PPLs)发现概率也随之增加。电磁导航支气管镜(electromagnetic navigation bronchoscopy,ENB)是一种能够进行肺部外周病变诊断、定位及治疗的工具,由于它的安全性和可靠性更高,ENB在未来有可能会改变肺部疾病的诊断和治疗方式,从而缓解病情甚至治愈肺癌,为肺癌的治疗开辟了新的路径。  相似文献   
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目的:探讨早产儿消化道穿孔的病因,分析影响早产儿消化道穿孔短期预后不良的危险因素。方法:回顾性分析山西省 儿童医院新生儿外科2015年1月—2021 年5月诊治的89 例早产儿消化道穿孔的临床资料。根据术后3 个月时结局分为生存 组和预后不良组。比较两组术前、术中及术后与早产儿消化道穿孔预后不良相关的因素,采用Logistic 回归分析筛选早产儿消 化道穿孔预后不良的危险因素。结果:早产儿消化道穿孔的病死率为25.84%,坏死性小肠结肠炎(NEC)和胃壁肌层缺损是早产 儿消化道穿孔常见的病因。单因素分析显示生存组患儿从发现气腹至手术时间在8 h 之内的比例显著高于预后不良组 (χ2=15.22,P<0.01)。预后不良组合并脓毒性休克的比例显著高于生存组(χ2=33.19,P<0.01)。预后不良组术后合并需非计划二次 手术的并发症比例显著高于生存组(χ2=7.24,P<0.01)。Logistic 回归分析显示脓毒性休克(OR=0.06,95%CI:0.02~0.21,P<0.01)和 气腹至手术时间大于8 h(OR=0.23,95%CI:0.07~0.81,P<0.05)是早产儿消化道穿孔短期预后不良的危险因素。结论:NEC 和胃 壁肌层缺损是早产儿消化道穿孔的主要病因,脓毒性休克和从气腹发生至手术时间大于8 h 是早产儿消化道穿孔短期预后 不良的危险因素。  相似文献   
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