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1.
目的 通过4DCT(four-dimensional CT)动态评估咽鼓管功能障碍(Eustachian tube dysfuction,ETD)患者Valsava动作时的咽鼓管(Eustachian tube,ET)功能。方法 2018年11月~2019年3月期间就诊于首都医科大学附属北京安贞医院的ETD患者15例,无中耳疾病的志愿者15名。使用咽鼓管测压(tubomanometry,TMM),七项咽鼓管功能障碍评分量表(the seven-item Eustachian tube dysfunction questionnaire,ETDQ-7)和咽鼓管评分量表-7(the Eustachian tube score-7,ETS-7)等方法对所有对象咽鼓管功能做初步评价。嘱患者做Valsava动作,行ADCT动态扫描,记录ET开放过程,重建图像。测量ET数值,判断阻塞部位,进行统计学分析。结果 正常对照组可观察到ET全长,ETD组均有不同程度的阻塞。ETD组ET长度和角度显著大于对照组[(44.41±2.21)mm vs(40.60±2.20)mm,P<0.01;(168.73±4.66)mm vs(162.88±5.44)mm,P <0.01],前鼓室部直径显著小于对照组[(3.5±0.8)mm vs(5.3±1.1)mm,P <0.001]。结论 ET长度越长、角度越大,越容易发生ETD。ADCT动态扫描可准确评估ETD患者ET阻塞部位,对咽鼓管球囊扩张术适应证具有指导意义,辐射剂量低,可作为ET常规检查方法。  相似文献   
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ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
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Toxicity resulting from off-target effects, beyond acetylcholine esterase inhibition, for the commonly used organophosphate (OP) insecticides chlorpyrifos (CPS) and malathion (MA) was investigated using Saccharomyces cerevisiae and Caenorhabditis elegans model systems. Mitochondrial damage and dysfunction were observed in yeast following exposure to CPS and MA, suggesting this organelle is a major target. In the C. elegans model, the mitochondrial unfolded protein response pathway showed the most robust induction from CPS and MA treatment among stress responses examined. GABAergic neurodegeneration was observed with CPS and MA exposure. Impaired movement observed in C. elegans exposed to CPS and MA may be the result of motor neuron damage. Our analysis suggests that stress from CPS and MA results in mitochondrial dysfunction, with GABAergic neurons sensitized to these effects. These findings may aid in the understanding of toxicity from CPS and MA from high concentration exposure leading to insecticide poisoning.  相似文献   
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目的 探讨外周血单核细胞髓样分化因子88(My D88)与Toll样受体4(TLR4)在早产儿窒息后多器官功能障碍综合征(MODS)中的表达,为早产儿窒息后MODS的早期诊断及预后评估提供新思路。方法 连续性纳入2019年1月-2020年12月唐山市妇幼保健院新生儿科收治的115例窒息早产儿进行前瞻性研究,按照1 min Apgar评分将窒息早产儿分为轻度窒息组(n=70)与重度窒息组(n=45),以同期的50例健康早产儿作为对照组。比较3组早产儿中MODS发生率、MODS病死率及单器官损害发生率,外周血单核细胞My D88 mRNA及蛋白与TLR4 mRNA及蛋白的表达水平。结果 重度窒息组、轻度窒息组与对照组的MODS发生率分别为73.33%、31.43%、6.00%,MODS病死率分别为24.44%、5.71%、0,3组间比较差异有统计学意义(χ2=47.845、16.978,P<0.001);重度窒息组与轻度窒息组的单器官损害发生率明显高于对照组(P<0.05),重度窒息组明显高于轻度窒息组(P<0.05);重度窒息组与轻度窒息组的My D88 mRNA及蛋白与TLR4 mRNA及蛋白均明显高于对照组,且重度窒息组明显高于轻度窒息组(F=4.251、4.804、4.772、4.690,P<0.001)。结论 早产儿窒息后MODS发生率、外周血单核细胞My D88与TLR4表达水平均明显增高,My D88与TLR4有望成为早产儿窒息后MODS的早期诊断及预后评估指标。  相似文献   
7.
目的 探讨降钙素原(PCT)与维持性血液透析(MHD)患者自体动静脉内瘘(AVF)并发症的关系。方法 选取使用AVF行MHD治疗的患者186例,根据随访过程中超声检查AVF是否出现并发症[狭窄和(或)血栓]分为并 发症组48例和非并发症组138例,收集2组患者透析龄、透析中收缩压下降≥30 mmHg(1 mmHg=0.133 kPa)例数、穿 刺失败或血肿形成例数、是否合并糖尿病等临床资料,并检测2组患者PCT、C反应蛋白(CRP)、血小板(Plt)等指标, 比较2组间上述指标的差异,应用二元Logistic回归分析AVF并发症的影响因素。结果 并发症组合并糖尿病、血液 透析中收缩压下降≥30 mmHg、穿刺失败或血肿形成发生率及PCT、CRP、透析龄高于非并发症组(P<0.05)。2组性 别、年龄、原发疾病、尿素清除指数、体质量指数、每月血液灌流及血液透析滤过时间等比较差异无统计学意义。二 元Logistic回归分析发现,较高水平的PCT、血液透析中收缩压下降≥30 mmHg、穿刺失败或血肿形成是发生AVF并发 症的独立危险因素(P<0.05)。结论 高水平PCT是MHD患者AVF并发症发生的危险因素,临床应重视对微炎症状 态的改善,并注意合理控制血压,避免血液透析中血压快速下降,不断提高穿刺技术。  相似文献   
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Tuberculosis is a major healthcare burden in India, which accounts for the maximum number of cases worldwide. Due to its non-specific features, peritoneal tuberculosis has been dubbed as the great mimicker of various other abdominal pathologies. This case series highlights the importance of incidental intra operative detection of peritoneal tuberculosis in cases being operated for renal pathologies. Diagnostic and therapeutic dilemma is bound to occur when surgeon is faced with such an unexpected finding. Incidental peritoneal tuberculosis was defined as peritoneal tubercular lesions (ascites or tubercles) detected intraoperatively in patients being operated for non-tuberculosis related indications and no prior preoperative suspicion of abdominal tuberculosis. We here review 3 cases with different renal pathologies and no prior history or exposure to tuberculosis in which intraperitoneal tuberculosis was encountered incidentally at the time of surgery. Case 1 was a suspected case of right renal cell carcinoma and underwent right robotic nephron sparing surgery. Case 2 underwent robotic assisted lap simple nephrectomy for a right nonfunctioning kidney due to obstructive ureteric calculus. Case 3 was a suspected case of left upper tract urothelial carcinoma who underwent robotic nephroureterectomy with bladder cuff excision. In all 3 cases, on encountering the peritoneal lesions, an intraoperative decision to continue with the proposed surgery was made after frozen section biopsies from the multiple peritoneal and omental deposits revealed no malignant cells. Histopathology of these lesions in all 3 cases revealed caseating granulomas consistent with a diagnosis of disseminated peritoneal tuberculosis. None of the resected specimen had features suggestive of tuberculosis. ATT was started and on follow up the patients are doing well. Peritoneal tuberculosis although uncommon is not a rare presentation of active tuberculosis. Surgeons on encountering such lesions during non-related surgeries should always have a high suspicion of tuberculosis. Despite the existing literature favoring abandoning the procedure in such situations, we successfully completed the proposed surgeries.  相似文献   
10.
ObjectiveDeterioration of the native aortic valve function by a late progression of rheumatic disease is not infrequent in patients who underwent rheumatic mitral valve surgery; however, this phenomenon has not been clearly quantified.MethodsA total of 1155 consecutive patients (age 52.0 ± 12.9 years; 807 female) who underwent rheumatic mitral valve surgery without concomitant aortic valve surgery from 1997 to 2015 were enrolled. The primary end point was the composite of progression to severe aortic valve dysfunction or a requirement of subsequent aortic valve replacements during follow-up. To determine the risk factors of the primary outcome, we performed the generalized linear mixed model.ResultsThe baseline severities of aortic valve were none to trivial in 880 patients (76.2%), mild in 256 patients (22.2%), and moderate in 19 patients (1.6%). The latest 1062 echocardiographic assessments (91.9%; median, 81.2 postoperative months; interquartile range, 37.3-132.1 months) demonstrated 26 cases (0.33%/patient-year) meeting the primary end point during follow-up. Cumulative incidence of the primary end point at 10 years was 0.4% ± 0.3% and 7.4% ± 2.5% depending on the presence of mild or greater aortic valve dysfunction at baseline (P < .01). In multivariable analyses, aortic valve peak pressure gradient (odds ratio, 1.14; 95% confidence interval, 1.10-1.20), aortic regurgitation degree (mild over none: odds ratio, 3.26; 95% confidence interval, 1.15-9.23), and time (odds ratio, 1.30; 95% confidence interval 1.19-1.41) were significantly associated with the occurrence of the primary end point.ConclusionsProgression of severe aortic valve dysfunction and the need for aortic valve replacement are uncommon in patients undergoing rheumatic mitral valve surgery. However, such events were relatively common among those with mild or greater aortic valve dysfunction at the time of mitral valve surgery.  相似文献   
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