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《Auris, nasus, larynx》2022,49(4):644-651
ObjectiveUvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in treatment effects and postoperative complications. Therefore, to improve those, we have devised and put into practice the so-called CWICKs, which is a modified version of barbed reposition pharyngoplasty as a surgical method. We outline the procedure of CWICKs and report the treatment results in comparison with the conventional UPPP.MethodsCWICKs are surgeries that use resorbable wound closure devices to pull the posterior palatal arch outward and elevate it anteriorly and superiorly to maintain an open upper airway during sleep at the soft palate level. We compared the therapeutic effects of 46 patients evaluated by polysomnography before and after surgery among CWICKs performed in our department between January 2015 and December 2019 and 91 patients who underwent UPPP in our department between January 2000 and December 2008.ResultsIn 46 patients who underwent CWICKs, significant improvement was observed before and after surgery using the apnea hypopnea index (AHI), obstructive apnea index (OAI), ration of each sleep stage, and SpO2 level > 90%. The improvement rate of AHI was 68.4%, and the surgical success rate was 58.7%. Postoperative patient satisfaction was also good, and significant improvement in subjective sleepiness (Epworth Sleepiness Scale) and subjective sleep quality (Pittsburgh Sleep Quality Index) was observed before and after surgery. No postoperative complications such as dysphagia or scar stenosis were observed in any of the patients in the CWICKs group. Compared with the 91 cases of UPPP, which is the conventional method, there was no significant difference in the improvement rate of AHI (p = 0.199), but the improvement rate of OAI had significantly improved (p = 0.013). Regarding the postoperative sleep stage, In the CWICKs group, a significant decrease in stage 1 and a significant increase in stage 2, stage 3, and stage rapid eye movement were observed, whereas in the UPPP group, no significant improvement in stage 3 was observed. Multivariate analysis of surgical success did not show an association with surgical methods (CWICKs or UPPP). On the other hand, an association was shown with age (<45), palatine tonsil size (≥3 / 5), high MPH (≥14 mm), and OAI rate (> 1/3).ConclusionThe treatment outcome of CWICKs was equal to or better than that of the conventional UPPP. Future follow-up is required for long-term prognosis, but no serious postoperative complications, such as dysphagia or scar stenosis, have been observed. CWICKs are considered to be minimally invasive, simple, and effective surgical procedures with few complications. 相似文献
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《Transfusion Clinique et Biologique》2022,29(1):94-97
Dynamic monitoring ABO chimera including erythroid ABO antigen and anti-A/B is crucial to not only assess the status of erythroid engraftment but also achieve personalized safety transfusion in patients post ABO incompatible hematopoietic stem cell transplantation. Transfusion support for ABO incompatible (ABOi) HSCT patients after achieved complete alteration to donor origin still remains cautious because the instant hematopoietic status on these transplant patients possibly returned to patient origin derived from early disease relapse and graft loss or failure. We reported that reemergent anti-B in a female patients (donor/patient: B/O) at the early phase after achievement complete donor type were not effectively found from partial automatic ABO blood grouping systems, which directly resulted in differential judgement of transplantation stage for about 15 days and disturbed the optimal recommendation on transfusion support. Meanwhile, the solely alteration of ABO chimera was found and earlier than changes of other markers such as MRD diagnosis, chimerism analysis by STR-PCR and sex chromosome assays, which can be an available predictors for bad transplant outcomes such as graft failure. 相似文献
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目的:探讨miR-145调控肝癌腹水模型Th9细胞升高的作用机制。方法:构建小鼠H22肝癌腹水模型。造模两周后处死小鼠并分离出脾脏组织,流式细胞术分析肝癌腹水组(MA组)与正常对照组(Control 组)小鼠脾脏Th9细胞表达水平。ELISA法检测脾脏IL-9表达水平。RT-PCR法检测脾脏miR-145表达水平。Western Blot法检测脾脏中PI3K/Akt/mTOR/P70S6K/HIF-1α相关蛋白表达水平。分选小鼠脾脏CD4+T细胞,随机分为miR-145 mimics组和NC组,分别应用miR-145-5P mimics、阴性对照寡核苷酸(negative control,NC)进行转染,RT-PCR检测各组miR-145、HIF-1α mRNA及IL-9 mRNA表达水平。结果:与Control 组相比,MA组Th9细胞及其细胞因子IL-9表达均升高(P<0.05),miR-145表达降低(P<0.05),p-PI3K、p-Akt、mTOR、p-mTOR、p-P70S6K、HIF-1α蛋白均升高(P<0.05)。与NC组相比,miR-145 mimics组miR-145显著升高,HIF-1α mRNA及IL-9 mRNA表达下降。结论:肝癌腹水中Th9细胞升高可能与miR-145下降导致的PI3K/Akt/mTOR/P70S6K/HIF-1α通路激活有关。 相似文献
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目的:系统评价中西医结合治疗癫痫伴抑郁患者的临床疗效。方法:计算机检索中国知网、万方数据库、中国医学生物文献数据库、维普资讯、PubMed及Web of Science等中英文数据库,筛选出自各数据库建库以来至2018年7月关于中西医结合治疗癫痫伴抑郁的临床随机对照试验(randomized controlled trial,RCT)研究,根据系统评价标准依次进行文献质量评价和Meta分析。结果:纳入14个研究,共1183例患者。Meta分析结果显示:中西医结合治疗癫痫伴抑郁在降低HAMD评分、提高QLOIE-31评分方面优于单纯西药治疗。癫痫发作频次改善率效应值合并量OR=3.53,95%CI(1.73,7.17),Z=3.48(P=0.0005),差异有统计学意义(P<0.05)。临床安全性效应值合并量OR=0.59,95%CI(0.35,0.98),Z=2.03(P=0.04),差异有统计学意义(P<0.05)。结论:中西医结合足疗程治疗癫痫伴抑郁临床疗效优于单纯西药治疗,且临床安全性良好,但因纳入研究数量和质量有限,上述结论尚待高质量的RCT研究验证。 相似文献
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目的运用360度评价对我院住培学员的岗位胜任力进行评价,对学员岗位胜任力的现状进行探讨分析。方法使用问卷调查表分别从专业基地教学主任、学员指导教师、同专业学员及学员本人的角度,对2017级222名住培学员的岗位胜任力进行360度评价,利用SPSS22.0对数据进行统计分析。结果连续两年的测评,住院学员8类岗位胜任力的自评和他评得分低于满分,学员在临床基本能力、医患沟通能力、掌握与运用医学知识、团队合作能力4项内容的评分,差异有统计学意义(P<0.05);同时学员在临床基本能力、医生职业精神与素质、医患沟通能力、掌握与运用医学知识、团队合作能力5项内容的评分较上一年相比,差异也有统计学意义(P<0.05)。结论调查结果提示360度评价可帮助住培学员提高岗位胜任力,后续培训应围绕调查结果和以岗位胜任力为导向来调整与设置,需增加人文属性内容的培训以及再量化培训测评内容、指标和进一步完善考评反馈机制。 相似文献