MSCT在对比剂外渗的急性腹部创伤性动脉损伤诊断中的应用价值

目的探讨MSCT在对比剂外渗的急性腹部创伤性动脉损伤诊断中的应用价值。方法回顾性分析本院2016年1月～2018年12月收治的44例急性创伤性腹部动脉损伤患者及58例腹部非创伤性动脉病变患者影像资料,分析急性腹部创伤性和非创伤性动脉病变所致对比剂外渗的相关性。结果 44例创伤性腹部损伤患者通过MSCT及图像后处理技术共检出59支动脉损伤,其中对比剂外渗34支、非对比剂外渗共25支;58例急性腹部非创伤组共检出58支动脉病变,其中8支存在对比剂外渗。对比剂外渗征象创伤组出现率明显高于非创伤性组(χ~2=24.42,P0.05)。结论与非创伤组相比,急性腹部创伤性动脉损伤对比剂外渗征象较为常见,MSCT可以较好地显示创伤性对比剂外渗的直接及间接征象。     

High plasma microfibrillar-associated protein 4 is associated with reduced surgical repair in abdominal aortic aneurysms

ObjectiveIdentifying biomarkers for abdominal aortic aneurysms (AAA) could prove beneficial in prognosis of AAA and thus the selection for treatment. Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein that is highly expressed in aorta. MFAP4 is involved in several tissue remodeling-related diseases. We aimed to investigate the potential role of plasma MFAP4 (pMFAP4) as a biomarker of AAA.MethodsPlasma samples and data were obtained for 504 male AAA patients and 188 controls in the Viborg Vascular (VIVA) screening trial. The pMFAP4 levels were measured by Alphalisa. The Mann-Whitney U test assessed differences in pMFAP4 levels between the presence and absence of different exposures of interest. The correlation between pMFAP4 and aorta growth rate were investigated through spearman's correlation analysis. Immunohistochemistry and multiple logistic regression adjusted for potential confounders assessed the association between pMFAP4 and AAA. Multiple linear regression assessed the correlation between pMFAP4 and aorta growth rate. Cox regression and competing risk regression were used to investigate the correlation between AAA patients with upper tertile pMFAP4 and the risk of undergoing later surgical repair.ResultsA significant negative correlation between pMFAP4 and aorta growth rate was observed using spearman's correlation analysis (ρ = −0.14; P = .0074). However, this finding did not reach significance when applying multiple linear regression. A tendency of decreased pMFAP4 was observed in AAA using immunohistochemistry. Competing risk regression adjusted for potential confounders indicated that patients with upper tertile pMFAP4 had a hazard ratio of 0.51 (P = .001) for risk of undergoing later surgical repair.ConclusionsHigh levels of pMFAP4 are associated with a decreased likelihood of receiving surgical repair in AAA. This observation warrants confirmation in an independent cohort.     

指压天枢穴加腹部按摩联合番泻叶在静脉肾盂造影患者中的应用效果

目的探讨指压天枢穴加腹部按摩联合番泻叶在静脉肾盂造影患者中的应用效果。方法选取我院2018年12月至2019年8月期间行静脉肾盂造影的120例患者,随机分为两组各60例。对照组给予番泻叶,观察组给予天枢穴指压加腹部按摩联合番泻叶,比较两组的肠道清洁力度和不良反应情况。结果治疗后,观察组的肠道清洁力度明显高于对照组(P <0.05);观察组的不良反应发生率为6.67%,明显低于对照组的23.33%(P <0.05)。结论静脉肾盂造影患者采用指压天枢穴加腹部按摩联合番泻叶的效果较好,可提高肠道清洁力度,降低不良反应发生率。     

Successful treatment of hemorrhagic bullous Henoch‐Schonlein purpura with intravenous immunoglobulins

Henoch‐Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. There is no consensus about the management for isolated cutaneous manifestations in HSP. We describe a case of HSP presenting with severe skin lesions that did not respond to standard therapy with corticosteroids. The 11‐year‐old child was treated with intravenous immunoglobulins, which induced rapid and persistent resolution of symptomatology.     

紫癜1号中药熏洗治疗小儿过敏性紫癜临床观察

目的观察紫癜1号中药熏洗治疗小儿过敏性紫癜的临床效果。方法选取收治的过敏性紫癜患者80例,按照研究方法的不同分为观察组和对照组,对照组患者40例,给予喜炎平注射液、维生素C注射液、葡萄糖酸钙注射液等进行治疗;观察组患者在对照组基础上采用紫癜1号中药熏洗进行治疗,比较2组患者的临床治疗效果、皮肤紫癜消退时间及关节肿痛缓解状况等相关指标。结果对照组患者的治疗有效率为75.0%,观察组患者的治疗有效率为97.5%,观察组治疗有效率显著高于对照组;观察组患儿皮肤紫癜消退时间为(4.10±1.02)d,少于对照组(7.69±1.79)d;观察组患者经治疗后关节肿痛情况完全缓解达到50.0%,缓解达到35.0%,明显优于对照组。结论紫癜1号中药熏洗治疗小儿过敏性紫癜,治疗效果明显,有效缩短患者紫癜消退时间及缓解关节痛的程度。     

Von Willebrand disease: diagnosis and management

Von Willebrand Disease is a common cause of excessive bruising and bleeding in children. This short article gives advice on diagnosis and management for paediatricians. Given its prevalence and presenting symptoms, VWD should always be considered in the assessment of children suspected of non-accidental injury. Its diagnosis can be challenging, not only because of the various subtypes of the disorder but because of the considerable overlap between VWD and normal individuals. Laboratory diagnosis requires a range of quantitative and qualitative tests of the VWF protein, with targeted gene analysis increasingly used to confirm the diagnosis of type 2 and type 3 VWD. Bleeding Assessment Tools may be helpful in directed laboratory testing but are often less so in young children who have had limited haemostatic challenges. Treatment for VWD includes the use of antifibrinolytic drugs, vasopressin or VWF-containing clotting factor concentrates. Treatment is often on-demand for individual bleeding episodes but there are specific indications for the use of prophylactic treatment in children.