TACE联合RFA治疗原发性肝细胞癌预后多因素分析

目的探讨TACE联合RFA治疗原发性肝癌（HCC）预后的主要影响因素。方法回顾性分析86例经治疗的HCC患者的临床和随访资料,观察远期疗效,应用Kaplan-Meier法计算累积生存率,绘制生存曲线,对可能影响预后的16项因素行Cox多因素回归分析。结果本组患者6、12、24、36个月生存率分别为94.20%、89.40%、65.80%、49.70%,平均生存时间为（42.98±3.80）个月。多因素分析显示影响预后因素包括肝功能Child分级、Barcelona分期、肿瘤最大直径及治疗效果。结论 TACE联合RFA是治疗HCC的有效方法,其中患者肝功能Child分级、肿瘤Barcelona分期、肿瘤大小是影响预后的危险因素,治疗效果是影响预后的保护性因素。     

原发性肝细胞癌综合介入治疗的临床疗效

目的评价不同介入治疗方法综合治疗肝细胞癌（HCC）的临床疗效。方法原发性HCC患者113例,分4组：单纯肝动脉化疗栓塞术（TACE）组48例,TACE＋射频消融术（RFA）组23例,TACE＋表阿霉素（EPI）＋碘油（LP）组33例,TACE＋经皮注射无水乙醇（PEI）组9例。以术后1个月、3个月CT平扫及增强扫描肿瘤缩小率、甲胎蛋白（AFP）下降50%的比例、1年、2年生存率评估治疗效果。结果TACE＋RFA组肿瘤缩小率、AFP下降50%比例均明显优于其他组,差异有统计学意义。1年及2年生存率各组间差异无统计学意义。结论TACE＋RFA是中晚期原发性HCC患者的首选治疗方法。     

125I粒子植入与射频消融对TACE术后AFP阳性中晚期肝细胞癌干预效果的对比分析

目的对比分析125I粒子植入或射频消融(RFA)对TACE术后甲胎蛋白(AFP)阳性中晚期原发性肝细胞癌(HCC)患者的干预效果。方法回顾性分析79例TACE术后AFP阳性的中晚期原发性HCC患者,其中41例接受125I粒子植入(A组),38例接受RFA(B组)。分别于治疗后1、3、6个月评价治疗效果,并检测血清AFP。结果术后1个月,2组治疗有效率差异无统计学意义(P=0.122);术后3、6个月A组治疗有效率均高于B组(P均<0.05)。A、B组术前及术后1个月血清AFP差异均无统计学意义(P均>0.05),术后3、6个月A组AFP均低于B组(P均<0.05)。结论125 I粒子植入治疗TACE术后AFP阳性中晚期HCC临床效果优于RFA,且降低AFP效果更显著。     

经肝动脉化疗栓塞联合射频消融术对中晚期原发性肝癌的近期疗效分析

目的探讨经肝动脉化疗栓塞(TACE)联合经皮肝穿刺射频消融术(RFA)治疗中晚期原发性肝癌(PHC)的临床疗效和安全性。方法将125例中晚期PHC患者按治疗方法不同分为TACE组(40例)、RFA组(38例)及TACE+RFA组(47例),观察3组近期疗效和并发症发生情况;采用Kaplan-Meier法计算复发率、生存率及中位生存期,比较采用Log-Rank时序检验。结果 TACE+RFA组总有效率为74.5%,明显高于TACE组的52.5%和RFA组的47.4%(P0.05);TACE+RFA组1、2年复发率分别为17.0%、31.9%,均明显低于TACE组(37.5%、57.5%)和RFA组(42.1%、60.5%)(P0.05);TACE+RFA组1、2年生存率分别为89.4%、70.2%,均明显高于TACE组(70.0%、47.5%)和RFA组(68.4%、44.7%)(P0.05);且TACE+RFA组中位生存期(26个月)明显长于TACE组(21个月)和RFA组(19个月)(P0.05)。结论 TACE联合RFA可有效治疗中晚期PHC,减少术后复发率并提高生存率,延长患者生存期,其疗效优于单纯TACE或单纯RFA治疗。     

肝动脉化疗栓塞术加或不加射频消融治疗中晚期原发性肝癌的临床研究

目的探讨经肝动脉化疗栓塞(TACE)联合超声引导下射频消融(RFA)治疗原发性肝癌的疗效。方法对2013年1月至2014年5月行 TACE 联合 RFA 治疗的81例中晚期原发性肝癌病人资料进行回顾性分析,并与同期单独行 TACE 的99例中晚期原发性肝癌病人进行疗效比较。结果TACE 联合 RFA 治疗的中晚期原发性肝癌病人疗效明显好于单纯行 TACE 组病人,TACE联合 RFA 组在肿瘤的疾病控制率(93.8%)、完全缓解率(13.6%)及部分缓解率(44.4%)均优于单纯行 TACE 组(76.8%、5.1%、30.3%),P <0.05;AFP 下降水平也优于单纯行 TACE 组(P <0.05)。结论TACE 联合 RFA 治疗中晚期原发性肝癌疗效好,可做临床推广。     

合并肝硬化中晚期肝癌TACE治疗后血清AFP检测的意义

目的 探讨合并肝硬化的中晚期肝癌患者血清AFP水平对经肝动脉化疗栓塞术（TACE）治疗预后的意义.方法 收集250例TACE术后的中晚期肝癌合并肝硬化患者的血清,采用放射免疫法测定患者血清AFP的水平.将测定的结果分成AFP升高组（＞20 μg/L,n＝165）例和正常组（＜20 μg/L,n＝85）,并对肝癌患者进行随访（1周～65个月,中位时间21.5个月）.用Kaplan-Meier生存曲线分析患者生存率,评估AFP水平及相关因素对中晚期肝癌患者预后的意义.结果 AFP升高组的1、2、5年生存率为57%、48%、5.1%,AFP正常组为37%、46%、12%.AFP升高组的1年生存率明显高于AFP正常组（P＜0.05）,AFP升高组5年生存率明显低于AFP正常组（P＜0.05）.结论 对于中晚期肝癌的患者,血清AFP水平高者较血清AFP水平低者短期预后好,但远期预后差.     

肝动脉化疗栓塞联合射频消融术治疗中晚期肝癌的疗效

目的评价TACE联合射频消融(RFA)治疗中晚期肝癌的疗效。方法回顾性分析72例中晚期肝癌患者,其中35例行TACE联合RFA治疗(联合组),37例行单纯TACE治疗(对照组)。术后随访,比较两组短期疗效、治疗后肝功能、血清甲胎蛋白、并发症以及远期生存率。结果联合组术后总有效率(29/35,82.86%)明显高于对照组(20/37,54.05%;P=0.009)。联合组和对照组术后血清甲胎蛋白降至(102.19±32.13)μg/L、(218.46±49.87)μg/L(P0.001)。联合组1、2、3年生存率分别82.86%、54.29%、34.29%,中位生存期25个月;对照组分别为54.05%、32.43%、13.51%,中位生存期16个月;两组生存率差异有统计学意义(P=0.009)。联合组及对照组治疗后肝功能均有一过性改变,术后2周基本恢复,两组比较差异无统计学意义(P均0.05)。结论 TACE联合RFA治疗中晚期肝癌是有效的综合介入治疗方法。     

TACE联合RFA与单纯RFA治疗肝细胞癌疗效与安全性比较的Meta分析

目的采用Meta分析评价TACE联合射频消融(RFA)与单纯RFA治疗肝细胞癌(HCC)的疗效及安全性。方法检索2000年1月—2016年11月关于TACE联合RFA与单纯RFA治疗HCC的临床随机对照试验设计的中英文文献,提取纳入研究的信息并行Meta分析。结果共12篇文献入选本研究。Meta分析结果显示,TACE联合RFA组1年、3年总体生存率及1年、3年无瘤生存率均优于单纯RFA治疗组,差异有统计学意义(P均0.05);两组间5年总体生存率差异无统计学意义(P=0.07)。对于肿瘤最大径3cm的HCC,TACE联合RFA组与单纯RFA组1年、3年总体生存率及1年、3年无瘤生存率差异均无统计学意义(P均0.05)。两组间严重并发症发生率差异无统计学意义(P=0.82)。结论 TACE联合RFA治疗HCC的近、中期疗效优于单纯RFA治疗,远期疗效无明显差异。     

经导管肝动脉化疗栓塞术联合经皮微波消融治疗复发性肝癌的预后分析

背景与目的:对于复发性肝细胞癌(HCC),肝移植和重复肝切除是主要的治疗方法,但两者均有各自的局限性,不能适用于所有患者。此外,经导管动脉化疗栓塞(TACE)与经皮微波消融(PMCT)也是治疗复发性HCC的有效方法,但TACE联合PMCT是否更能提高治疗效果尚未见报道,故本研究通过回顾性分析,对TACE联合PMCT与单纯TACE治疗复发性HCC的远期疗效进行比较。方法:按纳入标准收集2007年1月—2019年1月西南医科大学附属医院肝胆外科收治的术后首次复发的530例HCC患者资料,其中161例行TACE+PMCT治疗(观察组),369例行纯TACE治疗(对照组),两组疗法均可重复操作,直至CT显示肿瘤消融完全。比较两组患者治疗后的总体生存率(OS)和无瘤生存率(RFS),并分析预后的影响因素。结果:因纳入的两组患者间基线存在差异,故采用倾向得分匹配(PSM)对两组患者行1:1配对,最终从两组患者中匹配出150对基线特征均衡的患者。300例患者的中位随访时间为24.5个月,观察组中位OS时间与中位RFS时间均明显长于对照组(43.1个月vs.19.0个月,P=0.001;36.0个月vs.16.7个月,P=0.002)。两组患者1、2年OS和RFS差异无统计学意义(均P0.05),但观察组3、4、5年OS及RFS均明显优于对照组(均P0.05)。Cox多因素回归分析显示,TACE+PMCT(HR=1.473,95% CI=1.094～1.983,P=0.011),肝硬化(HR=1.101,95% CI=1.041～1.165,P=0.001)是复发性HCC患者OS的独立影响因素;TACE+PMCT(HR=1.093,95% CI=1.037～1.151,P=0.001)和分化程度(HR=1.445,95% CI=1.135～1.840,P=0.003)是复发性HCC患者RFS的独立影响因素。结论:TACE联合PMCT是复发性HCC安全有效的治疗方式,其临床疗效优于单纯TACE治疗,可明显改善复发性HCC患者的预后。     

RFA联合TACE治疗中晚期肝癌的疗效观察

目的观察射频消融术(RFA)联合导管动脉栓塞化疗(TACE)治疗晚期肝癌的临床效果。方法回顾性分析2005年6月～2011年6月蚌埠医学院第一附属医院肝胆外科92例接受TACE及RFA治疗的中晚期原发性肝癌患者,其中88例具有完整的临床治疗过程及随访资料,共43例接受TACE治疗(TACE组),45例接受TACE联合RFA治疗(TACE.RFA组),两组患者的一般临床资料及肿瘤情况差异无统计学意义,比较其生存状况并予以分层分析。结果手术前后螺旋CT摄片或彩超比较显示消融效果良好,两组治疗后肿瘤坏死总有效率(CR+PR)分别为67.4%(29/43)、91.1%(41/45),两组间差异有统计学意义(P<0.05)。接受RFA的患者与对照组相比其生存质量及生存时间均有显著提高。结论对于难以手术切除的原发性肝癌患者,RAF联合TACE的治疗效果明显优于单纯TACE。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.