Stanford A型主动脉夹层合并Kommerell憩室的外科治疗

目的总结Stanford A型主动脉夹层合并Kommerell憩室的治疗经验。方法对北京安贞医院心脏大血管外科2009年1月至2017年8月手术治疗的所有A型主动脉夹层合并Kommerell憩室患者进行资料收集和随访。共有13例患者纳入本研究, 其中男性11例, 女性2例, 年龄(47.0±8.4)岁。结果 Kommerell憩室平均最大直径(21.8±7.7)mm。全部患者均采用正中开胸孙氏手术。Kommerell憩室消除方式为缝闭Kommerell憩室开口3例, 结扎迷走右锁骨下动脉主干9例, 缝闭开口并结扎主干1例。住院期间无死亡。近期并发症包括二次开胸止血1例。随访期间死亡2例, 其中不明原因死亡1例, 肾脓肿感染性休克1例。随访期间1例患者因术中支架人工血管Ⅱ型内漏行介入封堵。结论孙氏手术中采用股动脉插管建立心肺转流、单侧颈总动脉插管进行选择性脑灌注、气管旁结扎迷走右锁骨下动脉主干治疗合并Kommerell憩室的A型主动脉夹层, 可以取得较好的治疗效果。     

腔内修复联合辅助技术治疗累及主动脉弓的Stanford B型夹层动脉瘤

目的 探讨主动脉腔内修复手术联合辅助技术治疗累及主动脉弓部的Stanford B型主动脉夹层动脉瘤.方法 分析腔内治疗累及主动脉弓部,破口邻近左锁骨下动脉或位于其近端的46例StanfordB型主动脉夹层动脉瘤的临床资料.腔内封堵左锁骨下动脉43例;PDA封堵器封堵左锁骨下动脉6例次;颈部动脉搭桥术9例次;“烟囱”技术重建左颈总动脉8例次;“开窗”技术封堵夹层破口,同时保留主动脉弓部所有分支动脉1例次.结果 患者术后均存活,随访时间(25±16)个月.未发生严重神经系统并发症.10例发生左锁骨下动脉Ⅱ型内漏,其中6例通过PDA封堵器隔绝,2例保守治疗后自愈;9例发生左上肢缺血症状,其中8例行保守治疗,另1例症状严重,行颈部动脉搭桥术重建左锁骨下动脉.随访中,所有人工血管和分支动脉支架均保持通畅,降主动脉真腔直径显著扩大,假腔直径逐渐缩小.结论 对累及主动脉弓部,破口邻近左锁骨下动脉或位于其近端的StanfordB型主动脉夹层,腔内治疗联合PDA封堵器、颈部动脉搭桥术、“烟囱”技术或“开窗”技术是安全有效的治疗方法.     

Castor支架治疗右位心、迷走右锁骨下动脉合并Stanford B型主动脉夹层1例

右位心、迷走右锁骨下动脉合并Stanford B型主动脉夹层罕见。我们采用Castor分支型支架对1例81岁女性患者实施主动脉腔内隔绝获得成功。与常规B型夹层的主动脉腔内隔绝术比较, 术前应通过主动脉CTA、超声等明确右位心、主动脉及其分支、尤其迷走右锁骨下动脉解剖、夹层的破口位置及其比邻;通过术前影像学以及术中造影寻找出充分展现主动脉弓部形态及其分支的投射角, 并由熟练掌握心血管介入技术的医师完成是手术成功的关键。     

迷走右锁骨下动脉合并Kommerell憩室的杂交及腔内治疗

迷走右锁骨下动脉是较常见的主动脉弓部发育畸形,其病因是由于早期胚胎弓动脉系统发育过程异常导致,约60%合并Kommerell憩室。迷走右锁骨下动脉患者出现锁骨下动脉开口瘤样扩张或有压迫症状时需外科干预治疗。随着腔内技术的发展,治疗方法从传统的开放手术向杂交及全腔内的方向发展,本文将从杂交及全腔内治疗的外科手术方法及术中注意事项作一简述。     

Kommerell憩室的外科治疗进展北大核心CSCD

Kommerell憩室是一种罕见的先天性主动脉发育异常,憩室可发生于左、右主动脉弓,发出一条迷走锁骨下动脉至对侧。仅少部分Kommerell憩室患者出现症状。成人患者的常见症状是吞咽困难、呼吸困难、胸痛或上肢血压差。由于Kommerell憩室患者发生主动脉夹层或主动脉瘤破裂的风险高于正常主动脉患者,建议早期手术干预,改善预后。目前外科手术方法包括开放手术、全腔内治疗及杂交手术。选择何种手术方式取决于患者具体解剖情况、患者状态、术者偏好等因素。本文回顾2015~2020年相关文献报道,对该疾病的手术方式、近期结果等进行综述。     

“烟囱”技术在累及主动脉弓部血管的动脉夹层腔内修复术中的应用

目的探讨"烟囱"技术在主动脉夹层腔内隔绝术中保留重要分支动脉的作用及疗效。方法对2009年6月—2010年2月收治的8名第一破口位于主动脉弓部重要分支附近、腔内修复治疗近端锚定区不足的主动脉夹层患者的临床资料进行回顾分析。在DSA下对夹层第一破口及左颈总动脉、左锁骨下动脉开口行腔内隔绝的同时,以"烟囱"支架重建左颈总动脉的血流。术后2周行螺旋CT检查,观察疗效以及有无内漏、支架移位等并发症。结果手术成功率100%,无I型内漏发生,2例发生左锁骨下动脉延迟性返血。术后随访2～10个月,主动脉内支架型人工血管位置良好,左颈动脉内"烟囱"支架保持通畅,无移植物相关的漏血发生。2例左锁骨下动脉延迟性返血的患者中,1例于术后2周消失,1例随访5个月持续存在,但为微量且有减少趋势。结论 "烟囱"技术可以为第一破口位于弓部重要分支动脉附近的动脉夹层患者,提供腔内隔绝术治疗机会,避免主动脉弓部血管重建开放手术带来的大的创伤。短期随访结果满意,远期疗效有待于进一步随访。     

不开胸“杂交”手术治疗主动脉弓部夹层的近中期随访研究

目的总结不开胸"杂交"手术(不开胸主动脉弓分支血管旁路术+主动脉腔内修复术)治疗主动脉弓部夹层的近中期疗效和经验。方法回顾性分析2011年1月至2014年9月在广州军区武汉总医院心胸外科接受主动脉弓分支血管旁路术+主动脉腔内修复术(主动脉弓分支血管旁路术毕即转入导管室行同期主动脉腔内修复术)治疗主动脉弓部夹层7例患者的临床资料,其中男12例、女5例,年龄46~71岁。分析该手术方式的选择及预后情况。结果行左颈总动脉-左锁骨下动脉旁路术4例,右颈总动脉-左颈总动脉-左锁骨下动脉旁路术3例,右颈总动脉-左颈总动脉旁路术、封闭左锁骨下动脉10例。全部手术均获得成功。1例患者术后出现喉返神经损伤。术后7 d、3个月、1年及之后每年复查CT,随访截至2015年9月,随访时间12~53个月。随访所有患者均健康存活,人工血管旁路通畅,血管支架无内漏。结论不开胸"杂交"手术可用于治疗难以耐受主动脉置换的主动脉弓部主动脉夹层高危患者。     

Stanford B型主动脉夹层合并迷走右锁骨下动脉的腔内治疗：附16例报告

背景与目的：迷走右锁骨下动脉（ARSA）为主动脉弓部的一种先天畸形,Stanford B型主动脉夹层（TBAD）合并ARSA是一种罕见且严重威胁患者生命的疾病。既往临床上对其处理通常采用开放手术或杂交手术。随着血管腔内技术的飞速发展,胸主动脉腔内修复术（TEVAR）已逐渐被应用与TBAD合并ARSA的治疗,并展现出其创伤小,恢复快的优势。但由于ARSA与夹层破口相对位置的不确定性,如何处理夹层破口与ARSA成为了影响其腔内治疗的主要因素,完全腔内治疗这一复杂主动脉弓部病变的安全性和有效性尚不明确。本文旨在探讨TBAD合并ARSA的腔内修复治疗方法,总结初步经验。  方法：回顾性分析2012年1月—2019年12月中南大学湘雅二医院血管外科采用TEVAR治疗的16例TBAD合并ARSA患者资料。其中男14例,女2例;平均年龄为（56.1±11.3）岁;13例患者破口位于Z3区,3例位于Z4区;左椎动脉优势14例,右椎动脉优势1例,双侧椎动脉均势1例。根据主动脉夹层破口位置与双侧锁骨下动脉开口位置、椎动脉形态制定手术方案。 结果：技术成功率100%,平均手术时间（95.2±38.9）min,无围手术期死亡。2例患者保留双侧锁骨下动脉,5例患者封堵ARSA,7例患者采用烟囱技术重建左锁骨下动脉（LSA）,1例患者采用烟囱技术重建LSA并采用潜望镜技术重建ARSA,1例患者采用开窗技术重建LSA。弓部分支动脉重建的患者,术后服用拜阿司匹林（100 mg/d）和氯吡格雷（75 mg/d）3个月。平均随访时间33.2（3~66）个月。无内漏、支架移位等;右上肢缺血2例,保守治疗后逐渐恢复;比较术前和末次随访的主动脉CTA,降主动脉最大直径从（37.1±9.6）mm降至（33.9±8.9）mm,假腔与真腔之比从1.03±0.62降至0.21±0.31。长期随访,所有烟囱支架均保持通畅,未出现弓部分支动脉缺血、锁骨下动脉窃血、脊髓缺血等症状。 结论：TEVAR辅以“烟囱”、开窗等技术治疗合并ARSA的TBAD安全可行,可以在保留LSA和（或）ARSA血流的同时良好封堵主动脉夹层破口,且创伤小、住院时间短、围手术期并发症发生率低。具体的手术方式应由夹层破口与双侧锁骨下动脉的相对位置来决定,应至少保证椎动脉优势一侧锁骨下动脉的血流供应。      

裂口位于主动脉弓远端Stanford A型主动脉夹层的腔内修复

目的总结腔内修复术治疗裂口位于主动脉弓远端Stanford A型主动脉夹层的临床经验。方法2001年1月至2006年6月在中山大学附属第一医院血管外科通过股动脉入路行主动脉腔内修复术,对21例内膜撕裂口位于主动脉弓远端和近端降主动脉的Stanford A型主动脉夹层进行血管腔内治疗,根据椎动脉造影确定是否重建左锁骨下动脉。结果全组21例中,急性夹层13例,慢性夹层8例,均接受了血管腔内带膜支架修复术,手术成功率100%。17例同时封闭了左锁骨下动脉,其中4例行左锁骨下动脉重建。4例发生内漏,1例术后发生脑梗死。平均随访22.3个月(6~65个月),所有病例均存活。假腔内完全血栓形成12例,部分血栓形成9例。结论主动脉腔内修复术治疗内膜撕裂口位于主动脉弓远端和近端降主动脉的Stanford A型主动脉夹层是有效和安全的,具有微创、成功率高和并发症少等特点。     

主动脉弓疾病腔内治疗体外开窗技巧

<正>主动脉弓疾病主要包括侵及主动脉弓部的主动脉瘤或主动脉夹层。腔内治疗的最大难点为在腔内隔绝动脉瘤和夹层裂口的同时,需要保留主动脉弓部的重要分支动脉,包括无名干动脉、左颈总动脉、左锁骨下动脉及变异的椎动脉与迷走右锁骨下动脉。目前临床上较为常用的方法包括复合手术、烟囱或潜望镜技术、体外开窗、原位开窗、分支移     

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。     

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.     

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.     

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。     

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.     

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。