早期重症加强治疗在预防急性重症胰腺炎继发感染中的意义

急性重症胰腺炎继发胰腺感染将导致病人住院时间延长,病死率增加.ICU在SAP发病早期从氧代谢水平对休克加以认识并给予充分的液体复苏,主张更积极的进行重要脏器功能的支持和(或)替代治疗,并强调多种治疗措施之间的相互协调和配合等.这些治疗理念和措施将有助于减少MODS的发生,从而降低SAP继发感染的发生率.     

重症急性胰腺炎的治疗（附94例报告）

目的探讨重症急性胰腺炎(SAP)的合理治疗方案.方法以1983～1992年的38例SAP为早期手术治疗(A组),1992～1999年的56例SAP为早期非手术治疗(B组).比较两组的主要并发症及死亡率.结果B组急性呼吸窘迫综合征、休克、肾衰、心衰、继发感染和死亡率均明显低于A组(P<0.001).死亡原因主要为器官功能衰竭及继发感染.结论早期非手术方法可以治愈大多数胰腺炎.胰腺组织坏死继发严重感染可行后期手术治疗,手术方法以充分引流为主.     

碳青霉烯类抗生素预防重症急性胰腺炎感染的研究

目的 :分析和探讨重症急性胰腺炎(severe acute pancreatitis,SAP)病人预防性抗生素应用的疗效及其影响因素。方法:选择2011年10月至2016年10月期间我院ICU收治的SAP病人139例,剔除收治入科时已存在感染者,选取应用碳青霉烯类抗生素的病人。最终纳入回顾性研究48例。分为发病72 h内应用组34例和72 h后应用组14例,分别预防性应用碳青霉烯类。分析SAP病人预防性抗生素应用的启动时机与预后的关系。结果:两组病人在ICU内死亡率、胰腺感染和胰外感染发生率、脏器功能衰竭持续时间、ICU住院时间差异均无统计学意义。单因素分析发现,72 h内应用病人的胰腺感染发生率与疾病严重程度(APACHEⅡ评分和SOFA评分)及胰腺病变程度(CT严重程度指数)有关,即评分越高,病人早期预防性抗生素应用失败率越高,而与病人的性别、年龄、胰腺炎病因无关。多因素分析未发现早期预防性抗生素应用失败的影响因素。结论:本研究中,早期即发病72 h内碳青霉烯类预防性抗生素应用方案不能降低SAP病人的ICU内死亡率、胰腺感染发生率和ICU住院时间。对于疾病严重程度高及胰腺坏死严重的病人,需制定个体化治疗方案。     

重症急性胰腺炎的抗菌药物应用

重症急性胰腺炎（SAP）易继发胰腺和胰周感染,并可导致脓毒症,病死率高,是SAP后期死亡的主要原因。合理应用抗菌药物是预防和治疗SAP继发感染的重要措施,笔者就SAP抗菌药物的应用进行综述。     

重症急性胰腺炎早期合并胰腺感染的危险因素分析

目的探讨与重症急性胰腺炎（SAP）早期胰腺感染有关的危险因素。方法回顾性分析2002年1月-2007年3月间收治的86例重症急性胰腺炎患者的年龄、性别、病因、人院时APACHEⅡ评分、血淀粉酶、血钙、血糖、血细胞比容、平均动脉压、ALT、AST、总胆红素、血清白蛋白、血肌酐、尿素氮、胰腺坏死、低氧血症、机械通气、肠功能障碍及导管应用等因素和胰腺感染的相关性。结果禁食时间、胰腺坏死程度、胆源性致病因素、低氧血症、肠功能障碍、血肌酐、尿素氮和人院血细胞比容与SAP患者继发感染的发生率呈正相关（P〈0．05），血清白蛋白水平与SAP患者继发感染的发生率呈负相关（P〈0．01）；其余各影响因素与胰腺感染均无明显相关性（P〉0．05）。结论在SAP发病过程中，禁食时间较长、胰腺坏死程度增高、胆源性致病因素、低氧血症、肠功能障碍以及血肌酐、尿素氮和人院血细胞比容的升高可能是导致胰腺发生感染的重要因素。     

重症急性胰腺炎早期感染的危险因素分析

目的：探讨重症急性胰腺炎（ＳＡＰ）早期胰腺感染的易感因素。方法：将１９９８年１月～２０００年１２目间收治重症急性胰腺炎６８例,根据发病后２局内胰腺是否继发感染．分为感染组和非感染组,并分析其易感因素。结果：胰腺继发感染的总发主率为４１．２％;ＡＰＡＣＨＥ ＩＩ积分与胰腺感染发生之间呈明显的正相关性（ｒ＝０．３１,Ｐ＜０．０１）;放置胃管≥７天、肠切能障碍≥５天、施行腹腔灌洗手术、胰腺有坏死及胆源性胰腺炎等危险因素与 ＳＡＰ患者继发胰腺感染的发生率明显相关（Ｐ＜０．０５）;其余各影响因素与胰腺感染均无明显联系（Ｐ＞０．０５）。结论：胃肠道功能障碍≥５天、胆源性胰腺炎、早期胰腺明显坏死和腹腔灌洗引流等是ＳＡＰ自期胰腺感染的主要易感因素。     

重症急性胰腺炎感染与肠屏障学术进展

重症急性胰腺炎（severe acute panereatitis，SAP）是一种病情凶险、并发症多的严重疾病，死亡率高，可达20％-30％。在SAP后期，与胰腺及其周围组织坏死、继发感染密切相关的脓毒症和多器官衰竭（multiple organ failure，MOF）是导致死亡的主要原因，其中80％与肠道屏障功能受损继发感染有关。     

重症急性胰腺炎早期ICU综合救治模式探讨

目的探讨重症急性胰腺炎（SAP）早期治疗模式。方法分析我院ICU建成前、后收治的SAP病例资料,对比ICU组和非ICU组的住院时间、后期并发症、死亡率、死亡原因等。结果ICU组抢救成功率明显提高（92.1% vs 54.8%）,P〈0.05。结论以ICU为中心的综合治疗模式,能提高SAP抢救成功率。     

重症急性胰腺炎肠粘膜屏障功能的损害及预防

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床上常见的危急重症,其中胰腺和胰周感染是SAP的主要死因,即使在发病早期救治成功,也常在疾病的第二、三周发生胰腺及其它器官继发感染,导致死亡[1].胰周脓肿的发生率虽不超过SAP的5%,但死亡却占SAP死亡患者的80%以上.     

腹膜后引流治疗重症急性胰腺炎引流时机及手术入路的选择

重症急性胰腺炎（SAP）是临床上的一种急、危、重症疾病,具有很高的死亡率。SAP早期出现的大量腹腔积液,多种胰源性的有害物质以及胰腺和胰周组织的感染、坏死,对SAP的病程演变起着重要的作用^[1,2]。由于SAP病程迁延,患者常存在免疫和代谢功能紊乱,使继发感染的机会增加,SAP继发感染的发生率高达40％-70％13^[3]。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.