Endotoxin Removal Column Containing Polymyxin B Immobilized Fiber Is Useful for the Treatment of the Patient with Vibrio Vulnificus

A case of primary septicemia due to Vibrio vulnificus infection is reported. The patient was successfully treated with appropriate antibiotic therapy, drainage, and debridement of the necrotic tissues and direct hemoperfusion (DHP) using polymyxin B immobilized fiber (PMX-F). The effectiveness of DHP using PMX-F, which removes endotoxin in the circulating blood for the treatment of septic shock and multiple organ dysfunction occurring due to this fulminant infectious disease, is discussed.
Vibrio vulnificus infection causes fulminant and frequently fatal septicemia. The fatality rate for Vibrio vulnificus septicemia is very high ( 1 , 2 ). Vibrio vulnificus is generally only pathogenic in immunocompromised hosts, and its pathogenicity is particularly related to liver diseases. Circulating endotoxin is considered to be seriously pathogenic in patients with Vibrio vulnificus infections. Direct hemoperfusion (DHP) using Polymyxin B immobilized fiber (PMX-F) is a new treatment for endotoxemia which eliminates endotoxin from the blood circulation (3). We report a case of primary endotoxemia due to Vibrio vulnificus infection successfully treated by a combination of aggressive intensive care and DHP using PMX-F.     

急性结肠穿孔经腹腔镜与传统开腹手术效果比较

目的对比腹腔镜与开腹手术治疗急性结肠穿孔的效果,探讨经腹腔镜手术的安全性。方法回顾性分析2008年1月~2014年12月我院收治的42例急性结肠穿孔的临床资料,22例行腹腔镜手术,20例行开腹手术,对比2组的手术治疗效果。结果与开放组相比,腹腔镜组手术时间短[(160.5±25.4)min vs.(210.3±45.6)min,t=-4.426,P=0.000],手术失血量少[(112±21)ml vs.(220±53)ml,t=-8.834,P=0.000],术后肠造口排气早[(4.2±1.2)d vs.(7.3±3.4)d,t=-4.016,P=0.000],肺部感染少[9.1%(2/22)vs.40.0%(8/20),χ2=3.945,P=0.047],总住院时间短[(10.3±2.6)d vs.(15.6±2.4)d,t=-6.839,P=0.000],住院费用少[(2.26±0.45)万元vs.(3.16±0.38)万元,t=-6.966,P=0.000]。围术期死亡率和切口感染率差异无显著性(P0.05)。结论对于急性结肠穿孔采取经腹腔镜的手术方式,具有手术创伤小、出血量少、术后肠功能恢复快、肺部感染少、住院时间短、住院费用低等优点,疗效确切,安全可行,值得临床推广。     

金属桩口腔修复与预成纤维桩口腔修复的临床疗效及安全性比较

比较金属桩口腔修复和预成纤维桩口腔修复的临床疗效。方法 选取2022年8月-2023年8月 于本院行口腔修复的80例患者为研究对象,按随机数字表法分为对照组和观察组,每组40例。对照组采用 金属桩口腔修复,观察组采用预成纤维桩口腔修复,比较两组临床疗效、修复时间、修复成功率、牙周指 数、并发症发生率及满意度。结果 观察组修复总有效率为95.00%,高于对照组的75.00%（P ＜0.05）;观 察组修复时间短于对照组,修复成功率高于对照组（P ＜0.05）;观察组修复后牙齿松动度、BI、PLI、PD 均低于对照组（P ＜0.05）;观察组并发症发生率为2.50%,低于对照组的17.50%（P ＜0.05）;观察组满意 度为95.00%,高于对照组的75.00%（P ＜0.05）。结论 相比于金属桩口腔修复,预成纤维桩口腔修复的临 床疗效更为理想,其修复时间较短,修复成功率较高,且并发症发生率较低,可有效改善患者的牙周指 数,提高患者满意度,值得临床应用。     

Validation of Traditional Prognosis Scoring Systems and Skeletal Oncology Research Group Nomogram for Predicting Survival of Spinal Metastasis Patients Undergoing Surgery

BackgroundMany scoring systems that predict overall patient survival are based on clinical parameters and primary tumor type. To date, no consensus exists regarding which scoring system has the greatest predictive survival accuracy, especially when applied to specific primary tumors. Additionally, such scores usually fail to include modern treatment modalities, which influence patient survival. This study aimed to evaluate both the overall predictive accuracy of such scoring systems and the predictive accuracy based on the primary tumor.MethodsA retrospective review on spinal metastasis patients who were aged more than 18 years and underwent surgical treatment was conducted between October 2008 and August 2018. Patients were scored based on data before the time of surgery. A survival probability was calculated for each patient using the given scoring systems. The predictive ability of each scoring system was assessed using receiver operating characteristic analysis at postoperative time points; area under the curve was then calculated to quantify predictive accuracy.ResultsA total of 186 patients were included in this analysis: 101 (54.3%) were men and the mean age was 57.1 years. Primary tumors were lung in 37 (20%), breast in 26 (14%), prostate in 20 (10.8%), hematologic malignancy in 18 (9.7%), thyroid in 10 (5.4%), gastrointestinal tumor in 25 (13.4%), and others in 40 (21.5%). The primary tumor was unidentified in 10 patients (5.3%). The overall survival was 201 days. For survival prediction, the Skeletal Oncology Research Group (SORG) nomogram showed the highest performance when compared to other prognosis scores in all tumor metastasis but a lower performance to predict survival with lung cancer. The revised Katagiri score demonstrated acceptable performance to predict death for breast cancer metastasis. The Tomita and revised Tokuhashi scores revealed acceptable performance in lung cancer metastasis. The New England Spinal Metastasis Score showed acceptable performance for predicting death in prostate cancer metastasis. SORG nomogram demonstrated acceptable performance for predicting death in hematologic malignancy metastasis at all time points.ConclusionsThe results of this study demonstrated inconsistent predictive performance among the prediction models for the specific primary tumor types. The SORG nomogram revealed the highest predictive performance when compared to previous survival prediction models.