外科治疗60岁以上肺癌223例临床分析

目的总结60岁以上肺癌患者的外科治疗经验。方法回顾性分析2004年1月～2005年6月间手术治疗223例60岁以上肺癌病例，其中左全肺切除6例（2．7％），右全肺切除2例（0．9％），肺叶切除195例（87．4％），支气管袖状切除8例（3．6％），双袖1例（0．4％），肺段切除2例（0．9％），肺楔形切除9例（4．0％）。结果本组术后死亡1例，死亡率0．4％，死于呼吸衰竭。出现其他并发症130例，占58．3％。其中窦性心动过速38例，占17．0％；房颤25例，占11．2％，房早8例，占3．6％，高血压17例，占7．6％；痰多致呼吸道不畅低氧血症37例：其中23例（10．3％）经鼻导管给氧或面罩给氧，鼓励患者多咳嗽排痰后，血氧恢复正常：14例（6．3％）经纤支镜吸痰后，帆氧恢复正常；肺部感染2例（0．9％），肺不张1例（0．4％），Ⅲ度漏气1例（0．4％），经积极治疗，均痊愈出院。结论60岁以上肺癌患者外科手术治疗是安全的；加强围术期管理可以预防或减少术后并发症，降低死亡牢。     

青木春夫式断流术180例临床报告

目的：评价青木春夫式断流术的疗效。方法：回顾性分析1980年1月－1996年6月施行青木春夫式断流术180例。结果：手术死亡率1.66%(3/180)，术后远期出血23例（12．99％），脑病4例（2．25％）。绝对生存率1年86．11％（155／180）；3年78．21％（122／156）；5年71．22％（99／139）；10年58.43%(52/89)。结论：再出血的原因与手术方式、病人状况、手术者水平有关。患者于术后1年内死亡与手术有关；术后1－5年的死亡多数与术后出血和脑病有关，并且超过术后出血总数2／3和脑病总数3／4；术后5年以上的死亡则与肝硬变程度及其进展有关。降低术后1年内死亡率的关键是注重围手术期处理，对术后1－5年的病人应定期检查食道胃底静脉，采取各种非手术的预防措施，减少再出血，降低死亡率。     

分化型甲状腺癌的外科治疗:167例回顾分析

目的 总结分化型甲状腺癌的诊治经验。方法 回顾性分析167例分化型甲状腺癌的临床资料及随访结果。结果 （1）术前细胞学诊断正确率为76．9％（97／126）。（2）术前或术中诊断为甲癌的患者共121例，首次手术病理发现癌肿由患侧蔓延侵袭到峡部和对侧的有5例。57例获随访，仅2例分别在术后2年及3年复发。3例分别在术后6－10个月死亡；93）因术前误诊为良性病变而再次手术占再次手术总数的87．5％（42／48），病理发现腺残留癌占45．2％（19／42），患侧淋巴结残留癌占19．05（8／42）。30例获随访，无复发。结论 （1）术前应重视细胞学诊断；（2）分化型甲状腺癌一般做患侧叶、峡部切除加对侧叶大部切除并清扫患侧肿大淋巴结；（3）术前误诊为良性病变而再次手术时应主要针对残叶及同侧淋巴结。若第一次切除范围足够，亦可随诊观察。     

食管超声心动图评价围术期儿童法洛四联症的右室流出道

目的 运用经食管超声心动图（TEE）对儿童法洛四联症（TOF）的右室流出道（RVOT）情况进行围术期评价。方法 32例TOF病儿体外循环前后分别进行TEE检查，年龄4个月～15岁8个月，平均4．0岁。结果 术前32例均TEE诊断为TOF。31例行根治术，1例行B-T分流术。RVOT扩大补片15例；跨肺动脉瓣环补片（TAP）16例，包括4例切除肺动脉瓣，2例带瓣移植物重建RVOT。术后TEE诊断RVOT残余梗阻5例（16．1％），与是否采用TAP无关（X^2=1．115，P=0．291）。肺动脉反流（PR）16例（51．6％），采用TAP比扩大补片术后更易出现PR（X^2=14．212，P=0．000）。保留原肺动脉瓣可减轻术后PR程度（X^2=5．915，P=0．015）。带瓣移植物重建RVOT可减少术后PR（X^2=8．163，P=0．004）。结论 术前TEE可明确诊断TOF，术后TEE可评价不同手术方法对于RVOT的效果。     

腹腔镜可调节胃绑带术治疗单纯性肥胖症228例

目的评价腹腔镜可调节胃绑带术（LAGB）的减重效果及手术并发症。方法回顾性分析2003年6月至2011年6月间在上海第二军医大学长海医院普通外科同一组医师施行LAGB手术的228例单纯性肥胖症患者的临床资料，观察其术后减重效果及近、远期并发症。结果228例患者中女性155例，男性73例；年龄（32．5＋10．3）岁；术前体质量指数（39．5＋6．3）kg／m。。除1例因显露不佳致中转开腹，其余均经腹腔镜顺利完成手术。术后随访3～70（中位37）月，早期并发症发生率2．2％（5／228），远期并发症发生率32．9％（75／228），其中与绑带相关远期并发症发生率24．6％（56／228）。术后1、3、5年额外体质量减重率（wwL％）分别为（40．5＋30．5）％、（59．5~41．5）％和（58．9±46．4）％。术后1、3、5年EWL％大于50％者所占比例分别为32．8％（64／195）、54．4％（62／114）和54．8％（23／42），大于75％者所占比例分别为0、15．8％（18／114）和21．4％（9／42）。结论LAGB手术死亡率和早期并发症发生率非常低，但远期并发症发生率较高，且术后减重效果欠理想，不宜作为减重首选术式。     

良性胆道疾病再次手术的原因及对策(附119例报告)

目的：探讨良性胆道疾病再次手术的原因及对策。方法：对1988年6月至1998年6月十年间收治的119例良性胆道疾病再次手术病人的临床资料进行回顾性分析。结果：119例中接受2次手术者78例（65．55％），3次者30例（25．21％），4次以上者11例（9．24％），死亡4例（3．36％），初次手术方式，开腹胆囊切除术61例（51．26％），胆囊切除加胆总管探查术35例（29．41％），胆肠吻合术15例（12．61％），腹腔镜胆囊切除术8例（6．72％），再次手术的原因，残留或复发结石占首位，共43例（36．13％），胆管损伤或损伤性狭窄32例（26．98％），残留胆囊炎或伴结石23例（19．33％），胆肠吻合口狭窄13例（10．92％），Oddi括约肌狭窄4例（3．36％），其他原因4例（3．36％），结论：良性胆道疾病再次手术的对策；（1）提高术前确诊率，通过各种影像学及造影检查，详细了解胆道系统情况。（2）术中全面细致检查，充分运用胆道镜，胆道造影及术中B超检查，选择合理的术式，降低残石率。（3）根据胆道的损伤类型，合理把握初次手术时机，成形后的肝管空肠端侧Roux-en-Y吻合术是胆道重建术的最佳选择。     

冷循环射频消融治疗实性肿瘤102例临床分析

目的 探讨冷循环射频消融治疗实性肿瘤的疗效、适应证和并发症。方法 对102例肿瘤患者共157个实质性肿块行冷循环射频治疗。肿块直径1～20cm，平均4．03cm。结果 肿块直径小于5cm的完全消融（complete ablation，CA）率为83．5％（91／109），大于5cm为35．4％（17／48）。射频后多数肺癌患者症状明显改善。胰腺癌组中40％（4／10）的患者术后疼痛消失或减轻。经皮穿刺组无中转手术，无皮肤烧伤，无气胸。肝脏射频术中有13．4％（11／82）出现疼痛和6．1％（5／82）出现恶心；术后9．7％（8／82）出现黄疸；23．2％（19／82）出现发热；3．7％（3／82）出现胸腔积液；1．2％（1／82）出现胆漏。肺癌射频术中14．3％（1／7）出现疼痛，术后14．3％（1／7）出现皮下气肿。胰腺射频20％（2／10）并发胰漏；70％（7／10）出现血淀粉酶升高；20％（2／10）出现消化道出血。结论 冷循环射频消融治疗实质肿瘤有效、适应证广且安全，但胰腺射频应慎重进行。     

解剖学方法行肝切除在老年肝癌患者临床应用的疗效观察

目的探讨解剖学方法行肝切除在老年肝细胞癌患者的疗效。方法回顾性分析了125例行手术切除的老年肝细胞肝癌患者的临床资料，其中72例为解剖学方法行肝切除的患者，53例为传统方法行肝切除的患者。结果解剖学方法组无手术死亡，无术后腹腔出血，术后并发症7例（9．7％），术后住院时间（12．6±4．5）d；1、3、5年生存率分别为87．4％、70．1％、60．7％；传统方法组围手术期死亡2例（3．7％），术后腹腔出血2例，术后并发症15例（28．3％），术后住院时间（17．2±9．7）d，1、3、5年生存率分别为79．5％、53．9％、40．8％。解剖学方法组较传统方法组术中出血及输血少，手术并发症发生率低，住院时间缩短（P〈0．05）。结论老年肝癌患者采取解剖学方法行肝切除术，术中出血少，术后并发症少，临床疗效满意。     

27例空回肠出血的诊断分析

目的：对经手术证实的27例空回肠出血患进行分析，探讨空回肠出血的病因诊断，方法：27例空回肠出血患分别进行B超、小肠气钡造影，选择性血管造影，术中肠镜等检查，最后均以手术及病理证实，结果：出血原因中，肿瘤14例（51．9％），血管发育不良5例（18．5％），Meckel憩室4例（14．8％），Crohn's病3例（11．1％）空肠非特异性溃疡1例（3．7％），术中肠镜检查6例，阳性诊断率为83．3％（5／6），阳性符合率为100％，选择性动脉造影12例，阳性诊断率为66．7％（8／12），阳性符合率为87．5％；气钡双重造影17例，阳性诊断率为23．5％（4／17），阳性符合率为100％；B超检查27例，阳性率为25．9％（7／27），阳性符合率为85．7％，结论：肿瘤为空回肠出血的主要原因，除传统的诊断方法外，B超在空回肠出血的诊断中也具有较为重要的作用。     

慢性阑尾炎腹腔镜与开腹手术疗效比较

目的比较腹腔镜手术与开腹手术对治疗慢性阑尾炎的I临床疗效。方法将2000年1月至2005年6月间收治的224例慢性阑尾炎患者按其个人意愿分为腹腔镜手术组（98例）与开腹手术组（126例），对比两组在手术时间、术中出血、住院时间、术中发现和处理的差异，并随访患者术后慢性腹痛的改善情况。结果开腹组手术时间（54．8±21．8）min，腹腔镜组则为（51．8±18．0）min（t=0.80，P〉0．05）；开腹组术中出血（18．6±23．3）ml，腹腔镜组则为（9．8±4．7）ml（t=3．13，P〈0．05）；开腹组住院时间（8．9±5．3）d，腹腔镜组则为（6．8±3．0）d（t=2．66，P〈0．05）。腹腔镜手术组发现有不同程度的腹腔粘连25例（25．5％），其中阑尾与周围粘连9例，回盲部与前侧腹壁粘连6例，大网膜与腹壁及肠管粘连4例，升结肠与周围及腹腔内其他粘连6例，均在术中给予松解：开腹手术组发现阑尾与周围粘连14例（11．1％），松解粘连行阑尾切除术（x^2=7．95，P〈0．05）。术后开腹手术组慢性腹痛发生率24．5％（24／98例），而腹腔镜手术组仅占10．3％（9／87例），两组比较x^2=6．29，P〈0．05；差异有统计学意义。结论腹腔镜手术对慢性阑尾炎的治疗同样具有一定优势，且能降低术后慢性腹痛的发生率。     

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.     

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。     

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.