高龄肺癌病人术前心肺功能不全与术后并发症的护理

目的 探讨70岁以上高龄肺癌患者术前心肺功能与术后并发症的关系,提出相应的护理对策。方法 回顾分析88例70岁以上肺癌患者术前的心肺功能、手术方式及术后并发症的资料。结果 88例高龄肺癌患者中,术前不同程度地存在心肺功能低下者62例（71．5％）;手术切除84例,4例探查,切除率95．4％。术后出现并发症的12例（占13．6％）,术后30天死亡1例。结论 对高龄伴心肺功能不全的患者,充分做好术前重要器官的检查、全身状况的评估是关键的一步,加强患者围手术期的心电监护、血气监测及做好围手术期的健康教育,指导患者进行肺功能锻炼,对预防术后并发症的发生也起着重要的作用。     

肝门胆管癌预后因素69例临床分析

目的探讨影响肝门胆管癌预后的因素及其治疗方法。方法回顾性分析69例肝门胆管癌患者的临床组织病理学特点、手术方法及随访资料。结果高分化腺癌21例（32．8％），中住生存期26．4个月；中、低分化腺癌43例（67．2％），中位生存期9．5个月；二者差异有统计学意义（P〈0．01）。按TNM分期，Ⅰ、Ⅱ期39例中位生存期24．2个月，Ⅲ、Ⅳ期30例中位生存期11．5月（P=0．033）；根治性切除46例中位生存期21．5个月，高于姑息性切除23例中位生存期（8．3个月，P=0．017）。结论肿瘤分化程度、临床分期、手术方式是影响肝门胆管癌预后的重要因素，加强围手术期处理，选择性地进行根治性切除或姑息性手术．是治疗肝门胆管癌的正确方法。     

老年肺癌病人的外科治疗

目的 探讨高龄肺癌的外科治疗体会。方法 回顾性研究30例70岁以上老年肺癌的临床资料和治疗情况。结果 术前ECG异常20例（66．7％），肺功能异常18例（60％），手术切除28例（93．3％）。术后心肺并发症36．7％。死亡率3．33％。1，3，5年生存率分别为75％，39．3％，28．6％。结论 高龄不应是手术禁忌症，加强围手术期管理，采取适当的手术方式，可以提高老年肺癌患的生存率。     

肺癌合并中度COPD患者肺叶切除术后肺功能变化及围手术期处理

【目的】探讨肺癌合并中度慢性阻塞性肺部疾病（c0PD）患者行肺叶切除手术对其肺功能的影响及围手术期处理措施。【方法】回顾性分析2003年3月至2009年1月在本院治疗的23例肺癌合并中度COPD行肺叶切除的患者,术后给予抗感染、机械辅助通气、纤维支气管镜吸痰、吸氧、平喘及呼吸物理学治疗,比较术前与术后3个月两个时期肺功能情况。【结果】患者术前最大通气量（MW）,第1秒用力呼气容积（FEV1％）和动脉氧分压（Pa02）平均值分别为（40．76±4．87）L,（61．9±9．7）％和（76土8）mmHg,术后分别为（39．5±4．24）L,（59．8±8．9）%和（78±7）mmHg,差异无显著性（P〉0.05）。用力肺活量（FVC％）略有下降,但差异也无显著性（P〉0．05）。【结论】中度COPD患者仍有一定的肺功能储备,能耐受肺叶切除手术;通过加强围手术期的管理,特别是术后的密切监护以及各种严重心肺并发症的及时处理,可达到满意的手术效果。     

Ⅲa期非小细胞肺癌新辅助化疗的临床评价

目的探讨术前新辅助化疗对Ⅲa期非小细胞肺癌预后的影响。方法Ⅲa期非小细胞肺癌患者64例，其中32例术前行长春瑞滨 顺铂化疗2个周期后，间隔2周行手术切除，另32例直接行单一手术切除，观察其疗效。结果新辅助化疗组的手术切除率(93．7％)，术后中位生存时间(32个月)和2年存活率(53．1％)均高于单一手术组。结论新辅助化疗可以提高Ⅲa期非小细胞肺癌的手术切除率及2年存活率，延长患者的中位生存时间。     

WHOQOL-100在子宫切除患者围手术期生存质量评估中的应用

目的应用世界卫生组织生存质量测定量表（WHOQOL-100）评估子宫切除患者围手术期生存质量,为提高其生存质量提供科学依据。方法应用WHOQOL-100量表对161例子宫切除患者,分别在入院时（术前）和术后3个月进行问卷调查,比较其子宫切除术前、术后的生存质量。结果经过手术和护理干预,子宫切除术后3个月患者总的生存质量和健康状况和生存质量自评分分别为（73±20）分和（81±6）分,高于术前的（63±14）分和（81±5）分,各领域得分也均高于术前,除生存质量自评分和独立性领域差异无统计学意义外（t=-0．110,P〉0．05;t=-1．323,P〉0．05）,其余领域手术前后差异均有统计学意义（P〈0．05）。对手术前后生存质量的24个方面进一步比较发现,术后患者的消极感受、医疗依赖、社会安全保障3个方面得分低于术前[（70±18）分VS（70±21）分,（73±21）分VS（81±19）分,（65±15）分VS（65±18）分],且医疗依赖方面差异有统计学意义（t=3．606,P〈0．01）;其他方面术后得分均高于术前,但积极感受、身材相貌、工作能力、交通条件4个方面差异无统计学意义（P〉0．05）。结论经过医疗和护理干预,子宫切除患者术后3个月的生存质量高于术前,应该重视子宫切除患者手术前、后的健康教育和心理治疗。     

非小细胞肺癌术后辅助治疗现状及进展

肺癌对人类健康的威胁日益严重,肺癌的发病率、死亡率大幅度上升。非小细胞肺癌（NSCLC）是肺癌中最常见的一种类型,占肺癌的80％～85％,外科手术切除是治疗可手术的NSCLC最好的方法,但仅20％左右肺癌患者就诊时适宜手术,按1997年国际分期,ⅠA期术后5年生存率为61％,ⅠB期为38％,ⅡA期为34％,ⅡB期为24％,ⅢA期为13％,ⅢB期为5％。     

胸外科围手术期死亡病例的临床分析及预防

目的：探讨降低胸外科围手术期病死率的措施。方法：回顾分析52例胸外科围手术期死亡病例资料。结果：≥60岁组和＜60岁组围手术期病死率分别为1．46％和0．34％（P＜0．01），肺切除组与非肺切除组围手术期病死率分别为1．15％和0．32％（P＜0．01），恶性肿瘤及良性病变的围手术期病死率分别为1．26％和0．22％（P＜0．01），死亡原因，循环并发症17例，呼吸并发症16例，肺癌术后癌转移4例，上消化道出血3例，感染性并症6例，手术出血2例，麻醉意外1例，术后猝死3例，结论：术前详细评估心肺功能，严格掌握手术适应症，尽量避免右全肺切除及不必要的肿瘤姑息性切除，是降低病死率的重要措施。     

胸腔镜在Ⅰ、Ⅱ、Ⅲ期肺癌根治术中的临床应用

目的探讨电视辅助胸腔镜手术(VATS)在Ⅰ、Ⅱ、Ⅲ期肺癌根治术中临床疗效,初步探讨胸腔镜手术在局部晚期肺癌中的应用价值。方法于2009年6月~2012年10月行胸腔镜肺癌根治术患者中,随机选取术后病理分期为Ⅰ期的患者40例,Ⅱ期40例,Ⅲ期40例,比较3组术前、术中、术后临床资料,并做统计学分析。结果 3组患者均无术中输血及中转开胸,围手术期无死亡病例。术前一般临床资料差异无显著性(P>0.05),Ⅰ期组与Ⅱ期组术中及术后资料各项差异无显著性(P>0.05),Ⅲ期组肺叶切除时间、淋巴结清扫时间、手术总时间均长于Ⅰ期及Ⅱ期组(P<0.05),淋巴结清扫数目、站数、术中出血量、术后引流量、术后带管时间、住院天数、术后并发症差异无显著性(P>0.05)。结论胸腔镜在Ⅰ期及Ⅱ期肺癌根治术中有着明显的优势,Ⅲ期肺癌并非胸腔镜手术禁忌证,某些局部晚期肺癌胸腔镜手术亦可达到根治目的,但手术风险也相应增高。     

输血和肺癌复发

近有报告,围术期输血,对手术切除的非小细胞肺癌(NSCLC)预后有不利影响。为此作者就围术期输血的病理Ⅰ及Ⅱ期NSCLC 352例患者,经根治术后的无复发期间进行了研究。本研究不包括术前或术后曾接受放疗或化疗、以及手术未完全切除肿瘤的患者。输血成分为全血或浓缩血细胞,不包括血小板、新鲜冰冻血浆和血浆代用品。随访时间长达120个月。本组性别:男240例,女112例;年龄:≤54.9岁92例,55-65岁122例,≥65.1岁138例;手术切除方式:全肺切除24例,双叶切除45例,单叶切除266例,楔形切除17例;肿瘤分期:Ⅰ期305例,其中T_1156例,T_21 49例,Ⅱ期47例。未接受输血215例和接受输血144例两     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.