采用真空封闭引流法治疗心肺手术后切口裂开

目的介绍采用真空封闭引流法(VAC)治疗心肺手术后胸部切口裂开,总结其初期临床经验。方法回顾性分析2010年10月至2011年10月天津武警后勤学院附属医院12例心肺手术后胸部切口裂开患者经VAC治疗的临床资料,男7例,女5例;平均年龄64.3(39～80)岁。均经胸骨正中切口或侧胸切口径路行心肺手术。术后手术切口裂开程度均达胸骨或肋骨。胸部切口经清创后安装VAC装置海绵,使用间断负压仪治疗,7～10 d更换切口负压海绵1次。结果所有使用VAC治疗的患者平均更换VAC海绵材料2次,治疗中切口周围组织水肿消退,切口肉芽新鲜,所有患者全身状况改善,患者可以下床,生活自理,不再使用抗生素。住院医师的主要工作变成每日检查负压辅助装置工作是否正常,患者不再有恐惧和每天换药时的疼痛感。所有患者经治疗后痊愈出院,均在门诊进行随访,平均随访时间7个月,切口愈合牢固,效果满意。结论 VAC使用方便,能迅速促进切口愈合、减轻局部切口和全身炎性反应,加速患者康复,同时减轻了住院医师的工作量,值得临床推广应用。     

Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

Our aim was to identify potential risk factors associated with severe hypocalcemia (SH) after microwave ablation (MWA) in patients with secondary hyperparathyroidism (SHPT). This retrospective cross-sectional study enrolled 204 consecutive patients (with 387 parathyroid glands) who underwent MWA between July 2015 and May 2018. Clinical parameters, laboratory indices, and parathyroid gland characteristics were analyzed to assess risk factors associated with SH after MWA. SH was defined as serum calcium level lower than 1.875 mmol/L (7.5 mg/dL) after MWA. Two models (I and II) for pre-MWA and post-MWA prediction were established, respectively. In accordance with the KDIGO guidelines, the target value for intact parathyroid hormone (iPTH) less than 300 pg/mL within 7 days after MWA was considered as a successful procedure. The success rate of MWA was 71.6% (146/204). The incidence of hypocalcemia and SH after MWA was 35.8% and 22.06%, respectively. The pre-MWA prediction models I and II showed that high pre-MWA iPTH, a dramatic reduction in iPTH, low pre-MWA serum calcium, multiple ablated gland, and lack of pruritus symptoms were risk factors for developing SH. The accuracy (82.23% versus 83.25% in models I and II, respectively), sensitivity (34.88% versus 44.19%), specificity (95.45% versus 94.59%), positive predictive value (PPV) (68.18% versus 70.37%), and negative predictive value (NPV) (84% versus 85.37%) of both models were promising. The logistic regression fitting of the nomograms showed high prediction efficiency (0.845 and 0.863). High pre-MWA iPTH, dramatic reductions in iPTH, low pre-MWA serum calcium, multiple gland ablation, and no pruritus symptoms were predictors of SH. © 2019 American Society for Bone and Mineral Research.     

重症急性胰腺炎并发胰腺感染的危险因素分析及防治措施

目的：分析重症急性胰腺炎患者胰腺及胰周坏死的危险因素,探讨防治措施,为临床工作提供帮助。方法：对120例重症急性胰腺炎患者采取治疗后观察患者发生感染的情况,进而对并发胰腺感染的危险因素进行分析。结果：120例重症急性胰腺炎患者中并发胰腺感染者51例,感染率为42.50%,其发生率与患者低氧血症、血淀粉酶、血钙、机械通气、APACHEⅡ评分、糖尿病史等方面有统计学意义（P＜0.05）;患者胰腺坏死组织和腹水经病原菌培养得到85株病原菌,构成比前3位的病原菌分别为阴沟肠杆菌、铜绿假单胞菌和金黄色葡萄球菌。结论：低氧血症、机械通气、APACHEⅡ评分、糖尿病史是重症急性胰腺炎患者并发胰腺感染的危险因素。     

重症腹腔结核患者外周血和腹水中Th17细胞及其相关因子的水平和意义

目的：通过检测重症腹腔结核患者外周血和腹水中Th17细胞及其相关因子的水平,探讨Th17细胞在重症腹腔结核疾病发展过程中的变化。方法：使用流式细胞术检测腹腔结核患者重症期、恢复期以及健康对照组外周血Th17的表达率,ELSIA法检测血清以及腹腔结核重症期、恢复期患者腹水IL-6、IL-17、IL-23水平,分析各组上述指标之间的差异以及各指标间的相关性。结果：腹腔结核重症期组患者Th17细胞所占CD4＋T细胞比率和外周血IL-6、IL-17和IL-23水平显著高于恢复期组和健康对照组,患者恢复期组和健康对照组Th17细胞比率和外周血IL-6、IL-17和IL-23水平无统计学差异;腹腔结核患者重症期腹水中的IL-6、IL-17和IL-23均高于其恢复期时腹水中的IL-6、IL-17和IL-23浓度,差异有统计学意义;重症腹腔结核患者Th17细胞和外周血IL-6、IL-17和IL-23呈正相关。结论：Th17细胞及相关细胞因子在腹腔结核重症患者的疾病发展过程中起着一定的调节作用,探索其分化与调控有助于认识它在疾病进展过程中的作用,也有利于生物学治疗靶点的发现。     

严重四肢骨折患者血浆中D-二聚体的变化及其临床意义

目的　探讨严重四肢骨折并消化道出血的发病因素。方法　对 71例严重四肢骨折患者采用乳胶凝集法 (半定量法 )测定血浆中D -二聚体。结果　严重四肢骨折患者伤后 1、 3d ,1、 2周血浆中D -二聚体浓度均比正常对照组呈不同程度的增高 (P <0 0 1) ;同时显示 :严重四肢骨折患者合并消化道出血组与不合并消化道出血组血浆中D -二聚体含量存在显著性差异 (P <0 0 5 )。结论　严重四肢骨折并消化道出血的发病因素与凝血机制异常有关。     

乌司他丁对重度烧伤患者SIRS发生率和氧化应激因子水平的影响

目的:研究乌司他丁对重度烧伤患者全身炎症反应综合征(Systemic inflammatory response syndrome,SIRS)发生率和氧化应激因子水平的影响。方法:选取笔者医院2016年4月-2018年7月收治的重度烧伤患者82例,根据治疗方法不同分为两组。对照组给予清洗、补液、抗感染、抗休克及加强营养支持等基本治疗,观察组在对照组基础上给予乌司他丁治疗。分析两组患者治疗后的SIRS发生率及丙二醛(Malonaldehyde,MDA)、脂质过氧化物(Lipid peroxide,LPO)、髓过氧化物酶(Myeloperoxidase,MPO)、白细胞介素-2(Interleukin-2,IL-2)、白细胞介素-10(Interleukin-10,IL-10)表达水平。结果:观察组患者住院时间为(16.98±4.27)d短于对照组的(23.25±5.11)d,差异具有统计学意义(t=6.029,P=0.000)。两组治疗前MDA、LPO、MPO、IL-2、IL-10水平比较,差异不具有统计学意义(P>0.05)。观察组治疗3d、5d、7d后MDA、LPO、MPO水平低于对照组,IL-2、IL-10水平高于对照组,差异有统计学意义(P<0.05)。观察组入院3d、7d时SIRS发生率低于对照组,差异有统计学意义(P<0.05)。结论:乌司他丁应用于重度烧伤患者可调节IL-2、IL-10的表达水平,抑制氧化应激反应,减少SIRS发生率,缩短住院时间,加速患者康复。     

Clinical and Pathological Factors Related to 18F-FDG-PET Positivity in the Diagnosis of Recurrence and/or Metastasis in Patients with Differentiated Thyroid Cancer

Background  Objectives were to analyze the relationship between a positive ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) result and clinical and tumor factors in patients treated for differentiated thyroid cancer (DTC) and under suspicion of recurrence or metastasis, and to determine the diagnostic validity of PET in DTC patients with elevated serum thyroglobulin (Tg) and negative ¹³¹I whole-body scan (¹³¹I-WBS). Methods  We studied 50 DTC patients with elevated serum Tg and negative WBS treated with total thyroidectomy and ¹³¹I ablation. Thyroxin treatment was withdrawn and patients were on iodine-free diet before WBS. Tg, anti-Tg antibodies, and thyroid-stimulating hormone (TSH) were determined. Patients with negative WBS and elevated Tg underwent PET study 1 week later. PET findings were verified by pathology findings or other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US)] and/or 12-month follow-up. The relationship between PET findings and tumor (histological type, size, multifocality, thyroid capsular invasion, lymph-node and/or metastatic involvement) and clinical (age at diagnosis, sex, Tg, accumulated iodine dose, and recurrence time) variables was analyzed. Results  PET was positive in 32/39 patients with confirmed disease (82% sensitivity) and negative in 7/11 of disease-free cases (64% specificity), a positive predictive value (PPV) of 89%. Tumor size (P < 0.05) and thyroid capsular invasion (P < 0.05) were significantly associated with positive PET study. The relationship of PET findings with Tg levels and age at diagnosis was close to significance. Conclusion   ¹⁸F-FDG-PET study offers a high sensitivity and positive predictive value (PPV) in patients with negative WBS and Tg positive. The use of FDG-PET is strongly recommended in DTC patients with large tumors, thyroid capsule invasion or poor-prognosis variants.     

异维 A 酸联合红蓝光治疗中重度痤疮患者的效果

目的 探究异维A酸联合红蓝光治疗中重度痤疮患者的临床疗效。方法 选取2019年8月-2021年 8月我院收治的80例中重度痤疮患者作为研究对象,采用随机数字表法分为对照组与研究组,各40例。对 照组予以异维A酸治疗,研究组予以异维A酸联合红蓝光治疗,比较两组ECCA评分、皮损状况缓解程度 及临床疗效。结果 研究组治疗后ECCA评分低于对照组,差异有统计学意义（P＜0.05）;两组治疗后皮 损状况均优于治疗前,且研究组优于对照组,差异有统计学意义（P＜0.05）;研究组治疗总有效率高于对 照组,差异有统计学意义（P＜0.05）。结论 采用异维A酸联合红蓝光治疗中重度痤疮,能改善其ECCA评 分,有效缓解患者的皮损状况,提高临床疗效,值得应用。     

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management

Background

Prevention, early identification, and effective management of periprosthetic joint infection (PJI) in patients with inflammatory joint disease (IJD) present unique challenges for physicians. Discontinuing disease-modifying anti-rheumatoid drugs (DMARDs) perioperatively may reduce immunosuppression and infection risk at the expense of increasing disease flares. Interpreting traditional diagnostic markers of PJI can be difficult due to disease-related inflammation.

Purposes

This review is designed to answer how to (1) manage immunosuppressive/DMARD therapy perioperatively, (2) diagnose PJI in patients with IJD, and (3) treat PJI in this population.

Methods

The PubMed database was searched for relevant articles with subsequent review by independent authors.

Results

While there is evidence to support the use of methotrexate perioperatively in RA patients, it remains unclear whether using anti-tumor necrosis factor medications perioperatively increases the risk of surgical site infections. Serum erythrocyte sedimentation rate and C-reactive protein can be useful for diagnosis of PJI in this population, but only as part of comprehensive workup that ultimately relies upon sampling of joint fluid. Management of PJI depends on several clinical factors including duration of infection and the likelihood of biofilm presence, the infecting organism, sensitivity to antibiotic therapy, and host immune status. The evidence suggests that two-stage revision or resection arthroplasty is more likely to eradicate infection, particularly when MRSA is the pathogen.

Conclusion

Immunosuppression and baseline inflammatory changes in the IJD population can complicate the prevention, diagnosis, and treatment of PJI. Understanding the increase in risk associated with IJD and its treatment is essential for proper management when patients undergo lower extremity arthroplasty.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9338-8) contains supplementary material, which is available to authorized users.     

132例肾实质性高血压中医证型及与肾脏病理损害等相关因素分析

目的：对肾实质性高血压的中医证型分布规律及与肾脏病理和主要预后指标的相互关系进行分析,为中西医结合诊治本病提供依据。方法：采用现场调查的方法,收集了132例具有肾脏病理活检的肾实质性高血压患者的中医证候学及实验室检查资料,分析肾实质性高血压病的中医证型分布及与肾脏病理、慢性肾脏病（chronic kidney disease,CKD）分级、高血压分级等的相关性。结果：在132例肾实质性高血压患者中,中医辨证分型以虚证最多,共105例（79.54%）,分别为脾肾两虚40例（38.09%）,肾气阴两虚38例（36.19%）,肝肾阴虚27例（25.71%）。其中虚中夹实者59例（56.2%）;纯实证者仅27例（20.45%）,主要包括水湿内停、肝阳上亢、湿浊内蕴。肾脏病理,IgA肾病中多见肝肾阴虚、水湿内停和肝阳上亢型,膜性肾病则多见于肝阳上亢和肾气阴两虚型,肥胖相关性肾小球病以湿浊内停型最多见。CKD分级与3种虚证关系密切;高血压3级以肝肾阴虚型最多见,高血压2级以肝阳上亢型多见,而高血压1级则多见于湿浊内蕴和水湿内停型。中医证型与患者性别、年龄、高血压病程、24 h尿蛋白定量无明显相关性。结论：脾肾两虚、肾气阴两虚、肝肾阴虚证是肾性高血压病的主要中医辨证分型,虚中夹实最多见;不同肾脏病理损害、肾功能分期及高血压分级均与不同中医证型有一定的相关性。     

MRI and 1H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma

Abstract: To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false‐negative outcome of Proton MR Spectroscopy (¹H MRS) exam in patients with invasive breast cancer. Sixteen patients with invasive ductal carcinoma of the breast were prospectively included and underwent both, contrast‐enhanced breast MRI and ¹H MRS examination of the breast. The MR images were reviewed and the lesions morphologic features, enhancement patterns and pharmacokinetic parameters (k21‐value) were scored according to the ACR BI‐RADS‐MRI lexicon criteria. For the in vivo MRS studies, each spectrum was evaluated for the presence of choline based on consensus reading. Breast MRI and ¹H MRS data were compared to histopathologic findings. In vivo ¹H MRS detected a choline peak in 14/16 (88%) cancers. A false‐negative ¹H MRS study occurred in 2/16 (14%) cancer patients. K21 values differed between both groups: the 14 choline positive cancers had k21 values ranging from 0.01 to 0.20/second (mean 0.083/second), whereas the two choline‐negative cancers showed k21 values of 0.03 and 0.05/second, respectively (mean 0.040/second). Also enhancement kinetics did differ between both groups; typically both cancers that were choline‐negative showed a late phase plateau (100%), whereas this was only shown in 5/14 (36%) of the choline positive cases. There was no difference between both groups with regard to morphologic features on MRI. This study showed that false‐negative ¹H MRS examinations do occur in breast cancer patients, and that the presence of a choline peak on ¹H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged.