经皮氩氦刀治疗结直肠癌肝转移31例临床分析

目的 评价B超引导经皮氩氦刀治疗结直肠癌肝转移的疗效.方法 CRYO-HITTM氩氦刀低温冷冻治疗系统治疗结直肠癌肝转移31例共55个病灶.随访观察病灶影像形态表现、血清CEA变化和患者生存率.结果 氩氦刀治疗后反应期2～5 d,包括局部疼痛不适、发热、ALT升高等;小肿瘤(＜3.0 cm)完全坏死率达92.9%(26/28),3.1～5.0 cm的肿瘤完全坏死率为73.3%(11/15),病灶＞5 cm者均未完全坏死;1、2、3年生存率分别为87.1%、77.5%和54.8%.结论 氩氦刀是治疗结直肠癌肝转移的一种微创疗法,对较小病灶疗效显著.     

火针配合拔罐的临床应用概况

综述近10余年来火针配合拔罐的临床应用概况。火针配合拔罐在皮肤科、骨伤科及外科得到了广泛的应用。今后可进一步提高其临床科研的设计水平,以充分体现火针配合拔罐的优势。     

Can health technology assessments assist the global campaign against poverty?

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists—over a third of the global popul...     

Surgical Management for Chronic Destructive Septic Hip Arthritis: Debridement,Antibiotics, and Single‐Stage Replacement is as Effective as Two‐Stage Arthroplasty

ObjectiveTo compare the surgical outcomes of debridement, antibiotics, and single‐stage total hip replacement (DASR) vs two‐stage arthroplasty (two‐stage arthroplasty) for chronic destructive septic hip arthritis (SHA).MethodsCases of chronic destructive SHA treated by DASR or two‐stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow‐up were compared between the two groups.ResultsA total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two‐stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two‐stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two‐stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow‐up between the two groups.ConclusionsBoth DASR and two‐stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two‐stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.     

Effectiveness,nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

ObjectivesWe aimed to assess the effectiveness and nephrotoxicity of polymyxin B in critically ill patients with nosocomial pneumonia and to evaluate the utility of its therapeutic drug monitoring (TDM).MethodsWe retrospectively analyzed patients who received polymyxin B treatment for ≥48 h since the establishment of polymyxin B TDM in a 26‐bed tertiary referral intensive care unit. Univariate and multivariate analyses were conducted to assess the variables associated with polymyxin B effectiveness and nephrotoxicity.ResultsA total of 62 patients were enrolled. Most (56.5%) of the patients performed TDM, 54.3% of them reached the therapeutic target of area under curve across 24 h at steady state (AUC_ss,24h) of 50–100 mg h L⁻¹, and 10 patients had an AUC_ss,24h value of <50 mg h L⁻¹. Thirty‐six (58.1) and 31 (50.0%) patients had favorable clinical and microbiological responses, respectively. Reaching the therapeutic target of AUC_ss,24h (odds ratio [OR] = 13.15, p = 0.015), a favorable microbiological response (OR = 40.80, p = 0.00), and complicated with septic shock (OR = 0.12, p = 0.021) were independently associated with favorable clinical outcomes of polymyxin B treatment. The incidence of acute kidney injury (AKI) was 45.2%. A lower creatinine clearance (OR = 0.96, p = 0.008) and concomitant treatment with loop diuretics (OR = 5.93, p = 0.046) were predictive of nephrotoxicity.ConclusionOur findings show that TDM of polymyxin B is a valuable intervention, and the achievement of its optimal pharmacodynamic target can improve treatment outcome. Renal insufficiency and concomitant treatment with loop diuretics were found to be associated with the risk of nephrotoxicity.     

男男性行为者艾滋病暴露前预防用药性行为去抑制化情况

目的：了解男男性行为者（men who have sex with men,MSM）在参加暴露前预防用药（pre-exposure prophylaxis,PrEP）临床试验中是否存在性行为去抑制化现象及其影响因素。方法：采用非概率抽样法招募并筛选出108名MSM,随机分为77名服用药物组和31名空白对照组,第12、24、36、48周进行临床随访和问卷调查,问卷调查主要包括社会人口学特征,艾滋病相关知识、态度和行为等相关情况。采用单因素和多因素的广义估计方程分析MSM在参与PrEP中是否存在性行为去抑制化现象及其影响因素。结果：药物服用组MSM在参与PrEP的第12、24、36、48周的性伴个数中位数分别为1（0,6）、1（0,6）、1（0,10）、1（0,3）、1（0,3）,高危性行为次数中位数分别为1（0,26）、1.5（0,8）、1（0,12）、1（0,9）、2（0,30）;空白对照组性伴个数中位数分别为1（0,21）、1（0,2）、1（0,3）、1（0,3）、1（0,3）,高危性行为次数中位数分别为1（0,9）、1（0,6）、0.5（0,15）、0（0,10）、1（0,10）;多因素广义估计方程分析发现MSM在参与PrEP过程中性伴个数及高危性行为次数均没有发生改变（Z=-0.24,P=0.811;Z=0.93,P=0.355）,性行为方式为“1”和“0.5”的较性行为方式为“0”的拥有更多的性伴（Z=2.47,P=0.014;Z=2.24,P=0.025）;发生过商业性行为的MSM较没有发生过的拥有较少的性伴和高危性行为（Z=-2.82,P=0.005;Z=-2.28,P=0.023）;已婚较离异MSM发生较少的高危性行为次数（Z=-2.34,P=0.019）。结论：本研究中暂未发现PrEP中存在性行为去抑制化现象,性行为方式为“1”和“0.5”的MSM拥有较多性伴,是后期随访中的重点管理人群。还需进一步加强对艾滋病相关知识的科普。     

青少年颈椎病的病因病机及预防

青少年颈椎病很少有人研究，笔者在临床中发现高中学生中时有颈椎病发生，比例约占学生总数１５．７９％，年龄均在１５—１９岁间。通过对５００余名高中、小学生的坐姿、睡姿调查发现：学生从小学一年级就开始的铅笔习字和枕高不合标准—使坐姿、睡姿改变—迫使颈椎生理弧度改变—颈部生物力学早期综合性失衡—颈部解剖学、组织学改变—最终出现病理学改变—颈椎病发生。Ｘ线平片证实：学生颈椎病主要是颈椎曲度值改变，与增生关系不大。并针对青少年颈椎病出现的病因病机，提出了一套保健措施，自编《青少年颈部保健操》。希望引起学校、家长、教育、卫生等对青少年颈椎病预防的重视     

非穿透性小梁手术超声生物显微镜检查

目的：应用超声生物显微镜（ＵＢＭ）检查技术,探讨非穿透性小梁手术联合透明质酸钠生物胶植入手术区域解剖特点和房水引汉机制。方法：对１４例１６只眼行非穿透性小梁手术联合透明质酸钠生物胶植入的患者,在术后１～３个月内进行手术区域ＵＢＭ检查。检查的指标（项目）包括：巩膜瓣下形成液间腔的大小（宽和高）、透明质酸钠生物胶吸收的情况、剩余角膜小梁膜的厚度以及滤过泡的形态,并对结果进行分析。结果：１６只眼术前平均     

Detection of abnormal visual cortex in children with amblyopia by voxel-based morphometry

PURPOSE: To detect the abnormalities of gray matter in children with amblyopia by voxel-based morphometry (VBM). DESIGN: Prospective, nonrandomized clinical trial. METHODS: Thirteen children with amblyopia and 14 normally sighted children underwent magnetic resonance (MR) examination. The two groups were age-matched with a mean age of 5.8 years. In the amblyopia group, five children had strabismus amblyopia, and eight had anisometropic amblyopia. We analyzed the original 3-dimensional T1 brain images using the VBM module within the widely used analysis software package SPM2 (Welcome Department of Cognitive Neurology, London, United Kingdom). After normalization, segmentation, and smoothing of the images, comparison between amblyopic and control groups was derived for the gray matter of the entire brain using parametric statistics. RESULTS: The results of VBM analysis indicated that the amblyopic group had decreased gray matter density in the middle frontal gyrus, parahippocampal gyrus, fusiform gyrus, inferior temporal gyrus of the left hemisphere, and the bilateral calcarine cortices. The radii of these regions ranged from 12 to 36 voxels. These abnormalities were consistent with morphologic changes in brain regions related to visual function. CONCLUSIONS: Using MR and VBM analysis, we detected morphologic changes in the visual cortex of children with amblyopia, which may indicate developmental abnormalities of visual cortex during the critical growth period.     

CYP1A1 and CYP1B1 genetic polymorphisms and uterine leiomyoma risk in Chinese women

Purpose  The aim of the study was to evaluate the association of CYP1A1 and CYP1B1 polymorphisms with uterine leiomyoma in Chinese women. Methods  We investigated 100 women with clinically diagnosed uterine leiomyoma and 110 healthy normal subjects from Chinese women. The genetic distribution of two CYP1A1 polymorphisms at MspI, Ile462Val and four CYP1B1 polymorphisms at Arg48Gly, Ala119Ser, Leu432Val, Asp449Asp were analyzed by polymerase chain reaction–restriction fragment length polymorphism and DNA sequencing method. Results  All the SNPs showed polymorphisms in Chinese women. The genotype A/G and the allele G on Ile462Val was significantly different between uterine leiomyoma patients and controls (P < 0.05). Conclusion  These results suggest that the genotype of CYP1A1 Ile462Val was associated with the increased risk of uterine leiomyomas in Chinese women. Capsule This is the first report that demonstrates the polymorphism at Ile462Val of CYP1A1 to be associated with uterine leiomyoma in Chinese women.