局部麻醉下腹膜前无张力疝修补术治疗老年腹股沟疝109例

目的探讨局部麻醉下腹膜前无张力疝修补术在老年腹股沟疝患者中的临床应用。方法回顾性分析2011年1月至2014年10月北京市垂杨柳医院在局部麻醉下行腹膜前无张力疝修补术的109例老年腹股沟疝患者临床资料,分析手术时间、术中麻醉效果、术后并发症、手术费用、平均住院时间和术后随访情况。结果本组患者均顺利完成手术,术中麻醉效果良好,单侧手术时间平均52 min,术后未出现尿潴留,术后随访2~36个月,2例患者出现阴囊浆液肿和血肿,1例出现切口感染。患者平均住院时间为2.6 d,平均住院费用为4 318元。有2例患者复发。结论局部麻醉下腹膜前无张力疝修补术安全可靠,麻醉效果好,手术适应证广,术后并发症少,恢复快,住院时间短且具有良好的效价比,适用于老年患者。     

Expression of the EphA1 protein is associated with Fuhrman nuclear grade in clear cell renal cell carcinomas

Aberrant expression of receptor tyrosine kinase EphA1 in malignant tissues has been reported. However, the expression profile of EphA1 in renal cell carcinoma (RCC) and its association with clinicopathological parameters remain unknown. The aim of this study was to determine the cancerous value of the EphA1 protein expression in patients with renal cell carcinomas. This study included 144 patients with clear cell RCC (ccRCC), 18 patients with chromophobe RCC and 6 patients with papillary RCC. The EphA1 protein was detected in RCC tissue samples by an immunohistochemical staining with a specific polycolonal antibody. The correlation of the expression of the EphA1 protein with clinicopathological parameters was evaluated. High level of the expression of EphA1 was observed in all normal renal tubes. The EphA1 protein was negatively or weakly expressed in 93 out of 144 ccRCC (64.6%) and positively expressed in 51 out of 144 ccRCC (35.4%). The high level expression of the EphA1 protein was significantly associated with younger patients (P<0.001), sex (P=0.016) and lower nuclear grade (P<0.001). No significant relation between the expression of EphA1 and tumor diameter was found (P=0.316). Positive expression of EphA1 was observed in all samples of chromophobe RCC and papillary RCC. Our data indicated that the EphA1 protein may be a new marker for the prognosis of ccRCC.     

Zebrafish in the study of early cardiac development

Heart development is a complex process that involves cell specification and differentiation, as well as elaborate tissue morphogenesis and remodeling, to generate a functional organ. The zebrafish has emerged as a powerful model system to unravel the basic genetic, molecular, and cellular mechanisms of cardiac development and function. We summarize and discuss recent discoveries on early cardiac specification and the identification of the second heart field in zebrafish. In addition to the inductive signals regulating cardiac specification, these studies have shown that heart development also requires a repressive mechanism imposed by retinoic acid signaling to select cardiac progenitors from a multipotent population. Another recent advance in the study of early zebrafish cardiac development is the identification of the second heart field. These studies suggest that the molecular mechanisms that regulate the second heart field development are conserved between zebrafish and other vertebrates including mammals and provide insight into the evolution of the second heart field and its derivatives.     

以按摩为主的综合治疗颞下颌关节紊乱病800例的体会

根据颞下颌关节紊乱病的发病机制,针对功能性肌紧张的咀嚼肌施行分离肌粘连、理顺紧张的肌纤维、痛点及关节区按摩加热敷、心理疏导等方法综合治疗颞下颌关节紊乱病。通过对临床800例患者近20年的观察,结果表明针对早期、病程较短、不伴有关节弹响而病因较明确的颞颌下关节紊乱病的患者采用本法治疗有较显著的疗效,其方法简便易行。     

Effect of unfolded protein response on the immune infiltration and prognosis of transitional cell bladder cancer

Background: Bladder cancer (BC) is one of the most common human malignancies worldwide. Previous researches have shown that the unfolded protein response (UPR) pathway could contribute to the tumorigenesis of BC. However, the role of UPR in the immune infiltration, progression, and prognosis of BC is unclear.Methods: The GSVA and ssGSEA methods were used for assessing the UPR score and immune cells infiltration score in three BC public datasets, respectively. The relationship between the UPR pathway and clinicopathological characteristics was analyzed by the Kruskal-Wallis, Wilcox test, and log-rank test. The association of the UPR pathway with various tumor-infiltrating immune cells was evaluated with the correlation analysis. Univariate Cox regression analysis was performed to identify risk factors significantly associated with prognosis. The predictive models were built based on risk factors and visualized with nomograms. The performance of our models was evaluated with the calibration curve, Harrell''s concordance index (c-index), and receiver operating characteristic (ROC) analysis.Results: We found that the UPR pathway and many UPR-related genes were significantly associated with the pathologic grade, tumor type, and invasive progression of transitional cell bladder cancer (TCBC), and a high UPR score predicted a poor prognosis in patients. The UPR score was positively correlated with the infiltration abundance of many tumor immune cells in TCBC. Besides, we constructed predictive models based on the UPR score, and good performance was observed, with c-indexes ranging from 0.74 to 0.87.Conclusions: Our study proved that the UPR pathway may have an important impact on the progression, prognosis, and tumor immune infiltration in TCBC, and the models we built may provide effective and reliable guides for prognosis assessment and treatment decision-making for TCBC patients.     

新型冠状病毒感染者航班同乘风险人员排查效果分析

目的 分析新型冠状病毒（新冠病毒）感染者航班同乘人员新冠病毒核酸阳性检出情况,为有效确定风险人员排查范围提供依据。方法 回顾性收集我国2020年4月1日至2022年4月30日本土新冠病毒感染者航班同乘人员信息,采用χ²检验分析比较指示病例发病前不同时间、不同座位距离和不同新冠病毒变异株流行期的同乘人员核酸阳性检出率。结果 研究期间,新冠病毒感染者共涉及370架次航班和23 548名同乘人员,累计判定指示病例433名。指示病例的同乘人员中,核酸检测阳性人员72名,其中,与指示病例同行人员57名,非同行人员15名。对15名非同行的阳性同乘人员进一步分析显示,86.67%在指示病例诊断后3 d内发病或检测阳性,乘机时间均在指示病例发病前4 d内,指示病例前后三排内的阳性检出率为0.15%（95%CI：0.08%~0.27%）,显著高于前后三排外的阳性检出率［0.04%（95%CI：0.02%~0.10%）,P=0.007］,前后三排内各排的阳性检出率差异无统计学意义（P=0.577）。不同类型变异株流行期间,非同行的同乘人员阳性检出率差异无统计学意义（P=0.565）。Omicron变异株流行期中,非同行人员阳性检出集中在指示病例发病前3 d内。结论 指示病例航班同乘人员的风险排查时间可设定为指示病例发病前4 d内。指示病例前后三排内的同乘人员应作为优先排查人员,并作为密切接触者进行管理,座位距离在指示病例前后三排外的同乘人员可作为一般风险人员进行排查和管理。     

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

Purpose

The aim of this study is to compare mTLIF vs. oTLIF with regard to peri-operative complications, operative time, estimated blood loss, fluoroscopic time, and the length of hospital stay.

Methods

The PubMed and EMBASE databases were searched for relevant articles reporting patients undergoing TLIF, and a comparison between mTILF and oTLIF was performed. The database included patient demographic information, complications, operative time, fluoroscopic time, and the length of hospital stay.

Results

Fourteen studies were included in this systematic review. The total number of subjects included was 901, of which 455 underwent mTLIF (50 %) and 446 underwent oTLIF (50 %). The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group. The estimated blood loss was lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively. Length of hospital stay was short for the mTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6 days for oTLIF. However the fluoroscopic time was consistently higher in the mTLIF group with a 49 to 106 seconds of fluoroscopy compared to 16.4 to 44 seconds for oTLIF. The complications divided into technical complications and infection complications. The main technical and infection complications included dural tears, screw malposition, and wound infection. Systemic complications included pneumonia, urinary tract infection, and DVT. The numbers of patients with complication was 54 out of 455 (11.87 %) in the mTLIF, and 64 out of 446 (14.35 %) in the oTLIF.

Conclusion

The review shows mTLIF offers several potential advantages in reducing blood loss and the length of hospital stay, especially lowering the complication rates for patients compared with oTLIF. However, it required much more operative time and radiation exposure. Class I evidence and high-quality randomized controlled trials are needed for further study.