Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3-year follow-up study

This study aimed to explore the risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis (DFO) and diabetic nephropathy (DN). This is a prospective cohort study. Between May 2018 and May 2021, we selected 120 inpatients with comorbid severe diabetic foot infection (PEDIS Grade 3 or above) and DN for inclusion in our study. All cases were followed up for 36 months. The study outcomes were whether foot ulcer recurred and the time to recurrence. The risk factors of ulcer recurrence were analysed by comparing the data of the three groups. According to the recurrence of foot ulcer, the participants were divided into three groups: Group A (no foot ulcer recurrence, n = 89), Group B (foot ulcer recurrence within 12-36 months, n = 19) and Group C (foot ulcer recurrence within 6-12 months, n = 12). The multivariate Cox regression analysis showed that urine albumin-creatinine ratio (UACR) (HR: 1.008, 95% CI: 1.005-1.011, P < .001) and vibration perception threshold (VPT) (HR: 1.064, 95% CI: 1.032-1.096, P < .001) were identified as independent risk factors. Kaplan-Meier curves showed a significant positive association between UACR or VPT and the risk of foot ulcer recurrence (log rank, all P < .05). Areas under the ROC curves for UACR, VPT and the combination of UACR and VPT were 0.802, 0.799 and 0.842, respectively. The best cut-off values of UACR and VPT were 281.51 mg/g and 25.12 V, respectively. In summary, elevated UACR and VPT were independent risk factors. The best clinical cut-off values of UACR and VPT for prediction of foot ulcer recurrence were 281.51 mg/g and 25.12 V, respectively. Besides, our results suggested that microcirculation disorders rather than macrovascular complications play a major role in the recurrence of foot ulcer in patients with comorbid DFO and DN.     

吻合血管游离腓骨移植修复长段骨缺损

传统骨移植术，由于缺乏血液供应，植入骨块需经长久的爬行替代过程才能愈合，且易发生骨不连、骨吸收及感染率高等缺点。１９９０年以来，采用吻合血管腓骨移植修复外伤性骨缺损７例，骨肿瘤及肿瘤样病变切除致长段骨缺损５例，骨髓炎骨缺损１例，均获成功。经随访６个月～７年均达骨愈合，其中４例携带腓骨头移植修复桡骨下端缺损重建桡腕关节，功能恢复满意。１例胫骨长段骨缺损行吻合血管移植术后９个月、１２个月，先后两次发生疲劳性骨折。认为，移植之腓骨虽愈合增粗，但可能因负重而发生疲劳性骨折，适当延长术后外固定时间，是防止骨折的重要措施。     

耻骨上前列腺摘除术后排尿困难的原因与治疗(附22例报告)

报告自１９７２～１９９７年收治耻骨上前列腺摘除术后排尿困难者２２例，以探讨耻骨上前列腺摘除术后排尿困难的原因和治疗办法。其中后尿道狭窄１０例，尿道内口闭锁３例，后唇瓣膜２例，腺体残留２例，增生复发３例，前列腺癌２例。尿道狭窄是排尿困难的主要原因。经冷刀内切开治疗一次成功１１例，冷刀内切开失败改开放手术２例，开放手术４例。认为经尿道冷刀内切开是首选治疗方法     

经内镜扩张治疗食管狭窄

摘要目的用内镜食管扩张治疗食管狭窄,介绍纤光内镜下扩张器的使用方法。方法用 Savary-Gilliard 探条和Key Med 扩张器,对食管狭窄病人进行内镜扩张。结果 45例食管狭窄病人,作了157次内镜扩张治疗。症状Ⅰ级改善13.3/(6/45),Ⅱ级改善4.4%(2/45),治愈率80%(36/45),总有效率97.8%(44/45),1例食管扩张不成功。全组未发生任何严重并发症和因食管扩张术而死亡者。结论认为这两种扩张器治疗食管狭窄,方法简便、安全、疗效确实,值得推广使用。     

Cellular apoptosis, proliferation and bcl-2 Bax expression in colorectal carcinoma and their association with tumor prognosis

OBJECTIVE: To investigate the relationship between cellular apoptosis, proliferation and bcl-2/bax expression in the tissue of colorectal carcinoma and biological behavior of the tumor. METHOD: The apoptotic cells index (AI) in situ were identified by the terminal deoxynucleotidyl transfer-mediated dUTP-biotin nick end labeling (TUNEL) and immunohistologic staining for Ki-67 proliferation index (KI), bcl-2/bax protein expression was performed on archival material from 77 adenocarcinomas. RESULT: The mean AI and KI were 5.3/45.4 in early stage cancer, 5.6/48.7 in non-metastatic cancer, 6.6/55.3 in advanced cancer and 8.9/60.1 in cancer with distant metastasis respectively. There was a positive relationship between the AI and KI in each specimen. bcl-2 and bax was expressed as 54.5%, 74% in carcinoma and highly differentiated carcinoma. In the univariate analysis, significantly longer survival time was observed in the subgroup of bcl-2 positive carcinoma with low AI. In the multivariate analysis, tumor stage, tumor type, KI, and bcl-2 expression were independent risk factors for prognosis. CONCLUSION: The data indicate that abnormally exchanged AI/KI, bcl-2/bax expression appears to be an event associated with tumor progression and apoptosis might also reflect the proliferative activity of human colorectal carcinoma.     

带前臂外侧皮神经营养血管筋膜皮瓣的应用解剖

目的：为带前臂外侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人上肢标本上，观测前臂外侧皮神经营养血管及其周围皮肤的供血情况。结果：前臂外侧皮神经近侧的血供为肱动脉末端和桡动脉起始部的肌皮支，起始处外径分别为１．４ｍｍ、１．１ｍｍ，穿出深筋膜前长为１．９ｃｍ、１．４ｃｍ；远侧主要为桡动脉的粗大皮支，起始处外径为０．８ｍｍ，穿出深筋膜前长０．８ｃｍ；此外，桡动脉的茎突返支及掌浅支的皮支营养其远端。其神经支在神经束间或神经旁相互吻合构成纵向（链式）血管网，并借分支与筋膜皮支所形成的皮下筋膜血管网沟通。结论：可设计带前臂外侧皮神经及其营养血管的筋膜皮瓣，顺行或逆行转位修复邻近部位的软组织缺损。     

One-stage open cancellous bone grafting of infected fracture and nonunion

Nineteen patients with either infected fractures or nonunions were managed by a one-stage protocol consisting of thorough debridement of the septic focus, followed by stabilization with an external fixator or a cast and fresh autogenous cancellous bone grafting; the wound was then left open. Nineteen fractures were healed and free of infection at an average of 3.5 years follow-up. Some considerations, including debridement, stabilization, bone grafting, and wound coverage, are discussed. Received for publication on Dec. 11, 1997; accepted on June 17, 1998     

SPECT／CT图像配准不良对心肌灌注显像CT衰减校正的影响

目的探讨CT与SPECT图像配准不良对MPICT衰减校正（CTAC）的影响。方法99Tcm-MIBIMPI受检者19名,均为行健康体格检查者,其中男11名,女8名,年龄（65．3±9．6）岁。对MPI图像进行CTAC。利用仪器自带的软件对CT图像进行模拟位移：相对心脏位置进行上、下、左、右、前、后6个方向的移动,移动幅度分别为0．5、1．0、1．5、2．0、2．5、3．0、3．5、4．0和4．5em。重建不同位移状态的CTAC心肌断层图像,利用靶心图获得左心室各壁段的放射性计数百分比,比较位移前后左心室各壁段放射性计数的差异和图像差异。采用SPSS13．0软件对数据进行配对t检验。结果当CT图像的移动距离为0．5cm时,所有位移方向的CTAC图像均未见明显可识别的图像伪影。当CT图像的移动距离≥1．0CITI时,左心室各壁段出现不同程度的图像伪影以及放射性计数的改变;CT图像向上、下、左、右、前、后方向位移时,分别对心尖部,前壁和心尖部,间壁,前壁、心尖部和侧壁,侧壁和下后壁,前壁、心尖部和间壁放射性计数的影响最为显著。向下位移时左心室各壁段放射性计数的改变大于向上位移[（-9．68±8．06）％和（-2．04±1．83）％;f=6．573,P〈0．01],向右位移的改变大于向左位移[（-9．02±8．47）％和（-4．38±3．67）％;t=1．987,P〈0．05]。在左心室各壁段中,前壁、心尖部和侧壁的伪影程度明显较下后壁和间壁显著。结论CT与SPECT图像配准不良可使MPICTAC图像出现不同程度的伪影,其伪影出现的部位和严重程度与配准不良的方向和幅度密切相关。     

^18F-FDGPET／CT在滤泡性淋巴瘤分期及疗效评价中的临床价值

目的探讨^18F—FDGPET／CT在滤泡性淋巴瘤（FL）的分期、疗效评价、复发监测及预后判断方面的临床价值。方法回顾性分析2005年12月至2013年1月行PET／CT检查的经病理确诊为FL的28例患者[男12例,女16例,平均年龄57（36～82）岁]资料。对患者均进行AnnArbor临床分期,统计行PET／CT检查后临床分期改变情况。比较不同临床分期组间、病理高级别（3a＋3b级）组和低级别（1＋2级）组间SUVmax差异。28例中有17例行化疗后PET／CT检查和电话随访（10-88个月）监测疗效,比较疗效佳（CR＋PR）和不佳（SD＋PD）者生存差异。统计分析采用Mann—Whitneyu秩和检验、Wilcoxon符号秩检验和Kaplan—Meier生存分析。结果（1）28例治疗前行^18F—FDGPET／CT的患者中,10．7％（3／28）分期上调,3．6％（1／28）分期下调。Ⅰ＋Ⅱ期组SUVmax为10．1±3．2,Ⅲ＋Ⅳ期组SUVmax为11．5±4．9,差异无统计学意义（z=-0．619,P〉0．05）。病理低级别组（15例）和高级别组（13例）SUVmax分别为6．9±3．6和12．4±5．6（Z=-3．706,P〈0．01）。（2）17例治疗前后均行^18F-FDGPET／CT检查的患者中,疗效佳组（11例）治疗前SUV～10．8±5．1,治疗后SUVmax3．4±2．3（Z=-2．312,P〈0．05）;疗效不佳组（6例）治疗前SUVmax11．2±6．9,治疗后SUVmax7．8±3．3,差异无统计学意义（Z=-1．153,P〉0．05）。疗效佳与疗效不佳组的中位无进展生存期（PFS）分别为48和26个月（x^2=4．207,P〈0．05）。结论^18F-FDGPET／CT有助于明确FL分期、评价疗效、监测复发及提示预后。     

hTERT启动子特异驱动IL-24重组腺病毒的包装及鉴定

目的 包装并鉴定人端粒酶逆转录酶（hTERT）启动子特异驱动白介素-24（IL-24）的重组复制缺陷型腺病毒.方法 全基因合成优化后的hTERT启动子,插入质粒pGL3-basic的多克隆位点（pGL3-phTERT）;从人外周血单核细胞扩增IL-24,插入pGL3-phTERT质粒的hTERT启动子下游获得pGL3-phTERT-IL24;随后将phTERT-IL24插入pShuttle中间质粒,使用AdEasy^TM Adenoviral Vector System包装Ad-phTERT-IL24重组腺病毒;同时包装CMV启动子驱动IL-24的腺病毒载体为阴性对照（Ad-CMV-IL24）,以空载腺病毒Ad作为空白对照.用20 MOI重组腺病毒感染SGC-7901、MKN-45、HF细胞,采用PCR及Western blot检测IL-24在RNA及蛋白水平的表达.结果 成功包装Ad-hTERT-IL24重组腺病毒.感染Ad-hTERT-IL24后,hTERT阳性肿瘤细胞内IL-24表达显著上调,但hTERT阴性的HF细胞则无IL-24表达;感染阴性对照Ad-CMV-IL24后,hTERT阳性或阴性细胞内均有IL-24表达,感染空白对照Ad后,hTERT阳性或阴性细胞内均无IL-24表达.结论 Ad-hTERT-IL24腺病毒载体可有效介导IL-24特异表达于hTERT阳性肿瘤细胞内.