加速康复外科联合腹腔镜手术对胃癌患者术后肠道生物屏障稳定性的影响研究

目的探讨加速康复外科(ERAS)联合腹腔镜手术对于胃癌患者术后肠道生物屏障稳定性、免疫功能及应激反应的临床研究。 方法回顾性分析2016年1月至2018年6月期间收治的胃癌患者88例资料,患者均进行腹腔镜胃癌根治术治疗,按照治疗干预方案不同分为ERAS组和传统组。ERAS组42例患者采用ERAS干预,传统组46例患者给予常规治疗。采用SPSS 20.0进行数据分析,术后各临床指标、肠道菌属数目等计量资料采用 ±s表示,独立t检验;术后并发症、病理分级等计数资料采用χ²检验;P<0.05表示差异有统计学意义。 结果ERAS组患者术后肛门通气时间、发热时间、下床活动时间、首次进食时间、住院时间显著短于传统组(P<0.05);术后ERAS组患者粪便各菌属数量明显多于传统组(P<0.05);术后3 d ERAS组患者血清CD4^＋、CD4^＋/CD8^＋ 、IgG、IgM、IgA明显优于传统组(P<0.05);术后ERAS组患者应激反应较传统组低,血清IL－6、CRP、TNF－α水平明显低于对照组,差异均有统计学意义(P<0.05)。 结论加速康复外科联合腹腔镜手术对于胃癌患者术后肠道生物屏障、术后免疫功能、应激反应等具有重大意义,且可有效促进患者术后康复,值得临床推广。     

美国毕业后医学教育的评鉴与认可

毕业后医学教育是医学教育连续统一体中的重要组成部分,是目前进一步完善我国医学教育体系的关键环节之一。本文介绍了美国毕业后医学教育评鉴与认可的组织实施情况,包括最新的发展趋势,并针对我国毕业后医学教育改革与发展的情况归纳了四点值得借鉴之处。     

A pilot investigation of e‐cigarette use and smoking behaviour among patients with chronic airway disease or respiratory symptoms

BackgroundThis pilot study aimed to investigate the current status of e‐cigarettes (ECs) use patterns among patients with chronic airway disease or chronic respiratory symptoms and the effects of ECs use on respiratory and mental health.MethodsA cross‐sectional survey was conducted at the outpatient clinic of eight teaching hospitals in South Korea between November 2019 and December 2019. All adult ECs users (19 years and above) who visited the outpatient clinic as a patient with chronic airway disease or chronic respiratory symptoms were eligible to participate in this study.ResultsA total of 51 subjects responded to the survey. Most of the participants were male (92.2%) and the mean age was 41.8 years. Dominant airway diseases were asthma and chronic obstructive pulmonary disease. Most of the subjects had a history of cigarette smoking, and 19 subjects were dual users of current cigarettes and ECs. Most of the subjects started ECs use due to health‐related reasons. When comparing exclusive ECs users and dual users, St. George''s respiratory questionnaire (SGRQ) scores, the proportion of cases with moderate to severe depressive symptoms, and average Fagerstrom test for nicotine dependence scores for ECs were higher in dual users than exclusive ECs users (mean 4.64 vs. 2.38, p = 0.006), respectively.ConclusionMost of the subjects started ECs use due to health concerns, but dual users have more respiratory symptoms and higher nicotine dependence in this pilot study. One hypothesis that comes from these results is that greater nicotine dependence may influence behaviours, habits, and views about ECs. These preliminary observations need confirmation in a large cohort.     

Cumulative Recurrence Rate and Risk Factors for Recurrent Abdominal Wall Endometriosis after Surgical Treatment in a Single Institution

PurposeThis study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment.Materials and MethodsA retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected.ResultsEighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6–106). The median age was 37 years (range, 22–48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment.ConclusionThe recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.     

农村妇儿肺通气功能免疫水平的配对分析

用配对比较的方法,探讨厨房位置和燃料不同对农村妇儿肺通气功能免疫水平的影响规律,结果是家庭月耗煤多的妇儿FEV1.0％、儿童唾液溶菌酶、血清IgG含量偏低;炉灶置宅内耗煤多的家庭儿童IgA含量偏高。说明合理布局厨房位置、设置排烟道及精选燃料,可大大改善室内空气质量,保护妇儿健康。     

Brain Stem Hypoplasia Associated with Cri-du-Chat Syndrome

Cri-du-Chat syndrome, also called the 5p-syndrome, is a rare genetic abnormality, and only few cases have been reported on its brain MRI findings. We describe the magnetic resonance imaging findings of a 1-year-old girl with Cri-du-Chat syndrome who showed brain stem hypoplasia, particularly in the pons, with normal cerebellum and diffuse hypoplasia of the cerebral hemispheres. We suggest that Cri-du-Chat syndrome chould be suspected in children with brain stem hypoplasia, particularly for those with high-pitched cries.     

兔肝VX2瘤活体二维多体素1H-MRS动态分析及病理对照研究

目的 探讨兔肝VX2瘤活体二维多体素1H-MRS动态变化特征.材料与方法对14只兔肝VX2瘤荷瘤兔分两期进行活体2D 1H-MRS和常规MRI检查,观察肿瘤中心部分、肿瘤周围部分与瘤周正常肝组织的代谢物波峰变化,测量代谢物峰下积分面积比值.取MRS检查相应部位标本进行常规病理学检查,并进行PAS染色,测量积分光密度.结果 肿瘤中心部分的脂质(Lip)、胆碱化合物(Cho)和糖原和葡萄糖复合物(Glyu)波峰与瘤周正常肝组织差别较大.肿瘤周围部分除Lip峰高于瘤周正常肝组织以外,Cho和Glyu峰差异不大.肿瘤中心部分的Cho/Lip和Glyu/Lip值均较瘤周正常肝组织低(P<0.05),肿瘤周围部分与瘤周正常肝组织无显著性差异(P>0.05).第二期三个部位的Glx/Lip、Cho/Lip、Glyu/Lip比值均较第一期明显降低(P<0.05).瘤周正常肝组织PAS染色积分光密度值与Glyu/Lip值之间存在显著线性相关关系(r=0.627,P<0.05).结论 活体2D 1H-MRS能动态显示兔肝VX2瘤不同区域和不同时期主要代谢物的变化,在一定程度上反映了肝组织糖原储备及肿瘤的生长、增殖、坏死情况.