肝门部胆管癌的分型分期系统及其临床应用价值

肝门部胆管癌（hilar cholangiocarcinoma，HC）分型和分期系统较为庞杂，包括改良Bismuth-Corlette分型，Gazzaniga T分期，Blumgart T分期，美国纪念Sloan-Kattering癌症中心（Memorial Sloan Katering Cancer Center，MSKCC）T分期，Mayo分期系统，美国癌症联合委员会（American Joint Committee on Cancer，AJCC）和国际抗癌联盟（International Union Against Cancer，UICC）联合发布的TNM分期，欧洲肝胆胰协会分期（Consensus classification from the European Hepato-Pancreato-Biliary Association，EHPBA），以及日本肝胆胰外科学会（Japanese Society of Hepato-Biliary-Pancreatic Surgery，JSHBPS）分期，各分期系统所包含的内容差异较大，各具特色和优缺点，本文就HC常见的分型和分期系统及其在临床中的应用价值做一综述。     

层面递进法激光腔内剜除高危前列腺增生的治疗体会

目的探讨1 470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果。 方法回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1 470 nm激光治疗共89例高危前列腺增生患者的临床资料，年龄平均（68±3）岁，前列腺体积（57.4±2.6）ml。所有患者均采用"寻找层面，先易后难，剜切结合"的层面递进法思路行激光腔内前列腺剜除术，比较患者术中及术后情况。 结果89例均顺利完成手术，与术前相比，术后3个月患者最大尿流率明显增加，[（6.9±2.1） ml/s vs（19.8±3.6） ml/s]。国际前列腺症状评分显著好转，[（24.6±1.7） vs（8.0±1.2）]。术中无输血、无电切综合征、无直肠和膀胱穿孔病例，无输尿管损伤、大出血、心脑血管意外等严重并发症发生。 结论层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势，且易于掌握，或可为业界同行提供一个新的思路。     

运用PDCA循环改进居家养老护理文件书写质量

目的运用PDCA循环的质量管理方法,改进居家养老护理文件书写质量。方法对现存的护理质量不合格项目进行原因分析、制定改进计划、组织实施、效果评价。结果改进后的居家养老护理文件书写合格率达到98%。结论通过应用PDCA循环质量管理工具进行护理质量管理,使该中心居家养老护理文件书写水平得到大幅度提高,同时促进了该中心护理管理质量的提升。     

输尿管支架管结壳患者尿液菌群的分布特点

目的探讨输尿管支架管结壳患者尿液菌群的分布特点。方法选取2018年10月至2019年3月在山东省立第三医院、山东大学齐鲁医院、济南市中心医院和济南市济钢医院就诊的35例输尿管支架管置入术后患者。纳入标准:年龄18~65岁;输尿管镜碎石术后留置内支架管4周。排除标准:尿液细菌培养阳性;严重肉眼血尿;近期口服抗生素;存在明显残石患者。本研究采用横断面研究方法(临床研究注册号为ChiCTR1800020025),根据有无支架管结壳将患者分为结壳组23例和无结壳组12例。收集拔管当日患者尿液行细菌16s DNA检测。使用UPARSE、UCHIME和RDP calssifier等软件分析两组患者尿液菌群分布特点,明确两组患者尿液中细菌种类总数、细菌丰度,以及丰度占比较大的细菌类别,比较两组患者尿液细菌种类、数量及细菌丰度的差异,明确结壳组患者尿液中丰度占比较大的细菌菌属。结果两组患者的年龄、性别、体质指数、置管侧别、内支架管型号及结石成分差异均无统计学意义(P>0.05)。16s DNA检测结果显示,结壳组丰度占比>1%的菌属数量为11个,丰度占比>0.01%的菌属数量为74个;无结壳组丰度占比>1%的菌属数量为7个,丰度占比>0.01%的菌属数量为11个,两组丰度占比>1%的菌属数量比较差异有统计学意义(t=5.12,P=0.000)。结壳组中菌属丰度占比前3位分别为乳杆菌属(23.1%)、拟杆菌属(18.8%)和未分级拟杆菌属(17.1%),非结壳组中菌属丰度占比前3位分别是为埃希菌-志贺菌属(32.2%)、肠球菌属(24.9%)和假单胞菌属(18.2%)。两组间差异最大的3种细菌是乳杆菌属(P=0.010),拟杆菌属(P=0.004)和未分级拟杆菌属(P=0.004)。结论支架管结壳患者尿液中细菌种类和数量都明显多于非支架管结壳患者。拟杆菌属细菌在支架管结壳患者尿液中的细菌种类丰度较大。     

Clinical Diagnostic Implications of Body Fluid MiRNA in Oral Squamous Cell Carcinoma: A Meta-Analysis

Oral cancer, predominantly oral squamous cell carcinoma (OSCC), is one of the most leading causes of cancers worldwide. Due to a low 5-year survival rate, highly effective methods for the early detection of OSCC are totally needed. MicroRNAs (miRNAs), as promising biomarkers, can bring insights into tumorigenesis of oral cancers. However, studies on the accuracy of miRNAs detection in OSCC have inconsistent conclusions, leading us to conduct this meta-analysis. The aim of this study was to systematically review the articles investigating the diagnostic value of miRNAs in OSCC.The PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), Web of Science were searched (updated to June 11th, 2015) to identify all articles evaluating the diagnostic yield of miRNAs for OSCC. The pooled sensitivity, specificity, and other diagnostic parameters were used to assess the performance of miRNAs assays on OSCC detection. Statistical analysis was conducted by employing the R software.The present meta-analysis comprised 23 studies from 10 articles, including 598 OSCC patients and 320 healthy individuals, available for analysis. The summary receiver operator characteristic (SROC) curve was plotted. Meanwhile, the pooled diagnostic parameters and the area under curve (AUC) were calculated based on all included studies. The pooled diagnostic parameters calculated from all 23 studies were as follows: pooled sensitivity of 0.759 (95% CI: 0.701–0.809), pooled specificity of 0.773 (95% CI: 0.713–0.823) and AUC of 0.832, which indicates a relatively high diagnostic accuracy of miRNAs in differentiating OSCC patients from healthy controls. Meanwhile, In addition, subgroup analyses were conducted to access the heterogeneity between studies, which is based on specimen (serum/plasma/blood/saliva/ tissue) and ethnicity (Asian/Caucasian).In summary, our meta-analysis suggests that miRNAs might be used in noninvasive screening tests for OSCC, which needs further large-scale studies to be validated.     

Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty

Background

Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.

出凝血异常普通外科病人围手术期静脉血栓栓塞症防治策略

易栓症是外科围手术期静脉血栓栓塞症(VTE)的防治重点。对于接受手术的止凝血障碍病人,需要谨慎评估VTE的个体风险,同时兼顾手术和麻醉的性质、出血障碍类型和严重程度、年龄、体重指数(BMI)、血栓形成史、恶性肿瘤和其他高危共患病。VTE风险应与已知出血障碍病人使用抗凝相关的出血风险平衡。实验室检查有助于发现和判断血栓与出血的病因,对病人的止凝血代偿能力作出评估,并对抗凝药物的合理使用提供依据。对上述病人,建议术后不常规使用药物预防血栓,尤其是血友病病人,但围手术期因子替代和止血药物的过度应用仍存在导致血栓的风险。使用低分子肝素(LMWH)和直接口服抗凝剂前应评估肾小球滤过率。当血小板计数<50×109/L,LMWH短期减量应用可能相对安全,监测抗Хa水平可用于调整中重度血小板减少症病人LMWH的剂量。主要消化道出血停止和重新使用华法林应至少相隔7 d。对于高血栓栓塞风险和术后高出血风险病人,术后当晚和术后第1天减量应用直接口服抗凝剂是一种可取的做法。