补阳还五汤治疗慢性脑供血不足疗效观察及对血流动力学、认知功能的影响

目的：观察补阳还五汤治疗慢性脑供血不足（CCCI） 的临床疗效及对脑部血流动力学、认知功能 的影响。方法：选取82 例CCCI 患者的临床资料作回顾性分析,根据不同治疗方式分为对照组和观察组各 41 例。对照组给予常规西药治疗,观察组在常规西药治疗基础上加用补阳还五汤治疗。治疗1 个月后比较 2 组临床疗效,治疗前后临床症状评分、基底动脉（BA）、左椎动脉（LVA）、右椎动脉（RVA）、左大脑中动 脉（LMCA）、右大脑中动脉（RMCA） 的平均血流速度（Vm） 及认知功能［蒙特利尔认知评估量表（MoCA）、 简易智力状态检查量表（MMSE）、长谷川痴呆量表（HDS）］ 评分,血浆一氧化氮（NO）、内皮素-1（ET-1） 水平,血清超敏C-反应蛋白（hs-CRP）、白细胞介素-6（IL-6） 水平。结果：观察组总有效率为95.12%,对 照组为80.49%,2 组比较,差异有统计学意义（P＜0.05）。治疗后,2 组头痛、眩晕、失眠、健忘等症状评分 均较治疗前降低（P＜0.05）,且观察组上述各项评分均低于对照组（P＜0.05）。治疗后,2 组BA、LVA、 RVA、LMCA、RMCA 的Vm 值均较治疗前升高（P＜0.05）,且观察组上述各项指标均高于对照组（P＜ 0.05）。治疗后,2 组MoCA、MMSE、HDS 评分均较治疗前升高（P＜0.05）,且观察组上述各项评分均高于对 照组（P＜0.05）。治疗后,2 组血浆ET-1 及血清hs-CRP、IL-6 水平均较治疗前降低（P＜0.05）,血浆NO 水 平较治疗前升高（P＜0.05）;且观察组ET-1、hs-CRP、IL-6 水平均低于对照组（P＜0.05）,NO 水平高于对 照组（P＜0.05）。结论：补阳还五汤治疗CCCI 可缓解临床症状,有效改善患者认知功能、血管内皮功能及血 流动力学状态,抑制机体炎症反应,提高临床治疗效果。     

两种促排卵方案在超重多囊卵巢综合征患者中助孕效果的比较

目的探讨拮抗剂方案和长方案对超重多囊卵巢综合征(PCOS)患者助孕结局的影响。方法回顾性分析2013年1月1日至2017年11月30日于本生殖中心初次行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的PCOS且超重(BMI≥24 kg/m2)的356例患者临床资料,根据促排卵方案不同分为拮抗剂方案组(n=226)和长方案组(n=130),比较两组患者的基本资料、促排卵情况和临床结局,分析两组患者的中重度卵巢过度刺激综合征(OHSS)发生率、优质胚胎率、一次移植妊娠结局和累积活产率的差异。结果基本资料中,两组患者的女方年龄、BMI、基础睾酮水平差异均无统计学意义(P>0.05);与长方案组比较,拮抗剂方案组患者的基础FSH水平[(6.42±1.63)U/L vs.(6.78±1.53)U/L]显著降低(P<0.05),而窦卵泡数[(32.55±11.06)个vs.(28.02±7.09)个]显著增多(P<0.05)。促排卵情况比较中,拮抗剂方案组患者的扳机日LH和P水平以及优质胚胎率(38.04%vs.32.26%)显著高于长方案组患者(P<0.05),但E2水平及获卵数无显著性差异(P>0.05)。在临床结局比较中,两种方案的中重度OHSS发生率、因OHSS高风险取消移植周期率、一次移植妊娠结局、乐观累积活产率以及保守累积活产率差异均无统计学意义。结论对于超重PCOS患者,与长方案相比,拮抗剂方案可获得更多的优质胚胎,但两种方案的临床结局相当。     

Effects of platelet‐rich plasma on the healing of sternal wounds: A meta‐analysis

Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet‐rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta‐analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms “platelet‐rich plasma” and “sternal wound” or “thoracic incision.” References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta‐analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta‐analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in‐situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high‐quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.     

Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1–4N1–3M0 Breast Cancer

Annals of Surgical Oncology - Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach...     

Overlapping obesity-related glomerulopathy and immunoglobulin A nephropathy: clinical and pathologic characteristics and prognosis

Clinical and Experimental Nephrology - In this study, we investigated the clinical and pathologic characteristics and prognosis of overlapping obesity-related glomerulopathy (ORG) and...     

Changes in humoral immune response after SARS-CoV-2 infection in liver transplant recipients compared to immunocompetent patients

The protective capacity and duration of humoral immunity after SARS-CoV-2 infection are not yet understood in solid organ transplant recipients. A prospective multicenter study was performed to evaluate the persistence of anti-nucleocapsid IgG antibodies in liver transplant recipients 6 months after coronavirus disease 2019 (COVID-19) resolution. A total of 71 liver transplant recipients were matched with 71 immunocompetent controls by a propensity score including variables with a well-known prognostic impact in COVID-19. Paired case–control serological data were also available in 62 liver transplant patients and 62 controls at month 3 after COVID-19. Liver transplant recipients showed a lower incidence of anti-nucleocapsid IgG antibodies at 3 months (77.4% vs. 100%, p < .001) and at 6 months (63.4% vs. 90.1%, p < .001). Lower levels of antibodies were also observed in liver transplant patients at 3 (p = .001) and 6 months (p < .001) after COVID-19. In transplant patients, female gender (OR = 13.49, 95% CI: 2.17–83.8), a longer interval since transplantation (OR = 1.19, 95% CI: 1.03–1.36), and therapy with renin–angiotensin–aldosterone system inhibitors (OR = 7.11, 95% CI: 1.47–34.50) were independently associated with persistence of antibodies beyond 6 months after COVID-19. Therefore, as compared with immunocompetent patients, liver transplant recipients show a lower prevalence of anti-SARS-CoV-2 antibodies and more pronounced antibody levels decline.     

Personal protective equipment related skin reactions in healthcare professionals during COVID‐19

Since the outbreak of COVID‐19 pandemic, clinicians have had to use personal protective equipment (PPE) for prolonged periods. This has been associated with detrimental effects, especially in relation to the skin health. The present study describes a comprehensive survey of healthcare workers (HCWs) to describe their experiences using PPE in managing COVID‐19 patients, with a particular focus on adverse skin reactions. A 24‐hour prevalence study and multi‐centre prospective survey were designed to capture the impact of PPE on skin health of hospital staff. Questionnaires incorporated demographics of participants, PPE type, usage time, and removal frequency. Participants reported the nature and location of any corresponding adverse skin reactions. The prevalence study included all staff in intensive care from a single centre, while the prospective study used a convenience sample of staff from three acute care providers in the United Kingdom. A total of 108 staff were recruited into the prevalence study, while 307 HCWs from a variety of professional backgrounds and demographics participated in the prospective study. Various skin adverse reactions were reported for the prevalence study, with the bridge of the nose (69%) and ears (30%) being the most affected. Of the six adverse skin reactions recorded for the prospective study, the most common were redness blanching (33%), itchiness (22%), and pressure damage (12%). These occurred predominantly at the bridge of the nose and the ears. There were significant associations (P < .05) between the adverse skin reactions with both the average daily time of PPE usage and the frequency of PPE relief. The comprehensive study revealed that the use of PPE leads to an array of skin reactions at various facial locations of HCWs. Improvements in guidelines are required for PPE usage to protect skin health. In addition, modifications to PPE designs are required to accommodate a range of face shapes and appropriate materials to improve device safety.     

利用CT表现鉴别肾上腺隐匿型嗜铬细胞瘤和皮质腺瘤

目的探讨如何利用CT表现对肾上腺隐匿型嗜铬细胞瘤和肾上腺皮质腺瘤进行鉴别诊断。方法收集2010年1月至2020年1月期间中国医科大学附属第一医院收治的177例肾上腺肿瘤患者进行回顾性分析,对比各组患者之间的一般临床资料和CT表现。结果隐匿型嗜铬细胞瘤56例、皮质醇腺瘤32例、醛固酮腺瘤44例、无功能腺瘤45例,隐匿型嗜铬细胞瘤组在肿瘤侧别上与无功能腺瘤组差异有统计学意义,在肿瘤最大直径、平扫CT值、动脉期和延迟期增强CT值上均显著大于三组肾上腺腺瘤组。以肿瘤直径≥2.95 cm诊断隐匿型嗜铬细胞瘤,曲线下面积(AUC)为0.872,敏感度为87.5%,特异性为76.0%;当平扫CT值≥24.5 Hu时,AUC为0.929,敏感度为94.0%,特异性为82.5%;当动脉期增强CT值≥89.5 Hu时,AUC为0.886,敏感度为72.7%,特异性为90.6%;当延迟期增强CT值≥82.5 Hu时,AUC为0.937,敏感度为84.6%,特异性为95.3%;联合以上四个指标时,AUC为0.981,阈值为≥0.118,敏感度为100%,特异性为90.6%。结论以肿瘤直径2.95 cm、平扫CT值24.5 Hu、动脉期增强CT值89.5 Hu和延迟期增强CT值82.5 Hu为阈值对肾上腺隐匿型嗜铬细胞瘤有较好的鉴别诊断价值。     

经口入路机器人甲状腺手术的研究进展

近年来,甲状腺疾病的发病率逐年上升,其中青年女性患者占较大比例.随着年轻患者对美容的要求提高,多种入路的内镜甲状腺手术已广泛成功开展.这些术式尽管避免了在颈部做切口,并取得了较好的美容效果,但不可避免地在其他部位留下切口瘢痕.经口入路手术被认为是真正无痕的手术,具有更好的美容效果,随着近年来达芬奇手术系统的不断完善,经口入路机器人甲状腺手术也取得较大发展.与其他术式相比,经口入路机器人甲状腺手术具有多种优势,如提供中线入路、最低程度地减少组织损伤、3D高清放大视野、手臂震颤过滤及7个自由度Endo-wrist等.因此,本综述对近年来经口机器人甲状腺手术的研究进展进行总结,为临床甲状腺疾病的治疗提供学习借鉴.