Colonoscopic perforations: a review of 30,366 patients

Background Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic colonoscopic perforation. Methods A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy between 1990 and 2005. The patients’ demographic data, endoscopic procedural information, perforation location, therapy, and outcome were recorded. Results In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%). All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%), and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon. Conclusion Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients.     

无细胞异种真皮与表皮细胞悬液复合移植的研究

目的　研究用无细胞异种真皮与表皮细胞悬液复合移植的效果及组织学变化。方法　将 4 2只裸鼠分为实验组及对照组 ,实验组于背部全层皮肤缺损创面移植无细胞异种真皮及人表皮细胞悬液 ,对照组单纯移植人表皮细胞悬液。于术后 2、3和 5周计算创面愈合率 ,术后 3、6和 12周计算创面收缩率 ,并取活检行组织学检测。结果　实验组创面愈合率高 ,分别为 79.1%± 4 .5 % ,89.6 %± 4 .4 % ,98.1%± 3.4 % ,收缩程度轻为 16 .3%± 5 .2 % ,2 5 .5 %±7.2 % ,32 .5 %± 7.1% ,外观平整 ,质地良好 ,胶原纤维排列整齐 ,基底细胞桥粒 -半桥粒结构及基底膜等结构重建明显 ,未见明显的急性排斥反应 ;对照组创面愈合率分别为 6 9.2 %± 4 .9% ,78.2 %± 7.6 % ,90 .6 %± 5 .0 % ,收缩率为2 0 .5 %± 6 .0 % ,31.3%± 6 .9% ,4 4 .6 %± 7.2 % ,与实验组相比 ,均有统计学意义 (P<0 .0 5 ) ,愈合后的表皮质地薄 ,易破溃 ,胶原纤维紊乱 ,表皮 -真皮连接结构重建不明显。结论　无细胞异种真皮与表皮细胞悬液复合移植修复创面 ,可改善创面愈合质量。     

AAV based gene delivery to myocardium in rodents and pigs

Objective: To optimize transgene expression levels after AAV‐mediated gene transfer different delivery methods were compared in a rat (A) and porcine (B) heterotopic heart transplantation model. Methods: (A) Heterotopic abdominal heart transplantations were performed in male Lewis rats. After harvesting the donor hearts, the viral vectors were delivered to the graft by the following methods: (1) 0.35 ml saline solution containing AAV2/9‐LacZ (2 × 10¹¹ vector genome, vg) was injected directly into the myocardium (apex) immediately after reperfusion. (2) cardioplegic solution (0.3 ml) containing AAV‐2(HBSD), 2/9‐LacZ vectors was rapidly injected into the aortic root with the pulmonary trunk clamped. Before transplantation the transfected heart was incubated for 20 min in iced cardioplegia. (3) A reperfusion system was applied: For 20 min a cold solution of cardioplegia (5 ml) and AAV‐2(HBSD) or AAV2/9‐LacZ vectors were recirculated through the donor heart. Transplanted grafts were explanted after 3 weeks. To detect and measure marker gene expression X‐gal staining or a luciferase assay was performed. In a second series we compared the effects of the transduction of PD‐L1 to LacZ using the optimum method (intraaortic root injection) in the same heart transplantation model. (B) Heterotopic abdominal HTX was performed in pigs (Landrace, 10–18 kg) following vector application to the donor heart in an in situ‐Langendorff perfusion system (AAV2/GFP and AAV2/Luciferase). Recipients were given tacrolimus (0.3 mg/kg BW), after 21 days the transplanted hearts were explanted for transgene expression analysis. In a second series we compared AAV2/9‐mediated transduction of PD‐L1 and LacZ in the in situ‐Langendorff model and consequent allogeneic heterotopic abdominal heart transplantation. Results: (A) Highest transfection efficiency was observed in the grafts treated with intracoronary infusion of AAV2/9 at the higher dosage, and the expression pattern was global and homogenous in the grafts. hPD‐L1 transduction resulted in no significant difference of survival time and signs of rejection after allogeneic rat heart transplantation. (B) AAV2‐mediated gene delivery was unable to yield sufficient transgene expression after in situ‐Langendorff perfusion of porcine hearts. AAV2/9 based gene transfer of LacZ and hPD‐L1 led to excellent myocardial gene expression lasting up to 2 months. Due to species incompatibility no protective effects were observed in our allogeneic porcine transplantation model. Conclusions: (A) We demonstrated that infusion of AAV vectors into the aortic root with the pulmonary trunk clamped is a simple and efficient method for gene delivery to the donor heart in an allogeneic rat heart transplantation setting. Gene transfer of hPD‐L1 was ineffective to protect against allorejection, on the contrary there was a trend to aggravated rejection. Therefore the exact mechanism of hPD‐L1 in allograft rejection needs further investigation. (B) The in situ‐Langendorff model was developed to allow isolated target organ perfusion with high vector concentrations under physiological conditions. Using this method AAV2/9 mediated gene delivery into porcine hearts proved effective to induce excellent marker gene expression. Expression of hPD‐L1 could also be achieved but was ineffective in pig allotransplantation due to species incompatibility. Double transgenic pig hearts (e.g. Gal‐KO+CD46) can now efficiently be transduced with hPD‐L1 or hCTLA4‐Ig to further optimize long‐term survival after pig‐to‐primate cardiac xenotransplantation.     

基于问卷调查的男性完全性脊髓损伤后肠道功能障碍的现状特征分析

目的：探讨成年男性完全性脊髓损伤患者肠道功能障碍的现状特征。方法：基于《国际脊髓损伤肠功能基础数据集-第2版》和《国际脊髓损伤肠功能扩展数据集》问卷量表,以116位成年男性完全性脊髓损伤患者作为研究对象,抽取关于排便功能的6项核心问题：排便频率、平均排便时间、排便方法/肠道管理方式、排便地点、排便独立程度和对生活质量的影响程度。评估分析完全性脊髓损伤后神经源性肠道功能障碍的现状特征。结果：多数患者（69例/59.5%）排便频率为2-6次/每周;排便时间相对较长,51 例（44%）患者平均排便时间分布于31-60 分钟;排便方法和肠道管理方式主要为灌肠剂介入,93例（80.1%）使用小包装灌肠剂（开塞露）为主;58例（50.0%）患者在床上排便;排便独立程度较差,63（54.3%）例需全部帮助,27 例（23.3%）需部分帮助;69例（59.5%）患者认为对生活质量严重影响。结论： 神经源性肠道功能障碍是成年男性完全性脊髓损伤患者常见并发症,是脊髓损伤康复治疗需要重视的问题。患者排便时间较长,多选择床上或坐便椅/坐桶上排便,多需要灌肠剂介助,排便独立性差,对生活质量影响大。     

新型高级创伤外科机动救治力量及其培训体系的建立

未来远海环境下的舰艇编队作战将成为我海军主要作战形式。远海作战战场广阔、攻防形势转换快、所致伤情伤势复杂,易在任意时间、任意战场地点瞬间产生批量伤员,救治难度极大。本文系统介绍了一种针对远海舰艇编队作战的新型高级创伤外科机动救治队伍及其专属模块化、标准化、轻量化的手术复苏装备系统,并阐述其培训体系构想,以备卫勤研究者、参与者借鉴参考。     

伴颈5/6椎间孔狭窄神经根型颈椎病影像学特点及临床意义

目的 观测伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔形态及三维空间下的各相关径值,分析并探讨其临床意义。方法 随机选取492例伴C5/C6椎间孔狭窄,在上海长征医院于2014年9月至2019年7月期间行手术治疗的神经根型颈椎病患者,行颈椎正侧位X线、颈椎CT、颈椎磁共振等检查,数字骨科系统重建后观测椎间孔形态并测量最佳投射角度下的纵径、上前后径、下前后径、横截面积、椎间隙高度等径值并对其进行统计学处理,比较病例组与正常成人组C5/C6椎间孔之间、病例组病变椎间孔与对侧椎间孔以及病例组中男女患者之间的差异。结果 病例组C5/C6椎间孔形态因骨赘增生等,以纺锤形、不规则形为主,病例组C5/C6椎间孔横径均值、纵径、横截面积、椎间隙平均高度分别为（5.81±1.40）mm、（10.45±1.70）mm、（50.02±15.46）mm2、（4.99±0.89）mm,均比正常成人组减小,且差异有统计学意义（P<0.01）;男女间比较差异无统计学意义（P>0.05）。结论 伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔的形态发生改变,导致椎间孔的横径均值及横截面积值均明显减小;椎间孔的横径在诊断颈椎间孔狭窄方面敏感性及特异性高;术中减压时应更加注重椎间孔横径的有效扩大,以提高手术效果。     

基于转化医学的高校图书馆嵌入式知识服务模式研究

转化医学是未来医学研究发展的趋势,主要目的是基础研究获得的成果快速应用到临床。医学发展模式的变化给高校图书馆原有的服务模式提出了新的挑战,高校图书馆面临服务模式转变和创新。作者从转化医学信息服务平台的构建、服务路径等方面对转化医学模式下高校图书馆嵌入式知识服务进行探讨。     

何任教授辨治妇科肿瘤用药规律探析

首届"国医大师"荣誉称号获得者何任教授,长期致力于中医药治疗内科杂病的临床研究,尤其在中医药治疗肿瘤疾病上积累了丰富的经验.何教授提出"扶正祛邪"的治疗大法,对于延长患者生命,提高生活质量等方面,都显示了积极的作用.现对2010年3月-2011年5月门诊75例初诊妇科肿瘤患者资料进行分析,探究和总结何教授治疗妇科肿瘤的用药规律和特点.     

颈分区性清扫术治疗头颈部鳞状细胞癌的远期疗效

目的　研究颈分区性清扫术在头颈部鳞状细胞癌 (简称鳞癌 )治疗中的效果。方法　回顾性分析 1997年 1月～ 2 0 0 1年 12月在中国医学科学院肿瘤医院接受分区性清扫术的头颈部鳞癌患者 12 3例 ,其中喉癌 77例、口腔癌 2 9例、口咽癌 2例、下咽癌 15例。分区性清扫术后发现淋巴结病理阴性 (pN0 ) 99例 ,淋巴结病理阳性 (pN + ) 2 4例。随访时间中位数为 2 5个月。结果　 10 1例cN0患者行分区性清扫术后发现pN + 14例 ( 13 9% ) ;2 2例cN +患者行分区性清扫术后发现pN + 10例( 4 5 5 % )。 15 7侧分区性清扫标本中共发现 5 2枚阳性淋巴结 ,其在颈部的分布如下 :Ⅰ区 2 5 % ,Ⅱ区4 8% ,Ⅲ区 2 5 % ,Ⅳ区 2 %。根据Kaplan Meier方法计算 5年颈部复发率 ,pN0患者为 5 87% ( 95 %可信区间 0 8% ,10 9% ) ,pN +患者为 9 2 % ( 95 %可信区间 0 0 % ,2 1 5 % )。结论　颈分区性清扫术从微创观念出发 ,只要选择恰当 ,对于头颈部鳞癌患者可以取得与传统颈清扫术相当的效果。更重要的是保留了患者的功能和外观 ,提高了生活质量     

1526例甲状腺癌患者术后护理”

目的：研究总结甲状腺癌术后症状管理的措施及效果。方法：回顾总结2015.4.1-2015.9.30我科1526例甲状腺癌患者,通过心理护理、疼痛评估、伤口引流管护理、术后并发症观察及护理措施。结果：患者均痊愈出院。结论：高水平的术后症状管理有利于保障医疗手术安全,提高护理整体质量。