非小细胞肺癌合并脑转移62例外科手术治疗分析

目的探讨手术改善非小细胞肺癌(NSCLC)合并脑转移患者的预后。方法对我院2005年3月—2013年5月切除NSCLC原发灶的62例患者进行分析,分析原发病灶的部位、手术方法、病理分型,脑转移灶的数量、治疗方式、治疗后的生存期等。结果本组男21例,女41例。全肺切除4例,肺叶、肺段或肺部分切除58例。腺癌47例(75.8%),鳞癌8例,混合型腺鳞癌7例。在处理脑转移瘤后再切除原发灶38例,先处理原发灶者24例。本组中位生存期18.7个月。其中1年生存率为75.9%;2年生存率为38.9%;3年生存率为16.7%。与同期未手术对照组比较1年生存率无差异,2、3年生存率比较差异有统计学意义(P<0.01)。结论积极处理肺部原发灶,结合头部放疗及全身化疗或基因靶向等综合治疗可延长生存期,提高此类患者预后。     

医院干细胞临床研究医生培训与政策认知调查

ObjectiveTo investigate clinical stem cell research doctors to know their profe ssional training situation, cognition of related policy and satisfaction. MethodsSix grade A hospitals including 23 departments and 128 doctors were investigated by using self made questionnaire. ResultsOf 128 doctors, 53.1% did not participate in the stem cell technology professional training while 27.3% of them were familiar with stem cell management policies and regulations. Age, title, education, hospital, department, years of working in clinical stem cell research, whether participation in training, whether trained in the organization by their hospitals were the influence factors. 32.0% of doctors were satisfied with the current stem cell policy. ConclusionHospitals should encourage doctors to participate in stem cell professional training to increase their professional technology. Hospitals need to organize stem cell policy lectures, propagate the national stem cell policy, standardize physician’s behavior of stem cell clinical trials, and consider doctors’ advice and feedback as reference for relevant policy.     

Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus

BackgroundShoulder function often is limited after tumor resection and endoprosthetic replacement of the proximal humerus. This is partly attributable to the inability to reliably reattach rotator cuff tendons to the prosthesis and achieve adequate shoulder capsule repair with a metallic prosthesis. An option to attain these goals is to use synthetic mesh for the reconstruction, although the value of this method has not been well documented in the literature.Questions/purposesWe asked whether patients who had shoulder reconstruction using synthetic mesh had (1) better shoulder function; (2) improved ROM compared with shoulder reconstructions without mesh; and (3) more stable joints compared with those in patients with similar resections who had reconstructions without synthetic mesh.MethodsDuring a 5-year period, we performed 41 intraarticular resections with endoprosthetic reconstructions for malignancies in the proximal humerus meeting specified criteria to generate similarity in the study groups. Twelve patients (29%) were lost to followup before 24 months, leaving 29 patients available for review at a mean of 45 months (range, 24–70 months). This retrospective study compared 14 patients with soft tissue reconstruction that included synthetic mesh with 15 patients with soft tissue reconstruction without the use of synthetic mesh. The choice was made during consultation between the patient and surgeon, after reviewing the perceived advantages and disadvantages of each approach. A tumor band (ligament advanced reinforcement system) was used as synthetic mesh and wrapped around the prosthesis of the proximal humerus for soft tissue reconstruction in the reconstruction-with-mesh group. Study endpoints included the Musculoskeletal Tumor Society (MSTS) function scores, American Shoulder and Elbow Surgeons (ASES) score, shoulder ROM, and proximal migration of the humeral prosthesis.ResultsThe mean MSTS score for patients without synthetic mesh reconstruction was 20 ± 3 points (66%), whereas for patients with synthetic mesh reconstruction, the mean score was 24 ± 2 points (79%; p = 0.001). Patients with synthetic mesh reconstruction had a higher mean total ASES score (85 ± 1.1 points versus 72 ±1.7 points; p = 0.025), and better function for activities of daily living. They also had better ROM on mean active forward flexion (p = 0.020), abduction (p < 0.001), and external rotation (p < 0.001) than patients without synthetic mesh reconstruction. Proximal migration of the prosthesis was observed in five of 15 of patients in the group without synthetic mesh reconstruction and in none of those treated with synthetic mesh (p = 0.042).ConclusionsPatients with intraarticular resection and endoprosthetic replacement of the proximal humerus with reconstruction that included synthetic mesh had better shoulder function and ROM, and more stable joints than patients who had reconstruction without synthetic mesh. This result supports prior observations by others and it remains to be shown whether use of the ligament advanced reconstruction system is superior to other types of mesh or other types of reconstructions. Further investigation is needed but our results indicate that using mesh should be considered for patients with tumor resection and endoprosthetic replacement of the proximal humerus.

Level of Evidence

Level III, therapeutic study.     

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan,China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classified into three types: type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open transection nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmacotherapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity declined with increasing duration of being trapped. In the first year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor(0 or 1) after a 1-year period of treatment, further treatment was not effective.     

Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States

Background and Purpose

The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.

Methods

Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence.

Results

The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05).

Conclusions

This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.     

新型彩头输液管用于多通道微量泵静脉输注的模拟实验研究

目的 探讨新型彩头输液管在多通道微量泵静脉输注时识别的准确性、效率,降低微量泵用药风险及提高抢救效率.方法 模拟微量泵静脉输注试验,设实验组和对照组,各组1个操作站,各有5台微量泵,2个操作站所用药物一致.对照组采用5根传统微量泵输液管连接注射器与三通,实验组采用新型彩头微量泵输液管连接注射器与三通.结果 对照组受试者完成所有药物与三通一一对应所用时间为(45.2±18.4)s,平均每种药物对应所需时间为(9.0±3.7)s,实验组用时分别为(15.7±3.1)s和(3.1±0.7)s;对照组91.95％受试者将药物与三通对应操作完全准确,实验组为99.66％,两组比较,差异有统计学意义(均P＜0.01).结论 新型彩头输液管能提高工作效率,保证微量泵用药的安全性和准确性,有助于降低医疗风险和提高抢救效率;且操作方便快捷.     

慢性肾脏病患者血清胎盘生长因子水平及其与左心室结构和功能的关系

目的 探讨慢性肾脏病(CKD)患者血清胎盘生长因子(placental growth factor,PLGF)水平及其与左心室结构和功能的关系.方法 选取CKD非透析患者72例,年龄、性别相匹配的健康体检者16例作为对照组.采用酶联免疫吸附法测定血清PLGF浓度,心脏超声评定心脏形态和结构.结果 (1)CKD患者血清PLGF显著高于对照组[3.32(2.97,19.77) ng/L比2.33 (2.27,2.49) ng/L,P＜0.01];且随着肾功能的减退,PLGF水平进行性升高(P＜ 0.05/6).(2)CKD各期患者的室间隔厚度(IVST)和左室后壁厚度(LVPWT)升高,射血分数(EF)下降.(3)CKD患者左心室肥厚组血清PLGF显著高于非左心室肥厚组[19.05 (3.31,21.05) ng/L比2.99 (2.60,3.32) ng/L,P＜0.05].PLGF高浓度组左室肥厚发生率显著高于PLGF低浓度组(70％比18％,P＜ 0.01).(4)相关分析显示PLGF与左心室质量指数、收缩压、舒张压、24 h尿蛋白、血肌酐(Scr)、血尿酸(UA)、血尿素氮(BUN)、甲状旁腺激素(iPTH)、高血压病史呈正相关(P＜0.05),与左心室射血分数、血红蛋白(Hb)、血白蛋白(Alb)、肾小球滤过率(eGFR)呈负相关(P＜0.01).多元线性逐步回归分析显示,血肌酐、血红蛋白、射血分数、血尿酸是PLGF的独立相关因素(P＜0.05).结论 CKD患者血清PLGF显著升高,PLGF与CKD患者心脏结构和功能改变密切相关,其可能参与CKD患者心血管事件的发生.     

Risk factors for cardiovascular and cerebrovascular morbidity and mortality in maintenance hemodialysis patients

Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2±16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI: 1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P＜0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.