TLIF术式在布氏杆菌性脊柱炎病人中的临床疗效及安全性分析

目的 对比分析单纯后路内固定+一期经腰椎间孔病椎间病灶清除(TLIF)与经典的前后联合手术在布氏杆菌性脊柱炎患者中的临床疗效及安全性。 方法 对我院2015年1月至2017年12月收治的93例布病性脊柱炎患者的临床资料进行分析。按手术方式分为观察组(45例)和对照组(48例)。对两组患者的基础数据、临床指标、术前术后各项指标水平以及术后并发症、植骨治愈情况。 结果 观察组与对照组基础数据比较,差异无统计学意义(P>0.05)。观察组患者的手术时间、住院天数、术中出血量及术后下床时间均明显低于对照组(P<0.01)。两组患者术后3个月的ODI、VAS、CRP、ESR及Cobb角均明显低于术前(P<0.05);术后3个月,观察组患者的ODI、VAS、CRP、ESR及Cobb角均明显低于对照组(P<0.05)。观察组术后并发症发生率(4.4%)明显低于对照组(25.0%)(Χ²=7.674,P<0.01)。 结论 TLIF治疗布氏杆菌性脊柱炎患者的临床疗效突出,安全性较好,更有利于患者术后身体的恢复。     

以病人为中心的口腔科门诊数字化建设初探

目的：总结以病人为中心的口腔科门诊数字化建设的经验。方法：从诊疗手段、就医流程、医疗文书以及科室管理4个方面总结广州军区武汉总医院口腔科门诊数字化建设的概况。结果：2009年以来开始进行El腔科门诊的数字化建设,经过3年多的运行,科室工作流程优化明显,提高了工作效率和医疗服务质量。结论：科室的数字化建设有助于提高科室的工作效率和医疗服务质量,充分体现了”以病人为中心”这一理念。     

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Introduction

The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach.

Methods

A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data.

Findings

A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46–7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31–3.80 and 0.59–225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79–11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31–5.21 and 0.25–6.50).

Conclusions

Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.     

Fibronectin binding to thrombin-stimulated platelets: evidence for fibrin(ogen) independent and dependent pathways

Plasma fibronectin binds in a specific and saturable manner to thrombin- stimulated platelets. gamma-Thrombin stimulated 80% as much fibronectin binding to platelets as alpha-thrombin with conversion of less than or equal to 1% of platelet fibrinogen to fibrin. Afibrinogenemic and normal platelets bound similar quantities of fibronectin in the presence of calcium or magnesium-ethylene glycol tetra-acetic acid (EGTA). These observations indicate that fibronectin can interact with platelets without involvement of fibrin or fibrinogen. Nevertheless, two different effects of fibrin(ogen) on fibronectin binding were observed. First, exogenous fibrinogen inhibited fibronectin binding to thrombin-stimulated platelets. This inhibition was unidirectional, as fibronectin did not inhibit fibrinogen binding to ADP or thrombin- stimulated cells. Second, formaldehyde-fixed cells with surface- associated fibrin bound significant quantities of fibronectin. This interaction required calcium and did not occur on fixed cells with or without surface-bound fibrinogen. A portion of the ligand bound to fixed cells with surface-associated fibrin was modified to form a derivative with a molecular weight identical to that of the fibronectin subunit cross-linked to the alpha-chain of fibrin. This high mol wt derivative was also observed to a variable extent with living cells in the presence of magnesium or calcium but not in the presence of magnesium-EGTA. Thus, fibronectin binds to platelets by at least two mechanisms: (1) a fibrin(ogen)-independent pathway that requires divalent ions and is inhibited by exogenous fibrinogen; and (2) a fibrin-dependent pathway with an absolute calcium requirement. With nonaggregated, thrombin-stimulated platelets, the former pathway appears to predominate.     

不同抗生素用药方案在预防腹膜透析置管术后腹膜炎中的比较

目的比较不同预防性用药方案在新置腹膜透析导管患者的使用情况,探讨抗生素用药在预防新置腹膜透析导管患者术后发生腹膜炎的重要性。方法回顾性分析2008年10月至2012年10月在北京大学深圳医院肾内科腹膜透析中心接受腹膜透析置管术开始行腹膜透析治疗的患者173例。按照预防性使用抗生素方法分为3组,A组:患者在腹膜透析置管术后3天内使用含有头孢唑啉0.25g/L的腹透液,共计101例次;B组:患者在腹膜透析置管术前3h静脉滴注头孢唑林0.5g,共计48例次;C组:患者术前及术后3天均未使用抗生素,共计24例次。比较3组患者术后14天内腹膜炎的发生率。结果 A组101例患者中1例出现腹膜炎,发生在术后第11天,占0.99%;B组48例患者中2例出现腹膜炎,均发生在术后第1天,占4.17%;C组24例患者中4例出现腹膜炎,3例发生在术后第1天,1例发生在术后第2天,占16.67%。对3组患者腹膜炎发生率进行两两比较,A组与C组比较,P=0.005,P<0.01,差异有统计学意义;B组与C组比较,P>0.05,差异无统计学意义;A组与B组比较,P>0.05,差异无统计学意义。结论腹膜透析置管术围手术期预防性抗生素用药十分有必要,术后腹腔内给药或术前一次静脉用药能有效预防术后腹膜炎发生。