Tracheoesophageal fistula after primary repair of type C esophageal atresia in the neonatal period: recurrent or missed second congenital fistula

Purpose

The aim of the study is to investigate whether a tracheoesophageal fistula (TEF) found after the primary repair of type C esophageal atresia (EA) is a recannulation of the original fistula, a missed proximal fistula, or other rare foregut malformation.

Methods

Between 2000 and 2009, 143 different types of patients with EA were admitted in our hospital. Seven patients (2 from our series, 5 referred to us by other hospitals with the history of primary repair of type C EA) had late presenting TEF. Esophagogram, 3-dimensional computed tomographic (CT) reconstruction, bronchoscopy, and reoperation were performed to confirm the TEF. Their medical records were reviewed and summarized.

Results

Persistent feeding or respiratory problems were the common symptom. The mean age of the first appearance was 17 ± 26 (1-63) months. Preoperative diagnosis was made by esophagograms and bronchoscopy in 6 patients. Reoperations were performed in all patients through thoracotomy. Missed proximal TEF shown as a distinct fistula above the primary anastomosis without much adhesion was confirmed in 5 cases. A recurrent TEF was found in 1 case. A case of communicating bronchopulmonary foregut malformation was confirmed by 3-dimensional CT reconstruction and reoperation.

Conclusion

A missed proximal TEF after repair of EA may be misdiagnosed as a recurrent TEF. Accurate preoperative diagnosis depends on combined evaluations of radiologic contrast study, 3-dimensional CT, and bronchoscopy.     

多巴胺联合去甲肾上腺素对感染性休克患者肾脏功能的影响

目的研究多巴胺与去甲肾上腺素联合应用对感染性休克患者肾脏功能的影响。方法选择1996年以来在我科ICU接受治疗的感染性休克患者87例,以去甲肾上腺素最大泵注速率分为3组:其中A组28例(0．5～0．9μg·kg-1·min-1),B组30例(1．0～1．5μg·kg-1·min-1), C组29例(1．6～2．0μg·kg-1·min-1)。测定记录所有患者的平均静脉压(MAP)、心率(HR)、尿量、血尿素氮(BUN)、肌酐(CRE)、尿白蛋白(U-ALB)和β2微球蛋白(Uβ2-MG)定量及APACHEⅢ评分。结果治疗前,3组患者均有低血压、心动过速和少尿,多数患者CRE、BUN、U-ALB、Uβ2-MG和APACHEⅢ评分高于正常值上限。经过抗休克治疗,所有患者的MAP、HR、尿量及BUN、CRE均恢复到正常范围,U-ALB、Uβ2-MG定量及APACHEⅢ评分也有所恢复,但仍高于正常。结论在感染性休克的治疗中,应以恢复脏器血流灌注为首要目标,以容量复苏为主,必要时辅以多巴胺、去甲肾上腺素等血管活性药物来维持循环稳定。     

The prognostic role of tumour‐infiltrating lymphocytes in oral squamous cell carcinoma: A meta‐analysis

It has been suggested that tumour‐infiltrating lymphocytes (TILs) are associated with the progression of oral squamous cell carcinoma (OSCC). However, the prognostic value of TILs is inconclusive due to the heterogeneity of immune cells within the tumour microenvironment. In this meta‐analysis, we aimed to assess the prognostic value of TILs in OSCC. The PubMed, Cochrane, Embase, Scopus and Web of Science databases were searched up to April 20, 2019, and 33 studies were ultimately included in this meta‐analysis. Our pooled meta‐analysis showed that high infiltration of CD8⁺ TILs, CD45RO⁺ TILs and CD57⁺ TILs favoured better overall survival (OS). However, high infiltration of CD68⁺ macrophages and CD163⁺ macrophages was associated with poor prognosis in OSCC. These findings suggest that CD8⁺ TILs, CD45RO⁺ TILs, CD57⁺ TILs, CD68⁺ macrophages and CD163⁺ macrophages might serve as novel prognostic factors and therapeutic targets in OSCC.     

股骨头坏死动物模型评价方法的优缺点及展望

背景:股骨头坏死发病机制仍需要进一步研究,因此需要建立一个能够高度模拟人类股骨头坏死的动物模型,而如何正确评价股骨头坏死动物模型,是建立股骨头坏死动物模型的前提条件.目的:归纳总结近几年国内外对股骨头坏死动物模型的评价方法,综述各评价方法的优缺点,并探索新的评价方法,为动物模型的建立提供参考.方法:以股骨头坏死,动物...     

外剥内扎联合侧方外括约肌部分切断术治疗混合痔的临床疗效

目的探讨外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗混合痔的临床疗效。方法将2013年1月—2016年1月大连市瓦房店妇婴医院肛肠科收治的80例混合痔患者随机分为治疗组(40例)与对照组(40例),其中治疗组患者采用外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗,对照组患者单纯采用外剥内扎术治疗。对比观察两组患者术后肛缘水肿、痔残留、排便费力、首次排便出血及疼痛等并发症的发生情况。结果两组患者均顺利完成手术,其中治疗组患者术后出现肛缘水肿者10例,首次排便疼痛评分2分者30例,首次排便出血评分2分者32例,痔残留者5例,排便费力者5例;对照组患者术后出现肛缘水肿者32例,首次排便疼痛评分2分者10例,首次排便出血评分2分者20例,痔残留者28例,排便费力者30例。两组患者术后出现肛缘水肿、首次排便疼痛评分2分、首次排便出血评分2分、痔残留及排便费力的患者例数对比采用四格表资料的卡方检验,χ~2值分别为24.260、20.000、7.912、27.290及31.750,P均0.01,差异具有统计学意义。结论外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗混合痔,可有效减少术后肛缘水肿、痔残留、排便费力、首次排便出血及疼痛等并发症的发生率,缩短术后创面愈合时间,提高患者生活质量,值得临床推广应用。     

应用金纳米颗粒复合材料(ssDNA-AuNPs)比色检测γ射线照射剂量的可行性研究

目的 建立检测γ射线照射剂量的新方法,探讨应用金纳米颗粒复合材料（ssDNA-AuNPs）比色检测γ射线照射剂量的可行性。方法 将寡核苷酸分子（ssDNA）修饰到金纳米颗粒（AuNPs）表面,制备出复合材料ssDNA-AuNPs。用⁶⁰Co γ射线对其进行照射,剂量分别为0、5、10、20和30 Gy,而后观察溶液颜色变化并测量紫外-可见吸收光谱,建立吸收光谱中625 nm处与521 nm处吸光度的比值（A₆₂₅/A₅₂₁）与照射剂量线性关系。结果 随着⁶⁰Co γ射线照射剂量的不断增加,ssDNA-AuNPs溶液的颜色由酒红色逐渐变为蓝紫色。在0~30 Gy剂量范围内,吸收光谱中A₆₂₅/A₅₂₁的比值对其拟合线性方程为A₆₂₅/A₅₂₁=0.020 6+0.303 6E（R²=0.991 5）。结论 本实验合成的ssDNA-AuNPs能够比色检测γ射线照射剂量,建立了一种比色检测γ射线照射剂量的新方法。     

222Rn-220Rn分辨探测器参加国际比对结果分析

目的 提高²²²Rn与²²⁰Rn的累积测量水平,保证测量结果的准确性与可靠性。方法 采用中国疾病预防控制中心辐射防护与核安全医学所的氡课题组（以下简称本实验室）改进的LD-P型²²²Rn-²²⁰Rn分辨探测器参加日本放射线医学综合研究所（NIRS）组织的²²²Rn-²²⁰Rn累积探测器国际比对。将²²²Rn-²²⁰Rn分辨探测器寄往日本,在NIRS的²²²Rn室和²²⁰Rn室进行不同条件下的比对,暴露结束后再寄回本实验室进行蚀刻与分析,测量结果告知NIRS。最后NIRS将²²²Rn与²²⁰Rn暴露参考值回馈本实验室。结果 在高²²²Rn和低²²²Rn条件下,测量值与NIRS提供的参考值的相对百分偏差（RPD）分别为-12.0%、-11.8%;变异系数（COV）分别为3.0%、6.2%。在高²²⁰Rn和低²²⁰Rn条件下,测量值与NIRS提供的参考值的相对百分偏差（RPD）分别为-0.8%、-8.0%;变异系数（COV）分别为6.7%、4.5%。结论 本次比对LD-P型探测器²²²Rn与²²⁰Rn的测量结果均为NIRS规定的Ι级结果（PRD<10%）,比对结果较好。     

A case report of left ventricular non-compaction in progression to dilated cardiomyopathy: Diagnostic utilization of multiple imaging modalities

Left ventricular non-compaction, which is characterized by left ventricular hypertrabeculation, is a rare congenital cardiomyopathy. The changing and progressing morphology, with different clinical manifestations, made the diagnosis difficult. Here is a case report of a middle-age woman, who had exercise intolerance for many years. Traditional echocardiography showed findings of dilated cardiomyopathy but obscure trabeculations, which was clearly seen by three-dimensional echocardiography. Subsequent cardiac magnetic resonance imaging well demonstrated the myocardial non-compaction and delayed enhancement. LVNC could be found early in a child, and also in a mid-age adult. When a patient with LVNC had progressing heart failure, the hypertrabeculation may become less prominent. The utilization of three-dimensional echocardiography and MRI would help identify such landmark findings.