特发性脊柱侧凸患者肩部失平衡的临床分析及其意义

目的：对不同类型特发性脊柱侧凸（idiopathic scoliosis,IS）患者肩部失平衡情况进行观察,探讨避免肩部失平衡的融合节段选择方案.方法：对137例随访2年以上资料完整的IS患者进行回顾性分析.对术前及术后的肩部平衡进行影像学评价.根据可能影响肩部平衡的因素（上胸椎侧凸情况、各个侧凸间相互平衡情况及主侧凸角度大小）将患者的Lenke分型进一步分为不同类型.分析各因素及手术融合方式对肩部平衡产生的影响.结果：术前肩部失平衡的病例71例;其中显著肩部失平衡22例;重度肩部失平衡10例,均为Lenke 1型及Lenke 2型.这些患者均存在较大角度的上胸椎侧凸（非结构性或结构性）.术后6例显著肩部失平衡.其中Lenke 1型第一类型1例,Lenke 2型第一类型1例,Lenke 2型第三类型4例,手术方式均为选择性融合.对Lenke 2型第二类型进行双侧凸融合,术后肩部失平衡改善.结论：术前肩部不平衡主要为Lenke 1型及Lenke 2型患者.上胸椎侧凸畸形对肩部平衡产生关键性影响.对Lenke 2型第二及第三类型不建议行选择性融合,对Lenke 2型第一类型进行选择性融合时应避免过度矫正.     

Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma

BACKGROUND: Radiofrequency ablation (RFA), currently used extensively for liver tumors, also has been applied successfully to hepatic cavernous hemangioma (HCH) percutaneously. The aim of this study was to assess the feasibility, safety, and efficacy of laparoscopic RFA for patients with HCHs. METHODS: Between March 2001 and March 2004, 27 patients with symptomatic and rapid-growth lesions were treated by laparoscopic RFA using the RF-2000 generator system. The treatment-related complications were observed. All the patients were followed up with helical computed tomography scans and ultrasonography at regular intervals to assess the therapeutic efficacy of laparoscopic RFA. RESULTS: This study assessed 9 men and 18 women with a mean age of 41.6 +/- 8.3 years. Three additional intrahepatic lesions missed preoperatively were found in three patients on intraoperative ultrasound. A total of 27 patients with 50 liver lesions were treated successfully with laparoscopic RFA. The mean maximum tumor diameter was 5.5 +/- 2.0 cm. The mean length of time for RFA per lesion was 20.7 +/- 11.9 min, and the mean blood loss was 134.4 +/- 88.9 ml. Laparoscopic cholecystectomy was performed simultaneously for gallstones in 13 patients and for abutting of gallbladder from hemangioma in 2 patients. In addition, 3 patients also had a laparoscopic deroofing of simple hepatic cysts. Although postoperative low-grade fever and transient elevation of serum transaminase levels were observed in 13 patients, there were no complications related to laparoscopic RFA. During a median follow-up period of 21 months (range, 12-42 months), complete lesion necrosis was achieved for all the patients. CONCLUSIONS: Laparoscopic RFA therapy is a safe, feasible, and effective treatment option for patients with symptomatic and rapid-growth HCHs located on the surface of the liver or adjacent to the gallbladder. Intraoperative ultrasonography is a useful adjunct for detecting additional liver lesions and offering more accurate targeting for RFA.     

CKC术与LEEP术在治疗高级别宫颈鳞状上皮内病变的临床研究

目的 比较冷刀锥切术(CKC)与宫颈环形电锥切术(LEEP)治疗高级别宫颈鳞状上皮内病变的临床价值.方法 167例阴道镜下活检病理诊断为高级别宫颈鳞状上皮内病变的患者,其中75例接受CKC治疗(CKC组),92例接受LEEP治疗(LEEP组),分别收集两组患者临床资料,分析对比两组患者临床治疗效果及并发症情况.结果 CKC术与LEEP术均能够弥补三阶梯诊断流程的不足,治疗效果二者比较差异无统计学意义(P＞0.05),而LEEP术在术中出血量、手术时间,以及术后宫颈狭窄的发生率方面均优于CKC术,二者比较差异有统计学意义(P＜0.05).结论 LEEP术在治疗高级别宫颈鳞状上皮内病变具有明显优势.     

改良分次酶消化法分离培养兔肌腱干细胞及诱导分化鉴定

目的  采用改良分次酶消化法体外分离培养家兔肌腱干细胞,观察其生物学特性,并进行诱导分化及鉴定。方法  无菌条件下取出家兔髌腱组织,分别运用改良的分次酶消化法和酶消化后低密度稀释接种法进行分离、培养、传代,用倒置相差显微镜观察细胞形态特征并绘制两种方法的生长曲线,通过流式细胞鉴定仪检测肌腱干细胞表面抗原标志物的表达,取P3-P4代肌腱干细胞向成骨细胞、成软骨细胞诱导分化并鉴定。结果  改良的分次酶消化法较酶消化后低密度稀释接种法细胞增殖速度加快,形态均一,杂质细胞少。分离出的肌腱干细胞表面抗原标志CD90、CD44呈阳性,而CD34、CD14呈阴性,证实之前分离的细胞为肌腱干细胞。鉴定出肌腱干细胞具有向成骨细胞和成软骨细胞分化能力。结论  采用改良的分次酶消化法分离培养兔肌腱干细胞简单易行,肌腱干细胞生长及传代速度可观,活性良好,纯度较高。另外,肌腱干细胞的成功分离培养,也为肌腱相关疾病的研究开辟了一条新途径。

     

神经系统副肿瘤综合征临床诊断进展

神经系统副肿瘤综合征（paraneoplastic neurological syndrome,PNS）是肿瘤通过远隔效应累及神经系统的一组罕见的免疫介导性疾病,其临床症状多样,通常伴有特异性的神经抗体。2021年,国际专家组修订了2004年PNS诊断标准,提出了新的临床评分系统,突出强调了“表型-抗体-肿瘤”的关联性。本研究回顾近年文献,围绕新标准,对PNS的临床诊断进展作一综述。     

血清ICAM-1、CRP及MCP-1水平与阿替普酶静脉溶栓脑卒中患者预后的关系

目的 探究血清细胞间黏附分子-1(ICAM-1)、C反应蛋白(CRP)和单核细胞趋化蛋白-1(MCP-1)水平与阿替普酶静脉溶栓脑卒中患者预后的关系。方法 选取2018年3月—2021年3月在本院接受阿替普酶静脉溶栓治疗的急性缺血性脑卒中(AIS)患者127例,根据治疗后90 d的改良Rankin量表(mRS)评分结果将患者分为预后良好组(mRS≤2分,n=81)和预后不良组(mRS>2分,n=46)。比较两组患者一般临床资料和血清ICAM-1、CRP、MCP-1水平,Logistic回归分析法分析影响AIS患者预后的危险因素,受试者工作特征曲线(ROC)评估ICAM-1、CRP、MCP-1对AIS患者溶栓后90 d预后不良的预测价值。结果 预后不良组患者的冠心病、心房颤动发生率和美国国立卫生研究院卒中量表(NIHSS)评分均高于预后良好组(P<0.05),血清ICAM-1、CRP和MCP-1水平均高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,心房颤动、NIHSS评分、ICAM-1、CRP和MCP-1是影响AIS患者阿替普酶静脉溶栓后预后不良...     

生活环境因素暴露对支气管哮喘非急性发作期患者呼出气一氧化氮水平的影响

背景 呼出气一氧化氮(FeNO)的测量具有安全、无创、简便、重复性好等特点已经被广泛应用于哮喘患者气道炎症的评估,但FeNO的测定结果受到多种因素的影响,生活环境因素暴露可能与FeNO水平有较为密切的关系,而目前关于生活环境因素暴露对FeNO水平影响的研究较少。目的 分析生活环境因素暴露对支气管哮喘非急性发作期患者FeNO水平的影响,以提高临床医生利用FeNO管理哮喘的效能。方法 纳入2018年7月至2020年6月就诊于广州医科大学附属第二医院呼吸内科门诊的109例支气管哮喘非急性发作期患者作为研究对象,通过问卷调查的方法收集资料,问卷信息主要包括一般资料(性别、年龄、身高、体质量)、生活环境因素(包括吸烟史,家人在家是否吸烟,过敏史,居住地位置,居住地离车流量大的主干道位置,居住地周围有无工厂,居住房屋楼层,房屋居住年限,床单、被/枕套清洗晾晒的频率,家中窗帘材料,家中有无盆栽花草,家中垃圾桶有无定期清洗,家中有无饲养宠物,家中有无蟑螂,厨房垃圾有无当天处置,家中是否有毛绒玩具),并收集FeNO的检查资料。根据FeNO水平将支气管哮喘患者分成3组:FeNO低水平组(FeNO<2...     

神经外科重症监护病房住院医师规范化培训教育的思考

重症神经外科是神经外科住院医师规范化培训的难点和重点之一。通过对重庆医科大学附属第一医院神经外科重症监护病房的住院医师进行以急救技能培训、理论与实践相辅相成的多模态病例分析、神经影像学及电生理知识的拓展、手术操作及围手术期管理的专科知识培训、定期病例讨论等方式构成的系统性、规范化的培训,他们的临床思维更加地成熟,对神经外科重症监护病人管理方法的掌握时间明显地缩短,参与临床实践的主动性也较前明显地增加,对神经外科患者围手术期管理的方法有了更深刻的认识,有效地提升了神经外科重症监护室的带教成效。     

Prognostic impact of stress echocardiography with discordant stress electrocardiography in patients with suspected coronary artery disease

INTRODUCTIONDuring stress echocardiography, the echocardiologist routinely collects both echocardiographic images and stress electrocardiogram (ECG) concurrently. The managing physician faces a dilemma when the stress ECG and stress echocardiography results are discordant; for example, when a patient has negative stress echocardiography but positive stress ECG. We therefore sought to evaluate the prognostic value of stress echocardiography in relation to concordant or discordant stress ECG findings in our local Singapore setting, which has a well-defined Southeast Asian population.METHODSThis was a retrospective observational study of all patients who underwent stress echocardiography in 2012 at Changi General Hospital, Singapore. All study patients were followed up for 18 months via electronic medical records.RESULTSThere was no difference in the major adverse cardiovascular events (MACE) outcome of patients with normal stress echocardiography and normal stress ECG (reference group) as compared with patients with normal stress echocardiography but positive (discordant) stress ECG (odds ratio 2.02, 95% confidence interval 0.82‑4.98; p = 0.125).CONCLUSIONThis study will help to reassure cardiologists that discordant results (negative stress echocardiography but positive stress ECG) do not portend a higher risk of MACE when compared to concordant results (i.e. both stress echocardiography and stress ECG are negative).