C反应蛋白白细胞及中性粒细胞百分比值对败血症早期患者的诊断意义

目的探讨血液C-反应蛋白(CRP)、白细胞(WBC)及中性粒细胞百分比值(NEU%)在血培养阳性败血症患者中的诊断价值。方法回顾性分析2010年9月至2011年5月血培养阳性患者14例、阴性76例,对血液CRP、WBC及不同临界值NEU%进行诊断评价。结果 CRP、WBC及70%临界值的NEU%在血培养阳性组和血培养阴性组间差异无统计学意义(P>0.05)。当NEU%以大于80%、90%为临界值时差异有统计学意义,敏感度分别为57.1%、28.6%,特异性分别为56.6%、89.5%,阳性预测值分别为19.5%、33.3%,阴性预测值分别为12.2%、12.8%。联合检测CRP、WBC和80%、90%临界值的NEU%3项非特异性指标时,各指标敏感度分别为28.6%、14.3%,特异性分别为27.6%、81.8%,阳性预测值分别为6.8%、22.2%,阴性预测值分别为67.7%、85.2%。结论 WBC、CRP、NEU%作为早期诊断败血症的指标有一定的局限性,不能作为准确的诊断指标。以大于80%、90%的NEU%为临界值在败血症早期具有诊断意义,联合检测CRP、WBC指标可以排除诊断。     

Medial plantar artery perforator flap for soft-tissue reconstruction of the heel

Soft-tissue wounds of the foot and especially the heel are challenging problems for reconstructive surgeons. An important principle that guides heel reconstruction is to provide sensate skin with a similar thickness to resurface the weight-bearing heel and avoid late flap ulceration. Among various techniques to achieve this result, the sensate medial plantar perforator flap is an excellent option, which provides durability to friction, a cushioning effect, and sensation. An anatomic study was performed to clarify the anatomy of the cutaneous perforators of the medial plantar artery and to determine the optimal method of medial plantar artery perforator flap harvest. Fifteen cases of heel reconstruction with the sensate medial plantar perforator flap are presented. The outcome of surgery at a mean follow-up of 12 months is reported. The indications for surgery, operative procedures, advantages and disadvantages, and results are presented. Satisfactory results were obtained with a good color and texture match for heel repair and a good sensory recovery. No functional deficit was found at the donor site.     

Resting and post‐exercise serum biomarkers of cardiac and skeletal muscle damage in adolescent runners

This study examined the response of serum biomarkers of cardiac and skeletal muscle damage at rest and after a routine workout of 21 km run in 12 male adolescent (16.2±0.6 years) long‐distance runners. Biomarkers of cardiac [troponins (cTnT, cTnI), creatine kinase MB mass (CK‐Mbmass)] and skeletal muscle [creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hydroxybutyrate dehydrogenase (HBD)] damage were assayed at rest, 2, 4 and 24 h post‐exercise. At rest, cTnT and cTnI were not detectable; however, CK, CK‐MBmass, AST, ALT and HBD were above corresponding clinical cut‐off values. Post‐exercise significant elevations above rest were observed for all biomarkers, except ALT, 2 and 4 h following the run, and remained elevated in cTnI, CK, CK‐MBmass, LDH and AST 24 h post‐workout. A significant increase in data points above clinical cut‐off values from rest to post‐exercise was reported for cTnT, cTnI and CK at 2 and 4 h, and in cTnI and CK 24 h post‐exercise. In conclusion, a 21 km run in adolescent runners increased post‐exercise biomarkers of cardiac and skeletal muscle damage.     

CD20阳性儿童前B急性淋巴细胞白血病临床特点与预后分析

急性淋巴细胞白血病(ALL)是儿童最常见的恶性肿瘤,其中多数为前B-ALL(PreB-ALL).在这部分患儿中,CD20表达阳性是否与患者治疗反应和预后相关,国外仅有个别文献报道,国内也只有成人病例报道,提示CD20表达对预后无显著影响[1].我们回顾性分析了CD20表达阳性的PreBALL患儿的临床特点,并探讨其与治疗反应和预后的关系.     

Expression of dendritic cell-specific intercellular adhesion molecule 3 grabbing nonintegrin on dendritic cells generated from human peripheral blood monocytes

AIM:To generate dendritic cells(DCs)from human pe-ripheral blood and to detect the expression of dendriticcell-specific intercellular adhesion molecule 3 grabbingnonintegrin(DC-SIGN;CD209)for the further study ofDC-SIGN in hepatitis C virus(HCV)transmission.METHODS:Peripheral blood monocytes were isolatedfrom blood of healthy individuals by Ficoll—Hypaquesedimentation and cultured in complete medium contain-ing rhGM-CSF and rhIL-4.Cells were cultured for sevendays,with cytokine addition every two days to obtainimmature DCs.Characteristics of the cultured cells wereobserved under light and scanning microscope,and theexpression of DC-SIGN was detected by immunofluores-cence staining.RESULTS:After seven-day culture,a large number ofcells with typical characteristics of DCs appeared.Theircharacteristics were observed under light and scanningelectron microscope.These cells had a variety of cellshapes such as those of bipolar elongate cells,elaboratestellate cells and DCs.DC-SIGN was detected by immu-nofluorescence staining and its expression level on culti-vated dendritic cells was high.CONCLUSION:DCs with a high expression of DC-SIGNcan be generated from human peripheral blood mono-cytes in complete medium containing rhGM-CSF andrhIL-4.     

Fast track clinical pathway implications in esophagogastrectomy

AIM： To investigate the feasibility of fast track clinica pathway for esophageal tumor resections. METHODS： One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation. RESULTS： Among 114 patients （84 men and 30 women）, 26 patients underwent fast track surgery, including 17 patients over 65 years old and 9 under 65 （P = 0.014）; 18 patients who had preoperative complications could not bear fast track surgery （P 〈 0.001）. No significant differences in tolerance of fast track surgery were attributed to differences in gender, differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d （5-28 d）, 4% patients were readmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION： The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.     

肝动脉变异在活体肝移植中的处理

目的:探讨活体肝移植术前肝动脉评估、术中切取及吻合方式和术后处理方法.方法:回顾性分析活体肝移植患者2例的肝动脉处理方法,通过术前CT血管造影术(CTA)评估供受体肝动脉走形,拟定术中肝动脉的切取方式及吻合方法,探讨移植术后预防肝动脉并发症的方法.结果:CTA是术前评估供受体血管简单有效的方法.肝动脉有变异或动脉内径非常细的情况下,将受体一段动脉完整游离切除在后台和供体肝动脉在高倍显微镜下吻合,可提高动脉吻合质量.术后超声检查的精确性受上腹部气体影响明显时,CTA检查可明确吻合肝动脉的流通状况.术后应及早使用抗凝治疗,及时准确调整全身凝血功能,防止肝动脉栓塞.结论:术前正确的评估和高质量的动脉吻合以及术后适当抗凝治疗是预防术后肝动脉并发症的有效措施.