离心对不同层次脂肪移植成活率的影响*

目的 探究离心后不同层次脂肪的移植成活率,以便更好地指导临床应用。方法 选取新西兰兔腹股沟脂肪,按照Coleman方法离心脂肪,并将其分为上、中、下3层,每层各1 ml移植于背部皮下;3个月后,对移植物进行组织学观察、测量体积及CD31免疫组织化学染色。结果 下层脂肪移植物成活体积,血管密度及成活质量均高于上层和中层脂肪移植物（P?<0.05）,而中层和上层脂肪移植物成活体积、血管密度脂肪成活质量比较,差异无统计学意义（P?>0.05）。结论 按Coleman方法离心后的下层的脂肪成活率及成活质量较好,可以作为临床脂肪移植的理想选择。     

Hybrid Lateral Closed-Wedge High Tibial Osteotomy Showed Similar Accuracy in Angular Correction and Reduction of Posterior Tibial Slope Compared to Opening-Wedge High Tibial Osteotomy: A Correction Angle Matched Cohort Study

BackgroundWe aimed to compare the accuracy of applied correction angle between hybrid lateral closed wedge high tibial osteotomy (hybrid HTO) and medial open wedge high tibial osteotomy (OWHTO), and verify previous reports on hybrid HTO by matching correction angle between groups. Change in various radiological parameters including union rate were also compared.MethodsA total of 50 OWHTO patients were selected for 2:1 propensity matching with 25 hybrid HTO patients. Rate of correction error was calculated by dividing the difference between the change in medial proximal tibial angle and preoperatively planned correction angle (PRD) by planned correction angle. Accuracy of angular correction was assessed using PRD and correction error rates. Hip-knee-ankle axis, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, and length of the entire lower limb and tibia were measured. The Caton-Deschamps index (CDI) was used to assess change in patellar height. Serial postoperative radiographic analysis was performed to assess the union rate.ResultsThe discrepancy between planned correction angle and real correction angle was 0.8 ± 2.3° in hybrid HTO and 1.1 ± 3.4° in OWHTO (P > .05), and the rate of error in osteotomy was similar between the groups approximately 6%. Postoperatively, posterior tibial slope (PTS) (P < .001), tibia length, and CDI (P < .001) were significantly different between groups. The amount of change in PTS (P < .001), tibia length in hybrid HTO (P < .001), and CDI (P < .001) were significantly different between groups. Union rate of osteotomy site was significantly faster in hybrid HTO than in OWHTO (P < .001).ConclusionHybrid HTO showed similar accuracy in angular correction compared to correction angle-matched OWHTO. Reduction in PTS, tibial shortening, maintained patellar height relative to the proximal tibia, and faster osteotomy site union were also confirmed in hybrid HTO.     

Long-Term Outcomes of Cementing Highly Cross-Linked Polyethylene Liners Into Well-Fixed Acetabular Shells in Revision Total Hip Arthroplasty

BackgroundCementing a new liner into a secure, well-positioned metallic shell can be a less-invasive strategy in revision total hip arthroplasty (THA). This study aimed to report the mean 14-year outcomes of cementing highly cross-linked polyethylene (XLPE) liners into well-fixed acetabular shells in revision THAs.MethodsThis study reviewed a single-surgeon series of cementing XLPE liners into well-fixed acetabular components. Of the 52 hips (51 patients) evaluated, 48 hips (47 patients) that satisfied a minimum follow-up of 10 years were included. The Harris Hip score was used for clinical evaluation. Final hip radiographs were used to determine the extent of acetabular osteolysis and stability of the components. The mean age at index operation was 53 years (range, 32 to 72). The mean follow-up duration was 14 years (range, 10 to 18).ResultsThe mean Harris Hip score improved from 58 points (range, 23-81) preoperatively to 91 points (range, 45-100) at the final evaluation (P < .001). A total of 3 acetabular rerevisions were performed, all for aseptic loosening of the outer shell. One postoperative dislocation occurred, but it was successfully treated with a closed reduction. Final radiographs showed a significant reduction in acetabular osteolysis (P < .001). Implant survivorship free from any rerevision was 93.3% (95% confidence interval, 85.9-100%) at 14 years.ConclusionCementing an XLPE liner into a well-fixed acetabular shell in revision THA demonstrated excellent clinical and radiographic outcomes at a mean of 14 years postoperatively. This technique could be a safe and durable option in the absence of XLPE liners compatible with preimplanted shells.     

术前血清学联合影像学检查预测肝内胆管癌根治性切除术后患者生存获益的研究

背景与目的 肝内胆管癌（ICC）起病隐匿、侵袭性高,患者往往确诊时已失去了最佳手术时机,接受手术者5年生存率也极低。早期判断患者根治性切除术的生存获益至关重要。本研究依据术前影像学联合血清学指标对ICC根治性切除患者生存获益实行预测,以期对临床判断是否适宜行根治性切除提供指导与参考。方法 回顾性收集2010年1月—2021年12月于中国13家三甲医院行根治性切除的821例ICC患者的影像学与血清学检测资料。影像学指标包括：发现肝脏肿块、肝内胆管扩张、门静脉侵犯、淋巴结侵犯、腹水及结石;血清学指标包括：血红蛋白、白细胞计数、淋巴细胞计数、中性粒细胞计数、甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、CA125、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、白蛋白（ALB）及凝血酶原时间（PT）。通过单因素与多因素Cox回归筛选目标变量,用目标变量构建CoxPH模型并绘制列线图,用Kaplan-Meier生存分析验证评分与患者预后的关系,通过受试者工作特征（ROC）曲线及校准曲线对模型预测效能进行评估。结果 影像学发现腹水、肝内胆管扩张、淋巴结侵犯与血清学指标CEA>5 μg/L、CA19-9>37 U/mL、CA125>40 U/mL是独立预后因素（均P<0.05）。用该六个变量构建CoxPH模型,根据该模型所区分的高风险组患者术后1、3、5年生存率均明显低于低风险组患者（均P<0.05）;所构建的列线图具有较好的区分度及有效性。ROC曲线显示,模型1、3、5年预测的曲线下面积分别为0.711、0.721、0.782;模型1、3、5年预测效能均高于独立指标的预测效能。结论 由CA125、腹水、肝内胆管扩张、淋巴结侵犯、CEA、CA19-9这六个术前指标组成的预后模型能较好地对患者进行高低风险分层,并对ICC患者根治性切除术后生存获益进行较精准的个体化预测,对临床医生判断患者是否适宜行根治性切除具有指导意义。     

阳和汤联合唑来膦酸治疗肺癌骨转移癌痛的疗效及对血清NTX、ALP的影响

目的 探讨阳和汤联合唑来膦酸治疗肺癌骨转移瘤癌痛的疗效及对血清NTX、ALP的影响。方法 采用完全随机法将84例患者随机分为对照组和观察组,各42例。对照组予以唑来膦酸治疗,观察组在对照组的基础上加用阳和汤。通过对比治疗前后癌痛的疗效、疼痛VAS评分、血清NTX及ALP水平、卡氏功能（KPS）评分、不良反应等,比较两组治疗方法的疗效差异。结果 治疗后两组癌痛治疗有效率比较,观察组为78.5%,对照组为54.7%,差异有统计学意义（P<0.05）,治疗后两组患者疼痛VAS评分均较治疗前下降,且观察组低于对照组,差异有统计学意义（P<0.05）。治疗后观察组血清骨代谢标志物NTX、ALP水平较对照组明显下降,差异有统计学意义（P<0.05）,治疗后两组患者KPS评分比较,观察组有效率为88.09%,对照组有效率为80.95%,差异无统计学意义（P>0.05）。两组患者不良反应比较,差异无统计学意义（P>0.05）。结论 阳和汤联合唑来膦酸能够有效缓解肺癌骨转移癌痛,并降低血清NTX、ALP水平。     

Evaluating the population measles susceptibility in Tianjin,China

BackgroundMeasles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. China has not reached elimination goals despite high vaccination coverage. We estimated the population susceptibility against measles in Tianjin, China and to tailor awareness raising activities in the measles elimination plan.MethodsAge-specific measles seroprevalence was evaluated by Enzyme-Linked Immunosorbent Assay (ELISA) on 12,164 individual aged 0–44 years in 2009–2018. Measles IgG avidity testing was performed to confirm the relationship of the waning immunity after vaccination and secondary vaccination failures (SVF) on 324 confirmed measles cases in 2013–2018.Results11,108 samples (91.32%) tested positive for measles IgG, 239 (1.96%) tested as equivocal and 817 (6.72%) were negative. The age distribution of measles cases in Tianjin followed a U-shaped curve and was highest for those at <8 months and again at 20–39 years which correlated closely with the age distribution of measles susceptibility based on measles IgG antibody status (r = 0.72, P < 0.001). The seropositivity rate and antibody geometric mean concentration (GMC) for the 2018 study population were significantly lower (χ² = 7.45, P = 0.006 and t = 12.01, P < 0.001) compared to 2009. The multivariate stepwise logistic regression analysis showed that age and region were the risk factors for both measles seropositivity rate and GMC after vaccination. The proportion of high avidity cases increased with age, being significantly higher in 75.31% of cases in patients aged 30–34 years (χ² = 18.04, P = 0.003).ConclusionsHigh immunization coverage in children alone will not be adequate to realizing sufficient levels of population herd immunity, particularly given that the potential susceptibility window in adult. Implementation of supplemental immunization activity (SIA) targeted to appropriate group aged 30–34 years is recommended.     

以每搏量变异度为指导的液体治疗在腹腔镜精准肝切除术中的应用

目的：观察以每搏量变异度(stroke volume variation,SVV)为指导的目标导向液体治疗(goal-directed fluid therapy,GDFT)在腹腔镜精准肝切除术中的安全性及对患者短期预后的影响。方法：120例18~65岁择期全麻下行腹 腔镜精准肝切除术患者,随机分为以SVV为指导的治疗组(S组)和以中心静脉压为指导的治疗组(C组),每组60例。 记录入室(T0)、切皮(T1)、始切肝(T2)、肝横断面完成(T3)、术毕(T4)的平均动脉压和心率,T0~T5(术后1 d)的乳酸值 (lactic acid value,LAC),术中出入量及低血压和去氧肾上腺素使用情况,术后肝功能、血红蛋白等恢复情况。结果： 与C组比较,S组术中低血压例数、出血量、去氧肾上腺素用量均明显降低(P<0.05),T3和T4时间点LAC升高不明显 (P<0.05),术后1和2 d的AST,ALT,DBIL,TBIL升高幅度明显降低(P<0.05)。S组术后1 d血红蛋白、红细胞压积明显 高于C组(P<0.05),术后排气时间、住院时间明显缩短(P<0.05),感染率和入住ICU率均降低(P<0.05)。结论：腹腔镜 精准肝切除术中以SVV为指导的目标导向液体治疗安全、有效,可减少术中失血量,利于患者短期预后。切肝期采 用高SVV值(13%~17%),横断面离断至术毕采用8%~12% SVV值可作为术中液体治疗策略之一。     

脂肪干细胞对大鼠急性放射性皮肤损伤的干预作用

目的：研究脂肪干细胞(adipose derived stem cells,ADSCs)在SD大鼠放射性皮肤损伤中的干预作用。方法： 采用剂量为90 Gy的192Ir放射源,对SD大鼠左侧大腿内侧皮肤进行单次近距离照射,建立放射性皮肤损伤动物模型, 并随机将其分为实验组和对照组(n=9)。照射后24 h,实验组大鼠照射处注射60 μL(5×105个)脂肪干细胞,对照组注 射等体积的PBS。每隔3~4 d观察大鼠照射处皮肤损伤及愈合情况。照射后第28天,处死所有SD大鼠,取照射处皮 肤组织,同时取未照射的正常组(n=9)相应部位的皮肤组织切片,采用免疫组织化学法比较3组皮肤组织中α-平滑肌 肌动蛋白(α-smooth muscle actin,α-SMA)表达情况;HE染色观察皮肤组织病理学表现。结果：SD大鼠在受照射后出 现III或IV度放射性皮肤损伤;实验组的创面评级明显低于对照组,愈合时间明显短于对照组;正常组皮肤组织中不 表达α-SMA,实验组较对照组皮肤组织中的α-SMA表达增强;实验组表皮厚度低于对照组,而血管密度明显增加(均 P<0.05)。 结论：192Ir放射剂量为90 Gy时可以导致大鼠皮肤损伤,而ADSCs可以减轻放射性皮肤损伤,并通过增加微 血管新生促进溃疡愈合。     

影像组学在预测非小细胞肺癌分子标志物P63中的应用价值

目的：建立基于非小细胞肺癌(non-small cell lung cancer,NSCLC)肿瘤CT图像的影像组学模型,预测NSCLC 分子标志物P63的表达状态。方法：回顾性分析2014年1月至2018年3月接受CT扫描的245例NSCLC患者。患者均经组 织病理学检查确诊,并在CT检查后2周内进行P63表达状态检测。通过MaZda软件提取CT平扫图像的影像组学特征, 并且定义肿瘤CT图像的主观影像征象。使用Lasso-logistic回归模型进行特征筛选并分别建立影像组学模型、主观影像 征象模型及融合诊断模型。通过受试者操作特征(receiver operator characteristic,ROC)曲线评估每个模型的预测性能, 并采用Delong检验进行比较。结果：在245例患者中,P63阳性96例,P63阴性149例。主观影像征象模型由6个影像征 象组成。通过特征选择,影像组学模型包括8个影像组学特征。主观影像征象模型和影像组学模型预测P63表达状态 的ROC曲线下面积分别为0.700和0.755,二者差异无统计学意义(P>0.05)。融合诊断模型较另2种模型具有最佳预测能 力,ROC曲线下面积为 0.817(P<0.01)。结论：基于CT图像的影像组学模型可以预测NSCLC分子标志物P63的表达状 态;融合影像组学特征和主观影像征象的诊断模型可以显著提高模型的预测性能,有助于无创性了解肺癌细胞分子 水平信息。     

个性化护理干预对甲状腺微小乳头状癌患者的应用效果

目的 探究个性化护理干预对甲状腺微小乳头状癌患者的护理效果。 方法 选取2016年1月—2018年8月在长沙市第一医院接受治疗的甲状腺微小乳头状癌患者120例,采用随机数字表法将患者分为常规组和个性化组,各60例,常规组使用常规护理方法进行护理,个性化组给予个性化护理;统计2组患者焦虑自评量表(self rating anxiety scale,SAS)、抑郁自评量表(self rating depression scale,SDS)评分情况以及生活质量、护理质量评分,对2组患者住院时间以及护理满意度进行统计。 结果 2组患者护理前的SDS量表、SAS量表评分对比,差异均无统计学意义(均P＞0.05);护理干预后个性化组的SDS量表、SAS量表评分显著低于常规组的SDS量表、SAS量表评分,差异均具有统计学意义(均P＜0.05)。2组患者护理前各生活质量评分对比,差异均无统计学意义(均P＞0.05);护理干预后个性化组的各生活质量评分显著高于常规组的各生活质量评分,差异均具有统计学意义(均P＜0.05)。个性化组患者的平均住院时间显著低于常规组,护理质量显著高于常规组,差异具有统计学意义(均P＜0.05)。个性化组的总满意度为95.00%,显著高于常规组73.33%的总满意度,差异具有统计学意义(P＜0.05)。 结论 使用个性化护理模式对甲状腺微小乳头状癌患者进行护理干预,可以明显改善患者的心理状态,促进患者身体恢复,提高患者的生活质量,使患者及家属更加满意。