Asian perspective on debulking surgery for advanced ovarian cancer: An E-survey

PurposeWe performed an E-survey to evaluate the practice patterns in debulking surgery for advanced ovarian cancer in Asia.MethodsWe designed a questionnaire, including 50 questions related to debulking surgery for advanced ovarian cancer. The questionnaire was sent to Gynecologic Oncologic Groups in Asia from December 2016 to February 2017.ResultsA total of 253 gynecologic oncologists from Japan (58.9%), the Republic of Korea (19%), Taiwan (12.6%), and the other counties including China (7.5%), Malaysia (0.8%), Indonesia (0.8%), and Thailand (0.4%) participated in this E-survey. The median number of debulking surgeries per year was 20, and 46.8% of the respondents preferred <1 cm as the criterion for optimal debulking surgery (ODS). The most common barrier and surgical finding precluding ODS were performance status (74.3%) and disease involving the porta hepatis (71.5%). Moreover, 63.2% had a fellowship program, and only 15% or less had opportunities to receive additional training courses in general, thoracic, or urologic surgery. The median percentage of patients receiving neoadjuvant chemotherapy (NAC) was 30%, and the achieved rate of ODS in primary debulking surgery (PDS) and interval debulking surgery (IDS) was 65% and 80%, respectively. Most of the respondents required three to 6 h for PDS (48.6%) and IDS (58.9%). Moreover, more than 50% depended on ultra-radical surgery conducted by specialists.ConclusionsThe ODS criteria are relatively lenient with a preference for NAC in 30% of the respondents in Asia. This trend might be associated with the dependence on aggressive surgery performed by specialists.     

Sequencing-based detection of drug-resistant Mycobacterium tuberculosis in patients with spinal tuberculosis

Introduction

Traditionally, bacterial cultures serve as the gold standard for the detection of drug resistance and can provide evidence for directing the treatment of tuberculosis. However, this method has a low positive rate and is time consuming, which significantly limits its wide application. Thus, in the present study, the genes associated with drug resistance were amplified and sequenced to determine the presence of drug-resistant mutations in Mycobacterium tuberculosis. In addition, to find a more sensitive, specific, rapid, and simple method for the detection of drug-resistant bacteria, this method was compared with traditional bacterial culture.

Materials and methods

Pus was collected from surgical patients with spinal tuberculosis. The common drug resistance genes (rpoB, rpsL, and katG) were amplified by PCR. The PCR products were then sequenced, and the sequences were compared with those in the NCBI database using DNATools v.5.1 software.

Results

Mutations were identified in 17 patients, including mutations in the rpsL gene in four patients, the rpoB gene in seven, and the katG gene in six. The mean time of detection was 6?days.

Conclusion

These results indicated that PCR and DNA sequencing are rapid, sensitive, and specific methods for the detection of drug-resistant genes of M. tuberculosis in patients with spinal tuberculosis. This method may provide critical evidence for the clinical treatment of tuberculosis when it is applied in combination with bacterial culture.     

Clinical evaluation of the stability of single-segment short pedicle screw fixation for the reconstruction of lumbar and sacral tuberculosis lesions

Introduction

The routine surgical approach to posterior reconstruction in spinal tuberculosis is short- or long-segment fixation and/or fusion. This method sacrifices movement at more than one vertebral level, limits normal movement of the spinal column, and leads to degeneration of the small joints of the adjacent levels. Surgical techniques that reduce the number of fixed vertebral levels and maximize the retention of movement of the spinal column are of current interest in the treatment of spinal tuberculosis.

Materials and methods

A total of 106 patients with lumbosacral tuberculosis were randomly divided into two groups: a single-segment fixation group and a short-segment fixation group. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting.

Results

The mean postoperative follow-up period was 58.09?±?17.01?months. The average bone graft healing time was 4.35?±?1.04?months in the single-segment group and 4.47?±?1.10?months in the short-segment group. In the single-segment group, correction of the Cobb angle was 14.47?±?3.76° and the loss rate was 7.22?%, and in the short-segment group, correction of the Cobb angle was 16.20?±?2.70° and the loss rate was 6.37?% (P?P?Conclusions Single-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It was be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.     

乙型肝炎患者实施辅助生殖技术中病毒传播的风险与防范

慢性乙型肝炎（简称乙肝）是中国第一大传染病,严重危害健康和威胁生命,受到广泛关注。随着乙肝患者发病率的上升及辅助生殖技术（ART）的迅猛发展,乙型肝炎病毒（HBV）感染者实施ART过程中HBV的传播成为热议话题。对慢性乙肝患者实施ART,因操作不当及管理不严,有发生交叉感染或院内感染的危险,既可能将病毒传播给正常者的配子和胚胎,也可能将病毒传播给医疗技术人员。然而,科学合理地ART可降低病毒传播给子代的风险。综述HBV感染者的ART传播风险和防范措施,为预防病毒传播和医源性感染提供科学依据。     

青春期多囊卵巢综合征不同临床亚型脂代谢的比较性分析

目的:比较青春期PCOS不同临床亚型的脂代谢异常,筛选出青春期PCOS易患心血管疾病的预测指标。方法:选取青春期PCOS患者92例及56例某高中女生作为对照组,测定人体测量学参数(体重指数、腰臀比)及脂代谢相关指标。将青春期PCOS患者分为3个亚型:Ⅰ型(完全满足鹿特丹3个标准):月经稀发或闭经、严重多毛、高雄激素血症和卵巢多囊样改变,Ⅱ型:月经稀发或闭经和高雄激素血症或严重多毛;Ⅲ型:月经稀发或闭经和卵巢多囊样改变,测定人体测量学参数及脂代谢相关指标。结果:PCOS组BMI、WHR、TG、LDL、LDL/HDL、APoB/APoA1高于对照组(P<0.05或P<0.01)。PCOSⅠ型WHR、TG、Chol、LDL、LDL/HDL、APoB、APoB/APoA1高于Ⅲ型(P<0.05),Ⅱ型LDL高于Ⅲ型(P<0.05)。结论:青春期PCOSⅠ型患者具有更严重的脂代谢紊乱,测定LDL/HDL和APoB/APoA1可能对早期发现脂代谢异常有重要价值。     

经皮椎体后凸骨水泥成形联合^125I放射粒子植入治疗脊柱转移瘤

背景：针对肿瘤破坏导致的椎体骨折,进而引起的神经功能障碍,单纯的放疗作用微小。近年来125I放射粒子已广泛应用于多种原发或继发肿瘤并取得良好效果。经皮球囊扩张椎体后凸成形可效恢复椎体高度,重建脊柱稳定性,缓解疼痛症状。 目的：观察经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤的疗效及安全性。 方法：回顾性分析2011年3月至2012年7月经皮球囊扩张椎体后凸成形注入骨水泥联合125I放射粒子治疗的30例脊柱转移瘤患者,收集患者的症状、体征、影像学资料,治疗前均有顽固性背痛,CT提示有椎体骨质破坏。采用目测类比评分、WHO疼痛缓解标准、功能障碍指数来评估治疗后临床症状转归及神经功能恢复情况,测量病椎高度变化。随访时间为治疗后1 d、1个月及6个月。 结果与结论：30例患者治疗过程顺利,治疗后24 h疼痛缓解,无神经损伤及压迫症状。治疗后目测类比评分、疼痛缓解情况、功能障碍指数、椎体高度均较治疗前显著改善（P 〈 0.05）。治疗后随访1个月及6个月,目测类比评分、功能障碍指数、椎体高度变化与治疗后24 h差异无显著性意义（P 〉 0.05）。骨水泥向椎间隙、前纵韧带下渗漏各2例无临床症状。提示经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤,能迅速缓解肿瘤所致的疼痛,有效恢复病椎高度,并发症少,显著提高患者生活质量。     

Long-term high-salt diet causes hypertension and decreases renal expression of vascular endothelial growth factor in Sprague-Dawley rats

We seek to determine: 1) whether a long-term high-salt (HS) diet induces hypertension and renal injury in Sprague-Dawley (SD) rats and 2) whether the HS diet–induced hypertension and renal injury are associated with decreased renal vascular endothelial growth factor (VEGF) expression. Twelve 10-week-old male SD rats received a HS diet (8%) and 12 SD rats received a normal salt diet (NS, 0.5 %) for 8 weeks. Using a tail cuff, weekly monitoring showed that blood pressure (BP) increased significantly after 6, 7, and 8 weeks in the HS group, compared with the NS group (P < .01). At 4 weeks and 8 weeks of diet, mean arterial pressure (MAP) was determined in conscious rats by continuous monitoring through a catheter placed in the carotid artery. MAP was not significantly different between HS and NS group in 4 weeks, but was significantly higher in HS than NS group (140 ± 5.3 vs. 112 ± 2.2 mm Hg; P < .01) in 8 weeks. Increased proteinuria and albuminuria were associated with marked renal histologic abnormalities in the HS group, compared with those in the NS group. Northern blot and enzyme-linked immunosorbent assay (ELISA) demonstrated that 8 weeks of HS diet significantly decreased renal expression of VEGF mRNA and protein, compared with the NS group (P < .01). In 8 weeks, total urinary excretion of sFlt-1 was significantly higher in HS than NS group (9.28 ± 1.05 vs. 2.05 ± 0.55 ng/day; P < .01), whereas the plasma levels of sFlt-1 remained stable. These results suggest that a long-term HS diet induces renal injury and hypertension, which are associated with decreased renal VEGF expression in normotensive rodent animals.     

芬太尼与瑞芬太尼对心脏瓣膜置换术患者 H - FABP 的影响

目的比较芬太尼和瑞芬太尼对在体外循环下行心脏瓣膜置换术患者心肌的影响。方法体外循环下单瓣瓣膜置换术患者40例,分为芬太尼组（F组）和瑞芬太尼组（R组）,每组20例。麻醉诱导2组依次静脉注射咪达唑仑0．05mg·kg-1,依托咪酯0．2mg·kg-1及顺苯磺酸阿曲库铵0．15mg·kg-1,芬太尼10μg·kg-1或R组瑞芬太尼2μg·kg-1。术中2组均持续泵入丙泊酚4～6mg·kg-1·h-1维持镇静,间断静脉推注顺苯磺酸阿曲库铵维持肌松。F组在切皮前、转机前、转机中、停机后,根据血压、心率分别追加芬太尼10～15μg·kg-1;R组持续静脉泵入瑞芬太尼0．2—0．5μg（kg·min）-1,根据血压、心率变化调整输注速度。于麻醉诱导前（哟）、主动脉阻断前即刻（T1）、主动脉开放1h（T2）、主动脉开放3h（13）、主动脉开放6h（T4）、主动脉开放12h（T5）、主动脉开放24h（T6）采动脉血5mL,测血清心型脂肪酸结合蛋白（H—FABP）的浓度。结果2组患者H—FABP蛋白血清浓度在眨、T3、T4及T5时间点均升高,与,IU时间点比较差异有统计学意义（P〈0．05）,且T3时间点升高最明显：2组间H—FABP蛋白血清浓度在各时间点比较差异无统计学意义（P〉0．05）。结论体外循环下心脏瓣膜置换手术可引起患者H—FABP血清浓度增高,临床常用剂量芬太尼和瑞芬太尼在心脏瓣膜置换手术中对H—FABP影响是相似的,故两者在缺血再灌注损伤中对心肌的影响有相似的效应。     

多层螺旋CT灌注成像在评价肝硬化储备功能中的应用

目的 探讨多层螺旋CT灌注成像（CTP）在肝硬化肝脏储备功能评价中的价值。方法 行上腹部CTP增强扫描的住院患者36名,采用GEAW4.3工作站分别测量肝血流量（HBF）、血容量（HBV）、平均通过时间（MTT）、肝动脉灌注分数（HAF）、肝动脉灌注量（HAP）、门静脉灌注量（PVP）值,采用灌注参数随终末期肝病模型（MELD）将所有受检者分为A、B、C三组,分析比较各灌注参数在三组之间的变化规律及差异。结果HBF值由213.53±113.64mL·min^-1·100g^-1减小到89.70±19.61mL·min^-1·100g^-1,A组与C组之间差异有统计学意义（P〈0.05）;HBV值由23.24±9.60mL·100g^-1减小到13.79±3.86mL·100g^-1,A、B组与C组之间差异有统计学意义（P〈0.05）,HAF值由0.20±0.11增大到0.41±0.17,A、B组与C组之间差异有统计学意义（P〈0.05）,HAP值由68.59±41.82mL·min^-1·100g^-1,减少到21.15±9.50mL·min^-1·100g^-1,A组与B、C组之间差异均有统计学意义（P〈0.05）。经相关分析,HBF、HAP与MELD分值呈负相关（r=-0.531,P=0.001;r=-0.542,P=0.001）,HAF与MELD分值呈正相关（r=0.375,P=0.024）。结论 CT灌注成像可以评价肝脏储备功能,为临床评估病情及制定治疗方案提供依据。     

测定异烟肼血药浓度RP—HPLC的建立及其应用

目的为了探讨治疗结核性脑膜炎时异烟肼的剂量选择,建立一种快速、灵敏的测定血浆中异烟肼药物浓度的反相高效液相色谱法（RP—HPLC）。方法替硝唑作内标,经与香草醛衍生化反应后进样。用Symme．tryC18（4．6mm×250mm,5um）反相色谱柱进行分离,以甲醇-0．02mol·L-1磷酸二氢钾溶液（体积比为39：61）为流动相,流速1．0mL·min-1,柱温为30℃,检测波长为340nm,20ul进样。结果异烟肼血药浓度在0．1～16ug·mL-1（r=0．9999）范围内线性关系良好;日内、日间RSD均〈15％,提取回收率60．63—66．95％。结论本方法简便、准确、灵敏,满足异烟肼血药浓度测定,可应用于临床结核性脑膜炎患者血药浓度的检测及药代动力学分析。