婴儿乳糜腹的诊疗分析

目的探讨婴儿乳糜腹的诊断及治疗方法。方法回顾性分析2004年至2011年我们收治的7例乳糜腹患儿的诊治过程,7例患儿均采用禁食水、联合静脉营养的保守治疗,间断辅以腹腔穿刺或腹腔引流进行治疗。结果7例患儿治疗后乳糜腹均好转,未见明显复发。结论婴儿乳糜腹水经控制饮食、静脉营养、腹腔穿刺等保守治疗多能痊愈,可不予手术治疗。     

胰腺癌新辅助治疗的现状与展望

传统综合治疗在改善胰腺癌疗效上的作用仍十分有限。鉴于乳腺癌、结直肠癌新辅助治疗的良好结果,胰腺癌新辅助治疗逐渐成为关注的热点。与术后辅助治疗相比,新辅助治疗有助于改善根治切除率,患者对放化疗的耐受性更好。但是,目前尚缺少胰腺癌新辅助治疗后手术与直接手术间比较的随机对照研究来评价新辅助治疗的疗效。因此需要进一步的高质量的循证医学证据来证实患者能否从新辅助治疗中获益,以期提高胰腺癌的治疗水平。     

早期肠内营养在小儿急性胰腺炎治疗中的应用

目的探讨早期经鼻空肠营养管行肠内营养,在小儿急性胰腺炎（acute pancreatitis,AP）治疗中的作用。方法2008年6月至2012年7月作者收治AP患儿18例,采用早期经鼻空肠营养管行肠内营养（enteral nutrition,EN）治疗,观察临床疗效。结果18例患儿均采用早期EN治疗,4周后随诊,患儿血红蛋白、血清白蛋白及血尿淀粉酶均正常,其中3例胰腺假性囊肿患儿CT复查均吸收,形态正常,随访效果满意。结论早期经鼻空肠营养管行肠内营养可有效治疗小儿急性胰腺炎,缩短病程,是一种经济、安全、有效的营养支持方式,值得临床推广。     

Efficacy and tolerability of paclitaxel,ifosfamide, and cisplatin as a neoadjuvant chemotherapy in locally advanced cervical carcinoma

Objective

To evaluate the efficacy and tolerability of a neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy in patients with locally advanced cervical carcinoma.

Methods

Patients with histologically confirmed locally advanced cervical carcinoma, aged ≥18 years, were treated with intravenous ifosfamide 5,000 mg/m² and mesna 5,000 mg/m², on day 1; intravenous paclitaxel 175 mg/m² and cisplatin 75 mg/m², on day 2; every 3 weeks for three cycles. Following chemotherapy, operable patients underwent radical hysterectomy and pelvic lymphadenectomy, and, if necessary, adjuvant radiotherapy.

Results

One hundred fifty-two patients with median age 53 years (range, 24 to 79 years), FIGO stage IIB in 126 (89%), were treated with chemotherapy for median 3 cycles (range, 1 to 3). Treatment was delayed or withdrawn in 23 patients (15%). One hundred thirty-nine patients (91%) underwent surgery. Postchemotherapy pathological complete response rate was 18% (25 patients). Postoperative radiotherapy was administered in 100 patients (72%). The 5-year overall survival and progression-free survival were 87.3% (95% confidence interval [CI], 84.5 to 90.3) and 76.4% (95% CI, 73.5 to 79.5), respectively.

Conclusion

Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy was feasible and effective in the treatment of locally advanced cervical carcinoma patients with older age and more advanced disease stage than reported in previous studies. Hematological and renal toxicity could be carefully prevented.     

Risk for corneal injury in intensive care unit patients: A cohort study

AimTo identify the incidence and risk factors for corneal injury amongst critically ill patients.MethodA prospective cohort study with adult patients from one intensive care unit in Northern Brazil. Logistic regression was performed to predict the risk factors associated with corneal injury.ResultsData from 149 patients revealed 18.8% (28/149) corneal injuries. Factors independently associated with corneal injury were patients with eyeball exposure (OR: 27.31; 95% CI: 3.50–212.78); lagophthalmos (OR: 17.15; 95% CI: 5.78–50.85); chemosis (OR: 7.39; 95% CI: 2.28–23.97), periorbital oedema (OR: 7.99; 95% CI: 2.19–29.13) and hospitalisation >7-days (OR: 11.96; 95% CI: 3.27–43.66) had a significantly higher risk of developing corneal injury in this ICU.ConclusionCorneal injury was a common complication amongst critically ill patients and was associated with altered physiological function of the eyes such as exposure, lagophthalmos, chemosis and periorbital oedema. This study suggests introduction of a corneal injury prevention protocol for nursing and adding lagophthalmos and chemosis to the NANDA-I Taxonomy, thus contributing to the assessment and monitoring for the risk for corneal injury in critically ill patients.     

外半规管良性阵发性位置性眩晕复位方法理论探讨

目的　基于标准空间半规管模型对外半规管良性阵法发性位置性眩晕复位方法进行理论探讨,分析各步骤的意义。方法　建立标准空间半规管模型并3D打印,通过对外半规管复位方法的模拟演示和观察,分析比较各种复位方法各步骤的意义和不足。结果　翻滚复位法自患侧卧位开始向健侧翻身,步骤包括仰卧位、健侧卧位和俯卧位再回到坐位是必要和足够的, Gufoni复位法实际上是翻滚复位法的简化,并无方法学上的优越性,而Appiani复位法仅对于壶腹嵴耳石脱落可能有作用。结论　基于标准空间半规管模型对复位方法进行模拟演示,分析各步骤是否合理,探讨对复位方法评估和改良是可行的。     

良性阵发性位置性眩晕的急性期处理策略

目的　探讨良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）急性期临床特点、处理策略。方法　回顾性分析福建医科大学附属第一医院 耳鼻咽喉头颈外科2010年10月～2014年10月期间诊断为急性期BPPV患者46例,予口服抗眩晕治疗,分析急性期处理策略、手法复位的相关风险及并发症。结果　46例急性期BPPV患者予口服抗眩晕治疗,1周后复诊时症状消失痊愈18例,症状改善有效27例,无效者1例;对仍有眩晕的28例予手法复位,眼震、症状均消失。另外报道1例急性期BPPV在手法复位过程中,出现腰椎骨折,予对应处理;1例在耳石复位后出现耳石嵌顿现象并短暂性脑缺血发作。结论  BPPV因发病病程长短、自愈性、急性期BPPV手法复位可能存在的风险,应充分评估患者全身情况;对骨质疏松、围绝经期患者,复位过程中应充分告知手法复位风险并采取相应预防性措施,避免副损伤。     

银杏叶提取物对突发性聋患者外周血清同型半胱氨酸和血脂浓度的影响

目的　研究银杏叶提取物对突发性聋患者外周血清同型半胱氨酸（homocysteine,Hcy）和血脂浓度的影响。方法　选取124例突发性聋患者随机分为治疗组和 对照组,两组患者均给予基础治疗,治疗组在基础治疗基础上给予银杏叶提取物注射液治疗,观察两组患者治疗后Hcy、纤维蛋白原（fibrinogen,Fb）及血脂浓度的变化。结果　治疗10 d后两组患者外周血清Hcy、Fb、总胆固醇（total cholesterol,TC）、总甘油三酯（total triglycerides,TG）浓度较治疗前有所降低（P＜0.05）,且治疗组上述指标明显低于对照组（P＜0.05）。结论　在基础治疗基础上给予静脉滴注银杏叶提取物能进一步降低突发性聋患者外周血清Hcy、Fb与血脂浓度。     

不同周期新辅助化疗后乳腺癌干细胞的分离培养和体外增殖特性

背景：接受不同周期新辅助化疗的乳腺癌组织中是否都存在乳腺癌化疗微球体以及其对乳腺癌干细胞分离培养的影响尚不清楚。目的：探讨不同周期新辅助化疗后乳腺癌组织乳腺癌干细胞的体外增殖特性。方法：从不同周期新辅助化疗后的乳腺癌组织中分离微球体,绘制细胞生长曲线,免疫细胞化学检测乳腺癌干细胞标记物ALDH1表达情况。结果与结论：从新辅助化疗1个周期的标本中无法获得微球体,化疗2,3,4个周期的部分标本中可以培养出微球体。在培养的前3 d,化疗3个周期和化疗2个周期细胞数差异无显著性意义,但在 3 d 之后,化疗3个周期的细胞增殖速度显著快于化疗2个周期,6 d 之后,化疗2个周期的细胞生长曲线呈现出平缓的状态,化疗3个周期则呈现出迅速上升的状态。化疗 3 个周期标本的乳腺癌干细胞微球体中ALDH1阳性细胞比例大于化疗 2 个周期。结果表明化疗2、3个周期的乳腺癌干细胞均具有一定的增殖和分化能力,从化疗后的乳腺癌组织中分离乳腺癌干细胞宜选取化疗3个周期及以上的标本。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程