分次切除在皮肤病损治疗中的应用价值

目的探讨分次切除在皮肤病损治疗中的应用价值。方法通过10年来对498例皮肤病损患者接受分次切除治疗的观察和分析,评估了皮肤病损分次切除的疾病适应证、部位适应证、切口的合理安排和优缺点等。结果所有病例中切除次数为2次的病例457例,治疗时间5~13月,平均(8.06±3.45)月;3次及以上41例,平均(3.12±0.32)次,治疗时间12~21月,平均(13.76±1.34)月。术后随访6~13月,复发5例,其中色素痣3例,疤痕疙瘩2例。色素痣再次手术切除后无复发,疤痕疙瘩采取切除加放疗后无复发。结论分次切除在较大面积及特殊部位的皮肤病灶切除术中有其特有的优点和临床应用价值。     

How Can We Identify Very High-Risk Heterozygous Familial Hypercholesterolemia?

Heterozygous familial hypercholesterolemia (HeFH) is a genetic disorder that elevates low-density lipoprotein cholesterol and increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). However, despite their atherogenic lipid profiles, the cardiovascular risk of HeFH varies in each individual. Their variety of phenotypic features suggests the need for better risk stratification to optimize their therapeutic management. The current review summarizes three potential approaches, including (1) definition of familial hypercholesterolemia (FH)-related risk scores, (2) genetic analysis, and (3) biomarkers. The International Atherosclerosis Society has recently proposed a definition of severe FH to identify very high-risk HeFH subjects according to their clinical characteristics. Furthermore, published studies have shown the association of FH-related genetic phenotypes with ASCVD, which indicates the genetic analysis’s potential to evaluate individual cardiovascular risks. Biomarkers reflecting disease activity have been considered to predict the formation of atherosclerosis and the occurrence of ASCVD in HeFH subjects. Incorporating these risk stratifications will be expected to allocate adequate intensity of lipid-lowering therapies in HeFH subjects, which ultimately improves cardiovascular outcomes.     

支气管肺泡冲洗联合无创通气治疗重症哮喘的疗效评价

目的 探讨支气管肺泡冲洗联合无创通气对常规治疗失败的重症哮喘的应用价值。方法 选择常规治疗失败的重症哮喘患者41例，随机分为两组：对照组和冲洗组。对照组给予常规基础治疗及无创通气治疗，冲洗组在对照组治疗的同时给予支气管肺泡冲洗。结果 冲洗组气管插管率、症状改善时间及ICU住院天数较对照组低（P〈0．05），第1秒钟用力呼气容积占预计值百分比、用力肺活量占预计值百分比、吸气相气道正压、PaO2、PaCO2的改善情况均优于对照组。结论 支气管肺泡冲洗联合无创通气应用于常规治疗失败的重症哮喘可以改善血气及肺功能，并且降低气管插管率及缩短ICU住院天数。     

生物标记物在宫颈癌鉴别诊断中的应用

病理学诊断在宫颈病变的诊断中发挥重要作用,用免疫组化法检测生物标记物,并与目前的组织学标准联合应用,可大大提高妇产科疾病诊断的一致性和可重复性。     

Modified method of cervical conization with hybrid use of a cold knife and an electric knife for high-grade squamous intraepithelial lesions

ObjectiveTo evaluate the feasibility and surgical outcome of the modified method of cervical conization with hybrid use of a cold knife and an electric knife.MethodsA retrospective analysis of cervical conization for high-grade squamous intraepithelial lesions was performed between January 2020 and December 2020. Traditional cold knife conization and modified conization were used. The clinical characteristics and surgical outcomes were compared between these methods.ResultsNinety-two patients with high-grade squamous intraepithelial lesions were included. Traditional conization was performed in 46 patients, and the modified method was used in 46 patients. There were no differences in clinical characteristics, such as age, menopausal status, and conization height, between the methods. Intraoperative blood loss with the modified method was significantly lower than that with traditional conization (27.6 ± 4.7 vs 51.3 ± 18.3 mL). Postoperative vaginal bleeding requiring emergent measures, such as prolonged gauze compression, sutures, or electrocautery, was significantly less with the modified method than with traditional conization (4.3% vs 17.4%). A median follow-up of 10.2 months showed no significant difference in persistence or recurrence between the methods.ConclusionsThe modified method of cervical conization with hybrid use of cold and electric knives may be a good alternative to traditional cold knife conization.     

ICU重症急性胰腺炎术后患者操作性疼痛体验及疼痛管理期望的质性研究

目的:了解ICU中重症急性胰腺炎术后患者操作性疼痛体验及对疼痛管理的需求,为临床制定操作性疼痛管理方案提供依据。方法:采用目的抽样的方法,对在2019年5月1日—12月31日期间入住四川大学华西医院ICU 24 h内的15例重症急性胰腺炎术后患者进行半结构式深入访谈,采用Nvivo 10. 0软件进行资料分析。结果:通...     

Functional mutations of SARS-CoV-2: implications to viral transmission,pathogenicity and immune escape

The pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to major public health challenges globally. The increasing viral lineages identified indicate that the SARS-CoV-2 genome is evolving at a rapid rate. Viral genomic mutations may cause antigenic drift or shift, which are important ways by which SARS-CoV-2 escapes the human immune system and changes its transmissibility and virulence. Herein, we summarize the functional mutations in SARS-CoV-2 genomes to characterize its adaptive evolution to inform the development of vaccination, treatment as well as control and intervention measures.     

骨骼肌肉恶性肿瘤病变CT引导下经皮穿刺活检正确性分析

目的 探讨CT导引下经皮穿刺活检对骨骼肌肉恶性肿瘤性疾病的诊断价值.方法 106例骨骼肌肉病变行CT导引下经皮穿刺活检,对比穿刺病理结果与临床诊断最终结果.结果 106例CT导引下经皮骨骼肌肉穿刺活检病例,经临床手术及切开活检病理结果全部为恶性肿瘤病变,其中89例病理结果与CT导引下经皮穿刺活枪结果相符,17例CT导引下穿刺活检病理结果为"阴性".活检正确率84.0%;结论CT导引下经皮穿刺对骨骼肌肉恶性肿瘤性病变是安全、简便、有效的诊断手段,对于活检结果为"阴性"的病例适时的切开活检可能是必要的.     

小网膜囊病变的MRI诊断

目的：探讨小网膜囊正常解剖及病变的MRI表现，评价小网膜囊病变的MRI诊断价值。方法：病例组28例，对照组18例，均进行了上腹部MRI平扫或增强扫描检查，病例组均经手术病理证实。结果：对照组小网膜囊不显示。病例组小网膜囊病变中：原发性肿瘤6例(神经鞘瘤1例，平滑肌瘤2例，血管瘤1例，脂肪肉瘤1例，淋巴瘤1例)，邻近脏器的良、恶性肿瘤7例(胰头癌3例，肝左叶肿瘤2例，胃平滑肌瘤、平滑肌肉瘤各1例)，转移性肿瘤2例，积液(腹水、炎性渗出液、脓液、血液、胆汁、淋巴液)8例，假性囊肿3例，脓肿2例。结论：正常小网膜囊不显示，MRI对小网膜囊病变具有重要的诊断价值。