经子宫动脉化疗栓塞治疗异位妊娠35例观察

目的探讨经子宫动脉化疗栓塞治疗异位妊娠的临床效果。 方法对35例异位妊娠患者利用标准的动脉造影技术,找到异位妊娠的供血血管,经导管向子宫动脉灌注化疗药甲氨蝶呤（MTX）或氟尿嘧啶（5-FU）,然后选择710～1000 μm的明胶海绵颗粒栓塞子宫动脉。术后观察患者的临床表现、生命体征、盆腔包块情况以及患者的绒毛膜促性腺激素（β-HCG）变化情况。 结果35例患者均一次性插管,成功35例,成功率为100%。β-HCG呈进行性下降,均在1个月左右下降至正常值(<2.9 IU/L),月经在术后1～2个月恢复正常。 结论经子宫动脉化疗栓塞治疗异位妊娠对患者创伤小、成功率高,能预防大出血,增加保守治疗的适应证。     

经肱动脉路径冠状动脉介入治疗患者组合式压迫止血器应用效果观察

目的 探讨组合式压迫止血器在经肱动脉路径行冠脉动脉介入治疗压迫止血的效果。方法 将经肱动脉路径行冠状动脉介入治疗患者60例分成两组各30例。对照组采用3M弹力绷带加压包扎的常规止血方法,观察组采用组合式压迫止血器压迫止血。比较两组压迫止血即刻,术后2 h、4 h、6 h出血发生率、局部肿胀程度及疼痛评分;压迫24 h局部压力性损伤发生率。结果 观察组不同时段局部肿胀程度及疼痛评分显著低于对照组,总出血发生率和压力性损伤发生率显著低于对照组(均P<0.05)。结论 组合式肱动脉止血器应用于经肱动脉路径行冠状动脉介入治疗压迫止血效果良好,操作安全且能减轻患者疼痛,预防压力性损伤发生。     

Treatment of Umbilical Granuloma in Infants With Topical Application of Common Salt: A Scoping Review

BackgroundCommon salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma.MethodsA literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords ‘umbilical granuloma’ and ‘salt treatment’ to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study.ResultsTwenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences.ConclusionTopical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic.Level of EvidenceI.     

结直肠癌术前肝动脉联合区域动脉灌注化疗对肿瘤增殖凋亡的影响

目的 探讨结直肠癌术前肝动脉联合区域动脉灌注化疗(PHRAIC)对肿瘤增殖凋亡的影响. 方法 将2001年6月至2007年6月收治的509例Ⅱ期和Ⅲ期结直肠癌患者随机分成PHRAIC组(n=256)和对照组(n=253),评价两组术前和术后组织标本的坏死程度、Ki67、P16、Bax、bel-2、survivin、凋亡率和细胞周期. 结果 两组一般临床资料无统计学差异.PHRAIC组术前标本的各项评价与对照组相比差异无统计学意义(P>0.05).PHRAIC组介入前后标本坏死程度3级者分别为3.1%和22.7%,4级者分别为0和13.5%(P<0.05);Ki67标记指数介入前后分别为48.6±17.1和38.4±13.3(P<0.05);BAX、bel-2和sttrvivin过表达率分别为48.0%和77.0%、75.0%和43.0%、52.0%和31.6%(P<0.05);凋亡率分别为4.3%±2.2%和16.7%±6.4%(P<0.05);PHRAIC组介入后病理标本S期比例为21.8%±10.7%,低于介入前的42.1%±11.2%(P<0.05);G0-G1的比例为57.1%±18.1%,高于介入前的35.1%±12.1%(P<0.05).所有患者均获得随访,平均随访(42±14)个月.PHRAIC组和对照组Ⅲ期患者术后5年肝转移率分别为18.9%和27.3%,转移复发率分别为26.3%和38.0%,总生存率分别为81.0%和60.4%,中位生存期分别为45和40个月,差异均有统计学意义(P<0.05);两组Ⅱ期患者间上述指标间无明显差异. 结论 术前肝动脉联合区域动脉灌注化疗可抑制肿瘤细胞的增殖,促进凋亡,降低Ⅲ期结直肠癌患者术后肝转移的发生率,延长生存期.     

人脐血内皮祖细胞对脐动脉内膜损伤的修复作用

目的 体外分离培养人脐带静脉血内皮祖细胞(EPCs),观察EPCs对损伤脐动脉的修复作用.方法 采用磁珠分选法(MACS)从人脐血中分离培养EPCs,用流式细胞术、免疫细胞化学和免疫荧光检测进行鉴定;牵拉钳夹损伤法制备去内膜脐动脉段,与EPCs共孵育7 d后,通过病理切片、免疫组织化学和图像分析技术评价EPCs对动脉损伤的修复效果.结果 成功从人脐血中分离培养EPCs,流式细胞术分析结果 为培养7 d后CD133+细胞＞90%;CD34、vWF因子相关抗原免疫染色均为阳性.EPCs移植组新生内膜厚度(43.5±5.5)ìm显著低于对照组内膜厚度(90.7±12.7)ìm,(t=-28.88,P＜0.01);EPCs移植组的再内皮化程度(77.8±0.1)%明显高于对照组(52.2±0.1)%,(t=21.86,P＜0.01).结论 成功从人脐血中培养出EPCs,人脐血EPCs可修复内皮损伤血管.     

Doppler assessment of brachial artery flow as a measure of endothelial dysfunction in pediatric chronic renal failure

Cardiovascular morbidity and mortality are highly prevalent among patients with chronic renal failure (CRF). Endothelial dysfunction is regarded as the initial reversible step in the development of atherosclerosis and has been demonstrated in all stages of renal failure. Non-invasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adults. We aimed to assess endothelial function in children with stage 4 chronic kidney disease (CKD 4) on conservative treatment, using a-non invasive, high-resolution, ultrasound Doppler study of the brachial artery flow, correlating it with other clinical and laboratory parameters. This study included 34 children with CKD 4 on conservative treatment who were compared with 30 healthy controls. Flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTG-MD) and FMD/NTG-MD ratio were estimated. FMD was abnormal (< 5%) in 24 patients (71%). FMD and FMD/NTG-MD ratio were significantly lower in patients than in controls (P = 0.001 and P = 0.01, respectively). FMD correlated positively with serum calcium and negatively with alkaline phosphatase. We concluded that endothelial dysfunction is present in children with CKD 4 on conservative treatment and may reflect increased atherogenic and thrombogenic properties of the endothelium, contributing to subsequent adverse cardiovascular outcome.     

Circumumbilical pyloromyotomy in the era of minimally invasive surgery

Background/purpose

No studies have investigated the cosmetic outcome of current approaches to pyloromyotomy in infants with hypertrophic pyloric stenosis. The purpose of this study was to evaluate the final appearance of the scar in patients undergoing circumumbilical pyloromyotomy.

Methods

During a 16-year period, 86 infants underwent circumumbilical pyloromyotomy at our institution. A detailed questionnaire was created to document the family members' perceptions of the esthetic appearance of the scar. Data were collected by telephone interview and at clinic visit. In addition, cosmesis was assessed by 5 staff members who scored blindly the esthetic outcome of the scars with comparative photographs, using a categorical scale.

Results

Fifty-seven families were tracked by telephone contact. In the family questionnaire, 100% of families reported an excellent or good scar. Of these, forty-one (72%) were available for cosmetic assessment. Follow-up ranged between 5 months and 15 years (mean, 6 years). The panel members ranked the scar, on average, as excellent or good for 90% of the patients. No assessor stated that a scar was unacceptable. Intra- and interobserver agreement was 0.72 and 0.78, respectively.

Conclusions

Overall satisfaction with the cosmetic outcome of circumumbilical pyloromyotomy is very high.