单中心近10年腹主动脉瘤1246例流行病学研究

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤（AAA）病人的流行病学特点，为研究近10年AAA流行病学变化趋势，以及为AAA的进一步预防和诊治提供依据。方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料，回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息，分析近10年AAA流行病学变化特点。结果 入院病人平均年龄为（66.9±10.5）岁，男女占比约为4∶1。男性AAA病人以同型半胱氨酸升高为主，女性以血脂升高为主。AAA病人的主要合并症为3级高血压（41.9%）、冠心病（31.1%）和合并髂动脉瘤（25.8%）。男性AAA合并髂动脉瘤比率明显高于女性（27.8% vs.17.8%，P＜0.01）。72.7%的AAA病人首诊原因为体检发现，其次是AAA破裂（18.7%）。AAA病人急诊与门诊就诊例数呈逐年升高态势，急诊与门诊就诊占比约为2∶3。65~69岁为现阶段住院病人主要年龄段。各年份男性占比约为80%，年龄段65~69岁为男性占比可达近90%。各年份腔内修复术（EVAR）是AAA的主要治疗方式，行EVAR治疗病人的例数和比例总体趋势逐年增加，行EVAR治疗的占比随病人年龄增加而逐渐增大。近10年AAA病人的病死率呈降低趋势，2015年后病死率总体维持在2%～3%，以男性为主，年龄段70~74岁的病死率最高为5.8%。AAA病人平均住院（17.0±16.4）d，平均住院费用为（11.3±10.7）万元。结论 近10年AAA住院病人有逐年增高趋势，主要患病人群为年龄＞60岁男性，男女临床特点有较大差异。采用EVAR治疗的占比逐年增加。对于老年AAA人群，尤其是年龄段65~69岁男性AAA病人，在AAA的防治过程中应给予更多关注。     

Using modern teaching strategies to teach upper abdominal sonography to medical students

BackgroundUpper abdominal sonography can help physicians to confirm the diagnosis of various hepatobiliary diseases. Teaching sonography skills to medical students is important because it may enhance their level of knowledge and overall development during their gastroenterology section rotation. Sonographic imaging is abstract and students can be easily confused when scanning the abdominal structures from different sites and directions. We used several modern teaching strategies to facilitate the learning of sonography skills.MethodsThe year five medical students beginning a gastroenterology section rotation for their first-year clerkship were taught abdominal sonography skills. Abstract sonographic images were related to concrete objects and the surrounding structures were further indicated. Each of the images was given a specific name and was sorted according to the scanning site. A mnemonics system was designed to help students to memorize the names of these images. A badge was created to recognize the achievement of being able to complete a basic upper abdominal sonography. Students were free (i.e., not obligated) to request a demonstration opportunity to show their skills within 2 weeks after receiving tutelage. We recorded the number of students who received training and were able to successfully complete the task; these individuals then received a badge to be pinned onto their white coats.ResultsSixty-three of 68 students (92.6%) requested evaluation and all of them passed.ConclusionWe have greatly simplified the process of learning about upper abdominal sonography by using andragogy to enhance learning, mnemonics to help memory, and a pin-badge reward system to stimulate incentives.     

Routine abdominal ultrasonography has limited value in the care for patients with indolent systemic mastocytosis

Objectives: Systemic mastocytosis (SM) is a myeloproliferative disease characterized by the accumulation of aberrant mast cells. Since advanced subtypes of SM can lead to organ dysfunction and shortened survival, timely recognition of progressive disease is important for the adequate treatment of SM patients.

Methods: Here, we report the results of our cohort study on the value of routine abdominal ultrasonography for the detection of progression of indolent systemic mastocytosis (ISM).

Results: We included 88 patients with ISM, of whom 9 developed new hepatosplenomegaly during follow-up. In this group, the median serum tryptase level increased by 11.60?μg/l, compared with a decrease of ?0.20?μg/l in the 79 patients with unchanged ultrasonography results (p?=?0.016). A change in liver and/or spleen size never led to a change in clinical classification, nor management.

Discussion: Based on the finding that a change in ultrasonography findings did not correlate to disease progression in general, it appears that isolated hepatosplenomegaly does not have prognostic implications in patients with ISM.

Conclusions: Routine abdominal ultrasonography is redundant in the follow-up of patients with ISM. A combination of physical examination with serum tryptase levels can be used to screen for hepatosplenomegaly.     

微波治疗妇产科腹部切口脂肪液化病人81例的效果分析

目的 分析评价微波治疗妇产科腹部手术后切口脂肪液化的临床应用价值.方法 将162例病人随机分成观察组与对照组各81例,前者进行微波治疗；后者采用传统治疗,比较分析两组病人的治疗所需时间、伤口愈合时间以及临床治疗的总有效率.结果 两组之间比较差异显著(P均＜0.05),具有统计学意义.结论 采用微波治疗能明显缩短治疗时间,促进病人的伤口愈合,值得在临床上广泛推广并应用.     

Irritable bowel syndrome in Asia: Pathogenesis,natural history,epidemiology, and management

Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom‐based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross‐cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.     

丙泊酚合用氯胺酮在小儿腹部以下手术麻醉中的疗效观察

目的探讨丙泊酚单独使用及与氯胺酮合用在小儿椎管内麻醉中的疗效。方法选取我科40名腹部以下手术的患儿,随机分为两组(Ⅰ组和Ⅱ组),分别以单独使用丙泊酚及联合氯胺酮给药的方式,记录术中生命体征及不良事件情况。术后记录恶心、呕吐等不适及疼痛评分。结果两组术中均无呼吸暂停等严重事件发生,手术开始及手术开始后各时段Ⅰ组的生命体征均有显著差异(P<0.05),Ⅱ组手术开始时的收缩压与手术前有显著差异(P<0.05)。两组术后恢复时间与不适发生无显著差异(P>0.05),Ⅱ组术后镇痛效果优于Ⅰ组(P<0.05)。结论丙泊酚合用氯胺酮能够提供更平稳的镇静效果,减轻不良反应的发生,同时不影响苏醒时间,术后不良反应及疼痛发生率较低,是一种理想的小儿椎管内麻醉方法。     

CXC趋化因子受体2及其配体在心血管疾病中的研究进展

CXC趋化因子受体2(CXCR_2)隶属趋化因子家族,其与配体的结合在心血管系统病理、生理各个阶段起重要作用,与高血压、心肌重塑、动脉硬化、腹主动脉瘤等重要疾病密切相关,已成为临床及基础研究的热点。本文就CXCR_2在心血管系统疾病中的研究进展作一综述。     

Time-interval to adjuvant chemotherapy and postoperative management after upper abdominal surgical procedures in advanced ovarian cancer

IntroductionIn advanced epithelial ovarian cancer (EOC), longer time-interval from surgery to initiation of adjuvant chemotherapy (TITC) is associated with decreased survival. Adding upper abdominal surgical procedures (UAP) increases rates of both complete gross resection and postoperative complications in EOC. Our objective was to investigate the association of UAP and TITC. Moreover, if specific postoperative monitoring after the most prevalent UAP increases early detection and management of complications.Material and methodsWomen diagnosed with EOC 2014–2016 in the Stockholm/Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynaecologic Cancer. The association between UAP and TITC was investigated by multivariable linear regression and adjusted for predefined confounders. The follow-up and detection of postoperative complications after diaphragm resection, splenectomy and cholecystectomy was examined.Results240 women were selected for analysis. The TITC in women subjected to UAP was similar with a median of 30 days (p = 0.99). Moreover, despite a higher rate of postoperative and major complications (p < 0.001) and longer hospital stay (p < 0.001), in the adjusted analysis there was no association between UAP and prolonged TITC, with a mean difference of −2.27 days (95% Confidence Interval (CI), −5.99 to −1.45, p = 0.23). After the most prevalent UAP (diaphragm resection, splenectomy and cholecystectomy), eventual postoperative interventions were based on routine clinical management rather than procedure-specific postoperative surveillance.ConclusionUAP does not prolong TITC despite an increased rate of postoperative complications and longer length of hospital stay. Clinical non-specific surveillance is sufficient to detect postoperative complications after the most prevalent UAP.