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小儿从出生到建立完好的恒牙列,是个漫长的过程。在此期间,常见的龋、牙齿发育异常、口腔不良习惯等,均会对牙、颌、面的生长产生影响,导致面型异常及各种错牙合畸形。如对正处于生长发育高峰期的儿童采取早期治疗,治疗效果最好,可使复杂问题简单化,常可在较短的时间内,用比较简单的矫治方法和矫治器改正,及早地阻断错牙合畸形的发展,引导牙、颌、面正常发育。开展早期治疗,要根据儿童的生长发育特点,依据生长发育的规律和发育的顺序进行诊断和治疗。早期治疗可能只是整个治疗计划的一部分,大多数的患儿常常需要到替牙期后再进行后期常规正畸治疗,所以要把乳牙、混合牙列期的早期治疗作为从乳牙、混合牙列期到恒牙列期的整体正畸治疗过程的一个环节来正确认识。     

Modified Glasgow prognostic score in patients with incurable stage IV colorectal cancer

Background

The modified Glasgow prognostic score is an inflammation-based prognostic score. This study examined whether this score, measured before surgical procedures, could predict postoperative cancer-specific survival.

Methods

We retrospectively studied 79 colorectal cancer patients who underwent a surgical procedure for incurable stage IV disease. The modified Glasgow prognostic score (0 to 2) comprises C-reactive protein (≤10 vs >10 mg/L) and albumin (<35 vs ≥35 g/L) measurements.

Results

In terms of overall survival, univariate analysis revealed significant differences in the status of lung metastasis, peritoneal dissemination, distant metastasis, hemoglobin, C-reactive protein, albumin, tumor resection, adjuvant chemotherapy, and modified Glasgow prognostic score. Multivariate analysis revealed that hemoglobin (P = .019), adjuvant chemotherapy (P = .002), and modified Glasgow prognostic score (0 and 1, low; 2, high) (P = .0001) were significant predictive factors for postoperative mortality.

Conclusions

The modified Glasgow prognostic score is simple to obtain and useful in predicting survival in incurable stage IV colorectal cancer patients undergoing surgery.     

First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia

Background/Purpose

Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO₂ as predictors of ECMO support and in-hospital mortality in neonates with CDH.

Methods

Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO₂ within the first 24 h of NICU admission were evaluated.

Results

Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO₂, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO₂ predicted mortality following multivariate adjustment.

Conclusions

The first 24-h SNAP-II score and highest PaCO₂ may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set.     

Quantitative assessment and determinants of suture-holding capacity of human pancreas

Background

Hard pancreas is welcome by surgeons performing resective pancreatic surgery, because it is believed to offer better suture holding capacity (SHC), thus decreasing the risk for a postoperative leak. However, neither the actual SHC of pancreatic tissue in humans nor its determinants have been studied.

Methods

We directly measured SHC for polydioxanone 5–0 suture and tissue hardness at the pancreatic isthmus in 53 human pancreata using a dynamometer and a durometer. A histologic score based on fibrosis grade, fat content, pancreatic duct size, and signs of chronic pancreatitis was calculated for every sample. We tested the hypothesis that SHC of the pancreas was proportional to tissue hardness, and evaluated the role of different possible histomorphologic determinants of SHC.

Results

Suture-holding capacity correlated perfectly with tissue hardness (r = 0.98; P < 0.001; 95% confidence interval, 0.96–0.99). The histologic score showed a stronger correlation with both parameters than any single histologic parameter. The SHC of transductal sutures was significantly higher than that of pure transparenchymal sutures. The SHC and hardness were significantly lower in patients who developed a clinically relevant pancreatic fistula postoperatively.

Conclusions

A mixture of histomorphologic features of human pancreas determines its tissue hardness and SHC. Involvement of the main pancreatic duct in the suture line appears to increase the mechanical strength of the pancreatic anastomosis.     

American Society of Anesthesiologists class and Charlson's Comorbidity index as predictors of postoperative colorectal anastomotic leak: a single-institution experience

Background

The American Society of Anesthesiologists (ASA) physical status classification and Charlson comorbidity index (CCI) was adopted to assess patients' physical condition before surgery. Studies suggest that ASA score and CCI might be a prognostic criterion (indicator) for patient outcome. The aim of this study is to determine if ASA classification and CCI can determine the risk of anastomotic leaks (AL) in patients who underwent colorectal surgery.

Methods

A retrospective analysis of 505 consecutive colorectal resections with primary anastomoses between 2008 and 2012 was performed at a university hospital. ASA score, CCI, surgical procedure, length of stay, age, body mass index (BMI), comorbidities, and postoperative outcomes were analyzed.

Results

Two hundred sixty-five patients had an ASA score of I and II, 227 patients had an ASA score of III, and 13 patients had an ASA score of IV. A total of 19 patients had an anastomotic leak (ASA I–II: 5 patients, 1.9%; ASA III: 12 patients, 5.58%; ASA IV: 2 patients, 18.18%). A higher ASA score was significantly associated with AL on further analysis (OR: 2.99, 95% CI: 1.345–6.670, P = 0.007). When matched for age, BMI, and CCI on logistic regression analysis, increased ASA level was independently related to an increased likelihood of leak (OR_steroids = 14.35, P < 0.01; OR_{ASA_III v I–II} = 2.02, P = 0.18; OR_{ASA_IVvI–II} = 8.45, P = 0.03). There were no statistically significant differences in means between the leak and no-leak patients with respect to age (60.69 versus 65.43, P = 0.17), BMI (28.03 versus 28.96, P = 0.46), and CCI (6.19 versus 7.58, P = 0.09).

Conclusions

ASA score, but not CCI, is independently associated with anastomotic leak. Patients with a high ASA class should be closely followed postoperatively for AL after colorectal operations.     

Degree of mucositis and duration of neutropenia are the major risk factors for early post-transplant febrile neutropenia and severe bacterial infections after reduced-intensity conditioning

Background and objectives: Whether the intensity of the conditioning regimen affects febrile neutropenia (FN) and severe bacterial infections (SBIs) is not well established. We analyzed the risk factors (RFs) for the development of FN and SBI in the first 100 d post‐transplant in 195 consecutive adult recipients of a reduced‐intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC‐allo). Materials and methods: The RIC regimens consisted of fludarabine plus melphalan (62%) or busulphan (38%) (FluMel or FluBu). SBIs include pneumonia, urinary tract infections, and bacteremia. Results: FN occurred in 141 patients (72%), always in the first 30 d post‐allo‐RIC. However, a SBI occurred in only 27 patients (14%) during this early post‐transplant period (P < 0.02) and NCI CTC grade III–IV mucosal damage in the first 10 d post‐transplantation (P = 0.03). RFs identified to SBI by multivariate analysis included corticosteroid therapy before day +100 (P < 0.01), mycophenolate mofetil‐based graft‐versus‐host disease (GVHD) prophylaxis (P < 0.01), and previous SBI before day +30 (P < 0.01). The rate of SBI from day +30 to +100 varied according to the number of RFs; thus, the rate of SBI was 1% in patients without any RF, 17% in patients with one RF, 29% with one RFs, and 53% in those with all three RFs. Conclusions: After an RIC‐allo, FN and early SBI occurred mostly in patients with severe mucositis and early‐onset neutropenia, while postengraftment high‐dose steroid therapy for acute GVHD was the major RF.     

早期康复治疗对老年卒中患者预后的影响

目的探索早期康复治疗对老年脑卒中患者预后的影响。方法入选2008年1月至2010年11月收治的急性脑卒中患者150例,其中康复组80例,对照组70例,对所有患者在入院24h内及入院后21d、35d采用神经功能缺损评分(NIHSS)评定其肢体运动功能状态;于治疗后35d采用Barthel指数(BI)评定其日常生活活动能力,同时统计其并发症及住院费用。结果康复组的肢体功能缺损评分在治疗后明显低于对照组(P<0.05),BI评分明显高于对照组(P<0.05),而其并发症及住院费用明显低于对照组(P<0.05)。结论早期康复治疗可以明显促进卒中患者肢体功能的恢复,增强患者的自理能力,减少并发症的产生,减轻患者负担,对老年患者是有效和安全的。     

老年食管癌患者术后早期肠内营养对预后影响的临床研究

目的 研究老年食管癌患者术后早期肠内营养(EEN)对预后的影响. 方法 将我院2006年1月至2011年6月收治老年食管癌手术患者120例,按不同的营养方式分为2组,EEN组60例,给予EEN支持;肠外营养(PN)组60例,常规深静脉PN,对2组老年患者术后肠功能恢复时间、住院时间、并发症的发生率以及术后1周营养、免疫等相关指标进行统计学分析. 结果 EEN组在术后患者肛门排气时间[(44.3±12.5)h比(73.6±11.8)h]、肛门排便时间[(81.5±15.1)h比(138.1±13.2)h]和住院时间[(14.0±1.9)d比(16.2±3.0)d]均短于PN组(P＜0.05);EEN组术后1周的血清白蛋白(ALB)、外周血淋巴细胞、转铁蛋白、24h尿素氮(BUN)均高于PN组;EEN组患者的IgG、IgA、IgM及CD3+、CD4+、CD8+、CD4+/CD8+外周血T淋巴细胞亚群等免疫指标较PN组均显著改善,差异均具有统计学意义(P＜0.05);2组间术后并发症发生方面比较,EEN组明显优于PN组(P＜0.05). 结论 老年食管癌患者术后EEN能促进术后代谢和免疫功能恢复、减少并发症,对患者的预后具有重要的临床意义,值得进一步推广和应用.