3种手术方案治疗慢性肥厚性鼻炎临床疗效的对比研究

目的探讨下鼻甲射频消融术、黏膜下部分切除术及下鼻甲射频消融术联合骨折外移术治疗慢性肥厚性鼻炎临床疗效差异。方法选取慢性肥厚性鼻炎患者共300 例,随机分为A、B 及C 组,每组100 例。分别采用鼻甲射频消融术、黏膜下部分切除术及下鼻甲射频消融术联合骨折外移术;比较3 组患者临床疗效和安全性。结果B组和C 组患者近期疗效、术后白天和夜间鼻通气主观评分,双侧鼻腔最小横截面积（NMCA）、鼻腔容积（NCV）、鼻气道阻力（NAR)及鼻腔最小横截面积到前鼻孔的距离（DCAN)水平等均优于A 组及同组术前（P <0.05）;3 组患者不良反应发生率比较差异无统计学意义（P >0.05）。结论黏膜下部分切除术与下鼻甲射频消融联合骨折外移术治疗慢性肥厚性鼻炎在保留鼻腔黏膜及腺体正常生理功能,缓解鼻部堵塞症状方面效果优于下鼻甲射频消融术。     

强脉冲光联合点阵铒激光对痤疮后增生性瘢痕的有效性与安全性分析

目的研究分析强脉冲光联合点阵铒激光对痤疮后增生性瘢痕的有效性与安全性。方法选择上海交通大学附属医学院苏州九龙医院2013 年8 月-2016 年7 月收治的135 例痤疮后增生性瘢痕患者。采用随机数字表法将其分为强脉冲组、点阵组、联合治疗组,每组45 例,比较治疗前和2 次治疗后的疗效、温哥华瘢痕评价量表（VSS）评分以及不良反应情况和误工期。结果3 组治疗有效率比较,差异无统计学意义（P >0.05）,但治疗后3 组患者色泽、血管分布、厚度、柔软度和VSS 评分比较,差异有统计学意义（P <0.05）,并均有下降趋势。联合治疗组2 次治疗后色泽、血管分布、厚度、柔软度和VSS 评分与强脉冲组和点阵饵激光组比较,差异有统计学意义（P <0.05）,联合治疗组各项指标低于其他两组。治疗后3 组患者的生活质量评分比较,差异有统计学意义（P <0.05）。治疗后联合治疗组的自我感知、情感功能、痤疮症状、社会功能等生活质量评分与同时期的强脉冲组和点阵铒激光组比较,差异有统计学意义（P <0.05）,联合治疗组各指标均高于其他两组。联合治疗组的误工期与强脉冲组和点阵铒激光组比较,差异有统计学意义（P <0.05）,联合治疗组均低于其余两组,但3 组不良反应发生率差异无统计学意义（P >0.05）。结论强脉冲光联合点阵铒激光治疗痤疮瘢痕具有非常好的疗效,治疗副作用较少,安全性高,同时能够降低误工期,具有广阔的临床应用前景。     

内科重症监护病房铜绿假单胞菌医院感染同源性及临床特点

目的研究内科重症监护病房(MICU)铜绿假单胞菌(PA)医院感染的同源性及临床特点,以指导临床预防PA传播,提高治疗效果。方法对某院2014年1—12月MICU发生医院感染的25例患者分离的55株PA进行脉冲场凝胶电泳(PFGE)同源性分析及聚类分析,对其临床特点、耐药性及其传播特点进行分析。结果共调查25例患者,平均年龄为(69.62±2.13)岁,平均住院时间(49.34±3.18)d;在分离出PA之前,84.00%的患者应用广谱抗菌药物2周,76.00%的患者入住过MICU,52.00%的患者使用呼吸机辅助通气。55株PA主要以A、F、H、K、N、V、W型为主要的流行菌株;感染A型、F型、H型及K型菌株的患者在各自住院时间上均存在交叉;有4例患者不同时期分离菌株的PFGE图谱分析显示不同菌型;PA对头孢他啶(72.73%)、哌拉西林/他唑巴坦(70.91%)、亚胺培南(70.91%)耐药率高,对阿米卡星耐药率最低(25.45%)。结论医疗机构应加强抗菌药物管理,加强医院感染控制措施,防止多重耐药和泛耐药细菌在医院内的播散。     

Renal simplicity denervation reduces blood pressure and renal injuries in an obesity‐induced hypertension dog model

This study aimed to investigate the effects of renal sympathetic denervation (RDN) on blood pressure, renal function, and renal tissue pathological changes in obesity‐induced hypertensive dogs. Thirty‐two beagle dogs (10‐12 months) were randomized to the control (n=10) and model groups (n=22). High‐fat diet (HFD) was used to establish the obesity‐induced hypertensive model. After 3 months of HFD, 20 animals with successfully induced hypertension were randomized to the RDN (n=10) and sham groups (n=10). Renal artery angiography, body weight, blood pressure, heart rate (HR), and blood and urine biochemistry were determined 1, 3 and 6 months after surgery. Models were killed 6 months after surgery. Pathological changes in the renal artery and renal tissue were assessed. The HFD group had significantly (P<.05) increased body weight, HR, and blood pressure, and higher levels of urine albumin, serum noradrenaline, and angiotensin II compared with controls. After RDN, blood pressure was decreased compared with baseline and the sham group (P<.05). In the RDN group, examination of the renal artery and renal tissue showed intact intima of renal artery in the surgical area, renal sympathetic nerve degeneration, necrosis, and dissolution, and widened space between nerve fibres. Hypertension‐induced renal pathological changes were mild to moderate in the RDN group, but severe in the sham group. The control group had normal glomerular structure. In conclusion, RDN can effectively lower blood pressure in obesity‐induced hypertensive dogs, as well as hypertension‐induced renal pathological changes.     

低强度脉冲式超声波机械力生物链内源性干细胞激活与功能修复的研究进展

近年来,以低强度脉冲式超声波(LIPUS)为代表的机械力治疗手段已被广泛用于康复医学、骨折修复、神经损伤修复、泌尿系统疾病等领域。目前研究表明,LIPUS可能通过激活内源性干细胞参与组织修复,但是机械力如何通过生物链的转化而激活干细胞的具体机制尚不明确,因此对机械力生物链传导过程的进一步探索有助于揭示LIPUS的作用机制并为后续的研究与临床应用提供帮助。     

低强度脉冲超声在脊髓损伤神经修复中的研究进展

脊髓损伤在临床医疗中倍受关注.作为一种致残率极高的中枢神经系统创伤性疾病,脊髓损伤可以导致严重的运动、感觉和自主功能障碍.目前仍未发现令人满意的治疗方法.低强度脉冲超声(LIPUS)作为物理治疗的一种方式,可非侵入性地传输能量,被应用于骨折愈合、肌肉损伤及组织修复等过程中.实验研究发现LIPUS可在脊髓损伤中发挥重要作用,有研究在细胞学和分子生物学等层面对其作用机制进行了探索,本文就此进行综述.     

低温等离子射频消融联合臭氧消融术治疗颈椎间盘突出症的临床研究

目的 探讨低温等离子射频消融联合臭氧消融治疗颈椎间盘突出症的临床效果以及对炎症反应的影响。方法 回顾性分析2018年3月-2021年3月我科收治的65例单节段颈椎间盘突出症手术患者的基本资料及相关数据。按照所采取手术方式将其分为复合组(36例)和单纯组(29例), 复合组患者采用低温等离子射频消融术联合臭氧治疗,单纯组患者仅采用低温等离子射频消融术治疗。分别采集术前、术后3天与术后1个月随访时的视觉模拟评分（visual analogue scale, VAS）,记录术前及术后72小时最常见伴随症状的变化以及抽取的静脉血中血沉、C反应蛋白和白细胞计数,对两组结果进行统计比较;并对两组的不良反应发生率进行比较。结果 两组患者术后3天及术后1个月疼痛评分较术前均显著降低(P<0.05),但两组间比较仅有术后第三天差异具有统计学意义(P＜0.05);复合组患者术后血沉、C反应蛋白及白细胞计数均低于单纯组(P<0.05);两组的不良反应发生率无统计学差异（P＞0.05）。结论 低温等离子射频消融联合臭氧消融术可有效缓解颈椎间盘突出症患者的疼痛症状,并能更好预防术后炎症的发生。     

大肝癌患者行 TACE 序贯射频消融的疗效及复发因素

目的：探讨经导管肝动脉化疗栓塞（TACE）联合序贯射频消融术（RFA）治疗大肝癌患者的疗效及复发因素。方法：选取我院2013年1月－2015年1月肿瘤外科中晚期原发性大肝癌患者110例并分为肝动脉化疗栓塞组（TACE 组）与肝动脉化疗栓塞联合序贯经皮射频消融术组（TACE ＋RFA 组）各55例,TACE 组患者行一次或多次单一肝动脉化疗治疗;TACE ＋RFA 组在肝动脉化疗治疗结束后1～2周再行序贯经皮射频消融术治疗。结果：TACE 组与 TACE ＋RFA 组总有效率分别为63．64％（35／55）、94．54％（52／55）。TACE ＋RFA 组1年生存率为72．7％（40／55）,2年生存率为20．0％（11／55）,而 TACE 组分别为56．36％（31／55）、7．27％（4／55）。Log －rank 检验结果显示肿瘤数量、分期、血清甲胎蛋白水平等为大肝癌患者预后的因素,与患者预后有一定关系。结论：经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗原发性中晚期大肝癌可以有效提高患者生存率,延长患者的生存期。肿瘤数量、直径、分期等是影响患者复发的危险因素。     

Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval

Introduction: Junctional tachycardia (JT) and atrioventricular nodal reentrant tachycardia (AVNRT) can be difficult to differentiate. Yet, the two arrhythmias require distinct diagnostic and therapeutic approaches. We explored the utility of the delta H-A interval as a novel technique to differentiate these two tachycardias.
Methods: We included 35 patients undergoing electrophysiology study who had typical AVNRT, 31 of whom also had JT during slow pathway ablation, and four of whom had spontaneous JT during isoproterenol administration. We measured the H-A interval during tachycardia (H-A_T) and during ventricular pacing (H-A_P) from the basal right ventricle. Interobserver and intraobserver reliability of measurements was assessed. Ventricular pacing was performed at approximately the same rate as tachycardia. The delta H-A interval was calculated as the H-A_P minus the H-A_T.
Results: There was excellent interobserver and intraobserver agreement for measurement of the H-A interval. The average delta H-A interval was −10 ms during AVNRT and 9 ms during JT (P < 0.00001). For the diagnosis of JT, a delta H-A interval ≥ 0 ms had the sensitivity of 89%, specificity of 83%, positive predictive value of 84%, and negative predictive value of 88%. The delta H-A interval was longer in men than in women with JT, but no gender-based differences were seen with AVNRT. There was no difference in the H-A interval based on age ≤ 60 years.
Conclusion: The delta H-A interval is a novel and reproducibly measurable interval that aids the differentiation of JT and AVNRT during electrophysiology studies.