二维超声评价原发性肾病综合征预后的价值

目的　探讨二维超声对原发性肾病综合征预后的判断价值。方法　根据临床检查结果将 12 0例原发性肾病综合征患者分为 3组 ,并与二维超声检查结果进行相关性分析。结果　完全缓解组的肾脏超声检查结果与对照组比较无显著性差异 (P >0 .0 5 ) ,部分缓解组的肾脏超声检查结果与对照组比较有显著性差异 (P <0 .0 5 ) ,无效组的肾脏超声检查结果与对照组比较有非常显著性差异 (P <0 .0 1)。结论　二维超声检查原发性肾病综合征患者的肾脏无异常时预后良好 ,而肾脏缩小越明显 ,肾皮质回声越强 ,则预后越差。     

用认识论的观点看肝癌诊断和治疗的发展

用认识论的观点论述现代科学技术,以及肝脏解剖和肝癌生物学行为的研究在肝癌诊断和治疗中的重要作用;回顾了已取得的成就,提出了今后亟待解决的一些问题。     

青年及老年原发性肝癌的临床分析

目的 :探讨青年及老年人原发性肝癌的临床特点。方法 :对 95例年龄≤ 3 9岁的青年肝癌和 112例年龄≥ 60岁的老年肝癌患者进行临床分析。结果 :(1)青年组HBV感染率为 92 .63 % ,其中HBsAg(+ )为 84.2 1% ,明显高于老年组的 62 .5 0 % ,P <0 .0 1。 (2 )青年组合并肝硬化者达 72 .63 % ,高于老年组的 5 4.46% ,P <0 .0 1。 (3 )青年组肝区疼痛症状明显高于老年组 ,前者以弥散型和巨块型多见 ,而后者则以单个局限为主。 (4)青年组甲胎蛋白 [AFP(+ ) ]为 67.3 7% ,老年组为 46.43 % ,P <0 .0 5。 (5 )老年组AKP、γ GT明显高于青年组 ,心脑血管合并症亦多于青年组 ,P <0 .0 1。结论 :青年肝硬化患者是原发性肝癌最重要的高危因素 ,应对这些患者长期追踪观察以早期发现和诊断。老年肝病患者AFP阳性率低 ,当其出现AKP、γ GT值升高时 ,应高度警惕肝癌。     

A report of pregnancy following ICSI in one of two sisters with familiar primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a disorder of structure and function of motor ciliary and dyskinetic activity of ciliary in the fallopian tubes of affected women and could lead to infertility in some cases. In vitro fertilisation (IVF) is a choice of treatment in infertile women with PCD, which could conquer the tubal dysfunction. In this case study, we report a PCD affected woman with infertility who was treated by IVF and pregnancy was achieved but it failed due to the spontaneous abortion. We also performed whole-exome sequencing for this case and her PCD-affected sister, which did not reveal any genetic abnormality related to the PCD or infertility.     

Migration Patterns for Revision Total Hip Arthroplasty in the United States as Reported in the American Joint Replacement Registry

BackgroundRevision total hip arthroplasty (revTHA) is associated with higher rates of complications and greater costs than primary procedures. The aim of this study is to evaluate the effect of hospital size, teaching status, and indication for revTHA, on migration patterns in patients older than 65 years old.MethodsAll THAs and revTHAs reported to the American Joint Replacement Registry from 2012 to 2018 were included and merged with the Centers for Medicare and Medicaid Services database. Migration rate was defined as a patient’s THA and revTHA procedures that were performed at separate institutions by different surgeons. Migratory patterns were recorded based on hospital size, teaching status, and indication for revTHA. Analyses were performed by statisticians.ResultsThe number of linked procedures included was 11,906. Migration rates in revTHA due to infection were higher for small hospitals than large hospitals (46.6% vs 28.6%, P < .0001). Migration rates were higher comparing non-teaching with teaching hospitals (55% vs 34%, P < .0001). This difference was significant for periprosthetic fractures (70.6% vs 37.2%, P = .005), instability (56.5% vs 35.5%, P = .04), and mechanical complications (88.9% vs 34.7%, P < .05). Most patients migrated to medium or large hospitals rather than small hospitals (89% vs 11%, P < .0001) and to teaching rather than non-teaching institutions (82% vs 18%, P < .0001).ConclusionHospital size and teaching status significantly affected migration patterns for revTHA. Migration rates were significantly higher in small non-teaching hospitals in revTHA due to infection, periprosthetic fracture, instability, and mechanical complications. Over 80% of patients migrated to larger teaching hospitals.     

The sorptivity and durability of gelling fibre dressings tested in a simulated sacral pressure ulcer system

Wound‐dressing performances are affected by exudate viscosity, resistance to flow because of gravity, and bodyweight loads, the level of which is related to the body position. Here, we focussed on two dressing properties: (a) Sorptivity—the ability of dressings to transfer exudate away from the wound bed by capillary action—and (b) Durability—the capacity of dressings to maintain their integrity over time and during their removal. Both properties are critically important for avoiding further tissue damage but require the development of new laboratory tests for their measurement. A computer‐controlled phantom of an exuding sacral pressure ulcer has therefore been developed and used to compare the performances of Exufiber (Mölnlycke Health Care) vs an alternative market‐leading dressing. Sorptivity was determined using weight tests, and durability was measured through tensile tests of the used dressings. For a supine configuration, the Exufiber dressing demonstrated ~three times higher sorptivity and better durability, withstanding ~five times greater strain energy than the other product before failure occurred. This work paves the way for quantitative, standardised testing of dressings in all aspects of exudate management. The reported tests are further suitable for testing dressing combinations or how dressings interact with negative pressure wound therapy.     

Supraclavicular lymph node metastases from distant primary tumors: Case reports and review of the literature

Cervical lymph nodes are a common site of metastases for malignant tumors, most commonly developed from head and neck primary tumors. But, they can also be secondary to distant primary tumors.We report the case of two patients treated in our Otorhinolaryngology and Head and Neck department for chronic supraclavicular lymphadenopathies, for whom further investigations showed lymph node metastasis originating from distant tumors.Thus, careful clinical examination, imaging tools, and if possible pathological analysis are necessary to establish an early diagnosis for adequate treatment.     

Measuring physician practice site characteristics: A comparison of data from SK&A and a practice site survey

ObjectiveTo evaluate the comparability of commercially available practice site data from SK&A with survey data to understand the implications of using SK&A data for health services research.Data sourcesResponses to the Comprehensive Primary Care Plus (CPC+) Practice Survey and SK&A data.Study designComparison of CPC + Practice Survey responses to SK&A information for 2698 primary care practice sites.Data collectionCPC + Practice Survey data collected through a web‐only survey from April through September 2017, and SK&A data purchased in November 2016.Principal findingsInformation was similar across data sources, although some discrepancies were common. For example, 56% of practice sites had differences in the reported number of practitioners, and larger sites tended to have larger differences. Among practice sites with 1 practitioner in the survey, only 1.3% had a difference of 3 or more practitioners between the data sources, whereas 63% of practice sites with 11 or more practitioners had a difference of 3 or more practitioners.ConclusionsDiscrepancies between data sources could reflect differences of interpretation when defining practice site characteristics, changes over time in those characteristics, or data errors in either SK&A or the survey. Researchers using SK&A data should consider possible ramifications for their studies.