改良外伤骨瓣开颅减压术在高血压脑出血术后二次开颅中的应用

目的探讨改良的骨瓣开颅减压手术在高血压脑出血后二次开颅的应用效果。方法回顾性分析2007年2月至2010年10月36例将改良外伤骨瓣开颅减压术用于高血压脑出血后二次开颅手术的患者的临床资料,总结患者手术的原因,临床手术方法,并分析手术的有效性。结果 36例患者采用此手术方法,有6例患者术后恢复良好,12例患者术后为中度残疾,9例患者严重残疾,5例患者呈植物状态,4例患者死亡。患者主要的手术原因为术后再出血。结论改良外伤骨瓣开颅减压术在高血压脑出血术后二次开颅中的临床价值较高,能够有效提高患者的抢救成功率,值得在临床推广使用。     

Wound healing effect of flavonoid rich fraction and luteolin isolated from Martynia annua Linn. on streptozotocin induced diabetic rats

ObjectiveTo evaluate wound healing potential of flavonoid fractions of Martynia annua (M. annua) Linn. leaves in diabetic rats on the basis of folkloric information and preliminary study.MethodsThe flavonoid compound luteolin and apigenin were isolated from dried leaves of plant by column chromatography. The two concentrations (0.2% and 0.5% w/w) of luteolin and flavonoid fraction were selected for topically applied as ointment on diabetic wound. The Povidone Iodine Ointment USP was used as a reference. On 18th days, protein content, hydroxyproline and antioxidants (SOD, CAT and GSH) level in granuloma tissues were determined.ResultsThe results showed that, percent wound contraction were observed significantly (P<0.01) greater in MAF fraction and 0.5% w/w of luteolin treatment groups. Presence of matured collagen fibres and fibroblasts with better angiogenesis were observed in histopathological studies.ConclusionsIn conclusion, our findings suggest that flavonoid fraction (MAF) and luteolin (0.5% w/w) may have potential benefit in enhancing wound healing in diabetic condition, possibly due to free-radical scavenging activity of plant.     

射束方向视图下部分切乳腺的调强方法在左乳腺癌改良根治术后放疗的剂量学研究

目的 研究采用在射束方向视图（BEV）下部分切乳腺（BEV射野设计调强方法，B-IMRT）的调强方法进行左乳腺癌改良根治术后胸壁放疗的剂量学特点。方法 对2020年5月—2020年11月在聊城市人民医院进行放疗的13例左乳腺癌改良根治术后患者，分别用BEV射野设计调强方法（B-IMRT）和切线野调强方法（T-IMRT）进行计划设计。比较2种计划在计划靶区的平均剂量、适形度指数、均匀性指数方面以及左侧肺、心脏的各项剂量体积参数上的差异。结果 B-IMRT计划较T-IMRT计划在计划靶区的适形性和均匀性上均有所改善，具有统计学差异（P < 0.05），靶区平均剂量相近。B-IMRT计划较T-IMRT计划在左侧肺的V₅、V₁₀、V₂₀、V₃₀、D_mean，心脏的V₅、V₁₀、V₃₀、D_mean剂量体积参数上均有所下降，具有统计学差异（P < 0.05）。B-IMRT计划较T-IMRT计划在患侧肺的V₅上减少了T-IMRT计划的9.23%，V₁₀上减少了13.29%，V₂₀上减少了9.54%，V₃₀上减少了8.28%，D_mean上减少了10.35%；在心脏的V₅上减少了T-IMRT计划27.62%，V₁₀上减少了29.72%，V₃₀上减少了21.45%，D_mean上减少了24.88%。结论 B-IMRT计划较T-IMRT计划在靶区剂量的适形度CI、均匀性HI上均有较好的剂量学优势（P < 0.05），而且在降低心肺的照射剂量和照射体积方面优势明显（P < 0.05）。     

改良早期预警评分在心脏科门诊预检分诊中的应用

目的评估改良早期预警评分系统（MEWS评分）在心脏科门诊识别危重患者的应用效果。方法将2012年10～12月来我院就诊的心内科门诊19971例患者进行MEWS评分，据此安排就诊先后顺序，并根据病情危重程度实施必要的处置，将MEWS评分与病情转归进行比较和分析。结果MEWSO～4分患者18634例随诊，5～8分患者1063例，与专科病房及CCU／ICU做好无缝隙连接；≥9分患者274例，死亡危险性明显增加，立即进行紧急医疗干预，实施特别护理。结论简便的MEWS将心脏科患者病情分值化，使医护人员对就诊患者分诊依据更充分，具有识别潜在危重病的作用。     

18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis

Prosthetic valve endocarditis is a major diagnostic challenge in clinical practice, due to the lower sensitivity of the modified Duke criteria and a higher percentage of cases with negative or inconclusive echocardiography results. The delay in establishing medical and surgical treatment increases the morbidity/mortality rate. New imaging techniques and 18F-FDG PET/CT in particular have meant a significant advance in cases of high clinical suspicion and negative or inconclusive echocardiography, increasing the overall sensitivity of the modified Duke criteria.We report the case of a male patient with prosthetic valve endocarditis, where 18F-FDG PET/CT provided the diagnostic key, determining the origin of the endocarditis and avoiding treatment delay.     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

银离子愈邦敷料联合银锌霜治疗重症剥脱性药疹疗效评价

目的:评价新型敷料银离子愈邦联合银锌霜应用于重症药疹大面积剥脱性创面愈合的疗效。方法:42例患者随机分为观察组与对照组,每组各21例。观察组采用愈邦与银锌霜,对照组采用油纱与金霉素眼膏。观察创面愈合时间、患者疼痛度,换药次数。结果:观察组创面愈合时间平均10.10±2.88天,对照组平均13.44+3.16天,差异有极显著统计学意义(P0.01)。观察组换药时疼痛总VAS评分为2.73+1.15分,对照组3.58+2.11分,差异有极显著统计学意义(P0.01);观察组换药次数平均2.47±1.15次,对照组平均4.45±1.22次,差异有极显著统计学意义(P0.01)。结论:愈邦敷料用于重症药疹大面积剥脱性皮损换药疗效肯定。