峡部入路与上外侧入路方法在改良Miccoli手术中的临床应用

目的：探讨峡部入路方法在改良Miccoli手术中应用的效果。方法选择2013年2月~2014年10月抚顺市中心医院收治的行改良Miccoli手术的56例良性甲状腺疾病患者,将其分为峡部入路组(n =30)与上外侧入路组(n=26),由同一手术组人员完成手术,比较不同入路方法患者手术时间、手术出血量、术后24 h引流量以及术后住院时间的差异。结果55例患者成功行改良Miccoli手术,上外侧入路组中1例患者术中出血中转开放手术,1例患者出现暂时性声音嘶哑,其余患者未见声音嘶哑、饮水呛咳、手足抽搐等严重并发症。峡部入路组和上外侧入路组的手术时间、手术出血量及术后24 h引流量比较差异有统计学意义(P约0.05),术后住院时间比较差异无统计学意义(P跃0.05)。结论峡部入路方法应用在改良Miccoli手术中可缩短手术时间,减少手术出血量及术后引流量,值得临床推广。     

Short-Pouch and Low-Anastomosis Duhamel Procedure Results in Better Fecal Control and Normal Defecation Pattern

PURPOSE The purpose of this study was to analyze the long-term outcome of the short-pouch and low-anastomosis Duhamel procedure and to evaluate the quality of life after pull-through. We also tried to answer the questions: Does the modified Duhamel procedure produce fecal continence? Is the quality of life correlated to normal bowel function (1–3 per day) without the use of laxatives?MATERIALS AND METHODS Between January 1993 and January 2002, 53 patients, 44 (83 percent) males and 9 (17 percent) females, who underwent a Duhamel procedure were assessed retrospectively. Of the 53 children, 36 (67.9 percent) underwent a primary Duhamel procedure at our institute (Group A). Seventeen (32.1 percent) patients had a primary Duhamel pull-through and subsequently a stoma before a redo modified Duhamel procedure (Group B). The technical modification was creation of a short rectal pouch of 35 mm, achieving a low colorectal anastomosis 0.5 cm from or on the dentate line. All 53 patients were assessed prospectively by a disease-specific questionnaire. The total score provided a single index of the quality of life associated with fecal continence.RESULTS For Group A (n = 36), the mean period of follow-up was 71.4 ± 29 months. Constipation was seen in four (11.1 percent) patients. In two (5.6 percent) patients there was a mild degree of soiling. Sensation and urge to defecate was intact in 34 (94.4 percent) children who could wait to go to the toilet until it was socially convenient. For Group B (n = 17), the mean period of follow-up was 73.9 ± 31.2 months. Constipation occurred in 17 (100 percent), encopresis in 14 (82.4 percent), and enterocolitis in 15 (88.2 percent) after the primary Duhamel procedure. In comparison, there was complete absence of constipation (100 percent), encopresis (100 percent), and complete resolution of enterocolitis (100 percent) after the redo modified Duhamel (P = 0.001). Continence to solid stools after primary Duhamel was seen in 5 (29.4 percent) vs. 17 (100 percent) after redo modified Duhamel. After the redo modified Duhamel all 17 (100 percent) patients have retained the sensation and urge to defecate and 15 (88.2 percent) can wait to get to the toilet until it is socially convenient. In all 53 patients, the quality of life was good in 86.8 percent (46/53) and correlated directly with fecal continence (r = 0.977). There was no correlation between age of patient and fecal continence (r = 0.597) and rate of fecal incontinence did not decrease with age. Direct correlation was seen with the presence of constipation and the incidence of late onset enterocolitis (r = 0.942).CONCLUSIONS Short-pouch, low-anastomosis Duhamel pull-through procedure results in fecal continence and complete emptying. The above procedure has a positive impact on the quality of life in these children.     

Model of cardiac arrest in rats established by modified transcutaneous electrical stimulation on epicardium北大核心CSCD

Objective To establish the cardiac arrest (CA) model in rats by modified transcutaneous elcctrical stimulation on epicardium. Methods This study was performed in the Emergency Medicine laboratory in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. After 10 Sprague-Dawley male rats weighing 330-380 g were anesthetized, two acupuncture needles connected to the anode and cathode of a stimulator were transcutaneously inserted into the epicardium as electrodes. The puncture points were located quantitatively according to the anatomical structure of the rat chest. The electrical stimulation was maintained for 3 minutes to induce ventricular fibrillation(VF). Cardiopulmonary resuscitation (CPR) included chest compressions, intravenous adrenaline and defibrillation operated at 6 min after a period of nonintervention. Results CA was induced after the implement of the effective electrical stimulation in all ten rats in this experiment. The average current intensity to induce VF was (1.80 ± 0.59) mA, the average time to induce CA was (5.07 ± 237) s, the average time of the total electrical stimulation was (187.50 ± 12.75) s and the total time of CA was 6 min. At the end of the electrical stimulation, 9 rats presented VF and 1 rat showed pulseless electrical activity. The restoration of spontaneous circulation was achieved in all 10 rats. The average time of CPR was(190.90±68.60) s, the mean numbers of defibrillation werc(1.20 ± 0.63), and he average number of adrenaline application were (1.20 ± 0.42) times. Neither visible hemorrhage on epicardium nor gross pulmonary congestion was observed. Conclusions The modified transcutaneous electrical stimulation on epicardium to produce CA model in rats is an easily applicable and effective technique. This model may provide an alternative for experimental research of CPR. © 2018 Chinese Medical Association. All rights reserved.     

Virus-specific T cells as correlate of (cross-)protective immunity against influenza

Since inactivated influenza vaccines mainly confer protective immunity by inducing strain-specific antibodies to the viral hemagglutinin, these vaccines only afford protection against infection with antigenically matching influenza virus strains. Due to the continuous emergence of antigenic drift variants of seasonal influenza viruses and the inevitable future emergence of pandemic influenza viruses, there is considerable interest in the development of influenza vaccines that induce broader protective immunity. It has long been recognized that influenza virus-specific CD8⁺ T cells directed to epitopes located in the relatively conserved internal proteins can cross-react with various subtypes of influenza A virus. This implies that these CD8⁺ T cells, induced by prior influenza virus infections or vaccinations, could afford heterosubtypic immunity. Furthermore, influenza virus-specific CD4⁺ T cells have been shown to be important in protection from infection, either via direct cytotoxic effects or indirectly by providing help to B cells and CD8⁺ T cells. In the present paper, we review the induction of virus-specific T cell responses by influenza virus infection and the role of virus-specific CD4⁺ and CD8⁺ T cells in viral clearance and conferring protection from subsequent infections with homologous or heterologous influenza virus strains. Furthermore, we discuss vector-based vaccination strategies that aim at the induction of a cross-reactive virus-specific T cell response.     

婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测及诊断截断点的探讨

目的:对婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测(NT-proBNP)的价值及诊断截断点进行探讨,为临床诊断提供指导.方法:选取2012年6月～2014年6月间佛山市顺德区妇幼保健院诊治的心力衰竭患者及体检的健康人员各76例为研究对象,分为观察和对照组.所有研究对象行NT-proBNP及心脏射血指数(LVEF)检测,并进行组间比较.观察组患者采用改良Ross标准进行评价,并按照分级对NT-proBNP结果进行比较.同时采用ROC曲线对观察组研究对象检测的敏感性、特异性及诊断截断点予以分析,并就婴幼儿及成人进行组间比较及数据分析.结果:观察者组研究对象中成年人、婴幼儿及平均NT-proBNP含量分别为(1 325.5±148.8)、(3 106.4±593.9)、(2 548.7±368.2)ng/L,均高于对照组(P＜0.05);对两组研究对象的NT-proBNP及LVEF进行组间比较,均具有统计学差异(P＜0.05);观察组在轻、中、重3个级别的NT proBNP含量比较有统计学差异(P＜0.05);组内按年龄组比较,婴幼儿NT-proBNP含量高于成年,且具有统计学差异(P＜0.05);根据ROC曲线分析得出婴幼儿心衰阳性的NT-proBNP参考指标为500ng/L.结论:血浆氨基末端B型利钠肽前体检测在心力衰竭诊断中具有重要的价值,且婴幼儿与成人患者的诊断截断点存在差异,可以500 ng/L作为婴幼儿心衰诊断的参考值.     

加味赤石脂禹余粮汤联合热敏灸治疗肝硬化腹水并顽固性腹泻疗效观察

【目的】观察加味赤石脂禹余粮汤联合热敏灸对肝硬化腹水并顽固性腹泻的临床疗效。【方法】选择肝硬化腹水并顽固性腹泻患者60例,随机分为治疗组与对照组各30例,对照组采用西医常规疗法加中药加味赤石脂禹余粮汤治疗,治疗组在对照组治疗基础上加用热敏灸疗法,观察2组患者腹泻、腹水及肝功能指标[总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、前白蛋白(PA)]改善情况。【结果】(1)腹泻疗效:治疗组总有效率为100.00%,优于对照组的86.67%(P<0.05)。(2)腹水疗效:经彩超检查,治疗后2组的肝硬化腹水均有显著改善(P<0.05),且治疗组疗效优于对照组(P<0.05)。(3)肝功能作用:治疗后,2组TBIL、ALT、AST、ALB、PA指标均显著改善(P<0.05),且治疗组的改善作用均优于对照组(P<0.05)。(4)不良反应及随访情况:治疗过程中,治疗组与对照组均未发生明显不良反应。3个月后随访,对照组腹泻治愈患者中复发5例,治疗组无复发病例。【结论】加味赤石脂禹余粮汤联合热敏灸对肝硬化腹水并顽固性腹泻患者疗效显著,具有止泻迅速、应用方便、安全可靠等优点,并且有加速腹水消退、促进肝功能恢复的作用。     

Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury

Objective

To determine the impact of long-term, body weight–supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers.

Mechanism of adrenocortical toxicity induced by quinocetone and its bidesoxy-quinocetone metabolite in porcine adrenocortical cells in vitro

Quinocetone (QCT) is a new feeding antibacterial agent in the QdNOs family. The mechanism of its adrenal toxicity is far from clear. This study was conducted to estimate the adrenal cell damage induced by QCT and its bidesoxy-quinocetone (B-QCT) metabolite and to further investigate their mechanisms. Following doses of QCT increasing from 5 to 50 μM, cell apoptosis and necrosis, mitochondrial dysfunction and redox imbalance were observed in porcine adrenocortical cells. The mRNA levels of the six components of intermediary enzymes and the adrenal renin-angiotensin-aldosterone system (RAAS) displayed a dysregulation induced by QCT, indicating that QCT might influence aldosterone secretion not only through the upstream of the production but also through the downstream of the adrenal RAAS pathway. In contrast, B-QCT had few toxic effects on the cell apoptosis, mitochondrial dysfunction and redox imbalance. Moreover, LCMS-IT-TOF analysis showed that no desoxy metabolites of QCT were found in either cell lysate or supernatant samples. In conclusion, we reported on the cytotoxicity in porcine adrenocortical cells exposed to QCT via oxidative stress, which raised awareness that its toxic effects resulted from N→O groups, and its toxic mechanism might involve the interference of the steroid hormone biosynthesis pathway.     

回顾性分析糖尿病周围神经病变患者接受加味黄芪桂枝五物汤治疗的临床有效性

目的探究糖尿病周围神经病变患者治疗中加味黄芪桂枝五物汤的应用效果。方法共计抽取90例糖尿病周围神经病变患者作为研究对象,患者均于2018年3月~2019年3月入院进行治疗,按照入院顺序分两个小组,对照组使用常规西药治疗,研究组在西药治疗基础上增加加味黄芪桂枝五物汤,分组对比患者治疗效果以及神经传导速度改善效果。结果研究组患者治疗痊愈及好转率高于对照组,神经传导速度改善效果优于对照组,差异均有统计学意义(P<0.05)。结论糖尿病周围神经病变患者治疗中加味黄芪桂枝五物汤的应用能够有效改善患者临床症状,缓解患者神经功能异常情况,确保患者血糖水平的稳定,促进患者疾病的康复。