Use of splenic volume estimation to distinguish primary thrombocythaemia from reactive thrombocytosis

Splenic volume was measured by visual assessment of planar images of the spleen, and also by single photon emission computerised tomography (SPECT) using 99mtechnetium tin colloid, in a group of 33 patients with primary thrombocythaemia (PT) or reactive thrombocytosis. Volumes greater than 337 cm3 correlated strongly though not absolutely with PT, all patients with volumes greater than this figure being in the PT group. Simple visual assessment of planar images by an experienced observer matched measured splenic volumes very closely.     

冷冻大段同种异体骨移植四肢骨肉瘤保肢治疗55例临床分析

目的: 观察冷冻大段同种异体骨移植保肢治疗四肢骨肉瘤的临床疗效.方法: 1997年6月～2005年7月收治55例四肢骨肉瘤患者,采用肿瘤广泛边缘性切除、大段冷冻同种异体骨移植修复重建骨缺损的保肢治疗,其中股骨42例,胫骨11例,肱骨2例.按Enneking分期,ⅠB期5例,ⅡA期9例,ⅡB期39例,Ⅲ期2例.术前术后联合化疗27例,单一药物化疗者22例,未化疗者6例.结果: 55例患者中49例随访1～8年,平均5年5个月.术后持续无瘤存活19例,局部复发5例,术后出现肺或其他部位转移25例,死亡20例,2年存活率为83.7%,3年存活率为71.4%,5年存活率为59.2%.除5例不愈合外,异体骨与宿主骨间均达骨性愈合,愈合率为89.8%,愈合时间5～24个月,平均7.8个月.3例异体骨关节移植患者发生异体骨骨折,骨折率为6.1%.Mankin分级法评估肢体功能,术后5年随访在可评估的29例病员中,优8例(27.6%),良11例(37.9%),一般2例(6.9%),失败8例(27.6%),优良率为65.5%.结论: 冷冻大段同种异体骨完全成活困难,但异体骨与宿主骨间较易愈合而达到永久性生物连接,目前仍是四肢骨肉瘤保肢术的较为理想的方法.     

Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis,Placental Insufficiency,and Hypoxic Ischemic Fetal Demise,Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy

Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.     

成分输血在25例外科手术患者大出血的应用

目的探讨成分输血在抢救外科手术患者手术中大出血的临床疗效。方法回顾性分析25例大量输血手术患者的临床资料,根据患者病情分为择期手术组和急诊手术组,统计分析患者输注红细胞悬液（CRCs）、新鲜冰冻血浆（FFP）、浓缩血小板（PC）和冷沉淀（Cryo）等成分血的种类和剂量以及输注后的不良反应。结果25例大出血患者经成分输血抢救后出血症状均得到控制,并获得良好的疗效;输注量最大的血液品种是红细胞悬液,两组大量输血手术患者手术前、后实验室检查结果比较无显著性差异（P〉0．05）。结论成分输血在外科手术患者手术中大出血时应用可获得良好的止血效果,为手术继续进行提供了很好的机会,但在各种成分血液用量上有很大差异,应根据患者的出血情况和实验室检查结果输注不同的成分血液。     

Calcium channel antagonist (nifedipine) attenuates Plasmodium berghei-specific T cell immune responses in Balb/C mice

Nifedipine and verapamil (Martin et al. Science 1987;235:899-901) are a class of calcium channel blockers involved in the reversal of chloroquine (CQ) drug resistance in CQ-sensitive Plasmodium spp. Nifedipine alters calcium-dependent functions of macrophages and neutrophils during Plasmodium berghei malaria. However, knowledge of nifedipine-induced immunomodulation of T cell functions during P. berghei malaria is still limited. We investigated the effect of nifedipine on the immune status of splenic T cells during P. berghei malaria. The intracellular calcium levels were determined in the FURA-2A/M loaded T cells by spectrofluorometry. Splenic T cell proliferation, phosphatidylserine (PS) externalization, Fas expression and Bcl2/Bax expression were determined by flow cytometry. We report a significant increase in mean percent parasitemia in nifedipine-treated and P. berghei-infected mice. Although nifedipine treatment alone did not affect the resting state free calcium levels in splenic T cells, the rise in intracellular calcium levels of T cells following P. berghei infection was significantly less in nifedipine-treated mice compared to untreated groups at various parasitemia levels. Antigen-specific splenic T cell proliferation and apoptosis was ablated in nifedipine-treated and untreated groups at various parasitemia levels. The study unequivocally reflects the suppression of P. berghei-specific T cell immune responses by nifedipine.     

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Background: Liver transplantation (LT) is associated with a significant risk of intraoperative hemorrhage and massive blood transfusion. However, there are few relevant reports addressing the long-term impacts of massive transfusion (MT) on liver transplantation recipients.Aim: To assess the effects of MT on the short and long-term outcomes of adult liver transplantation recipients.Methods: We included adult patients who underwent liver transplantation at West China Hospital from January 2011 to February 2015. MT was defined as red blood cell (RBC) transfusion of ≥10 units within 48 hours since the application of LT. Preoperative, intraoperative and postoperative information were collected for data analyzing. We used one-to-one propensity-matching to create pairs. Kaplan-Meier survival analysis was used to compare long-term outcomes of LT recipients between the MT and non-MT groups. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with MT in LT.Results: Finally, a total of 227 patients were included in our study. After propensity score matching, 59 patients were categorized into the MT and 59 patients in non-MT groups. Compared with the non-MT group, the MT group had a higher 30-day mortality (15.3% vs 0, p=0.006), and a higher incidence of postoperative complications, including postoperative pulmonary infection, abdominal hemorrhage, pleural effusion and severe acute kidney injury. Furthermore, MT group had prolonged postoperative ventilation support (42 vs 25 h, p=0.007) and prolonged durations of ICU (12.9 vs 9.5 d, p<0.001) stay. Multivariate COX regression indicated that massive transfusion (OR: 2.393, 95% CI: 1.164-4.923, p=0.018) and acute rejection (OR: 7.295, 95% CI: 2.108-25.246, p=0.02) were significant risk factors affecting long-term survivals of LT patients. The 1-year and 3-year survival rates patients in MT group were 82.5% and 67.3%, respectively, while those of non-MT group were 93.9% and 90.5%, respectively. The MT group exhibited a lower long-term survival rate than the non-MT group (HR: 2.393, 95% CI: 1.164-4.923, p<0.001). Finally, the multivariate logistic regression revealed that preoperative hemoglobin <118 g/L (OR: 5.062, 95% CI: 2.292-11.181, p<0.001) and intraoperative blood loss ≥1100 ml (OR: 3.212, 95% CI: 1.586-6.506, p = 0.001) were the independent risk factor of MT in patients undergoing LT.Conclusion: Patients receiving MT in perioperative periods of LT had worse short-term and long-term outcomes than the non-MT patients. Massive transfusion and acute rejection were significant risk factors affecting long-term survivals of LT patients, and intraoperative blood loss of over 1100 ml was the independent risk factor of MT in patients undergoing LT. The results may offer valuable information on perioperative management in LT recipients who experience high risk of MT.     

施他宁联合奥美拉唑治疗肝硬化并上消化道大出血的疗效观察

目的探讨施他宁(生长抑素)联合奥美拉唑治疗肝硬化合并上消化道大出血的疗效。方法将确诊的83例患者随机分为三组。治疗组采用施他宁联合奥美拉唑的治疗方案,对照1组采用奥曲肽联合奥美拉唑的方案,对照2组采用垂体后叶素联合奥美拉唑的方案,观察时间为72 h。结果治疗组、对照1组、对照2组的止血有效率分别为93.3%、68.0%、57.1%,治疗组的止血有效率明显高于两个对照组(P<0.05);治疗组、对照1组、对照2组的有效止血时间分别为(29.71±6.35)h,(38.24±7.04)h,(40.88±9.98)h,治疗组的有效止血时间明显短于两个对照组(P<0.01)。结论施他宁联合奥美拉唑治疗肝硬化合并上消化道大出血疗效满意。     

腹腔镜下巨脾切除联合贲门周围血管离断术15例

目的探讨腹腔镜巨脾切除联合贲门周围血管离断术的可行性、安全性及有效性。方法 2010年1月～2012年1月行15例腹腔镜下巨脾切除联合贲门周围血管离断术,取右侧斜卧位,超声刀自下向上离断脾结肠、脾胃、脾肾及脾膈韧带,游离脾动脉并结扎,线型切割缝合器（Endo-GIA）离断脾蒂,切除脾脏;切割缝合器切断胃左动静脉,继续游离胃周血管直至食道下端6～8 cm,完成断流。结果 12例腹腔镜下完成巨脾切除,3例因难以控制出血中转开腹。手术时间236～318 min,平均267.2 min;术中出血量200～1000ml,平均400 ml;术后住院时间5～12 d,平均7.8 d。1例出现胰漏,带管引流1个月后漏口愈合,无围手术期死亡。15例术后随访6个月,脾功能亢进纠正,钡餐示5例轻度食管胃底静脉曲张,余10例正常,未再出现呕血、黑便等症状。结论严格把握手术适应证,腹腔镜巨脾切除联合贲门周围血管离断术安全可行。     

全腹腔镜下二级脾蒂离断法原位巨脾切除术的临床研究

［摘要］ 目的 总结全腹腔镜下二级脾蒂离断法原位巨脾切除术的手术要点和临床体会。方法 回顾性分析2013年1月~2017年6月48例实施巨脾切除术的患者临床资料,根据手术方式分为观察组（全腹腔镜下二级脾蒂离断法原位巨脾切除）和开放组（开腹传统法）。比较2组患者手术时间、术中出血、留置腹腔引流管情况、术后拔除引流管时间、并发症及术后住院时间等指标。结果 48例患者均成功完成手术,其中观察组25例均成功在全腹腔镜下完成二级脾蒂离断法原位脾切除术,无中转开腹,观察组手术时间比开放组长（130.40±63.60 min vs 99.13±33.97 min,P=0.038）,术中出血量更少（75.20±50.67 mL vs 206.09±116.77 mL,P=0.000）,术后住院时间更短（8.24±2.20天vs 11.00±3.49天,P=0.002）;观察组留置腹腔引流管的例数更少,差异有统计学意义（P<0.05）,但两组术后拔除引流管的时间相当;两组间脾窝积液、切口感染和发热两组差异无统计学意义（P>0.05）;而观察组术后胸腔积液少于开放组,其差异有统计学意义（P<0.05））;两组均无腹腔出血,腹腔感染,门静脉系统血栓,胰瘘,胃瘘,肝功能衰竭等并发症。术后随访6个月,患者无门静脉系统血栓及肝功能衰竭并发症,胸腔积液已吸收。结论 全腹腔镜下二级脾蒂离断法原位巨脾切除安全可靠,与开腹传统方法比较,术中出血更少,恢复更快。