颈椎前路Hybrid手术治疗颈椎病的疗效观察

目的:观察颈椎前路Hybrid手术(颈椎前路减压椎间融合术+颈椎全椎间盘置换术)治疗颈椎病的临床疗效.方法:收集2017年7月～2019年12月接受颈椎前路Hybrid手术的颈椎病患者的临床资料,符合纳入和排除标准并获得临床随访资料者共56例,其中获得完整影像学随访资料者40例.56例患者中神经根型颈椎病36例,混合型...     

直肠前突3种手术疗效比较

为探讨不同术式治疗直肠前突的优缺点,分析2007～2010年采用Sehapayah术式（41例）、PPH术式（57例）和Starr术式（13例）治疗的直肠前突患者在手术时间、术中出血量、有效例数、住院时间、费用、恢复工作时间、术后并发症等指标的对比资料。结果显示,3种术式的有效率相近,Sehapayah术式手术时间长,术中出血量较多,Starr术式费用最高。结果表明,PPH治疗直肠前突是一种有效方法,手术简单,疗效确切,住院时间短、恢复快,术后疼痛轻。Starr术式治疗直肠前突近期疗效确切,但开展时间短,手术例数少,有待于进一步积累资料。     

单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的比较

【摘要】 目的 比较单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的临床效果,评估两种术式在治疗高能量闭合性Pilon骨折中的优劣。 方法 回顾性分析2001年12月至2010年12月收治的42例高能量闭合性Pilon骨折的临床资料。按手术方式不同分为两组:A组26例,行切开复位单纯内固定手术(ORIF);B组16例,行切开复位有限内固定结合外固定手术(LORIF+ EX)。分析术后两组患者感染、骨延迟愈合或不愈合、创伤性关节炎、关节僵硬等并发症的发生率,测量术后8个月患者关节活动度并根据AOFAS评分标准评价其踝足功能。 结果 术前两组患者在性别、年龄、骨折分型、受伤至手术时间等方面无明显差异(P>0.05),术后随访8~109月个月,平均 37.6个月,两种治疗方法在术后并发症发生率、关节活动度及AOFAS评分并无明显差别(P>0.05)。结论 对于高能量闭合性pilon骨折的治疗,切开复位内固定和切开复位有限内固定结合外固定临床疗效相当,并发症的发生率无明显差别,均可作为其治疗手段。     

胰腺癌细胞株PANC-1中肿瘤干细胞的体外耐药性研究

目的:根据肿瘤干细胞学说理论,探讨胰腺癌耐药的新机制。方法:通过胰腺癌肿瘤干细胞表面标记途径和侧群(side population,SP)细胞途径,分离出人胰腺癌细胞株PANC-1中的SP/NSP(非SP)细胞及CD44+CD24+/CD44-CD24-细胞亚群,用MTT检测上述各亚群细胞在体外对化疗药物耐受的差异,用AnnexinV-PI双染法检测2种肿瘤细胞的抗凋亡能力,并采用实时荧光定量PCR检测两者耐药基因ABCG2、ABCB1和PLK-1表达的差异。结果:人胰腺癌细胞株PANC-1中的SP细胞比例为(7.64±0.96)%,CD44+CD24+细胞比例为(2.60±0.96)%。相对于NSP和CD44-CD24-细胞而言,SP和CD44+CD24+细胞具有更强的化疗耐受能力(P0.01)和抗凋亡能力(P0.01);荧光定量RT-PCR结果均提示,SP和CD44+CD24+细胞高表达耐药基因ABCG2、ABCB1和PLK1。结论:人胰腺癌细胞株PANC-1中SP及CD44+CD24+细胞具有更强的化疗耐受能力,研究胰腺癌肿瘤干细胞可为克服胰腺癌化疗敏感性差的现状提供新的实验基础和理论依据。     

高功率微波辐照小鼠免疫组织基因表达谱初步分析

目的：观察一定强度高功率微波(HPM)诱发的小鼠胸腺及淋巴结免疫组织差异基因表达谱的变化,揭示非热效应在分子水平上的作用机制。方法：应用cDNA基因芯片技术分析微波非热效应的分子机制。结果：(1)淋巴结上调的差异表达基因519个,下调基因305个;胸腺上调基因149个,下调基因205个。(2)差异表达基因的生物学功能主要涉及免疫反应及防御、细胞凋亡、DNA修复与复制、应激反应、信号转导、细胞粘附、细胞生长及周期、组织器官发生、物质代谢、细胞增殖等多个方面。结论(1)胸腺差异表达基因总数少于淋巴结,且胸腺差异基因上调及下调的幅度也低于淋巴结,表明淋巴结对HPM辐照的敏感性要高于胸腺。(2)HPM对机体免疫组织的影响可能属非热效应的作用机制,且涉及的差异基因范围也较为广泛。     

Effect of Intra‐wound Vancomycin for Spinal Surgery: A Systematic Review and Meta‐analysis

Intra‐site prophylactic vancomycin in spine surgery is an effective method of decreasing the incidence of postsurgical wound infection. However, there are differences in the prophylactic programs used for various spinal surgeries. Thus, this systematic review and meta‐analysis aimed to evaluate the effectiveness of using intra‐wound vancomycin during spinal surgery and to explore the effects of dose‐dependence and the method of administration in a subgroup analysis. A total of 628 citations or studies were searched in PubMed, Ovid, Web of Science, and Google Scholar that were published before August 2016 with the terms “local vancomycin”, “intra‐wound vancomycin”, “intraoperative vancomycin”, “intra‐site vancomycin”, “topical vancomycin”, “spine surgery”, and “spinal surgery”. Finally, 19 retrospective cohort studies and one prospective case study were eligible for inclusion in the systematic review and meta‐analysis. The odds of developing postsurgical wound infection without prophylactic local vancomycin use were 2.83‐fold higher than the odds of experiencing wound infection with the use of intra‐wound vancomycin (95% confidence interval, 2.03–3.95; P = 0.083; I² = 32.2%). The subgroup analysis including the dosage and the method of administration, revealed different results compared to previous research. The value of I² in the 1‐g group was 27.2%, which was much lower than in the 2‐g group (I² = 57.6%). At the same time, the value of I² was 0.0% (P = 0.792, OR = 2.70) when vancomycin powder was directly sprinkled into all layers of the wound. However, there is high heterogenicity (I² = 60.0%, P = 0.007, OR = 2.83) when vancomycin powder is not exposed to the bone graft and instrumentation. There are differences found with the method of local application of vancomycin for reducing postoperative wounds and further studies are necessary, including investigations focusing on the dose‐dependent effects during spinal or the topical pharmacokinetic and other orthopaedic surgeries.     

失效模式与效应分析在床边监护仪报警管理的应用

目的降低床边监护仪使用过程中的潜在风险,提高护理质量,确保患者安全。方法对5个监护病区60张床位的床边监护仪报警管理,运用失效模式与效应分析(FMEA)对使用流程进行分析,查找每个环节中可能存在的风险,针对操作流程、规范培训、质量监管等关键环节实施改进措施。结果实施FMEA管理后,床边监护仪报警管理质量检查结果、护士监护仪使用相关知识掌握评分与实施前比较,差异有统计学意义(均P0.01)。结论对床边监护仪报警运用FMEA管理,能降低床边监护仪不报警的风险,保障患者安全。     

阿戈美拉汀治疗重度抑郁症的临床疗效

目的 探讨新型抗抑郁药物阿戈美拉汀在治疗重度抑郁患者方面的临床疗效和安全性.方法 选取我院2013年2月～2014年2月收住院的重度抑郁症患者58例随机分为两组,研究组应用阿戈美拉汀25～50mg/d,平均剂量（46.36±4.48）mg/d,对照组选用艾司西酞普兰10～20mg/d,平均剂量（16.83±2.94）mg/d,均治疗8周.治疗前及治疗后第2,4,8周分别采用汉密尔顿抑郁量表（HAMD-17）对两组进行评估,在治疗过程中应用治疗不良反应量表（TESS）进行测量.结果 治疗2周后研究组HAMD减分为（8.36±4.07）分,对照组为（6.19±3.68）分,两组减分情况比较差异有统计学意义（q=3.38,P＜0.05）.治疗8周后阿戈美拉汀组HAMD减分为（18.15±4.29）分,艾司西酞普兰组HAMD减分为（16.26±3.83）分,两组减分情况比较差异有统计学意义（q=4.12,P＜ 0.05）.药物安全性方面,研究组主要不良反应依次是头痛（5例）、便秘（4例）和肝功能异常（3例）;对照组主要不良反应依次是头痛（9例）、恶心呕吐（6例）和血压升高（5例）.TESS总分比较,研究组（3.42±1.24）分低于对照组（4.08±1.69）分,差异有统计学意义（t=7.45,P＜0.01）.结论 阿戈美拉汀在治疗重度抑郁症方面,较艾司西酞普兰起效快,疗效明显,不良反应少.     

Minimizing pharmacodynamic interactions of high doses of lacosamide

Edwards HB, Cole AG, Griffiths AS, Lin B, Bean A, Krauss GL. Minimizing pharmacodynamic interactions of high doses of lacosamide.
Acta Neurol Scand: 2012: 125: 228–233.
© 2011 John Wiley & Sons A/S. Objectives – To determine whether pharmacodynamic interactions between high doses of lacosamide (400–800 mg/day) and concomitant sodium channel antiepilepsy drugs (AEDs) can be minimized in patients with drug‐resistant partial‐onset seizures. Materials and methods – Patients were rapidly initiated with high‐dose lacosamide (100 mg/week; increases to 400 to 800 mg/day), while simultaneously tapering concomitant sodium channel AEDs. Seizure frequency and side effects were evaluated at six time points: baseline, titration, 3, 6, 9 and 12 months. Results – Twenty‐three patients had a baseline median of 4 seizures/month with persisting partial‐onset seizures, despite previous treatment with an average of 6.8 AEDs. Mean decreases in monthly seizure frequency were as follows: 3 months 49.9% (P = 0.011), 6 months 55.4% (P = 0.010), 9 months 60.8% (P = 0.002) and 12 months 58.2% (P = 0.011). Most adverse events were mild CNS‐related symptoms and occurred transiently only during titration – there was no significant relationship (χ² < 1.5, P > 0.1) between lacosamide dose and the presence of side effects at 3, 6, 9 or 12 months. Conclusion – s – Drug‐resistant patients rapidly titrated to high doses of lacosamide with simultaneous tapering of traditional sodium channel AEDs had marked reduction in CNS‐related adverse events compared with patients treated in three previous pivotal trials that used fixed doses of concomitant AEDs.     

Correlates of subjective well-being in schizophrenic patients treated with atypical antipsychotics

Objective

A growing body of research indicates that a low subjective well-being (SW) may be predictive of non-adherence and less favourable outcome. This study examined baseline variables and variables in the course of treatment hypothesised to be associated with later SW.

Methods

Sixty-three inpatients with schizophreniform disorder or schizophrenia were randomly assigned to treatment with various atypical antipsychotics after a wash-out phase of 2 days. Subjects were evaluated with a protocol that examined psychopathology (Positive and Negative Symptom Scale, PANSS), side effects (Scandinavian Society of Pharmacology, UKU), and subjective well-being (Subjective Well-being under Neuroleptic treatment, SWN) at baseline and endpoint (mean duration of treatment 39.9 days). Two-thirds of subjects were multiple episode schizophrenic inpatients pre-treated with antipsychotics.

Results

Multiple regression analyses revealed that the PANSS negative score, neurological side effects, and SWN at baseline, as well as change of the PANSS positive score between baseline and endpoint, were associated independently with SW at endpoint (R²=0.55 after exclusion of two subjects).

Conclusions

Patients with low SW, severe negative symptoms, and neurological side effects, all at baseline, as well as those without improvement or deterioration of positive symptoms are at risk of low SW later in treatment and, most likely, of non-adherence.