南阳地区5岁以下儿童社区获得性肺炎病原菌检测分析

目的通过对南阳地区≤5岁儿童社区获得性肺炎(CAP)患儿下呼吸道分泌物病原菌的检测，探讨近年儿童CAP病原菌构成和耐药谱的新特点。 方法选择2003 11—2005 12来自南阳地区各不同社区于南阳医专附院儿科就诊，符合肺炎诊断标准的儿童CAP住院患者1276例，用多平板不同条件对未抗菌治疗采得的标本进行接种培养，分离菌株采用Bio Merieux VITEK 2型全自动微生物仪进行菌种鉴定和药物敏感试验，结果采用WHONET5软件分析处理，得出儿童CAP病原菌种分布构成比及主要致病菌种对常用抗菌药物的耐药率。 结果检出病原菌以革兰阴性菌为主，占68.6%(297/433)，其中前3位分别为大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌。6种主要革兰阴性菌对氨苄西林、复方磺胺、头孢唑啉显示高抗药性，而对美洛培南、亚安培南高度敏感，对阿米卡星、头孢吡肟较敏感。4种主要革兰阳性菌对万古霉素高度敏感，对利福平、氨苄西林/舒巴坦及左氧氟沙星较敏感。 结论儿童CAP病原菌构成在发生变迁，细菌的耐药性也在发生改变，且各地及不同时期存在差异，故应作好病原及药敏监测并改进检测方法，掌握本地区一定时期内儿童CAP的病原学情况。     

ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

Maruyama软件术前预测胃癌淋巴结转移的前瞻性研究

[目的]研究应用Maruyama软件术前预测胃癌淋巴结转移范围的可靠性和可行性.[方法]选择2002年1月～2004年6月问施行根治术的胃癌病人166例进行前瞻性研究.将患者性别、年龄、Borrmann分型、组织学类型、浸润深度、肿瘤部位及大小等预后因素输入计算机,应用Maruyama软件对淋巴结转移范围进行分析,并与术后病理诊断结果比较.[结果]Maruyama软件对各站淋巴结转移的术前预测准确率分别为N1:82.2%,N2:89.0%,N3:95.8%.[结论]Maruyama软件术前预测胃癌淋巴结转移率准确率较高,如能进一步提高术前对浸润深度的判断,将有望增加该软件的临床使用价值.     

单中心近10年腹主动脉瘤1246例流行病学研究

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤（AAA）病人的流行病学特点，为研究近10年AAA流行病学变化趋势，以及为AAA的进一步预防和诊治提供依据。方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料，回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息，分析近10年AAA流行病学变化特点。结果 入院病人平均年龄为（66.9±10.5）岁，男女占比约为4∶1。男性AAA病人以同型半胱氨酸升高为主，女性以血脂升高为主。AAA病人的主要合并症为3级高血压（41.9%）、冠心病（31.1%）和合并髂动脉瘤（25.8%）。男性AAA合并髂动脉瘤比率明显高于女性（27.8% vs.17.8%，P＜0.01）。72.7%的AAA病人首诊原因为体检发现，其次是AAA破裂（18.7%）。AAA病人急诊与门诊就诊例数呈逐年升高态势，急诊与门诊就诊占比约为2∶3。65~69岁为现阶段住院病人主要年龄段。各年份男性占比约为80%，年龄段65~69岁为男性占比可达近90%。各年份腔内修复术（EVAR）是AAA的主要治疗方式，行EVAR治疗病人的例数和比例总体趋势逐年增加，行EVAR治疗的占比随病人年龄增加而逐渐增大。近10年AAA病人的病死率呈降低趋势，2015年后病死率总体维持在2%～3%，以男性为主，年龄段70~74岁的病死率最高为5.8%。AAA病人平均住院（17.0±16.4）d，平均住院费用为（11.3±10.7）万元。结论 近10年AAA住院病人有逐年增高趋势，主要患病人群为年龄＞60岁男性，男女临床特点有较大差异。采用EVAR治疗的占比逐年增加。对于老年AAA人群，尤其是年龄段65~69岁男性AAA病人，在AAA的防治过程中应给予更多关注。     

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??Multi-disciplinary team and conversion therapy for colorectal cancer with unresectable liver metastases??A report of 86 patients WEI-Ye*??YE Qing-hai??YU Yi-yi??et al. *Department of General Surgery, Zhongshan Hospital??Fudan University??Shanghai200032??China
Corresponding author??QIN Xin-yu??E-mail??qin.xinyu@zs-hospital.sh.cn
Abstract Objective To analyze safety and effect of the conversion therapy for initially unresectable colorectal liver metastases (CLMs) under the guidance of multi-disciplinary team (MDT). Methods The retrospective analysis was conducted for 86 patients with unresectable CLMs received MDT management and arrived conversion therapy successfully from January 2008 to December 2011 in Zhongshan Hospital of Fudan University. The perioperative and survival outcomes??prognostic factors were evaluated. Results During the mean follow-up of 41 months (24-68 months), according to the finding time of liver metastases of 86 patients??recurrence events were 73 patients??and 39 patients died. The 1 year??2 year and 3 year overall survival rate (OS) was 90.6%??75.6% and 65.1% respectively. The median OS time was ??47.5±3.1?? months. The 1 year??2 year and 3 year disease free survival rate (DFS) was 72.1%??48.8% and 31.4% respectively. The median DFS time was ??22.0±2.9?? months. The OS and DFS were no significant difference when compared 86 patients with initially unresectable CLMs successfully arrived conversion therapy with 99 patients with initial resectable CLMs??P >0.05??. The perioperative mortality rate was 1.5%??and operative complication rate was 24.4%. Tumor regression grade and early tumor shrink could predict the prognosis of CLM patients received conversion therapy. Conclusion The conversion therapy under the guidance of MDT mode is safe and effective for unresectable CLMs. The mid-term survival rate is similar with initially resectable CLMs??and long-term survival is expected.     

穿山引水

锻炼身体灵活度和增强团队合作意识。 游戏贴士：前一对小朋友还未钻完山洞时，下一对不得匆忙开始。架洞的手不能松开。     

iRoot SP��AH Plus�������ڸ�������Ч����Meta����

??Objective    To systematically evaluate the effect of iRoot SP and AH Plus paste in the treatment of root canal. Methods    Online databases including PubMed??EMBASE??the Cochrane Library??Web of Knowledge??and Chinese databases ??Wanfang database??VIP and CNKI?? were searched systematically up to February 2017. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Two qualified reviewers reviewed the original articles??evaluating qualities of articles??and extracting data independently. After heterogeneity test??Meta-analysis was performed. Results    In total??seven original clinical controlled trials were included??containing 493 teeth. iRoot SP paste could improve the immediate root canal quality ??OR=0.30??95%CI????0.10 ~ 0.85?????reduce the rate of postoperative pain ??OR=0.23??95%CI????0.06 ~ 0.89?????and decrease the apical leakage ??WMD=-0.13??95%CI????-0.22 ~ -0.05????. Conclusion    iRoot SP paste in root canal therapy can significantly alleviate pain??and the long-term curative effect is good??has better biological compatibility??which is an ideal root canal filling material. Because of the small number of the literatures included??which are all in China??it is necessary to include large sample??multicenter??randomized??double-blind??placebo-controlled trails to further confirm the clinical effect.     

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??Abstracts??Objective Different diagnostic methods of biliary atresia ??BA?? and infantile intrahepatic cholestasis disease were investigated in order to find a simple?? fast??practical??economic and non invasive differential diagnostic method. Methods A total of 584 cases of infantile cholestasis were collected from May 2006 to June 2012 for persistent jaundice??pale yellow or white shit who lived in Department of Pediatric Digestion and Infection?? Tongji Hospital?? Tongji Medical College?? Huazhong University of Science & Technology??HUST??. Seven methods including clinical diagnosis??blood biochemical tests?? liver and gallbladder ultrasonography?? dynamic continuous duodenal liquid bile check?? nuclide hepatic imaging?? magnetic resonance imaging and histology were applied for differential diagnosis and the results were analyzed. Results The correctness of clinical diagnosis method was 74.5%?? sensitivity 81.6%??specificity 69.9%?? liver size: 49.0%??89.0%?? and76.9%?? stool color:83.2%??96.1% and96.7%??blood total bilirubin:63.0%??93.1%and91.2% ?? serumγ-GT:79.7%?? 71.1%and78.7% ?? dynamic duodenal liquid color check:93.3%??91.7% and92.7%?? bile acid of duodenal liquid:97.8%??100.0% and 100.0%??B graphy :89.7%??91.7%and94.3%??porta fibre block check:72.1%??29.4%and 68.7%??nuclide hepatic imaging :60.5%??100.0% and 100.0%??MRCP:88.3%??96.5%and94.4%??liver pathology :97.4%??98.2% and 94.9%. Conclusion Differential diagnosis in 1 week can help differentiate biliary atresia from infantile intrahepatic cholestasis. B-ultrasonography and dynamic duodenal fluid test are simple?? fast practical??economic and noninvasive as differential diagnostic methods.     

绿色多一点搭配红色少一点

在画面慢慢浮现的过程中不仅是红色笔迹与黄色笔迹混合出橙色效果这么简单。我们需要用心推敲色彩之间互补和对比的关系。