足趾移植长手指全形再造术的临床应用

目的探讨足趾移植长手指全形再造手术的临床疗效。方法自2015年6月至2019年6月,对16例因外伤致手指缺损患者采用足趾移植长手指全形再造术,术后评估供区及受区的感觉功能、运动功能及外观形态,分析指甲畸形及增生性瘢痕的发生情况,并记录术后发生感染、血肿、皮片坏死及供区愈合不良等情况;通过调查问卷的方式分析患者的满意度。结果所有患者术后获随访1~12个月,其中2例受区发生感染,1例受区皮片边缘发生坏死,经换药后予以缓解;其余患者的供、受区均未出现长时间的痛疼感觉,受区感觉功能恢复达87.50%,受区运动功能恢复均较满意,手指外形基本满意。供区感觉受影响者2例,运动功能受限者1例,外形一般者2例。所有患者无指甲畸形及增生性瘢痕发生;满意者1例,基本满意者14例,不满意者1例。结论采用足趾移植长手指全形再造手术,基本可以满足患者及医师对于缺损手指进行完美修复的目标。     

金黄色葡萄球菌锰超氧化物歧化酶的表达纯化及活性分析

目的克隆表达、纯化金黄色葡萄球菌(Staphylococcus aureus)锰超氧化物歧化酶(Mn-SOD)并测定其活性。方法使用Clustal Omega比对不同来源Mn-SOD的序列,使用Swiss model网站预测金黄色葡萄球菌Mn-SOD的三级结构。提取细菌DNA,以此为模板PCR扩增获得Mn-SOD基因并将其与pET28a连接,构建pET28a-Mn-SOD重组质粒。将重组质粒转化大肠埃希菌BL21(DE3)获得重组菌BL/pET28a-Mn-SOD,使用IPTG诱导表达重组Mn-SOD,通过镍柱亲和层析纯化Mn-SOD蛋白并测定不同pH条件下的酶活性。结果金黄色葡萄球菌Mn-SOD具有Mn-SOD的特征序列和锰离子结合位点。成功得到重组质粒pET28a-Mn-SOD,转化大肠埃希菌BL21后表达相对分子质量为24.8×10^3的Mn-SOD,使用Ni^2+柱纯化后得到高纯度的Mn-SOD,且在pH值为7.5时活性较高,约为3 200 U/mL。结论成功构建了pET28a-Mn-SOD重组质粒能,表达的Mn-SOD重组蛋白纯化后仍具有SOD活性。     

鳖甲煎丸的古代文献研究

目的:通过检索、系统整理经典名方鳖甲煎丸的中医古代文献,系统梳理鳖甲煎丸的历史源流及朝代传承,以期为鳖甲煎丸的进一步文献、临床及药物研究提供文献支持。方法:基于中医古籍数据库,采用文献计量学方法,对中医古代文献中鳖甲煎丸相关数据进行提取,统计分析朝代分布、文献分类、方名、药物组成、主治病症、剂量、制法及服法。结果:获得鳖甲煎丸相关文献数据127条,共涉及中医古籍104本。分析后发现鳖甲煎丸自东汉以来,沿袭日久,并在清朝分布集中,以医案医话类文献为最多,在后世传承中对鳖甲煎丸方名、药物组成、剂量、制法及服法的记载基本遵循《金匮要略》鳖甲煎丸原文,同时基于本方化裁,扩大了鳖甲煎丸的临床应用范围。结论:鳖甲煎丸应用于临床历史久远,且行之有效,传承至今。     

Relever ensemble les nouveaux défis de la lutte contre les cancers

The “États Généraux du Cancer” held in 1998 paved the way for new legislative systems, allowing patients to receive appropriate care in accordance with their rights and the ethics of care. Advances related to the two national cancer plans as well as the continuous improvement of these systems allow optimizing the organization models and the quality of the care pathway of cancer patients. This care pathway is complex, and requires a proper coordination of homecare and hospital professionals whose cultures must converge to meet the needs of the patients and the estimated burden of care anticipated through the personalized care plan. So, the general practitioner will base his action on hospital homecare services and home networks where supportive care is provided. Finally, the quality of care requires a proactive approach, seeking anticipated instructions and, within each institution, a managerial and organizational paradigm shift. This last point reminds the necessary teamwork and multidisciplinary time and takes into account the quality of work life of healthcare professionals.     

The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer

Objectives

We conducted a multi-institutional prospective observational study of elderly patients (≥?75 years-old) with resected non-small cell lung cancer. In this report, we have followed the cohorts for 2 years after surgery and examined both the influence of preoperative comorbidity [Adult Comorbidity Evaluation-27 (ACE-27) index] on the postoperative survival and the change in the Karnofsky Performance Status (KPS).

Methods

From March 2014 to April 2015, 264 patients were prospectively registered from 22 hospitals affiliated with the National Hospital Organization. The mean age at the time of surgery was 79.3 years (range 75–90 years), and 41% of the patients were ≥?80 years of age. A total of 26% underwent sublobar resection. The study endpoints were the postoperative overall survival (OS), its prognostic factors, and the changes in the postoperative KPS.

Results

The 2-year OS was 85.3% (95% confidence interval 80.4–89.1%). Male gender, age?≥?80, a smoking history, grade 2 of ACE-27, and an advanced disease stage were significantly poor prognostic factors for the OS in the univariate risk analysis. The multivariate analysis showed that male gender, age?≥?80, an advanced disease stage and sublobar resection were significantly poor prognostic factors for the OS. In comparison with the preoperative KPS, no marked decline was observed in the postoperative chorological change of KPS.

Conclusions

In the surgical treatment of elderly patients, the comorbidity as assessed by the ACE-27 index might affect the postoperative survival, and therefore should be taken into accounts in the preoperative evaluation of the surgical indications.

     

<Emphasis Type="Italic">Toxoplasma gondii</Emphasis> infection in patients with hematological malignancies

Toxoplasmosis is one of the most common parasitic infections in humans, but in most cases it does not cause serious illness; this protozoan can nevertheless cause devastating disease in immunocompromised hosts such as HIV-positive individuals. Only rarely is toxoplasmosis documented in hematological patients, and among them, those who undergo a transplant procedure are more frequently affected. In a retrospective multicenter survey, we collected data on six cases of toxoplasmosis in hematological patients. In the majority of cases, patients had undergone transplant procedures (five had undergone autologous or allogeneic transplantation). This complication needed special care in diagnosis, usually based on serology, neuroradiology, and PCR examination. However, in our experience the appropriate therapeutic approach was successful in the majority of cases.