超声心动图对室间隔穿孔的诊断价值(附27例报告)

目的 评估超声心动图对室间隔穿孔的诊断价值.方法 回顾性分析27例室间隔穿孔的病例,总结其超声心动图特征.结果 27例患者中26例为急性心肌梗死并室间隔穿孔,其中室间隔心尖部及前间隔穿孔17例,后间隔穿孔9例,均伴有节段性室壁运动异常.1例为钢针穿透伤,肌部室间隔穿孔,二尖瓣前叶腱索断裂伴轻度脱垂.结论 超声心动图能方...     

造血干细胞移植后输尿管狭窄1例

Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation (HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves and ureteral jets of the ileal ureter was confirmed on cine magnetic resonance urography. To sum up, ureteral stenosis after HSCT is relatively rare. Obstruction caused by scarring is usually irreversible and surgical intervention should be designed according to the location and length of the lesion. Ileal ureter replacement can be a safe, feasible and effective method to solve this kind of complex stricture.     

急性脑卒中患者肺部感染风险预测模型的构建及验证

目的 构建急性脑卒中患者发生肺部感染的风险预测模型,为制订针对性的预防措施提供参考。方法 回顾性收集2020年7月至2021年12月440例（建模组）住院急性脑卒中患者临床资料,分析肺部感染现状及风险因素,构建风险预测模型。选择2022年1-5月188例（验证组）急性脑卒中患者对风险预测模型进行验证。结果 建模组急性脑卒中患者肺部感染发生率为23.18%,共分检出病原菌115株,其中革兰阴性菌、革兰阳性菌、真菌分别75株、33株、7株。美国国立卫生研究院卒中量表评分＞15分、入院48 h首次血清C-反应蛋白及降钙素原增高、气管插管、留置胃管、口腔功能障碍、低蛋白血症是急性脑卒中患者发生肺部感染的风险因素（均P＜0.05）。建模组和验证组入院后肺部感染发生风险的ROC曲线下面积分别为0.931和0.927（均P＜0.05）;模型验证结果显示,约登指数为0.721,灵敏度为90.9%,特异度为81.2%,准确率为93.6%。结论 急性脑卒中患者肺部感染发生率高,病原菌以革兰阴性菌为主。可根据预测模型中的风险因素尽早落实医院感染标准防控技术,降低肺部感染发生率。     

腰椎退行性疾病术后近端交界性后凸的危险因素及治疗

背景:老年腰椎退行性疾病的手术治疗中,有时需要进行长节段固定融合,在获得稳定的同时,可能带来固定节段近端交界性后凸(PJK)。目的:回顾腰椎长节段固定融合病例,对PJK发生的危险因素、发生后的处理、预防方法等进行分析。方法:选取2013年1月至2018年6月行腰椎长节段固定融合术后患者117例,最终82例获得随访(随访率70%),记录患者年龄、性别、身高、体重、随访时间、骨密度、体重指数、固定节段等。手术前后及随访时行X线检查,使用Surgimap软件测量胸椎后凸角(TK)、腰椎前凸角(LL)、脊柱矢状轴(SVA)、近端交界角(PJA)、脊柱整体力线(GSA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS),记录Oswestry功能障碍指数(ODI)。对发生PJK的患者记录Hart-ISSG PJKSS量表得分。结果:远端固定到S1的患者以及近端固定到胸腰段的患者PJK发生比例更高。PJK组术前LL、SS较非PJK组更小,术前SVA、PI-LL、GSA较非PJK组更大。末次随访时,27例患者发生PJK(32.9%,27/82),其中9例患者行翻修手术。结论:长节段固定融合手术时远端固定椎应尽量选择L5及L5近端,而近端固定椎尽可能避开胸腰段。对于术前矢状位失衡明显的患者应重视矢状位平衡的恢复,Hart-ISSG PJKSS量表对PJK患者翻修手术具有一定指导价值。     

磷脂酸肌醇-3-激酶/蛋白激酶B信号通路在肺部疾病中的作用研究进展

磷脂酸肌醇-3-激酶(PI3K)/蛋白激酶B(Akt)信号通路是细胞内与增殖、分化和凋亡相关的信号通路，是机体自我保护的重要通路。PI3K被激活后会使其下游分子Akt磷酸化，进而抑制细胞凋亡、调控细胞生存及增殖。PI3K/Akt信号通路在众多肺系疾病，如急性肺损伤、肺炎、哮喘、肺纤维化、肺癌等的发展进程中起着重要作用。该文对PI3K/Akt信号通路在肺系疾病进展中的作用机制进行了综述。     

右室心肌纵向应变评价二尖瓣狭窄患者右室收缩功能的临床研究

目的 应用二维斑点追踪成像技术评价二尖瓣狭窄患者右室心肌纵向应变,探讨该技术在评价此类患者右室收缩功能中的临床应用价值。方法 随机选取我院收治的风湿性心脏病单纯二尖瓣狭窄患者55例,经胸超声心动图测量二尖瓣瓣口面积(MVA)及右室收缩功能指标,包含三尖瓣环收缩期峰值速度(S′)、三尖瓣环收缩期位移(TAPSE)、右室做功指数(RIME)及右室面积变化分数(FAC),根据三尖瓣反流法估测肺动脉收缩压(PASP);二维斑点追踪成像(2D-STI)测量右室游离壁纵向收缩期峰值应变(RVLS_FW),并根据RVLS_FW值将患者分为两组,RVLS_FW<-19%为A组,RVLS_FW≥-19%为B组。结果 两组患者MVA、PASP、TAPSE、S′、RIMP、FAC及RVLS_FW差异有统计学意义(P<0.05),其中RVLS_FW≥-19%的二尖瓣狭窄患者右室收缩功能减低更为明显(P<0.05);RVLS_FW与PASP、RIMP呈正相...