MSCT在对比剂外渗的急性腹部创伤性动脉损伤诊断中的应用价值

目的探讨MSCT在对比剂外渗的急性腹部创伤性动脉损伤诊断中的应用价值。方法回顾性分析本院2016年1月～2018年12月收治的44例急性创伤性腹部动脉损伤患者及58例腹部非创伤性动脉病变患者影像资料,分析急性腹部创伤性和非创伤性动脉病变所致对比剂外渗的相关性。结果 44例创伤性腹部损伤患者通过MSCT及图像后处理技术共检出59支动脉损伤,其中对比剂外渗34支、非对比剂外渗共25支;58例急性腹部非创伤组共检出58支动脉病变,其中8支存在对比剂外渗。对比剂外渗征象创伤组出现率明显高于非创伤性组(χ~2=24.42,P0.05)。结论与非创伤组相比,急性腹部创伤性动脉损伤对比剂外渗征象较为常见,MSCT可以较好地显示创伤性对比剂外渗的直接及间接征象。     

干扰素在恶性淋巴瘤自体移植后早期干预的应用

目的:观察非霍奇金淋巴瘤（non-Hodgkin's lymphoma，NHL）患者自体造血干细胞移植（autologous hematopoietic stem cell transplantation，ASCT）术后应用重组人α-2b干扰素（α-2b IFN）进行早期干预治疗的临床疗效。方法:选取18例行ASCT的NHL患者为研究对象，移植前疾病评估均未达到完全缓解（complete remission，CR），试验组血象恢复后给予IFN 3 000 000 U次/隔日干预治疗，3个月后停用；对照组未行干扰素干预治疗，分析总体疗效及两组对比的生存情况。结果:随访中位时间为34（10~50）个月，患者中位生存时间为37（31~45）个月，3年总体无进展生存（progressive free survival，PFS）、总生存（overall survivial，OS）分别为54.7%、66.8%。ASCT后试验组1年内无疾病复发，2年内复发率为12.5%；对照组1年内复发率为20%，2年内复发率为30%。结论:NHL患者在ASCT后给予重组人α-2b IFN早期干预治疗，患者耐受性好，可能降低移植后早期复发率。     

High plasma microfibrillar-associated protein 4 is associated with reduced surgical repair in abdominal aortic aneurysms

ObjectiveIdentifying biomarkers for abdominal aortic aneurysms (AAA) could prove beneficial in prognosis of AAA and thus the selection for treatment. Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein that is highly expressed in aorta. MFAP4 is involved in several tissue remodeling-related diseases. We aimed to investigate the potential role of plasma MFAP4 (pMFAP4) as a biomarker of AAA.MethodsPlasma samples and data were obtained for 504 male AAA patients and 188 controls in the Viborg Vascular (VIVA) screening trial. The pMFAP4 levels were measured by Alphalisa. The Mann-Whitney U test assessed differences in pMFAP4 levels between the presence and absence of different exposures of interest. The correlation between pMFAP4 and aorta growth rate were investigated through spearman's correlation analysis. Immunohistochemistry and multiple logistic regression adjusted for potential confounders assessed the association between pMFAP4 and AAA. Multiple linear regression assessed the correlation between pMFAP4 and aorta growth rate. Cox regression and competing risk regression were used to investigate the correlation between AAA patients with upper tertile pMFAP4 and the risk of undergoing later surgical repair.ResultsA significant negative correlation between pMFAP4 and aorta growth rate was observed using spearman's correlation analysis (ρ = −0.14; P = .0074). However, this finding did not reach significance when applying multiple linear regression. A tendency of decreased pMFAP4 was observed in AAA using immunohistochemistry. Competing risk regression adjusted for potential confounders indicated that patients with upper tertile pMFAP4 had a hazard ratio of 0.51 (P = .001) for risk of undergoing later surgical repair.ConclusionsHigh levels of pMFAP4 are associated with a decreased likelihood of receiving surgical repair in AAA. This observation warrants confirmation in an independent cohort.     

骨盆骨折大出血救治技术与流程

由于骨盆的特殊结构,其内侧的血管网损伤导致不可压迫性出血。即使创伤中心和救治体系的建设,以及损害控制技术等发展,病死率仍然高达30%~60%。损害控制性复苏、骨盆带、外固定支架、复苏性腹主动脉内球囊阻断(REBOA)、动脉栓塞和腹膜外填塞等技术不断发展,部分已经得到普及,但迄今仍没有公认的确定性止血流程。我国正在普遍建设创伤中心,亟待制订适合我国的骨盆骨折大出血患者的救治流程,以提高救治成功率。本文阐述控制骨盆骨折大出血的外科技术和流程进展供同道参考。     

指压天枢穴加腹部按摩联合番泻叶在静脉肾盂造影患者中的应用效果

目的探讨指压天枢穴加腹部按摩联合番泻叶在静脉肾盂造影患者中的应用效果。方法选取我院2018年12月至2019年8月期间行静脉肾盂造影的120例患者,随机分为两组各60例。对照组给予番泻叶,观察组给予天枢穴指压加腹部按摩联合番泻叶,比较两组的肠道清洁力度和不良反应情况。结果治疗后,观察组的肠道清洁力度明显高于对照组(P <0.05);观察组的不良反应发生率为6.67%,明显低于对照组的23.33%(P <0.05)。结论静脉肾盂造影患者采用指压天枢穴加腹部按摩联合番泻叶的效果较好,可提高肠道清洁力度,降低不良反应发生率。     

Dorsal suspension for Morton’s neuroma: A comparison with neurectomy

BackgroundThe purpose of this study was to investigate and compare the clinical outcomes of dorsal suspension with those of neurectomy for the treatment of Morton’s neuroma.MethodsWe conducted a retrospective study of dorsal suspension and neurectomy group. The dorsal suspension was performed by dorsal transposition of neuroma over the dorsal transverse ligament after neurolysis. The visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), postoperative satisfaction, and complications were evaluated.ResultsBoth groups reported significant pain relief, and there were no significant differences between the groups with respect to postoperative pain. The postoperative FAAM outcomes showed no significant between-group differences. Satisfaction analysis showed ‘excellent’ and ‘good’ results in the dorsal suspension and neurectomy groups (95% and 77.7%, respectively). Complications of numbness and paresthesia reported in the dorsal suspension group (5% and 5%, respectively) were significantly fewer than those of neurectomy group (61.1% and 33.3%, respectively) (both, p < .05).ConclusionsWith its favorable results, dorsal suspension can be another operative option for the treatment of Morton’s neuroma.Level of Evidence: Level III, retrospective comparative case series.