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CLINICAL APPLICATION OF IRREGULAR ANTERIOR LATERAL FEMORAL FLAP IN HAND SURGERY

Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.

多发性硬化的神经眼科表现及治疗

多发性硬化（MS）是中枢神经系统的脱髓鞘病变，以青年起病，慢性复发、缓解为特点；病变多累及神经系统无症状区，少数累及症状明显的区域如视神经和脑干。其中，视觉传入通路受累的视神经炎和眼球运动系统受累的各种眼球运动障碍的诊断和治疗值得眼科医生关注。

光相干断层扫描检查在多发性硬化视觉系统损伤及发病机制研究中的应用

多发性硬化(MS)是一种中枢神经系统(CNS)的炎性脱髓鞘性疾病。视觉传导通路是CNS的重要组成部分, MS发生于CNS的病理损伤同样累及视觉系统。光相干断层扫描(OCT)检查不仅可以直观反映视网膜形态改变, 还能定量测量视网膜各层厚度及容积。以视网膜作为窗口, 通过OCT检查, 评估MS导致的视觉系统结构与功能损伤, 进而探讨MS的病理机制、神经损伤与修复, 减轻MS视觉系统损伤的危害及评估CNS预后具有重要的临床应用和基础研究价值。

误诊为多发性硬化及胶质瘤的原发性中枢系统血管炎一例

Leber多发性粟粒状视网膜动脉瘤病3例临床特征分析

Efficacy and safety analysis of glucocorticoid and tacrolimus in the treatment of anti-synthetase syndrome-associated interstitial lung disease

Objective To evaluate the efficacy and safety of glucocorticoids (GC) monotherapy and GC combined with tacrolimus (TAC) therapy in patients with anti-synthetase syndrome-associated interstitial lung disease (ASS-ILD). Methods Through retrospective analysis and propensity score matching (PSM) analysis, the 2-year progression-free survival (PFS) and related side effects of ASS-ILD patients in TAC+GC group and GC monotherapy group were compared. Predictors associated with PFS were analyzed with COX. Results The 2-year PFS rate of TAC+GC group was better than that of GC group [P=0.0163; hazard ratio (HR) 0.347]; Univariate and multivariate analysis of the COX regression model for 2-year PFS in the two groups suggested that creatine kinase level (P=0.0019, HR 1.002) and initial treatment selection [(TAC+GC) vs. GC, P=0.0197, HR 0.207] were independent predictors of PFS; PSM analysis showed that the 2-year PFS rate of TAC+GC group (54.5%) was higher than that of GC group (18.2%) (P=0.0157, HR 0.275). In terms of adverse effect, there was no significant increase in GC+TAC group compared with GC group. Conclusion Compared with GC monotherapy, initial TAC+GC treatment significantly prolonged PFS in ASS-ILD patients and did not increase the incidence of drug-related complications.

以胸腔积液为首要表现的多发性骨髓瘤一例

目的 分析多发性骨髓瘤合并胸膜转移患者的临床特征。方法 回顾性分析1例多发性骨髓瘤合并胸腔积液患者的临床资料、实验室检查、影像学检查、病理学结果及预后，并复习相关文献。结果 患者为52岁女性，经血常规、生化常规、血清肿瘤标志物及胸腔穿刺行积液常规、生化、肿瘤标志物及细胞学等检查，发现患者中度贫血、肿瘤标志物神经元特异性烯醇化酶显著升高，胸腔积液沉渣见大量浆细胞。经局部麻醉内科胸腔镜胸膜活检，镜下见胸膜肥厚，血管扩张、紊乱，部分结节样增生。后组织病理诊断为浆细胞瘤，结合后续尿蛋白电泳等检查，确诊为多发性骨髓瘤。经化疗及自体干细胞移植术等治疗，患者于13个月后因疾病复发死亡。多发性骨髓瘤出现胸膜浸润的患者较为罕见，多为预后不良的标志，神经元特异性烯醇化酶升高也可作为其预后相关指标。对于疑难胸膜疾病，创伤性相对较小的内科胸腔镜手术可作为诊断的重要手段。 结论 合并胸腔积液的多发性骨髓瘤患者临床特征不典型，需重视胸腔积液细胞学检查并及时获取组织病理。

以胸腔积液为唯一表现的多发性骨髓瘤一例

多发性骨髓瘤（MM）是原发于浆细胞的恶性肿瘤，其临床表现为广泛骨质破坏，反复感染，贫血，高钙血症，高黏滞综合征，肾功能不全等。国内偶见多发性骨髓瘤并胸腔积液的报道，但以胸腔积液为唯一表现者尚未见报道。

The Administration of Highdose Recombinant Human Erythropoietin in Multiple Myeloma Patients with Anemia

目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。

Characteristics of polymyositis/dermatomyositis with anti-aminoacyl-tRNA synthetase antibody positive

Objective To describe the clinical characteristics of polymyositis/dermatomyositis (PM/DM) with anti-aminoacyl-tRNA synthetase (ARS) antibody positive. Methods The clinical, laboratory and radiographic results of PM/DM patients hospitalized in our department from September 2014 to November 2017 were retrospectively analyzed. Results A total of 39 patients were diagnosed (14 cases positive for anti-Jo-1 antibody, 10 cases positive for non-anti-Jo-1 ARS antibodies, and 15 negative for ARS antibodies). The frequency of ARS antibodies positive patients who had interstitial lung disease was higher than those patients without ARS antibodies (P<0.05). Amyosthenia and mechanic's hand were more common in the patients with anti-Jo-1 positive (P<0.05) and the frequency of clinical amyopathic dermatomyositis in non-anti-Jo-1 positive patients was significantly higher (P<0.05). Conclusions The clinical characteristics are similar between anti-Jo-1-positive and non-Jo-1 ARS antibodies positive patients. Most PM/DM patients carrying anti-Jo-1 antibodies with interstitial lung disease own typical imaging characteristics of nonspecific interstitial pneumonia overlap organizing pneumonia (NSIP/OP). It can be diagnosed of non-anti-Jo-1 antibody syndrome although there is no clinical manifestation of myositis and anti-jo-1 antibody is negative.