ObjectiveTo design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application.MethodsThe clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C4, 5 in 2 cases, C5, 6 in 6 cases, and C6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient’s quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria.ResultsAll operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient’s feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores (P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively (P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%.ConclusionThe P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.
目的:探讨儿童颅骨血管瘤的临床特点和手术治疗。方法:报告自2002年1月至2008年12月我院收治的3例儿童颅骨血管瘤病例,结合相关文献分析该疾病的临床表现,影像学特征,病理特点及治疗方法。结果:儿童颅骨血管瘤临床上极为罕见。影像学检查显示颅骨呈蜂窝状溶骨性改变并向颅内外生长。病理切片显示骨结构异常,并伴有大小不等异常血管增生及血栓形成。结论:颅骨血管瘤是一种侵蚀颅骨内外板的破坏性疾病。手术应早期进行,完整切除后,患者预后良好。
Objective To study the expressions of phosphatese and tensin homolog deletedin chromosom ten （PTEN）, Fas/FasL system and matrix metalloproteinnases-2 （MMP-2） in human gastric cancer. Methods Seventy-five cases of gastric carcinoma were selected from paraffin wax embodied specimens with full clinicopathological data, and another 15 cases of normal gastric mucosa specimens were selected as the control group. SP immunohistochemistry was used to measure the expressions of PTEN， Fas/FasL and MMP-2 in them. The data was statistically analyzed by χ2 test and relative analysis. Results The expressions of PTEN, Fas/FasL and MMP-2 were correlated with the lymphatic metastasis, degree of infiltration, clinical TMN stage and pathological histological differentiated degree of gastric cancer (Plt;0.05). PTEN was positive correlated with Fas/FasL (r=0.401, Plt;0.001). MMP-2 was negative correlated with Fas/FasL (r=－0.720， Plt;0.001). MMP-2 was negative correlated with PTEN (r=－0.336， Plt;0.001). Conclusion There is guidance meaning in testing the expressions of PTEN, Fas/FasL and MMP-2 in gastric cancer to estimate the prevention, diagnoses, therapy and prognosis of gastric cancer.
Objective To research the anti-fungal spectrum and activity of the cream containing 1% naftifine-0.25% ketoconazole compared with other two creams that contain of 2% ketoconazole and of 1% terbinafine, respectively. Methods The agar diffusion method was used to judge drug sensitivity. Twenty-nine isolates of pathogenic fungi belonging to 11 species from clinic and three species of Malassezia standard stains were enrolled into the experiment. Organism suspension of each species was spread on the surface of the plate of the optimal media containing 2% agar. Then wells were made in the plate and three types of cream were put in each well respectively. After seven-day incubation, the diameter of the inhibition zone around the well full of each cream was observed and recorded. Results The inhibition zone around the well full of 1% naftifine-0.25% ketoconazole cream for all experiment isolates (Dermatophytes, Candida spp., Sporothrix schenkii, Fonsecaea pedrosoi, Fusarium graminearum, Malassezia furfur, M. globosa and M. sympodialis) was observed, with the mean diameter of 45.46mm. Similarly, the mean diameter of inhibition zone of 2% ketoconazole cream for all experiment isolates was 23.92mm. About 1% terbinafine cream, the mean diameter was 29.81mm but there was no inhibition zone observed around Candida krusei and Candida albicans mycelial-form. There were significant significances for mean diameters of the inhibition zone when comparing 1% naftifine-0.25% ketoconazole cream with 2% ketoconazole cream (P=0.000) and with 1% terbinafine cream (P=0.000). Conclusion The anti-fungal spectrum of 1% naftifine-0.25% ketoconazole cream is wider than that of 1% terbinafine cream. The antifungal activity of 1% naftifine-0.25% ketoconazole cream is ber than that of 2% ketoconazole cream and 1% terbinafine cream.
急性呼吸窘迫综合征( ARDS) 柏林定义指出: ARDS 以急性起病, 胸部X 线片示双肺弥漫性渗出性改变, 无左房高压的证据, 氧合指数≤300 mm Hg 为临床特征, 发病率及病死率高。几乎所有的 ARDS患者都需要机械通气治疗, 但是传统的通气模式及参数可能导致呼吸机相关性肺损伤 (VILI) , 主要包括气压伤, 容积伤和萎陷伤等。ARDS Network 的研究显示: 与大潮气量( 12 mL/ kg) 合并低呼气末正压 (PEEP) 的通气方式相比, 小潮气量( 6 mL/ kg) 合并高呼气末正压的肺保护性通气策略可以扩张陷闭的肺泡, 同时防止正常肺泡过度扩张, 从而降低肺损伤的发生率, 改善通气和氧合, 降低患者的死亡率。但是, 在实施肺保护性通气策略的基础上, 患者可能在较高的通气压力下仍然无法达到基本的通气和氧合目标, 所以死亡率仍然很高。高频振荡通气( HFOV) 以较快的频率( 成人180 ～600 次/min) 、较低的潮气量( 等于或略低于解剖死腔量) 和较高的平均气道压为特征, 也是一种肺保护性通气方式, 可作为传统通气方式的替代治疗, 降低ARDS患者的死亡率。
Objective To investigate the difference in acetabular tilt angle (ATA) between adults with deve-lopmental dysplasia of the hip (DDH) and normal adults and the effect of ATA on acetabular version. Methods Between February 2009 and October 2015, 31 adult female patients with DDH (39 hips) (DDH group) and 31 female patients with osteoarthritis of the knee (31 hips) who had no history of hip disease (control group) were included in this study. The average age was 39 years (range, 18-59 years) in the DDH group, and was 69 years (range, 52-79 years) in control group. The morphometric parameters of the acetabulum including ATA, acetabular anteversion angle (AAA), acetabular inclination angle (AIA), acetabular cranial anteversion angle (ACAA), and acetabular sector angle (ASA) were mea- sured by CT reconstruction; The ASA was used as an index for acetabular coverage of the femoral head. The correlation between ATA and other parameters was analyzed using Pearson correlation analysis. Results The values of ATA, AAA, and AIA of the DDH group were significantly larger than those of the control group (P<0.05). The ASA in all directions was significantly decreased in the DDH group when compared with the values in the control group (P<0.05). There was no significant difference in ACAA between two groups (t=1.918, P=0.523). The ATA was positively correlated with AAA and ACAA in the DDH group (r=0.439, P=0.001; r=0.436, P=0.002), but there was no correlation between ATA and AIA (r=0.123, P=0.308). In the control group, the ATA was not correlated with AAA, ACAA, and AIA (r=–0.004, P=0.724; r=–0.079, P=0.626; r=–0.058, P=0.724). Regarding acetabular coverage of the femoral head, the ATA and AAA were correlated negatively with anterior ASA (P<0.05) and positively with posterior ASA (P<0.05), but had no correlation with superior ASA (P>0.05) in the DDH group; AIA was correlated negatively with anterior ASA and superior ASA (P<0.05) and had no correlation with posterior ASA (r=–0.092, P=0.440). In the control group, there was no correlation between ATA and ASA in any direction (P>0.05). In the DDH group, defects of the acetabular anterior wall, lateral wall, and posterior wall were observed in 18 hips (46.2%), 15 hips (38.5%), and 6 hips (15.3%), respectively. ATA value of the posterior wall defect [(15.70±10.00)°] was significantly smaller than those of the acetabular anterior wall and lateral wall defects [(22.91±5.06)° and (21.59±3.81) °] (P<0.05), but no signficant difference was found between anterior wall and lateral wall defects (P>0.05). Conclusion ATA will influence acetabular version in DDH. The anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular defect, while the maneuver should be avoided in hips with posterior acetabular defect.
ObjectiveTo retrospectively analyze antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains for guiding the rational use of antibiotics in the area of the Bai nationality.MethodsThe antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains were retrospective analyzed, which were isolated from specimens of inpatients in First People’s Hospital of Dali between May 2016 and May 2017.ResultsAmong the 1 342 samples of various kinds of samples, 262 strains of Klebsiella pneumoniae were isolated, with the detection rate of 19.52% (262/1342). Clinical isolated strains were mainly from the new pediatric, intensive care unit, respiratory medicine, pediatrics, and mostly from sputum specimens (78.24%, 205/262). By screening of 22 kinds of antimicrobial agents, all strains had ampicillin resistance (100.00%), while none of these strains had ertapenem resistance. Extended-spectrum β-lactamases (ESBLs) positive strains’ resistance rate was higher than ESBLs negative strains (χ2=261.992, P<0.01). There were 76 drug resistant profiles, most of which were multidrug-resistant bacteria except 116 (44.27%) strains were resistant to ampicillin antibiotics only. And the number of strains in other resistant types ranged from 1 to 16. Only one of 262 strains had amikacin resistance, two of them were resistant to imipenem and meroenan.ConclusionsThere are many multidrug-resistant bacteria in Klebsiella pneumoniae in the population of Bai nationality, and there are no extensively drug resistant bacteria and pandrug-resistant bacteria strains. The strains of carbapene-resistant antibiotics should be worthy of clinical attention.
目的 探讨水通道蛋白4（AQP4）在脑胶质瘤性脑水肿的分子调节机制及与血管内皮生长因子（VEGF）的关系。 方法 收集2007年10月-2008年6月间65例脑胶质瘤患者手术切除新鲜肿瘤标本（胶质瘤Ⅰ级6例、Ⅱ级18例、Ⅲ级11例、Ⅳ级30例）。应用免疫荧光细胞化学方法检测肿瘤组织中AQP4蛋白和VEGF蛋白的阳性表达情况，并分析AQP4和VEGF的表达差异与关系。 结果 免疫荧光细胞化学法染色显示，AQP4蛋白在正常脑组织中主要表达于细胞膜表面，胞浆和细胞核着色较浅。在胶质瘤细胞内，AQP4广泛分布于胞浆内；肿瘤中AQP4表达和VEGF呈正相关（r=0.877，P=0.000）。 结论 在胶质瘤性脑水肿中，AQP4在胶质瘤细胞内主要分布于胞浆内，且与VEGF呈明显正相关。
ObjectiveTo investigate the timing and clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart disease (CHD) operation.MethodsFrom January 2013 to February 2019, 30 children with CHD who were treated in Fuwai Hospital were collected, including 17 males and 13 females with a median age of 19.5 (3, 72) months. There were 6 patients with bilateral diaphragmatic paralysis (bilateral group) and 24 patients with unilateral diaphragmatic paralysis (unilateral group). The clinical data of the two groups were compared.ResultsAmong the 6 bilateral diaphragmatic paralysis patients, 2 underwent bilateral diaphragmatic plication, and the other 4 patients continued their off-line exercise after unilateral diaphragmatic plication. Patients in the unilateral group had shorter ventilator use time (266.77±338.34 h vs. 995.33±622.29 h, P=0.001) and total ICU stay time (33.21±23.97 d vs. 67.33±28.54 d, P=0.008) than those in the bilateral group. One patient died in the bilateral group, and there was no statistical difference between the two groups (P=0.363). There was no statistical difference in the ICU stay time after diaphragm plication between the two groups (11.68±10.28 d vs. 29.83±27.73 d, P>0.05).ConclusionDiaphragmatic plication is an effective treatment for diaphragmatic paralysis after CHD operation once the conservative treatment failed. The prognosis of bilateral diaphragmatic paralysis is worse than that of unilateral diaphragmatic paralysis. Strict control of indications for surgery is beneficial to the early recovery of patients.
ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.