目的 探讨胰性脑病的可能的发病机制、发病情况及防治措施.方法 计算机检索中文科技期刊全文数据库(1989～2004),收集有关胰性脑病的临床研究,并进行统计分析.结果 共纳入43篇文献,435例患者.胰性脑病在重症急性胰腺炎中的发病率远高于轻症急性胰腺炎;发病年龄趋向中、老年;病死率为43.67%;病因仍以胆系疾病为主;伴发低氧的几率不高于未并发胰性脑病患者.结论 胰性脑病的发生可能是多因素共同作用的结果,仍需进一步探讨其发病机制.血清髓鞘碱性蛋白有望成为有价值的诊断指标.防治以治疗原发病急性胰腺炎为主,重在预防.胰酶抑制剂和早期营养支持有一定预防作用.
As a common disease in orthopedics, osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people. Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications. There are a large number of operative methods for preserving hip joint in clinical practice without definitive effectiveness. How to choose appropriate surgical methods at the right time is also a continuous understanding. The pathological process of necrosis of the femur helps to choose the choice of the femoral head necrosis for the treatment of hip operation. Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms, but they cannot remove necrotic bone completely. Hence, they are only used for ONFH in the early stage. Vascularized bone transplantation can fill defects of the former, as it can not only completely remove necrotic bone, but also provide bone graft with nourishing vessels for femoral head, being beneficial to reconstruct the bone structure of femoral head. Subsequently, the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head. Hip joint preserving surgery, in recent years, has been performed increasingly, and has obtained improvement in clinical effects. The multiple combination of a variety of its operative methods provides more effective treatments for ONFH. It is an essential notion that hip joint preserving surgery, however with any operative method, should as far as possible select a surgical plan with little trauma, simple methods, and little injury of hip joint bone structure based on ensuring the effectiveness.
ObjectiveTo summarize the clinical morphological classification feature of symptomatic spontaneous isolated celiac artery dissection (SICAD), basing on the relative diameter of the true lumen (TLRD) and type of lesion, and then summarize the reasonable clinical treatment strategies and timing of arterial reconstruction.MethodsRetrospectively analyzed the imaging data, treatment methods, perioperative complications, and follow-up results of 26 symptomatic SICAD patients admitted to the Department of Endovascular Surgery of The First Affiliated Hospital of Zhengzhou University from May 2012 to May 2019, patients were divided into conservative treatment group (n=12) and endovascular intervention group (n=14) according the treatment, and then compared the clinical data of the two groups.ResultsTwelve patients in the conservative treatment group had an average of 12.6 days (5–22 days) and discharged from hospital with better condition, of which 11 patients’ TLRD≥30%. In the endovascular intervention group, 2 patients continued to aggravate the symptoms at the 3rd day of admission and received endovascular intervention, the remaining 12 patients’ symptoms were not significantly relieved or the symptoms reappeared after averaged 11.4 days, whose TLRD<30% or diameter >1.5 cm. Compared with the endovascular intervention group, the duration of symptoms was shorter (P=0.04), proportions of back pain (P=0.02) and chest pain (P=0.04) were lower, TLRD value and proportion of TLRD value>30% (subtype of a) were higher (P=0.01, P=0.02). The average follow-up duration of 26 patients was 28.2 months (12–83 months). The follow-up results of all patients in the conservative treatment group were good and no relevant symptoms had appeared since discharge. One patient in the endovascular intervention group had transient liver function damage, 1 patient had severe deformation of the proximal end of the stent at 1 year after implantation of the celiac artery stent. The remaining patients were stable with no progress.ConclusionsFor symptomatic SICAD, if the clinical symptoms are stable after hospitalization, conservative medication and close imaging follow-up are preferred, if there is no relief of symptoms, continuous organ perfusion and other manifestations based on medication, endovascular intervention can be considered for arterial reconstruction, the early and medium follow-up results were satisfactory under this treatment algorithm. In addition, there are differences in TLRD value between the conservative treatment group and the endovascular intervention group, suggesting that TLRD as the morphological characteristics of the classification has a potential guiding significance for the development of clinical treatment strategy.
End-stage renal disease is a late complication of chronic kidney disease (CKD) and one of the leading causes of high mortality worldwide. Over the years, the impacts of gut microbiota and their associated uremic toxins on kidney diseases through the intricate “gut-kidney axis” have been extensively studied. However, translation of microbiome-related omics results into specific mechanisms is still a significant challenge. In this paper, we review the interaction between gut microbiome and blood purification, as well as the current microbiota-based therapies in CKD. Additionally, the current sequencing technologies and progresses in the gut microbiome research are also discussed.
Childhood obesity is a global public health problem that seriously affects the normal growth and development of children. In recent years, a large number of studies have pointed out that the intestinal microbiome is closely related to childhood obesity, and the treatment strategies targeting the intestinal microbiome have a certain improvement effect on childhood obesity. This article elaborates on the establishment and development of intestinal microbiome, intestinal microbiome characteristics, the mechanisms of intestinal microbiome involvement in the occurrence and development of childhood obesity, and potential intervention strategies, so as to provide more ideas for basic and clinical research on childhood obesity.
Seawater drowning leads to acute lung tissue structure injury, lung ventilation and air exchange dysfunction, acute pulmonary edema, and even acute respiratory failure. The pathogenesis of seawater induced acute lung injury is complex, involving inflammatory response, pulmonary edema, pulmonary surfactant, oxidative stress, apoptosis and autophagy. Timely and effective treatment is the key to reduce the mortality and disability rate of patients with seawater induced acute lung injury. This article summarizes the research progress in the pathogenic mechanism and treatment strategy of seawater induced acute lung injury, aiming to provide reference for the comprehensive treatment of seawater induced acute lung injury patients in clinical work and subsequent related research.
ObjectiveTo summarize and explore the individualized surgical treatment strategy and prognosis of anomalous aortic origin of coronary artery (AAOCA). MethodsThe clinical data of children with AAOCA admitted to Shanghai Children's Medical Center from March 2018 to August 2021 were retrospectively analyzed. ResultsA total of 17 children were enrolled, including 13 males and 4 females, with a median age of 88 (44, 138) months and a median weight of 25 (18, 29) kg. All patients received operations. The methods of coronary artery management included coronary artery decapitation in 9 patients, coronary artery transplantation in 5 patients and coronary artery perforation in 3 patients. One patient with severe cardiac insufficiency (left ventricular ejection fraction 15%) received mechanical circulatory assistance after the operation for 12 days. No death occurred in the early postoperative period, the average ICU stay time was 4.3±3.0 d, and the total hospital stay was 14.4±6.1 d. All the children received regular anticoagulation therapy for 3 months after discharge. The median follow-up time was 15 (13, 24) months. All patients received regular anticoagulation therapy for 3 months after discharge. No clinical symptoms such as chest pain and syncope occurred again. The cardiac function grade was significantly improved compared with that before operation. Imaging examination showed that the coronary artery blood flow on the operation side was unobstructed, and no restenosis occurred. ConclusionAAOCA is easy to induce myocardial ischemia and even sudden cardiac death. Once diagnosed, operation should be carried out as soon as possible. According to the anatomic characteristics of coronary artery, the early effect of individualized surgery is satisfactory, and the symptoms of the children are significantly improved and the cardiac function recovers well in the mid-term follow-up.
ObjectiveTo elucidate the correlation between radiological tumor size (RTS) and pathological tumor size (PTS), and to evaluate the accuracy of clinical T staging. Methods Data on patients who underwent complete resection between September 2018 and June 2019 were retrospectively collected. The correlation between RTS and PTS was analyzed by and we assessed the agreement between clinical and pathologic T staging. Results Finally, 1 880 patients were included. There were 778 males and 1 102 females at average age of 57±11 years. In the entire cohort, the RTS and PTS was 19.1±13.5 mm and 17.7±14.0 mm, respectively (P<0.001). The RTS and PTS showed a strong linear correlation with the Pearson’s correlation coefficient calculated as 0.897. The mean RTS was significantly larger than PTS (P<0.001) in tumors≤3 cm, but significantly smaller in tumors>4 cm. The overall concordance rate between clinical and pathological T staging was 65.6%. Clinical staging failed to detect T4 disease in 29.4% (5/17) of patients. Male patients and the presence of cavities within nodules were independent significant factors leading to inaccurate clinical T staging. Conclusions The correlation between the tumor sizes measured on thin-section computed tomography and pathologic specimens varies with the real tumor size. Methods and techniques for improving clinical T staging accuracy is in urgent need.
ObjectiveTo summarize the treatment strategies and clinical experiences of 5 cases of giant plexiform neurofibromas (PNF) involving the head, face, and neck. MethodsBetween April 2021 and May 2023, 5 patients with giant PNFs involving the head, face, and neck were treated, including 1 male and 4 females, aged 6 to 54 years (mean, 22.4 years). All tumors showed progressive enlargement, involving multiple regions such as the maxillofacial area, ear, and neck, significantly impacting facial appearance. Among them, 3 cases involved tumor infiltration into deep tissues, affecting development, while 4 cases were accompanied by hearing loss. Imaging studies revealed that all 5 tumors predominantly exhibited an invasive growth pattern, in which 2 and 1 also presenting superficial and displacing pattern, respectively. The surgical procedure followed a step-by-step precision treatment strategy based on aesthetic units, rather than simply aiming for maximal tumor resection in a single operation. Routine preoperative embolization of the tumor-feeding vessels was performed to reduce bleeding risk, followed by tumor resection combined with reconstructive surgery. Results All 5 patients underwent 1-3 preoperative embolization procedures, with no intraoperative hemorrhagic complications reported. Four patients required intraoperative blood transfusion. A total of 10 surgical procedures were performed across the 5 patients. One patient experienced early postoperative flap margin necrosis due to ligation for hemostasis; however, the incisions in the remaining patients healed without complications. All patients were followed up for a period ranging from 6 to 36 months, with a mean follow-up duration of 21.6 months. No significant tumor recurrence was observed during the follow-up period. Conclusion For patients with giant PNF involving the head, face, and neck, precision treatment strategy can effectively control surgical risks and improve the standard of aesthetic reconstruction. This approach enhances overall treatment outcomes by minimizing complications and optimizing functional and cosmetic results.