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膿毒癥休克患者免疫細胞變化與疾病演變及預后關系的研究

目的 評價膿毒癥休克患者外周血中性粒細胞、單核細胞、淋巴細胞計數與多器官功能衰竭及預后的關系。方法 記錄患者被診斷為膿毒癥休克后第1、3、5、7 d 中性粒細胞、單核細胞、淋巴細胞的變化, 同時進行膿毒癥相關性器官衰竭評分( SOFA) 。根據院內預后分為存活組和死亡組。結果 100 例持續存在7 d 以上膿毒癥休克的患者中, 50 例存活,50 例死亡。死亡組單核細胞計數、SOFA 評分在第5、7 d 明顯升高, 并顯著高于存活組的對應值( P lt;0. 05) 。死亡組淋巴細胞計數在第5、7 d 明顯降低, 并低于存活組的對應值( P lt;0. 05) 。兩組外周血中性粒細胞計數均未發生明顯變化( P gt;0. 05) 。結論 膿毒癥休克時, 單核細胞凋亡可能是機體的保護機制, 而淋巴細胞計數呈下降趨勢預示患者預后不良。將SOFA 評分與淋巴細胞計數的變化相結合觀察膿毒癥休克的病情, 對患者的治療及預后的評價有指導意義。

局部進展期直腸癌新輔助治療決策：結合 NCCN 和 ESMO 指南的分析

Effect on Cellular Immune Function of Treating Gastrointestinal Stromal Tumor by Imatinib Mesylate

目的　探討甲磺酸伊馬替尼治療胃腸道間質瘤對患者細胞免疫功能的影響。方法　對病理診斷明確的16例行甲磺酸伊馬替尼治療的胃腸間質瘤患者的CD3+、CD4+、CD8+、CD4+/CD8+及NK細胞水平進行回顧性分析比較。結果　16例接受嚴格甲磺酸伊馬替尼治療的患者，其CD3+、CD4+、CD8+、CD4+/CD8+及NK細胞水平在甲磺酸伊馬替尼治療前、后無明顯變化（Pgt;0.05）。結論　采用甲磺酸伊馬替尼在對胃腸間質瘤患者進行分子靶向治療時，對患者的細胞免疫功能無明顯影響。

Morphological characteristics and reduction techniques of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures

Objective To summarize the morphological characteristics of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures and to investigate the technical skills in fracture reduction. Methods A clinical data of 31 patients with femoral intertrochanteric fractures between May 2021 and April 2023 was retrospectively analyzed. The fractures had sagittal beak-like deformity of head-neck fragment in all patients. There were 13 males and 18 females, with an average age of 76.2 years (range, 68-83 years). The time from injury to operation was 36-76 hours (mean, 51.2 hours). Fractures were classified as type A1.2 in 10 cases, type A1.3 in 11 cases, type A2.2 in 6 cases, and type A2.3 in 4 cases according to the AO/Orthopaedic Trauma Association (AO/OTA)-2018 classification; and as type A1.3 in 10 cases, type A2.1 in 11 cases, type A2.2 in 6 cases, type A2.3 in 2 cases, and type A2.4 in 2 cases according to a novel comprehensive classification for femoral intertrochanteric fractures proposed by the “Elderly Hip Fracture” Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association. Based on preoperative X-ray films, CT scan and three-dimensional reconstruction, the fractures were classified into two types: type 1 (14 cases), with uncomplicated fracture morphology, severe bone interlocking and (or) soft tissue incarceration; type 2 (17 cases), with severe fracture crushing, obvious dissociation between bone blocks, and severe soft tissue hinge destruction. After the failure of the closed reduction, all patients underwent fracture reduction assisted with instrument via anterior minimal incision and proximal femoral nail antirotation nails internal fixation. The operation time, intraoperative fluoroscopy, intraoperative visible blood loss, length of hospital stay, and incidence of complications were recorded. The fracture reduction quality and stability score were assessed at immediate after operation under fluoroscopy. The fracture healing was evaluated and healing time was recorded by X-ray films. The pain visual analogue scale (VAS) score was performed at 48 hours after operation and Parker-Palmer activity score at 3 months after operation for function evaluation. ResultsThe operation time was 39-58 minutes (mean, 46.3 minutes); fluoroscopy was performed 13-38 times (mean, 23.5 times) during operation; the intraoperative visible blood loss was 45-90 mL (mean, 65.3 mL). The fracture reduction quality and stability score were rated as good in 29 cases and acceptable in 2 cases. The pain VAS score was 2-6 (mean, 3.1) at 48 hours after operation. Eleven patients developed deep vein thrombosis of the lower limbs after operation. Patients were hospitalized for 6-10 days (mean, 7.3 days). All patients were followed up 5-8 months (mean, 6.5 months). All fractures healed at 3.5-8.0 months after operation (mean, 4.5 months). Parker-Palmer activity score at 3 months after operation was 9 in 28 cases and 6 in 3 cases. Conclusion The femoral intertrochanteric fracture with sagittal beak-like deformity of head-neck fragment is difficult to manually reduce. The pin combined with cannulated screw insertion to the neck cortex can hold the fragment and assist fracture reduction, which is a simple and effective technique.