目的:探討聚焦超聲治療慢性宮頸炎的安全性和有效性。方法:回顧性分析2003年1月至2006年12月我院門診診斷治療的慢性宮頸炎患者,行聚焦超聲治療后并于3月內隨訪的574例患者,分析其安全性及有效性。結果:574例中,痊愈 378例(65.9%),顯效155例(27.0%),總有效率96.7%。治愈率與糜爛面積及深淺程度有關(Plt;0.05)。超聲治療后部分患者出現陰道少量流液及血性分泌物。結論:聚焦超聲應用于慢性宮頸炎的治療安全有效,療效確切,不良反應及并發癥小,值得推廣。
Tuberculosis remains a major public health problem. Genetic epidemiological studies have shown that the differences in host genes partly determine the susceptibility to tuberculosis. The occurrence of tuberculosis is the result of the joint action of Mycobacterium tuberculosis and host gene regulation immune response. The study of susceptibility candidate genes has differences in race, population and region, and the study of susceptibility gene polymorphism still has a long way to go in clinical precision diagnosis and treatment. The study and clinical application of mendelian susceptibility to mycobacterial disease can be used as a classic application of precision medical treatment in tuberculosis; although it is a rare case, this model is worthy of reference.
ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.
We reported a patient intubated for more than 30 d following brain injury, transferred to our department with tracheocutaneous fistula and a 2 cm fistula between the trachea and the esophagus. We performed tracheal resection and esophageal closure with a latissimus dorsi myocutaneous flap interposed between suture lines. The patient continued mechanical ventilation after surgery and the tracheotomy was achieved 14 d after the beginning of surgical treatment. The patient was started oral feeding and discharged on the 10 d after tracheotomy and referred to a neuromotor recovery clinic for treatment of post-traumatic sequelae.
目的 初步測試中文版情緒障礙快速篩查量表K6、SCL-8AD及其分量表（SCL-8、SCL-ANX4及SCL-DEP6）在綜合醫院內科和精神科住院患者中的適用性。 方法 2011年11月－12月對四川大學華西醫院內科（心臟內科、消化內科、風濕免疫科、內分泌科、神經內科）和精神科的住院患者共373例應用由K6和SCL-8AD量表構成的問卷進行自評，分析總問卷、各量表及分量表的信度及相互之間的相關性；在各科患者間進行評分結果差異性比較，并分別將內科及精神科評分結果與住院日進行相關分析。 結果 各量表及全問卷的Cronbach’s α系數和分半系數＞0.75（內科：0.802～0.952，精神科：0.774～0.944）；其中，K6及SCL-8的Cronbach’s α系數和分半系數在內科及精神科均≥0.817。總問卷、各量表及分量表相互之間均存在較高相關性（r≥0.676）；其中，K6及SCL-8與問卷總分均有極高相關性（r≥0.959）。問卷總分、各量表及分量表評分內科組均低于精神科組。 結論 條目少、操作簡便的中文版K6和SCL-8量表內部一致性高、其評定結果能較全面反應綜合醫院內科及精神科住院患者中不同程度的焦慮及抑郁情緒，值得對其進行更深入研究，以便推廣應用于非精神科患者情緒障礙的快速篩查。
Atrial fibrillation (AF) and breast cancer are common diseases with high incidence, which can be promoted and maintained by a wide range of regulatory factors (changes of hormone secretion, chronic inflammation, dysfunctions in autonomic nervous system, coagulation system and endothelia). There may be a consistent pathophysiological link between the increased incidence of breast cancer and AF, which is currently seldomly reported. The development process of these two diseases are complex, and the occurrence of breast cancer may increase the incidence of AF. In this paper, we reviewed the relationship between breast cancer and AF based on the latest reports.
ObjectiveTo explore the classification of ultrasound breast imaging reporting and data system (BI-RADS) classification combined with serum trefoil factor 1 (TFF1) and human growth differentiation factor 3 (GDF3) in the differential diagnosis of benign and malignant breast masses. MethodsThe prospective study collected 113 female patients with breast masses who got treatment in Tangshan People’s Hospital from September 2020 to September 2023. Ultrasound diagnostic equipment was applied for ultrasound BI-RADS classification, ELISA method was applied to detect serum TFF1 and GDF3 levels, Consistency Kappa test was used to compare the consistency of ultrasound BI-RADS classification, serum TFF1 and GDF3 alone and combined in the diagnosis of benign and malignant breast masses and pathological results, In addition, receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the above indicators in the diagnosis of benign and malignant breast masses. ResultsAmong the 113 patients with breast mass, the pathological diagnosis showed benign mass in 48 cases and malignant mass in 65 cases. The serum levels of TFF1 [(1.62±0.25) μg/L vs (1.24±0.27) μg/L] and GDF3 [(118.62±21.73) ng/L vs (96.47±16.05) ng/L] in malignant patients were obviously higher than those in benign patients (P<0.001). There were 70 cases of malignant breast masses and 43 cases of benign breast masses according ultrasound BI-RADS classification combined with serum TFF1 and serum GDF3. The diagnosis consistency with pathological results was very high and Kappa value was 0.835 (P<0.001). The sensitivity and specificity of ultrasound BI-RADS classification combined with serum TFF1 and serum GDF3 in differential diagnosis of benign and malignant breast masses were 96.92% (63/65), 85.42% (41/48), respectively, the negative predictive value was 95.35% (41/43), and positive predictive value was 90.00% (63/70). The sensitivity, negative predictive value and accuracy were higher than those of ultrasonic BI-RADS classification and serum GDF3 alone (P<0.05), and the missed diagnosis rate was lower than that of ultrasonic BI-RADS classification and serum GDF3 alone (P<0.05). ConclusionsThe serum levels of TFF1 and GDF3 increase in patients with malignant breast masses. The combination of ultrasound BI-RADS classification and serum TFF1 and GDF3 can improve the sensitivity and accuracy of the diagnosis of benign and malignant breast masses, and reduce the missed diagnosis rate.
Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P＜0.05， P＜0.01). Apoptotic indices of pancreas and duodenum both showed positive correlations with histopathologic rejection scores (r=0.965， P＜0.01; r=0.942, P＜0.01). The rejection score and apoptotic index elevated, the expression of FasL increased, bcl-2 decreased, and Fas and bax changed over time after operation. Conclusion Apoptosis maybe significantly positive correlated with the degrees of damage of the acute pancreaticoduodenal allograft rejection, and the apoptotic index maybe valuable to estimate the damage. FasL and bcl-2 were significantly related to the impairment of acute pancreatic allograft rejection as well. Duodenum biopsy may contribute to the early diagnosis of the rejecting transplanted tissues.
目的:探討使用Moss Miami系統經骶棘肌肌間隙入路在APERTURE工具的引導下微創治療腰椎滑脫癥的療效。方法:20例腰椎滑脫癥患者(男11例,女9例),年齡30～65歲(平均40歲)。其中退變性14例、峽部裂5例、腰椎間盤突出合并鈣化1例;Ⅰ度滑脫15例,Ⅱ度滑脫5例。滑脫部位:L4滑脫14例,L5滑脫6例,采用全麻俯臥位下經下腰部正中小切口(5cm),經雙側骶棘肌肌間隙入路在APERTURE工具的引導下放置Moss Miami系統進行復位固定和椎體間及后外側植骨融合。結果:本組患者術中在C臂X光機監視,經骶棘間隙放置Moss Miami固定系統簡單易行,切口較小、顯露好、出血少,對骶棘肌等軟組織造成的損傷輕,復位固定效果滿意。術后經6月隨訪表明:本組患者腰腿痛等臨床癥狀緩解,X線片顯示滑脫復位無丟失、植骨融合良好、內固定器械無松動及斷裂。結論:在C臂X光機監視下,采用Moss Miami經骶棘肌肌間隙入路在APERTURE工具的引導下治療腰椎滑脫癥具有切口小、肌肉軟組織損傷輕、出血少、固定器械放置簡單易行等優點,有利于患者術后康復。
Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. The existing treatment of postoperative AF mainly focuses on preoperative prevention, intraoperative protection and postoperative treatment for factors prone to AF before, during and after surgery, but the postoperative treatment in various areas and hospitals is different. This article combines the latest literature published in Europace about the practice guidance of cardioversion of AF and atrial flutter, and summarizes the treatment of electrical cardioversion, in order to provide clinical guidance for electrical cardioversion of AF after cardiac surgery.