【摘要】 目的 探討自制雙孔導線針在腹腔鏡小兒腹股溝疝手術中的應用價值。 方法 回顧性分析2006年4月-2010年6月行腹腔鏡小兒腹股溝疝手術655例患兒的臨床資料。單孔針手術組452例，雙孔針手術組203例，將兩組患兒術中、術后資料進行對比分析。 結果 單孔針組手術時間(17. 7±3. 5) min；術中出血(5. 4±1. 3) mL，住院時間(2. 5±1. 0) d發生腹壁下小血腫15例，術后復發3例；雙孔針組手術時間(8. 2±2. 3) min，術中出血(1. 4±0. 3) mL，住院時間(2. 1±0. 8) d，發生腹壁下小血腫2例，術后復發1例。雙孔針組的手術時間、術中出血、并發癥發生率等均明顯優于雙孔針組(Plt;0. 05)，兩組住院天數、復發率差異均無統計學意義(Pgt;0. 05)。 結論 自制雙孔導線縫扎針在腹腔鏡小兒腹股溝疝手術中應用能夠縮短手術時間，操作安全快捷，創傷更小等優點，值得推廣應用。【Abstract】 Objective To explore the clinical value of self-made diplopore suture needle in laparoscopic herniorrhaphy in children. Methods The clinical data of 655 patients who underwent laparoscopic herniorrhaphy between April 2006 and June 2010 were retrospectively analyzed. The patients were divided into the single-hole needle group (452 patients) and the diplopore needle group (203 patients), and the operative and post-operative data of the two groups were analyzed and compared. Results The operation time in the single-hole needle group was (17.7±3.5) minutes and the bleeding volume during the operation was (5.4±1.3) mL; while 15 patients suffered from small hematoma under the abdominal wall and three recurred. The operation time in the diplopore needle group was (8.2±2.3) minutes with (1.4±0.3) mL blood loss; while two patients suffered from small hematoma under the abdominal wall and one recurred. The patients in the single-hole needle group stayed in the hospital for (2.5±1.0) days, while the patients in diplopore needle group stayed for (1.4±0.3) days. The operation time, bleeding volume, rate of complications in diplopore needle group were significantly less than those in the single-hole needle group (Plt;0.05). The hospital staying days, and the recurrence rate in the two groups didn’t differ much (Pgt;0.05). Conclusion The advantages of self-made diplopore needle in laparoscopic herniorrhaphy in children include short operation time, less trauma, and simple operation; it is worth generalizing and applying.
目的:探索早期乳腺癌的臨床特點和診斷方法。方法:回顧性分析46例早期乳腺癌的臨床資料。結果:46例患者中表現為乳腺痛及腫塊者30例,以乳房腫塊就診者16例。鉬靶照片14例,診斷為乳腺癌5例(35.7%)。42例作彩色超聲檢查,發現不規則低回聲結節37例(89.0％),部分腫塊內可見點狀強回聲,周圍有蟹足狀,血流增加。細針穿刺細胞學檢查40例,23例發現癌細胞,直接住院,術中冰凍切片決定手術方式;23例門診先行切除活檢后住院治療。結論:高危婦女表現為乳腺增生,用藥不好轉、癥狀加重者,應懷疑乳腺癌,首選彩色超聲檢查,診斷價值優于鉬靶照片。有腫塊者結合穿刺細胞學檢查,可提高早期乳腺癌的診斷率。
目的:探討青年人大腸癌臨床表現、病理特點。方法:回顧性分析四川省成都市第五人民醫院普外科1997年7月至2007年12月收治的23例35歲以下青年大腸癌患者臨床資料。結果:23例青年大腸癌患者平均年齡24.5歲,男女比例為2.8∶1;病變部位以直腸多見,組織學分型以低分化腺癌與印戒細胞癌最多;Dukes分期:A期1例,B期3例,C期13例,D期6例。結論:青年大腸癌表現為病理分化程度低、Dukes分期晚,更具進展性。提高認識及早期行腸鏡檢查有助于早期診斷。
目的:分析原發性肝癌手術切除的方法及效果。方法:對手術切除的原發性肝癌112例從腫瘤部位、大小、人肝血流阻斷、切除方式、失血量、手術時間等方面進行分析。結果:手術切除率26.23%,手術死亡率0.89%,5年生存率18.75%,10年生存率僅2例。結論:原發性肝癌患者就診時多數已為中晚期或大肝癌,手術切除后療效較差。提高生存率關鍵是:小肝癌的切除、切除方式、術后TACE、復發再切除及術后生物治療等。
ObjectiveTo explore the biomechanical characteristics and clinical application effects of three-dimensional (3D) printed osteotomy guide plate combined with Ilizarov technique in the treatment of rigid clubfoot. Methods A retrospective analysis was performed on the clinical data of 11 patients with rigid clubfoot who met the inclusion criteria and were admitted between January 2019 and December 2024. There were 6 males and 5 females, aged 21-60 years with an average of 43.2 years. Among them, 5 cases were untreated congenital rigid clubfoot, 4 cases were recurrent rigid clubfoot after previous treatment, and 2 cases were rigid clubfoot due to disease sequelae. All 11 patients first received slow distraction using Ilizarov technique combined with circular external fixator until the force lines of the foot and ankle joint were basically normal. Then, 1 male patient aged 24 years was selected, and CT scanning was used to obtain imaging data of the ankle joint and foot. A 3D finite element model was established and validated using the plantar stress distribution nephogram of the patient. After validation, the biomechanical changes of the tibiotalar joint under the same load were simulated after triple arthrodesis and fixation. The optimal correction angle of the hindfoot was determined to fabricate 3D-printed osteotomy guide plates, and all 11 patients underwent triple arthrodesis using these guide plates. The functional recovery was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) score, International Clubfoot Study Group (ICFSG) score, and 36-Item Short Form Survey (SF-36) score before and after operation. Results Finite element analysis showed that the maximum peak von Mises stress of the tibiotalar joint was at hindfoot varus 3° and the minimum at valgus 6°; the maximum peak von Mises stress of the 3 naviculocuneiform joints under various conditions appeared at lateral naviculocuneiform joint before operation, and the minimum appeared at lateral naviculocuneiform joint at neutral position 0°; the maximum peak von Mises stress of the 5 tarsometatarsal joints under various conditions appeared at the 2nd tarsometatarsal joint at hindfoot neutral position 0°, and the minimum appeared at the 1st tarsometatarsal joint at valgus 6°. Clinical application results showed that the characteristics of clubfoot deformity observed during operation were consistent with the preoperative 3D reconstruction model. All 11 patients were followed up 8-24 months with an average of 13.1 months. One patient had postoperative incision exudation, which healed after dressing change; the remaining patients had good incision healing. All patients achieved good healing of the osteotomy segments, with a healing time of 3-6 months and an average of 4.1 months. At last follow-up, the AOFAS score, SF-36 score, and ICFSG score significantly improved when compared with those before operation (P<0.05). ConclusionThe 3D-printed osteotomy guide plate combined with Ilizarov technique has favorable biomechanical advantages in the treatment of rigid clubfoot, with significant clinical application effects. It can effectively improve the foot function of patients and achieve precise and personalized treatment.
Objective To study the growth characteristics of umbil ical cord MSCs (UCMSCs) in vitro and its effect on the nerve regeneration after spinal cord injury (SCI). Methods UCMSCs isolated from pregnant rats umbil ical cord were cultured and purified in vitro. Sixty female Wistar rats weighing (300 ± 10) g were randomized into three groups (n=20per group). UCMSCs group (group A) in which UCMSCs suspension injection was conducted; DMEM control group (groupB) in which 10% DMEM injection was conducted; sham group (group C) in which the animal received laminectomy only.Establ ish acute SCI model (T10) by Impactor model-II device in group A and group B. The recovery of the lower extremity was observed using BBB locomotor scoring system, neurofilament 200 (NF-200) immunofluorescence staining was performed to detect the neural regeneration, and then the corticospinal tract (CST) was observed using the biotinylated dextran amine (BDA) tracing. Results Cultured UCMSCs were spindle-shaped fibrocyte-l ike adherent growth, swirl ing or parallelly. The USMSCs expressed CD29, but not CD31, CD45, and HLA-DR. The BBB score was higher in group A than group B 4, 5, and 6 weeks after operation, and there was a significant difference between two groups (P lt; 0.05). The BBB scores at different time points were significantly lower in groups A and B than that in group C (P lt; 0.05). UCMSCs was proved to survive and assemble around the injured place by frozen section of the cords 6 weeks after injury. NF-200 positive response area in groups A, B, and C was (11 943 ± 856), (7 986 ± 627), and (13 117 ± 945) pixels, respectively, suggesting there was a significant difference between groups A, C and group B (P lt; 0.05), and no significant difference was evident between group A and group C (P gt; 0.05). BDA anterograde tracing 10 weeks after operation demonstrated that more regenerated nerve fibers went through injured area in group A, but just quite few nerve fibers in group B went through the injuried cavity. The ratios of regenerative axons amount to T5 axons in group A and group B were smaller than that of group C (P lt; 0.05). Conclusion UCMSCs can prol iferate rapidly in vitro, survive and differentiate to neurons after being grafted into injured spinal cord. The transplantation of UCMSCs is effective in promoting functional recovery and axonal regeneration after SCI.
Objective To evaluate the therapeutic effect and safety of Bupropion hydrochloride sustained-release tablets in the treatment of depression. Methods A total of 48 patients meeting the diagnostic criteria of depression of CCMD-3 were randomly treated with Bupropion hydrochloride sustained-release tablets or Fluoxetine tablets for 42 days. Hamilton depression rating scale, Hamilton anxiety rating scale, clinical global impression and treatment emergent symptom scale were used to evaluate the therapeutic effect. Blood routine test, urine routine test and electrocardiogram were examined before and after the treatment. Results The effective rate of Bupropion hydrochloride sustained-release tablets [83% (20/ 24) ] was higher than that of Fluoxetine tablets [63% (15/ 24)], with a P value of 0.104. The incidence of adverse reactions was 46% (11/24) in both groups. Conclusion The therapeutic effect of Bupropion hydrochloride sustained-release tablets on depression is similar to that of Fluoxetine tablets, with mild adverse reactions to both treatments.
目的 比較中高度散光患者配戴框架眼鏡和透氣性硬性接觸鏡（RGPCL）的主客觀視覺質量。 方法 選取2008年6月－2011年5月中高度角膜散光20例共40只眼進行角膜地形圖、綜合驗光儀驗光等檢查后，選擇合適試戴片作配適評估并定制RGPCL。要求患者戴鏡后1周、1個月、3個月和6個月復查，記錄矯正視力、鏡片配適、眼部情況，并在第4次復查時進行對比敏感度視力檢查及主觀問卷調查。 結果 RGPCL矯正視力優于框架眼鏡，但兩者對比敏感度視力在各空間頻率均無明顯差異。主觀評分時，遠視力兩者無明顯差別；中距離視力框架眼鏡評分（3.825 ± 0.245）分，RGPCL評分（3.525 ± 0.302）分，差異有統計學意義（t=5.339，P=0.000）；近距離視力框架眼鏡評分（3.795 ± 0.233）分，RGPCL評分（3.690 ± 0.194）分，差異有統計學意義（t=3.462，P=0.030）。有45%患者選擇RGPCL為主要配戴方式；40%患者選擇RGP CL和框架眼鏡交替使用的方式；10%患者選擇僅在有特殊社交需求時使用RGPCL；另5%患者放棄使用RGPCL。 結論 RGPCL和框架眼鏡矯正中高度角膜散光均能取得較滿意效果，在中近距離精細作業時框架眼鏡矯正視力更為穩定清晰。但由于RGPCL在成像質量和外觀上的優勢，多數患者仍愿意堅持配戴RGPCL。
Objective To understand the incidence of frailty in maintenance hemodialysis (MHD) patients, and to explore the correlation and influencing factors of frailty in MHD patients, so as to provide some basis for the intervention of frailty in MHD patients. Methods Patients who underwent MHD in the Department of Nephrology of West China Hospital of Sichuan University from January to March 2021 were selected. Frail scale and Pittsburgh Sleep Quality Index (PSQI) were used for evaluation, and the influencing factors of frail in patients with MHD and its correlation with frail were analyzed. Results A total of 141 patients with MHD were included, including 57 cases without frailty (40.43%), 71 cases in early frailty (50.35%), and 13 cases in frailty (9.22%). 54 cases (38.30%) had very good sleep quality, 56 cases (39.72%) had good sleep quality, 24 cases (17.02%) had average sleep quality, and 7 cases (4.96%) had very poor sleep quality. The frailty of MHD patients was positively correlated with age (rs=0.265, P=0.002), PSQI (rs=0.235, P=0.005) and magnesium (rs=0.280, P=0.001). Logistic regression analysis showed that the influencing factors of MHD patients’ frailty were gender [odds ratio (OR) =4.321, 95%confidence interval (CI) (1.525, 12.243), P=0.006], PSQI [OR=1.110, 95%CI (1.009, 1.222), P=0.032], magnesium [OR=122.072, 95%CI (4.752, 3 135.528), P=0.004], hypertension [OR=0.112, 95%CI (0.023, 0.545), P=0.007] and other diseases [OR=0.102, 95%CI (0.019, 0.552), P=0.008]. Conclusions The incidence of frailty in MHD patients is high. Gender, PSQI, magnesium, hypertension and other diseases are the influencing factors of frailty in MHD patients, and there is a correlation between frailty and sleep. It is suggested that renal medical staff should pay more attention to the assessment of MHD frailty and sleep, and carry out multi-disciplinary personalized intervention to improve the quality of life of MHD patients.
Objective To study whether human amniotic fluid colony derived stem cells (hAFCSCs) are involved in regeneration of injured muscles in mice and to investigate the method and feasibil ity of hAFCSCs-based cytotherapy in the treatment of injured muscles. Methods Human second-trimester amniotic fluid was collected through ultrasound-guided amniocentesis, hAFCSCs were isolated from second-trimester amniotic fluid and cultured, and the cells at 6th-8th passages were spared. The mRNA was extracted to identify the stem cell related genes by RT-PCR. The muscular injury model of bilateral tibial is anterior muscle was establ ished by cardiotoxin and X-ray irradiation in 16 Nod/Scid mice (aged 6-8 weeks, and weighing 20-24 g). The hAFCSCs (3.3 × 107/mL, 30 μL) were injected into the right injured tibial is anterior muscles as the experimental group, while the same volume of complete medium (α-MEM containing 15%FBS, 18%Chang B, 2%Chang C, 1% penicill instreptomycin, and 1% L-glutamine) was injected into the left injured tibial is anterior muscles as the control group. At 2 and 4 weeks after cell transplantation, the immunofluorescence staining of tibial is anterior muscles was performed to detect hepatocyte growth factor receptor (c-Met), myogenic regulatory factor (Myf-5), Laminin, Desmin, and human specific nuclear mitotic apparatus protein (NuMa). Results The clone formation was observed at 5-7 days of primary hAFCSCs culture; after 8-10 days, the clones with homogeneous morphology were selected for subculture. Adequate stem cells were available after 6th-8th subculture. RT-PCR analysis showed that hAFCSCs expressed mRNA of the stem cell related genes. The immunofluorescence double-staining showed that NuMa expressed in tibial is anterior muscles of the experimental group and no myogenic phenotype expressed at 2 weeks after cell transplantation, and that single cell co-expressed NuMa and c-Met or Myf-5 at 4 weeks after cell transplantation. In some myofibers, NuMa and Laminin or Desmin were also co-expressed. No NuMa positive hAFCSCs were detected in the control group at 2 and 4 weeks after cell transplantation. Conclusion hAFCSCs can participate in the regeneration of injured mouse muscle.