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脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究

目的 评价脓毒症休克患者外周血中性粒细胞、单核细胞、淋巴细胞计数与多器官功能衰竭及预后的关系。方法 记录患者被诊断为脓毒症休克后第1、3、5、7 d 中性粒细胞、单核细胞、淋巴细胞的变化, 同时进行脓毒症相关性器官衰竭评分( SOFA) 。根据院内预后分为存活组和死亡组。结果 100 例持续存在7 d 以上脓毒症休克的患者中, 50 例存活,50 例死亡。死亡组单核细胞计数、SOFA 评分在第5、7 d 明显升高, 并显著高于存活组的对应值( P lt;0. 05) 。死亡组淋巴细胞计数在第5、7 d 明显降低, 并低于存活组的对应值( P lt;0. 05) 。两组外周血中性粒细胞计数均未发生明显变化( P gt;0. 05) 。结论 脓毒症休克时, 单核细胞凋亡可能是机体的保护机制, 而淋巴细胞计数呈下降趋势预示患者预后不良。将SOFA 评分与淋巴细胞计数的变化相结合观察脓毒症休克的病情, 对患者的治疗及预后的评价有指导意义。

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

目的　探讨甲磺酸伊马替尼治疗胃肠道间质瘤对患者细胞免疫功能的影响。方法　对病理诊断明确的16例行甲磺酸伊马替尼治疗的胃肠间质瘤患者的CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平进行回顾性分析比较。结果　16例接受严格甲磺酸伊马替尼治疗的患者，其CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平在甲磺酸伊马替尼治疗前、后无明显变化（Pgt;0.05）。结论　采用甲磺酸伊马替尼在对胃肠间质瘤患者进行分子靶向治疗时，对患者的细胞免疫功能无明显影响。

局部进展期直肠癌新辅助治疗决策：结合 NCCN 和 ESMO 指南的分析

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.