ObjectiveTo design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application.MethodsThe clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C4, 5 in 2 cases, C5, 6 in 6 cases, and C6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient’s quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria.ResultsAll operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient’s feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores (P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively (P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%.ConclusionThe P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.
目的:探讨儿童颅骨血管瘤的临床特点和手术治疗。方法:报告自2002年1月至2008年12月我院收治的3例儿童颅骨血管瘤病例,结合相关文献分析该疾病的临床表现,影像学特征,病理特点及治疗方法。结果:儿童颅骨血管瘤临床上极为罕见。影像学检查显示颅骨呈蜂窝状溶骨性改变并向颅内外生长。病理切片显示骨结构异常,并伴有大小不等异常血管增生及血栓形成。结论:颅骨血管瘤是一种侵蚀颅骨内外板的破坏性疾病。手术应早期进行,完整切除后,患者预后良好。
Objective To study the expressions of phosphatese and tensin homolog deletedin chromosom ten （PTEN）, Fas/FasL system and matrix metalloproteinnases-2 （MMP-2） in human gastric cancer. Methods Seventy-five cases of gastric carcinoma were selected from paraffin wax embodied specimens with full clinicopathological data, and another 15 cases of normal gastric mucosa specimens were selected as the control group. SP immunohistochemistry was used to measure the expressions of PTEN， Fas/FasL and MMP-2 in them. The data was statistically analyzed by χ2 test and relative analysis. Results The expressions of PTEN, Fas/FasL and MMP-2 were correlated with the lymphatic metastasis, degree of infiltration, clinical TMN stage and pathological histological differentiated degree of gastric cancer (Plt;0.05). PTEN was positive correlated with Fas/FasL (r=0.401, Plt;0.001). MMP-2 was negative correlated with Fas/FasL (r=－0.720， Plt;0.001). MMP-2 was negative correlated with PTEN (r=－0.336， Plt;0.001). Conclusion There is guidance meaning in testing the expressions of PTEN, Fas/FasL and MMP-2 in gastric cancer to estimate the prevention, diagnoses, therapy and prognosis of gastric cancer.
Objective To research the anti-fungal spectrum and activity of the cream containing 1% naftifine-0.25% ketoconazole compared with other two creams that contain of 2% ketoconazole and of 1% terbinafine, respectively. Methods The agar diffusion method was used to judge drug sensitivity. Twenty-nine isolates of pathogenic fungi belonging to 11 species from clinic and three species of Malassezia standard stains were enrolled into the experiment. Organism suspension of each species was spread on the surface of the plate of the optimal media containing 2% agar. Then wells were made in the plate and three types of cream were put in each well respectively. After seven-day incubation, the diameter of the inhibition zone around the well full of each cream was observed and recorded. Results The inhibition zone around the well full of 1% naftifine-0.25% ketoconazole cream for all experiment isolates (Dermatophytes, Candida spp., Sporothrix schenkii, Fonsecaea pedrosoi, Fusarium graminearum, Malassezia furfur, M. globosa and M. sympodialis) was observed, with the mean diameter of 45.46mm. Similarly, the mean diameter of inhibition zone of 2% ketoconazole cream for all experiment isolates was 23.92mm. About 1% terbinafine cream, the mean diameter was 29.81mm but there was no inhibition zone observed around Candida krusei and Candida albicans mycelial-form. There were significant significances for mean diameters of the inhibition zone when comparing 1% naftifine-0.25% ketoconazole cream with 2% ketoconazole cream (P=0.000) and with 1% terbinafine cream (P=0.000). Conclusion The anti-fungal spectrum of 1% naftifine-0.25% ketoconazole cream is wider than that of 1% terbinafine cream. The antifungal activity of 1% naftifine-0.25% ketoconazole cream is ber than that of 2% ketoconazole cream and 1% terbinafine cream.
急性呼吸窘迫综合征( ARDS) 柏林定义指出: ARDS 以急性起病, 胸部X 线片示双肺弥漫性渗出性改变, 无左房高压的证据, 氧合指数≤300 mm Hg 为临床特征, 发病率及病死率高。几乎所有的 ARDS患者都需要机械通气治疗, 但是传统的通气模式及参数可能导致呼吸机相关性肺损伤 (VILI) , 主要包括气压伤, 容积伤和萎陷伤等。ARDS Network 的研究显示: 与大潮气量( 12 mL/ kg) 合并低呼气末正压 (PEEP) 的通气方式相比, 小潮气量( 6 mL/ kg) 合并高呼气末正压的肺保护性通气策略可以扩张陷闭的肺泡, 同时防止正常肺泡过度扩张, 从而降低肺损伤的发生率, 改善通气和氧合, 降低患者的死亡率。但是, 在实施肺保护性通气策略的基础上, 患者可能在较高的通气压力下仍然无法达到基本的通气和氧合目标, 所以死亡率仍然很高。高频振荡通气( HFOV) 以较快的频率( 成人180 ～600 次/min) 、较低的潮气量( 等于或略低于解剖死腔量) 和较高的平均气道压为特征, 也是一种肺保护性通气方式, 可作为传统通气方式的替代治疗, 降低ARDS患者的死亡率。
目的探讨纤维支气管镜（纤支镜）在体外循环术后机械通气患者中的应用。 方法回顾性分析2014年1～12月行纤支镜检查76例体外循环术后机械通气患者的临床资料，男45例、女31例，年龄21～71（42.8±6.3）岁。其中行二尖瓣置换术35例，主动脉瓣置换术11例，二尖瓣置换术+主动脉瓣置换术17例，冠状动脉旁路移植术5例，升主动脉+主动脉全弓或半弓人工血管置换术8例。术前心功能Ⅱ级25例、Ⅲ级39例、Ⅳ级12例。术前合并中、重度肺动脉高压13例，感染性心内膜炎5例。 结果76例患者中气道大量分泌物59例，气道严重充血、水肿明显9例，痰痂阻塞气管导管3例，血痂阻塞气管导管2例，导管部分闭塞2例，气道轻微渗血1例。59例经纤支镜检查吸出气道分泌物后，肺部湿啰音较检查前明显减轻，呼吸状态明显好转；其余17例也经纤支镜检查进行准确诊断和有效处理。本组患者在纤支镜检查中顺利完成痰液标本采集共31例，未发生缺氧、心律失常和出血等操作并发症。 结论体外循环术后机械通气患者行纤支镜检查，在维持呼吸道通畅、正确指导抗生素应用、辅助诊断治疗中有积极作用。
Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.
ObjectiveTo retrospectively analyze antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains for guiding the rational use of antibiotics in the area of the Bai nationality.MethodsThe antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains were retrospective analyzed, which were isolated from specimens of inpatients in First People’s Hospital of Dali between May 2016 and May 2017.ResultsAmong the 1 342 samples of various kinds of samples, 262 strains of Klebsiella pneumoniae were isolated, with the detection rate of 19.52% (262/1342). Clinical isolated strains were mainly from the new pediatric, intensive care unit, respiratory medicine, pediatrics, and mostly from sputum specimens (78.24%, 205/262). By screening of 22 kinds of antimicrobial agents, all strains had ampicillin resistance (100.00%), while none of these strains had ertapenem resistance. Extended-spectrum β-lactamases (ESBLs) positive strains’ resistance rate was higher than ESBLs negative strains (χ2=261.992, P<0.01). There were 76 drug resistant profiles, most of which were multidrug-resistant bacteria except 116 (44.27%) strains were resistant to ampicillin antibiotics only. And the number of strains in other resistant types ranged from 1 to 16. Only one of 262 strains had amikacin resistance, two of them were resistant to imipenem and meroenan.ConclusionsThere are many multidrug-resistant bacteria in Klebsiella pneumoniae in the population of Bai nationality, and there are no extensively drug resistant bacteria and pandrug-resistant bacteria strains. The strains of carbapene-resistant antibiotics should be worthy of clinical attention.