目的 探讨持续性非卧床腹膜透析（CAPD）患者低钾血症的发生及临床特点。 方法 选取2002年12月－2011年12月采取持续非卧床腹膜透析治疗的47例尿毒症患者，就其透析过程中低钾血症发生情况进行总结分析。 结果 低钾血症31例（66%）；低钾血症组与非低钾血症组比较，低钾血症组血尿素氮、肌酐、血钠、血氯、血钙及白蛋白明显降低（P＜0.05）；两组年龄、性别、糖尿病肾病所占的比例及透析龄差异均无统计学意义（P＞0.05）。血钾水平随白蛋白浓度、血氯及血钙的提高而下降（OR=0.756， 0.772，0.022，P＜0.05）。 结论 密切联系、定期随诊观察CAPD患者，提高患者就诊依从性，及时发现与纠正低钾血症，有助于提高CAPD患者的生活质量与长期存活率。
ObjectiveTo observe the clinical effects, advantages, and disadvantages of a new penile circumcision and suturing device in circumcision, by comparing it with traditional circumcision and circumcision with Shang Ring.MethodsThe clinical data of 397 outpatients who underwent surgery for redundant prepuce or phimosis between February 2016 and February 2018 in the Third Affiliated Hospital of Zunyi Medical University were retrospectively collected. The patients chose their surgical types in accordance with the principle of voluntary, with 134 cases undergoing traditional circumcision (the traditional circumcision group), 153 cases undergoing circumcision with Shang Ring (the Shang Ring group), and 110 cases undergoing circumcision with the new penile circumcision and suturing device (PCSD group). The safety, clinical efficacy, and complications among the three groups were compared.ResultsThere were significant differences in postoperative pain scores (F=86.901, P<0.001), edema scores (F=315.656, P<0.001), and appearance scores (F=230.952, P<0.001) among the three groups, and the pain, edema, and appearance scores were significantly better in the PCSD group than those in the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05). The differences among the three groups in the postoperative pain relief time (F=236.622, P<0.001), intraoperative bleeding volume (F=115.375, P<0.001), edema subsiding time (F=75.614, P<0.001), operation time (F=965.420, P<0.001), and incision healing time (F=42.584, P<0.001) were statistically significant, and the PCSD group was superior to the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05) in pain relief time, edema subsiding time, and incision healing time. The incidence of postoperative complications in the PCSD group was significantly lower than that in the traditional group and the Shang Ring group (χ2=21.622, P<0.001; χ2=22.778, P<0.001). However, there was no significant difference in intraoperative bleeding volume or operation time between the Shang Ring group and the PCSD group (P=1.000, 0.379), and no significant difference in the incidence of postoperative complications between the traditional circumcision group and the Shang Ring group (χ2=0.014, P=0.912). The proportion of cases undergoing the three surgical methods in each half year changed significantly (χ2=18.721, P<0.001).ConclusionThe use of the new type of penile circumcision and suturing device for circumcision is simple and convenient in clinical operation, with fewer complications, quick recovery, and high satisfaction, and it is worthy of application and promotion.
目的:建立登革病毒的荧光定量PCR检测技术。方法:针对1～4型登革病毒3′端非编码区的一段高度保守序列设计引物和探针,建立登革病毒实时荧光PCR 检测方法及定量的检测方法。并对10例ELISA法检测为登革病毒阳性的病例,取其发热1～2天的临床血清标本进行荧光定量PCR 检测。结果:实时荧光PCR 检测1～4 型登革病毒均为阳性,该探针和引物是登革病毒检测的通用探针和引物。实时荧光PCR检测10份临床血清,6份为阳性,阳性率为60%。结论:实时PCR方法是一个快速、特异性强、敏感性高的检测登革病毒的方法,适用于登革热的临床早期诊断,具有很好的社会效益和经济效益。
ObjectiveTo evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow.MethodsBetween March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days).ResultsAll incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points (P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered.ConclusionThe intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.
Objective To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley’s nonunion evaluation criteria. Results All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley’s nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.
ObjectiveTo explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.MethodsBetween January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria.ResultsAll patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%.ConclusionThe metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.
ObjectiveTo explore the key genes and potential molecular mechanisms of liver and lymph node metastases relevant to duodenal neuroendocrine tumors (DNET). MethodsThe tissues of paracancerous duodenal epithelial, primary lesion, liver metastasis lesion, and lymph node metastasis lesion of a rare DNET accompanied by liver and lymph node metastases were sequenced and analyzed. The differentially expressed genes (DEGs) were screened for different tissues and the functional enrichment analysis was performed. ResultsThe tissues of paracancerous duodenal epithelial was used as the control, a total of 2 053 DEGs expressed only in the liver metastases lesion tissues and 742 DEGs expressed only in the lymph node metastases lesion tissues were screened out, and the top 5 genes expressed in the liver metastases lesion tissues were ORM1, C4BPA, AHSG, C9, and LBP, which in the lymph node metastases lesion tissues were ABHD12B, AC100850.1, HOXC9, AC083967.1, and HOXC8. Kyoto Encyclopedia of Genes and Genomes enrichment analysis found that the DEGs were mainly enriched in the phosphatidylinosiol 3 kinase / protein kinase B pathway, mitogen-activated protein kinase pathway, human papillomavirus infection, etc. ConclusionMultiple DEGs and pathways in metastatic lesions are found in this patient with DNET accompanied by liver metastasis and lymph node metastasis, which provides a new direction for treatment and prophylaxis of DNET.
Objective To analyze the cl inical features of scol iosis associated with Chiari I malformation in adolescent patients, and to explore the val idity and safety of one-stage posterior approach and vertebral column resection for the correction of severe scol iosis. Methods Between October 2004 and August 2008, 17 adolescent patients with scol iosis associated with Chiari I malformation were treated with surgical correction through posterior approach and pedicle instrumentation. There were 9 males and 8 females with an average age of 15.1 years (range, 12-19 years). The MRI scanning showed that 16 of 17 patients had syringomyel ia in cervical or thoracic spinal cord. Apex vertebra of scol iosis were located atT7-12. One-stage posterior vertebral column resection and instrumental correction were performed on 9 patients whose Cobb angle of scol iosis or kyphosis was more than 90°, or who was associated with apparent neurological deficits (total spondylectomy group). Other 8 patients underwent posterior instrumental correction alone (simple correction group). All patients’ fixation and fusion segment ranged from upper thoracic spine to lumbar spine. Results The operative time and the blood loss were (384 ± 65) minutes and (4 160 ± 336) mL in total spondylectomy group, and were (246 ± 47) minutes and (1 450 ± 213) mL in simple correction group; showing significant differences (P lt; 0.05). In total spondylectomy group, coagulation disorder occurred in 1 case, pleural perforation in 4 cases, and lung infection in 1 case. In simple correcction group, pleural perforation occurred in 1 case. These patients were improved after symptomatic treatment. All patients were followed up 24-36 months (32.5 months on average). Bony heal ing was achieved at 6-12 months in total spondylectomy group. No breakage or pull ingout of internal fixator occurred. The angles of kyphosis and scol iosis were significantly improved at 1 week after operation (P lt; 0.01) when compared with those before operation. The correction rates of scol iosis and kyphosis (63.4% ± 4.6% and 72.1% ± 5.8%) in total spondylectomy group were better than those (69.4% ± 17.6% and 48.8% ± 19.3%) in simple correction group. Conclusion Suboccipital decompression before spine deformity correction may not always be necessary in adolescent scol iosis patients associated with Chiari I malformation. In patients with severe and rigid curve or apparente neurological deficits, posterior vertebral column resection would provide the opportunity of satisfied deformity correction and decrease the risk of neurological injury connected with surgical correction.
Objective To investigate the effects and possible mechanism of the local content changes of nitrogen monoxidum on bile reflux in rats’ pylori stress ulcer. Methods Fifty adult SD rats were restrained in planes and then were soaked in cold water to make stress ulcer. They were divided into three groups randomly: the stress group (30 cases), the L-NAME group (10 cases), whose pylori were injected with L-NAME solution and the normal saline group (10 cases), whose pylori were treated with saline solution. Besides, there were another 10 rats taken as the control group. The gastric ulcer index, pH value and bile acid concentration of gastric juice in each group were measured before and after stress. The local concentrations of nitrogen monoxidum in rats’ pylori were also measured by nitrogen monoxidum Biochemical Detection Kit. Results The local content of nitrogen monoxidum in rats’ pylori increased to maximum at 1 h after stress （P＜0.01）, while the bile acid and pH value of gastric juice went up to the maximum at 2 h after stress （P＜0.01）. The ulcer index reached the peak value at 4 h after stress （P＜0.01）. The bile acid concentration and ulcer index of the group injected with L-NAME solution in rats’ pylori decreased significantly compared with those of the group treated with normal saline solution (P＜0.01). The local concentration of nitrogen monoxidum also decreased significantly in the L-NAME group (P＜0.05）. However, there was no difference on pH values of gastric juice between those two groups (Pgt;0.05). Conclusion There is a positive correlation between the local concentration of nitrogen monoxidum in pylori and bile acid in the stomach in rats with stress ulcer. Injection of L-NAME solution in rats’ pylori may reduce the local content of nitrogen monoxidum so that the pyloric sphincter become less tense, which may lead to the significant decreases of ulcer index and bile acid in the stomach. Thus, L-NAME may protect gastric mucus effectively.
ObjectiveTo summarize the experience of comprehensive treatment of parathyroid carcinoma (PTC).MethodThe clinicopathologic data of patient with PTC admitted to the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed.ResultsThe patient was a 42-year-old male, who was diagnosed with the primary hyperparathyroidism after suffering from systemic joint pain for more than 2 years. The patient accepted the first operation in a primary hospital, including the resection of the PTC and ipsilateral thyroid lobectomy, and the PTC was confirmed pathologically. The second operation was performed due to the tumor relapse within thyroid bed. The third operation was performed with the palliative resection of the recurrent tumor in the right neck and the three-dimensional conformal radiation therapy was performed. The fourth operation was performed in the left neck with lateral lymph node dissection of level Ⅲ and level Ⅳ. The lower left lung cuneiform resection was performed in the fifth operation. For the last operation, the mediastinal metastatic tumor was removed with thoracoscopy. The multiple imaging evaluation showed no evidence of recurrence in the neck, but the extensive pulmonary metastasis occurred.ConclusionsSurgery is the only effective treatment for PTC. En bloc excision consists of resection of primary tumor, ipsilateral thyroid lobectomy, other surrounding structures involved by the tumor and central neck dissection. During operation, tumor rupture should be avoided. Accessible metastatic tumor should be resected when possible. Radiotherapy should be performed in patient with local infiltration or unresectable tumor. Effect of chemotherapy for PTC is poor. Supportive medical care should be given for fatal hypercalcemia in patient when treatment failed to control tumor.