目的：探讨单纯脑白质疏松症(LA)以及LA合并脑梗死及其MRI影像学严重程度与年龄、性别、高血压、糖尿病相关性初步分析。方法：根据郭氏等2003年制定的LA诊断标准纳入168例脑白质疏松症患者，分为A、B两组：A组95例为单纯脑白质疏松(LA)，B组73例为LA合并脑梗死(LA+CI)。两组患者均行头MRI检查。根据Kinkel等的方法将T2WI显示脑室周围高信号范围及程度分为5型.结果：年龄与脑白质疏松的严重程度呈线性相关性(Plt;0.05)，男性与女性间比较脑白质疏松的发生率无显著差异(Pgt;0.05)，LA以及LA+CI患者，其高血压及糖尿病伴发率较高，而且LA+CI组高于LA组(高血压Plt;0.01，糖尿病Plt;0.01)，LA患者MRI表现以1型为主，LA+CI患者表现以2型为主，Plt;0.01)。结论：脑白质疏松症的严重程度与年龄密切相关，LA的发生率在男女性别间无明显差异。高血压、糖尿病可能是LA的危险因素。LA+CI组与单纯LA组相比，其高血压、糖尿病伴发率更高且MRI表现程度更重。
Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.
Objective To explore the safety and efficiency of cervical expansion balloon in promoting cervical ripening of cicatrical uter women with full-term pregnancy attempting vaginal delivery. Methods Fifty cases of pregnant women at the third trimester with cicatrical uter admitted to Nanshan District Maternal and Child Health Care Hospital of Shenzhen from July 2015 to March 2016 were retrospectively and randomly collected as the observation group. Another 50 pregnant women at the third trimester with normal uter admitted to the same hospital in the same period were retrospectively and randomly collected as the control group. All the cases had indications for labor induction, and had intention and conditions of vaginal delivery. Cervical expansion balloons were used in the two groups to promote cervical ripening. The effective rate of promoting cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between the two groups. Results The differences in effective rate of promoting cervical ripening and success rate of induced labor of cervical ripening of pregnant women between the observation group (66%, 76%) and the control group (76%, 84%) were not statistically significant (P>0.05). There were no significant differences in the time of birth process, amout of postpartum bleeding, birth immediate Apgar score, neonatal birth weight, and vaginal delivery rate, and the incidences of acute chorioamnionitis and cervical laceration of pregnant women between the two groups (P>0.05). Incomplete uterine rupture occurred in one case in the observation group, while none in the control group; neonatal mild asphyxia occurred in one case in the control group, while none in the observation group; the differences were not statistically significant (P>0.05). No postpartum hemorrhage occurred in the two groups. Conclusions Under the premise of strictly following the indications, cervical expansion balloon can be used in promoting cervical ripening at the third trimester of pregnant women with cicatrical uter attempting vaginal delivery, improve the success of attempting vaginal delivery, reduce the occurrence of reduplicated cesarean section, and not increase the incidence of maternal and fetal adverse outcomes.
Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
目的 探讨上皮细胞钙黏蛋白（E-Cadherin）、尿激酶型纤溶酶原激活剂（uPA）表达与乳腺癌的浸润、淋巴结转移的关系。 方法 采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连接法对乳腺纤维腺瘤、乳腺腺病和乳腺癌各40例蜡块中E-Cadherin、uPA表达进行研究。 结果 乳腺纤维腺瘤、腺病和乳腺癌中E-Cadherin阳性率分别为85.0%、82.5%和20.0%，三者差异有统计学意义（P＜0.05）；E-Cadherin表达阴性患者淋巴结转移率（90.6%）高于E-Cadherin表达阳性者（25.0%），差异有统计学意义（P＜0.01）。uPA在乳腺纤维腺瘤、腺病均呈阴性表达，在乳腺癌中的阳性率为60.0%，三者差异有统计学意义（P＜0.05）；uPA表达阳性患者淋巴结转移率（88.5%）显著高于阴性者（50.0%），两者的表达差异有统计学意义（P＜0.05）。 结论 E-Cadherin和uPA的表达与乳腺癌的浸润转移密切相关，同步检测其在乳腺癌组织中的表达并综合分析二者之间的关系，对评价乳腺癌细胞的侵袭转移能力及预后判断具有一定价值。uPA在乳腺癌中表达率较高，而且和乳腺癌的生物学特性有关，它对提示预后和开展靶向治疗有指导意义。
Objective To observe the prognosis of pregnant patients with renal failure who underwent blood purification. Methods Pregnant patients with renal failure undergoing blood purification (hemodialysis or hemofiltration) from January 2009 to February 2017 were included in this study. Clinical data and pregnancy outcome were collected retrospectively. Results A total of 42 patients were enrolled in this study, including 38 with acute renal failure, 3 with chronic progressed renal failure, and 1 with chronic renal failure. There were 5 patients (11.9%) with chronic kidney disease (CKD) before pregnancy, 3 (7.2%) with systemic lupus erythematosus, 24 (54.8%) with hypertension, 5 (11.9%) with acute pancreatitis, and 7 (14.3%) with acute liver failure. In perinatal period, 7 patients (16.7%) died, whose underlying diseases were acute pancreatitis in 2, lupus nephritis in 1, acute hepatic failure in 3, and pulmonary tuberculosis breakout in 1. There were 5 patients with twin pregnancy, and 37 patients with single pregnancy. In the 28 patients with natural pregnancy ending, the live birth rate was 82.1% (23/28), and the live birth rate of twin pregnancy was only 50% (5/10). Twenty-seven patients were followed up, in whom 10 were in end stage of renal disease (ESRD), which was correlated with hypertension (P=0.001), and 3 patients were in CKD 1–4. Renal diseases were completely recovered in 14 patients. New CKD were diagnosed in 8 patients, without any correlated factor. Conclusions For pregnant patients with renal failure undergoing hemodialysis or hemofiltration, the death risk and the dead birth rate are high. Patients with hypertension or pre-existed renal failure have higher risk for ESRD. Some patients are not completely recovered from acute renal failure, with CKD left.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
ObjectiveThis study aimed to revise the perioperative recovery scale for integrative medicine (PRSIM) based on item response theory (IRT). MethodsUnder the guidance of IRT, a total of 349 patient data collected during the development of the original version of PRSIM at Guangdong Provincial Hospital of Chinese Medicine were used. Principal component analysis was performed using SPSS 18.0 software to test the unidimensionality. The R language was utilized for parameter estimation, including discrimination coefficient, difficulty parameters and information content, as well as drawing item characteristic curves to assess item quality and estimate item functioning differences. A comprehensive screening process was carried out by combining expert consultations, patient evaluations, and discussions within a core group. ResultsThe degree of discrimination of all items ranged from −0.535 to 2.195. The difficulty coefficient ranged from −10.343 to 5.461, and the average information content of all items ranged from 0.043 to 1.075. Based on the criteria for parameter selection, nine items were retained. The results of expert consultations indicated the removal of 5 items and the modification of 7 items. After discussion within the core group, a final decision was made to remove 5 items. ConclusionBased on a synthesis of IRT and expert consultation feedback, and following discussions within the core group, a revised version comprising 15 items is retained and modified from the original 20 items.