【摘要】 目的 探讨高三尖杉酯碱（HHT）联合三氧化二砷（As2O3）、羟基脲治疗高白细胞慢性粒细胞白血病（CML）的疗效和毒副作用。 方法 对2004年11月-2009年12月行高三尖杉酯碱联合As2O3、羟基脲治疗高白细胞CML患者21例的疗效和不良反应进行分析。 结果 经高三尖杉酯碱联合As2O3、羟基脲治疗后3～6个疗程，21例CML患者中完全缓解15例，占71%；部分缓解2例，占10%；总有效率81%；未缓解4例，占19%。不良反应仅表现乏力、纳差、恶心、脱发。 结论 HHT联合As2O3、羟基脲是治疗高白细胞CML一种有效率高，临床容易开展，安全性好的方法。【Abstract】 Objective To investigate the effects and side effects of homoharringtonine combined with arsenic trioxide or hydroxycarbamide on hyperleukocytic chronic myelocytic leukemia (CML). Methods The therapeutic effects and adverse effects of homoharringtonine combined with arsenic trioxide or hydroxycarbamide administered in 21 cases with CML from November 2004 to December 2009. Results In 21 patients with CML, the CR rate was 71% (15/21) and PR rate was 10% (2/21). The total respondence rate was 81% and the side effects were slight. The side effect only shows short of strength, appetite decrease, naupathia, hair loss and no heart side effect. Conclusion Homoharringtonine combined with arsenic trioxide or hydroxycabamide has a high effect rate on CML with good safety.
Objective To investigate the risk factors of new-onset postoperative atrial fibrillation (POAF) in patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB). Methods Between January 2016 and January 2018, a total of 583 patients who underwent OPCAB in TEDA International Cardiovascular Hospital were retrospectively analyzed. There were 434 males and 149 females with an average age of 62.79±8.08 years. The patients were divided into 2 groups, a POAF group (n=158) and a non-POAF group (n=425) , in accordance with the occurrence of POAF. The perioperative clinical parameters of the two groups were analyzed by univariate analysis. Then, statistically significant factors in the univariate analysis were subjected to multivariate logistic regression analysis to determine if it was an independent risk factor for POAF. Results Univariate analysis showed that age≥65 years (P=0.012), history of chronic obstructive pulmonary disease (COPD, P=0.028), left atrial diameter (LAD)≥38 mm (P=0.016) and neutrophil-lymphocyte ratio (NLR, P=0.002) were related to POAF. Logistic multivariate regression analysis showed that age≥65 years (OR=1.717, P=0.006), LAD≥38 mm (OR=1.562, P=0.023) and higher NLR level (OR=1.215, P=0.022) were the independent risk factors of POAF after OPCAB, but not previous history of COPD (OR=2.489, P=0.326). Conclusion In patients with OPCAB, advanced age (≥65 years), LAD enlargement (≥38 mm) and higher NLR level are the independent risk factors of POAF after OPCAB.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.
Objective To evaluate the feasibil ity of direct anastomosis in the rat model of the brachial plexus extravertebral foramen nerve root division of C5-7. Methods Forty-eight SD rats (male or female) aging 4-6 months and weighing 250-300 g were selected to make the model of extravertebral foramen nerve root division of C5-7. The left C5-7 nerve roots, as the experimental sides, were separated to the brachial plexus nerve trunk and the transected roots were sutured to theproximal stump immediately after cutting off the brachial plexus extravertebral foramen nerve root division. The right C5-7nerve roots, as the control sides, received no operation. The general condition of rats after operation was observed. The gross observation, the histological observation and BDA nerve tracing technology were adopted to observe the wet weight of musculus biceps brachii, the cross section of biceps brachii and the spinal cord and distal nerve trunk at 3 weeks, 3 months and 6 months after operation. Results All rats survived well after operation. Claudication and unfold claw reflex were observed in the experimental sides, and the unfold claw reflex disappeared 3 months later. Comparatively, the control sides were normal. Nerve adhesion aggravated gradually and the neural stems were shriveled within 6 months after operation in the experimental sides. Comparatively, the control sides were normal. The wet weight of biceps brachii in the experimental sides and the control sides at 3 weeks, 3 months and 6 months after operation was (0.28 ± 0.12), (1.37 ± 0.33), (0.58 ± 0.10), (1.36 ± 0.35), (1.39 ± 0.31), (1.37 ± 0.38) g, respectively, indicating significant differences between two sides at 3 weeks and 3 months (P lt; 0.05), but no significant difference at 6 months (P gt; 0.05). The modified Marsland and the LFB staining of spinal cord and superior trunk of brachial plexus showed that the number of neurons, cell nuclear and Nissl body decreased and cell bodies changed from swell ing to shrinkage, dyeing nerve fibers increased, neural axone was thin and myel in sheath was sl ightly stained at each time point in experimental side. The number of motor neurons in cornu anterius medullae spinal is in the experimental side was 84.5% ± 3.2%, 74.4% ± 4.5%, 73.7% ± 3.8% of that in the control side at each time point, respectively. HE staining of biceps brachii detected thatthe muscle denaturation was very serious at 3 months after operation and then recovered. Neural tracing used BDA showed that the closer to the proximal of nerve trunk, the more obviously stained it was of myel in sheath and the more massive of axon at 6 months after operation. And there was almost no myel in and axon stained in musculocutaneous nerve. Conclusion In the rat model of brachial plexus extravertebral foramen nerve root division, the motoneuron in cornu anterius medullae spinal is necrosis rate reaches 20%-30%, and most of the residual neurons are pathologic. The regenerated fibers manifest as insufficient dynamic power and incomplete development, making no sense for the recovery of end organ function. Therefore, the exact mechanism of the recovery of biceps brachial muscle demands further study.