目的:探讨黄芪颗粒对紫癜性肾炎的临床疗效,为本病的后续治疗提供更多的药物选择。方法:对我院2003年至2008年收治的51例紫癜性肾炎患儿进行出院后的后续治疗并作随访对照观察。对照组根据病情酌情使用双嘧达莫、泼尼松、中药及对症等。治疗组加服黄芪颗粒,6个月～3岁:每次1/2袋,3～6岁每次2/3袋,6～13岁每次1袋,一天两次,疗程2～3个月。结果:治疗组尿常规异常2例(2/26),对照组8例(8/25),差异有统计学意义(χ2=478,Plt;005);治疗组肾炎复发1例(1/26),对照组5例(5/25),差异有统计学意义(χ2=1543,Plt;001)。结论:黄芪颗粒在紫癜性肾炎后续治疗中有肾脏保护作用,可以明显减少尿常规异常和肾炎复发。
Since 2016, the guidelines for the management of adults with hospital-acquired pneumonia (HAP) / ventilator-associated pneumonia (VAP) have been updated in the United States, Europe, and China, respectively. The differences among these guidelines are demonstrated in this paper. The definition of VAP, how to evaluate the effect of anti-infection therapy, and the prevention strategy are controversial. The consensuses contain diagnostic value of respiratory secretions achieved by noninvasive way for VAP and shorter anti-infection course for VAP. Importantly, pathogenic spectrum for HAP in China is different from others, which is essential for clinical practice.
目的 探讨超声刀（ultrasonic harmonic scalpel，UHS）在消化道恶性肿瘤开腹手术中的应用价值。方法 回顾性分析2009年10月至2011年10月期间广西壮族自治区人民医院普通外科-小儿外科收治并由同一手术者进行消化道恶性肿瘤开腹手术的186例患者的临床资料，根据接受手术的种类（UHS开腹手术或传统电刀开腹手术）将其分为UHS组（86例）和传统电刀组（100例），比较2组患者的手术切口长度、手术时间、术中出血量、术后3d引流量、术后住院时间以及住院总费用。结果 UHS组手术切口长度、手术时间、术中出血量以及术后住院时间均短于（少于）传统电刀组（P＜0.05）；术后3d引流量和住院总费用2组间比较差异均无统计学意义（P＞0.05）。结论 将UHS应用于消化道恶性肿瘤开腹手术可获得较好的效果，能提高手术操作的效率，具有很好的应用前景。
Abstract: Objective To investigate the phonetype and tolerogenic function of semimature dendritic cells (DC) transfected by myeloid differentiation marker 88（MyD88） small interfering ribonucleic acid（siRNA）. Methods Bone marrow of BALB/c mice was inoculated and cultured in vitro，and induced into DC by 10ng/ml recombinated granulocyte macrophage colony stimulating factor (rmGM-CSF) ，then DC was divided into three groups at the 8th day: blank control group: added nothing; lipopolysaccharide （LPS）group: added with 1μg/ml LPS; and experimental group: added with 1μg/ml LPS after transfected by MyD88 siRNA for 4 hours. The phonetype of three groups was analysed by fluorescenceactivated cell sorting (FACS). The concentration of interleukin 10（IL-10）and interleukin 12（IL-12） in culture supernatant was detected by enzyme linked immunosorbent assay（ELISA）.The function of stimulating alloreactive T cell roliferation were evaluated by primary and secondary mixed lymphocyte reaction （MLR）. The cardiac allograft survival time was compared after DC of three groups injected into recipient mice. Results The phonetype of blank control group DC was CD11c＋，CD25-，CD40low，CD80low，CD86low，MHC-Ⅱlow， which could be induced to mature DC by LPS. Experimental group DC was phonetypically semimature DC (CD11c＋，CD25－，CD40mid，CD80low，CD86low，MHC-IIid) and the IL-10/IL-12 ratio of semimature DC increases significantly. yporesponsiveness of alloactive T cells can be induced by experimental group DC and the survive time of heart allograft was prolonged. Conclusion Immature DC could become semimature DC after transfected by MyD88 siRNA and stimulation by LPS. These semimature DC are more tolerogenic than immature DC.
Objective To study the features of lymph node metastasis in gastric stump cancer （GSC） in order to provide the basis for the reasonable lymph node dissection in the GSC lymphadenectomy. Methods Twenty-two GSC patients accepted residual radical gastrectomy and 50 primary gastric cancer patients accepted distal D2 lymphadenectomy by the same surgeon from June 2004 to June 2012 at the department of general surgery-pediatric surgery of the People’s Hospital of Guangxi Zhuang Autonomous Region were included in this retrospective study. And the clinicopathologic factors and lymph node metastasis were compared in two groups. Results The combined organ resection rate in the primary gastric cancer patients was significantly lower than that in the GSC patients 〔14.00% （7/50） versus 54.55% （12/22），χ2=12.929，P=0.000〕. In the lymph node metastasis，the total positive rate and No.10 positive rate of lymph node metastasis in the GSC patients were significantly higher than those in the primary gastric cancer patients 〔30.56% （103/337） versus 22.13% （208/940），χ2=9.583，P=0.002；52.17% （12/23） versus 17.39% （4/23），χ2=6.133，P=0.013〕. The positive rate of lympl node micrometastasis between the GSC patients and primary gastric cancer patients was no significant difference〔2.97% （10/337） versus 1.49% （14/940），χ2=2.939，P=0.086〕 . There was 4/12 lymph node micrometastasis in the GSC patients，which was 0/4 in the primary gastric cancer patients. The positive rate of the jejunal mesentery lymph node metastasis was 35.71% （5/14） in the GSC patients. Conclusions GSC has a unique pattern in lymph node metastasis. D2 dissection and jejunsl mesentery lymph node dissection should be performed for these patients，especially，on No.10 lymph nodes. If needed，en bloc resection with invaded adjacent organs should be considered．
ObjectiveTo evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. MethodsBetween June 2014 and December 2017, 17 patients with diabetic foot ulcer were treated. There were 11 males and 6 females, with a median age of 57 years (range, 46-72 years). The duration of diabetes was 2.4-32.0 years (mean, 16.0 years). According to the Wagner grading criteria, 7 cases were rated as grade 2, 8 cases as grade 3, and 2 cases as grade 4. The CT angiography (CTA) showed the arterial occlusion or stenosis of varying degrees below knee joint. All cases were treated with transverse tibial bone transport. Bone transport started at 3 to 5 days after placing external fixator and lasted 14 days (1 mm per day), and then reverse transport started. The total transport time was 28-30 days. ResultsAll 17 patients were followed up 5-12 months (mean, 8.5 months). During transportation, 4 cases had screw orifice infection, and 3 cases had liquefaction and seepage. And other 15 cases ulcers healed and the healing time was 35-72 days (mean, 48 days). There were significant differences in visual analogue scale (VAS) scores, skin temperature, ankle brachial index (ABI) between before and after ulcer healed (P<0.05). The CTA showed that the collateral circulation was established. The foot ulcer of 2 cases (Wagener grade 3 in 1 case and grade 4 in 1 case) still progressed after treatment, and amputation was performed. ConclusionTransverse tibial bone transports has good effectiveness for diabetic foot ulcer.
ObjectiveTo explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. MethodsThe anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. ResultsThe accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91%), slightly curved splenic arteries in 44 cases (51.16%), and significantly curved splenic arteries in 18 cases (20.93%). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58%（65/86）, 74.42%(64/86), and 91.86%(79/86), respectively. ConclusionsPreoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.
ObjectiveTo compare three staging systems for predicting the prognosis of patients with advanced hepatocellular carcinoma (HCC) after hepatectomy. MethodsThe clinical data of advanced HCC patients who underwent hepatectomy from January 2004 to December 2008 in this hospital were retrospectively analyzed.Tumor stage was evaluated following the Chinese staging system, tumor node metastasis (TNM) staging system, and cancer of the liver Italian program (CLIP) scoring system, respectively.Survival curves for the HCC patients were plotted using the Kaplan-Meier method and difference was compared by the log-rank test.The accuracy of each staging system for predicting survival of HCC patients was evaluated by calculating the area under curve of the receiver operating characteristic. ResultsFifty-five patients were included in this study, including 48 males and 7 females.The median age was 47 years and the median overall survival was 7 months.The clinical staging of HCC patients was 25 cases ofⅡB and 30 cases ofⅢA using Chinese staging system; 39 cases ofⅢA, 5 cases ofⅢB, 7 cases ofⅣA, and 4 cases ofⅣB using TNM staging system.The score of 0-1 was 16 cases, the score of 2-3 was 26 cases, and the score≥4 was 13 cases using CLIP scoring system.Log-rank test showed that the cumulative survival rate had a significant difference for the HCC patients betweenⅡB andⅢA of Chinese staging system (P < 0.05) and amongⅢA toⅣB of TNM staging system (P < 0.05).However, there was no significant difference in the HCC patients among score of 0-4 of CLIP scoring system (P > 0.05).The accuracy of Chinese staging system was higher than that of the TNM staging system and CLIP scoring system for predicting the survival rate of HCC patients (P > 0.05). ConclusionAccording to this limited preliminary data, Chinese staging system for strati-fying and predicting the prognosis of advanced HCC patients after hepatectomy is better than that of TNM staging system and CLIP scoring system.