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应用前臂皮瓣管修复咽、食管缺损一例

CANAL LAMINOPLASTY WITH TITANIUM MINIPLATE REIMPLANTATION OF VERTEBRAL LAMINA

Objective To evaluate the reliability and the advantageof canal laminoplasty with laminoplasty over laminectomy for treatment of lumbar spinal stenosis.Methods From June 2000 to September 2004, the titanium miniplate fixation technique was applied to re-implantation of the vertebral lamina in the lumbar spine. The vertebral lamina was made with a specially made osteotome and a special technique in 18 patients with lumbar spinal stenosis. Results The patients were followed up for 1 yr and 8 mon on average (range, 3 mon4 yr and 3 mon) and were observed to have a bony fusion of the re-implanted lamina 3-9 months postoperatively. There was no nonunion, displacement of the re-implanted lamina, overgrowth of the anterior bone edge of osteotomy, recompression of the nerves or instability of the lumbar spine. Conclusion The result demonstrates that canal laminoplasty with the titanium miniplate re-implantation of the vertebral lamina in lumbar spine can restore the normal anatomy, keep stability of the spine, and avoid adhesion and scar in the canal.

重度烧伤并发脓毒血症患者的降钙素原动态变化

Surgery of Pseudocyst Due to Acute Pancreatitis

目的 探讨急性胰腺炎后网膜囊早期症状性和感染性假性囊肿的手术引流治疗。 方法 对8例网膜囊早期症状性或感染性假性囊肿行内引流和外引流相结合的引流效果进行临床观察和分析。 结果 内、外引流相结合的方法治疗8例早期症状性假性囊肿或感染性假性囊肿均获得治愈，无并发症。 结论 在急性胰腺炎后早期的网膜囊症状性或感染性假性囊肿的治疗中，内、外引流相结合的治疗方法有更大的适应范围，可以取内、外引流之利，弃内、外引流之弊。

自固化磷酸钙人工骨在腰椎结核病灶清除术中的初步应用

胃食管吻合术后胃食管反流症状的特征与相关因素的关系

目的 探讨胃食管吻合术后胃食管反流症状的特征与相关因素的关系，以降低胃食管反流的发生率。 方法 回顾性分析239例食管、贲门癌切除胃食管吻合术后胃食管反流症状及与吻合平面、胃镜下表现和吻合口狭窄的关系。 结果 108例出现胃食管反流症状，发生率45.2% (108/239) ，主动脉弓下胃食管反流症状的发生率大于主动脉弓上反流症状发生率(707% vs.318%, Plt;0.01). 影响生活的反流症状（≥6分）发生率为25.5%，主动脉弓下吻合反流症状程度较主动脉弓上吻合重（439% vs. 159%, Plt;0.01) 。胃镜RE分级0+I级、II+III级出现反流症状的发生率分别为41.7%(63/151)和500% (44/88) ，两者比较差异无统计学意义（χ2=1.541, P=0.214) ，反流症状的严重程度与RE分级无相关性（r=0080, P=0.276) 。在有症状的反流患者中吻合口狭窄发生率为37% (40/108) ，无症状的反流患者中未发现吻合口狭窄,两者比较差异有统计学意义（χ2=49.262, P=0.000) 。吻合口狭窄与有胃食管反流症状呈正相关(r=0.480,P=0048). 结论 食管胃吻合术后只有部分患者出现反流症状，主动脉弓下吻合反流症状多于主动脉弓上吻合，且程度较重。反流症状的严重程度及发生率与RE分级无关。吻合口狭窄与胃食管反流相关。

Effects of Hypertonic Saline on Levels of Nitric Oxide and Endothelin-1 in Hepatic Ischemia-Reperfusion Injury Rats

ObjectiveTo explore the effect of hypertonic saline (HTS) pretreatment on levels of nitric oxide (NO) and endothelin-1(ET-1) and their correlation in hepatic ischemia reperfusion (HIR) injury in rats. MethodsThe HIR injury models were made by using Pringle, s maneuver in 45 healthy adult male Sprague-Dawley rats, which were randomly divided into three groups (n=15):sham operation (SO) group, HIR group, and HTS group. The animals were killed at 1, 6, and 24 h after reperfusion. The levels of serum NO and ET-1 were measured respectively, the correlation between NO level and ET-1 level at 6 h after reperfusion was analyzed. ResultsAt the time points of 1 h, 6 h, and 24 h after reperfusion, the serum NO levels in the HTS group and HIR group were all significantly lower than those in the SO group (P < 0.01), but the serum ET-1 levels were all significantly higher than those in the so group (P < 0.01). The serum NO levels at the time points of 1 h, 6 h, and 24 h in the HTS group were significantly higher than those at the same time in the HIR group (P < 0.01), but the serum ET-1 levels in the HTS group were significantly lower than those in the HIR group (P < 0.01). At all the time points, every detected goal had more marked level at the time point of 6 h after reperfusion. The NO level was negatively correlated with the ET-1 level. ConclusionsHTS could change levels of serum NO and ET-1 after HIR injury, and which has a negative correlation. Its mechanism might probably stimulate serum NO level and reduce the ET-1 level through some way so as to enable both dynamic balance to the benign development direction and achieve a protective effect.

男性乳腺发育的腔镜手术治疗

目的　评价腔镜手术方法治疗男性乳腺发育症的效果。 方法　2010年9月－2013年3月采用腔镜手术方法治疗男性乳腺发育症共10例。 结果　手术损伤小，效果满意，胸部外形良好，瘢痕增生隐蔽、轻微。结论　选择合适的病例采用腔镜手术的方法能够在完整切除乳腺腺体的同时，获得良好的外形效果。

Use of patient-sharing techniques to study healthcare provider networks: a scoping review

ObjectiveTo provide a scoping review of the healthcare provider patient-sharing network. MethodsPubMed, EMbase, Scopus, ProQuest, Web of Science Core Collection, ScienceDirect, SAGE, Wiley Online Library, Google Scholar, CNKI and WanFang Data databases were electronically searched to collect studies on patient-sharing network of healthcare providers from inception to July 31, 2021. Two reviewers independently screened literature, extracted data and then Arksey and O 'Malley's scoping review method was used to analyze the study. ResultsA total of 110 studies were included. In which, 70.0% were published in 2016 and later, 78.2% were carried out in the United States, 96.4% used secondary data, and 45.5% adopted social network analysis methods such as exponential random graph model. In terms of network characteristics, 43.6% of the studies adopted the theoretical framework of social network theory, and the network node type was mainly 1-mode, accounting for 87.3%. When constructing the physician patient-sharing networks, 64.5% of the studies had a threshold of 1 patient. We also synthesized existing studies on patient-sharing networks of healthcare providers in the light of factors of networks and related outcomes. ConclusionThe studies of healthcare provider patient-sharing network have potentials to improve clinical practice and health policies. Further studies should consider adopting longitudinal design to validate evidence of study, expanding the scope of study subjects except physicians and enriching the evidence of the relationship between network and health-related outcomes.

Differential expression of BKCa channels in atrial fibroblasts in patients with sinus rhythm and atrial fibrillation

Objective Through analyzing BKCa channel expression in atrial fibroblasts in patients with sinus rhythm and atrial fibrillation (AF), to explore the mechanism of myocardial fibrosis and provide new therapeutic strategies for the treatment and reversal of AF structure reconstruction. Methods We selected 10 patients of rheumatic heart valvular disease who underwent valve replacement surgery. They were 5 patients with sinus rhythm (a sinus rhythm group, 2 males and 3 females with an average age of 49.1±8.3 years) and 5 with AF (an AF group, 3 males and 2 females with an average age of 50.3±5.8 years). About 100 mg tissue was obtained from the right auricula dextra, and the atrial fibroblasts were cultured by tissue block adherence method, and the expression of BKCa channel genes and proteins in cultured fibroblasts was detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting methods. Results (1) The general data of 10 patients between the AF group and the sinus rhythm group were compared. There was no significant difference between the two groups in age (t=1.21, P=0.67) and sex (t=2.56, P=0.75). There was statistical difference in the left atrial diameter and the right atrium diameter between the two groups (t=19.45, P=0.01; t=23.52, P=0.06); (2) the mRNA expression of BKCa subunit was detected by qRT-PCR method, and there was no significant difference in the mRNA expression of BKCa α and BKCa β1 between the two groups (t=3.14, P=0.79; t=2.88, P=0.69); (3) the expression of BKCa protein was detected by western blotting method, and there was no significant difference in the protein expression of BKCa α and BKCa β1 between the two groups (t=0.55, P=0.31; t=0.73, P=0.46). Conclusion BKCa pathway may not be involved in the pathogenesis and maintenance of AF, but it may play an important role in the process of myocardial fibrosis.