目的:探讨预成型肋骨锁定钛板内固定手术与超声引导下胸椎旁神经阻滞联合应用对于老年多发性肋骨骨折患者的疗效。方法:回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者,根据是否手术治疗,分为预成型肋骨锁定钛板联...目的:探讨预成型肋骨锁定钛板内固定手术与超声引导下胸椎旁神经阻滞联合应用对于老年多发性肋骨骨折患者的疗效。方法:回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者,根据是否手术治疗,分为预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞组(手术组)102例,保守治疗组(非手术组)119例。手术组中男58例,女44例;年龄60~85(67.2±3.6)岁;肋骨骨折3~12(5.3±2.1)处。非手术组中男66例,女53例;年龄60~84(66.8±3.2)岁;肋骨骨折2~11(6.1±2.3)处。比较分析两组患者的临床资料、治疗效果及并发症情况。结果:两组患者术前临床资料比较,差异无统计学意义(P>0.05),所有患者顺利出院。手术组患者肺部感染(P=0.028),肺不张(P=0.032),呼吸衰竭(P=0.026),主动下床时间(P=0.040),骨折愈合时间(P=0.035),住院时间(P=0.043),治疗后3 d疼痛视觉模拟评分(visual analogue scale,VAS)(P=0.028),治疗后5 d VAS(P=0.032),治疗后7 d VAS(P=0.019),术后3个月最大自主通气量(maximal voluntary ventilation,MVV)(P=0.042),1 s用力呼气容积(forced expiratory volume in one second,FEV1)(P=0.035)以及术后6个月MVV(P=0.021),FEV1(P=0.026)均优于非手术治疗组。结论:对于老年严重多发肋骨骨折的患者,预成型肋骨锁定钛板与超声引导下胸椎旁神经阻滞的联合应用与非手术治疗相比较,能够及时有效镇痛,恢复胸廓稳定性,缩短住院时间,减少肺部感染及急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)等并发症的发生率。预成型肋骨锁定钛板治疗老年多发性肋骨骨折具有较好的临床效果。展开更多
Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carr...Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carry a high risk of injury because of the radiation and contrast agent.Patients with nephrotic syndrome(NS)or some other renal diseases may prone to thrombosis due to the excretion of protein C and protein S overmuch.So,it is necessary to develop a new therapy without contrast agent.Mixed-reality(MR)is a new technology as a guidance of inferior vena cava filter implantation exposed under no X-ray and required no contrast agent.展开更多
BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant d...BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomo展开更多
BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney dise...BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.展开更多
文摘目的:探讨预成型肋骨锁定钛板内固定手术与超声引导下胸椎旁神经阻滞联合应用对于老年多发性肋骨骨折患者的疗效。方法:回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者,根据是否手术治疗,分为预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞组(手术组)102例,保守治疗组(非手术组)119例。手术组中男58例,女44例;年龄60~85(67.2±3.6)岁;肋骨骨折3~12(5.3±2.1)处。非手术组中男66例,女53例;年龄60~84(66.8±3.2)岁;肋骨骨折2~11(6.1±2.3)处。比较分析两组患者的临床资料、治疗效果及并发症情况。结果:两组患者术前临床资料比较,差异无统计学意义(P>0.05),所有患者顺利出院。手术组患者肺部感染(P=0.028),肺不张(P=0.032),呼吸衰竭(P=0.026),主动下床时间(P=0.040),骨折愈合时间(P=0.035),住院时间(P=0.043),治疗后3 d疼痛视觉模拟评分(visual analogue scale,VAS)(P=0.028),治疗后5 d VAS(P=0.032),治疗后7 d VAS(P=0.019),术后3个月最大自主通气量(maximal voluntary ventilation,MVV)(P=0.042),1 s用力呼气容积(forced expiratory volume in one second,FEV1)(P=0.035)以及术后6个月MVV(P=0.021),FEV1(P=0.026)均优于非手术治疗组。结论:对于老年严重多发肋骨骨折的患者,预成型肋骨锁定钛板与超声引导下胸椎旁神经阻滞的联合应用与非手术治疗相比较,能够及时有效镇痛,恢复胸廓稳定性,缩短住院时间,减少肺部感染及急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)等并发症的发生率。预成型肋骨锁定钛板治疗老年多发性肋骨骨折具有较好的临床效果。
基金supported by Capital Clinical Application Research Project(No.Z181100001718042)
文摘Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carry a high risk of injury because of the radiation and contrast agent.Patients with nephrotic syndrome(NS)or some other renal diseases may prone to thrombosis due to the excretion of protein C and protein S overmuch.So,it is necessary to develop a new therapy without contrast agent.Mixed-reality(MR)is a new technology as a guidance of inferior vena cava filter implantation exposed under no X-ray and required no contrast agent.
基金the National Natural Science Foundation of China,No.81972829.
文摘BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomo
文摘BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.
