微生物检验在临床应用中的价值

目的探讨在临床工作中进行微生物检验的价值。方法方便选取2015年12月—2016年7月南京医科大学附属江宁医院收治的肺部感染患者120例,将其随机分成两组,其中60例患者为观察组,采用微生物检验法做检测,在详细分析检测结果后进行针对性的治疗,另60例为对照组,直接根据临床经验进行常规治疗诊治,观察两组患者的治疗效果。结果经过治疗,60例患者的病情均有所缓解,其中观察组30例患者的治疗有效率显著优于对照组30例患者(98.33%vs 88.33%),差异有统计学意义(P<0.05)。结论临床在进行疾病治疗时,开展微生物检验致病菌工作的效果显著,可有效降低感染率,提高治疗效果,可在临床上进行推广应用。

住院癫痫患者临床护理干预

目的探讨神经内科癫痫住院患者护理干预临床效果。方法 168例癫痫患者,按照随机数字表法分为干预组和对照组,每组84例,对照组患者给予一般护理,干预组在一般护理基础上给予心理护理、康复护理以及饮食护理等护理干预措施,并比较两组患者临床治疗效果。结果经过治疗和护理后,干预组患者治疗总有效率为94.0%,对照组为67.9%,干预组患者治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。结论通过对住院癫痫患者给予护理干预可有效地提高患者治疗有效率以及减少癫痫的复发,临床可积极应用。

Clinical application of anterior cervical decompression and fusion under METRx system

Objective: To explore the feasibility and effect of anterior cervical decompression and fusion under METRx system. Methods: Between Nov. 2001 and Nov. 2003, totally 23 consecutive patients were performed anterior cervical decompression and fusion under METRx system. The clinical outcome was evaluated by Odom standard. Results: Decompression and fusion along with internal fixation was obtained in all the 23 patients with minimal tissue damage and operation-caused scar. There were no wound infection, neurological injuries, throat discomfort and other complications. The total rate of excellent and good outcome in patients with degenerative cervical diseases was 94%. Conclusion: Cervical decompression and fusion can be performed under METRx system with its own advantages, such as minimal tissue damage and operation-caused scar, less throat discomfort.

Clinical Significance of Recurrent Laryngeal Nerve Exposure During Esophagogastric Anastomosis of the Neck

OBJECTIVE To investigate the clinical value in a comparison between intraoperative exposure and non-exposure of the recurrent laryngeal nerve （RLN） of the neck during left neck esophagogastric anastomosis following resection of carcinomas of the middle and inferior-segment esophagus. METHODS From January 2003 to April 2009, 237 patients were selected to undergo resection of esophageal squamous carcinoma via posteroexternal incision of the left chest plus gastroesophageal anastomosis at the left neck incision. The 237 cases were divided into 2 groups： 115 of the total cases were in group A （the study group）, cases of resections with neck RLN exposure. Of the patients in this group, 64 were male and 51 female, with a mean age of 49 ranging from 31 to 73 years. Another 122 cases were in group B （the control group）, cases of resections without neck RLN exposure. In this group, 51 of the patients were male and 71 female, with a mean age of 45 ranging from 33 to 75 years. In the 2 groups, there were 9 cases in total with symptoms induced by RLN injury. RESULTS Hoarseness, choking cough when drinking, and difficult expectoration were found in 1 of the cases （1/115） in group A （0.087%）, while there were 8 cases （8/122） presenting with these symptoms in group B （6.5%）. There is statistical signi.cance in the di.erences of RLN injury between the 2 groups （P 〈 0.05）. CONCLUSION Analysis of study cases of esophageal carcinoma resection with left-neck esophagogastric anastomosis in the 2 groups indicated that the exposure of the RLN in group A resulted in an obviously lower rate of neck RLN injury after the surgery, compared to group B, where the RLN was not exposed. Exposure can lead to the avoidance of complications induced by RLN injury, such as dysarthria and choking cough when eating. As a result, satisfactory expectoration, which would diminish the incidence of pulmonary complications, can be reached allowing the patients to recover as early as possible. The results of our study suggest that the exposure of the RLN during the left -neck esophagogastric anastomosis has signi.cant clinical value, and that this approach can be recommended with con.dence.

Clinical application of intraperitoneal chemotherapy before surgery for ovarian cancer and its evaluation

Objective： To investigate the clinical efficacy of intraperitoneal chemotherapy before surgery for ovarian cancer. Methods： 60 patients with stages Ⅱ-Ⅳ of ovarian cancer were treated with intraperitoneal chemotherapy of CAP or TP regimen followed by a surgery treatment and another chemotherapy for 6 cycles. And then the efficiency of the therapy was evaluated by analyzing the changes of ascites, the serum CA-125 and CA-19-9 levels and the findings in the operation, and investigating the recurrence of cancer and the survival. Results： After 1-3 cycles of intraperitoneal chemotherapy, serum levels of CA-125 and CA-19-9 and carcinous ascites significantly reduced in all patients, ascites reduce was over 50% in 98.3% cases; all cases were successfully treated with cytoreduction and it was found during the operation that bulky tumor was reduced and looser so as to be easily isolated and removed; PFS of the patients was prolonged, while the toxicity and side-effects were not so serious as beyond the patient toleration. Conclusion： Intraperitoneal chemotherapy before surgery for ovarian cancer has an active efficacy in clinic, being able to improve conditions of surgery and increase the opportunity of maximal cytoreduction, and prolong survival of the patients, and should be a good selection for the treatment of advanced ovarian cancer.

Application of ultrasound in the diagnosis of clinical anesthesia

During the past 10 years, the rapid development of ultrasound technology in clinical anesthesia has become one of the hot clinical researches. Researches in this area home and abroad also made great progress. On the one hand due to improved high-resolution portable ultrasound instrument and probe technology, ultrasound changed from a purely clinical diagnostic into the operating room; on the other hand, with the traditional method of anesthesia increasingly unable to meet the clinical requirements, it is an objective need of technological innovation for clinical anesthesia. And ultrasound has non-invasive, real-time, visible and repeatable characteristics which are able to provide accurate data and rich means for preoperative assessment, intraoperative monitoring and treatment of pain in pre-clinical anesthesia

Clinical application of specific antibody against glypican-3 for hepatocellular carcinoma diagnosis

Glypican-3(GPC3) is a promising tumor marker for hepatocellular carcinoma(HCC) diagnosis with high sensitivity and specificity.The aim of this study was to establish an immunohistochemical detection method for GPC3 using the 7D11 monoclonal antibody(7D11 mAb) and evaluate its application for HCC diagnosis.The feasibility of the 7D11 mAb was evaluated by immunohistochemistry performed on adjacent normal liver and intrahepatic cholangiocarcinoma(ICC) samples,Furthermore,the serum GPC3 levels were evaluated in 40 HCC patients,7 ICC patients and 50 healthy donors.The results showed that GPC3 was expressed in 85% of HCC tissues(34/40),but was undetectable in ICC tissues and adjacent normal tissues.GPC3 was significantly increased in the serum of HCC patients(17/40,42.5%) but was undetectable in the serum of ICC patients(0/7,0%) and healthy donors(0/50,0%).This prospective study evaluated the clinical usefulness of 7D11 mAb for GPC3 detection in HCC patients.In conclusion,the use of 7D11 mAb might be good for GPC3 large-scale applications for clinical diagnosis of HCC.

Paraspinal approach for thoracolumbar fracture

Objective： To explore the advantages and indications of the paraspinal approach by anatomical study and clinical application.Methods： The anatomical data and clinical practice of 27 cases were analyzed to explore the accurate approach between the paraspinal muscles and the structure of ambient tissues, as well as the results of clinical application of paraspinal approach. The operation time, blood loss, incision length, radiographic result （Cobb angle, height of anterior edge of the vertebrae） were compared with those in 24cases treated by traditional approach.Results： Complete exposure of the facets could be easily performed by identifying natural cleavage plane between the multifidus and Iongissimus muscles. The natural muscular cleavage was （1.47±0.23） cm lateral to the midline for females, and （1.64±0.35） cm for males at T12 level. The distance was （3.3±0.6） cm lateral to the midline for females,and （3.7±1.0） cm for males at L4 level. In paraspinal approach group, the operation time was （76.2±15.7） min, blood loss was （91.6±16.9） ml and incision length was （7.6±0.8） cm. In traditional approach group, the operation time was （121.4±19.6） min, blood loss was （218.7±32.3 ） ml and incision length was （17.4±2.1） cm. To compare paraspinal approach with traditional approach, the operation time, blood loss and incision length had statistical difference （P〈0.05） and the radiographic result （Cobb angle, height of anterior edge of the vertebrae） had no statistical difference （P〉0.05）.Conclusions： When the paraspinal approach is performed through natural cleavage plane between the multifidus and longissimus muscles, there are no wide muscular disinsertions, leaving the supraspinous and interspinous ligaments intact. The distance of natural cleavage to the midline is different at T12 and L4 planes. By this approach,the facet joints can be explored easily and completely, and a clear surgical field will be available for the placement of pedicle screws. As a minimally invasive approach, it can be widely used in thoracolumbar spine surgery.

Study on Traditional Chinese Medicine theory of lung being connected with large intestine

OBJECTIVE:The theory of lung being connected with large intestine,which is a major topic in Traditional Chinese Medicine(TCM),has guided clinical practice for thousands of years in China.METHODS:In this study,we analyzed the history,main contents,clinical application,and material basis of the theory,to attempt to improve the potential clinical significance of "lung being connected with large intestine" in China.RESULTS:The lung being connected with large intestine was first described in "Huang Di Nei Jing",and formed one of the basic theories of TCM.For thousands of years,the majority of TCM practitioners explored this theory continuously,leading to its development and use as an important theory in the guidance of TCM clinics In the last decade,researchers in the field of integrated TCM and Western medicine have studied clinical applications and biomedical mechanisms with experimental methods to explore the implications of the theory.CONCLUSION:With the further development of science and technology,research concerning the theory of lung being connected with large intestine will be greatly stimulated and contribute to the modernization of TCM.