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尺神经松解前置术治疗迟发性尺神经炎

目的 探讨迟发性尺神经炎手术治疗的临床疗效。 方法 1995年10月-2006年6月对128例迟发性尺神经炎采用肘部尺神经松解前置手术治疗，术后配合功能锻炼。 结果 术后106例患者前臂、手指疼痛、麻木感消失，手指活动恢复正常，持物有力；18例患者手指麻木感减轻，痛觉迟钝，手指活动较术前灵活；3例患者自觉疼痛减轻，感觉、痛觉仍迟钝；1例无效。 结论 采用肘部尺神经松解前置术治疗迟发性尺神经炎，可解除患者痛苦，具有一定的效果。

CT Diagnosis Significance in Traumatic Skull Hangfire Haematoma

目的:探讨外伤性颅内迟发性血肿CT表现特点和规律,为临床即时诊治提供可靠依据。方法:对136例外伤性颅内迟发性血肿患者首次CT及伤后迟发性血肿发生时间进行分析。结果:外伤性颅内迟发性血肿患者多数首次CT检查,可仅表现为蛛网膜下腔出血、脑肿胀、脑挫裂伤和颅骨骨折;颅内迟发性血肿发生的高峰期为伤后24～72小时。结论:外伤性颅内迟发性血肿首次CT检查多有异常,但无颅内血肿者,应在24~72小时内进行CT复查,以发现颅内迟发性血肿,方不至贻误诊治。

迟发性创伤性膈疝的治疗并文献复习

气管切开术后迟发性出血致死亡一例及文献回顾

地震挤压综合征迟发性肌肉坏死的临床研究

目的总结5·12汶川大地震期间5例挤压综合征（crush syndrome，CS）患者伤后中期出现迟发性肌肉坏死的可能原因、发病机制及临床治疗措施。 方法5·12汶川大地震期间收治5例CS患者，男3例，女2例；年龄15～35岁，平均23.4岁。肢体共17个受压部位，受压时间21～72 h，平均36 h。入院时病情危重，均表现为急性肾功能衰竭和肝功能损害，合并多部位、大面积感染创面。伤后中期创面动脉性大出血后出现寒战、高热等全身中毒症状，随后出现迟发性肌肉坏死；伤后晚期坏死肌群与周围正常肌群形成明显界限并自然脱离，当创面肉芽屏障形成后，心率、体温逐渐恢复正常。全身治疗主要为纠正肝、肾功能衰竭，抗感染、支持、输血等，局部早期加强引流、结合手术扩创，中期注意有限扩创，晚期进行创面换药及植皮覆盖创面。 结果治疗后5例患者创面均愈合，皮肤干燥，无渗液、红肿、坏死、裂开及皮下积脓，愈合时间10～21个月，平均15.2个月。5例获随访13～45个月，平均19.6个月。均康复出院；随访期间无死亡，可佩戴假肢或扶拐活动。 结论地震CS迟发性肌肉坏死可能是多因素共同作用的结果，具体机制有待进一步研究。

帕珠沙星致严重剥脱性皮炎一例

【摘要】　目的　报道1例帕珠沙星致严重剥脱性皮炎的不良反应。　方法　结合文献和患者临床诊疗情况，对不良反应发生的过程及原因进行阐述及分析。　结果　帕珠沙星引起剥脱性皮炎的机制目前尚不明确；虽然不能明确患者最终死亡是否由于剥脱性皮炎所致，但此不良反应的发生加速了患者的衰竭。　结论　临床治疗此类患者时，应注意选择低致敏的药物，做到最大程度安全用药。

Systematic evaluation of hyperbaric oxygen therapy for delayed encephalopathy caused by carbon monoxide poisoning

ObjectiveTo systematically evaluate the effect of hyperbaric oxygen therapy on delayed encephalopathy caused by carbon monoxide poisoning.MethodsChina National Knowledge Infrastructure, Wanfang Data, CQVIP data, China Biology Medicine Database, PubMed, Embase, and Cochrance Library were searched by computer for randomized controlled trials on hyperbaric oxygenation for delayed encephalopathy caused by carbon monoxide poisoning which were published in English or Chinese from the dates of establishment of the databases to March 31st, 2019. After literature including, excluding, and screening, RevMan 5.2 software was used to conduct a meta-analysis.ResultsA total of 25 studies were included, including 1 797 patients, 924 in the hyperbaric oxygen therapy group (the trial group) and 873 in the control group. The clinical effective rate [relative risk (RR)=1.24, 95% confidence interval (CI) (1.19, 1.30), P<0.000 01], the normal rate of electroencephalogram [RR=2.10, 95%CI (1.18, 3.75), P=0.01], the Mini-Mental State Examination score [standard mean difference (SMD)= 3.19, 95%CI (2.06, 4.32), P<0.000 01], and the Activities of Daily Living score [SMD=1.46, 95%CI (1.02, 1.90), P<0.000 01] were all higher in the trial group than those in the control group.ConclusionHyperbaric oxygen therapy for delayed encephalopathy caused by carbon monoxide poisoning can improve symptoms.

Analysis of Risk Factors for Development of Hemorrhagic Cystitis in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation

【摘要】　目的　分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相关的危险因素，动态监测受者尿BK病毒（BK virus，BKV），分析其与HC发病的关系。　方法　回顾性分析2003年3月-2008年1月期间接受allo-HSCT的121例患者的资料，选择8个临床参数[年龄、性别、疾病类型、移植时疾病状态、供者类型、预处理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的预防方案]作COX回归分析。采用SYBR Green染料实时荧光定量聚合酶链反应法对2006年9月-2008年1月42例allo-HSCT患者尿BKV载量进行动态监测，分析被检查者尿液BKV基因载量与HC发生以及严重程度的关系。　结果　121例患者中有24例发生HC，发病时间为术后0~63 d，中位时间40 d；持续时间7~150 d，中位时间22 d。Ⅱ~Ⅳ度aGVHD为HC的独立危险因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV检出率为100%（42/42）。与正常人及未发生HC的allo-HSCT受者相比，HC患者尿中BKV基因载量具有更高平均峰值。　结论　Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高载量与HC的发生有相关性。【Abstract】　Objective　To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC.　Methods　The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC.　Results　Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load.　Conclusions　Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.

Clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake

objective To analyze clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake．Methods Clinical data of three patients with late-onset injuries were analyzed retrospectively．Results The first patient was compromised with late-onset traumatic diaphragmatic hernia complicated with shock．The second and third patients were suffered from late—onset traumatic hepatic rupture．After prompt surgery operation，the first and second subjects survived．Unfortunately，the third patient died of severe abdominal infection despite successful operation .Conclusion Late-onset organ injuries must be recognized and treated promptl

Construction of a nomogram prediction model for delayed encephalopathy after acute carbon monoxide poisoning

Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.