Objective To investigate the effect of myoblast transplantation on duchenne muscular dystrophy (DMD) and to explore the method and feasibil ity of applying gene therapy to DMD. Methods Myoblast of C57/BL10 mice were cultured using multiple-step enzyme digestion method and differential velocity adherent technique. The morphology of the cells was observed with inverted phase contrast microscope. The cells at passage 4 were labeled with 5-BrdU. Twenty-four DMDmodel mice (mdx mice: aged 4-6 weeks, male, 13.8-24.6 g) were randomly divided into two groups (n=12 per group): group A, 1 × 106/mL labeled myoblast were injected via ven caudal is twice at an interval of 2 weeks; group B: 1 mL DMEM/F12 was injected in the same manner serving as a control group. The mice were killed 4 weeks after operation and the motor abil ity of the mice was detected by one-time exhaustive swimming before their death. HE staining and immunohistochemistry staining observation for 5-BrdU, desmin, and dystrophin (Dys) were preformed, and the imaging analysis was conducted. Results The primary myoblast could be sub-cultured 5-7 days after culture, providing stable passage and sufficient cells. The time of onetime exhaustive swimming was (60.72 ± 5.76) minutes in group A and (47.77 ± 5.40) minutes in group B, there was significant significance between two groups (P lt; 0.01). At 4 weeks after injection, HE staining showed that in group A, there were round and transparent-stained myocytes and the percentage of centrally nucleated fibers (CNF) was 67%; while in group B, there were uneven muscle fiber with such pathological changes as hypertrophia, atrophia, degeneration, and necrosis, and the percentage of CNF was above 80%. Immunohistochemistry staining revealed that the expression of 5-BrdU, desmin, and Dys was positive in group A; while in group B, those expressions were l ittle or negative. Image analysis result displayed that integral absorbency (IA) value of desmin was 489.70 ± 451.83 in group A and 71.15 ± 61.14 in group B (P lt; 0.05) and the ratio of positive area to thetotal vision area was 0.314 3 ± 0.197 3 in group A and 0.102 8 ± 0.062 8 in group B (P lt; 0.05); the Dys IA value was 5 424.64 ± 2 658.01 in group A and 902.12 ± 593.51 in group B (P gt; 0.05) and the ratio of positive area to the total vision area was 0.323 7 ± 0.117 7 in group A and 0.035 2 ± 0.032 9 in group B (P lt; 0.05). Conclusion Myoblast transplantation has certain therapeutic effect on DMD of mice.
目的 探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。 方法 回顾性分析四川大学华西医院消化内镜中心2010年1月－2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。 结果 38例患者，男18例，女20例，年龄8～80岁；病变下缘距肛门齿状线1～4.0 cm24例，侵及齿状线14例。病变大小（按病变最大径分类）：1.5～3.0 cm 12例，3.1～4.0 cm 8例，4.1～5.0 cm4例，5.1～7.0 cm 10例，10 cm 4例。病变直径在5.0 cm以下的24例患者，经首次手术治疗肿瘤完整切除，术后2例灶性癌变，追加外科手术；其余22例2个月复查，病变无残留，6个月复查，2例复发，经再次手术病变完整切除。随访1年，全部未见复发，治愈率为100%，无残留。病变直径5.1～7.0 cm的10例患者，经首次手术治疗肿瘤分次切除，2个月复查，6例病变完整切除无残留，6个月复查，其中2例复发，经再次内镜下手术切完病变，随访1年，无复发；另4例有残留，经再次内镜下手术切完病变，6个月复查无复发，随访1年，4例均未见复发。病变直径10 cm 的4例患者，经多次手术后复查均有病变残留，无法完全切除，患者拒绝外科手术。5.1 cm以上病变治愈率71.43%，残留率高达57.14%。本组术后出血16例，感染1例，直肠狭窄1例，肛门坠胀3例，无穿孔发生。 结论 内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效，对5.0 cm以下病变能一次完整切除，5.1 cm以上病变残留率高，需再次内镜下手术，10 cm以上病变切除不完全。应慎重选择病例，术后密切随访。
摘要:医院有效事前监测、管控医疗不良事件，是保障患者安全、提高医疗质量的管理措施之一。超大型医院对医疗不良事件管理的实战中，建立、实施医疗安全隐患事件关键监测指标、医疗安全隐患事件筛查程序指标，积极开展医疗不良事件后台监管工作，切断医疗安全隐患事件向医疗风险事件演变、医疗风险事件向医疗纠纷事件演变的环节，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.
ObjectiveTo explore the application of pre-examination and triage service for outpatients in large general hospitals to improve the quality of service and increase the satisfaction of the patients. MethodsBy using convenience sampling, the outpatients from four third-class A level hospitals were investigated with self-designed questionnaire between July and August, 2013. The patients were differentiated according to the frequency of visiting doctors; the first and subsequent visit being the variables, the rank-sum test was used to investigate the demand and satisficing of the pre-examination and triage service in the two kinds of outpatients in large general hospitals. ResultsThe satisficing of the pre-examination and triage service was high; the demand of the service was high in the first-visit patients with high satisficing. The difference in out-patient consultation between the two kinds of patients were significant. ConclusionPre-examination and triage service has a great guiding effect on outpatients in large general hospitals, and its availability is related to the type of the patients, awareness rate of the service and satisfaction to nurses.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
Objective To optimize the environment of outpatient clinics in large hospitals, facilitate the patients’ visits and improve the comprehensive management level. Methods From September to November 2015, 2 hospitals in each part of a provincial city (middle, east, west, north and south), a total of 10 hospitals were chosed by convenient sampling method. The forms, types and distribution of outpatient navigation service system were investigated and analyzed by using a self-designed questionnaire. Results There were a total of 14 forms of counseling-guide services in the 10 hospitals. Just 1 hospital provided all the 14 forms of counseling-guide services, and 2 hospitals provided 13 forms of counseling-guide services, which were relatively complete. While the other 7 large hospitals provided only 4 to 6 forms of counseling-guide services, which were relatively simple. Conclusion Qualified outpatient navigation service system can help patients to receive more effective treatment, optimize the environment, highlighting the modern hospital humanistic service and the concept of intelligent service and scientific management.