ObjectiveTo observe the OCT characteristics of lamellar hole-associated epiretinal proliferation (LHEP).MethodsA retrospective case analysis. A total of 128 patients (133 eyes) with lamellar macular hole (LMH) and 202 patients (212 eyes) with full-thickness macular hole (FTMH) diagnosed by the examinations of spectral-domain OCT (SD-OCT) in Department of Ophthalmology, The Third People's Hospital of Chengdu from January 2013 to December 2016 were included in this study. Among 133 eyes with LMH, there were 53 eyes (39.8%) with LHEP and 80 eyes (60.2%) without LHEP. Among 212 eyes with FTMH, there were 12 eyes (5.7%) with LHEP and 200 eyes (94.3%) without LHEP. The mean age of LMH with or without LHEP patients were 70.88±10.98, 64.76±13.60 years old, respectively. The difference of mean age between LMH with or without LHEP patients was statistically significant (U=1521.5, P=0.006). The inner diameter, median diameter and base thickness of the LMH, the height, base diameter and minimum diameter of FTMH were measured by SD-OCT. The traction index (THI) and the macular hole index (MHI) were calculated. An independent sample t-test or rank-sum test was used to compare the inner diameter, median diameter, and base thickness of the LMH in patients with or without LHEP, and χ2 test was used to compare the injury rate of ellipsoid zone.ResultsOf the LMH patients with or without LHEP, the inner diameter were 611.15±209.83 and 521.70±198.05 μm, the median diameter were 961.22±571.09 and 497.01±172.30 μm, the base thickness were 99.83± 38.69 and 154.12±43.17 μm. The differences of the inner diameter, median diameter and the base thickness between LMH patients with or without LHEP were statistically significant (t=2.490, 5.747, －7.395; P=0.014, 0.000, 0.000). Among the 53 eyes with LHEP, There were 50 eyes (94.34%) were injured in ellipsoid zone among 53 eyes with LHEP, while 17 eyes (21.25%) were injured in ellipsoid zone among 80 eyes without LHEP. The injury rate of ellipsoid zone between LMH patients with or without LHEP was statistically significant (χ2=68.126, P=0.000). In 12 eyes of FTMH with LHEP, there were 10 eyes with THI＜1.0 and MHI＜0.5.ConclusionCompared with the LMH without LHEP, the LMH with LHEP has larger inner diameter and median diameter, thinner base and higher injury rate of ellipsoid zone.
Objective To increase the success rate of vaginal reconstruction with pudendal-thigh flap, reduce the chance of hemocirculatory disorder and rel ieve the deformity of greater l ip of pudendum and vaginal orifice. Methods FromJune 1998 to May 2004, 15 patients, 2 males with transsexual ism and 13 females with vaginal absence, aged 23-31 years old (26.2 on average), received vaginal reconstruction. Arterial perforator was detected at 3 cm laterally away from the mid-point between the vaginal orifice and the anus. The flap of 12.0 cm × 5.5 cm was designed at the lateral of the greater l ip of pudendum, with the groin as the axis. After the flap was elevated beneath the deep fascia, the fascial pedicle was partially severed from lateral to medium, keeping the perforator intact into the flap. Then the flap was transferred through the tunnel to the socket. The inner layer and the orifice were formed. Results All flaps survived, and the contour of the vulva was satisfactory. Among the 15 patients, 14 patients’ incisions obtained heal ing by first intention, and only 1 male with transsexual ism was discovered to suffer from rectovaginal fistula at the remote juncture of the two flaps at 7 days after the operation. By taking out all the gauze and cleaning the feces, the fistula healed automatically. All patients were followed up for 6 months-3 years. The reconstructed vagina was about 10 cm deep and 2 fingers wide. One female’s vagina was found pilous at 20 months after the operation, and no special treatment was given. The other patients’ vaginal inner walls were smooth and complete. Two female patients had the experienceof sexual intercourse and felt satisfied after using lubricant. Conclusion The modified pudendal-thigh flap has rel iable blood supply and makes the transferring during vaginal reconstruction more convenient and the contour of the vulva more satisfactory.
ObjectiveTo investigate the influence of sepsis on the expression of apoptotic protease caspase-3 in hippocampus neurons of rats. MethodsModels of rats with sepsis were established by the cecal ligation and puncture (CLP) method. Eighty 30-day-old male Wistar rats were randomly divided into CLP group (n=50) and control group (n=30). In the CLP group, only CLP was performed on the rats. Ten rats in the CLP group and another 10 in the control group were taken at 6, 12, and 24 hours after operation, respectively. Five of them in each group were taken for neurobehavioral score, and the other five were killed and their brains were removed. Then the Western blot and immunohistochemistry staining were used to detect the expression changes of apoptosis protein caspase-3. ResultsIn the control group, there were very low expression of apoptotic protease caspase-3 and high scores of neurological behavior. In the CLP group, the expression of apoptotic protease caspase-3 started to increase at the 6th hour, and reached the peak at the 24th hour after CLP, both of which were significantly higher than the control group (P<0.05). The scores of neurological behavior of the CLP group began to decline at 6h after CLP, and decreased gradually along with the time, and the scores were significantly lower at various time points after CLP in the CLP group than those in the control group (P<0.05). ConclusionThe scores of neurological behavior decrease and the expression of apoptosis protease caspase-3 increase in the rat hippocampus with sepsis, and fluctuate with time change.
Objective To evaluate the association between N-acetyltransferase 2 (NAT2) gene polymorphisms and the risk of antituberculosis drug-induced liver injury (ATDILI). Methods We searched the PubMed, Embase, Wanfang, China National Knowledge Internet and VIP databases to find case-control studies, with the last updated search being performed on June 2017. Odds ratio (OR) with 95% confidence interval (CI) was calculated to evaluate the strength of association. Results A total of 29 studies, involving 1 382 cases and 5 967 controls were included. The results of the Meta-analysis indicated that NAT2 slow acetylators were associated with increased risk of ATDILI compared with fast and intermediate acetylators [OR=3.08, 95%CI (2.44, 3.88), P<0.000 01]. Similar results were also found in subgroup analysis when stratified by ethnicity, isoniazid dosage and diagnostic criteria of ATDILI. Conclusion Individuals with NAT2 slow acetylators may have increased risk of ATDILI.
Objective To investigate whether postoperative therapy can bring survival benefits to patients with locally advanced esophageal squamous cell carcinoma who have received neoadjuvant chemotherapy with TP regimen. Methods We retrospectively reviewed clinical data of 115 patients with locally advanced esophageal squamous cell carcinoma who received neoadjuvant chemotherapy with TP regimen and underwent esophagectomy in our hospital from January 2007 through December 2016. Patients were divided into two groups including a non-receiving treatment group (54 patients with 47 males and 7 females) and a receiving treatment group (61 patients with 52 males and 9 females). There were 31 patients with postoperative chemotherapy, 14 with postoperative radiotherapy, and 16 with postoperative chemotherapy and radiotherapy in the receiving treatment group. Results In the non-receiving treatment group, the 5-year median disease free survival (DFS) rate was 54.7%, and the 5-year overall survival (OS) rate was 55.3%. In the receiving treatment group, the median DFS was 46.0 months (95% CI 22.9–69.1), the 5-year DFS rate was 42.3%; and the median OS was 68.0 months (95% CI 33.0–103.0), the 5-year OS rate was 51.3%. Furthermore, there was no statistical difference between the two groups with regards to DFS (P=0.641) or OS (P=0.757) using Kaplan-Meier method. Besides, in each subgroup, the results of Cox proportional hazard model analysis showed postoperative treatment did not improve survival (P>0.05, respectively). Conclusion Postoperative treatment does not bring survival benefits to patients with esophageal squamous cell carcinoma who have received neoadjuvant chemotherapy with TP regimen.
ObjectiveTo systematically review the efficacy and safety of respiratory fluoroquinolones monotherapy versus β-lactams plus macrolides combination therapy for non-ICU hospitalized community acquired pneumonia (CAP) patients. MethodsWe searched databases including PubMed, the Cochrane Library (Issue 3, 2015), EMbase, CNKI, WanFang Data, VIP and CBM to identify randomized controlled trials (RCTs) involving the comparison of fluoroquinolones monotherapy with β-lactams plus macrolides combination treatment for the non-ICU hospitalized patients with CAP up to April 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the risk bias of included studies, and then meta-analysis was performed using the RevMan 5.0 software. ResultsA total of 17 RCTs involving 5 423 patients were included. The results of meta-analysis showed that there was no significant difference between the two therapy groups on the mortality. For the clinical treatment success rates, no significant differences between the two groups were found based on the data of intention-to-treat (ITT) and per-protocol (PP) analyses. However, respiratory fluoroquinolones monotherapy was associated with higher clinical treatment success rates based on the data that it was unclear whether ITT or PP analysis was used (RR=1.08, 95% CI 1.01 to 1.18, P=0.02), especially in Asians (RR=1.10, 95%CI 1.02 to 1.18, P=0.01). Additionally, respiratory fluoroquinolones monotherapy was associated with less adverse events (RR=0.81, 95%CI 0.73 to 0.90, P<0.000 1), especially in Caucasians (RR=0.64, 95%CI 0.36 to 1.14, P=0.13). ConclusionCurrent evidence shows that the efficacy of respiratory fluoroquinolones monotherapy may be similar to β-lactams plus macrolides combination treatment for non-ICU hospitalized CAP patients. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify the above conclusion.
Objective To evaluate the prognostic values of CURB-65 score and inflammatory factors in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study was conducted in hospitalized adult CAP patients in West China Hospital between January 1st, and December 31th, 2013. Data of CURB-65 score and serum levels of inflammatory factors (WBC, ESR, PCT, CRP, IL-6 and ALB) on admission and clinical outcomes were collected. The associations between CURB-65 score, inflammatory factors and clinical outcomes were examined. Logistic regression analysis was performed to develop combined models to predict in-hospital death of CAP patients, and ROC analysis was conducted to measure and compare the prognostic values of CURB-65 score, inflammatory factors or combined models. Results A total of 505 hospitalized CAP patients were included. 81 patients died during the hospitalization and the in-hospital mortality rate was 16.0%. Possible risk factors of in-hospital death included old age, male sex, hypertension, cardiovascular or cerebrovascular diseases, multi-lobular pneumonic infiltration, high risk scores, ICU admission, mechanical ventilation and severe pneumonia (all P values<0.05). Logistic regression analysis showed that CURB-65 score, ALB and IL-6 were the independent factors in predicting in-hospital death of CAP patients and the area under curve (AUC) of them while predicting in-hospital death were 0.75 (95%CI 0.69 to 0.81), 0.75 (95%CI 0.69 to 0.81) and 0.75 (95%CI 0.69 to 0.80), respectively. ROC analysis found that ALB and IL-6 could improve the AUC of CURB-65 score significantly while predicting the in-hospital death (P<0.05). When ALB and IL-6 were added to the CURB-65 score simultaneously, the AUC was improved to 0.84 (95%CI 0.80 to 0.87). When IL-6 or ALB was added to the CURB-65 score to form a new scale, the AUC of the new scale was significantly higher than that of the CURB-65 score in predicting in-hospital death (P<0.001). Conclusion The prognostic values of CURB-65 score and inflammatory factors may be not ideal when they are used alone in hospitalized CAP patients. IL-6 and ALB may significantly improve the prognostic value of CURB-65 score in predicting in-hospital death.
Interfacility transport of critically ill children is an important part of pre-hospital emergency care. The development of 5th generation mobile networks has brought revolutionary changes to emergency medicine, which can realize real-time sharing of information between hospitals and transfer ambulance units. In order to give full play to the advantages of superior medical institutions in diagnosis and treatment technology, equipment resources, and realize the safe and fast transfer of critically ill children, the technical specifications for the construction of interfacility transport of critically ill children’s ambulances with 5th generation mobile networks are specially formulated to standardize the team building, equipment and materials, transport process and quality control requirements for critically ill children’s ambulance transport, so as to reduce the fatality rate of critically ill children and improve the prognosis.