ObjectiveTo evaluate the effect of the early enteral nutrition（EEN） on the natural course in dogs with severe acute pancreatitis（SAP）.MethodsSAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000-10 000 BAEE units trypsin/ml into pancrease via pancreatic duct.Fifteen dogs were divided into parenteral nutrition(PN) group and EEN group.Two groups were isonitrogenous and isocaloric.EEN was used at postoperative 24 h.Systemic plasma endotoxin level was quantified by the chromogenic limulus amebocyte lysate technique.Both portal and systemic blood sample were obtained before and 1，4，7 d following SAP, and cultured for aerobic as well as anaerobic bacterial.Serum glucose, calcium,amylase and lysosomal enzymes were determined.All dogs were injected with 1.85×106 Bq 125IBSA 4 h before sacrificed.The 125IBSA index of the pancreas/muscle and pancreas/blood was measured,and pancreas pathology was observed.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenata were cultured as blood mentioned above.The thickness of mucosa,the whole gut layer,the height of intestinal villi and their protein and DNA contents in the intestinal and transverse colon were determined.ResultsThe study showed that EEN significantly reduced the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ,serum glucose in PN group was higher than that in EEN after SAP 4 d.There were no difference between two groups in the data of serum calcium,amylase and lysosomal enzymes,pathologic index and 125IBSA index of pancreas/muscle and pancreas/blood.EEN improved the gut barrier function by increasing the thickness of mucosa,the whole gut layer and the height of intestinal villi,increasing its protein and DNA contents in the bowel.ConclusionOur results suggest that EEN is safe and effective,and can decrease the rate of intestinal bacterial translocation.
【摘要】 目的 探讨难治性癫痫不同类型手术的预后与病程长短有无相关关系。 方法 回顾性分析2005年1月-2009年12月在四川大学华西医院神经外科进行难治性癫痫手术的143例患者，根据Engel分级对预后进行评估，分别分析各类型手术不同病程时间之间的预后差异以及相关关系。 结果 不同病程组颞叶手术和颞叶合并颞叶外手术的预后差异无统计学意义（Pgt;0.05），两者之间无相关关系；颞叶外手术的预后在不同病程组间差异有统计学意义（Plt;0.05），两者之间呈负相关。 结论 颞叶外癫痫手术的预后与病程存在相关关系；病程越短，预后越好。【Abstract】 Objective To discuss the relationship between prognosis of different intractable epilepsy surgeries and the disease course. Methods A total of 143 patients who had undergone surgeries for intractable epilepsy in the Neurosurgery Department of West China Hospital of Sichuan University from 2005 to 2009 were enrolled, and the prognosis with different disease course were assessed based on the Engel classification. Results Between different disease duration groups, the difference between the prognosis of the temporal surgery and the surgery of temporal lobe combined with other lobes was not statistically significant (Pgt;0.05), which indicated no relationship between the disease course and the prognosis. However, the difference between the prognosis of the surgeries outside the temporal lobe was statistically significant (Plt;0.05), which showed that patients with a longer disease course had a worse prognosis. Conclusion The prognosis of the epilepsy surgery outside the temporal lobe is correlated with the disease course. The shorter course has a better prognosis after surgery.
摘要:目的:分析慢性乙肝病毒携带者肝组织病理与年龄、病程、血清学及肝脏免疫组化指标的相关性,以确定孰是对病理进程影响最主要的指标。方法:对134例临床诊断的慢性乙肝病毒携带者进行乙肝血清学标志物、肝功能、肝活组织病理及免疫组化的检查。结果:①病理表现为不典型增生者HBeAg阴性组少于HBeAg阳性组,而表现为慢性肝炎者前者多于后者,差异均有显著性;HBVDNAlt;105亚组分析两组病理表现无统计学差异;两种病理表现类型在年龄18~40岁组及gt;40岁组明显多于lt;18岁,差异均有显著性;两种病理类型在免疫组化双阳性组均多于单阳性组及全阴
ObjectiveTo observe the clinical characteristics, the characteristics of organ dysfunction and death related factors in the natural course of severe acute pancreatitis (SAP). MethodsThe data of 302 cases of SAP from January 1999 to June 2007 in our hospital were retrospective analyzed. The APACHEⅡscore, state of each organ, and death related factors were recorded and analyzed according to the admission and on 1, 3, 5, 7, 14, and 28 d after admission, a total of 7 time points. ResultsIn natural course of SAP, the APACHEⅡscore took on a double-peak type distribution, the peaks appearing nearly about one week and two weeks after the onset of SAP. Systemic inflammatory response syndrome (SIRS), hypoxemia, metabolic acidosis, hyperglycemia, and abdominal compartment syndrome were the main causes of early organ failure. Incidence of organ failure and infection increased significantly for patients with intestinal paralysis lasting longer than five days. The most affected organ failure was followed by respiratory organs, peripheral circulation, kidneys, and gastrointestinal tract. The mortality rate increased significantly for patients with organ failure more than 48 hours. Four cases of death (9.5%) caused by severe shock and cardiac arrest within 24 h after admission; 6 deaths (14.3%) led by persistent shock with ARDS or acute renal failure within 24-72 h; 14 cases of death (33.3%) arose from 3-10 d after onset, mainly for acute respiratory distress syndrome (ARDS), acute renal failure associated with multiple organ dysfunction syndrome (MODS); 18 cases (42.8%) of the death arose on 10 d after the onset, mainly for the MODS caused by intra-abdominal infections, bleeding, pancreatic fistula, and biliary fistula. ConclusionsThe natural course of SAP can be divided into three phases:systemic inflammation, systemic infection, and recovery. Duration of intestinal paralysis is an important factor affecting the natural history of SAP. Early complications in patients with organ failure appeared as SIRS, metabolic acidosis, hyperglycemia, and abdominal hypertension. MODS led by SIRS is the leading cause in early death of SAP; MODS caused by pancreas and peripancreatic tissue infections, abdominal bleeding, pancreatic fistula, and biliary fistula are the main death factor in the late phase. Early recovery of gastrointestinal function can reduce the incidence of MODS.
Myopic traction maculopathy (MTM) is one of the most common macular degeneration in highly myopic eyes, which is the main cause of visual impairment. MTM is a slowly progressing disease. Macular retinoschisis (MRS), macular detachment and macular hole are the three main manifestations of MTM. Under the combined action of various traction mechanisms, MTM may manifest as stable anatomical structure, progressing or spontaneous improvement. The possibility of spontaneous improvement of MTM is small and the degree of improvement of BCVA varies, while the risk of deterioration of MTM increases with its development. Attention should be paid to patient follow-up and timely surgical treatment to prevent MTM from further threatening the patients’ vision in clinically.
ObjectiveTo observe and analyze the rate of visual acuity progression and binocular symmetry in patients with choroideremia (CHM). MethodsA single-center retrospective longitudinal cohort study. From April 2009 to August 2022, 38 eyes of 19 patients diagnosed with CHM through clinical and genetic testing at the Department of Ophthalmology, Peking Union Medical College Hospital, were included in this study. All patients underwent at least 2 follow-up visits with a minimum interval of 1 year between visits, and binocular best-corrected visual acuity (BCVA) results were recorded at each follow-up visit. Decimal visual acuity was converted into logarithm of the minimum angle of resolution (logMAR) for analysis. The patient group consisted of 19 males from 16 unrelated families. The age at initial visit was (39.52±13.24) years, with a (2.63±1.61) follow-up visits over a duration of (4.95±2.68) years. A total of 50 binocular BCVA data were included. Annual progression rate of visual acuity was calculated based on longitudinal and cross-sectional data. Spearman correlation coefficient and Bland-Altman method were used to evaluate the binocular symmetry. ResultsThe rate of visual acuity progression was (0.095±0.148) logMAR units/year based on longitudinal data and (0.018±0.009) logMAR units/year based on cross-sectional data. The binocular symmetry for BCVA of the baseline values was strong; however, the binocular symmetry of progression rates for BCVA was moderate. Spearman correlation analysis showed that binocular symmetry in baseline BCVA was high (r=0.881, P＜0.001). The symmetry of binocular vision progression rates based on longitudinal data was moderately symmetric (r=0.528, P=0.020). Bland-Altman analysis showed that 94.7% of binocular baseline BCVA differences were within 95% confidence interval (CI) of 95% limit difference (LOA), indicating good symmetry of binocular baseline BCVA. The number of binocular BCVA progression rate differences within 95%CI of 95%LOA was 89.5%, suggesting moderate symmetry in binocular BCVA progression rate. The results of Spearman correlation coefficient and Bland-Altman analysis of binocular symmetry were basically consistent. ConclusionsThe rate of visual acuity progression of patients with CHM based on longitudinal and cross-sectional data is (0.095±0.148) and (0.018±0.009) logMAR units/year, respectively. Cross-sectional data from patients of different ages should not be used to infer the progression rate of the natural history. Binocular eyes with highly symmetrical baseline visual acuity may differ in the rate of visual acuity progression.