目的:研究巯基转移酶(thioltransferase,TTase)在年龄相关性白内障患者晶状体上皮细胞中的表达和活性,探讨白内障的发病机制。方法:利用RT-PCR技术检测白内障组和正常对照组晶状体前囊膜下上皮细胞TTase mRNA,以β-actin为参照标化检测指标含量,并比较各组之间TTase表达的差异。结果:RT-PCR结果显示,白内障组晶状体前囊膜下上皮细胞TTase mRNA表达低于正常对照组;白内障皮质组与后囊膜下组差异无显著性,其余各组间差异有显著性。结论:TTase在年龄相关性白内障晶状体前囊膜下上皮细胞中有表达且比正常人低,不同临床类型的表达不同,存在着发病机制的差异。
Objective To verify the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velar movement through the lateral radiography. Methods From October 1988 to October 2000, 62 patients with cleft palate and velopharyngeal insufficiency were treated. Of them, 32 were repaired by velopharyngeal muscular reconstruction (group A) and 30 by modified von Langenbeck’s procedure (group B). The lateral radiographs and cephalometric analysis were taken. The velopharyngeal closure, velar extensibility, the angle changes of velar elevation, the distance changes of velar levator eminence based on anatomy (LEA) to velopharyngeal closure line (VCL), the varieties in LEA, the comparison of LEA and velar levator eminence based on phonation (LEP), the distance comparison between posterior nasal spine (PNS) to LEA and LEP through soft palate line (SPL) were measured. Results During the phonation, group A was significantly greater than group B in the velopharyngeal closure rate(Plt;0.01)， the velar extensibility(Plt;0.05) and the location comparison between LEA and LEP(Plt;0.01); group B was significantly greater than group A in velar elevation angle (Plt;0.05), the varieties in LEA(Plt;0.05). In velar rest position, the distance of LEA to VCL was greater inB group than in A group(Plt;0.01). There was significant difference in thedistance comparison between LEA and LEP(Plt;0.05), difference between LEA and LEP(Plt;0.01) and the distance PNS-SPL-LEA and PNSSPL-LEP(Plt;0.05) within group B; contrary to the results within group A(P＞0.05). Conclusion The velopharyngeal muscular reconstruction in palatoplasty can result in a near normalizationof anatomic measurement of velar levator muscles and improve the velar functionand velopharyngeal competence. Repositioning of velar muscles in a more anatomic correct, transverse position is more important to improve the velar length andaccordant velar movement with velopharyngeal muscles in functional palatoplasty. The velar angle change and velar elevation during phonation are not determinative factors for velopharyngeal competence.
目的 系统评价纳洛酮治疗病毒性脑炎的疗效与安全性。 方法 计算机检索Medline、Cochrane图书馆、EMbase、CBM、CNKI、万方从建库至2012年2月收录的相关中英文文献，收集所有关于在抗病毒、肾上腺皮质激素以及脱水、止惊、降温等综合治疗的基础上，辅助应用纳洛酮治疗病毒性脑炎对照试验。根据纳入与排除标准筛选文献、评价质量、提取资料，采用RevMan 5.1软件进行Meta分析。 结果 共纳入5个对照试验，包括279例病毒性脑炎患者。Meta分析结果显示：纳洛酮的应用对13岁以上病毒性脑炎患者的总有效率[RR=1.15，95%（0.94，1.42），P=0.18]及死亡率[RR=0.45，95%（0.17，1.16），P=0.10]并无影响，但可以缩短退热时间[WMD=−0.85，95%（−1.74，0.03），P=0.06]、头痛消失时间[WMD=−0.40，95%（−0.55，0.25），P＜0.000 01]、抽搐停止时间[WMD=−0.87，95%（−1.09，−0.66），P＜0.000 01]、意识恢复时间[WMD=−1.10，95%（−2.05，−0.15），P=0.02]、脑膜刺激征消失时间[WMD=−0.15，95%（−0.73，0.29），P＜0.000 01]、呼衰纠正时间[WMD=−1.22，95%（−2.11，−0.33），P=0.007]及病程[WMD=−1.38，95%（−2.65，−0.11），P=0.03]。 结论 现有证据表明，纳洛酮不能提高病毒性脑炎的疗效，但对改善症状有一定帮助。受本系统评价纳入研究数量和质量的限制，上述结论尚需更多高质量的随机对照试验验证。
目的:探讨手术患者潜在不安全隐患,采取有效措施,防微杜渐。方法:对手术患者各个环节进行分析研究。结果:将不安全隐患消灭在萌芽状态,未出现一例差错事故。结论:有意识对患者进行安全管理,让患者平安度过手术期。
ObjectiveTo observe the effect of acute normovolemic hemodilution (ANH) with autologous blood transfusion (ABT) and controlled hypotension (CH) during surgery on allogeneic blood transfusion and blood coagulation function. MethodsSixty patients in our hospital from February 2012 to January 2014 were chosen as our study subjects. They underwent surgeries of grade Ⅲ to Ⅳ, and the estimated amount of bleeding during surgery was more than 400 mL. The patients were randomized into group A (ANH+CH group) and group B (control group), with 30 in each. Patients in group A were first administered a standard endotracheal general anesthesia. Then an invasive arterial blood pressure monitoring was performed and the central venous blood was taken. ANH was implemented, and CH was applied to reduce bleeding. When the procedure was almost completed, ABT was implemented. The value of hematocrit, hemoglobin, platelet, prothrombin time (PT), activated partial thranboplastin time (APTT), fibrinogen, international normalized ratio (INR), heart rate, mean arterial pressure and central venous pressure were measured and recorded at the end of blood volume collection (T1), and before ABT (T2) and after ABT (T3). When hemoglobin was lower than 70 g/L during the surgery, ABT was implemented. After surgery, no allogeneic blood transfusion was performed if hemoglobin was higher than 90 g/L. Patients in group B received routine treatment. ResultsPatients' hemodynamics maintained relatively stable during ANH+ABT+CH. Blood volume collected from patients was (408.3 ±142.1) mL; blood loss volume was (705.4±586.8) mL. Compared with group B, the amount of bleeding was significantly lower, and it was reduced by (549.2±250.2) mL. No organ damage was found. For group A, compared with those values at T0, PT, hematocrit, hemoglobin, fibrinogen, and INR were significantly different at T1 and T2 (P<0.05), but the average value was within the acceptable range which did not affect the blood coagulation function. PT, APTT, platelet, hematocrit, hemoglobin, fibrinogen, and INR were significantly different before and after autologous blood transfusion (P<0.05). Postoperative infection and non-healing wounds rate was not significantly different between the two groups (P>0.05). ConclusionThis technique of acute normovolemic hemodilution with autologous blood transfusion and controlled hypotension is a useful, efficient and cost-effective blood conservation strategy. Moderate hemodilution has no influence on blood coagulation function in patients.
ObjectiveTo observe the clinical characteristics and survival rate of the patients with extraocular retinoblastoma (RB). MethodsThis is a retrospective case analysis. From November 2003 to May 2015, 38 eyes of 31 patients with RB in the extra-ocular stage from 213 RB patients were enrolled in this study. There were 18 males and 13 females. Bilateral lesions were observed in 7 patients and unilateral lesions were observed in 24 patients.19 patients were diagnosed at less than 2 years old, 10 patients at 2 to 5 years old, and 2 patients at age over 5 years old. First visit time was less than 1 month in 12 patients, from 1 to 3 months in 15 patients, over 3 months to 6 months in 4 patients. Medical history and family history were record at the first visit. All patients underwent orbital CT, MRI, double color Doppler imaging and wide angle digital retinal imaging system. CT and (or) MRI examination detected tumor extraocular invasion. Histopathological examination showed that there were tumor cells invasion of the scleral, optic nerve root and optic nerve. Chemotherapy was done after surgery. In the extra-ocular stage, 3 to 6 rounds of intensive chemotherapy combined with orbital radiotherapy were done. The average follow-up period was (25.5±4.5) months after treatment. The cumulative survival rate was observed after 6 months, 1 and 5 years after treatment, and the relationship between the initial age, time, sex, single eye, tumor and survival time of the patients was analyzed. ResultsThe extraocular RB accounted 14.55% of all RB patients in this study. There is no family history of RB, no special history. There were 15 patients with leukocoria and yellow-white reflection in the pupil; 5 patients with lacrimation, swelling, photophobia and exophthalmos; 11 patients with strabismus. The cumulative survival rate at 6 months, 1, 5 years after treatment was (78.0±9.0)%, (62.0±11.0)%, (57.0±11.0)% respectively. The average survival time was (53.9±7.8) months; the cumulative survival rate was (59.3±11.3)%. When the age of first visit was less than 1 month, 1-3 months, 3-6 months, the median survival time was 78, 15 and 18 months respectively, the cumulative survival rate was 100.0%, (40.0±21.9)% and (25.0±21.7)%, respectively. The survival time of the newly diagnosed patients at 1 month was more than at 1 to 6 months, and the difference was statistically significant (t=9.20, P < 0.05). Conclusions14.55% of all RB patients was extraocular RB in this study. One of the most common clinical manifestations is leukocoria at the first visit. The cumulative survival rate of extraocular RB is lower, while the survival rate of patients with the age of first visit time was less than 1 month is higher.
To investigate the immunoreaction, histological reaction and turnover by comparing the xenotransplantation of fresh human amniotic membrane (HAM) with that of preserved HAM, and to analyze the cl inical appl ication value of different kinds of HAM preparations. Methods Subcutaneous implant models were establ ished in 150 BALB/C mice, which were randomized into 5 groups of 30 mice each, based on different implants: fresh amniotic membrane (FAM), double fresh amniotic membrane (DFAM), glycerin preserved amniotic membrane (GPAM), chorion (positive control) or merely operation (negative control). The tissue samples from grafted area were observed with SABC and HE staining, and the inflammatory cells were calculated with l ight microscopy. 1, 2, 4, 8 and 12 weeks after surgery. Results The mice in all of groups were normal in eating and moving, and the wound surface healed well. In all of AM groups, the expression of MHC Ⅱ and the calculation of inflammatory cells were much less than those in chorion groups, showing significant differences (P lt; 0.01). At 1, 8 and 12 weeks after surgery, there were no significant differences in the expression of MHC Ⅱ and the calculation of inflammatory cells in all of AM groups, compared with other groups (P gt; 0.05). From 2 weeks to 4 weeks after surgery, there were no significant differences in the expression of MHC Ⅱ and the calculation of inflammatory cells between FAM and DFAM groups (P gt; 0.05), but they were both more than those in GPAM groups, showing significant differences (P lt; 0.05). At the 4th week after surgery, in all of AM groups, the expression of MHC Ⅱ and the calculation of inflammatory cells were less than those at the 2nd week, showing significant difference (P lt; 0.01).The amniotic epithel ium was still al ive in fresh AM groups until 4 weeks after transplantation. Early after surgery, fibroblasts infiltrated AM from the substantia basilaris layer while made fibrous capsule around the epithel ium. After 12 weeks, the amnion absorbed. Conclusion As a kind of heterologous biomaterial, whether fresh or preserved, HAM can be seemedof ideal immunocompatibil ity and histocompatibil ity. Fresh HAM with al ive epithel ium may be more successful in area ofrepair and reconstruction.
【摘要】 目的 了解北京地区400例新型甲型H1N1流感患者的流行病学和临床特征，总结规律，进一步指导临床诊治。 方法 2009年5-12月期间，收治400例甲型H1N1流感确诊病例，主要采用描述性流行病学方法对患者资料进行回顾性分析，并运用单因素方差分析的方法对结果进行检验。 结果 患者以青年和儿童人群为主，47.0%的患者有明确甲型H1N1流感接触史，主要症状包括发热（98.8%）、咳嗽（85.8%）、咽痛（58.5%）。咽部充血（94.0%）和扁桃体肿大（49.5%）为主要体征。外周血白细胞正常或偏低，349例（82.3%）患者血清铁降低，268例（72.6%）患者C反应蛋白升高。在发病后不同时间内给予奥司他韦治疗的患者发热持续时间和咽拭子的阴转时间有显著差异（Plt;0.001）。 结论 新型甲型H1N1流感发病多以青年和儿童人群为主，以流感样症状为主，多数症状轻微，预后良好，C反应蛋白和血清铁的变化可能对于早期诊断有指导价值，奥司他韦早期抗病毒治疗可以缩短病程。【Abstract】 Objective To investigate the clinical and epidemiologic characteristics of pandemic influenza A (H1N1) virus infection in Beijing. Methods The epidemiological information and clinical characteristics of 400 patients with pandemic influenza A (H1N1) virus infection hospitalized in Beijing 302 Hospital from May to December, 2009 were analyzed retrospectively by descriptive epidemiology. One-way ANOVA was used to assess the results. Results H1N1 virus infection preferentially affected adolescents and young adults. The mean age of the patients was 23 years. A total of 189 (47.0%) of the patients had an identifiable epidemiologic link to another confirmed patient. The most common symptoms were fever (98.8%), cough (85.8%) and sore throat (58.5%). The main physical signs were pharyngeal portion congestion (94.0%) and antiadoncus (49.5%). The number of leukocytes in the peripheral blood was normal or low. The decreased serum iron and elevated C-reaction protein were found in 82.3% and 72.6% of the patients. There was significant difference in the duration of fever and viral shedding from throat swabs among the patients who accept the antiviral medication within the different time. Conclusion H1N1 virus infection preferentially affects adolescents and young adults, and presents with influenza-like illness. The clinical course of H1N1 virus infection is generally mild. The change of C-reaction protein and serum iron may be favorable for the diagnosis of H1N1. Early antiviral treatment may shorten the duration of fever and viral shedding.
ObjectiveTo systematically review the effectiveness of scalp acupuncture for treating ischemic stroke. MethodWe searched databases including PubMed, EMbase, MEDLINE, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to December 30th 2014 for randomized controlled trials (RCTs) on scalp acupuncture in the treatment of ischemic stroke. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 27 studies involving 2 741 patients were included. The results of meta-analysis showed that:a) As for the improvement of nervous functional deficiency, the scalp acupuncture plus drug group was superior to the drug alone group (MD=-5.33, 95%CI -6.71 to -3.96, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (MD=-2.11, 95%CI -3.31 to -0.91, P=0.0006). b) As for the effective rate, the scalp acupuncture group was superior to the body acupuncture group (OR=0.28, 95%CI 0.15 to 0.53, P<0.000 01), the scalp acupuncture plus drug group was superior to the drug alone group (OR=0.20, 95%CI 0.14 to 0.29, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (OR=0.12, 95% CI 0.02 to 0.56, P=0.008). However, there was no significant difference between the scalp acupuncture group and the drug alone group (OR=0.16, 95%CI 0.03 to 0.97, P=0.05). ConclusionScalp acupuncture appears to be an effective adjuvant therapy method for ischemic stroke, and can significantly improve the nervous functional deficiency when combined with other treatment. However, the strength of evidence is low due to high risk of bias of the included studies. More rigorous studies are needed to verify the above conclusion.