硒补充剂对妊娠期糖尿病患者血糖和血脂代谢及妊娠结局的影响分析

目的探讨硒补充剂对妊娠期糖尿病患者血糖、血脂代谢和妊娠结局的影响。方法将2018年7月-2019年6月盘锦市中心医院收治的45例妊娠期糖尿病患者随机分为对照组21例和硒酵母组24例。两组患者均给予健康教育、饮食指导、运动指导等常规治疗,硒酵母组在常规治疗基础上给予硒酵母片治疗。比较两组治疗前后空腹血糖、胰岛素抵抗指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平及妊娠结局。结果治疗后两组空腹血糖和胰岛素抵抗指数均较治疗前下降,且硒酵母组两项指标均低于对照组,差异均具有统计学意义(P<0.05)。治疗后两组孕妇总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平较治疗前下降,且硒酵母组三项指标水平低于对照组,差异均具有统计学意义(P<0.05)。治疗后硒酵母组高密度脂蛋白胆固醇水平高于治疗前,差异具有统计学意义(P<0.05)。对照组治疗前后以及两组治疗后高密度脂蛋白胆固醇水平差异均无统计学意义(P>0.05)。硒酵母组新生儿高胆红素血症发生率和新生儿住院率均低于对照组,差异均具有统计学意义(P<0.05)。两组其他不良妊娠结局差异均无统计学意义(P>0.05)。结论硒补充剂能够进一步改善妊娠期糖尿病患者的血糖和血脂代谢,同时,也能降低新生儿高胆红素血症发生率和住院率,值得推广使用。     

视网膜光凝对糖尿病视网膜病变患者神经纤维层厚度的影响

目的：探讨分析糖尿病视网膜病变(diabetic retinopathy,DR)患者全视网膜激光光凝术(panretinal photocoagulation,PRP)治疗后1a视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的变化。

方法：选取2014-05/2017-06在我院行PRP治疗的92例92眼DR患者,采用OCT的DISC CIRCLE程序,测量分析以视盘为中心、直径3.45mm范围DR患者PRP术前和术后1a(采用Follow-Up程序自动追踪模式)视盘周围RNFL厚度,按视盘上方(S)、下方(I)、鼻侧(N)、颞侧(T)4个象限分区所得的数值进行统计分析。

结果：DR患者PRP术后1a较术前视盘周围上方、下方、鼻侧、颞侧和全周平均RNFL厚度明显变薄,且差异有统计学意义(均P<0.05)。

结论：PRP治疗可导致视网膜RNFL变薄,临床上应充分重视和考虑RNFL的损伤,更好地保护视网膜神经细胞的机能对DR治疗具有重要意义。     

周围型肺癌支气管气相的HRCT分型及其诊断价值

目的研究周围型肺癌支气管气相的}IRcT表现和分型，评估其诊断价值。材料和方法对63例具有支气管气相的周围型肺癌进行回顾性分析，在HRcT图像上对全部支气管气相进行分型。比较各型支气管气相的诊断和鉴别诊断价值。结果全部63例周围型肺癌支气管气相的HRcT表现分为5种类型。普通CT可检出由HRCT所显示的支气管气相的52％，与HRCT比较，其分型符合率为82％。全部具有支气管气相的周围型肺癌中，腺癌占86％，出现全部5种类型支气管气相：其它组织类型占14％，仅见于I型。V型一中心网格或假空洞型全部为细支气管肺泡癌。结论支气管气相的HRCT分型有助于鉴别肺腺癌与其它类型的周围型肺癌。     

Benefits and shortcomings of superselective transarterial embolization of renal tumors before zero ischemia laparoscopic partial nephrectomy

AimsTo report feasibility, safety and effectiveness of “zero-ischemia” laparoscopic partial nephrectomy (LPN) following preoperative superselective transarterial embolization (STE) for clinical T1 renal tumors.MethodsWe retrospectively reviewed perioperative data of 23 consecutive patients, who underwent STE prior LPN between March 2010 and November 2012 for incidental clinical T1 renal mass. STE was performed by two experienced radiologists the day before surgery. Surgical procedures were performed in extended flank position, transperitoneally, by a single surgeon.ResultsMean patients age was 68 years (range 56–74), mean tumor size was 3.5 cm (range 2.2–6.3 cm). STE was successfully completed in 16 patients 12–15 h before surgery. In 4 cases STE failed to provide a complete occlusion of all feeding arteries, while in 3 cases the ischemic area was larger than expected.LPN was successfully completed in all patients but one where open conversion was necessary; a “zero-ischemia” approach was performed in 19/23 patients (82.6%) while hilar clamp was necessary in 4 cases, with a mean warm-ischemia time of 14.8 min (range 5–22).Mean operative time was 123 min (range 115–130) and mean intraoperative blood loss was 250 mL (range 20–450).No patient experienced postoperative acute renal failure and no patient developed new onset IV stage chronic kidney disease at 1-yr follow-up.ConclusionsSTE is a viable option to perform “zero-ischemia” LPN at beginning of learning curve; however, hilar clamp was necessary to achieve a relatively blood-less field in 17.4% of cases.     

Utility of CD127 combined with FOXP3 for identification of operational tolerance after liver transplantation

Loss of cell surface expression of CD127 on CD4⁺ CD25⁺⁺ regulatory T-cells (Tregs) may be a useful marker to efficiently isolate Tregs. As FOXP3 was specifically used to identify Tregs, combining these two markers could give better identification for patient with operational tolerance (OT) after liver transplantation. To testify this mixed lymphocyte reaction (MLR), the function of circulating CD4⁺ CD25⁺⁺ CD127^dim cells (CD127^dim cells) was examined in immunosuppression (IS)-free pediatric recipients after liver transplantation (LTx) (group operational tolerance: OT) (Gr-tol n = 25) compared to recipients who could not stop IS due to clinically overt rejection (group intolerance) (Gr-intol n = 18), recipients who were weaning IS (Gr-weaning n = 11) and age-matched healthy volunteers (Gr-vol n = 11). In addition, the frequencies of CD127^dim cells vs CD4⁺ CD25⁺⁺ CD127^dimFOXP3⁺ (CD127^dimFOXP3⁺) cells were compared in these four groups by FACS analyses. Our results showed that The proliferation of CD4 cells to donor antigens was reduced compared to third-party antigens only in Gr-tol (P = 0.022) but not in other groups (P = NS). Depletion of CD127^dim cells resulted in a donor antigen-specific abrogation of this MLR hyporesponsiveness in Gr-tol (P < 0.001) but not other groups (P = NS). This implied that CD127 efficiently isolated donor antigen-specific Tregs. The frequencies of CD127^dim cells were significantly lower in Gr-intol (5.2% ± 1.9%) compared to those in Gr-tol (7.8% ± 1.8%) (P < 0.001) as were the frequencies of CD127^dim FOXP3⁺ cells (Gr-tol: 5.4% ± 1.7% vs Gr-intol: 2.9% ± 1.0%, P < 0.001). Of interest, there were fewer CD127^dimFOXP3⁺ cells in Gr-intol (2.9% ± 1%) than in Gr-weaning (5.1% ± 1.8%) (P = 0.002), but no difference in CD127^dim cells (Gr-intol: 5.2% ± 1.9% vs Gr-weaning: 6.7% ± 2.0%) (NS). Thus, combining FOXP3 with CD127 for phenotype analysis demonstrated an unequivocal difference between Gr-intol and Gr-weaning that was not detected by CD127 alone. In conclusion CD127 was a useful surface marker to isolate donor-antigen-specific-Tregs in OT after LTx. The additive effect of its combination with FOXP3 is important in phenotypical Treg analyses of OT patients.     

Patient preferences for clinical follow-up after primary treatment for soft tissue sarcoma: A cross-sectional survey and discrete choice experiment

BackgroundPatients treated for soft tissue sarcoma (STS) require long-term follow-up to detect recurrent or metastatic disease, yet marked differences exist in clinical approaches to the length of follow-up, frequency of consultations and investigations undertaken at follow-up visits. There has been no published work assessing patient expectations or the acceptability of post-treatment follow-up strategies. This study aimed to assess the patient acceptability of different follow-up strategies following curative surgery for soft tissue sarcoma and to investigate the hypothetical levels of recurrence risk at which different follow-up regimes were acceptable.MethodsPatients were recruited from the Royal Orthopaedic Hospital in Birmingham. The study used a cross-sectional survey incorporating a best-worst scaling discrete choice experiment to assess patient preferences regarding different aspects of follow-up.Results132 patients participated (47% response). The nature of investigations undertaken during follow-up was the most important aspect of post-surgical care. Patients typically preferred appointments routinely consisting of clinical examination and chest X-ray, and for follow-up to remain in secondary care rather than general practice.ConclusionClear protocols for STS patient follow-up can improve consistency and equity of care. In determining the optimum follow-up plan for STS patients from the patient perspective, this study provides valuable information that should be considered alongside the clinical effectiveness of follow-up strategies to maximise patient outcomes and use NHS resources appropriately.     

白内障摘除联合人工晶体植入术治疗闭角型青光眼患者的效果及安全性评价

目的评价白内障摘除联合人工晶体植入术治疗闭角型青光眼患者的效果及安全性评价。方法选择2012年4月~2014年4月辽宁省盘锦市中心医院治疗的闭角型青光眼伴白内障患者94例(100眼),根据自愿原则将其分为观察组及对照组,每组各47例(50眼)。对照组行小梁切除术治疗,观察组行白内障摘除联合人工晶体植入术。术后对两组患者进行随访,观察并记录其手术治疗效果及并发症的发生情况。结果随访期间,观察组未发现视力<0.1的患者,视力0.1~0.5者所占比例为46%,视力>0.5比例为54%,对照组视力<0.1的患者比例为16%,视力0.1~0.5者所占比例为32%,视力>0.5者所占比例为52%,差异有统计学意义(χ2=9.1173,P=0.0204)。术后复查结果表明,采用白内障摘除联合人工晶体植入患者前房深度为(3.06±0.42)mm,眼内压为(13.17±4.02)mm Hg;小梁切除的患者前房深度为(2.15±0.50)mm,眼内压为(12.83±3.70)mm Hg。两组患者并发症发生情况比较,差异无统计学意义(χ2=1.9560,P=0.0674)。结论采用白内障摘除联合人工晶体植入术治疗闭角型青光眼合并白内障,患者术后视力恢复良好,效果较为明显,且不良反应较少,安全性高,值得在临床上广泛推广。     

霍乱弧菌毒力基因LAMP方法快速检测

目的建立快速、特异检测霍乱弧菌的环介导等温扩增(LAMP)方法。方法针对霍乱弧菌毒素基因(ctxA)设计4条引物,建立环介导等温扩增检测方法,优化反应体系,测定方法的特异性和灵敏度,并进行鱼肉模拟样品和实际样品检测。结果 LAMP最佳反应条件为8.0 mmol/L Mg2+、0.6 mmol/L d NTPs、1.6μmol/L FIP和BIP(2条内引物)、0.2μmol/L F3和B3(2条外引物);对细菌纯培养物的检测灵敏度为10 cfu/m L,对鱼肉模拟样品检测灵敏度为102cfu/g;在16份实际样品中检测出4份ctxA基因阳性。结论建立的LAMP方法灵敏度高、特异性强,可快速地检测食品样品中霍乱弧菌。     

磁共振内耳水成像的临床应用价值

目的探讨磁共振(MRI)内耳水成像在内耳病变患者中的临床价值。方法对45例怀疑内耳病变患者,行磁共振内耳水成像扫描,并进行最大密度投影(MIP)、多平面重建(MPR)、容积重建(VR)后处理。结果 45例患者均能清晰显示内耳结构,其中内耳畸形8例,结构正常37例。结论内耳水成像能清晰、立体的显示内耳膜迷路及内听道精细解剖结构,并显示其发育状况及通畅程度,能够为内耳病变患者的诊断和术前评估提供重要的影像学依据。