几种视觉电生理检查对原发性开角型青光眼早期诊断的意义

目的：评价几种视觉电生理检查在原发性开角型青光眼早期诊断中的价值,为临床青光眼早期诊断提供客观敏感的指标。方法：选择36例（70眼）原发性开角型青光眼患者、8例（12眼）可疑性青光眼患者和30例（60眼）正常对照者分别进行闪光视网膜电图（FERG）、视网膜振荡电位（OPs）、闪烁光视网膜电图（FLERG）、图形视网膜电图（PERG）、图形视诱发电位（PVEP）检查,并与视野指数、眼压、视力等进行多元相关分析。结果：原发性开角型青光眼PERG、PVEP、OPs表现异常,与正常对照组相比差异有显著性意义（p＜0.05）。FLERG振幅降低,但和FERG同样与正常对照组相比差异无显著性意义（p＞0.05）。在原发性开角型青光眼早期（特别是视野改变出现前）,PERG的异常率较高。原发性开角型青光眼患者OPs与C／D负相关,与视野指数、眼压、视力不相关。PERG振幅与视野指数和眼压负相关,与C／D和视力不相关。PVEP潜伏期与视野指数和C／D正相关,而与眼压不相关。结论：统计学结果表明,对原发性开角型青光眼不同的表现形式,可选用不同的检查指标。在早期眼底改变出现前（C／D不大）,如眼压升高,PERG应为比较敏感的指标;而一旦眼底发生改变,尽管眼压不高,可选用OPs或PVER作为观察指标。对早期和中晚期青光眼,PERG诊断和监测价值较好。联合多种视功能检查对原发性开角型青光眼的早期诊断具有较好的意义。     

清胆汤的制备及临床疗效观察

目的介绍清胆汤的制备及临床疗效观察.方法按现代工艺制备清胆汤,建立性状、质量控制,并用之于临床,治疗急性性胆囊炎,并与消炎利胆片对照.结果治疗组261例中,痊愈215例,好转40例,无效6例,有效率为97.8%.对照组261例中,痊愈2 06例,好转36例,无效19例,总有效率92.7%.两组经Ridit分析,总有效率有明显差异(P＜0.05).结论清胆汤的工艺简单,组方合理,治疗急慢性胆囊炎疗效显著.     

Comparison of CryoMaze With Cut-and-Sew Maze Concomitant With Mitral Valve Surgery: A Randomized Noninferiority Trial

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Pharmacokinetics and Safety of Sodium Benzoate,a d-Amino Acid Oxidase (DAAO) Inhibitor,in Healthy Subjects: A Phase I,Open-label Study

PurposeN-methyl-d-aspartate receptor (NMDAR)-mediated neurotransmission plays a critical role in cognition and memory, and d-serine is a co-agonist of the receptor. d-serine is metabolized by d-amino acid oxidase (DAAO). Sodium benzoate is a DAAO inhibitor that leads to the elevation of d-serine levels and enhances NMDAR functions as a therapeutic for wide-spectrum central nervous system (CNS) disorders, including schizophrenia and dementia. For therapeutic application of sodium benzoate in CNS disorders, we conducted a Phase I study to evaluate its safety, tolerability, and pharmacokinetic profile after single-dose oral administration in healthy volunteers. In contrast to the accumulation in the CNS, sodium benzoate has a rapid pharmacokinetic profile when measured peripherally.MethodsIn this Phase I study, subjects were randomized into 4 different dose groups after a single oral administration. The pharmacokinetic parameters of sodium benzoate were assessed after exposure to 250, 500, 1000, and 2000 mg of sodium benzoate. All adverse events were investigated and recorded.FindingsThe C_max and AUC of sodium benzoate exhibited a higher than dose-proportional increase within the dose range from 250 to 2000 mg under fasting conditions. The slopes were 1.78 and 2.61 and the 90% CIs were 1.41 to 2.15 and 2.20 to 3.03 for C_max and AUC, respectively. Sodium benzoate was absorbed and converted to benzoic acid rapidly, reaching C_max after ～0.5 hour and elimination t_1/2 after ～0.3 hour. No subjects reported adverse events that were sodium benzoate related.ImplicationsThe nonlinear pharmacokinetic response was observed within the dose range up to 2000 mg. Sodium benzoate treatment exhibited a favorable safety profile and was well tolerated at all dose levels. The study results serve as a foundation that should be useful for investigating efficacy and safety in the drug's subsequent clinical development. Trial registration: TFDA-103607047.     

肝组织中丙型肝炎病毒抗原的表达及其临床意义

目的研究肝炎患者肝组织中丙型肝炎病毒抗原的表达及其临床意义。     

医院病人投诉案例的分析与思考

通过对复旦大学附属中山医院2年来接待的196个信访投诉案例的分析,论述了医院管理上应该注意的问题,指出对医务人员要进一步强化医疗作风和职业道德教育,增强为人民服务的意识;处理医疗纠纷既要职责分明又要综合治理,正确对待病人的投诉;提高依法办事的能力,保障医务人员的合法权益.     

The pulmonary arterial hypertension of patients on maintained hemodialysis is positively associated with the decreased percent of CD8 T cell in the peripheral blood independently

Objective To explore the risk factors of pulmonary artery hypertension (PAH) and the its relationship with T cell subsets to provide a foundation for the prevention and treatment of PAH. Methods 154 maintained hemodialysis (MHD) patients in our dialysis center were recruited according to the criterion and divided into two groups subsequently: PAH group (pulmonary artery systolic pressure, PASP＞35 mmHg) and non-PAH group (PASP≤35 mmHg). The related clinical, biochemical and ultrasonic cardiogram data were collected and peripheral blood was acquired to detect the expressions of the surface antigen CD3, CD4, CD8 and CD69 with flow cytometry. Logistic regression analysis was used to find out the relationship between PAH and T cell subsets. Results There was no significant difference between 56 cases of PAH and 98 cases of non-PAH as regards gender, age, mean systolic and diastolic pressure, dialysis durations, morbidities of hypertension and diabetes, smoking rate, and left ventricular diameter. Compared with the non?PAH group, the PAH group demonstrated a lower percent of CD8 T cells and CD8 CD69 T cells, but a much higher left atrial diameter (LAD), Interventricular septum thickness, left ventricular posterior wall thickness, and NT?proBNP. The percentage of T cells, CD4 T cells and CD4 CD69 T cells showed no difference between the two groups. Multivariate analysis confirmed that PAH was negatively independently associated with the percentage of CD8 T cells and CD8CD69 T cells. Conclusions The decreased percentage of CD8 T cells and CD8CD69 T cells in the peripheral blood is a risk factor of PAH in maintained hemodialysis patients, and CD8 T cells may play an important role in the genesis of PAH.     

Application of Lung-Screening Reporting and Data System Versus Pan-Canadian Early Detection of Lung Cancer Nodule Risk Calculation in the Alberta Lung Cancer Screening Study

BackgroundFalse-positive scans and resultant needless early recalls can increase harms and reduce cost-effectiveness of low-dose CT (LDCT) lung cancer screening. How LDCT scans are interpreted and classified may impact these metrics.MethodsThe Pan-Canadian Early Detection of Lung Cancer risk calculator was used to determine nodule risk of malignancy on baseline screening LDCTs in the Alberta Lung Cancer Screening Study, which were then classified according to Nodule Risk Classification (NRC) categories and ACR Lung Screening Reporting and Data System (Lung-RADS). Test performance characteristics and early recall rates were compared for each approach.ResultsIn all, 775 baseline screens were analyzed. After a mean of 763 days (±203) of follow-up, lung cancer was detected in 22 participants (2.8%). No statistically significant differences in sensitivity, specificity, or area under the receiver operator characteristic curve occurred between the NRC and Lung-RADS nodule management approaches. Early recall rates were 9.2% and 9.3% for NRC and Lung-RADS, with the NRC unnecessarily recalling some ground glass nodules, and the Lung-RADS recalling many smaller solid nodules with low risk of malignancy.ConclusionPerformances of both the NRC and Lung-RADS in this cohort were very good with a trend to higher sensitivity for the NRC. Early recall rates were less than 10% with each approach, significantly lower than rates using the National Lung Screening Trial cutoffs. Further reductions in early recall rates without compromising sensitivity could be achieved by increasing the NRC threshold to 20% for ground glass nodules or by applying the nodule risk calculator with a 5% threshold to 6- to 10-mm solid nodules under Lung-RADS.