Application of reflectance confocal microscopy to evaluate skin damage after irradiation with an yttrium-scandium-gallium-garnet (YSGG) laser

The objective of this study was to observe the characteristics of the skin after irradiation with a 2790-nm yttrium-scandium-gallium-garnet (YSGG) laser using reflectance confocal microscopy (RCM). A 2790-nm YSGG laser was used to irradiate fresh foreskin (four doses, at spot density 3) in vitro. The characteristics of microscopic ablative columns (MAC), thermal coagulation zone (TCZ), and microscopic treatment zones (MTZ) were observed immediately after irradiation using digital microscope and RCM. The characteristics of MAC, TCZ, and MTZ with variations in pulse energy were comparatively analyzed. After irradiation, MAC, TCZ, and MTZ characteristics and undamaged skin between MTZs can be observed by RCM. The depth and width of MTZ obviously increased with the increase in pulse energy. At 80, 120, and 160 mJ/microbeam (MB), the MTZ actual area and proportion were about two times that of the theoretical value and three times at 200 mJ/MB. With increases in depth, the single MAC gradually decreased in a fingertip-shaped model, with TCZ slowly increasing, and MTZ slightly decreasing in a columnar shape. RCM was able to determine the characteristics of thermal injury on the skin after the 2790-nm YSGG laser irradiation with different pulse energies. Pulse energy higher than 200 mJ/MB may have much larger thermal injury and side effect. RCM could be used in the clinic in future.     

Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis

Aims: The study evaluated the predictive role of preoperative fasting C-peptide, hemoglobin (Hb)A1c, fasting plasma glucose (FPG), and body mass index (BMI) levels on diabetes remission in patients with type 2 diabetes following bariatric surgery. Methods: Medline, PubMed, Central, and Google Scholar databases of up to September 7, 2016 were searched using the following terms: type 2 diabetes mellitus, gastric bypass, Roux-en-Y, anastomosis, C-peptide, weight loss, HbA/HbA1c, predictive/predictor. Results: Meta-analysis of the pooled data indicated that fasting C-peptide was predictive of increased chance of remission of type 2 diabetes (pooled difference in means = 0.93, 95% confidence interval [CI] = 0.61 to 1.25, p < .001). The analysis also found that FPG (pooled standardized mean difference = ?0.42, 95% CI: ?0.64 to ?0.20, p < .004) and HbA1c levels (pooled difference in means = ?1.05, 95% CI: ?1.48 to ?0.62, p < .001) were associated with reduced odds of type 2 diabetes remission. BMI was not found to be associated with remission (pooled difference in means = 0.29, 95% CI: 0.30 to 0.88, p = .343). In general, subgroup analysis, which evaluated the pooled data from the retrospective and prospective studies separately, gave similar results. Conclusions: Preoperative fasting plasma C-peptide was associated with increased type 2 diabetes remission after bariatric surgery, whereas baseline HbA1c and FPG levels were associated with reduced chance of remission. These parameters may be used as a guideline in weighing the risks and benefits for surgical intervention in patients with type 2 diabetes.     

夜戴型角膜塑形镜对青少年近视患者眼球参数的短期影响

目的：：评价青少年近视患者配戴夜戴型角膜塑形镜后6 mo角膜内皮细胞密度、中央角膜厚度、角膜曲率和眼轴长度的变化。方法：回顾性病例研究。利用超声诊断仪、非接触角膜内皮显微镜和角膜地形图仪,测量和观察44例86眼7~17岁青少年近视患者配戴夜戴型角膜塑形镜前和配戴后6 mo的角膜中央厚度、角膜内皮细胞密度、中央角膜厚度、角膜曲率和眼轴长度的变化和相关性。结果：配戴夜戴型角膜塑型镜6 mo后,白天裸眼视力稳定在1.0~1.2,无明显眼部并发症。角膜内皮细胞密度稍有减少,但与戴镜前相比差异无统计学意义(P>0.05)。角膜曲率及前房深度无明显变化。角膜中央厚度变薄及眼轴长度仍有增长,差异有统计学意义(P<0.05)。角膜内皮细胞密度与眼轴长度具有相关性(右眼：P=0.005,左眼：P=0.013),中央角膜厚度与眼轴长度具有相关性(右眼：P=0.019,左眼：P=0.006)。结论：配戴夜戴型角膜塑型镜6mo,眼轴长度依然有增长,角膜内皮细胞密度降低,中央角膜厚度变薄。     

开放式喷射通气在犬全身麻醉下硬质气管镜介入治疗中的应用

目的 观察国产开放式喷射通气在犬全身麻醉下硬质气管镜(简称硬镜)介入治疗时的通气效果及其调控方法.方法 成年健康杂种犬10只,雌雄各5只,体重14～16 kg.全身麻醉下插入硬镜后,按随机数字表法分为单纯自主呼吸组(A组)、常频喷射通气保留自主呼吸组(B组)和单纯常频喷射通气组(C组),于不同通气状况下模拟介入治疗.在模拟治疗前和治疗30、60、90及120 min时检查动脉血气变化,并比较单纯常频喷射通气(C组)时按一定顺序依次实施不同驱动压力(0.2、0.25及0.3 mPa)的动脉血气变化.体外测量常频喷射通气高压氧驱动下(吸入氧流量为100％)不同驱动压力(0.1、0.2及0.3 mPa)及吸呼比分别为1∶1.5和1∶3时硬镜近端和远端的氧浓度.结果 各组在模拟介入治疗后PaCO2均有上升,以C组PaCO2上升和pH值下降幅度最大,与A组和B组比较差异有统计学意义(均P＜0.01);模拟介入治疗后C组PaO2下降,与A组和B组比较差异有统计学意义(F=7.645,P＜0.05).常频喷射通气的效果与通气驱动压力相关,通气驱动压力高有助于改善氧合及促进CO2的排出.体外常频喷射通气高压氧驱动(吸入氧流量为100％)时硬镜远端氧浓度低于50％,喷射针尖伸进3～6 cm时硬镜远端氧浓度低于40％,调节喷射通气驱动压力和吸呼比对硬镜远端氧浓度影响不明显.结论 单纯常频喷射通气可能难以有效维持介入治疗期间的通气需要,随着治疗时间的延长可导致PaO2下降、PaCO2升高和pH值下降,临床应给予关注.在全身麻醉下行硬镜介入治疗时,推荐结合术中患者的反应及一般情况,保留患者一定程度的自主呼吸,以维持氧合状态并减少CO2潴留.常频喷射通气的效果与通气驱动压力相关,通气驱动压力高有助于改善氧合促进CO2排出.体外常频喷射通气高压氧驱动(吸入氧流量为100％)时,硬镜远端氧浓度在40％左右,热消融治疗安全.     

Szabo技术在口部病变经皮冠状动脉介入治疗中应用的安全性和可行性

背景和目的：冠状动脉口部病变的经皮冠状动脉介入（PCI）治疗手术操作难度大,易有并发症,既要支架准确植入口部病变,又要边支不受压。本研究探讨解决这一难题的Szabo技术的成功率、安全性和可行性。方法：Szabo技术是利用边支导丝（抛锚导丝）穿过支架最靠近边支的支架网眼,防止支架前进时停止在口部病变外,保证主支导丝穿过支架腔。作者回顾性分析利用Szabo技术治疗39例病人冠状动脉口部病变的结果。手术操作成功定义：支架没有脱落,边支导丝没有退出。造影成功定义：支架准确植入到口部,而边支没有受压。血管内超声定义成功：支架准确植入到口部,近段没有突出,支架完全覆盖病变。39例病人中,男性28例,女性11例,年龄43～79,平均（65±12）岁。6F和7F指引导管分别用于35例（89.7%）和4（10.3%）例病人。经桡动脉途径31（79.5%）例和经股动脉途径8（20.5%）例。病变相关血管：前降支（LAD）26（66.7%）例,右冠（RCA）5（12.8%）例,旋支及钝缘支（LCX-OM）3（7.7%）例,后降支（PDA）5（12.8%）例。支架植入后30（76.9%）例病变相关血管和9（23.1%）例边支血管经过了血管内超声（IVUS）检查。结果：手术操作成功：36例（92.3%）,这36例造影均成功（100%）。IVUS检测：支架准确植入口部者96.7%（29例/30例）,支架近段轻度凸出的只有1例（3.3%）。没有发生严重并发症。结论：结果说明Szabo技术用于冠状动脉口部病变PCI成功率很高,是安全和可行的,值得推广。     

Topical application of dexamethasone to prevent cerebral vasospasm after aneurysmal subarachnoid haemorrhage: a pilot study

BACKGROUND AND OBJECTIVE: Cerebral vasospasm is a common and serious complication of aneurysmal subarachnoid haemorrhage (SAH). Many studies have revealed a role of inflammation in the development of cerebral vasospasm. This study aimed to investigate whether topically administered dexamethasone could attenuate vasospasm in SAH patients. METHODS: Paired samples were designed to compare postoperative mean middle cerebral artery velocity between treated patients and controls matched for age (+/-10 years), sex, location and size (small, medium or large) of aneurysm, as well as baseline mean middle cerebral artery velocity. We enrolled ten consecutive aneurysmal SAH patients who had Hunt-Hess (HH) grade 3 and Fish grade 3 lesions and were admitted within 24 hours following the onset of SAH. These patients were treated with dexamethasone 10mg topically at the end of the operation. Each treated patient was matched with a control patient who did not receive topical dexamethasone. All controls also had HH grade 3 and Fish grade 3 SAH and were admitted within 24 hours after the onset of SAH. Serial measurements of mean middle cerebral artery velocity were performed postoperatively every day for 2 weeks. Results were analysed with the paired t-test. RESULTS: One patient (10%) in the treated group had vasospasm, without neurological deficit, compared with four patients (40%) in the control group, one of whom had hemiplegia. Paired t-test showed that the mean middle cerebral artery velocity in controls was significantly higher than that in treated patients on days 4-14. CONCLUSION: Topical application of dexamethasone is a promising strategy for prevention and attenuation of vasospasm following aneurysmal SAH.     

Polymorphism in the human C-reactive protein (CRP) gene, serum concentrations of CRP, and the difference between intracranial and extracranial atherosclerosis

BACKGROUND: C-reactive protein, a proinflammatory factor, is involved in the development of atherosclerosis. The CRP 1059G>C polymorphism appeared to be a susceptive marker for atherosclerosis. We investigated the relationship of the distribution of cerebral atherosclerosis with triggered serum CRP concentrations following acute ischemic stroke/transient ischemic attack (IS/TIA) and CRP 1059G>C polymorphism. METHODS: We recruited 222 IS/TIA patients (122 with only intracranial atherosclerotic lesions and 100 with isolated extracranial atherosclerotic lesions) and 227 controls. Intra- and extracranial atherosclerotic lesions were determined by digital subtraction angiography. Serum CRP concentrations were measured by particle-enhanced immunonephelometry assay. CRP 1059G>C genotypes were obtained through PCR amplification and restriction enzyme digestion. RESULTS: CRP concentrations were significantly higher in intra- and extracranial groups than in controls. No significant difference was found in CRP concentrations between intra- and extracranial groups. The CRP 1059G>C single-nucleotide polymorphism did not influence CRP serum concentrations. CRP genotype and allele frequencies did not differ significantly between patients and controls. However, the frequencies of GC genotype and C allele were significantly higher in extracranial group than that in intracranial group. The GC individuals showed a higher risk of extracranial atherosclerosis compared with GG individuals (OR 3.41; 95%CI, 1.124-10.347; P=0.030). CONCLUSIONS: Serum CRP is associated with cerebral atherosclerotic disease. CRP 1059G>C polymorphism is one possible genetic determinant for the difference between intra- and extracranial atherosclerosis.     

克拉霉素缓释片微生物限度的检查方法

目的建立克拉霉素缓释片微生物限度检查方法。方法采用薄膜过滤并在冲洗液中加入增溶剂的方法,去除克拉霉素缓释片的抗菌活性。结果满足《中华人民共和国药典》2005版验证试验的基本要求。5株验证菌株中枯草芽孢杆菌对克拉霉素缓释片最敏感,可作为克拉霉素缓释片微生物限度检查方法的质控菌株。结论该方法可作为克拉霉素缓释片的常规微生物限度检查方法。     

Carotid endarterectomy when the distal internal carotid artery is small or poorly visualized

Purpose: This is a report of the operative findings and results of carotid endarterectomy (CEA) when the conventional arteriogram demonstrates an internal carotid artery with a high-grade origin stenosis and a small or poorly visualized distal extracranial segment with an apparent diameter of 2 mm or less.Methods: Eighteen CEA were performed on 17 patients with this preoperative finding and patent common and external carotid arteries. The indications for CEA were transient ischemia in seven patients, completed minor stroke in five and amaurosis fugax in four patients. One patient had bilateral findings and global cerebral ischemic symptoms.Results: At CEA 16 internal carotid arteries had atherosclerotic very high-grade origin stenosis, and two had chronic occlusion. Ten of the 16 open arteries had true external diameters of 4 mm or more. Of these, seven were normal above the stenosis, two had a long, trailing intraluminal thrombus that was removed, and one had high-grade distal stenosis. Of the six arteries with true diameters of 3 mm or less (hypoplastic), two had a thick fibrotic wall. The carotid stump back pressure for the 16 open internal carotid arteries was 56 ± 15 mm Hg (mean ± SD). This was significantly higher than the 39 ± 14 mm Hg back pressure measured in 1016 arteries without a string sign (p < 0.001). There was one 30-day postoperative death after a stroke. There was no systemic or neurologic morbidity. Post-CEA duplex scans demonstrated eight normal, five mildly stenotic, and five occluded internal carotid arteries. Two of the occlusions were found at CEA and the other three occluded arteries had low flow after CEA, two of which were hypoplastic and the other had a distal stenosis.Conclusions: Patients with symptoms with these findings on arteriograms should undergo CEA. However, the success of CEA in this setting depends on the internal carotid artery anatomy and disease, which is difficult to determine before CEA. Patients with a truly normal extracranial internal carotid artery have an excellent probability of a successful CEA, but this is not the case when the artery is small or fibrotic. Low internal carotid artery flow after a technically satisfactory CEA is a harbinger of thrombosis and should be managed by internal carotid artery ligation and external CEA. (J VASC SURG 1994;19:23-31.)