Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty

AIM: To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). METHODS: This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). RESULTS: The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. CONCLUSION: Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.     

The embryonic development of iridial muscles]

Development of iridial muscles was observed in 116 fetal eyes (72 human embryos 7 weeks to full gestation). Bundles of microfilaments with local high density spots appeared in the cytoplasm of the anterior pigment epithelium early in 10 week embryos. The high density spots later grew to be the dense-bodies in the myofilaments, the original structure of the pupillary sphincter. In embryos of 4 1/2 months, blood capillaries grew into the sphincter, which was fully developed in the 6th month, and myofilaments of the dilator muscles began to appear in the cytoplasm of peripheral anterior pigment epithelium, with villous protrusions toward the stroma. Many myofilaments with scattered dense-bodies were seen in the protrusions. It was thus confirmed that both the sphincter and dilator muscles originated from the iridial anterior pigment epithelium of neuro-ectoderm; however, the former developed fully to form independent smooth muscle bundles, while the latter was less developed and remained part of the pigment epithelium (myo-epithelium). The appearance of both muscles was earlier than previously reported.     

腰麻硬膜外和安氟醚全麻对凝血功能影响的比较

目的：了解不同麻醉方法对凝血功能的影响。方法：选择ＡＳＡⅠ￣Ⅱ级、无血液病及凝血功能障碍的择期手术患者６０例，随机分为三组：Ⅰ组，０．０５％布比卡因腰麻组；Ⅱ组，２％利多卡因硬膜外组；Ⅲ组，安氟醚吸入全麻组，每组２０例。分别于麻醉前、手术开始时和术毕采取外周静脉血测定血小板聚集功能及ＴＴ、ＰＴ、ＫＰＴＴ。结果：安氟醚吸入全麻组血小板聚集率明显降低。结论：安氟醚吸入全麻对血小板聚集功能有抑制作用。     

Effect of Trichosanthin on Cell Cycle and Apoptosis of Murine Melanoma Cells

Effect of Trichosanthin on Cell Cycle and Apoptosis of Murine Melanoma Cells@毕黎琦@李洪军@张玉华     

Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee

This paper describes a flap for covering defects around the knee. Dissections of 20 legs showed that in the majority the lateral sural cutaneous artery branched from the popliteal artery and descended along the posterolateral aspect of the leg together with two venae comitantes and the lateral sural cutaneous nerve. An island flap was designed, pedicled on these vessels and nerve, and was used in 17 patients with defects around the knee, including acute trauma (three cases), soft tissue tumours (three cases), unstable scar or ulcer (seven cases), and chronic osteomyelitis or infected open fractures with tissue loss (four cases). All the flaps survived entirely and possessed normal sensation. Furthermore, it was not necessary to sacrifice the main vessels of the lower leg.     

Gastric cytoprotection by amoxycillin in the rat

Abstract Amoxycillin in combination with anti-ulcer agents has been shown to prolong duodenal ulcer remission. While this effect can be related to the eradication of Helicobacter pylori , it is not known if amoxycillin might possess cytoprotective properties. Protection against ethanol-induced gastric mucosal damage by intragastric instillation of amoxycillin suspension (prepared from capsule form) and solution (from injection form, 100% pure amoxycillin), and by intraperitoneal injection of amoxycillin solution was studied using an ex vivo gastric chamber in the rat. Intragastric and intraperitoneal administration of amoxycillin dose-dependently protected the rat gastric mucosa from damage by absolute ethanol. This protection was lost when the rats were pretreated with indomethacin. Gastric mucosal blood flow as measured by laser Doppler flowmetry and gastric acid output were unaffected by amoxycillin. Amoxycillin imparts gastric cytoprotection, and one possible mechanism is by the release of prostaglandins.     

人胆汁胆固醇单水结晶形成过程的电镜研究

对２０例胆石病病人和１５例对照组的胆汁中胆固醇单水结晶（ＣＭＣ）形成过程进行了连续１０天电镜研究，结果表明，ＣＭＣ的形成可分为五个阶段：（１）泡聚集、融合形成小聚集物，（２）在小聚集物增大的同时其中央部浓缩形成核，（３）结晶前体自核内析出，析出后核便消失，（４）结晶前体逐渐增大形成亚显微ＣＭＣ，（５）亚显微ＣＭＣ再增大形成显微ＣＭＣ，小聚集物增大的同时其中央部浓缩形成的核是我们新发现的。核在ＣＭＣ形成过程中起重要作用。     

新时期新型医患关系现状的多维思考

本文针对新时期新型医患关系的现状、成因及所给启示，依据社会学和心理学的理论，从社会政治、经济、文化、心理、法律多维层面进行了思考。认为医患关系恶化的现状是令人担忧的；其形成原因是多元的；其改善途径应是全方位的；努力应是社会的；历程是漫长的；人性化的医疗服务是必要的。     

Lymph node pathology in infectious diseases

Lymph node biopsy is usually undertaken to investigate possible neoplastic involvement and it is appropriate that most emphasis in the teaching of lymph node pathology is placed on recognizing neoplastic diseases correctly. However, it is important also to recognize the suggestive and sometimes specific changes that occur in lymph nodes due to infection. A number of fairly standard reactive patterns involving different lymphoid and stromal components within nodes can be recognized, and different combinations can suggest specific infectious causes. It remains challenging to confirm the presence of organisms in many cases of infective lymphadenopathy and, therefore, additional clinical, serological, microbiological – and now molecular diagnostic – investigations, in response to recognition of suggestive pathology, are essential. In this review, the typical lymph node histological features associated with relatively common infectious agents are described. How the causative organisms and the effects of infection in lymph nodes may differ between individuals with intact immunity or immunocompromise is discussed.     

Aprepitant triple therapy for the prevention of chemotherapy-induced nausea and vomiting following high-dose cisplatin in Chinese patients: a randomized,double-blind,placebo-controlled phase III trial

Purpose

Aprepitant, an oral neurokinin-1 receptor antagonist, has demonstrated improved control of chemotherapy-induced nausea and vomiting (CINV) in previous studies. This is the first phase III study to evaluate the efficacy and tolerability of aprepitant in patients receiving highly emetogenic chemotherapy (HEC) in Asian countries.

Methods

This multicenter, double-blind, placebo-controlled trial assessed the prevention of CINV during the acute phase (AP), delayed phase (DP), and overall phase (OP). Patients receiving HEC were randomized to either an aprepitant group (day 1, aprepitant 125 mg; days 2–3, aprepitant 80 mg) or a standard therapy group (days 1–3, placebo). Both groups received intravenous granisetron and oral dexamethasone. The primary end point was complete response (CR; no emesis and no use of rescue therapy) during the OP.

Results

Of the 421 randomized patients, 411 (98 %) were assessable for efficacy; 69.6 % (142/204) and 57.0 % (118/207) of patients reported CR during the OP in the aprepitant and standard therapy groups, respectively (P?=?0.007). CR rates in the aprepitant group were higher during the DP (74.0 % vs. 59.4 %, P?=?0.001) but were similar during the AP (79.4 % vs. 79.3 %, P?=?0.942). Toxicity and adverse events were comparable in both groups.

Conclusions

The addition of aprepitant to standard antiemetic treatment regimens for Chinese patients undergoing HEC provided superior CINV prevention and was well tolerated.