原因不明复发性流产患者淋巴细胞主动免疫治疗前后细胞亚群的变化

目的探讨淋巴细胞主动免疫治疗对原因不明复发性流产的疗效及在主动免疫治疗前后患者微量淋巴细胞毒实验淋巴细胞亚群的变化。方法应用荧光染色法和流式细胞术,分别对2009年4月至2010年12月在安徽医科大学第一附属医院行主动免疫治疗的48例原因不明复发性流产患者治疗前后的淋巴细胞坏死率和CD3、CD4、CD8及CD16+CD56+NK细胞的比率进行测定;同时随访其预后。结果 43例成功妊娠至孕12周之后,5例患者在孕12周前流产,主动免疫治疗成功率89.6%(43/48)。治疗后患者淋巴细胞坏死率上升,CD3、CD4和CD16+CD56+NK亚群比率下降,CD8亚群比率上升,差异有统计学意义(P<0.05,P<0.01)。结论淋巴细胞主动免疫治疗对原因不明复发性流产治疗效果满意,CD8亚群的升高可能有利于妊娠。     

Chronic recurrent multifocal osteomyelitis of the left femur associated with ulcerative colitis: a case report

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterized by chronic relapsing noninfectious bone inflammation of unknown etiology. Although CRMO is considered an extraintestinal manifestation in patients with inflammatory bowel disease, most cases of CRMO are associated with Crohn’s disease; very few are associated with ulcerative colitis (UC). We herein describe a 21-year-old patient with UC who developed recurrent left thigh pain. The patient was diagnosed with CRMO associated with UC, which was well controlled with azathioprine treatment.     

Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features

Introduction

Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM).

Intussusception

Intussusception is the most common cause of intestinal obstruction in infancy and early childhood. It occurs when one segment of bowel (the intussusceptum) invaginates into an adjacent distal segment of bowel (the intussuscepien). The classical presentation is with intermittent abdominal pain, vomiting and redcurrant jelly-like stool. Diagnosis can be accurately confirmed with an ultrasound scan. Initial management is with fluid resuscitation and antibiotics. Following adequate resuscitation, treatment is usually with a non-operative air enema reduction under fluoroscopic guidance. If this fails to completely reduce the intussusception, the air enema may be repeated in patients that are clinically stable. The main risks associated with an air enema are bowel perforation, failed reduction and recurrence. Surgical intervention is indicated in patients presenting with perforation, those that are clinically unstable or where multiple air enemas have failed to reduce the intussusception. Surgery can be performed open or laparoscopic and involves attempted manual reduction of the intussusception and may require bowel resection and anastomosis.     

Immune modulation of i.v. immunoglobulin in women with reproductive failure

Background

The mechanism of maternal immune tolerance of the semi‐allogenic fetus has been explored extensively. The immune reaction to defend from invasion by pathogenic microorganisms should be maintained during pregnancy. An imbalance between the immune tolerance to the fetus and immune activation to the pathogenic organisms is associated with poor pregnancy outcomes. This emphasizes that the immune mechanism of successful reproduction is not just immune suppression, but adequate immune modulation.

Methods

In this review, the action of i.v. immunoglobulin G (IVIg) on the immune system and its efficacy in reproductive failure (RF) was summarized. Also suggested is the indication of IVIg therapy for women with RF.

Main findings (Results)

Based on the mechanism of the immune regulation of IVIg and following confirmation of the immune modulation effects of it in various aberrant immune parameters in patients with RF, it is obvious that IVIg is effective in recurrent pregnancy losses and repeated implantation failures with immunologic disturbances.

Conclusion

The authors recommend IVIg therapy in patients with RF with aberrant cellular immunologic parameters, including a high natural killer cell proportion and its cytotoxicity or elevated T helper 1 to T helper 2 ratio, based on each clinic's cut‐off values. Further clinical studies about the safety of IVIg in the fetus and its efficacy in other immunologic abnormalities of RF are needed.     

滋肾健脾化瘀方对复发性流产患者凝血功能的影响

目的:观察滋肾健脾化瘀方对复发性流产脾肾两虚、血瘀阻络证患者凝血功能的影响,探求其作用机制。方法:将105例符合条件的患者随机分为A组,B组和C组,各35例。分别给予滋肾健脾化瘀方、阿司匹林片、低分子量肝素钙。观察各组患者治疗前后中医辨证"数堕胎"脾肾两虚、血瘀阻络证量表(中医证候)评分,凝血功能[部分纤溶酶原激活物抑制剂-1(PAI-1),活化部分凝血活酶时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB),组织型纤溶酶原活化因子(t-PA),凝血酶原时间(PT),D-二聚体(D-D),组织因子(TF),纤维蛋白肽A(FPA),狼疮抗凝物质(LA),活化蛋白S(PS),活化蛋白C(PC),抗心磷脂抗体(ACA),血小板聚集功能(PAF),纤维蛋白原(Fig),纤溶酶-抗纤溶酶复合物(PAP),凝血酶原片段(F1+2),血小板α颗粒膜糖蛋白-140(GMP-140),抗凝血酶(AT),血酶-抗凝血酶复合物(TAT)];比较各组有效率和不良反应发生率。结果:A组总有效率84.4%,高于B组的58.1%和C组的60.6%(P0.05)。与治疗后B组比较,A组PAI-1,PAF,F1+2降低,ACA,PS,PC,Fig,AT升高(P0.05)。与治疗后C组比较,A组FIB,D-D,LA,ACA,PAF,F1+2,TAT降低,TT,PC,Fig,AT升高(P0.05)。A组总不良反应发生率3.1%,低于B组的38.7%和C组的30.3%(P0.05)。结论:滋肾健脾化瘀方可明显改善复发性流产脾肾两虚、血瘀阻络证患者临床症状和凝血功能,不良反应发生率低。     

Alcohol delamination of the corneal epithelium for recurrent corneal erosion syndrome

AIM: To evaluate the outcomes of alcohol delamination (ALD) of the corneal epithelium for the treatment of recurrent corneal erosion syndrome (RCES) and to implement a standardized treatment protocol for this condition utilizing evidence based practice and the findings of an internal audit. METHODS: A retrospective analysis of 42 eyes of 40 patients diagnosed with RCES who were treated with ALD between January 2006 and March 2016 was conducted. Patients had 20% alcohol applied to the cornea with the use of a well for 40s. Patients were reviewed one week later in the Outpatient Department. Outcome criteria were established based on standards from other studies in the medical literature. These included, a treatment success rate of at least 72% (defined as complete resolution of symptoms one month after treatment), a postoperative complication a rate of <5% (mainly infective keratitis, and subepithelial haze), and the absence of any detrimental effect on visual acuity in ≥95% of patients. RESULTS: The mean age at the time of ALD was 41.17±13.44y. Patients were followed for an average of 12.8±15.65mo. The majority were female (52.5%, n=21) and the majority of eyes treated with ALD were left eyes (62.9%, n=26). Trauma was the primary aetiology in our study population. Treatment was successful in 73.8% (n=31) of eyes and in 75% (n=30) of patients. Recurrence occurred in 26.2% of eyes at a mean of 10.41±12.63mo post treatment. CONCLUSION: ALD is an efficacious and cost-effective primary surgical intervention for RCES.     

Regression splines in the time-dependent coefficient rates model for recurrent event data

Many epidemiologic studies involve the occurrence of recurrent events and much attention has been given for the development of modeling techniques that take into account the dependence structure of multiple event data. This paper presents a time-dependent coefficient rates model that incorporates regression splines in its estimation procedure. Such methods would be appropriate in situations where the effect of an exposure or covariates changes over time in recurrent event data settings. The finite sample properties of the estimators are studied via simulation. Using data from a randomized community trial that was designed to evaluate the effect of vitamin A supplementation on recurrent diarrheal episodes in small children, we model the functional form of the treatment effect on the time to the occurrence of diarrhea. The results describe how this effect varies over time. In summary, we observed a major impact of the vitamin A supplementation on diarrhea after 2 months of the dosage, with the effect diminishing after the third dosage. The proposed method can be viewed as a flexible alternative to the marginal rates model with constant effect in situations where the effect of interest may vary over time.     

Analysis of recurrent event data under the case-crossover design with applications to elderly falls

The case-crossover design is useful for studying the effects of transient exposures on short-term risk of diseases or injuries when only data on cases are available. The crossover nature of this design allows each subject to serve as his/her own control. While the original design was proposed for univariate event data, in many applications recurrent events are encountered (e.g. elderly falls, gout attacks, and sexually transmitted infections). In such situations, the within-subject dependence among recurrent events needs to be taken into account in the analysis. We review three existing conditional logistic regression (CLR)-based approaches for recurrent event data under the case-crossover design. A simple approach is to use only the first event for each subject; however, we would expect loss of efficiency in estimation. The other two reviewed approaches rely on independence assumptions for the recurrent events, conditionally on a set of covariates. Furthermore, we propose new methods that adjust the CLR using either a within-subject pairwise resampling technique or a weighted estimating equation. No specific dependency structure among recurrent events is needed therein, and hence, they have more flexibility than the existing methods in the situations with unknown correlation structures. We also propose a weighted Mantel-Haenszel estimator, which is easy to implement for data with a binary exposure. In simulation studies, we show that all discussed methods yield virtually unbiased estimates when the conditional independence assumption holds. These methods are illustrated using data from a study of the effect of medication changes on falls among the elderly.     

喉返神经及其分支解剖特征在甲状腺手术中的临床意义

目的: 探讨喉返神经及其分支解剖在甲状腺手术中的临床意义。方法: 对95例甲状腺切除术中观测的105侧喉返神经的有关资料进行回顾性分析。结果: 97侧(92.38%)喉返神经入喉前分成前、后2支,1支入喉者6侧(5.71%),3支入喉者2侧(1.91%);分叉距入喉点0.4~2.5 cm;1例术后出现暂时性声音嘶哑。结论: 喉返神经存在着分支等解剖特点,术中正确辨认并安全地解剖喉返神经是避免喉返神经损伤的关键。