视力残疾的病因分析及预防

目的：了解重庆市渝中区近5年来视力残疾的状况、特点及致残病因，提出相应的预防措施。方法：由指定眼科医师进行多次常规及特殊检查，分析403例806只眼的调查资料。结果：0～14岁儿童组人群的主要致残因素是先天遗传、屈光不正／弱视、斜视／弱视、角膜病和视神经病变；60岁以上老年人群为青光眼、白内障、角膜病、视网膜病变和视神经病变；其他人群依次为高度近视网脱及黄斑变性、眼外伤、角膜病、青光眼和视网膜病变。结论：对不同年龄段的人群应制定相应的预防视残措施。重点开展孕期保健工作及遗传咨询，加大眼部疾病预防知识宣传，预防眼部感染和外伤，积极治疗原发病。     

一站式复合技术治疗冠状动脉粥样硬化性心脏病进展

一站式复合(one-stop hybrid)技术是外科、内科、影像科、麻醉科等各个学科之间的完美结合,是多学科知识和技术的融合。一站式复合技术充分结合外科治疗和介入治疗技术的优点,以患者为中心,达到创伤、痛苦最小化,疗效最大化。近年来,随着该技术的发展,已经成功用于复杂冠心病的治疗并显示出特有的优势。本文总结一站式复合技术在冠心病中的应用现状,并对其未来发展方向进行讨论。     

Hemifacial spasm caused by a tortuous recurrent perforating artery: A case report

IntroductionWhen the culprit vessel in hemifacial spasm (HFS) is hard to determine, this is a challenge in microvascular decompression (MVD) surgery. In such a situation, small arteries such as perforators to the brainstem might be suspected. But small arteries are omnipresent near the facial nerve root exit/entry zone (fREZ). How to decide whether a given small artery is responsible for HFS is unclear.MethodWe report a case with a previously unreported form of neurovascular impingement, in which the culprit was found to be the recurrent perforating artery (RPA) from the anterior inferior cerebellar artery (AICA). An aberrant anatomic configuration of the RPA was found intraoperatively, which we thought was responsible for generating focal pressure on the facial nerve.Case reportA 62-year-old woman presented with a 1-year history of paroxysmal but increasingly frequent twitching in her right face. MRI showed tortuosity of the vertebral artery and apparently marked neurovascular impingement on the asymptomatic left side, while only the right AICA could be implicated as the possible culprit. Hemifacial spasm was diagnosed based on the typical clinical manifestation, and MVD was performed. The pre-meatal segment of the AICA was found not to be impinging the facial nerve at any susceptible portion near the fREZ: root exit point, attached segment, or root detachment point. The real culprit was in fact the RPA. This occult culprit vessel was tortuous, forming a coil-shaped twist which was interposed between the facial nerve and the intermediate nerve near the root detachment point. Focal pressure atrophy of the nerve was clearly observed at the compressing site. The patient achieved total spasm relief immediately after surgery, and remained spasm-free at 1-year follow-up, without any postoperative complications.ConclusionMVD is the only curative treatment for hemifacial spasm, but with a failure rate of around 10%. Mistaking the real culprit has been reported to be the most likely reason for surgical failure. Therefore, intraoperative identification of atypical occult forms of vascular compression is of importance to improve surgical outcome. In the present case, the RPA formed a coil-shaped twist, which inflicted focal vascular compression causing hemifacial spasm. We recommend careful inspection of the recurrent perforating artery during MVD for HFS, and decompressing any such neurovascular impingement.     

重庆地区艾滋病病毒感染孕产妇接受预防艾滋病母婴传播干预现状及对策分析

目的通过对艾滋病病毒(HIV)感染孕产妇及所生婴儿采取预防艾滋病母婴传播措施的现状分析,探讨重庆地区预防艾滋病母婴传播干预措施实施的相关影响因素及对策。方法采用统一问卷及个案表,对68例HIV感染孕产妇进行有关检测时间、感染原因、妊娠结局、影响各种预防传播措施的实施情况的回顾性调查。结果在调查的68例HIV感染孕产妇中,22例在孕期终止了妊娠,占32.4%。28.3%的分娩产妇和68.6%的新生儿服用了抗逆转录病毒药物,100%婴儿采用了人工喂养方式。结论现行的预防艾滋病母婴传播措施是可行的。孕产妇初次产检的时间影响了孕产妇的服药比例,应该提高孕早期检测率。     

Activated complement classical pathway in a murine model of oxygen-induced retinopathy

AIM: To investigate whether the complement system is involved in a murine model of oxygen-induced retinopathy (OIR). METHODS: Forty C57BL/6J newborn mice were divided randomly into OIR group and control group. OIR was induced by exposing mice to 75%±2% oxygen from postnatal 7d (P7) to P12 and then recovered in room air. For the control group, the litters were raised in room air. At the postnatal 17d (P17), gene expressions of the complement components of the classical pathway (CP), the mannose-binding lectin (MBL) pathway and the alternative pathway (AP) in the retina were determined by quantitative real-time polymerase chain reaction (RT-PCR). Retinal protein expressions of the key components in the CP were examined by Western blotting. RESULTS: Whole mounted retina in the OIR mice showed area of central hypoperfusion in both superficial and deep layers and neovascular tufts in the periphery. The expressions of C1qb and C4b genes in the OIR retina were significantly higher than those of the controls. The expression of retinal complement factor B (CFB) gene in OIR mice was significantly lower than those of the controls. However, the expressions of C3 and complement factor H (CFH) genes were higher. The protein synthesis of the key components involved in the CP (C1q, C4 and C3) were also significantly higher in OIR mouse retina. Although MBL-associated serine protease 1 (MASP1) and MASP2 were detected in both the OIR and the control groups, the expressions were weak and the difference between the two groups was not significant. CONCLUSION: Our data suggest that the complement system CP is activated during the pathogenesis of murine model of OIR.     

SARS-CoV-2病毒载量及其临床意义

在应对全球大流行的2019年冠状病毒病(COVID-19)疫情过程中,对患者、疑似感染者或接触者进行SARS-CoV-2病毒核酸检测是确认感染、管理感染者、预防病毒扩散的重要措施。核酸检测不仅反映了检测对象的病毒感染状态,大部分检测结果还能够对阳性样品进行定量。理论上多种病毒疾病中,病毒载量与患者潜在感染性、疾病转归等密切相关。本文拟简要介绍实时荧光RT-PCR和数字PCR测定SARS-CoV-2病毒载量的原理及特点,探讨病毒载量在宿主体内分布及其动态变化,分析病毒载量与疾病严重程度、患者感染性以及与疾病预后的相关性,以便深入认识COVID-19特征,指导感染控制、患者治疗与管理,更加精准地抗击大流行疫情。     

基于平扫CT的Logistic回归模型和朴素贝叶斯模型预测血肿扩大

目的探究基于平扫CT的Logistic回归模型和朴素贝叶斯(NB)模型预测自发性脑出血早期血肿扩大(HE)的价值。方法回顾性分析208例自发性脑出血患者的临床、初次CT扫描和24 h内随访CT资料,以随访CT显示血肿体积比例较前增加>33%或体积差>6 ml为HE,将患者分为HE组(86例)和非HE组(122例)。比较2组间临床资料和影像学特征的差异,采用Logistic回归和NB方法分别建立预测HE模型,并评估其预测性能。结果多因素方差分析表明男性患者(OR=3.814)、糖尿病病史(OR=0.442)、CT卫星征(OR=0.083)与漩涡征(OR=0.232)及伴脑室内出血(OR=0.442)是HE的独立预测因素。Logistic回归模型曲线下面积(AUC)为0.823,NB模型训练集和测试集的AUC分别为0.768和0.847。结论基于平扫CT的Logistic回归模型和NB模型有助于预测自发性脑出血早期HE,NB模型预测HE效能优于Logistic回归模型。     

乳腺癌锁骨上区不同放疗技术甲状腺剂量学比较及其对生存期和淋巴细胞亚群的影响

目的:比较乳腺癌锁骨上区不同放疗技术甲状腺剂量学特点,并对比其对患者生存期和淋巴细胞亚群的影响。方法:71例乳腺癌患者按照根治术后放疗方案分组,接受调强放疗(IMRT)者纳入IMRT组(n=37),接受三维适形放疗(3D-CRT)者纳入3D-CRT组(n=34)。比较两组患者计划靶区(PTV)剂量、甲状腺受量,放疗前后淋巴细胞亚群变化,以及5年无病生存率、总生存率,比较两种放疗技术甲状腺保护作用及其对患者预后的影响。结果:IMRT组Dmean、CI高于3D-CRT组,Dmax、HI低于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组甲状腺剂量体积V20、V30、V40高于3D-CRT组,Dmin、Dmean也高于3D-CRT组,差异有统计学意义(P<0.05)。两组放疗后1 d淋巴细胞总数、B淋巴细胞百分比均较放疗前下降,CD3+、CD4+均较放疗前升高,3D-CRT组放疗后1 d淋巴细胞总数、B淋巴细胞百分比、CD3+、CD4+均高于IMRT组,差异有统计学意义(P<0.05)。IMRT组失访3例、3D-CRT组失访1例,其余患者均获得有效随访,随访时间≥5年。IMRT组5年无病生存率、总生存率分别为47.06%(16/34)、73.53%(25/34),与3D-CRT组的51.52%(17/33)、78.79%(26/33)比较,差异无统计学意义(P>0.05)。结论:IMRT的靶区剂量均匀性更佳,但甲状腺受量更高且患者放疗后淋巴细胞亚群变化更为明显;IMRT与3D-CRT对乳腺癌患者远期生存的影响无明显差异。     

Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.     

改良B-Lynch缝扎术对于双胎剖宫产术后子宫收缩乏力性出血患者的止血临床研究

目的探讨改良B-Lynch缝扎术对于双胎剖宫产子宫收缩乏力性出血患者的止血有效性的探讨。方法选取2011年2月至2013年6月我院收治的双胎剖宫产子宫收缩乏力性出血的患者98例;随机分成对照组(49例)与实验组(49例),分别采取宫腔内填塞纱布术与改良B-Lynch缝扎术,记录两组患者的有效止血率,手术时间,出血量,术后并发症及住院时间进行对比。结果 1实验组患者的有效止血率明显高于对照组(P<0.05);2实验组患者的手术时间、出血量及术后并发症明显低于对照组(P<0.05);3住院时间两组患者间无统计学差异(P>0.05)。结论双胎剖宫产术后子宫收缩乏力性出血患者实施B-Lynch缝扎术的改良术具有效果好、止血快及并发症少等优点。