Two monitoring methods of oral anticoagulant therapy in patients with mechanical heart valve prothesis: a meta-analysis

Oral anticoagulant therapy (OAT) with warfarin has become the standard therapy for the patients with mechanical heart valve prothesis. The monitoring method of self-monitoring or self-management was promising to optimize the use of warfarin, but most of previous studies have included patients with various indications of OAT, which made it difficult to extrapolate the results to the specific patient population with mechanical heart valve prostheses. This study was intended to evaluate the new and traditional monitoring methods in patients with mechanical heart valve prostheses. Relevant literature finished before Dec. 2010 were searched through a number of digital databases. And then they were pooled by RevMan 4.2 and R 2.13.0 in three fields: rate within the target range, test frequency and occurrence rate of poor events. Five randomized control trials with a total of 2,219 patients were identified. Pooled estimates showed reductions in thromboembolic events (OR 0.52, 95% CI 0.35–0.77; P = 0.0012) and all-cause mortality (OR 0.50, 95% CI 0.29–0.86; P = 0.0115). No difference was noted in major and minor haemorrhage. All trials reported improvements in the mean proportion of international normalized ratios in range. Self-monitoring and self-management can improve the quality of OAT in the patients with mechanical heart valve prostheses. The patients spend more time within the therapeutic range resulting in decreases in thromboembolic events and mortality, with no increase in haemorrhage. However, self-monitoring and self-management was not feasible for all patients, and require identification and education of suitable candidates. The success of self-monitoring and self-management method depends on consistent, regular, and frequent testing.     

Mycobacterium smegmatis in Skin Biopsy Specimens from Patients with Suppurative Granulomatous Inflammation

Formalin-fixed, paraffin-embedded skin biopsy specimens, including 72 suppurative granulomatous inflammation (SGI) and 47 non-SGI controls, were tested for mycobacteria by using a broad-range PCR and a suspension array identification system. Mycobacterium smegmatis was detected in 13 (18.1%) of the SGI skin biopsy specimens, which was significantly more than 2 (4.3%) in the controls (odds ratio, 5.73; 95% confidence interval, 1.21 to 27.06; P = 0.028).     

25G经结膜无缝合巩膜切口与常规20G巩膜切口愈合的实验研究

目的：观察比较25G经结膜无缝合巩膜切口与常规20G巩膜切口的愈合情况。 方法：版纳实验用小型猪4只，采用随机对照的方法，选择一只眼行25G巩膜切开术（25G组），另一眼行常规20G玻璃体手术（20G组）。术后0d、10d、20d、60d分别观察大体和石腊切片苏木素-伊红（HE）染色，比较两组巩膜切口的愈合情况。 结果：25G组的巩膜切口明显小于20G组。术后第1天，20G组结膜充血较25G组明显。25G组的巩膜切口术后10d已基本愈合，仅有少量炎症细胞。20G组的巩膜切口在术后20d仍未完全愈合，有大量的炎症细胞浸润。术后60d两组切口均无炎症细胞浸润。术后，25G组中1个切口，20G组中2个切口可见玻璃体嵌顿；25G组中2个切口．20G组中4个切口可见纤维组织内生。 结论：与20G手术相比，25G手术巩膜切口具有创伤小、愈合快、炎症反应轻的优点。     

高海拔地区急性颈髓损伤早期并发症多因素分析及治疗策略研究

目的探究高海拔地区急性颈髓损伤早期并发症多因素分析及治疗策略。方法回顾性分析2011年1 月-2016 年12 月青海省人民医院骨科收治的302 例急性颈髓损伤患者的临床资料，分析患者早期并发症的分布，单因素和Logistic多因素分析高海拔地区急性颈髓损伤早期并发症的危险因素。结果302 例急性颈髓损伤患者中共241（79.80％）例存在不同类型的早期并发症，主要有便秘（75.49％）、心率减慢（47.35％）、低钠血症（45.03％）、高热（40.72％）、呼吸功能障碍（34.10％）和血压下降（30.79％）。Logistic多因素分析结果显示，西宁市定居时间<1 年、完全性脊髓损伤、脊髓损伤部位为C4及以上、合并颅脑损伤、未进行气管切开和未进行雾化吸入排痰为高海拔地区急性颈髓损伤患者发生早期并发症的危险因素（OR=1.737、3.522、3.673、2.301、1.993 和2.942，均<0.05）。结论高海拔地区急性颈髓损伤患者早期并发症发生率较高，临床上可以对西宁市定居时间<1 年、完全性脊髓损伤、脊髓损伤部位为C4及以上、合并颅脑损伤、未进行气管切开和未进行雾化吸入排痰患者加强监控，降低早期并发症的发生率。     

三种精索静脉高位结扎术治疗儿童精索静脉曲张的疗效分析

目的探讨经腹腔、腹膜后、腹股沟三种不同精索静脉结扎手术对儿童精索静脉曲张疗效的影响。 方法回顾性分析2009年至2017年单中心收治的97例行精索静脉高位结扎手术患儿（0～14岁）的临床资料，并对其随访。根据精索静脉结扎的手术方式分为A组（腹腔镜下精索静脉高位结扎术，30例）、B组（腹膜后高选择性精索静脉高位结扎术，38例）、C组（腹股沟高选择性精索静脉高位结扎术，29例），比较三组患儿手术时间、出血量、术后住院天数、阴囊水肿、睾丸鞘膜积液、复发、睾丸萎缩、阴囊不适改善情况的差别。 结果A组平均手术时间（63±4）min长于B组（36±2）min，（P<0.001）和C组（45±4）min，（P=0.002）。A组术后平均住院时间（2.40±0.18） d高于B组（1.04±0.18）d，（P<0.001）和C组（1.28±0.22）d，（P<0.001）。三组患者术后均未出现睾丸萎缩。A组阴囊水肿发生率高于C组（χ²=6.15，P=0.015），A组鞘膜积液发生率高于B组（χ²=4.76，P=0.034）和C组（χ²=7.67，P=0.006）。三组复发率、阴囊不适改善率比较差异均无统计学意义。 结论腹股沟精索高选择性静脉结扎术操作简单、创伤小、恢复快、并发症发生率低。腹腔镜下精索静脉结扎术需注意保护淋巴管，以减少阴囊水肿和鞘膜积液的发生。     

腕踝针在老年无痛胃镜检查中对丙泊酚用量的影响*

目的探讨腕踝针灸法对老年患者无痛胃镜检查中丙泊酚用量的影响。方法收集胃镜检查患者120例,年龄70～85岁,美国麻醉医师协会(ASA)分级Ⅱ级或病情稳定Ⅲ级,按随机数字表法分为对照组和腕踝针组,各60例。腕踝针组入室前在相应区域穿刺留针,入室后两组静脉给予纳布啡0.1 mg/kg,静脉靶控输注丙泊酚,待睫毛反应消失、呼之不应时进行胃镜操作,根据术中体动情况,酌情追加丙泊酚。记录丙泊酚总用量、胃镜操作时间、唤醒时间、离室时间、呼吸抑制、低血压和恶心呕吐等不良反应情况。结果腕踝针组丙泊酚用量、唤醒时间和离室时间明显低于对照组(P 0.05),呼吸抑制、低血压和术后恶心呕吐的发生率低于对照组(P 0.05)。结论腕踝针在丙泊酚无痛胃镜检查中,可有效减少丙泊酚用量,降低不良反应,缩短恢复时间。     

Role of microRNA-25 in high glucose cultured Müller glia

AIM: To investigate the role of microRNA-25 (miR-25) in proliferation and apoptosis of retinal Müller glia (MG) under high glucose condition. METHODS: The purity of the cultured cells was verified by immunocytochemistry and flow cytometry using antibodies that specifically recognized MG. The expression level of miR-25 under normal and high glucose conditions were validated by RT-PCR. MiR-25 mimics and negative control (miR-NC) were transfected into MG and multiple functional experiments including cell counting kit-8 assay, EDU assay, and flow cytometry were conducted to explore the effects of miR-25 on the proliferation and apoptosis of high glucose cultured MG (HGMG). RESULTS: Immunocytochemistry and flow cytometry confirmed the high purity of primary cultured MG. RT-PCR results showed that the expression level of miR-25 was significantly repressed in HGMG, while over-expression of miR-25 by miR-25 mimic markedly inhibited the high glucose induced cell apoptosis and promoted the proliferation of MG. CONCLUSION: The expression level of miR-25 is significantly downregulated in HGMG and its overexpression could attenuate the high glucose damages on MG by promoting proliferation and reducing apoptosis.