POSTOPERATIVE EVALUATION OF TENSION-FREE VAGINAL TAPE PROCEDURE

Objective To study the outcome of tension-flee vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI)in women with cystocele. Methods Forty-two patients with SUI confirmed by urodynamics underwent the TVT procedure under local anesthesia.A prolapse repair was done simultaneously.Results Mean TVT operation time was 26.29 minutes. Mean blood loss was 29.86 mL. Eighty-eight percent of the patients were able to micturate spontaneously within 12 hours and residual urine was less than 100 mL. And 12% of the patients had to use indwelling catheter for 3-ll days. Average hospital stay was 2.91 days. Eighty-eight percent of patients were discharged within 2 days. All patients were followed up (an average of 10.26 months). According to subjective and objective assessment of the outcome, 39 patients (93%) were cured, another 3 patients (7%) were significantly improved and none was failed. There were no major complications such as bladder injury occurred. Conclusion TVT procedure is a minimal invasive, effective, and safe surgery for treatment of SUI.     

Nude mouse interim host model for human parathyroid grafts. II. Alteration of MHC antigens in human PTG grafts in the nude mouse.

Human parathyroid (PTG) tissues from cadaver (C-PTG), 5-month fetus (F-PTG) and PTG adenoma (A-PTG) were transplanted into the kidney subcapsular areas of Balb/C nude mice as interim host. Dynamic changes in the amount of tissue major histocompatibility complex (MHC) antigen present within the transplantation period were observed. The results showed that during 100 days of interim hosting, no obvious changes in the expression of tissue MHC class I antigens were seen, but the expression of tissue MHC class II antigens was significantly reduced. The changes of MHC antigens in different donor human PTG tissues were compared.     

颈动脉支架的安全性和有效性

目的评价颈动脉支架植入安全性和有效性。方法前瞻性观察70位中国人所接受的76次颈动脉内膜旋切术 (CEA),对CAS的安全性及有效性做初步探讨。人选者均属高危患者,包括不稳定型心绞痛、同侧CEA史、对侧颈动脉狭窄、颈动脉放疗后狭窄及其他严重的合并症。患者于术前、术后及半年后随访时均接受独立的神经专科检查;于远期随访时复查脑血管造影。结果手术成功率为100％;术前平均狭窄程度达(82±18)％,术后狭窄程度下降至(5±10)％。所有患者共发生3次小卒中(5．7％),均无大卒中事件;住院期间及术后30 d内均无心肌梗死及死亡事件。平均随访期达 (20±12)月;2例患者发生无症状颈动脉再狭窄;2例患者发生非Q波型心肌梗死;两例患者因非神经源性因素死亡;3 例患者发生小卒中;远期随访未发现大卒中。结论在中国人群中,经皮颈动脉支架植入术是安全可行的,它的远期再狭窄率亦低。     

预防性应用他汀类药物对单纯冠脉旁路移植术后早期并发症的影响

目的 研究术前预防性应用他汀类药物是否可以降低冠脉旁路移植术后早期兵并发症。方法 回顾性分析2013年6月~2014年8月中国人民解放军总医院心血管外科接受单纯体外循环下冠状动脉旁路移植术(CCABG)患者共199例;根据术前是否应用他汀类降脂药物将病例分为他汀类药物组99例(男性84例,女性15例)(至少术前7天开始服用他汀类药物:瑞舒伐他汀钙片10毫克/晚或阿托伐他汀钙片20毫克/晚);对照组100例(男性88例,女性12例)。观察术后30天内出现主要心脏相关不良事件(主要包括死亡、伴或不伴有病理性Q波的围术期心肌梗死、再次再血管化等)。结果 他汀类药物组术后早期发生并发症概率与对照组比较,差异无统计学意义(P>0.05),两组均无围术期死亡及再次再血管化病例。两组术前及术后3天内肌钙蛋白T、CK-MB和C反应蛋白水平比较,差异无统计学意义(P>0.05);术前及术后3天内肌钙蛋白T、CK-MB升高超过参考值5倍以上病例差异无统计学意义(P>0.05)。他汀类药物组中,术后肌钙蛋白T升高超过参考值5倍的患者占25.3%,对照组则有26%;他汀类药物组中,术后CK-MB升高超过参考值5倍的患者占10.1%,对照组则有7%,差异均无统计学意义(P>0.05)。结论 根据本研究结果,预防性应用他汀类药物能否降低冠脉旁路移植术后早期心肌损伤及炎性反应,进而减少术后早期并发症尚不确定。     

肺表面活性物质对不同胎龄呼吸窘迫综合征早产儿的疗效

目的探讨肺表面活性物质(PS)对不同胎龄呼吸窘迫综合征(RDS)早产儿的疗效差异,以及应用PS预防RDS的最佳时机。方法选择2003年1月至2011年8月入院胎龄28～35周的早产儿207例,其中应用PS 93例(应用组),未应用PS 114例(未应用组)。比较两组不同胎龄早产儿的患病率、5 d内病死率、机械通气时间、氧疗时间、住院时间以及主要并发症的发生情况。结果应用组RDS患病率比未应用组降低了27.0%(P<0.05)。应用组5 d病死率(5.94%)比未应用组(17.7%)明显降低(P<0.05);应用组机械通气时间、氧疗时间比未应用组明显减低(P<0.05);但住院时间两组无显著性差异(P>0.05)。应用组肺出血,肺炎发生率均低于未应用组(P<0.05)。结论应用PS可减少RDS患病率,降低早产儿的病死率,缩短机械通气时间和氧疗时间,减少肺出血、呼吸机相关性肺炎的发生率。     

冠状动脉和肾动脉狭窄同期介入治疗的安全性和急性期疗效

目的 回顾性分析冠状动脉狭窄和肾动脉狭窄患者同一住院期间内行经皮介入治疗的安全性和急性期疗效.方法 血管造影检查证实的冠状动脉狭窄合并肾动脉狭窄患者,根据造影剂用量和术前.肾功能情况,于冠状动脉介入治疗后即刻、7 d内和7 d后行肾动脉介入治疗.结果 102例患者共有148处冠状动脉狭窄和113处肾动脉病变植入支架,即刻手术均成功.术后30 d随访,l例患者于术后15 d因自行停止服用氯吡格雷后出现心肌梗死,其余患者无不良心脏事件发生.65例高血压患者中,7例(10.7%)血压恢复正常,11例(16.9%)抗高血压药物减量,其余47例(72.3%)患者的血压无变化.21例慢性肾衰竭患者术前血肌酐水平为(158±57)μmol/L,术后为(142±71)μmol/L,差异无统计学意义(P>0.05).结论 冠状动脉狭窄和肾动脉狭窄患者同一住院期间内行经皮介入治疗是安全有效的.     

替格瑞洛对急性ST段抬高型心肌梗死患者行急诊介入治疗的中期随访

Objective： To evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Methods: In the study, 96 patients suffering from acute ST segment elevation myocardial infarction onset within 12 h undergoing primary percutaneous coronary intervention from May to October in 2013 were randomly divided into ticagrelor group (n=48) and clopidogrel group (n=48) by using the method of random number table. Ticagrelor and clopidogrel antiplatelet treatment were used before and after operation. Their baseline data, coronary artery disease characteristics, platelet count, adenosine diphosphate(ADP)-induced platelet inhibition rate by thrombelastograph after 5 days of treatment, the major adverse cardiovascular events of the follow up for 6 months and bleeding complications were observed and compared in the two groups. Results: The differences between the two groups of patients with their baseline data, the features of coronary artery lesions, platelet count before and after 5 days of treatment had no statistical significance (P>0.05). ADP induced platelet inhibition rate ［(80.2±10.7)%］ after 5 days of treatment in ticagrelor group was significantly higher than that in clopidogrel group ［(75.3±12.1)%, P<0.05］. The two groups of patients were followed up for 6 months, 8 cases of major adverse cardiovascular events occurred in clopidogrel group, 2 cases of major adverse cardiovascular events occurred in ticagrelor group, and there was significant difference between the two groups (P<0.05). The two groups (7 cases of 48 patients in ticagrelor group vs. 3 cases of 48 patients in clopidogrel group) had no statistically significant difference in bleeding complications (P>0.05).Conclusion: Antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing emergency PCI has good efficacy and safety.     

75例可疑诊断病例相关因素分析

目的了解我院可疑诊断病例的比例、住院天数、平均住院费用、病种分布、会诊情况5个指标的数值,为我院对可疑诊断病例的质量控制与管理提供科学依据。方法利用可疑诊断检索技术体系中的其中一种方法"扩展码"对该院2011年6月-2012年8月的出院病例进行检索,并作出回顾性的统计分析。结果在研究范围内共检索出75份可疑诊断病例,占同期出院病人的0.44%,平均住院天数为3.6天,平均住院费用为3100.4元;病人3天会诊率为零,4天及4天以上会诊率为68.97%,其中4-6天会诊率只有51.72%;科内会诊率26.67%,科间会诊率4.67%,全院会诊率只有1.33%;其中住院3天的会诊率为零,住院4天及4天以上的科间会诊和全院会诊率均为零;在病种上恶性肿瘤排在第一位。结论该院可疑诊断病例的诊断水平在合理范围内,平均住院时间相对较短,没有大额医疗的行为,但会诊制度有待完善,会诊范围有待扩大,肿瘤专业是薄弱学科,应重视这个学科的建设及人才的配备。     

Percutaneous endoscopic gastrostomy — results of an irish single unit series

The technique of percutaneous endoscopic gastrostomy (PEG) was first described in 1980, as an alternative to traditional surgical methods. The main indication for PEG is the need for longterm nutritional support. It is reported to have many advantages over surgical gastrostomy, being safer and cheaper. We reviewed our experience with the first 44 patients referred to our unit for PEG. The most common indications for referral were stroke, head injury and post brain surgery. There was a success rate of 97.6% and a complication rate of 13.8%. One patient (2.3%) suffered major complications as a result of early tube displacement. There were no procedure related deaths in our series and no deaths as a result of an underlying disease process within 30 days, reflecting appropriate patient selection. All patients benefited nutritionally from PEG placement. Two patients recovered sufficiently to no longer require a gastrostomy and the tube was easily removed in both cases.     

儿童喉乳头状瘤方的急性毒理实验

目的观察儿童喉乳头状瘤方的急性毒性反应。方法对对照组和中药组小鼠采用最大给药量毒性实验法，记录14d内小鼠的外观、饮食、活动、排泄、体重及死亡等情况，于解剖后观察其重要脏器（心、肝、脾、肺、肾、胃、肠等）的变化。结果急性毒性实验小鼠灌胃给药最大耐受量相当于患儿临床日用量的206倍，中药组与对照组一般表现、主要脏器均未见明显异常改变，14d内两组体重差异无统计学意义（P〉0．05）。结论儿童喉乳头状瘤方拟定剂量及途径在临床应用上是安全的。     

Comparison of the safety of simultaneous bilateral carotid artery stenting versus unilateral carotid artery stenting: 30-day and 6-month results

Background  Severe bilateral carotid stenosis caused by atherosclerosis has not been unusual in the elderly. Such patients have high stroke risk. Many studies show that carotid artery stenting (CAS) is an alternative to treat unilateral carotid stenosis. However, the optimal procedural strategy of bilateral carotid stenosis remains unclear. The purpose of our study was to evaluate the safety of simultaneous bilateral carotid artery stenting (SBCAS) compared with unilateral carotid artery stenting (UCAS).

Methods  In this single-center retrospective study, we analyzed 234 consecutive patients who underwent carotid stenting from January 2005 to December 2009. Thirty-nine patients (16.7%) of them underwent SBCAS, and the others (n=195) underwent UCAS. Indication for CAS was defined as carotid artery diameter reduction >60% (symptomatic) or >80% (asymptomatic). Six-month and 30-day hemodynamic depression (HD), hyperperfusion syndrome (HPS), stroke, death and myocardial infarction (MI) after carotid stenting were assessed.

Results  SBCAS group had no more HD and HPS compared with UCAS group at 30 days (HD: 28.2% vs. 20.0%, P=0.396; HPS: 2.6% vs. 2.1%, P=0.262). Moreover, there was no statistically significant difference between SBCAS group and UCAS group in major stroke, death, MI and their combinations within 30 days (major stroke: 0 vs. 3.6%, P=0.604; death: 2.6% vs. 1.5%, P=0.520; MI: 2.6% vs. 0.5%, P=0.306; and their combinations: 5.1% vs. 4.6%, P=1.000) and 6 months (major stroke: 0 vs. 3.6%, P=0.604; death: 5.1% vs. 2.1%, P=0.262; MI: 5.1% vs.1.0%, P=0.130 and their combinations: 7.7% vs. 5.1%, P=0.459).

Conclusions  The patients undergoing SBCAS had no more events than those undergoing UCAS in 30-day and 6-month follow-up. Our finding suggests that SBCAS appears to be as safe as UCAS.

     

低分子肝素在经皮冠状动脉成形术中的应用

目的：探讨低分子肝素在经皮冠状动脉介入治疗（PCI）中应用的有效性和安全性。方法：将612例行择期PCI术的患者分为两组,A组为PCI术中常规用普通肝素（UFH）,B组为术中用体重校正低分子肝素（LMWH）。结果：A组与B组手术成功率（98．7％与98．0％）、30d内再次血运重建（3例与2例）、30d内主要心血管不良事件（各2例）、急性血栓形成（均为0例）和周围血管并发症（6例与4例）比较,差异均无统计学意义（均P〉0．05）。结论：低分子肝素在PCI术中的应用是一种安全、有效的方法。     

急性肾小球肾炎肾病型26例临床分析

目的: 分析和评价急性链球菌感染后肾小球肾炎肾病型的临床特征及预后。方法: 对我院1993~2001年住院患者中符合标准者进行观察和门诊随访的资料进行分析。结果: 水肿5~35天消失,蛋白尿2周~3个月消失,血压7~28天恢复正常,血尿8天~19个月消失。所有患儿均治愈,无死亡病例。结论: 急性链球菌感染后肾小球肾炎肾病型的临床表现较重,肉眼血尿和蛋白尿持续时间较长。经长期随访观察,绝大多数预后良好。     

Adverse events following DTP immunization in Maryland, 1987

Between January 1, 1987 and December 31, 1987, a total of 184 adverse events were reported to have occurred within 28 days following diphtheria, tetanus, pertussis (DTP) immunization in Maryland. More than half the reports (54 percent) were of serious or major vaccine reactions. Screaming episodes were the most frequently reported serious reaction, having occurred in 64 (35 percent) of the reports.     

声带损伤后自身修复特点研究

目的通过研究兔声带固有层损伤后不同时期组织病理及主要细胞外基质(extra cellular matrix,ECM)的变化情况,探讨声带损伤后的自身修复特点。方法对实验用兔声带行锐性损伤深达声韧带,于术后3 d～12个月观察声带形态学变化,HE染色、Masson染色、Alcian Blue染色及免疫组化染色,观察声带组织学结构变化及固有层内胶原、透明质酸及纤维连接蛋白等主要ECM的分布及含量变化。结果兔声带损伤后3 d～3个月成纤维细胞明显增加,40 d～12个月纤维组织持续增生,12个月声带局部无分层结构。ECM中胶原在损伤后3 d～12个月含量均明显高于正常对照组(P<0.05),在固有层内不规则紊乱分布;透明质酸在损伤后40 d内含量有增加趋势,其后降低至正常对照组水平;纤维连接蛋白在损伤后40 d～12个月时含量均高于正常对照组(P<0.05),散在分布于固有层各层。结论兔声带损伤后,在损伤早、中期各种ECM分泌增加,主要表现为以胶原为主的纤维组织明显增多且呈无序排列,透明质酸略有增加,纤维连接蛋白明显增加;在损伤后期胶原和纤维连接蛋白含量持续高于正常,声带局部瘢痕形成。     

Depression, disability days, and days lost from work in a prospective epidemiologic survey

We describe the relationship of depression and depressive symptoms to disability days and days lost from work in 2980 participants in the Epidemiologic Catchment Area Study in North Carolina after 1 year of follow-up. Compared with asymptomatic individuals, persons with major depression had a 4.78 times greater risk of disability (95% confidence interval, 1.64 to 13.88), and persons with minor depression with mood disturbance, but not major depression, had a 1.55 times greater risk (95% confidence interval, 1.00 to 2.40). Because of its prevalence, individuals with minor depression were associated with 51% more disability days in the community than persons with major depression. This group was also at increased risk of having a concomitant anxiety disorder or developing major depression within 1 year. We conclude that the threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity. Only by changing our nosology can the societal impact of depression be adequately addressed.     

不稳定型心绞痛的择时冠状动脉内支架治疗

目的　观察紧急支架术治疗不稳定型心绞痛 (UAP)的疗效和安全性 ,并与延迟支架术治疗作比较。方法　 55例UAP患者随机于入院后 4 8小时内 ( 2 9例 ;早期介入组 )或 7- 10天后 ( 2 6例 ;延迟介入组 )行冠状动脉造影及支架术。观察两组手术成功率、心绞痛缓解时间、住院时间和 30天总心脏事件发生率。结果　两组的临床特征和冠状动脉病变严重性相似。早期介入组中手术成功率与延迟介入组无显著差异 ( 93%和 96% ) ,但早期介入组心绞痛缓解时间 ( 4 4± 3 1天 )和住院时间 ( 8 8± 3 2天 )较延迟介入组 ( 5 7± 2 9天和13 5± 3 1天 ,P均 <0 .0 5)明显缩短。早期介入组 30天总心脏事件发生率较延迟介入组明显减低 ( 0 %和19 2 % ,P <0 0 5)。结论　不稳定型心绞痛时 ,早期冠状动脉内支架术治疗安全、有效。     

Optimal timing of coronary stenting in unstable angina patients

Objective　To assess the efficacy and safety of intracoronary stenting in the acute phase of unstable angina pectoris (UAP). Methods　Fifty-five patients with UAP were randomized to early (Group Ⅰ, n=29) and delayed interventional treatment (Group Ⅱ, n=26). Coronary angiography and stenting were performed within 48 hours in Group Ⅰ and 7-10 days later in Group Ⅱ. Procedural success rate, time interval from admission to angina relief and duration of hospitalization were recorded. Cardiac events within 30 days were observed as well. Results　Clinical characteristics and angiographic features were similar between the two groups. There was no significant difference in the procedural success rate (93% versus 96%), but the cardiac event rate within 30 days was significantly lower in Group Ⅰ than in Group Ⅱ (0% versus 9.2%, P&lt;0.05). The time interval from admission to angina relief (4.4±3.1 days versus 5.7±2.9 days) and the duration of hospitalization (8.8±3.2 days versus 13.5±3.1 days) were significantly reduced in Group Ⅰ (both P&lt;0.05). Conclusions　Intracoronary stent implantation is effective and safe in the acute phase of UAP. Early percutaneous coronary intervention results in rapid improvement in symptomatology and a shorter hospitalization. Its long-term effect has to be confirmed in a future randomized study.     

冠脉内注射法舒地尔对STEMI患者急诊PCI术中无复流的疗效观察

目的 观察冠状动脉内注射法舒地尔对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中无复流的临床疗效。方法 STEMI行急诊PCI术中出现无复流患者60例,随机分成观察组30例(冠状动脉内注射法舒地尔5 mg)和对照组30例(冠状动脉内注射硝酸甘油200μg)。根据冠状动脉内注入药物5 min后的冠状动脉造影结果评定冠脉血流速度,观察术中TIMI血流分级、计算CTFC计帧数、术后24 h心电图STR,术后1周LVEF,低血压、出血及术后60 d内MACE事件发生率情况,将试验组与对照组进行比较。结果 观察组TIMI血流3级比例明显高于对照组,而CTFC计帧数明显低于对照组(P＜0.05);观察组ST段完全回落率、术后1周左室射血分数均明显高于对照组,而术后60 d内MACE事件发生率均明显低于对照组,差异有统计学意义(P＜0.05);两组低血压、出血并发症发生率比较差异无统计学意义(P＞0.05)。结论 冠状动脉内注射法舒地尔能有效改善STEMI患者急诊PCI术中出现无复流后的冠状动脉血流,且安全性较高。     

血汗净口服液毒理学研究

目的：观察血汗净口服液对小鼠的急性毒性作用和大鼠的长期毒性作用。方法：按最大给药法一日内分3次灌服(960g/kg)小鼠，观察7天内动物的死亡情况；按不同剂量(80g/kg、40g/kg、2g/kg)给大鼠连续灌胃12周，停药2周，检测其血象、血液生化指标、脏器重量及重量指数，并做病理切片观察组织形态学变化。结果：小鼠7天内未引起死亡；大鼠血象、血液生化指标、脏器重量及重量指数检测未见异常，病理组织切片无异常改变。结论：小鼠灌服血汗净960倍于临床剂量，大鼠灌服血汗净80倍、40倍、20倍临床剂量末见急性毒性反应和长期毒性反应。