乌灵胶囊联合地塞米松鼓室内灌注治疗慢性耳鸣临床研究

目的：观察乌灵胶囊联合地塞米松鼓室内灌注治疗慢性耳鸣的临床疗效。方法：依据随机数字表 法将160例慢性耳鸣患者分为对照组和观察组各80例。对照组采用地塞米松鼓室内灌注疗法,观察组在对照组 基础上联合乌灵胶囊治疗。2组均治疗4周,并随访1个月。比较2组临床疗效和不良反应发生率,以及治疗前 后耳鸣评价量表（TEQ） 评分、耳鸣残疾评估量表（THI） 评分、匹兹堡睡眠质量指数表（PSQI） 评分、中医 证候评分、γ-氨基丁酸（GABA） 水平和5-羟色胺（5-HT） 水平。结果：观察组总有效率为85.00%,对照组 为68.75%,2组比较,差异有统计学意义（P＜0.05）。治疗后,2组TEQ评分较治疗前降低（P＜0.05）,且观 察组TEQ评分低于对照组（P＜0.05）。治疗后,2组THI量表中功能性、情感性、严重性评分均较治疗前降 低（P＜0.05）,且观察组上述3项评分均低于对照组（P＜0.05）。治疗后,2组血清GABA 水平较治疗前升 高（P＜0.05）,5-HT水平较治疗前降低（P＜0.05）;且观察组GABA水平高于对照组（P＜0.05）,5-HT水平 低于对照组（P＜0.05）。治疗后,2 组PSQI 评分较治疗前降低（P＜0.05）,且观察组PSQI 评分低于对照 组（P＜0.05）。治疗后,2组中医证候评分较治疗前降低（P＜0.05）,且观察组中医证候评分低于对照组（P＜ 0.05）。观察组不良反应发生率为7.50%,对照组为18.75%,2组比较,差异有统计学意义（P＜0.05）。结论： 在地塞米松鼓室内灌注的基础上联合乌灵胶囊治疗慢性耳鸣疗效显著,可缓解临床症状,改善听觉功能,提高 睡眠质量,且可减少不良反应的发生。     

Difference between bone age at the hand and elbow at the onset of puberty

In the pubertal period, bone age advances rapidly in conjunction with growth spurts. Precise bone-age assessments in this period are important, but results from the hand and elbow can be different. We aimed to compare the bone age between the hand and elbow around puberty onset and to elucidate the chronological age confirming puberty onset according to elbow-based bone age.A total of 211 peripubertal subjects (127 boys and 84 girls) who underwent hand and elbow radiographs within 2 months was enrolled. Two radiologists and a pediatric orthopedic surgeon assessed bone age. Hand bone age was graded using the Greulich–Pyle (GP) method, and elbow bone age was determined using the Sauvegrain method. The correlation of 2 methods was evaluated by Demining regression analysis, and the mean absolute difference (MAD) with chronological age was compared between pre-pubertal and pubertal subjects. Receiver-operating characteristic curve analysis was performed to determine the chronological age confirming puberty onset.There was a statistically significant difference in bone age revealed by the GP and Sauvegrain methods in the pubertal group. In the pubertal group, the MAD was 1.26 ± 0.90 years with the GP method and 0.61 ± 0.47 years with the Sauvegrain method in boys (P < .001), while in girls, the MAD was 0.84 ± 0.60 years and 0.53 ± 0.36 years with the same 2 methods (P = .033). The chronological age for confirming puberty onset using the elbow was 12.2 years in boys and 10.3 years in girls.The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. Puberty onset according to elbow occurred slightly earlier than expected.     

Effects of the Type of Intraoperative Fluid in Living Donor Kidney Transplantation: A Single-Center Retrospective Cohort Study

PurposePerioperative fluid management in kidney transplant recipients is crucial to supporting the fluid, acid-base, and electrolyte balance required for graft perfusion. However, the choice of intraoperative crystalloids in kidney transplantation remains controversial. We conducted a single-center retrospective cohort study to evaluate the impact of intraoperative fluids on acid-base and electrolyte balance and graft outcomes.Materials and MethodsWe included 282 living donor kidney transplant recipients from January 2010 to December 2017. Patients were classified into two groups based on the type of intraoperative crystalloids used (157 patients in the half saline group and 125 patients in the balanced crystalloid solutions group, Plasma-lyte).ResultsCompared with the half saline group, the Plasma-lyte group showed less metabolic acidosis and hyponatremia during surgery. Hyperkalemia incidence was not significantly different between the two groups. Changes in postoperative graft function assessed by blood urea nitrogen and creatinine were significantly different between the two groups. Patients in the Plasma-lyte group exhibited consistently higher glomerular filtration rates than those in the half saline group at 1 month and 1 year after transplantation after adjusting for demographic differences.ConclusionIntraoperative Plasma-lyte can lead to more favorable results in terms of acid-base balance during kidney transplantation. Patients who received Plasma-lyte showed superior postoperative graft function at 1 month and 1 year after transplantation. Further studies are needed to evaluate the superiority of intraoperative Plasma-lyte over other types of crystalloids in relation to graft outcomes.     

MiR-494-3p Upregulation Exacerbates Cerebral Ischemia Injury by Targeting Bhlhe40

PurposeCerebral ischemia is related to insufficient blood supply and is characterized by abnormal reactive oxygen species (ROS) production and cell apoptosis. Previous studies have revealed a key role for basic helix-loop-helix family member e40 (Bhlhe40) in oxidative stress and cell apoptosis. This study aimed to investigate the roles of miR-494-3p in cerebral ischemia/reperfusion (I/R) injury.Materials and MethodsA mouse middle cerebral artery occlusion (MCAO/R) model was established to mimic cerebral ischemia in vivo. Brain infarct area was assessed using triphenyl tetrazolium chloride staining. Oxygen-glucose deprivation/reoxygenation (OGD/R) operation was adopted to mimic neuronal injury in vitro. Cell apoptosis was analyzed by flow cytometry. The relationship between miR-494-3p and Bhlhe40 was validated by luciferase reporter and RNA immunoprecipitation assays.ResultsBhlhe40 expression was downregulated both in MCAO/R animal models and OGD/R-induced SH-SY5Y cells. Bhlhe40 overexpression inhibited cell apoptosis and reduced ROS production in SH-SY5Y cells after OGD/R treatment. MiR-494-3p was verified to bind to Bhlhe40 and negatively regulate Bhlhe40 expression. Additionally, cell apoptosis and ROS production in OGD/R-treated SH-SY5Y cells were accelerated by miR-494-3p overexpression. Rescue experiments suggested that Bhlhe40 could reverse the effects of miR-494-3p overexpression on ROS production and cell apoptosis.ConclusionMiR-494-3p exacerbates brain injury and neuronal injury by regulating Bhlhe40 after I/R.     

Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy

PurposeTo evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC).Materials and MethodsThe medical records and imaging data of patients diagnosed with CSC and treated with SPRL were retrospectively reviewed. Central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) at baseline, at 1, 3, and 6 months, and at the last visit after the treatment were analyzed.ResultsIn total, 103 patients with 107 eyes were included. The mean age of the patients was 51.5±9.3 years, and 77 (72.0%) were male. The mean follow-up duration was 48.6±40.2 weeks. The mean duration of oral SPRL therapy was 15.5±13.4 weeks. CMT, SRF height, and SFCT improved significantly at 1, 3, and 6 months after SPRL therapy and at the last follow-up. BCVA, however, showed no significant change at any time point. The rate of complete resolution of SRF at 1 month was higher in those with chronic CSC than in those with acute CSC (21.1% vs. 6.0%, respectively). Recurrence occurred in 14 (13.1%) eyes after the complete resolution of SRF. Older age (p=0.001), a greater number of previous intravitreal bevacizumab injections (p=0.006), and poor initial visual acuity (p=0.048) were associated with recurrence. No permanent adverse effects were observed.ConclusionOral SPRL showed therapeutic benefits in patients with CSC in terms of SRF resolution, but relatively frequent recurrence was observed, especially in older patients.     

术前γ-谷氨酰转肽酶对非转移性肾细胞癌预后的影响

目的 评价术前γ-谷氨酰转肽酶（GGT）对非转移性肾细胞癌(nmRCC)患者术后预后的影响。方法 收集2013年1月—2018年7月在本院接受根治性肾切除手术或肾部分切除术治疗的118例nmRCC患者的临床资料。按受试者工作特征（ROC）曲线确定GGT最佳临界值并分为高GGT组和低GGT组,比较两组患者性别、年龄、肿瘤直径等临床资料,运用Kaplan-Meier法进行生存分析,绘制生存曲线,并采用Log-rank法比较各组生存曲线的差异,采用Cox多因素回归分析影响nmRCC患者预后的独立危险因素。结果 根据ROC曲线最大约登指数得出GGT最佳截断值为48.5。本研究结果显示,高GGT组的T3-T4分期所占百分比高于低GGT组(38.9% vs 13.0%,P＜0.05）和高GGT组的G3-G4分级所占百分比高于低GGT组(33.3% vs 3.0%,P＜0.05)。高GGT组总生存期（OS）和无复发生存期（RFS）均低于低GGT组（Log-rank=33.743,P＜0.001; Log-rank=30.854,P＜0.001）。Cox多因素分析结果表明,肿瘤大小≥4 cm、更高的肿瘤T分期、术前GGT≥48.5和更高的G分级是影响nmRCC患者术后OS和RFS的独立危险因素(P＜0.05)。结论 nmRCC患者术前高GGT是肿瘤高T分期和高G分级的重要预测指标,同时也是患者术后总生存期和无复发生存期不佳的独立危险因素,能预测其预后     

A New General Fatigue Limit Diagram and Its Application of Predicting Die Fatigue Life during Cold Forging

Traditional fatigue fracture theory and practice focus principally on structural design. It is thus too conservative and inappropriate when used to predict the high-cycle fatigue life of dies used for metal forming, especially cold forging. We propose a novel mean stress correction model and diagram to predict the high-cycle fatigue lives of cold forging dies, which focuses on the upper part of the equivalent fatigue strength curve. Considering the features of die materials characterized by high yield strength and low ductility, a straight line is assumed for the tensile yield line. To the contrary, a general curve is used to represent the fatigue strength. They are interpolated, based on the distance ratio, when finding an appropriate equivalent fatigue strength curve at the mean stress and stress amplitude between the line and curve. The approach is applied to a well-defined literature example to verify its validity and shed light on the characteristics of die fatigue life. The approach is also applied to practical forging and useful qualitative results are obtained.