青光眼双滤过手术的临床报告

目的　观察双滤过手术治疗青光眼的疗效。方法　选择 130只眼晚期、绝对期原发性青光眼随机分为两组 ,每组 6 5只眼。 组行双滤过手术 , 组行小梁切除术。结果　术后随访观察 5～ 2 1月 ,平均 (14 .34±4 .35 )个月。 组眼压≤ 2 1m m Hg(1m m Hg=0 .133k Pa) 6 2只眼 (95 .4 % ) ,其中需局部用药 6只眼 (9.2 % ) ,术后平均眼压为 (19.37± 2 .92 ) m m Hg,较术前下降 (33.2 6± 12 .33) m m Hg; 组眼压≤ 2 1mm Hg5 5只眼 (84 .6 % ) ,其中需局部用药 12只眼 (18.5 % ) ,术后平均眼压 (2 2 .6 2± 5 .6 8) m m Hg,较术前下降 (2 7.83± 8.81) m m Hg。两组手术成功率差异有显著性 (P <0 .0 5 )。并发症 : 组 9只眼 (13.8% ) ,其中浅前房 6只眼 (9.2 % ) ,前房积血 3只眼 (4 .6 % ) ; 组 2 2只眼 (33.8% ) ,其中浅前房 15只眼 (2 3.1% ) ,恶性青光眼 2只眼 (3.1% ) ,脉络膜脱离 2只眼 (3.1% ) ,前房积血 3只眼 (4 .6 % )。两组并发症的发生率差异有显著性 (P <0 .0 5 )。结论　青光眼双滤过手术效果好 ,并发症少 ,是治疗青光眼安全有效的手术方法     

山羊血浆TNF与MODS的关系

在山羊ＭＯＤＳ的模型上，观察了血浆ＴＮＦ与ＭＯＤＳ的关系，３２只山羊分为三组：失血性休克组（Ｈ）；门静脉毒素血症组（Ｅ）；失血性休克＋内毒素血症组（Ｍ）。结果表明，三组动物血浆ＴＮＦ均见升高，Ｍ组最明显。动物死亡率及ＭＯＤＳ的发生率也是Ｍ组最高。可以认为ＴＮＦ持续升高导致ＭＯＤ发生发展的重要因素之一。     

Clastogenic effect of fenfluramine in mice bone marrow cells in vivo

Fenfluramine, an amphetamine derivative used in the treatment of obesity, has been evaluated in vivo in the bone marrow cells of Swiss albino mice using two cytogenetic endpoints for assessing its genotoxic and clastogenic potentials. Concentrations of 0.75, 1.5, 3.0, and 5.0 mg/kg b.w. were administered orally for the study of sister chromatid exchange frequencies and chromosome aberrations (CA). SCE frequencies showed a positive dose response; 1.5 mg/kg being the minimum effective concentration. Fen caused a prolongation of cell cycle at all concentrations. Except for the minimum therapeutic dose (0.75 mg), all other doses (1.5, 3.0, and 5.0 mg) showed a significant increase in the percentage of damaged cells over that of the vehicle control. The degree of clastogenicity was directly proportional to the dosage used and inversely related with the duration of treatment. A gradual reduction of the clastogenic potential was observed after 12 and 24 hr of exposure, indicating that the maximum effect occurs at the middle or late synthetic phase of the cell cycle. This study, probably the first detailed screening of the drug for its genotoxicity, shows that Fen is moderately clastogenic and a DNA damaging agent in vivo.     

双炔失碳酯类似物的抗生育活性研究

本文报道八个双炔失碳酯类似物的小鼠抗早孕、抗着床试验结果,同时考查了生物活性与油水分布系数之间的关系,发现抗早孕活性与油水分布系数之间为线性相关。双炔失碳半琥珀酸酯的抗早孕效果优于已用于临床的双炔失碳丙酸酯。     

TANDEM URETEROCYSTOPLASTY

Background : Bladder augmentation may be undertaken by using various gastrointestinal segments but their use is associated with a multitude of well-recognized complications. The mega-ureter has proven to be a satisfactory alternative; in patients with bilateral mega-ureters, both ureters may be used for this purpose. Methods : Seventeen patients had augmentation ureterocystoplasty, including three in whom both distal ureters were used in tandem. The latter included two patients with neurogenic bladder and one with bladder exstrophy. Results : Satisfactory augmentation was achieved in all patients undergoing tandem ureterocystoplasty. The neurogenic bladder patients are managed by urethral clean intermittent catheterization (CIC) and the exstrophy patient is managed by CIC of an appendico-vesicostomy (Mitrofanoff). All are continent. Conclusions : The mega-ureter provides an excellent source of augmentation material in patients with small non-compliant bladders. In those with bilateral mega-ureters, consideration should be given to using both ureters in tandem to achieve the maximum possible bladder capacity.     

Isolated splenic hemangioma presenting with bleeding into serous body cavities

We present two children with massive bleeding into the serous body cavities accompanied by intractable consumption coagulopathy. One had a large spleen palpable at admission, the other developed progressive splenomegaly while in hospital. Neither child had any external evidence of angiomatous lesions. A splenic hemangioma was suspected clinically and on abdominal ultrasound; the diagnosis was confirmed at laparotomy. Splenectomy resulted in a prompt cure in both cases.     

中国肥厚型心肌病患者血栓栓塞事件风险预测模型的构建研究

背景 血栓栓塞（TE）事件是肥厚型心肌病（HCM）的重要并发症。目前针对HCM患者TE事件的风险预测,仅国外学者构建了两个模型：HCM Risk-CVA及French HCM score,然而,现有研究发现HCM Risk-CVA模型对于中国HCM患者的临床价值较为有限。目的 本研究拟构建适合中国HCM患者的TE事件风险预测模型。方法本研究系回顾性队列研究,收集2010—2018年在四川大学华西医院就诊的537例HCM患者的病例资料。本研究通过电话随访或电子病历系统查询患者就诊记录,每6～12个月随访1次,直至出现终点事件或死亡或研究拟定的评估日期（2019-12-31）,终点事件定义为复合性TE事件。采用单因素和多因素Cox回归分析构建风险预测模型,并使用自助重抽样的方法进行内部验证。结果 537例患者中,24例患者有不同程度的数据缺失,最终纳入513例患者。中位随访时间为4.2(1.3,6.2)年,随访过程中42例（8.18%）发生TE事件,年发病率为2.10%[95%CI(1.47%,2.73%)]。根据多因素Cox回归模型构建TE事件风险预测模型,最终纳入年龄、既往TE事件、心...     

国外新冠医疗防疫体系建设策略研究及启示：以新加坡、英国为例

目的 通过案例研究总结国外新冠医疗防疫体系建设策略。方法 选取新加坡和英国作为研究案例,采用深度访谈和资料研究相结合的方式,访谈对象包括政府卫生署官员、传染病学专家以及基层全科医师等各类别专业人员,访谈内容涉及受访对象所在国家的医疗防疫体系设置情况和设计逻辑等。结果 两国的新冠防疫体系以分级诊疗为重要特征,其中新加坡通过"Hot Clinic"分流患者,英国通过远程诊疗分流患者。两国的门急诊设施改建以利用现有设施为主。两国全科诊所医护基本配置都相对简单,应对新冠疫情时常通过借用全院医护、统筹安排、适当延长工作时间等方式来扩充医护数量。两国在医疗防疫体系建设中均积极采取了信息化方式,疫情数据采集和信息公开较为及时。两国坚持"平战结合"策略,在逐步放开过程中灵活调整防疫政策和资源配置方案。结论 两国案例的优势及劣势可为我国医疗防疫体系实行分级建设、规范诊疗流程、细化基础设施、完善人员配置、推进信息化建设、贯彻"平战结合"策略并落实转化方案提供参考。     

Surgical treatment of intracavernous neoplasms: a four-year experience

Forty-two patients with neoplasms involving the cavernous sinus had operations between 1983 and 1987. The lesions included 25 benign tumors (e.g., meningioma, neurilemoma) and 17 malignant tumors (e.g., chondrosarcoma, adenoid cystic carcinoma). The cavernous sinus was entered by inferior, anterolateral, or medial extradural approaches or by superior or lateral intradural approaches. The intracavernous internal carotid artery was managed by dissecting tumor away from it or by occlusion and excision with or without direct vein graft reconstruction, based on the results of a preoperative balloon occlusion test. Cranial nerves III, IV, V, and VI usually were dissected from tumor, but in 3 cases of tumor invasion, the excised nerve segment was reconstructed by direct suture or with a sural nerve interposition graft. Twenty-one of the benign tumors and 8 of the malignant tumors were excised totally and the remainder subtotally. On follow-up ranging from 3 to 48 months, one subtotally excised meningioma recurred and was treated with re-excision and adjuvant radiation therapy. Two "totally" excised malignant tumors recurred outside the cavernous sinus at the margins of excision. There was no operative mortality or permanent cerebral morbidity. Postoperatively, the ocular and neurological function of most patients was similar to the preoperative status; in some, it was significantly improved. Thirteen additional patients with intracavernous neoplasms also were evaluated during the same period and followed without operation. The early follow-up information regarding these patients is provided.