双手微小切口白内障超声乳化术的临床疗效观察

目的探讨双手微小切口白内障超声乳化吸除术的临床疗效。方法将患者分为两组:对照组使用常规超声乳化吸除术,研究组使用双手微小切口白内障超声乳化吸除术,观察术中平均超声乳化能量、时间、术后视力和手术并发症,并分析对比术后第1周、第1个月及第3个月的角膜内皮计数。结果两组病例术中超声乳化能量及时间差异有显著性(P<0.05),研究组平均超声能量为11.5%,平均超声时间为(0.68±0.62)min,术后第1天、第1周及第1个月时,裸眼视力≥0.5的术眼分别占51.85%、81.48%及90.47%,术后第1个月最佳矫正视力≥0.5和0.8者占88.98%及74.07%。所有术眼术中前房稳定,无切口热损伤,术后并发症主要为后囊破裂2眼(占3.70%),轻度虹膜损伤4眼(占7.40%);术后第1周,研究组平均角膜内皮密度明显高于对照组,术后第1个月及第3个月平均角膜内皮密度差异则无显著性。结论双手微小切口白内障超声乳化吸除术是一种新型的手术方法,具有安全、有效、微创的临床特点。     

Prognostic significance of pathological and biological factors in hepatocellular carcinoma

Prognostic factors in hepatocellular carcinoma (HCC) conventionally consist of staging with the tumour node metastasis system and grading by tumour cellular differentiation. There are also other factors useful in prognostication but most of them are clinical. With new discoveries in the pathobiology of cancers and introduction of new medical technology, pathological and biological factors of HCC in relation to prognosis have been studied quite extensively. Morphological features of the tumour, both gross and histological, have been found to be significantly related to tumour recurrence and patient survival. Recently, applications of new antibodies and techniques have enabled studies on cellular proliferation using different antibodies such as those for proliferating cell nuclear antigen and Ki-67 protein. These studies on cellular proliferation, as well as assessment of argyrophilic nucleolar organizing regions, have been shown to provide good prognostic significance. Flow cytometric studies on DNA ploidy and studies on expression of genes including the p53 gene, hormone receptors and others show less unanimous results in their prognostic significance. The influence of gender on survival is also reviewed. In conclusion, pathological and biological factors are useful and help to guide clinicians in the management of patients and in assessment of long-term prognosis.     

Roxatidine versus ranitidine in the treatment of duodenal ulcers: A randomized double-blind controlled multicentre study in Singapore

Roxatidine acetate, a new H₂ receptor antagonist, was compared with ranitidine in the treatment of duodenal ulcers in a double-blind multicentre study. Eighty-four patients with endoscopically proven duodenal ulcer were randomized to receive 150 mg roxatidine acetate or 300 mg ranitidine at bedtime. Repeat endoscopy was performed after 4 weeks (25–33 days) and if the ulcer had not healed, another endoscopy was performed after a further 4 weeks of treatment. Using per protocol analysis 73.6% of ulcers treated with roxatidine healed at 4 weeks compared to 72.2% of ulcers treated with ranitidine (P=NS). The healing rates at 8 weeks were 92% with roxatidine and 83.3% with ranitidine (P=NS). Using equivalence tests, the healing rate of roxatidine was found to be equivalent to that of ranitidine within a 20% region. Roxatidine users took significantly less antacids than ranitidine users (P < 0.05). There were no significant adverse effects due to roxatidine or ranitidine. Roxatidine is a safe effective drug in the treatment of duodenal ulcers with a healing rate comparable to that of ranitidine.     

Low-level chronic mercury exposure in children and adolescents: Meta-analysis

BACKGROUND: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. METHODS: A literature search was undertaken of MEDLINE (1980-2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string 'mercury' was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. RESULTS: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, r w = 0.61), with 24 h urine ( r w = 0.46) and with cord blood ( r w = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36-0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. CONCLUSION: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism.     

Angiographic and Clinical Outcomes of Everolimus‐Eluting Stent in the Treatment of Extra Long Stenoses (AEETES)

Objectives

The purpose of this study was to examine the angiographic and clinical results of stent full metal jacket in treating long lesions using everolimus‐eluting stents (EES).

Background

Data are lacking regarding the use of EES for this lesion subgroup.

Methods

From 2007 to 2011, 77 symptomatic patients who had severe coronary stenoses necessitating implantation of stents with total length longer than 60 mm were treated with overlapping EES.

Results

The mean age of patient was 61 ± 11 years with male predominance (66%). Diabetes mellitus was seen in 35 (45.5%) patients. Majority of patients had class III angina with normal heart function. On average, 3.1 stents were implanted per lesion; the mean stent size and length were 2.70 ± 0.28 mm and 82 ± 16 mm. Restudy angiography was performed on 71 patients (72 lesions) at 8.9 ± 2.5 months. Angiographic restenosis was seen in 9 (12.5%) lesions; the lesion length and late loss were 67 ± 15 mm and 0.4 ± 0.6 mm, respectively. The use of intravascular ultrasound has been found to be a predictor of less restenosis (P = 0.02; HR: 0.02; CI: 0.01–0.59). The in‐hospital and 1 year major adverse cardiac event rates were 7.8% and 13%. The annual cardiac death rates were 2.6%, 3.4%, and 5.3% in the first 3 years.

Conclusions

The use of EES full metal jacket for long lesions is only associated with good short‐term clinical and angiographic outcomes. Long‐term follow‐up has revealed a high cardiac death rate which may necessitate prolongation of dual antiplatelet therapy. (J Interven Cardiol 2013;26:22–28)