染色体9p21多态性与急性非心源性脑梗死患者颈动脉斑块的易感性分析

目的: 探讨急性非心源性脑梗死患者染色体9p21区域rs10757274、rs7044859、rs4977574和rs496892基因多态性与颈动脉斑块的相关性。方法: 应用聚合酶链反应-连接酶检测反应（polymerase chain reaction-ligase detection reaction, PCR-LDR）对新疆和上海地区共411例急性非心源性脑梗死患者（无颈动脉斑块组181例,伴有颈动脉斑块组230例）的染色体9p21区域rs10757274、rs7044859、rs4977574和rs496892这4个位点进行基因多态性分析。结果: 在新疆和上海地区的中老年脑梗死患者中,颈动脉斑块组的携带rs4977574的G等位基因百分比明显多于无颈动脉斑块组,分别是52.6% 比41.7%（校正后P=0.006）;颈动脉斑块组患者rs4977574的GG基因型携带百分比高于无颈动脉斑块组,分别是26.5%比 20.4%(P=0.002)。位点rs10757274与rs4977574之间、位点rs7044859与 rs496892之间存在强的连锁不平衡关系。结论: 在新疆和上海地区的中老年脑梗死患者中,染色体9p21区带中rs4977574的基因多态性与颈动脉斑块的发生可能有一定关联。     

彩色多普勒超声在移植肾急性排异反应中的应用

目的 应用彩色多普勒超声寻找移植肾急性排异反应较为特异的诊断指标.方法 经移植肾穿刺活检证实的急性排异反应患者42例,经长期随访(1年以上)和临床检查证实的功能稳定期患者115例.对两组移植肾长径、宽径、厚径、实质厚度以及主肾动脉和弓状动脉的阻力指数(RI)进行统计学比较;选取肾体积增大,锥体肿大回声减低、RI＜0.7、RI≥0.7及RI≥0.8作为诊断标准,按诊断试验评价原则分别计算灵敏度、特异度、误诊率、漏诊率和符合率;并绘制ROC曲线,确定诊断界值.结果 两组的移植肾长径、宽径、厚径及实质厚度差异有统计学意义(P＜0.05);急性排异反应组肾内血流灌注减少,肾动脉舒张期血流速度明显下降,RI明显增高,与移植肾功能稳定期比较差异有统计学意义(P＜0.05);各诊断标准对应的灵敏度分别为55.30%,55.20%,42.10%,57.90%和31.60%;特异度分别为71.30%、87.10%、25.70%、74.20%、98.20%.结论 肾体积增大、肾锥体肿大、回声减低、RI升高对诊断移植肾急性排异反应有特异性.     

Cornea plana associated with open-angle glaucoma: a case report

Cornea plana is a rare disease in which the cornea is flattened with a low refractive power. In addition to these features, hypermetropia, deep central corneal opacities, hazy corneal limbus, peripheral scleralization of the cornea and early arcus senilis can also be seen. Closed-angle glaucoma may occur as a result of shallow anterior chamber and narrow angle; however, open-angle glaucoma has also been reported in these patients. Measuring the real intraocular pressure (IOP) value of such eyes is difficult since tonometers are affected by corneal curvature. Therefore, the diagnosis of glaucoma may be delayed for a long time. In this case report we aimed to present a case of cornea plana with early open-angle glaucoma and to investigate which tonometer was appropriate for measuring the correct IOP value in such eyes.     

Intraocular lens implantation without the use of ophthalmic viscosurgical device

The purpose of this study was to determine whether single-piece hydrophilic acrylic intraocular lens can be safely implanted without the use of ophthalmic viscosurgical devices. This retrospective study comprised 100 eyes having phacoemulsification and intraocular lens implantation without the use of ophthalmic viscosurgical device. 80 eyes with the use of a viscosurgical device are used as control group. In this intraocular lens implantation technique, the anterior chamber was maintained with an irrigation cannula and intraocular lens was implanted with a lens injector. Visual acuity, corneal clarity and edema, intraocular pressure, and corneal endothelial cell count were evaluated preoperatively and postoperatively at days 1, 7, and 30. Corneal endothelial cell count was repeated 2 weeks after surgery. Complications of this technique were also evaluated. No significant complications of this intraocular lens implantation technique, such as posterior capsule rupture, intraocular lens buttonholing, zonular dialysis, Descemet’s tear/detachment, occurred. On the seventh postoperative day, 90 % of eyes achieved 20/20 or better vision. There was no difference in corneal endothelial cell loss between viscoelastic device-used and not-used cases (p = 0.356). When implanting intraocular lens without the use of ophthalmic viscosurgical device, significant intraoperative complications did not occur. The possible advantages are shortened surgery time, avoidance of postoperative IOP spike from ocular viscosurgical device (OVD) remnant, and reduced cost.     

Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors

Purpose

We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program and identify improvements of physical symptoms, per patient and clinical evaluation.

Methods

Evaluability criteria included gynecologic exam at initial visit, at least one follow-up with gynecologic exam within 8 months of initial visit, and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least one follow-up from 09/12 to 10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n = 90, 53 %), gynecologic (n = 54, 32 %), or colorectal/anal (n = 15, 9 %) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes.

Results

Mean number of visits was 3.43. Mean age was 55.4 years; 92 % (n = 155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises, and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy, and function) associated with cancer treatment and support. At last assessment, 89 % had complied with the clinical recommendation (moisturize 2–5+ times/week). Vaginal pH scores >6.5 declined over time (p = 0.03). VAS scores improved by last assessment (p < 0.001), as did VuAS scores (p = 0.001). Sexual function scores significantly improved (p < 0.001), confidence about future sexual activity increased (p = 0.004), and sexual/vaginal health concerns decreased (p = 0.00003).

Conclusion

Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and increased intimacy confidence.

Implications for Cancer Survivors

These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.

     

Medical Criteria for Passenger Flying

To determine if increased lead absorption was associated with sperm count suppression or perterbation of the hypothalamopituitary system, we compared battery workers (N=18), who were exposed to high airborne lead levels, with cement workers (N=18), who were exposed to ambient lead levels. Blood lead, urinary lead, semen lead, and zinc protoporphyrin concentrations were markedly elevated (p<.001) in battery workers. Battery workers had a significantly shifted (p<.025) frequency distribution of sperm count (median count, 45 vs. 73 × 10⁶ cells/cc, respectively). There were no significant differences between the two groups in mean follicle-stimulating hormone, testosterone, prolactin, luteinizing hormone, or total neutral 17-ketosteroid levels. Potential confounding factors (alcohol, cigarette, and coffee consumption, frequency of intercourse, and days of abstinence prior to semen donation) were not significantly different between the two groups. These results suggest a direct toxic effect of increased lead absorption on sperm production or transport in man.