耳后进路夹层法与内植法鼓膜修补术疗效比较

【目的】探讨并比较耳后进路夹层法与内植法鼓膜修补术疗效。【方法】收集需行鼓膜修补术患者80例（92耳）,按手术方法分为夹层法组42例（46耳）与内植法组38例（46耳）。分别观察两组术后听力恢复情况、术前术后言语频率平均听阈、术后3个月鼓膜情况、术后6个月愈合率。【结果】术后听力恢复情况夹层法优于内植法（P ＜0．05）;夹层法术后言语频率平均听阈明显高于内植法（P ＜0．01）;术后随访3个月后两组引起再穿孔、鼓膜内陷的发生有统计学差异（ P ＜0．05）;术后6个月愈合率比较,夹层法优于内植法,两组有统计学差异（ P ＜0．05）。【结论】耳后进路夹层法与内植法鼓膜修补术短期疗效相当,但前者更有利于听力恢复,是治疗鼓膜穿孔的较为理想的方法。     

延续护理干预对慢性阻塞性肺疾病患者出院后生存质量的改善作用

目的：探讨慢性阻塞性肺疾病（COPD）应用延续干预性护理对患者出院后生存质量的改善作用。方法选择2013年1～12月该科收治COPD患者82例,按护理方式的不同分为观察组和对照组,每组各41例。对照组患者予以兴奋呼吸剂、低流量持续氧疗、气道通畅、抗感染、输液、营养支持等常规治疗护理,观察组在对照组基础上于患者康复出院后,予以延续干预性护理,1年后随访并比较两组出院后感冒、住院次数、血常规指标情况,应用生存质量评估量表（QOL）评估患者出院后的生存质量,评估患者出院后的肺功能各项指标。结果观察组随访后感冒、住院次数、血常规指标明显优于对照组（P＜0．05）;治疗组的动脉血气分析、肺功能测定指标明显优于对照组（P＜0．05）;观察组的日常生活能力、社会活动情况、抑郁心理状况、焦虑心理症状等生存质量评估指标明显优于对照组（P＜0．05）。结论COPD患者康复出院后予以延续干预性护理,可明显改善COPD患者的肺功能情况,延缓疾病进展,提升患者的生存质量,效果确切,值得临床推广应用。     

The profile of patients attending a triaged eye emergency service

Background

Galway University Hospital provides a 24-h referral eye emergency service for patients triaged by a primary health network.

Aims

A prospective study was designed to evaluate the profile of patients referred to the eye emergency service and an attempt was made to compare the data recorded to those of a walk-in eye casualty.

Methods

All cases seen in Galway University Hospital eye emergency service over five consecutive weeks in 2012 were recorded and analyzed.

Results

Four hundred and eight cases were seen in total. 312 (76.5 %) were seen during normal working hours and 96 (23.5 %) after-hours. 33.3 % of cases were inflammatory and 31.9 % traumatic. Anterior uveitis [39 cases (9.6 %)] and corneal abrasion [37 cases (9.1 %)] were the most common diagnosis, while bacterial keratitis [9 cases (2.2 %)] and globe rupture/penetration [4 cases (1 %)] were the most serious. 85.6 % of patients were seen within 30 h from referral. A&E department was the main referral source (35 % of cases seen during normal hours and 70.8 % of those seen after-hours). 42.5 % of patients needed to be followed-up in the clinics. Seventy-two patients (17.6 %) were seen after 5 pm, Monday to Monday. Twenty-one were traumatic, 4 required admission and only 9 were deemed inappropriate after assessment.

Conclusions

Serious eye pathology presents after normal working hours. The triage process results in lower number of minor complaints being referred to the service. Compared to a walk-in casualty, a triaged service manages greater percentage of complex pathology.     

Placental Insufficiency Decreases Pancreatic Vascularity and Disrupts Hepatocyte Growth Factor Signaling in the Pancreatic Islet Endothelial Cell in Fetal Sheep

Hepatocyte growth factor (HGF) and vascular endothelial growth factor A (VEGFA) are paracrine hormones that mediate communication between pancreatic islet endothelial cells (ECs) and β-cells. Our objective was to determine the impact of intrauterine growth restriction (IUGR) on pancreatic vascularity and paracrine signaling between the EC and β-cell. Vessel density was less in IUGR pancreata than in controls. HGF concentrations were also lower in islet EC-conditioned media (ECCM) from IUGR, and islets incubated with control islet ECCM responded by increasing insulin content, which was absent with IUGR ECCM. The effect of ECCM on islet insulin content was blocked with an inhibitory anti-HGF antibody. The HGF receptor was not different between control and IUGR islets, but VEGFA was lower and the high-affinity VEGF receptor was higher in IUGR islets and ECs, respectively. These findings show that paracrine actions from ECs increase islet insulin content, and in IUGR ECs, secretion of HGF was diminished. Given the potential feed-forward regulation of β-cell VEGFA and islet EC HGF, these two growth factors are highly integrated in normal pancreatic islet development, and this regulation is decreased in IUGR fetuses, resulting in lower pancreatic islet insulin concentrations and insulin secretion.     

Lactoferrin biosynthesis during granulocytopoiesis

We examined the synthesis of lactoferrin, an iron binding protein that, among hematopoietic cells, is restricted to secondary granules of polymorphonuclear leukocytes. Lactoferrin biosynthesis was absent from leukemic myeloblasts and promyelocytes but abundant in normal bone marrow and both the bone marrow and peripheral blood of patients with chronic myelogenous leukemia (CGL) if the samples contained substantial numbers of myelocytes and metamyelocytes. Lactoferrin was present in the steady state in normal or CGL bands and polymorphonuclear leukocytes, but no lactoferrin biosynthesis was detectable in these samples. Taken together, these results suggest that lactoferrin accumulation begins with the onset of biosynthesis at the myelocyte stage and is largely complete by the beginning of the band stage of maturation. HL-60 cells, a permanent promyelocytic leukemia cell line, synthesized no lactoferrin. Translation of messenger RNA in Xenopus laevis oocytes revealed that mRNA from patients with chronic myelogenous leukemia and abundant myelocytes and metamyelocytes directed the synthesis of readily detectable amounts of lactoferrin, whereas HL-60 cells contained no translatable lactoferrin mRNA. We thus hypothesize that lactoferrin is a useful marker of gene expression restricted to the terminal stages of granulocyte maturation. Biosynthesis of this protein appears to be mediated by appearance of translatable mRNA at the myelocyte stage, coincident with development of secondary granules. Absence of lactoferrin production by HL-60 cells is due to absence of translatable lactoferrin mRNA, either because of lineage infidelity of these transformed cells or because of arrest before the developmental stage at which secondary granules appear.     

Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma

BACKGROUND: Asthma guidelines urge teaching patients the knowledge and skills required for self-management, based on the assumption that education will lead to improved skills and better asthma control. METHODS: In a prospective, randomized controlled trial of 65 adults with mild-to-moderate asthma, we examined whether an educational self-management intervention would improve adherence to inhaled corticosteroid therapy, decrease markers of airway inflammation, and improve clinical control. Peak flow, symptoms, and adherence were monitored for 7 weeks. After a 1-week run-in, subjects were assigned randomly to either the educational intervention or control group. The 30-minute intervention was delivered and reinforced at biweekly intervals. RESULTS: Compared with the control group, the intervention group had improvements in adherence to inhaled corticosteroid therapy (by 30% vs. -5%, P = 0.01), self-reported control of asthma (by 14% vs. 5%, P = 0.04), and perhaps quality of life (by 37% vs. 21%, P = 0.06). The direction of change for all other clinical outcomes was more favorable in the intervention group, but not significantly so. Markers of inflammation in sputum decreased more in the intervention group, with sputum eosinophils declining significantly (P = 0.02). CONCLUSION: In asthmatic patients treated with inhaled corticosteroids, education and training in self-management improves adherence with inhaled therapy, perceived control of asthma, and sputum eosinophilia.     

Pediatric melanoma in New Mexico American Indians,Hispanics, and non-Hispanic whites, 1981–2009

Background

Pediatric melanoma rates are increasing nationally. Our purpose was to determine the incidence of melanoma in New Mexico's (NM's) American Indian, Hispanic, and non-Hispanic white children.

Methods

A retrospective review (1981 to 2009) of the NM Tumor Registry was conducted. Melanomas diagnosed in children <19 years of age were identified. Average annual age-adjusted incidence rates per million were calculated.

Results

Sixty-four cases were identified. Rates per million were 7.4 for non-Hispanic whites, 2.1 for Hispanics, and 3.3 for American Indians. Fifty-nine percent were women. Fifty-five (86%) cases were localized, 6 (9%) were regional, and 1 (3%) case was metastatic. Majority of cases (49/64; 77%) occurred in children >14 years of age. American Indians presented with thicker melanomas as compared to whites and Hispanics.

Conclusions

Incidence rates for pediatric melanoma in NM are highest for non-Hispanic whites. Distant metastasis is uncommon. Melanoma in children is rare, but practitioners must be aware of its occurrence for prompt diagnosis and treatment.