高血压丘脑出血破入脑室的临床治疗体会

目的：探讨高血压丘脑出血破入脑室的治疗方法。方法：回顾分析本院高血压丘脑出血破入脑室30例患者的临床资料,15例行双侧脑室外引流术,6例行血肿穿刺引流＋脑室外引流,5例行开颅血肿清除,4例意识清醒。结果：生活自理18例,中残6例,重残3例,死亡3例。结论：高血压丘脑出血破入脑室者应急诊行脑室外引流。     

使用Pipeline栓塞器械治疗颅内动脉瘤成功率预测的Meta分析（英文）

OBJECTIVE To conduct meta-regression for the identification of clinically meaningful characteristics that can predict successful treatment of intracranial aneurysms(IAs)with the Pipeline Embolization Device(PED).METHODS Using the keyword"Pipeline Embolization Device"and pre-specified eligibility criteria,we searched PubM ed and EMBASE and identified 105 original research articles(10,813 patients)published or in press(April 6,2011-December 31,2016)focused on safety and/or effectiveness of PED.We constructed meta-regression models to identify predictors of three measures of PED treatment success,specifically rates of aneurysm occlusion,modified Rankin score(mRS)and death.Rates were loge-transformed and the adjusted R2 statistic was reported for each model.RESULTS Aneurysm morphology and type accounted for substantial variation in 1-year aneurysm occlusion rate(14 studies with 689 patients;Radj2=88.91%).By contrast,predictors of 6-months aneurysm occlusion rate(aneurysm location,aneurysm type)(24 studies with 1,321 patients;Radj2=31.67%)and aneurysm occlusion rate at unspecified follow-up time(year of publication,mean duration of angiographic follow-up)(34 studies with 1,663 patients,Radj2=42.82%)accounted for less variability.Few predictors were identified for death rate(number of patients,aneurysm morphology;34 studies with 6,463 patients,Radj2=50.69%)or mRS≤2(year of publication,mean age,aneurysm morphology;14 studies with 556 patients,Radj2=100%).CONCLUSIONS:Few clinically meaningful characteristics appear to be relevant as predictors of the selected measures of PED treatment success.Future studies should attempt to identify additional predictors while focusing on aneurysm morphology as a key predictor of PED outcomes.     

Identification of T lymphocytes in human mixed hemopoietic colonies

The addition of a T-cell growth-promoting medium (PHA-TCM) to culture conditions that support growth of multi-lineage hemopoietic colonies enhances the proliferation of cells with lymphoid morphology within these colonies. These cells were identified as T lymphocytes by their ability to form rosettes with SRBC and their reaction with monoclonal antibodies (OKT3, OKT4) directed against T-cell-specific surface components. They continue to proliferate extensively under the influence of PHA-TCM after transfer of mixed colonies into liquid suspension culture. Supportive evidence for a common progenitor of myeloid and lymphoid cells within single mixed colonies is provided by Y-chromatin body analysis of E-rosette positive and negative cells in colonies grown in cocultures of male and female bone marrow cells.     

Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate

Objective?To assess the knowledge of, attitude towards and practices of emergency contraception among health-care providers at a university hospital located in a region with a high birth rate.

Methods?The survey was conducted among 214 health-care providers working at a university hospital located in eastern Turkey.

Results?Two hundred participants completed the questionnaire. Of the respondents, 26.0% said that they did not know anything about emergency contraception, while the remaining 74.0% said that they knew about at least one of the methods of emergency contraception. But among these, the knowledge of 38.5% of the participants about emergency contraception was accurate and that of 61.5% was inaccurate. Thirty-four percent of the respondents stated that they had previously required personally to use emergency contraceptive methods. The most commonly used emergency contraceptive methods were oral contraceptives (69.1%) and intrauterine device (14.7%). None of the respondents knew anything about mifepristone and levonorgestrel.

Conclusion?There is a knowledge deficit among health-care providers who play a significant role in the dissemination of the information about emergency contraception.     

改良头皮冠状切口在颧骨复合体骨折中的应用

目的:探讨改良头皮冠状切口在各类颧骨复合体骨折坚固内固定术中的应用。方法:将87例颧骨复合体骨折病例分为改良组和传统组,分别应用改良冠状切口(42例)与传统切口(45例)进行复位和固定,对比分析改良冠状切口的优越性、可能并发症及预防措施。结果:改良组切口均Ⅰ期愈合,随访3⁶个月,面部瘢痕不明显,开口度恢复理想,咬合关系正常,术后秃发率及颞部凹陷率较低,无1例出现面神经功能障碍。传统组中,2例术后第5天出现创区感染,切口延期愈合,术后肿胀反应明显;4例患者术后3月时仍存在面神经功能障碍,术后秃发率及颞部凹陷率较高。结论:改良冠状切口较传统切口具有切口隐蔽、术野暴露好、复位精确、美观效果好、面神经损伤率低等优点,值得推广应用。     

Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients

Background

There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients’ prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery.

Methods

The study included 60 patients who underwent elective laparoscopic RYGB surgery. Subjects were randomized to two groups as being managed with either standard fluid regimen (control group) or PVI (PVI group) during intraoperative period. After induction of general anesthesia, control group received 500 ml crystalloid bolus followed by 4–8 ml/kg/h infusion. Fluid management of the control group was guided by central venous pressure and mean arterial pressure. PVI group received 500 ml crystalloid bolus followed by 2 ml/kg/h infusion. If PVI had been > 14%, 250 ml colloid was administered. Norepinephrine was given by infusion to keep mean arterial pressure > 65 mmHg, if needed. Perioperative lactate levels, hemodynamic parameters, and renal functions were recorded.

Results

In PVI group, volume of crystalloid and total fluid infusion during intraoperative period was significantly lower than the control group (p < 0.05). The groups did not significantly differ in terms of lactate or creatinine levels before or after the surgery (p > 0.05).

Conclusions

There is no need to administer extra volume of fluid to obese patients undergoing laparoscopic bariatric surgery. Use of dynamic indicators like PVI helps to decrease intraoperative volume of infused fluids with no effects on either intraoperative or postoperative lactate levels in laparoscopic bariatric interventions.

     

Ameliorative effect of polydatin on oxidative stress‐mediated testicular damage by chronic arsenic exposure in rats

Arsenic causes lipid peroxidation leading to alterations in antioxidant status in organisms. In this study, the reproductive effects of chronic exposure to arsenic and the protective effects of polydatin (PD) were evaluated in 35 Wistar male rats, which were divided equally into five groups. The control group received a normal diet and tap water, arsenic (100 mg l^?1, approximately 1/50 of oral LD₅₀) was given via drinking water to experimental groups except control group, and PD was orally given to the other groups at dose of 50, 100 and 200 mg kg^?1 for 60 days. Arsenic administration decreased sperm motility, glutathione level, superoxide dismutase and catalase activities in testicular tissue of rats. In contrast, malondialdehyde level and DNA damage were found to be high levels in arsenic‐treated group. Histopathologically, it was observed that decreased sperm concentration and degeneration of Sertoli cells in testicular tissue. PD administration, partially 200 mg kg^?1, reversed arsenic‐induced lipid peroxidation, DNA damage, antioxidant enzyme activity and cell integrity in testis of rats. These results demonstrate that PD decreases arsenic‐induced lipid peroxidation, enhances the antioxidant defence mechanism and regenerates tissue damage in testis of rats.