预防和治疗乙型肝炎病毒感染

乙型肝炎(简称乙肝)病毒感染是全球性的公共卫生问题,总共约有4亿慢性感染者,全球每年死于乙肝者超过50万人.急性乙肝病毒感染后,大多出现无症状的亚临床感染(70%)及急性肝炎(30%),亦有暴发性肝功能衰竭(占0.1%～0.5%).感染持续6个月则为慢性感染,成人中占5%～10%,在新生儿和儿童中的比例远高于这个数字.慢性乙肝病毒感染的疾病谱范围从无症状的病毒携带状态,到慢性乙型肝炎、肝硬化甚至肝细胞癌,其病程复杂且受多种因素影响.总体来说,有15%～40%的慢性感染患者进展到终末期肝病.     

Radiological correlation of mechanism of intravascular migration of the ventriculoperitoneal shunt and technical considerations for endovascular retrieval

Migration of ventriculoperitoneal shunt into the pulmonary artery is a rare complication that can lead to shunt malfunction and cardiopulmonary complications. This case illustrates the significance of accidental transvenous placement of the shunt. Identification of the transvenous course of the catheter on cross sectional imaging can predict future catheter migration and also aid at surgical extraction. Formation of knot within the distal portion of the shunt catheter during migration or endovascular retrieval can occur, therefore measures to retrieve with knot and adhesions should be factored in before.     

Hemodynamic Parameters and Timing of Surgical Decompression in Acute Cervical Spinal Cord Injury

Abstract

Background/Objectives: To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of neurogenic shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial.

Methods: Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP).

Results: Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with neurogenic shock (SBP < 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P < 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP < 90 mmHg and 58 hours for patients with initial SBP > 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D.

Conclusions: The presence of neurogenic shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes.     

Omentum autotransplantation in thromboangiitis obliterans: Report of three cases

Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India of chronic arterial occlusion of the limbs. The current modalities of therapy do not provide adequate relief to a large number of these patients. An omentum autotransplantation to the lower limbs was performed in three patients as a limb salvage procedure. The initial results with up to a year of follow-up are so far encouraging.     

A glued technique of external dacryocystorhinostomy

Purpose:Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy.Methods:A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site.Results:The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non-significant.Conclusion:Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable.     

Increased myocardial wall thickening as index of viability assessment: a preliminary report on delayed contrast MRI

Purpose : Regional wall thickening measurement by delayed contrast MRI may assess myocardial viability and functional recovery of ischemic cardiomyopathy. Materials and methods : Delayed contrast MRI data was used in 40 patients with significant coronary artery disease and severe left ventricular dysfunction. Regional wall thickening on follow‐up MRI served as an index of functional recovery in patients receiving revascularization. For comparison, myocardial viability was assessed by MRI and ²⁰¹Tl SPECT in 10 patients using a 17‐segment method. Results : On 480 segments, MRI hyperintensities showed positive correlation with ²⁰¹Tl reduction (r = 0.71, p < 0.0001) in the inferior wall and apex. Delayed MRI detected myocardial viability better than ²⁰¹Tl SPECT. Delayed contrast‐enhanced MRI showed diagnostic accuracy 65%, sensitivity 95%, specificity 25%, positive predictive value 65% and negative predictive value 75%, whereas ²⁰¹Tl SPECT showed diagnostic accuracy 54%, sensitivity 72%, specificity 25%, positive predictive value 52% and negative predictive value 54%. Areas under the ROC curves by MRI and ²⁰¹Tl SPECT were 0.59 ± 0.04, 0.52 ± 0.05, respectively (p = 0.07). The viability concordance was 80% between ²⁰¹Tl SPECT and MRI. Conclusion : Delayed contrast‐enhanced MRI may detect the inferior wall thickening and apex as an index of viable myocardium better than ²⁰¹Tl SPECT. Myocardial viability may predict functional recovery after revascularization in ischemic cardiomyopathy. Copyright © 2009 John Wiley & Sons, Ltd.     

Effectiveness and safety of ranibizumab in patients with central retinal vein occlusion: results from the real-world,global, LUMINOUS study

ObjectiveTo evaluate the effectiveness, treatment patterns and long-term safety of ranibizumab 0.5 mg in treatment-naïve patients with central retinal vein occlusion (CRVO) in a real-world setting.MethodsLUMINOUS, a 5-year, global, prospective, multicentre, multi-indication, observational, open-label study, recruited treatment naïve or prior treated patients who were treated as per the local ranibizumab label. Here, we report the mean change in visual acuity (VA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), treatment exposure over year (Y) 1 and 5-year safety in treatment-naïve CRVO patients.ResultsAt baseline, the mean age of treatment-naïve CRVO patients (n = 327) was 68.9 years, with a mean (Standard deviation [SD]) VA of 40.6 (23.9) letters. At Y1, patients (n = 144) had a mean (SD) VA gain from baseline of 10.8 (19.66) letters, with a mean (SD) of 5.4 (2.65) ranibizumab injections. Patients demonstrated mean (SD) VA gains of 2.7 (19.35), 11.6 (20.56), 13.9 (18.08), 11.1 (18.46) and 8.2 (24.86) letters with 1, 2–3, 4–5, 6–8 and >8 ranibizumab injections, respectively. Mean (SD) VA gains at Y1 in patients receiving loading (67.4%) and no loading dose (32.6%) was 11.9 (20.42) and 8.4 (17.99) letters, respectively. Over five years, the incidence of ocular/non-ocular adverse events (AEs) and serious AEs was 11.3%/8.6% and 1.2%/6.7%, respectively.ConclusionsThese results demonstrate the effectiveness of ranibizumab in treatment-naïve CRVO patients at Y1 with clinically meaningful VA gains and no new safety findings over five years. These findings may help inform routine practice and enable better clinical management to achieve optimal visual outcomes.Subject terms: Retinal diseases, Clinical pharmacology