Long-term intraocular pressure control by trabeculectomy: a ten-year life table

A retrospective study of 179 eyes in 127 patients who underwent trabeculectomy at Sydney Eye Hospital under the supervision of two surgeons between 1977 and 1982 was carried out. Survival analysis by life table method shows cumulative two, five, and 10 year success rates to be 78%, 70%, and 67% respectively, with mean duration of intraocular pressure control (IOP<21 mmHg) being 88 months. Anti-glaucoma medication improved the long-term survival significantly (Hazard Ratio of 0.49 and P = 0.01) so that when the definition for failure is taken as IOP >20 mmHg while using medication, the two, five and 10 year success rates were 89%, 87% and 86% respectively. A rise in average intraocular pressure is seen between two weeks and three months after trabeculectomy. The improvement in long-term success rate with use of topical steroids was suggestive (Hazard Ratio of 0.69) but not conclusive (P = 0.21). No difference was found in survival comparing fornix versus limbal based flap technique.     

特殊部位异位妊娠的临床分析

目的 探讨特殊部位（如子宫颈、输卵管间质部等）异位妊娠的早期诊断与预后的关系,及与重复异位妊娠相关的因素。方法 对特殊部位的异位妊娠及重复异位妊娠进行回顾性分析。结果 回顾分析201例异位妊娠,其中宫颈妊娠1．49％（3／201）,输卵管间质部妊娠2．98％（6／201）,卵巢妊娠1．00％（2／201）,重复异位妊娠4．48％（9／201）。宫颈妊娠均B超早期诊断全部保守治疗成功,3例间质部妊娠、2例卵巢妊娠也经B超检查而早期发现及时处理,避免了大出血及休克的发生。重复异位妊娠中第一次异位妊娠前有剖宫产史者占77．78％。第二次异位妊娠腹腔内出血明显少于第一次。结论 特殊部位异位妊娠早期诊断预后较好,B超对其早期诊断有重要价值,重复异位妊娠与剖宫产的关系有待于进一步探讨。     

Relative Skeletal Maturation and Population Ancestry in Nonobese Children and Adolescents

More rapid skeletal maturation in African‐American (AA) children is recognized and generally attributed to an increased prevalence of obesity. The objective of the present study was to evaluate the effects of population ancestry on relative skeletal maturation in healthy, non‐obese children and adolescents, accounting for body composition and sexual maturation. To do this, we leveraged a multiethnic, mixed‐longitudinal study with annual assessments for up to 7 years (The Bone Mineral Density in Childhood Study and its ancillary cohort) conducted at five US clinical centers. Participants included 1592 children, skeletally immature (45% females, 19% AA) who were aged 5 to 17 years at study entry. The primary outcome measure was relative skeletal maturation as assessed by hand‐wrist radiograph. Additional covariates measured included anthropometrics, body composition by dual‐energy X‐ray absorptiometry (DXA), and Tanner stage of sexual maturation. Using mixed effects longitudinal models, without covariates, advancement in relative skeletal maturation was noted in self‐reported AA girls (～0.33 years, p < 0.001) and boys (～0.43 years, p < 0.001). Boys and girls of all ancestry groups showed independent positive associations of height, lean mass, fat mass, and puberty with relative skeletal maturation. The effect of ancestry was attenuated but persistent after accounting for covariates: for girls, 0.19 years (ancestry by self‐report, p = 0.02) or 0.29 years (ancestry by admixture, p = 0.004); and for boys, 0.20 years (ancestry by self‐report, p = 0.004), or 0.29 years (ancestry by admixture, p = 0.004). In summary, we conclude that advancement in relative skeletal maturation was associated with AA ancestry in healthy, non‐obese children, independent of growth, body composition, and puberty. Further research into the mechanisms underlying this observation may provide insights into the regulation of skeletal maturation. © 2016 American Society for Bone and Mineral Research.     

手术治疗老年Stanford A型急性主动脉夹层的近期和远期疗效分析

目的:探讨外科手术治疗老年Stanford A型急性主动脉夹层(AAD)的近远期疗效。方法:回顾性分析2008年6月—2017年3月郑州大学第二附属医院心血管外科应用手术治疗的196例Stanford A型AAD患者资料,患者均采用全麻、深低温停循环加单侧选择性脑灌注技术进行外科手术治疗,其中33例患者年龄≥60岁(老年组),163例患者年龄60岁(年轻组),比较两组患者的临床资料和预后情况。结果:与年轻组比较,老年组男性患者比例低(45.5%vs.73.0%,P=0.000),De Bakey II型主动脉夹层发病率高(21.2%vs.6.7%,P=0.009);升主动脉置换+全弓置换+象鼻支架术应用比例低于年轻组(9.1%vs.28.2%,P=0.021)升主动脉置换+全弓置换+象鼻支架术应用比例减少(9.1%vs.28.2%,P=0.021),但单纯升主动脉置换比例增加(21.2%vs.2.5%,P=0.000),平均体外循环时间、主动脉阻断时间、手术时间均缩短(215.70 min vs.252.98 min,P=0.000;121.12 min vs.134.00 min,P=0.008;489.15 min vs.533.52 min,P=0.004);术后ICU停留时间延长(235.27 h vs.163.55 h,P=0.011),术后肾功能不全(21.2%vs.6.7%,P=0.009)、感染发生率(30.3%vs.9.8%,P=0.002)升高;术后生存率差异无统计学意义(P=0.1466)。全组病例分析显示,体外循环时间是AAD患者手术后院内死亡的危险因素(OR=0.987,95%CI=0.977~0.997,P=0.011),而年龄(OR=1.790,95%CI=0.651~4.921,P=0.259)与其他因素并非手术后院内死亡的危险因素。结论:对于老年AAD患者,根据夹层累及范围选择恰当的手术方式可以取得较满意的预后,术中尽可能缩短体外循环时间有助于提高手术疗效。     

非洲绿猴血液学和血清生化指标的测定及分析

目的检测50只健康非洲绿猴血液学、血清生化指标,分析不同性别、不同年龄段(青幼年组:1~3岁,成年组:4~6岁)非洲绿猴的血液学、血清生化指标的差异。方法应用全自动血细胞分析仪及血液生化分析仪分别测定清醒状态下健康非洲绿猴血液学及血清生化指标。结果血液学指标中青幼年组与成年组差异显著的指标有红细胞数(RBC)、血红蛋白(HGB)、血细胞压积(HCT)、中性粒细胞百分比(NEUT%)、淋巴细胞百分比(LYMPH%)、单核粒细胞百分比(MONO%)、嗜碱性粒细胞百分比(BASO%)(P0.05)。青幼年组中雌猴与雄猴差异显著的指标有白细胞数(WBC)、RBC、HGB、HCT、NEUT%、LYMPH%、MONO%(P0.05),成年组中雌猴与雄猴差异显著的指标有HCT(P0.05),其它指标差异不显著。血清生化指标中青幼年组与成年组差异显著的指标有白蛋白(ALB)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、肌酐(CREA)(P0.05),青幼年组雌猴与雄猴差异显著的指标有CREA(P0.05),成年组雌猴与雄猴差异显著的指标有总蛋白(TP)、胆固醇(CHOL)(P0.05),其它指标差异不显著。结论本文初步建立了非洲绿猴的常规生物学数据,为评价其生物学特性及相关应用提供一定的数据基础,可供参考。     

冠心病患者体力活动自我管理行为现状及影响因素分析

目的：了解冠心病患者体力活动自我管理行为现状并分析其影响因素,为提高冠心病患者体力活动自我管理能力提供参考依据。方法：采用便利抽样法,于2021年1月至4月对279例冠心病患者采用一般资料调查表、中文版冠心病患者体力活动自我管理行为量表进行问卷调查。结果：冠心病患者体力活动自我管理行为总分为（72.07±27.35）分。多元线性回归分析结果显示,职业状态、体育锻炼次数、体育锻炼方式、心功能分级、是否接受过心脏运动康复训练是冠心病患者体力活动自我管理行为的影响因素（P<0.05）。结论：冠心病患者体力活动自我管理行为处于中等偏下水平,有待进一步提高。护理人员应重视冠心病患者的体力活动自我管理行为,根据个性化差异,有针对性的为其开展相关健康教育,使患者安全有效的进行体育锻炼,从而提高冠心病患者体育活动自我管理水平。     

单向活瓣式补片治疗室缺合并重度肺动脉高压的临床研究

目的　探讨单向活瓣式补片在治疗室缺合并肺动脉高压中的作用。方法　自 2 0 0 1年 1月～ 2 0 0 2年 12月应用单向活瓣式补片治疗室缺合并严重肺动脉高压患者 10例。平均肺动脉压为 6 0～ 90mmHg[(72± 11)mmHg],动脉血氧饱和度 0 .89～ 0 .95 (0 .92± 0 .0 4 )。结果　术后 4 8h均顺利脱离呼吸机 ,无早期死亡。随访 1～ 2 4个月 ,活瓣均已关闭 ,平均肺动脉压降至 15～ 30mmHg[(2 0± 5 )mmHg],动脉血氧饱和度升至 0 .95～ 0 .98(0 .96±0 .0 2 ) ,术后早期无肺高压危象发生 ,术后晚期症状均明显缓解消失。结论　单向活瓣式补片治疗室缺合并严重肺动脉高压 ,有利于渡过术后肺动脉高压危象期 ,能预防右心功能不全的发生 ,降低手术死亡率。     

自体骨髓单个核细胞移植治疗缺血性心脏病临床疗效观察

目的 研究经冠状动脉内移植骨髓单个核细胞治疗缺血性心力衰竭的可行性和疗效。方法 缺血性心力衰竭病人20例，抽取骨髓用密度梯度离心法分离出骨髓单个核细胞，经外周动脉穿刺插管，将自体骨髓单个核细胞注入冠脉。比较病人的临床症状，NYHY分级和治疗后由于心血管事件造成的再住院情况。结果 病人自觉症状改善，心功能提高，ECT检查显示在缺血区有血管新生。结论 自体骨髓单个核细胞移植是安全有效的。     

Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study

Background  

Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE (vancomycin-resistant enterococci). The aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.     

蛛网膜下腔出血患者迟发性脑血管痉挛相关因素的临床分析

目的 探讨动脉瘤性蛛网膜下腔出血(SAH)患者迟发性脑血管痉挛(DCVs)的临床影响因素. 方法 回顾性分析南方医科大学珠江医院神经外科自2005年1月至2008年12月收治的74例动脉瘤性SAH患者的临床资料,判定DCVS,统计分析其影响因素. 结果年龄、出血次数、吸烟史、Hunt-Hess分级、Fisher分级、白细胞计数峰值与DCVS的发生具有明显相关性,其中年龄、出血次数、Hunt-Hess分级、Fisher分级是DCVS发生的独立影响因素. 结论 低年龄、出血2次以上及Hunt-Hess分级或Fisher分级Ⅲ级以上患者更易发生DCVS,临床上对此类患者应加强监测、及早发现和处理.