Structure–function relationship between Bruch’s membrane opening-minimum rim width and perimetry in open-angle glaucoma subtypes

Graefe's Archive for Clinical and Experimental Ophthalmology - To seek the threshold value of Bruch’s membrane opening-minimum rim width (BMO-MRW) where visual field (VF) damage occurs in...     

大鼠心肌梗死后心肌炎症与骨髓干细胞归巢于缺血心肌的关系

目的:分析大鼠急性心肌梗死后心肌组织炎症与骨髓干细胞归巢于缺血心肌的关系。方法:实验于2005-05在西安交通大学动物实验中心完成。①选取清洁级健康雄性SD大鼠128只,取8只大鼠作为正常对照组,剩余120只大鼠随机数字表法分为单纯粒单细胞集落刺激因子组、地塞米松干预组、假手术组,40只/组。②单纯粒单细胞集落刺激因子组、地塞米松干预组建立急性心肌梗死模型,假手术组在左前降支挂线不结扎,正常对照组不进行任何手术。③单纯粒单细胞集落刺激因子组、地塞米松干预组、假手术组大鼠于造模前连续5d皮下注射粒单细胞集落刺激因子50μg/(kg·d)。地塞米松干预组于造模后1h一次性给予地塞米松500μg/kg肌注。④各组大鼠于造模后1,3,5,10d免疫组化观察心肌组织中ckit阳性细胞数及肿瘤坏死因子的表达。造模后28d进行梗死灶组织形态学观察。结果:128只SD大鼠全部进入结果分析。①术后28d各组心肌梗死灶组织形态学观察结果:单纯粒单细胞集落刺激因子组心内膜下有完整的心肌结构,心肌细胞排列整齐,中层由从梗死区边缘伸向斑痕区的心肌组织和结缔组织组成;地塞米松干预组心内膜下仅有散在的心肌细胞,心内膜与心外膜之间的结缔组织稀薄,中层未见有心肌组织;假手术组心脏结构完整未见瘢痕组织。②术后不同时间点各组ckit多克隆抗体特异性免疫组化染色结果:术后1,3,5d各时相点,以单纯粒单细胞集落刺激因子组ckit 细胞密度最大,地塞米松干预组ckit 细胞明显受到抑制(P<0.01);术后10d两组梗死区周边均未发现ckit 细胞。假手术组术后各时间点均未见ckit 细胞。③术后不同时间点各组肿瘤坏死因子的表达情况:地塞米松干预组术后1,3,5,10d各时间点肿瘤坏死因子表达均显著低于单纯粒单细胞集落刺激因子组(P<0.01),而假手术组未发现有肿瘤坏死因子表达。结论:心肌损伤后的炎症反应是骨髓干细胞归巢的先决条件,炎症抑制后限制了骨髓干细胞归巢。提示骨髓干细胞归巢于缺血心肌是机体潜在的修复机能。     

5-氨基酮戊酸光动力疗法联合电灼术治疗肛周尖锐湿疣疗效观察

目的 评价5-氨基酮戊酸光动力疗法（ALA-PDT）联合电灼术治疗肛周尖锐湿疣的疗效和复发率.方法 将67例肛周尖锐湿疣患者按门诊就诊顺序随机分为三组,联合治疗组22例用电灼术去除显性疣体后立即进行ALA-PDT治疗,每周1次,连续治疗3～4次;光动力组22例,用ALA-PDT治疗,每周1次,1个月为1个疗程;电灼术组23例,用传统方法电灼术对所有皮损逐个进行电灼气化治疗,每周1次的分批治疗,1个月为1个疗程.末次治疗后随访6个月判定疗效及观察复发率.结果 联合治疗组痊愈率为90.9％（20/22）,复发率为9.1％ （2/22）;光动力组痊愈率为54.5％ （12/22）,复发率为22.7％ （5/22）;电灼术组痊愈率为39.1％ （9/23）,复发率为43.5％ （10/23）.联合治疗组的痊愈率和复发率与电灼术治疗组差异有统计学意义（P =0.000;P =0.017）.结论 ALA-PDT治疗肛周尖锐湿疣治愈率高,复发率低,副作用小.     

肠梗阻大鼠小肠黏膜屏障功能变化的实验研究

目的：探讨大鼠肠梗阻时肠黏膜屏障功能的动态变化。方法建立急性完全性小肠梗阻模型,按肠梗阻时间不同进行分组,采血测定血清二胺氧化酶（DAO）的活性和肠型脂肪酸结合蛋白（IFABP）的浓度,取肠系膜淋巴结鉴定细菌移位的发生率并观察小肠组织病理变化。结果肠梗阻12 h后血清IFABP浓度开始升高,随着肠梗阻时间的推移,血清IFABP浓度值逐渐上升,与肠黏膜损伤程度变化趋势一致,两者呈正相关关系（r＝0．841,P＜0．01）。肠梗阻24 h后血清DAO活性升高,至48 h后达峰值,随后下降。大鼠肠梗阻48 h后才开始发生肠系膜淋巴结细菌移位,明显高于假手术组（P＜0．01）。结论肠梗阻早期就发生肠黏膜屏障功能损害,细菌移位滞后于血清生物学指标改变。肠型脂肪酸结合蛋白浓度变化可用来判断肠黏膜损伤程度的生物学指标,为肠梗阻严重并发症的防治和预后评估提供有益的参考和实验依据。     

Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Platelet Count Less Than 10 × 109/L Who Underwent Laparoscopic Splenectomy?

Background

Laparoscopic splenectomy (LS) is considered as the gold standard procedure for patients with immune thrombocytopenia (ITP). In many institutions, platelet counts less than 10 × 10⁹/L contraindicate LS.

Objective

This study aimed to investigate the safety and feasibility of LS for ITP patients with platelet counts less than 10 × 10⁹/L.

Methods

A total of 88 cases of LS were performed for ITP patients from June 2010 to December 2012. The patients were prospectively divided into three groups based on their immediate preoperative platelet count: < 10 × 10⁹/L (group 1); 10 × 10⁹/L to 30 × 10⁹/L (group 2); and > 30 × 10⁹/L (group 3). We collected the patients’ demographic characteristics, perioperative details, and platelet count response to surgery.

Results

The patients in the three groups had comparable demographic characteristics. Only one patient in group 1 required conversion (2.4 %). The patients in group 1 experienced more blood loss than those in group 3, but this was not statistically significant. There were no significant differences between group 2 and group 3 in terms of operating time and blood loss. No statistically significant differences were found between the three groups with regard to complications and postoperative hospital stay.

Conclusions

It is safe and feasible to perform LS in ITP patients with platelet count less than 10 × 10⁹/L, without platelet transfusion. The indication for platelet transfusion during LS for ITP patients should be the bleeding manifestations due to thrombocytopenia other than low platelet count itself.     

Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease

Purpose

The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease.

Methods

We conducted a prospective cohort study of 82 patients, who underwent two-level minimally invasive or open transforaminal lumbar interbody fusion (TLIF) from March 2010 to December 2011. Forty-four patients underwent minimally invasive transforaminal lumbar interbody fusion (MITLIF) (group A) and 38 patients underwent the traditional open TLIF (group B). Demographic data and clinical characteristics were comparable between the two groups before surgery (p > 0.05). Peri-operative data, clinical and radiological outcomes between the two groups were compared.

Results

The mean follow-up period was 20.6 ± 4.5 months for group A and 20.0 ± 3.3 months for group B (p > 0.05). No significant difference existed in operating time between the two group (p > 0.05). X-ray exposure time was significantly longer for MITLIF compared to open cases. Intra-operative blood loss and duration of postoperatively hospital stay of group A were significantly superior to those of group B (p < 0.05). On postoperative day three, MITLIF patients had significantly less pain compared to patients with the open procedure. No statistical difference existed in pre-operative and latest VAS value of back pain (VAS-BP) and leg pain (VAS-LP), pre-operative and latest ODI between the two groups. The fusion rate of the two groups was similar (p < 0.05). Complications included small dural tear, superficial wound infection and overlong screws. When comparing the total complications, no significant difference existed between the groups (p > 0.05).

Conclusions

MITLIF offers several potential advantages including postoperative back pain and leg pain, intra-operative blood loss, transfusion and duration of hospital stay postoperatively in treating two-level lumbar degenerative disease. However, it required much more radiation exposure.     

Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards

The study was conducted to investigate drug resistance, OXA-type carbapenemases-encoding genes and genetic diversity in airborne Acinetobacter baumannii (A. baumannii) in burn wards. Airborne A. baumannii were collected in burn wards and their corridors using Andersen 6-stage air sampler from January to June 2011. The isolates susceptibility to 13 commonly used antibiotics was examined according to the CLSI guidelines; OXA-type carbapenemases-encoding genes and molecular diversity of isolates were analyzed, respectively. A total of 16 non-repetitive A. baumannii were isolated, with 10 strains having a resistance rate of greater than 50% against the 13 antibiotics. The resistance rate against ceftriaxone, cyclophosvnamide, ciprofloxacin, and imipenem was 93.75% (15/16), but no isolate observed to be resistant to cefoperazone/sulbactam. Resistance gene analyses showed that all 16 isolates carried OXA-51, and 15 isolates carried OXA-23 except No.15; but OXA-24 and OXA-58 resistance genes not detected. The isolates were classified into 13 genotypes (A-M) according to repetitive extragenic palindromic sequence PCR (REP-PCR) results and only six isolates had a homology ≥90%. In conclusion, airborne A. baumannii in the burn wards had multidrug resistance and complex molecular diversity, and OXA-23 and OXA-51 were dominant mechanisms for resisting carbapenems.     

Role of IL‐17 and TGF‐β in peritoneal adhesion formation after surgical trauma

Peritoneal adhesions are fibrous tissues formed after surgery. Both cytokines and transforming growth factors (TGFs) are involved in this process. The objective of this study was to investigate the cross talk between these entities. Peritoneal drainage fluid after surgery from patients and rodent models was examined by enzyme‐linked immunosorbent assay and fluorescence‐activated cell sorter. Data showed that the concentrations of interferon (IFN)‐γ and interleukin (IL)‐17 reached their peaks 6–12 hours after surgery, whereas TGF‐β1 concentrations showed two postoperative peak time points at 2 and 72–96 hours. By neutralizing IFN‐γ, IL‐17 6–12 hours, and TGF‐β1 72–96 hours after surgery, the degree of adhesion reduced significantly. However, neutralizing TGF‐β1 2 hours after surgery did not affect adhesion formation. Furthermore, in vitro studies showed that compared with the fibroblasts that were directly stimulated with TGF‐β1, the prestimulation of IL‐17 promoted plasminogen activator inhibitor‐1 production while inhibiting tissue‐type plasminogen activator production. Moreover, additional stimulation with IFN‐γ enhanced this effect. Together, these data indicate that IL‐17 may promote adhesion formation by increasing the reaction of fibroblasts against TGF‐β1. Blocking IL‐17 might have a therapeutic potential in preventing adhesion formation after surgery.     

Significance of perivesical lymph nodes in radical cystectomy for bladder cancer

ObjectiveThe location of positive lymph nodes (LNs) is important for bladder cancer staging. Little is known regarding the impact of perivesical (PV) lymph node (PVLN) involvement on survival. This study characterized PVLN identified after radical cystectomy (RC) and analyzed their impact on recurrence and survival.Materials and methodsWe reviewed our institutional review board–approved database including all patients who underwent RC with pelvic lymphadenectomy for curative intent for urothelial carcinoma. Clinical and pathologic data were obtained. Patients were analyzed in groups according to the location of positive LNs: PV+/other LN (ON)+, PV+/ON?, and PV?/ON+. Kaplan-Meier curves were used to estimate recurrence-free survival (RFS) and overall survival (OS). Multivariable Cox regression (including pathologic T category, number of positive LNs, highest level of positive LNs, chemotherapy, and margin status) was performed to evaluate associations between PVLN status and survival.ResultsIn total, 2,017 patients met inclusion criteria and 465 (23%) were LN+. PVLNs were identified in 936 patients (47%), positive in 197 patients (10%), and represented isolated LN+disease in 101 patients (5%). On univariate analysis, RFS and OS were significantly worse in the PV+/ON+group compared with the PV+/ON? and PV?/ON+ groups. There were no significant differences in RFS or OS between the PV+/ON? and PV?/ON+ groups. On multivariable analysis, PV+/ON+disease was independently associated with worse RFS and OS when compared with PV?/ON+ disease.ConclusionsPVLNs were identified in a significant number of patients after RC. Positive PVLN, when in combination with other positive LNs, portends worse survival even when correcting for the number of positive nodes.