基于CT评估解剖压迫性左头臂静脉狭窄的解剖学因素及临床意义

目的 探讨解剖压迫性左头臂静脉狭窄的解剖学因素及临床意义。方法 回顾性研究。纳入重庆医科大学附属第一医院2018年1月—2019年9月有左上肢功能性血透通路(自体动静脉内瘘或人工血管动静脉内瘘)且行胸部增强CT扫描的血液透析患者107例作为观察组,2019年7—9月行胸部增强CT扫描的非血透患者758例作为对照组。观测指标:左头臂静脉最小前后径(D1)、胸骨与主动脉弓(或头臂干)之间的最短前后距离(D2)、胸廓前后内径(D3)。分析:(1)D1、D2、D3之间关系;(2)D1、D2与身高、体质量、年龄、性别、高血压病史的关系;(3)左上肢功能性血透通路内瘘存续时间对D1、D2的影响;(4)D1≤2 mm患者的情况。结果 观察组患者较对照组年龄更大、高血压病史者更多,差异均有统计学意义(P值均＜0.01);性别、身高、体质量组间比较差异均无统计学意义(P值均＞0.05)。(1)观察组D1大于对照组,分别为(8.513±3.337)mm、(7.812±3.176)mm,差异有统计学意义(P＜0.05);两组D2比较差异无统计学意义(P＞0.05);观察组、对照组患者的D1与D2均呈正态分布、线性相关(r=0.663、0.694,P值均＜0.01),与D3均没有明显的线性关系。(2)身高、体质量与D1、D2均无明显的线性关系(P值均＞0.05)。男性的D1、D2均较女性大:观察组的D2以及对照组的D1、D2,男女差异均有统计学意义(t=3.323、2.048、5.721, P值均＜0.01)。对照组患者的D1、D2随着年龄增高而减小,差异均有统计学意义(F=14.025、11.822, P值均＜0.01)。(3)患者左上肢功能性血透通路内瘘存续的时间与D1、D2均无线性关系(r=0.471、0.223, P值均＞0.05)。(4)D1≤2 mm的患者在两组中比例相当,观察组2.8%(3/107)、对照组3.6%(27/758):观察组3例有左上肢功能性血透通路透析患者均未报告左上肢肿胀症状;对照组中有3例患者在经左侧置入导管后出现不同程度的左上肢肿胀症状,其中2例被诊断为深静脉血栓形成。结论 左头臂静脉最小前后径与同层面胸骨与主动脉弓(或头臂干)之间的最短距离密切相关,解剖压迫性左头臂静脉狭窄可能增加左上肢功能性血透通路建立后出现左上肢水肿以及静脉治疗导管置入后深静脉血栓形成的风险。     

Association of nitric oxide synthase gene polymorphisms (−786T>C, 4a4b, 894G>T) with primary ovarian insufficiency in Korean women

ObjectivesThe aim of our study was to investigate whether the endothelial nitric oxide synthase (eNOS) gene polymorphisms ?786T>C, 4a4b, and 894G>T that affect nitric oxide (NO) generation confer a risk for primary ovarian insufficiency (POI) in Korean women.Study designWe genotyped 136 POI patients and 236 controls among Korean women for the three single nucleotide polymorphism sites with PCR-RFLP analysis. Differences in the eNOS ?786T>C (rs2070744), 4a4b (rs61722009), and 894G>T (rs1799983) genotype frequencies between patients and controls were compared, and odds ratios and 95% confidence intervals were determined as a measure of the strength of the association between the genotypes and POI.ResultsThe POI patients had significantly decreased frequencies of the eNOS 894GT and ?786TT/894GT genotypes (P = 0.025 and 0.027, respectively). However, the significant association between these eNOS polymorphisms and POI disappeared after adjustment for multiple comparisons (adjusted P = 0.075 and 0.081, respectively). The eNOS ?786T/894G haplotype is more frequent in patients than controls (P = 0.030), whereas the ?786T/894T haplotype was less frequent in patients (P = 0.031). The associations between ?786/894 haplotypes and POI were confirmed by permutation tests. We did not find associations between the eNOS ?786T>C or 4a4b polymorphisms and POI.ConclusionsOur data suggest that the eNOS ?786T/894T haplotype is associated with a decreased POI risk, and we postulate that the eNOS ?786T/894T haplotype may confer less risk on POI occurrence by reducing pathologically increased NO generation by eNOS in POI. Further study is warranted to elucidate the effect of the eNOS 894G>T polymorphism and POI occurrence.     

角膜塑形镜和多区正向光学离焦眼镜及单焦框架眼镜的近视控制效果比较

目的:比较角膜塑形镜(OK镜)、多区正向光学离焦眼镜(DIMS)和单焦框架眼镜(SVS)对青少年近视的控制效果。方法:回顾性研究。选取2020-04/2021-03于宁波爱尔光明眼科医院就诊的近视患者111例221眼,根据近视矫正方式分为OK组(42例83眼)、DIMS组(30例60眼)和SVS组(39例78眼)。随访24mo,记录并分析所有患者戴镜前后眼轴和等效球镜度变化情况。结果:戴镜后6、12、18、24mo,三组患者眼轴均呈增长趋势,且SVS组患者眼轴增长量均高于OK组和DIMS组(P<0.01)。戴镜后24mo,角膜塑形镜的眼轴控制效果为59.7%,DIMS的眼轴控制效果为41.7%。戴镜后12、18、24mo, DIMS组和SVS组患者等效球镜度均呈增长趋势,且SVS组等效球镜度增长量均高于DIMS组(P<0.01)。戴镜后24mo, DIMS的近视度数控制效果为58.6%。结论:角膜塑形镜和DIMS对青少年近视的控制均有较好的临床效果,且角膜塑形镜的控制效果优于DIMS。     

因胎儿畸形终止妊娠产妇悲伤反应与应对方式的相关性分析

目的探索因胎儿畸形终止妊娠产妇悲伤反应的现状及其与应对方式的相关性。方法 2008年1月至2011年1月,按便利抽样法选择在宁波市两所医院产科因胎儿畸形终止妊娠的产妇302名,采用一般情况、中文版围产期悲伤量表(perinatal grief scale,PGS)及简易应对方式问卷(simple coping style questionnaire,SCSQ)对其进行调查。结果因胎儿畸形终止妊娠产妇的悲伤反应总分为(94.21±10.23)分,总分及各维度得分均高于西方常模;应对方式中消极应对得分为(1.95±0.92)分,积极应对得分为(1.42±0.54)分;悲伤反应与应对方式之间差异有统计学意义(P<0.05)。结论因胎儿畸形终止妊娠产妇的产后存在明显的悲伤反应,比正常人更多的应用消极应对方式;帮助胎儿畸形终止妊娠产妇克服消极情绪,鼓励采取积极的应对策略是降低悲伤反应的关键途径。     

Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

Exploring the potential for age estimation using facial image sensing technology for postmortem investigation

In this study, we examine the potential for using face imaging sensing technology in place of a human forensic practitioner to estimate the age of cadavers. We used the age estimation software FieldAnalyst for Signage Ver. 6.0 AW32. To validate the usefulness of its age estimation for living subjects, images of 28 subjects were taken at three angles (+30°, 0°, and −30°) with respect to the horizontal plane, with their eyes open and closed. The highest positive correlation between mean the estimated age and the actual age (y = 1.02x − 0.35, and Spearman’s rank correlation coefficient of 0.78, P < 0.001) was obtained when the subjects had their eyes closed and the image was captured at an angle of 0°. The ages of 93% of the subjects were estimated within ±10 years of their actual ages. We then applied this procedure to 61 cadavers with their eyes closed. Facial images were taken at an angle of 0° with respect to the horizontal plane and used to estimate the ages of the cadavers. Although a positive correlation between the actual and mean estimated ages was obtained (y = 1.28x + 0.43, Pearson’s correlation coefficient of 0.69, P < 0.001), the mean estimated ages of only 39.3% of the subjects were within ±10 years of their actual ages. It appears that this technology is not accurate enough to use to determine the age of a cadaver. Therefore, medical inspectors with adequate knowledge and experience are still required for postmortem examination.     

UPLC法测定度鲁特韦有关物质含量

目的:建立测定度鲁特韦原料药有关物质含量的超高效液相色谱方法.方法:色谱柱为Waters BEH C18(2.1 mm×150 mm×1.7μm),流动相:10 mmol·L-1甲酸铵溶液(pH=2.5)为流动相A,乙腈为流动相B,梯度洗脱:0～15 min,流动相B 20％ ～80％,柱温30℃,流速0.28 mL·...     

基于顾客满意度指数模型的病人满意度问卷编制

目的编制病人满意度调查问卷。方法立足美国顾客满意度指数模型理论(ACSI),参考国内相关研究,分两次调查,分别对问卷进行项目分析、探索性和验证性因素分析。结果最后确定问卷由6个维度(约束条件、质量期望、质量感知、病人满意、病人抱怨、病人忠诚)共17个项目组成,信度为0.871,模型拟合指标χ2/df、GFI、NFI、CFI、TLI、RFI、RMSEA分别为1.758、0.936、0.910、0.959、0.950、0.892、0.047。结论基于ACSI模型的病人满意度调查问卷具有良好的信效度,可以有效测量病人满意度情况,作为进一步研究的调查工具。     

外踝前动脉降支顺行岛状皮瓣修复足踝部皮肤缺损

目的:探讨采用外踝前动脉降支顺行岛状皮瓣修复足踝部创面的手术方法及其临床应用效果。方法 :2015年6月至2017年1月,采用外踝前动脉降支顺行岛状皮瓣修复9例足踝部皮肤缺损的患者,其中男6例,女3例;年龄32～63岁。创面均位于足、踝部,并伴有骨、肌腱或血管神经外露,其中足部创面6例,踝部创面3例。皮肤缺损面积为1.5 cm×2.0 cm～6.0 cm×13.0 cm,切取皮瓣面积为2.0 cm×3.0 cm～7.0 cm×15.0 cm。皮瓣供区均取腹部全厚皮片植皮修复。术后观察岛状皮瓣外观、质地、供区情况,根据张浩等制定的疗效满意度评分方法进行满意度评价,并采用美国足踝外科学会(AOFAS)踝-后足功能评分进行功能评价。结果:9例患者术后皮瓣血液循环稳定,无一例发生回流障碍,均于术后2周Ⅰ期愈合。术后所有患者获得随访,时间2～18(8.0±2.3)个月。皮瓣全部Ⅰ期成活,蒂部平整,无臃肿及"猫耳"畸形,皮瓣质地柔软,外观满意,颜色与周围皮肤接近。供区游离植皮后创面平整,无明显瘢痕增生。9例患者满意度评分均为满意,AOFAS评分均为优。结论:采用外踝前动脉降支顺行岛状皮瓣具有不牺牲主干血管、皮瓣薄等优点,是修复足踝部创面的一种简单、有效的治疗方法。     

Alpha B-crystallin improved survival of retinal ganglion cells in a rat model of acute ocular hypertension

Increased endogenous αB-crystallin protein levels have been shown to reduce cell apoptosis,although the effects of exogenous αB-crystallin protein remain poorly understood.The present study established an acute ocular hypertension model in the right eye of Sprague-Dawley rats.Fluorogold retrograde tracing and immunofluorescence methods showed that the number of retinal ganglion cells decreased in the right eyes and caspase-3 expression increased following acute ocular hypertension.Intravitreal injection of αB-crystallin in the right eye increased the number of retinal ganglion cells and reduced caspase-3 expression.Results demonstrated that exogenous αB-crystallin protein inhibited caspase-3 expression and improved retinal ganglion cell survival following acute ocular hypertension.