老年睑板腺功能障碍蠕形螨感染率及茶树精油联合氟米龙的疗效

目的：研究老年睑板腺功能障碍(MGD)蠕形螨感染率及茶树精油联合氟米龙的疗效。

方法：回顾性病例对照研究。选择2017-09/2018-03在宁波市眼科医院门诊就诊的老年MGD患者59例118眼。将睫毛蠕形螨镜检为阳性的38例患者76眼进行症状评分、蠕形螨数量、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、Schirmer I试验(SIaT)等检查,并按不同治疗方法分成3组,A组使用0.02%氟米龙滴眼液滴眼24眼; B组使用茶树精油(TTO)湿巾敷眼26眼; C组用0.02%氟米龙滴眼液滴眼联合TTO湿巾敷眼26眼,随访4wk。

结果：118眼中76眼(64.4%)睫毛蠕形螨镜检为阳性。睫毛蠕形螨阳性的三组患者治疗后的主观症状评分均较治疗前有改善(P<0.05)。治疗后A组蠕形螨数量较治疗前无显著差异(P=0.11); B、C组较治疗前明显减少(均P<0.01)。三组患者BUT治疗前后比较,A组BUT无显著差异(P=0.22); B、C组BUT明显延长(均P<0.05)。治疗后C组的BUT较A、B组明显延长(均P<0.05)。三组患者治疗前后的FL评分均较治疗前明显改善(P<0.05)。

结论：老年MGD患者睫毛蠕形螨感染率较高,睑板腺热疏通后TTO湿巾联合0.02%氟米龙滴眼液能有效驱螨、缓解MGD患者局部症状。     

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging,alloimmune thrombocytopaenia and monochorionic twins

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.     

中西医结合治疗急性胰腺炎伴胃肠功能障碍疗效评价研究

目的探讨中西医结合治疗急性胰腺炎（AP）伴胃肠功能障碍的临床疗效。方法回顾性分析377例AP临床资料,按治疗方法分为中西医结合组和西医组,对比分析2组胃肠功能改善的差异性。结果中西医结合组在腹胀缓解时间、自主排便好转时间、肠鸣音好转时间方面均优于西医组,差异有统计学意义（P〈0.05）。结论中西医结合治疗可显著改善AP患者的胃肠功能。     

Post-voiding residual volume in 154 primiparae 3 days after vaginal delivery under epidural anesthesia

OBJECTIVES: To use 3-dimensional ultrasonography (3D-US) to determine the frequency of post-voiding residual volume (PVRV) > or =100 mL in primiparae 3 days after receiving epidural anesthesia for vaginal delivery. Potential relationships between day-3 PVRV > or =100 mL and obstetrical-pediatric parameters, especially those possibly implicated in post-obstetrical bladder dysfunction, were examined. STUDY DESIGN: We recruited 154 primiparae who vaginally delivered term singletons following uncomplicated pregnancies in the maternity unit of a French teaching hospital. All women had been systematically catheterized 2-h postpartum to measure precisely the volume of urine retained. On the morning of discharge (day 3), when the patient felt the urge to urinate, her 3D-US pre-voiding bladder volume was determined with BladderScan (BVI-3000), then her spontaneously voided urine was collected to accurately quantify its volume and 3D-US was repeated immediately to evaluate the PVRV. PVRV > or =100 mL on day 3 was considered pathological. RESULT: Among these 154 women, 88 (57%) felt the need to urinate and 97 (63%) had a retained volume > or =500 mL at 2-h postpartum. On day-3 postpartum, the median [range] volumes for the entire cohort were: 426.7 [158-999.7] mL 3D-US-measured pre-voiding, 350 [15-1000] mL collected by spontaneous urination, 82.2 [5.3-433.3] mL 3D-US-determined post-voiding; PVRV exceeded 100 mL for 55 (36%). According to our univariate analysis, no factor considered was able to predict PVRV > or =100 mL on day 3. CONCLUSION: Our observations confirmed the existence of PVRV > or =100 mL on day 3 in more than one-third of these primiparae who delivered vaginally under epidural anesthesia. No obstetrical-pediatric factor could be implicated in this bladder dysfunction. Therefore, we recommend frequent and systematic non-invasive 3D-US monitoring of all postpartum patients at least until day 3 to avoid excessive urine retention.     

Fetal growth restriction

Normal fetal growth is determined by the genetically predetermined growth potential and further modulated by maternal, fetal, placental, and external factors. Fetal growth restriction (FGR) is a failure to reach this potential and is clinically suspected if sonographic estimates of fetal weight, size, or symmetry are abnormal. Integration of fetal anatomy assessment, amniotic fluid dynamics, uterine, umbilical, and fetal middle cerebral artery Doppler is the most effective approach to differentiate potentially manageable placenta-based FGR from aneuploidy, nonaneuploid syndromes, and viral infection. Although placental dysfunction results in a multisystem fetal syndrome with impacts on short- and long-term outcome, only cardiovascular and behavioral responses are helpful to guide surveillance and intervention. Early-onset FGR before 34 weeks gestation is readily recognized but challenging to manage as questions about optimal delivery timing remain unanswered. In contrast, near-term FGR provides less of a management challenge but is often missed as clinical findings are more subtle. Once placenta-based FGR is diagnosed, integrating multivessel Doppler and biophysical profile score provides information on longitudinal progression of placental dysfunction and degree of fetal acidemia, respectively. Choosing appropriate monitoring intervals based on anticipated disease acceleration and intervention when fetal risks exceed neonatal risks are the prevailing current management approaches.     

2型糖尿病早期血管内皮功能改变的临床研究

目的：探讨2型糖尿病（T2DM）早期患者血管内皮功能的变化及影响因素。方法：选取45例新诊断无并发症的T2DM患者（T2DM组）,另设正常对照组38例（NC组）,比较两组的一般情况、血脂、糖代谢等生化指标和可溶性血管细胞黏附分子1（SVCAM-1）的差异。结果：①T2DM组SVCAM-1高于NC组[（47.51±13.84）mmol/L vs（27.99±11.66）mmol/L],差异有高度统计学意义（P〈0.01）。②相关分析显示,血清SVCAM-1与体重指数（BMI,r=0.432,P〈0.01）、舒张压（DBP,r=0.229,P〈0.05）、空腹血糖（FPG,r=0.409,P〈0.01）、三酰甘油（TG,r=0.226,P〈0.05）、总胆固醇（TC,r=0.237,P〈0.05）、低密度脂蛋白胆固醇（LDL-C,r=0.241,P〈0.05）呈显著正相关,与高密度脂蛋白胆固醇（HDL-C,r=-0.259,P〈0.01）呈显著负相关。结论：T2DM早期患者即存在血管内皮功能损伤。     

Single nucleotide polymorphisms in the D-loop region of mitochondrial DNA and age-at-onset of patients with chronic kidney disease

Background The mitochondrial displacement loop （D-loop） accumulates mutations and single nucleotide polymorphisms （SNPs） at a higher frequency than other regions of mitochondrial DNA （mtDNA）.We previously identified disease riskassociated SNPs in the D-loop of chronic kidney disease （CKD） patients; in this study,we investigated the association of age-at-onset and D-loop SNPs in CKD patients.Methods The D-loop region of mtDNA was sequenced in 119 CKD patients attending the Fourth Hospital of Hebei Medical University between 2002 and 2008.The age-at-onset curve of the CKD patients was calculated using the KaplanMeier method at each SNP site,and compared using the log-rank test.Results The mean age of 119 CKD patients was （55.6±14.2） years,and 56.3% were males.The mean estimated glomerular filtration rate （eGFR） was （81.2±12.4） ml·min^-1·1.73 m^-2,with 79.8% （n=95） of patients having an eGFR 〈60 ml·min^-1·1.73 m^-2.All participants had an eGFR 〉30 ml·min^-1·1.73 m^-2.The age-at-onset for CKD patients who smoked was significantly lower than that of non-smoking CKD patients.The SNP sites of nucleotides 150C/T were identified for their association with age-at-onset using the log-rank test.The age-at-onset of patients with the minor allele T genotype was significantly lower than that of patients with the C genotype at the 150 SNP site （P=0.010）.Conclusions Genetic polymorphisms in the D-loop appear to be predictive markers for age-at-onset in CKD patients.Accordingly,the analysis of genetic polymorphisms in the mitochondrial D-loop may help identify CKD patient subgroups at high risk of early onset disease.