超广角眼底自发荧光在Stargardt病中的特征和应用价值

目的：探讨超广角眼底自发荧光在Stargardt病中的特征和应用价值。

方法：回顾分析2016-05/2020-08在云南省第二人民医院眼科门诊经过多种影像检查及基因测序而确诊的Stargardt病患者38例76眼。使用超广角眼底自发荧光成像检查,并对比传统眼底彩照、眼底55°自发荧光、光相干断层扫描的影像特征,评估超广角眼底自发荧光在Stargardt病中的影像特征及其临床应用优势。

结果：超广角眼底自发荧光检查中76眼(100%)均发生了后极部的高自发荧光,而传统55°自发荧光检查仅有42眼(55%)可见明显的后极部高自发荧光。76眼中66眼(87%)可见不同数量的斑点,从后极部向周边视网膜分布,超广角眼底自发荧光较眼底彩照能显示更为清晰和更多数量的视网膜斑点,更为完整地显示斑点的分布数量和面积。76眼(100%)均可见黄斑中心处RPE萎缩所呈现的卵圆形低自发荧光区域,随病变进展,萎缩区扩大、低荧光区域相应扩大,超广角眼底自发荧光能完整显示萎缩范围和面积,但无法从萎缩深度上进行显示。48眼(63%)超广角眼底自发荧光中可见强背景自发荧光从黄斑处向视盘鼻侧和颞下方扩展,在视盘下方形成一明显的近似垂直的分界线。

结论：Stargardt病中的自发荧光变化不仅局限于后极,而且可能在周围延伸得更多,超广角眼底自发荧光成像是评估Stargardt病患者的有用工具。     

福建省消除麻疹免疫策略实施的成本-效益分析

[目的]为评价福建省加速麻疹控制目标的卫生经济学效益,对福建省1982—2002年的资料进行分析。[方法]采用标准期望寿命年损失计算法,计算伤残调整生命年(DALYs),并用EPi Info软件和Excel软件进行分析。[结果]福建省实施消除麻疹免疫策略时期,如不考虑无形效益的影响,按消除麻疹免疫策略实施时期(1998—2002年)和计划免疫时期(1982—1997年)相比,产生效益114 318 250元(人民币),成本效益比为1∶2.96。[结论]福建省消除麻疹免疫策略取得了良好的经济效益。     

Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure

Objective  The aim of this review is to systematically analyze the prospective randomized controlled trials on the efficacy of botulinum toxin injection (Botox) vs. lateral internal sphincterotomy (LIS) for the treatment of chronic anal fissure (CAF). Materials and methods  A systematic review of the literature was undertaken. The prospective randomized controlled trials on the effectiveness of Botox vs. LIS for the management of CAF were selected according to specific criteria and analyzed to generate pooling data. Results  Four studies encompassing 279 patients were qualified for the meta-analysis. There was a statistically significant higher healing in LIS group compared with Botox group (RR 1.31[1.57, 1.50] 95% CI, z = 4.11, p < 0.0001). Absolute benefit increase rate (ABI) is 23% for LIS group compared with Botox group. The recurrence rate was statistically significantly higher in Botox groups than in LIS groups (RR 5.83[2.96, 11.49] 95% CI, z = 5.09, p < 0.00001).LIS was associated with a high rate of minor anal incontinence as compared to Botox (RR 0.08[0.01, 0.59] 95% CI, z = 2.47, p = 0.01). Conclusion  Botulinum toxin injection was associated with a higher rate of recurrent disease. LIS was more effective in healing chronic anal fissure.     

中国大陆地区克罗恩病临床误诊的汇总分析

目的:了解我国大陆地区克罗恩病(Crohn’s disease,CD)的临床特征,尤其是病变部位及其累及情况,以及临床诊断上的误诊情况,为临床医生快速准确地诊断提供重要线索．方法:对我国近50 a来报道的CD文献资料通过计算机CBM与文献追溯检索,对符合文献入选标准的63篇文献有关误诊情况的数据进行摘录、登记、统计分析．结果:计入统计的CD患者共有1644例,误诊为肠梗阻与套叠为19．33％、肠道肿瘤为19．89％、腹部肿块为10．00％、回盲部占位为13．95％、肠结核为14．47％、溃疡性结肠炎为12．25％、慢性肠炎为33．85％、阑尾病变为17．54％．结论:CD的临床表现缺乏特异性,病变侵犯胃肠道任意部位,且常常侵犯多个部位,给临床诊断带来困难,极易导致误诊．     

Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients

MethodsThis study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients.ResultsADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS).ConclusionsWith the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.     

The potential mechanism of Bupleurum against anxiety was predicted by network pharmacology study and molecular docking

Metabolic Brain Disease - Bupleurum chinense DC. (Chaihu) is a traditional Chinese medicine (TCM) used in the treatment of anxiety. But the anxiolytic mechanisms of bupleurum are still unclear....     

17-beta-hydroxysteroid dehydrogenase 13 inhibits the progression and recurrence of hepatocellular carcinoma

Background: Our previous study showed that 17-beta-hydroxysteroid dehydrogenase 13(HSD17 B13) is down-regulated in hepatocellular carcinoma(HCC). But its function in HCC remains unknown. This study aimed to reveal the function of HSD17 B13 and its clinical significance in HCC.Methods: m RNA levels of HSD17 B13 were analyzed in cohort 1(30 normal, 30 HBV cirrhosis, 60 HBVrelated HCC and 60 peritumoral tissue) by real-time PCR. HSD17 B13 protein was evaluated in cohort 2(15 normal, 33 HBV-cirrhosis, 12 dysplastic nodules, 34 HBV-related HCC, and 9 metastatic HCC) using immunohistochemistry. The association between HSD17 B13 and the survival of HCC patients was analyzed in cohort 3(n = 88). The inhibitory mechanism of HSD17 B13 on HCC was explored.Results: The m RNA of HSD17 B13 and its protein expression were significantly down-regulated in HCC compared to non-tumor specimens(P 0.001). The sensitivity, specificity and area under curve(AUC)values of HSD17 B13 expression levels for HCC detection were 81.7%, 83.7% and 0.856, respectively(P 0.001). Lower HSD17 B13 in peritumoral tissue was an independent risk factor of worse recurrence free survival of HCC patients(HR: 0.41; 95% CI: 0.20–0.83; P = 0.014). The study in Huh 7 and SK-HEP-1 cells showed that HSD17 B13 induced an accumulation of cells in G1 phase and reduction of cells in S and G2 phases via up-regulating the expression of P21, P27 and MMP2.Conclusions: Lower HSD17 B13 in peritumoral tissues was associated with worse recurrence free survival and overall survival of HCC patients. HSD17 B13 delayed G1/S progression of HCC cells. HSD17 B13 may be a therapeutic target for the treatment of HCC.     

五步蛇伤患肢肿胀不能切开引流吗？

五步蛇属咀循毒类毒蛇,被其咬伤后不但会造成肢体严重肿胀,而且会破坏机体的凝血机制,严重时会导致DIC09发生。故既往临床工作者往往不主张患肢切开引流消肿。即使患肢出现感染、化脓也只主张抽出脓液。但炎症水肿引起的患肢肿痛,不但导致患者极为痛苦,而且会促进患肢感染、导致骨筋膜室综合征等,使得患肢血运进一步受损,从而出现严重的溃疡甚至肢体坏死。是否切开患肢引流以及切开的时机怎么确定．目前还具有较大争议。我们认为选择合适的时机切开引流减压并不会造成大出血,还可以促进患肢消肿,对预防患肢感染、溃疡和伤残等都具有积极的作用。     

应用鸡胚活体电转GFP示踪技术观察脊髓左右两侧神经元纤维投射

目的:探索鸡胚发育过程中,脊髓左右侧神经元经纤维之间的联系,为脊髓两侧神经纤维投射提供形态学基础;方法:采用鸡胚带壳开窗培养技术,待胚胎发育至第3天,通过活体电转基因,将pCAGGS-GFP质粒0.1～0.5μl准确注射到脊柱,在电压18 V、每次脉冲60 ms,间隔100 ms,电脉冲6次的条件下进行定时定位活体电转基因,电转后6小时开始到10天,分别收集胚胎,甲醛固定冰冻切片,DAPI染细胞核观察组织形态结构变化。结果:电转后6小时便可以观察到GFP的表达,24小时后可以看到GFP标记细胞纤维的投射,3天可以清晰的观察到转入GFP一侧脊髓的运动神经元纤维束投射到另外一侧脊髓。结论:电转GFP成功标记运动神经元纤维在脊髓左右两侧的投射。