激光光凝联合玻璃体腔注气治疗玻璃体切割术后再发黄斑孔

目的 探讨激光光凝联合玻璃体腔注气治疗玻璃体切割术后再发与未愈黄斑孔的疗效。方法 应用COHERENT Omni多波长激光光凝黄斑裂孔底部的视网膜色素上皮层。随后眼内注入20％C3F80．5～0．8ml并置换出玻璃体腔液体。治疗后每天坚持俯卧位。结果 19只眼中16只眼黄斑孔愈合，成功率为84．2％，视力提高15只眼，占78．9％，未出现严重的并发症。结论 应用激光光凝联合眼内注气治疗玻璃体切割术后再发与未愈黄斑孔具有方法简单、费用低、疗效确定、大部分患者无须住院等优点。     

Factors affecting the survival following surgical treatment of chronic subdural haematoma: Single institutional experience

BackgroundChronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH.MethodsRetrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010–2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination.ResultsThe overall survival in the cohort was 37.0 months (IQR: 20.0–60.0). The median age of the patients was 76 years (IQR: 66–82) and the median length of hospital stay was 10 days (range 1–126 days; IQR: 6–17 days). The recurrence rate was 6.37% (n = 17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04–3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41–4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26–3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically.ConclusionAge at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.     

Surviving Black Holes and Finding the Third Dimension,with Alex

This article discusses challenges in the treatment of a child, Alex, who is 11?years old when he begins treatment with the author. By the end of Alex’s first year of treatment, his sessions have become so deadening that his therapist often struggles to stay awake. Some days, she remains alert, but finds herself unable to feel or think. During a particularly grueling stretch, the author encounters Francis Tustin’s The Protective Shell, Tustin’s account of her psychoanalytic work with autistic children. Tustin’s ideas, when used by this author, have a transformative effect on Alex’s treatment. The author comes to understand that Alex employs autistic defenses, or protections—i.e., he is partially encapsulated. Tustin’s formulations regarding the etiology of autistic protections facilitate new possibilities for understanding and metabolizing Alex’s communications. In addition, the author grasps the importance of becoming a bolder and more active therapeutic presence with Alex.     

应用腹膜缝缘跳跃式戳孔法预防急腹症术后切口感染的探讨──附274例临床观察

本文观察我科１９９３年４月～１９９５年７月收治的２７４例急腹症手术病例，均应用腹膜缝缘跳跃式戳孔法关闭腹膜，切口不冲洗，不放置引流物，术后切口感染率为３．６５％，本法预防急腹症术后切口感染效果较为理想     

经脐单孔与三孔法腹腔镜胆囊切除术疗效比较

目的分析对比经脐单孔与三孔法腹腔镜胆囊切除术的疗效。方法将90例拟行腹腔镜切除术患者随机分为对照组和观察组,每组45例。对照组行三孔法腹腔镜胆囊切除术,观察组行经脐单孔腹腔镜胆囊切除术,行视觉模拟评分(VAS)和美容满意度评分,记录手术时间、术中出血量、进食时间、住院治疗时间等。结果观察组VAS评分显著低于对照组,美容满意度评分显著高于对照组,差异具有统计学意义(P0.05)。观察组手术时间高于对照组,差异具有统计学意义(P0.05)。结论在掌握手术适应证前提下,与三孔法腹腔镜胆囊切除术相比,经脐单孔手术美容效果好,术后疼痛程度低。     

三孔法腹腔镜下胆囊、阑尾联合切除36例临床体会

目的:探讨三孔法腹腔镜下胆囊、阑尾同时切除这一手术方法的可行性。方法:全麻下腹腔镜三孔法先切除胆囊,然后调换进镜孔和调整显示器位置,再切除阑尾。结果:30例病人均治愈,顺利出院,无1例发生并发症。结论:三孔法腹腔镜胆囊、阑尾同时切除,不但省时、省力,同时1次手术解决1个疾病,创伤小,术后恢复快,并发症少,患者对疗效满意。     

Nd:YAG倍频激光治疗视网膜裂孔疗效观察

目的 评价掺钕钇铝石榴石倍频激光（Nd：YAG倍频激光）治疗视网膜裂孔的临床疗效。方法 应用Nd：YAG倍频激光治疗视网膜裂孔39例47眼。追踪观察是否成功封闭视网膜裂孔、阻止视网膜脱离的发生。结果 成功封闭视网膜裂孔的37例45眼，有效率95．7％，2例2眼发展为视网膜脱离而需手术治疗。结论 Nd：YAG倍频激光治疗视网膜裂孔安全、有效。成功的光凝治疗可封闭视网膜裂孔、阻止视网膜脱离。     

A large-bore teflon endoprosthesis with side holes for nonoperative decompression of the biliary tract in malignant obstructive jaundice

A large-bore Teflon tube with side holes was used for nonsurgical palliative bile drainage in eight patients with malignant tumors. The drainage period ranged from 5 to 26 weeks. The bile drainage through the endoprosthesis was regarded as optimal in two patients, satisfactory in four, and ineffective in two. Significant complications of the method are intervening bile duct infections, risk of sepsis, spontaneous dislodgement, and occlusion of the endoprosthesis.     

Active Bax and Bak are functional holins

The mechanism of Bax/Bak-dependent mitochondrial outer membrane permeabilization (MOMP), a central apoptotic event primarily controlled by the Bcl-2 family proteins, remains not well understood. Here, we express active Bax/Bak in bacteria, the putative origin of mitochondria, and examine their functional similarities to the λ bacteriophage (λ) holin. As critical effectors for bacterial lysis, holin oligomers form membrane lesions, through which endolysin, a muralytic enzyme, escapes the cytoplasm to attack the cell wall at the end of the infection cycle. We found that active Bax/Bak, but not any other Bcl-2 family protein, displays holin behavior, causing bacterial lysis by releasing endolysin in an oligomerization-dependent manner. Strikingly, replacing the holin gene with active alleles of Bax/Bak results in plaque-forming phages. Furthermore, we provide evidence that active Bax produces large membrane holes, the size of which is controlled by structural elements of Bax. Notably, lysis by active Bax is inhibited by Bcl-xL, and the lysis activity of the wild-type Bax is stimulated by a BH3-only protein. Together, these results mechanistically link MOMP to holin-mediated hole formation in the bacterial plasma membrane.