【摘要】 目的 探讨乳突根治术后耳内窥镜换药与常规换药相比是否具有优势。 方法 2003年3月-2008年10月对89例共89只耳行开放式乳突根治术患者按随机数字表法随机分为试验组及对照组，试验组45例45只耳采用耳内窥镜换药，对照组44例44只耳常规换药；分别观察试验组和对照组的干耳人数及干耳的时间，计算干耳率及干耳的平均时间。 结果 试验组45只耳中42只干耳，干耳率93.3％；对照组44只耳中40只干耳，干耳率90.9％。两组比较差异无统计学意义（Pgt;0.05）。试验组42例干耳患者平均干耳时间为术后（50.8±13.4） d，对照组40例干耳患者平均干耳时间为术后（60.7±12.2） d；两组比较，差异有统计学意义（Plt;0.001）。 结论 中耳乳突根治术后耳内窥镜下换药与常规换药相比不能显著提高干耳率，但能有效缩短干耳时间。【Abstract】 Objective To evaluate the application of otoendoscope in dressing change after mastoidectomy. Method Between March 2003 and October 2008, 89 patients (89 ears) underwent mastoidectomy in Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University and in Department of Otolaryngology, Nuclear Industry 416 Hospital of Chengdu. The patients were randomly divided into two groups by simple randomization (trial group and control group). Forty-five patients in the trial group underwent the dressing change under otoendoscope, while 44 patients in the control group under the routine method. The ear drying rate and the ear drying time in the two groups were observed. Results The ear drying rate was 93.3% (42 dry ears)in the trial group, and was 90.9% (40 dry ears) in the control group; the difference between the two groups was not significant (Pgt;0.01). The ear drying time was (50.8±13.4) days in the trial group and was (60.7±12.2) days in the control groups; the difference between the two groups was significant (Plt;0.001). Conclusion Dressing change under the otoendoscope after mastoidectomy may not improve the ear drying rate but can shorten the ear drying time.
ObjectiveTo systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries. MethodsWe searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01). ConclusionCurrent evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
慢性阻塞性肺疾病( COPD) 是由吸烟诱发, 以气流持续受限为特征, 与CD4 + T 细胞及CD8 + T 细胞密切相关的由炎症及自身免疫反应引起的疾病[ 1] 。CD8 + T 细胞发挥效应及其所受调节的机制是COPD 炎症持续放大且戒烟后也不能缓解的关键, 对其在COPD 炎症中免疫作用及机制的研究有助于突破COPD 抗炎治疗和免疫调节治疗的难点, 对遏制甚至逆转COPD 炎症发展进展过程具有重要意义。Tc17 细胞是近年发现的一种分泌前炎症细胞因子IL-17 的CD8 + T 细胞亚群, 其分泌IL-17、IL-21、 IL-22等细胞因子, 与肺部炎症、哮喘、类风湿性关节炎等炎症免疫性疾病关系密切。在COPD 的肺部炎症中, Tc17 细胞很可能是连接CD4 + T 细胞和CD8 + T 细胞的另一条重要途径, 共同参与COPD 的炎症和免疫方面的机制。
ObjectiveTo compare the clinical outcomes of laparoscopic magnetic compression cholangiojejunostomy (LMCCJ) with laparoscopic hand-sutured cholangiojejunostomy (LHSCJ). MethodsA retrospective case-control study was performed. From January 2019 to May 2022, 37 patients, who underwent laparoscopic treatment in this hospital, were enrolled in this study. There were 16 cases in the LMCCJ group and 21 cases in the LHSCJ group. The demographic information, procedure time to complete bilioenteric reconstruction, postoperative hospital stay, operative complications, magnets expulsion time, and follow-up results were collected and analyzed. ResultsThere were no statistical differences in the baseline data such as the gender, age, composition of primary diseases, preoperative total bilirubin, and preoperative common bile duct diameter between the two groups (P＞0.05). The outer diameter of the magnets was (10.50±0.97) mm, the expulsion time of the magnets was (49.69±37.58) d, and the expulsion rate of the magnets was 100% (16/16). There was no intestinal obstruction or gastrointestinal perforation caused by the retention of the magnets. The procedure time to complete bilioenteric reconstruction in the LMCCJ group was statistically shorter than that in the LHSCJ group [(11.31±3.40) min vs. (24.81±3.40) min, t=11.96, P＜0.01]. There was no statistical difference in the total bilirubin level at the first week after surgery between the two groups (U=142.0, P=0.80). The postoperative hospital stay in the LMCCJ group was longer than that in the LHSCJ group [(28.31±14.11) d vs. (16.19±7.56) d, t=3.36, P＜0.01]. During the perioperative period, there was no bleeding or biliary infection in the two groups, but one case of biliary leak in the LHSCJ group. In all 37 patients were followed-up for (548.8±259.2) d. During the follow-up period, the incidence rates of biliary intestinal anastomosis stenosis, tumor recurrence, and mortality had no statistical differences between the two groups (P＞0.05). ConclusionFrom the results of comparative analysis in this study, it can be concluded that LMCCJ is not only safe equally, but also easier and less time-consuming as compared with LHSCJ.
目的 探讨伴颞下颌关节紊乱病（TMD）的成人正畸患者的心理社会因素。 方法 2009年5月－2011年12月伴TMD的成人正畸患者42例为观察组，无矫正要求、伴TMD的错牙合患者50例为对照组。采用九十项症状清单（SCL-90）、艾森克人格问卷（EPQ）进行测试，同时进行TMD调查。 结果 观察组与对照组相比，得分较高的有强迫、焦虑、抑郁、人际关系敏感等因素，差异有统计学意义（P＜0.05）；观察组患者P量表、N量表得分高于对照组，差异有统计学意义（P＜0.05）。 结论 伴TMD的成人正畸患者心理健康问题普遍存在,倾向于神经质和精神质的人格特征。
目的 比较更昔洛韦联合甲泼尼龙综合疗法和甲泼尼龙综合疗法治疗病毒性视神经炎的疗效。 方法 将2008年10月－2010年3月入院41例（60只眼）病毒抗体检测阳性的病毒性视神经炎患者随机分为治疗组，21例30只眼）和对照组（20例30只眼）。于治疗前和治疗第3、7、14、30、90、180天观察两组患者的视力、视野。 结果 两组患者的视力、平均视野缺损治疗组采用更昔洛韦联合甲泼尼龙综合疗法，对照组采用甲泼尼龙综合疗法。均随时间得到改善（P＜0.001）。两组患者视力在治疗的第3天开始恢复，30 d治疗组视力明显优于对照组（P＜0.05），治疗180 d时两组视力改善无差异（P＞0.05）；治疗组与对照组分别在第7天和第14天平均视野缺损开始恢复（P＜0.001）。 结论 更昔洛韦联合甲泼尼龙综合疗法较单纯甲泼尼龙综合疗法治疗病毒性视神经炎能更快提高患者视力、恢复视野、改善患者视觉质量。
ObjectiveTo study the expressions of microRNA-221 (miR-221) and the protein of phosphatase and tension protein homologue (PTEN) in the proximal and distal stumps after sciatic nerve injury in rats and their correlation with the repair of peripheral nerve injury, so as to provide a new target for clinical diagnosis of peripheral nerve injury.MethodsNinety-six male Sprague-Dawley rats of SPF grade were selected to establish sciatic nerve injury models. Twenty-four rats were sacrificed at 0 (immediately after operation), 1, 4, and 7 days after operation. The proximal and distal sciatic nerve fragments were taken under aseptic conditions. The expression of miR-221 was detected by real-time fluorescent quantitative PCR, and the expression of PTEN protein was detected by Western blot and immunofluorescent staining. The relationship between miR-221 and PTEN was verified by dual-luciferase reporter gene. At the same time, the ultrastructure of nerve stump was observed by transmission electron microscopy.ResultsThe results of real-time fluorescent quantitative PCR, Western blot, and immunofluorescence staining showed that the relative expression of miR-221 in the proximal and distal stumps increased gradually with time, and the relative expression of PTEN protein decreased gradually, and the differences between different time points after operation were significant (P<0.05). At 1, 4, and 7 days after operation, the relative expression of miR-221 in proximal stump was significantly higher than that in distal stump, and the relative expression of PTEN protein in proximal stump was significantly lower than that in distal stump (P<0.05). Dual-luciferase reporter gene suggested that PTEN was the target for miR-221. Transmission electron microscopy observation showed that the normal morphological structure was observed at 0 day after operation, and the proliferation of Schwann cells and degeneration of axons and myelin sheaths gradually increased with time. There was no significant difference between proximal and distal stumps at 1 day after operation. At 4 and 7 days, Schwann cells proliferated more in proximal stump than in distal stump, and the degeneration of axons and myelin sheaths was less.ConclusionAfter sciatic nerve injury in rats, the up-regulation of the miR-221 expression targets the down-regulation of PTEN expression, which results in the difference of expression levels of miR-221 and PTEN in proximal and distal stumps. This phenomenon may play a role in promoting nerve repair after peripheral nerve injury.