To investigate the effects of fibrin glue on repair and regeneration of acute complete spinal cord injury. Methods Acute complete transaction spinal cord injury model were made in 10 adult healthy SD rats(female, weighing 250-300 g), randomized grouping: treated group(n=5) and control group(n=5). In the treated group, fibrin glue was implanted covering on the injury site and fill ing the lesion gap. In the control group, no treatment was given. At 4 weeks, the locomotor functions of the rats were detected by basso, beattie and bresnahan (BBB) score, then the means of immunohistochemistry were used to observe neurofilament(NF) and gl ial fibrillary acidic protein(GFAP). And image analysis was used to measure the quantify of the nerve fiber and the fibers area ratio of astrocyte. Results The BBB scores were 2.40 ± 0.51 in control group, 3.00 ± 0.45 in treated group, showing no significant difference (P gt; 0.05). By immunohistochemistry: a l ittle positive NF cells and GFAP frame were found in control group; more positive NF cells and GFAP frame were found in treated group, the cells and frame grew toward the center but did not arrive at the center. Image analysis showed the amount of never fibers in treated group (rostral region: 113.10 ± 20.75, caudal region: 73.60 ± 33.61) was more than that in control group (rostral region: 45.50 ± 17.18, caudal region 23.50 ± 8.20), showing significant difference. The fibers area ratio of astrocyte in treated group(rostral region: 33.75% ± 11.06%, caudal region: 27.75% ± 7.15%) was more than that in control group(rostral region: 23.78% ± 5.76%, caudal region: 19.78% ± 5.17%), showing significant difference (P lt; 0.05). Conclusion Fibrin glue can promote repair and regeneration of acute spinal cord injury.
Objective To conduct bibliometric analysis of systematic review and meta-analysis published in the Chinese Journal of Evidence-based Medicine. Methods Based on the Chinese academic periodical network as a data pool, literature on systematic reviews (involving meta-analysis) and clinical decision-making researches were retrieved in the Chinese Evidence-Based Medicine Magazine from 2001 to 2010, screened and categorized by the medical and hygienic standards of Chinese Library Classification (fourth edition), and then were counted and sorted. Results There were 425 articles about systematic reviews (involving meta-analyses) and clinical decision-making studies in the Chinese Evidence-Based Medicine Magazine, with an yearly increasing number. Basically, those articles involved all subjects such as clinical medicine, preclinical medicine, hygenics, pharmacy, and traditional Chinese medicine. Conclusion Development levels of evidence-based research in medical subjects are different, each of which has its own feature. Also, some systematic reviews do not strictly follow the Cochrane Handbook. Therefore, high-quality systematic review is still needed in each subject.
Objective To assess the correlation between obstructive sleep apnea-hypopnea syndrome (OSAHS) and hypertension. Methods Such databases as MEDLINE (1950 to April 2011), EMbase (1989 to April 2011), VIP (1989 to April 2011), WANFANG (1977 to April 2011), CBM (1978 to April 2011) and CNKI (1979 to April 2011) were searched to collect literatures about the correlation between OSAHS and hypertension. The literatures in conference proceedings and some unpublicized articles were also retrieved. All cohort studies and case control studies were included. Two reviewers independently collected the data, assessed the quality, and conducted the Meta-analysis by using RevMan5.1 software. Results Among the total 11 studies involving 4 019 participants were included, 1 was prospective cohort study and the other 10 were case control studies. The results of Meta-analyses showed that: a) the OSAHS was correlated with hypertension (P=0.16, RR=2.52, 95%CI 2.21 to 2.87); and b) the correlation between OSAHS and hypertension was related with the different grades of OSHAS (P=0.83, RR=1.84, 95%CI 1.53 to 2.22). The more severe grade the OSAHS, the greater possibility the hypertension. Conclusion OSAHS is significantly related with hypertension, and they may be the mutual risk factor for each other. The correlation between OSAHS and hypertension may be related with different grades of OSAHS.
目的 探讨凉山州第一人民医院医务人员锐器伤职业暴露的危险因素及应对措施。 方法 对医务人员在2011年8月1日－31日期间里的锐器伤发生情况进行问卷式和面对面提问式相结合的方式进行调查，共调查医务人员1 112名，包括医生288名，护士589名，医技人员180名，其他55名；采用《医务人员锐器伤调查问卷》进行筛查，筛查后与发生锐器伤的人员面对面交谈，并填写《医务人员锐器伤危险因素调查表》。用医务人员职业暴露监测系统（EPINeT）进行统计分析。 结果 发生锐器伤45例，发生率为4.05%，护士发生锐器伤的比例较高，达到了5.3%，医生为4.5%，医技人员较低为0.56%，其他人员发生锐器伤的可能性较小，经四格表的χ2检验，医生与护士锐器伤的发生率差异无统计学意义（χ2=0.010，P＞0.05）。锐器伤发生的主要时机以抽血（占16%）、拔出动静脉针（占14%）、双手回套针帽（占14%）、手术缝针（占12%）以及将针头放入锐器盒（占10%）为主；发生的场所以普通病房（占60%）和手术室（占22%）为主；锐器伤发生的器械以一次性注射器（占32%）、静脉留置针（占18%）、真空采血针（占16%）和手术缝针（占14%）为主。 结论 医生和护士是锐器伤发生的高危人群，应采取一系列措施降低其发生职业暴露的风险，包括增加医护人员数量、加强职业培训、禁止双手回套针帽、采用安全留置针和使用皮肤粘合剂以及采用腹腔镜、阴道镜进行手术等措施，尽量降低医护人员的职业暴露风险。
【摘要】 目的 探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。 方法 回顾性分析2007年7月—2010年10月72例胆管结石患者的临床资料，采用三孔法腹腔镜胆总管探查术，术中胆道镜配合胆道手术器械取石，一期缝合胆总管进行治疗。 结果 72例手术均获成功，无中转开腹，4例出现术后胆漏，经腹腔引流3~5 d治愈，无严重并发症。术后住院4~7 d（平均4.4 d）。72例均获随访，随访时间1~24个月（平均10个月）。术后1个月B型超声，未发现胆道狭窄及残余结石。 结论 腹腔镜胆总管探查术后一期缝合胆总管，安全、有效、微创效果显著，是临床微创治疗胆囊结石合并胆管结石的一种理想术式，值得临床推广应用。其关键是术中取尽结石和把握适应证，同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】 Objective To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture. Methods We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation. Results All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone. Conclusions Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.
Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.
Objective To improve the knowledge of bone marrow tuberculosis by summarizing the risk factors, clinical features, diagnosis, therapeutic response and prognosis. Methods The medical records of 62 patients with bone marrow tuberculosis from January 2004 to December 2014 were retrospectively analyzed. Results The patients included 34 males and 28 females. Their age ranged from 15 to 80 years with a mean age of 45.3±35.7 years. Among them, 21 cases (33.9%) had one or more risk factors such as advanced kidney disease or liver disease, chronic respiratory disease, rheumatoid immune system disease and diabetes. No specific clinical features were found in patients with bone marrow tuberculosis, and the most common symptom was fever (98.4%). Blood routine examination revealed that variety of hematological abnormalities include leucopenia, thrombocytopenia, anemia or pancytopenia occurred in 59 patients (95.2%). Chest CT scan showed typical disseminated tuberculosis in 22 patients (36.1%), secondary pulmonary tuberculosis in 6 patients (9.8%), and atypical manifestations of tuberculosis in 26 patients (42.6%). The common patterns of abdomen abnormalities on ultrasonic testing or CT scan were hepatosplenomegaly. Bone marrow biopsy was performed in all the 62 patients, among them, the needle-aspirated bone marrow specimens showed granulomatous lesions in 53 patients (85.5%). The acid-fast staining of bone marrow smear was performed in a total of 57 patients, which was positive in 28 patients (49.1%). Twenty-five patients completed phone call follow-up, and 8 patients died from bone marrow tuberculosis and its complications. Conclusions Bone marrow tuberculosis is a rare manifestation of disseminated tuberculosis. The common symptom of this disease is pyrexia . The clinical presentations and laboratory examinations of this disease are nonspecific. Bone marrow biopsy is a major method for diagnosis. Part of patients with bone marrow tuberculosis lack of imaging proof for lung lesion. Therefore, we should heighten vigilance for bone marrow tuberculosis in patients with fever of unknown origin.
Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．
目的 了解艾滋病高发区医务人员血源防护情况以及培训所取得的效果。 方法 采用自行设计的问卷，对凉山州某医院参加培训的职工进行培训前后调查。 结果 培训前89人参加调查，培训后93人参加调查；女性、护士和初级职称者占绝大多数；培训前调查参加者中84.3%接受过预防锐器伤培训，79.8%工作中被锐器刺伤，38.2%报告过职业暴露，95.5%接种过乙肝疫苗；6道知识考核题培训后答对率比培训前均有不同程度的提高，其中4道比较具有统计学上的意义（P＜0.05）。 结论 该院医务人员已具备一定职业防护意识，对一些知识点掌握较好，但培训强化可提高职业暴露报告依从性和预防治疗及时性，更好维护艾滋病高发区医务人员的职业健康。
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.