Objective To formulate an evidence-based treatment for a patient newly diagnosed with follicular lymphoma. Methods Based on the clinical questions we raised, evidence including systematic reviews and randomized controlled trials was collected from ACP Journal Club (1991 to November 2007), The Cochrane Library (Issue 4, 2007) and PubMed. The retrieved studies were further critically appraised. Results The addition of rituximab to chemotherapy (R-chemo) was superior to chemotherapy alone in patients with follicular lymphoma. The regimen of CVP chemotherapy plus rituximab (R-CVP) was administered to the patient. After 4 courses of R-CVP, the patient had a complete response (CR). Conclusion In newly diagnosed patients with follicular lymphoma, R-chemo is an effective treatment regimen.
目的：研究心肌灌注显像（MPI）经CT衰减校正（CTAC）后伪影的产生及其对临床诊断的影响。方法：回顾性分析按Bayesian理论，冠心病患病率＜5%的48例受检者所行的72例次MPI（负荷41例次，静息31例次），图像在未行CTAC时显示正常者进行研究。将左心室心肌划分为20个节段，半定量分析（0分=放射性分布正常；1分=放射性分布轻度减低；2分=放射性分布中度降低；3分=放射性分布重度减低；4分=放射性分布缺损）各心肌节段在CTAC后放射性分布变化情况。结果：72例次MPI中，16例次（22.2%）的75个心肌节段（均在左心室心尖、前壁、前间壁区域）在CTAC后出现了放射性分布不同程度的减低。75个受累节段中分别有51、21和3个节段评分增加了1、2和3分，平均每个心肌节段评分增加了1.3分。41例次负荷MPI和31例次静息MPI中，分别有9例次（21.9%）的39个心肌节段、7例次（22.6%）的36个心肌节段在CTAC后出现了放射性分布减低，负荷与静息MPI相比，CTAC后发生心肌节段放射性分布减低的概率（χ2＝2.84，P＞0.05）与程度（u＝0.54，P＞0.05）均无显著统计学差异。10例负荷/静息MPI都满足纳入标准而纳入研究者中，4例的负荷/静息MPI在CTAC后，出现了相同部位（尖前壁、尖下壁）、相同程度（评分均增加了2分）的灌注降低；3例出现了同一部位，但不同程度的灌注减低；另有3例出现了不同部位心肌节段的灌注减低。CTAC后出现心肌节段灌注减低者与未出现者相比年龄、性别构成无统计学差异。结论：分析SPECT/CT心肌灌注图像时，应同时分析CTAC前后的灌注图像。对于只在CTAC后出现的灌注缺损，需要考虑可能存在CT与SPECT图像配位不准。
Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
Objective To determine the effects of controlled hypotension (CH) on cerebra1 blood flow, cerebra1metabolism, and cognitive functions. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to 2008), EMbase (1974 to 2008), The Cochrane Library (Issue 2, 2008), CBM (1978 to 2008), and CNKI (1994 to 2008). The quality of included trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by The Cochrane Collaboration was used for statistical analysis. Results Nine RCTs involving a total of 295 patients were included. Most of the studies were of poor methodological quality. Meta-analysis was performed because the outcomes were the comparisons of the means of several repeated measures, and so a descriptive analysis was conducted. There were no significant differences in cerebral blood flow velocity, hypoxia-induced metabolites, and cognitive function between the CH group and the control group (Plt;0.05). But the S100B protein level in cerebrospinal fluid or blood was significantly higher in the CH group than that in the control group (Plt;0.02). Conclusion CH has no adverse effects on cerebra1 blood flow, cerebra1 metabolism, or cognitive functions. But isoflurane-induced hypotension may increase the release of S100B, indicating worse brain injury. The above conclusions were made from the limited evidence, and more rigorous RCTs are needed.
Objective To study the application, safety and efficiency of tetracaine sprayed through thyrocricoid puncture before intubation in intensive care unit ( ICU) . Methods Forty-one patients ready to undergo intubation, admitted in ICU from November 2009 to February 2010, were recruited in the study. They were randomly divided into a tetracaine group and a control group. 2% tetracaine was sprayed through thyrocricoid puncture before intubation in the tetracaine group but not in the control group. The hemodynamic variables and SpO2 at baseline ( T0 ) , beginning of intubation ( T1 ) , 1 min after intubation ( T2 ) , and 5 min after intubation ( T3 ) were recorded. The dosage of propofol and vasoactive agents, the incidence of hypotension, the times of intubation, and complications were also recorded. Results The variance rate about heart rate ( HR) , mean arterial pressure ( MAP) and rate pressure production on time of T1 and T2 were significantly lower in the tetracaine group than those in the control group ( P lt; 0. 05) . There was no difference about the incidence of successful intubation and hypoxia ( P gt; 0. 05) . The dosage of propofol during induction and vasoactive agents after intubation in the tetracaine group were less than those in the control group ( P lt;0. 05) . The incidence of hypotension after intubation in the tetracaine group was 35% , which was lower than 61. 9% in the control group ( P lt;0. 05) . There was no any complications and adverse accidents in the tetracaine group. Conclusions It is safe and simple to spray tetracaine through thyrocricoid puncture before intubation in ICU, which can effectively stabilize the hemodynamics, and decrease the dosages of propofol and vasoactive agents.
OBJECTIVE: To study the therapy effect of improved bilateral tibia lengthening. METHODS: From May 1997 to May 2000, 32 patients (varus knee deformity in 8 cases) with low stature were adopted in this study. Among them, there were 26 females and 6 males, aged from 18 to 45 years old. Operative procedures included: 1. tibia osteotomy 1 cm distal from tibia tuberosity and fibula osteotomy 10 cm proximal from lateral malleolus; 2. fixation of the tibia osteotomy with interlocking nail and locking the proximal nail; 3. fixation of the lengthening apparatus; 4. lengthened bilateral tibia 0.7 mm per day; 5. removed the apparatus and locked the distal nail 2 weeks later after limb lengthening was over. RESULTS: The mean distance of lengthening was 8.5 cm (ranged 3.5 to 12.0 cm), the mean duration of lengthening was 128 days(ranged 53 to 180 days), and the mean time of bone union was 180 days (ranged 120 to 270 days). Followed up for 1 to 3 years, 98% patients felt satisfactory in lengthening, gait and joint movement. CONCLUSION: The improved bilateral tibia lengthening technique is recommended for advantage of short time of bone union, less complication and correcting the varus deformity of knee simultaneously.
Objective To isolate and purify the melanoma stem cells (MSC) in choroidal melanoma OCM-1 cells. Methods OCM-1 cells were resuscitated, and after cultured in standard Dubecco's modifided Eagle's medium (DMEM)/F12, they were cultured in serum-free medium (SFM). The cultured MSC were isolated and purified, and the positive rate of CD133, the specific markers of neurostem cells, was observed by flow cytometry (FCM). The 6th generation of the cells were stained by musashi-1 immunocytochemistry, and the rate of the positive cells was observed under the microscope. Results After the Adherent OCM-1 cells cultured in SFM, the number of the adherent number decreased obviously. The cells at the 6th generation grew as the suspended gobbets, which represented the typical grow manner of the stem cells. Positive CD133 could be found in the cells of different generations, which was 2.5％, 21.7％, and 57.8％ in the non-isolated OCM-1 cells, the 1st generation of isolated cells, and the 2nd generation cells, respectively. The positive rate of CD133 in the cells at the sixth generation was 79.8% with b positive expression of musashi-1. Conclusion MSC is in the human choroidal melanoma OCM-1 cells. The suspended stem cells may be purified by limited differentiation and serial passage in SFM. (Chin J Ocul Fundus Dis, 2007, 23: 87-90)
Objective To investigate the survivability of ret inal ganglion cells (RGC) after optic nerve crush with intraocular injection of schwann cells(SC) derived neurotrophic (SCNA) in vivo． Methods Schwann cells of 3～5 day newborn mice were cultured,conditioned media without serum was collected,ultraspeed centrifugalized,and frozen-dry.SD rats were divided into normal contrl,crush control,medium treatment and SCNA treatment groups,and 20 eyes in every group.RGC of adult rats were labelled with flu orogold.Seven days later,the optic nerve was intraorbitally crushed and SCNA was injected into the vitreous on the 5th,7th,21th and 28th day after crush,the number of RGC were counted respectively. Results The densities of RGC began to decrease on the 7th day after injury,the number of RGC was 70.2% and 40.5% of normal controls on the 14th and 28th day,respectively .In the group with SCNA injection,RGC densities decreased on the 7th day,but RGC densities were much higher then that of controls on the 14th,21th,and 28th day after injury (Plt;0.01). Conclusions SCNA administered intraocularly at the time of crush of optic nerve can protect RGC from injury and death of the cells. (Chin J Ocul Fundus Dis，2000，16：1-70)
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
Objective To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade. Methods The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed. Results Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, Plt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, Plt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, Plt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06). Conclusion Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.