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.
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.
【摘要】 目的 探討腹腔鏡膽總管探查一期縫合的可行性和適應證及臨床價值。 方法 回顧性分析2007年7月—2010年10月72例膽管結石患者的臨床資料，采用三孔法腹腔鏡膽總管探查術，術中膽道鏡配合膽道手術器械取石，一期縫合膽總管進行治療。 結果 72例手術均獲成功，無中轉開腹，4例出現術后膽漏，經腹腔引流3~5 d治愈，無嚴重并發癥。術后住院4~7 d（平均4.4 d）。72例均獲隨訪，隨訪時間1~24個月（平均10個月）。術后1個月B型超聲，未發現膽道狹窄及殘余結石。 結論 腹腔鏡膽總管探查術后一期縫合膽總管，安全、有效、微創效果顯著，是臨床微創治療膽囊結石合并膽管結石的一種理想術式，值得臨床推廣應用。其關鍵是術中取盡結石和把握適應證，同時需要術者熟練掌握膽道鏡技術及腹腔鏡下膽總管切開縫合、打結等技術。【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.
目的 探討涼山州第一人民醫院醫務人員銳器傷職業暴露的危險因素及應對措施。 方法 對醫務人員在2011年8月1日－31日期間里的銳器傷發生情況進行問卷式和面對面提問式相結合的方式進行調查，共調查醫務人員1 112名，包括醫生288名，護士589名，醫技人員180名，其他55名；采用《醫務人員銳器傷調查問卷》進行篩查，篩查后與發生銳器傷的人員面對面交談，并填寫《醫務人員銳器傷危險因素調查表》。用醫務人員職業暴露監測系統（EPINeT）進行統計分析。 結果 發生銳器傷45例，發生率為4.05%，護士發生銳器傷的比例較高，達到了5.3%，醫生為4.5%，醫技人員較低為0.56%，其他人員發生銳器傷的可能性較小，經四格表的χ2檢驗，醫生與護士銳器傷的發生率差異無統計學意義（χ2=0.010，P＞0.05）。銳器傷發生的主要時機以抽血（占16%）、拔出動靜脈針（占14%）、雙手回套針帽（占14%）、手術縫針（占12%）以及將針頭放入銳器盒（占10%）為主；發生的場所以普通病房（占60%）和手術室（占22%）為主；銳器傷發生的器械以一次性注射器（占32%）、靜脈留置針（占18%）、真空采血針（占16%）和手術縫針（占14%）為主。 結論 醫生和護士是銳器傷發生的高危人群，應采取一系列措施降低其發生職業暴露的風險，包括增加醫護人員數量、加強職業培訓、禁止雙手回套針帽、采用安全留置針和使用皮膚粘合劑以及采用腹腔鏡、陰道鏡進行手術等措施，盡量降低醫護人員的職業暴露風險。
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 investigate the role of long chain non coding ribonucleic acid (LNcRNA) small nucleolar RNA host gene 14 (SNHG14) in regulating microribonucleic acid 223-3p (miR-223-3p) in alleviating sepsis associated lung injury in rats. Methods Sepsis rat models were established and the rats were randomly divided into SNHG14 upregulation group, SNHG14 upregulated control group, SNHG14 downregulation group, SNHG14 downregulation control group, miR-223-3p upregulation group, miR-223-3p upregulation control group, miR-223-3p downregulation group, miR-223-3p downregulation control group, and model group. Sham operation group was set up simutalously. All of them were administered through the tail vein. After 48 hours, the lung tissues was euthanized to detect the expressions of LncRNA SNHG14 and miR-223-3p. Tumor necrosis factor α (TNF- α), interleukin-1β (IL-1β), interleukin-18 (IL-18), lung wet weight/dry weight ratio (W/D) and the alveolar fluid clearance rate (AFC) were detected. Pathological changes in lung tissues were observed. Human NOD like receptor family protein 3 (NLPR3), cysteine-requiring aspartate protease 1 (caspase-1), and 1-aminocyclopropane-1-carboxylate synthase (ACS) genes and proteins expressions in lung tissues were detected. The dual luciferase reporter gene experiment was used to verify the targeted regulatory effect of LncRNA SNHG14 on miR-223-3p. Results Compared with the sham operation group, the model group showed increase in lung tissue LncRNA SNHG14 expression, serum inflammatory factor levels, W/D, pathological change quantification score, and lung tissue NLPR3, caspase-1 and ACS expressions (P<0.05), decrease in miR-223-3p expression and AFC (P<0.05). Compared with the model group and corresponding control groups, the SNHG14 upregulation group showed increase in LncRNA SNHG14 expression (P<0.05), and the SNHG14 upregulation group and the miR-223-3p downregulation group showed decrease in miR-223-3p expression and AFC (P<0.05), and increase in the levels of serum inflammatory factors, W/D, quantitative scores of pathological changes, and the expressions of NLPR3, caspase-1 and ACS in lung tissues (P<0.05). Compared with the model group and corresponding control groups, the expression of LncRNA SNHG14 in the SNHG14 downregulation group decreased (P<0.05), while the expression of miR-223-3p and AFC in the SNHG14 downregulation group and miR-223-3p upregulation group increased (P<0.05), which showed decrease in the levels of serum inflammatory factors, W/D, quantitative scores of pathological changes, and the expressions of NLPR3, caspase-1 and ACS in lung tissues (P<0.05). There were binding sites between LncRNA SNHG14 and miR-223-3p, and the former could negatively feedback targeted to regulate the latter. Conclusion Downregulation of LncRNA SNHG14 targets an increase in miR-223-3p expression and inhibit the NLRP3 pathway to alleviate sepsis related lung injury, which is related to the inhibition of inflammatory response, while upregulation of LncRNA SNHG14 negatively feedback targeting miR-223-3p and activated the NLRP3 pathway to exacerbate sepsis related lung injury.
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.
【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.
Due to the aging population intensifies, the number of people suffering from mild cognitive impairment (MCI) or dementia is expected to increase, which may lead to a series of public health and social health problems. In the absence of drugs to prevent the transformation of MCI into dementia, it is urgent to find effective non-pharmacological therapies to delay the progress of cognitive impairment. This article will review the diagnosis of MCI and the research progress of non-pharmacological therapies, focusing on the non-pharmacological therapies related to MCI in recent years, including exercise intervention, cognitive intervention, physical and mental exercise, dietary intervention, electroacupuncture, repeated transcranial magnetic stimulation, and multi-component intervention, in order to provide an effective treatment for preventing or delaying the progression of MCI to dementia.