摘要:目的: 評估手術、栓塞及γ刀綜合治療腦動靜脈畸形的療效。 方法 :回顧性分析了我科自2002年3月至2009年7月期間綜合治療的43例腦AVM患者,分析評估這43例腦AVM的臨床特點及治療效果,隨訪患者并對其進行GOS評分。 結果 :本組病例采取栓塞＋手術治療3例、栓塞＋γ刀治療26例、手術＋γ刀治療11例、栓塞+手術＋γ刀治療3例。術后隨訪28例,隨訪時間4月至7年6月,GOS評分5分者25例,患者均能重新回到工作或學校;GOS評分4分者2例,患者生活能夠自理;GOS評分1分者1例,患者死亡。 結論 :對大型、功能區、有深部靜脈引流的腦AVM綜合治療有一定的優越性,它不僅使腦AVM治愈率明顯提高,而且與治療相關的各種并發癥和病死率也明顯降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
摘要:目的： 檢測大腸癌組織中Kras基因的突變情況以指導臨床治療。 方法 ：通過提取15例大腸癌石蠟組織中的DNA并進行PCR擴增,之后采用國際金標準方法直接測序法進行檢測獲得突變信息。 結果 ：15例大腸癌石蠟組織樣本中Kras有4例發生突變,突變率為266%。值得注意的是發現一個新的突變位點密碼子42,并且與密碼子12突變共存。 結論 ：密碼子42的突變進一步證明Kras突變不僅局限于密碼子12,13,61,還有與密碼子12共存的42位突變。Abstract: Objective: To detect the mutation status of Kras gene in colorectal cancers and to assist the clinical treatments Methods : DNA was extracted from fifteen formalinfixed, paraffinembedded tumor samples of colorectal cancers, and then the fragments containing codons 12,13 and codon 61 were amplified by PCR The sequences were indentified by direct sequencing which is gold standard for the detection of mutation Results : In the 15 samples of colorectal cancer patients, 4 mutations were observed, with 2 in codon 12 and 2 in codon 13 Suprisingly, a novel point mutation at codon 42 of Kras was found, and coexisted with mutation in codon 12 Conclusion : Except for codons 12,13,61 mutation, Kras has other mutation at codon 42 with coexisted with codon 12 point mutation
ObjectiveTo explore the characteristics of induced sputum microbiome in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsInduced sputum samples from 55 patients with AECOPD and 45 patients with stable COPD were analyzed by sequencing of 16S rRNA gene. Microbiota was measured by alpha diversity, beta diversity and LDA effect size analysis (LefSe).ResultsThe microbiome diversity of induced sputum in the AECOPD group was lower than that in the stable COPD group. The microbiome richness in the AECOPD group was higher than that in the stable COPD group. The microbiome structure changed in the AECOPD group compared with the stable COPD group. The proportion of some common pathogens got enriched. The levels of hypersensitive C reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and Global Initative for Chronic Obstructive Lung Disease (GOLD) grade were negatively related to the diversity of microbiome in the AECOPD group.ConclusionsThe microbiome diversity of induced sputum in AECOPD patients is decreased, and is negatively correlated with the levels of hs-CRP, IL-8, TNF-α and GOLD grade. There are differences in the microbiome structure between AECOPD and stable COPD patients. Some enrichment of common pathogens are found in the induced sputum of patients with AECOPD. These results suggest that there is a significant bacterial dysbiosis in patients with AECOPD.
ObjectiveTo evaluate visual field changes in early mild Parkinson's disease. Methods A total of 66 eyes of 33 cases with early mild Parkinson's disease and 72 eyes of 36 age-matched normal individuals were enrolled into the study. Humphrey Field Analyzer II was applied for central visual field test. The visual field indices of mean deviation (MD) and pattern standard deviation (PSD) were analyzed to evaluate the location and the characteristics of visual field defect in this study. ResultsVisual field indices MD (-3.4±2.5) dB was significantly changed in patients with PD when compared to the controls (-0.6±1.7) dB. PSD (4.3±2.6) was significantly higher in patients with PD than that in the control group (2.1±1.8) dB. Glaucoma hemifield test (GHT) assessment was within normal limits in the controls. Of the 33 patients (66 eyes) in PD, GHT showed outside normal limits in 31 eyes, borderline in 8 eyes, and within normal limits in 27 eyes. 31 eyes outside normal limits appeared glaucomatous visual field defects, in which 16 with nasal step and 5 with arcuate defect. ConclusionsVisual field indices including MD and PSD in early mild patients with PD were significantly worse than that in the controls group. GHT abnormalities could be found in early mild PD patients with visual field defects, including pericentral scotoma and nasal step, which mimicked glaucomatous changes.
Schwannoma originating from the common bile duct is rare. We presented a patient who was diagnosed with biliary cystadenoma preoperatively and pathologically confirmed as a choledochal Schwannoma, analyzed the CT and MRI imaging manifestations, and illustrated its anatomical and pathological basis, and to improve the understanding of clinicians and radiologists for choledochal Schwannoma.
Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH), but the visual acuity and MH closure rate remains to be further improved. After removal of posterior vitreous cortex, the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH. During the circumferential peeling, the ILM is not removed completely from the retina but is left attached to the edges of the MH. The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades. Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy, especially for MH with large diameter and unhealed MH after ILM peeling. Compared with conventional vitrectomy combined with ILM peeling, inverted ILM flap technique can enhance MH closure and improve visual acuity. Due to lack of large sample observation in clinical trials of inverted ILM flap technique, we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.
ObjectiveTo observe the changes of retinal microstructure in lamellar macular hole (LMH) after vitrectomy.MethodsA retrospective clinical observational study. Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People’s Hospital from January 2014 to September 2018 were included in this study. Among them, 14 patients (15 eyes) were males and 26 patients (26 eyes) were females, with an average age of 67.8±8.6 years. There were 37 eyes with a lens and 4 eyes with an IOL. There were 29 eyes with LMH of tractional type, 7 eyes of degenerative type, and 5 eyes of mixed type. All patients underwent BCVA and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. After the surgery, the same equipment and method before the surgery were used for relevant examination. The changes of BCVA, CRT, and MRT before and after surgery were observed. Continuous variables were compared by t test.ResultsAt the last follow-up, the mean logMAR BCVA was 0.37±0.26. Compared with before surgery, the difference was statistically significant (t=5.98, P＜0.01). The mean CRT and MRT were (245.2±90.8) and (347.0±46.7) μm, respectively. Compared with before surgery, the differences were statistically significant (t=-2.49, -5.24; P＜0.05, ＜0.01). CRT and MRT changed greatly within 6 months after surgery, and then tended to be gentle. Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery, ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye. Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery, there were still 4 eyes with retinal cavity, but all the retinoschisis were disappeared. Among the 5 eyes with retinal cavity of degenerative type before surgery, there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone. Among 10 eyes with a follow-up time of equal or greater than 24 months, the macular ganglion cell complex partially atrophied in 6 eyes, and the nerve fiber layer separated in 2 eyes. There was no full-thickness macular hole after surgery.ConclusionFor most LMH patients, vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.
The Technical Specifications for Evaluation of Age-friendly Medical Institutions is a set of evaluation standard for admittance of age-friendly medical institutions. The standard was prepared by Beijing Geriatric Hospital, organized by Beijing Municipal Health Commission and issued by Beijing Municipal Bureau of Market Supervision and Administration in 2021. The standard evaluates the construction of age-friendly medical institutions in four profiles, involving age-friendly culture, age-friendly management, age-friendly service, and age-friendly environment, and standardizes the specific links in the medical institutions evaluation and acceptance, displaying important guiding value for construction activities of national age-friendly medical institutions.
Objective To observe the thickness of the retina, retinal nerve fiber layer (RNFL), choroid and sclera among the difference posterior sclera shape (PSS) in high myopia (HM). Methods Sixty HM patients (96 eyes) were enrolled in this study. There were 18 males (25 eyes) and 42 females (71 eyes). The mean age was (51.32±10.06) years. The mean spherical equivalent was (-14.38±6.31) DS. The mean axial length was (29.49±2.44) mm. The eyes were evaluated from deep range imaging optical coherent tomography (DRI-OCT) Atlantis 3D model, and divided as four groups include PSS-Ⅰ (27 eyes), PSS-Ⅱ (46 eyes), PSS-Ⅲ (11 eyes) and PSS-Ⅸ (12 eyes) according to the Curtin classification method. The thickness of the retina, RNFL, choroid and sclera were measured in the EDTRS Grid area. Results There were statistically significant differences in the thickness of retina of the central, first circle, second circle in the EDTRS Grid area among PSS-Ⅰ, PSS-Ⅱ, PSS-Ⅲ and PSS-Ⅸ groups (F=4.48, 5.03, 4.98; P＜0.01). There was no statistically significant differences in the thickness of RNFL among four groups (F=0.13, P=0.93). There was no statistically significant differences in the central choroidal thickness (F=0.31, P=0.81). There were statistically significant differences in the first circle, second circle choroidal thickness among four groups (F=2.86, 2.96; P=0.04, 0.04). There was no statistically significant differences in the thickness of sclera under macular fovea among four groups (F=0.80, P=0.49). Conlusions There are changes of thickness of the retina, choroid present in the difference EDTRS Grid area among the difference PSS in HM, and changes in PSS-Ⅸ is most obvious.