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 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。
【Abstract】ObjectiveTo generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. MethodsThe published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. ResultsEEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. ConclusionEEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.
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)
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。
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)
ObjectiveTo explore the new hospital management method about diagnosis-related groups (DRGs), and put forward some strategic suggestions.MethodsIn March 2019, using literature research method, relevant documents were consulted to understand the research policy and background. In April 2019, the DRGs data and first pages of medical records of a tertiary grade A hospital in 2018 were obtained through field survey. The DRG with the largest quantity of patients was selected, and then the top two treatment centers ranked by the quantity of patients were selected for analysis.ResultsA total of 11 936 patients’ face sheets for medical records were investigated, covering 18 major disease categories (MDCs) and 93 DRGs. Treatment center A and B were the top two treatment centers ranked by the quantity of patients, covering 8 MDCs and 34 DRGs. There were 1 116 patients in treatment center A and 470 patients in treatment center B, with the same case-mix index (0.820). There was no statistically significant difference in the average length of hospital stay between the two treatment centers (t=−1.926, P=0.054). The average hospitalization expenses [(45 902.64±30 028.22) vs. (40 763.34±25 141.12) yuan, t=−3.260, P=0.001], drug expenses [21 481.43 (10 663.16, 34 251.64) vs. 11 740.36 (5 818.37, 21 572.09) yuan, Z=−9.812, P<0.001], and other expenses [138.00 (84.00, 178.00) vs. 120.00 (72.00,155.28) yuan, Z=−3.573, P<0.001] in treatment center B were higher than those in treatment center A. But the medical technology expenses [(7 319.11±3 781.52) vs. (10 995.61±4 784.55) yuan, t=12.324, P<0.001] and nursing expenses [(578.42±226.82) vs. (882.99±781.63) yuan, t=8.187, P<0.001] in treatment center B were lower than those in treatment center A.ConclusionsThe disease diagnosis and treatment specifications need to be strengthened and the process needs to be optimized. In the next hospital management, we should pay attention to key indicators to improve performance appraisal, standardize the diagnosis and treatment process to promote clinical path, and mine deep data to make performance management detailed.
Objective To assess the efficacy of naloxone for cardio-pulmonary-cerebral resuscitation (CPCR). Methods Randomized controlled trials (RCTs) involving naloxone for CPCR were identified from MEDLINE (1966 – Jun.2006), EMbase (1974 - Jun.2006), PubMed, The Cochrane Library (Issue2,2006), CBM(1978 - Jun.2006) and CNKI (1994 - Jun.2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis. Results Ten RCTs were included. The quality of included RCTs was low. All the patients were in-patients or out-patients receiving CPCR due to cardial arrest at the age of 18-75 years. Meta-analysis indicated that the resuscitation rate in naloxone group was significantly higher than the placebo group (Plt;0.00001). And the recovery of the brain function in naloxone group was better than in the placebo group(Plt;0.00001) Conclusions Naloxone is effective for CPCR and it may ameliorate its prognosis. Because of the low quality of included trials and the small sample size, more RCTs are required to assess the efficacy of naloxone for CPCR.
Objective To describe the clinical characteristics of polymyositis/dermatomyositis (PM/DM) with anti-aminoacyl-tRNA synthetase (ARS) antibody positive. Methods The clinical, laboratory and radiographic results of PM/DM patients hospitalized in our department from September 2014 to November 2017 were retrospectively analyzed. Results A total of 39 patients were diagnosed (14 cases positive for anti-Jo-1 antibody, 10 cases positive for non-anti-Jo-1 ARS antibodies, and 15 negative for ARS antibodies). The frequency of ARS antibodies positive patients who had interstitial lung disease was higher than those patients without ARS antibodies (P<0.05). Amyosthenia and mechanic's hand were more common in the patients with anti-Jo-1 positive (P<0.05) and the frequency of clinical amyopathic dermatomyositis in non-anti-Jo-1 positive patients was significantly higher (P<0.05). Conclusions The clinical characteristics are similar between anti-Jo-1-positive and non-Jo-1 ARS antibodies positive patients. Most PM/DM patients carrying anti-Jo-1 antibodies with interstitial lung disease own typical imaging characteristics of nonspecific interstitial pneumonia overlap organizing pneumonia (NSIP/OP). It can be diagnosed of non-anti-Jo-1 antibody syndrome although there is no clinical manifestation of myositis and anti-jo-1 antibody is negative.