Objetivos: El objeto de este trabajo es describir cuatro pacientes con distonía cráneocervical (DCC) tratados con Estimulación Cerebral Profunda (ECP). Además, investigamos la eficacia del tratamiento y los predictores de la evolución quirúrgica, por medio de la revision y análisis de publicaciones previas.Métodos: Cuatro pacientes con distonía cráneocervical (DCC) fueron tratados con ECP el globo pálido interno (Gpi) o del Núcleo Subtalámico (NST). Se realizaron búsquedas en Pubmed y Medline para obtener información detallada de pacientes que fueron operados con ECP para DCC. El punto principal que señala la eficacia de este tratamiento fue el cambio en la escala de Burke–Fahn–Marsden para Distonia (Puntuación de movimiento y discapacidad, BFMDRS- M/D) luego de la cirugía. Resultados: Setenta y cinco pacientes fueron incluidos en el conjunto de datos, incluyendo 69 pacientes con Gpi-ECP y 6 pacientes con NST - ECP. El promedio temporal de seguimiento fue de 28 meses luego de la cirugía. La mejoría promedio en la puntuación de la BFMDRS-M fue de 24.5 ± 11.2 en los exámentes preoperatorios y 8.1 ± 5.7 en los postoperatorios, al momento de la última evaluación, con un promedio de mejoría del 66.9% (p < 0.001). El puntaje promedio de la BFMDRS-D score fue de 8.1 ± 4.6 en el preoperatorioy and 3.6 ± 2.5 en el postoperatorio, con un promedio de mejoría del 56.0% (p < 0.01). Se encontraron correlatos positivos entre cada uno de las puntuaciones de movimiento y discapacidad preoperatorios y en las puntuaciones de movimiento y discapacidad y en los porcentajes de mejoría postoperatoria (r = 0.247, p = 0.034; r = 0.331, p = 0.034, respectivamente).Conclusión: La ECP en los núcleos GPi/NST es un tratamiento efectivo para pacientes con DCC médicamente refractaria, incluyendo aquéllos con síntomas preoperatorios severos. La edad al comienzo de la DCC y la duración de la enfermedad no predijeron la mejoría en las puntuaciones para el movimiento.
A large number of venipunctures are placed on the dorsal of the hand, and it is suitable for the majority of patients with the advantage of few complications. Here, the ulnar nerve on the dorsal was injured during peripheral intravenous catheter insertion, and a painful traumatic neuroma was discovered a week later. Through oral medication and topical lidocaine medicated plaster, the patient’s pain is greatly reduced, and allowed to engage in nearly all activities. Knowledge of this complication may help with its recognition and early treatment.
Abstract Background: This study aimed to observe the effect of lamellar keratoplasty (LK) after pre-Descemet’s membrane (pre-DM) suture healing of acute corneal hydrops (ACH). Methods: In a retrospective noncomparative case series, 11 patients (11 eyes) with ACH, who underwent pre-DM suture combined with intracameral air injection in the acute stage, underwent LK when the oedema subsided. During surgery, the diseased cornea was stripped layer by layer, and a mild scar in the deep stroma occasionally remained. The age, sex, diagnosis, scope of acute corneal oedema, size and location of scar after oedema healing, operation interval, postoperative best-corrected visual acuity (BCVA), astigmatism, and intraoperative and postoperative complications were recorded. Results: The average follow-up time was 15.45 ± 8.54 months (6–30 months). The average time from corneal suture to LK was 41.91 ± 36.39 days. After LK, the BCVA was 0.52 ± 0.18 (0.15–0.8), astigmatism on the front surface of corneal topography was 5.63 ± 1.28 D, and apparent optometry CYL was -4.50 ± 1.87 D. The central corneal thickness was 552.81 ± 62.81 μm (449–637 μm). Microperforation occurred in two cases. No other complications occurred in any patients until the last follow-up. Conclusions: LK can be performed earlier after the pre-DM suture of ACH. The combination of the two can shorten the overall course of the disease, significantly improve vision, and avoid the complications of penetrating keratoplasty.
The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.
To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified via MRI was the only factor associated with a positive surgical outcome.
Yonkenafil hydrochloride, a novel synthetic phosphodiesterase type 5 inhibitor, is a promising drug for the treatment of erectile dysfunction. The repeated-dose toxicity of yonkenafil hydrochloride was assessed in male and female beagle dogs. Twenty-four dogs were randomly allocated to four groups and administered yonkenafil hydrochloride orally at dosages of 0, 7, 30 or 120 mg/kg/day for 90 days followed by a 28-day recovery period. During the test period, clinical signs, mortality, body weight, food consumption, ophthalmoscopy, electrocardiography, hematology, serum biochemistry, urinalysis, organ weights, gross findings and histopathology were examined. There were no abnormal changes in the clinical observations except that gastrointestinal intolerance was observed in the 120 mg/kg/day group. The laboratory and histopathological examinations revealed yonkenafil hydrochloride toxicity to various organs, including the thyroid gland, liver, prostate, uterus and breast; at the end of the recovery period, this damage was resolved. The level of yonkenafil hydrochloride that resulted in no observable adverse effects in beagle dogs was 7 mg/kg/day.
Deep convolutional neural networks have been widely used for medical image segmentation due to their superiority in feature learning. Although these networks are successful for simple object segmentation tasks, they suffer from two problems for liver and liver tumor segmentation in CT images. One is that convolutional kernels of fixed geometrical structure are unmatched with livers and liver tumors of irregular shapes. The other is that pooling and strided convolutional operations easily lead to the loss of spatial contextual information of images. To address these issues, we propose a deformable encoder-decoder network (DefED-Net) for liver and liver tumor segmentation. The proposed network makes two contributions. The first is that the deformable convolution is used to enhance the feature representation capability of DefED-Net, which can help the network to learn convolution kernels with adaptive spatial structuring information. The second is that we design a Ladder-atrous-spatial-pyramid-pooling module using multi-scale dilation rate (Ladder-ASPP) and apply the module to learn better context information than the atrous spatial pyramid pooling (ASPP) for CT image segmentation. The proposed DefED-Net is evaluated on two public benchmark datasets, the LiTS and the 3DIRCADb. Experiments demonstrate that the DefED-Net has better capability of feature representation as well as provides higher accuracy on liver and liver tumor segmentation than stateof-the art networks. The available code of DefED-Net we propose can be found from https://github.com/SUST-reynole/DefED-Net.
Objective To investigate the comparison with corneal nerve injury and recovery of rabbits after LASIK and LASEK. Methods Selected thirty healthy, peal-bred New Zealand white rabbits, then divided into 6 groups randomly, 5 rabbits each group, 1 was normal control group, the remaining 5 groups as the experimental group. One eye underwent LASIK and LASEK on the contrast eye in the experimental group. The rabbits were killed at 1 day, 7 days, 1 month, 3 and 6months after surgery. Corneal nerves were stained with the gold chloride staining method. The changes in corneal nerve injury and recovery were observed after LASIK and LASEK with microscope. Results There were obvious differences in corneal nerve injury and recovery in different periods after LASIK and LASEK. Conelusions Corneal nerves are injured more severely and recover slower after LASIK than LASEK.
Key words:
Rabbit; LASIK; LASEK; Corneal nerve
In this cross-sectional study, consecutive Chinese Han ethnic inpatients in the Division of Cardiology, the First Affiliated Hospital of Soochow University from January 1, 2010 to December 31, 2013 were included. According to the exclusion criteria, 9 587 patients [1 604 with type 2 diabetes mellitus(T2DM)and 7 983 without T2DM]were obtained for final analysis. Logistic regression model was used to analyze the association of ApoB/A-1 ratio with T2DM and the possible interactions between ApoB/A-1 ratio and other risk factors. The results showed that the distribution of ApoB/A-1 ratio was positively skewed in Chinese Han ethic population. The median of ApoB/A-1 ratio of female was lower than that of male(0.68 vs 0.73, P<0.01). In all groups, the proportion of T2DM was increased with the raised ApoB/A-1 ratio. By the stratification analyses of sex, age, coronary artery disease, and the use of statins, ApoB/A-1 ratio was still correlated with T2DM. There existed significant interactions between ApoB/A-1 ratio and the smoking status or creatinine in T2DM. (Chin J Endocrinol Metab, 2017, 33: 321-325)
Key words:
ApoB/A-1 ratio; Diabetes mellitus, type 2; Cross-sectional study
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