Objective To study the ultrastructure of macular puck er (MP) from the patients with rhegmatogenous retinal detachment (RRD) and the mechanism associated with its development． Methods Twenty specimens of MP surgically removed by vitrectomy from 13 patients were dissected into two layers in each of them．The ultrastructure of two layers,i,e,near the vitreous and near the retina,was studied with electron microscopy． Results Seven sections of the near vitreous ones appeared prodominant collagen deposits and a few of epithelial like cells,and pigment particles might be present in the cytoplasm．While cells with foot processes were found in 13 membrane sections near the retina and increasing number of various types of cells rich in collagen around were observed including fibroblast like cells and glial cells． Conclusion The findings suggest that the MP after surgery of retinal detachment may possess a characteristic lamination,and posterior hyaloid cortex was involved in the developmetn of MP． The adhesion between posterior hyaloid cortex and macular area might be a key factor for forming MP． (Chin J Ocul Fundus Dis, 2001,17:52-54)
Objective To systematically review the effectiveness and safety of autologous implantation of stem cells for diabetic peripheral neuropathy (DPN). Methods Randomized controlled trials on relevant studies were retrieved in databases including CBM (1978-2011.6), CNKI (1979-2011.6), MEDLINE (1950-2011.6), PubMed (1950-2011.6), EMbase (1970-2011.6) and The Cochrane Library (Issue 3, 2011). References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software.Results Four RCTs involving 68 patients (136 limbs) were included, most of which were low in methodological quality. The results of meta-analysis indicated that, autologous stem cell therapy improved or even eliminated DPN symptoms including pain, numbness, and cold sensation in the limbs, intermittent limping, and rest pain. Compared with the routine therapy, autologous stem cell therapy improved tibial sensory nerve conduction velocity (MD=5.75, 95%CI 3.86 to 7.64, Plt;0.000 01), tibial motor nerve conduction velocity (MD=4.04, 95%CI 0.90 to 7.18, P=0.001), sural sensory nerve conduction velocity (MD=7.47, 95%CI 4.00 to 10.94, Plt;0.000 1), and sural motor nerve conduction velocity (MD=3.38, 95%CI 0.07 to 7.58, P=0.05), with no adverse reaction reported. Conclusion Current evidence shows that, autologous stem cell therapy is effective in treating DPN. Due to the lack of high quality studies, more high quality RCTs are needed to verify the above conclusion.
Objective To provide references for fast assessment after disasters in China by assessing articles on fast assessment of health needs after disasters. Methods We systematically searched CNKI, VIP, CBM, and PubMed from their establishments to Jan. 2011. The main results of the eligible articles were described. Results A total of 65 articles were included, of which introductions for methodology and cross-sectional studies accounted for 52.31% and 44.62%, respectively. Articles which focused on natural disasters made up 86.15% of the total. Post-disaster rapid assessment should include seismic death estimate and on-site public health assessment which contained the public health status in affected areas, health coping capacity, health condition of victims and health needs. Rapid assessment of seismic death mainly used methods based on GIS and ANN model. On-site public health assessment mainly used epidemiological field investigation. Questionnaires, interviews and surveillance of diseases were adopted. Conclusion Rapid post-disaster health needs assessment is one of the most important tasks after disasters, and the current rapid assessment methods need to be refined and improved.
ObjectiveTo develop altering intake managing symptoms (AIMS) dietary intervention and evaluate its effects on nutritional status and dietary compliance for patients after gastrectomy.MethodsFrom April 2017 to July 2018, 176 patients underwent the gastrectomy in the Xijing Hospital of Air Force Military Medical University were selected, then were divided into an AIMS group and a control group by the Excel 2007 random function method. The AIMS group was intervened by the AIMS dietary intervention, the control group was given the routine diet management. The body mass, body mass index (BMI), albumin, and dietary intake at the admission, on the 2nd week and the 3rd month after the discharge were compared between the two groups. The nutritional status of the two groups was assessed by the PG-SGA scale. The diet-related symptoms and dietary compliance of the two groups were assessed by the dietary related symptoms scale and the dietary compliance scale.ResultsA total of 176 eligible patients were enrolled in this study, including 92 patients in the AIMS group and 84 patients in the control group. There were no significant differences in the baseline data such as the gender, age, educational level, occupation, disease type, surgical method, tumor TNM stage, and pathological differentiated type between the two groups (P>0.050). There were no significant differences in the body mass, BMI, and albumin between the AIMS group and the control group before and after the dietary intervention (P>0.050). The PG-SGA score, diet-related symptom score, and dietary compliance score had significant differences between on the 2nd week or the 3rd month after the discharge and at the admission in the AIMS group and the control group (P<0.050), which had significant differences on the 2nd week or the 3rd month after the discharge between the AIMS group and the control group (P<0.001). The dietary intake of the AIMS group was significantly higher than that of the control group on the 3rd month after the discharge (P<0.001). The complications incidences of total diet-related symptoms was 5.5% (5/91) and 14.6% (12/82) in the AIMS group and the control group, respectively, the difference was statistically significant (P=0.047).ConclusionUsing AIMS dietary intervention for patients after radical gastrectomy can significantly improve their overall nutritional status and improve dietary compliance.
Objective To evaluate the effectiveness and safety of sarpogrelate hydrochloride for patients with peripheral arterial disease (PAD). Methods The randomized controlled trials (RCTs) on PAD treated by sarpogrelate hydrochloride were identified from CBM (1978 to September 2011), CNKI (1979 to May 2011), PubMed (1950 to May 2011), EMbase (1970 to May 2011) and The Cochrane Library (Issue 3, 2011). According to the criteria of the Cochrane Handbook, two reviewers independently screened the studies, extracted and cross-checked the data, and assessed the methodological quality. Then meta-analysis was conducted by using RevMan 5.0 software. Results Nine RCTs involving 522 patients and 532 limbs were included, with low methodological quality in most trials. The results of meta-analyses indicated that compared with the conventional treatment, sarpogrelate hydrochloride could reduce the area of ulcers (MD= –3.22, 95%CI –3.99 to –2.45), and it could increase the ankle-brachial index (SMD=0.49, 95%CI 0.07 to 0.91), blood flow of dorsalis pedis artery (MD=0.16, 95%CI 0.09 to 0.23) and pain-free walking distance (MD=200.87, 95%CI 3.39 to 398.36). Five trials reported the adverse effects of sarpogrelate hydrochloride, most of which were mild gastrointestinal symptoms. Conclusion Based on the review, sarpogrelate hydrochloride may have positive effect on patients with PAD. However, the evidence is not b enough due to the general low methodological quality, so the reliable conclusion has to be drawn with more high quality studies in future.
Objective To evaluate the effectiveness and safety of autologous hemopoietic stem cell implantation for peripheral arterial disease (PAD). Methods Randomized controlled trials (RCTs) were identified from CBM (1978 to September 2010), CNKI (1979 to September 2010), MEDLINE (1950 to September 2010), Pubmed (1950 to September 2010), Embase (1970 to September 2010), and Cochrane l ibrary (issue 4, 2010). The papers of the RCTs of cl inical therapeutic studieson PAD treated by autologous hemopoietic stem cell implantation were included and analyzed according to the criteria of the Cochrane handbook. Results Eight RCTs involving 280 patients and 322 extremities were included, with majority of trials of low methodological qual ity. Meta-analysis indicated that autologous hemopoietic stem cell transplantation had an increased ulcer cure rate [RD=0.38, 95% CI= (0.25, 0.50)], a significant improvement in the ankle brachial index [MD=0.11, 95%CI= (0.04, 0.18)], transcutaneous oxygen tension [MD=7.33, 95%CI= (3.14, 11.51)], and pain-free walking distance [SMD=1.35, 95%CI= (0.90, 1.79)], a significant reduction in rest pain scores [MD= —1.70, 95%CI= (—2.15, —1.25)], and a significant benefit in terms of l imb salvage [RD= —0.19, 95%CI= (—0.31, —0.07)]. Only 2 trials reported the side effects of autologous hemopoietic stem cell transplantation, such as l imbs swell ing and concentrations of serum creatine phosphokinase increasing, and the long-term safety was not reported. Conclusion Based on the review, autologous hemopoietic stem cell transplantation may have positive effect on “no-option” patients with PAD. However, the evidence is not b enough due to the general low methodological qual ity, so we can not draw a rel iable conclusion about the effects of autologous stem cell transplantation for PAD at the moment. Further larger, randomized, double bl ind, placebo-controlled, and multicenter trials are needed.
ObjectiveTo investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease (CKD).MethodsA total of 336 patients with CKD were investigated by a general data questionnaire, the CKD Self-care Behavior Scale, Social Support Scale, Generalized Anxiety Self-assessment Scale, and 9-item Patients Health Questionnaire through WeChat platform, and the influencing factors of self-care behavior were explored by binary logistic regression analysis.ResultsThe median score of self-care behavior of CKD patients without dialysis was 60, and the patients with median and high level of self-care behavior accounted for 97.6%. The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support (r=0.210, P<0.001), objective support score (r=0.127, P=0.020), subjective support score (r=0.195, P<0.001), and social support utilization score (r=0.164, P=0.002), and negatively correlated with the anxiety score (r=–0.132, P=0.015), depression score (r=–0.230, P<0.001), body mass index (r=–0.181, P=0.001), and systolic blood pressure (r=–0.168, P<0.001). The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’ self-care behavior were gender [(odds ratio, OR)=2.179, 95% confidence interval, CI (1.134, 4.187), P=0.019], systolic blood pressure [OR=0.967, 95%CI (0.947, 0.987), P=0.002], and depression score [OR=0.844, 95%CI (0.765, 0.931), P=0.001].ConclusionsThe self-care behavior of CKD patients without dialysis is at the median and high level. Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression, and guiding patients to carry out blood pressure management, to delay the progress of the disease.
Objective To explore the safety and efficacy of regional citrate anticoagulation in hemoperfusion combined with continuous renal replacement therapy (CRRT). Methods Patients who underwent continuous veno-venous hemodiafiltration tandem hemoperfusion between January 2021 and March 2022 in West China Hospital of Sichuan University were retrospectively enrolled. All patients received double-lumen catheter indwelling through internal jugular vein or femoral vein for vascular access, and were treated with Prismaflex V8.0 CRRT machine, extracorporeal circulation line ST150, and disposable hemoperperfusion device HA380. Four percent sodium citrate was pumped from the arterial end at the rate of 180-200 mL/h. The blood pump rate was 130-150 mL/min, the ratio of dialysis fluid to the dose of replacement fluid was 1∶1, the amount of CRRT treatment agent was 20-35 mL/(kg·h), replacement fluid was added by post-dilution method, and the treatment time of hemoperfusion was 8-10 h. The dialysis treatment completion rate, the cardiopulmonary bypass life, the incidence of coagulation events, and the levels of procalcitonin, C-reactive protein, interleukin-6, etc. were observed. Results A total of 143 cases of treatment were completed in 75 patients, among them, 119 cases were successfully completed and the completion rate of hemoperfusion treatment was 83.2%. The average life of hemoperfusion devices was (8.5±1.5) h. Bleeding or blood clotting occurred in 18.9% of the treatment (27/143), 13 cases had CRRT extracorporeal circulation coagulation, 11 cases had hemoperfusion device coagulation, and 3 cases had gastrointestinal bleeding. The ionic calcium levels after the filter of 93 cases of treatment were maintained around 0.25-0.35 mmol/L, and the peripheral calcium levels were maintained around 1.0-1.1 mmol/L. Compared with that at 0 h, the procalcitonin decreased significantly 72 h after hemoperfusion treatment (P=0.014), while there was no significant change in interleukin-6 or C-reactive protein after 72 h treatment (P>0.05). None of the patients experienced anaphylaxis during treatment. Conclusion In CRRT combined with hemoperfusion, the use of regional citrate anticoagulation results in good cardiopulmonary bypass life, inflammatory mediators clearance, and a lower risk of bleeding.
Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) without anticoagulation between June and September 2021 were prospectively collected. The patients were randomly divided into three groups by envelope method, namely 30 min-flushing group (flushing every 30 minutes for extracorporeal circulation), 2 h-flushing group (flushing every 2 hours for extracorporeal circulation), and non-flushing group (no flushing for extracorporeal circulation during treatment). All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150 extracorporeal circuit, through either femoral or internal jugular venous double-lumen catheter. CVVHDF was adopted, the blood pump rate was 200 mL/min, and the rates of replacement fluid and dialysate were both 1 000 mL/h. The replacement fluid was pre-post dilution. Extracorporeal circuit lifespan, treatment time delayed by flushing, overall treatment time of CRRT, actual treatment time of CRRT, proportion of actual treatment time achieved, delayed daily treatment time, and small molecule solute removal efficiency before and after treatment were recorded. Results A total of 83 patients were included, including 24 in the 30 min-flushing group, 30 in the 2 h-flushing group, and 29 in the non-flushing group. There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups (P<0.05). Compared with the 2 h-flushing group and the non-flushing group, the 30 min-flushing group significantly shortened the extracorporeal circuit lifespan, delayed more treatment time by flushing, and delayed the longest daily treatment time (P<0.05). The proportion of actual treatment time in the non-flushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group (P<0.05), and in the 2 h-flushing group was also higher than that in the 30 min-flushing group (P<0.05). There was no significant difference in the blood urea nitrogen clearance rate among the three groups (P=0.570), but the serum creatinine clearance rate was significantly different among the three groups (P=0.020). Compared with the 30 min-flushing group, the 2 h-flushing group had a higher serum creatinine clearance rate, and there was statistical significance (P<0.05). Twenty-five patients had hypotension during treatment. The frequency of 30 min-flushing caused a higher risk of coagulation during cardiopulmonary bypass (hazard ratio=2.502, P=0.001). Conclusion For CVVHDF without anticoagulation, longer extracorporeal circuit lifespan and longer effective treatment time can be achieved without using normal saline flush.