两种术式治疗翼状胬肉疗效观察

目的:比较翼状胬肉切除术联合游离结膜瓣移植术与联合自体角膜缘干细胞移植术的临床疗效。方法:将156例(206只眼)翼状胬肉患者随机分成两组,一组行翼状胬肉切除联合游离结膜瓣移植术,另一组行翼状胬肉切除联合角膜缘干细胞移植术,随访6～24个月,观察胬肉复发情况。结果:术后复发:游离结膜瓣移植组22只眼(21.6%),角膜缘干细胞移植组5只眼(4.8%),差异有统计学意义(P<0.05)。结论:翼状胬肉切除联合自体角膜缘移植术明显优于游离结膜瓣移植术,自体角膜缘干细胞移植术复发率低,值得临床推广。     

三种治疗翼状胬肉手术方法的临床观察

目的 :比较翼状胬肉手术治疗三种方法的疗效。方法 :对 15 6例 (16 2眼 )翼状胬肉病例 ,随机分三组 ,A组行翼状胬肉结膜下转移术 ,4 6例 (6 0眼 ) ;B组行翼状胬肉切除术 ,术中应用丝裂霉素c,5 8例 (6 0眼 ) ;C组行翼状胬肉切除术联合自体结膜瓣移植术 ,术中应用丝裂霉素c ,5 2例 (5 6眼 )。结果 :A组术后复发 10眼 ,复发率 2 1.74 % ;B组术后复发 2眼 ,复发率 3.33% ;C组术后复发 1眼 ,复发率 1.79%。结论 :翼状胬肉切除术联合自体结膜瓣移植术 ,术中应用丝裂霉素c ,手术复发率低 ,术后效果好。     

角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉疗效观察

[目的]比较自体角膜缘干细胞移植并术中应用丝裂霉素C(MMC)与翼状胬肉切除 球结膜瓣转住术的疗效.[方法]105例(126眼)翼状胬肉患者随机分为两组,A组53例(65眼)行自体角膜缘干细胞移植联合术中使丝裂霉素C;B组52例(61眼)行翼状胬肉切除 球结膜瓣转位术,比较两组患者术后复发情况.[结果]术后随访6～14个月,A组复发5例,复发率7.69%;B组复发8例,复发率13.11%,两组比较差异有显著性(P<0.05).[结论]角膜缘干细胞移植并术中应用丝裂霉素C术后翼状胬肉复发率低且手术简便、安全,是目前理想的手术方法.     

翼状胬肉不同手术方法疗效分析

目的:比较单纯切除或联合羊膜移植或联合自体角膜缘干细胞移植等3种不同方法治疗初发翼状胬肉的疗效。方法:102例106只眼分为A、B、C3组,A组单纯胬肉切除30例30只眼,B组翼状胬肉切除联合羊膜移植33例35只眼,C组翼状胬肉联合角膜缘干细胞移植39例41只眼。术后随访观察3～20个月,观察比较复发情况。结果:A组30眼中10眼复发,复发率33.3%;B组35眼中4眼复发,复发率11.4%;C组41眼中2眼复发,复发率4.9%。A组与B组比较,差异有显著性(χ2=4.59,P<0.05);A组与C组比较,差异有显著性(χ2=9.98,P<0.01);B组与C组比较,差异无显著性(χ2=1.12,P>0.05)。结论:初发翼状胬肉采取单纯切除联合羊膜移植或联合自体角膜缘干细胞移植均可有效降低术后复发率。     

三种方法治疗112例翼状胬肉的临床效果观察

目的观察单纯翼状胬肉切除、胬肉切除联合丝裂霉素治疗与胬肉切除加自体角膜缘上皮联合球结膜移植治疗翼状胬肉的临床疗效。方法选择符合手术标准的翼状胬肉患者93例112只眼,分为A（38眼）、B（38眼）、C（36眼）三组。A组翼状胬肉单纯切除,B组胬肉切除联合丝裂霉素治疗,C组胬肉切除加自体角膜缘上皮联合球结膜移植。观察三组术后角结膜愈合情况以及胬肉复发率。结果随访12～30月,复发率A组23.68%,B组10.53%,C组无复发病例。C组与A、B组比较,差异均有统计学意义（P〈0.05）。结论 胬肉切除加角膜缘干细胞联合结膜移植是处理胬肉复发的最佳方式。该手术较简便,成功率高,复发率低。     

自体角膜缘干细胞联合羊膜移植治疗翼状胬肉的临床分析

目的比较自体角膜缘干细胞移植与联合羊膜移植治疗翼状胬肉的疗效。方法126例132眼翼状胬肉患者随机分成A、B2组,A组63例68眼,行自体角膜缘干细胞移植术;B组63例64眼行自体角膜缘干细胞联合羊膜移植术。结果A组8例8眼复发,复发率11．8％,B组3例3眼复发,复发率4．7％,2组术后复发率在统计学上有显著性差异（P〈0．05）。结论自体角膜缘干细胞联合羊膜移植术可有效治疗翼状胬肉,降低复发率改善视功能。     

两种术式治疗翼状胬肉临床分析

回顾我院2011年2月～2012年2月进行翼状胬肉治疗的患者207例(238眼),根据患者选择术式的不同分为A组100眼,B组138眼,分别进行翼状胬肉切除术联合游离结膜瓣移植术和联合自体角膜缘干细胞移植术,在手术后比较两组患者的治疗效果,随访1年,比较两组患者的复发情况。结果 A组治愈87眼(87.0%),B组治愈130眼(94.2%),两组无明显性差异(P>0.05);随访1年,A组复发20眼(25.3%),B组复发5眼(3.8%),两组差异性显著(P<0.05)。对于翼状胬肉的治疗,采用翼状胬肉切除联合自体角膜缘干细胞移植术其效果不但显著,且复发率低。     

自体带结膜瓣角膜缘干细胞移植治疗翼状胬肉的疗效观察

目的探讨自体带结膜瓣的角膜缘干细胞移植术治疗翼状胬肉的临床疗效。方法对65例80眼初发性翼状胬肉患者行翼状胬肉切除联合自体带结膜瓣的角膜缘干细胞移植,观察其复发率。结果65例80眼未见植片排斥反应发生．其角膜创面上皮愈合时间3～6d;术后随访6个月～2年,有4眼复发,复发率为5％。结论自体带结膜瓣的角膜缘干细胞移植术治疗翼状胬肉复发率低,角膜创面修复快,是一种较理想的手术方法。     

自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉的疗效

目的探讨自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉的疗效。方法对86例（96眼）翼状胬肉患者在显微镜下行自体角膜缘干细胞移植术,术中联合应用丝裂霉素C治疗。结果 86例患者术后早期均有不同程度的结膜和植片水肿、畏光,3 d后症状明显减轻,2～3周结膜植片充血、水肿消退,角膜恢复透明,所有植片均成活。86例患者均随访6～24个月,平均15个月,复发5眼,复发率为5.2%。结论自体角膜缘干细胞移植联合丝裂霉素C可有效地降低翼状胬肉术后的复发率。     

带结膜瓣自体角膜缘干细胞移植治疗翼状胬肉

目的:观察胬肉切除联合带结膜瓣自体角膜缘干细胞移植术治疗翼状胬肉的疗效,探讨减轻患者刺激症状、降低翼状胬肉术后复发率的方法.方法:对338例翼状胬肉患者随机分为两组,第一组采用单纯翼状胬肉切除术,第二组采用翼状胬肉切除+带结膜瓣自体角膜缘干细胞移植术,对两组患者术后7天刺激症状(术后反应)、术后复发时间及复发率进行比较.结果:术后反应的发生率,第二组明显优于第一组,术后复发率,第二组明显低于第一组.结论:胬肉切除联合带结膜瓣自体角膜缘干细胞移植是治疗翼状胬肉的一种有效的、理想的方法.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.