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简介：·AIM:Toinvestigatethepossibleeffectsofintracameralbevacizumabonoxidativestressparametersandapoptosisincornealtissue.·METHODS:Intotal,30ratswereassignedrandomlyintothefollowingthreegroupsof10ratseach:ashamgroup(Group1;n=10),acontrolgroup[Group2;balancedsaltsolution(BSS)wasadministeredat0.01mL;n=10],andatreatmentgroup(Group3;bevacizumabwasadministeredat0.25mg/0.01mL;n=10).Thetotalantioxidantstatus(TAS)andthetotaloxidantstatus(TOS)inthecornealtissueandbloodsamplesweremeasured,andtheoxidativestressindex(OSI)wascalculated.Additionally,cornealtissuehistopathologywasevaluatedforcaspase-3and8stainingandapoptoticactivity.·RESULTS:Inthebloodsamples,theTAS,TOS,andOSIlevelswerenotsignificantlydifferent(allP>0.05).Comparedwiththeshamandcontrolgroups,theTOSandOSIlevelsinthecornealtissuesweresignificantlydifferentinthebevacizumabgroup(allP<0.05).Nostatisticallysignificantdifferenceswereobservedbetweentheshamandcontrolgroups(allP>0.05).However,comparedwiththeshamandcontrolgroups,greaterimmunohistochemicalstainingforcaspases-3and8andanelevatedlevelofapoptoticactivitywereobservedinthebevacizumabgroup.·CONCLUSION:Thisstudyrevealedthatintracameralbevacizumabinjectionsseemedtobesystemicallysafebutmayhaveelicitedlocaltoxiceffectsinthecornealtissue,asindicatedbytheoxidativestressparametersandhistopathologicalevaluations.

简介：AbstractBackground:Pioglitazone may be beneficial in the treatment of psoriasis. However, based on the effectiveness and safety considerations, it has not been widely used. To fully evaluate the strength of evidence supporting psoriasis treatment with pioglitazone, we conducted a meta-analysis of existing published studies.Methods:PubMed, Ovid, Cochrane Library, Google Scholar, and Web of Science databases were systematically searched before February 2019. Randomized controlled trials (RCTs) of pioglitazone administration compared with placebo, administered to patients with psoriasis for at least 10 weeks, and published in English were included. Quality of the included RCTs was identified by the modified Jadad scale. The quality of evidence for each outcome was evaluated using the GRADEpro Guideline Development Tool online software. Primary outcomes were proportion of patients showing psoriasis area and severity index (PASI) score improvement (<75%) and the mean percent change in PASI score from baseline to the end of treatment. Dichotomous data were analyzed using odds ratios (ORs) corresponding to the 95% confidence interval (CI), whereas continuous variables, expressed as mean and standard deviation, were analyzed using the mean differences (MD) with the 95% CI.Results:Six RCTs were analyzed. Meta-analysis showed that pioglitazone reduced the PASI scores in patients with psoriasis compared with the control group when administered at 30 mg per day (P < 0.001, MD = -3.82, 95% CI = -5.70, -1.93) and at 15 mg per day (P = 0.04, MD = -3.53, 95% CI = -6.86, -0.20). The PASI-75 of the pioglitazone group was significantly higher than that of the control group at 30 mg per day (P < 0.001, OR = 8.30, 95% CI = 3.99, 17.27) and at 15 mg per day (P = 0.03, OR = 2.96, 95% CI = 1.08, 8.06). No statistically significant differences in total adverse events were observed between the groups. There were no significant differences in common adverse reactions such as weight gain and elevated liver enzymes between the two pioglitazone groups.Conclusions:Use of pioglitazone in the current treatment of psoriasis is beneficial. The therapeutic effect of the daily 30 mg dose may be greater than that of the 15 mg dose per day with no significant change in the frequency of adverse reactions.

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简介：AbstractObjective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy (CSP-II).Methods:This was a retrospective clinical cohort study, and, in total, 131 women diagnosed with CSP-II and primarily treated in our hospital were recruited. Women treated using laparoscopy assisted by operative hysteroscopy (LAOH; Group A, n = 25), uterine artery embolization (UAE) followed by LAOH (Group B, n = 21), ultrasound-guided dilatation and curettage (D&C; Group C, n = 24), and UAE followed by D&C (Group D, n = 61) were evaluated. Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age, gestational age, size of lesion, and pretreatment serum β-human chorionic gonadotropins (β-hCG) level. Operation time was longer (P < 0.001) and the success rate was higher (P = 0.01) in both Group A and Group B than in Group C and Group D. When the cohort was further analyzed regarding patients with myometrial thickness ≤3 mm (n = 75, defined as CSP-IIb), a lower rate of perioperative complications (P = 0.036) and a higher success rate (P < 0.001) remained in Group A (n = 15) and Group B (n = 15) but not in Group C (n = 11) or Group D (n = 34). In multiple logistic regression analysis, the risk factors related to lower treatment efficacy for patients with CSP-II were thinner myometrial thickness of cesarean scar (CS) (≤3 mm) (odds ratio [OR] = 5.470, P = 0.062), number of cesarean sections (a2) (OR = 8.877, P = 0.013), mass protruding into the bladder or abdominal cavity (OR = 25.507, P < 0.001), and direct D&C modality (OR = 38.247, P = 0.010).Conclusions:Compared with D&C ± UAE, LAOH ± UAE showed a higher success rate for patients with CSP-II, especially when the zygote was more deeply implanted with a myometrial thickness of CS ≤ 3 mm. CSP-II treatment should be individualized on the basis of many risk factors.

简介：客观：观察膜dialyzer在临床的维护hemodialysis(MHD)由长期的肾的失败病人使用了的polyethersulfone的安全和功效。方法：从1月到2009年2月，36个病人从加盟上海JiaoTong的新华医院被招募大学医学院。实验被人种的委员会同意，新华医院并且在从病人的权限下面。所有病人被使随机化进polyethersulfone组(足，n=18)并且polysulfone组(PS，n=18)。Hemodialysis被使用Fresenius4008S给控制能力的dialyser和极端净化酸式碳酸盐透析液，超过3.5h每次，三次每星期，由肝磷脂antieoagulation列在后面一个星期，三次完全。在血脲氮(甜面包)的变化，浆液creatinine(Scr)，磷酸盐(P2+)，血红素和白朊层次为功效和安全评估被决定。结果：显著地与不同dialyzers在hemodialysis以后减少的浆液甜面包，Scr和P2+集中，和二个组的减少振幅是相等的(P>0.05)。浆液甜面包和重量的单位的清理率没在二个组之中有重要差别(P>0.05)。浆液P2+的清理率(ml/min)是144.57

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简介：AbstractObjective:To study the 12-month effects and possible mechanisms of low-dose mifepristone in the treatment of adenomyosis.Methods:Patients included in this retrospective study had painful adenomyosis and previously received 5 mg mifepristone daily (group A, n = 45) or 5 mg mifepristone daily with a poor-effect levonorgestrel-releasing intrauterine device (group B, n = 13) for 12 months. Uterine size, serum CA125 levels, estradiol levels, Visual Analogue Scale (VAS) score, endometrial thickness, and hemoglobin levels were compared before and after treatment and investigated again at 3 to 6 months after drug withdrawal. Another 8 patients with adenomyosis (group C, n = 8) who underwent surgery for severe dysmenorrhea during the same period were only used as a control group for immunohistochemical research. Endometrial biopsy results and expression of nerve growth factor (NGF), cyclooxygenase-2 (COX-2), and nuclear-associated antigen Ki-67 (Ki-67) in endometrial tissues and adenomyotic lesions were also analyzed.Results:The VAS scores in both experimental groups at all time points during treatment and follow-up were significantly lower (P <0.001) than those before treatment. The uterine size was significantly reduced, and endometrial thickness was distinctly thicker after 12 months of treatment than that before treatment in group A receiving 5 mg/d mifepristone. The immunohistochemical expression of NGF and COX-2 decreased in both eutopic and ectopic endometrium after treatment, whereas that of Ki-67 slightly increased in eutopic endometrium after treatment and rapidly recovered to the baseline value after stopping mifepristone. There were no signs of hyperplasia, atypical hyperplasia, or malignancy in the endometrial biopsies.Conclusions:The results suggested that a daily dose of 5 mg mifepristone for 12 months down-regulated the expression of NGF and COX-2 and was effective in treating painful adenomyosis with few side effects.

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简介：CpGoligodeoxynucleotides(CpGODN)asadjuvanthavebeenextensivelystudiedinrecentyears.PhosphodiesterCpGODN(POCpGODN)canperfectlymimicbacterialDNAinenhancingimmuneresponsebutarevulnerabletonucleasesinvivo.ThisstudyaimedtoevaluatetheimmunostimulatorypotentialandsafetyofphosphodiesterCpGODNencapsulatedinnonphospholipidliposomes.BALB/cmicewereimmunizedintramuscularlywithdifferentformulationsofliposomes,CpGODNandhepatitisBsurfaceantigen(HBsAg).TheresultsdemonstratedthattheencapsulatedPOCpGODNwereprotectedagainstrapiddegradationinvivoandretainedtheiradjuvantactivity.POCpGODNencapsulatedwithHBsAginliposomesinducedstrongTh1-biasedorTh1/Th2mixedhumoralimmuneresponseinmicewiththemagnitudesimilartotheirphosphothioateequivalentinthesameformulation.HighIFN-gammaproductioninducedbythisformulationconfirmedthegenerationofstrongcellularimmuneresponse.Additionally,co-deliveryofHBsAgandPOCpGODNimprovedtheimmuneresponseoverthatobtainedwithseparatedelivery.Safetyexperimentshowedthatliposome-encapsulaedPOCpGODNandHBsAgcausedmildsystemicandmoderatelocaladversereaction.Inconclusion,ourdatashowsthatPOCpGODNencapsulatedinliposomesfullyexhibittheirTh1-typeadjuvantactivityandactasapotentialadjuvantforvaccines.

简介：AIMToevaluatetheclinicaloutcomesofpatientswhounderwentendoscopicsubmucosaltunneldissection(ESTD)foresophagealsquamouscellcarcinoma(ESCC)andprecancerouslesions.METHODSESTDwasperformedin289patients.Theclinicaloutcomesofthepatientsandpathologicalfeaturesofthelesionswereretrospectivelyreviewed.RESULTSAtotalof311lesionswereincludedintheanalysis.Theenblocrate,completeresectionrate,andcurativeresectionratewere99.04%,81.28%,and78.46%,respectively.TheESTDproceduretimewas102.4±35.1min,themeanhospitalizationtimewas10.3±2.8d,andtheaverageexpenditurewas3766.5±846.5dollars.Theintraoperativebleedingratewas6.43%,thepostoperativebleedingratewas1.61%,theperforationratewas1.93%,andthepostoperativeinfectionratewas9.65%.Esophagealstrictureandpositivemarginweresevereadverseevents,withanincidencerateof14.79%and15.76%,respectively.Notumorrecurrenceoccurredduringthefollow-upperiod.CONCLUSIONESTDforESCCandprecancerouslesionsisfeasibleandrelativelysafe,butforlargemucosallesions,therateofesophagealstrictureandpositivemarginishigh.

简介：一个核电厂的抑制容器是最后障碍阻止核反应堆放射。Aseismic安全分析是适当抑制容器设计的关键。有一个半无限的有弹性的基础和腱的实际安排的一个对的具体抑制容器(PCCV)模型被建立了在地震负担和内部压力下面分析CPR1000PCCV结构的aseismic能力。为有水泥的对的腱和它的相互作用建模的一个方法被建议，对的腱的轴的力量证明模拟合理、精确。数字结果证明为具体结构，在设备开口附近并且在戒指横梁附近的柱体墙底部的地点是有大主要应力的批评地点。具体裂缝在0.50g的山峰地震运动下面发生在PCCV柱体墙的底部，然而，PCCV处于一个有弹性的状态基本上是静止的。而且，具体裂缝在设计下面发生在设备开口附近0.4MPa的内部压力，而是钢班机仍然在有弹性的阶段并且它的防漏功能稳固被验证。结果为抑制容器的分析和设计提供基础。

简介：ObjectivesToevaluateantihypertensiveefficiencyandsafetyofanewdomesticofL-&N-typeCa^2+antagonist-eilnidipinewithimidaprilasapositivecontrol.MethodsAfter2weeks'placebowashingout,22patientsweretreatedwitheilnidipine5mgdailyand27patientsweretreatedwithimidapril5mgdaily.4weekslater,ifpatient'ssittingdiastolicbloodpressureisover90mmHg,his/herdosagewasdoubledforanother4weeks,theothersmeasuringupremainedtheirdosageunchangedforanother4weeks.Bloodpressure,heartrate,bloodandurineroutineexamination,serumglucose,serumchemicalexaminationincludingtotalcholesterol,triglyceride,HDL,LDL,transaminase,creatineetcandsidereactionswererecordedbeforeandafterthetrial.Datawereanalyzedstatistically.ResultsAfter8weeks'treatment,bloodpressurewassignificantlydecreased(P<0.05)inbothgroups,andthetwomedicineshadsimilarantihypertensiveeffects.Furthermore,thereducingofheartratewasstatisticallysignificantcomparedwithbaseline(P<0.01)inthecilnidipinegroup,butnotintheimidaprilgroup.Thenegativechronotropiceffectofcilnidipinehadlittleeffectoncontinuingthetherapy.Therewerenochangesonbloodandurineroutineexaminationandserumlipid,serumglucose,creatine,transaminaseandetcinbothgroups.Theirsidereactionsweremildandwell-tolerated.ConclusionsCilnidipinehasacon-vincingantihypertensiveeffectsimilartothatofimi-dapril.Especiallycilnidipinemaybeadministeredtopatientswithrelativelymildtachycardia.

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简介：AbstractBackground:Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure.Methods:All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann–Whitney tests were used.Results:A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group (P < 0.05). The number of patients requiring double myotomy was higher in the same day discharge group (P < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events.Conclusion:G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring.

简介：AbstractObjectives:Patients with obstructive sleep apnea (OSA) are at increased risk of perioperative and postoperative morbidity. The use of continuous positive airway pressure (CPAP) in the perioperative period may be of potential benefit. However, among patients who have undergone endonasal skull base surgery, many surgeons avoid prompt re-initiation of CPAP therapy due to the theoretical increased risk of epistaxis, excessive dryness, pneumocephalus, repair migration, intracranial introduction of bacteria, and cerebrospinal fluid (CSF) leak. The objective of this article is to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endonasal skull base surgery.Data Sources and Methods:This review combines the most recent literature as queried through PubMed regarding the safety of CPAP resumption following endonasal skull base surgery.Results:Recent surveys of skull base surgeons demonstrate little consensus regarding the post-operative management of OSA. Recent cadaveric studies suggest that approximately 85% of delivered CPAP pressures are transmitted to the sphenoid sinus. Further, at frequently prescribed CPAP pressure settings, common sellar reconstruction techniques maintain their integrity while preventing very little transmission of pressure into the sella. In small retrospective case series, patients with OSA who received CPAP immediately following transsphenoidal pituitary surgery had similar rates of surgical complications as OSA patients who did not receive CPAP in the immediate post-operative period. Concerns of reinitiating CPAP too early, such as the development of pneumocephalus, rarely develop.Conclusions:There remains a paucity of objective data regarding when it is safe to resume CPAP following endonasal skull base surgery. Recent cadaveric studies and small retrospective case series suggest that it may be safe to resume CPAP earlier than is often practiced following endonasal skull base surgery.

简介：<正>Safety-KleenSystems公司将开始其在北美第三个基础油再生炼厂的初步工程工作,并且正在分析该厂在美国东南部和墨西哥湾沿岸地区的可能地点。据称,该公司已将几个地点纳入其评估范围

简介：摘要：在公路桥梁施工中，往往会伴随许多安全事故，安全事故不可逆，一旦出现就会造成国家和人民群众生命财产安全，特别是桥梁施工。本文将结合云湛高速公路坡头枢纽互通F匝道桥现浇施工，（该桥10#～13#跨越省道S081，省道车速快，且车流量大），分析和讨论坡头枢纽互通F匝道桥上跨省道S081施工中的安全要点，在施工过程中研究该类桥梁施工的安全管理，以便能提前预防和过程中的安全管控，最大限度消除安全隐患、避免安全事故。

简介：农业上的基因操作重要昆虫现在为更高度有效的生物学上基于的人口控制程序允许基因sexing和男绝育系统的开发，最尤其是无菌的昆虫技术(坐)，为植物和动物昆虫害虫。四圜素能压制住(Tet离开)有条件的致命的系统可以一起工作以便转基因的种类将是在包含四圜素的节食可行、肥沃，却女性致命、男性处于没有四圜素的条件无菌。这将为无菌的男性唯一的生产在一个统一系统允许他们的很有效的使用为坐。然而，为如此的转基因的昆虫紧张的地版本的批评考虑是频率和致命性revertant幸存的基因基础的一颗决心。这将提供对评估致命性系统的基因稳定性必要的知识，它的环境安全，并且为保证最佳的功效的修正提供基础。为Tet离开致命的幸存决心，大规模屏蔽协议的开发应该也允许测试这些修正，并且测试另外的有条件的致命的系统的能力充分压制繁殖稀罕Tet离开幸存者。如果主导的温度敏感(DTS)蛹的致命性系统在果蝇为第二等的致命性证明有效，它可以提供需要支持sexing/sterility紧张的版本的保护措施，并且潜在地，版本不分男女致命性作为基因男绝育的一张表格拉紧。假如DTSProsβ21变化应该为冗余的致命性证明有效，它结构、功能的保存的高水平应该允许主人特定的cognates为大量昆虫种类被创造。