Objective To investigate the relationship among rats′ stress ulcer and gastric acid, prostaglandin (PGs) and adrenocorticotropin (ACTH) and to probe the pathogenesis, prophylaxis and therapy. Methods Rats′ stress ulcer model was made by cold water soaking and was properly treated with drugs such as hyoscine, dexamethasone, ranitidine and losec. The amount and pH of gastric juice, change of gastric mucosa and PGs and ACTH of blood were determined. Results After rats were fasted for 24 hours a little gastric juice was aspirated. After cold water soaking of rats gastric juice was increased with the pH decreased, there was gastric mucosal bleeding, blood PGs was decreased and ACTH was increased. These suggest that on stress gastric mucosa bleeding is related with decreased gastric juice pH, decreased PGs and increase ACTH.Conclusion To control stress ulcer, pH of gastric juice and amount of PGs should be increased. Losec can increase gastric juice pH, so losec is the first choice to control stress ulcer.
ObjectiveTo investigate the effectiveness of clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate for genital virilization in girls with congenital adrenal hyperplasia (CAH). MethodsBetween June 2000 and October 2015, 27 girls with genital virilization were treated with clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate. The chromosomal karyotype was 46, XX in all patients, whose age ranged from 3 to 11 years (mean, 3.9 years). According to Parder's virilization scale, 5 cases were classified as stage Ⅱ, 18 cases as stage Ⅲ, and 4 cases as stage Ⅳ. The hormone tests showed decreased cortisol level and increased testosterone and 17-hydroxyprogesterone levels. They were diagnosed with non-salt-wasting CAH. ResultsAll of the patients underwent clitoroplasty successfully. The mean operation time was 74 minutes (range, 58-95 minutes). Incision healed primarily. The patients were followed up 6 months to 10 years (median, 19 months). The external genitalia had good appearance, without necrosis of flap and the glans clitoris, abnormal sensation of the glans clitoris, or clitorism recurrence. Five girls had breast development and normal menstrual cycle during adolescence, and 1 patient who was followed up for 10 years gave birth to a son. ConclusionClitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate is a relatively ideal method for treating genital virilization in girls. It has less complications, good aesthetic and functional results. There are satisfactory outcomes when combining with the endocrine treatment.
Objective To evaluate the safety and efficacy of dexamethasone intravitreal implant 0.7 mg (DEX) for treatment of macular edema associated with retinal vein occlusion (RVO). Methods This study was a six-month, randomized, double-masked, sham-controlled, multicenter, phase 3 clinical trial with a 2-month open-label study extension. Patients with branch or central RVO received DEX (n=129) or sham procedure (n=130) in the study eye at baseline; all patients who met re-treatment criteria received DEX at month 6. Efficacy measures included Early Treatment Diabetic Retinopathy Study (ETDRS), best-corrected visual acuity (BCVA), and central retinal thickness (CRT) on optical coherence tomography. Results Time to ≥15-letter BCVA improvement from baseline during the first 6 months (primary endpoint) was earlier with DEX than sham (P＜0.001). At month 2 (peak effect), the percentage of patients with ≥15-letter BCVA improvement from baseline was DEX: 34.9%, sham: 11.5%; mean BCVA change from baseline was DEX: 10.6±10.4 letters, sham: 1.7±12.3 letters; and mean CRT change from baseline was DEX: −407±212 μm, sham: −62±224 μm (all P＜0.001). Outcomes were better with DEX than sham in both branch and central RVO. The most common treatment-emergent adverse event was in-creased intraocular pressure (IOP). Increase sin IOP generally were controlled with topical medication. Mean IOP normalized by month 4, and no patient required incisional glaucoma surgery. Conclusions DEX had a favorable safety profile and provided clinically significant benefit in a Chinese patient population with RVO. Visual and anatomic outcomes were improved with DEX relative to sham for 3 - 4 months after a single implant.
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.
Objective To explore the evaluation value of burden of amplitudes and epileptiform discharges score (BASED) in the efficacy of adrenocorticotropic hormone (ACTH) combined with magnesium sulfate therapy for infantile epileptic spasms syndrome (IESS). Methods Retrospective collection the clinical and EEG data of 124 patients admitted to the Dongguan Maternal and Child Health Care Hospital from 2015 to 2023, who were diagnosed with IESS and treated with ACTH combined with magnesium sulfate. According to whether there were epileptic seizures 14 days after ACTH treatment, the patients were divided into two groups: non seizure group (n=74 cases) and seizure group (n=50 cases). The BASED system was used to evaluate the relationship between changes in EEG before and after ACTH treatment and clinical efficacy in both groups. The analysis of electroencephalogram included: ① abnormally high amplitude background waves, ② >3 spike foci , ③ grouped multifocal spikes, ④ paroxysmal voltage attenuation. ResultThe control rate of ACTH combined with magnesium sulfate in the treatment of IESS was 59.7% (74/124), and there was no statistically significant difference in the control rate among children with different etiologies (P=0.09). The BASED score suggests that the overall response rate of electroencephalogram (EEG) in infants with epileptic spasm syndrome after treatment was 57.2%. The EEG remission rate in the seizure control group was 81% (60/74), while in the uncontrolled group was 22% (11/50). The EEG remission rate in the seizure control group was significantly higher than that in the uncontrolled group after treatment (P<0.001), and the EEG score was closely related to clinical efficacy (Spearman correlation coefficient rp=0.601, P<0.001). ConclusionThe BASED score is related to clinical efficacy, and it can provide a quantitative basis for evaluating the efficacy of ACTH combined with magnesium sulfate in the treatment of IESS.