简介：得到中央neurocytoma的更好的识别并且减少的目的错误诊断。回顾的评论识别了中央neurocytoma的15个盒子的方法。中央neurocytoma的所有情况为他们的临床的症状，病理学的变化，染色的immunohistochemical，预后和微分诊断被分析。临床列在后面在上面被执行。在那里的结果1064年是8男性和7女性(中部32.93年)。最普通的介绍症状是与增加的intracranial压力(ICP)有关的那些，包括头疼(100%)，papilledema(93%)并且呕吐(80%)。所有肿瘤位于室的系统。肿瘤由一致房间组成与围着原子核和一个好染色质模式，并且在一些区域，有perinuclear光圈的小房间能被看见。特别地，无核的区域可以有一个好fibrillary矩阵(neuropil)。原子atypia和脉管的增长分别地出现在二种情况中。焦点的坏死能在一种情况中被看见。Immunohistochemical调查结果包括了synaptophysin(15/15)的表示，神经原特定的enolase(12/15)和glialfibrillary酸的蛋白质(GFAP)(3/15)。MIB-1增长索引从0.812.5%，并且在估计的15个盒子中的3个中是超过2%。11个病人的后续信息是可得到的。结论中央neurocytoma一般来说，但是在里面有有利预后一些情况，临床的功课能是好攻击的。GFAP确实，增长索引和脉管的增长的增加可能建议一个更恶意的过程。

简介：OBJECT:Optimummanagementforelderlypatientswithnewlydiagnosedglioblastoma(GBM)inthetemozolomide(TMZ)eraisnotwelldefined.Theobjectofthisstudywastoclarifyoutcomesinthispopulation.METHODS:Theauthorsretrospectivelyreviewed105consecutivecasesinvolvingelderlypatients(age≥65years)withnewlydiagnosedGBMwhoweretreatedattheMayoClinicbetween2003and2008.RESULTS:Thepatients'medianagewas74years(range66-87years),andthemedianKarnofskyPerformanceStatus(KPS)scorewas80(range40-90).Halfofthepatientsunderwentbiopsyandhalfunderwentresection.Patientswithdeep-seatedlesions(19patients[18%])ormultifocallesions(34patients[32%])weremorelikelytohavebiopsythanresection(p=0.0001and0.0009,respectively).Newpersistentneurologicaldeficitsdevelopedin7patients(6.7%).Postoperativehemorrhageoccurredin6patients(5.7%),allofwhomunderwentbiopsy.Completefollow-updataregardingadjuvanttreatmentwasavailablein84patients.Forty-one(49%)weretreatedwithchemotherapy(mostlyTMZ)andradiationtherapy(RT),and23(27%)withRTalone.Nineteen(23%)receivedonlypalliativecareaftersurgery(morecommonwithbiopsy,p=0.03).Chemotherapycomplicationsoccurredin28.6%(Grade3or4hematologicalcomplicationsin11.9%).Themedianvaluesforprogression-freesurvival(PFS)andoverallsurvival(OS)were3.5and5.5months.Inamultivariateanalysis,youngerage(p=0.03,riskratio[RR]0.34,95%CI0.13-0.89),singlelesion(p=0.02,RR0.51,95%CI0.30-0.89),resection(p=0.04,RR0.54,95%CI0.31-0.94),andadjuvanttreatment(p=0.0001,RR0.24,95%CI0.11-0.49)wereassociatedwithbetterOS.OnlyadjuvanttreatmentwassignificantlyassociatedwithprolongedPFS(p=0.0007,RR0.27,95%CI0.13-0.57).Withcombinedtherapywithresection,RT,andchemotherapy,themedianPFSandOSwere8and12.5months,respectively.CONCLUSIONS:TheprognosisforGBMworsenswithincreasingageinelderlypatients.Withimportantrisks,resectionandadjuvanttreatmen

简介：Alongwiththedevelopmentofinformationandcommunicationstechnology,openeducationalresourceswerewidelyappliedintrainingusage.Theuseoftheseresourcesfacilitatestheaccesstoknowledgebyenablinglearnerstotranscendtimeandspace.Inthisway,learnersareabletoobtainnewknowledgemoreactivelyandefficientlythanbefore.UsingTechnologyAcceptanceModel(TAM)asthetheoreticalfoundation,thisstudyaimstoexplorethelearningoutcomeofusingopeneducationalresourceswiththeperceivedconvenienceastheexternalvariable.Inthisstudy,theopeneducationalresourcesweredefinedasonlinecoursesontheOpenCourseWare(OCW)andMassiveOpenOnlineCourses(MOOCs),onwhichthelearnerschoosecoursesthemselvesandstudywithouttheimpactfrompeople,matters,time,space,andthingswiththehelpoftheInternet.Toachievetheobjectivesofthestudy,theresearchersconductedasurveywiththeparticipantswhohadalreadyusedtheopeneducationalresources.Intotal,124validsampleswerecollected.ThePartialLeastSquares(PLS)statisticalmethodwasusedtocarryouttheanalysis.Overall,themodelofthisstudyhasgoodpredictionandexplanatorypower.Afterthedataanalysis,thestudyfoundthattheperceivedconvenienceexertsapositiveimpactontheuseoftheopeneducationalresources.Inaddition,amongthefourTAMvariables,theperceivedusefulnessdoesnotexertasignificantimpactonthebehavioralintentiontouse,buttheotherthreeTAMvariablesallhaveasignificantimpactonthebehavioralintention.

简介：摘要Background and objectiveCloser monitoring and treatment is vital for pregnant carbon monoxide (CO) poisoning cases due to fetal poisoning component. Permanent damage can occur in both the mother and the baby. It may cause stillbirth even though no serious clinical symptoms occur in the mother. Hyperbaric oxygen (HBO) treatment is advised for all pregnant patients regardless of their clinical symptoms. Pregnant CO poisoning patients that received HBO treatment and their fetal status were evaluated in this study.MethodsPregnant patients poisoned with CO treated in the same hyperbaric clinic were evaluated. Pregnant patients that received HBO treatment in a multiplace chamber were evaluated in terms of clinical status, demographic structure, laboratory tests, fetal effects and progress of the fetus until birth and 6 months postpartum.ResultsA total number of 32 pregnant cases were treated. COHb values were over 20% (min 6.9- max 40.2) in 23 patients, 11 patients had a history of syncope. All patients took HBO treatment under 2.4 ATA pressure for 120 min. 3 patients received more than 1 session of HBO treatments due to fetal stress; all other cases took 1 session of HBO treatment. No spontaneous abortus occurred in early follow-ups; only 4 babies were born prematurely. 2 of the babies were lost in the early phases after birth, due to causes non-related to CO poisoning complications (cyanotic heart disease, necrotizing enterocolitis). No significant difference were observed in the comparison of laboratory results of patients with syncope and of those who did not have syncope and comparison of patients with COHb value higher than 20% and patients with COHb value lower than 20% (P>0.05)．ConclusionHBO is not advisable for pregnant patients except for CO poisoning. In this study it is observed that HBO treatment under 2.4 ATA pressure for 120 min has no harmful effects on the mother and the fetus. It is observed that continuation of HBO treatment in the cases with fetal distress findings has beneficial effects. COHb levels and syncope were shown to have no significant effect on clinical symptoms and on blood tests.

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简介：AIM:Toevaluatetheindications,complications,andvisualandgraftsurvivaloutcomesineyesthathadundergonesimultaneouscataractextractionandpenetratingkeratoplasty(PKP).·METHODS:Wedescribedaretrospectivestudyof101patientswhohadundergonesimultaneouscataractextractionandPKPatKingKhaledEyeSpecialistHospitalbetweenJanuary1,2001,andDecember31,2002.Allpatientswerefolloweduppostoperativelywithmaximumfollow-up68months.·RESULTS:Themeanageofpatientswas61years.Themeanoverallfollow-upwas27months.Themostcommonindicationsforsurgerywerecornealscarring(45.5%),previousfailedgraft(15.8%),cornealulcer(12.9%),Fuchsendothelialdystrophy(8.9%),stromaldystrophy(2.9%),andotherconditions(14.5%).Overall,69grafts(68.3%)remainedclearatfinalfollow-up.Previousglaucomaorpostoperativeglaucomahadnostatisticallysignificanteffectsongraftoutcome(P>0.05).Thegraftrejectionrate(17.8%)wasasignificantriskfactorforfailure(P=0.00).Age,gender,indicationsforsurgery,cornealgraftdiameter,andintraoperativevitreouslosshadnostatisticallysignificanteffectsonthePKPoutcome(P>0.05).Postoperativevisualacuitywassignificantlyassociatedwithpreoperativevisualacuity(P<0.01).·CONCLUSION:Thepresentstudyprovidesevidencethatperformingacombinedprocedureresultsinmorerapidvisualrehabilitationandgoodgraftclarity.

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简介：Purpose:Theaimofthisstudywastoevaluatetheprogram"Nomoresmoking!It’stimeforphysicalactivity",withamixedmethodsdesign,inordertocollectinformationtoimprovetheprogramforfutureapplications.Methods:Fortypatientsacrossfiveanti-smokingclinicsinCentralGreececompletedtheprogram.Counselors’recordsandparticipants’questionnairesandinterviewswereusedasdatainordertoevaluatetheprograms’processandoutcome.Results:Quantitativemeasuresbeforeandaftertheprogramrevealedsignificantdifferencesonsmokingbehavior,physicalactivity(PA)behavior,self-efficacy,andsmokinghabitmeasures.QualitativedataimpliedthatthepromotionofPAasacessationaidwasperceivedaspositivebytheparticipantsandbothparticipants’andcounselors’statementswereencouragingfortheeffectivenessofPApromotionduringtheprogramasacessation-aidtechnique.Conclusion:Evaluationofthe"Nomoresmoking!It’stimeforphysicalactivity"programshowedencouragingresults.PeoplewhotrytoquitsmokingcanbecomemorephysicallyactivethroughtargetedinterventionandtheyregardPAasasignificantaidintheireffortstoquitsmoking.

简介：Traumaticbraininjury(TBI)isamajorpublichealthproblemthroughouttheworld.Morethan400000patientswithTBIintheUnitedStatesofAmericaandmorethanamillionpatientswithTBIinChinaareadmittedtohospitaleveryyear.HeadtraumaisalsoNo.1killerofyoungpeopleinthedevelopedcountriesaswellasinsomedevelopingcountries.Unfortunately,theoutcomeofpatientswithsevereTBIisstillpoorallovertheworld.ThemortalityofsevereTBIpatients(GCS3-8)inmajorityofhospitalsisover30%andverysevereTBIpatients(GCS3-5)isover80%withonly15%functionalrecovery.1,2However,recentadvanceincerebralprotectionbymild(35-33℃)tomoderatehypothermia(32-30℃)iscertainlyencouraging,whichbringsneurosurgeonsthehopetoimprovetheoutcomeofsevereheadinjuredpatients.

简介：AbstractBackground:Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors.Methods:Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients’ age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study.Results:The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years’ success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt.Conclusions:Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.

简介：AbstractBackground:Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).Methods:A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan-Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.Results:In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer-Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.Conclusion:A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.

简介：在男孩，中央早熟的发身(CPP)是以前垂体促性腺激素分泌物驾驶的第二等的性别特征的外观9年的年龄。在最后年里，在CPP的处理的相关改进被完成了。因为CPP在男孩是稀罕的，这个问题上的报纸的多数集中于女孩并且不关于结束结果和安全探讨男病人的特定的特征。在现在的纸，有在男人的GnRH类似物的CPP管理的最近的进展被总结。在未经治疗、对待的病人的结束结果被最近出版的文学的分析也在男人在CPP的治疗上考察。可得到的数据显示没有重要不利短期、长期的效果，有GnRH类似物的那治疗能改进最后的高度进目标高度的范围，但是病人的更大的系列的更长的后续是仍然要求了得出权威的结论。

简介：AbstractObjective:To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods:This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results:For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group (P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly (P < 0.05). Weight (odds ratio (OR)= 1.03, 95% confidence interval (CI): 1.01-1.05)), parity (OR= 1.18, 95%CI: 1.03-1.34), number of miscarriages (OR= 1.31, 95%CI: 1.17-1.47), number of previous cesarean sections (OR= 2.57, 95%CI: 2.02-3.26), history of premature rupture of membrane (OR= 1.61, 95%CI: 1.32-1.96), previous cesarean-section transverse incisions (OR= 1.38, 95%CI: 1.12-1.69), history of placenta previa (OR= 2.44,95%CI: 1.50-3.96), and the combination of prenatal hemorrhage (OR= 9.95,95%CI: 8.42-11.75) and placenta previa (OR= 91.74, 95%CI: 74.11-113.56) were all independent risk factors for PA.Conclusion:There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

简介：AIMTo把主要、周期性的pterygium外科的长期的结果与三种不同技术作比较：联合结膜自体移植和覆盖羊膜的膜移植(有AMT的猫)，结膜自体移植移植(猫)独自一个、羊膜的膜移植(AMT)alone.METHODSIn这回顾的研究，142个pterygium病人的142只眼睛(104主要，38周期性)经历了猫(组A)，AMT(组B)或有AMT(组C)的猫分别地后面的外科的切除基于复发和手术后的complications.RESULTSThe数字被考察并且比较一样的描述在下面)，18(10，8)并且2(1，1)在组A，B，和C分别地；干燥眼睛是22(16，6)，27(18，9)并且7(3，4)；结膜发炎是30(17，13)，27(16，11)并且11(6，5)。在组C(主要或周期性的任何一个或两个)的病人主要在组A或B比那些显示出显著地更好的结果(P<0.05)关于上述临床的effects.CONCLUSIONCombined猫并且过分AMT比猫或AMT为主要、周期性的pterygium外科有复发和手术后的复杂并发症的显著地更低的率独自一个。

简介：AbstractObjective:The meiotic spindle controls chromosome movement and mediates various functions essential for fertilization and early postfertilization events. This study aimed to examine whether vitrification causes meiotic damage in vitro-matured metaphase II (MII) human oocytes, and whether the meiotic spindle morphology influences the subsequent developmental outcomes.Methods:The spindle characteristics of MII human oocytes in vitro matured were studied before and after vitrification using PolScope imaging and immunofluorescence staining. The developmental competence of oocytes was also examined.Results:A total of 419 human MII oocytes were obtained from 593 intracytoplasmic sperm injection cycles at our hospital. Of these oocytes, 54 were used for immunofluorescence staining, whereas the other oocytes were examined by PolScope imaging and classified into three groups according to the meiotic spindle morphology: (A) normal morphology, (B) weak refraction and short meiotic spindle, and (C) no detectable meiotic spindle. The three groups demonstrated statistically significant differences in terms of survival after vitrification. However, differences were not found in terms of oocyte chromosome structure and meiotic spindle morphology on immunofluorescence staining performed before and after vitrification. Oocyte survival, fertilization, and early embryonic development rates were significantly higher in Group A than in Groups B and C with or without vitrification. While vitrification had no effect on these metrics in Group A, Groups B and C demonstrated significantly lower fertilization and cleavage rates after vitrification/warming.Conclusions:Screening for normal meiotic spindle morphology and chromosome configuration before vitrification may increase the yield of healthy viable oocytes for various assisted reproductive technologies.

简介：ObjectivesToinvestthesuccessprocedure,immediateoutcomeafterprocedure,therateofmainadversecardiaceventsafterprocedureandrestenosisafterstentplacementinsmallcoronaryvessels.Methods290patientswithselectedoremergencystentimplantationinsmallvesselsfromApril,1997toMarch,2002.Total299vessels,304lesionsand316stentswerestatisted.Thesuccesssrateofprocedure,immediateoutcomeafterprocedure,therateofmainadversecardiaceventsafterprocedureandrestenosisafterstentplacementinsmallcoronaryvesselswereassessed.Thepatientswerefollowedup1monthto4years.Re-catheterangiographyweredonein122/290patients.ResultsThenarrowrateoflesiondroppedfrom89%±12%beforeprocedureto5%±5%afterprocedure(diameter).202patientswerefollowedup1month(69.7%).197/202casesweresurvival.5/202casesdiedin3hrsto7days.2/5casesdiedofpersistenthypotensionafterprocedure.1/5casediedofacuteleftheartfailure.2/5casesdiedofsuddendeath.180caseswerefollowedup5monthsto4years.Thenon-eventsurvival(NES)ratewas73.3%(132/180).There-angiographyweredonein122cases.Restenosishappenedin39cases(30.3%).37patientsrepeatedPCI.2patientswenttoCABG.2casesgotanginarecurrenceandwereprovedsecondtimerestenosisbyre-angiography.ThethirdtimePCIwasdonein1patient.TheotherpatientswenttoCABG.1casediedofchronicheartfailureafter2years.1casesufferedacutemyocardialinfarctiononarterystentimplanted.ConclusionsTherearehighsuccessrateofprocedureandperfectimmediateoutcomeinstentplacementinsmallvessels.Mainadversecardiaceventsdidnotincreased.Non-eventsurvialwassatisfiedinlongtermfollow-up.Restenosisratewasshowedslightlyhigherthantheoneofmainvessels.

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