摘要
Keratopathy-associated cataract, that is, on the basis of corneal disease, and later the development of lens opacity, seriously damage visual quality. In order to avoid corneal transplantation for some patients, partial visual quality can be restored. A comprehensive and accurate evaluation of the effect of corneal opacity on visual function is of great improtance for determining cataract surgery alone. Due to the opacity of the cornea, the operation is very difficult and challenging. Therefore, it is of clinical value to develop and use new assistive technologies, including capsule staining, endoillumination, pupil dialation technology, femtosecond laser assisted technology, etc., avoiding problems such as limited visibility and decreased light flow caused by corneal opacity and facilitating cataract surgery. This article reviews progress of assistive technologies for keratopathy-associated cataract, hoping to guide clinical application.
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Objective:To study the effect of rapamycin on the disorder of CD4 + T cell subsets in Graves′ ophthalmopathy(GO) mice, as well as the ophthalmopathy and hyperthyroidism phenotype, providing new possibilities for the treatment of GO. Methods:6-8 weeks old female Balb/c mice were injected intramuscularly with adenovirus expressing the A-subunit of TSHR(A-sub-Ad) 9 times. Rapamycin was given by embedding in the feed(14 ppm). The animals were euthanized 4 weeks after the final injection to obtain blood, spleen cells, thyroid glands, and orbital tissue. TT 4, thyrotropin receptor antibody(TRAb), thyroid, and orbital pathologic changes were detected, and the CD4 + T cell subgroup was evaluated by flow cytometry and immunohistochemistry. Results:After final immunization, the mice showed characteristics of GO: increased retrobulbar fibrosis and retrobulbar adipogenesis that indicated ophthalmopathy, increased autoantibodies, and serum total thyroxin that indicated hyperthyroidism. After the intervention of rapamycin, retrobulbar fibrosis and retrobulbar adipogenesis were significantly improved, and the incidence of ophthalmopathy was reduced from 80%-90% to 20%. Moreover, the increase of total thyroxin was reduced from 80% to 20%, and the metabolic condition and thyroid pathology were also improved. Flow cytometry of the spleen, immunohistochemistry of the thyroid and orbital tissue revealed that GO mice exhibited Th1 dominance in Th1/Th2 balance and reduction of Treg cells. After the intervention of rapamycin, flow cytometry showed that the ratio of Th1 and Th17 cells decreased and the ratio of Th2 and Treg cells increased. Immunohistochemistry of thyroid and orbital tissues also confirmed improvement of Th1/Th2 cell imbalance and Treg cell reduction.Conclusion:GO mouse model showed a significant imbalance of CD4 + T cell subsets, and rapamycin could not only regulate the disorder of CD4 + T cell subsets in GO mice, but also effectively improve the phenotype of ophthalmopathy and hyperthyroidism. Therefore, the imbalance of CD4 + T cell subsets is one of the etiological intervention targets of GO, and rapamycin is a potential intervention mode of GO, which can be further explored by randomized clinical studies in the future.
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Objective:To observe the effect of Ba Duan Jin(Eight-brocade Exercise)plus Tuina(Chinese therapeutic massage)in treating primary dysmenorrhea due to cold-induced blood stasis in female college students and on the score of fatigue scale-14(FS-14). Methods:Seventy-two female college students with primary dysmenorrhea due to cold-induced blood stasis were randomized into a Tuina group and a joint group,with 36 cases in each group.The Tuina group only received Tuina manipulations.In the joint group,besides the same Tuina manipulations,patients practiced Ba Duan Jin.For both groups,the once-daily intervention was conducted from 6 d before the menstrual period until menstrual day 1 for 3 menstrual cycles.Changes in the scores of COX menstrual symptom scale(CMSS),visual analog scale(VAS),and FS-14 after the intervention were observed.Clinical efficacy was also estimated. Results:During the process,1 case dropped out in the Tuina group,and 35 cases completed the intervention;2 cases dropped out in the joint group,and 34 cases completed the intervention.The total effective rate was 94.1%in the joint group,higher than 88.6%in the Tuina group(P<0.05).After treatment,the symptom duration and intensity scores in the scores of CMSS,VAS,and FS-14 declined in both groups(P<0.05 or P<0.01);the CMSS symptom duration score and FS-14 score were lower in the joint group than in the Tuina group(P<0.05). Conclusion:Tuina manipulations alone or combined with Ba Duan Jin practice can effectively treat primary dysmenorrhea due to cold-induced blood stasis in female college students;when combined with Ba Duan Jin practice,Tuina manipulations can more significantly improve pain duration and fatigue,suggesting the advantages of combining Tuina Gongfa and manipulations.
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AIM: To compare the differences and agreement of anterior segment biometric parameters of myopic patients measured by domestic Scansys and the imported Sirius based on the principle of Scheimpflug imaging technique.METHODS: In this case series study, 103 cases(103 eyes)that underwent pre-refractive surgery(including small incision lenticule extraction, femtosecond laser-assisted in situ keratomileusis, transepithelial photorefractive keratectomy and implantable contact lens implantation)at Aier Excellent Eye Hospital from May 2022 to October 2022 were recruited. Preoperative keratometry(Km), central corneal thickness(CCT), anterior chamber depth(ACDEndo.), anterior chamber angle(ACA), anterior chamber volume(ACV), white to white(WTW)of patients were recorded.RESULTS: The results of Km, CCT, ACA, and WTW measured by Scansys and Sirius were 42.88(41.54, 44.60)and 42.98(41.56, 44.52)D,(541.52±29.08)and(549.55±29.62)μm, 42.70°±2.67° and 46.63°±5.13°, 12.10±0.60 and 11.98±0.47 mm, respectively, showing the difference was statistically significant(all P<0.01). The ACV measured by Scansys and Sirius was 194.26±31.06 and 191.47±25.65 mm3, and ACDEndo. was 3.40(3.17, 3.57)and 3.43(3.19, 3.56)mm, with no statistically significant difference(all P>0.05). The range of Km, CCT, ACA, ACDEndo., ACV and WTW values measured by the two instruments was small, with an average difference close to zero, and the points percentage of 95% limits of agreement(LoA)was <5%, which is of good consistency.CONCLUSIONS: Scansys and Sirius have small differences and good agreement in the parameters, which can be replaced by each other in clinical practice. Scansys could theoretically be used to extrapolate the implantable contact lens model or could be a new option for anterior segment parameter measurements.
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Objective:To investigate the utilization and demand of health care services for children with mental disabilities and provide implications for the development and update of related policies. Methods:Data of utilization and demand of health care services for children with mental disabilities aged 0 to 17 years were selected from The Second China National Sample Survey on Disability in 2006. The difference of utilization and demands of health care services for children was analyzed in socio-economic characteristics including gender, age, urban and rural areas, disabled level, parents' highest level of education and family income. Results:The utilization rate of health care service was relatively low (44.35%), and the demands was high (98.26%) among children with mental disabilities. Medical services and assistance, rehabilitation training and services, and aid and support for poor people with disabilities were the most-utilized and most-demanded services for children with mental disabilities. In terms of utilization, the utilization rates of medical services and assistance, and rehabilitation training and services were higher among children with mental disabilities in urban areas than in rural areas (χ2 > 11.028, P < 0.01). And the utilization rate of these two services also was higher among mentally disabled children from family with higher parental education and income than among the counterparts from families with low socioeconomic status (χ2 > 9.169, P < 0.05). In terms of demand, children with more severe mental disability had higher demand of aid and support for poor people with disabilities (χ2 = 17.822, P < 0.001). And higher demand of rehabilitation training and services was found among mentally disabled children with better family socio-economic status (χ2 = 7.797, P < 0.05). Conclusion:The demands for health care services among children with mental disabilities urgently need to be further met. Reinforcing the development of above three types of services, addressing the imbalance of health care services allocation between urban and rural areas, and improving the economic conditions of disabled families will effectively improve the utilization of the health care service for mentally disabled children.
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Objective To explore the effects of cases-based flipped class in the hybrid teaching for neuroanatomy. Methods A comparative study was conducted among 102 students majored in clinical medicine of 2019 grade, one was the experiment group (n = 51) and another was the control group (n = 51). The traditional teaching method was applied in control group, while the teaching during neuroanatomy based on cases-based flipped class was applied in experimental group. The teaching effects were evaluated by theory and experiment examination and investigated by the questionnaire of students' satisfaction with the new teaching mode. Results Most students supported the cases-based flipped class teaching and thought it was helpful to improve the autonomous learning ability. The satisfaction rate of experimental group on the cases-based flipped class teaching effectiveness was 98.04%. The total scores, the scores of neuroanatomy and the student number who got 81-90 and 91-100 of experiment group were significantly higher than those of control group, and the difference was statistically significant (P<0.05). Conclusion Cases-based flipped class could effectively improve the quality of neuroanatomy teaching and students' learning ability and effects for undergraduates.
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Objective To explore the application value and evaluate the safety of ESD in treatment of early colorectal cancer. Methods The clinical data of patients with early colorectal cancer admitted from May 2014 to May 2016 were retrospectively analyzed. According to the different operation methods, the patients were divided into EMR group and ESD group. The changes of clinical efficacy, safety and inflammatory index level were compared between the two groups. Results 126 patients were involved in the study. The operative time was longer than that of the lesion diameter < 2 cm (P < 0.05) when the lesion diameter was more than 2 cm. The operative time of ESD group was longer than that of EMR group. The resection rate and complete resection rate of lesion were higher than that of EMR group (P < 0.05). When the diameter of lesion was ≥ 2 cm, the operation time of ESD group was longer than that of EMR group. In EMR group, the whole and complete resection rate were lower than that in the diameter less than 2 cm (P < 0.05). There was no significant difference in the levels of TNF- α IL-6 and CD3+and CD4+between the two groups before operation (P > 0.05), but one week after operation, the levels of CRP, TNF- α and IL-6 was lower than that of EMR group (P < 0.05), while the levels of CD3+and CD4+were higher (P < 0.05). There was no significant difference in the incidence and recurrence rate of anastomotic leakage (P > 0.05). The incidence of hemorrhage in ESD group was higher than that in EMR group (P < 0.05). Conclusion ESD was effective in treatment of early colorectal cancer. The stress response was small and the recurrence rate was low, but the bleeding rate was higher than that in EMR group, so the monitoring should be strengthened.
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To clone,express and purify the E Protein and EDⅢ of Zika virus in E.coli and prepare two kinds of polyclonal antibodies,the virus was amplified by Vero E6 cell culture.Total RNA was extracted by RT-PCR and reverse transcribed into cDNA.The prokaryotic expression vectors pET32a/E and pET28a/EDⅢ were constructed by cDNA sequence of E and EDⅢ gene.Then,recombinant plasmids were transformed into E.coli BL21 and induced by IPTG,and purified by Ni+ column affinity chromatography.BALB/C mice were immunized with purified recombinant proteins.Antiserum was collected and titer was determined by indirect ELISA.Western blot was used to detect the specificity.Results showed that the recombinant proteins were successfully expressed and purified.The titer of the polyclonal antibodies both reached 1:409 600.Western Blot analysis showed that the polyclonal antibodies could specifically recognize the recombinant proteins.Thus,the specific polyclonal antibody were successfully prepared,laying a foundation for further study on the pathogenesis,detection methods and immune strategies of Zika virus.
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Objective To systematically evaluate the association of diuretics with falls in the elderly. Methods Data of case-control studies and cohort studies of diuretics with falls in the elderly were collected by searching eleven electronic databases:MEDLINE,Embase,CENTRAL,AMED,CINAHL,Web of Science,Wiley online library, CBM,CNKI,VIP and WanFang Data from inception to July 2017. Study quality was assessed by the NOS scale. Meta-analysis was conducted by RevMan 5.3 software. Results A total of 17 studies involving 78284 patients were included(seven case-control studies and ten cohort studies). Meta-analysis showed that:①Case-control studies:crude OR showed that diuretics would not increase the risk of falls in elderly patients [OR=0.95,95%CI (0.66,1.38),P=0.80];adjusted OR showed that diuretics would increase the risk of falls in elderly patients[adjusted OR=1.25,95%CI (1.15,1.36),P<0.05]. ②Cohort studies:crude OR showed that diuretics would increase the risk of falls in elderly patients[OR=1.16,95%CI(1.02,1.32),P=0.03];adjusted OR showed that diuretics would not increase the risk of falls in elderly patients[adjusted OR=1.06,95%CI(0.92,1.22),P=0.43]. ③There was no statistically sig-nificant difference in the risk of falls among the elderly at different places,and there was no significant difference in the risk of falls among various diuretics (P>0.05). Conclusion Based on meta-analysis results of cohort studies that controlled confounders,and the results of diuretics in different places and different kinds,diuretics will not in-crease the risk of falls in older adults. Due to limited quantity and quality of included studies,the results need to be further confirmed by more rigorous clinical trials in the future.
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Objective: To summarize the typical experiences and practices based on the quality evaluation of medical consumables in foreign countries and the practice of drug bidding in China,and to explore the establishment of a bidding grouping scheme for medical consumables in China. Methods: Using literature analysis and evaluation method of combing foreign countries typical measures of medical consumables quality assessment,this paper summa-rized the construction of index system of bidding in China Pharmaceutical Group, and used simple statistical data to reflect the present policy of China's medical supplies such as lack of relevant policies,different levels of quality etc.. Results:There are many problems in the quality evaluation of medical consumables in China. However, the typical measures of extraterritorial quality evaluation and the practice of pharmaceutical bidding in China provide a solid theo-retical and practical basis for the establishment of medical consumable supplies bidding grouping. Conclusion:Estab-lishing bidding grouping scheme is necessary in the Chinese Medical supplies context. Based on a clear difference be-tween medical supplies and medicines,and according to the"three stage"our conceptualization gradually improved. On the basis of the existing data and practical situation,the establishment of scientific selection index bidding group division standard,has been in the exploration of the formation of China's medical supplies bidding grouping scheme.
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Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.
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OBJECTIVE:To provide reference for prescriptions audit before payment in hospital pharmacy. METHODS:The management measures of prescriptions audit and intervention before payment in our hospital were introduced. 1 200 outpatient pre-scriptions within 1 year before and after management were subjected to a statistical analysis. The effects of prescriptions audit be-fore payment were evaluated through analyzing and comparing qualification rate of prescription and unqualified prescriptions. RE-SULTS:Our hospital adopted a series of measure to realize prescriptions audit and intervention before payment by clinical pharma-cists,such as using information audit system,formulating audit standard,educating pharmacists,establishing audit job system, prescriptions review and feedback system,setting up communication system,etc. Of the total audited 189 665 prescriptions, 14 581(7.69%)failed to audit and 606 prescriptions hadn’t been revised after 1 year management,with effective intervention rate of 95.84%. Compared with before management,the prescription qualification rate increased from 88.83% to 98.67% after manage-ment(P<0.01). The quantity of overdose,inconformity with medical insurance,overload and other conditions reduced to 0. CON-CLUSIONS:It is feasible for pharmacists to audit and intervent prescriptions before payment in hospital pharmacy to improve pre-scription qualification and promote rational drug use in the clinic.
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Objective:To investigate the stress distribution surrounding an implant under different thickness of cancellous bone and cortical bone,and to analyze the influence of thickness ratio and total thickness of bone tissues on the reliability of an implant.Methods:By using the commercial finite element method software Abaqus, a simplified three-dimensional model of a jawbone consisting of a cancellous bone,a cortical bone,an implant,and a ceramic crown was constructed,and then the computation was performed.Under the condition that the system was loaded by lateral and normal stresses, the influence of thickness ratio and total thickness of cancellous bone and cortical bone in the stress distribution surrounding the implant was studied,where the thickness ratios were 3∶1, 2∶1, 1∶1, 1∶2, and 1∶3;the total thickness were 0.5, 1.0, 2.0, 3.0 and 4.0 mm, respectively. Results:The maximum stresses on the cortical bone,the cancellous bone as well as the implant were all found to decrease with the increasing of the total thickness of cortical and cancellous bones,with a higher decreasing rate in the range between 0.5-2.0 mm and a lower decreasing rate between 2.0-4.0 mm. More importantly, the maximum value of stress in the cortical bone within the neck region of the implant was observed to increase dramatically via reducing the total thickness below 2 mm, while it was increased insignificantly when the total thickness was above 2.0 mm. Conclusion:The thickness ratio and the total thickness of cancellous bone and cortical bone have strong influence in the stress distribution surrounding the implant.In dental implantation surgery, the total thickness of cancellous bone and cortical bone should be at least 2 mm, and therefore 2 mm is an optimal value.
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OBJECTIVE: To analyze the safety monitoring effects of pediatric drug data protection regime in the US and provide the suggestions to improve the safety of pediatric drugs in China. METHODS: Theoretical analysis and case study of Duragesic (Fentanyl transdermal patch). RESULTS: The pediatric drug data protection regime promoted safety monitoring effectively. CONCLUSION: II is necessary to establish pediatric drug data protection system in China by referring to the experience of US, to enhance the lilecycle risk management and the responsibilities of enterprises, so as to improve the safety of pediatric drug.
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OBJECTIVE: To provide domestic innovative pharmaceutical enterprises practical advice on patent strategy and innovation capacity-building. METHODS: Choose the first class innovative drug NBP as study subject, make an empirical study from three aspects, including patent creation, management and implementation, about how to take full advantage of the national innovation policies and patent strategy to improve the innovation capability of enterprises to ensure its sustainable development. RESULTS: The patent strategy of NBP turns out to be a very big success. CONCLUSION: CSPC has developed a virtuous cycle, in which patent strategy and innovation capacity-building facilitate each other, its successful experience is worth learning for high-tech enterprises.
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Objective To evaluate the influence of different insertion torque values on stress and strain distributions at implant-bone interface. Methods The three-dimensional finite element model of the whole mandible with dental implants for immediate loading was created by CT scanning and self-developed USIS (universal surgical integration system) software. The insertion torque values of dental implants were supposed to be 0、15、25 N•cm3, respectively. The values of Von Mises stress and strain at implant-bone interface were calculated with ANSYS software, when the dental implants were loaded with vertical and buccolingual force at a 45°oblique angle of 150 N. Results When the dental implants under the three insertion torques were loaded with the vertical force, the maximum Von Mises stress was 33.6, 56.4, 69.6 MPa and the maximum strain was 5 157, 8 645, 15 630 με, respectively, while loaded with the buccolingual force, the maximum Von Mises stress was 95.3, 100.6, 108.3 MPa and the maximum strain was 17 110, 18 690, 21 380 με, respectively. Conclusions With the increased torque value of dental implants, the stress and strain at the implant-bone interface were both increased, but the increase was much slower under buccolingual loading than that under vertical loading.
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<p><b>OBJECTIVE</b>To study the impact of gonadotropin-releasing hormone analogs (GnRHa) on body mass index (BMI) in girls with idiopathic central precocious puberty (ICPP).</p><p><b>METHODS</b>One hundred and thirty-four girls with ICPP were enrolled. Fifty-seven out of the 134 girls were treated with GnRHa for 1.69±0.43 years. The height, weight, bone age and BMI were measured before treatment, at the end of the treatment and after reaching near adult height and compared with those in the untreated 77 girls.</p><p><b>RESULTS</b>The adult predicted height standard deviation score (SDS) at the end of treatment was significantly higher than that before treatment (P<0.01) and was similar to the target height SDS in the GnRHa treatment group (P>0.05). With GnRHa treatment, the near-adult height SDS was higher than the target height SDS (P<0.01). At the end of treatment, the BMI SDS slightly increased compared with pretreatment level (P>0.05). A significant reduction in the BMI was observed when reaching the near-adult height in the GnRHa treatment group compared to the level of pretreatment and the untreated group (P<0.01). However, the BMI in the GnRHa treatment group before treatment, at the end of the treatment and after reaching near adult height remained in the normal range (±1 SD).</p><p><b>CONCLUSIONS</b>GnRHa may improve the final height in girls with ICPP. The alterations of BMI after GnRHa therapy fluctuate in a normal range.</p>
Subject(s)
Child , Female , Humans , Body Height , Body Mass Index , Follow-Up Studies , Gonadotropin-Releasing Hormone , Therapeutic Uses , Puberty, Precocious , Drug Therapy摘要
<p><b>OBJECTIVE</b>To introduce a self-developed bone collector designed by the authors and evaluate its effect in clinical application.</p><p><b>METHODS</b>A self-developed bone collector was used in 38 patients who underwent the dental implant operation from May 2008 to October 2009. During the operation the bone particles were harvested, which was used for the reconstruction of the bone defects around the implant simultaneously. The defects were fenestrate in 29 regions and triangle in 23 regions on buccal or lingual side of the dental implants.</p><p><b>RESULTS</b>All cases had no surgical wound infection and dehiscence 7 - 10 days after operation. Three to six months after implantation, the X-ray showed that all the dental implants had perfect osseointergration and the alveolar bone were successfully augmented.</p><p><b>CONCLUSIONS</b>Bone debris harvested by self-developed bone collector could repair small peri-implant bone defects, which is simple to use in clinic.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Transplantation , Bone and Bones , Dental Implantation , Oral Surgical Procedures, Preprosthetic , Osseointegration , Tissue and Organ Harvesting , Tooth Loss , General Surgery , Transplantation, Autologous摘要
Objective To study the risk factors of human cystic echinococcosis (CE) in Hobukesar Mongolian Autonomous County of Xinjiang (HMACX) and to discuss the related strategies for prevention and control. Methods A randomized sampling method was used to screen local residents for human CE in HMACX. CE related risk factors including ethnicity,age,sex,occupation and personal status on hygiene etc. were analyzed under multi-factor logistic regression. Results The prevalence rates of CE and alveolar echinococcosis (AE) were 3.7% (23/627) and 0.16%(1/627) respectively,with the seropositive rate as 12.4% (76/613). The main risk factors that significantly associated with CE were age (OR=7.6,95% CI: 2.481-23.579) and slaughtering livestock in the households (OR=3.2,95%CI: 1.297-7.809). Herdsmen had the highest prevalence of CE in all of the occupations in this study. Conclusion HMACX had been a highly endemic area for human CE,with age and family slaughtering-livestock-behavior appeared to be the main possible risk factors.
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<p><b>OBJECTIVE</b>To report nine cases of descending necrotizing mediastinitis (DNM) and to summarize the management experience.</p><p><b>METHODS</b>Between December 2005 and December 2008, nine patients (mean age, 55.7 years; age range, 38 to 78 years) with DNM were treated. Eight patients underwent surgical drainage of the involved cervical region and mediastinum (4 with cervical drainage alone; 4 with cervical drainage and right thoracotomy).</p><p><b>RESULTS</b>Two patients died, one of them refused surgical therapy and the other one died of multiorgan failure related to postoperative septic shock. Seven patients recovered. The mortality rate was 22%.</p><p><b>CONCLUSIONS</b>Delayed diagnosis and inadequate drainage are the main causes of high mortality rate of DNM. Aggressive surgical drainage and debridement of the neck and mediastinum by a multidisciplinary team of surgeons are very important in the treatment of DNM.</p>