囊袋张力晶状体环在外伤性白内障伴晶状体悬韧带断裂手术中的应用(英文)

[目的]评价晶状体囊袋张力环(capsular tension ring,CTR)在外伤性白内障伴晶状体悬韧带断裂手术中的应用.[方法] 7例(7只眼)外伤性白内障伴晶状体悬韧带部分断裂,在白内障手术连续环形撕囊术(CCC)后植入CTR,然后施行超声乳化白内障吸除及后房人工晶状体(PC-IOL)囊袋内植入.[结果]术后7只眼PC-IOL均处于正位,无倾斜或明显偏斜.随访6～12个月,最佳矫正视力2眼0.5,3眼0.6和2眼0.8,未见有何严重手术并发症.[结论]外伤性白内障伴晶状体悬韧带断裂患者,术中应用CTR有利于手操作,防止术后PC-IOL偏位,可加快视力的恢复.CTR对外伤性白内障伴晶状体悬韧带断裂者手术是一有用的辅助工具.     

非球面Toric人工晶状体植入术后的临床研究

目的比较非球面和球面Toric人工晶状体植入术后患者的视觉质量。方法选择术前角膜散光1．0～3．0D的单纯年龄相关性白内障患者65例（70眼），其中非球面（IQToric）组32例（35眼）植入AcrysofIQToricIOL（SN6AT），球面（Toric）组33例（35眼）植入AcrysofToric10L（SN601Yr），术后3月评估2组间的裸眼视力、矫正视力、残余散光和轴位旋转，并采用CSV-1000E对比敏感测试仪分别进行明视状态、暗视状态及暗视眩光状态下的对比敏感度检查。结果术后3月非球面组和球面组的裸眼视力分别为LogMAR0．18±0．12和LogMAR0．19±0．12；矫正视力分别为LogMAR0．07±0．09和LogMAR0．08±0．10；残余散光分别为（0．47±0．29）D和（0．54±0．33）D；轴位旋转分别为3．51±1．76度和3．62±1．85度，2组间相比较差异均无统计学意义（P〉0．05）。非球面组在暗视及暗视眩光状态下中高空间频率的对比敏感度明显高于球面组，2组间差异有统计学意义（P〈0．05）。结论IQTo．ricIOL和ToricIOL均可有效及安全地矫正白内障患者的术前角膜散光，其中IQToricIOL植入术后的视觉质量更优于Toric10L。     

Corneal relaxing incision combined with phacoemulsification and IOL implantation

Objective: To analyze the effectiveness and safety of corneal relaxing incisions (CRI) in correcting keratometric astigmatism during cataract surgery. Methods: A prospective study of two groups: control group and treatment group. A treatment group included 25 eyes of 25 patients who had combined clear corneal phacoemulsification, IOL implantation and CRI. A control group included 25 eyes of 25 patients who had clear corneal phacoemulsification and IOL implantation.Postoperative keratometric astigmatism was measured at 1 week, 1 month, 3 months and 6 months. Results: CRI significantly decreased keratometric astigmatism in patients with preexisting astigmatism compared with astigmatic changes in the control group. In eyes with CRI, the mean keratometric astigmatism was 0.29±0.17 D (range 0 to 0.5 D) at 1 week, 0.41±0.21 D (range 0 to 0.82 D) at 1 month, respectively reduced by 2.42 D and 2.30 D at 1 week and 1 month postoperatively (P=0.000, P=0.000), and postoperative astigmatism was stable until 6 months follow-up. The keratometric astigmatism of all patients decreased to less than 1.00 D postoperatively. Conclusions: CRI is a practical, simple, safe and effective method to reduce preexisting astigmatism during cataract surgery. A modified nomogram is proposed. The long-term effect of CRI should be investigated.     

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Objective

To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus.

Methods

Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao’s hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups.

Results

A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006).

Conclusions

Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.     

Accuracy of a combined score of zygote and embryo morphology for selecting the best embryos for IVF

Objective:To evaluate the accuracy of a scoring system combining zygote and embryo morphology in predicting the outcome of in vitro fertilization(IVF)treatment.Methods:In a study group,117 consecutive IVF or intracytoplasmic sperm injection(ICSI) cycles with embryo transfer were carried out and 312 embryos were scored Using a combmed scoring system(CSS)of zygote and embryo morphology before transplantation.In a control group,a total of 420 IVF or ICSI cycles were carried out and 1176 embryos were scored using a cumulative embryo score(CES).The effects of the combined scoring system on the embryo implantation rate and pregnancy rate per cycle were analyzed.Results:Using the combined scoring system,the embryo implantation rate(27.6%)and the clinical pregnancy rate(48.7%)were significantly higher than those in the control group(20.8%and 38.6%,respectively).Also,the implantation rate of embryos scoring≥70 (38.5%:82 sacs/213 embryos)was significantly higher (P＜0.001)than that of embryos scoring＜70(4%:4 sacs/99 embryos).The pregnancy rate of patients with embryos scoring≥70 using the combined scoring system(66.7%)Was significantly higher(P＜0.001)than that of patients with embryos scoring≥20 using the cumulative embryo score(59.0%).Conclusion:The results suggest that selecting embryos with a high Score(≥70)using the combined scoring system could inerease the implantation rate and pregnancy rate,and that using a scoring system combining assessments of human zygotes and pre-implantation embryos might predict IVF outcomes more accurately than using a cumulafive embryo score.     

Effects and complications of placement of motility coupling post in porous polyethylene orbital implants

Objective: To investigate the effects and complications of primary and secondary placements of motility coupling post (MCP) in the unwrapped porous polyethylene orbital implant (PPOI) following enucleation. Methods: We investigated 198 patients who received PPOI implantation following the standard enucleation procedure in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, from 2002 to 2004. These patients were subgrouped into PPOI-only patients (112 cases, received PPOI following enucleation), primary MCP patients (46 cases, received primary placement of MCP during PPOI operation), and secondary MCP patients (40 cases, received secondary placement of MCP 6 months after the initial surgery). Effects and complications among these three groups were compared. Results: The PPOI-only patients took shorter treatment course when compared with other two MCP groups (P<0.001), without significant difference noted between the two MCP groups. However, the two MCP groups had better prosthetic motility than PPOI-only group (P<0.001), without significant difference between the two MCP groups. In the early stage, 2 eyes in the PPOI-only group and 1 eye in the primary MCP group had PPOI infection. In PPOI-only group, 3 (2.68%) eyes had PPOI exposure, which occurred after fitting the prostheses; 4 eyes (8.70%) in primary MCP group and 1 eye (2.50%) in secondary MCP had PPOI exposure, which occurred before fitting the prostheses. After prosthesis was fit successfully, the excessive discharge and granuloma were 33.9% and 1.79% in PPOI group-only, 53.3% and 8.9% in primary MCP group, and 52.5% and 7.5% in secondary MCP group, respectively. Conclusion: Both primary and secondary placements of MCP into the PPOI following enucleation can help patients to obtain desirable prosthetic motility, but maybe associated with more complications. The primary placement of MCP with skilled operation in selected patients is more recommendable than secondary placement.     

Sensory exotropia subsequent to senile cataract

INTRODUCTION Sensory exotropia is a condition of unilateral divergence as a sequela to loss of vision or long-standing poor vision in one eye,which was caused by refractive errors,unilateral aphakia or other organic reasons.Convergence insufficiency or disruption is possible.The most important aspect of the manage-ment is to find and/or eliminate and/or reverse a treatable cause of the exotropia.In clinic,the sensory exotropia secondary to senile cataract was often ob-served.Prospectively…     

冷凝或联合小梁切除术治疗新生血管性青光眼

[目的]探讨冷凝联合小梁切除术治疗新生血管性青光眼的疗效.[方法]A组12例14眼新生血管性青光眼,施行180°视网膜周边部巩膜外和睫状体冷凝;B组20例22眼,除上述冷凝外,又联合小梁切除术治疗.[结果]随访3～6个月,两组术后视力均无明显改善,A组平均眼压自57.48mmHg降至32mmHg,需要再做冷凝或手术减压;B组随访的15例(16眼)有14眼的眼压<21mmHg,2眼需加用0.1%噻吗心安滴眼治疗,两组术后短期内眼压控制有明显的差异(P<0.05).[结论]冷凝或联合小梁切除术对新生血管性青光眼治疗有较好的短期疗效.     

呋喃唑酮、法莫替丁、乐得胃联合治疗十二指肠溃疡临床观察

目的:探求适用于低收入人群十二指肠溃疡(DU)患者经济、有效的治疗方案。方法:将156例活动性DU患者随机分成2组,治疗组82例,用呋喃唑酮200mg、乐得胃2片每天三次,法莫替丁20mg早晚各一次治疗2周:对照组74例,用羟氨苄青霉素500mg、胶体果胶铋100mg(以Bi计)每天三次,奥美拉唑40mg每天早晨一次治疗2周,疗程结束时复查胃镜观察溃疡愈合情况,疗程结束后4周取胃粘膜检查幽门螺杆菌(HP),观察HP根除情况。结果:治疗组和对照组对DU有效率分别为93.6％和94.5％,无统计学差异(P>0.05),HP根除率分别为82.3％和95.7％,对照组明显高于治疗组(P<0.01);治疗组2例出现白细胞轻度降低(3.5×10~9/L),对照组1例ALT轻度升高,治疗结束后均恢复,余无严重不良反应。呋喃唑酮、乐得胃、法莫替丁联合治疗DU,虽然HP根除率稍低,但经济、安全、有效,尤其适用于低收入患者。     

冰冻保存供体的周边深板层角膜移植治疗Terrien’s角膜变性的临床疗效

研究目的：创新要点：研究方法：观察采用冰冻保存供体的周边深板层角膜移植治疗Terrien’s角膜变性（TMD）的临床疗效,探讨TMD的最佳手术治疗方式。供体角膜为冰冻保存,其中部分为中央角膜移植术后剩余的角巩膜环,并改进传统的手术方法。采用周边深板层角膜移植,既充分利用和节约供体,避免排斥反应,又简化了手术操作过程,有效地恢复了眼球完整性和提高术后视力。研究对象为1998年6月至2012年12月期间在浙江大学医学院附属邵逸夫医院眼科中心进行周边深板层角膜移植术的27例TMD病人的31只眼。根据病变范围和大小,分别进行环形深板层角膜移植和D形深板层角膜移植。所有植片均于-20℃冰冻保存,冰冻保存的角巩膜环植片用于环形深板层角膜移植,冰冻保存的整个眼球用于D形深板层角膜移植。对所有术眼的病例资料、视频及影像学检查进行回顾性分析,记录并总结患者的一般情况、术中表现、术后角膜结构的变化、屈光及视力的变化及术后并发症等。重要结论：采用冰冻保存供体的周边深板层角膜移植治疗TMD可以有效地恢复角膜结构的完整性且能长期维持（图3和4）。术后随访过程未发现免疫排斥反应,环形深板层角膜移植术后视力较前明显提高,而3例（100％）D形深板层角膜移植术后散光及视力均不提高（表1和2）。术前炎症及术中穿孔并不影响术后最终结果。     

Intraoperative ERCP and endoscopic sphincterotomy combined with laparoscopic cholecystectomy for treatment of cholelithiasis with choledocholithiasis

Objective: To evaluate the benefit of intraoperative ERCP and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in the treatment of cholelithiasis with choledocholithiasis. Methods: Fifty-two patients with cholelithiasis and choledocholithiasis (as determined by intraoperative cholangiography) were randomly divided into 2 groups during LC. In group A (27 patients), common bile duct stones were extracted by intraoperative EST during LC. In group B(25 patients), common bile duct (CBD) stones were extracted by conversion to open CBD exploration and cholecyctectomy. Results: The success rate was 26/27 (96.3%) in group A and 25/25 (100%) in group B (0.25<P<0.5); The mean postoperative hospitalization was 3.32±0.56 days in group A and 17.5±4.61 days in group B (P<0.001). In group A, two cases were complicated transient hyperamylasemia after the combined procedure. In group B, one case of bile leakage and one case of duodenal ulcer occurred after conversion to open cholecystectomy with CBD exploration. There were no retained stones in group A but 2 cases in group B. Conclusion: Intraoperative ERCP and endoscopic sphincterotomy combined with LC for treatment of cholelithiasis and chiledochlithiasis is safe, effective and results in shorter hospitalization and fewer complications than traditional open cholecystectomy with CBD exploration.     

Effects of combination of irbesartan and perindopril on calcineurin expression and sarcoplasmic reticulum Ca2＋-ATPase activity in rat cardiac pressure-overload hypertrophy

INTRODUCTION Left ventricular hypertrophy has been thought to be the principal predicators of predisposing risk factor of cardiac morbidity and mortality (Devereux, 1995; Levy et al., 1990). The pathogenesis that mediates cardiac hypertrophy is poorly understood. Cardiachypertrophy can be induced by hemodynamic over-load, ischemic disease, neurohumoral factors and intrinsic defects in cardiac structural protein genes (Sadoshima and Izumo, 1997; Vikstrom and Lein-wand, 1996). Another in…     

高屈曲人工全膝关节表面置换术临床研究

目的:探讨应用高屈曲型假体行人工全膝关节置换术的早期临床效果。方法:2002.12~2006.3月间,对125例(213膝)患者用LPS-FLEX高屈曲型假体行TKA。其中男36例(62膝),女89例(151膝),年龄51~85岁,平均68.1岁。骨性关节炎90例(149膝),类风湿性关节炎35例(64膝)。所有病人均行常规髌骨置换,假体均采用骨水泥固定。结果:术后第一天即开始康复训练,伤口均一期愈合。随访12~52个月,平均34个月。2例因早期屈曲不佳(<90°)于术后6周在连续硬膜外麻醉下行手法松解后获得满意屈曲度,2例发生感染,其余均疗效优良。随访X线片结合临床均无感染、假体松动、假体周围骨折、骨吸收及脱位发生。HSS评分由术前30~65分,平均48分,提高至术后85~98分,平均91分。结论:LPS-FLEX高屈曲型假体在高屈曲位时仍在胫骨上保持面接触,且胫骨CAM始终在股骨SPINE的基部,从而在获得最大屈曲的同时保持了良好的稳定性。     

Resistin levels of serum and follicular fluid in non-obese patients with polycystic ovary syndrome during IVF cycles

INTRODUCTION Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility and affects 5%~10% of reproductive age women (Dunaif, 1997). It is characterized by hyperandrogenemia and chronic anovulation and is associated with insulin resistance, obesity and increased risk for type 2 diabetes (Kno- chenhauer et al., 1998). Insulin resistance is thought to play an important role in aetiology of PCOS (Chang et al., 1983; Shoupe et al., 1983). In vitro and in vivo studies …     

Extended follow-up of neurological,cognitive, behavioral and academic outcomes after severe abusive head trauma

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes.     

国产干涉条纹视力计预测白内障术后视力的临床研究

探讨国产干涉条纹视力计对预测白内障术后视力的准确性及其影响因素。方法:收集105例(105眼)白内障患者,年龄为69.89±10.04岁(30~92岁),术前分别用德国Heine视网膜视力计和国产干涉条纹视力计检测患者的术后预测视力,与术后1月最佳矫正视力比较,进行统计学分析。国产干涉条纹视力计和德国Heine视网膜视力计测量的预测视力分别为0.13±0.04和0.17±0.11,术后1月的最佳矫正视力为0.07±0.03,三者之间两两比较,有显著性差异(P<0.05),国产干涉条纹视力计与术后最佳矫正视力之间的差异较小。国产干涉条纹视力计预测视力符合率为66.67%(两者之间相差≤2行)。晶状体重度混浊和合并眼部疾病如青光眼、黄斑前膜、糖尿病性眼底病变等是其影响因素。国产干涉条纹视力计能有效预测白内障术后视力,但在重度白内障和合并眼底其他疾病的患者应结合相关临床检查做综合性评估。     

经导管主动脉瓣置入术在中国人群二叶式主动脉瓣重度狭窄中的安全性和有效性评估(英文)

目的:评估经导管主动脉瓣置入术在中国人群二叶式主动脉瓣重度狭窄中的安全性和有效性。创新点:首次在中国人群比较经导管主动脉瓣置入术在二叶式和三叶式主动脉瓣重度狭窄中的安全性和有效性。方法:选取2013年3月至2014年9月行经导管主动脉瓣置入术的40位主动脉瓣狭窄的患者,分二叶式和三叶式主动脉瓣两组,比较基线水平、手术以及随访1月结果的差别。结论:经导管主动脉瓣置入术在中国人群中二叶式主动脉瓣重度狭窄中的应用是安全有效的。     

High density porous polyethylene material （Medpor） as an unwrapped orbital implant

Objective： To introduce the clinical effect among patients who received an unwrapped orbital implant with high density porous polyethylene material （Medpor） after enucleation or evisceration. Methods： Retrospective analysis of a series of 302 patients with anophthalmia who underwent placement of an unwrapped high density porous polyethylene orbital implant. We compared the patients （n=180） who accepted primary implant placement with those （n=122） who accepted secondary implant placement. Parameters evaluated included： age at time of surgery, date of surgery, sex, implant type and size, surgery type, the surgical procedure and technique performed, and complications. Results： The time of follow-up ranged from 2.0 to 58.0 months （mean 32.5 months）. A total of 5 of 302 （1.66%） cases had documented postoperative complications. The following problems were noted after surgery： implant exposure, 3 patients （0.99%）; implant removed due to orbital infection, 1 patient （0.34%）; ptosis, 1 patient （0.34%）. There were no significant complications＇observed in other 297 cases and all implants showed good orbital motility. The clinical effect of primary implant placement is better than that of secondary placement. Conclusion： High density porous polyethylene material can be used successfully as an unwrapped orbital implant in anopthalmic socket surgery with minimal complications. The material is well tolerated, nonantigenic and has low rate of infection and migration.     

Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?

Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.