圆锥角膜基质环植入术的研究进展

角膜基质环植入术(ICRS)是一种用于治疗轻中度圆锥角膜的手术方法。ICRS是通过植入基质环,使中央角膜扁平化,弧长缩短,角膜曲率半径增大,屈光力降低,从而改善角膜前突导致的轴性近视眼与不规则散光。ICRS具有微创性、安全性、有效性、可逆性且并发症少等优点,其中长期疗效较佳。本文中笔者就ICRS的发展史、适应症、手术方法、手术疗效的影响因素、术后处理及疗效的评估等方面进行阐述。     

Glucose-independent racial disparity in HbA1c is evident at onset of type 1 diabetes

ObjectiveHigher levels of HbA1c, independent of blood glucose levels, have been described in Blacks compared to Whites patients with established diabetes. The goal of this study was to determine if glucose-independent racial disparity in HbA1C is evident at diabetes onset.Research design and methodsWe conducted a retrospective single-center chart review of 189 youth with new onset Type 1 diabetes (T1D) 60 % Whites and 40 % Blacks. HbA1c, glucose and other biochemistry measures were obtained at presentation in the Emergency Department before initiation of any therapy. HbA1c levels were adjusted for presenting glucose, self-identified race, age, gender, hematocrit, and RDW-CV.ResultsBlacks with T1D had statistically significant higher unadjusted HbA1c (11.9 ± 1.9 vs 11.04 ± 2.0 %, p = 0.004), initial glucose (530.6 ± 230.4 vs 442 ± 211.3 mg/dL, p = 0.0075) and lower pHs (7.28 ± 0.15 vs 7.33 ± 0.12, p = 0.02) compared to white patients. Least squares means of HbA1c remained higher in Black patients even after statistical adjustment for presenting glucose, age, gender, RDW-CV, and pH. In a multiple variable model (R² = 0.38, p < 0.0001) c-peptide was influenced by HCO₃ (p = 0.0035), gender (p = 0.0092), BMI (p < 0.0001), but not race or glucose.ConclusionsHbA1c at initial presentation of T1D is higher in young Black patients compared to Whites even after adjustment for glucose, age, gender, and RDW-CV. This racial disparity is consistent with other studies in individuals without diabetes and patients with long-standing diabetes under treatment.     

同种异体半月板移植和半月板切除术后中期临床效果比较

目的:比较同种异体半月板移植和半月板切除术后中期临床效果。方法:2005年6月至2009年8月,16例半月板切除术后患者接受18个同种异体半月板移植(移植组),其中男12例,女6例,年龄25.7±7.9岁。以同期行半月板切除术的20例患者为对照(切除组),其中男12例,女8例,年龄25.0±7.2岁。采用IKDC评分、Lysholom评分、Tegner评分、VAS评分等比较两组患者临床效果,并通过X线、核磁共振成像(MRI)比较两组患者膝关节退变和软骨损伤进展情况。结果:两组平均随访时间分别为60±20、54.4±6.1个月,术前IKDC评分、Lysholom评分、Tegner评分、VAS评分无显著性差异。术后两组患者的临床评分、单腿跳、关节间隙变化和力线等无显著性差异。切除组Kellgren-Laurence分级术后与术前的差值为1.4(1~2),明显高于移植组的0.3(0~1)(P<0.05)。移植组术后MRI软骨分级和软骨损伤进展程度均明显低于切除组,分别为1.2(0~3)vs 2.0(1~3)(P=0.028),0.7(0~2)vs 1.4(0~2)(P=0.001)。结论:半月板移植术后中期临床效果良好,与半月板切除无明显差异;半月板移植具有保护软骨、减缓关节退变的作用。     

后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的疗效分析

目的:分析后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的手术效果,探讨影响疗效的因素。方法:2004年5月~2011年9月,采用后路全椎节切除、双轴旋转矫形固定融合术治疗重度陈旧结核性后凸畸形患者33例。男15例,女18例;平均年龄34.7±14.1岁(11~63岁),其中年龄≥35岁18例,35岁15例;术前平均后凸角98.9°±18.2°(70.0°~130.0°),其中≥100°者17例,100°者16例;后凸顶点位于上中胸椎(T10及以上)19例,胸腰段及腰椎(T11及以下)14例。脊髓损伤Frankel分级A、B级各1例,C级5例,D级12例,E级14例。ODI术前平均19.5±9.4分。根据年龄、后凸顶点位置、后凸角度、术前Frankel分级、有无并发症等情况进行分组。对所有患者行手术前后及末次随访时的后凸局部和全脊柱正侧位X线摄片,测量后凸Cobb角,对合并侧凸的患者测量侧凸Cobb角。对手术前和随访时的患者进行脊柱矢状位平衡测量、实际身高测量、Frankel神经功能分级、Oswestry评分、VAS评分和手术PSI满意指数的评定。总结患者术中和术后并发症,并积极采取相应处理。结果:所有患者术前平均后凸Cobb角98.9°±18.2°,术后平均为30.9°±11.3°,矫正率为69.1%,末次随访时平均为34.8°±15.1°,矫正率为65.3%。患者脊柱矢状位平衡、身高测量、神经功能Frankel分级、生活质量Oswestry评分、腰背痛VAS评分均改善,手术总体满意率为87.9%。并发症发生率为54.5%,其中术中并发症12例、术后短期并发症2例、术后中远期并发症4例。所有并发症均及时采取相应处理。发生并发症者的总体后凸矫正率与未发生并发症者相当,但严重神经并发症发生者在神经功能恢复和生活质量改善方面均明显不如无并发症者。结论:后路全椎节切除、双轴旋转矫形手术是治疗重度陈旧结核性后凸畸形的有效方法,可以获得较好的手术效果,但需要尽量防止严重神经并发症的发生。     

Synergistic interaction of β-galactosyl-pyrrolidinyl diazeniumdiolate with cisplatin against three tumor cells

Cisplatin is a platinum-based compound that is largely employed as an effective antitumor drug against a wide spectrum of solid neoplasms for many years. Despite of its initial therapeutic success, cisplatin often results in high incidence of chemoresistance and high-dose cytotoxicity. Consequently, considerable efforts in hopes of reducing the dose-dependent side effects of cisplatin while retaining, or even enhancing, its antitumor properties have been undertaken throughout the past three decades. Nitric oxide (NO) is a small lipophilic free radical gas possessing versatile biological functions, including antitumor activities. However, NO, of itself, is difficult to be used, because of its extreme instability and short half-life. Previously, we have reported a stable NO donor, β-galactosyl-pyrrolidinyl diazeniumdiolate (β-Gal-NONOate), which exerts tumor killing effects through site-specific intracellular release of exogenous NO. In this study, we further investigated the combined inhibitory effect of β-Gal-NONOate and cisplatin against C6/LacZ, 9L/LacZ, and HeLa/LacZ tumor cells. It was shown that, in combination with β-Gal-NONOate, the antitumor effects of cisplatin against these common tumor cell lines were increased in a dose-dependent manner. Furthermore, the combination of these chemicals resulted in a synergistic suppression on tumor growth, which was achieved under a much lower cisplatin dosage. Collectively, our findings indicate that β-Gal-NONOate can synergistically improve the antitumor effect of cisplatin, and may therefore reduce its side effects caused by high dose cisplatin monochemotherapies. Accordingly, β-Gal-NONOate is an important therapeutic assistant reagent with great potential of clinical applicability, and thus worth of continuous research in the coming future.     

纳米铁粉对小鼠血糖和血脂的影响

[目的]探讨纳米铁粉对小鼠血糖、血脂的影响。[方法]分别以5g/kg剂量微米粒径铁粉(Micro-Fe)或纳米粒径铁粉(Nano-Fe)给小鼠1次经口灌胃,14d后处死;测定肝、肾脏器系数、血糖(Glu)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的变化。[结果]Micro-Fe和Nano-Fe染毒小鼠肝脏系数明显高于对照组相(P﹤0.05)。与对照组相比,Nano-Fe染毒小鼠血清Glu明显降低(P﹤0.05);Micro-Fe组血清TG比control组有明显升高(P﹤0.05),Nano-Fe组血清TG比control组有升高趋势,但差异无统计学意义(P﹥0.05)。Control、Micro-Fe和Nano-Fe染毒组3组小鼠血清TC、LDL-C和HDL-C水平间差异无统计学意义(P﹥0.05)。[结论]大剂量Nano-Fe经口染毒可使血清Glu降低,对TC、TG、HDL-C和LDL-C无明显影响。