Secondary outcomes of lens and cataract surgery: More than just “best-corrected visual acuity”

Most studies evaluating cataract surgery focus on the primary outcome of early, central, best-corrected visual acuity. However, cataract surgery and intraocular lens (IOL) design have other secondary visual outcomes as well as impacts on various ocular tissues, the visual function, and quality of life. Some of these aspects are more difficult to quantify, or are historically neglected, but might be extremely important to patients. One important development was the addition of blue-light filtering to IOL design. Whether these IOLs truly have the retinal protective qualities they were designed for is disputed, yet other inadvertent desirable and possibly detrimental influences are being examined. Risk of falls, driving accidents, and other injuries decrease following cataract surgery, especially in the elderly, the importance of which cannot be overemphasized. Cataract formation contributes to social isolation and decreases cognitive stimulation in the elderly population, while cataract extraction can reduce the risk of dementia and cognitive decline. Diffractive multifocal and extended depth-of-focus IOLs improve spectacle independence and patient reported outcomes, but positive and negative dysphotopsia may be persistent. Future directions such as using the IOL enabling clear spectacle-free vision at all distances, or intraoperative drug delivery systems show promising preliminary results. It seems inevitable that a higher focus on the secondary outcomes of surgery will increase. We believe that these aspects will become more and more relevant when considering new IOL designs and surgical techniques, a fact that will benefit both the patients and the surgeons.     

无托槽隐形矫治拔牙病例的后牙不同轴倾度对牙齿三维力学影响

目的 研究无托槽隐形矫治技术拔除双侧上颌第一前磨牙病例整体内收前牙，后牙不同轴倾度时，各个牙齿的瞬时受力情况。方法 设置4组后牙不同轴倾度的上颌牙列，T1组后牙为正常牙合轴倾度，T2组后牙在T1组基础上后倾5°,T3组后牙在T1组基础上前倾5°,T4组后牙在T1组基础上前倾10°。拔除双侧第一前磨牙，整体内收前牙0.25 mm,在矫治器六轴力传感器测试平台上测量4组牙列中各个牙齿在三维方向的瞬时力。每组牙列设计12副隐形矫治器。结果 与T1组相比，T2组切牙伸长力减小，尖牙远中向力增加，后牙近中向力减小，磨牙颊向和伸长力增大，差异均有统计学意义(P<0.05)。与T1组相比，T3和T4组切牙舌向力和伸长力增大，尖牙远中向力增大，后牙近中向力也增大，磨牙颊向和伸长力增大，差异均有统计学意义(P<0.05)。结论 后牙后倾时利于前牙转矩的表达，有助于保护后牙支抗，但增加了磨牙的颊向力和伸长力。后牙前倾时，前牙更容易出现转矩丢失，覆牙合加深的现象。后牙越前倾，覆牙合越容易加深，后牙支抗容易丢失。     

The 2022 Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitor Therapy for Renal Cell Carcinoma

In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the trial until final overall survival data and results from other trials were available. Meanwhile, the primary DFS endpoints were not met for adjuvant atezolizumab (PD-L1 inhibitor; IMmotion010), adjuvant nivolumab plus ipilimumab (CheckMate 914), or perioperative nivolumab (PROSPER). Owing to heterogeneity, a meta-analysis is not recommended. Pembrolizumab remains the only immune checkpoint inhibitor currently recommended in this setting. Overall survival data are immature and biomarkers to predict outcome are lacking. Uncertainty exists and overtreatment is occurring. Treatment decisions should be made with caution and with the involvement of each patient.Patient summaryNew results from three trials of immunotherapy after surgery for kidney cancer to reduce the risk of recurrence showed no improvement with these treatments. These results are in contrast to an earlier study that showed that the antibody pembrolizumab did extend the time before kidney cancer recurrence, even though it is not yet clear if overall survival is longer. Thus, we cautiously recommend pembrolizumab as additional treatment in high-risk kidney cancer after surgery, but patient preference should be carefully considered and the risk of overtreatment should be discussed.     

浅析系统性红斑狼疮皮肤损害的中医治法

经整理相关医家治疗经验,认为中医治疗系统性红斑狼疮皮肤损害可在整体辨证的基础上,灵活选用医家经验以提高临床疗效。一者,系统性红斑狼疮常见热毒炽盛证,治疗以清热凉血为主,配伍清热解毒、清气分热药;二者,血瘀常伴随于疾病的发展过程中,也是皮损的重要病因,治疗可灵活选用养血和血、破血消癥药;三者,清肺祛风,擅治在表在上之邪,尤其适合在头面部的皮疹;四者,花类药轻灵清化,具有清热解毒、行气活血的作用,可起到清透病邪的功效。     

比较糖尿病病人白内障超声乳化术不同隧道长度切口对角膜生物力学的影响

目的比较糖尿病合并白内障病人行白内障超声乳化手术采用不同隧道长度切口角膜生物力学的差异。方法收集 2020年 10月至 2021年 11月于贵州医科大学附属医院拟行白内障超声乳化手术的 2型糖尿病病人 67例 67眼，行颞侧三平面透明角膜切口，按切口隧道长度分为两组:长隧道组(长度 ≥1.75 mm，<2.40 mm)共 33例( 33眼)。短隧道组(长度 >1.20 mm，<1.75 mm)共 34例( 34眼)。应用可视化角膜生物力学分析仪测量两组病人术术后 1d、术后 1周和术后 1个月的角膜生物前、力学参数，透，明角膜切口隧道长度通过眼前节光学相干断层扫描在病人术后 1d进行测量。结果术前及术后 1d、术后 1周、术后 1个月两组眼压、中央角膜厚度、最大形变幅度、第一压平时间、第二压平时间、峰距、矫正眼压、第一压平时角膜硬度参数(stiffness parameter at applanation 1，SP-A1)及角膜生物力学指数( corneal biomechanical index，CBI)的总体相比，差异有统计学意义(均 P<0.05)；其中术后 1d中央角膜厚度、 CBI［(长隧道组( 647.21±96.07)μm、0.58(0.10，0.82)，短隧道组( 674.34±115.59) μm、0.50(0.23，0.80)］较术前［长隧道组:(564.03±29.45)μm、0.06(0，0.24)，短隧道组:(553.19±29.54)μm、0.13(0，0.43)］均显著增大(均 P<0.05)术后 1个月两组中央角膜厚度及 CBI恢复至术前水平(均 P>0.05)。 l两组术后 1d第二压平时间及峰距较术前减少(均 P<0.05)、，在术后 1周及术后 1个月均比术后 1d增大(均 P<0.05)。两组术后 1个月及术后 1周最大形变幅度较术后 1d增大( P<0.05)，SP-A1在术后 1个月及术后 1周较术后 1d及术前明显减小( P<0.05)。长隧道组与短隧道组术后 1d眼压［1.83(0.08，4.17)mmHg比 0.33(?0.50，1.83)mmHg］、第一压平时间［ 0.22(0.01，0.57)ms比 0.04(?0.09，0.23)ms］、第二压平时间［?0.47(?0.68，?0.21)ms比?0.22(?0.48，0.01)ms］及矫正眼压［ 0.6(?0.99，1.72)mmHg比?1.53(?3.80，?0.36)mmHg］的变化量比较，差异有统计学意义( P<0.05)，术后 1周第二压平时间、峰距及矫正眼压的变化量比较，差异有统计学意义( P<0.05)。结论对于行白内障超声乳化术透明角膜三平面切口的糖尿病病人，长隧道切口组比短隧道切口组角膜生物力学在早期变化更明显、角膜生物力学改变更大，角膜修复愈合更慢。同正常白内障病人一样，对于糖尿病合并白内障病人而言，两组病人白内障超声乳化术后 1个月角膜硬度也较术前降低。     

特瑞普利联合舒尼替尼对晚期肾透明细胞癌 VEGF、GDF–15 及肾功能影响

〔摘 要〕 目的：研究特瑞普利联合舒尼替尼治疗晚期肾透明细胞癌的效果及对血管内皮生长因子（VEGF）、生长分化 因子 15（GDF–15）及肾功能的影响。 方法：回顾性分析 2019 年 1 月至 2021 年 1 月福建医科大学附属漳州市医院收治的采 用特瑞普利联合舒尼替尼治疗的 20 例晚期肾透明细胞癌患者。分析患者生活质量、血清 VEGF、GDF–15 水平、肾功能指标、 T 淋巴细胞亚群水平、不良反应发生情况、临床疗效。 结果：治疗后，患者临床疗效的总有效率为 60 %；患者血清 VEGF、 GDF–15 水平均低于治疗前，差异具有统计学意义（P ＜ 0.05）；患者血肌酐（Scr）、血尿素氮（BUN）及尿白蛋白（ALB） 水平均低于治疗前，差异具有统计学意义（P ＜ 0.05）。治疗前后，患者 T 淋巴细胞亚群水平比较，差异无统计学意义 （P ＞ 0.05）。治疗后，患者生理领域、心理领域、社会关系及环境领域评分均高于治疗前，差异具有统计学意义（P ＜ 0.05）。 治疗期间，患者不良反应发生率为血液学毒性 35 %、腹泻 20 %、食欲不振 30 %、发热 20 % 及脱发 60 %。 结论：特瑞普利 联合舒尼替尼治疗晚期肾透明细胞癌效果明显，可有效改善 VEGF、GDF–15 及肾功能水平。     

Comparison of alveolar bone thickness and height after slow expansion using quad-helix or clear aligners

ObjectiveThe study was conducted to investigate the thickness and height of the alveolar bone of individual teeth after slow maxillary expansion (SME) with quad helix or clear aligner appliances and hypothesized that there is no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners.Material and MethodsThis is a retrospective study; the records of 22 patients treated between December 2019 to April 2020 by dental arch expansion using either clear aligners or quad helix appliances were retrieved and studied. The results obtained through cone beam computed tomography (CBCTs) before and immediately after maxillary expansion (2 + 1 mm per side) were analyzed (11 in the Quad Helix group and 11 in the clear aligner). The data collected was analyzed using linear and angular measurements obtained through On-demand 3D App software. Furthermore, Statistical Package for Social Sciences (SPSS) version 25.0 was used to present the findings by mean and standard deviations, and Scheffe’s test was applied for comparing forces.ResultsThe results showed that the mean age of patients in the clear aligner group and Quad Helix was 16.27 ± 0.56 years and 15.5 ± 1.53 years, respectively. There was no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. This is due to the findings that suggest that there was a decrease in bone height and bone width when treated with a quad helix as compared to clear alignment.ConclusionIt can be concluded that the quad helix SME treatment affects alveolar bone integrity; therefore, clear aligners might be better for treating patients than the quad helix.     

Power Arm在隐形矫治器联合微种植钉整体内收上前牙中的作用

目的 探讨Power Arm在无托槽隐形矫治器(clear aligner,CA)联合微种植体支抗(micro-implant anchorage,MIA)整体内收上前牙中的作用.方法 建立CA联合MIA整体内收上前牙三维有限元模型,在尖牙或尖牙所对应矫治器上加入高6 mm的Power Arm,分析矫治器施力+尖牙15...