经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中，3例发生硬脊膜撕裂，发生率为1.3%(3/236)。2例术中诊断，其中1例术中转为显微镜下修补硬脊膜，1例术中未做处理；1例术后诊断，在显微镜下完成硬脊膜修补。3例随访12个月，末次随访时视觉模拟量表评分从术前8.0分降至1.7分，Oswestry功能障碍指数从82.1%降至17.8%，均无神经功能障碍等后遗症；改良MacNab评分2例为优，1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症，应根据术中和术后情况，采取综合治疗措施，总体预后良好     

低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成的有效性和安全性

目的探讨低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成(DVT)的有效性和安全性。方法回顾性分析广安市广安区人民医院68例腰椎退行性疾病患者的临床资料,术后均采用抗凝预防血栓形成,按照术后预防DVT所采用方式的不同分为对照组和低分子肝素钙组。分析比较2组患者术后引流量、切口愈合情况、DVT发生率、皮下瘀斑情况、血小板数值、凝血功能、D-二聚体。结果术后2组患者引流量、切口愈合情况、皮下瘀斑情况、凝血功能相关指标比较,差异无统计学意义(P>0.05)。术前和术后1、10 d 2组患者血小板数量的变化差异无统计学意义(P>0.05)。DVT发生率2组患者比较差异有统计学意义(P<0.05)。术前及术后1 d 2组患者D-二聚体比较,差异无统计学意义(P>0.05);术后10 d,对照组患者D-二聚体显著增加,2组比较差异有统计学意义(P<0.05)。结论腰椎退行性疾病术后使用低分子肝素钙进行抗凝,可以显著降低DVT的发生率,具有良好的安全性。     

Extracts of different pollen species and their effect on human tear fluid and an epithelial cell line

Purpose: Hazelnut and birch pollen are known to destroy tear film components and attack ocular surface cells. We investigated further pollen species from different plant families, whether they show similar effects on human tear fluid and an epithelial cell line in vitro, to provide a broad basis for further research on pollen reactions affecting the tear film and ocular surface.

Materials and methods: Regional pollen species from different plant families (Adoxaceae, Betulaceae, Fagaceae, Juglandaceae, Malvaceae, Oleaceae, Pinaceae, Plantaginaceae, Poaceae, Salicaceae, Sapindaceae) were collected. Their proteolytic activity was evaluated by Zymography. Human tear fluid and cells of an epithelial cell line were incubated with pollen extracts. Tear fluid was analyzed by Polyacrylamide gel electrophoresis (PAGE). Cytomorphology was assessed microscopically and cell viability by proliferation (MTS), water-soluble tetrazolium (WST-1) assay and the impedance-based xCELLigence real-time analysis (RTCA).

Results: Zymography revealed significant protease activity and PAGE showed the degradation of tear proteins by different pollen species. Cells incubated with pollen extracts presented dose- and time-dependent cytomorphological changes. MTS, WST-1, and RTCA revealed cytostatic as well as cytotoxic effects of pollen extracts.

Conclusions: Pollen species from different plant families exert proteolytic activity and degrade human tear fluid as well as epithelial cells, which may play a crucial role in the pathogenesis of allergic and non-allergic reactions affecting the ocular surface.     

Tear film,contact lenses and tear biomarkers

This article summarises research undertaken since 1993 in the Willcox laboratory at the University of New South Wales, Sydney on the tear film, its interactions with contact lenses, and the use of tears as a source of biomarkers for ocular and non‐ocular diseases. The proteome, lipidome and glycome of tears all contribute to important aspects of the tear film, including its structure, its ability to defend the ocular surface against microbes and to help heal ocular surface injuries. The tear film interacts with contact lenses in vivo and interactions between tears and lenses can affect the biocompatibility of lenses, and may be important in mediating discomfort responses during lens wear. Suggestions are made for follow‐up research.     

Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

Background

Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery.

中药熏蒸联合人工泪液治疗干眼症的临床观察及对患者视觉相关生命质量的影响

目的:探究中药熏蒸联合人工泪液治疗干眼症的临床疗效,分析其对患者视觉相关生命质量的影响。方法:选取2014年11月至2016年12月北京市健宫医院收治的干眼症患者72例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组36例(72只患眼),对照组给予人工泪液治疗,观察组在对照组的基础上联合中药熏蒸治疗,2周为1个疗程,2组均连续治疗2个疗程。统计2组临床疗效;比较2组患者治疗前后主要中医症状积分、泪液分泌量、泪膜破裂时间;采用美国国家眼科研究所视觉相关生命质量量表(NEI-VFQ-25)评价并比较2组患者治疗前后视觉相关生命质量。结果:治疗后观察组总有效率为90. 28%,较对照组的63. 89%显著升高(P 0. 01);与治疗前比较,治疗后2组患者患眼疲劳感、干涩感、异物感及烧灼感等症状积分均显著降低,且观察组显著低于对照组(P 0. 01);与治疗前比较,治疗2周后至治疗4周后2组泪液分泌量呈逐渐升高趋势(P 0. 01),泪膜破裂时间呈逐渐延长趋势(P 0. 05),且治疗后2组间差异有统计学意义(P 0. 05或P 0. 01);与治疗前比较,治疗后2组患眼一般健康状况、活动障碍及视力障碍评分均显著升高(P 0. 01),且观察组显著高于对照组(P 0. 01)。结论:中药熏蒸联合人工泪液治疗干眼症可有效缓解患眼临床症状,促进患眼泪液分泌并增强泪膜稳定性,同时还可显著改善患眼视觉相关生命质量,疗效显著优于人工泪液单用。     

Hidden coexisting pathology diagnosed after cervical surgery in patients with degenerative cervical myelopathy or myeloradiculopathy: A case series report

Many neurological disorders can present similar symptomatology to degenerative cervical myelopathy (DCM) or myeloradiculopathy (DCMR). Therefore, to avoid misdiagnosis, it is important to recognise the differential diagnosis, which has been well described in previous literature. Additionally, DCM or DCMR can also coexist with other diseases that overlap some of its clinical manifestations, which may be overlooked before cervical surgery. Nevertheless, few studies have addressed this clinical situation. In clinical practice, the diagnosis of coexisting disease with DCM or DCMR would be typically made when some symptoms persist without improvement after cervical surgery. To inform the patients of this possibility preoperatively and arrive at the early diagnosis during the postoperative period, some knowledge of the possible coexisting diseases would be necessary. In this report, we reviewed 230 patients who underwent surgery for DCM or DCMR in an academic centre to examine the prevalence and kind of underlying disease that was overlooked preoperatively. The coexisting diseases relevant to their baseline symptoms were diagnosed only after cervical surgery in three patients (1.3%) and included amyotrophic lateral sclerosis, lung cancer and polymyalgia rheumatica. The overlapping symptoms were gait difficulty, scapular pain and neck pain, respectively. Surgeons should recognise that the coexisting disease with DCM or DCMR may be overlooked before cervical surgery because of overlapping symptomatology, although its prevalence is not certainly high. Further, when the specific symptom persisted without improvement after surgery for DCM or DCMR, the patient should be comprehensively examined, considering diverse pathological conditions, not only neurological disorders.