Phacoemulsification,Intraocular Lens Implantation,Goniosynechialysis, and Pseudo-Pupilloplasty for Refractory Acute Primary Angle Closure with Atonic Dilated Pupil

ObjectiveTo evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty.MethodsA consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed.ResultsA total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t = 11.945, P < 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t = –27.711, P < 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit.ConclusionsPrompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.     

Reliability and criterion validity of two-dimensional movement assessments in those with patellofemoral pain

ObjectivesDetermine criterion validity and intra/inter-rater reliability of 2-dimensional (2D) knee frontal plane projection angle (kFPPA), hip frontal plane projection angle (hFPPA), and dynamic valgus index (DVI) during forward step-downs in those with patellofemoral pain (PFP).DesignCross-sectional.SettingUniversity research laboratory.Participants39 participants with PFP (34.18 ± 7.41years, 170± .1 cm, 81.03 ± 19.36 kg, duration of pain: 68.67 ± 85.08months, anterior knee pain scale: 80.49 ± 7.87, visual analog scale:2.08 ± 2.02)Main outcome measuresAverage 3D hip and knee sagittal, frontal, and transverse joint angles and 2D kFPPA, hFPPA, and DVI at maximum knee flexion were variables of interest. 3D DVI was calculated as the sum of hip and knee frontal and transverse angles. 2D kFPPA, hFPPA, and DVI were calculated by two raters independently on two occasions.ResultsIntra- and inter-rater reliability of all 2D angles were excellent. kFPPA was moderately correlated to 3D knee transverse angles. hFPPA was moderately correlated to 3D hip frontal and transverse angles and largely correlated to 3D DVI. 2D DVI was moderately correlated to hip transverse angles.ConclusionkFPPA, hFPPA, and DVI are reliable. hFPPA may be reflective of 3D hip and knee frontal and transverse motion during forward step-downs in those with PFP.     

恶性肿瘤患者低相位角与营养风险和住院时间相关性研究

目的探讨恶性肿瘤患者相位角与营养风险和住院时间相关性。方法利用生物电阻抗分析对2017年10月至2018年9月在河北医科大学第一医院接受治疗的259例恶性肿瘤患者进行人体成分检测、应用营养风险筛查2002和患者主观整体营养评估进行营养风险筛查和评估、同时收集患者血清ALB指标和住院时间。结果正常相位角组患者的BMI、ICW、FFM、SMM、BCM、蛋白质等均高于低相位角组（P<0.05）；正常相位角组与低相位角组男性患者ICW、FFM、SMM、BCM、蛋白质等均高于女性患者（P<0.05）；相位角与营养风险筛查2002评分（r=－0.346，P<0.05）、患者主观整体营养评估（r=－0.393，P＜0.05）呈负相关，与血清ALB值呈正相关（r=0.363，P<0.05）；与正常相位角组患者相比，低相位角组营养风险更高，计算相关风险比发现，按营养风险筛查2002评价营养不良分组，发现存在营养风险（OR=3.7，95%CI=1.8～7.7），按PG-SGA评估分组，结果显示中度风险（OR=4.5，95％CI=2.1～9.4），重度风险（OR=12.6，95％CI=5.1～31.3），按血清ALB值分组，ALB<40g/L（OR=3.7，95％CI=2.1～6.4）（P<0.05）；与正常相位角组患者相比，低相位角组住院时间较长，住院时间≥14d（OR=1.9，95％CI=1.0～3.3）（P<0.05）。 结论低相位角与营养风险和住院时间密切相关。与正常相位角患者相比，低相位角患者存在营养风险高，住院时间延长。因此对肿瘤患者进行相位角测量有助于快速判断其是否存在营养风险，为及时进行营养干预的实施提供了客观依据，利于患者疾病控制与好转。     

浅析茯苓“角药”在《伤寒杂病论》中的配伍与应用

"角药"是由3味中药联合应用、配伍而成,相辅相成,互为犄角。《伤寒杂病论》中包含着大量的角药运用,根据其在方剂中发挥作用的不同。文章分别从独立成方、方剂中主要作用、方剂中次要或辅助作用以及多组角药联合作用4个方面对经方中茯苓"角药"进行详细的梳理和分析,以期为临床提供指导与参考。