清热透邪法在新冠肺炎中的应用＊

目前新冠肺炎中医归属于“疫病”“瘟疫”范畴。其病因为疫戾邪气从口鼻而入，病理特点主要涉及湿、热、毒、瘀、浊、虚6个方面，但对于其病邪的性质，中医学界尚无完全统一认识。呈现百花齐放百家争鸣状态，此次疫病，王灿晖教授认为部分患者虽极早期或早期疠气挟夹寒湿为患，但速传于肺，以致出现高热、咳嗽、苔黄腻等肺热之征，秉承“祛邪为第一要义”，笔者临床根据王灿晖教授理论观点，施以“清热透邪”之法，获得良好效果，并列举典型案例，以期丰富中医药治疗新冠肺炎的理论与实践。     

RPV‐modified epirubicin and dioscin co‐delivery liposomes suppress non‐small cell lung cancer growth by limiting nutrition supply

Chemotherapy for non‐small cell lung cancer (NSCLC) is far from satisfactory, mainly due to poor targeting of antitumor drugs and self‐adaptations of the tumors. Angiogenesis, vasculogenic mimicry (VM) channels, migration, and invasion are the main ways for tumors to obtain nutrition. Herein, RPV‐modified epirubicin and dioscin co‐delivery liposomes were successfully prepared. These liposomes showed ideal physicochemical properties, enhanced tumor targeting and accumulation in tumor sites, and inhibited VM channel formation, tumor angiogenesis, migration and invasion. The liposomes also downregulated VM‐related and angiogenesis‐related proteins in vitro. Furthermore, when tested in vivo, the targeted co‐delivery liposomes increased selective accumulation of drugs in tumor sites and showed extended stability in blood circulation. In conclusion, RPV‐modified epirubicin and dioscin co‐delivery liposomes showed strong antitumor efficacy in vivo and could thus be considered a promising strategy for NSCLC treatment.     

透灸背俞穴治疗寒性腰痛60例

目的:观察透灸背俞穴治疗寒性腰痛的临床疗效。方法:选取2016年3月至2018年8月本院治疗的寒性腰痛患者120例作研究对象,随机分为对照组和治疗组,每组60例。治疗组给予透灸背俞穴治疗,对照组给予磁疗治疗。治疗前后四周两组分别采用VAS得分评估。结果:治疗组有效率95.0%,对照组有效率70.0%,治疗组有效率高于对照组,差异有统计学意义(P<0.05);治疗组治疗后VAS评分低于对照组,差异有统计学意义(P<0.05);治疗组治疗后前屈、后伸腰椎活动度高于对照组,差异有统计学意义(P<0.05);治疗组治疗后平均功率频率、中位频率斜率低于对照组,平均肌电波幅高于对照组,差异有统计学意义(P<0.05)。结论:透灸背俞穴治疗寒性腰痛可改善患者腰部肌肉功能,减轻腰部肌肉劳损,改善腰椎稳定性。     

First report of Mortierella wolfii causing fungal keratitis from a tertiary eye hospital in India

A young 33 year old male presented with non-resolving corneal infiltrate for 2 month duration in the right eye. KOH/ Calcoflour wet mount revealed sparsely septate fungal hyphae. Post therapeutic penetrating keratoplasty 3 doses of intracameral voriconazole(100μg/0.1ml) was administered suspecting recurrence. Fungal culture revealed non sporulating mould on SDA. PCR based DNA sequencing targeting the ITS region identified the fungal isolate as Mortierella wolfii (M. wolfii) belonging to zygomycetes. To the best of our knowledge, this is the first report of human fungal keratitis caused by M. wolfii.     

Acute endophthalmitis after penetrating and endothelial keratoplasty at a tertiary eye care center over a 13-year period

Purpose:To evaluate the clinico-microbiological profile, donor cornea risk factors, and outcomes of postkeratoplasty endophthalmitis at a tertiary care center.Methods:Retrospective analysis of charts of 28 consecutive patients (28 eyes) of acute endophthalmitis following either an endothelial keratoplasty (EK) or an optical penetrating keratoplasty (PK) surgery, performed between 2006 and 2018 (13-year period). Positive microbiology, identification and classification of predisposing factors, surveillance of utilized paired donors, treatment outcomes, and differences in the rate and severity of the event between optical penetrating and endothelial keratoplasty.Results:The estimated incidence of endophthalmitis was 0.23% in the entire cohort; it was 0.34% and 0.15%, after EK and PK, respectively (P = 0.049). The median time of endophthalmitis was 4.5 days postsurgery. Donor-related endophthalmitis was recognized in 7/28 (25%) eyes. Culture positivity was 68% (n = 19 of 28). Bacteria was isolated in 84% (n = 16 of 19) instances; Gram-negative bacilli were more common (87.5%; 14 of 16), and Pseudomonas species (50%; 7 of 14) was the most common Gram-negative bacterium. Majority (>75%) of the Gram-negative bacteria were resistant to all fluoroquinolones, aminoglycosides, 3^rd generation cephalosporins, and meropenam; 1/3^rd were resistant to imipenem; and 90% were sensitive to colistin. Treatment included intraocular antibiotic injections (96.4%), vitrectomy (42.9%), and therapeutic keratoplasty (50%). In 85.7% (24 of 28), globe was salvaged. The final vision was 20/200 or better in 39.1% (9 of 23) eyes.Conclusion:EK carried a higher risk of endophthalmitis than PK in this cohort. Bacterial infection was more common in this series, with Gram negative bacilli being the commonest organisms. Multidrug resistance was common (~75%) in Gram negative isolates.     

Shotgun Wounds: Nationwide Trends in Epidemiology,Injury Patterns,and Outcomes from US Trauma Centers

BackgroundShotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce.ObjectiveThis study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level.MethodsPatients with shotgun injury were identified from the National Trauma Data Bank (2007–2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range).ResultsShotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29 years (21–43) and most were male (n = 9887, 88%). Most injuries occurred in the South (n = 4092, 36%) and among white patients (n = 4945, 44%). The median Injury Severity Score was 9 (3–16). Overall in-hospital mortality was 14% (n = 1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n = 6762, 60%), followed by accidental (n = 2081, 19%) and self-inflicted (n = 1954, 17%). The lower and upper extremities were the most commonly affected body regions (n = 4071, 36% and n = 3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2–5]).ConclusionsIn the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.     

Changing trends in penetrating keratoplasty indications at a tertiary eye care center in Budapest, Hungary between 2006 and 2017

AIM: To analyse the changing trends in penetrating keratoplasty (PKP) indications. METHODS: This retrospective study included all patients with PKP between 2006 and 2017. Patients were classified using histological diagnoses. Our groups were more than 10 various keratopathies. Additionally, two different time-periods (2006-2012 and 2013-2017) were analysed. Results: Totally 1721 histological analyses of 1214 patients were available for review. The diagnoses were pseudophakic or aphakic bullous keratopathy in 487 (28.3%), regraft in 443 (25.7%), acute necrotizing and ulcerative keratitis in 313 (18.2%), corneal scar in 153 (8.9%), keratoconus in 140 (8.1%). Fuchs’ dystrophy in 61 (3.5%), corneal dystrophy other than Fuchs’ in 46 (2.7%), other diagnoses in 44 (2.6%) and failed endothelial keratoplasty graft in 34 (2.0%) cases. From the first to the second analysed time-period, incidence of acute necrotizing and ulcerative keratitis, corneal scar, Fuchs’ dystrophy increased (P≤0.032 for all) and incidence of keratoconus significantly decreased (P=0.015). Conclusion: Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP, followed by regraft and acute necrotizing and ulcerative keratitis.     

The Effect of Donor- and Recipient-Related Factors on Corneal Graft Survival in Penetrating Keratoplasty

Purpose: To investigate the impact of donor and recipient factors on graft survival in penetrating keratoplasty (PK).

Material and Methods: This retrospective study included 365 eyes that underwent PK using corneas from 231 donors between June 2010 and June 2015. Patients were divided into three groups (group 1: primary endothelial diseases; group 2: iatrogenic endothelial disorders; and group 3: other pathologies with a healthy endothelium) according to PK indications. The primary outcome measure was corneal graft survival at the last visit (clear or opaque). Graft clarity was assessed using Kaplan–Meier survival analysis.

Results: The most frequent PK indication was keratoconus (KC) (20.5%) followed by pseudophakic bullous keratopathy (PBK) (18.9%). Donor age had a negative impact on endothelial cell density (ECD) measured by an eye bank specular microscope (p < 0.001). Median best-corrected visual acuity in logarithm of the minimum angle of resolution units increased from 2.1 to 0.8 at 1 year after PK (p < 0.001). The clear graft rate was 96.7% at year 1, 88.8% at year 2, and 85.5% at year 3. Overall graft survival was 84.9% during a median of 39 months (range: 24–79 months) of follow-up. A higher graft survival rate (67.2%) was observed in KC compared to PBK during 6 years (p < 0.001). Recipients younger than 50 years of age showed a better graft survival rate than those older than 70 years of age (p = 0.037). Donor ECD, time between excision and death, and preservation time had no significant effect on graft survival. Frequent graft rejection episodes (GREs) and additional procedures during surgery had a negative impact on graft survival (p < 0.001 and p = 0.014, respectively). A worse graft survival was observed in group 2 compared to groups 1 and 3 (p = 0.042).

Conclusions: Young recipient age and KC were associated with a better graft survival. Graft endothelial density and preservation time had no impact on graft survival. PBK, low vision at baseline and year 1, frequent GREs, and additional interventions during surgery had a negative impact on graft survivals.     

先天性角膜混浊患儿的临床特征分析

目的　分析先天性角膜混浊（congenital corneal opacities,CCO）患儿的临床特征,为其诊断及治疗提供依据。方法　回顾性分析2017年1月1日至12月31日在我院接受手术治疗的CCO患儿的临床资料,包括CCO患儿一般特征及临床分类、患病单双侧、相关的眼部和全身异常、病理改变和接受的治疗等资料。结果　本研究纳入66例（93眼）CCO患儿,其中年龄3~36（13.11±9.63）个月,39例（59.1％）为单眼患病,最常见的临床类型是Peters异常（32例,48.5%）和角膜巩膜化（15例,22.7%）;虹膜粘连（61眼,65.6％）和白内障（22眼,23.7％）是两种最常见的眼部异常;5例（7.6％）患儿出现全身异常,包括生长迟缓（4例）和先天性脑缺陷（1例）。93眼中85眼（91.4％）进行了穿透性角膜移植术,6眼（6.5％）进行了板层角膜移植术。结论　年龄≤3岁的CCO患儿中最常见的临床类型为Peters异常及角膜巩膜化;除角膜混浊外,CCO患儿还可能存在虹膜粘连、白内障等眼部异常或生长迟缓等全身异常;穿透性角膜移植术为治疗CCO的主要手术方法。