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.     

角膜内皮移植术后早期玻璃酸钠对泪膜及角膜上皮细胞再生的作用

目的　研究1 g·L^-1和3 g·L^-1玻璃酸钠（hyaluronate，HA）滴眼液对角膜内皮移植术后早期泪膜及角膜上皮细胞再生的作用。方法　选择2017年9月至2018年2月在北京大学第三医院行角膜内皮移植术的患者60例（60眼），随机分成1 g·L^-1HA组和3 g·L^-1HA组，每组各30例，观察标准干眼评估问卷（SPEED）评分、结膜角膜染色评分（OSS）、泪膜破裂时间（TBUT）、角膜上皮缺损范围，进行激光共聚焦显微镜检查。比较不同时间点组间、组内各指标差异。结果　SPEED评分:各时间点两组间比较差异均无统计学意义（均为P>0.05）。组内比较:两组组内术后7 d、14 d、28 d均低于前一时间点（均为P=0.000），余相邻时间点两两比较差异均无统计学意义（均为P>0.05）。TBUT:术后7 d、14 d、28 d 3 g·L^-1HA组均显著高于1 g·L^-1HA组（均为P<0.05），而术前组间差异不显著；组内比较:1 g·L^-1 HA组后一时间点较前一时间点、3 g·L^-1HA组术后7 d较术前均显著延长(均为P<0.05)，而3 g·L^-1HA组术后14 d、28 d与前一时间点差异均无统计学意义（均为P>0.05）。 OSS评分:术前及术后1 d、3 d两组间比较差异均无统计学意义（均为P>0.05），术后7 d、14 d、28 d 3 g·L^-1HA组均显著低于1 g·L^-1HA组（均为P<0.05）；组内比较:两组术后1 d OSS评分均显著高于术前（均为P=0.000），其余时间点两组均低于前一时间点（均为P=0.000）。角膜上皮缺损范围:术后1 d 两组间比较差异均无统计学意义（均为P>0.05），术后3 d、7 d 两组间比较，以及两组组内与前一时间点比较差异均有统计学意义（均为P<0.05）。角膜基底细胞密度:术前、术后28 d两组间比较，以及1 g·L^-1HA组组内术前与术后28 d比较差异均无统计学意义（均为P>0.05），而3 g·L^-1 HA组术后28 d显著低于术前（P=0.002）。结论　HA可以有效改善角膜内皮移植术后早期泪膜状态并促进角膜上皮细胞再生，存在浓度依赖性。