Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis: A Prospective,Randomized Controlled Study

The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis.There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years.A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20–52 years) was followed up for a minimum of 12 months (range: 12–60 months). Patients were randomly divided into 2 groups. Group A (n = 21) was treated by the subscapularis transthoracic approach and group B (n = 22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation.Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb''s angle (P > 0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P > 0.05). The Cobb''s angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed significant postoperative improvement in both groups, with no significant difference between the groups.The subscapularis transthoracic approach and the posterolateral approach with debridement, bone graft fusion, and internal fixation are both sufficient and satisfactory for the surgical treatment of upper thoracic tuberculosis. However, the posterolateral approach is superior to the subscapularis transthoracic approach in terms of surgical trauma, operative time, and kyphosis correction.     

IL-2-PE40体外抑制γ-干扰素诱导的角膜内皮细胞MHC抗原表达的研究

目的了解正常大鼠角膜内皮细胞在体外经γ-干扰素诱导后，主要组织相容性复合体（major histoeompatibility complex，MHC）-Ⅰ、Ⅱ类抗原异常表达的情况。并观察比较白细胞介素-2-绿脓杆菌外毒素（interleukin-2-pseudomonas exotoxin40。IL-2-PE40）、环胞霉素A（cyclosporine A，CsA）对角膜内皮细胞MHC-Ⅰ、Ⅱ类抗原异常表达的免疫抑制作用。方法采用ACAS-570黏附式细胞分析仪和免疫荧光技术，对体外原代培养经γ-干扰素诱导后的正常大鼠角膜内皮细胞分成A、B2组进行MHC-Ⅰ、Ⅱ类抗原表达的相对量测定，并在培养液中加入新型免疫抑制剂IL-2-PE40和CsA，进一步测定角膜内皮细胞MHC-Ⅰ、Ⅱ类抗原的表达量。结果未加入γ-干扰素前，MHC-Ⅰ类抗原的表达量为97．8±8．1，MHC-Ⅱ类抗原无表达；经γ-干扰素诱导后，MHC—Ⅰ类抗原的表达量为1006．3±13．2，MHC-Ⅱ类抗原表达量为406．5±10．5，γ-干扰素加入前后MHC-Ⅰ、Ⅱ类抗原比较均有统计学意义（P〈0．05）。IL-2．PE40组MHC-Ⅰ类抗原的表达量为618．2±13．5，MHC-Ⅱ类抗原表达量为204．5±7．8，CsA组MHC-Ⅰ类抗原的表达量为609．5±12．9，MHC-Ⅱ类抗原表达量为198．5±6．9，IL-2．PE40组、CsA组分别与注射用水比较，MHC—Ⅰ、Ⅱ类抗原间均有统计学意义（P〈0．05）。IL-2．PE40组与CsA组比较．MHC—Ⅰ、Ⅱ类抗原间差异无统计学意义（P〉0．05）。结论在体外，γ-干扰素可诱导角膜内皮细胞MHC-Ⅰ、Ⅱ类抗原异常表达；IL-2-PE40及CsA均能不同程度的抑制这种表达。[眼科新进展20ff7；27（3）：170．172]     

人胚胎肾上腺皮质褪黑素受体亚型蛋白的分布

目的：研究褪黑素（Mel)受体亚型在人胚胎肾上腺皮质的分布。方法：应用免疫组化染色检测Ｍel受体亚型的人胚胎肾上腺皮质的分布。结果：在人胚胎肾上腺皮质的球状速、束状带和网状带均存在Ｍel受体mt1(Mella)和ＭＴ２（Ｍellb)亚型蛋白的表达,且主要分布于细胞质。结论：人胚胎肾上腺皮质存在Ｍel受体mt1和ＭＴ２亚型。     

ACEI对血压正常的早期糖尿病肾病治疗作用的Meta分析

目的：对血管紧张素转换酶抑制剂（ＡＣＥＩ）能否延缓血压正常的早期糖尿病肾病（ｄｉａｂｅｔｉｃ ｎｅｐｈｒｏｐａｔｈｙ,ＤＮ）患者的病情进展进行系统评价。方法：检索ＭＥＤＬＩＮＥ及中国生物医学文献数据库中收录的１９９０年１月至１９９９年４月间,有关ＡＣＥＩ对伴微量白蛋白尿的早期ＤＮ治疗作用的随机对照临床试验方面的文献。按照入选标准,最终有１０项随机对照临床试验纳入本研究。用ＲｅｖＭａｎ３．１软件对１     

综合治疗发育性弱视243例

目的:探讨各种类型发育性弱视治疗的疗效。方法:对243例发育性弱视患者进行包括验光配镜、遮盖治疗、红光闪烁治疗、后像疗法、精细目力训练等的综合治疗。结果:基本治愈率为56.4%,有效率为92.4%,其中轻度弱视的治愈率为81.6%,中度为41.1%,重度为24.3%;屈光不正性弱视的治愈率为62.9%,斜视性弱视为49.0%,屈光参差性弱视为43.1%,形觉剥夺性弱视为18.8%;中心注视的治愈率为65.3%,旁中心注视为20.7%;年龄≤6岁的治愈率为82.7%,年龄在7~9岁间的为49.4%,年龄≥10岁的为19.6%。结论:弱视的治疗效果与弱视程度、类型、注视性质、初诊年龄等密切相关,早期发现,早期治疗效果好。综合疗法的疗效优于单一治疗方法。     

复合式与常规小梁切除术后浅前房的对比分析

目的:对比分析复合式与常规小梁切除术后浅前房的发生情况。方法:青光眼56例(71眼)分为2组。复合式手术组(A组)29例(36眼)行复合式小梁切除术;对照组(B组)27例(35眼)行常规小梁切除术。观察两组术后浅前房的发生情况,并作统计学分析。结果:A组术后浅前房发生率为14%(5眼),B组为37%(13眼),两者差异有统计学意义(χ2=5.07,P<0.05)。结论:复合式小梁切除术较传统的小梁切除术能较迅速恢复和维持术后前房深度,有效减少术后浅前房发生,提高手术成功率。     

新型冠状病毒感染新生儿院间转运应急预案——浙江大学医学院附属儿童医院经验

自2019年12月以来，2019冠状病毒病（COVID-19）疫情已成为目前最严峻的公共卫生问题。新生儿作为免疫功能不成熟的特殊人群，已有COVID-19病例报道。鉴于疑似/确诊COVID-19新生儿应转运到定点医院隔离救治，为建立健全相应急救转运机制，特编写COVID-19新生儿急救转运预案。该预案提出了新生儿COVID-19的转运指征、组织管理、防护策略、工作流程、消毒处置方法等，旨在为疑似或确诊新生儿COVID-19的院间转运提供相关指导与建议。     

多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼

目的　探讨多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼的临床疗效。方法　回顾性病例研究。２０１２年３月至２０１４年５月在河北省眼科医院白内障科就诊的晶状体悬韧带松弛继发急性闭角型青光眼患者２３例（２３眼）,采用微切口囊袋内预劈核超声乳化联合张力环植入、前部玻璃体切割和房角分离术进行治疗。术后随访观察最佳矫正视力、眼压、前房深度以及前囊收缩情况、后囊膜混浊程度、人工晶状体的居中性。结果　术后３个月最佳矫正视力＞０．６～１．０者８眼,＞０．３～０．６者１２眼,０．１～０．３者３眼。术后３个月最佳矫正视力较术前增加,差异有统计学意义（ｔ＝３６．２２５,Ｐ＜０．０１）。所有患者术后１ｄ眼压均下降至正常,为１０．３～１６．５（１４．２±１．９）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,与术前相比差异有统计学意义（ｔ＝２７．９０２,Ｐ＜０．０１）。术后随访３个月,未见眼压明显波动。术中未出现灌注液迷流综合征,术后未发生恶性青光眼。术后３个月所有患者人工晶状体居中性良好,未出现囊袋收缩、后发性白内障等并发症。结论　采用多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼可以取得满意的疗效。     

亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用

目的:探讨亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用价值。方法:对慢性泪囊炎患者21例21眼(其中6例6眼为小泪囊慢性泪囊炎)施行泪囊鼻腔吻合手术,术中应用亚甲蓝及粘弹剂。术后随访3mo～1a,观察手术疗效。结果:所有21眼中治愈19眼,好转2眼,治愈率90.5%,总有效率100.0%。其中6眼小泪囊慢性泪囊炎中治愈4眼,好转2眼。结论:亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用可有效提高手术成功率,小泪囊慢性泪囊炎可作为泪囊鼻腔吻合术的手术适应证。     

全球首款疟疾疫苗的现场评价及应用前景

本文介绍了全球首款疟疾疫苗(RTS,S/AS01)最新现场试点研究中安全性、有效性和可操作性的评价结果,以及WHO专家组对该疫苗使用的建议,并对目标儿童疫苗接种率和全程率与降低发病率和死亡率指标的关系,以及对5岁以下儿童采用5剂以上季节性预防措施的科学依据等问题提出建议.