全身性遗传疾病对角膜移植排斥的影响

角膜移植为治疗角膜盲的主要手段，而角膜移植排斥则是决定角膜植片存活时间和病人术后视力的关键。角膜得益于其特殊的眼前节“免疫赦免”状态，使得角膜移植能够在众多器官移植中享有极低的排斥率，然而排斥反应发生的风险依然存在。当机体处于遗传物质异常的特殊状态时，宿主将通过宏观调控“免疫赦免”状态对植片的保护作用或受体对移植物排异产生的有害作用，延迟或促进角膜移植排斥反应的发生，进而影响移植物的存活时间和透明度。该文综述与角膜移植排斥相关的多种全身性遗传疾病，总结全身性遗传疾病对角膜移植排斥的影响，浅析其发生的病理生理学机制以及诊疗的特殊性。     

Developing a measure of blind patients’ interactions with their healthcare providers

BackgroundPeople who are blind (PWB) are often perceived as being incompetent with common tasks and functions. When patients detect that their healthcare providers (HCPs) have negative perceptions of them, they often report less satisfaction with their healthcare and disengage in their own healthcare.ObjectiveA scale assessing the experiences of PWB interacting with HCPs was developed and validated across two studies.MethodsIn Study 1, 144 participants completed the scale and provided feedback. In Study 2, 214 participants completed the scale and 4 additional scales to assess construct validity.ResultsAn exploratory factor analysis in Study 1 revealed a two-factor model consisting of General Quality of Health Care (30.5% variance explained) and Stereotype Content-related items (9.4% variance explained). Study 2 confirmed and validated this two-factor structure (RMSEA (90% CI) = 0.068 (0.057, 0.079), CFI = 0.898, SRMR = 0.066, AIC = 14568.902).ConclusionsThis scale is one of the first tools developed from the perspectives of PWB. Results from these studies highlight and elaborate on how PWB perceive that they are viewed by their HCPs in terms of competence and how they perceive to be treated by these HCPs. This scale can be used in training HCPs to better serve their patients with disabilities.     

Causes of Missed Referrals to Low-Vision Rehabilitation Services: Causes in a Tertiary Eye Care Setting

Purpose: To identify the referral pattern and identify causes of missed referrals to low-vision services in a tertiary eye care center. Methods: A retrospective review of all the hospital records of patients seen from September-December 2012 was done to identify patients with visual impairment. Low vision was defined as has a best-corrected visual acuity (BCVA) in the better eye of <20/60 to light perception (as per WHO definition); or a visual field of <20° from the point of fixation. The frequency of referrals in this database was used to identify referral patterns of physicians and also causes for missed referrals for these patients. Results: Of 14,938 hospital medical records reviewed during the period, 499 patients missed low-vision services with a mean age of 46?±?18.2 years, including 158 females. Among those missed, 12.07% were in the age group 0-15 years, while 30.9% of the patients were >60 years, with 157 requiring rehabilitative services and training. Causes for missed referrals were clear misses or non-referrals by the physician (39%), non-acceptance of services by the patient (53%), loss from appointment desks (4.5%), and loss to follow-up (3.5%). Conclusion: Missed referral to low-vision services in tertiary centers can be considerable; these need to be identified for optimal utilization and delivery of these services to patients with low vision.     

2015年重庆市生物剂量盲样考核结果分析

目的 为进一步提高放射卫生技术机构染色体非稳定性畸变的分析能力和水平,保障对受照者生物剂量的评估质量。方法 中国疾病预防控制中心辐射安全所按照能力考核方案对其实验及其结果进行分析。结果 两个样品的估算剂量的相对偏差均小于20%,考核结果均为合格。结论 本单位生物剂量实验室的整体技术水平符合国家有关标准要求。     

90例防盲小切口白内障体会

目的：探讨经角膜缘后2mm“一字形”巩膜隧道切口行小切口非超声乳化+人工晶体植入术,在防盲中的治疗效果及应用价值。方法在开展防盲工作中90例（90眼）白内障手术,做“一字形”巩膜隧道小切口,连续环形撕囊或截囊,水分离,用圈套器脱出晶状体核,注吸皮质,囊袋内植入人工晶状体,切口不予缝合。结果术后第一天裸眼视力≥0.3者52眼(57.8％),0.05-0.3者29眼(32.2％),≤0.05者9眼(10％)。术后一月裸眼视力≥0.3者74眼(82.2％),0.05-0.3者11眼(12.2％),≤0.05者5眼(5.6％)。术后三个月时裸眼视力≥0.3者83眼(92.2％),0.05-0.3者6眼(6.7％),≤0.05者1眼(1.1％)。术后1个月角膜散光为(1.30±0.47)D,术后3个月角膜散光为(0.82±0.52)D,与术前比较（0.8.±0.64D）差异无统计学意义(P>0.05)。结论手法小切口自内障+人工晶体植入术,设备简单,易于掌握,手术费用低,疗效可靠。适合基层医院全面开展,是一种可行手术方式。     

西藏藏族自治区眼科医疗资源现况调查

背景 眼科医疗保健体系的不断完善是防盲治盲工作的有力保障,但目前西藏自治区的眼科医疗资源分配情况仍不能满足当地防盲治盲工作的需要.了解西藏地区眼科医疗资源现状有助于当地合理分配紧缺的医疗资源,推进防盲治盲工作的开展. 目的 对西藏自治区的眼科医疗资源分配进行调查,为尽快建立该地区的眼科医疗保健网络和有效提供资源供给提供依据. 方法 本研究组于2016年4-6月面向西藏藏族自治区各级医疗单位眼科科室负责人和眼科医生发放西藏自治区医疗机构眼科专业情况调查问卷.西藏地区21家医疗机构的21名眼科科室负责人和52名眼科医生就眼科专业情况参与调查,由经过统一培训的专职人员按照统一调查方式收集整理,以确保回答问卷的真实有效性.结果 所有调查问卷发放的全区覆盖率为100％并全部收回,问卷填写符合要求,应答率及问卷有效率均为100％.截止2016年6月,西藏自治区共有21所有眼科诊疗能力的医疗机构,按照国家统计局公布的2014年西藏人口状况计算,平均每15.1万人拥有1个眼科医疗机构,但无独立眼科专科医院.其中有眼科专科医生者19所,占90.5％,有独立眼科科室者13所,占61.9％,有眼科独立手术室11所,占52.4％.全区眼科共有病床数量120张,平均每10万人拥有眼科医生1.6名,其中硕士学历者3名,尚无主任医师;全区共有专业护士14人,其中全职和兼职者各7人.目前西藏藏族自治区具备了基本的诊断仪器和最基本的手术设备,2015年全区平均眼科手术量为326.2人次.结论 西藏藏族自治区的眼科医疗资源不足,尤其是基层乡镇卫生院和县级医院眼科医疗机构,制约当地眼科防盲治盲工作的开展.