林周县苏州小学高年级学生近视现况调查与结果分析

目的 了解拉萨市林周县小学生近视现况,为制订预防小学生近视的相关措施提供依据.方法 应用分层整群抽样方法,抽取拉萨市林周县苏州小学高年级学生200名,对所抽取的小学生进行视力检查和危险因素的问卷调查.结果 林周县小学生近视患病率为49.0%.男生近视率(53.5%)高于女生(44.4%),四年级学生近视率(49.5%)高于五年级学生(48.6%).结论 林周县小学生近视率较高,影响近视主要原因为外在因素.     

气道平滑肌生物力学与哮喘病理机制的研究进展

哮喘病是危害人类健康的重要呼吸疾病,但其病理机制至今依然不完全清楚。由于呼吸依赖于各级肺组织在外力作用下的一系列力学过程,其力学因素必定在呼吸功能方面发挥着重要作用。其中,气道平滑肌细胞对物理环境很敏感,异常的力学因素刺激将可能改变气道平滑肌细胞的结构和／或功能,导致气道平滑肌过度收缩等病理变化。近年来,人们对气道平滑肌生物力学及其在哮喘的病理机制中的作用展开了大量研究,获得了许多重要的发现。本文将围绕气道平滑肌与肺中的力学环境介绍有关研究的最新进展,包括气道平滑肌收缩和骨架纤维的组织结构,气道平滑肌功能长度范围以及适应性,力学刺激引起的气道平滑肌细胞结构和功能的变化,气道平滑肌紧张度对应变诱导的响应的调控,细胞骨架软玻态动力学行为等,并探讨气道平滑肌生物力学与哮喘病病理机制的关系。     

PPARγ在不同周龄apoE-/-小鼠主动脉斑块表达及与斑块成份的相互关系

目的:研究PPARγ基因表达与ApoE-/-小鼠主动脉斑块成份的相互关系。方法:以20和40周龄ApoE-/-小鼠(n=10/组)为研究对象,相同基因背景和周龄C57BL/6 J小鼠设为对照。采用RT-PCR和免疫印迹技术检测各组小鼠主动脉PPARγ基因和蛋白表达变化;Movat 5色套染法和油红O染色检测ApoE-/-小鼠主动脉斑块成份;免疫组织化学技术检测斑块内PPARγ、SM-actin、MOMA-2抗原表达。结合免疫荧光技术分析PPARγ基因在主动脉斑块巨噬细胞、平滑肌细胞的表达及与脂质、弹性纤维、胶原和蛋白聚糖的相互关系。结果:20和40周龄C57BL/6 J小鼠主动脉壁有少量PPARγ表达,以20周龄组明显。ApoE-/-小鼠主动脉壁和斑块内PPARγ表达增多,以斑块内表达明显(P<0.05);与20周龄组比较,40周龄组表达最显著;且斑块脂质含量丰富;弹性纤维、胶原和蛋白聚糖含量减少,血管正性重塑明显;MOMA-2表达增加,SM-actin表达降低(P<0.05)。PPARγ在斑块内巨噬细胞、血管中膜平滑肌细胞和斑块内平滑肌细胞都有表达,但以脂质含量丰富处PPARγ表达最明显。结论:PPARγ在C57BL/6 J小鼠动脉壁表达随增龄而减少;在ApoE-/-小鼠主动脉壁和斑块内PPARγ表达随AS病变进程而增加。推测ApoE-/-小鼠主动脉斑块PPARγ表达上调可能是机体一种代偿行为和自我保护机制。     

造血前体细胞凋亡与再生障碍性贫血

再生障碍性贫血(AA)患者的骨髓造血功能衰竭,与其造血前体细胞(CD34+细胞)过度凋亡有关,AA患者的细胞免疫异常、体液免疫异常以及造血基质的异常,均可导致CD34+细胞过度凋亡,这可能是各种因素引起骨髓造血功能衰竭,进而导致AA的一个重要发病学机制.     

Pin1通过抑制Wnt/β-catenin信号参与CKD-MBD的发病

慢性肾脏病-矿物质和骨异常（CKD-MBD）是慢性肾脏病（CKD）常见并发症之一。近年研究表明骨代谢异常在CKD早期即已出现,是CKD-MBD发生发展的中心环节。而骨细胞特异性Wnt/β-catenin信号的异常是造成CKD骨代谢紊乱的重要机制。肽酰脯氨酰胺同分异构酶（Pin1）依赖的磷酸化丝/苏-脯氨基酸基序异构是调控Wnt/β-catenin信号通路的重要途径,Pin1的调节异常能够改变Wnt/β-catenin信号的作用,可能参与CKD MBD的进展。本文旨在探讨Pin1通过抑制Wnt/β-catenin信号参与CKD-MBD的发病。     

高血压病患者大网膜小动脉重塑的观测及相关蛋白表达探讨

目的: 研究高血压病患者大网膜小动脉病理损害、重塑及相关蛋白的表达。方法: 检测12例非高血压病对照者和12例高血压病患者血液流变学及大网膜小动脉形态学的变化,采用免疫组织化学方法检测大网膜小动脉Bcl-2、Bax、c-Myc、c-Fos、MMP-9和TIMP-2蛋白表达,用Masson染色法观察大网膜小动脉壁胶原含量变化。结果: 高血压病患者血液流变学异常,大网膜小动脉胶原沉积增多,中膜厚度/管腔直径比值增大,动脉壁Bcl-2、Bax、c-Myc、c-Fos、MMP-9和TIMP-2蛋白表达增强。结论: 高血压病患者大网膜小动脉存在病理损害和重塑,其机制与血液动力学(高血压)和血液流变学异常,动脉壁Bcl-2和Bax、MMP-9和TIMP-2表达失衡及c-Myc和c-Fos过度表达有关。     

彩色多普勒心脏超声对冠心病节段性室壁运动异常的诊断价值

目的探讨彩色多普勒心脏超声对冠心病节段性室壁运动异常的诊断价值。方法选择冠心病节段性室壁运动异常患者80例均接受彩色多普勒心脏超声检查,以综合诊断结果为金标准,对彩色多普勒心脏超声诊断结果、特异度、敏感度及安全性进行观察。结果彩色多普勒心脏超声对左室内径异常、左房内径异常、右房内径异常、右室内径异常与主动脉内径异常等检出率与金标准比较无明显差异(P0.05),诊断冠心病节段性室壁运动异常的特异度、敏感度、准确率为75.00%(3/4)、 98.65%(73/77)、 91.25%(73/80),与金标准比较无明显差异(P0.05)。结论彩色多普勒心脏超声诊断冠心病节段性室壁运动异常准确率、特异度与敏感度高,不良反应少,可作为首选检查方法。     

近视的遗传学研究

近视是一种在环境因素和遗传因素共同作用下的多因素复杂性疾病。本文详细介绍了有关近视的遗传性研究,概括了目前关于高度近视基因位点的报道,并综合论述了有关近视候选基因的动物实验和人群研究。     

永康地区2018年儿童视力筛查状况分析

目的了解永康市2018年学龄前儿童的视力异常状况,为干预视力异常儿童提供依据。方法采用美国伟伦公司"SURESIGHT"视力筛查仪对视力筛查,2018年1月至20l8年12月期间在我院儿童保健门诊就诊的8月~3岁及以上的儿童视力检查。统计分析检查结果儿童视力筛查正常13 800名,正常率为53.84%;异常3065例,异常率为11.96%;可疑8763例,可疑率为34.19%。各年龄组视力异常可疑和异常的检出率,均随年龄增长呈下降趋势(P均<0.01)。视力异常儿童中女童屈光异常检出率为12.57%,高于男童异常检出率11.37%(P<0.05)。不同年龄儿童视力筛查结果,远视1620人,占49.53%;远视+散光685人,占20.95%;散光517人,占15.81%;屈光参差320人,占9.79%,近视和近视+散光所占比例为2.35%和1.66%。各年龄组随着年龄的增长屈光异常检出率呈下降趋势(P<0.01)。结论学龄前儿童视力异常率处于较高水平,需要引起足够的重视和关注。     

全髋置换术中髋臼过度扩锉对髋臼缘骨量和前倾角的影响

目的　通过髋臼的三维重建及基于此的解剖形态研究，就临床上假体安装前的髋臼同心扩锉准备方式时过度扩锉对臼窝前后壁骨量丧失和髋臼缘开口前倾角改变作一定量分析。方法　选取40例成人髋臼标本，通过CT扫描、图像边界处理和定标，利用Pro/Engineer软件拟合出髋臼三维结构，再将其导入Unigrapics软件中，运用其集成的工具条和球体表面逼贴技术，对二种过度髋臼同心扩锉，即扩锉至Harris窝底或扩锉至髋臼内侧壁时，髋臼横断面开口扭转角度变化及髋臼后壁与前壁骨量丧失量作定量分析。结果　(l)当髋臼同心扩大至Harris窝底时，髋臼横断面开口扭转角度在不同髋臼层面均发生变化，其中，髋臼上半部分最大前倾角度可增加483°；而髋臼下半部分开口前倾角度轻微减小。(2)髓臼同心扩大至Harris窝底时，髋臼后壁与前壁骨量丧失量平均为6.75 mm和6.11 mm、(3)当髋臼同心扩大至髋臼内侧壁时，髋臼横断面上半部分开口扭转角度进一步增大，最大前倾角度增加达8.55°；此时，髋臼后壁与前壁骨量丧失量也增加至平均9.54 mm和9.56 mm。结论　髋臼同心扩挫虽能保持髋臼活动中心点不变，但过度扩锉仍可造成较明显的髋臼前后壁骨量丧失与前倾角度变化，不利于髋杯假体与骨面的牢固固定和正确置放。髋臼扩锉达到或超过Harris窝底深度以上应尽可能在临床应用中避免。     

Features of the cerebral and ocular blood flow in patients with different clinical course of myopia

A total of 3 groups of patients aged 16-32 years: 1st-30 patients (60 eyes)--with a stationary myopia of 6.5 to 9.0 D and normal intraocular pressure (IOP); 2nd-23 patients (46 eyes)--with a high degree of progressive myopia and glaucoma with normalized intraocular pressure during instillation azopta included 2 subgroups: subgroup A--14 patients (28 eyes) - with ischemic variant of glaucoma; subgroup B--9 patients (18 eyes)--with dyscirculatory variant of glaucoma; 3rd group (control)--10 somatically healthy individuals of similar age. Results of color Doppler mapping of the main arteries of the brain and the eyeball revealed features: the predominance of the ability of middle cerebral arteries to vasoconstriction combined with reduced blood flow in central retinal artery and short posterior ciliary arteries and cause ischemica variant of glaucoma, slowing blood flow in the vertebrobasilar basin combined with a reduction of venous outflow of the of the eyeball and is accompanied by the development of glaucoma in dyscirculatory variant in patients with myopia of high degree.     

An animal model of myopia

Myopia develops in macaque monkeys when their lids are surgically fused at birth and kept closed for one year. This experimental refractive error has many features in common with human myopia: It is caused by progressive axial elongation of the eye, is often accompanied by fundus changes, and can only be induced before eye growth has been completed. Myopia does not develop in animals raised in the dark; thus, it is triggered by an alteration of the visual input and is presumably mediated by the nervous system. In Macaca arctoides, atropine administration prevents abnormal eye elongation, and this suggests that lid-fusion myopia is caused by excessive accommodation. In M. mulatta, atropine is ineffective; furthermore, myopia develops when lids are sutured after interruption of the optic pathways. Thus, in this species accommodation can be ruled out as a determinant of eye elongation, and other neural mechanisms may be responsible for the refractive error. Our experiments suggest that the refractive state is largely programmed on a genetic basis, but that an abnormal visual experience can disrupt the process of postnatal eye growth and induce axial myopia.     

Sympathetic nerves bridge the cross-transmission in hemifacial spasm

The pathophysiologic basis of hemifacial spasm is abnormal cross-transmission between facial nerve fibers. The author hypothesized that the demyelinated facial nerve fibers were connected with the sympathetic nerve fibers on the offending artery wall, and thus the latter function as a bridge in the cross-transmission circuit. This hypothesis was tested using a rat model of hemifacial spasm. A facial muscle response was recorded while the offending artery wall was electrically stimulated. The nerve fibers on the offending artery wall were blocked with lidocaine, or the superior cervical ganglion, which innervates the offending artery, was resected, and meanwhile the abnormal muscle response was monitored and analyzed. A waveform was recorded from the facial muscle when the offending artery wall was stimulated, named as “Z-L response”. The latency of Z-L response was different from that of abnormal muscle response. When the nerve fibers on the offending artery wall were blocked by lidocaine, the abnormal muscle response disappeared gradually and recovered in 2 h. The abnormal muscle response disappeared permanently after the sympathetic ganglion was resected. Our findings indicate that cross-transmission between the facial nerve fibers is bridged by the nerve fibers on the offending artery wall, probably sympathetic nerve fibers.     

Ophthalmologic aspects in the treatment of traumatic orbit deformity

Results of ophthalmologic examinations of a total of 65 patients with traumatic orbit deformations and a pronounced dislocation of the eyeball (a mean time elapsed from trauma to surgery is 19 months) are presented in the article. Enophthalmos was diagnosed in 89% of patients, ptosis of the eyeball--in 69% of patients and ophthalmoplegia--in 77% of patients. Pathology of the posterior eye segment was recorded in a majority of cases, while pathology of the optic nerve was recorded in more than 43% of cases. Inferior orbital wall plasty was performed in all patients. A reduced optic neuropathy (a mean postoperative follow-up of 15 months) was registered in a number of cases after the surgical repositioning of the eyeball and conservative treatment.     

角巩膜生物力学2021年度研究进展

角巩膜为眼外壁组织,在维持眼球形状和屈光功能方面均发挥着重要作用。作为典型的黏弹性组织,角巩膜力学性能的变化会引起相应的眼部疾病,如近视和圆锥角膜等。临床上,可通过人为改变角巩膜组织的几何结构(如屈光手术、角膜接触镜的佩戴、角膜胶原交联术)改变生物力学行为,治疗一些与屈光有关的眼科疾病。本文通过对与角巩膜相关疾病及临床治疗方法中的生物力学研究进展进行综述,理出这些临床诊疗手段中仍需要解决的问题,以期为进一步临床诊疗策略的完善和新的潜在治疗手段的开发提供参考。     

Refractive status and prevalence of refractive errors in suburban school-age children

Objective: This study investigated the distribution pattern of refractive status and prevalence of refractive errors in school-age children in Western China to determine the possible environmental factors. Methods: A random sampling strategy in geographically defined clusters was used to identify children aged 6-15 years in Yongchuan, a socio-economically representative area in Western China. We carried out a door-to-door survey and actual eye examinations, including visual acuity measurements, stereopsis examination, anterior segment and eyeball movements, fundus examinations, and cycloplegic retinoscopy with 1% cyclopentolate. Results: A total of 3469 children living in 2552 households were selected, and 3070 were examined. The distributions of refractive status were positively-skewed for 6-8-year-olds, and negatively-skewed for 9-12 and 13-15-year-olds. The prevalence of hyperopia (≥+2.00 D spherical equivalent [SE]), myopia (≤-0.50 D SE), and astigmatism (≥1.00 diopter of cylinder [DC]) were 3.26%, 13.75%, and 3.75%, respectively. As children''s ages increased, the prevalence rate of hyperopia decreased (P<0.001) and that of myopia increased significantly (P<0.001). Children in academically challenging schools had a higher risk of myopia (P<0.001) and astigmatism (≥1.00DC, P =0.04) than those in regular schools. Conclusion: The distribution of refractive status changes gradually from positively-skewed to negatively-skewed distributions as age increases, with 9-year-old being the critical age for the changes. Environmental factors and study intensity influence the occurrence and development of myopia.     

Autosomal‐dominant myopia associated to a novel P4HA2 missense variant and defective collagen hydroxylation

We recently described a complex multisystem syndrome in which mild‐moderate myopia segregated as an independent trait. A plethora of genes has been related to sporadic and familial myopia. More recently, in Chinese patients severe myopia (MYP25, OMIM:617238) has been linked to mutations in P4HA2 gene. Seven family members complaining of reduced distance vision especially at dusk underwent complete ophthalmological examination. Whole‐exome sequencing was performed to identify the gene responsible for myopia in the pedigree. Moderate myopia was diagnosed in the family which was associated to the novel missense variant c.1147A > G p.(Lys383Glu) in the prolyl 4‐hydroxylase,alpha‐polypeptide 2 (P4HA2) gene, which catalyzes the formation of 4‐hydroxyproline residues in the collagen strands. In vitro studies demonstrated P4HA2 mRNA and protein reduced expression level as well as decreased collagen hydroxylation and deposition in mutated fibroblast primary cultures compared to healthy cell lines. This study suggests that P4HA2 mutations may lead to myopic axial elongation of eyeball as a consequence of quantitative and structural alterations of collagen. This is the first confirmatory study which associates a novel dominant missense variant in P4HA2 with myopia in Caucasian patients. Further studies in larger cohorts are advisable to fully clarify genotype‐phenotype correlations.     

Adipose body of the orbit

The adipose body of the orbit (ABO) fills most of the orbital cavity, surrounding the eyeball, muscles, nerves, and vessels. It was studied in histologic section in the three basic planes in the fetus, neonate, and adult. In the retrobulbar area, that is, posterior to the eyeball, adipose tissue occupies the space around the optic nerve and penetrates between the recti muscles, describing a four-leafed clover pattern in frontal section. The fatty tissue of the retrobulbar area also includes the peripheral ring of fat that lies between the muscles and the walls of the orbit. In the part of the peribulbar area located between the muscular insertions on the eyeball anteriorly and the emergence of the optic nerve from the sclera posteriorly, the pattern of adipose tissue is identical to the peripheral ring of fat and the fat between the muscles in the retrobulbar area. External to the muscular insertions and the anterior part of the eyeball, there is a thin ring of histologically similar fatty tissue that is continuous anteriorly with the fatty bodies of the upper and lower eyelids. Histologic examination shows that the lobules are large in that part of the retrobulbar area within the muscle cone and that they are smaller with more fibrous septa in the remaining restricted regions, such as the area between the eyeball and muscles and in the rings around the muscles and around the eyeball. In no case was a septum found separating the peripheral adipose ring from the fat located within the muscle cone.     

中青年头晕与颈椎曲度异常的相关性

目的 探讨中青年患者头晕与颈椎生理曲度改变的相关性。 方法 收集2016年6月～2017年3月于新乡医学院第三附属医院神经内科住院治疗的中青年头晕患者，共78例，其中男性32例，女性46例。对所有患者拍摄颈椎4位片，根据Borden测量法将所有患者分为颈椎曲度正常组（n=22例）与颈椎曲度异常组（n=56例），分析两组之间的临床特点，探讨颈椎曲度改变与头晕不同分型的相关性。 结果 颈曲异常组患者入院ABCD2评分、头晕临床症状显著高于颈曲正常组，差异具有统计学意义（P＜0.05）。颈椎曲度异常与不同头晕分型之间具有高度正相关（P＜0.01）。 结论 随着患病时间的延长，颈椎生理曲度改变的加重，中青年头晕的临床症状也越来越严重。     

Microphthalmos with cyst--case presentation.

The author has experienced a case of microphthalmos with large orbital cyst in a 4 months old female, that was found at the time of birth. To facilitate fitting a cosmetic prosthesis, the microphthalmos with cyst was removed surgically. On serial section I could find an area of discontinuation of the sclera that was suspected to be the defective closure of the embryonic cleft. Some aberrant retinal tissue was found in the wall of the cyst, and markedly disorganized ocular tissue forming a tumor-like mass filled the microphthalmic eyeball. In view of these histopathologic findings I could draw the conclusion that developmental failure of the embryonic eyeball and consequential proliferation of the embryonic neuroepithelial cells occurred at an early developmental stage causing the formation of microphthalmos with cyst.