两种不同切口白内障超声乳化吸除术对角膜散光的影响

目的评价两种不同切口白内障超声乳化吸除术对角膜散光的影响。方法对我院305例(347只眼)白内障患者分别采用巩膜隧道切口(A组)和透明角膜切口(B组)行白内障超声乳化吸除术,术前和术后1周、1个月及3个月测量角膜散光度,采用矢量分析法计算手术源性散光(SIA)值。结果 A、B组术后1周、1个月平均角膜散光度与各自术前比较的差异均有统计学意义(P<0.05),术后1周、术后1个月A组与B组间两两比较的差异无统计学意义(P>0.05)。术后1周、术后1个月A组与B组间SIA值两两比较的差异有统计学意义(P<0.05),术后3个月A组与B组间SIA值两两比较的差异无统计学意义(P>0.05)。结论两种切口对角膜散光改变均较小,但透明角膜切口缩短了手术时间。     

飞秒激光辅助的白内障手术与常规白内障超声乳化手术治疗软核白内障的临床疗效比较

目的比较飞秒激光辅助的白内障手术和常规白内障超声乳化手术在软核白内障病人中的临床疗效。方法根据 Emery?Little白内障晶状体核硬度分级,回顾性纳入 2018年 6月至 2019年 3月海南医学院第一附属医院晶状体核硬度为 Ⅰ?Ⅱ级核的病人,完整完成随访者 20例共 20只眼,按术式分为飞秒组和常规组,均为 10例 10眼,分别行飞秒激光辅助的白内障超声乳化手术和常规白内障超声乳化手术。术前和术后 1d、1周、 1个月和 3个月分别评价视力、中央角膜厚度和角膜内皮细胞计数。结果飞秒组的平均超声乳化能量［常规组:(15.89±2.75)%,飞秒组:(12.80±1.79)%］和有效超声乳化时间［常规组:(18.94±2.43)s,飞秒组:(12.02±0.92)s］均比常规组的低,差异有统计学意义( P＝0.008,P＜0.001)。两组病人在术后 3月的视力恢复上差异无统计学意义( P＝0.423)。两组病人术后早期［术后 1d:(579.61±8.19)μm、术后 1周:(565.28±7.72)μm］中央角膜厚度均低于同随访点的常规组［术后 1d:(592.41±7.83)μm、术后 1周:(577.74±15.06)μm］(P＜0.05)。术后 1月［飞秒组:(555.05±10.68)μm、常规组:(561.75±5.65)μm］、 3月［飞秒组:(549.25±7.37)μm、常规组:(553.02±4.93)μm］,两组病人的中央角膜厚度均呈下降趋势,但差异无统计学意义。两组病人的角膜内皮细胞计数均呈逐渐下降趋势。术后早期飞秒组［术后 1d:(2 533.40±178.47)mm2、术后 1周:(2 548.00±152.78)mm2、术后 1月:(2 522.10±128.88)mm2］的角膜内皮细胞计数均高于同时期的常规组［术后 1d:(2 359.10±110.71)mm2、术后 1周:(2 403.50±114.00)mm2、术后 1月:(2 389.30±104.69)mm2］,且差异有统计学意义( P＝0.044,P＝0.028,P＝0.021)。术后 3月飞秒组( 2 573.00±193.81)mm2的角膜内皮细胞计数与同时期的常规组( 2 443.30±182.64)mm2组间差异无统计学意义( P＝0.141)。结论飞秒激光辅助的软核白内障手术与常规白内障超声乳化手术相比,具有一致的临床疗效,且安全性更高。     

不同透明角膜切口导致的角膜屈光力动态变化对比

目的探讨白内障超声乳化手术中,颞侧和上方2.8mm透明角膜隧道切口对角膜屈光力影响的动态变化。方法收集老年性白内障患者60例60眼,分为颞侧透明角膜切口组(A组)、上方透明角膜切口组(B组)两组。检查术前、术后1d、1周、1和3个月的视力、手术源性散光和角膜地形图。结果A、B两组术前散光分别为(0.67±0.31)、(0.70±0.35)D。术后1d、1周、1、3个月,A组的散光分别为(0.85±0.41)、(0.75±0.38)、(0.70±0.35)、(0.68±0.33)D;B组分别为(1.18±0.46)、(0.98±0.39)、(0.80±0.31)、(0.73±0.33)D。术后各阶段散光均高于术前。A组的散光小于B组(P<0.05)。术后第1天各组散光最大,以后渐减小。术后1d、1周、1、3个月,A组的SIA分别为(0.65±0.30)、(0.50±0.28)、(0.43±0.21)、(0.40±0.18)D;B组分别为(0.85±0.38)、(0.71±0.35)、(0.62±0.25)、(0.49±0.20)D。术后1d,A组SIA较B组小(P<0.05);各组SIA均随时间推移而减小,但A组SIA始终小于B组(P<0.05)。结论颞侧切口操作方便,术后的角膜散光状态和SIA均小于上方切口。     

透明角膜小切口白内障超声乳化术后角膜散光的变化

目的评价角膜地形图引导的透明角膜小切口超声乳化白内障吸除折叠式人工晶体植入术后角膜散光的变化。方法将119例(130只眼)白内障患者分为A、B、C三组,A组为对照组,B组为循规性散光组,C组为逆规性散光组;A、B两组行上方透明角膜切口,C组行颞侧透明角膜切口,行超声乳化白内障吸除折叠式人工晶体植入,比较术后角膜散光的变化情况。结果A、B、C三组术后90d平均手术性角膜散光度分别为(0.64±0.65)D、(0.75±0.58)D和(0.69±0.55)D,两两比较无显著性差异(P>0.05);平均角膜散光度A组较术前增加0.07D,B、C两组较术前减少0.34、0.37D,与A组比较有显著性差异(P<0.05)。结论以透明小切口行超声乳化白内障吸出折叠式人工晶体植入术,术后角膜散光度小,角膜地形图可准确反映角膜曲率变化,对指导术前角膜切口位置的选择及评价白内障术后角膜散光的变化具有重要的临床意义。     

青光眼术后白内障术式选择与疗效观察

目的：探讨研究透明角膜切口超声乳化术与经颞侧巩膜隧道小切口白内障摘出术治疗青光眼后白内障的临床效果。方法选取医院83例（87眼）青光眼术后白内障患者作为研究对象,分为Ⅰ组42例（44眼）和Ⅱ组41例（43眼）,Ⅰ组采用透明角膜切口超声乳化术进行治疗,Ⅱ组采用经颞侧巩膜隧道小切口白内障摘出术治疗。观察2组患者术前术后的眼压水平、角膜内皮计数、术中术后并发症,评价2种术式临床效果。结果Ⅰ组患者视力恢复率为63.64％,Ⅱ组患者视力恢复率为60.47％,2组比较差异无统计学意义（P﹥0.05）;Ⅰ组患者术后出现眼压过高症状4眼,Ⅱ组术后出现眼压过高6眼,经治疗后均可恢复正常;2组患者经治疗后角膜内皮计数指标均得到改善,比较差异无统计学意义（P﹥0.05）;2组患者均出现一定程度的术中术后并发症,发生例数无显著差异。结论透明角膜切口超声乳化术和颞侧巩膜隧道小切口白内障摘出术均为临床治疗青光眼术后白内障的有效方式,应根据患者眼部情况以及实际需求选择合理的手术方式。     

白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效及对患者角膜内皮细胞损伤的影响

目的：探讨白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效及对患者角膜内皮细胞损伤的影响。方法：选取本院2020-05～2021-12收治的硬核白内障患者60例(均为单眼),按照不同手术方案分为观察组(n=32)和对照组(n=28)。对照组患者给予超声乳化白内障摘除术治疗，观察组患者给予白内障手法碎核折叠人工晶状体植入术治疗，比较术前、术后1天、1周和1个月视力情况、术前和术后2h、12h、24h、1周眼压变化情况、角膜内皮细胞损伤程度。结果：观察组治疗效果明显优于对照组(P<0.05)。术后1个月、3个月观察组角膜内皮细胞密度明显低于对照组(P<0.05),而六角形细胞比率差异不大(P>0.05)。结论：白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效较好，对硬核白内障患者角膜内皮细胞损伤较大，但是角膜内皮细胞丢失率不大。     

术中前房注射地塞米松治疗葡萄膜炎并发白内障的效果及有效率分析

目的：分析、探究葡萄膜炎并白内障患者采取术中前房注射地塞米松诊疗的有效性。方法：选择54例葡萄膜炎并白内障患者研究,均于2019年1月至2022年1月入院就诊,按照随机数字表法分组,等分为2组,一组视为对照组,一组视作治疗组,对照组于术中不注射地塞米松,治疗组于术中向前房注射地塞米松(0.1mL),进行两组术后相关指标的评价,如眼压状况、角膜水肿程度及前房渗出率等。结果：(1)有效性：治疗组有效率为96.30%(26/27),较对照组70.37%(19/27)高(P<0.05);(2)术后视力改善状况：治疗组术后1d视力改善程度相比之对照组高(P<0.05);术后7d两组视力改善程度对比无统计学意义(P>0.05);(3)角膜水肿状况：术后1d,治疗组角膜水肿率相较于对照组低(P<0.05),术后7d两组对比无统计学意义(P>0.05);(4)前房渗出与闪辉阳性率：两组前房渗出率对比(P>0.05);治疗组术后1d前房闪辉阳性率与之对照组比低(P<0.05);(5)眼压状况：两组眼压对比(P>0.05)。结论：葡萄膜炎并白内障患者采取术中...     

白内障手术切口对眼表影响的探究

目的:探讨不同白内障手术切口对患者眼表所产生的影响。方法:选取某院收治的71例(82眼)行白内障手术患者的临床资料,根据患者的白内障手术切口部位,将其分为两组,分别为上方组(角膜上方切口组)与颞侧组(角膜颞侧切口组),比较两组患者的眼科检查结果。结果:(1)从患者的角膜内皮细胞计数、角膜染色分级、泪河高度上看,两组在术前、术后7d末、术后30d末3个时间段对比无统计学意义(P>0.05);(2)就泪膜破裂时间、眼压、视力指标而言,两组患者在术前、术后7d末、术后30d末3个时间段对比无统计学意义(P>0.05)。结论:对于行白内障手术的患者而言,选取角膜颞侧切口与角膜上方切口,都不会对患者眼表产生太大影响。     

手法小切口白内障青光眼联合手术37例

目的探讨和研究手法小切口白内障青光眼联合手术的临床效果。方法摘取我院近年来收治的37例(42眼)急性闭角型青光眼合并白内障患者的临床资料作为研究对象,本组患者均采用手法小切口白内障摘除术的巩膜隧道切口内做小梁切除术,对患者术后视力恢复情况、眼压以及并发症等进行统计分析。结果术后本组患者视力提高平均3~4行,手术前后的最佳矫正视力差异统计具有统计学意义(P<0.05)。术后平均眼压(11.94±2.44)mmHg,术后7d眼压在9~18mmHg之间,平均降低(8.14±0.48)mmHg,随访3~6个月,3个月后眼压在21mmHg以下共39眼,眼压控制率为92.86%,术后眼压较术前明显降低,差异具有统计学意义(P<0.05)。并发症发生率为9.52%(4眼),其中2眼为角膜内皮重度水肿,1眼为前房积血,1眼为后发性白内障。结论手法小切口白内障摘除术的巩膜隧道切口内做小梁切除术治疗白内障青光眼的效果较好,而且具有操作简单、损伤小、视力恢复快等特点,安全性也较高,值得在临床上加以推广和应用。     

角巩膜缘切口白内障超声乳化联合人工晶体植入术对白内障患者术后干眼症的影响

目的探讨对白内障患者采用角巩膜缘切口白内障超声乳化联合人工晶体植入术对术后干眼症的影响。方法76例(76眼)行白内障超声乳化联合人工晶体植入术患者,按照随机数字表法分为对照组和观察组,每组38例(38眼)。对照组予以透明角膜切口白内障超声乳化,观察组患者予以角巩膜缘切口白内障超声乳化。比较两组患者治疗效果、术后临床症状(异物感、干涩感、烧灼感、眼红、晨起眼睑黏滞)评分以及不同时间的角膜荧光素染色评分、泪膜破裂时间、基础泪液分泌量。结果观察组患者治疗总有效率92.11%高于对照组的73.68%,差异具有统计学意义(P<0.05)。观察组患者术后异物感、干涩感、烧灼感、眼红、晨起眼睑黏滞评分分别为(0.95±0.32)、(0.98±0.31)、(1.12±0.38)、(1.09±0.31)、(0.98±0.32)分,均低于对照组的(1.72±0.42)、(1.52±0.36)、(1.65±0.52)、(1.72±0.53)、(1.56±0.49)分,差异具有统计学意义(P<0.05)。两组患者术后1周及1个月角膜荧光素染色评分高于本组术前,且观察组高于对照组,差异具有统计学意义(P<0.05);两组患者术后1周及1个月泪膜破裂时间短于本组术前,但观察组长于对照组,差异具有统计学意义(P<0.05);两组患者术后1周及1个月基础泪液分泌量少于本组术前,但观察组多于对照组,差异具有统计学意义(P<0.05)。结论对白内障患者采用角巩膜缘切口白内障超声乳化联合人工晶体植入术临床疗效确切,可有效缓解干眼症状、改善泪膜稳定性。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.