Late contralateral recurrence of retinal detachment in incontinentia pigmenti: A case report

BACKGROUNDIncontinentia pigmenti (IP) is a rare X-linked genetic disease. It mainly manifests as skin lesions and causes problems in the eyes, teeth, bones, and central nervous system. Of the various ocular manifestations, the most severe with difficult recovery is retinal detachment (RD). Here, we report an unusual case of bilateral asymmetrical RD. CASE SUMMARYWe present the case of an 11-year-old Chinese girl with IP who complained of sudden blurring of vision in the left eye. At that time, she had been blind in her right eye for 4 years. RD with traction was observed in both eyes. A massive retinal proliferative membrane, exudation, and hemorrhage were seen in the left eye. We performed vitrectomy in her left eye. Her visual acuity recovered to 20/50, and her retina had flattened within 2 d after surgery. During the 3-mo follow-up, we performed retinal laser treatment of the non-perfused retinal area in her left eye. Eventually, her visual acuity returned to 20/32, and no new retinal abnormalities developed. CONCLUSIONIn patients with IP with fundal abnormalities in one eye, it is important to focus on the rate of fundal change in the other eye. RD in its early stages can be effectively treated with timely vitrectomy and laser photocoagulation.     

二维及彩色多普勒超声对视网膜脱离的诊断价值比较

目的:比较2DU及CDFI两种超声检查法对视网膜脱离的诊断价值。方法:对经2DU诊断为视网膜脱离的83只患眼进行CDFI检查,并与临床检眼镜诊断对照。结果:CDFI诊断符合率97%,明显高于2DU(80%),两者间有显著性差异(P<0.05)。结论:CDFI检测视网膜中央动脉及其网脱上分支血流对视网膜脱离具有特异性诊断价值,提高了诊断准确性。     

Intravitreous injection of conbercept for bullous retinal detachment: A case report

BACKGROUNDDiffuse retinal pigment epitheliopathy (DRPE) associated with bullous retinal detachment is a severe variant of DRPE that is frequently misdiagnosed and often improperly treated. CASE SUMMARYA 36-year-old female patient complained of painless vision decline in the left eye with obscuration for 10 d. Slit-lamp microscopic fundus examination revealed white-yellow subretinal exudates in the posterior pole in both eyes, retinal detachment with shifting subretinal fluid in the left eye, and no retinal hiatus. Fundus fluorescein angiography revealed multiple subretinal leakage foci and localized hypofluorescent lesions with patched hyperfluorescence. There was fluorescence leakage in the retinal vessels in the retinal detachment area and occluded blood vessels in the lower and peripheral areas. Indocyanine green angiography revealed multifocal lamellar hyperfluorescence in the middle stage and low fluorescence in the retinal detachment area in the late stage. Retinal anatomical reduction significantly improved with intravitreal conbercept injections. CONCLUSIONIntravitreal injection of conbercept can anatomically reattach the retina in patients with bullous retinal detachment.     

Retinal detachment due to facial gunshot wound: the utility of ultrasonography in a medically austere environment

Background

Retinal detachment is one complication of ocular trauma. Retinal detachments resulting from gunshot wounds are typically associated with significant facial trauma, orbital trauma, or globe penetration. Ultrasonography has been shown to be of diagnostic utility in the evaluation of retinal detachments.

Objectives

In this case, an atypical mechanism for retinal detachment is described. The aim is to describe the successful use of ultrasound as an aid for accurate diagnosis and disposition of a retinal detachment in practice environments with limited medical resources.

Case Report

We present a case of a low-velocity gunshot wound resulting in retinal detachment from pressure wave forces. A 21-year-old patient sustained a facial gunshot wound injury from a ricocheting AK-47 round, resulting in a closed globe retinal detachment. Portable ultrasonography was utilized as an accurate diagnostic modality in the management and disposition of this patient, allowing prompt confirmation of the diagnosis in a medically austere environment.

Conclusion

Ultrasonography can be a valuable diagnostic tool in the evaluation of ocular trauma in medically austere environments.     

围术期护理干预对视网膜脱离患者心理状态及术后生活质量的影响

目的探讨围术期护理干预对视网膜脱离患者心理状态及术后生活质量的影响。方法将本院200例视网膜脱离手术患者,根据随机数字法,分为对照组(常规护理)和观察组(护理干预),各100例,比较2组患者护理前后焦虑、抑郁评分,术后生活质量,以及护理满意度。结果与对照组相比,观察组护理后SAS、SDS评分均显著降低(P0.05);与对照组相比,观察组术后生活质量各维度得分及总分均显著增高(P0.05);与对照组相比,观察组患者对护理服务满意度显著提升(P0.05)。结论围术期护理干预有效调整视网膜脱离手术患者的负面情绪,提升了患者术后生活质量及护理满意度,值得临床推广。     

巩膜扣带术治疗多发性裂孔性视网膜脱离应用硅胶与硅海绵垫压效果观察

目的探讨联合应用硅胶与硅海绵垫压的巩膜扣带术治疗多发性裂孔性视网膜脱离的临床疗效。方法多发性裂孔性视网膜脱离31例(31眼)在我院行联合应用硅胶及硅海绵垫压的巩膜扣带术,术中采用硅海绵垫压较大的和(或)较多的裂孔区,用硅胶垫压较小的和(或)较少的裂孔区。结果术后随访12～30个月,31只眼中,手术一次性视网膜完全复位29眼(93.54%),2例再次行玻璃体切割术后网膜复位;矫正视力在0.1以上者14眼;所有患者未见严重并发症。结论联合硅胶与硅海绵垫压手术是治疗多个裂孔视网膜脱离的有效治疗方法。     

A theoretical study of nonlinear effects with focused ultrasound in tissues: an "acoustic bragg peak"

This is a theoretical study of the absorbed power density that arises when a focused ultrasound beam is absorbed in a tissue-like medium. The specific application is selective tissue heating for cancer hyperthermia. Results are expressed in terms of an enhancement ratio which describes the fractional gain in absorbed power density when nonlinear effects are taken into account relative to the absorbed power density that results when only linear effects are considered. Starting from a standard configuration in which the transducer has a (Gaussian) diameter of 0.12 m, a radius of curvature of 0.16 m and an operating frequency of 1 MHz a numerical sensitivity analysis is performed in which transducer and tissue parameters are varied one at a time. Enhancement ratios are invariably greater than unity, often being in the range of 1.5-2 for regions near the focus of the beam. The prediction is that nonlinear effects will probably be useful in selectively increasing the temperature rise in the focal region of a focused applicator.     

First case of coloboma,lens neovascularization,traumatic cataract,and retinal detachment in a young Asian female

Lens neovascularization is a very rare entity to be encountered in the clinical practice. It is possibly a result of chronic ocular inflammation due to injury and subsequent uveitis. Early diagnosis and meticulous management can salvage visual acuity in such cases.     

心理脱离在急诊科护士情绪劳动与工作投入间的中介效应

目的探讨心理脱离在急诊科护士情绪劳动与工作投入间的中介效应,为提高急诊科护士工作投入提供新思路。方法 2019年1月-3月对安徽省20所公立医院284名急诊科护士以心理脱离量表、情绪劳动量表、工作投入量表为研究工具进行问卷调查,采用Amos23.0构建结构方程模型,分析安徽省急诊科护士心理脱离、情绪劳动、工作投入水平并探讨三者间关系。结果急诊科护士心理脱离、情绪劳动、工作投入得分分别为(7.98±3.19)分、(53.05±11.30)分、(62.62±19.30)分。心理脱离、情绪劳动与工作投入三者之间两两均呈正相关(P<0.05)。结构方程模型拟合度良好,心理脱离在急诊科护士情绪劳动与工作投入之间存在部分中介效应(β=0.054)。结论情绪劳动中的深层扮演与情绪表达要求维度和心理脱离水平的提高有助于提升急诊科护士工作投入水平,心理脱离在急诊科护士情绪劳动与工作投入中起部分中介效应。护理管理者可通过情绪劳动培训提高急诊科护士的心理脱离水平,以促进其工作投入。     

复杂性视网膜脱离患者疾病感受与围手术期体验的质性研究

目的 了解复杂性视网膜脱离患者的疾病感受与围手术期体验,以期为患者制订个体化的护理干预措施提供参考依据。方法 采用现象学研究法,选取2020年7-12月四川省某三级甲等综合医院眼科收治的14例复杂性视网膜脱离手术患者作为研究对象,对其进行半结构式深入访谈,并应用Colaizzi 7步分析法分析、提炼主题。结果 复杂性视网膜脱离患者的疾病感受与围手术期体验可归纳为5个主题:(1)疾病自我管理能力不足;(2)舒适度改变;(3)自我感受负担重;(4)生活质量降低;(5)支持系统薄弱。结论 复杂性视网膜脱离患者围手术期容易产生生理、心理和社会诸多方面的问题与需求,临床医护人员应重视此类患者的疾病感受与围手术期体验,给予必要的心理、社会支持和专业技术指导。     

Systematic extended posterior right sectionectomy with simultaneous resection of the dorsal part of segment 1 and middle hepatic vein detachment

Parenchymal sparing surgery should be the strategy of choice for patients with bilobar liver metastases and lesions within the central liver sites.     

自制网脱复位垫应用于复杂性视网膜脱离术后被动体位120例效果观察及护理

目的:探讨自制网脱复位垫应用于复杂性视网膜脱离术后被动体位的效果及护理方法.方法:将120例复杂性视网膜脱离术后患者随机分为观察组与对照组各60例.观察组应用网脱复位垫行俯卧位护理,对照组行常规俯卧位护理. 结果:与对照组相比,观察组患者俯卧位维持时间、首次入睡持续时间明显延长(P<0.01),住院天数明显缩短(P<0.05);俯卧位出现颈、腰部不适及胸闷憋气、皮肤压力伤、肢体麻木等不适均明显减轻(P<0.01).结论:应用网脱复位垫行被动体位,可减轻患者痛苦,降低并发症发生率,保证手术效果,值得临床推广应用.     

In vitro regulation of adipogenesis: tunable engineered tissues

A major clinical challenge in creating a tissue-engineered medical implant is the ability to expand cells biopsied from the patient to obtain a clinically relevant cell volume. A common tissue engineering strategy involves the culture of autologous progenitor cells on biomaterials to form an implantable cellular device. However, autologous progenitor cells often lose their differentiation potential during the expansion process. The acute regulation of mammary tissue expansion in vivo through local modulation of connective tissue suggests that the parenchymal-stromal interactions are crucial to develop tissue ex vivo. To better understand cellular behaviour in co-culture in two-dimensional systems, mesenchymal stem cells were treated with mammary epithelial cell conditioned medium and assessed for cell proliferation, lipid production and morphological changes over a 17 day culture period. The results showed that bovine epithelial cells (MAC-T) are able to inhibit mouse mesenchymal stem cell differentiation (D1), even in the presence of adipogenic cocktails. The inhibitory effect is reversible, thus potentially providing a mechanism for 'tuning' a cell-based device prior to implantation. Further studies found that there were significantly higher levels of urokinase plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) in the MAC-T-conditioned medium than in the murine mammary epithelial cell (NMuMG)-conditioned medium, which was not able to inhibit adipogenesis of D1 cells. D1 cells are able to proliferate and maintain their differentiation potential in MAC-T-conditioned medium. The long-term implication is that new culture media may be developed that allow the rapid, clinical expansion and differentiation or dedifferentiation of cells for regenerative medicine applications.     

精神分裂症患者家庭主要照顾者心理脱离在照顾者负担和连带病耻感间的中介作用

目的：探讨精神分裂症患者家庭主要照顾者心理脱离在照顾负担与连带病耻感间的中介作用,为缓解其连带病耻感制定相应干预措施提供依据。方法：采用便利抽样法选取132例精神分裂症患者家庭照顾者为研究对象。采用一般资料调查问卷、心理脱离量表（PD）、照顾者负担量表(ZBI)、贬低-歧视感知量表（PDD）进行调查,运用多元回归中介效应分析及Bootstrap法进行验证。结果：精神分裂症患者主要照顾者的照顾负担与心理脱离呈负相关（r=-0.540,P<0.05））;照顾负担与连带病耻感呈正相关（r=0.629,P<0.05）;心理脱离与连带病耻感呈负相关（r=-0.688,P<0.05）;中介效应分析显示,心理脱离在照顾负担与连带病耻感之间起完全中介作用,效应值为78.42%。结论：在精神分裂症患者家庭主要照顾者中,心理脱离是照顾负担与连带病耻感的中介变量。医护人员应多关注精神分裂症患者主要照顾者的心理情况,采取积极措施提高其心理脱离水平,使其从繁重的照顾工作中脱离出来,进而促进其身心健康。     

Intravenously administered pharmaceuticals impact biofilm formation and detachment of Staphylococcus lugdunensis and other staphylococci

Coagulase-negative staphylococci and Staphylococcus aureus are major causes of catheter-related infections because of their ability to form biofilms on indwelling polymeric devices. Staphylococcus lugdunensis is a particularly virulent coagulase-negative species responsible for several types of biofilm-related infections, but factors that influence biofilm formation by this species remain undetermined. Heparin and catecholamine inotropes are common intravenously administered drugs reported to stimulate biofilm formation of some staphylococci. This study assessed the effects of catecholamines and heparin on biofilm formation of a collection of S. lugdunensis isolates and other Staphylococcus species. Dopamine stimulated biofilm formation in two-thirds of S. lugdunensis isolates, whereas dobutamine prevented nearly all S. lugdunensis isolates from adhering to polystyrene. Heparin markedly reduced biofilm formation by 87% of S. lugdunensis isolates. Preformed biofilms of S. lugdunensis and other Staphylococcus species detached from polystyrene after exposure to heparin at concentrations used in catheter locks. Our data suggest that intravenous pharmaceuticals may influence staphylococcal biofilm formation on and detachment from intravascular catheters.     

Effectiveness of treatment to prevent adhesions after abdominal surgery: An experimental evaluation in rats

This study was conducted to determine the probability of adhesion formation with certain materials after abdominopelvic surgery, and to assess the effectiveness of adhesion-preventing agents. The study included 2 phases. In the first phase of the study, 50 rats that had been divided into 5 groups were examined. Group 1 served as the control group. In group 2,2 mL blood was taken from the femoral vein of the rat; in group 3,0.0625 g talcum powder was mixed with 2 mL saline; in group 4, 2 mL ileal content was identified; and in group 5, 2 mL cecal content had spilled into the peritoneum. In the second phase of the study, 50 rats that had been divided into 5 groups were examined. Ileal content was the leading cause of intraperitoneal adhesions in the first phase; in the second phase, in group 1, 2 mL ileal content and 5 mL povidone-iodine (10%) were used; in group 2,2 mL ileal content and 5000 units aprotinin were mixed with 5 mL saline; in group 3, 2 mL ileal content and 25 IU heparin (5000 IU/L) were mixed with 5 mL saline; in group 4,2 mL ileal content and 5 mL 32% dextran 70 were combined; and in group 5, 2 mL ileal content was used together with 5 mL Ringer’s lactate. On postoperative day 14, the rats were killed with the use of high-dose intramuscular ketamine, and necropsies were performed on all rats. Adhesions were most often established because of ileal and cecal contents. Blood and talcum powder produced less adhesion formation. Heparin and 32% dextran 70 were significantly more effective at preventing adhesion formation due to ileal contents. Intraperitoneal heparin and 32% dextran 70 may be particularly valuable for the prevention of adhesions due to intestinal content in cases with no contraindications.     

Cutting characteristics of the Nd: YAG contact technique using a laser with tissue effect control,conical fibres and a normal bare fibre: First results of a physical,morphometrical and clinical study

Summary

In the present study, a Nd : YAG laser with tissue effect control (MediLas 4060-N-Fibertom, Dornier-Medizintechnik, Munich) and two newly developed conical bare fibres (Sharplase Conical Fibers, Sharplan Lasers, Freising) were used and the cutting effect compared to that of a conventional bare fibre. Methodology: The two conical fibres had a body diameter of 600 and 800 μm, a 400 μm bare fibre served as a reference. In the first step, radiation geometry was physically measured. Subsequently, in an in vivo experiment, linear uterotomies were performed on Wistar rats with the three types of fibres and the tissue effect control system at an initial power output of 10, 15 and 20 W. Serial cuts were HE-stained and the zones of tissue damage evaluated with the Cue-2 Image Analysis System. In the third step, operative hysteroscopies and laparoscopies were performed. Results: Physical measurements showed a characteristic radiation profile for each fibre. The tissue effect control system prevents melting of the distal end of the fibre in case of non-contact handling, but does not significantly improve tissue effect (P lt; 0.001). Both conical bare fibres resulted in considerably increased cutting depth while the zones of tissue lesion were significantly reduced as compared to the 400 μm control fibre (P lt; 0.001). Clinical application confirmed the cutting properties established in the experimental phase.     

间接测热法与传统能量估算法测定重症监护病房患者能量消耗的比较

目的 比较间接测热法测定能量消耗值(MEE)与传统方法得到估计能量消耗值(EEE)的差异,为危重患者的能量补充提供依据.方法 采用自身前后对照研究方法,对57例重症监护病房(ICU)患者使用间接测热法得到MEE,使用传统能量估算法如HB公式法、HB系数法和体重法得到EEE,其中低体重者[体质指数(BMI)<18.4 kg/m2]使用理想体重表计算,并以EEE与MEE的比值来评价估算能量的准确性.结果 HB公式法、HB系数法和实际体重法得到的EEE与间接测热法得到MEE比较差异均有统计学意义[(6335±1004)kJ、(9125±1795)kJ、(7188±1029)kJ比(7753±1439)kJ,P<0.05或P<0.01].HB系数法与实际体重法比较差异也有统计学意义(P<0.01),且后者的结果更接近实际测定值.用HB公式法估计能量会造成多数患者营养不足[低体重者占100%(4/4);体重正常者(BMI 18.5～23.9 kg/m2)占73.59%(39/53)].低体重者使用理想体重估算能量均能在营养充足范围内[100%(4/4)];体重正常者使用HB系数法和实际体重法可造成大量的营养不足[分别占39.62%(21/53)和43.39%(23/53)]及营养过度(分别占24.53%(13/53)和13.22%(7/53)].结论 对于危重病患者,各种传统公式估算能量消耗都很不精确,容易造成大量的营养不足和营养过度,最好使用间接测热法测定目标能量;在没有间接能量测定仪的情况下,低体重者使用理想体重,而体重正常者使用实际体重的估算法似乎较为合理.

Abstract：

Objective To compare measurement of energy expenditure(MEE)by indirect calorimetry (IC)with traditional estimation of energy expenditure(EEE),to provide a basis for energy supplementary for critically ill patients.Methods Using self-controlled study,the energy expenditure of 57 intensive care nnit(ICU)patients was measured by IC.Meanwhile,EEE was also calculated using the following equations:Harris-Benedict(HB),HB×factor,or 104.6 kJ/kg.Body weight were calculated using actual body weight(ABW)or ideal body weight(IBW).If body mass index(BMI)<18.4 kg/m2 it was considered as underweight,and the IBW was selected from the IBW table.The potential adequacy of estimated energy was assayed by ratio of EEE/MEE.Results There was significant difference in MEE by IC and EEE by HB,HB×factor and 104.6 kJ/kg [(6335±1004)kJ,(9125±1795)kJ,(7188±1029)kJ vs.(7753±1439)kJ,P<0.05 or P<0.01].There was significant difference between EEE by HB × factor and 104.6 kJ/kg(P<0.01),and EEE by 104.6 kJ/kg×ABW,and the latter was closer to MEE.Underfeeding would occur in most ICU patients if HB equation was used [100%(4/4)in underweight patients and 73.59%(39/53)in normal weight(BMI 18.5-23.9 kg/m2)].EEE as calculated by 104.6 kJ/kg ×IBW was reasonable in the underweight patients 100%(4/4),but EEE in the patients with normal weight by using HB×factor or 104.6 kJ/kg × ABW resulted in significant underfeeding[39.62%(21/53)and 43.39%(23/53)]or overfeeding[24.53%(13/53)and 13.22%(7/53)].Conclusion EEE derived from the equations was extremely inaccurate and may result in significant underfeeding or overfeeding in individuals.On the basis of this study we would recommend IC for measuring energy expenditure in ICU patients.Otherwise,the equations of 104.6 kJ/kg × IBW in underweight and 104.6 kJ/kg × ABW in normal weight patients may be reasonable.     

Engineering tendon and ligament tissues: present developments towards successful clinical products

Musculoskeletal diseases are one of the leading causes of disability worldwide. Among them, tendon and ligament injuries represent an important aspect to consider in both athletes and active working people. Tendon and ligament damage is an important cause of joint instability, and progresses into early onset of osteoarthritis, pain, disability and eventually the need for joint replacement surgery. The social and economical burden associated with these medical conditions presents a compelling argument for greater understanding and expanding research on this issue. The particular physiology of tendons and ligaments (avascular, hypocellular and overall structural mechanical features) makes it difficult for currently available treatments to reach a complete and long‐term functional repair of the damaged tissue, especially when complete tear occurs. Despite the effort, the treatment modalities for tendon and ligament are suboptimal, which have led to the development of alternative therapies, such as the delivery of growth factors, development of engineered scaffolds or the application of stem cells, which have been approached in this review. Copyright © 2012 John Wiley & Sons, Ltd.