Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report

Rationale:Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.Patient concerns:A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.Diagnoses:Based on the patient''s symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.Interventions:FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.Outcomes:IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.Conclusions:We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.     

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study

Background:The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.Methods:This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.Results:A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).Conclusion:The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.     

Neoadjuvant chemotherapy endows CD9 with prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer

BackgroundThe selective pressure imposed by chemotherapy creates a barrier to tumor eradication and an opportunity for metastasis and recurrence. As a newly discovered stemness marker of pancreatic ductal adenocarcinoma (PDAC), the impact of CD9 on tumor progression and patient''s prognosis remain controversial.MethodsA total of 179 and 211 PDAC patients who underwent surgical resection with or without neoadjuvant chemotherapy, respectively, were recruited for immunohistochemical analyses of CD9 expression in both tumor and stromal areas prior to statistical analyses to determine the prognostic impact and predictive accuracy of CD9.ResultsThe relationship between CD9 and prognostic indicators was not significant in the non‐neoadjuvant group. Nevertheless, CD9 expression in both tumor (T‐CD9) and stromal areas (S‐CD9) was significantly correlated with the clinicopathological features in the neoadjuvant group. High levels of T‐CD9 were significantly associated with worse OS (p = 0.005) and RFS (p = 0.007), while positive S‐CD9 showed the opposite results (OS: p = 0.024; RFS: p = 0.008). Cox regression analyses identified CD9 in both areas as an independent prognostic factor. The T&S‐CD9 risk‐level system was used to stratify patients with different survival levels. The combination of T&S‐CD9 risk level and TNM stage were accurate predictors of OS (C‐index: 0.676; AIC: 512.51) and RFS (C‐index: 0.680; AIC: 519.53). The calibration curve of the nomogram composed of the combined parameters showed excellent predictive consistency for 1‐year RFS. These results were verified using a validation cohort.ConclusionNeoadjuvant chemotherapy endows CD9 with a significant prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer.     

岩沙海葵毒素人工抗原的合成及鉴定

目的制备岩沙海葵毒素(PTX)的人工抗原和抗血清,为建立PTX的酶联免疫检测方法提供技术基础。方法用小分子succinimidyl3-(2-pyridyldithio)propionate(SPDP)将PTX巯基化成半抗原PTX-PDP,用2-iminothiolane将大分子载体蛋白质匙眼血蓝蛋白(KLH)巯基化成KLH-SH,再将PTX-PDP和KLH-SH反应合成人工抗原PTX-PDP-KLH免疫雌性6~8周龄Balb/c小鼠,进行多抗的制备。用同样的方法制备酶联免疫反应之包被抗原PTX-PDP-BSA,用于检测血清抗体效价。结果根据紫外检测图谱,PTX的最大吸收波长在264nm处,KLH及BSA的最大吸收波长在278及279nm处,而合成的人工抗原PTX-PDP-KLH和PTX-PDP-BSA的最大吸收波长分别在267和273nm处。抗血清经间接酶联免疫吸附法检测,效价达到1∶3200,且与正常Balb/c小鼠、昆明种小鼠及兔血清间无交叉反应。结论合成的人工抗原纯度高,具有较好的免疫原性。     

南阳市通过评审验收静脉用药调配中心现状调查

目的 了解南阳市通过评审验收静脉用药调配中心(PIVAS)运行现状,分析该市PIVAS建立和运行中存在的问题,探讨符合该地区发展需要的工作模式.方法 采用问卷调查和电话采访,调查南阳市通过评审验收PIVAS的有关情况.结果 几家医院PIVAS建造模式主要为企业援建与医院自建两种方式,工作模式以药护结合为主,几家医院都未在全院开展调配服务,药学人员配备不足,整体素质偏低.结论 PIVAS是未来医院药学发展的一个重要方向,各家医院应重视PIVAS的建设和药学技术人员综合能力的培养,以利于该学科健康发展.     

不同来源千金藤中千金藤素的HPLC法测定

目的建立不同来源的千金藤植物中千金藤素的HPLC测定方法。方法采用Angela C18色谱柱(250 mm×4.6 mm,5μm);流动相:乙腈–水(52∶48,含0.5%三乙胺、0.01%磷酸);检测波长:282 nm;柱温:30℃;体积流量:1.0 m L/min;进样体积:20μL。结果千金藤素质量浓度在9~216μg/m L时与峰面积值呈良好的线性关系(r=0.999 7),平均回收率为96.0%,RSD值为2.0%(n=6)。产自湖南的千金藤(No.13)、产自广西的白药子(No.17)中千金藤素的量较高,分别为0.013 9%、0.122 1%;同一植株的不同用药部位(No.12~15)中千金藤素的量也不尽相同,湖南产千金藤中千金藤素主要分布在茎中,其质量分数为0.013 9%。结论该方法操作简便、准确、重复性好,可用于千金藤植物千金藤、地不容和白药子中千金藤素的测定。     

Association of Gut Microbiota Enterotypes with Blood Trace Elements in Women with Infertility

Infertility is defined as failure to achieve pregnancy within 12 months of unprotected intercourse in women. Trace elements, a kind of micronutrient that is very important to female reproductive function, are affected by intestinal absorption, which is regulated by gut microbiota. Enterotype is the classification of an intestinal microbiome based on its characteristics. Whether or not Prevotella-enterotype and Bacteroides-enterotype are associated with blood trace elements among infertile women remains unclear. The study aimed to explore the relationship between five main whole blood trace elements and these two enterotypes in women with infertility. This retrospective cross-sectional study recruited 651 Chinese women. Whole blood copper, zinc, calcium, magnesium, and iron levels were measured. Quantitative real-time PCR was performed on all fecal samples. Patients were categorized according to whole blood trace elements (low levels group, <5th percentile; normal levels group, 5th‒95th percentile; high levels group, >95th percentile). There were no significant differences in trace elements between the two enterotypes within the control population, while in infertile participants, copper (P = 0.033), zinc (P < 0.001), magnesium (P < 0.001), and iron (P < 0.001) in Prevotella-enterotype was significantly lower than in Bacteroides-enterotype. The Chi-square test showed that only the iron group had a significant difference in the two enterotypes (P = 0.001). Among infertile patients, Prevotella-enterotype (Log(P/B) > −0.27) predicted the low levels of whole blood iron in the obesity population (AUC = 0.894; P = 0.042). For the high levels of iron, Bacteroides-enterotype (Log(P/B) <−2.76) had a predictive power in the lean/normal group (AUC = 0.648; P = 0.041) and Log(P/B) <−3.99 in the overweight group (AUC = 0.863; P = 0.013). We can infer that these two enterotypes may have an effect on the iron metabolism in patients with infertility, highlighting the importance of further research into the interaction between enterotypes and trace elements in reproductive function.     

小儿功能性便秘罗马Ⅳ标准的外科学解读

胃肠道疾病可分为三类:器质性疾病、动力型疾病及功能性疾病.器质性疾病的诊断依赖于病理学,如胃肠道肿瘤.动力型疾病的诊断依赖于动力改变,如假性肠梗阻.功能性胃肠道疾病(functional gastrointestinal disorders,FGIDs)是一类主要通过症状进行诊断的疾病,而这些症状可与动力紊乱、内脏高敏感性、黏膜和免疫功能失调、肠道菌群失衡及中枢神经系统调节功能异常等相关,如功能性便秘、肠易激综合征等[1].     

子宫动脉栓塞术和米非司酮治疗子宫肌瘤比较研究

目的 观察子宫动脉栓塞术(UAE)和米非司酮(mifepristone)治疗子宫肌瘤的临床疗效、副作用及复发率.方法 子宫肌瘤患者共80例,随机分为2组,UAE组34例,行超选择性子宫动脉栓塞术.米非司酮组46例,口服米非司酮3个月.观察2组治疗前后子宫肌瘤大小、子宫体积变化、不良反应及复发率.结果 2种治疗方法均能明显改善临床症状,缩小子宫体积和肌瘤体积(P<0.01),且短期内米非司酮组比UAE组缩小明显(P<0.05).UAE后子宫肌瘤无复发,米非司酮治疗后有复发.UAE前后血清性激素变化差异无统计学意义(P>0.05),而米非司酮治疗前后变化差异有统计学意义(P<0.05),但可恢复.结论 UAE和米非司酮均为保守性治疗子宫肌瘤的有效方法,使临床症状减轻或消失.但米非司酮停药后有复发,适用于术前辅助用药和围绝经期治疗.