氙光低周波加封闭治疗腰腿痛的临床观察

我们对门诊就诊５２例腰腿痛病人，男３０人，女２２人，随机分为三组进行了对比观察。患者分组１（超短波组）、组２（Ｘｅｎｏｎ氙光低周波治疗组）和组３（氙光低周波加椎旁或硬膜外腔封闭组）。对于上述各组以ＶｉｓｕａｌＡｎａｌｏｇＳｃａｌｅ（ＶＡＳ）测痛法以疼痛为主要指标、快适度以舒适轻松程度为主要指标，就治疗前后自觉症状的改变进行了评价及统计学处理。结果表明：组３优于组２，组２优于组１，都具有显著性差异。本组结果提示日本医广公司生产的５５０／型氙光低周波治疗仪加激素类药物行椎旁或硬膜外腔封闭具有良好的协同作用，治疗效果显著。使ＶＡＳ痛苦度明显降低，同时治疗后还具有良好的舒适感，是治疗腰腿痛的好方法。     

Ocular bacterial infections at a tertiary eye center in China: a 5-year review of pathogen distribution and antibiotic sensitivity

AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections. METHODS: This study applied a retrospective analysis of 3690 bacterial isolates from ocular specimens, which were obtained from the conjunctiva, cornea, aqueous humor, vitreous body, and other ocular sites of the patients at Shandong Eye Institute in northern China from January 2013 to December 2017. The parameters assessed mainly included the distribution of isolated bacteria and the results of susceptibility tests for antibiotics. In the analysis of antibiotic sensitivities, the bacteria were divided into four groups according to gram staining, and statistical methods were used to compare their antibiotic sensitivities. RESULTS: Among the 3690 isolated bacterial strains, Staphylococcus epidermidis (2007, 54.39%) accounted for the highest proportion. As for the total isolates, their sensitivity rate to gatifloxacin was up to 90.01%, with four types of gram-stained bacteria being all highly sensitive to it, but their sensitivity rate to levofloxacin was only 51.91%. The sensitivity rate of gram-negative bacilli (G-B) to levofloxacin was 83.66%, significantly higher than the other three types of gram-stained bacteria (P<0.05). Gram-positive cocci (G+C, 97.95%) and gram-positive bacilli (G+B, 97.54%) were more sensitive to vancomycin than gram-negative cocci (G-C, 70.59%) and G-B (68.57%; P<0.05). For fusidic acid, the sensitivity rates of G+C (89.83%) and G+B (73.37%) were significantly higher than that of G-B (29.83%; P<0.05). The gram-negative bacteria’s sensitivity rate to cefuroxime was as low as 59.25%, but only G-B was less sensitive to cefuroxime (57.28%), while G-C was still highly sensitive (89.29%). The sensitivity rate of gram-positive bacteria to moxifloxacin was as high as 80.28%, but only G+C was highly sensitive to moxifloxacin (81.21%), while G+B was still less sensitive (32.00%). CONCLUSION: Staphylococcus epidermidis is the predominant isolate in all ocular specimens with bacteria. Gatifloxacin is more suitable for topical prophylactic use than levofloxacin in ophthalmology when necessary. Vancomycin and fusidic acid both have better effects on gram-positive bacteria than gram-negative bacteria. More accurate antibiotic sensitivity analysis results can be obtained when a more detailed bacterial classification and more appropriate statistical methods are performed.     

Clinical and experimental study of therapeutic effect of Weixibaonizhuan pills on gastric precancerous lesions

ＣｌｉｎｉｃａｌａｎｄｅｘｐｅｒｉｍｅｎｔａｌｓｔｕｄｙｏｆｔｈｅｒａｐｅｕｔｉｃｅｆｅｃｔｏｆＷｅｉｘｉｂａｏｎｉｚｈｕａｎｐｉｌｓｏｎｇａｓｔｒｉｃｐｒｅｃａｎｃｅｒｏｕｓｌｅｓｉｏｎｓＺＨＡＮＧＸｕＣｈｅｎ１,ＧＡＯＲｕｉＦｅｎｇ２,ＬＩ...     

From the Cover: Leukocyte immunoglobulin-like receptor B1 is critical for antibody-dependent dengue

Viruses must evade the host innate defenses for replication and dengue is no exception. During secondary infection with a heterologous dengue virus (DENV) serotype, DENV is opsonized with sub- or nonneutralizing antibodies that enhance infection of monocytes, macrophages, and dendritic cells via the Fc-gamma receptor (FcγR), a process termed antibody-dependent enhancement of DENV infection. However, this enhancement of DENV infection is curious as cross-linking of activating FcγRs signals an early antiviral response by inducing the type-I IFN-stimulated genes (ISGs). Entry through activating FcγR would thus place DENV in an intracellular environment unfavorable for enhanced replication. Here we demonstrate that, to escape this antiviral response, antibody-opsonized DENV coligates leukocyte Ig-like receptor-B1 (LILRB1) to inhibit FcγR signaling for ISG expression. This immunoreceptor tyrosine-based inhibition motif-bearing receptor recruits Src homology phosphatase-1 to dephosphorylate spleen tyrosine kinase (Syk). As Syk is a key intermediate of FcγR signaling, LILRB1 coligation resulted in reduced ISG expression for enhanced DENV replication. Our findings suggest a unique mechanism for DENV to evade an early antiviral response for enhanced infection.Despite long-lived serotype-specific immunity upon initial infection, predicted global prevalence of dengue now surpasses World Health Organization estimates by more than threefold with 390 million cases annually (1). Furthermore, the risk of severe disease is augmented by cross-reactive or subneutralizing levels of antibody (2, 3), which opsonize dengue virus (DENV) to ligate Fc-gamma receptor (FcγR) for entry into monocytes, macrophages, and dendritic cells, a phenomenon known as antibody-dependent enhancement (ADE) of DENV infection (4, 5). The resultant greater viral burden leads to increased systemic inflammation that precipitates plasma leakage, a hallmark of dengue hemorrhagic fever (6). However, ligation of the activating FcγRs by immune complexes has been shown to induce type-I IFN stimulated genes (ISGs), independent of autocrine or paracrine IFN activity, unless the inhibitory FcγRIIB is coligated (7). We and others reported recently that coligation of FcγRIIB by DENV immune complexes requires high antibody concentration, and such coligation inhibited the entry of DENV immune complexes into monocytes (8, 9). At low antibody concentrations where ADE occurs, the inhibitory FcγRIIB is not coligated (9). Ligation of the activating FcγRs by DENV opsonized with subneutralizing levels of antibody would thus induce the expression of ISGs and hinder DENV replication (10). Here, we demonstrate that DENV employs a unique evasive mechanism by coligating LILRB1 to down-regulate the early antiviral responses triggered by activating FcγRs for ADE.     

Accumulation of FLT3+ CD11c+ dendritic cells in psoriatic lesions and the anti-psoriatic effect of a selective FLT3 inhibitor

Psoriasis is a common chronic T-cell-mediated autoimmune skin disease, and traditional immunotherapies for psoriasis have focused on the direct inhibition of T cells, which often causes toxicity and lacks long-term effectiveness. Safe and effective therapeutic strategies are strongly needed for psoriasis. In this study, we show for the first time a significant accumulation of FLT3⁺ CD11c⁺ dendritic cells (DCs) in human psoriatic lesions and in the skin of experimental preclinical K14-VEGF transgenic homozygous mice, our animal model, although not an exact match for human psoriasis, displays many characteristics of inflammatory skin inflammation. SKLB4771, a potent and selective FLT3 inhibitor that we designed and synthesised, was used to treat cutaneous inflammation and psoriasis-like symptoms of disease in mice and almost completely cured the psoriasis-like disease without obvious toxicity. Mechanistic studies indicated that SKLB4771 treatment significantly decreased the number and activation of pDCs and mDCs in vitro and in vivo, and subsequent T-cell cascade reactions mediated by Th1/Th17 pathways. These findings show that targeted inhibition of FLT3, and hence direct interference with DCs, may be a novel therapeutic approach for the treatment of psoriasis.     

No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

Background

To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery.

Methods

In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route.

Results

There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P<0.001]. There were no differences in other neonatal morbidities, including intraventricular hemorrhage [126/351 (35.9%) vs. 134/359 (37.3%), P=0.69], bronchopulmonary dysplasia [39/351 (11%) vs. 31/359 (8.6%), P=0.38] and necrotising enterocolitis [40/351 (11.4%) vs. 32/359 (8.9%), P=0.32] between the two groups. The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery [105/351 (29.9) vs. 104/359 (29.0%), P=0.78].

Conclusions

In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.     

血清脑利钠肽(BNP)在正常孕妇及子痫前期患者中的研究

目的:探讨正常孕妇各孕期血清脑利钠肽(BNP)值的变化及其与子痫前期发病的关系。方法:共检测199例从孕早期至分娩前期孕妇血清BNP值,统计分析子痫前期孕妇与正常孕妇各孕期外周血清BNP值中位数的差异。结果:正常孕妇各孕期血清BNP中位数保持相对稳定,分别为17.3 pg/mL、16.9 pg/mL、15.8 pg/mL和18.6 pg/mL,正常孕妇,轻度子痫前期和重度子痫前期孕妇血清BNP值为17.1 pg/mL、22.7 pg/mL和118 pg/mL,重度子痫前期患者血清BNP值与正常孕妇及轻度子痫前期孕妇血清BNP差异有统计学意义(P<0.001)。结论:正常孕妇血清BNP浓度在各孕期保持相对稳定;子痫前期患者血清BNP浓度显著高于同孕周正常孕妇,BNP与子痫前期发病存在相关关系。     

近视眼LASIK术后AC/A比率的变化

目的研究近视眼患者准分子激光原位角膜磨镶（laser in sfiu keratomileusis，LASIK）后调节性集合（accommodative convergence,AC）与调节（accommodation,A）比率的变化。方法将230眼按近视屈光度等效球镜值-1．50～-3．00D、-3．25～-6．00D和-6．25～-11．00D分为A、B、C3个组行LASIK手术。采用同视机测定患者术前戴镜、术后1个月、3个月裸眼Ac／A值，并进行统计学分析。结果A、B、C3组术前戴镜AC／A值分别为3．02±0．79、3．03±0．69和2．71±0．47；术后1个月裸眼AC／A值分别为2．77±0．33、2．40±0．33和2．49±0．40；术后3个月裸眼AC／A值分别为3．04±0．74、2．79±0．58和2．74±0．60。术后1个月裸眼AC／A值明显低于术前戴镜和术后3个月，有显著性差异（P〈0．01）；术后3个月裸眼Ac／A值与术前戴镜Ac／A值比较无显著性差异（P〉0．05）；不同近视程度间各组AC／A值比较术前戴镜、术后1个月和术后3个月均无统计学差异（P〉0．05）。结论对于长期戴镜患者。近视程度对术前戴镜、术后裸眼Ac／A值均无影响；不同近视程度患者LASIK术后裸眼AC／A值的变化趋势相同，即均表现为先下降。后上升，至术后3个月时基本恢复到术前戴镜水平。[眼科新进展21107；27（2）：120-122]