ACEI/ARB对经皮冠脉介入诊疗后对比剂肾病影响的系统评价

目的:评价血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)或血管紧张素受体阻滞剂(angiotensin receptor blockers,ARB)在接受冠状动脉造影(coronary angiogram,CAG)或经皮冠脉介入(percutaneous coronary intervention,PCI)治疗患者中对对比剂肾病(contrast induced nephropathy,CIN)的影响。方法:在Pub Med、The Cochrane library、维普、知网、万方数据库中搜索从建库到2014年8月的与ACEI/ARB和对比剂肾病相关的文献。根据纳入/排除标准选择文献,评价纳入文献的质量,提取资料采用Stata 11.0软件进行数据Meta数据分析,采用Begg’s法和Egger’s法评估发表偏倚。结果:11项随机对照研究纳入分析,在接受冠脉造影或介入治疗的患者中,与对照组相比,术前使用ACEI/ARB不增加CIN的发生风险,差异无统计学意义(RR=0.78,95%CI=0.53~1.15,P=0.22)。亚组分析显示,治疗时间≥2周组(RR=0.78,95%CI=0.37~1.62,P=0.50)和<2周组(RR=0.79,95%CI=0.50~1.24,P=0.30)均不影响CIN的发生风险。但ACEI/ARB的使用明显降低术后72 h时CIN的发生风险(RR=0.44,95%CI=0.23~0.87,P=0.02);在平均造影剂用量≤150 ml组,CIN的风险也明显降低(RR=0.57,95%CI=0.33~0.99,P=0.046)。结论:目前尚无证据表明经皮冠状动脉介入诊疗术前使用ACEI/ARB会增加术后CIN的风险。     

Fully Bio-Based Adhesive from Tannin and Sucrose for Plywood Manufacturing with High Performances

Fully bio-based adhesives are beneficial to reduce the dependence of the wood adhesive industry on synthetic resins based on petrochemical resources and enhance the market competitiveness of adhesives. A fully bio-based wood adhesive composed of tannin and sucrose was developed and successfully used in the preparation of plywood. Effects of the preparation technology on the bonding strength and water resistance of plywood were investigated, and the properties of the adhesive were analyzed by Fourier transform infrared spectroscopy (FT-IR), thermogravimetry (TG) and X-ray diffraction (XRD) in this study. The results showed that: (1) Compared with other biomass adhesives, tannin–sucrose adhesive had the characteristics of high-solid content and low viscosity, which had the potential to prepare particleboard and fiberboard. (2) A proper mass ratio of tannin to sucrose was key to obtaining a tannin–sucrose adhesive with better properties. (3) The optimum preparation process of tannin–sucrose adhesive for plywood was as follows: hot-pressing temperature of 210 °C, hot-pressing time of 1.2 min/mm, m(tannin):m(sucrose) of 60:40 and adhesive loading of 160 g/m². Under these conditions, the water-resistant bonding strength of the plywood was 0.89 MPa, which met the strength requirements of the Type II standard of plywood in GB/T 17657-2013. (4) The hot-pressing temperature played a decisive role in the tannin–sucrose adhesive, and the good performance of the plywood was maintained when the temperature was 210 °C or above. Thus, the prepared tannin–sucrose adhesive had high-bonding strength, good water resistance and thermal stability.     

Advanced Nanomedicine for High-Risk HPV-Driven Head and Neck Cancer

The incidence of high-risk Human Papillomavirus (HR-HPV)-driven head and neck squamous cell carcinoma (HNSCC) is on the rise globally. HR-HPV-driven HNSCC displays molecular and clinical characteristics distinct from HPV-uninvolved cases. Therapeutic strategies for HR-HPV-driven HNSCC are under investigation. HR-HPVs encode the oncogenes E6 and E7, which are essential in tumorigenesis. Meanwhile, involvement of E6 and E7 provides attractive targets for developing new therapeutic regimen. Here we will review some of the recent advancements observed in preclinical studies and clinical trials on HR-HPV-driven HNSCC, focusing on nanotechnology related methods. Materials science innovation leads to great improvement for cancer therapeutics including HNSCC. This article discusses HPV-E6 or -E7- based vaccines, based on plasmid, messenger RNA or peptide, at their current stage of development and testing as well as how nanoparticles can be designed to target and access cancer cells and activate certain immunology pathways besides serving as a delivery vehicle. Nanotechnology was also used for chemotherapy and photothermal treatment. Short interference RNA targeting E6/E7 showed some potential in animal models. Gene editing by CRISPR-CAS9 combined with other treatments has also been assessed. These advancements have the potential to improve the outcome in HR-HPV-driven HNSCC, however breakthroughs are still to be awaited with nanomedicine playing an important role.     

肺移植治疗肺尘埃沉着病的临床研究进展与问题

肺尘埃沉着病(尘肺病)是世界上最严重且患病人数最多的职业病, 目前治疗的主要方法有药物治疗、肺灌洗技术及肺移植。当前的药物治疗主要起缓解症状的作用, 不能有效清除肺部粉尘。肺灌洗技术能清除部分肺部粉尘, 但是存在远期效果不佳以及并发症发生率较高等问题。肺移植治疗尘肺病的效果得到越来越多医师和患者的肯定, 但诸多因素限制了肺移植治疗尘肺病的发展。本文就尘肺病的概况、尘肺病的治疗、肺移植治疗尘肺病的问题与困境进行综述, 以期给临床医师选择治疗方案时提供一些参考。     

泪道高频电灼浚通术后两种药物充注效果的临床观察

目的探讨泪道高频电灼浚通术后两种不同药物充注的效果。方法237例（258只眼）泪道阻塞随机分成两组,A组120例（120只眼）和B组117例（128只眼）。分别应用典必舒眼膏充注和透明质酸钠充注。术后观察1周、1个月、3个月、6个月、1年。结果术后典必舒眼膏充注组治愈109只眼,有效12只眼,共121只眼（93．79％）,无效8只眼（6．21％）。透明质酸钠充注组治愈49只眼,有效48只眼,共97只眼（75．78％）,无效31只眼（24．22％）。两组间差异有显著意义（P〈0．01）。结论典必舒眼膏充注组疗效明显优于透明质酸钠充注组。     

间接检眼镜简捷用法结合前房穿刺降压的不放液手术

目的:改进视网膜脱离的不放液手术。方法:不同脱离形态和不同裂孔部位的孔源性视网膜脱离82例施行不放液手术,通过前房穿刺降低眼压,在间接检眼镜下,便于顶压视网膜检查裂孔和外加压及球内注气。结果:前房穿刺操作82例无1例晶状体混浊、前房出血和感染等并发症。不同类型的视网膜脱离1次复位率91%。一次复位的75例中经6～12mo的随访,仅有4例再次脱离。结论:此方法安全、方便、缩短了手术时间,同时适时的降压对直视下手术操作也很有利。     

神经生长因子对糖尿病大鼠神经视网膜超微结构的影响

目的:通过观测实验性糖尿病动物的神经视网膜的超微结构变化,从视网膜的神经功能角度来探讨糖尿病视网膜病变的发生机制以及相关药物干预后的影响作用。方法:用链脲佐菌素制作糖尿病大鼠动物模型,分为正常对照组(CON组)、糖尿病对照组(DM组)、糖尿病神经生长因子治疗组(D+N组)。分别于病程3,6,9,12mo取大鼠眼球制备石蜡切片,将视网膜组织行HE染色,并将上述标本制备超薄切片,用透射电镜观察并分析。结果:从病程3mo开始,DM组视网膜血管内皮细胞及周细胞的核变形、线粒体肿胀变性、基底膜增厚。视神经节细胞水肿,胞器减少,线粒体变性。光感受器细胞(视锥、视杆)膜盘间隙扩大,线粒体及核也有病理改变。上述病变随病程延长而逐渐加重。经过NGF治疗后,上述DM改变有所减轻,主要表现在感光细胞外节膜盘间隙较DM组缩小,平行度好转;神经细胞突起水肿减轻,胞器水肿好转。各组DM大鼠的视网膜血管、神经网膜及视神经的糖尿病性病变之间未见明显的先后因果关系。结论:神经生长因子对DM大鼠视网膜形态学上所见的视网膜血管、感光细胞和神经节细胞的超微结构改变有着明确的改善作用。在DR的发病过程中,视网膜血管的病变与视网膜神经组织的病变可能是同时存在、互相促进,共同造成糖尿病视网膜病变和视功能的损害。     

真菌性角膜炎29例诊疗体会

目的:通过对29例真菌性角膜炎的诊疗,探讨避免其误诊和漏诊的方法。方法:对29例具有真菌性角膜炎临床特征的病例,采用100g/LKOH湿片镜检,查找真菌丝或孢子,并送真菌培养。一旦确诊,立即抗真菌治疗。结果:29例患者通过100g/LKOH湿片镜检和/或真菌培养均确诊为该病,经有效的抗真菌治疗取得较满意效果。结论:真菌性角膜炎的治疗效果与是否诊断及时、治疗合理密切相关。首诊时利用实验室检查,可以有效避免真菌性角膜炎的误诊和漏诊,并提高治愈率。     

角膜接触镜治疗LASIK术后继发性圆锥角膜——附1例报告

目的:报道1例角膜接触镜治疗准分子激光原位角膜磨镶术(laser in situ keratomi leusis,LASIK)术后双眼圆锥角膜3a随访结果,并对相关文献进行简要回顾。方法:一位27岁的女性患者行常规LASIK治疗中度近视。术前散瞳验光的结果为右眼-5.50 /-0.50×50°和左眼-4.50/-1.00×15°。中央角膜厚度分别为右眼526μm和左眼541μm。术前角膜地形图正常,没有显示任何圆锥角膜或者亚临床期圆锥角膜的改变。手术中制作160μm角膜瓣后进行激光切削,切削深度分别是右眼102μm和左眼86μm,预计剩余角膜厚度为264μm和295μm。结果:术后29mo,患者双眼出现明显视力下降,下方角膜膨出,中央角膜曲率变大。验光结果分别为右眼-12.50/-4.00×160°和左眼-6.00/-4.25×125°。中央角膜厚度变薄。诊断双眼继发性圆锥角膜,给予硬性角膜接触镜配戴。3a的随访(期间曾两次更换镜片)显示患者病情基本稳定,视力矫正满意,接触镜全天佩戴耐受性良好,并发症较少。结论:虽然经过严格的术前筛查,轻度到中度的近视LASIK治疗术后仍可能出现继发性圆锥角膜。硬性角膜接触镜是改善此类患者视力安全和可逆的方法,也可以延迟或避免患者进行角膜内基质环的植入和穿透性角膜移植。