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.     

大鼠肠道菌群对长梗冬青苷体外代谢的影响

摘 要 目的：探究体外孵育的大鼠肠道菌群对长梗冬青苷的代谢转化规律。方法: 将长梗冬青苷与大鼠肠道菌群在厌氧条件下共孵育,分别于0,4,8,12,24,48 h时取样,经乙酸乙酯萃取后采用HPLC法进行定性和定量分析。结果: 在与大鼠肠道菌群共孵育48 h后,90.8%的长梗冬青苷被代谢转化为M₂,M₂与铁冬青酸对照品通过HPLC分析时色谱行为一致,故确定M₂为铁冬青酸。结论:长梗冬青苷可以被体外孵育的大鼠肠道菌群代谢转化为铁冬青酸。     

Numerical Analysis of Microcrack Propagation Characteristics and Influencing Factors of Serrated Structural Plane

The serrated structural plane is the basic unit of structural plane morphology. However, the understanding of its internal stress distribution, failure mode and crack evolution law was not clear enough in previous studies. In this paper, the shear mechanical properties of the serrated structural planes were studied by numerical simulation, and the crack evolution law of the serrated structural planes and the effects of four microscopic parameters on the shear properties were analyzed. The results show that: (1) the number of microcracks increases with the increase in normal stress; the crack expansion rate is slow before the shear stress reaches the peak. After the shear stress reaches the peak, the crack expansion rate continues to increase, and the microcracks keep sprouting and expanding, and the number of microcracks tends to stabilize when the shear stress reaches the residual shear strength. (2) The particle contact stiffness ratio kn∗/ks∗ and parallel bond stiffness ratio kn/ks were negatively correlated with the shear strength; and the particle contact modulus E and parallel bond modulus E∗ were positively correlated with the shear strength. As the particle contact modulus E and parallel bond modulus E∗ increase, the peak shear displacement gradually decreases. The parallel bond stiffness ratio kn/ks has a negative correlation with the peak shear displacement. This study is expected to provide theoretical guidance for the microscopic parameter calibration and shear mechanical analysis of serrated structural planes. (3) Several XGBoost, WOA-XGBoost, and PSO-XGBoost algorithms are introduced to construct the quantitative prediction model, and the comparative analysis found that WOA-XGBoost has the best fitting effect and can be used for the prediction of shear strength. When using this model to calculate the weight shares of micro-parameters, it was found that kn∗/ks∗ has the greatest influence on shear strength, followed by E∗; E and kn/ks had the least influence.     

0.05%环孢素A纳米粒滴眼液治疗干眼症的实验研究

目的观察0.05%环孢素A纳米粒滴眼液对干眼症的治疗效果。方法将新西兰兔24只随机分为4组,空白组、阴性对照组、0.05%环孢素A滴眼液组、0.05%环孢素A纳米粒滴眼液组,每组6只。利用东莨菪碱诱导干眼模型,造模成功后开始实验干预:阴性对照组不予处理;0.05%环孢素A滴眼液组及0.05%环孢素A纳米粒滴眼液组分别给与相应滴眼液,3次/天,共持续28天。在干预第1、2、3、4周分别进行Schirmer I(SIT)试验、泪膜破裂时间(BUT)、角膜荧光素染色(CFS)检测。并于干预结束后光镜下观察结膜组织的病理学改变。结果与空白组相比,造模后各干预组泪液分泌量明显减少、泪膜破裂时间显著缩短(P<0.05)。与阴性对照组相比,干预后同时段0.05%环孢素A滴眼液组及0.05%环孢素A纳米粒滴眼液组泪液分泌量增加、泪膜破裂时间延长,干预第1周改善效果最为明显,且0.05%环孢素A纳米粒滴眼液组效果更为显著(P<0.05)。造模后结膜上皮结构紊乱,杯状细胞反应性增多、胞浆丰富,固有层炎性细胞浸润增多。0.05%环孢素A滴眼液组及0.05%环孢素A纳米粒滴眼液组干预4周后,结膜上皮形态排列结构趋于规则,杯状细胞数量减少、胞浆丰富,固有层炎性细胞浸润减少,且0.05%环孢素A纳米粒滴眼液干预效果更为显著。结论0.05%环孢素A纳米粒滴眼液能够有效改善干眼症状,且效果优于传统的0.05%环孢素A滴眼液。     

Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma: clinical outcomes and patterns of failure

The objective of the study was to report clinical outcomes and patterns of failure for these patients with cervical esophageal squamous cell carcinoma (CESCC) treated with intensity-modulated radiotherapy (IMRT). A total of 64 patients with CESCC treated with definitive IMRT from May 2005 to March 2012 in our center were analyzed. Forty-two patients received radiotherapy alone and 22 patients received concurrent chemoradiotherapy. The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. For all patients, the overall 2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was 74.5, 88.0, 66.6 and 42.5 %, respectively. Twenty-eight patients had developed treatment failure. Of the 28 patients, 14, 5, and 18 had developed local failure, regional failure, and distant metastasis, respectively. All of the 14 local failures were considered in-field failures. Of the five regional failures, three were considered in-field failures and two were marginal failures. The most frequently observed acute toxicity was mainly Grade 1 or 2. The incidence of acute Grade 3 mucositis (including pharyngitis), skin reaction, and leukopenia was 4.7, 12.5 and 10.9 %, respectively. IMRT provides satisfactory locoregional control for CESCC. Distant metastasis remains the predominate pattern of failure and the predominate pattern of locoregional failures is in-field failure.     

工作流程梳理在门诊药房应用的体会

目的总结门诊药房工作流程梳理及应用体会。方法从建立和应用的角度,介绍工作流程制订的方法和使用的意义。结果建立工作流程可避免传统带教弊端,提高工作效率,减少工作差错,便于药房统一管理。结论合理的工作流程是高质高效完成各项工作的有力保障。     

Antiosteoporotic chemical constituents from Er-Xian Decoction, a traditional Chinese herbal formula

AIM OF THE STUDY: Er Xian Decoction (EXD), a traditional Chinese medicine formula, has long been used for the treatment of osteoporosis and menopausal syndrome in China. The present study was designed to investigate the antiosteoporotic constituents of EXD, and evaluate their antiosteoporotic effects in ovariectomized rats. MATERIALS AND METHODS: Osteoblasts in neonatal calvaria cultures and osteoclasts derived from rat marrow cells were used to bioactivity-guided screen the active constituents. The proliferation of osteoblast was assayed by MTT methods. The activity of ALP and TRAP was measured by p- nitrophenyl sodium phosphate assay. The antiosteoporotic effects of icariin (1), anemarsaponin B II (8) and berberine (6) were verified by using OVX rats model. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry using the small animal scan mode. The undecalcified longitudinal proximal tibial metaphysical (PTM) sections were cut and stained for the bone histomorphometric analysis. RESULTS: Bioactivity-guided fractionation has led to the successful isolation of antiosteoporotic constituents, i.e., icariin (1), icariside I (2), baohuoside I (3), mangiferin (4), neomangiferin (5), berberine (6), anemarsaponin B (7), anemarsaponin BII (8), anemarsaponin C (9), anemarrhenasaponin I (10), rubiadin-1-methyl ether (11) and obaculactone (12) from EXD. Further study showed that icariin (1), anemarsaponin BII (8) and berberine (6) increased the BMD in ovariectomized rats, and icariin (1) not only increased the bone formation, but also inhibited bone resorption; anemarsaponin BII (8) mainly increased bone formation and berberine (6) only inhibited the bone resorption in ovariectomized rats. CONCLUSION: Our findings demonstrate that multiple ingredients are responsible for antiosteoporotic activity in traditional Chinese medicine formula Er-Xian decoction.     

聚焦超声治疗外阴上皮内非瘤样病变的近远期疗效及其影响因素

目的 探讨聚焦超声治疗外阴上皮内非瘤样病变的近远期疗效及并发症,并初步分析其预后影响因素。方法 选择经病理检查证实为外阴上皮内非瘤样病变患者共76例,采用聚焦超声进行治疗。术后定期随访局部瘙痒症状的改善情况,采用阴道镜检查方法观察体征的变化。结果 聚焦超声治疗后平均随访28．3个月（24～60个月）,有39例患者治愈（27例为鳞状上皮增生型,12例为硬化性苔癣型）,总治愈率为51％（39／76）,总有效率达95％（72／76）,累计复发率为36％（26／72）。对复发病例在间隔一段时间后进行再次聚焦超声治疗,同样可以获得显著的临床治疗效果,18例复发后再治疗患者中,6例完全恢复正常,12例症状明显减轻或缓解。76例患者中,4例（2例鳞状上皮增生型,2例硬化性苔癣型）于治疗后2～4h出现治疗区皮肤少量水疱,经抗炎、对症治疗后均痊愈。另有2例（1例鳞状上皮增生型,1例硬化性苔癣型）在治疗后2周出现治疗区局部皮肤浅表溃疡,经抗炎、对症及促表皮生长等治疗3周后痊愈。76例患者经24～60个月的临床观察未发现有远期并发症。不同的麻醉方式及不同的病理类型对聚焦超声治疗效果的影响比较,差异无统计学意义（P〉0．05）,但病程越短、年龄越小,聚焦超声治疗的临床效果越好。结论 聚焦超声用于治疗外阴上皮内非瘤样病变安全有效,无远期并发症发生。