应用微波治疗仪治疗普外科急慢性炎症的疗效观察

微波治疗仪已在临床上广泛应用，自2000年以来我科应用南京华贝电子医疗设备有限公司制造的型号HBS-A多功能微波治疗仪于临床，对急性乳腺炎、丹毒、静脉炎、淋巴管炎、疖肿、蜂窝织炎、坏死性筋膜炎等48例普外科急慢性炎症病人进行了重点观察，效果明显，现介绍如下。     

仙桃市一起急性血吸虫病突发疫情的调查与处理

一起急性血吸虫感染（简称急感）突发疫情，暴露出仙桃市血防工作中存在春季查灭螺、健康教育、耕牛查治、防护措施及乡镇、乡村医务人员的血防知识及诊断水平“六”个不到位等薄弱环节。     

应用微波治疗仪治疗普外科急慢性炎症的疗效观察

微波治疗仪已在临床上广泛应用,自2000年以来我科应用南京华贝电子医疗设备有限公司制造的型号HBS-A多功能微波治疗仪于临床,对急性乳腺炎、丹毒、静脉炎、淋巴管炎、疖肿、蜂窝织炎、坏死性筋膜炎等48例普外科急慢性炎症病人进行了重点观察,效果明显,现介绍如下.     

LASEK治疗高度近视疗效分析

准分子激光角膜上皮瓣下磨镶术（LASEK）是利用酒精软化角膜上皮，并通过上皮刀作60～80μm上皮瓣后用准分子激光进行原位磨镶来改变角膜屈光度治疗近视，更加适用于角膜较薄、近视度数较高的患者。本文回顾性分析我院采用LASEK治疗的高度近视患者的临床资料，以探讨LASEK治疗高度近视的有效性和安全性，现报道如下。     

高度近视眼黄斑劈裂的OCT影像特征

目的 观察高度近视眼黄斑劈裂的OCT形态学特征,分析其发生的相关危险因素.方法 回顾性分析268例(369只眼)屈光度≥-6.00D的高度近视眼患者继发视网膜劈裂的OCT表现以及与眼轴长度、屈光度、后巩膜葡萄肿、后极部脉络膜视网膜萎缩变性等因素的相互关系.结果 OCT显示68例(93只眼)存在视网膜劈裂;其中78只眼为外层劈裂,14只眼为混合性劈裂,1眼为内层劈裂.所有存在劈裂眼中,2只眼劈裂远离黄斑区,91只眼位于黄斑区,累及一至四个象限不等,其中53只眼为中央凹劈裂,38只眼为旁中央凹劈裂,中央凹劈裂的形态多样,并伴有视网膜前膜或玻璃体牵引、局限性视网膜脱离、黄斑板层裂孔等改变.所有高度近视眼患者中,视网膜劈裂眼与未发生视网膜劈裂眼的眼轴长度、屈光度、后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性比较,差异均有统计学意义(P均<0.01),Logistic回归结果示:超长眼轴(≥29mm)是视网膜劈裂发生的危险因素,屈光度并不是其发生的危险因素,后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性均是其发生的危险因素(P=0.002,0.073,0.027,0.003,0.011).结论 OCT能明确视网膜劈裂发生的部位,清晰地显示视网膜劈裂的形态特征,视网膜劈裂多发生在黄斑中央凹.可累及整个黄斑区,以外层劈裂多见.视网膜劈裂的发生与超长眼轴、后巩膜葡萄肿、玻璃体视网膜牵引以及后极部脉络膜视网膜萎缩变性等因素有关.

Abstract：

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

两种fms-样络氨酸激酶受体-1基因片段对磷脂酰肌醇-3激酶/蛋白酶B之间信号通路的影响

目的 观察可溶性fms-样络氨酸激酶受体-1(sFlt-1)基因胞外第2～3区和2～4区对缺氧、高糖环境下视网膜血管通透性及磷脂酰肌醇-3激酶/蛋白酶B(PI3K/Akt)之间信号通路的影响.方法 构建真核表达质粒编码增强型绿色荧光蛋白质粒(pcDNA3.1-EGFP)/s Flt-1(2～3)和pcDNA3.1-EGFP/s Flt-1(2～4),采用酶切、电泳及基因测序鉴定.将实验分为正常对照组、缺氧组和高糖组进行.以羧甲基化匍聚糖(CMD)纳米磁颗粒为基因载体,分别携带两种重组质粒转染缺氧、高糖条件下培养的人脐静脉血管内皮细胞(HUVEC).采用分光光度计检测各组兔视网膜血管对伊凡思蓝(EB)染料的渗漏量.逆转录聚合酶链反应(RT-PCR)和免疫蛋白印迹(Western blot)法分别检测各组细胞PI3K/Akt信号通路下游特异性磷酸化激酶Akt(p-Akt)mRNA和蛋白的表达.结果 缺氧组和高糖组注射转染细胞上清液后,视网膜血管EB渗漏量较正常对照组明显增加(t=2.476,2.515;P值均＜0.01).缺氧组和高糖组转染了pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后,视网膜血管EB渗漏量较未转染明显降低(t=2.598,2.679,2.386,2.732;P值均＜＜0.01).缺氧组、高糖组HUVEC p-Akt mRNA表达较正常对照组明显上调(t=2.612,2.545;P值均＜0.01),转染pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后明显下调(t=2.512,2.189,2.372,2.687;P值均＜0.01).缺氧组和高糖组HUVEC p-Akt蛋白表达较正常对照组明显上调(t=2.376,2.712;P值均＜0.01),转染pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后明显下调(t=2.259,2.391,2.399,2.413;P值均＜0.01).结论 sFlt-1受体胞外第2～3区和2～4区均可抑制缺氧、高糖环境下的视网膜血管通透性增高和PI3K/Akt通路的信号传导.     

影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

Objective To discuss the effect of treatment of rhegmatogenous retinal detachments (RRD) by scleral buckling surgery as well as the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Methods Seventy-two patients (72 eyes) with RRD treated by scleral buckling surgery in our hospital during January 2005 to December 2008 were retrospectively analyzed. Patients were followed up for 6 to 30 months, an average of (13.96± 8.28) months, and observed the rate of postoperative retinal anatomic reattachment, the best corrected visual acuity (BCVA) and complications. The Logistic regression was used to analyze the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Results Retinal reattachment was achieved in 90.28% after initial surgery and the final success rate for anatomic reattachment was 97.22% assessed with ophthalmoscope and B-mode ultrasonography. But the first and final retinal reattachment rates assessed with the optical coherence tomography (OCT) were 59.72% and 77.78% respectively. Postoperative BCVA =0.3 reached to 62.5%. Retinal reattachment was affected by Grade Cl PVR and multiple breaks (P=0.0183 and P=0.0181, respectively). Preoperative visual acuity , macular detachment status and time, as well as the grade of PVR affected visual recovery significantly (P =0.0235, P =0.0124, P=0.0325 and P=0.0357, respectively). The complications included uveitis (13.89%), dysmorphopsia (9.72%), proliferative vitreous retinopathy (6.94%), macular pucker (6.94%), ocular hypertension (4.17%) and diplopia (2.78%). After SB, the anterior chamber depth, axial length, re fraction and astigmatism were all changed significantly (P=0.0260, P<0.0001, P=0.0005 and P=0.0018, re spectively) than before. Conclusions Scleral buckling is an effective technique for managing RRD, but grade Cl PVR and multiple breaks are significant risk factors for anatomic failure. Preoperative visual acuity, macular detachment status and time, as well as the grade of PVR affected visual recovery significantly. Simultaneously, the surgery could make anterior chamber depth decrease and axial extension. The refractive and astigmatic changes after buckling surgery were negative shifted.     

应用Nd:YAG激光行外伤性白内障切开的临床观察(摘要)

于1987年12月至1989年12月应用Nd:YAG激光机对43例43眼外伤性白内障进行切开手术。年龄最小6岁,最大53岁,平均22岁。角膜及角巩膜穿孔伤后无眼内异物者31例,眼内异物取出术后4例.爆炸伤3例,眼部钝挫伤5例。26例在激光术前2周至10年曾进行白内障手术。全部病例均可见皮质残留和囊膜混浊,绝大部分有角膜粘连性白斑和虹膜粘连等。术前均给予散瞳及表面麻醉,放置角膜接触镜,选择最佳视轴部位切割。切开形式有“ ”字形、环形或逐渐从一点以蚕蚀方式扩大。孔径以超过2.5～3mm为佳。5眼分2     

准分子激光原位角膜磨镶术患者的人群特征调查及近六年对比研究

目的调查当前接受准分子激光原位角膜磨镶术矫正屈光不正患者的人群特征的现状并与6年前的情况进行对比研究。方法分别选取2003年全年与1997年全年在我院接受准分子激光原位角膜磨镶术患者的一般资料,对其年龄、性别、职业及屈光状况进行统计分析。结果2003年接受LASIK术患者的平均年龄为(25.20±6.59)岁,男性略多于女性,平均等效球镜值为(-6.66±3.31)D,职业分布上学生所占比例高达50.73%。与97年相比,2003年的LASIK手术总量增加了6倍多;两个年份中LASIK患者的平均等效球镜值与职业构成的差异有显著意义(t=-2.712,χ2=25.117,P<0.05)。结论接受LASIK治疗的屈光不正患者以青年人为主,主要是中高度近视患者,学生是最大的手术群体,LASIK年手术量近六年来以平均每年近40%的速度增长。