黄斑裂孔诊断的新方法:自体荧光检测

目的 评价自体荧光检测诊断黄斑裂孔的效果。方法 应用自体荧光检测黄斑裂孔。对黄斑裂孔、手术修补术的患者(组1)和作为对照的黄斑假洞或黄斑皱褶的患者(组2)，分别行眼底荧光血管造影、自体荧光检测、眼底彩照、无赤光和红外摄像检查，进行回顾性研究。其中自体荧光采用132型Heidelberg眼球探针，对所得到的9个图象进行平均处理。而所有患者手术前后都进行OCT Ⅲ检测。结果 10个术前被自体荧光检测发现的黄斑裂孔均由OCT确诊，而且所有病例的自体荧光信号均与黄斑裂孔相对应。自体荧光也可应用于术后，以评价裂孔的闭合程度。在OCT确诊裂孔闭合的所有患者以及对照组10例黄斑皱褶或假洞患者，均没有发现自体荧光。对照组均由OCT证实，没有黄斑裂孔的发生。结论 自体荧光检测是诊断黄斑裂孔的一个新方法，它同时能够检测术后黄斑裂孔的封闭效果，没有自体荧光则表明裂孔已封闭。     

Bioavailability of oral vitamin E formulations in adult volunteers and children with chronic cholestasis or cystic fibrosis

Purpose:  To test bioequivalence of oral vitamin E formulations, water-soluble tocofersolan (test) and water-miscible (reference), in healthy adult volunteers, and their bioavailability in children with chronic cholestasis or cystic fibrosis.
Methods:  In a two-way open randomized single dose cross-over design, 1200 IU were administered in 12 healthy volunteers and 100 IU/kg in 12 children with chronic cholestasis or cystic fibrosis.
Results:  In healthy volunteers, formulations were not bioequivalent with a higher exposure to tocofersolan. In cholestatic children tocofersolan bioavailability was significantly higher than reference formulation (maximum plasma concentration: P  = 0·008 and AUC: P  = 0·0026). Bioavailability was not statistically different in cystic fibrosis.
Conclusions:  Oral tocofersolan was more bioavailable than the reference formulation in children with chronic cholestasis and similarly bioavailable in cystic fibrosis. Tocofersolan may represent an alternative to painful intramuscular vitamin E injections in chronic cholestasis, or to other oral formulations in cystic fibrosis.     

Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy

Background

Hidradenitis supppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands affecting 1–4% of the population. While surgical excision is a mainstay of therapy, lesions often recur. Biologic therapies, including tumor necrosis factor‐α and IL‐12/23 inhibitors, are effective for mild to moderate HS. However, longitudinal studies investigating biologic therapy in conjunction with surgery are limited. The purpose of this analysis was to investigate impact of surgery and biologic therapy on HS disease activity.

Methods

Data from 68 HS patients were analyzed. Outcome measures included hidradenitis suppurativa Sartorius Score (HSS), active nodule (AN) count, Hurley stage, and probability of achieving 75% reduction in active nodule count (AN75).

Results

Mean age was 40 ± 14 years; 66% were female and 72% were African American. Mean disease duration was 10 years, and Hurley stage III disease was seen in 63% of patients. Patients who received biologics had a larger drop in HSS and AN count than those who never received biologics (P = 0.002). Biologic treatment was associated with average reduction in 22 (15–29) HSS points (P < 0.0001). The effect of biologics was greater in patients who also underwent surgery (P = 0.013). Timing of biologics relative to surgery did not impact efficacy. Patients who received HS surgery with biologic therapy were most likely to achieve the AN75 (P = 0.017).

Conclusions

In this diverse cohort of patients with severe HS, biologic therapy was associated with a more rapid decline in disease activity, with the greatest effect in patients who also underwent HS surgery.     

Postoperative wound dehiscence: Predictors and associations

The Agency for Healthcare Research and Quality patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI‐14 measures postoperative wound dehiscence and specifically how often a surgical wound in the abdominal or pelvic area fails to heal after abdominopelvic surgery. Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure as it impacts morbidity, length of stay, healthcare costs and readmission rates. Postoperative wound dehiscence cases from the Nationwide Inpatient Sample demonstrate 9.6% excess mortality, 9.4 days of excess hospitalization and $40,323 in excess hospital charges relative to matched controls. The purpose of the current study was to investigate the associations between PSI‐14 and measurable medical and surgical comorbidities using the Explorys technology platform to query electronic health record data from a large hospital system serving a diverse patient population in the Washington, DC and Baltimore, MD metropolitan areas. The study population included 25,636 eligible patients who had undergone abdominopelvic surgery between January 1, 2008 and December 31, 2012. Of these cases, 786 (2.97%) had postoperative wound dehiscence. Patient‐associated comorbidities were strongly associated with PSI‐14, suggesting that this indicator may not solely be an indicator of hospital safety. There was a strong association between PSI‐14 and opioid use after surgery and this finding merits further investigation.