特发性黄斑前膜患者的光学相干断层扫描血流成像和微视野检查指标与视力的相关性

目的　观察特发性黄斑前膜（IMEM）患者微视野和光学相干断层扫描血管成像（OCTA）的微血管变化及与视力的相关性。方法　横断面研究。选择2019年10月至2020年10月来我院就诊的IMEM患者37例（72眼）,根据Gass分期分为A组（2期IMEM 23眼）和B组（0期、1期IMEM 25眼）及C组（健康对侧眼24眼）。另选择健康对照组13人26眼为D组。利用OCTA检测所有受试者视网膜厚度、黄斑区中心凹视网膜浅层血流密度（FSVD）、黄斑中心凹视网膜厚度（CMT）、黄斑中心凹脉络膜厚度、黄斑中心凹无血管区（FAZ）面积和FAZ 300 μm宽度内血流密度（FD-300）。微视野计检查各组受检眼黄斑中心6°范围的视觉敏感度（MS）,分析不同组别受检眼OCTA检测指标、MS与视力的相关性。结果　A组患眼BCVA大于B组、C组和D组,B组大于D组;A组患眼CMT大于B组,B组大于C组、D组;5个方位视网膜厚度中央视网膜厚度A组大于B组、C组和D组,B组大于D组,上方、下方、鼻侧、颞侧视网膜厚度A组大于B组、C组和D组。5个方位MS A组小于D组。A组FSVD大于B组;各组间黄斑中心凹下脉络膜厚度无显著差异;FAZ面积A组、B组小于C组、D组;A组FD-300大于B组、C组和D组,B组大于D组。BCVA（logMAR）与视网膜中央厚度和FD-300均呈正相关（r=0.719,P<0.01;r=0.407,P<0.01）,与视网膜中央MS呈负相关（r=-0.564,P<0.01）,与FSVD不相关（r=0.267,P=0.066）,与FAZ面积不相关（r=-0.004,P=0.978）。IMEM患眼中央、上方、颞侧、下方、鼻侧视网膜厚度与其所对应的MS均呈负相关（均为P<0.05)。结论　IMEM引起的黄斑区视网膜厚度和血流改变会导致患者视力和MS的改变。     

延长应用低分子肝素治疗急性冠脉综合征高龄患者1例并文献复习

心血管系统疾患是导致老年人群主要患病率及死亡率的相关疾病之一。老年人群通常表现多支冠状动脉病变并存且常无症状。这类人群中最常见的急性冠脉综合征（acute coronary syndrome,ACS）表现为急性非sT段抬高性心肌梗死（non-ST elevation myocardial infarction,NSTEMI）,常伴发较高死亡率Ⅲ。2007年ACC＼AHA、ESC心肌梗死指南指出：一旦不稳定型心绞痛（unstable angina,UA）／NSTEMI患者就诊,应当尽可能在抗血小板治疗基础上加用抗凝治疗,将肝素的应用推荐为I类指征。应用肝素等抗凝血酶药物的目的就是改变或阻断凝血瀑布样连锁反应中间环节,实现对纤维蛋白形成和血小板激活的抑制作用。现将沈阳军区总医院干部病房收治的1名高龄ACS患者的诊疗过程报告如下。     

双焦点及散光双焦点人工晶状体混搭植入术后双眼视觉质量的研究

目的：研究散光矫正型双焦点人工晶状体与双焦点人工晶状体混搭植入术后的双眼视觉质量。

方法：横断面研究。纳入2020-01/2021-01收治的年龄相关性白内障患者54例108眼,按植入人工晶状体及术前角膜散光不同分为3组,A组21例42眼术前角膜散光均<1.0D,双眼植入双焦点人工晶状体; B组15例30眼术前角膜散光均≥1.0D,双眼植入散光双焦点人工晶状体; C组18例36眼,一眼术前角膜散光<1.0D,另一眼术前角膜散光≥1.0D,前者植入双焦点人工晶状体,后者植入散光双焦点人工晶状体。比较三组患者术前单眼视力,术后双眼视力、残余散光、双眼离焦曲线、对比敏感度(CS),三组患者术后进行问卷调查评估视觉质量。

结果：三组患者术前视力、术前眼压均无差异(P>0.05)。A组术后残余散光显著高于另两组(P=0.012,<0.05)。B组和C组双眼远视力优于A组(均P<0.05); B组和C组双眼近视力优于A组(均P<0.01); A组双眼中视力优于B组和C组(均P<0.01)。明视眩光6、12c/d,暗视6、12、18c/d,以及暗视眩光1.5、3、6、12、18c/d的空间频率下A组CS较B组和C组显著降低(均P<0.05)。术后视功能调查表三组间无差异(P>0.05)。

结论：散光双焦人工晶状体与双焦人工晶状体混搭植入可改善患者术后视觉质量。矫正散光有助于提高术后患者的视觉CS,但是散光全矫后,可能会导致患者术后中视力的下降。     

寄生虫感染中髓系抑制性细胞的免疫抑制机制研究

髓系抑制性细胞(myeloid-derived suppressor cells,MDSC)是髓系来源的一群异质细胞,具有强大的免疫抑制功能.在病理情况下可大量扩增,包括各种感染、肿瘤和急慢性炎症等.在肿瘤模型和肿瘤患者体内均发现有MDSC,其促进肿瘤免疫逃避的机制已取得很大进展.寄生虫感染一般都伴随免疫逃避和显著抑制机体免疫应答的现象,而目前较少关注MDSC在寄生虫感染中的免疫抑制功能.该文综述了一些种类的原虫和蠕虫感染中,MDSC的扩增、活化、趋化、表型和功能.     

特发性急性嗜酸粒细胞性肺炎一例临床特征分析

目的 探讨特发性急性嗜酸粒细胞性肺炎(IAEP)患者的临床特征.方法 分析解放军第81医院收治的1例IAEP患者的临床表现、影像学和病理特点,并综述有关IAEP的文献报道.结果 患者为70岁女性,咳嗽、胸闷、间断发热,急性病程,严重低氧血症.胸部CT示游走性肺浸润影伴少量胸腔积液.诊断性胸腔穿刺示胸水嗜酸粒细胞占28％.支气管肺泡灌洗液嗜酸粒细胞占59％.胸部CT引导下经皮肺穿刺活检示嗜酸粒细胞肺浸润.结论 IAEP是一种少见病,易被误诊为重症肺炎、急性肺损伤或急性呼吸窘迫综合征,对糖皮质激素敏感,治愈后无复发,预后良好.     

Properties and mechanism for selective adsorption of Au(iii) on an ionic liquid adsorbent by grafting N-methyl imidazole onto chloromethylated polystyrene beads

To recover Au(iii) from an acidic chloride-containing solution efficiently, an ionic liquid absorbent (CMPS-IL) was synthesized by grafting N-methyl imidazole onto chloromethylated polystyrene beads (CMPS). The adsorption capacity, selectivity, and reusability were systematically evaluated by a series of adsorption experiments. The maximum adsorption capacity reached up to 516.5 mg g⁻¹ at 318 K. The adsorbent can selectively recover Au(iii) from binary system solutions with a higher separation factor β_Au/M (10⁴–10⁶). Moreover, the adsorption–desorption cycles (7 cycles) showed that the CMPS-IL maintained a stable adsorption performance and high adsorption efficiency. Finally, the adsorption mechanism of CMPS-IL for Au(iii) was investigated by SEM, TEM, XPS, and FT-IR, then proposed with a combination of electrostatic interactions and d–π interaction between imidazolium and AuCl₄⁻. This study provides an easily-prepared and economical adsorbent for Au(iii) with high selectivity and large adsorption capacity to boost its practical applications.

The synthesis and adsorption properties for Au(iii) of CMPS-IL synthesized by grafting N-methyl imidazole onto chloromethylated polystyrene beads (CMPS).     

Spinal infection: state of the art and management algorithm

Introduction

Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management.

Methods

Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health.

Results

Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment.

Conclusions

A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.     

A pilot study of ruxolitinib as a front-line therapy for 12 children with secondary hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is an immune-regulatory disorder characterized by excessive production of inflammatory cytokines. The treatment recommendations of the HLH- 1994 and HLH-2004 protocols have long been used in HLH therapy, but some patients still do not respond well to or have unacceptable side effects from conventional therapies. It is believed that cytokine-targeted strategies that directly target disease-driving pathways will be promising options for HLH. This prospective study aimed to investigate the efficacy and safety of ruxolitinib, a Janus kinase 1/2 inhibitor, as a front-line therapy in children with secondary HLH. Twelve newly diagnosed patients without previous treatment were enrolled in this study with a median follow-up of 8.2 (range, 7.1-12.0) months, including eight cases of Epstein-Barr virus associated HLH (EBV-HLH), two cases of autoinflammatory disorder (AID)- associated HLH, and two cases of unknown etiology. Patients received oral ruxolitinib dosed on 2.5 mg, 5 mg or 10 mg twice daily depending on the body weight for 28 consecutive days. The overall response rate at the end of treatment (day 28) was 83.3% (ten of 12), with 66.7% (eight of 12) in complete response (CR), 8.3% (one of 12) in partial response (PR), and 8.3% (one of 12) in HLH improvement. Among the patients achieving CR, 87.5% (seven of eight) maintained CR condition more than 6 months, and one patient with EBV-HLH relapsed following CR. For the EBV-HLH subgroup, all eight patients responded to ruxolitinib, with a CR rate of 75% and a PR rate of 25%. Two patients with AID-associated HLH had quite different responses, with one showing reversal of the HLH abnormalities soon and the other showing no improvement, as did the two cases of unknown etiology. Patients who had no response or discontinued ruxolitinib all responded well to the subsequent HLH-1994 regimen. The expected 6-month event-free survival rate was 58.3±10.2%. No serious adverse effects were reported. Our study provides further support for the possibility of ruxolitinib targeted therapy for secondary HLH in children. This study was registered in the Chinese Clinical Trials Registry Platform (http://www.chictr.org.cn/) as clinicaltrials gov. Identifier: ChiCTR2000029977.     

自制滑轮牵引架在肩关节镜手术中的应用

将自制滑轮牵引架应用于57例肩关节手术患者,提出该牵引架具有术野暴露充分、无需人工牵引、保证术中肢体位置稳定等优点。     

条件性敲除Osterix基因获得先天性脊柱侧凸小鼠动物模型及表型分析

目的 通过Osterix基因敲除获得先天性脊柱侧凸动物模型及表型分析.方法 应用Cre-LoxP系统繁育成骨细胞特异性敲除Osterix基因小鼠.取4、12周龄的敲除小鼠各10只,以同龄同系野生型小鼠各10只为对照,行全身及脊柱X线摄像观察;收集脊柱标本行苏木素-伊红(HE)染色及抗酒石酸酸性磷酸酶(TRAP)染色观察并检测.结果 成功获得成骨细胞特异性敲除Osterix基因小鼠,X线显示敲除小鼠中75％出现严重的脊柱侧凸,Cobb角平均值为35..HE染色显示敲除小鼠椎体生长板增宽,椎体骨量增加,TRAP染色显示腰椎中破骨细胞数量显著减少(P＜0.05).结论 小鼠成骨细胞中条件性敲除Osterix基因后成功获得先天性脊柱侧凸模型,提示Osterix在先天性脊柱侧凸的发病中有重要作用.