有晶状体眼后房屈光晶状体植入术治疗超高度近视的临床疗效

目的：观察有晶状体眼后房屈光晶状体(PC-PRL)植入术治疗超高度近视的临床疗效。

方法：回顾性病例研究。选取2021-01/2022-01于我院行PC-PRL植入术治疗的超高度近视患者36例67眼,按术前球镜度数分成两组：球镜≤-18.00D者16例30眼和球镜>-18.00D 者20例37眼。比较两组患者手术前后视力、眼压、角膜内皮细胞密度(ECD)、中央前房深度(ACD)以及术后拱高、并发症的情况。

结果：两组患者术后3mo UCVA均达到或超过术前BCVA(均P<0.05),且球镜>-18.00D组的视力提高幅度更大(P<0.01); 两组患者术后1d眼压、角膜内皮细胞密度与术前比较均有差异(均P<0.05); 术后不同时间点拱高均呈下降趋势,但均在正常范围内; 术后3mo ACD均低于术前(均P<0.01)。两组间手术前后眼压、ECD、ACD及术后拱高比较均无差异(P>0.05)。两组患者术后均未发生严重并发症。

结论：PC-PRL植入术治疗超高度近视患者早期视力得到良好改善、屈光状态稳定、安全可靠、无严重并发症。     

Acupuncture for major depressive disorder: A review of the recommendations stated at clinical practice guidelines

BackgroundThe use of acupuncture to treat depression is not uncommon. However, recommendations regarding acupuncture issued by clinical practice guidelines (CPG) vary widely.ObjectiveTo describe the recommendations regarding acupuncture in CPGs for depression in adults, and to assess the methodology used to reach them.MethodsWe conducted a scoping review of CPGs for depression management in adults, which performed systematic reviews (SRs) to answer their review questions, were published between January 2014 and May 2018, and assessed the use of acupuncture as a review question. We limited out search to articles published in English/Spanish. We assessed the SRs quality using the “A MeaSurement Tool to Assess Systematic Reviews-2” (AMSTAR-2), and described how the recommendation regarding acupuncture was reached.FindingsWe found five CPGs that fulfilled our inclusion criteria: three from the US, one from Canada, and one from China. Four CPGs fulfilled between two and three items of AMSTAR-2, and one CPG fulfilled seven items. The methodology used to formulate the recommendations varied between CPGs. Regarding acupuncture use recommendations: three CPGs did not issue any recommendation (although one mentions that it should not be used), whilst two were in favor.DiscussionsThe lack of a clearly stated review question presented in the majority of CPGs prevents the reader from understanding what the CPG developing group was trying to answer. Moreover, the arguments presented to support a decision are usually not detailed enough. Therefore, the assessment of the recommendations was extremely difficult.Clinical implicationsGiven that the formulation of recommendations is not always reliable, clinicians should carefully read and assess the recommendations presented in CPGs before implementing them.     

静息态功能MRI观察原发性甲状腺功能减退症患者脑局部一致性及其意义

目的 观察原发性甲状腺功能减退症(甲减)患者静息态功能MRI(rs-fMRI)局部一致性(ReHo)存在差异的脑区,分析其意义。方法 对50例首诊未经治疗原发性甲减患者(甲减组)及38名健康志愿者(对照组)行颅脑rs-fMRI,计算ReHo值;观察组间ReHo值差异有统计学意义的脑区,分析甲减组血清甲状腺激素水平与其ReHo值及认知神经心理量表评分之间的相关性。结果 甲减组左侧舌回、颞中回、中央前回、中央后回及小脑蚓部ReHo值均较对照组减低(高斯随机多重比较校正后,单个体素P均＜0.001,簇大小P均＜0.05)。Pearson相关性分析结果显示,甲减组血清促甲状腺激素与蒙特利尔认知评估量表(MoCA)评分(r=－0.259,P=0.037)及左侧舌回ReHo值(r=－0.347,P=0.015)均呈负相关,与汉密尔顿抑郁量表-24项(HAMD-24)评分呈正相关(r=0.313,P=0.011)。结论 甲减患者左侧舌回、颞中回、中央前回、中央后回及小脑蚓部ReHo值减低,提示优势半球神经功能活动同步性减低可能是其神经功能受损的重要神经病理生理机制。     

不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时镇痛效果的网状Meta分析

目的 采用网状Meta分析系统评价不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时的镇痛效果。
方法 计算机检索PubMed、Cochrane Library、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网、维普、万方，检索时间为建库至2022年8月，纳入髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的随机对照研究。由两名研究员独立进行文献筛选、资料提取和偏倚风险评价，采用Stata 17.0和RevMan 5.3软件进行统计分析。
结果 共纳入28篇文献，患者1 773例。累计排序概率曲线下面积（SUCRA）显示，降低摆放体位时VAS疼痛评分PENG阻滞（94.4%）效果最佳，其次是FIB联合IVA（83.8%）和FIB（71.1%）；降低椎管内麻醉时VAS疼痛评分PENG阻滞（98.2%）效果最佳，其次是FIB（71.1%）和FNB（55.6%）；缩短椎管内麻醉操作时间PENG阻滞（84.1%）效果最佳，其次是FNB（70.7%）和FIB（68.5%）；升高体位摆放质量评分PENG阻滞（99.1%）效果最佳，其次是FIB（73.1%）和FNB（52.9%）。
结论 神经阻滞或神经阻滞联合IVA可降低髋部或股骨干骨折患者体位摆放和椎管内麻醉时VAS疼痛评分、缩短麻醉操作时间和升高体位摆放质量评分。PENG阻滞对髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的效果最佳。     

2型糖尿病共病抑郁患者静息态脑功能局部一致性

目的 采用静息态功能MRI(rs-fMRI)观察2型糖尿病(T2DM)共病抑郁(T2DD)患者静息态脑功能活动同步性异常改变及其与临床指标的相关性.方法 纳入接受认知心理量表评估及头颅M RI检查的52例T 2DD患者(T2DD组)、59例T2DM患者(T2DM组)及53名健康成人[健康对照(HC)组],记录其临床资料...     

糖尿病肢体缺血再灌注心肌损伤防治的研究进展

［摘要］　糖尿病患者机体内环境长期处于高血糖的状态。当发生肢体缺血再灌注（IR）时,相较于非糖尿病患者的组织和脏器更易受损,且程度更严重。该文就糖尿病肢体IR心肌损伤及其防治作一综述。     

胸腔镜肺叶切除术中肺动、静脉切断顺序对非小细胞肺癌患者手术疗效与安全性影响的系统评价

Objective To systematically evaluate the effect of sequence of pulmonary artery and vein transection in thoracoscopic lobectomy on the efficacy and safety of patients with non-small cell lung cancer. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched for the researches on The post-operative efficacy of pulmonary arteriovenous and pulmonary vein resection sequence in thoracoscopic lobectomy for non-small cell lung cancer. The retrieval time is from the database construction to May 2022. Meta-analysis was performed using RevMan 5.4 software. Results Eight articles were included, including 3 randomized controlled studies and 5 cohort studies, with a total of 1810 patients. Meta-analysis results showed that: The operative time (MD=13.34, 95%CI(7.36, 19.32), P<0.0001) and intraoperative blood loss (MD=45.29, 95%CI(40.24, 50.35), P<0.0001) in the group with priority pulmonary vein resection were significantly higher than those in the group with priority pulmonary vein resection. The difference was statistically significant. However, the benefits of OS (HR=1.34, 95%CI (1.12, 1.60), P=0.001) and DFS (HR=1.44, 95%CI(1.18, 1.76), P=0.0003) in the group of priority pulmonary vein transection were significantly better than those in the group of priority pulmonary artery transection, with statistically significant differences. Conclusion Priority pulmonary vein transection during thoracoscopic lobectomy effectively improved patients’ OS and DFS, resulting in higher survival benefit for patients with non-small cell lung cancer, but intraoperative bleeding and operation time are more than those with priority pulmonary artery transection. © 2023, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Comparative study of the outcomes of the second kidney transplantation from the young deceased donors versus living-unrelated donors

PurposeTo compare the kidney graft function and survival in patients who had second kidney transplantation from living donors versus those who had a second transplant from young deceased donors.MethodsIn this retrospective cohort study, a total of 86 patients who underwent second kidney transplantation in Shariati hospital from 2001 until 2017 were enrolled. Baseline clinical data on the age, sex, type of kidney donor (living unrelated or deceased), duration of pretransplant dialysis, and the length of hospitalization were recorded. As the indicators of the graft function, we used the serum creatinine level and estimated glomerular filtration rate (eGFR) at time intervals during the study. The 1, 5, and 10-year graft survival rates were reported using life tables and the relative hazard ratios of the graft failure were calculated using the forward stepwise Cox proportional hazard model.ResultsForty-six of our patients were men (53.5%), with a mean ± SD age of 44.3 ± 12.3 years at the time of transplantation. The majority of the enrolled patients received the kidney from living unrelated donors (50 vs. 36 patients). In terms of serum creatinine and eGFR, at time intervals, no significant difference was found between the two recipient groups. In the living donor group, the 1, 5, and 10-year graft survival rates of the second transplant were 91% (95%CI: 73–96%), 87% (95%CI: 69–95%), and 82% (95%CI: 59–92%), and for the deceased donor group were 95% (95% CI: 69–99%), 95% (95%CI: 69–99%), and 79% (95%CI: 31–95%), respectively.ConclusionConsidering the long-term outcomes of the second kidney transplantation, in our experience, the graft function and survival, either from the living or deceased donors, were favorable; and the type of organ donation had no significant effect on the risk of graft failure.     

Th17/Treg cell balance in stable liver transplant recipients

BackgroundImmune monitoring of transplanted patients may provide a reliable basis for the individualization of immunosuppressive therapy. In addition, it might be applied for realizing the early and non-invasive diagnosis of acute allograft rejection.MethodsPercentages of TCD4 + IL-17+ (Th17) and TCD4 + CD25 + CD127^dim/− (Treg) cells, as well as serum levels of interleukin (IL)-17 and transforming growth factor (TGF)-β1, were evaluated in 30 stable patients using flow cytometry and ELISA techniques before and six months after liver transplantation. Besides, the same cells and cytokines were quantified in 10 recipients with acute allograft rejection.ResultsSix months post-transplant, the percentage of Th17 and Treg cells in the peripheral blood of stable liver transplant recipients reduced significantly, but the Th17/Treg ratios were comparable to the pre-transplant period (1.24 vs. 1.56); however, Th17/Treg ratios in the rejection group was significantly higher than in the stable recipients (4.06 vs. 1.56, P-value = 0.001). Stable patients showed decreased amounts of serum IL-17 which was remarkably lower than in the rejection group (P-value = 0.01). Moreover, there was a significant correlation between the serum level of IL-17 and the percentage of Th17 cells (P-value <0.001). Th17 frequency was negatively associated with the liver allograft function. Notably, TGF-β1 levels differed neither between pre-and post-transplant samplings nor between stable and rejection groups.ConclusionSix months after liver transplantation, the mean Th17/Treg ratio in stable recipients remained comparable to the pre-transplant values; however, it was significantly elevated in patients with acute allograft rejection, suggesting the Th17/Treg ratio as a probable predictor of acute rejection.