Clinical evaluation of the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome: a prospective,randomized, multicenter study

Purpose

To assess the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome.

Methods

This study evaluated 64 eyes of 32 patients (age: 62.6±12.8 years (mean±SD)) in whom treatment with 0.1% sodium hyaluronate was insufficiently responsive. The eyes were randomly assigned to one of the two regimens in each patient: topical administration of sodium hyaluronate and diquafosol tetrasodium in one eye, and that of sodium hyaluronate in the other. Before treatment, and 2 and 4 weeks after treatment, we determined tear volume, tear film break-up time (BUT), fluorescein and rose bengal vital staining scores, subjective symptoms, and adverse events.

Results

We found a significant improvement in BUT (P=0.049, Dunnett test), fluorescein and rose bengal staining scores (P=0.02), and in subjective symptoms (P=0.004 for dry eye sensation, P=0.02 for pain, and P=0.02 for foreign body sensation) 4 weeks after treatment in the diquafosol eyes. On the other hand, we found no significant change in these parameters after treatment in the control eyes.

Conclusions

In dry eyes, where sodium hyaluronate monotherapy was insufficient, diquafosol tetrasodium was effective in improving objective and subjective symptoms, suggesting its viability as an option for the additive treatment of such eyes.     

硫酸软骨素联合甘油长期冷冻保存角膜植片的实验研究

背景 硫酸软骨素(CS)是从动物软组织中提取的一种具有高黏滞性和高弹性的酸性黏多糖类物质,因具有广泛的生物活性而用于眼科临床.中期保存液中含有CS时,对角膜内皮细胞(CECs)具有显著的保护作用.然而,CS对长期甘油冷冻保存的CECs是否起到保护作用尚待研究. 目的 研究CS在甘油冷冻保存角膜中对CECs的保护作用,并与透明质酸钠(SH)比较,探索长期保存CECs活性的新方法.方法 获取52只Wistar雌性大鼠角膜片104只,采用随机数字表法随机分为4个组,正常对照组为新鲜角膜直接进行实验,质量分数3％ CS处理组、质量分数1％ SH处理组的角膜分别在内皮面黏附3％ CS、1％SH后放入甘油中冷冻保存,单纯甘油保存组角膜直接装入甘油中-25℃冷冻保存,每组26只角膜片.96只雌性SD大鼠作为受体,角膜植片保存2个月后各组取24只植片行同种异体穿透角膜移植术(PKP),CECs锥虫蓝-茜素红染色分别评价保存的角膜片和移植术后14d的角膜植片上CECs的存活率;透射电子显微镜下观察不同方法保存的角膜植片的超微结构.角膜移植术后1d通过裂隙灯显微镜检查各组角膜排斥反应指数(RI)和植片存活时间,分别于术后7、14、30 d制备角膜标本行常规组织病理学检查,免疫组织化学法检测各时间点植片中转化生长因子β1(TGF-β1)和细胞间黏附因子1(ICAM-1)的表达水平.结果 正常对照组大鼠角膜植片CECs细胞结构正常,未见锥虫蓝-茜素红蓝染细胞,3％ CS处理组偶见细胞蓝染,1％ SH处理组和单纯甘油保存组蓝染CECs数增加.与3％ CS处理组比较,1％ SH处理组和单纯甘油保存组的细胞密度均明显下降,差异均有统计学意义(t=2.214、4.068,P＜0.05),细胞活性率表现出同细胞密度同样的趋势.CECs超微结构检查表明,3％ CS处理组仪表现为内质网的轻度肿胀,而1％SH处理组和单纯甘油保存组细胞内质网肿胀程度较重.3％ CS处理组术后14d时植片淋巴细胞浸润及新生血管明显少于1％ SH处理组和单纯甘油保存组.临床评分表明,与1％ SH处理组和单纯甘油保存组比较,3％ CS处理组的R1明显降低而CECs生存时间明显延长,差异均有统计学意义(P＜0.05).免疫组织化学检测显示,在各时间点,3％ CS处理组植片中TGF-β1的表达量(A值)明显高于1％ SH处理组和单纯甘油保存组(P＜0.01);而ICAM-1的表达量低于1％ SH处理组和单纯甘油保存组(P＜0.05),3％ CS处理组植片中TGF-β1和ICAM-1的表达量接近于正常对照组表达水平.结论 3％ CS处理后的甘油保存方法能长期维持CECs的活性,同种异体PKP结果显示3％ CS处理后的甘油保存方法效果优于1％ SH处理后的甘油保存法.     

Percutaneous interstitial brachytherapy for adrenal metastasis: technical report

We developed and evaluated the feasibility of a brachytherapy technique as a safe and effective treatment for adrenal metastasis. Adapting a paravertebral insertion technique in radiofrequency ablation of adrenal tumors, we developed an interstitial brachytherapy for adrenal metastasis achievable on an outpatient basis. Under local anesthesia and under X-ray CT guidance, brachytherapy applicator needles were percutaneously inserted into the target. A treatment plan was created to eradicate the tumor while preserving normal organs including the spinal cord and kidney. We applied this interstitial brachytherapy technique to two patients: one who developed adrenal metastasis as the third recurrence of uterine cervical cancer after reirradiation, and one who developed metachronous multiple metastases from malignant melanoma. The whole procedure was completed in 2.5 hours. There were no procedure-related or radiation-related early/late complications. FDG PET-CT images at two and three months after treatment showed absence of FDG uptake, and no recurrence of the adrenal tumor was observed for over seven months until expiration, and for six months until the present, respectively. This interventional interstitial brachytherapy procedure may be useful as a safe and eradicative treatment for adrenal metastasis.     

加味二仙颗粒配合透明质酸钠治疗膝骨关节炎肾虚火旺证的疗效观察

目的观察药物内服配合透明质酸钠关节腔注射治疗膝退行性骨关节炎肾虚火旺证的临床疗效。方法对80例（95膝）膝关节退行性骨关节炎患者行透明质酸钠关节腔注射,每周1次,注射当日口服加味二仙颗粒,5周为1个疗程,1个疗程结束后统计疗效。结果经3个月～1年随访,治愈62例;显效20例;有效9例;无效4例,总有效率达95.79%。结论非手术联合疗法是膝退行性骨关节炎肾虚火旺证较为理想的治疗方法,治疗方法简单,费用相对较低,易于临床推广应用。     

重度膝关节骨关节炎关节积液生化分析与临床治疗

目的：观察关节腔内冲洗联合玻璃酸钠注射用于重度膝关节骨关节炎的实际疗效。方法：选择92例重度膝关节骨关节炎患者,随机分为观察组46例,采用关节腔内冲洗联合玻璃酸钠注射进行治疗,以及对照组46例,单用关节腔内冲洗治疗,记录两组患者有效率、关节积液CRP及LDH,对数据进行比较分析。结果：观察组及对照组有效率、关节积液CRP及LDH组间均存在统计学差异（P＜0.05）。结论：关节腔内冲洗联合玻璃酸钠注射用于重度膝关节骨关节炎疗效显著,值得临床推广应用。     

宫腔镜下清宫术处理稽留流产的疗效观察

目的：探讨宫腔镜指导下清宫术＋宫腔留置透明质酸钠凝胶方案处理稽留流产的方法和效果。方法98例稽留流产患者入院后完善相关检查,给予米非司酮片＋米索前列醇片序贯治疗,而后按照清宫术方法的不同,分为两组。对照组（49例）采用B超监视下清宫术,观察组（49例）采用宫腔镜指导下清宫术＋术后宫腔留置透明质酸钠凝胶。比较两组术后发生二次清宫和宫腔粘连的情况及发现宫腔畸形的几率。结果观察组在术后妊娠物残留和宫腔粘连方面均优于对照组（ P﹤0.05）;在发现细微宫腔畸形方面也具有优势,但与对照组比无统计学差异。结论宫腔镜指导下清宫术＋透明质酸钠凝胶留置宫腔的方法可避免多次清宫,减少宫腔粘连的发生率;并能发现宫腔畸形,及早进行处理。     

玻璃酸钠注射结合针刀治疗肱骨外上髁炎的临床分析

目的探讨玻璃酸钠注射结合针刀治疗肱骨外上髁炎的疗效。方法将102例肱骨外上髁炎患者,按接诊先后顺序,单号为观察组51例,双号为对照组51例,两组治疗重点均在桡骨头环状关节面上。治疗组采用玻璃酸钠注射结合针刀治疗;对照组采用混合液局部注射结合针刀治疗。两组均在治疗后6个月随访。结果治疗组的疗效优于对照组(P0.05)。6个月后随访,治疗组无复发病例,对照组有7例复发。结论玻璃酸钠注射结合针刀治疗肱骨外上髁炎时,重点在桡骨头环状关节面上,疗效肯定,逐日递增,远期疗效稳定。     

玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液雾化治疗干眼症的成本效果分析

目的评价玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液雾化治疗干眼症的临床治疗效果和经济性,为临床提供有效、安全、经济的干眼症治疗方案。方法收集天津市眼科医院2020年1月—2020年12月符合本研究制定的纳入标准的124例中、重度干眼症病例,将其分为2组:对照组接受玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液局部点眼治疗,治疗组接受玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液局部点眼治疗的同时,加以雾化治疗。以愈显率为疗效评价指标,并运用成本-效果法对两种不同的治疗方案进行经济学评价。结果纳入对照组和治疗组的有效病例各62例。两组愈显率分别为56.45%、95.16%,有显著性差异(P0.05)。采用成本-效果分析可得,以对照组为基准,增量成本效果比为7.29,治疗组每获得1%总有效率,需多支付7.29元,远低于意愿支付阈值(两种治疗方案平均总成本为276.83元),提示治疗组的成本-效果性更佳。敏感性分析显示两组的成本效果相对于药品价格及治疗费用波动稳定。结论玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液雾化治疗,能够显著提高临床疗效,具有药物经济学优势。