Glaucoma agudo de ángulo cerrado inducido por topiramato con miopización aguda y estrías maculares: a propósito de un caso

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25 mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50 mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.     

轴外型桥小脑角区髓母细胞瘤2例报告及文献复习

目的：探讨轴外型桥小脑角（CPA）区髓母细胞瘤（MB）的临床特点,分析其影像学特征和临床预后,为其临床诊断和治疗提供参考。方法：收集2例诊断为轴外型CPA区MB患者的临床资料;结合相关文献,分析该病的临床特点、诊断和治疗方法。结果：2例患者因头痛伴听力下降入院,头部核磁共振（MRI）平扫及增强提示CPA占位性病变。2例患者均行CPA区肿瘤切除术。2例患者手术顺利,术中可见肿瘤位于轴外,术后病理证实为MB,随访15个月未见肿瘤复发和转移。结论：对于轴外型CPA占位性病变,术前应考虑MB的可能性。积极的手术治疗有助于改善预后并延长患者的生存期。     

枢椎以横突后支与下关节突交界处为解剖标志行椎弓根置钉的应用解剖研究

目的 :探讨枢椎以横突后支与下关节突交界处为解剖标志行椎弓根置钉的可行性,为临床应用提供参考。方法:30具湿性成人颈椎尸体标本,显露并以枢椎横突后支与下关节突外侧缘交界处作为参照点标志。经该解剖标志作水平线,以椎弓根内、外侧缘与侧块交界处连线的中点作纵垂线,以两线的交点偏外1~2mm处为进钉点。分别测量枢椎横突后支的宽度,进钉点与该解剖标志、C2神经根、横突孔内下壁和椎管内侧壁的距离。取上述进钉点,经枢椎双侧椎弓根以内倾角25°~30°、头倾角20°~25°共置入60枚螺钉,再行CT扫描观察钉道的完整性,测量置入螺钉的内倾角和头倾角,统计螺钉偏置率。结果:所有解剖参数及螺钉角度左、右侧比较差异均无统计学意义(P0.05),双侧数据合并后计算总体平均数值。枢椎横突后支的宽度为5.13±0.15mm,进钉点与解剖标志、C2神经根、横突孔内下壁和椎管内侧壁的距离分别为5.73±0.62mm、4.04±0.21mm、5.32±0.49mm和4.94±0.38mm。螺钉内倾角和头倾角分别为28.4°±3.1°和22.5°±2.9°。60枚螺钉中,共有4枚螺钉偏置进入横突孔或椎管,螺钉偏置率为6.7%(4/60);4枚螺钉过长穿破椎体前缘骨皮质。结论:枢椎以横突后支与下关节突交界处作为椎弓根置钉进钉点的参照点解剖标志是可行的,但因解剖差异仍存在螺钉误置的可能。     

Ideal angle of syndesmotic screw fixation: A CT-based cross-sectional image analysis study

Without clear reference, the precision of syndesmotic screw placement cannot be guaranteed and malposition of these screws leads to poor results. Therefore, to prevent malpositioning of syndesmotic screws, an improved understanding of the orientation of tibiofibular syndesmosis is essential. We analyzed cross-sectional computed tomography (CT) scans of the foot and ankle to identify precise screw positions for the treatment of syndesmotic injuries. A total of 134 calcaneal fractures with intact tibiofibular syndesmosis were enrolled in this retrospective study. We measured the angle between the perpendicular line of the second proximal phalanx and the line start apex of the lateral cortex of the fibula bisecting the tibial incisura and crossing the center of the tibia in neutral ankle joints, with the second toe positioned anteriorly using a short leg splint. The second toe was used as the reference for clarity and applicability. The ideal angle of syndesmotic screw placement in cross-sectional CT images was 18.8 ± 5.6° (mean ± standard deviation) and did not differ according to independent variables (P > 0.05). In neutral ankle joints with the second toe positioned anteriorly, the ideal angle of syndesmotic screw placement is 18.8°, which is less than that currently in used in conventional methods.     

Topical treatment of glaucoma: established and emerging pharmacology

Introduction: Glaucoma is a collection of optic neuropathies consisting of retinal ganglion cell death and corresponding visual field loss. Glaucoma is the leading cause of irreversible vision loss worldwide and is forecasted to precipitously increase in prevalence in the coming decades. Current treatment options aim to lower intraocular pressure (IOP) via topical or oral therapy, laser treatment to the trabecular meshwork or ciliary body, and incisional surgery. Despite increasing use of trabecular laser therapy, topical therapy remains first-line in the treatment of most forms of glaucoma.

Areas covered: Novel glaucoma therapies are a long-standing focus of investigational study. More than two decades have passed since the last United States Food and Drug Administration (FDA) approval of a topical glaucoma drug. Here, the authors review established topical glaucoma drops as well as those currently in FDA phase 2 and 3 clinical trial, nearing clinical use.

Expert opinion: Current investigational glaucoma drugs lower IOP, mainly through enhanced trabecular meshwork outflow. Although few emerging therapies show evidence of retinal ganglion cell and optic nerve neuroprotection in animal models, emerging drugs are focused on lowering IOP, similar to established medicines.     

正常汉族成年人前牙区牙槽宽度及根尖位置的研究

目的研究正常[牙合]成人前牙根尖与周围骨皮质的位置关系，为正畸矫治设计、筛选根吸收高危人群和预防医源性并发症等提供指导。方法选择正常拾青年98人，男女各半，年龄范围17～25岁，平均年龄20．29岁。拍摄头颅侧位定位片，测量并计算反映上下颌切牙根尖到周围骨皮质位置关系的12项指标及下颌平面角。建立上述测量指标的均值范围；相关分析研究下颌平面角对其影响。结果（1）建立正常[牙合]男女根尖位置及牙槽宽度的均值。（2）男性组中SN／MP与UH、UH／UW正相关，与UP负相关；女性组中SN／MP与LW负相关。结论（1）正常汉族成年人上下颌前牙牙槽骨宽度及根尖相对皮质骨位置比较稳定。（2）下颌平面角对根尖位置及牙槽宽度有一定影响。     

A simulation study to compare the phase-shift angle radiofrequency ablation mode with bipolar and unipolar modes in creating linear lesions for atrial fibrillation ablation

Purpose In pulmonary veins (PVs) isolation (PVI), radiofrequency (RF) energy is often used to create a linear lesion for blocking the accessory conduction pathways around PVs. By using transient finite element analysis, this study compared the effectiveness of phase-shift mode (PsM) ablation with bipolar mode (BiM) and unipolar mode (UiM) in creating a continuous lesion and lesion depth in a 5-mm thick atrial wall. Materials and methods Computer models were developed to study the temperature distributions and lesion dimensions in atrial walls created through PsM, BiM, and UiM. Four phase-shift angles – 45°, 90°, 135°, and 180° – were considered in PsM ablation (hereafter, PsM-45°, PsM-90°, PsM-135°, and PsM-180°, respectively). Results At 60?s/30 V peak value of RF voltage, UiM and PsM-45° did not create an effective lesion, whereas BiM created a lesion of maximum depth and width approximately 1.01 and 1.62?mm, respectively. PsM-135° and PsM-180° not only created transmural lesions in 5-mm thick atrial walls but also created continuous lesions between electrodes spaced 4?mm apart; similarly, PsM-90° created a continuous lesion with a maximum depth and width of nearly 4.09 and 6.12?mm. Conclusions Compared with UiM and BiM, PsM-90°, PsM-135° and PsM-180° created continuous and larger lesions in a single ablation procedure and at 60?s/30 V peak value of RF voltage. Therefore, the proposed PsM ablation method is suitable for PVI and linear isolation at the left atrial roof for treating atrial fibrillation.     

人体肩关节运动功能康复评估研究

目的针对上肢运动功能障碍患者康复治疗中,常规康复评价方法繁琐费时的问题,探讨人体肩关节运动功能康复评价的新方法。方法选取20名健康志愿者,利用上肢多关节复合运动训练系统(multi-joint system,MJS)进行上肢运动功能评价实验,并对肩关节运动功能评价参数进行统计。选取在临床进行康复治疗的20例偏瘫患者作为常规评价组,采用上肢Fugl-Meyer评分(Fugl-Meyerassessment,FMA)评定患者的上肢运动功能,并对上肢运动功能评分的参数数据进行统计分析。结果在健康人MJS运动功能评价实验中,经参数间的相关性分析,统计无显著意义(P005)。在多元逐步回归分析时,只引进了水平外展活动度,差异有统计学意义(P005)。在对偏瘫患者上肢运动功能的评估数据分析中,在多元逐步回归分析时,只引进了水平外展活动度,差异有统计学意义(P005)。结论肩关节外展活动度对肩关节运动评估等级划分和上肢FMA评分影响最大。     

Load distribution and postural changes in young adults when wearing a traditional backpack versus the BackTpack

Backpacks lead to poor posture due to the posterior placement of the load, which overtime may contribute to low back pain and musculoskeletal complications. This study examined postural and load distribution differences between a traditional backpack (BP) and a nontraditional backpack (BTP) in a young adult population. Using a 3D motion analysis system, 24 healthy young adults (22.5 ± 2.5 years, 12 male) completed both static stance and walking trials on a treadmill with No Load and with 15% and 25% of their body weight using the two different backpacks. There was a significant difference in trunk angle, head angle, and lower extremity joint mechanics between the backpack and load conditions during walking (p < .05). Notably, relative to the No Load condition, trunk angle decreased approximately 14° while head angle increased approximately 13° for the BP 25% state on average. In contrast, average trunk and head angle differences for the BTP 25% state were approximately 7.5° and 7°, respectively. There was also a significant difference in head angle from pre- to post-walk (p < .05) across backpacks, loads, and time. Taken together, the results indicate that the BTP more closely resembled the participants’ natural stance and gait patterns as determined by the No Load condition. The more upright posture supported by the BTP may help reduce characteristics of poor posture and, ideally, help to reduce low back pain while carrying loads.