斜视手术切口选择及手术配合分析

目的了解斜视手术不同切口的效果。方法采用4种结膜切口方式,观察临床效果。结果通过50例58只眼手术,不同术式各有利弊。结论根据临床需求选择合适的切口,才能利于视功能恢复并达到美容目的。     

Recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct

Surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. A major role of the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) is to advise on surveillance priorities. A sub-committee was set up to systematically review existing UK surveillance schemes. The following three systems were examined in detail: mandatory reporting of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infection to the HPA; surveillance of surgical site infection undertaken by the HPA; and surgical site infection surveillance undertaken at University College London Hospital. Recommendations included the extension of mandatory reporting to include bacteraemia due to Escherichia coli and methicillin-susceptible S. aureus (MSSA), post-discharge surveillance of surgical site infection, the need for validation of surveillance systems and mandatory reporting of Caesarean section wound infections. Mandatory reporting of bacteraemia due to E. coli and MSSA were introduced during 2011 and further extension of surveillance is likely.     

Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes

OBJECTIVE

To re-evaluate the relationship between glycemia and diabetic retinopathy.

RESEARCH DESIGN AND METHODS

We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20–79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n = 21,334], and A1C [n = 28,010]) was examined.

RESULTS

When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4–6.8 mmol/l for FPG, 9.8–10.6 mmol/l for 2-h PG, and 6.3–6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C.

CONCLUSIONS

This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.The current diagnostic cut points for diabetes (fasting plasma glucose [FPG] of 7.0 mmol/l and 2-h post oral glucose load plasma glucose [2-h PG] of 11.1 mmol/l) are largely based on glycemic levels associated with a substantially increased risk of diabetes-associated microvascular complications, particularly retinopathy, above these levels (1,2). These cut points were derived from cross-sectional epidemiological studies that examined retinopathy across a range of glycemic levels. The datasets used for this purpose were from Pima Indians, an Egyptian study, and unpublished data from the Third National Health and Nutrition Examination Survey (NHANES) (2).Other studies (3–5) also have examined this relationship, but the results have been inconsistent. All studies reported to date have had limited statistical power to examine this relationship in detail and have adopted a very broad definition of retinopathy that included many cases of mild retinopathy, now known to have causes other than hyperglycemia (6). A more clinically relevant end point is diabetes-specific retinopathy (moderate or more severe levels of retinopathy) that is invariably attributed to hyperglycemia. Also different statistical methods have been used in previous studies, which has an important effect on derived cut points (5,7).Several new datasets with retinopathy data have become available since the original studies used to derive current diabetes diagnostic cut points (1,2). The DETECT-2 collaboration has pooled these datasets to examine and re-evaluate the relationship between retinopathy and three glycemic measures: FPG, 2-h PG, and A1C. The size of the DETECT-2 dataset has allowed us to focus on the relationship between measures of glycemia and diabetes-specific retinopathy (i.e., moderate or more severe levels of retinopathy). These analyses were designed to inform current deliberations on possible revisions to the diagnostic criteria for diabetes.