小梁切除术联合可松解缝线以及抗代谢药物治疗原发性闭角型青光眼的疗效

目的 探讨小梁切除术联合可松解缝线及抗代谢药物对原发性闭角型青光眼（PACG）的疗效.方法 对小梁切除术联合可松解缝线及抗代谢药物的PACG 146例（180眼）进行回顾性研究,分析术后眼压控制情况、滤过泡形态及并发症.结果 所有180眼中,152眼（84.4％）不用降眼压药物情况下眼压在10～21 mmHg：26眼（14.4％）加用局部降眼压药物,眼压控制在10～21 mm-Hg：2眼（1.1％）眼压失控,分别于术后3个月和5个月行睫状体冷凝治疗.未出现浅前房、低眼压或滤过泡相关并发症.结论 小梁切除术联合可松解缝线及抗代谢药物治疗PACG能较好控制术后眼压并避免术后早期浅前房、低眼压等并发症,减少滤过道瘢痕化的发生.     

[In Press] Comparison of visual performance recovery after thin-flap LASIK with 4 femtosecond lasers

AIM: To compare the speed of visual recovery following myopic thin-flap laser in situ keratomileusis (LASIK) with four femtosecond lasers. METHODS: Eighty-eight eyes of 46 patients who were consecutively scheduled for bilateral LASIK with the IntraLase FS60 (Group 1), Femto LDV Crystal Line (Group 2), Wavelight FS200 (Group 3) and VisuMax (Group 4) femtosecond lasers were enrolled in. Monocular uncorrected distance visual acuity (UDVA), best-corrected distant visual acuity (CDVA), refraction, contrast sensitivity and higher-order aberrations (HOAs) were evaluated at 1d, 3d, 1wk and 1mo postoperatively. RESULTS: Seventy-two point seven percent of eyes achieved 20/16 and 36.4% of eyes were 20/12.5 at 1d in Group 2, which was significantly more than other 3 groups. At 1wk, 90.9% of eyes achieved 20/16 in Group 2 and 4. At 1mo, 90.9% and 92.5% of eyes achieved 20/16 in Group 2 and Group 4, which is significantly more than other two groups. While by 1mo, the difference of the residual SE was not statistically significant among 4 groups (P=0.121). The induction of spherical aberration (SA) were significantly less for Group 2, 3, 4 than for Group 1 one day surgery(P=0.015). The differences among 4 groups were not statistically significant before and after surgery on every time points (all P>0.05). CONCLUSION: The thin-flap LASIK procedure using the Femto LDV Crystal Line and VisuMax femtosecond laser showed faster visual performance recovery.     

准分子激光屈光性角膜切削术治疗近视的临床分析

目的：评价准分子激光屈光性角膜切削术（PRK）治疗不同程度近视的疗效。方法：应用SchwindKeratomF准分子激光机对1995眼不同程度近视（－0．75～15．50D）行PRK治疗。按屈光度分三组：组Ⅰ≤－6．00D,873眼;组Ⅱ－6.25D—－10．00D,774眼;组Ⅲ＞－10．00D,348眼。术后12个月,对三组术后的视力、屈光度及Haze进行随访比较。结果：术后12个月Ⅰ、Ⅱ、Ⅲ组裸眼视力≥0．5者分别为986%,94．2％和60.04％;≥1.0者分别为85．5％,71.3％和25.9％;屈光度在±1．00D以内分别为90．5％,68．8％和29．3％。角膜雾状混浊（Haze）≥2级者分别为0.8％,11．5％和13．7％。结论：PRK治疗中低度近视疗效较好,对高度和超高度近视由于术后Haze和屈光度回退发生率增高,疗效受到明显影响,有待进一步完善手术方法和术后用药等问题。     

Functional and molecular characterization of multiple K-Cl cotransporter isoforms in corneal epithelial cells

The dependence of regulatory volume decrease (RVD) activity on potassium-chloride cotransporter (KCC) isoform expression was characterized in corneal epithelial cells (CEC). During exposure to a 50% hypotonic challenge, the RVD response was larger in SV40-immortalized human CEC (HCEC) than in SV40-immortalized rabbit CEC (RCEC). A KCC inhibitor-[(dihydroindenyl)oxy] alkanoic acid (DIOA)-blocked RVD more in HCEC than RCEC. Under isotonic conditions, N-ethylmaleimide (NEM) produced KCC activation and transient cell shrinkage. Both of these changes were greater in HCEC than in RCEC. Immunoblot analysis of HCEC, RCEC, primary human CEC (pHCEC), and primary bovine CEC (BCEC) plasma membrane enriched fractions revealed KCC1, KCC3, and KCC4 isoform expression, whereas KCC2 was undetectable. During a hypotonic challenge, KCC1 membrane content increased more rapidly in HCEC than in RCEC. Such a challenge induced a larger increase and more transient p44/42MAPK activation in HCEC than RCEC. On the other hand, HCEC and RCEC p38MAPK phosphorylation reached peak activations at 2.5 and 15 min, respectively. Only in HCEC, pharmacological manipulation of KCC activity modified the hypotonicity-induced activation of p44/42MAPK, whereas p38MAPK phosphorylation was insensitive to such procedures in both cell lines. Larger increases in HCEC KCC1 membrane protein content correlated with their ability to undergo faster and more complete RVD. Furthermore, pharmacological activation of KCC increased p44/42MAPK phosphorylation in HCEC but not in RCEC, presumably a reflection of low KCC1 membrane expression in RCEC. These findings suggest that KCC1 plays a role in (i) maintaining isotonic steady-state cell volume homeostasis, (ii) recovery of isotonic cell volume after a hypotonic challenge through RVD, and (iii) regulating hypotonicity-induced activation of the p44/42MAPK signaling pathway required for cell proliferation.     

表面麻醉颞侧位超声乳化及人工晶状体植入术

目的:探讨并总结表面麻醉颞侧位超声乳化技术及5.5mm无缝线遂道切口人工晶状体植入术的方法和经验。方法:总计植入5.5mmPMMA人工晶状体采用无缝线隧道切口的白内障患者529例(568眼),植入折叠式人工晶状体患者51例(51眼)。前者核硬度为I和II级者248眼,III级296眼,IV级24眼。后者核硬者为I和II级者30眼,III级21眼,颞侧位超声乳化碎核,能量设定为50%~70%,有效超声时间10~88(平均46)s。结果:术后第1d视力≥0.5者分别为75%和76%,术后1mo裸眼或矫正视力≥0.5者分别为87%和84%,平均散光分别为0.25±0.38D和0.58±0.62D,两组比较,差异无显著性(P>0.05)。全部病例均无需缝线,96%的表麻颞侧位超声乳化成功,手术主要并发症是后囊破裂和虹膜色素脱失。结论:表麻颞侧位超声乳化白内障吸除术及5.5mm无缝线隧道切口的人工晶状体植入术与折叠术人工晶状体一样,具有手术时间短,无需缝线,视力恢复快等优点,而价格相对便宜,特别是对不宜在原位手术的患者是一种安全有效的手术方式,故值得推广。     

泪点栓子对干眼病患者泪膜功能的影响

目的 评价一种新型泪点栓子对干眼病患者泪膜功能的影响.方法 采用美国产新型泪点栓子治疗62例(123只眼)确诊为干眼病的患者,询问治疗前后患者的主观症状、检查治疗前后的泪膜破裂时间、荧光素染色情况和泪液分泌量的变化.结果 泪点栓子治疗后干眼病患者主观症状明显减轻;治疗后泪膜破裂时间延长,与治疗前比较差异具有显著意义;治疗前和治疗后角膜上皮点状荧光素染色差异具有显著意义(P<0.05);泪液分泌量有所增加.结论 该新型泪点栓子用于治疗干眼病能限制泪液流出,重建泪液平衡,改善泪膜的稳定性,是一种有效的、可逆的治疗干眼病的方法.     

儿童抗生素相关性腹泻诊断、治疗和预防专家共识

抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)是抗菌药物使用后最常见的不良反应,尤其是儿童。AAD会延长原发疾病的恢复时间、增加医疗费用,重者可引起死亡。儿科医师对AAD关注不够,现组织国内呼吸、感染和消化领域专家,制定本共识,以提高我国儿童AAD诊治及预防水平,保障儿童健康。     

Cornuside Is a Potential Agent against Alzheimer’s Disease via Orchestration of Reactive Astrocytes

Cornuside is an iridoid glycoside from Cornus officinalis, with the activities of anti-inflammatory, antioxidant, anti-mitochondrial dysfunction, and neuroprotection. In the present research, a triple-transgenic mice model of AD (3 × Tg-AD) was used to explore the beneficial actions and potential mechanism of cornuside on the memory deficits. We found that cornuside prominently alleviated neuronal injuries, reduced amyloid plaque pathology, inhibited Tau phosphorylation, and repaired synaptic damage. Additionally, cornuside lowered the release of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and nitric oxide (NO), lowered the level of malondialdehyde (MDA), and increased the activity of superoxide dismutase (SOD) and the level of glutathione peroxidase (GSH-Px). Cornuside also significantly reduced the activation of astrocytes and modulated A1/A2 phenotypes by the AKT/Nrf2/NF-κB signaling pathway. We further confirmed that LY294002 and Nrf2 silencing could block the cornuside-mediated phenotypic switch of C6 cells induced by microglia conditioned medium (MCM) in response to lipopolysaccharide (LPS), which indicated that the effects of cornuside in astrocyte activation are dependent on AKT/Nrf2/NF-κB signaling. In conclusion, cornuside may regulate the phenotypic conversion of astrocytes, inhibit neuroinflammation and oxidative stress, improve synaptic plasticity, and alleviate cognitive impairment in mice through the AKT/Nrf2/NF-κB axis. Our present work provides an experimental foundation for further research and development of cornuside as a candidate drug for AD management.     

新型冠状病毒感染新生儿院间转运应急预案——浙江大学医学院附属儿童医院经验

自2019年12月以来，2019冠状病毒病（COVID-19）疫情已成为目前最严峻的公共卫生问题。新生儿作为免疫功能不成熟的特殊人群，已有COVID-19病例报道。鉴于疑似/确诊COVID-19新生儿应转运到定点医院隔离救治，为建立健全相应急救转运机制，特编写COVID-19新生儿急救转运预案。该预案提出了新生儿COVID-19的转运指征、组织管理、防护策略、工作流程、消毒处置方法等，旨在为疑似或确诊新生儿COVID-19的院间转运提供相关指导与建议。