更正

目的：回顾性分析棘阿米巴角膜炎的临床特点、误诊原因,以减少临床误诊率。方法：对1998年以来我院收治的2例经临床确诊的棘阿米巴角膜炎患者进行回顾性研究,探讨其临床特点、误诊原因及鉴别要点。结果：2例棘阿米巴角膜炎患者早期均被误诊为病毒性角膜炎,抗病毒治疗无效,后经组织刮片确诊为棘阿米巴角膜炎,经抗阿米巴治疗后2例均形成角膜白斑。结论：棘阿米巴角膜炎是严重的致盲眼病之一,了解其临床特点,早期诊断、早期治疗是提高疗效,减少并发症的有效方法。     

棘阿米巴角膜炎误诊原因分析

目的:回顾性分析棘阿米巴角膜炎的临床特点、误诊原因,以减少临床误诊率.方法:对1998年以来我院收治的2例经临床确诊的棘阿米巴角膜炎患者进行回顾性研究,探讨其临床特点、误诊原因及鉴别要点.结果:2例棘阿米巴角膜炎患者早期均被误诊为病毒性角膜炎,抗病毒治疗无效,后经组织刮片确诊为棘阿米巴角膜炎,经抗阿米巴治疗后2例均形成角膜白斑.结论:棘阿米巴角膜炎是严重的致盲眼病之一,了解其临床特点,早期诊断、早期治疗是提高疗效,减少并发症的有效方法.     

两种手术方式治疗真菌性角膜炎的临床观察

目的 观察深板层角膜移植术（deep lamellar keratoplasty,DLKP）和穿透性角膜移植术（penetrating keratoplasty,PKP）治疗真菌性角膜炎的临床疗效.方法 回顾44例（44眼）临床确诊为真菌性角膜炎的患者,根据共焦激光显微镜检查是否累及角膜内皮分别行DLKP 28例（28眼）或PKP 16例（16眼）.术后随访6～24个月,观察术后真菌复发情况以及拆线后两周视力和角膜地形图散光.结果 术后角膜病理切片检查均检出真菌.术后DLKP组有1例、PKP组有3例出现排斥反应,经抗排斥治疗后均好转.拆线后两周最佳矫正视力DLKP组为0.59×0.04,PKP组为0.41 ×0.05,两组间相比较差异具有统计学意义（t =2.577,P =0.01）;角膜地形图散光DLKP组为（2.0 ×0.17） D;PKP组为（2.9×0.30）D,两组间相比较差异具有统计学意义（t =0.088,P=0.016）.结论 激光共焦显微镜检查对于手术方式的选择提供了良好的客观依据.两种手术方式治疗真菌性角膜炎均有良好的疗效,DLKP术后视觉疗效优于PKP.     

应用ROC曲线分析泪液(1-3)-β-D葡聚糖对真菌性角膜炎的诊断价值

目的探讨真菌性角膜炎患者泪液(1-3)-β-D葡聚糖的阈值,通过受试者工作特征曲线(ROC)评价其对真菌性角膜炎的诊断价值。方法分别测定100例真菌性角膜炎患者和100例健康志愿者泪液中(1-3)-β-D葡聚糖水平,应用ROC曲线评估泪液(1-3)-β-D葡聚糖诊断真菌性角膜炎的最佳临界值及其灵敏度、特异性。结果泪液(1-3)-β-D葡聚糖诊断真菌性角膜炎的ROC曲线下面积为0.992,阈值为23.82pg/mL,灵敏度为97.0%,特异性为98.0%。结论泪液(1-3)-β-D葡聚糖对真菌性角膜炎的诊断具有较高的灵敏度和特异性,具有一定临床应用价值。     

钼靶和超声检查在乳腺癌临床诊断的准确性的比较分析

摘要 目的：比较与分析钼靶和超声检查在乳腺癌临床诊断的准确性。方法：2018年8月到2021年1月选择在本院进行诊治的乳腺肿瘤患者110例作为研究对象,所有患者都给予钼靶和超声检查,记录影像学特征并判断诊断价值。结果：在110例患者中,病理诊断为乳腺良性肿瘤76例、乳腺癌34例。恶性组钼靶的分叶征、钙化、大角征、毛刺征等比例高于良性组,病灶大小也高于良性组(P<0.05)。恶性组超声的形态不规则、边缘不光整、高回声晕、回声衰减、微钙化等比例高于良性组(P<0.05)。钼靶乳腺影像报告及数据系统(Breast imaging report and data system,BI-RADS)判断为乳腺良性肿瘤72例,乳腺癌38例;超声BI-RADS判断为乳腺良性肿瘤75例,乳腺癌35例,钼靶鉴别诊断乳腺癌的敏感性为93.4%,特异性为97.1%,准确性为94.5%;超声鉴别诊断乳腺癌的敏感性为98.7%,特异性为100.0%,准确性为99.1%。多因素logistic回归分析显示病灶大小、分叶征、回声衰减、毛刺征为导致误诊的重要因素(P<0.05)。结论：乳腺癌在钼靶和超声检查中都有明显的征象特征,超声诊断的准确性更高,病灶大小、分叶征、回声衰减、毛刺征为影响诊断效果的很重要因素。     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

不同放散试验对新生儿ABO溶血病的诊断价值对比

摘要 目的：分析与比较不同放散试验对新生儿ABO溶血病的诊断价值。方法：选择2017年9月至2019年6月在本院进行ABO溶血病检测的新生儿240例,取所有新生儿的静脉血样本2~3 mL,采用冷冻复融放散试验方法与改良热放散试验方法检测新生儿ABO溶血病的发生情况,并比较单独诊断和联合诊断的价值。结果：在240份标本中,冷冻复融放散试验检出新生儿ABO溶血病阳性130例,阳性检出率为54.2 %;改良热放散试验检出新生儿ABO溶血病阳性94例,阳性检出率为39.2 %;二者联合检出新生儿ABO溶血病阳性100例,阳性检出率为41.67 %,联合检出新生儿ABO溶血病阳性率和冷冻复融放散试验检出新生儿ABO溶血病阳性率显著高于改良热放散试验检出新生儿ABO溶血病阳性率(P<0.05)。临床最终诊断为新生儿ABO溶血病101例,阳性率为42.08 %,患儿ABO血型包括A型56例,B型45例。冷冻复融放散试验诊断新生儿ABO溶血病的敏感性和特异性为73.8 %和95.5 % ,ROC曲线面积0.775;改良热放散试验检诊断为新生儿ABO溶血病的敏感性和特异性为100 %和95.2 %,ROC曲线面积0.853;二者联合诊断对新生儿ABO溶血病的敏感性和特异性为90.0 %和97.85 %,ROC曲线面积0.872,联合诊断特异性优于改良热放散试验检诊和冷冻复融放散试验诊断,且改良热放散试验检诊敏感性优于冷冻复融放散试验诊断。结论：相对于冷冻复融放散试验,改良热放散试验对新生儿ABO溶血病的诊断敏感性更高,且不影响诊断特异性,两种放散方法联合检测具有更好的应用价值。     

糖尿病真菌性角膜炎患者临床特征及病原学分析CSCD

目的调查与探讨糖尿病真菌性角膜炎患者临床特征及病原学状况,发现影响糖尿病真菌性角膜炎患者预后的主要危险因素。方法采用回顾性研究方法,选择2013年2月~2016年5月在我院眼科确诊的,具有完整病例资料和随访资料的真菌性角膜炎患者120例作为研究对象,包括合并糖尿病的真菌性角膜炎60例(糖尿病组)和无糖尿病的真菌性角膜炎60例(非糖尿病组),调查所有患者的人口学特征、临床症状、病原学检查结果,同时记录患者的预后情况并进行危险因素分析。结果两组患者的性别、体重指数、病程等对比,差异无统计学意义(P>0.05),糖尿病组糖尿病病史平均为(8.14±2.11)a,糖尿病组的年龄和角膜感染程度评分与非糖尿病组相比,差异有统计学意义(P<0.05)。在糖尿病组中,镰刀菌属10例(16.7%),曲霉菌属40例(66.7%),念珠菌属10例(16.7%);在非糖尿病组中,镰刀菌属25例(41.7%),曲霉菌属30例(50.0%),念珠菌属5例(8.3%),两两比较差异都有统计学意义(P<0.05)。糖尿病组与非糖尿病组的治疗总有效率分别为86.7%和98.3%,糖尿病组的治疗总有效率明显差于非糖尿病组(P<0.05)。多分变量Logistic回归显示浸润病灶、前房积脓、曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素(P<0.05)。结论糖尿病真菌性角膜炎患者相对于非糖尿病患者而言主要表现为发病年龄偏大、角膜感染较重、预后差的特点,曲霉属为其主要病原菌。浸润病灶、前房积脓和曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素。     

CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用

摘要 目的：探讨电子计算机断层扫描(Computed Tomography,CT)与磁共振成像(Magnetic resonance imaging,MRI)扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用。方法：2016年9月到2019年10月选择在本院诊治的下拟诊为四肢骨关节隐匿性骨折118例,所有患者都给予CT与MRI扫描三维重建诊断,记录影像学特征与判断诊断价值。结果：在118例患者中,最终确诊为四肢骨关节隐匿性骨折98例,无骨折20例,其中腕关节骨折34例,踝关节骨折22例,膝关节骨折15例,肘关节骨折15例,肩关节骨折8例,髋关节骨折4例。在98例确诊的四肢骨关节隐匿性骨折中,MRI三维重建显示双边征、骨质破坏、充气征、软组织影等比例显著都高于CT (P<0.05)。CT与MRI三维重建诊断四肢骨关节隐匿性骨折的敏感性为89.8 %和99.0 %,特异性为95.0 %和100.0 %,误诊率分别为9.3 %和0.8 %,MRI三维重建诊断的敏感性高于CT ,漏诊率低于CT。结论：CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用都有很好的价值,特别是MRI三维重建能清晰显示骨折特征,具有更高的诊断敏感性,能减少漏诊率,可作为四肢骨关节隐匿性骨折的首选检查方法。     

彩色多普勒超声评估卵巢癌周围血管受侵程度及可切除性的应用价值

摘要 目的：探讨彩色多普勒超声评估卵巢癌周围血管受侵程度及可切除性的应用价值。方法：选择2018年2月至2019年8月在本院诊治的卵巢癌患者548例作为研究对象,所有患者都给予彩色多普勒超声,评估患者的周围血管受侵程度及可切除性,记录患者的超声血流频谱。结果：超声诊断为卵巢癌周围血管受侵犯78例,占比14.2 %,诊断敏感性与特异性为97.5 %和100.0 %, ROC曲线面积为0.963。超声诊断为卵巢癌可切除450例,占比82.1 %,诊断敏感性与特异性为99.1 %和90.4 %,ROC曲线面积为0.897。手术切除患者的年龄、体重指数、病理类型、病程等与未手术切除患者对比差异无统计学意义(P>0.05)。手术切除患者的搏动指数(pulsation index,PI)和阻力指数(resistance index,RI)高于非手术切除患者,血管舒张末期流速(end-diastolic velocity,EDV)、峰值流速(peak systolic velocity,PSV)低于非手术切除患者,差异均有统计学意义(P<0.05)。结论：彩色多普勒超声评估卵巢癌周围血管受侵程度及可切除性具有很好的敏感性与特异性,有利于指导卵巢癌患者的病情评估与治疗。     

14例茄病镰刀菌所致角膜溃疡临床分析

目的探讨真菌性角膜溃疡的病原学特点、临床表现及抗真菌综合治疗的方法。方法对2004年10月-2006年10月送检的疑似感染的角膜标本进行镜检、培养及菌种鉴定。对其中14例病历资料完整的茄病镰刀菌所致角膜溃疡患者进行临床分析。结果在33例送检标本中分离出茄病镰刀菌24株（72．7％）。上述14例患者中,有3例角膜穿孔合并眼内炎行眼球内容物除去术,3例行结膜瓣或羊膜移植,1例角膜移植,7例经非手术治疗保留较好视力。结论茄病镰刀菌是我国北方真菌性角膜炎的主要致病菌,可导致视力严重受损且治愈困难。早期诊断配合以抗真菌为主的综合治疗可阻止病情进展,明显改善视力。     

Identification of causative pathogens in mouse eyes with bacterial keratitis by sequence analysis of 16S rDNA libraries

The clone library method using PCR amplification of the 16S ribosomal RNA (rRNA) gene was used to identify pathogens from corneal scrapings of C57BL/6-corneal opacity (B6-Co) mice with bacterial keratitis. All 10 samples from the eyes with bacterial keratitis showed positive PCR results. All 10 samples from the normal cornea showed negative PCR results. In all 10 PCR-positive samples, the predominant and second most predominant species accounted for 20.9 to 40.6% and 14.7 to 26.1%, respectively, of each clone library. The predominant species were Staphylococcus lentus, Pseudomonas aeruginosa, and Staphylococcus epidermidis. The microbiota analysis detected a diverse group of microbiota in the eyes of B6-Co mice with bacterial keratitis and showed that the causative pathogens could be determined based on percentages of bacterial species in the clone libraries. The bacterial species detected in this study were mostly in accordance with results of studies on clinical bacterial keratitis in human eyes. Based on the results of our previous studies and this study, the B6-Co mouse should be considered a favorable model for studying bacterial keratitis.     

Cytologic diagnosis of acanthamoebic keratitis

A case of acanthamoebic keratitis was identified from a corneal scraping stained with a modified Papanicolaou stain. The characteristic double-walled cyst forms were easily identified. Corneal scraping cytology provides a rapid, noninvasive means of diagnosis and follow-up for this serious disease.     

A Multi-Center,Cross-Sectional Study on the Burden of Infectious Keratitis in China

Objective

To understand the prevalence and demographic characteristics of infectious keratitis and infectious corneal blindness.

Methods

A multi-center, population-based cross-sectional study was conducted from January 1 to August 31, 2010. A total of 191,242 individuals of all age groups from 10 geographically representative provinces were sampled using stratified, multi-stage, random and systematic sampling procedures. A majority, 168,673 (88.2%), of those sampled participated in the study. The examination protocol included a structured interview, visual acuity testing, an external eye examination, and an anterior segment examination using a slit lamp. The causes and sequelae of corneal disease were identified using uniform customized protocols. Blindness in one eye caused by infectious keratitis was defined as infectious corneal blindness.

Results

The prevalence of past and active infectious keratitis was 0.192% (95% confidence interval [CI], 0.171–0.213%), and the prevalence of viral, bacterial, and fungal keratitis was 0.11%, 0.075%, and 0.007%, respectively. There were 138 cases of infectious corneal blindness in at least one eye in the study population (prevalence of 0.082% [95%CI, 0.068%–0.095%]). Statistical analysis suggested that ocular trauma, alcoholic consumption, low socioeconomic levels, advanced age, and poor education were risk factors for infectious corneal blindness.

Conclusions

Infectious keratitis is the leading cause of corneal blindness in China. Eye care strategies should focus on the prevention and rehabilitation of infectious corneal blindness.     

Queratomicosis en un centro de atención oftalmológica en la Ciudad de México

BackgroundSome of the most common precipitating events for keratomycoses (fungal keratitis), include surgical trauma (after cornea transplantation), the use of contaminated contact lenses or alterations in lacrimal secretions. Diagnosis and treatment (to avoid loss of vision) for these type of infections are challenging.ObjectiveRetrospective review of the diagnosis, epidemiology, etiology and response to treatment in 219 patients with fungal keratitis in Mexico.MethodsWe have studied the diagnosis, epidemiology, etiology and response to treatment in 219 patients from different states in the Mexican Republic in the Cornea Department at an Ophthalmology Hospital in Mexico D.F.ResultsTrauma was the precipitating event in 77 patients (36%), of which 12 (5.4%) were due to surgical trauma; 152 patients (64.8%) did not report any prior trauma. There were 165 male (75.3%) and 54 female (24.6%) patients, with an average age of 46 years old. For clinical and visual treatment patients were treated with topical and oral antifungals and surgery. One or more surgeries were performed on a total of 81 patients (36.9%). A total of 62 patients (28.3%) received a corneal transplant, and 19 patients (8.7%) were subjected to conjunctival flap or scleral-conjunctival surgery.ConclusionsIn Mexico, keratomycoses affect mostly male patients in a 4:1 ratio over females. Fusarium solani was the most frequent agent of fungal keratitis in our study (37.2%), and the highest number of corneal ulcers and eviscerations (26%) was present in patients infected by Aspergillus. The best therapeutic responses were with combination of topical antifungals against dematiaceous fungi.     

Biofilm testing of microbiota: An essential step during corneal scrap examination in Egyptian acanthamoebic keratitis cases

Purpose

To detect co-infections in the culture-proven acanthamoebic keratitis (AK) cases, and to test the capability of biofilm formation in the isolated microbiota. The clinical findings, habit of wearing contact lens and in-vitro antibiotic resistance were analyzed further according to the biofilm formation capability.

IL-17 produced by Th17 cells alleviates the severity of fungal keratitis by suppressing CX43 expression in corneal peripheral vascular endothelial cells

Fungal keratitis is a relatively common ocular disease requiring positive medical management combined with surgical intervention. Interleukin-17 (IL-17) was reported to promote the activation and mobilization of neutrophile granulocyte to foci of inflammation. This study investigated the effect of IL-17 production from Th17 cells on the progression of fungal keratitis. A mouse model of fungal keratitis induced by Candida albicans was successfully constructed to detect infiltration of inflammatory cells in corneal tissues by hematoxylin-eosin (HE) staining and immunohistochemistry. Fungal load capacity of mouse cornea was also detected. The regulatory role of IL-17 in fungal keratitis with the involvement of CX43 was investigated with the relevant expression of inflammatory factors detected and activation of vascular endothelial cells assessed. Furthermore, in vivo experiment was also performed to confirm the role of CX43 in keratitis. Mice with fungal keratitis showed increased level of inflammatory cytokines and infiltration of inflammatory cells. Silencing IL-17 in Th17 cells and overexpressing CX43 could inhibit the activation of vascular endothelial cells. Besides, CX43 knockdown in vivo alleviated fungal keratitis in mice. The possible mechanism of the above findings could be IL-17 inhibiting the level of CX43 through the AKT signaling pathway. Taken together, IL-17 could inhibit the occurrence and development of fungal keratitis by suppressing CX43 expression through the AKT signaling pathway. Therefore, this study provides a potential target for the treatment of fungal keratitis.     

颗粒状角膜营养不良的研究进展

颗粒状角膜营养不良是一种临床少见的常染色体显性遗传病,由于5q31染色体上的TGFBI突变使TGFBIp在角膜前弹力层和基质层异常聚集以及代谢的障碍,导致患者双侧角膜进行性出现不同程度的的浑浊,造成视力的进行性损害。目前报道的TGFBI突变至少有66种,其中至少有10种与颗粒状角膜营养不良有关,由于基因型的差异、纯合子以及杂合子的区别,患者表现型也有很大的差别。随着人们对该病认识的提高,共聚焦显微镜、基因诊疗等方法的应用,越来越多的患者得到了正确诊断,目前的治疗的方法主要有角膜移植和激光消融治疗,但由于术后复发甚至加重的原因,并不能使患者满意。由于颗粒状角膜营养不良动物模型的建立,锂或者基因治疗等方法将会有良好的应用前景。