角膜生物力学的测量及临床应用进展

摘要：角膜是重要的屈光间质,约占眼光学系统总屈光力的70％;因其特殊的生理结构,可表现出复杂的生物力学性质。随着近年来科学技术的进步,用于测量角膜生物力学的方法也在不断更新,获得的生物力学参数也更加精确。越来越多的国内外研究团队将对角膜生物力学的研究同临床相结合,发现当角膜形态发生变化时,其生物力学参数也会发生相应的改变。因此,可以通过对患者角膜生物力学的测量来判断病变的发展程度,也可以根据所测得的力学参数来进行手术设计,甚至可以初判患者的愈后情况。但在角膜生物力学方面的研究仍缺乏深度,对其与部分临床疾病的联系仍缺乏充分的认知,仍需探讨如何将角膜生物力学检查更好地服务于临床。本文将对角膜生物力学的离体、活体测量方法及其目前在圆锥角膜、青光眼、翼状胬肉、屈光不正及屈光不正的矫正等临床方面的应用研究作一综述。     

弹性髓内钉与接骨板内固定治疗儿童股骨干骨折的临床疗效对比研究

摘要 目的：对比弹性髓内钉与接骨板内固定治疗儿童股骨干骨折的临床疗效。方法：本研究为回顾性研究,选取我院于2018年3月~2019年8月期间收治的儿童股骨干骨折患者98例,根据固定方式的不同将患儿分为A组（n=50,接骨板内固定治疗）和B组（n=48,弹性髓内钉治疗）,观察两组优良率、术前/术后相关指标及并发症发生情况。结果：B组的优良率高于A组（P<0.05）。B组手术时间、切口长度短于A组,术中出血量少于A组（P<0.05）。B组骨折愈合时间、住院时间、手术至内固定拆除时间、取出内固定手术时间短于A组（P<0.05）。两组患儿并发症发生率对比,差异无统计学意义（P>0.05）。结论：相对于接骨板内固定治疗,弹性髓内钉治疗儿童股骨干骨折,疗效更好,可有效改善术中、术后指标,且不增加并发症的发生率。     

Advances in percutaneous coronary intervention for chronic total occlusions: current antegrade dissection and reentry techniques and updated algorithm

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is considered relatively complex with low success rates and high complication rates. Treating a CTO with PCI using the hybrid algorithm increases success rates with acceptable complication rates. An essential part of the hybrid algorithm is antegrade dissection and reentry (ADR). In PCI of a non-CTO coronary lesion, the guidewire over which the stent is advanced and placed stays within the true lumen of the coronary artery. ADR techniques make it possible to cross the lesion through the wall of the coronary artery, the subintimal space, thus creating a small bypass within the architecture of the coronary artery and restoring antegrade blood flow. ADR increases success rates, especially in more difficult CTO procedures. In the last decade, new materials and techniques have been introduced in quick succession, which are summarised in this review. Consequently an updated ADR algorithm is presented, which can support the CTO operator during an ADR procedure.

     

Translational products of adipose tissue-derived mesenchymal stem cells: Bench to bedside applications

With developments in the field of tissue engineering and regenerative medicine, the use of biological products for the treatment of various disorders has come into the limelight among researchers and clinicians. Among all the available biological tissues, research and exploration of adipose tissue have become more robust. Adipose tissue engineering aims to develop by-products and their substitutes for their regenerative and immunomodulatory potential. The use of biodegradable scaffolds along with adipose tissue products has a major role in cellular growth, proliferation, and differentiation. Adipose tissue, apart from being the powerhouse of energy storage, also functions as the largest endocrine organ, with the release of various adipokines. The progenitor cells among the heterogeneous population in the adipose tissue are of paramount importance as they determine the capacity of regeneration of these tissues. The results of adipose-derived stemcell assisted fat grafting to provide numerous growth factors and adipokines that improve vasculogenesis, fat graft integration, and survival within the recipient tissue and promote the regeneration of tissue are promising. Adipose tissue gives rise to various by-products upon processing. This article highlights the significance and the usage of various adipose tissue by-products, their individual characteristics, and their clinical applications.     

输尿管软镜术后肾结石患者的临床特征及结石残留的影响因素分析

摘要 目的：探究输尿管软镜术后肾结石患者的临床特征及结石残留的影响因素。方法：选择2019年1月~2022年1月本院收治的200例肾结石患者，所有患者予以输尿管软镜术治疗，术后一周，开展泌尿系CT及尿路平片复查，根据术后结石残留情况，将其分为无残石组（n=155）及残石组（n=45）。并依据两组患者术后是否伴随并发症，将其分为并发症组（n=41）及无并发症组（n=159）。比较术后并发症组与无并发症组的基线资料、术后结石残留率、影响肾结石患者术后结石残留的单因素及肾结石患者术后结石残留的Logistic回归分析。结果：既往输尿管疾病史、鹿角形结石、操作时间及住院时间，均会在不同程度上增加术后并发症风险（P＜0.05），年龄、术前合并慢性病、性别、体质量指数、结石位置未明显增加术后并发症风险（P＞0.05）；200例肾结石患者，输尿管软镜术后，结石残留率为22.50 %（45/200），结石清除率为77.50 %（155/200），残石组及无残石组性别、年龄及平均病程比较，无较大差异（P＞0.05）；肾功能不全、结石直径、结石数量、结石脓苔包裹、肾盂肾下盏夹角、结石成分、手术时间、术中出血量是影响肾结石术后结石残留的单因素（P＜0.05），糖尿病、高血压、肾积水、结石位置等因素未对术后结石残留产生显著影响（P＞0.05）；Logistic回归分析提示，肾功能不全、结石直径≥2 cm、结石脓苔包裹、肾盂肾下盏夹角＜30°及结石成分是影响肾结石患者术后结石残留的独立危险因素（P＜0.05）。结论：肾结石患者输尿管软镜术后，可依据影响术后并发症的临床特征，对不良风险事件予以预警，此外研究结果提示，肾功能不全、结石直径≥2 cm、结石脓苔包裹、肾盂肾下盏夹角＜30°及结石成分是影响结石残留的独立危险因素，术前可基于危险因素开展相应预防，以提高结石清除率。     

20例葡萄球菌感染所致化脓性脊柱炎的临床特征分析

为探讨葡萄球菌感染所致化脓性脊柱炎(pyogenic vertebral osteomyelitis,PVO)的临床及影像学特征,本研究回顾性分析了2009年1月-12月上海交通大学附属第六人民医院感染病科收治的20例葡萄球菌感染所致PVO患者的临床特征、实验室检查指标、影像学资料及治疗效果。结果显示,20例PVO患者中金黄色葡萄球菌感染较为多见,85%患者病变在腰椎,50%患者白细胞计数升高,13例发热(65%),12例(60%)出现椎旁脓肿,所有患者C反应蛋白、红细胞沉降率、铁蛋白均升高。计算机断层扫描(computed tomography,CT)平扫示感染椎体骨质破坏;磁共振成像(magnetic resonance imaging,MRI)示病变椎体及椎间盘破坏区异常信号灶,增强后可见明显强化;单光子发射计算机断层扫描(emission computed tomography,ECT)示病变椎体不均匀放射性摄取增高。金黄色葡萄球菌对青霉素耐药率达77.8%。12例椎旁脓肿患者经CT引导下穿刺置管引流加敏感抗生素治疗,临床结局良好。结果提示,金黄色葡萄球菌是葡萄球菌感染所致PVO的主要致病菌,其对青霉素普遍耐药,炎症指标和影像学检查可用于疗效评估及随访,内科保守治疗对PVO有效。     

Novel method for early signs of clinical shock detection by monitoring blood capillary/vessel spatial pattern

The ability to monitor capillary/vessel spatial patterns and local blood volume fractions is critical in clinical shock detection and its prevention in Intensive Care Units (ICU). Although the causes of shock might be different, the basic abnormalities in pathophysiological changes are the same. To detect these changes, we have developed a novel method based on both spectrally and spatially resolved diffuse reflectance spectra. The preliminary study has shown that this method can monitor the spatial distribution of capillary/vessel spatial patterns through local blood volume fractions of reduced hemoglobin and oxyhemoglobin. This method can be used as a real‐time and non‐invasive tool for the monitoring of shock development and feedback on the therapeutic intervention. (© 2014 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

针刺人迎穴在改善颈性眩晕症状的临床疗效分析

目的:探究针刺人迎穴在改善颈性眩晕症状的临床疗效。方法:选取2012年3月到2013年6月在我院门诊的颈性眩晕患者130例,随机分为对照组与观察组,其中对照组50例,采取常规针刺方法,观察组80例采用毫针针刺人迎穴。将两组患者的眩晕改善时间,眩晕持续时间,临床有效率,显效率等数据进行分析。结果:观察组在平均眩晕改善时间为2.3±1.3天优于对照组的3.7±1.6天(P0.05)。在眩晕平均持续时间、有效率、显效率方面与对照组均无明显差异。结论:针刺人迎穴具有改善颈性眩晕的效果,与传统针刺方法疗效相当,而且在眩晕改善时间的方面较传统针法更具优势,具有临床推广意义。     

急诊分层管理对急性下肢动脉血栓患者的临床效果观察

目的:探讨急诊分层管理配合介入治疗对急性下肢动脉血栓患者的临床效果,为临床护理工作提供可借鉴的方法。方法:回顾性分析2010年9月-2013年11月在我院接受治疗的69例急性下肢动脉血栓患者的临床资料。所有患者均接受手术溶栓治疗,术后将患者随机分为两组。常规护理组患者采用基本护理模式,而分层管理组患者采用层级管理的护理模式。观察并比较两组患者术后并发症的发生率及对护理服务的满意度等。结果:分层管理组患者患肢复通率为91.28%;常规护理组患者患肢复通率为84.61%;两组患者治疗后的患肢与健肢周径差均明显小于本组溶栓前的对应值,组内比较差异具有统计学意义(P0.05),组间比较差异无显著性(P0.05)。分层管理组护理工作的落实率为95.68%,患者治疗的依从性为93.91%,对护理人员服务态度的满意度为94.56%,对护理技能的满意度为93.78%,对健康指导的满意度为95.46%,对护患沟通的满意度为97.76%;常规护理组护理工作的落实率为76.55%,患者治疗的依从性为67.82%,对护理人员服务态度的满意度为89.66%,对护理技能的满意度为86.32%,对健康指导的满意度为85.47%,对护患沟通的满意度为86.21%。分层管理组的护理质量、工作落实率、患者依从性及满意度显著高于常规护理组,差异具有统计学意义(P0.05)。结论:分层管理的护理模式对急性下肢动脉血栓患者的治疗与预后起着重要的作用,值得临床推广。