目的:探讨大气污染物NO<sub>2</sub>水平与干眼患病的相关性。方法:选取2014年1月至2018年1月共计75 279例干眼患者的临床资料,进行资料汇总。空气质量和天气数据来自西安市气象局2014—2018年的每日环境空气质量数据。分析中包括的环境空气污染物NO<sub>2</sub>。所有数据均按小时收集。计算每个变量的每日平均值,并计算本研究中使用的每周平均值。本研究中患者均自愿参加,并经南昌大学第一附属医院医学研究伦理委员会批准。结果:干眼的门诊就诊次数与NO<sub>2</sub>水平显著相关。本研究发现不同年龄段的人受到不同的参数变化影响,环境中NO<sub>2</sub>的浓度对于全年龄段的人患干眼有显著相关性,对性别无选择性,男女均会因为NO2在环境中的不同水平而患干眼。较高水平的环境NO<sub>2</sub>会增加门诊患者干眼的概率。我们通过对患者人数的累计与环境中NO<sub>2</sub>浓度进行相关性分析,发现其有显著相关性,因此环境空气污染和天气变化可能导致干眼的恶化。结论:大气污染物NO2与干眼患病有显著相关性。
Objective: To investigate the correlation between NO2 levels in air pollutants and dry eye. Methods: The clinical data of 75 279 patients with dry eye from January 2014 to January 2018 were selected and summarized. The air quality and weather data were from the daily ambient air quality data of Xi’an Meteorological Bureau from 2014 to 2018. Environmental air pollutants NO2 was included in the analysis. All data were collected on an hourly basis. We calculated the daily average for each variable and then calculated the weekly average used in this study.All patients in this study volunteered to participate. , and this study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of Nanchang University. Results: We found that the number of outpatient visits for dry eye was significantly correlated with NO2 levels. Our study found that people of different ages were affected by different parameter changes. The concentration of NO2 in the environment was significantly correlated with dry eyes in all age groups, and is not selective for gender. Both men and women could develop dry eyes due to different levels of NO2 in the environment. Our results showed that higher levels of environmental NO2 increased the chances of dry eyes in outpatients. By analyzing the correlation between the cumulative number of patients and the NO2 concentration in the environment, we found that the correlation was significant.Therefore, ambient air pollution and weather changes may lead to the deterioration of dry eye. Conclusion: There is a significant correlation between atmospheric pollutant NO2 and dry eye disease.
目的:研究短时间内大量摄入咖啡因对健康成年人眼表泪膜动力学的影响。方法:受试者为12名健康的成年人(20~30岁),没有既往眼表疾病史。受试者在恒定的常规条件下摄入5.0 mg/kg咖啡因(取咖啡粉剂按浓度预调)。在摄入咖啡因前后2 h进行泪膜参数评估和泪液收集。受试者接受了泪河高度、泪膜破裂时间、Schirmer I试验、眼压和平均脂质层厚度的测量。结果:摄入大量咖啡因后,泪河高度、泪膜破裂时间和眼压的检测值显著增加,而平均脂质层厚度的检测值与摄入咖啡因之前相比显著下降。摄入咖啡因后,Schirmer试纸收集的泪液量改变无明显统计学意义,未观察到咖啡因对泪液分泌的影响中的性别差异。结论:在大量摄入咖啡因后,眼表泪液动力学发生显著改变且咖啡因可以刺激健康的非干眼受试者的泪液分泌。
Objective: To investigate the effects of high caffeine intake in a short period on tear film dynamics in healthy adults. Methods: The participants were 12 healthy adults (20–30 years old) with no history of ocular surface disease. Participants were given 5.0 mg/kg caffeine (preset the coffee powder according to the concentration)under constant routine conditions. Tear film parameters were assessed and tear collection was performed 2 h before and after caffeine intake. The tear meniscus height, non-invasive tear break-up time, Schirmer I test, intraocular pressure and average lipid layer thickness were all measured after a large amount of caffeine intake. Results: The tear meniscus height, non-invasive tear break-up time and intraocular pressure were significantly increased after caffeine intake, while the average lipid layer thickness was significantly lower than that before caffeine intake. The amount of tear fluid collected by Schirmer’s I test paper was not statistically significant, and there was no gender difference in the effects of caffeine on tear secretion. Conclusion: After high caffeine intake, ocular tear dynamics are significantly altered and caffeine can stimulate tear secretion in healthy, non-dry-eyed subjects.
青光眼睫状体炎综合征(Posner-Schlossman syndrome,PSS)表现为单眼反复发作性非肉芽肿性前葡萄膜炎,伴有眼压升高,可发展为慢性继发性青光眼,最终导致视神经损伤。尽管PSS总体预后良好,但仍有部分患者因反复眼压骤升造成视神经损伤持续进展,甚至导致失明。目前,PSS的确切病因尚不明确,治疗方式以控制炎症及眼压为主。本文将从病因及治疗两方面阐述PSS的研究现状,以期为PSS相关基础研究及临床诊治提供思路及参考。
Posner-Schlossman syndrome (PSS), also called glaucomatocyclitic crisis, is characterized by recurrent non-granulomatous anterior uveitis, accompanied by elevated intraocular pressure. It is able to develop into chronic secondary glaucoma and eventually lead to optic nerve injury. Although the overall prognosis of PSS is favourable, there are still some patients whose optic nerve injury continues to progress and even lead to blindness due to recurrent attacks of ocular hypertension. At present, the exact cause of PSS is not clear, and the treatment is mainly to control inflammation and intraocular pressure. This article will elaborate the research status of PSS from two aspects of etiology and treatment to provide ideas and reference for the basic research clinical diagnosis and treatment of PSS.
目的:探索基于眼外伤急诊救治胜任力的教学模式。方法:通过分析眼外伤急诊救治的教学现状,结合医学生岗位胜任力特征,构建基于眼外伤急诊救治胜任力的教学体系。结果:基于胜任力构建的眼外伤急诊救治教学体系的优势在于一切以临床实际需求为出发点,使学生在临床实践能力、思辨能力、团队合作、自我认知、医学人文素养等几个方面得到提升,从而更好地胜任临床工作。结论:基于胜任力的教学模式可以全面提高培训医师眼外伤急诊救治的实际能力。
Objective: To explore the teaching mode based on competency in emergency treatment of ocular trauma.Methods: By analyzing the teaching status of emergency treatment for ocular trauma and combining with the competency characteristics of medical students, a competency-based teaching system for emergency treatment of ocular trauma was constructed. Results: The advantage of the teaching system for emergency treatment of ocular trauma based on competency was that it took actual clinical needs as the starting point, which could improve students’ clinical practice ability, critical thinking ability, team work, self-cognition, medical humanistic quality and other aspects, so as to be better qualified for clinical work. Conclusion: The teaching mode based on competency can comprehensively improve the practical ability of training doctors in emergency treatment of ocular trauma.
目的:分析眼科护理对人工智能技术应用的内在需求,为眼科医院临床的人工智能技术开发及应用提供导向与依据。方法:采用整群抽样和单纯随机抽样相结合的方法,于2019年7月至2019年8月,对抽取的中山大学中山眼科中心,中山大学附属第一医院、珠海市人民医院、无锡人民医院、新疆维吾尔族自治区人民医院等目标医院其中的眼科护理人员进行问卷调查,内容包括一般资料及人工智能需求等。结果:调查对象绝大部分来自三级甲等医院(89.2%),以华南地区为主(87.2%),人工智能在眼科临床护理应用的需求多种多样,其中以健康教育、接诊与分诊、患者回访领域需求最强烈,分别占比95.7%、93.5%、93.2%。结论:人工智能在眼科临床护理应用有较强及多样化的需求,应结合实际需求为导向,重点推进人工智能在眼科患者健康教育等相关应用的研发。
Objective: To analyze the internal demands of the application of artificial intelligence technology to ophthalmic care, and provide guidance and basis for the development and application of artificial intelligence technology in ophthalmic hospitals. Methods: Using the method of combining cluster sampling with simple random sampling, a questionnaire survey was conducted on the ophthalmic nursing staff in the selected target hospitals from July to August 2019, which included general information and artificial intelligence needs. Results: Most of the respondents came from the third-class hospitals (89.2%), and hospitals in South China account for 87.2% of them. There are diverse demands of artificial intelligence in ophthalmology clinical nursing applications, including health education, clinical reception and triage, patients return visits, which have the strongest demand for the artificial intelligence, accounting for 95.7%, 93.5%, and 93.2%, respectively. Conclusion: The application of artificial intelligence in ophthalmic clinical nursing has strong and diversified demands, and the research and development of artificial intelligence in the health education of ophthalmic patients and other related applications should be promoted according to the actual demands.
报告1例因电路短路产生电弧光烧伤患者双眼角膜的病例。专科检查:双眼角膜缘颞侧球结膜缺血区小于1/3,角膜上皮呈白色混浊,上皮部分脱落。入院给予清除角膜表面白色坏死组织、抗炎、扩瞳对症治疗,2周后角膜恢复透明,随访3个月患者晶状体及眼底未见明显异常;探讨电弧光在眼球不同部位的致病机制。
A case of corneal burn caused by arc light due to electrical short is reported. Specialist examination: ischemic areas of the temporal limbus bulbar conjunctiva in both eyes were less than 1/3, the corneal epithelium was white and cloudy, and the epithelium was partially peeled. The corneas became transparent after 2 weeks’ treatment of removing the white necrotic tissue, anti-inflammatory and dilating pupil. During the follow-up within 3 months, the patient’s lens and fundus showed no obvious abnormalities. The injury mechanism of arc light caused by electrical short to the eyeball is discussed.
目的:调查引导式教育训练对视力障碍学生生活质量的影响。方法:前瞻性随机对照临床研究。选取2020年在泉州特殊教育学校就读视力障碍学生,按照入组条件随机分为引导式教育训练组和对照组,引导式教育训练组进行引导式教育训练,对照组进行常规康复训练。采用中文版低视力者生活质量量表(Chinese-version low vision quality of life questionnaire,CLVQOL)评估视力障碍学生的基线和训练3个月的生活质量,并进行比较分析。结果:72例视力障碍学生全部完成了基线和随访时的生活质量问卷调查。进行基线检查时,各组CLVQOL评分总分差异无统计学意义(P>0.05)。3个月后,各组CLVQOL评分总分均增加,引导式教育训练组从基线59(48.5,80.5)上升到105(97.5,119.5),差异有统计学意义(Z=?4.781,P<0.001);对照组从基线69(56,85)上升到106(80,112),差异有统计学意义(Z=?4.438,P<0.001);引导式教育训练组在CLVQOL评分总分(P=0.021)及阅读和精细工作维度(P=0.004)、日常生活能力维度(P=0.003)的评分差值均高于对照组。结论:引导式教育训练是一种重要的低视力康复训练方法,可以明显提高患者的生活质量。
Objective: To investigate the effect of conductive education training on the quality of life in visually impaired students. Methods: It was a prospective randomized controlled trial. The visual impairment students who had registered in Quanzhou Special Education School in 2020 were selected and randomly divided into two groups: conductive education training group and control group. The conductive education training group received conductive education training, while the control group received routine rehabilitation training. Chinese version low vision quality of life questionnaire (CLVQOL) was used to assess the quality of life of low vision students at baseline and 3 months after training, and comparative analysis was conducted. Results: All 72 students with visual impairment completed CLVQOL surveys. At baseline, there was no significant difference in total CLVQOL scores between groups. After 3 months, overall CLVQOL scores increased in both groups, from baseline 59 (48.5, 80.5) to 105 (97.5, 119.5) in the conductive education group (Z=-4.781, P<0.001), and 69 (56, 85) to 106 (80, 112) in the control group (Z=-4.438, P<0.001). The total score of CLVQOL (P=0.021), reading and fine work subscale (P=0.004), and daily activities subscale (P<0.003) in the conductive education training group were higher than those in the control group. Conclusion: Conductive education training is an important method of low vision rehabilitation training, which can significantly improve the quality of life of patients.
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++),眼眶鼻侧可触及约黄豆大小硬结,界不清,质地中等,压痛(?),伴上睑下垂,遮盖角膜下缘。双眼眼位正,左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀,考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor,IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例,提示早期规范治疗是降低此病复发率的关键,尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
局部点药是眼部用药最常见的方式,但一般药物通过角膜困难,药物生物利用度低。纳米载体药物于8 0年代开始用于眼部,脂质体和类脂质囊泡(niosomes)与眼表的黏蛋白相互作用,延长药物在眼表的停留时间。纳米乳剂(nanoemulsion)的表面活性剂可以松解角膜上皮细胞紧密连接,形成转运开口,抑制细胞表面糖蛋白酶P(glycoprotein P,Pgp)降解药物活性蛋白。纳米粒子(nanoparticles)通过角膜上皮和结膜上皮而不会引起毒性。纳米胶囊(nanocapsules)更深地内化到角膜上皮(50 μm处)。聚合物胶束(polymeric micelles)自组装成核-壳纳米载体增强药物渗透角膜的能力。阴离子高代聚酰氨基胺(poly-amidoamine,PAMAM)树枝状大分子增强药物通透性,中性和阳离子低代树枝状大分子通过网格蛋白途径介导药物更高的通透性。纳米晶体(nanocrystal),除增强药物溶解度和溶解速率之外,它的高黏附能力帮助药物保留和渗透到眼组织中。纳米结构材料与干眼关联密切,为干眼的治疗、诊断提供手段。
Topical administration is the most common method of ocular medication, but it is generally difficult for the drug to pass through the cornea, and the bioavailability of the drug is low. Nanocarrier drugs were used in eyes in the 1980s, and liposomes and lipoids vesicles (Niosomes) interacted with ocular surface mucins to prolong the residence time of the drug on the ocular surface. Nanoemulsion surfactants can release the tight junctions of corneal epithelial cells, form transport openings, and inhibit the degradation of pharmaceutically active proteins by cell surface glycoprotein P (Pgp). Nanoparticles pass through the corneal and conjunctival epithelium without causing toxicity. Nanocapsules internalize deeper into the corneal epithelium (at 50 μm). Polymeric micelles self-assemble into core-shell nanocarriers to enhance the ability of drugs to penetrate the cornea. Anionic high-generation poly-amidoamine (PAMAM) dendrimers enhance drug permeability. Neutral and cationic low-generation dendrimers mediate higher drug permeability through clathrin pathway. Nanocrystal, in addition to enhancing drug solubility and dissolution rate, its high adhesion ability helps drug retention and penetration into ocular tissues. Nanostructured materials are closely related to dry eye and provide a choice for the treatment and diagnosis of dry eye.