目的：探讨以岗位需求为导向的培训模式在眼科手术室护士上岗前消毒供应专科专项培训中的应用效果。方法：手术室上岗前护士共44名，按随机分配原则，其中23名为实验组，另外21名为对照组。实验组以医院消毒供应中心三大行业标准和医院消毒技术规范为理论依据，以手术室护理岗位需求为目标，制定针对性培训内容，采用多方式培训方法，在消毒供应中心培训3个月考核合格后调入手术室。对照组直接调入手术室工作。采用手术室带教老师对新上岗护士满意度调查作为评价指标。结果：23名学员的理论知识考核、技术操作考核全部合格，小讲课顺利完成。手术室带教老师对实验组的满意度明显高于对照组。结论：建立以岗位需求为导向的眼科手术室护士消毒供应专科培训模式，有助于提高新上岗的手术室护士工作适应性，并提升手术室护士对专科器械的管理能力。
Objective: To explore the application effect of job demand-oriented training model in specialized training of sterile supplying for nurses in the ophthalmic operation room. Methods: A total of 44 nurses who would work in the operating room were randomly divided into the experimental group (n=23) and control group (n=21). Based on the three industrial standards of Central Sterile Supply Department (CSSD) and the technical specifications of disinfection in hospital, and targeting the job requirements of operating room nursing, the experimental group formulates specific training contents and adopts various training methods. The experimental group was transferred to the operating room after being trained in CSSD for 3 months and passing the examination. The control group was transferred directly to the operating room. The degree of satisfaction from the teachers of operating room to new nurses was used as the evaluation index. Results: All the 23 students passed the examination of theoretical knowledge and technical operation, and the small lectures were completed successfully. The degree of satisfaction from teachers in operating room to trainees was obviously higher than that of untrained nurses. Conclusion: The establishment of job demand-oriented training model in specialized training of sterile supplying for nurses in ophthalmic operation room is helpful to improve the work adaptability of the newly-hired nurses in the operation room. It also helps the nurses in the operation room to enhance the management ability on the specialized instruments.
角膜病是眼科常见疾病，治疗主要以病因治疗为主。角膜疾病治疗不及时会发展为角膜云翳、角膜斑翳、角膜白斑甚至丧失视力。本例患者主要是一例因外伤形成角膜白斑致使视力低下，于三峡大学附属仁和医院行自体穿透性角膜移植(autologous penetrating keratoplasty，APK)的特殊病例。
Keratoconus is a common disease in ophthalmology and treatment is mainly based on etiology. Untreated corneal diseases can develop into corneal clouding, corneal macula, corneal leukoplakia or even loss of vision. This is a special case of a patient who underwent autologous penetrating keratoplasty (APK) in our hospital for low vision due to traumatic formation of corneal leukoplakia.
抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗视网膜静脉阻塞(retinal vein occlusion，RVO)继发黄斑水肿(macular edema，ME)的有效性及安全性已得到广泛证实。但抗VEGF治疗方案尚无统一标准。现行的治疗方案主要包括固定治疗方案、按需(pro re nata，PRN)治疗方案、稳定性标准驱使的按需(stabilization criteria-driven PRN)治疗方案、治疗与延长(treat and extend，T&E)方案。近年来不少研究综合比较了各个治疗方案在改善视功能、量化评估疾病活动性、调整随访频率等多个维度的表现，为临床医生提供选择抗VEGF治疗方案的参考依据。本文旨在回顾并总结近年来对抗VEGF药物治疗RVO继发ME的研究，阐述抗VEGF治疗方案的研究进展。
The efficacy and safety of anti-vascular endothelial growth factor (VEGF) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) have been widely confirmed. However, there is no unified standard for anti-VEGF treatment regimens. Current treatment regimens mainly include fixed treatment regimen, pro re nata (PRN) treatment regimen, stabilization criteria-driven PRN treatment regimen, and treat and extend (T&E) regimen. In recent years, many studies have compared different treatment regimens in composite dimensions,including improving visual function, assessing disease activity quantitatively and adjusting the follow-up frequency,to provide clinicians with a reference of choosing anti-VEGF treatment regimens. The purpose of this article is to review and summarize recent researches on anti-VEGF drugs in the treatment of ME secondary to RVO, and to clarify the research progress in the anti-VEGF treatment regimens.
暴露性角膜炎是角膜失去眼睑保护而暴露在空气中，引起角膜干燥、上皮细胞脱落进而继发感染的角膜炎症，多见于眼睑缺损、眼球突出、睑外翻、面神经麻痹、手术麻醉等。泪液的缺失、眼睑闭合不全、眼表暴露等因素皆会影响角膜健康，使其处于炎症、溃疡及穿孔的危险中。暴露性角膜炎治疗目的是去除暴露因素、保护角膜上皮和维持眼表湿润，目前常用的治疗手段有手术治疗与药物治疗，有些是暂时性的，有些是永久性的。
Exposure keratitis is an inflammation of the cornea that occurs when the cornea loses the protection of the eyelid and is exposed to air, resulting in dryness, epithelial exfoliation, and secondary infection. Most of them are found in eyelid defect, protopsis, eyelid ectropion, facial palsy, and anesthesia. Loss of tears, lagophthalmos and exposed ocular surface all affect the health of the cornea, putting it at risk of inflammation, ulceration, and perforation. The purpose of treatment is to remove exposure factors, protect the corneal epithelium and keep ocular surface moist.Currently, the commonly used treatments are surgical treatment and medical treatment, and some of them are temporary while others are permanent.
角膜神经性疼痛(neuropathic corneal pain，NCP)的患者具有眼部及躯体症状，但临床体征不典型，治疗效果不理想。随着干眼诊治的规范化程度不断提升，NCP的患者日益增多。NCP与全身慢性疼痛综合征相互交织。角膜共聚焦显微镜及活体印迹细胞检测可以发现特征性神经形态及相关蛋白改变。NCP的治疗应基于个体化、多学科联合的原则。本文综述近年来，NCP的病因学、病理生理学、综合治疗等取得新的进展以指导临床及转化医学研究。
Patients with neuropathic corneal pain (NCP) have local and physical symptoms, but the clinical signs are atypical,and the treatment is not effect. With the improvement of standardization of diagnosis and treatment of dry eye, the number of patients with NCP has been increasing. The NCP is intertwined with systemic chronic pain syndrome.Corneal confocal microscope and in vivo blot cytology can find the signs of morphology and associated proteins variation. The treatments of NCP should be based on the principle of individualized, multidisciplinary treatment (MDT). This article reviews recent advances in the etiology, pathogenesis, and comprehensive treatment of NCP to guide clinical translational medicine research.
目的：探讨品管圈在提高玻璃体切除术后患者俯卧位执行率中的应用效果。方法：成立品管圈活动小组，选定提高玻璃体切除术后患者俯卧位执行率作为活动主题，运用品管圈工具和方法，对现状进行分析，找出影响因素，制定相应的措施并组织实施，比较品管圈活动前后玻璃体切除术后患者俯卧位执行率情况。结果：玻璃体切除术后患者俯卧位执行率由活动前的64.70%提高到95.83%。结论：运用品管圈能显著提高玻璃体切除术后患者俯卧位执行率，值得临床推广。
Objective: To explore the effect of quality control circle on improving the prone position execution rate of patients after vitrectomy. Methods: Establish quality control circle activity group, select improving the prone position execution rate of patients after vitrectomy as the activity theme, use quality control circle tools and methods to analyze the status quo, find out the influencing factors, formulate corresponding measures and implement them, and compare the prone position execution rate of patients before and after quality control circle activity. Results: The prone position execution rate of patients after vitrectomy increased from 64.70% to 95.83%.Conclusion: The application of quality control circle can significantly improve the prone position implementation rate of patients after vitrectomy, which is worthy of clinical promotion.
目的：分析玻璃体腔注射术后眼内炎的发生并总结原因，旨在进一步提高手术安全性。方法：回顾性分析中国人民解放军总医院第六医学中心2010年9月至2019年11月行玻璃体腔注射术的421例患者(973眼)的术后1 d、1周、1个月的随访资料。归纳注射药物种类、注射病因、患者全身病史，总结术后眼内炎的发生及治疗情况。结果：玻璃体腔注射术安全性高，但严重并发症眼内炎(0.41%)仍偶有发生。4例眼内炎患者中2例为Irvine-Gass综合征患者行曲安奈德玻璃体腔注射后，1例为视网膜中央静脉阻塞患者行曲安奈德玻璃体腔注射后，1例为中心性渗出性视网膜脉络膜病变患者行雷珠单抗玻璃体腔注射后。其中曲安奈德引起的眼内炎(1.99%)明显高于抗血管内皮生长因子(vascular endothelial growth factor，VEGF)药物引起的眼内炎(0.12%)。结论：严格按照操作指南操作，当针对高血压老年群体尤其是Irvine-Gass综合征患者玻璃体腔注射曲安奈德时尤其防范眼内炎的发生。
Objective: To analyze the incidence and causes of endophthalmitis after intravitreal injection and to further improve the safety of the surgery. Methods: The follow-up data of 973 eyes of 421 patients who received intravitreal injection in our hospital in the past 9 years at 1 day, 1 week and 1 month were retrospectively analyzed.The types of injected drugs, the cause of injection and systemic history were summarized, and the occurrence and treatment of postoperative endophthalmitis were summarized. Results: The intravitreal injections were safe.However, the severe complication of endophthalmitis (0.41%) occurred occasionally. Among these 4 patients with endophthalmitis, 2 patients were intravitreal injected triamcinolone acetonide because of Irvine-Gass syndrome;1 patient accepted intravitreal injection by Ranibizumab because of central retinal vein occlusion; 1 patient accepted intravitreal injection by Ranibizumab because of central exudative chorioretinopathy. The incidence of endophthalmitis (1.99%) after intravitreal injection of triamcinolone acetonide was higher than that of anti-vascular endothelial growth factor (VEGF) agents (0.12%). Conclusion: The clinical operating guideline of intravitreal injection should be followed strictly. Furthermore, the elderly people with hypertension diagnosed of Irvine-Gass syndrome have a higher risk of endophthalmitis after intravitreal injection of triamcinolone acetonide than others and should be paid more important attention.
目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)扫描信号强度对视盘周围血管密度的影响。方法：本研究为单中心横断面研究，所有受试者分别接受了身高、体重、血压、眼压、眼轴及视盘OCTA检查，利用广义估计方程分析OCTA扫描信号强度对视盘周围血管密度的影响。结果：共186人359眼纳入本研究，年龄为(47.86±17.86)岁，视盘周围血管密度为(17.75±1.99)mm?1 。单因素分析显示视盘周围血管密度与眼轴呈负相关(β=?0.5120，P<0.001)，与扫描信号强度呈正相关(β=1.0240，P<0.001)。在校正了年龄、性别、视盘面积及眼轴后的多因素分析中，OCTA扫描信号强度依然与视盘周围血管密度显著正相关(β=0.9721，P<0.001)。结论：视盘周围血管密度不仅与眼轴和视盘面积显著负相关，而且与OCTA扫描信号强度显著正相关，在临床应用或研究中，需要考虑其影响。
Objective: To explore the effect of scanning signal intensity on the peripapillary vessel density measured by optical coherence tomography angiography (OCTA). Methods: This study was a single-center cross-sectional study. All the participants received comprehensive examinations including height, weight, blood pressure,intraocular pressure, axial length, and OCTA scan of the optic disc. The effect of OCTA scanning signal intensity on the peripapillary vessel density was analyzed using the generalized estimation equation. Results: A total of 186 participants with 359 eyes were included in this study. The mean age of all the participants was (47.86±17.86)years old, and the average peripapillary vessel density was (17.75±1.99)mm?1. In a univariate analysis,peripapillary vessel density was associated with the axial length (β=?0.5120, P<0.001) and the scanning signal intensity (β=1.0240, P<0.001). After adjusting for age, gender, axial length, and optic disc area in the multivariate analysis, the OCTA scanning signal intensity was still significantly associated with the peripapillary vessel density (β=0.9721, P<0.001). Conclusion: The peripapillary vessel density is significantly negatively associated with the axial length and optic disc area, significantly positively associated with the scanning signal intensity. In clinical practice, the influence needs to be considered.
目的：观察并分析不同类型黄斑裂孔的患病相关影响因素。方法：回顾性分析2012年1月 至2018年12月在兰州大学第二医院住院治疗的1 150例(1 202只眼)全层黄斑裂孔患者的年龄、性别、民族、最佳矫正视力、黄斑裂孔类型以及是否继发孔源性视网膜脱离等临床资料。结果：黄斑裂孔患病人数随年龄增长呈趋势性分布，60~69岁年龄段患病人数最多；男女患病差异有统计学意义(P<0.05)，眼别差异无统计学意义(P>0.05)；特发性黄斑裂孔继发孔源性视网膜脱离的占比明显低于其他类型；特发性黄斑裂孔的入院最佳矫正视力较高，与高度近视黄斑裂孔相比，差异有统计学意义(P<0.05)。结论：黄斑裂孔多发于老年人，女性多见，高度近视黄斑裂孔容易继发孔源性视网膜脱离，可考虑尽早安排手术治疗；外伤性黄斑裂孔好发于中青年男性，常见于眼球钝挫伤，若未引发视网膜脱离等并发症，应适当观察而不急于手术。每1例黄斑裂孔都可能有其特殊性，需要认真分析病情综合判断，酌情选择观察或手术。
Objective: To observe and analyze the disease related factors of different types of macular hole. Methods: Clinical data including age, sex, ethnicity, best corrected visual acuity, macular hole type and whether accompanied by rhegmatogenous retinal detachment were retrospectively analyzed in 1 150 patients (1 202 eyes) hospitalized in our hospital from January 2012 to December 2018. Results: The number of patients with macular hole increased with age. There was statistically significant difference between male and female patients (P<0.05), and no statistically significant difference between eyes (P>0.05). The rate of rhegmatogenous retinal detachment caused by idiopathic macular hole was significantly lower than other types. The optimal corrected visual acuity of idiopathic macular hole was higher in admission, which was statistically different from that of high myopia macular hole and ametropia macular hole (P<0.05). Conclusion: Macular hole is more common in the elderly and more common in women. High myopia and ametropia macular hole are easily associated with rhegmatogenous retinal detachment, so surgical treatment should be arranged as soon as possible. Traumatic macular hole often occurs in young and middle-aged men and is often seen in blunt contusion of the eyeball. Each case of macular hole may have its particularity, which requires careful analysis of the condition, comprehensive analysis, and appropriate choice of observation or surgery.
目的：应用生物信息学方法分析视网膜母细胞瘤(retinoblastoma，RB)基因表达谱芯片，从转录水平探讨RB与正常视网膜组织的差异表达基因(differentially expressed genes，DEGs)的功能及相互作用。方法：通过公共基因表达数据库(gene expression omnibus，GEO)数据库中选取GSE97508和GSE110811两个芯片数据，共有34个RB组织和6个正常视网膜组织。利用GEO2R工具对和Draw Venn Diagrams软件，筛选出正常视网膜组织与RB组织间的DEGs。通过在线STRING检索工具(search tool for the retrieval of interacting genes，STRING)，对DEGs进行基因本体注释(gene ontology，GO)、KEGG富集通路分析、蛋白互作(protein-protein interaction，PPI)K分析。结果：在2个芯片中发现视网膜母细胞瘤共有20个DEGs，包括3个上调DEGs和17个下调DEGs，GO本体注释结果显示表达上调DEGs所富集的功能主要在细胞分裂、染色体浓缩、核分裂和DNA构象改变。下调DEGs主要富集在光传导、视觉感知、光感受器细胞修复、感光细胞内外节和调节视紫红质介导的信号通路等。KEGG通路显示上调DEGs没有显著的信号通路，下调DEGs参与光传导信号通路，其中包括CNGA1，CNGB1，RHO，SAG四个基因，通过PPI网络提示这4个基因相互联系，并发现与其他节点连接最紧密核心基因RHO。结论：利用生物信息学方法能有效对RB基因芯片数据进行挖掘，为进一步研究RB发生发展机制及寻找潜在的药物治疗靶点提供参考。
Objective: To find differentially expressed genes between retinoblastoma and normal retinal tissues by bioinformatics analysis, and to investigate their molecular function and interactions in the transcriptional level.Methods: The gene expression profile datasets GSE97508 and GSE110811, including 34 retinoblastoma (RB) tissues and 6 normal retinal tissues, were downloaded from gene expression omnibus (GEO). Differentially expressed genes (DEGs) between normal retinal tissues and RB tissues were identified by GEO2R tool and the Draw Venn Diagrams software. The gene ontology (GO) analysis, KEGG pathway and protein-protein interaction (PPI) were analyzed by STRING. Results: In two microarrays of retinoblastoma we found total 20 DEGs were identified, including 3 up-regulated and 17 down-regulated genes. The GO ontology annotation results showed that the enrichment functions of up-regulated genes were mainly in cell division, chromosome enrichment, nuclear division, and DNA conformation change. Down-regulated genes were mainly concentrated in light conduction,visual perception, photoreceptor cell repair, photoreceptor cell inner and outer segment, and regulation of rhodopsin mediated signaling pathway. The KEGG pathway showed that there was no significant signal pathway in which up-regulated genes up-regulated DEGs, and down-regulated genes were involved in the phototransduction signaling pathway, including four genes of CNGA1, CNGB1, RHO and SAG. PPI network suggested that these four genes were interlinked, and RHO was found to be the most closely connected core gene with other nodes.Conclusion: Bioinformatics can be used effectively to analyze RB microarray data to provide theoretical reference for further exploration of tumorigenesis mechanism and help search for potential drug therapeutic targets.
