LASEK术中弃留角膜上皮瓣对高度近视疗效的影响

目的:对比研究LASEK术中弃留上皮瓣治疗高度近视的手术疗效。方法:回顾性分析高度近视患者58例115眼,根据手术方式分为,LASEK留瓣组30例59眼,LASEK弃瓣组28例56眼。观察两组患者术后疼痛感、裸眼视力、角膜haze、上皮愈合时间。结果:留瓣组和弃瓣组术后1d疼痛积分分别为1.64±0.64、1.57±0.57分,术后2d为0.83±0.49、0.84±0.56分,术后3d为0.36±0.48、0.34±0.47分;两组不同时间疼痛积分无差异(P>0.05)。留瓣组和弃瓣组术后1wk裸眼视力分别为0.15±0.06、0.12±0.05,术后1mo时为0.032±0.004、0.041±0.003,术后3mo时为0.018±0.004、0.022±0.005;两组不同时间裸眼视力无差异(P>0.05)。术后1、3mo,角膜haze 0.5~1级发生率差异均无统计学意义(P>0.05);角膜2级haze发生率差异均有统计学意义(P<0.05);留瓣组和弃瓣组上皮愈合时间分别为4.22±0.30、3.89±0.32d(P<0.05)。两组患者上皮延迟愈合数分别为0眼、6例10眼(P<0.05)。结论:留瓣与弃瓣术后裸眼视力恢复无明显差异,角膜刺激症状相似。弃瓣组上皮愈合较快,但弃瓣组角膜haze 2级发生率稍高,上皮延迟愈合和愈合不良较多。因此,对于高度近视行LASEK手术时建议留瓣。

SMILE治疗大散光2a的疗效观察

目的:观察小切口基质内透镜取出术(small incision lenticule extraction,SMILE)治疗大散光患者的2a临床疗效。方法:回顾性分析在我院手术的大散光患者17例33眼,年龄18～36岁,其中散光-3.50～-4.00D者12例24眼,散光-4.25～-5.00D 5例9眼;合并球镜+1.00～0D者4例7眼,合并-1.00～0D者13例26眼。采用小切口基质内透镜取出术,手术切口长度为2mm,位于120°,角膜帽的厚度均为120μm,透镜直径6.6～6.8 mm,帽直径为7.3～7.5 mm。观察时间点为术后1 d,1 wk,1、3、6 mo,1、2 a。分别观察术后裸眼视力、术后等效球镜、残余残光度数、角膜地形图SimK平均值及SimK值的差值。结果:与术前裸眼视力相比,术后1d裸眼视力差异有统计学意义(P<0.05),与术后1wk裸眼视力相比,术后1、3、6mo,1、2a差异均无统计学意义(P>0.05)。裸眼视力均无增加或减少两行及以上,目标屈光度为+0.25D。与术后1d相比,术后各时间点等效球镜及残余散光差异均无统计学意义(P>0.05)。术后各时间点SimK等效值、SimK差值差异无统计学意义(P>0.05)。结论:远期观察SMILE治疗大散光均安全有效,稳定性及可预期高,术后2a角膜形态良好,值得临床应用。

Sarcopenia in geriatric patients from the plateau region of Qinghai- Tibet: A cross-sectional study

BACKGROUND Sarcopenia is an age-related decline in skeletal muscle mass,which depends on an assessment of muscle strength and muscle mass.It has been reported that the prevalence of sarcopenia in non-hospitalized elderly people was 9.0%-18.5%in the lowland plains.However,epidemiological investigations of sarcopenia in plateau regions are limited.The city of Xining in Qinghai Province(altitude 2260 m)is the sole point of access to the Qinghai-Tibet plateau.We hypothesized that the diverse ethnicities or dietary habits of the people living in the plateau may influence the prevalence of sarcopenia.AIM To investigate the prevalence and risk factors of sarcopenia in geriatric patients from the Qinghai-Tibet plateau region.METHODS From October to December 2018,150 hospitalized geriatric patients(72.4±5.60 years)from Xining City(altitude 2260 m)in Qinghai Province were recruited.Collected data included demographics,history of fall,nutritional status,self-care ability,depression,handgrip,muscle mass,and 6-m gait speed.Sarcopenia was diagnosed based on the 2014 criteria of the Asian Working Group for Sarcopenia.RESULTS The overall rate of sarcopenia was 20%(8.7 and 11.3%in men and women,respectively).Binary logistic regression analysis indicated that widowhood and a history of falling were associated with sarcopenia,while higher body mass index and beef and mutton consumption were protective.CONCLUSION The prevalence of sarcopenia in hospitalized geriatric patients in the Qinghai-Tibet plateau region was higher than that in the plain region and in non-hospitalized geriatric people(reported elsewhere).Specific cultural features of the region,including ethnicity,brewed tea and ghee consumption,were not significantly associated with sarcopenia.Higher body mass index and consumption of beef and mutton were protective,while patients who were widowed or with a history of falling were at increased risk.

Health care worker occupational experiences during the COVID-19 outbreak:A cross-sectional study

BACKGROUND Health care workers treating coronavirus disease 2019(COVID-19)patients experience burnout and stress due to overwork and poor working conditions.AIM To investigate the work experiences of frontline health care workers in Wuhan city and Qinghai province,China,during the COVID-19 outbreak.METHODS In this cross-sectional descriptive study,a self-reported questionnaire was designed to evaluate work experiences of medical staff throughout the course of the COVID-19 pandemic.A total of 178 health care workers responded to the questionnaire between February 19 and 29,2020.Higher questionnaire dimensional score confirmed dimensional advantage.RESULTS Of all dimensions evaluated by this questionnaire,the occupational value dimension had the highest mean score of 2.61(0.59),followed by the support/security dimension score of 2.30(0.74).Occupational protection scored lowest at 1.44(0.75),followed by work environment at 1.97(0.81).The social relationships dimension had an intermediate score of 2.06(0.80).Significant differences in working conditions were observed across hospital departments,with the fever ward scoring lowest.Total scores also differed significantly across workplaces;the fever outpatient department scored lowest(P<0.01).This phenomenon was likely due to the fact that work in the fever outpatient department,where many patients present to hospital,necessitates constant contact with a large number of individuals with insufficient provision of resources(such as protective equipment and social support).Medical workers in the fever outpatient department were burdened with a fear of COVID-19 infection and a lower sense of professional value as compared to workers in other hospital departments.Medical staff in Wuhan worked longer hours(P<0.01)as compared to elsewhere.The mean support/security dimension score was higher for tertiary hospital as compared to secondary hospital medical staff as well as for Wuhan area as compared to Qinghai region staff(P<0.01).Staff in Wuhan had a lower mean work environment score as compared to staff in Qinghai(P<0.05).CONCLUSION Medical staff treating COVID-19 patients in China report poor occupational experiences strongly affected by work environment,occupational protection and social relationships.Health care managers must address the occupational needs of medical staff by ensuring a supportive and safe work environment.

Comparison of the prevalence of sarcopenia in geriatric patients in Xining based on three different diagnostic criteria

BACKGROUND Sarcopenia is an age-related decline in skeletal muscle mass,which depends on an assessment of muscle strength and muscle mass.The diagnostic definition of sarcopenia varies by region.AIM To determine the optimal diagnostic criteria for sarcopenia in a plateau population.Cut off values for the components of diagnostic algorithms for sarcopenia in plateau populations should consider altitude.METHODS One hundred and fifty subjects aged>60 years attending a tertiary comprehensive hospital in the city of Xining(elevation:2260 m)between October and December 2018 were enrolled.Handgrip strength,muscle mass,and physical performance were measured.Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia(AWGS)2019 criteria,Beijing criteria,and Lasha criteria.RESULTS Across diagnostic criteria,there were significant differences in the prevalence of sarcopenia in the overall population and stratified by gender.The prevalence of sarcopenia measured by the AWGS 2019 or Lasha criteria was significantly higher in female compared to male subjects.In males,the prevalence of sarcopenia measured by the Beijing criteria was significantly higher in subjects who identified as Han compared to Minority.In females,there were no significant differences in the prevalence of sarcopenia by ethnicity according to any criteria.CONCLUSION The Lasha criteria provided a lower prevalence of sarcopenia(males,8.7%;females,22.41%;overall,14%)and were able to differentiate between males and females.The Lasha criteria are likely most appropriate for detection of sarcopenia in this plateau population.We recommend the Lasha criteria for detection of sarcopenia in Xining.

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.