Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） wit...Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） with fair MH closure rates as well as gains in visual acuity.In the current study,longitudinal changes in multi-focal electroretinogram （mfERG） responses,best-corrected visual acuity （BCVA） and spectral-domain optical coherence tomography （SD-OCT） were evaluated in eyes with large MHs managed by this technique.Methods：A prospective noncontrolled interventional study of eight patients （eight eyes） with large MHs （minimum diameter 〉400 μm） was conducted.All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique.SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results：All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure.Partial microstructural reconstruction,demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone,was observed in all cases as early as 1 month after surgery.Functionally,as compared to baseline,all patients showed improvements in BCVA and all but one in mfERG response during follow-up.However,Pearson＇s test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions：Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results.Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response,of which the latter might be a supplement for the former in postoperative functional follow-up.展开更多
Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT an...Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.展开更多
Atomic layers of hexagonal boron nitride(h-BN)crystal are excellent candidates for structural materials as enabling ultrathin,two-dimensional(2D)nanoelectromechanical systems(NEMS)due to the outstanding mechanical pro...Atomic layers of hexagonal boron nitride(h-BN)crystal are excellent candidates for structural materials as enabling ultrathin,two-dimensional(2D)nanoelectromechanical systems(NEMS)due to the outstanding mechanical properties and very wide bandgap(5.9 eV)of h-BN.In this work,we report the experimental demonstration of h-BN 2D nanomechanical resonators vibrating at high and very high frequencies(from~5 to~70 MHz),and investigations of the elastic properties of h-BN by measuring the multimode resonant behavior of these devices.First,we demonstrate a dry-transferred doubly clamped h-BN membrane with~6.7 nm thickness,the thinnest h-BN resonator known to date.In addition,we fabricate circular drumhead h-BN resonators with thicknesses ranging from~9 to 292 nm,from which we measure up to eight resonance modes in the range of~18 to 35 MHz.Combining measurements and modeling of the rich multimode resonances,we resolve h-BN’s elastic behavior,including the transition from membrane to disk regime,with built-in tension ranging from 0.02 to 2 N m−1.The Young’s modulus of h-BN is determined to be EY≈392 GPa from the measured resonances.The ultrasensitive measurements further reveal subtle structural characteristics and mechanical properties of the suspended h-BN diaphragms,including anisotropic built-in tension and bulging,thus suggesting guidelines on how these effects can be exploited for engineering multimode resonant functions in 2D NEMS transducers.展开更多
目的探索品管圈(quality control circle,QCC)活动在肠造口术前造口定位中的作用。方法 2016年3-8月,第二军医大学长海医院肛肠外科病区成立QCC小组,按照QCC理论进行主题选定、活动计划、现状把握、要因分析、对策拟定与实施等共10个步...目的探索品管圈(quality control circle,QCC)活动在肠造口术前造口定位中的作用。方法 2016年3-8月,第二军医大学长海医院肛肠外科病区成立QCC小组,按照QCC理论进行主题选定、活动计划、现状把握、要因分析、对策拟定与实施等共10个步骤逐项进行活动。结果肠造口术前造口定位准确率由QCC活动实施前的61.90%上升至实施后的95.65%(P<0.05);造口相关并发症由实施前的45.24%下降至实施后的28.26%(P<0.05);通过QCC活动,圈员在QCC的步骤运用、团队精神、专业能力、沟通协调、信心提升和责任荣誉等6个方面的能力均有所提高,差异均有统计学意义(均P<0.05)。结论 QCC活动能够提高肠造口术前造口定位的准确率,有效降低肠造口并发症的发生率。展开更多
文摘Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） with fair MH closure rates as well as gains in visual acuity.In the current study,longitudinal changes in multi-focal electroretinogram （mfERG） responses,best-corrected visual acuity （BCVA） and spectral-domain optical coherence tomography （SD-OCT） were evaluated in eyes with large MHs managed by this technique.Methods：A prospective noncontrolled interventional study of eight patients （eight eyes） with large MHs （minimum diameter 〉400 μm） was conducted.All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique.SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results：All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure.Partial microstructural reconstruction,demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone,was observed in all cases as early as 1 month after surgery.Functionally,as compared to baseline,all patients showed improvements in BCVA and all but one in mfERG response during follow-up.However,Pearson＇s test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions：Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results.Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response,of which the latter might be a supplement for the former in postoperative functional follow-up.
文摘Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.
基金We are grateful for support from the National Academy of Engineering(NAE)Grainger Foundation Frontier of Engineering(FOE)Award(FOE2013-005)the National Science Foundation CAREER Award(Grant ECCS-1454570)partial support from the Department of Energy(DOE)EERE Award(Grant DE-EE0006719),a ThinkEnergy Fellowship(X.-Q.Zheng),and the Case School of Engineering.A portion of the device fabrication was performed at the Cornell NanoScale Science and Technology Facility(CNF),a member of the National Nanotechnology Infrastructure Network(NNIN)supported by the National Science Foundation(Grant ECCS-0335765).
文摘Atomic layers of hexagonal boron nitride(h-BN)crystal are excellent candidates for structural materials as enabling ultrathin,two-dimensional(2D)nanoelectromechanical systems(NEMS)due to the outstanding mechanical properties and very wide bandgap(5.9 eV)of h-BN.In this work,we report the experimental demonstration of h-BN 2D nanomechanical resonators vibrating at high and very high frequencies(from~5 to~70 MHz),and investigations of the elastic properties of h-BN by measuring the multimode resonant behavior of these devices.First,we demonstrate a dry-transferred doubly clamped h-BN membrane with~6.7 nm thickness,the thinnest h-BN resonator known to date.In addition,we fabricate circular drumhead h-BN resonators with thicknesses ranging from~9 to 292 nm,from which we measure up to eight resonance modes in the range of~18 to 35 MHz.Combining measurements and modeling of the rich multimode resonances,we resolve h-BN’s elastic behavior,including the transition from membrane to disk regime,with built-in tension ranging from 0.02 to 2 N m−1.The Young’s modulus of h-BN is determined to be EY≈392 GPa from the measured resonances.The ultrasensitive measurements further reveal subtle structural characteristics and mechanical properties of the suspended h-BN diaphragms,including anisotropic built-in tension and bulging,thus suggesting guidelines on how these effects can be exploited for engineering multimode resonant functions in 2D NEMS transducers.
文摘目的探索品管圈(quality control circle,QCC)活动在肠造口术前造口定位中的作用。方法 2016年3-8月,第二军医大学长海医院肛肠外科病区成立QCC小组,按照QCC理论进行主题选定、活动计划、现状把握、要因分析、对策拟定与实施等共10个步骤逐项进行活动。结果肠造口术前造口定位准确率由QCC活动实施前的61.90%上升至实施后的95.65%(P<0.05);造口相关并发症由实施前的45.24%下降至实施后的28.26%(P<0.05);通过QCC活动,圈员在QCC的步骤运用、团队精神、专业能力、沟通协调、信心提升和责任荣誉等6个方面的能力均有所提高,差异均有统计学意义(均P<0.05)。结论 QCC活动能够提高肠造口术前造口定位的准确率,有效降低肠造口并发症的发生率。
