[Management strategy of femoral artery pseudoaneurysm combined with infectious wounds]

Objective: To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects. Methods: The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery. Results: The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence. Conclusions: Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

[Clinical features of 19 cases of lower respiratory papillomatosis]

Objective: To explore the clinical characteristics and prognosis of lower respiratory papilloma(LRP)and therefore to improve clinical diagnosis and treatment. Methods: We performed a retrospective analysis of patients who were diagnosed with LRP in our department from October 2008 to October 2020. Results: Nineteen patients were enrolled and 12 were male and 7 were female. The average age of the 7 adult patients was (41.3±17.5)years and that of the 12 pediatric patients was (5.5±3.5)years. Ten (83.3%)of the pediatric patients showed disease onset at an age of less than 5 years. The main symptoms were cough and sputum production (13/19), dyspnea (15/19), hoarseness (10/19) and signs of stridor or wheezing (7/19). Chest CT examination was performed in 9 patients, which showed nodules or masses (9/9), cystic thin-walled cavity (4/9), obstructive pneumonia (2/9), atelectasis (2/9), and spicule sign (1/9). The upper respiratory tract was affected in all the pediatric patients (12/12) and 3/7 of the adult patients. Eighteen cases (18/19) were diagnosed by bronchoscopy, 1 (1/9) by thoracoscopy. Eighteen cases (18/19) showed mulberry-like and papillary lesions under bronchoscopy. All the cases were histologically confirmed as squamous cell papilloma, with 17 cases(17/19)showing tissue HPV6/11(+), 2 negative (2/19). The positive rate of HPV6 was 36.8%, ant that of HPV11 was 21.1%, while the double positive rate of HPV6/11 was 31.6%, and HPV16/18 were negative in all the 19 cases. Isolated respiratory papillomatosis was found in 4 cases (4/19), and multiple papillomatosis in 15 cases (15/19). Seventeen cases (17/19) underwent endoscopic interventional therapy, and the result showed that 15 cases relapsed, and 2 cases had no recurrence. One patient was treated with thoracoscopic lobectomy, and died 4 months after surgery. One patient gave up treatment. Conclusions: LRP is a rare clinical disease with a chronic course, and isolated LRP is even rarer. Young patients often suffer from upper respiratory tract involvement, and the main symptoms are cough, sputum production, dyspnea and hoarseness. CT scanning showed nodules and masses, cystic thin-walled cavities or signs of airway obstruction. Bronchoscopy often demonstrates papillary lesions. The diagnosis depends on pathology, with squamous cell papilloma being the most common, and most tests are positive for HPV6/11. It is suggested that the incidence is associated with low-risk HPV infection. Endoscopic resection is the main treatment, which is prone to relapse. The treatment should take into account the pathological changes of upper respiratory tract, and the etiological treatment of HPV should be stressed.

SLC13A4 Might Serve as a Prognostic Biomarker and be Correlated with Immune Infiltration into Head and Neck Squamous Cell Carcinoma

SLC13A4 is a sodium sulfate co-transporter, which is expressed in brains, placentas, thymes and other tissues, plays an essential role in maintaining the metabolic balance of sulfate in vivo. The TCGA database shows that it is differentially expressed in a variety of tumors, but its prognostic value in tumors has not been clarified. TCGA, Oncomine and Timer databases were used to analyze SLC13A4 mRNA expression in cancer tissues and normal tissues, and its correlation with clinical prognosis in head and neck tumor. The CIBERSORT database was used to analyze the correlation between SLC13A4 expression and the infiltration of immune cells. SLC13A4 enrichment analysis was carried out by GSEA. SLC13A4 mRNA levels were significantly lower in head and neck tumors than in paracancer tissues. SLC13A4 expression in Head and neck squamous cell carcinoma (HNSCC) was closely related to tumor pathological grade and clinical stage. Decreased SLC13A4 expression was associated with poor overall survival (OS), progression free survival (PFS), disease specific survival (DSS) and recurrence free survival (RFS) in HNSCC patients. The expression of SLC13A4 was negatively correlated with Monocytes, M1 macrophages, M2 macrophages, resting CD4+ memory T cells, resting NK cells and activated NK cells, but positively correlated with neutrophils, plasma cells, T follicular helper cells, gamma delta T cells, regulatory T cells and naive B cells. In addition, the genes in SLC13A4 low-expression group were mainly concentrated in immunity-related activities, viral diseases, typical tumor pathways and metabolism. The SLC13A4 high expression group was mainly enriched in metabolic pathways. These suggest that SLC13A4 may be a potential prognostic biomarker in HNSC and correlated with immune infiltrates.

Impact of Cardiovascular Diseases on COVID-19: A Systematic Review

In December 2019, pneumonia of unknown cause broke out, and currently more than 150 countries around the world have been affected. Globally, as of 5: 46 pm CET, 6 November 2020, the World Health Organization (WHO) had reported 48 534 508 confirmed cases of COVID-19, including 1 231 017 deaths. The novel coronavirus disease (COVID-19) outbreak, caused by the SARS-CoV-2 virus, is the most important medical challenge in decades. Previous research mainly focused on the exploration of lung changes. However, with development of the disease and deepening research, more and more patients showed cardiovascular diseases, even in those without respiratory symptoms, and some researchers have found that underlying cardiovascular diseases increase the risk of infection. Although the related mechanism is not thoroughly studied, based on existing research, we speculate that the interaction between the virus and its receptor, inflammatory factors, various forms of the stress response, hypoxic environment, and drug administration could all induce the development of cardiac adverse events. Interventions to control these pathogenic factors may effectively reduce the occurrence of cardiovascular complications. This review summarizes the latest research on the relationship between COVID-19 and its associated cardiovascular complications, and we also explore possible mechanisms and treatments.

[Efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients]

Objective: To explore the efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients. Methods: From June 2017 to September 2018, the clinical data of 101 patients with chronic wounds who were just discharged from Department of Wound Repair of the Affiliated Hospital of Jiangnan University (hereafter referred to as the author's affiliation) and still needed continuous treatment, meeting the inclusion criteria, were analyzed with the method of retrospective cohort study. Based on the management method of continuous treatment after discharge, the patients were divided into path management group (52 patients, 27 males and 25 females, aged (44±6) years, 57 wounds) and conventional management group (49 patients, 26 males and 23 females, aged (45±6) years, 53 wounds). The patients in path management group were carried out with full-path management under hierarchical medical mode, and the patients in conventional management group were carried out with conventional continuous treatment management. The discharge time from the author's affiliation was the time before continuous treatment management (hereafter referred to as before management), and 12 weeks post discharge was the time after continuous treatment management (hereafter referred to as after management). The depression and anxiety of patients in two groups were assessed by Hamilton Depression Scale 24 item version (HAMD-24) and Self-rating Anxiety Scale (SAS), and the positive ratios of depression and anxiety were calculated. The effective rates of wound treatment, times of debridement and dressing change, and treatment cost during the continuous treatment management period were counted. Data were statistically analyzed with two independent sample t test, chi-square test, Fisher's exact probability test, and Wilcoxon rank-sum test. Results: (1) Before management, the HAMD-24 and SAS scores of patients in two groups were similar. After management, the HAMD-24 and SAS scores of patients in path management group were significantly lower than those of conventional management group (t=4.341, 3.840, P<0.01). Before and after management, the positive rates of depression and anxiety of patients in two groups were similar. (2) After management, the effective rate of wound treatment of patients in path management group was 98.25% (56/57), which was significantly higher than 86.79% (46/53) of conventional management group (χ(2)=5.341, P<0.05). (3) During the management, the times of debridement and dressing change in patients of path management group was 20±4, which was significantly less than 27±7 of conventional management group (t=5.833, P<0.01). (4) During the management, the treatment cost of patients in path management group was (2 479±213) yuan, which was significantly less than (5 215±326) yuan of conventional management group (t=50.185, P<0.01). Conclusions: In the continuous treatment of chronic wound patients, the full-path management under hierarchical medical mode can improve the effective rate of wound treatment, reduce the times of debridement and dressing change and treatment cost, and improve their psychological state.

[Normative application of negative-pressure wound therapy to improve the wound repair level]

In recent 20 years, the technology of negative-pressure wound therapy (NPWT) has been widely used in the field of wound repair. Basic research and clinical application have proved that NPWT plays a positive role in regulating wound repair in many aspects. Compared with the previous 10 years, NPWT has made great progress in the last 10 years in negative pressure materials or equipment, as well as in the use method, mechanism research, and clinical application strategy. Strict and accurate grasp of the clinical application indication of NPWT and scientific application of NPWT to regulate the microenvironment of wound healing, effective improvement of the healing quality of different types of wounds, and further improve the level of wound repair are the core principles of the normative use of NPWT.

Correlation between higher-order aberrations and visual acuity recovery (CoHORT) after spectacles treatment for pediatric refractive amblyopia: A pilot study using iDesign measurement

Purpose

To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children.

Methods

This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined.

Results

We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049).

Conclusions

trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia.

[Pelvic floor function of 5 143 women in early postpartum stage and analysis on the effect factors]

Objective: To describe the situation of early stage of pelvic floor function and investigate the effect factors in postpartum women. Methods: A retrospective survey was conducted, and women who did regular examination and gave birth in Peking University People's Hospital and had an annual pelvic floor examination at 6-12 weeks after delivery from Sep. 2012 to Dec. 2017 were interviewed. General information and pelvic floor electrical physiological indexes were collected and analyzed. Results: Totally 5 143 puerpera were included in the study. The normal strength of type Ⅰ muscle was 52.40% (2 695/5 143) and the normal strength of type Ⅱ muscle was 52.69% (2 710/5 143). The abnormal degree of fatigue of type Ⅰ muscle was 55.84% (2 872/5 143) and the abnormal degree of fatigue of typeⅡmuscle was 27.34% (1 406/5 143). Pelvic floor dynamic pressure was (93±37) cmH(2)O (1 cmH(2)O=0.098 kPa). The incidence of stress urinary incontinence (SUI) was 23.49% (1 208/5 143) after delivery and it was as high as 57.58% (95/165) for women who had family history of pelvic floor dysfunction. Family history of pelvic floor dysfunction was the risk factor of the fatigue index of type Ⅰ and type Ⅱ muscle (P<0.05). The incidence of SUI was associated with vaginal delivery and age (≥30 years old) and family history of pelvic floor dysfunction (P<0.01). Conclusions: Pelvic floor electrical physiological indicators are reduced in about half of women in early postpartum stage. Age (≥30 years old) and vaginal delivery and family history of pelvic floor dysfunction are the risk factors.

A novel bio-based AB2 monomer for preparing hyperbranched polyamides derived from levulinic acid and furfurylamine

A new AB₂ type bio-based monomer (FDA-E) with two amino functional groups and one ester functional group was prepared from renewable levulinic acid and furfurylamine using a three-step reaction.

[Respecting discipline laws and innovating leaping development]

Under the guidance of the predecessors and the efforts of the whole staff, Department of Burns and Plastic Surgery of Wuxi Third People's Hospital has grown into a well-known regional burn diagnosis and treatment center in China after about 30 years of development. Summarizing the experience, gain, and loss in the course of department growth, following and attaching importance to the discipline development law, consolidating the foundation, strengthening the skills, and being diligent in innovation are the most important. The future trend of discipline development is as follows: wound treatment is still fundamental, burn emergency treatment system should be further improved, interdisciplinary and multidisciplinary cooperation should be further strengthened, and basic scientific research should have the potential to transform to reality.

[The clinic experience of implantable diaphragm pacer in a patient with high cervical spinal cord injury and literature review]

Objective: To report the use of implantable diaphragm pacer (IDP) in a patient with high cervical spinal cord injury(HCSCI). Methods: A 14-year-old male patient, who suffered from a HCSCI at C2 neurological level and had been on a ventilator for 2 years, received IDP in August 2017 at China Rehabilitation Research Center. A systematic literature review was performed on IDP in patients with HCSCI in Pubmed, CNKI, and Wanfang databases, using the keywords: phrenic nerve and electrical stimulation and spinal cord injury; IDP and spinal cord injury; breathing pacemaker system and spinal cord injury. All fields were covered from 1970/01/01 to 2018/01/01 in Pubmed, from 1981/01/01 to 2018/01/01 in CNKI, and from 1900/01/01to 2018/01/01 in Wanfang. Results: No spontaneous breathing was observed preoperatively in the patient. The electrical response of phrenic nerves was intact on the right, but unresponsive on the left. We got started with the IDP at 4 weeks after surgery. The threshold voltage of the right hemidiaphragm pacing was 0.1 V and at the level of 0.7 V with an optimal effect. No significant diaphragmatic contraction was found at left side with the extent up till 0.7 V. The maximum tidal volume was 840 ml when electrical stimulation was given at an intensity of 0.7 V bilaterally. The bilateral stimulation voltage at 0.1-0.2 V, pacing frequencies at 9 beats/min in bed, or at 12 beats/min on wheelchair, were set to maintain the tidal volume at the level of (435±32) ml. After 2-week adaptive training, the patient could wean from the ventilator for 12 hours and had a normal blood gas analysis. At 6 week after surgery, with the aid of IDP, the patient could get out in wheelchair for outdoor activities. By literature review, we found 78 English papers, including 6 clinical trials, 10 reviews, and 11 Chinese papers, consisting of 8 reviews, 1 study in animal, and 2 news reports. Extensive contents, such as preoperative evaluation, preoperative preparation, surgical procedures, complications, surgical outcomes, and animal model studies of IDP were involved. The indications of IDP reported by literature were: (1) central alveolar hypoventilation; (2) Sleep apnea syndrome (Biot's respiration); (3) Respiratory failure induced by brainstem injury or disease; (4) Respiratory failure induced by spinal cord injury or disease above C3 level. Conclusion: Our case study confirmed the therapeutic effect of IDP on patients with respiratory failure caused by HCSCI.

[Pharmacokinetics of eight constituents in rat plasma after oral administration of Modified Xiaochaihu Granules for gastric ulcer based on UPLC-MS/MS]

An ultra-performance liquid chromatography-tandem mass spectrometric method (UPLC-MS/MS) was developed in this study to simultaneously determine the contents of eight effective constituents in rat plasma, including baicalin, wogonoside, baicalein, liquiritin, glycyrrhizic acid, berberine hydrochloride, saikosaponin a and saikosaponin d in plasma of gastric ulcer rats, and investigate the pharmacokinetics of Modified Xiaochaihu Granules. Chromatographic separation was conducted on Zorbax SB-C₁₈ column (2.1 mm×100 mm, 1.8 μm) with acetonitrile -0.1% formic acid aqueous solution as the mobile phase for gradient elution, at a flow rate of 0.4 mL·min⁻¹ and column temperature of 40 °C. Detection was performed in the multiple reaction monitoring (MRM) mode with ESI ion source. All calibration curves showed good linearity (r>0.996) over a wide concentration range for all constituents. RSDs of intra-day and inter-day precision were all within 15% and the extraction recoveries of all the constituents were in the range of 81.92% to 104.8%. The time to peak (tmax) of these eight constituents was (2.69±2.02), (5.17±2.04), (0.25±0), (0.83±0.26), (0.92±0.20), (0.92±0.20), (0.58±0.20), and (0.083±0) h, respectively; the half-life (t1/2) of them was (7.85±0.34), (10.16±2.21), (6.79±0.21), (8.32±0.48), (11.05±1.78), (11.56±3.46), (15.30±1.84), and (5.54±1.91) h, respectively; the peak concentration (Cmax) of them was (55.02±1.67), (213.66±4.62), (62.61±0.69), (68.43±1.42), (62.22±0.39), (30.17±1.89), (61.79±4.81), and (38.02±1.75) μg·L⁻¹, respectively. This established method is simple and accurate with good repeatability and strong specificity, which could provide modern experimental basis for modified Xiaochaihu granules in clinical treatment of gastric ulcer.

[Ultrastructure of the lens anterior capsule in secondary cataract associated with uveitis under an electron microscope]

Objective: To observe the ultrastructure of lens epithelium cells in cataract associated with uveitis. Methods: A cross-sectional study. Seven patients(7 eyes) received phacoemulsification in Peking University First Hospital from August 2016 to March 2017 due to complicated cataract associated with uveitis[2 males and 5 females,with an average age of (49±20) years] and 3 patients of age-related cataract (3 eyes, females, aged 54, 71, 74 years) were enrolled. Anterior capsule samples were collected during surgery. Transmission electron microscopy was performed. The cell morphology, the proportion of cell nuclear and organelle changes and the proportion of apoptosis in cataract associated with uveitis were described statistically by x±s or median (range). Results: Spindle-shaped epithelial cells were observed in cataract associated with uveitis (100%), while 28.00%,16.67%,16.67% of spindle-shaped epithelial cells were observed in age-related cataract. The organelle changes included mitochondria swelling and damage to the tight cell junction in cataract associated with uveitis. The tight junction between two cells was damaged in different degrees, only 8.33% (0-16.67%)of the cell nuclei appeared normal, and increased chromatin density(47.07%±22.28%), nuclear pyknosis(38.02%±19.61%) and nuclear fragmentation (9.96%±8.10%) were observed in cataract secondary to uveitis. The apoptosis rate was (48.16%±26.66%) in cataract associated with uveitis and correlated to the duration of intraocular inflammation. While the apoptosis rate were 0, 8.33%, 0 in age-related cataract patients. No autophagosome was observed in cataract associated with uveitis. Conclusions: Ultrastructure changes existed in lens epithelium cells in cataract associated with uveitis. The increased rate of apoptosis and inhibition of autophagy could be the possible mechanism of cataract formation in uveitic eyes. (Chin J Ophthalmol, 2018, 54: 357-362).

[Studies on serum pharmacochemistry of effective parts of modified Xiaochaihu Tang for treatment of gastric ulcer]

To conduct the studies on serum pharmacochemistry of effective parts of modified Xiaochaihu Tang for treatment of gastric ulcer by using chromatography-mass spectrometry. Absolute ethyl alcohol induced-gastric ulcer model of mouse was used in this study to investigate the pharmacology of modified Xiaochaihu Tang and its effective parts. Both groups could significantly decrease the absolute ethyl alcohol induced-ulcer. Gasphase-mass spectrometry (GC-MS) was used to detect chemical compositions of volatile fractions and the drug components after gastric administration. A total of 63 compounds were identified in extracts, accounting for more than 93% of the all volatile oil, including 23.51% α-curcumene, 11.96% zingiberene, 9.56% curzerene, 6.54% β-sesquinene, 4.77% camphene, and 6 prototype components were also detected in serum for gastric ulcer model. In liquid chromatography-mass spectrometry (LC-MS), a total of 17 compounds were identified in extracts, 6 prototype components and 2 metabolites (3,5-O-feruloylquinic acid and palmatine) were obtained in serum. In a conclusion, this study provides an important scientific basis for identifying the active ingredients in modified Xiaochaihu Tang, and also helps to reveal the pharmacological effect of modified Xiaochaihu Tang for treatment of gastric ulcer.

[Effects of application of citrate anticoagulation in bedside continuous blood purification of severe burn patients with sepsis]

Objective: To investigate the effects of application of citrate anticoagulation in bedside continuous blood purification (CBP) of severe burn patients with sepsis, so as to provide reference for choosing anticoagulants in CBP of these patients. Methods: Thirty severe burn patients with sepsis, conforming to the study criteria, were admitted to our burn intensive care unit from January 2014 to July 2017. Patients were divided into heparin group and citrate group according to computer randomization method, with 15 cases in each group. Patients in two groups all received bedside CBP treatment. Patients in heparin group used local heparin anticoagulation, while patients in citrate group used local citrate anticoagulation. Time of predicted single-time CBP treatment, time of single-time CBP treatment, time of accumulative CBP treatment, and rate of reaching the standard of CBP treatment time were counted. Changes of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, serum procalcitonin, and C-reactive protein (CRP) of patients before and after treatment were monitored. Hemorrhage in wounds, incision on trachea, and arteriovenous intubation point, and other complications during and after CBP treatment were observed. Data were processed with independent sample t test and chi-square test. Results: (1) Time of predicted single-time CBP treatment of patients in the two groups was equal. Time of single-time CBP treatment and time of accumulative CBP treatment of patients in citrate group were longer than those in heparin group. Rate of reaching the standard of CBP treatment time of patients in citrate group was significantly higher than that in heparin group (χ(2)=16.655, P<0.01). (2) There was no statistically significant difference in PT, APTT, INR, fibrinogen, serum procalcitonin, and CRP of patients in the two groups before CBP treatment (t=0.203, -1.006, 0.203, 0.039, -1.591, -0.824, P>0.05). PT and APTT of patients in citrate group after CBP treatment were (14.2±1.6) and (45±7) s, respectively, significantly shorter than (15.5±1.4) and (53±6) s in heparin group (t=2.395, 3.321, P<0.05 or P<0.01). INR of patients in citrate group after CBP treatment was 1.13±0.12, significantly lower than 1.24±0.12 in heparin group (t=2.395, P<0.05). Fibrinogen of patients in citrate group after CBP treatment was (3.5±0.6) g/L, significantly higher than (3.0±0.6) g/L in heparin group (t=-2.427, P<0.05). Serum procalcitonin and CRP of patients in citrate group after CBP treatment were significantly lower than those in heparin group (t=2.520, 2.710, P<0.05). Decreased degree of serum procalcitonin and CRP of patients in citrate group after CBP treatment were (1.8±0.6) ng/mL and (143±69) mg/L, respectively, significantly higher than (0.9±0.6) ng/mL and (95±50) mg/L in heparin group (t=-4.033, -2.170, P<0.05 or P<0.01). (3) During CBP treatment, patients in heparin group experienced 21 times of exacerbation of wound hemorrhage and 10 times of new hemorrhage, including 2 times of hemorrhage at incision on trachea and 8 times of hemorrhage at arteriovenous intubation point. No exacerbation of hemorrhage or new hemorrhage happened in patients of citrate group. After CBP treatment, no electrolyte disturbance happened in patients of heparin group, but 1 patient in citrate group experienced hypocalcemia. Conclusions: Application of citrate anticoagulation in bedside CBP of severe burn patients with sepsis shows light impact on systematic coagulation status, and can effectively decrease inflammation reaction of burn sepsis with low rate of hemorrhage.

Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial

PURPOSE

To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities.

DESIGN

Multi-area, cluster-randomized intervention controlled trial.

PARTICIPANTS

A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group.

METHODS

Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires.

MAIN OUTCOME MEASURES

Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures.

RESULTS

The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28-0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02-0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002-0.32; P = 0.048).

CONCLUSIONS

The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered.

Factors affecting surgical outcome of intermittent exotropia

PURPOSE

The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia.

DESIGNS

This was a retrospective interventional study.

METHODS

Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome.

RESULTS

We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94-1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80-11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84-28.58).

CONCLUSION

In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.

Management of diplopia with visual-field defects

PURPOSE:

The management of diplopia can be challenging in patients with a concurrent visual-field (VF) defect. We conducted a retrospective chart review to analyze and compare treatment outcomes for different types of VF defects.

METHODS:

A retrospective chart review.

RESULTS:

Seven patients with diplopia and VF defects were identified during the study. Four had bitemporal hemianopia, one had homonymous hemianopia, and two had a constricted central VF. A favorable or satisfactory outcome was achieved in all but two patients with bitemporal hemianopia.

CONCLUSIONS:

The hemifield-slide diplopia may develop in patients with bitemporal hemianopia or heteronymous altitudinal visual defects. Sensory abnormalities usually persist, even after elimination of ocular misalignment.

Managing Hypoplasia of the Inferior Rectus Muscle by Inferior Oblique Anterior Transposition in Children

Congenital hypoplasia or aplasia of the inferior rectus muscle is an uncommon condition. The authors present two pediatric patients with hypoplasia of the inferior rectus muscle treated by inferior oblique anterior transposition. The long-term follow-up outcomes of eye position and stereopsis acuity development were favorable. [J Pediatr Ophthalmol Strabismus. 2017;54:e50-e53.].

[Lay further emphasis on cause analysis and non-surgical treatment of chronic refractory wound]

There are many pathogenic correlation factors of chronic refractory wound. Due to the complexity and particularity of the causes of wounds and lack of a standard diagnosis guide, it is hard to treat this kind of wound. Based on our recent scientific research data and the relative research at home and abroad in the present, we systematically analyze and summarize the causes and non-surgical treatment of chronic refractory wound in this article.

[Effect of hydrocinnamoyl-L-valyl pyrrolidine on healing quality of deep partial-thickness scald wound in mice]

Objective: To observe the effect of Toll interleukin-1 recptor homology/BB-loop mimetic hydrocinnamoyl-L-valyl pyrrolidine (AS-1) on the healing quality of deep partial-thickness scald wound in mice. Methods: Forty-two adult C57BL/6 mice were divided into sham injury group (SI), scald group (S), early AS-1 treatment group (EAT), early dimethyl sulfoxide (DMSO) control group (EDC), late AS-1 treatment group (LAT), late DMSO control group (LDC) according to the random number table, with 7 mice in each group. Mice in group SI were sham injured without other treatment. Deep partial-thickness scald model with 10% total body surface area was reproduced on the back of the other mice, and the wound was treated by daily wound cleaning with saline and dressing changing with vaseline gauze after injury. Mice in group EAT and those in group LAT were intraperitoneally injected with 20 mg/mL AS-1 50 mg/kg each day respectively from post scald hour (PSH) 8 and post scald day (PSD) 15 on. Mice in group EDC and those in group LDC were intraperitoneally injected with 20 mg/mL DMSO 50 mg/kg each day respectively from PSH 8 and PSD 15 on. On PSD 21, the gross condition of wound healing of mice with scald was observed, and the wound healing rate was calculated. Tissue samples of healed wound were collected and stained with HE and Masson respectively to observe the histomorphological change and fibrosis of collagen, and the percentage of fibrosis of collagen was calculated. The mRNA expressions of interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), transforming growth factor β₁ (TGF-β₁), matrix metalloproteinase-1 (MMP-1), tissue inhibitors of metalloproteinase 1 (TIMP-1), connective tissue growth factor (CTGF), type Ⅰ collagen and type Ⅲ collagen in healed wound tissue were detected by real time fluorescent quantitive reverse transcription polymerase chain reaction. The protein expressions of type Ⅰ collagen and type Ⅲ collagen in healed wound tissue were detected by Western blotting. Skin tissue of mice in group SI at the same area as that observed and collected in mice with scald was performed with the same observation and detection as mentioned above at the same time. Data were processed with one-way analysis of variance and Tukey test. Results: On PSD 21, no abnormal appearance was found in skin tissue of mice in group SI. Wounds of mice in group EAT were healed completely without scar formation, while those in the other four groups were not completely healed with scars formed in different degree. The wound healing rate of mice in group EAT was (97±4)%, close to that of group SI (100%, q=1.753, P>0.05), and both of them were obviously higher than those of groups S, EDC, LAT, and LDC [respectively (83±8)%, (87±6)%, (85±9)%, and (85±7)%, with q values from 4.819 to 6.803, P<0.05 or P<0.01]. On PSD 21, no abnormal appearance was found in morphology of skin tissue of mice in group SI. The morphology of healed wound tissue of mice in group EAT was close to that in group SI, with little epidermis hyalinosis and few newly formed collagen fibers arranged orderly. Epidermis hyalinosis in band- or flake-shape and obvious proliferation of collagen fibers arranged disorderly were observed in healed wound tissue of mice in the other four groups. Much infiltration of inflammatory cells was found in group S. The percentage of fibrosis of collagen in healed wound tissue of mice in group EAT was (30±3)%, close to that of group SI [(30±4)%, q=0.159, P>0.05], and both of them were obviously lower than those of groups S, EDC, LAT, and LDC [respectively (86±9)%, (74±5)%, (82±4)%, and (82±7)%, with q values from 12.080 to 15.530, P values below 0.01]. On PSD 21, compared with those of group SI, the mRNA expressions of IL-1β, TNF-α, TGF-β₁, MMP-1, and CTGF in healed wound tissue of mice in group S, the mRNA expressions of TGF-β₁ in healed wound tissue of mice in groups EDC and LDC, and the mRNA expression of MMP-1 in healed wound tissue of mice in group LAT were significantly increased (with q values from 4.039 to 5.232, P values below 0.05), while the mRNA expression of TIMP-1 in healed wound tissue of mice in group S was significantly decreased (q=4.921, P<0.05). Compared with those of group S, the mRNA expressions of IL-1β, TNF-α, TGF-β₁, MMP-1, and CTGF in healed wound tissue of mice in group EAT and the mRNA expressions of IL-1β and CTGF in healed wound tissue of mice in group LAT were significantly decreased (with q values from 4.418 to 6.402, P<0.05 or P<0.01), while the mRNA expressions of TIMP-1 in healed wound tissue of mice in groups EAT and LAT were significantly increased (with q values respectively 3.929 and 8.299, P<0.05 or P<0.01). Compared with those of group SI, the mRNA and protein expressions of type Ⅲ collagen in healed wound tissue of mice in the other groups and the mRNA and protein expressions of type Ⅰ collagen in healed wound tissue of mice in groups S, EDC, LAT, and LDC were significantly increased (with q values from 7.054 to 11.650, P values below 0.01). Compared with those of group EAT, the mRNA and protein expressions of type Ⅰ collagen in healed wound tissue of mice in groups S, EDC, LAT, and LDC were significantly increased (with q values from 5.156 to 7.451, P<0.05 or P<0.01). Conclusions: AS-1 can effectively promote wound healing and reduce fibrosis degree in the early stage of inflammation response after deep partial-thickness scald in mice, which may be related to its effect in decreasing the expression of inflammation related factors IL-1β and TNF-α and fibrosis related factors TGF-β₁, MMP-1, CTGF, and type Ⅰ collagen.

Relationship of lifestyle and body stature growth with the development of myopia and axial length elongation in Taiwanese elementary school children

Context:

The development of myopia and growth of the eye, occur at a time when body stature is increasing.

Aims:

To investigate the relationship of lifestyle and body growth with axial elongation and myopia development among schoolchildren aged 7 to 9 years.

Settings and Design:

Prospective study.

Materials and Methods:

Children in elementary schools without serious eye disorders were invited to participate. We measured cycloplegic refraction, corneal curvature, intraocular pressure, axial length, body height, and weight. Questionnaires about the children's daily lifestyles, family members’ myopia and parents’ socio-demographic status were completed. The children were followed up every 6 months in a 3-year period.

Statistical Analysis Used:

Bivariate correlations, simple and multiple regression.

Results:

Eighty-eight children participated in this study. Forty-eight were myopic at the beginning of the study, and their myopia correlated with longer axial length and parental myopia (P = 0.015, 0.012). Sixty-five children (74%) completed the study, and the rates of change per year were -0.43 ± 0.58 (mean + standard deviation) diopters in spherical equivalence, 0.32 ± 0.25 mm in axial length (AL), 5.73 ± 2.71 cm in body height, and 3.84 ± 2.23 kg in weight. The axial length change was positively correlated with the height change (P < 0.001). The myopia shift was correlated to axial length change (P = 0.000) but not correlated to height change. Using multiple regression test, near work was the only significant risk factor for myopia progression (P = 0.022).

Conclusions:

Our study showed that body height increment was correlated to axial length elongation but not to myopia shift in children aged 7-9 years. Genetic factors such as parental myopia and body height had a possible influence on myopia development, and the environment factor as near work intensity was related to myopia progression.

[HPV type determination and clinical characteristics in juvenile onset recurrent respiratory papillomatosis]

Objective:To investigate the relationship between different subtypes of human papillomavirus(HPV) infection and clinical features in juvenile onset recurrent respiratory papillomatosis(JORRP) patients. Method:Two hundred and forty cases with JORRP from 2010 to 2014 were retrospectively analyzed. HPV tpye were determined using tumor specimens taken from surgery, and all patients were divided into different groups based on HPV type. Clinical characteristics of patients from each groups were analyzed. Result:Except for HPV11 single infection or HPV6 single infection, some HPV11 and 6 co-infections were found in children with JORRP. Compared with patients with HPV6 single infection, HPV11 positive patients present an earlier age of onset, more times of operation and higher derkay score during surgery.Conclusion:JORRP in patients infected with HPV11 is more severe than that in patients with HPV6 infection in children.

TPM3 deletions cause a hypercontractile congenital muscle stiffness phenotype

OBJECTIVE

Mutations in TPM3, encoding Tpm3.12, cause a clinically and histopathologically diverse group of myopathies characterized by muscle weakness. We report two patients with novel de novo Tpm3.12 single glutamic acid deletions at positions ΔE218 and ΔE224, resulting in a significant hypercontractile phenotype with congenital muscle stiffness, rather than weakness, and respiratory failure in one patient.

METHODS

The effect of the Tpm3.12 deletions on the contractile properties in dissected patient myofibers was measured. We used quantitative in vitro motility assay to measure Ca(2+) sensitivity of thin filaments reconstituted with recombinant Tpm3.12 ΔE218 and ΔE224.

RESULTS

Contractility studies on permeabilized myofibers demonstrated reduced maximal active tension from both patients with increased Ca(2+) sensitivity and altered cross-bridge cycling kinetics in ΔE224 fibers. In vitro motility studies showed a two-fold increase in Ca(2+) sensitivity of the fraction of filaments motile and the filament sliding velocity concentrations for both mutations.

INTERPRETATION

These data indicate that Tpm3.12 deletions ΔE218 and ΔE224 result in increased Ca(2+) sensitivity of the troponin-tropomyosin complex, resulting in abnormally active interaction of the actin and myosin complex. Both mutations are located in the charged motifs of the actin-binding residues of tropomyosin 3, thus disrupting the electrostatic interactions that facilitate accurate tropomyosin binding with actin necessary to prevent the on-state. The mutations destabilize the off-state and result in excessively sensitized excitation-contraction coupling of the contractile apparatus. This work expands the phenotypic spectrum of TPM3-related disease and provides insights into the pathophysiological mechanisms of the actin-tropomyosin complex.

Spectrum and features of congenital heart disease in Xi'an, China as detected using fetal echocardiography

This study aimed to investigate the spectrum and features of congenital heart disease (CHD) in Xi'an, China using fetal echocardiography. All pregnant women referred for fetal echocardiography underwent a systematic fetal echocardiographic examination. Each case of complex defects was diagnosed according to the predominant pathophysiology, and the overall frequency of each defect was recorded and classified according to its location in the fetal heart. CHD was diagnosed in 195 fetuses. The top 5 types of CHD were, in order, single ventricle (15.9%, 31/195), atrioventricular septal defect (12.3%, 24/195), ventricular septal defect (VSD) (11.8%, 23/195), tetralogy of Fallot (10.8%, 21/195), and double-outlet right ventricle (8.2%, 16/195). The 195 cases of CHD comprised 316 defects in total. The most common defect was ventricular malformation (40.5%, 128/316), followed by great artery anomalies (38.0%, 120/316), endocardial cushion abnormalities (11.7%, 37/316), atrial abnormalities (6.6%, 21/316), and semilunar valve abnormalities (3.2%, 10/316). VSD accounted for the largest proportion (24.4%, 77/316) of the ventricular malformations. The total proportion of obstructive lesions in this group was much higher for the right than for the left side of the heart (18.4% (58/316) vs 9.5% (30/316), respectively). The spectrum of fetal CHD detected by echocardiography was much different compared to that accepted in the past. Complex defects were more common prenatally. Ventricular malformations were the largest constituent of all of the defects associated with fetal CHD, and VSD was the most common component of complex defects. Chinese fetal CHD encompassed more right-sided than left-sided obstructive lesions.

Necrotizing scleritis after strabismus surgery in thyroid eye disease

Surgically induced necrotizing scleritis, which can lead to potentially devastating consequences, is a rare sequela to many types of ocular surgeries. We describe a 58-year-old woman who developed necrotizing scleritis following strabismus surgery for thyroid ophthalmopathy. Tectonic corneal patch grafting resulted in a favorable outcome.

Changes in serum runt-related transcription factor 2 levels after a 6-month treatment with recombinant human parathyroid hormone in patients with osteoporosis

BACKGROUND

The mechanisms regulating the anabolic response of the skeleton for recombinant human PTH (1- 34) [rhPTH (1-34)] administration has not been fully elucidated.

AIM

The aim of this study was to evaluate the effect of rhPTH (1-34) on serum levels of runt-related transcription factor 2 (Runx2) in women with osteoporosis.

METHODS

Sixty post-menopausal women with osteoporosis (EO group) and 45 control subjects (NC group) were enrolled in this study. The EO group received daily injection of 20 μg rhPTH (1-34) plus oral 500 mg elemental calcium and 400 IU vitamin D3 for 6 months. Runx2 and Matrix metalloproteinase 13 (MMP-13) were measured with commercially available enzyme-linked immunosorbent assay kits. Bone mineral density (BMD) was also measured before and 6 months after rhPTH (1-34) treatment.

RESULTS

Serum total Ca2+, phosphate, and bone-specific alkaline phosphatase were significantly increased (p<0.05 or p<0.01), and the lumbar spine BMD (LS-BMD) was also increased by 4% in patients with osteoporosis after treatment with rhPTH (1-34) (p<0.05). On the contrary, serum Runx2 and MMP-13 were significantly decreased at post treatment (13.1% and 36.6%, respectively, p<0.05 and p<0.01). At baseline, serum Runx2 positively correlated with MMP-13 (r=0.74, p<0.01), the correction remained after adjusting for age and body mass index.

CONCLUSION

The daily injection of rhPTH (1-34) was able to stimulate bone formation. The therapy of 20 μg rhPTH (1- 34) for 6 months resulted in decrease of serum Runx2 and MMP-13. These changes might reflect the increase of active osteoblasts and the better bone homeostasis.

The expression of angiopoietin-1 and -2 in the endometrium of women with abnormal bleeding induced by an intra-uterine device

This study identified differences in expression of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in the endometrium of 33 women with abnormal bleeding induced by an intra-uterine device (IUD; 23 proliferative phase, 10 secretory phase) compared with 28 control samples from normal endometria in women without an IUD fitted (12 proliferative phase, 16 secretory phase). Expression of Ang-1, Ang-2 and endothelial cell-specific tyrosine kinase receptor-2 (Tie-2) mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR), and Ang-1 and Ang-2 protein levels were detected by immunohistochemistry. The RT-PCR results showed significantly decreased Ang-1 expression in the endometrium from IUD patients during both phases compared with the control women. Expression of Tie-2 mRNA and the Ang-1:Ang-2 mRNA ratio were also significantly decreased in endometria from IUD patients in the secretory phase compared with the control women. Immunohistochemical analysis showed elevated Ang-2 protein levels in secretory phase endometrium from IUD patients compared with the control women. These results suggest that the angiopoietin/Tie-2 system promotes vascular remodelling in the endometrium and that changes in the expression of Ang-1, Ang-2 and Tie-2 may contribute to abnormal uterine bleeding in some IUD users.

Overview of paediatric neuromuscular disorders and related pulmonary issues: diagnostic and therapeutic considerations

Pulmonary compromise is common in neuromuscular disease. Respiratory failure may be a presenting feature of neuromuscular disease and remains a major cause of morbidity and mortality. This article will review the current understanding of the more commonly encountered neuromuscular disorders in childhood and emphasize related pulmonary issues.

Mechanisms of organophosphate resistance in a field population of oriental migratory locust, Locusta migratoria manilensis (Meyen)

The susceptibilities to three organophosphate (OP) insecticides (malathion, chlorpyrifos, and phoxim), responses to three metabolic synergists [triphenyl phosphate (TPP), piperonyl butoxide (PBO), and diethyl maleate (DEM)], activities of major detoxification enzymes [general esterases (ESTs), glutathione S-transferases (GSTs), and cytochrome P450 monooxygenases (P450s)], and sensitivity of the target enzyme acetylcholinesterase (AChE) were compared between a laboratory-susceptible strain (LS) and a field-resistant population (FR) of the oriental migratory locust, Locusta migratoria manilensis (Meyen). The FR was significantly resistant to malathion (57.5-fold), but marginally resistant to chlorpyrifos (5.4) and phoxim (2.9). The malathion resistance of the FR was significantly diminished by TPP (synergism ratio: 16.2) and DEM (3.3), but was unchanged by PBO. In contrast, none of these synergists significantly affected the toxicity of malathion in the LS. Biochemical studies indicated that EST and GST activities in the FR were 2.1- to 3.2-fold and 1.2- to 2.0-fold, respectively, higher than those in the LS, but there was no significant difference in P450 activity between the LS and FR. Furthermore, AChE from the FR showed 4.0-fold higher activity but was 3.2-, 2.2-, and 1.1-fold less sensitive to inhibition by malaoxon, chlorpyrifos-oxon, and phoxim, respectively, than that from the LS. All these results clearly indicated that the observed malathion resistance in the FR was conferred by multiple mechanisms, including increased detoxification by ESTs and GSTs, and increased activity and reduced sensitivity of AChE to OP inhibition.

Pediatric ocular trauma in Taiwan

BACKGROUND

Ocular trauma is a significant problem in pediatric patients. The aim of this investigation was to evaluate the demographic, etiologic and prophylactic factors of pediatric ocular trauma in a tertiary center in northern Taiwan.

METHODS

A retrospective review of medical charts of patients aged 15 years or younger who visited the emergency department of Chang Gung Memorial Hospital, Taoyuan for ocular trauma between July 2003 and June 2004 was undertaken.

RESULTS

Of the 228 children in this study, ocular trauma occurred more frequently in boys than in girls (151:77 patients, p < 0.0001). Twenty-one patients (9.2%) presented with bilateral trauma. The most common ocular injury was closed globe injury (178 patients, 78.1%). The next most common ocular injuries were burns (35 patients, 15.4%), open globe injuries (8 patients, 3.5%) and orbital injuries (7 patients, 3.1%). Falling was the most common cause of ocular trauma in these children, followed by trauma caused by a fist or other part of the body. Sharp objects such as knives or scissors were the most common cause of open globe injuries. Visual impairment (visual acuity less than 20/50) occurred in three open globe injury patients.

CONCLUSIONS

Ocular trauma in children is associated with visual loss. Many of the cases were preventable. Public education, general awareness and aggressive primary management may be indicated to optimize visual outcome.

Primary intraocular lens implantation for unilateral idiopathic cataract in children

BACKGROUND

To examine the efficacy of intraocular lens implantation on visual rehabilitation and ocular growth in children with unilateral idiopathic cataracts.

METHODS

Preoperative characteristics, visual outcome and postoperative refraction change were analyzed through a retrospective study of the charts of children who underwent cataract removal and primary intraocular lens implantation for unilateral idiopathic cataracts between 1994 and 2003.

RESULTS

Thirty-one children were included in this study. Preoperatively, 83% of the eyes with cataracts had best corrected visual acuity (BCVA) of less than 20/200. Posterior subcapsular opacity was the most common type of cataract. The average age at surgery was 66.8 months (range 14-115 months) and the mean follow-up was 43.4 months (range 12-117 months). At the final visit, there was no significant difference in refractive development between the pseudophakic eyes and the fellow eyes of the subjects. Sixty percent of the pseudophakic eyes had a BCVA of 20/200 or better and 37% had a BCVA of 20/60 or better. Preoperative visual acuity was the only significant factor related to visual outcome.

CONCLUSION

Primary intraocular lens implantation in children with unilateral idiopathic cataracts is an effective treatment for visual rehabilitation. The refractive development of the pseudophakic eyes was not significantly different from the fellow eyes.

Dose-response relationship between ingested arsenic and cataracts among residents in Southwestern Taiwan

This association study was carried out to examine the effect of long-term exposure to ingested arsenic on various types of cataract. A total of 349 residents living in arseniasis-hyperendemic villages of southwestern Taiwan were recruited. Cumulative arsenic exposure was derived from the history of consuming artesian well water and the arsenic level in well water. The Lens Opacities System III was used to classify different types of cataract. The cataract surgery prevalence was 10% for the age group of 50 or more years. Cortical opacity was most common (35%), while nuclear and posterior subcapsular opacities were observed in 24% and 22% of subjects, respectively. Diabetes mellitus was a significant risk factor for all types of cataract. Occupational sunlight exposure was associated with cortical and posterior subcapsular opacities in a dose-response relationship. The cumulative exposure to arsenic from artesian well water and the duration of consuming artesian well water were associated with an increased risk of all types of lens opacity. But statistically significant dose-response relations with the cumulative arsenic exposure and the duration of consuming artesian well water were observed only for posterior subcapsular opacity (P=0.014 and P=0.023, respectively) after adjustment for age, sex, diabetes status, and occupational sunlight exposure. It was concluded that there was an increasing prevalence of posterior subcapsular opacity with the increase in exposure to ingested arsenic.

Fibrinogen adsorption and platelet lysis characterization of fluorinated surface-modified polyetherurethanes

A polyetherurethane (PU) was modified using fluorinated surface-modifying macromolecules (SMMs). A double radiolabel method was used simultaneously to measure the number of adhered platelets ((51)Cr) and the quantity of adsorbed Fg ((125)I), in a cone-and-plate instrument. The objectives were to determine if adsorbed Fg levels correlated to platelet adhesion on the surfaces, and to assess if any reductions in platelet adhesion for the SMM-treated surfaces resulted from surface-induced platelet lysis, rather than changes directly related to lower platelet activation and attachment on the novel surfaces. Platelet lysis was determined from lactate dehydrogenase (LDH) and unbound (51)Cr released into plasma isolated from whole blood exposed to test materials. The corresponding Fg adsorption, evaluated under the same platelet adhesion conditions, did not account for the reduced platelet adhesion on the treated surfaces. LDH and (51)Cr platelet release were very low and indicated no statistically significant differences between the materials. It was therefore concluded that platelet lysis did not contribute to the reduction in platelet adhesion characteristic observed on the SMM-treated surfaces. More importantly, the work emphasizes that the platelet activation cannot be inferred to by assessing the quantity of fibrinogen as is commonly done in the literature. The finding suggests a much more complex mechanism of action for the SMM surface modifiers. On-going work is investigating other Fg parameters such as protein binding affinity and protein conformational state in order to establish the mechanism by which the fluorinated surface modifiers may be reducing platelet adhesion via intermediary changes in initial protein adsorption.

Functional visual disturbance due to hysteria

A 23-year-old male complained of loss of peripheral visual field and everything having purple shadows in the afternoon. This had lasted for 3 years but he had paid little attention to the symptoms. Investigations, including visual acuity, intra-ocular pressure, pupil reflex, and anterior and posterior segment of the eyes, were normal. He denied ocular pain, history of head injury, epilepsy or related family history. The Goldmann perimeter and tangent screen examinations showed a bilateral constricted tubular visual field defect within the central 10 degrees and steep margins. Tracing his past social history, he had been in jail for 3 months. He also complained his work was hard and caused him tension. The visual symptoms were a functional disturbance, not an organic disorder. We diagnosed him with hysterical functional visual disturbance. Hysteria, or conversion disorder, has long been a puzzling and fascinating problem in psychology and ophthalmology. The mechanism and reasons for hysteria are still not clear. The tangent screen is useful in diagnosis. The constricted tubular, spiral or star-shaped visual fields with steep slopes are specific findings in hysteria. We suggest that ophthalmologists should treat patients with psychogenic symptoms, using suggestion, patience and reassurance.

Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan

PURPOSE

To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions.

METHOD

This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients' demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded.

RESULTS

Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively.

CONCLUSIONS

Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.

Fibrinogen surface distribution correlates to platelet adhesion pattern on fluorinated surface-modified polyetherurethane

In previous work, it had been shown that platelet adhesion could be reduced by fluorinating surfaces with oligomeric fluoropolymers, referred to as surface-modifying macromolecules (SMMs). In the current study, two in vitro blood-contacting experiments were carried out on a polyetherurethane modified with three different SMMs in order to determine if altered platelet adhesion levels could be related to the pattern of adsorbed protein and more specifically to the manner in which fibrinogen (Fg) distribution occurs at the surface. In the first experiment, the materials were placed in whole human blood and the adherent platelets were viewed with high-resolution scanning electron microscopy (SEM). In a second experiment, the materials were incubated with human plasma with the absence of platelets. The plasma contained 5% fluorescent-Fg. The materials were then viewed with a fluorescence microscope and images were collected to define the distribution of high-density fluorescent-Fg areas. The SEM and fluorescent-Fg images were imported to Image Pro Plus imaging software to measure the area, length and circularity and a bivariate correlation test was conducted between the two sets of data. For area and length morphology parameters, there were high and significant correlations (r > 0.9, p < 0.05) between the platelets and Fg aggregates. The data suggest that the Fg distribution may serve as a predictor of platelet morphology/activation and provides insight into the non-thrombogenic character of biomaterials containing the fluorinated SMMs.

The surgical outcome of strabismus in patients with general fibrosis syndrome

BACKGROUND

This study investigates the clinical features of strabismus in patients with general fibrosis syndrome (GFS) and the results of surgery performed on such patients.

METHODS

We conducted a retrospective review of patients with GFS who visited our clinic at Chang Gung Memorial Hospital between 1 August 1992 and 31 January 2002. After evaluating the family histories of 9 patients with GFS, patients were given a complete ophthalmic evaluation. Myectomies of the inferior rectus muscle were performed to correct hypotropia and recessions and/or resections of medial rectus and/or lateral rectus were performed to correct esotropia or exotropia, respectively. The post-operative conditions of the survey patients were reviewed for at least 6 months after the completion of the procedures.

RESULTS

Six patients (67%) were identified with inherited autosomal dominance. All patients displayed the characteristic 'chin-up' position, limited extraocular muscle movement and eye abnormalities. High astigmatism (>=-2.0 diopter) was noted in 9 eyes (50%) and amblyopia was noted in all cases. With regard to vertical eye deviation, 11 eyes (61%) were corrected through myectomy of the inferior rectus muscle to within 5 degrees as measured using a Hirschberg test. Furthermore, three cases (33%) were complicated by lower scleral show.

CONCLUSION

The presence of GFS complicates the surgical correction of strabismus making procedure results more difficult to predict. Strabismus surgery has been demonstrated to reduce eye deviation in the primary position, thus improving patients' head posture. The resulting improvements to cosmetic appearance and functionality lead us to recommend that strabismus surgery be performed in conjunction with ptosis surgery for GFS patients.

Early predict the outcomes of refractive accommodative esotropia by initial presentations

BACKGROUND

The differential diagnosis between fully and partially refractive accommodative esotropia (Ac-ET) depends on outcomes after intervention with refraction correction. Whether the differences exist in terms of initial clinical features between these two variants has not been fully explored.

METHODS

Children between the ages of 6 months and 8 years with esotropia and spherical equivalent greater than +3.00 (D) were included in this study. After wearing diopters glasses for at least 2 years, children were classified according to the indexed criteria into the fully Ac-ET group (group A, N=28) partially Ac-ET (group or the B, N=17). Six clinical parameters, including age at onset, age at first visit, visual acuity, refractive error, angle of esodeviation, and presence or absence of inferior oblique overaction at initial presentation were compared between these two groups.

RESULTS

The angle of esodeviation (31.4+/-11.6 PD vs. 42.6+/-12.6 PD, p = 0.004) was significantly different between the fully and partially Ac-ET groups, while refraction (+5.79+/-1.84 D vs. +4.79+/-1.40 D, p = 0.062) had borderline significance. On the contrary, the age at onset (2.35+/-1.74 yrs vs. 2.01+/-1.96 yrs, p=0.539), age at first visit (3.51+/-1.36 yrs vs. 3.01+/-1.70 yrs, p =0.285), inferior oblique overaction (32% vs. 47%, p =0.317), and visual acuity before (LogMAR: 0.40+/-0.25 vs. LogMAR: 0.34+/-0.25, p =0.544) and after treatment (LogMAR: 0.057+/-0.079 vs. LogMAR: 0.051+/-0.19, p = 0.088) were similar in the two groups.

CONCLUSIONS

Children with a smaller angle of esodeviation and higher hyperopia were more likely belonging to fully Ac-ET, which can be treated with glasses without the need of surgical intervention. Early detection and early treatment of accommodative esotropia are needed to prevent strabismus and amblyopia.

Surgical management of strabismus for dysthyroid ophthalmopathy

BACKGROUND

The study reports our 8-year experience in the surgical treatment of restrictive myopathy resulting from dysthyroid ophthalmopathy. We tried to determine the factors that contributed to favorable surgical outcomes.

METHODS

The charts of patients who had surgical treatment for strabismus related to dysthyroid ophthalmopathy at Chang Gung Memorial Hospital between January 1995 and December 2002 (n=25) were retrospectively reviewed, and factors that possibly influenced the outcome were statistically analyzed for significance.

RESULTS

The mean pre-operative vertical deviation of the 25 patients was 23.3 prism diopters and the pre-operative horizontal deviation was 11.3 prism diopters. The mean follow-up time was 29.7 months. Each patient had strabismus surgery an average of 1.5 times. The majority of patients (84%) were satisfied with the result. No significant difference in the success rate was evident between patients who waited less than 3 months before the surgery and those who waited for a longer period. The repeat surgery rate was significantly higher in the latter group. A shorter duration of diplopia and smaller angle of pre-operative horizontal deviation were contributors towards a favorable outcome.

CONCLUSIONS

A waiting time of less than 3 months prior to treatment of strabismus associated with dysthyroid ophthalmopathy produced a favorable outcome. The duration of diplopia and the pre-operative angle of horizontal deviation were the most important prognostic factors.

Functional MRI of amblyopia before and after levodopa

Functional magnetic resonance imaging (fMRI) was applied to five older amblyopes with monocular amblyopia before and after levodopa treatment. During the experiment, images were acquired in two runs with visual stimulation delivered through the sound and the amblyopic eyes, respectively. The experiment was performed on each of the subjects, before and after their oral administration of levodopa/carbidopa (0.5/0.12 mg/kg) three times per day for 7 weeks. Our study demonstrated that there was no effect on the spatial extent of the visual cortical activation during the sound eye stimulation (P=0.17), but some improvement during the amblyopic eye stimulation (P=0.06). The volume ratio between the amblyopic and sound eye stimulation significantly increased after the treatment (P<0.05). This finding supports the previous studies of levodopa effect on amblyopia at the visual cortical level, and suggests that fMRI can be a useful tool in assessing changes of visual cortical activity after the treatment

Excessive myopia and anisometropia associated with familial exudative vitreoretinopathy

BACKGROUND

To describe associations between familial exudative vitreoretinopathy (FEVR) and refractive status.

METHODS

We conducted retrospective studies of patients with clinical diagnoses of familial exudative vitreoretinopathy from June 1986 through September 2000. All patients had cycloplegic refraction, visual acuity with correction, and underwent fundus examination. Ocular history since early childhood was described.

RESULTS

Nine patients were recruited. All had excessive myopia, which was noted since early childhood. Amblyopia was noted in seven of the nine patients. Asymmetric FEVR was found in four of the nine patients. In all four patients with asymmetric FEVR, anisometropia equal to or greater than 2.5D was noted. Myopia was higher and amblyopia was more severe in the eye more severely affected with FEVR.

CONCLUSION

Excessive myopia, anisometropia and amblyopia were more likely to occur in eyes with familial exudative vitreoretinopathy. Patients with asymmetric disease tended to have higher myopia in the eye with more severe degree of FEVR as compared with the paired eye and thus correlated with anisometropia.

Familial congenital ocular motor apraxia

Congenital ocular motor apraxia (COMA) is a unique ocular motor disorder which is characterized by a deficit in initiation of voluntary horizontal eye movement with reserved reflex eye movement. Although a portion of cases with COMA were found to be associated with other abnormalities, COMA in most patients is an isolated disorder. The most characteristic appearance of these patients is compensatory head thrusts which usually become less evident with increasing age. Since Cogan first described COMA in 1952, many cases have been reported. The majority of these occurred sporadically with only a few exceptions. We report on 4 patients with COMA. Two of them were siblings, and the other 2 patients were father and daughter. The ocular motility status is described in detail.

Biological characterization of a novel biodegradable antimicrobial polymer synthesized with fluoroquinolones

Biomaterial-related infections continue to represent a significant challenge to the medical community. Several approaches have been utilized to incorporate antimicrobial agents at the surface of implant devices in attempts to delay or eliminate the formation of biofilms. To date, most of these strategies have focused on drug conjugation or diffusion-limited systems for the delivery of such pharmaceutical agents. More recently, work has been presented on the feasibility of incorporating drugs into the backbone of polymers as a main-chain monomer. When sequenced into the backbone of the polymer with other monomers that are hydrolytically sensitive to enzyme-catalyzed breakdown, it is thought that drugs may be able to be selectively released. Specifically, degradable polyurethanes have been synthesized with fluoroquinolone antibiotics and have shown an ability to kill bacteria when released following degradation of the polymer chains by the macrophage-derived enzyme cholesterol esterase. However, specificity of the cleavage sites in the polymer was difficult to control. Since cholesterol esterase has specificity for hydrophobic moieties, it is desirable to alter the formulation of the polyurethanes to incorporate long hydrophobic monomers immediately adjacent to the ciprofloxacin molecule. Hence, the current study focuses on evaluating the enzyme-catalyzed degradation of a degradable polyurethane synthesized with 1,12 diisocyanatododecane as a substitute for 1,6 diisocyanatohexane, which was used in previous work. Validation of specific ciprofloxacin release and the generation of antimicrobial are shown. A preliminary cell study to assess the cytotoxicity of this biodegradable antibiotic polymer shows that the material has no observable effects on cell proliferation or cell membrane structure.

[Clinical observation on effect of xuejie jiawei decoction on vaginal hemorrhagic amount and duration in patients after drug-abortion]

OBJECTIVE

To observe the effect of Xuejie Jiawei Decoction (XJJWD) in reducing vaginal hemorrhagic amount, shortening hemorrhagic duration and lowering the curettage rate of incomplete abortion in patients after drug-abortion.

METHODS

Group A was treated with XJJWD No. I from the 2nd day after abortion, one dose per day for 7 days. Group B was treated with XJJWD No. II from the 11th day after abortion, one dose per day for 5 days. The therapeutic effect of the two groups was compared with that of the untreated control group.

RESULTS

In the Group A, the total score on vaginal hemorrhagic amount was markedly less than that in the control group (P < 0.01), and the vaginal hemorrhagic duration in patients with menostasis less than 45 days was shorter than that in the control group (P < 0.01). In the Group B, the total score on vaginal hemorrhagic amount in patients with menostasis less than 45 days was lower than that in the control group (P < 0.05).

CONCLUSION

XJJWD could reduce the vaginal hemorrhagic amount and duration in patients after drug-abortion. It should be applied early after abortion, the less the duration of menostasis, the more effective the treatment.

Humic acid induced growth retardation in a sertoli cell line, TM4

Humic acid (HA) is a fluorescent deep brown organic, polymeric compound composed of phenolic acid. Intraperitoneal injection of HA in rats induced testicular morphological changes including degeneration of the seminiferous tubule, reduction in the number of Sertoli cells and spermatogonia, and a loss of spermatids. It was suggested that Sertoli cells may be involved in the progression of testicular atrophy. In this study, we used a mouse Sertoli cell Line, TM4, to investigate the effect of HA on Sertoli cells and the mechanism of the testicular atrophy induced by HA. We found that the cell growth of TM4 cells were reduced in 1 to 4 days of HA exposure. FACScan analysis of the DNA content of HA-treated TM4 cells revealed that there was no sub-G1 peak, indicating that the TM4 cells did not commit to the programmed cell death. However, a large proportion of TM4 cells were arrested at the G1 phase. The percentage of TM4 cells at the G1 phase increased from 36% to 84% after HA treatment for 4 days. Western blot assay of HA-treated TM4 cells showed that the expression of cyclin D1 protein decreased while the expression of p27kiP1 protein increased. These results suggest that HA-induced testicular atrophy is linked in part to an inhibitory effect on the growth of Sertoli cells. This model may be useful in investigation of environmental agents inducing testicular atrophy.