Long-term outcomes of adjuvant intravitreal injection of conbercept therapy in juvenile Coats disease / 中华眼底病杂志

Objective:To study the long-term effects and outcomes of adjuvant intravitreal injection of conbercept (IVC) therapy in juvenile Coats disease.Methods:A retrospective case series study. From January 1, 2015 to December 31, 2018, 40 patients (40 eyes) who were diagnosed as juvenile Coats disease at Beijing Tongren Hospital Affiliated to Capital Medical University were included in the study. Among them, there were 37 males (37 eyes) and 3 females (3 eyes). All patients had unilateral Coats disease. The average age was 55.00 (44.75, 81.25) months. Five eyes were in stage 2B, 15 eyes were in stage 3A, 19 eyes were in stage 3B and 1 eye was in stage 4. Idiopathic retinal vascular telangiectasia associated with extensive subretinal fluid (SRF) (stage 3 or above) or massive foveal exudation and edema (stage 2B) were found in fundus examination. All affected eyes underwent wide-field color fundus images and fluorescein fundus angiography. Thirty-one eyes underwent best corrected visual acuity (BCVA) examination. The BCVA was carried out using a standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity. All cases received adjuvant IVC combined with treatments such as retinal photocoagulation. The average number of injections was 4 (1, 5). The average follow-up after initial treatment was 59.00 (52.50, 63.00) months. The changes in BCVA, occlusion of abnormal blood vessels in fundus, absorption of SRF and ocular and systemic complications were observed.Results:At last follow-up, among 31 affected eyes with the examination of BCVA, 13 (32.5%, 13/40) eyes had an improved vision, 12 eyes(30.0%, 12/40) had a stable vision and 6 eyes (15.0%, 6/40) had a decreased vision. The difference between average logMAR BCVA of the affected eyes in each stage after treatment and that before treatment was not statistically significant ( Z=-0.56, -1.80, -0.84; P>0.05). Abnormal blood vessels in fundus were all partially or completely occluded, and SRF was obviously or completely absorbed in all cases; of which, 28 eyes (70.0%, 28/40) were completely occluded, and 12 eyes (30.0%, 12/40) were partially occluded. No patient underwent eye enucleation. Nineteen eyes (47.5%, 19/40) developed vitreoretinal fibrosis; 8 eyes (20.0%, 8/40) developed tractional retinal detachment; 15 eyes (37.5%, 15/40) developed complicated cataract. None had ocular or systemic complications related to IVC therapy during follow-up. Conclusions:IVC combined with classic treatments such as photocoagulation in juvenile Coats disease can keep or improve the visual acuity in most juvenile patients by reducing SRF. IVC is a long-term safe and effective adjuvant therapy in juvenile Coats disease.

Pediatric Coats disease of stage 2 and greater managed with 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab / 中华眼底病杂志

Objective:To investigate the efficacy of 532 nm wavelength laser using indirect ophthalmoscope combined with ranibizumab (IVR) in treating stage 2 and greater pediatric Coats disease.Methods:A retrospective, non-controlled clinical study. From February 2018 to August 2020, 21 eyes of 21 patients with Coats disease stage 2 and greater diagnosed by examination in the Eye Center of Beijing Tongren Hospital were included in the study. Among them, 20 patients were males; 1 patient was female. Mean age was 5.00±1.92 years old. Stage 2A, 2B, 3A, 3B, and 4 were 2, 8, 7, 2, and 2 eyes, respectively. All eyes underwent wide-field fundus color photography and fluorescein fundus angiography (FFA). Best corrected visual acuity (BCVA) was performed in 17 eyes. Abnormal dilated retinal blood vessels, interretinal and subretinal exudates were found in all eyes. Abnormally dilated capillaries and aneurysms in the retina was shown in FFA examination. All eyes underwent 532 nm laser photocoagulation using indirect ophthalmoscope combined with IVR. Patients with severe retinal detachment of stage 3B or greater were treated by external drainage of subretinal fluid (SRF). The subsequent treatment was the same as before. The follow-up time was 35.67±6.13 months. Relevant examinations were performed using the same equipment and methods before. The frequency of treatment, visual acuity changes, anatomic prognosis, and complications were observed.Results:The frequency of eye photocoagulation was 2.43±0.98. The number of IVR treatments was 2.00±0.89. Three eyes were treated with SRF drainage in the first time. At the last follow-up, visual acuity improved, no change, and decreased in 5, 11, and 1 eyes after BCVA examination, respectively. In 21 eyes, the retina was in situ in 17 eyes; 5 eyes with retinal cysts. During the follow-up, cataract and vitreous hyperplasia occurred in 1 eye, which was treated by vitrectomy, and mild vitreous hyperplasia occurred in 1 eye.Conclusion:Indirect ophthalmoscope 532 nm wavelength laser combined with IVR is an effective treatment for pediatric Coats disease.

Anti-vascular endothelial growth factor treatment in X-linked retinoschisis with vitreous hemorrhage / 中华眼底病杂志

Objective:To review the outcome of intravitreous anti-vascular endothelial growth factor (VEGF) treatment in patients with X-linked retinoschisis (XLRS) complicated with vitreous hemorrhage (VH).Methods:A retrospective clinical study. From March 1, 2016 to April 1, 2022, 18 patients (19 eyes) diagnosed with XLRS complicated with vitreous hemorrhage in Beijing Tongren Hospital, Capital Medical University of Eye Center were included. All the patients were male, with a median age of 7.05±3.8 years. Best corrected visual acuity (BCVA) and wide-angle fundus photography were performed in all the patients. BCVA was carried out using international standard visual acuity chart, and converted into logarithm of minimum resolution angle (logMAR) in statistics analysis. According to whether the patients received intravitreal injection of ranibizumab (IVR), the patients were divided into injection group and observation group, with 11 eyes in 10 cases and 8 eyes in 8 cases, respectively. In the injection group, 0.025 ml of 10 mg/ml ranibizumab (including 0.25 mg of ranibizumab) was injected into the vitreous cavity of the affected eye. Follow-up time after treatment was 24.82±20.77 months. The VH absorption time, visual acuity changes and complications were observed in the injection group after treatment. Paired sample t test was used to compare BCVA before and after VH and IVR treatment. Independent sample t test was used to compare the VH absorption time between the injection group and the observation group. Results:LogMAR BCVA before and after VH were 0.73±0.32 and 1.80±0.77, respectively. BCVA decreased significantly after VH ( t=-3.620, P=0.006). LogMAR BCVA after VH and IVR were 1.87±0.55 and 0.62±0.29, respectively. BCVA was significantly improved after IVR treatment ( t=6.684, P<0.001). BCVA records were available in 5 eyes before and after IVR, and the BCVA values after VH and IVR were 0.58±0.31 and 0.48±0.20, respectively, with no statistically significant difference ( t=1.000, P=0.374). BCVA increased in 1 eye and remained unchanged in 4 eyes after treatment. BCVA records were available in 5 eyes before VH and after VH absorption in the 8 eyes of the observation group. LogMAR BCVA before VH and after VH absorption were 0.88±0.28 and 0.90±0.26, respectively, with no significant difference ( t=-1.000, P=0.374). After VH absorption, BCVA remained unchanged in 4 eyes and decreased in 1 eye. The absorption time of VH in the injection group and the observation group were 1.80±1.06 and 7.25±5.04 months, respectively. The absorption time of VH was significantly shorter in the injection group than in the observation group, the difference was statistically significant ( t=-3.005, P=0.018). Multivariate linear regression analysis showed that IVR treatment was significantly correlated with VH absorption time ( B=-6.66, 95% confidence interval -10.93--2.39, t=-3.40, P=0.005). In the injection group, VH recurrence occurred in 1 eye after IVR treatment. Vitrectomy (PPV) was performed in one eye. In the 8 eyes of the observation group, VH recurrence occurred in 2 eyes, subsequent PPV in 1 eye. The rate of VH recurrence and PPV was lower in the injection group, however, the difference was not statistically significant( P=0.576, 1.000). In terms of complications, minor subconjunctival hemorrhage occurred in 2 eyes and minor corneal epithelial injury occurred in 1 eye in the injection group, and all recovered spontaneously within a short time. In the injection group, 9 eyes had wide-angle fundus photography before and after IVR treatment. There was no significant change in the range of peripheral retinoschisis after treatment. No obvious proliferative vitreoretinopathy, infectious endophthalmitis, retinal detachment, macular hole, complicated cataract, secondary glaucoma or other serious complications were found in all the treated eyes, and there were no systemic complications. Conclusion:Intravitreous anti-VEGF treatment may accelerate the absorption of vitreous hemorrhage in patients with XLRS. No impact is found regarding to the peripheral retinoschisis.

Clinical features and treatment of glaucoma secondary to familial exudative vitreoretinopathy / 中华眼底病杂志

Objective:To investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma.Methods:A retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed.Results:Among the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred.Conclusions:The main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.

Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis / 中华眼底病杂志

Objective:To observe the efficacy of parsplana vitrectomy (PPV) combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis (OT).Methods:A retrospective clinical study. Fifty-three pediatric patients (53 eyes) diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included. There were 30 males and 23 females, with an average age of 7.07±3.45 (4-14) years; all were unilateral. Color Doppler imaging, fundus color photography, optical coherence tomography examinations were performed for patients who can cooperated with the examiners. Forty-three eyes were examined by best corrected visual acuity (BCVA); 47 eyes were examined by intraocular pressure; 29 eyes were examined by ultrasound biomicroscopy. According to the location of granuloma, OT was divided into posterior pole granulomatous type (posterior type), peripheral granulomatous type (peripheral type), and chronic endophthalmitis type. According to whether Ozurdex was implanted into the vitreous cavity after PPV, the children were divided into the oral glucocorticoid group after PPV (group A) and the PPV combined with vitreous cavity implantation of Ozurdex group (group B), 37 cases with 37 eyes and 16 cases with 16 eyes, respectively. There was no significant difference in age ( t=0.432), sex composition ratio ( χ2=0.117), BCVA ( χ2=0.239), and clinical type ( χ2=0.312) between the two groups ( P>0.05). The follow-up time after surgery was ≥5 months. The intraocular pressure at 1 week and 1, 3, and 6 months after surgery, the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up, and the incidence of obesity in the children during the follow-up period was recorded. The measurement data between groups was compared by independent sample t test; the enumeration data was compared by χ2 test. Results:One month after the operation, the intraocular pressure of group A and group B were 15.17±6.21 and 25.28±10.38 mm Hg (1 mm Hg=0.133 kPa) respectively; the intraocular pressure of group B was significantly higher than that of group A, the difference was statistically significant ( t=0.141, P=0.043). At the last follow-up, there was no significant difference in the percentage of visual acuity improvement between the two groups ( χ2=0.315, P=0.053); there was no significant difference in the incidence of concurrent cataract and epimacular membrane ( χ2=0.621, P >0.05). Among the 37 cases in group A, 32 cases (86.5%, 32/37) developed obesity symptoms during the follow-up period. Conclusion:PPV combined with intravitreal implantation of Ozurdex and oral glucocorticoid after PPV can effectively improve the visual acuity of the affected eye; the incidence of complications is similar, however, the incidence of obesity after oral glucocorticoid is higher.

Correctly understanding the complexity of diagnosis and treatment of children's open ocular trauma to improve its diagnosis and treatment effect / 中华眼底病杂志

Open ocular trauma in children is one of the main causes of non-congenital monocular blindness in children. Children’s psychological and daily activities are different from those of adults; the eye tissue structure is not maturely enough, and the characteristics of high response to injury and incompatibility with various diagnostic and treatment methods determine the factors that cause injuries and injuries in children with open ocular trauma. The environment, diagnosis and treatment, and prognosis of children are more complicated than adults. For the emergency of first and second stage on diagnosis and treatment of children with open ocular trauma, it should follow the principles of adult open ocular trauma management, combined with the children's characteristics, clarifying the anatomical location of the ocular trauma before surgery, and closing the wound during the first-stage operation. At the same time, the disturbance of intraocular tissue should be minimized, the timing of the second stage operation and the individualization of the operation design, and the medication and care after the operation should also be combined with the characteristics of children. Prevention of ocular trauma in children is the focus of attention. In the new information era, clinical research and public information platforms should be fully utilized to advance the epidemiological study of children's ocular trauma and guide the construction of the prevention and treatment system for children's ocular trauma more scientifically.

Study on the mechanism of death related protein kinase 3 deficiency and inhibition of endoplasmic reticulum stress to alleviate vascular calcification / 中国综合临床

Objective:To investigate whether the deficiency of death associated protein kinases (DAPK) 3 can reduce vascular calcification by inhibiting endoplasmic reticulum stress.Methods:The method of prospective cohort study was used to observe and analyze the cell culture in vitro.Human aortic vascular smooth muscle cells (VSMC) were cultured in F10K Kaighn′s modified medium, and divided into calcified group and non-calcified group according to whether β-phosphoglycerin (10 mmol/L) was added into the medium.The cells in calcified group and non calcified group were divided into DAPK3 inhibition group and its control group, endoplasmic reticulum stress inhibition group and its control group, mitogen-activated protein kinase (MAPK) activation group and its control group, DAPK3 inhibition + AMP-activated protein kinase (AMPK) inhibition and blank control group, respectively. DAPK3 mRNA and protein concentration, calcium content, alkaline phosphatase, protein concentration of VSMC differentiation marker genes (SM22α, α-SMA), osteogenic differentiation transcription factor (Runχ2, bone morphogenetic protein-2, BMP-2), endoplasmic reticulum stress markers (AFT4, GRP78, GRP94 and CHOP) and p-PAMK protein expression were measured.Results:The mRNA level(highest value was 15.24±0.72 on the 14th day ) and protein level(highest value was 11.31±0.38 on the 14th day) of DAPK3 were significantly higher than those in non calcified cells(5.63±0.62, 2.59±0.33, respectively). The difference was statistically significant ( P< 0.001). In the calcified cells, calcium content (86.54±8.21) mmol/g in dapk3 deficient group was significantly lower than that in control group (194.63±8.54) mmol/g ( t=22.35, P<0.001), alkaline phosphatase activity was significantly decreased((96.27±10.28) IU/g vs.(224.67±10.94) IU/g, t=20.951, P<0.001), the expression of the VSMC differentiation marker genes (SM22α, α-SMA) were upregulated significantly (SM22α: (0.82±0.14) vs.(0.44±0.13), t=4.872, P=0.001; α-SMA: (0.95±0.18) vs.(0.56±0.13), t=4.303, P=0.002), the level of bone differentiation transcription factor (Runχ 2, BMP2) was significantly decreased (Runχ 2: (1.12±0.28) vs.(2.21±0.35), t=5.957, P<0.001; BMP2: (0.82±0.12 ) vs.(1.26±0.16), t=5.39, P<0.001), MAPK level was up-regulated (DAPK3 inhibited group 0.74±0.12 of calcified cells, 1.04±0.14 of non calcified cells, higher than the control group 0.44±0.10 of calcified cells, 0.78±0.12 of non calcified cells, t=4.704, P=0.001; t=3.454, P=0.006), and the inhibited calcium content of ESR calcified cells significantly reduced (after inhibition of AMPK pathway, cells transfected with shRNA group 150.21±11.98, cells transfected with shRNA group 83.21±12.12 were lower than those transfection blank control group 164.82±12.34, P<0.001). The activity of alkaline phosphatase was significantly reduced (226.54±16.57) IU/g protein in the shRNA group and (112.34±15.96) IU/g protein in the shRNA group were significantly lower than 242.32±16.32 in the blank control group, P<0.001); calcium content and ALP activity in the calcified MAPK cells were significantly reduced ( P<0.001). Conclusion:DAPK3 deficiency can inhibit endoplasmic reticulum stress through AMPK signaling pathway to slow down VSMC calcification.

Application of multi-slice spiral CT in the diagnosis of children's parotid cleft deformity / 临床耳鼻咽喉头颈外科杂志

The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity. The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. In 16 casescystic mass and tubular fistula were found in the parotid gland or at the edge of the parotid gland. One case was accompanied by atresia of the lateral auditory meatus. After contrast enhancement, the cystic wall（tube wall） of 55 patients were enhanced. In 9 patients with infection, the boundary of the lesion was blurred, and the density of the cyst or lumen increased after contrast enhancement. MSCT diagnosed 6 cases of parotid cleft cyst with fistula, 35 cases of branchial cleft cyst, 13 cases of parotid fistula, and 1 case misdiagnosed as lymphadenitis. Among all the cases, 15 were type Ⅰ, 36 were type Ⅱand 4 were type Ⅲ. Compared with the results of pathological diagnosis and clinical operation, the accuracy of qualitative diagnosis and localization was 99.9% and 100.0%. Multi-slice spiral CT thin-slice images combined with MPR image post-processing technology can better display the location of branchial cyst and the course of branchial fistula.

Preliminary research of 3D digital vitrectomy in the treatment of persistent fetal vasculature / 中华眼底病杂志

Objective:To observe the clinical effect of 3D digital head-up vitreoretinal surgery and conventional optical microscope surgery in the treatment of persistent fetal vasculature (PFV).Methods:A retrospective case analysis study was performed. From November 2017 to August 2019, the enrolled patienres included that 20 eyes of 19 patients with PFV undergoing 3D digital head-up vitreoretinal surgery and 26 eyes of 26 patients with PFV undergoing traditional microscopic vitrectomy in the Eye Center of Beijing Tongren Hospital. The operation age of patients in the two groups were ≤14 years old and followed up for at least 1 month. There were no significantly statistical differences in gender ( χ2=0.114), age ( t=0.337), axial length ( t=0.578) between the two groups ( P=0.267, 0.782, 0.650). All the patients were operated under general anesthesia by the same doctor. All the surgical procedures were completed by the surgeon watching the 3D screen with 3D glasses, and all the surgical process were observed by the other medical staff including the nurses and the anaesthetists in the observation group. While in the observation group, the surgical doctor and one assistant doctor watched the surgery through the operating microscope, the other doctors watched the 2D surgical video system. The general information, pre-and postoperative visual acuity, anatomical changes and surgical complications were reviewed and compared between the two groups. Difficulty and complexity of each surgery were classified by the chief surgical doctor into 5 scores. 1: easy, 2: a little difficult, 3:much difficult, 4 very difficult; 5:most difficult. Opinions of medical staff majored in or not majored in ophthalmology were also recorded. Independent sample t test was used to compare the count data between the two groups, while chi-square test was used to compare the measurement data. Results:The average operating time was 34.7±8.5 minutes and the difficulty score was 2.8±0.9 in the observation group. The average operating time was 37.5±1.6 minutes and the difficulty score was 3.1±1.1 in the comparison group. There was no significant statistically differences between the two groups ( t=0.782, 0.938; P=0.703, 0.562). Seven eyes had visual acuity improvement at last visit while 13 eyes with no changes compared with pre-operative visual acuity in the observation group, 8 eyes showed visual acuity improvement at last visit while 18 eyes showed no changes compared with pre-operative visual acuity in the comparison group. There was no significantly statistical differences between the two groups ( χ2=0.279, P=0.254). No surgical complications such as endophthalmitis or secondary glaucoma were observed in the two groups. 3D digital system showed better stereoscopic pictures and better resolution compared with traditional microscopic vitrectomy. All the medical staff which participated in the surgery preferred to the 3D digital vitrectomy system. Conclusions:3D heads-up digital vitrectomy shows better stereoscopic pictures and better resolution. 3D heads-up digital vitrectomy and traditional microscopic vitrectomy yielded comparable visual and anatomical outcomes for treatment of pediatric vitreoretinal diseases, however, there is not a significant difference in clinical outcomes.

Application of multi-slice spiral CT in the diagnosis of children's parotid cleft deformity / 临床耳鼻咽喉头颈外科杂志

Objective@#The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity.@*Method@#The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. @*Result@#CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. In 16 casescystic mass and tubular fistula were found in the parotid gland or at the edge of the parotid gland. One case was accompanied by atresia of the lateral auditory meatus. After contrast enhancement, the cystic wall（tube wall） of 55 patients were enhanced. In 9 patients with infection, the boundary of the lesion was blurred, and the density of the cyst or lumen increased after contrast enhancement. MSCT diagnosed 6 cases of parotid cleft cyst with fistula, 35 cases of branchial cleft cyst, 13 cases of parotid fistula, and 1 case misdiagnosed as lymphadenitis. Among all the cases, 15 were type Ⅰ, 36 were type Ⅱand 4 were type Ⅲ. Compared with the results of pathological diagnosis and clinical operation, the accuracy of qualitative diagnosis and localization was 99.9% and 100.0%. @*Conclusion@#Multi-slice spiral CT thin-slice images combined with MPR image post-processing technology can better display the location of branchial cyst and the course of branchial fistula.

CEUS and planewave ultrasensitive imaging analysis of thyroid papillary carcinoma / 中国医学影像技术

Objective To observe manifestations of thyroid papillary carcinoma (PTC) in CEUS and planewave ultrasensitive imaging (AngioPLUS). Methods CEUS and AngioPLUS features of histopathologically proved PTC in 83 patients were retrospectively analyzed. According to CEUS enhancement, the patients were divided into hypo-enhancement group, iso-enhancement group and hyper-enhancement group. The differences of the peak intensity (PI) between lesion and adjacent thyroid tissue (ΔPI) were compared among 3 groups. The correlation of PI, ΔPI and CEUS enhancement of the lesions were evaluated, so as the correlation of CEUS enhancement, PI, ΔPI and the microvascular distribution showed with AngioPLUS. Results The differences of ΔPI among the 3 groups were statistically significant (χ2=52.35, P<0.001). ΔPI of hypo-enhancement group was less than that of iso-enhancement group (Z=-6.45, P<0.001) and hyper-enhancement group (Z=-3.99, P<0.001). ΔPI of iso-enhancement group was less than that of hyper-enhancement group (Z=-3.73, P<0.001). The differences of PI were statistically significant among 3 groups (F=34.97, P<0.001). PI of hypo-enhancement group was less than that of iso-enhancement group and hyper-enhancement group (both P<0.001). No significant difference was found for PI between iso-enhancement group and hyper-enhancement group (P=0.322). PI (rs=0.650, P<0.001) and ΔPI (rs=0.798, P<0.001) both had positive correlation with CEUS enhancement of the lesions. CEUS enhancement (rs=0.768, P<0.001), PI (rs=0.442, P<0.001) and ΔPI (rs=0.647, P<0.001) all had positive correlation with microvascular distribution demonstrated with AngioPLUS of the lesions. Conclusion CEUS enhancement of PTC showes positive correlation with microvascular distribution demonstrated with AngioPLUS of the lesions, which may be used to evaluate the perfusion indirectly of the lesions.

Clinical characteristics of pediatric ocular toxocariasis / 中华实验眼科杂志

Objective To describe the clinical manifestations of pediatric ocular toxocariasis.Methods The clinical data of 163 pediatric patients (163 eyes) with ocular toxocariasis from March 2012 to March 2018 at Beijing Tongren Hospital were retrospectively analyzed,with at least a follow-up of 5 months.The mean age of the patients was (7.03±2.54) years old,and 71.8％ of the patients were male.The provenances,clinical features,color doppler image (CDI) and ultrasound biomicroscope (UBM) manifestations and treatment of the patients were retrospectively analyzed.Results The patients were mainly from north area of China,72.4％ of the patients came from rural area,and 59.5％ had a history of close contact with cats or dogs;84.8％ of the patients had an initial best corrected visual acuity (BCVA) of less than 0.1,48.5％ of the patients had peripheral granuloma formation,most cases presented with manifestations of chronic inflammation,such as lamellar vitreous opacity,tractional retinal detachment and band-shaped degenerations of the cornea.CDI examination demonstrated tractional retinal detachment in 84.4％ of the patients and UBM detected that 52.7％ of the patients had peripheral vitreoretinal pathologies ranged more than 6 clock-hours.Eighty-four percent of the patients undergone vitrectomy for severe vitreous opacity and/ or tractional detachment.Conclusions Most of the patients are school-age children,with a history of close contact of cats or dogs,and have poor visual acuity and severe clinical manifestations,such as vitreous opacity and/or tractional detachment which needed vitrectomy.CDI and UBM are helpful in confirming the scope and severity of introcuar pathologies.

RT-PCR detection of cytokine expression in gastric mucosae of mice with Helicobacter heilmannii infection / 中华微生物学和免疫学杂志

Objective To compare the changes in IFN-γ, IL-4, IL-10 and IL-1β expression at mRNA level in gastric mucosae of BALB/c, C57BL/6 and nude mice at different stages of Helicobacter heilmannii ( H. heilmannii) infection, and to investigate the types of induced immune responses. Methods Each kind of mice was randomly divided into two groups: infection ( n=30 ) and control ( n=6 ) groups. Those in the infection groups were intragastrically inoculated with H. heilmannii strains to establish long-term stable mouse infection models. Gastric mucosa tissues were collected at weeks 4, 8, 12, 24 and 36 and ana-lyzed by semi-quantitative RT-PCT to detect the expression of IFN-γ, IL-4, IL-10 and IL-1βat mRNA lev-el. Results In the early stage of infection (weeks 4-12), INF-γ, IL-4, IL-10, and IL-1β expression at mRNA level in the gastric mucosae of BALB/c and C57BL/6 mice were significantly increased compared with those of the control groups (P<0. 05). IL-4, IL-10 and IFN-γexpression peaked at weeks 8-12, while IL-1βexpression reached the peak at week 4. After 12 weeks, IFN-γexpression at mRNA level in BALB/c mice was significantly decreased, but showed no significant change in C57BL/6 mice. IL-4 expression at mRNA level in C57BL/6 mice at the late stage of infection (week 36) was lower than that in the correspond-ing control group (P<0. 05). Expression of IFN-γ, IL-4, IL-10 and IL-1β at mRNA level in nude mice were all higher than those in the control group, and there were significant differences in IL-1βand IL-4 ex-pression between groups (P<0. 05). Conclusions Expression of cytokines in H. heilmannii-infected mice increased over time. IFN-γ-mediated Th1 immune responses were the predominant immunity induced by H. heilmannii infection. Immune responses to H. heilmannii infection varied with the kinds of mice. C57BL/6 mice showed mainly Th1 cell immune responses, while Th1/Th2 mixed immune responses were induced in BALB/c mice.

Efficacy and safety of rotational atherectomy combined with drug eluting coronary in the treatment of severe coronary artery calcified lesions / 中国综合临床

Objective To investigate the efficacy and safety of rotational atherectomy(RA)combined with drug eluting stent(DES)implantation in the treatment of severe coronary artery calcification,and analyze key operation points.Methods The clinical data of sixty-two patients(68 lesions)treated with RA combined with DES from January 2014 to December 2015 were retrospectively analyzed,including the characteristics of operation,postoperative curative effect,complications,incidence of major adverse cardiovascular events(MACE) during hospitalization and follow-up period.Results A total of 75 rotary blur were used in the 62 cases,with an average of(1.18±0.27)per case,the blur diameter/target vessel diameter was(0.54±0.07),the success rate of RA was 98.4%(61/62);A toal of 103 DES were implanted in 61 patients,with an average of(1.67±0.55)per case,average length was(44.5 ± 11.8)mm,immediate DES success rate was 100%.After RA,target vessel diameter was(2.33± 0.52)mm,target vessel narrow degree was(29.6 ± 4.8)%,thrombolysis in myocardial infarction grade Ⅲ blood flow ratio was 66.2%,which have been significantly improved compared with preoperation((0.75±0.21)mm,(82.5±7.2)%,10.3%)(P<0.05),the target vascular lumen diameter and stenosis of target vessel continued to improve after DES((3.26 ± 0.43)mm,(8.7 ± 2.1)%,98.5%)(P<0.05);At 3 days after operation,the left ventricular ejection fraction was significantly higher than that before the operation((60.5±5.5)% vs.(56.8±4.7)%)(P<0.05).The incidence of complications associated with interventional procedures was 9.7%,in which 1 case with burr incarceration switched to coronary artery bypass grafting.The incidence of major adverse cardiovascular events incidence during hospitalization was 4.8%,the follow-up period was 9.0-22.0 months.The incidence of major adverse cardiovascular events incidence during follow-up was 8.2%.Conclusion DES implantation following RA in the treatment of severe coronary artery calcification can further improve blood flow and artery stenosis,medium-term efficacy is safe and reliable;standardized RA operation is the key to ensure the success of interventional therapy.

The changes of content and proportion of main components in glycyrrhiza ura-lensis Fisch under different processing and extraction conditions / 药学实践杂志

Objective To explore the licorice herbs principal component isomer content and percentage change in differ-ent processing and extracting conditions.Methods RP-HPLC method were used with 18 beta glycyrrhizic acid(18β-Gly)and 18 alpha glycyrrhizic acid(18α-Gly)as the basis of evaluation,determination of main components and impurities of licorice pieces,effects of processing temperature and processing time on licorice pieces and standard mixture of principal components andimpuritiesthecontentof18-Glyand18α-Glyand18β-Glyratiochange.Results Duringtheprocessof Glycyrrhizauralen-sis Fisch,increasing the processing temperature and prolonging the processing time caused the decomposition of 18β-Gly and 18α-Gly,which was the main component isomer of licorice root,and the total content of licorice root was slightly decreased. During the processing,the main components did not change the conformation,and had no effect on the proportion of the two. The content of 18β-Gly and 18α-Gly content of glycyrrhizic acid in Glycyrrhiza uralensis Fisch after processing were lower than those before processing in 18β-Gly and 18α-Gly.Conclusion The processing time of licorice pieces could not be too long,the temperature could not be too high,so as to avoid excessive loss of active ingredients.Baking conditions suitable for baking tem-perature was 65 ℃,time was 1-2 h.The processing condition was convenient,the time and the temperature were controllable, and the sample quality was stable.

The effect of estimated glomerular filtration rate on outcome of patients with acute ischemic stroke after intravenous thrombolysis with recombinant tissue plasminogen activator / 中华神经科杂志

Objective To explore the association between estimated glomerular filtration rate (eGFR) and prognosis of acute ischemic stroke (AIS) patients who were treated by intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA).Methods We consecutively screened AIS patients who were treated by intravenous thrombolysis with rt-PA from January 2006 to September 2016 in Tangshan Gongren Hospital.According to eGFR value of patients at admission,the eligible patients were divided into two groups:normal eGFR group (eGFR ≥ 90 ml ? min-1 ? 1.73 m-2) and decreased eGFR group (eGFR ＜ 90 ml? min-1 ? 1.73 m-2).The incidence of symptomatic intracerebral hemorrhage (SICH),early neurological deterioration (END) at 24 hours and seven days after thrombolysis,mortality within seven days and 90 days,and excellent recovery at 90 days were compared between the two groups.The OR with 95％ CI and the adjusted OR with 95％ CI were analyzed by univariate and multivariate Logistic regression models.Results A total of 258 patients were enrolled,including 182 cases in the normal eGFR group and 76 cases in the decreased eGFR group.After adjusting for the potential confounders,multivariate Logistic regression analysis showed that the rates of SICH (13.2％ (10/76) vs 3.3％ (6/182),OR =3.859,95％ CI 1.313-11.341),END at 24 hours (21.1％ (16/76) vs 8.2％ (15/182),OR =2.958,95％ CI 1.347-6.495) and seven days (32.9％ (25/76) vs 12.6％ (23/182),OR =3.129,95％ CI 1.555-6.293),mortality within seven days (22.4％ (17/76) vs 6.0％ (11/182),OR =4.079,95％ CI 1.588-10.477) and 90 days (23.7％ (18/76) vs 9.9％ (18/182),OR =2.457,95％ CI 1.050-5.749) were higher in the decreased eGFR group than in the normal eGFR group.On the other hand,the chance of excellent recovery at 90 days (22.4％ (17/76) vs 43.4％ (79/182),OR =0.435,95％ CI 0.229-0.824) was less in the decreased eGFR group than in the normal eGFR group.Conclusion Decreased eGFR may not only increase the risks of SICH,END and death,but also reduce the chance of 90-day excellent recovery in AIS patients after intravenous thrombolysis with rt-PA.

Study on correlation of serum levels of galectin-3,N-terminal pro brain natriuretic peptide,brain natriuretic peptide and c-reactive protein with mortality during 30-day hospitalization in patients with decompensated acute attack of chronic heart failure / 中华老年医学杂志

Objective To analyze the correlation of serum levels of galectin-3(Gal-3), N-terminal pro brain natriuretic peptide(NT-proBNP),brain natriuretic peptide(BNP)and C reactive protein(CRP)with prognosis of patients with decompensated acute attack of chronic heart failure (DAACHF),and to evaluate its significance in predicting mortality during 30-day hospitalization. Methods 103 DAACHF patients admitted in Peking University First Hospital and Capital Medical University-affiliated Beijing Anzhen Hospital Department of Cardiology from July 2012 to June 2015 were divided into death group(n=53,died of DAACHF)and survival group(n=50)matched for age, gender,cardiac function during 30-day hospitalization.Serum levels of Gal-3,NT-proBNP,BNP,CRP and the Minnesota Living with Heart Failure Questionnaire(MLHFQ)were retrospectively collected and compared on the first hospital day and 3 days,7 days,14 days after treatment.After 7 days of treatment,the serum levels of four markers were correlated with MLHFQ.The areas under the receiver operating characteristic(ROC)curve were used for estimating efficiencies of serum levels of four markers in predicting DAACHF patients' mortality during 30-day hospitalization. Results With prolonged treatment,the scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were gradually increased in the group of death,and gradually decreased in survival group.The scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were higher in the death group than in control group(P<0.05)at the day of hospital admission and at 3 days,7 days and 14 days after treatment(P<0.05).On 7 days after treatment,Gal-3,NT-proBNP, BNP,and CRP were positively correlated with MLHFQ score(r=0.748,0.730,0.6872,all P<0.01),and the areas under ROC curves predicting performance for mortality during 30-day hospitalization were 0.943, 0.907,0.876,0.867,0.913 for Gal-3,NT-proBNP,BNP,CRP and MLHFQ score,respectively,all P<0.01). Conclusions Serum levels of Gal-3,NT-proBNP,BNP and CRP were positively correlated with adverse prognosis for DAACHF patients,and they may be predictors of mortality during 30-day hospitalization with sequence effect of Gal-3>NT-proBNP>BNP>CRP.And their joint monitoring is better in predicting the prognosis of patients with heart failure.

CT imaging features and its correlation with histopathology of thyroid nodules in children / 中华实用儿科临床杂志

Objective To investigate the CT features of benign and malignant thyroid nodules in children and their correlation with histopathology of thyroid nodules.Methods The clinical data of 28 children with thyroid nodules confirmed by pathological diagnosis in Shanghai Children's Hospital from June 2014 to October 2017 were retrospectively analyzed.The CT imaging features and pathological results were compared and analyzed.Results The thyroid nodules of benign,malignant and uncertain malignant potential nodules in this group respectively were 35 nodules (11 cases),15 nodules (10 cases) and 8 nodules (7 cases) respectively,with a total of 58 nodules.Benign and uncertain malignant potential nodules were all(100.0％) enveloped,4 nodules(11.4％,4/35 nodules) were benign nodules and 1 nodule (12.5％,1/8 nodules) was uncertain malignant potential nodules and its capsule was incomplete.There were 11 nodules (73.3％,11/35 nodules) malignant nodules without capsule and 4 nodules(26.7％,4/15 nodules) were malignant nodules with incomplete capsule.In the benign nodules,9 nodules(25.7％,9/35 nodules) of them were cystic,and the others were solid or solid cystic (74.3 ％,26/35 nodules).All of the malignant nodules and uncertain malignant potential nodules were solid or solid cystic nodules.Benign nodules and uncertain malignant potential nodules were mostly had clear edges,but the edges of malignant nodules were not clear.There were 2 cases (18.2％,2/ll cases) of the benign nodules which had calcification,8 cases(80.0％,8/10 cases) of the malignant nodules had calcification,and 3 cases (42.9％,3/7 cases)of the uncertain malignant potential nodules had calcification.There was no lymph node metastasis in the patients with benign and uncertain malignant potential nodules.In the malignant nodules,there were 7 cases with lymph node metastasis,accounting for 70.0％ (7/10 cases).It had certain reference value for the differentiation of benign and malignant nodules to know whether the boundary of the mass was clear or not,whether the capsule was intact or not,and whether there was calcification or not.The surrounding lymph node enlargement had certain reference value for the differential diagnosis of benign and malignant nodules.The diagnostic results of CT and the coincidence rate of pathological histological diagnosis after operation,the benign nodules and malignant nodules,and also the uncertain malignant potential were respectively 61.1％ (11/18 cases),90.0％ (9/10 cases) and 14.3％ (1/7 cases).The thyroid nodules of uncertain malignant potential CT imaging were lack of specificity,and definite diagnosis should be based on pathology.Conclusions There is a certain relationship between CT imaging features and pathology of thyroid nodules,which is of great value for the diagnosis and differential diagnosis of thyroid nodules in children.

Associations between Mycobacterium tuberculosis Beijing genotype and drug resistance to four first-line drugs: a survey in China / 医学前沿

Investigations on the genetic diversity of Mycobacterium tuberculosis in China have shown that Beijing genotype strains play a dominant role. To study the association between the M. tuberculosis Beijing genotype and the drug-resistance phenotype, 1286 M. tuberculosis clinical isolates together with epidemiological and clinical information of patients were collected from the center for tuberculosis (TB) prevention and control or TB hospitals in Beijing municipality and nine provinces or autonomous regions in China. Drug resistance testing was conducted on all the isolates to the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin, and ethambutol). A total of 585 strains were found to be resistant to at least one of the four anti-TB drugs. The Beijing family strains consisted of 499 (53.20%) drug-sensitive strains and 439 (46.80%) drug-resistant strains, whereas the non-Beijing family strains comprised 202 (58.05%) drug-sensitive strains and 146 (41.95%) drug-resistant strains. No significant difference was observed in prevalence (χ= 2.41, P > 0.05) between the drug-resistant and drugsensitive strains among the Beijing family strains. Analysis of monoresistance, multidrug-resistant TB, and geographic distribution of drug resistance did not find any relationships between the M. tuberculosis Beijing genotype and drug-resistance phenotype in China. Results confirmed that the Beijing genotype, the predominant M. tuberculosis genotype in China, was not associated with drug resistance.

Value of 3.0T magnetic resonance cholangiopancreatography on diagnosis of congenital biliary malformation in children / 中华实用儿科临床杂志

Objective To investigate the clinical value of 3.0T magnetic resonance cholangiopancreatography (MRCP) in diagnosis of congenital biliary malformation in children.Methods Magnetic resonance imaging (MRI)and MRCP images,including the source image data and maximum intensity projection (MIP) reconstruction images,were analyzed retrospectively in 83 children with congenital biliary malformation diagnosed at Shanghai Children's Hospital,and their operative results and intraoperative cholangiopancreatography images were compared.Two experienced radiologists independently reviewed the images then they reached diagnostic conclusions by consensus.Eighty-three patients included 35 boys and 48 girls,aged from 20 days to 14 years.Results The MRCP indicated that 69 cases with choledochal cysts were consistent with intraoperative cholangiopancreatography findings,and the common bile duct showed different degrees of saccular and fusiform or columnar expansion with different types(Todani classification type Ⅰ 59 cases,type Ⅱ 1 cases,type Ⅳ a 7 cases,and type V 2 cases).The accuracy of localization and quality were 100％.MRCP demonstrated the anomalous junction of pancreaticobiliary duct in 14 cases.MRCP in 19 cases detected by intraoperative cholangiopancreatography with a sensitivity of 79％ and a specificity of 100％.Among 13 cases of biliary atresia,including 1 case accompanied with peritoneal organ inversion proved by MRI,11 cases of the entire extra—hepatic bile duct could not be completed visually,and 2 cases of small or small triangular signals were seen near the hepatic portal area,with the portal vein,and the left or right branches with 100％ accuracy of localization and quality including 1 case accompanied with peritoneal organ inversion proved by MRI.Congenital absence of gallbladder accompanied with duodenal obstruction was seen in 1 case,no gallbladder was found in the gallbladder fossa by MRCP,but the proximal duodenum was obviously dilated.Surgery confirmed that it was complicated and annular pancreas without gallbladder congenitally.Conclusion 3.0T MRCP is a noninvasive and effective method for diagnosis of congenital biliary malformation in children.It can be used as the preferred technique for diagnosis and long-term follow-ups.