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AIM: To explore the pathogenesis and surgical outcomes of different types of myopic traction maculopathy(MTM)using optical coherence tomography(OCT).METHODS: A total of 193 patients(210 eyes)with MTM were retrospectively included, of which 74 eyes(35.2%)underwent vitrectomy combined with internal limiting membrane(ILM)peeling. The patients were categorized into three groups: foveal detachment(FD), foveoschisis(FS)and lamellar macular hole(LMH). Based on the central foveal thickness(CFT)at baseline(M0), eyes with FD were classified into two subgroups: extensive FD and limited FD. Outcomes included best-corrected visual acuity(BCVA), CFT, posterior staphyloma height(PSH), the presence of epiretinal membrane(ERM)and ILM detachment. Risk factors for BCVA at 6mo after vitrectomy(M6)were analyzed using linear regression.RESULTS: At M0, ERM was highly present in eyes with LMH(rs=0.28, P<0.001). Eyes with FD and FS were characterized by higher incidence of ILM detachment(rs=-0.25, P<0.001). After vitrectomy, CFT and BCVA significantly improved in all eyes(P<0.001). Eyes with extensive FD were characterized by a thicker CFT(rs=0.56, P<0.001), a lower incidence of ILM detachment(rs=-0.25, P=0.034)and a thicker nasal PSH(rs=0.27, P=0.024)than eyes with limited FD. Eyes with extensive FD were associated with a worse BCVA at M0(P=0.013)and M6(P=0.030)than eyes with limited FD. Extensive FD(β=-0.295, P=0.042)and BCVA at M0(β=0.669, P<0.001)were risk factors for a worse BCVA at M6.CONCLUSION: There are several pathogenetic mechanisms in MTM. ILM detachment may exert a dominant role in the development of FD and FS, while ERM may have a role in LMH. Vitrectomy combined with ILM peeling improved functional and anatomical outcomes in MTM patients. Eyes with extensive FD may carry a poor prognosis.
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Objective: Total neoadjuvant therapy has been used to improve tumor responses and prevent distant metastases in patients with locally advanced rectal cancer (LARC). Patients with complete clinical responses (cCR) then have the option of choosing a watch and wait (W&W) strategy and organ preservation. It has recently been shown that hypofractionated radiotherapy has better synergistic effects with PD-1/PD-L1 inhibitors than does conventionally fractionated radiotherapy, increasing the sensitivity of microsatellite stable (MSS) colorectal cancer to immunotherapy. Thus, in this trial we aimed to determine whether total neoadjuvant therapy comprising short-course radiotherapy (SCRT) combined with a PD-1 inhibitor improves the degree of tumor regression in patients with LARC. Methods: TORCH is a prospective, multicenter, randomized, phase II trial (TORCH Registration No. NCT04518280). Patients with LARC (T3-4/N+M0, distance from anus ≤10 cm) are eligible and are randomly assigned to consolidation or induction arms. Those in the consolidation arm receive SCRT (25Gy/5 Fx), followed by six cycles of toripalimab plus capecitabine and oxaliplatin (ToriCAPOX). Those in the induction arm receive two cycles of ToriCAPOX, then undergo SCRT, followed by four cycles of ToriCAPOX. Patients in both groups undergo total mesorectal excision (TME) or can choose a W&W strategy if cCR has been achieved. The primary endpoint is the complete response rate (CR, pathological complete response [pCR] plus continuous cCR for more than 1 year). The secondary endpoints include rates of Grade 3-4 acute adverse effects (AEs) etc. Results: Up to 30 September 2022, 62 patients attending our center were enrolled (Consolidation arm: 34, Induction arm:28). Their median age was 53 (27-69) years. Fifty-nine of them had MSS/pMMR type cancer (95.2%), and only three MSI-H/dMMR. Additionally, 55 patients (88.7%) had Stage III disease. The following important characteristics were distributed as follows: lower location (≤5 cm from anus, 48/62, 77.4%), deeper invasion by primary lesion (cT4 7/62, 11.3%; mesorectal fascia involved 17/62, 27.4%), and high risk of distant metastasis (cN2 26/62, 41.9%; EMVI+ 11/62, 17.7%). All 62 patients completed the SCRT and at least five cycles of ToriCAPOX, 52/62 (83.9%) completing six cycles of ToriCAPOX. Finally, 29 patients achieved cCR (46.8%, 29/62), 18 of whom decided to adopt a W&W strategy. TME was performed on 32 patients. Pathological examination showed 18 had achieved pCR, four TRG 1, and 10 TRG 2-3. The three patients with MSI-H disease all achieved cCR. One of these patients was found to have pCR after surgery whereas the other two adopted a W&W strategy. Thus, the pCR and CR rates were 56.2% (18/32) and 58.1% (36/62), respectively. The TRG 0-1 rate was 68.8% (22/32). The most common non-hematologic AEs were poor appetite (49/60, 81.7%), numbness (49/60, 81.7%), nausea (47/60, 78.3%) and asthenia (43/60, 71.7%); two patients did not complete this survey. The most common hematologic AEs were thrombocytopenia (48/62, 77.4%), anemia (47/62, 75.8%), leukopenia/neutropenia (44/62, 71.0%) and high transaminase (39/62, 62.9%). The main Grade III-IV AE was thrombocytopenia (22/62, 35.5%), with three patients (3/62, 4.8%) having Grade IV thrombocytopenia. No Grade V AEs were noted. Conclusions: SCRT-based total neoadjuvant therapy combined with toripalimab can achieve a surprisingly good CR rate in patients with LARC and thus has the potential to offer new treatment options for organ preservation in patients with MSS and lower-location rectal cancer. Meanwhile, the preliminary findings of a single center show good tolerability, the main Grade III-IV AE being thrombocytopenia. The significant efficacy and long-term prognostic benefit need to be determined by further follow-up.
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Humans , Middle Aged , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy , Immune Checkpoint Inhibitors/therapeutic use , Neoadjuvant Therapy , Prospective Studies , Rectal Neoplasms/pathology , Thrombocytopenia/drug therapy , Treatment OutcomeABSTRACT
Objective To analyze the direct medical expenses and its influencing factors of patients with pulmonary tuberculosis (TB) from 2011 to 2018 in Wuhan, so as to provide references for improving the TB derating policy. Methods A total of 1 258 953 medical records were studied, the direct medical expenses and its influencing factors were analyzed by rank sum test, multivariable linear regression and generalized estimated equation. Results The average direct medical expense of TB outpatients was 147.51 yuan each time, while that of TB inpatients was 8 849.57 yuan; and the average direct medical expenses of each year was 9 607.01 yuan per person. The average reimbursement ratio for TB outpatients was 6.36%, and 67.56% for inpatients. Analysis on the influencing factors showed that the direct medical expenses were related with patients’ age, sex, year, health care insurance, medical institution and whether they had surgery and Chinese traditional medicine or not (all P<0.01). Conclusions The current direct medical expenses of TB inpatients are relatively affordable, but low-income patients and patients still have heavy financial burden. TB treatment cycle is long and the outpatient medical service B also safficient. Improved derating policy is in need.
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Objective: To generate mouse B7-2 gene RNAi lentivirus and study its interference effects on B7-2 expression and T lymphocytes proliferation induced by dendritic cells. Methods: Three sequences specific targeting B7-2 gene and one non-specific sequence were respectively synthesized, and inserted into lentiviral vector, then the recombinant vectors were sequencing. 293 T cells were co-transfected with lentiviral expression plasmid and packaging plasmids to produce recombinant lentivirus which titre was checked according to the expression level of green fluorescent protein ( GFP). Bone marrow cells from C57 BL/6 mice were isolated to differentiate into DCs at the present of GM-CSF, IL-4 and LPS for 48 h, then morphology and phenotypic was identified. DCs were infected by recombinant RNAi lentivirus and then the efficiency of infection and the expression of B7-2 on the surface of DCs were detected by flow cytometry. Effects on the proliferation of T cells were detected by co-culturing with DCs which were infected by B7-2 RNAi lentivirus and murine spleen T cells in vitro. Results: DNA sequencing confirmed that three B7-2 RNAi and one non-specific recombinant lentiviral transfer plasmids were successfully constructed, the titer of recombinant lentivirus was ( 2-4) × 108 TU/ml. The recombinant lentivirus could effectively infect DC and inhibit the expression of B7-2. After the B7-2 recombinant lentivirus infection, the ability of DCs to stimulate the proliferation of T cells decreased obviously ( P＜0. 05). Conclusion: The lentiviral B7-2 gene RNAi vector can effectively silence the expression of B7-2 on the surface of DCs and inhibit the proliferation effect of T cells induced by DCs.
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Objective To investigate the relationship between mean platelet volume (MPV) and diabetic macular edema (DME) in type 2 diabetic patients.Methods The study included 4 patient groups:40 healthy control as group 1,40 diabetic patients without diabetic retinopathy(DR) as group 2,40 DR patients without DME as group 3,and 40 DR patients with DME as group 4.Then the collection of general information,fundus photograph and OCT were conducted for the measurement and comparison of serum levels of platelet parameters including platelet count (PLT),MPV,platelet distribution width (PDW) and plateletcrit (PCT).Results Significant differences were found in MPV and PDW among the four groups (all P ＜ 0.05),but there was no significant difference in PLT and PCT levels (all P ＜ 0.05).Furthermore,MPV and PDW level was (11.07 ± 1.06)fL and (13.57 ±2.25)fL in group 3,as well as (11.27 ±0.85)fL and (13.89 ± 1.76)fL in group 4,respectively,which were both significantly higher than those in group 1 [(10.41 ±0.63)fL and (11.93 ± 1.22)fL] as well as in group 2 [(10.38 ± 0.51) fL and (12.33 ± 1.28) fL] (all P ＜ 0.05).Both MPV and PDW levels of group 4 were higher than those of group 3,but there was no significant difference (P =0.254,0.388).As for males,MPV level was increased gradually in group 2 [(10.29 ±0.58)fL],group 3 [(10.67 ± 1.08)fL] and group 4 [(11.42 ±0.90) fL] (all P＜0.05),but there was no significant difference between group 1 [(10.27 ± 0.55)fL] and group 2.For females,MPV level was (11.37 ± 0.69) fL in group 3 and (11.13 ± 0.79) fL in group 4,both which were significantly higher than that in group 1 [(10.55 ± 0.70) fL] and group 2 [(10.42 ± 0.49) fL],respectively (all P ＜ 0.05),but there was no significant difference between group 3 and group 4 (P ＞ 0.05).Conclusion High MPV level may be an important risk factor for the development of DME in DR patients.Platelet parameter surveillance can aid in the monitoring of this disease.
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Little is known about the association between parity and the risk of ovarian cysts. The aim of this study was to examine the association between parity and the risk of ovarian cysts among a population of Chinese women. A total of 20 502 women aged 45-86 years from the Dongfeng-Tongji Cohort study completed baseline questionnaires, medical examination and provided baseline blood samples. Participants were categorized into four groups according to parity (one, two, three, and four or more live births). Logistic regression models were used to investigate the association between parity and the risk of ovarian cysts. The prevalence of ovarian cysts in the study population was 4.0% (816/20 502). Increasing parity was associated with decreasing risk of ovarian cysts without adjustment for any covariates and after age-adjusted model (P<0.001). After adjusting for potential confounders, women who had had four or more live births had lower risk of ovarian cysts (OR: 0.51; 95% CI: 0.27-0.96) compared with women who had had one live birth. There was a consistent but non-significant decreased risk of ovarian cysts for women who had had two, and three live births (OR: 0.85; 95% CI: 0.68-1.05) and (OR: 0.84; 95% CI: 0.59-1.20) respectively compared with women who had had one live birth. It was concluded that higher parity was associated with decreasing risk of ovarian cysts in this population of Chinese women. These findings could be helpful in decision making in clinical practice for gynecologists when evaluating women suspected to have ovarian cysts.
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Aged , Aged, 80 and over , Female , Humans , Middle Aged , Pregnancy , Age Factors , Asian People , China , Decision Making , Live Birth , Ovarian Cysts , Blood , Epidemiology , Parity , Physiology , Risk FactorsABSTRACT
Background The recurrent rate of retinal detachment is much higher after silicone oil removal in high myopia with macular hole.How reduce the recurrence is a hot topic.Whether optical coherence tomography (OCT)-assisted examination is helpful for the improvement of surgery successful rate is in clinical observation ObjectiveThis study was to observe macular retinal status before silicone oil removal in eyes with macular holerelated retinal detachment in highly myopic eyes by OCT and evaluate the factors that influence successful silicone oil removal.MethodsFifty-five eyes of 49 consecutive patients who received vitreoretinal surgery for highly myopic retinal detachment caused by macular hole from January 2005 to December 2008 were involved,and 45 eyes of 40 patients who underwent silicone oil tamponade were retrospectively analyzed.Three to six months after vitreoretinal surgery combined with silicone oil tamponade,removal of silicone oil was performed based on the macular appearance on the OCT and the patients were followed up for over 1 year.The OCT manifestation of macular hole and the best corrected visual acuity (BCVA) were compared between before vitrectomy combined with silicone oil tamponade surgery,and after removal of silicone oil.The healing of the macular hole was classified into type Ⅰ and Ⅱ healing according to the OCT results.ResultsThe retina at the macular area completely reattached in 40 eyes(88.89％ )before removal of silicone,and the margin of the macular hole had disappeared in 2 of the 40 eyes,showing type Ⅰ heal.Thirty-eight eyes were determined to exhibit type Ⅱ healing,presenting with a visible hole margin and local defection of nervous fiber layer.Two years after the removal of silicone,retinal detachment reappeared in 1 eye with type Ⅱ heal.The BCVAs were 1.93±0.06 and 1.16±0.07 before and 1 year after removal of silicone,respectively,showing a significant difference between them(P =0.00).ConclusionsOCT is a useful tool for the prediction of anatomic outcomes in macular hole-related retinal detachment eyes with high myopia.Silicone oil removal can be performed in macular hole closure eye or attached-well hole edge eye based on OCT examination.However,attachedwell hole edge eye should receive longer follow-up time.
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BackgroundIron-containing foreign body trapped in the eyeball wall without affecting the opticus occurs occasionally in clinic. Operation always is performed in an attempt to avoid the deposition of rust in different tissues of the eye-balls. However,a few animal experimental studies showed that a small foreign body does not affect the retina and opticus in the period of three months. The question of whether surgery needs to be carried out is worth discussion. ObjectiveThe aim of this study was to evaluate the influence of posterior intrascleral iron foreign body on the rabbit retina and opticus. MethodsTwelve healthy adult Japan flap-eared white rabbits were randomly divided into two groups. Medium carbon iron with rust or without rust( size of 2. 0 mm × 1. 0 mm×0. 2 mm) were implanted into the posterior sclera of the left eye to create the animal model with iron foreign body in the eyeball wall. The cornea, anterior chamber, crystalline lens, vitreous and fundus of the rabbits were observed under a slit lamp microscope 1weekbeforeoperationand 1week, 2weeks, 1monthand 3months after operation.Flash electroretinogram(F-ERG) and flash visual evoked potential (F-VEP) were recorded at the time points mentioned above. All the rabbits were sacrificed and the eye balls were extracted at the end of the experiment, and the position of the iron foreign body was determined. The histopathological examinations of the retina and opticus were performed under the light microscope. This experiment complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. ResultsThere were no statistical differences for the a-wave amplitude of F-ERG among different time points( F =1. 885,P =0. 129 ) and different treatment groups ( F =1. 188, P =0. 340 ), as with the ERG b-wave amplitude ( time: F =2. 73, P =0. 064 ; group : F =1. 114, P =0. 367). The differences in the latencies of F-VEP N1-wave were insignificant among the different time points( F =1. 605, P =0. 263 ) as well as various groups ( F=1. 556, P =0.314 ), and those of F-VEP P1 -wave were not evidently changed ( time: F =2. 329, P =0. 092 ; group : F =2. 186, P =0. 103 ). No correlations were seen between the time factor and grouping factor ( P ＞ 0. 05 ). There was no apparent siderosis bulbi change during the follow-up duration. No morphological abnormality in the retina and optical nerve was found under the light microscope. At the end of the experiment,intrascleral iron foreign body was wrapped by surrounding tissue in a stable condition. Conclusions The small posterior intrascleral iron foreign body, whether it is oxidized or not, does not produce distinctive functional or pathological damage on retina and opticus in the short term.