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Objective:To investigate the clinical characteristics, treatment and prognosis of primary vitreoretinal lymphoma (PVRL) diagnosed and treated in our hospital during the past 10 years.Methods:A retrospective clinical study. From 2011 to 2021, 126 eyes of 67 patients with PVRL who were diagnosed and treated in Department of Ophthalmology, Eye-ENT Hospital, Fudan University were included in the study. Among them, there were 23 males (34.3%, 23/67) and 44 females (65.7%, 44/67); the average age was 57.1 years. There were 59 cases with both eyes (88.1%, 59/67) and 8 cases with one eye (11.9%, 8/67). At the initial eye diagnosis, 22 cases had a clear history of primary central nervous system lymphoma (PCNSL); 5 cases were found to have intracranial lesions by head imaging examination; 40 cases had no central nervous system involvement. Twenty cases were treated with glucocorticoids due to misdiagnosed uveitis. All patients received intravitreal injection of methotrexate (IVM) treatment. The treatment regimen was twice a week in the induction period for 2 weeks, once a week in the consolidation period for 1 month, and once a month in the maintenance period. Patients with PCNSL or both eyes received concurrent systemic chemotherapy (chemotherapy), and some in combination with radiation therapy to the brain (radiotherapy). The mean follow-up time was 39.3 months. The clinical manifestations, treatment and prognosis of the patients were retrospectively analyzed. The visual acuity before and after treatment was compared by t test. Results:Among the 22 cases with a clear history of PCNSL at the initial eye diagnosis, the average time from intracranial diagnosis to eye diagnosis was 22.9 months. Among the 40 cases without central nervous system involvement at first, 14 cases (20.9%, 14/67) developed central nervous system lesions during follow-up period. The mean time from ocular diagnosis to intracranial diagnosis was 9.9 months. Among the 126 eyes, 42 eyes (33.3%, 42/126) had anterior segment inflammation. vitreous inflammation type, retinal type, and vitreous retinal type were 58 (46.0%, 58/126), 7 (5.6%, 7/126), and 61 (48.4%, 61/126) eyes, and 9 of them (7.1%, 9/126) had optic nerve involvement at the same time. Patients received an average of 12 IVM treatments. IVM combined with systemic chemotherapy in 59 cases (88.1%, 59/67), of which 16 cases were combined with brain radiotherapy. All patients achieved complete remission after completing the treatment cycle (100.0%, 67/67). After treatment, 21 eyes (16.7%, 21/126) had ocular recurrence; 22 (32.8%, 22/67) had intracranial recurrence; 8 cases (11.9%, 8/67) died. The mean progression-free survival of patients was 23.7 months; the mean survival time was 43.6 months; the 5-year overall survival rate was 72.5%.Conclusions:The manifestations of PVRL are complex and diverse, and most of them are accompanied by involvement of the central nervous system. It can be divided into vitreitis type, retinal type and vitreoretinal type, and the optic nerve can be involved at the same time; IVM combined with systemic treatment can completely relieve the disease.
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Primary vitreoretinal lymphoma (PVRL) is a rare and aggressive high-grade non-Hodgkin lymphoma. PVRL always with non-specific symptoms and has therefore been called as masquerade syndrome. Thus, the early and correct diagnosis of PVRL is a difficulty. For PVRL, the imaging findings can be specific but variety, histological diagnosis is still the gold standard. Its diagnosis needs to be combined with clinical manifestations, imaging features, pathological diagnosis and molecular biology. With the advancement of technology, especially in the field of the cytokines detection and the gene expression profiling research, molecular biology diagnosis of PVRL is becoming a research hotspot and an important auxiliary diagnostic method.
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Objective To evaluate the efficiency of multimodal analgesia for the patients who had the posterior lumbar spine surgery.Methods Sixty-four cases of patients who were scheduled to the posterior lumbar spine surgery were randomly divided into two groups, multimodal analgesia group (n =32) and control group(n=32).Multimodal analgesia group patients were given oxycodone acetaminophen 1 day before and the next day after operation, during the operation the patients received injiection of multimodal drugs (consisting of ropivacaine 150 mg, flurbiprofen 50 mg, phenylephrine 0.4 ml, normal saline 50 ml) around the incisions by infiltrated injection before the skin incision closed, then had controlled intravenous analgesia.In the control group, the incisions were sutured without the local infiltration analgesia.Then only had patient controlled intravenous analgesia after operati on.Visual analogue scale(VAS) ,Japanese Orthopedic Association(JOA) and Prolo lumbar function score was recorded respectively perioperatively.Results (1) VAS: the patients of multimodal analgesia group had significantly lower rest pain scores and activity pain scores at 6, 12,24 hours, first moving than the control group((3.1±1.6) ,(2.8±1.1),(2.4±0.9) ,(2.3±1.1) vs.(3.5±1.8) ,(3.4± 1.3), (3.4±0.8), (3.0± 1.5), P＜0.05).There was no significant difference at the discharge between the two groups (P＞0.05).(2)JOA:JOA scores of the patients of multimodal analgesia group were obviously higher than that of the control group at 1,3,7 days after operation (P＜0.05).There was no significant difference at the discharge between the two groups (P＞0.05).(3) Prolo lumbar function score : Prolo scores of the patients of the multimodal analgesia group were obviously higher than that of control group at 1,3,7 days after operation (P ＜0.05).There was no significant difference at the discharge between the two groups(P＞0.05).Conclusion Multimodal Analgesia is shown to safely provide excellent pain control and functional recovery.It can reduce visual analogue pain score and improve lumbar function after surgery.
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Objective To compare the efficacy and safety of intravesical instillation of pirarubicin (T HP) to prevent the post -operative recurrence of superficial bladder cancer with same dose variable concentration .Methods A tota1 of 56 cases of superficial bladder cancer after transurethral resection (TURBT ) were randomly divided into two groups(High concentration group :25 cases , Low concentration group :31 cases) .Infusion dose of THP is 30 mg .The concentration of THP is 1 .0 g/L in H group ,0 .6 g/L in L group .Both groups were installed within 24 hours after operation .Both groups were installed once a week for 8 weeks after the first installation ,then once a month until 1 year after operation .All cases were followed up ,the tumor recurrence time ,recurrence rates and complications were compared .Results All cases except 2 in L group received 6 -30 months follow up ,with an average time of 17 .6 months .In H group ,1 patients recurred during the follow-up period ,with a recurrence rate of 4 .0% and recurrence time of 12 .4 months ,while in L group ,3 cases recurred ,with a recurrence rate of 10 .3% and an average recurrence time of 9 .8 months .Adverse reactions were main1y Urinary irritation symptoms .The difference of recurrence rate and average recurrence time in each group were statistically significant (P0 .05) .Conclusion This study shows that high concentration THP intravesical instillation could effectively reduce the recur-rence rate and delay the recurrence time .Each concentration was well tolerated .
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Objective To investigate the effects of high fat diet induced obesity on rat prostatitis and assesses the metabolic fea-tures .Methods The normal diet group ,high-fat diet group and the positive control group were established according to the experi-mental requirements .Obesity model was established due to high-fat-diet feed .Microscopy was performed to analyze Lecithin density and leucocyte count .IL-6 and IL-8 Release level in the prostatic fluid were measured with ELISA (enzyme-linked immunosorbent as-say) kits according to the manufacturer′s directions .IL-6 and IL-8 mRNA levels of prostate were measured by real time PCR .Re-sults Compared with normal diet group ,high-fat diet group tended to be obesity obviously in 5 weeks of high-fat diet .The inci-dence rate of prostatitis in high fat diet group was significantly higher than that of control group ,and high-fat diet group had higher IL-6 and IL-8 releasing and mRNA levels .Conclusion High-fat diet could increase incidence of prostatitis in rat .The effect is par-tially due to IL-6 and IL-8 releasing and expression .
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Objective To investigate the effect of micro-ecological agent on the intestinal flora of patients with posterior lumbar spine surgery.Methods Seventy-two patients with lumbar spine surgery were selected as our subjects.Of them,42 patients with occurred the intestinal flora dysfunction were served as experimental group (group A),other 30 patients were as control group (group B).The levels of plasma endotoxin,plasma tumor necrosis factor-α (TNF-α),Interleukin 6 (IL-6) were detected before and after operation.The patients in group A were treated with micro-ecological agent Jinshuangqi.Collected stool samples at preoperative,postoperative first natural defecation (after 1-4 d),and compared intestinal flora difference and Bifidobacterium (B)/Enterobacteriaceae (E) value of two groups patients.Results The levels of plasma endotoxin in group A were (1.82 ±0.12),(2.29 ±0.15),(1.91 ±0.08) ng/L at before surgery,the 2nd and 7th day after surgery,and that in group B were(1.91 ±0.21),(2.35 ±0.16),(2.26 ±0.24) ng/L The TNF-α level in group A were (275 ±51),(309 ±45),(276 ±34) ng/L and that in group B were (269 ±48),(318±67),(297 ±53) ng/L at before surgery,the 2nd and 7th day after surgery.The IL-6 levels in group A were (138 ± 22),(159 ± 15),(137 ± 17) ng/L and that in group B were (159 ± 16),(187 ± 19),(174 ± 21) ng/Lat before surgery,the 2nd and 7th day after surgery.The repeated measured repeated measures analysis of variance showed that among three indexes of plasma endotoxin,TNF-α,IL-6 levels,differences of between group and interaction were statistically significant (P ＜ 0.05),but there was no significant difference within groups (P＞ 0.05).The levels of plasma endotoxin,TNF-α,IL-6 decreased after surgery ware gradually decreasing with hospitalization prolonged.There was significant difference between before surgery and at the 2nd,7th day after surgery(P ＜ 0.05),and there was significant difference between the 2nd and the 7th day after surgery(P＜ 0.05).At the 2nd day after surgery,there was significant difference between group A and group B in terms of the level of plasma endotoxin,TNF-α,IL-6.At the 7th day,the levels of plasma endotoxin,TNF-α,IL-6 were slowly decreased in group A,and there were significant difference compared to group B (P ＜ 0.05).The numbers of intestinal Bifidobacterium,Bacteroides,and B/E values of group A were decreased after surgery compared to group B((9.17 ±0.54) lg cfu/g vs.(10.01 ± 0.75) lg cfu/g,(9.23 ± 0.47) lg cfu/g vs.(10.09 ± 0.81)lg cfu/g,(1.01 ± 0.16) vs.(1.20 ± 0.11)),and the difference was significant (P =0.031,0.042,0.029respectively).The levels of Enterobacter and Enterococcus in group A were (9.11 ± 1.02) lg cfu/g,(7.80± 1.02) lg cfu/g,higher than that of group B ((8.81 ± 0.89) lg cfu/g,(7.29 ± 0.98) lg cfu/g(P =0.037,0.043)).There was no significant difference between two groups in terms of small clostridium and lactobacillus (P ＞ 0.05).After treated with micro-ecological agent Jinshuangqi,the levels of intestinal Bifidobacterium,Bacteroides,and B/E value at was increased compared to before treated in group A (Bifidobacterium:(13.01±0.87) lg cfu/g vs.(9.17 ±0.54) lg cfu/g; Bacteroides:(14.12 ±0.75) lg cfu/g vs.(9.23 ±0.47)lg cfu/g; B/E value:(1.28 ± 0.45) vs.(1.01 ± 0.16) ;P =0.045,0.034,0.038 respectively).No significant difference was seen in terms of the levels of Enterobacter,Enterococcus,small clostridium and lactobacillus between two groups(8.71 ±0.91) lg cfu/g vs.(9.11 ± 1.02) lg cfu/g,(7.01 ±0.54) lg cfu/g vs.(7.80± 1.02) lg cfu/g,(5.23 ± 1.04) lg cfu/g vs.(5.15 ± 0.89) lg cfu/g,(6.71 ± 1.04) lg cfu/g vs.(6.53± 0.86) lg cfu/g respectively; P ＞ 0.05).Conclusion Posterior lumbar operation patients with intestinal dysbacteriosis often associated with endotoxemia and inflammatory reaction,the levels of bifidobacteria,Bacteroides intestinal Enterobacteriaceae decrease while Enterococcus,opportunistic pathogens increase,and intestinal microbial colonization resistance decrease.Micro-ecological agent Jinshuangqi treatment can ease the body's endotoxemia and inflammatory response,improved lumbar surgery intestinal flora after surgery,and beneficial to rebuild the intestinal microflora balance.
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Objective To investigate the clinical feature of perioperative management of non-small cell lung cancer(NSCLC) in aged patients and improve the efficacy of surgical treatment.Methods The clinical data of 35 aged patients with NSCLC were retrospectively analyzed.The risk factors of postoperative complications were analyzed by single factor analysis,the factors had statistical significance were included in Logistic regression analysis.Results Postoperative complications occurred in 10 cases,accounting for 28.6％,and 1 case died,accounting for 2.9％.Logistic regression analysis showed that smoking,chronic bronchitis,coronary heart disease,pulmonary lobectomy were independent risk factors of postoperative complications.ConCLusion Correct staging before operation,strict surgical indication,choose the standard surgical method to reduce surgical trauma,strengthen the perioperative management can still achieve satisfactory therapeutic effect in surgical operation for aged patients with NSCLC.