Comparison of short-time efficacy of anti-VEGF therapy or anti-inflammatory therapy on different types of macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the efficacy of anti-inflammatory treatment and anti-vascular endothelial growth factor(VEGF)treatment on different types of macular edema secondary to retinal vein occlusion(RVO-ME).<p>METHODS: The clinical data of RVO-ME patients who were treated in the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University from 2019-06/2020-12 were retrospectively collected. A total of 108 cases(108 eyes)of RVO-ME patients were collected, including 52 cases(52 eyes)with cystoid macular edema(CME), 38 cases(38 eyes)with macular edema with serous retinal detachment(SRD), and 18 cases(18 eyes)with diffuse retinal thickening(DRT). Patients with various types of ME were further classified into anti-VEGF group and anti-inflammatory group. The observation metrics such as best corrected visual acuity(BCVA)and foveal thickness(CMT)before and 3mo after surgery were collected and compared in each group.<p>RESULTS: There was no difference in baseline data between the anti-VEGF group and the anti-inflammatory group in all types of ME patients(all P>0.05). Patients with CME in the anti-VEGF group in BCVA, CMT, and the sum of CME diameter after operation were different from that before operation(Z= -4.463, -4.541, -4.541, all P<0.001); the postoperative BCVA, CMT, and the sum of CME diameter in the anti-inflammatory group were significantly different from those before operation(Z= -3.743, -4.345, -4.372, all P<0.001); and there was no difference between the anti-VEGF group and the anti-inflammatory group in the postoperative CMT and the sum of CME diameter(Z= -1.017, -0.968, all P>0.05), but there was a difference in BCVA after operation in two groups(Z= -1.978, P<0.05). SRD patients in the anti-VEGF group had differences in postoperative BCVA, CMT, and SRD heights compared with preoperative ones(Z= -4.111, -4.198, -4.198, all P<0.01); the BCVA, CMT, and SRD height in the anti-inflammatory group after operation were different from those before operation(Z= -3.410, -3.408, -3.408, all P<0.05); and there was no difference in BCVA and CMT between the two groups after operation(Z= -0.857, -1.030, all P>0.05), but the postoperative SRD height in the anti-inflammatory group was significantly lower than that in the anti-VEGF group(Z= -2.117, P<0.05). DRT patients in the anti-VEGF group were significantly different in BCVA and CMT after operation compared with preoperative ones(Z= -2.207, -2.521, all P<0.05), and in the anti-inflammatory group after injection, BCVA and CMT were significantly different from preoperative ones(Z= -2.207, -2.521, all P<0.05). There were differences in BCVA and CMT after injection in the anti-inflammatory group compared with those before operation(Z= -2.207, -2.803, all P<0.05). There was no difference in postoperative BCVA and CMT between the two groups(Z= -0.359, -0.845, all P>0.05). <p>CONCLUSION: Anti-inflammatory and anti-VEGF treatments are effective for all kinds of ME in improving vision and reducing CMT. Anti-VEGF treatment is superior to anti-inflammatory treatment in improving BCVA of CME patients and is inferior to anti-inflammatory in decreasing SRD thickness of SRD patients.

Research progress of anesthesia methods in prostate biopsy / 中华外科杂志

Prostate biopsy is the gold standard for the diagnosis of prostate cancer. In order to successfully and effectively complete the biopsy, clinicians should not only select the correct puncture method, but also pay attention to the pain control of patients undergoing puncture. It is necessary to select a reasonable anesthetic method for biopsy. The pain during biopsy comes from the skin, muscle and other structures in the puncture approach, and also comes from the prostate capsule. Therefore, the anesthesia emphasis of transperineal and transrectal biopsy approaches will also be different. The use of appropriate anesthesia is of great significance to improve the patient's cooperation and ensure the success rate of biopsy. With the continuous maturity of the technology and concept of prostate biopsy, a single anesthesia method has been unable to meet the actual anesthetic needs of biopsy, and the use of multi-site and multi-phase combined anesthesia for different sources of pain has become the mainstream anesthetic option.

Role of adrenalectomy in recurrent Cushing's disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cushing's disease is a pituitary-dependent type of Cushing's syndrome. Treatment consists of pituitary surgery or radiotherapy, but the recurrence rate at 10 years is as high as 40%. Adrenalectomy is considered an effective treatment to refractory Cushing's disease. The objective of this study was to examine the efficacy of laparoscopic adrenalectomy and open adrenalectomy in Cushing's disease, focusing on reversing the sequelae of hypercortisolism and improving patients' quality of life.</p><p><b>METHODS</b>Forty-three patients (29 women, 14 men) with recurrent Cushing's disease after transsphenoidal operation underwent laparoscopic (n = 32) or open (n = 11) adrenalectomy from 2000 to 2008. Surgical results were evaluated for all the 43 patients. Patients completed a follow-up survey, including the short-form 36-item (SF-36) health survey.</p><p><b>RESULTS</b>All the 43 patients achieved clinical reversal of hypercortisolism after adrenalectomy. Time to symptom resolution varied from a few weeks to up to 3 years. Most physical changes had resolved by a mean of 8 months after surgery. These conditions were not significantly different between the laparoscopy and open groups. Median length of hospital stay was shorter in the laparoscopy group (4 vs. 9 days; P < 0.001). Median follow-up was 48.5 months. Of the 34 (79%) patients available for follow-up, 22 (65%) had adrenocorticotropic hormone levels > 200 ng/ml and 6 (27%) had clinical Nelson syndrome. Four patients died by 75 months after surgery. Using SF-36, 30 (88%) patients reported they felt their health status was good to excellent compared with 1 year before adrenalectomy; however, they showed significantly lower scores in all the 8 SF-36 parameters compared with the general population. No significant difference emerged in SF-36 scores between the laparoscopy and open groups.</p><p><b>CONCLUSIONS</b>Adrenalectomy showed high survival and clinical benefits in recurrent Cushing's disease patients. Despite patient-reported improvement in health after adrenalectomy, patients continue to experience poor health status compared with the general population.</p>

Analysis of the risk factors of upper urinary tract dilatation due to spinal cord injury / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI).</p><p><b>METHODS</b>Ninety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography: 16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received urodynamic test. Responses were evaluated using single and multiple analysis after examination.</p><p><b>RESULTS</b>The incidence of male was significantly higher than that of female. Residual urine volume, maximum cystometric capacity, detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B. There were no significant differences in age, the incidence of detrusor hyperreflexia, relative safe bladder capacity, the incidence of detrusor-sphincter dyssynergia, maximum flow rate and maximum urethral closure pressure between 2 groups. Bladder low compliance was cardinal risk factors according to Logistic regression analysis.</p><p><b>CONCLUSION</b>An early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.</p>