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@#AIM: To analyze the influence of total femtosecond laser small incision lenticule extraction(SMILE)on corneal surface regularity index(SRI).<p>METHODS:Totally 210(401 eyes)myopic patients treated in Qinhuangdao Optometry Ophthalmology Hospital between January 2017 and December 2019 were enrolled in the study. Among them, patients treated with total femtosecond laser SMILE were included in the observation group(<i>n</i>=110, 205 eyes), while those treated with femtosecond laser-assisted <i>in situ</i> keratomileusis(FS-LASIK)were includded in the control group(<i>n</i>=100, 196 eyes). The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), anterior corneal surface asphericity index(Q-value)at a diameter of 6mm and SRI were compared between the two groups before and after operation.<p>RESULTS: The UCVA and BCVA of both groups were improved at 3mo and 6mo after operation(<i>P</i><0.05), without significant differences between the groups(<i>P</i>>0.05). The observation group had higher SRI than the control group at 3mo, 6mo and 1a(<i>P</i><0.05). The asphericity parameter Q-values increased at each time point after operation. Besides, the observation group had lower Q-values than the control group at 6mo and 1a(<i>P</i><0.05).<p>CONCLUSION: Compared with FS-LASIK, SMILE can achieve similar visual recovery effect. However, the SRI is larger after SMILE, and the influence on asphericity index Q-value is less.
ABSTRACT
Sj(o)gren's syndrome is a systemic autoimmune disease which is characterized by xerosis,and multiple organs can be affected,causing interstitial lung disease,renal tubular acidosis,blood system involvement,peripheral neuropathy,and liver damage,but cardiac involvement is rare.Here we report a case of Sj(o)gren's syndrome with prominent aortic valve involvement.A 66-year-old woman was admitted for exertional dyspnea,and the ultrasonic cardiogram showed severe aortic stenosis with moderate regurgitation.Preoperative examination for valve replacement found that the patient had elevated erythrocyte sedimentation rate and positive rheumatoid factor,so she was referred to the rheumatology outpatient department for further examination and treatment.Further questions about medical history found that the patient had dry eyes and dry mouth for more than ten years,and had obvious caries.Further laboratory examination showed elevated serum immunoglobulin levels and positive anti-nuclear antibody.The findings of ophthalmologic examination and labial gland biopsy also supported the diagnosis of Sj(o)gren's syndrome.After treatment of glucocorticoids and hydroxychloroquine for ten months,her dyspnea symptoms were obviously improved in the patient,and the rheumatoid factor had become negative while her erythrocyte sedimentation rate normal.Repeated ultrasonic cardiogram examination showed that her aortic stenosis was also improved.The patient has been followed up for four years,and her condition kept stable.Cardiac involvement in Sj(o)gren's syndrome can affect all parts of the heart,but valve involvement is relatively rare.The specific relationship between cardiac involvement and Sj(o)gren's syndrome and the mechanisms behind these associations both need further research.
ABSTRACT
Objective:To evaluate the ability of 2015 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria to diagnose gout compared with the widely used 1977 American Rheumatism Association (ARA) criteria and other criteria in clinical practice in Chinese patients,and to compare the sensitivity and specificity of different classification criteria for gout in early and established diseases.Methods:The patients who had ankle arthritis and visited the Department of Rheumatology and Clinical Immunology,Peking University First Hospital between February 2012 and February 2016 were screened.The patients who had been already diagnosed with gout or pyrophosphate deposition disease through arthrocentesis or tissue aspiration and those who had been diagnosed with rheumatoid arthritis,spondyloarthritis,and osteoarthritis were excluded.The patients were diagnosed by two experienced rheumatologists and all of them were followed up for at least one year.Early disease was defined as symptom onset of no more than 2 years;established disease was defined as symptom duration of more than 2 years.The 2015 ACR classification criteria were divided into clinical form with clinical parameters included and complete form with not only clinical parameters but also synovial fluids tests,imaging findings and monosodium urate (MSU) included.The two forms above were short for "clinical form (incorporating clinical parameters)" and "complete form (incorporating imaging and MSU data) " respectively.Results:In this study,284 patients suffering from ankle arthritis were included in the study,219 of them were classified as gout and 65 of them had alternative diagnoses.The sensitivity and specificity of 2015 ACR complete form (incorporating imaging and MSU data) for diagnosing gout were 88.13％ and 95.38％,respectively.The area under the curves (AUC) of 2015 ACR "complete form (incorporating imaging and MSU data)",2015 ACR "clinical form (incorporating clinical parameters) ",2010 Netherlands criteria and 1977 ARA criteria were 0.982,0.983,0.963,and 0.928,respectively.For the 94 early gout patients,the AUC of the above criteria were 0.973,0.968,0.916,and 0.910,respectively.For the established gout patients,the AUC were 0.987,0.991,0.982,and 0.936,respectively.For the patients with disease duration within two years,the odd ratio (OR) for sensitivity of 2015 ACR "complete form (incorporating imaging and MSU data)",2015 ACR "clinical form (incorporating clinical parameters)",2010 Netherlands criteria and 1977 ARA criteria were 1.562 (1.003-2.435),1.500 (1.001-2.346),and 1.812 (1.177-2.791),nevertheless,for the patients with established gout,the OR were 1.702 (1.300-2.229),1.607 (1.224-2.110),and 1.821 (1.396-2.377),respectively.Conclusion:The 2015 ACR/EULAR criteria are more accurate in gout diagnosis compared with the 1977 ARA criteria by elevating the sensitivity and specificity,in respective of the disease duration.The 2015 ACR/EULAR criteria may serve as new diagnostic tools in daily clinical practice in Chinese patients.