Effects of low concentration atropine on macular microcirculation in children with different degrees of myopia / 中国临床药理学与治疗学

AIM: To investigate the effects of 0.01% atropine eye drops on macular blood flow density and retinal thickness in children with different degrees of myopia. METHODS: This was a prospective case-control study. Sixty-four patients (112 eyes) diagnosed with myopia for the first time with 0.01% atropine eye drops before and 6 months after medication were investigated with the uncorrected distance visual acuity (UCVA), axial length (AL), spherical equivalent (SE), macular ganglion cell-inner plexiform layer thicknes (mGCIPL) using slit lamp examination and optical coherence tomography (OCT), vascular density in the macular area and the area of the avascular in the fovea using optical coherence tomography angiography (OCTA) . Changes in various indicators before and after medication were compared. RESULTS: Compared with before medication, the AL of the three groups of myopia patients increased significantly (P0.05). The difference was statistically significant between the moderate myopia group and the high myopia group (P0.05). After 6 months of medication, the central circle macular vessel density (cCVD) increased in the low myopia group and moderate myopia group (P0.05). Before and after medication, there was no significant difference in outer circle macular vessel density (oCVD), inner circle macular vessel density (iCVD), and whole circle macular vessel density (wCVD) among the three myopia groups (P>0.05). The increase in mGCIPL was statistically significant in the low myopia group (P0.05). There was no significant difference in foveal avascular zone (FAZ) among the three myopia groups before and after medication (P>0.05). There was no correlation between CVD, AL, and SE in the three myopia groups (P>0.01). There was a low correlation between CVD and mGCIPL in the low myopia group (r=0.442, P0.01). CONCLUSION: 0.01% atropine can significantly reduce the rate of axial and refractive growth in children with low to moderate myopia, increase the density of central macular vessels, and increase the thickness of mGCIPL in children with low to moderate myopia.

Improvement on Quality Standard of Yuanhu Zhitong Oral Liquid / 中国实验方剂学杂志

ObjectiveTo improve the quality standard of Yuanhu Zhitong oral liquid in order to strengthen the quality control of this oral liquid. MethodThin layer chromatography（TLC） was used for the qualitative identification of Corydalis Rhizoma and Angelicae Dahuricae Radix in Yuanhu Zhitong oral liquid by taking tetrahydropalmatine， corydaline reference substances and Corydalis Rhizoma reference medicinal materials as reference， and cyclohexane-trichloromethane-methanol（5∶3∶0.5） as developing solvent， Corydalis Rhizoma was identified using GF254 glass thin layer plate under ultraviolet light（365 nm）. And taking petroleum ether（60-90 ℃） -ether-formic acid（10∶10∶1） as developing solvent， Angelicae Dahuricae Radix was identified using a silica gel G TLC plate under ultraviolet light（305 nm）. High performance liquid chromatography（HPLC） was performed on a Waters XSelect HSS T3 column（4.6 mm×250 mm， 5 μm） with acetonitrile（A）-0.1% glacial acetic acid solution（adjusted pH to 6.1 by triethylamine）（B） as the mobile phase for gradient elution（0-10 min， 20%-30%A； 10-25 min， 30%-40%A； 25-40 min， 40%-50%A； 40-60 min， 50%-60%A）， the detection wavelength was set at 280 nm， then the fingerprint of Yuanhu Zhitong oral liquid was established， and the contents of tetrahydropalmatine and corydaline were determined. ResultIn the thin layer chromatograms， the corresponding spots of Yuanhu Zhitong oral liquid， the reference substances and reference medicinal materials were clear， with good separation and strong specificity. A total of 12 common peaks were identified in 10 batches of Yuanhu Zhitong oral liquid samples， and the peaks of berberine hydrochloride， dehydrocorydaline， glaucine， tetrahydropalmatine and corydaline. The similarities between the 10 batches of samples and the control fingerprint were all >0.90. The results of determination showed that the concentrations of corydaline and tetrahydropalmatine had good linearity with paek area in the range of 0.038 6-0.193 0， 0.034 0-0.170 0 g·L-1， respectively. The methodological investigation was qualified， and the contents of corydaline and tetrahydropalmatine in 10 batches of Yuanhu Zhitong oral liquid samples were 0.077 5-0.142 9、0.126 1-0.178 2 g·L-1， respectively. ConclusionThe established TLC， fingerprint and determination are simple， specific and reproducible， which can be used to improve the quality control standard of Yuanhu Zhitong oral liquid.

Evaluation of ganglion cell complex and retinal nerve fiber layer thinning in epilepsy patients

Purpose: This study aimed to compare the perimacular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness measurements of epileptic and healthy individuals. Methods: The right eyes of 38 epileptic and 38 healthy individuals who had been using antiepileptic drugs (AEDs) for at least 1 year were included in the study. Central macular thickness, perimacular GCC thickness and volume, and peripapillary retinal nerve fiber layers were measured by optical coherence tomography (OCT) device. Perimacular 1, 3, and 6 mm circle diameters of Early Treatment of Diabetic Retinopathy Study (ETDRS) were selected for GCC measurements. Results: In epilepsy patients, GCC was significantly lower in the 3 mm superior quadrant and 6 mm in all quadrants compared to the control group (P < 0.05). RNFL was significantly thinner in epilepsy patients only in the temporal?inferior quadrant (P < 0.05). There was no significant difference between the patients who received AEDs as monotherapy and polytherapy (P > 0.05). Conclusion: We found that epilepsy patients had significant thinning in the GCC layers and temporal?inferior quadrant of RNFL compared to the control group. Our findings from the study show that early retinal changes in epilepsy patients, especially perimacular GCC layers, can be followed up with OCT.

Correlation between different retinal layers with visual acuity in diabetic retinopathy patients with clinically significant macular edema

Purpose: To study the corelation between outer retinal layer thickness (ORL), outer photoreceptor segment thickness (PROS), and central macular thickness (CMT) with best?corrected visual acuity (BCVA) in patients having clinically significant macular edema (CSME) and compare these parameters with normal patients. Methods: This was a prospective, nonrandomized, observational, comparative study done during the period of January to May 2019. The study included 60 eyes of 36 patients. The patient population was segregated into two Groups: Group ? (30 normal eyes of 15 normal patients) and Group ?? (30 eyes of 21 diabetic patients) with CSME. The comparison between ORL, PROS, and CMT was made between both the groups, and the correlation between ORL thickness, PROS thickness, and CMT with BCVA in Group ?? was studied. Results: The mean age in Group I was 52.6+10.66 years, and 53.42+8.15 years in Group II. The male/ female ratio was 1.1:1 in Group I and 4:3 in Group II. The mean CMT was greater in Group ?? (330.13 ± 37.01) than in Group ? (222.20 ± 12.30). The mean ORL thickness was greater in Group ? (97.73 ± 6.92) than in Group ?? (80.63 ± 9.03). The PROS thickness was statistically significant in Group ? (35.05 ± 3.4) than in Group ?? (28.57 ± 3.53). There was a strong correlation between BCVA and ORL thickness (r = ?0.580, P < 0.001) and more strong correlation between BCVA and PROS thickness in Group ?? (r = ?0.611, P < 0.000). There was a moderate correlation between BCVA and CMT (r = 0.410, P < 0.025), and all results were statistically significant. Conclusion: Both ORL and PROS thickness were greater in healthy normal eyes than in eyes with CSME. BCVA was strongly correlated with PROS and ORL thickness and moderately associated with CMT.

Detección de glaucoma mediante tomografía de coherencia óptica

La tomografía de coherencia óptica se ha convertido en el sistema de imagen más común para detectar de manera precoz el daño glaucomatoso; de ahí que resulte imprescindible para las decisiones clínicas y como criterio de inclusión en investigaciones y ensayos clínicos. El objetivo es exponer los avances en la aplicación de la tomografía de coherencia óptica en la detección del glaucoma a través de la revisión de las publicaciones de los últimos cinco años. La búsqueda se realizó en Google Académico para lo cual se emplearon palabras clave. Las mejoras en la tecnología de dominio espectral y de fuente de barrido han permitido la segmentación de células ganglionares, el reconocimiento de la apertura de la membrana de Bruch como punto de referencia para el análisis de los parámetros del disco óptico y el desarrollo de la angiografía sin contraste. Para el diagnóstico de glaucoma se analizó la estructura en tres localizaciones (células ganglionares maculares, capa de fibras neuroretiniana peripapilar, anillo neuroretiniano y copa en el disco óptico) y el plexo vascular superficial en dos (parafoveal y peripapilar). Se recomienda chequear calidad y presencia de artefactos previo al análisis de los resultados; así como complementar estos resultados con el interrogatorio y hallazgos al examen oftalmológico, fundamentalmente mediante biomicroscopia de polo posterior, para minimizar posibilidad de errores diagnósticos. Es útil tener esto en cuenta, a pesar de que sea numerosa la cantidad de pacientes que acuden cada día a la clínica del glaucoma. Se señalan ventajas y limitaciones de los parámetros estructurales y vasculares en el diagnóstico de glaucoma.

Optical coherence tomography has become the most common imaging system for early detection of glaucomatous damage; hence, it is essential for clinical decisions and as a criterion for inclusion in research and clinical trials. The objective is to present the advances in the application of optical coherence tomography in the detection of glaucoma by reviewing the publications of the last five years. The search was performed in Google Scholar using keywords. Improvements in spectral domain and scanning source technology have allowed the segmentation of ganglion cells, the recognition of Bruch's membrane aperture as a reference point for the analysis of optic disc parameters and the development of non-contrast angiography. For the diagnosis of glaucoma, the structure was analyzed in three locations (macular ganglion cells, peripapillary neuroretinal fiber layer, neuroretinal ring and optic disc cup) and the superficial vascular plexus in two (parafoveal and peripapillary). It is recommended to check quality and presence of artifacts prior to the analysis of the results; as well as to complement these results with the interrogation and findings on ophthalmologic examination, mainly by posterior pole biomicroscopy, to minimize the possibility of diagnostic errors. It is useful to keep this in mind, despite the large number of patients that come to the glaucoma clinic every day. Advantages and limitations of structural and vascular parameters in the diagnosis of glaucoma are pointed out.

Desprendimiento de la capa bacilar de la retina asociado a enfermedad inflamatoria ocular

El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico.

Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view.

A cross-sectional study analyzing the correlation between the mean retinal nerve fiber layer and ganglion cell layer thickness with axial length and refractive errors among children aged 5–15 years

Purpose: To analyze the correlation between the mean retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness with axial length and refractive errors among children aged 5–15 years. Methods: This cross?sectional, observational study was done on 130 eyes of 65 consecutive subjects with refractive errors. The patients were evaluated for RNFL thickness and macular GCL thickness using spectral domain? optical coherence tomography. Results: One hundred and thirty eyes of 65 subjects aged between 5 and 15 years were divided into three groups based on their spherical equivalent in diopters (D). The children with a spherical equivalent of ??0.50 D were considered myopic, ??0.5 to ?+0.5 D were considered emmetropic, and ?+0.50 D were considered hypermetropic. RNFL thickness and GCL thickness were correlated with age, gender, spherical equivalent, and axial length. The mean global RNFL thickness was 104.58 ?m ± 7.567. Conclusion: There exists a negative correlation between RNFL thickness and macular GCL thickness with increasing severity of myopia and increase in axial length, and the possible reason could be stretching of the sclera, which further leads to stretching of the retina, resulting in thinner RNFL and macular GCL thickness

Papillomacular bundle sparing versus conventional internal limiting membrane peeling for idiopathic macular hole ?400 µm

Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.

Study of retinal nerve fiber layer thickness in diabetic patients using optical coherence tomography

Purpose: This study aimed to assess and compare the changes in peripapillary retinal nerve fiber layer (RNFL) thickness in nondiabetics and diabetics with various stages of diabetic retinopathy (DR). Methods: The study subjects were divided into four groups based on their diabetic status and findings, namely, controls (normal subjects without diabetes [NDM]), diabetics without retinopathy (NDR), nonproliferative DR (NPDR), and proliferative DR (PDR). Peripapillary RNFL thickness was assessed using optical coherence tomography. One?way analysis of variance (ANOVA) with the post?Tukey HSD test was done to compare RNFL thickness in different groups. The Pearson coefficient was used to determine the correlation. Results: There was statistically significant difference in measured average RNFL (F = 14.8000, P < 0.05), superior RNFL (F = 11.7768, P < 0.05), inferior RNFL (F = 12.9639, P < 0.05), nasal RNFL (F = 12.2134, P < 0.05), and temporal RNFL (F = 4.2668, P < 0.05) across the different study groups. Pairwise comparison showed that there was a statistically significant difference in RNFL measured (average and all quadrants) in patients with DR (NPDR and PDR) and the NDM control group (P < 0.05). In diabetics without retinopathy, the RNFL measured was reduced compared to controls, but it was statistically significant only in the superior quadrant (P < 0.05). Average RNFL and RNFL in all quadrants showed a small negative correlation with the severity of DR and it was statistically significant (P < 0.001). Conclusion: In our study, peripapillary RNFL thickness was reduced in diabetic retinopathy compared to normal controls and the thinning increased with the severity of DR. This was evident in the superior quadrant even before the fundus signs of DR set in

Optical coherence tomography-based assessment of macular vessel density, retinal layer metrics and sub-foveal choroidal thickness in COVID-19 recovered patients

Purpose: The primary objective of the study was to assess the macular retinal vessel density, subfoveal choroidal thickness, and retinal layer metrics by optical coherence tomography angiography (OCTA), enhanced?depth imaging optical coherence tomography (EDI?OCT), and spectral domain optical coherence tomography (SD?OCT), respectively, in recovered COVID?19 patients and its comparison with the same in control subjects. The secondary objective was to evaluate differences in OCTA parameters in relation with the severity of COVID?19 disease and administration of corticosteroids. Methods: A case–control study was performed that included patients who had recovered from COVID?19 and age?matched healthy controls. Complete ocular examination including OCTA, SD?OCT, and EDI?OCT were performed three months following the diagnosis. Results: Three hundred sixty eyes of 180 subjects were enrolled between the two groups. A decreased mean foveal avascular zone area in both superficial capillary plexuses (P = 0.03) and deep capillary plexuses (P < 0.01), reduced average ganglion cell layer?inner plexiform layer thickness (P = 0.04), and increased subfoveal choroidal thickness (P < 0.001) were observed among cases in comparison to the control group. A significant correlation was found between sectoral macular vessel density in relation to disease severity and a decrease in vessel density with greater severity of the disease. Conclusion: OCTA detected retinal microvascular alterations following SARS?CoV?2 infection in subjects with the absence of any clinical ocular manifestation or systemic thrombotic events. These parameters could be used to help identify patients with a higher incidence of systemic thromboembolism on longer follow?ups and identify the impact of corticosteroids on retinal architecture.

Retinal nerve fiber layer thinning found in amyotrophic lateral sclerosis – Correlation with disease duration and severity

Purpose: The retinal involvement of amyotrophic lateral sclerosis (ALS) is a novel idea about a possible correlation between retinal nerve fiber layer (RNFL) thickness in different spectra of ALS patients. Finding the association of RNFL with disease duration and severity will help identify a novel noninvasive biomarker. Methods: The study was designed as a cross?sectional study and was conducted with a suitable proforma. We included the ALS cases based on the revised El Escorial criteria. Healthy controls were age and gender matched. We used the revised ALS functional rating scale (ALSFRS?R) to assess the operational status of the patients. We measured RNFL thickness in the four quadrants with spectral?domain optical coherence tomography (OCT) and analyzed it. Results: We included 30 cases (60 eyes) and 10 healthy controls (20 eyes) having a mean (standard deviation [SD]) age of 49.5 (11.1) years with a median of 50 years, and a majority of them (65%) were middle aged (between 41 and 60 years). We found statistically significant differences in RNFL thicknesses between ALS patients and healthy controls. On segmental analysis, the right eye superior and nasal quadrants and the left eye superior, inferior, and nasal quadrants were significantly affected, along with a gross asymmetry found between the left and right eyes among ALS patients. There was a significant decrease in average RNFL thickness in definite ALS patients than probable ALS patients, with significantly reduced average RNFL thickness in moderate to severe ALS patients. On correlation analysis, disease duration showed a good negative correlation with bilateral average RNFL thickness, and the ALSFRS?R score demonstrated a good positive correlation with bilateral average RNFL thickness, which was statistically significant. Thus, a reduced bilateral RNFL thickness is associated with a decreased ALSFRS?R score. Conclusion: The retinal changes can serve as a marker for diagnosing and monitoring patients with ALS

Relationship between optical coherence tomography findings and clinical variables in patients with opiate use disorder / Relação entre os achados da tomografia de coerência óptica e as variáveis clínicas em pacientes com transtorno por uso de opiáceos

ABSTRACT Purpose: This study aimed to examine optical coherence tomography findings in patients with opiate use disorder by comparing them with healthy controls. Methods: The study included 30 opiate use disorder patients and 30 controls. The participants' detailed biomicroscopic examinations, visual acuity, intraocular pressure, and both eye examinations were evaluated. A total of 120 eyes were evaluated using optical coherence tomography, measuring the central macular thickness, mean macular thickness, mean macular volume and retinal nerve fiber layer thickness. Moreover, all participants filled in the demographic data form and Barratt Impulsiveness Scale. Results: Upon examination of the optical coherence tomography findings, central macular thickness, mean macular thickness, and mean macular volume were thinner in both eyes in patients with opiate use disorder (p<0.01 in all measurements in both eyes). Similarly, the total values of the superior quadrant and retinal nerve fiber layer thickness were statistically significant in both eyes compared to that in the control group (p=0.007, p=0.002; p=0.049, p=0.007, in the right and left eyes, respectively). Only the left eye was positively correlated with retinal nerve fiber layer superior quadrant measurement and hospitalization (r=0.380, p=0.039). Conclusion: Our results revealed that the patients' central macular thickness, mean macular thickness, and mean macular volume values were thinner. Increase in the retinal nerve fiber layer thickness superior quadrant thickness and total value was also observed. Further studies with larger sampling groups that evaluate neuroimaging findings should be conducted.

RESUMO Objetivo: O objetivo foi investigar foi, os achados da tomografia de coerência óptica em pacientes com transtorno do uso de opiáceos, comparando-os com controles saudáveis. Métodos: O estudo incluiu 30 pacientes com transtorno do uso de opiáceos e 30 controles. Os exames biomicroscópicos detalhados de todos os participantes, acuidade visual, pressão intraocular e ambos os exames oculares foram avaliados com tomografia de coerência óptica. Um total de 120 olhos foram avaliados usando tomografia de coerência óptica, e a espessura macular central, espessura macular média, volume macular médio e a espessura da camada de fibra nervosa da retina dos participantes foram medidos. Além disso, todos os participantes preencheram o Formulário de Dados Demográficos e a Escala de Impulsividade Barratt (BIS-11). Resultados: Quando os achados de tomografia de coerência óptica foram examinados, espessura macular central, espessura macular média e volume macular médio eram mais finos de acordo com controles saudáveis em ambos os olhos em pacientes com transtorno do uso de opiáceos (p<0,01 em todas as medições em ambos os olhos). Da mesma forma, os valores totais do quadrante superior e espessura da camada de fibra nervosa da retina estavam mais em níveis estatisticamente significativos em ambos os olhos em comparação com o grupo controle (p=0,007, p=0,002; p=0,049, p=0,007, no olho direito e esquerdo, respectivamente). Estar internado em hospital e apenas a medida do quadrante superior da espessura da camada de fibra nervosa da retina do olho esquerdo associou-se positivamente (r=0,380, p=0,039). Conclusão: Em nossos resultados, descobrimos que os valores de espessura macular central, espessura macular média e volume macular médio dos pacientes eram mais finos. Verificamos também espessamento no quadrante superior e valor total da espessura da camada de fibra nervosa da retina. Nosso estudo deve ser apoiado por novos estudos com grupos de amostragem maiores, nos quais os achados de neuroimagem são avaliados.

Effect of Glycolic Acid, Maleic Acid, and EDTA in the Removal of Smear Layer from Root Canal Dentin

ABSTRACT Objective: To assess the efficacy of 5% Glycolic Acid (GA), 17% ethylenediaminetetraacetic acid (EDTA) and 7% maleic acid (MA), in removing the smear layer (SL). Material and Methods: For the experiment, forty single-rooted human teeth were selected. To perform the chemo‑mechanical preparation, the root canals were instrumented to an apical size of #30, along with simultaneous irrigation of 2.5% NaOCl. The samples were allotted to the experimental groups based on the final irrigating solution (n=10): (1) The GA group: 05%, (2) the EDTA group: 17%, (3) the MA group: 7%, and (4) the control group: Distilled water. The teeth were evaluated for the presence or absence of SL using SEM. Results: Comparing the 5% GA, 7% MA and 17% EDTA groups, no statistically significant differences were found at the coronal and middle thirds (p>0.05). However, in the apical third, MA had greater efficacy than EDTA (p=0.002) and GA (p=0.041), with a significant difference in the SL removal, while there was no significant difference between the latter (p=0.148). Conclusion: Thus, it was concluded that 7% maleic acid as a final irrigating solution is more efficacious than 17% EDTA and 5% glycolic acid in eliminating the smear layer from the apical portion of the root canal.

Analysis of retinal sublayer thickness in Leber hereditary optic neuropathy and G11778A mutation carriers / 中华眼底病杂志

Objective:To analyze the thickness of peripapillary retinal nerve fiber layer (pRNFL) and photoreceptor (PR) sublayer in Leber hereditary optic neuropathy (LHON) and G11778A mutation carriers. Methods:A cross sectional study. From September 2020 to October 2021, 68 LHON patients (136 eyes) (patient group) and 40 G11778A mutation carriers (80 eyes) of LHON patients' families (carrier group) were included in the study. All patients were found to have G11778A mutation by Genetic testing. Forty healthy volunteers with 80 eyes matched to the age and gender of the patient group were recruited as a normal control group. All eyes were examined by optical coherence tomography (OCT). The pRNFL thickness was automatically measured by the built-in software of the OCT device. The total retinal thickness (MT) and the thickness of the outer bundle layer (OPL), outer nuclear layer (ONL), external limiting membrane to retinal pigment epithelium (ELM-RPE) in macular OCT images were measured by Image J software. Linear mixed model was used to analyze and compare the thickness of pRNFL, macular fovea and four layers above the nasal and temporal paracentral retina in patients, carriers and normal controls. The correlation between pRNFL and macular retinal sublayer thickness and the course of disease was also analyzed. Results:The thickness of the upper and lower pRNFL, temporal pRNFL and average pRNFL of the patients were smaller than those of the carriers and the normal control group ( P<0.01), and the nasal pRNFL thickness of the patients was smaller than that of the carriers ( P<0.01). Fovea: compared with the normal control group, the thickness of MT and ONT in the patient group was decreased, ONL thickness decreased in carrier group, with the significant different ( P<0.05). Parafovea: compared with normal control group, the thickness of MT and temporal ONL decreased and temporal OPL increased in the patients group, with the significant different ( P<0.05). In the carrier group, the thickness of MT and temporal, nasal ONL decreased, and the thickness of nasal OPL increased, with the significant different ( P<0.05). Compared with the carrier group, the MT thickness of the patient group was decreased, and the nasal ONL and nasal ELM-RPE thickness were increased, with the significant different ( P<0.05). Correlation analysis results showed that the thinning of pRNFL in the superior, nasal, temporal and average ( r=-0.22, -0.21, -0.25, -0.22), and the thickening of ELM-RPE in foveo-temporal ( r=0.19) were correlated with the course of disease ( P<0.05). Conclusions:The pRNFL of LHON patients with G11778A mutation becomes thinner and is related to the course of the disease. There were significant differences in the thickness of MT and PR sublayers between patients and carriers compared to the normal control group.

Apply ultra-thin lobulated anterolateral thigh perforator flap in repairing of large soft tissue defect in foot: a report of 8 cases / 中华显微外科杂志

Objective:Exploring the clinical efficacy of using ultra-thin lobulated anterolateral thigh perforator flap(ALTPF) with retrograde separation of perforating vessels from the superficial and deep junction layer of the superficial fascia to repair large soft tissue defects in the foot.Methods:From August 2021 to November 2022, 8 patients (5 males and 3 females) were admitted to the Second Department of Hand and Foot Surgery, the Affiliated Central Hospital of Dalian University of Technology. The patients were 28 to 52 years old in age. The soft tissue defects were located in dorsal and plantar foot. At the plantar foot, the wound involved the weight-bearing area with explosion of bone, tendon or internal fixtures. The area of soft tissue defects was 6.0 cm × 5.0 cm - 16.0 cm × 8.0 cm, and the sizes of ALTPF were 8.0 cm ×5.5 cm - 18.0 cm × 8.5 cm. Preoperative high frequency CUD combined with CTA angiography were employed to locate the 2 flap perforator vessels. By keeping the perforator vessels at center and according to the soft tissue defect area and the wound shape, an ALTPF with a proper size and shape was designed in anterolateral thigh. The perforator were separated in the boundary layer between superficial and deep fascia, where it helped to obviously thin the flap. After the flap was harvested, it was further lobulated between the 2 perforators into 2 lobes after having confirmed the effective blood supply. Finally the lobulated ALTPF was transferred to covered the defect in foot. Cautions should be taken to ensure that the flap covered the weight-bearing area of foot. All the donor sites were directly sutured. Postoperative follow-up was conducted to observe the survival of flaps and the functional recovery of the reconstructed site, also to evaluate the clinical effect. Postoperative follow-up included outpatient visits and reviews over WeChat or telephone. Recovery of the ankle motor function was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hind foot score scale.Results:All 8 ALTPF survived. Over 6 to 18 months (10.8 months in average) of follow-up, the transferred flaps had good blood supply, soft in texture, with good elasticity and thin in appearance. Appearance and function of donor sites recovered well, except 1 patient who had mild scar hyperplasia. The plantar flap had good abrasion resistance. No flap damage, bleeding or granulation tissue hyperplasia occurred when walking. The mean score of AOFAS ankle-hind foot score achieved 95.6.Conclusion:The application of ultra-thin lobulated ALTPF with retrograde separation of perforating vessels from the superficial fascia at the junction layer for repairing large soft tissue defects in the foot has good clinical efficacy.

Comprehensive comparison between Halcyon 2.0 and Truebeam VMAT plans for different treatment sites: dosimetric quality and plan complexity / 中华放射肿瘤学杂志

Objective:To analyze the differences in dosimetric quality and plan complexity of volumetric modulated arc therapy (VMAT) plans based on Halcyon 2.0 and Truebeam for different treatment sites of the patients.Methods:Halcyon 2.0 VMAT plans in head & neck, chest, abdomen, and pelvis treatment sites of 49 cases were retrospectively selected and the VMAT plans were re-designed based on Truebeam with the same optimization parameters. The differences in dosimetric metrics and plan complexity between the two types of plans were compared and analyzed. P<0.05 was considered as statistically significant. Results:In terms of PTV, Halcyon 2.0 plans showed better homogeneity index (HI), conformal index (CI) in the head & neck and chest. Besides, Halcyon 2.0 plans yielded better D 98% and CI in the abdomen and better D 2% in the pelvis. For organs at risk (OAR), the D 20% and D mean of bilateral lungs, and D meanof heart for Halcyon 2.0 plans in the chest were lower than those for Truebeam plans (all P<0.05). For the complexity metrics, the median average aperture area variability (AAV) of Halcyon 2.0 plans in the head & neck, abdomen and pelvis were 0.414, 0.425 and 0.432, which were better than 0.385, 0.368 and 0.361 of Truebeam plans in the corresponding sites, respectively. In the abdomen and pelvis, Halcyon 2.0 plans showed better median modulation complexity score (MCS) than Truebeam plans (0.320 vs. 0.268, 0.303 vs. 0.282; both P<0.05). The median small aperture score (SAS) for all plans of Halcyon 2.0 were better than that of Truebeam plans (all P<0.05), and the median plan average beam area (PA) of all plans of Halcyon 2.0 were larger than that of Truebeam plans (all P<0.05). Conclusions:Compared with conventional fractionated VMAT plans based on Halcyon 2.0 and Truebeam, Halcyon 2.0 plans have similar or even better dosimetric quality. However, Halcyon 2.0 plans have lower plan complexity, which makes it an advantage in clinical application.

Clinical application of LinaTech linear accelerator VenusX to hippocampal protection in whole-brain radiotherapy / 中华放射医学与防护杂志

Objective:To compare the dosimetric differences between the VenusX accelerator with an orthogonal dual-layer multi-leaf collimator (MLC) and the Varian′s CLINAC IX and EDGE accelerators with a single-layer MLC for hippocampus protection in the whole-brain radiotherapy (WBRT).Methods:Forty patients with multiple brain metastases admitted to the Radiotherapy Department of the Shanghai General Hospital from June 2021 to February 2023 were selected in this study. Three whole-brain treatment plans were designed based on the above three accelerators for each patient. Under the same prescription dose, radiation field, and plan constraints, the three plans were compared in terms of the dosimetric differences in target volumes, hippocampi, and adjacent organs at risk (OARs), as well as the execution efficiency.Results:For the planning target volume (PTV), there were statistically significant differences in approximate maximum dose ( D2) between the VenusX and IX plans ( t = 4.94, P < 0.05), in approximate minimum dose ( D98) between the VenusX and EDGE plans ( t = 5.98, P < 0.05), in the target conformity indices (CIs) between VenusX plan and EDGE plans, and between the VenusX and IX plans ( t = -6.84, -14.30; P < 0.05), and dose homogeneity indices (HIs) between the VenusX and IX plans ( t = 3.48, P < 0.05). For OARs, the maximum doses ( Dmax) and average doses ( Dmean) to bilateral hippocampi of the VenusX plan were lower than those of the EDGE and IX plans ( t = 8.59-17.11, P < 0.05); the maximum doses ( Dmax) to bilateral lenses, bilateral optic nerves, and optic chiasma of the VenusX plan were lower than those of the other two plans ( t = 2.10-20.80, P < 0.05); and the differences between the maximum doses ( Dmax) to the brain stem of the VenusX and EDGE plans were statistically significant ( t = 3.86, P < 0.05). In terms of plan execution efficiency, the number of machine jumps (MU) and the treatment time of the VenusX plan were higher than those of the EDGE and IX plans, with statistically significant differences ( t = -56.48, -56.90, P < 0.05). Conclusions:The doses to target volumes of the three treatment plans all meet the prescription requirements, and the VenusX plan outperforms the EDGE and IX plans in the protection of OARs. Despite the reduced execution efficiency, the VenusX plan shortens the actual treatment time by improving the dosage rate, thus meeting the clinical requirements.

Efficacy of quantitative parameters of dual-layer spectral detector CT in preoperative prediction of Ki-67 expression in esophageal squamous cell carcinoma / 中华放射学杂志

Objective:To explore the efficacy of quantitative parameters of dual-layer spectral CT in preoperative prediction of Ki-67 expression in esophageal squamous cell carcinoma (ESCC).Methods:From December 2021 to December 2022, 64 patients with histopathologically diagnosed ESCC were retrospectively analyzed at Liaoning Cancer Hospital & Institute. The expression level of Ki-67 in ESCC tumor tissue was detected by the immunohistochemical method. The patients were divided into the Ki-67 high expression group (the Ki-67 expression index≥30%, 47 cases) and the Ki-67 low expression group (the Ki-67 expression index<30%, 17 cases). The quantitative parameters of spectral CT were measured, including traditional 120 kVp CT value, 40 keV CT value, iodine density (ID), normalized iodine density (NID), and Z-effective in arterial and venous phases. Independent sample t test was used to compare the differences in the parameters between the Ki-67 high and low expression groups. The receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of each parameter in predicting Ki-67 expression. DeLong test was used to compare the area under the curve (AUC). Results:The 120 kVp CT value, 40 keV CT value, ID, and Z-effective in the arterial phase and the 120 kVp CT value, 40 keV CT value, ID, NID, Z-effective in venous phase in the Ki-67 high expression group were all higher than those in the Ki-67 low expression group ( P<0.05). There was no statistically significant difference in arterial phase NID between the two groups ( t=1.85, P=0.070). NID in the venous phase had the highest AUC in predicting high expression of Ki-67 in ESCC (AUC=0.965, 95%CI 0.923-1.000). With a venous phase NID value of 0.28 as the diagnostic threshold, the sensitivity and specificity were 93.6% and 100%. There was no significant difference in AUC between venous phase NID and venous phase ID (AUC=0.926) and Z-effective (AUC=0.909) ( Z=-1.52, 1.81, P=0.128, 0.071), but there was a significant difference of AUC between venous phase NID and 120 kVp CT value (AUC=0.719) and 40 keV CT value (AUC=0.747) ( Z=3.41, 3.30, P=0.001, 0.001). There were statistical differences of AUC between venous phase NID and each parameter of arterial phase ( P<0.05). Conclusion:The three spectral CT parameters (ID, NID, and Z-effective) in the venous phase have high diagnostic efficacy in predicting ESCC Ki-67 expression.

Value of dual-layer spectral detector CT in evaluating the intramedullary invasion of limb osteosarcoma / 中华放射学杂志

Objective:To explore the optimal keV value of the virtual monoenergetic image (VMI) for displaying the osteosarcoma by using the dual-layer spectral detector CT and to evaluate its application value in determining the extent of intramedullary invasion of osteosarcoma.Methods:From August 2021 to August 2022, 57 patients with conventional osteosarcoma of long bone confirmed by biopsy in Beijing Jishuitan Hospital, Capital Medical University were retrospectively analyzed. All patients completed dual-layer spectral CT enhanced examination before limb salvage surgery, and tumor segment resection specimens were obtained after surgery. Conventional 120 kVp image and VMI of 40, 50, 60, 70 and 80 keV were obtained by spectral CT examination, and the CT values of tumors, image noise were measured and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the corresponding images were calculated. The objective evaluation among the six groups of images were assessed with the Friedman test, and then determined the optimal keV value. The maximum distance between the intramedullary boundary of osteosarcoma and the adjacent articular surfaces was measured on the best keV VMI and the tumor segment resection specimens. The Wilcoxon signed rank test was used to find the differences and the Spearman correlation analysis was used to evaluate the correlation between the distance measured from the best keV VMI and the specimens.Results:There were significant differences in CT value, image noise, SNR and CNR between 40-80 keV VMI and 120 kVp conventional CT images ( P<0.05). The CT value, SNR and CNR of 40 and 50 keV VMI were better than 120 kVp ( P<0.001). The 50 keV VMI was chosen as the best keV VMI to measure the intramedullary extent of osteosarcoma. The distance measured from 50 keV VMI was 103.9 (80.4, 131.4) mm, while the distance measured from specimens was 113.5 (94.0, 142.0) mm, and the difference was statistically significant ( Z=-5.76, P<0.001). The 50 keV VMI measurements in 51 patients were smaller than the gross specimens, which underestimated the tumor intramedullary extent, with the difference was 11.1 (6.6, 13.8) mm. The Spearman correlation analysis demonstrated a high positive correlation of distance measured on gross specimens with the 50 keV VMI ( r s=0.960, P<0.001). Conclusions:Dual-layer spectral detector CT with 50 keV VMI is the best image to show the limb osteosarcoma. Compared with gross specimens, the distance measured from CT underestimated the intramedullary invasion range of limb osteosarcoma about 10 mm, but the two show a good correlation.

Diagnosis of pulmonary artery sarcoma and differential diagnosis of pulmonary embolism with double-detector spectral CT: a case report / 中国医师杂志

Objective:The differential diagnosis of pulmonary artery sarcoma (PAS) and pulmonary embolism (PE) by double-detector spectral computerized tomography (CT) provides a new way to improve the detection rate of PAS and reduce the misdiagnosis rate.Methods:In the way of retrospective study, the Philips Nebula Workstation (ISP) was used to reconstruct electron density map, iodine density map and spectral curve in the spectral CT plain scan and enhancement of the PAS patient. In the plain scan image, the low density areas of the ascending aorta and the right pulmonary trunk were selected to measure their electronic density values. In the chest enhancement image, the iodine density of PAS area and PE area were measured respectively, and the spectral curves of PSA area and PE area were compared.Results:The electron density of the ascending aorta and the right pulmonary trunk in the low density area of the PAS patient during the plain scan of spectral CT were 104.4% EDW (relative to the percentage of the electron density of water) and 102.2% EDW, respectively, which were lower than those in the normal ascending aorta area. The fusion image of mixed energy and electron density clearly reflected the scope of the lesion. The iodine density in PAS area was 1.89 mg/ml, and the iodine density in PE area was 0.03 mg/ml during the enhancement phase. The iodine uptake in PAS area was significantly higher than that in PE area. The slope of PAS region was 2.08, and the slope of PE region was -1.86. The slopes of the two spectral curves were inconsistent.Conclusions:The electronic density, iodine density and spectral curve measured by double-detector spectral CT may provide powerful imaging basis for the diagnosis of PAS and the differentiation of PAS from PE, which is helpful for the early diagnosis of the lesions, and also provide basis for the biopsy location of the mixed lesions of PAS and PE.