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Infectious keratitis often occurs in single eye and causes changes in the nervous system, immune system and tear function, which may affect contralateral uninfected eye.Changes in the uninfected eye include a decrease in corneal nerve density and tear secretion, an increase in corneal dendritic cells and changes in tear cytokines.All the changes can be observed by in vivo confocal microscopy, Schirmer test I and tear film break-up time tests.Alternations in immune cells, cytokines and immunodulatory neuropeptide levels in contralateral eyes might mediate the incidence of bilateral infectious keratitis, and are also correlated with lacrimal reflex pathway.This article reviewed the pathophysiological changes in the contralateral uninfected eye of monocular infectious keratitis, which may help increase our understanding of the mechanisms involved in the corneal homeostasis and pathophysiology of corneal diseases.
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Background and Objective: Spontaneous coronary artery dissection [SCD] remains a rare and important cause of coronary artery disease [CAD]. The purpose of this study was to describe the clinical and angiographic features in SCD and to evaluate the treatment and long-term prognosis of this condition in China
Methods: This retrospective cohort study included 118 Chinese patients with SCD confirmed by coronary angiography. Clinical and angiographic features, treatment modalities and outcomes of SCD were estimated
Results: The overall prevalence of SCD was 0.15%. Age was 57 +/- 10 years; 86% patients were men; 75% presented with acute coronary syndrome [ACS]; 72% had concomitant atherosclerotic CAD. SCD often affected right coronary artery [RCA] and caused a short dissection [< 20mm]. A conservative therapy was used in 28% of patients and revascularization in 72% [percutaneous coronary intervention [PCI] 57%; coronary artery bypass grafting [CABG] 15%]. Only one patient died during hospitalization due to multiple organ failure after CABG. During a median follow-up of 43 months [range, 1 - 158 months], 32 patients had a new-onset ACS, 9 received revascularization [7 PCI and 2 CABG], and 8 died. The Kaplan-Meier estimated 12-year rates of freedom from cardiac death and ACS were both higher in revascularization versus conservative therapy [78% versus 57%; P = 0.023; 48% versus 25%, P = 0.014]. No significant difference was found in freedom from revascularization between the two therapies
Conclusions: In China, SCD was usually associated with atherosclerosis and predominantly affected male population. SCD often affected RCA and caused a short dissection. In-hospital mortality rate was low regardless of therapeutic strategy. However, a significantly better long-term prognosis was observed in the revascularization compared with conservative therapy
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Objective To evaluate the clinical changes of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves in contralateral eyes of patients with unilateral infectious keratitis.Methods A prospective serial case observation study was conducted in patients with unilateral infectious keratitis from January to August 2018 in the First Affiliated Hospital of Harbin Medical University.The corneal epithelial cells density,dendritic cells density,endothelial cells density,total nerve density,total number of nerves and branch nerve density were analyzed with in vivo confocal microscopy (IVCM),slit lamp microscopy was performed on all subjects to observe the conjunctiva,cornea and anterior chamber.Corneal branch nerve density and total nerve density were compared with the control group by homogeneity test of variance.This study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No.IRB-AF/SC-04/01.0).Results Slit lamp microscopy showed no significant changes in anterior segment of the contralateral uninfected eyes in the 3 groups.The corneal epithelial cells density of uninfected eyes in viral keratitis group,bacterial keratitis group and fungal keratitis group was 1 834 (1 584,2 107),1 905 (1 651,2 332) and 1 859 (1 477,1 995)/mm2,respectively,which were significantly lower than 3 479 (3 080,3 910)/mm2 in the control group,the dendritic cells densities in viral keratitis group and bacterial keratitis group were 175 (139,214)/mm2 and 156 (118,190)/mm2,which were higher than 69(57,76)/mm2 in the control group,the differences were statistically significant (all at P＜0.05).The corneal endothelial cells density of uninfected eyes in viral keratitis group was 1 107(945,1 270)/mm2,which was less than 1 905(1 651,2 332)/mm2 in the bacterial keratitis group and 1 859(1 477,1 995)/mm2 in the fungal keratitis group (both at P＜0.05).The corneal nerve number and total nerve density of uninfected eyes in viral keratitis group were l0(7,11)/mm2 and (1 822.85±622.34) μm/mm2,which were lower than 11 (9,13)/mm2 and (2 340.91±:408.70)μm/mm2 in the bacterial keratitis group,with significant differences between them (P＜ 0.05,P＜ 0.008 3).The morphology of corneal epithelial cells and endothelial cells in each infectious keratitis group was larger than that in the control group,while the morphology and number of dendritic cells in the contralateral eye of patients with viral and bacterial keratitis increased.Conclusions In unilateral uninfected eyes of infectious keratitis,the density of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves changes correspondingly.There may be a close relationship of corneal immunity and nervous system between the two eyes.
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Objective: To find out the association between serum total cholesterol [TC] on admission and in-hospital mortality in patients with acute aortic dissection [AAD]
Methods: From January 2007 to January 2014, we enrolled 1492 consecutive AAD patients with serum TC measured immediately on admission. Baseline characteristics and in-hospital mortality were compared between the patients with serum TC above and below the median [4.00 mmol/L]. Propensity score matching [PSM] was used to account for known confounders in the study. Cox proportional hazard model was performed to calculate the hazard ratio [HR] and 95% confidence interval [Cl] for admission serum TC levels
Results: With the use of PSM, 521 matched pairs of patients with AAD were yielded in this analysis due to their similar propensity scores. Patients with admission serum TC < 4.00 mmol/L, as compared with those with admission serum TC > 4.00 mmol/L, had higher in-hospital mortality [11.7% vs. 5.8%; HR, 2.06; 95% Cl, 1.33-3.19, P = 0.001]. Stratified analysis according to Stanford classification showed that the inverse association between admission serum TC and in-hospital mortality was observed in patients with Type-A AAD [24.0% vs. 11.3%; HR, 2.18; 95% Cl, 1.33- 3.57, P = 0.002] but not in those with Type-B AAD [3.8% vs. 2.2%; HR, 1.71; 95% Cl, 0.67-4.34, P= 0.261]
Conclusions: Lower serum TC level on admission was strongly associated with higher in-hospital mortality in patients with Type-A AAD
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Objective: To explore the clinical characteristics of ST elevation and non-ST elevation acute myocardial infarction (AMI) related with left circumflex artery (LCX) occlusion. Methods: Clinical data of 86 consecutively enrolled patients with LCX occlusion -related AMI undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. According to manifestations of electrocardiography, the patients were divided into ST elevation myocardial infarction (STEMI) group (n=32) and non STEMI (NSTEMI) group (n=54). Clinical features and prognosis were compared between two groups. Results: Compared with NSTEMI group, there were significant increase in serum level of creatinine [(80±23) μmmol/L vs. (100±30) μmmol/L], in rates of intra-aortic balloon counterpulsation （IABP）support (3.7% vs. 18.8%), usage of invasive respiratory machine (1.9% vs. 15.6%), ischemic mitral reflux (13.0% vs. 40.6%), complete atrioventricular block (0 vs. 9.4%), proportion of left coronary artery dominant type (7.4% vs. 28.1%) and left ventricular end-diastolic diameter [LVEDd,（46±4）mm vs.（48±5）mm?]; And significant decrease in percentage of triple-vessel coronary disease (72.2% vs. 46.9%) in STEMI group, P0.05) between STEMI group and NSTEMI group. Conclusions: Compared with patients with NSTEMI, patients with STEMI have poorer heart function in patients with left circumflex artery occlusion, which may be related to more left coronary dominance.