Vitamin A palmitate eye gel and carboxymethylcellulose sodium eye drops on prevention of dry eye after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To observe the efficacy of vitamin A palmitate eye gel and carboxymethylcellulose sodium eye drops on prevention of dry eye after phacoemulsification. ·METHODS: Ninety patients ( ninety eyes ) with age-related cataract enrolled in our hospital from March 2016 to August 2017 were performed phacoemulsification with intraocular lens implantation. They were randomly divided into three groups as control group ( n = 30 ), treated group Ⅰ ( n=30) and treated group Ⅱ ( n=30). The control group was administered with tobramycin and dexamethasone eye drops for 15d as the basis therapy. In treated group Ⅰ, patients were administered with carboxymethylcellulose sodium eye drops for 30d based on the treatment of the control group. The treated groupⅡ was administered with vitamin A palmitate eye gel for 30d on the basis of the treated group Ⅰ. The dry eye symptom score, corneal fluorescence ( FL ) staining scores, breakup time of tear film ( BUT) and Schirmer Ⅰtest ( SⅠt) without topical anesthesia were examined in 1d before operation and 15d and 30d after operation. · RESULTS: There were no statistically significant differences in subjective symptom scores of dry eye, BUT values, FL scores, and SⅠt values among the three groups before treatment (P>0. 05). After treatment, dry eye symptom scores, FL scores, and S Ⅰ t values increased at first and then decreased with time. BUT values decreased at first and then increased. Fifteen and thirty days after surgery, dry eye symptom scores, FL scores, and SⅠt values were significantly lower in the treated group Ⅰ and the treated group Ⅱ than in the control group. While BUT values were significantly higher than that in the control group. The dry eye symptom scores and S Ⅰ t value of treated group Ⅱ were significantly lower than the treated groupⅠ, and the BUT value was significantly higher than that of the treated group Ⅰ(P<0. 05). · CONCLUSION: Phacoemulsification combined with intraocular lens implantation has a certain damage of ocular surface tissue on the initial stage. The application of vitamin A palmitate eye gel combined carboxymethylcellulose sodium eye drops can improve the dry eye symptoms.

Selection and Short-Term Outcomes of Living Kidney Donors in Singapore - An Analysis of the Donor Care Registry

<p><b>INTRODUCTION</b>Transplant rates in Singapore have been falling and there is limited information on baseline characteristics and clinical outcomes of living kidney donors nationally. This study aimed to determine the safety of living kidney donor transplant in Singapore by exploring the proportion of donors that meets international selection guidelines and describing short-term clinical outcomes.</p><p><b>MATERIALS AND METHODS</b>We analysed 472 donors who underwent nephrectomies from 1 January 2010 to 31 December 2014 from the Donor Care Registry. We described donor characteristics against 5 international guidelines and measured post-nephrectomy outcomes in 150 local donors for up to 24 months. A multivariate analysis was performed to determine the baseline variables associated with poorer outcomes.</p><p><b>RESULTS</b>There were more foreign than local donors, with differences in gender and hospital types. Selection was generally aligned with international recommendations although 3.0% (using the Chronic Kidney Disease Epidemiology [CKD-EPI] equation) to 8.5% (using radionuclide and creatinine clearance methods) of donors had inappropriate baseline estimated glomerular filtration rates (eGFR) forage. Post-procedure, many foreign donors were lost to follow-up. Over 24 months, eGFR decreased by 33.8% from baseline before recovering gradually to 29.6%. During this period, only 2 donors were admitted for renal or urological conditions and there were no cases of end-stage renal failure or deaths. A lower baseline eGFR (HR: 1.05; 95% Cl, 1.02 to 1.09) and older age (HR: 1.04; 95% Cl, 1.00 to 1.08) were associated with a post-nephrectomy eGFR of less than 60 mL/kg/1.73 m.</p><p><b>CONCLUSION</b>Kidney donation is safe in Singapore. Donor selection is in keeping with international guidelines and short-term outcomes are comparable to other cohorts.</p>

Pretreatment Diffusion-Weighted MRI Can Predict the Response to Neoadjuvant Chemotherapy in Patients with Nasopharyngeal Carcinoma.

PURPOSE: To explore the potential of diffusion-weighted (DW) magnetic resonance imaging (MRI) using apparent diffusion coefficient (ADC) for predicting the response to neoadjuvant chemotherapy in nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Ninety-two consecutive patients with NPC who underwent three cycles of neoadjuvant chemotherapy were retrospectively analyzed. DW and anatomical MRI were performed before and after neoadjuvant chemotherapy prior to radiotherapy. Pretreatment ADCs and percentage increases in ADC after chemotherapy were calculated for the primary lesions and metastatic adenopathies. Receiver operating characteristic curve analysis was used to select optimal pretreatment ADCs. RESULTS: Pretreatment mean ADCs were significantly lower for responders than for nonresponders (primary lesions, P = 0.012; metastatic adenopathies, P = 0.013). Mean percentage increases in ADC were higher for responders than for nonresponders (primary lesions, P = 0.008; metastatic adenopathies, P < 0.001). The optimal pretreatment primary lesion and metastatic adenopathy ADCs for differentiating responders from nonresponders were 0.897 × 10(-3) mm(2)/sec and 1.031 × 10(-3) mm(2)/sec, respectively. CONCLUSIONS: NPC patients with low pretreatment ADCs tend to respond better to neoadjuvant chemotherapy. Pretreatment ADCs could be used as a new pretreatment imaging biomarker of response to neoadjuvant chemotherapy.

Prognostic value of classifying parapharyngeal extension in nasopharyngeal carcinoma based on magnetic resonance imaging.

PURPOSE: To subclassify parapharyngeal extension in nasopharyngeal carcinoma (NPC) and investigate its prognostic value and staging categories based on magnetic resonance imaging (MRI). METHODS AND MATERIALS: Data from 1504 consecutive NPC patients treated with definitive-intent radiotherapy were analyzed retrospectively. Sites of parapharyngeal extension were defined by MRI. Overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were calculated by the Kaplan-Meier method and compared with the log-rank test. Hazard consistency and hazard discrimination were determined by multivariate analysis with Cox proportional hazards models. RESULTS: 1104 patients (73.4%) had parapharyngeal extension; 1.7-63.8% had involvement of various anatomic sites. The hazard ratio for death was significantly higher with extensive parapharyngeal extension (lateral pterygoid muscle of masticator space and beyond or parotid space) than with mild extension (medial pterygoid muscle of masticator space, or carotid, prestyloid, and prevertebral or retropharyngeal space). OS, LRFS, and DMFS with extensive parapharyngeal extension were similar to those in T4 disease; OS, LRFS, and DMFS with mild parapharyngeal extension were significantly higher than in those T3 disease (all P ≤ 0.015). CONCLUSIONS: Parapharyngeal extension in NPC should be subclassified as mild or extensive, which should be regarded as stages T2 and T4 diseases, respectively.

Prognostic value of grading masticator space involvement in nasopharyngeal carcinoma according to MR imaging findings.

PURPOSE: To derive a suitable method for grading masticator space invasion in nasopharyngeal carcinoma on the basis of magnetic resonance (MR) images and to determine its prognostic value in patients undergoing intensity-modulated radiation therapy. MATERIALS AND METHODS: After institutional review board approval and informed consent were acquired, 808 patients with nasopharyngeal carcinoma who were treated with definitive intensity-modulated radiation therapy were analyzed retrospectively. The anatomic sites of masticator space involvement were identified with MR imaging. Overall survival, local relapse-free survival, and distant metastasis-free survival were calculated by using the Kaplan-Meier method and were compared by using the log-rank test. Potential prognostic factors were identified by means of multivariate analysis. RESULTS: Masticator space involvement was diagnosed in 163 of 808 patients (20.2%). Patients with lateral invasion (involvement of the lateral pterygoid muscle of the masticator space and beyond) had significantly poorer overall survival and distant metastasis-free survival than those with medial invasion (involvement of the medial pterygoid muscle of the masticator space) (P = .035 and P = .026, respectively). Furthermore, their overall survival, local relapse-free survival, and distant metastasis-free survival were significantly poorer compared with patients with stage T2 or T3 disease (all P ≤ .023) but similar to patients with stage T4 disease. The grade of masticator space involvement was an independent prognostic factor for overall survival, local relapse-free survival, and distant metastasis-free survival (all P ≤ .023). CONCLUSION: Masticator space involvement in nasopharyngeal carcinoma should be graded as medial (stage T2 disease) or lateral (stage T4 disease). This can facilitate staging of nasopharyngeal carcinoma and may be a suitable prognostic indicator of survival.

Concurrent weekly docetaxel chemotherapy in combination with radiotherapy for stage III and IVA-B nasopharyngeal carcinoma.

BACKGROUND AND PURPOSE: Cisplatin is the most common chemotherapeutic agent for loco-regionally advanced nasopharyngeal carcinoma (NPC); however, toxicity is a limiting factor for some patients. We retrospectively compared the efficacy and toxicity of weekly docetaxel-based and cisplatin-based concurrent chemoradiotherapy in loco-regionally advanced NPC. METHODS AND MATERIALS: Eighty-four patients with Stage III and IVA-B NPCs, treated between 2007 and 2008, were retrospectively analyzed. Thirty received weekly docetaxel-based concurrent chemotherapy, and 43 were given weekly cisplatin-based concurrent chemotherapy. Radiotherapy was administered using a conventional technique (seven weeks, 2.0 Gy per fraction, total dose 70-74 Gy) with 6-8 Gy boosts for some patients with locally advanced disease. RESULTS: Median follow-up time was 42.3 months (range, 8.6-50.8 months). There were no significant differences in the 3-year loco-regional failure-free survival (85.6% vs. 92.3%; p=0.264), distant failure-free survival (87.0% vs. 92.5%; p=0.171), progression-free survival (85.7% vs. 88.4%; p=0.411) or overall survival (86.5% vs. 92.5%, p=0.298) of patients treated concurrently with docetaxel or cisplatin. Severe toxicity was not common in either group. CONCLUSIONS: Weekly docetaxel-based concurrent chemoradiotherapy is potentially effective and has a tolerable toxicity; however, further investigations are required to determine if docetaxel is superior to cisplatin for advanced stage NPC.

Primary nasopharyngeal adenocarcinoma: a review.

Primary nasopharyngeal adenocarcinoma (NAC) accounts for approximately 0.5% of all nasopharyngeal cancer. The diagnosis, staging and treatment of NAC has not been well described. This article presents a literature review on NAC and identifies its characteristics and management. The NAC group of diseases contains various pathological types and has a series of specific clinical characteristics, including slow progression, a low incidence of neck masses and frequent cranial neuropathy. The Epstein-Barr virus may not play an important role in NAC carcinogenesis. The rarity of the disease makes the staging classification and treatment strategies of NAC parallel to those recommended for nasopharyngeal squamous carcinoma. Some patients might benefit from surgery, and radiotherapy using precise techniques might achieve good control for treating NAC, but the roles of chemotherapy and target therapy are not clear. The proper staging system and optimal treatment strategies need to be established in NAC.

Radiologic criteria of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma treated with radiation therapy.

PURPOSE: To determine the appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: After institutional review board approval and informed consent, 303 consecutive NPC patients treated with definitive radiation therapy were examined after completion of therapy. RLNs were classified as metastatic on the basis of the results of magnetic resonance (MR) imaging follow-up.The receiver operating characteristic curve and area under the curve were determined to assess the accuracy of different size criteria in the diagnosis of RLN metastasis. RESULTS: Initial MR images revealed 523 RLNs in 265 patients. Two hundred sixty-four (50.5%) RLNs positive for malignant involvement were confirmed in 177 patients. The remaining 259 (49.5%) nodes were classified as negative for benign process at follow-up. The minimal axial diameter was found to be more accurate than the maximal axial diameter for assessing metastatic RLNs. The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 6 mm or larger, resulting in an accuracy of 87.5% (457 of 522). Central necrosis or groups of two or more of RLNs had a 100% specificity for diagnosis of RLN metastases. CONCLUSION: The radiologic criteria that should be used for assessment of RLN metastases in NPC patients are nodes with a minimal axial diameter 6 mm or larger, any node with central necrosis, groups of two or more RLNs, or any medial RLN; these criteria may be useful in tumor staging and treatment planning.

[Application of 99mTc-DTPA in evaluation of blood-brain barrier permeability in patients receiving whole brain irradiation].

OBJECTIVE: To study the pattern of blood-brain barrier (BBB) permeability changes during whole brain radiotherapy (WBRT) for metastatic brain tumor. METHODS: Twenty patients with metastatic brain tumors receiving WBRT by 6 MV X-ray underwent (99)mTc-DTPA brain SPECT before and during WBRT (20, 40 Gy) and at 2 weeks after the end of irradiation. A frame of transverse (99)mTc-DTPA brain SPECT image that best displayed the brain metastasis was chosen, and the regions of interest (ROI) were defined in the tumor foci (T), the contralateral normal brain tissue (N) and the background outside the soft tissues around the cranium (B). The radioactive counts of every ROI were measured and the ratios of the total counts (T/B and N/B) before and during WBRT (20 Gy, 40 Gy) and at 2 weeks after the irradiation were calculated. RESULTS: The average T/B and N/B in the 20 patients with 30 brain metastases was 142.2-/+51.1 and 82.6-/+42.3 before WBRT, 260.3-/+121.5 and 150.7-/+72.5 during 20 Gy WBRT, 251.6-/+118.3 and 161.8-/+68.4 during 40 Gy WBRT, and 250.3-/+117.2 and 158.6-/+73.5 at 2 weeks after the irradiation, respectively. The measurements during WBRT (20 and 40 Gy) and at 2 weeks after the irradiation group underwent no significant variations (P>0.05), but showed significant differences from those before WBRT (P<0.05). CONCLUSIONS: Irradiation causes direct damage of the BBB function, and the permeability of the BBB increases significantly during and within 2 weeks following 20 and 40 Gy WBRT, which provides the optimal time window for interventions with chemotherapy.

Changing seroprevalence of hepatitis B virus markers of adults in Singapore

<p><b>INTRODUCTION</b>We presented the findings from 2 seroprevalence studies conducted 6 years apart, so as to determine changes in the hepatitis B surface antigen (HBsAg) positivity rate and immunity to hepatitis B virus (HBV) among Singapore residents aged 18 to 69 years, and to assess the impact of a 4-year catch-up hepatitis B immunisation programme for adolescents and young adults launched in 2001.</p><p><b>MATERIALS AND METHODS</b>Two hepatitis B seroprevalence studies (HBSS) were conducted in 1999 and 2005 based on stored blood samples collected from 4698 participants aged 18 to 69 years during the national health survey (NHS) 1998 and from 3460 participants during the NHS 2004, respectively. Serology for HBsAg, hepatitis B e antigen (HBeAg) and antibody to HBsAg (anti-HBs) were tested by enzyme immunoassay in HBSS 1999 and electrochemiluminescence in HBSS 2005.</p><p><b>RESULTS</b>The overall age-standardised prevalence of HBsAg among Singapore residents aged 18 to 69 years decreased significantly from 4.0% in HBSS 1999 to 2.8% in HBSS 2005 (P = 0.002). The age-standardised prevalence of HBsAg in males (4.9% in 1999) and Chinese (4.7% in 1999) both decreased significantly to 2.7% and 2.8%, respectively in 2005. The overall age-standardised population immunity to HBV (anti-HBs >10 mIU/ml) increased from 39.7% in 1999 to 42.1% in 2005 (P = 0.019). In particular, the age-specific prevalence of anti-HBs showed a significant increase among those in the age group of 18 to 29 years from 27.9% in 1999 to 41.7% in 2005 (P <0.001) and among those in the age group of 30 to 39 years from 39.9% in 1999 to 44.7% in 2005 (P = 0.021).</p><p><b>CONCLUSION</b>There was an overall decline in the HBsAg positivity rate as well as an overall increase in population immunity to HBV. Following the 4-year catch-up immunisation programme, there was a significant increase in the immunity to HBV infection in the younger population aged 18 to 29 years.</p>