[Outcomes of surgical treatment of congenital cataract with microphthalmia in infancy].

Objective: To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). Methods: It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired t-tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). Results: The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (OR=0.072, P<0.001) and age at the first stage of surgery (OR=7.270, P<0.001), but not with preoperative corneal diameter (P=0.735). The incidence of VAO was associated with preoperative corneal diameter (OR=4.124, P=0.011), but not with age at the first stage of surgery (P=0.489) or preoperative axial length (P=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (U=49.50, P=0.003). Conclusions: Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.

Cost-effectiveness analysis of five drugs for treating postmenopausal women in the United States with osteoporosis and a very high fracture risk.

PURPOSE: Five strategies were recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) guidelines for the treatment of postmenopausal osteoporosis (PMO) patients with a very high fracture risk. We aimed to assess their cost-effectiveness in the United States (US). METHODS: A microsimulation Markov model was created to compare the cost-effectiveness of five treatment strategies, including zoledronate, denosumab, abaloparatide, teriparatide, and romosozumab in PMO patients with a recent fracture from the healthcare perspective of the US. The data used in the model were obtained from published studies or online resources. Base-case analysis, one-way deterministic sensitivity analysis (DSA) and probability sensitivity analysis (PSA) were conducted for 65-, 70-, 75-, and 80-year-old patients. RESULTS: In base case, at 65 years, zoledronate was the cheapest strategy. The incremental cost-effectiveness ratios (ICER, which represent incremental costs per QALY gained) of denosumab, teriparatide, abaloparatide, and romosozumab against zoledronate were $13,020/QALY (quality-adjusted years), $477,331 /QALY, $176,287/QALY, and $98,953/QALY, respectively. Under a willing-to-pay (WTP, which means the highest price a consumer will pay for one unit of a good of service) threshold of $150,000/QALY, denosumab and romosozumab were cost-effective against zoledronate. The PSA results showed that denosumab was the most cost-effective option with WTP thresholds of $50,000/QALY, $100,000/QALY and $150,000/QALY. The results were similar in other age groups. The DSA results indicated that the most common parameters that have important influence on the outcome were drug persistence, incidence of adverse events, the efficacy of drugs on hip fractures and the cost of the drug. CONCLUSION AND RELEVANCE: Among PMO patients with a very high fracture risk in the US, zoledronate is the cheapest strategy and denosumab is the most cost-effective choice among these five strategies.

[An analysis on the relationship between indwelling time after tube insertion and recurrence in children with secretory otitis media].

Objective:To analyze the relationship between indwelling time after tube insertion and recurrence after tube removal or extrusion in children with secretory otitis media(SOM). Method:Medical history and clinical data obtained by follow-up were analyzed in 465 pediatric patients with SOM who underwent tube insertion. Result:①331 of 465 children were followed up, including 220 males(66.47%), 111 females(33.53%), totally 576 ears in which SOM recurred in 177 ears after tube removal or extrusion with the recurrence rate of 30.73%. The average age was (4.69±2.18) years old in children who underwent tube insertion, gathering at age of 3 to 6 years. The average indwelling time was（9.96±3.72）months for all ears, while(8.59±3.49) months in recurrent ears, and(10.57±3.65) months in healing ears. The recurrence rate was 46.09% in ears in which indwelling time less than 6 months. The prevalence of allergic rhinitis in children with recurrent SOM after tube removal or extrusion was 59.62%, which was higher than the overall prevalence rate of 38.67%. ②Of 177 ears, a second time of the tube insertion was performed in 79 ears (44.63%). The average of the initial indwelling time was(7.50±3.40) months in children with recurrent SOM. The prevalence rate of allergic rhinitis in children who underwent a second time of the tube insertion was 68.09%, which was higher than rate of 29.07% in children cured. Conclusion:SOM was inclined to recur in 3-6 year old children. The shorter indwelling time and with allergic rhinitis in children, the higher recurrence rate after tube removal or extrusion. The recurrence rate was significantly lower when indwelling time was more than 13 months.

Magnetic resonance imaging study of the rat cerebral ventricular system utilizing intracerebrally administered contrast agents.

Magnetic resonance imaging (MRI) was employed to study the rat brain in conjunction with intracerebral (ic) injection of three contrast agents: GdHAM, GdDPTA, and MnCl2. The results demonstrate several advantages of ic administration of MRI contrast agents over the other routes of injection in examining CSF dynamics and brain ventricular structure. Apparent affinity of the luminal ventricular wall of the brain for positively charged GdHAM and Mn2+ ions is observed, presumably reflecting the presence of negatively charged wall components. Respiratory distress caused by (intravenous) injection of GdHAM was found to be minimized in the case of ic injections. Time-dependent changes in observed contrast indicate that diffusive processes rather than flow of CSF play a dominant role in distributing the contrast agents. Possible applications of this approach in brain research are discussed.

In vivo pharmacokinetics by electron magnetic resonance spectroscopy.

Low-field in vivo electron spin resonance (ESR) has been used to follow the course of metabolism and distribution of a paramagnetic spin probe, 3-carboxamido-2,2,5,5-tetramethylpyrrolidine-1-oxyl. Sprague-Dawley rats (250-300 g) were catheterized in the jugular vein and given serial doses of the nitroxide spin probe above. The decrease in the tail blood nitroxide ESR spectrum with the time was followed. This reflects both normal distribution/excretion and a significant metabolic step--reversible reduction of the nitroxide group to its hydroxylamine. The studies serve as important and useful comparisons to the nitroxide reduction kinetics in vitro while offering the important advantage of avoiding those non-steady-state artifacts frequently expected in ex vivo procedures. This study represents the first report of systematic in vivo pharmacokinetics of a paramagnetic probe.

Feasibility study of imaging a living murine tumor by electron paramagnetic resonance.

An electron paramagnetic resonance image was measured for the first time from in vivo field gradient spectra of a living murine tumor (Cloudman S-91 melanoma in the tail of a DBA-2J mouse) using the paramagnetic nitroxide imaging agent 3-carboxamido-2,2,5,5-tetramethylpyrroline-1-oxyl injected into the tail vein. The experiments were accomplished at L-band frequency (1.55 GHz) with a single-turn flat-loop coil. A cross-sectional image was obtained perpendicular to the tail axis, which clearly distinguished features to the submillimeter resolution level.