CLOSE protocol versus lower ablation index value for paroxysmal atrial fibrillation: A randomized noninferior clinical trial.

INTRODUCTION: The optimized ablation index (AI) value for catheter ablation of atrial fibrillation (AF) remains to be defined. We aimed to compare the efficacy and safety of CLOSE protocol and lower AI protocol in paroxysmal AF. METHODS AND RESULTS: Patients with symptomatic, drug-resistant paroxysmal AF for first ablation were prospectively enrolled from September 2020 to January 2022. The patients were randomly divided into CLOSE group (AI ≥ 550 for anterior/roof segments and ≥400 for posterior/inferior segments) and lower AI group (AI ≥ 450 for anterior/roof segments and ≥350 for posterior/inferior segments). First-pass isolation, acute pulmonary vein (PV) reconnections, 1-year arrhythmia recurrence, and major complications were assessed. Of the 270 enrolled patients, 238 completed 1-year follow-up (118 in CLOSE group and 120 in lower AI group). First-pass isolation in left PVs was higher in CLOSE group (71.2% vs. 53.3%, p = .005). Acute PV reconnections were comparable between groups (9.3% vs. 14.2%, p = .246). At 1 year, 86.4% in CLOSE group versus 81.7% in lower AI group were free from atrial arrhythmia (log rank p = .334). The proportion difference was -4.8% (95% CI: -14.1% to 4.6%), and p = .475 for noninferiority. Stroke occurred in four patients of lower AI group, and no cardiac tamponade, atrioesophageal fistula, major bleeding or death occurred post procedure. CONCLUSION: For patients with paroxysmal AF and treated by AI-guided PV ablation, lower AI is not noninferior to CLOSE protocol.

Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition).

OBJECTIVE: Helicobacter pylori infection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-based H. pylori infection control and management to reduce the related disease burden. METHODS: Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements. RESULTS: Experts discussed and modified the original 23 statements on family-based H. pylori infection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1) H. pylori infection and transmission among family members, (2) prevention and management of H. pylori infection in children and elderly people within households, and (3) strategies for prevention and management of H. pylori infection for family members. In addition to the 'test-and-treat' and 'screen-and-treat' strategies, this consensus also introduced a novel third 'family-based H. pylori infection control and management' strategy to prevent its intrafamilial transmission and development of related diseases. CONCLUSION: H. pylori is transmissible from person to person, and among family members. A family-based H. pylori prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.

3-methyadenine inhibits lipopolysaccharides-induced pulmonary inflammation at the early stage of silicosis via blocking NF-κB signaling pathway.

Occupational exposure to silica dust is related to pulmonary inflammation and silicosis. Lipopolysaccharides (LPSs) could aggravate apoptosis in alveolar macrophages (AMs) of human silicosis through autophagy, yet how the reduction of autophagy attenuated LPS-induced lung injury and the related mechanisms need to be investigated. In the study, we aim to understand the role of 3-methyladenine (3-MA), an inhibitor of autophagy, in LPS-mediated inflammatory responses and fibrosis. We collected AMs from observers/silicosis patients. The results showed that LPS induced NF-κB-related pulmonary inflammation in observers and silicosis patients, as confirmed by an increase in the expression of IL-1ß, IL-6, TNF-α, and p65, which could be inhibited by 3-MA treatment. In mice models, at the early stage (7d) of silicosis, but not the late (28d) stage, blocking autophagy reversed the increased levels of IL-1ß, IL-6, TNF-α, and p65 caused by LPS. Mechanism study revealed that LPS triggered the expression of LC3 II, p62, and cleaved caspase-3 at the early stage exposed to silica, which could be restored by 3-MA, while there was no difference in the expression of LAMP1 either at the early or late stage of silicosis in different groups. Similarly, 3-MA treatment did not prevent fibrosis characterized by destroyed alveoli, collagen deposition, and increased expression of α-SMA and Col-1 induced by LPS at the late stage of silicosis. The results suggested that 3-MA has a role in the protection of lung injury at the early stage of silicosis and provided an experimental basis for preventive strategies of pulmonary inflammation and silicosis.

Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta-analysis.

BACKGROUND AND OBJECTIVE: Chlorhexidine (CH) and povidone-iodine (PI) are the most commonly used preoperative skin antiseptics at present. However, the prevention of the surgical site infection (SSI) and the incidence of skin adverse events do not reach a consistent statement and conclusion. This meta-analysis aimed to evaluate the efficacy of chlorhexidine and povidone-iodine in the prevention of postoperative surgical site infection and the incidence of corresponding skin adverse events. METHOD: Substantial studies related to "skin antiseptic" and "surgical site infection" were consulted on PUBMED, Web of Science, EMBASE, and CNKI. The primary outcome was the incidence of postoperative SSI. The secondary outcome was associated with skin adverse events. All data were analyzed with Revman 5.3 software. RESULTS: A total of 30 studies were included, including 29,006 participants. This study revealed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.55-0.77; p < 0.00001, I2 = 57%). Further subgroup analysis showed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI in clean surgery (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.67-0.98; p = 0.03), I2 = 28%) and clean-contaminated surgery (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.47-0.73; p < 0.00001, I2 = 43%). However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups. CONCLUSION: Chlorhexidine was superior to povidone-iodine in preventing postoperative SSI, especially for the clean-contaminated surgery. However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups.

Adopting Social Media for Improving Health: Opportunities and Challenges.

Social media's ubiquitous influence is changing the landscape of health-related practices. Health organizations and individuals continue to utilize social media for health with mixed results. We discuss current perspectives and challenges of using social media for improving health outcomes. We conclude this paper by highlighting five specific areas that warrant further investigation to better harness social media for health.

The Energy Density and Treatment Times Are the Main Factors That Affect the Efficacy of Long-Pulsed 1,064-nm Nd:YAG Laser Treatment for Onychomycosis Caused by Trichophyton rubrum.

BACKGROUND: No optimal regimen exists for the LPNYL (long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser) for treating onychomycosis. OBJECTIVE: To establish an optimal LPNYL treatment regimen for onychomycosis caused by Trichophyton rubrum (OCTr). PATIENTS AND METHODS: First, 511 infected nails of 177 patients were treated using LPNYL with orthogonally designed regimens according to various energy densities, spot sizes, pulse widths, and treatment times. The optimal treatment regimen was established by multivariate analysis. Next, 69 patients with 221 infected nails were randomized to receive oral itraconazole (drug group) and the optimal regimen of LPNYL treatment (laser group). The clinical efficacy (CE) and mycological efficacy (ME) were evaluated at 6 and 12 months following the start of treatment, and adverse reactions were recorded in both groups. RESULTS: Both CE and ME were significantly correlated with the energy density (p < 0.05) and treatment times (p < 0.05), but not with the spot size (0.071 < p < 0.083) or pulse width (0.051 < p < 0.060), at 6 or 12 months. There were no significant differences at 6 or 12 months (p > 0.05), and no significant difference was observed in CE at 12 months between the two groups (p > 0.05). At 6 months, the CE in the laser group was significantly higher than that in the drug group (p < 0.001). CONCLUSIONS: LPNYL is effective and safe for treating OCTr. The energy density and treatment times are the main factors that affect the efficacy. The optimal regimen for LPNYL is an energy density of 45 J/cm2, pulse width of 35 ms, spot size of 4 mm, frequency of 1 Hz, and 6 treatments with 1-week intervals. Laser treatment has rapid clinical recovery.

[Research in technical regulations for production of pollution-free Chinese herbal medicines].

Aimed to solve the issues of pesticide residue, heavy metal contents and harmful elements in the productive process of Chinese herbal medicines, the research team built the technical regulations for production of pollution-free Chinese herbal medicines. This regulation included the environment of production area, the process of production, quality of products etc., which were the key steps controlled the quality of Chinese herbal medicines. The environment of production area was selected according to the ecological factors which were stipulated by Ecological Suitability Regionalization of Chinese herbal medicines (second edition). The quality of air should be attain the one or two levels of GB/T3095-2012 standard values. The cultivation soils should reach to the one or two levels of GB15618 and NY/T391 standard values. The quality of irrigation water should accord with the stipulation of GB5084-2005. Aimed to the production of Chinese herbal medicines, disease-resistant and superior varieties which were suitable to the local stations should be selected, and the breeding of superior seeds and seedlings should be strengthened. Additionally, rational fertilizer application of pollution-free Chinese herbal medicines should be conformed to the principles, requirements, and the kinds of fertilizers allowed or limited for use, which were stipulated by the standard of DB13/T454. Furthermore, the plant protection policy of priority to prevention and synthetical prevention should be followed; improving ecological environment and strengthening cultivation management should be served as the basics. Agricultural measures, and biological and physical control strategies should be preferred to use; and high toxicity, residue pesticide and its mixture should be inhibited; the use of chemical pesticides should be minimized and then to decrease contamination and residue. Additionally, the quality of products should be reached to the standard of pollution-free Chinese herbal medicines; high toxicity and detection rate of pesticide residues and the contents of heavy metal and harmful elements (e.g. plumbum, cadmium, mercury, arsenic and cuprum) should accord with the common criteria of pollution-free Chinese herbal medicines. Application of technical regulations for production of pollution-free Chinese herbal medicines guarantees significantly social, economic and ecological benefits.

[DNA marker-assisted selection of medicinal plants (â ¢)Evaluation of disease resistance of "Miaoxiang Kangqi 1" --a new cultivar of Panax notoginseng].

DNA marked-assisted selection of medicinal plants accelerated the breeding and promotion of new cultivars, and guaranteed the healthy development of Chinese medicinal materials industry. The first disease-resistant cultivar of notoginseng, namely "Miaoxiang Kangqi 1", served as the object of study. We evaluated the Kangqi's resistance of seeds, seedlings and root against the pathological bacteria (Fusarum oxysporum) of root rot. Compared to the traditional cultivars, the disease index of notoginseng seeds declined by 52.0% after inoculation for seven days; the death rate of seedlings and disease index of root respectively decreased by 72.1% and 62.4% after inoculation for 25 days. Additionally, the growth inhibition ratio of notoginseng seeds and seedlings declined after inoculation. The seeds, seedlings and roots of "Miaoxiang Kangqi 1" showed significantly resistant to root rot. The evaluation of disease-resistance of Kangqi provided the basis for the popularization of new cultivar and guaranteed the favoring conduct of notoginseng pollution-free cultivation.

Impact of Anatomically Guided Ganglionated Plexus Ablation on Electrical Firing from Isolated Pulmonary Veins.

BACKGROUND: The mechanisms underlying atrial fibrillation (AF) initiation and pulmonary vein isolation (PVI) effectiveness remain unclear. Ganglionated plexus (GPs) have been implicated in AF initiation and maintenance. In this study, we evaluated the impact of GP ablation in patients with pulmonary vein (PV) firing after PVI. METHODS: Patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation therapy with PVI were screened. Among 840 cases over a 3.75-year period, 12 cases were identified with persistent PV firing (left = 4 and right = 8) after PVI was achieved and left atrial sinus rhythm restored. Adjacent GP ablation was performed anatomically and followed if necessary by additional PV ablation. RESULTS: In eight patients, PV firing was terminated during GP ablation outside of the circumferential ablation line. In one patient, additional PV ablation resulted in cessation of PV firing and in the remaining three patients, firing could not be terminated by GP ablation or additional PVI. CONCLUSION: GP ablation outside of wide antral circumferential line frequently results in the cessation of rapid firing from electrically isolated PVs. These observations suggest that interactions between left atrium and PV beyond electrical conduction warrant consideration in AF mechanisms.

[Study on botanical pesticides and its application in production of traditional Chinese medicine].

The issues including excessive pesticide residues and heavy metal contamination have become the bottle-neck in the development of Chinese herbal medicines. Compared with traditional chemical pesticides, biological pesticides, especially botanical pesticides, are more safe and environment-friendly, which were beneficial to the quality improvement Chinese medicinal materials. Though there exists a weak basic research and it is hard for promotion and regulation, the policy of good and the desire for botanical pesticides will accelerate its development, and replace traditional chemical pesticides gradually. This paper reviews the current situation of botanical pesticides, and gives some pertinence suggestions according to the existing problems and challenges. Research on botanical pesticides will become the key point to solve the problem of excessive pesticides residues and heavy metal contamination, and promote the healthy development of Chinese materia medica.

[Identification and prevention of root rot pathogen in model of ginseng cultivated in farmlands].

Root rot is one of the major diseases of Panax ginseng cultivated in northeastern farmlands. This study aims to identify pathogens that causing ginseng root rot disease, verify inhibiting effects of perilla crude extracts on the pathogens and present the basis for control of ginseng root rot. The species of root rot pathogens was isolated using the tissue isolation. The morphological analysis showed that the strain contained two forms of conidia, one was sickle-shaped or columnar and the other was large oval. There were obvious separations in the conidia. Based on the molecular analysis, sequence of 18s rDNA from this strain showed 100% homology with that of Fusarium oxysporum JF807402.1 by Blast. The results confirmed that F. oxysporum was the pathogenic strain for root rot of ginseng cultivated in farmlands. Inhibiting effects of perilla crude extracts were evaluated by the method of Oxford cup. The results indicated that 0.50 g•L⁻¹ of the perilla crude extract showed better sensitivity on the pathogenic strain, and its bacteriostatic diameters were 11.75 mm. The species of root rot pathogens of ginseng cultivated in farmlands was confirmed in this study. Our results presented materials for exploitation of botanical pesticide against root rot, and guaranteed the successful development of ginseng cultivated in farmland.

Dynamic Associations Between Centers for Disease Control and Prevention Social Media Contents and Epidemic Measures During COVID-19: Infoveillance Study.

BACKGROUND: Health agencies have been widely adopting social media to disseminate important information, educate the public on emerging health issues, and understand public opinions. The Centers for Disease Control and Prevention (CDC) widely used social media platforms during the COVID-19 pandemic to communicate with the public and mitigate the disease in the United States. It is crucial to understand the relationships between the CDC's social media communications and the actual epidemic metrics to improve public health agencies' communication strategies during health emergencies. OBJECTIVE: This study aimed to identify key topics in tweets posted by the CDC during the pandemic, investigate the temporal dynamics between these key topics and the actual COVID-19 epidemic measures, and make recommendations for the CDC's digital health communication strategies for future health emergencies. METHODS: Two types of data were collected: (1) a total of 17,524 COVID-19-related English tweets posted by the CDC between December 7, 2019, and January 15, 2022, and (2) COVID-19 epidemic measures in the United States from the public GitHub repository of Johns Hopkins University from January 2020 to July 2022. Latent Dirichlet allocation topic modeling was applied to identify key topics from all COVID-19-related tweets posted by the CDC, and the final topics were determined by domain experts. Various multivariate time series analysis techniques were applied between each of the identified key topics and actual COVID-19 epidemic measures to quantify the dynamic associations between these 2 types of time series data. RESULTS: Four major topics from the CDC's COVID-19 tweets were identified: (1) information on the prevention of health outcomes of COVID-19; (2) pediatric intervention and family safety; (3) updates of the epidemic situation of COVID-19; and (4) research and community engagement to curb COVID-19. Multivariate analyses showed that there were significant variabilities of progression between the CDC's topics and the actual COVID-19 epidemic measures. Some CDC topics showed substantial associations with the COVID-19 measures over different time spans throughout the pandemic, expressing similar temporal dynamics between these 2 types of time series data. CONCLUSIONS: Our study is the first to comprehensively investigate the dynamic associations between topics discussed by the CDC on Twitter and the COVID-19 epidemic measures in the United States. We identified 4 major topic themes via topic modeling and explored how each of these topics was associated with each major epidemic measure by performing various multivariate time series analyses. We recommend that it is critical for public health agencies, such as the CDC, to update and disseminate timely and accurate information to the public and align major topics with key epidemic measures over time. We suggest that social media can help public health agencies to inform the public on health emergencies and to mitigate them effectively.

[Preliminary clinical study of percutaneous transhepatic bipolar radiofrequency ablation catheter in the treatment for malignant biliary obstructive jaundice and biliary stent re-stenosis].

OBJECTIVE: To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent re-stenosis. METHODS: Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter. The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile. The procedural practicality, clinical safety and operative complications were analyzed. RESULTS: The ablation therapy was successful for 4 patients. The mean operating duration was 40 min without any 30-day mortality. No postoperative complications such as massive hemorrhage, biliary fistula, biliary infection, hemothorax, pneumothorax, chylothorax, chole-heart syndrome, liver penetrating wound and biliary peritonitis etc. occurred. Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin. One case with biliary stent re-stenosis was re-blocked postoperatively. The average patency time of biliary tract and stent was 124 (90 - 171) days in 4 cases. Conditions were created for further anti-tumor treatment. CONCLUSION: Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent re-stenosis so as to enhance the therapeutic efficacy.

[Rapid detection of extrinsic harmful contaminants using quantum dots-coated probes and their application prospects in traditional Chinese medicine].

The contamination of extrinsic harmful contaminants including mycotoxins, heavy metals and pesticides, etc, brings serious risks to traditional Chinese medicines (TCMs), further to human health. Due to their unique photoluminescence, chemiluminescence, electrochemical and electrochemiluminescence properties, semiconductor quantum dots (QDs) nanoparticles are widely used to immobilize bioprobes and biosensors, etc. In this review, the luminescence characteristics and specific ligands of QDs probles which are used to determine contaminants were summed up. Then, the applications of QDs-coated novel probes in the determination of mycotoxins, heavy metals and pesticides were discussed in detail. In addition, the contamination levels and characteristics of extrinsic harmful residues in TCMs were investigated. Further, the maximum levels of those contaminants in TCMs were compared with those set by various countries. Finally, the future development trends and problems of QDs-coated probes in the determination of those extrinsic residues in TCMs were prospected.

Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary Angiography.

BACKGROUND: Patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) are at high risk of contrast-associated acute kidney injury (CA-AKI) and mortality. Therefore, there is a clinical need to explore safe, convenient, and effective strategies for preventing CA-AKI. OBJECTIVES: This study sought to assess whether simplified rapid hydration is noninferior to standard hydration for CA-AKI prevention in patients with CKD. METHODS: This multicenter, open-label, randomized controlled study was conducted across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after CAG at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after CAG at a rate of 1 mL/kg/h). The primary endpoint of CA-AKI was a ≥25% or 0.5-mg/dL rise in serum creatinine from baseline within 48 to 72 hours. RESULTS: CA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk: 0.8; 95% CI: 0.5-1.2; P = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 vs 25 hours; P < 0.001). CONCLUSIONS: In CKD patients undergoing CAG, SH is noninferior to standard hydration in preventing CA-AKI with a shorter hydration duration.

Safety and immunogenicity of a mosaic vaccine booster against Omicron and other SARS-CoV-2 variants: a randomized phase 2 trial.

An ongoing randomized, double-blind, controlled phase 2 trial was conducted to evaluate the safety and immunogenicity of a mosaic-type recombinant vaccine candidate, named NVSI-06-09, as a booster dose in subjects aged 18 years and older from the United Arab Emirates (UAE), who had administered two or three doses of inactivated vaccine BBIBP-CorV at least 6 months prior to enrollment. The participants were randomly assigned with 1:1 to receive a booster dose of NVSI-06-09 or BBIBP-CorV. The primary outcomes were immunogenicity and safety against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant, and the exploratory outcome was cross-immunogenicity against other circulating strains. Between May 25 and 30, 2022, 516 adults received booster vaccination with 260 in NVSI-06-09 group and 256 in BBIBP-CorV group. Interim results showed a similar safety profile between two booster groups, with low incidence of adverse reactions of grade 1 or 2. For immunogenicity, by day 14 post-booster, the fold rises in neutralizing antibody geometric mean titers (GMTs) from baseline elicited by NVSI-06-09 were remarkably higher than those by BBIBP-CorV against the prototype strain (19.67 vs 4.47-fold), Omicron BA.1.1 (42.35 vs 3.78-fold), BA.2 (25.09 vs 2.91-fold), BA.4 (22.42 vs 2.69-fold), and BA.5 variants (27.06 vs 4.73-fold). Similarly, the neutralizing GMTs boosted by NVSI-06-09 against Beta and Delta variants were also 6.60-fold and 7.17-fold higher than those by BBIBP-CorV. Our findings indicated that a booster dose of NVSI-06-09 was well-tolerated and elicited broad-spectrum neutralizing responses against divergent SARS-CoV-2 variants, including Omicron and its sub-lineages.

Early Outcomes of Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy in Children With Noonan Syndrome.

Noonan syndrome (NS) is a genetic syndrome causing obstructive hypertrophic cardiomyopathy (HCM) in infants. Studies of cardiac surgery in pediatric HCM patients with NS (NS-HCM) are lacking. We aim to characterize the early disease course of young NS-HCM patients before adolescence and assess their complications and survival condition after septal myectomy. Pediatric obstructive HCM patients who underwent septal myectomy at age 10 years or under were enrolled consecutively between 2009 and 2019. Ten patients with NS and 43 non-NS patients were enrolled in our study. NS-HCM patients were diagnosed at a younger age (5.00 ± 7.48 months vs. 18.73 ± 26.96 months) and more often had biventricular outflow tract obstruction (90.00% vs 30.23%). The surgical treatment can significantly reduce the pressure gradient of the outflow tract. More NS-HCM patients had biventricular reconstruction (70.00% vs 25.58%). The overall survival rates in all patients were 98.04% during 5-year follow-up, respectively. Complete heart block (CHB) was the most prevalent complication in patients with NS and tended to be more common than in non-NS patients (20% vs 7.32%). No sudden cardiac death (SCD) occurred in CHB patients who had pacemaker implantation. Biventricular reconstruction was the risk factor for CHB. Septal myectomy is safe and effective surgery to relieve obstruction in young age pediatric obstructive NS-HCM patients. Postoperative CHB is a common complication, especially in patients who underwent biventricular reconstruction. The implantation of pacemaker can protect CHB patients from SCD and improve their prognosis.

Meta-analysis of clinical outcomes comparing surface ablation for correction of myopia with and without 0.02% mitomycin C.

PURPOSE: To evaluate the current clinical evidence of safety and efficacy of intraoperative topical application of 0.02% mitomycin C (MMC) used for up to 2 minutes after surface ablation for correction of myopia. METHODS: A comprehensive literature search was conducted of Cochrane Library, MEDLINE, and EMBASE to identify relevant trials comparing surface ablation for correction of myopia with and without MMC. A meta-analysis was performed on the results of the reports and statistical analysis was performed. RESULTS: Eleven clinical trials were identified with MMC used in 534 eyes and no MMC in 726 eyes. Surface ablations with MMC led to significantly less corneal haze in photorefractive keratectomy, whereas the results were comparable in laser epithelial keratomileusis (LASEK) and epithelial laser in situ keratomileusis (epi-LASIK). Although proportionately more eyes in the MMC group achieved uncorrected distance visual acuity 20/25 or better and less frequently lost ≥ 2 lines of corrected distance visual acuity, the difference was not statistically significant. CONCLUSIONS: Our meta-analysis suggests that the topical intraoperative application of 0.02% MMC may reduce haze and improve visual acuity after surface ablation for correction of myopia. However, the advantage of using MMC in LASEK and epi-LASIK is unclear.