Retinal honeycomb appearance and its role in patients with X-linked retinoschisis.

BACKGROUND: To investigate the clinical characteristics of retinal honeycomb appearance in a large cohort of patients with X-linked retinoschisis (XLRS) and to determine whether it is associated with complications like retinal detachment (RD) and vitreous hemorrhage (VH). METHODS: A retrospective observational case series. A chart review of medical records, wide-field fundus imaging, and optical coherence tomography (OCT) was performed on 78 patients (153 eyes) diagnosed with XLRS at Beijing Tongren eye center between Dec 2017 and Feb 2022. The chi-square test or Fisher exact test was performed on the 2 × 2 cross-tabulations of honeycomb appearance and other peripheral retinal findings and complications. RESULTS: Thirty-eight patients (48.7%), and 60 eyes (39.2%) had a honeycomb appearance of different areas on the fundus. The supratemporal quadrant was the most commonly affected (45 eyes, 75.0%), followed by the infratemporal (23 eyes, 38.3%), the infranasal (10 eyes,16.7%), and supranasal (9 eyes,15.0%). The appearance was significantly associated with peripheral retinoschisis, inner retinal layer break, outer retinal layer break, RD, and rhegmatogenous retinal detachment (RRD) (p < 0.01, p = 0.032, p < 0.01, p = 0.008, p < 0.01, respectively). All the eyes complicated with RRD had the appearance. None of the eyes without the appearance had RRD. CONCLUSIONS: The data suggest that the honeycomb appearance is not uncommon in patients with XLRS and is more likely to be accompanied by an RRD, and inner and outer layer breaks, thus should be treated with caution and close observation.

N-acetylcysteine improves diabetic associated erectile dysfunction in streptozotocin-induced diabetic mice by inhibiting oxidative stress.

Oxidative stress appears to play a role in the pathogenesis of diabetes mellitus erectile dysfunction (DMED). This study aimed to investigate the effect of N-acetylcysteine (NAC) on DMED in streptozotocin-induced diabetic mice and to explore potential mechanisms. In the present study, we show that an erectile dysfunction is present in the streptozotocin-induced mouse model of diabetes as indicated by decreases in intracavernous pressure responses to electro-stimulation as well as from results of the apomorphine test of erectile function. After treatment of NAC, the intracavernous pressure was increased. In these DMED mice, oxidative stress and inflammatory responses were significantly reduced within the cavernous microenvironment, while activity of antioxidant enzymes in this cavernous tissue was enhanced after NAC treatment. These changes protected mitochondrial stress damage and a significant decreased in apoptosis within the cavernous tissue of DMED mice. This appears to involve activation of the nuclear factor erythroid 2-like-2 (Nrf2) signalling pathway, as well as suppression of the mitogen-activated protein kinase (MAPK) p38/ NF-κB pathway within cavernous tissue. In conclusion, NAC can improve erectile function through inhibiting oxidative stress via activating Nrf2 pathways and reducing apoptosis in streptozotocin-induced diabetic mice. NAC might provide a promising therapeutic strategy for individuals with DMED.

Deep learning-based detection and stage grading for optimising diagnosis of diabetic retinopathy.

AIMS: To establish an automated method for identifying referable diabetic retinopathy (DR), defined as moderate nonproliferative DR and above, using deep learning-based lesion detection and stage grading. MATERIALS AND METHODS: A set of 12,252 eligible fundus images of diabetic patients were manually annotated by 45 licenced ophthalmologists and were randomly split into training, validation, and internal test sets (ratio of 7:1:2). Another set of 565 eligible consecutive clinical fundus images was established as an external test set. For automated referable DR identification, four deep learning models were programmed based on whether two factors were included: DR-related lesions and DR stages. Sensitivity, specificity and the area under the receiver operating characteristic curve (AUC) were reported for referable DR identification, while precision and recall were reported for lesion detection. RESULTS: Adding lesion information to the five-stage grading model improved the AUC (0.943 vs. 0.938), sensitivity (90.6% vs. 90.5%) and specificity (80.7% vs. 78.5%) of the model for identifying referable DR in the internal test set. Adding stage information to the lesion-based model increased the AUC (0.943 vs. 0.936) and sensitivity (90.6% vs. 76.7%) of the model for identifying referable DR in the internal test set. Similar trends were also seen in the external test set. DR lesion types with high precision results were preretinal haemorrhage, hard exudate, vitreous haemorrhage, neovascularisation, cotton wool spots and fibrous proliferation. CONCLUSIONS: The herein described automated model employed DR lesions and stage information to identify referable DR and displayed better diagnostic value than models built without this information.

Choroidal thickening in retinal vein occlusion patients with serous retinal detachment.

PURPOSE: To evaluate choroid thickness and macular retinal metrics in treatment naïve retinal vein occlusion (RVO) patients with serous retinal detachment (SRD) before and after intravitreal anti-vascular endothelial cell growth factor (VEGF) injection and to elucidate the possible role of choroid in the development of SRD and the potential role of SRD as a prognostic parameter. METHODS: This is a retrospective study involving 85 RVO patients, 41 central retinal vein occlusion (CRVO), and 44 branch retinal vein occlusion (BRVO), with macular edema: 21 central retinal vein occlusion and 22 branch retinal vein occlusion with SRD and the rest without SRD. Patients were evaluated with ophthalmic examinations and swept-source optical coherence tomography (SS-OCT) both before and 4-6 weeks after intravitreal anti-VEGF treatment. Choroid thickness and retinal metrics were measured and compared between SRD and non-SRD groups within each RVO subtype. RESULTS: In both CRVO and BRVO patients, the mean central subfield foveal thickness (CSFT) and central subfoveal choroid thickness (CSCT) of the SRD groups were thicker than those in the non-SRD groups (p < 0.05) at onset. After one anti-VEGF injection, CSFT and FNRT decreased in all groups (p < 0.05). The CSCTs were thicker in the SRD groups compared with the non-SRD groups (p < 0.05). The mean changes of CSFT were more remarkable in the SRD groups (p < 0.05). CONCLUSION: Thicker choroid was a feature of naïve RVO patients with SRD and SRD may be an indicator of better anatomical recovery of retina in RVO patients after a single dose of anti-VEGF treatment.

SENSITIVITY AND SPECIFICITY OF MULTISPECTRAL IMAGING FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To evaluate the sensitivity and specificity of multispectral imaging (MSI), a noninvasive imaging technique composed of a series of monochromatic scanning light, for polypoidal choroidal vasculopathy (PCV). METHODS: This was a prospective observational study. Polypoidal lesions on MSI are defined by oval or lobular hyperreflective oval lesion with dark hyporeflective center. Branching vascular networks on MSI is featured by hyperreflective interlacing signal. Detection sensitivity and specificity of polypoidal lesions was compared with indocyanine green angiography, whereas sensitivity and specificity of branching vascular networks, subretinal fluid, and pigment epithelium detachment were compared with optical coherence tomography. RESULTS: Among 67 eyes, 38 eyes (56.7%) were diagnosed with PCV, 7 eyes (10.4%) with neovascular age-related macular degeneration, 13 eyes (19.4%) with central serous chorioretinopathy, 6 eyes (9.0%) with pathological myopia, and 3 eyes (4.5%) with idiopathic choroidal neovascularization. Compared with indocyanine green angiography, the sensitivity and specificity for diagnosing PCV by MSI alone was 84.21% and 93.10%, respectively, and the positive predictive value and the negative predictive value for PCV by MSI was 94.12% and 81.82%, respectively. The sensitivity and specificity for detecting polypoidal lesions were 84.21% and 93.10% compared with indocyanine green angiography. Compared with optical coherence tomography, the sensitivity and specificity for detecting branching vascular networks were 95.83% and 88.37%, for the subretinal fluid were 76.92% and 86.67%, and for the pigment epithelium detachment were 91.11% and 90.91%, respectively. CONCLUSION: Multispectral imaging allowed noninvasive visualization of polypoidal lesions and branching vascular networks and may serve as a new diagnostic option for PCV.

Application of micronised acellular dermal matrix for primary premature ejaculation: A preliminary study.

This study aimed to explore the efficacy of injection of micronised acellular dermal matrix (MADM) particles for treating primary premature ejaculation. This study was a prospective single-arm clinical trial. Thirty patients who met the surgical indications were enrolled. MADM particles, mixed in platelet-rich plasma, were injected into Buck's fascia to spread over the dorsal penile nerve, suppress the influx of nerve impulses and, thus, reduce penis sensitivity. We evaluated the changes according to intravaginal ejaculation latency time using a stopwatch and a premature ejaculation diagnostic tool. Meanwhile, we also recorded sexual partner satisfaction and adverse events. All patients recovered well after surgery with no complications such as infections or allergies. The mean intravaginal ejaculation latency time before surgery was 0.72 ± 0.28 min, compared with 2.41 ± 0.54 min, 2.64 ± 0.41 min, 2.79 ± 0.25 min and 2.89 ± 0.35 min at, respectively, 4, 8, 16 and 20 weeks after surgery. The premature ejaculation diagnostic values and sexual partner satisfaction had significantly improved after treatment. Injection of MADM particles is an effective, safe and simple method for treating premature ejaculation.

Effect of prostate volume on f/tPSA value: A cross-sectional study.

Previous studies have suggested that there is a positive correlation between prostate-specific antigen (PSA) levels and prostate volume (PV). A better understanding of the possible influence of PV on a ratio of free to total PSA (f/tPSA) may improve the diagnostic value of the prostate disease. The study group consisted of 342 men with lower urinary tract symptoms (LUTS). All patients underwent urinary tract ultrasonography and had tests carried out on PSA, serum glucose, total cholesterol, triglyceride, HDL, LDL and blood pressure. Univariate and multivariate analyses were used to assess the associations between prostate volume and f/tPSA value. We found no obvious relationship between prostate volume and f/tPSA value when PSA >10 ng/ml but did observe a positive correlation when 4 ng/ml < PSA ï¼œ 10 ng/ml (hazard ratio [HR]: 0.0012; 95% confidence interval [CI]: 0.0009-0.0248). With increasing prostate volume, multivariate analysis showed an obvious increase in f/tPSA value (HR: 0.0011; 95% CI: 0.0007-0.0015) (p ≤ .0001). We confirmed that prostate volume could affect the f/tPSA levels in serum. There was an obvious positive correlation between prostate volume and f/tPSA level when PSA levels were between 4 and 10ng/dl. There was no significant correlation between prostate volume and f/tPSA value when PSA >10 ng/ml.

Three-dimensional choroidal vascularity index in acute central serous chorioretinopathy using swept-source optical coherence tomography.

PURPOSE: To evaluate the three-dimensional choroidal vascularity index (CVI) in the eyes with treatment-naïve acute central serous chorioretinopathy (CSC) using swept-source optical coherence tomography (SS OCT). METHODS: In this prospective cross-sectional study, OCT and OCT angiography covered an area of 12 × 12 mm centered on the fovea. Three-dimensional CVI was defined as the ratio of the choroidal vascular luminal volume to the total choroidal volume. The location of pigment epithelial detachment (PED) and the area with abnormal perfusion at choriocapillary layer were compared with the distribution of the three-dimensional CVI. RESULTS: Thirty-two eyes with treatment-naïve acute CSC, 18 fellow eyes, and 48 control eyes were enrolled. Three-dimensional CVI had good repeatability on control eyes, with a coefficient of variation of 0.166. The mean CVI in the scan area was 0.35 in the eyes with CSC, 0.34 in the fellow eyes of CSC, and 0.30 in the control eyes. The overall CVI in the control eyes was significantly lower than that in the eyes with CSC and that in fellow eyes (P < 0.001 and P = 0.006, respectively). The eyes with CSC and the fellow eyes had significantly higher CVI values at the posterior pole and the drainage routes of choroidal veins. In the eyes with CSC, PEDs and choriocapillary with abnormal perfusion colocalized with the dilated choroidal vessels, which had high three-dimensional CVI values. CONCLUSION: Increased three-dimensional CVI suggested an increased vascular component in the eyes with CSC and in fellow eyes. The three-dimensional CVI is a useful imaging marker of choroidal diseases that volumetrically assesses the choroidal vasculature and might advance our understanding of CSC pathophysiology.

Evaluation of microvascular network with optical coherence tomography angiography (OCTA) in branch retinal vein occlusion (BRVO).

BACKGROUND: To evaluate changes of microvascular network of macular and peripapillary regions and to provide a quantitative measurement of foveal avascular zone (FAZ) in unilateral BRVO patients. METHODS: Forty-seven unilateral BRVO patients and forty-seven normal controls were enrolled. A 3*3 mm scan centered on fovea followed by a 4.5*4.5 mm scan centered on optic nerve head (ONH) were obtained in BRVO eyes, fellow eyes and control eyes of each individual using OCTA (Optovue Inc., Fremont, CA, USA). Vessel density (VD) in superficial (SVC) and deep vascular complex (DVC) of macula and radial peripapillary capillary (RPC) were automatically calculated. Parameters of FAZ region including size, perimeter, acircularity index (AI) and foveal vessel density 300 (FD-300) were measured. RESULTS: VDs of SCV and DVC were significantly lower, especially in affected regions, in BRVO eyes compared with fellow eyes (P < 0.05). BRVO affected eyes has larger FAZ size, FAZ perimeter, AI and lower FD-300 compared with fellow eyes (all P < 0.05). VD of SVC and FD-300 were lower in fellow eyes compared with normal control eyes (P < 0.05). The average vessel density in whole area and peripapillary area in BRVO eyes were significantly lower compared with fellow eyes (P < 0.05). VD of inside disc in fellow eyes was lower than normal eyes (P < 0.05). CONCLUSIONS: OCTA provided quantitative information of vascular changes in BRVO. FAZ in BRVO eyes showed significant morphological alterations and decreases of VD in surrounding area. Decreases of VD existed not only in SVC and DVC in macular region but also in RPCs in BRVO eyes. Unaffected eyes of unilateral BRVO showed vascular abnormalities in superficial retinal layer, peri-FAZ area and also peripapillary regions.

Comparison of cytokine levels in the aqueous humor of polypoidal choroidal vasculopathy and neovascular age-related macular degeneration patients.

BACKGROUND: The concentrations of cytokines in the aqueous humor from neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) may vary. The study was conducted to compare various cytokine levels in the aqueous humor of eyes with PCV, nAMD and control. METHODS: The present case control study included 49 treatment-naïve eyes from 49 patients (PCV 24, nAMD 11, and cataract 14 eyes). Totally 34 angiogenic and inflammatory cytokines in the aqueous humor were measured by Luminex bead-based multiplex array. RESULTS: After adjusting for gender and age by multivariate logistic analysis, concentrations of IL-31, LIF, SDF1-α, VEGF-A, VEGF-D were significantly higher in eyes with nAMD or PCV compared with control eyes (all P < 0.05, times in nAMD: 59.5, 6.0, 7.0, 4.5, 5.6, respectively, times in PCV: 51.9, 5.21, 6.6, 4.0, 5.1, respectively), and concentrations of HGF, IP-10, MCP-1, IL-13 were significantly lower in eyes with nAMD or PCV than in control eyes (all P < 0.05, times in nAMD: 2.6, 2.0, 4.5, 4.7, respectively, times in PCV: 1.9, 3.0, 3.0, 2.8, respectively), but none of the 34 cytokines, including VEGF and IL-8, showed significantly different between eyes with nAMD and PCV. CONCLUSIONS: Various cytokines involved in inflammation and angiogenesis including elevated IL-31, LIF, SDF1-α, VEGF-A, VEGF-D might be involved in the pathogenesis of nAMD or PCV. None of the 34 cytokines may help to differentiate nAMD and PCV.

Comparison of choriocapillary flow density between fellow eyes of polypoidal choroidal vasculopathy and neovascular age-related macular degeneration.

BACKGROUND: To compare the choriocapillary flow density (CFD) among the fellow eyes of polypoidal choroidal vasculopathy (PCV), neovascular age-related macular degeneration (nAMD), and healthy controls using spectral-domain optical coherence angiography tomography (SD-OCTA). METHODS: This is a cross-sectional study that includes the fellow eyes of 38 patients with unilateral PCV, 36 patients with unilateral nAMD, and 36 eyes from 36 healthy volunteers. The PCV group was further classified into polypoidal CNV (P-CNV) and typical PCV (T-PCV) for subgroup analysis. The age, subfoveal choroidal thickness (SFCT), Age-Related Eye Disease Study (AREDS) classification, and fellow eye diagnosis were acquired. All subjects underwent SD-OCTA with a 6.0-mm scan pattern. Circles with radius of 1.00, 1.50, and 3.00 mm were manually selected in the choriocapillaris (CC) slab, and the CFD was calculated as the percentage of the flow area to the whole selected area as CFD-1.00, 1.50, and 3.00, respectively. Univariate and multivariate analysis were performed to study the correlation between the aforementioned factors with CFD. RESULTS: The mean CFD-1.00, 1.50, and 3.00 of the nAMD group were 61.51, 63.18, and 66.20, respectively; these were significantly lower than those of the PCV group (65.90, 66.89, and 67.94; P < 0.001, P < 0.001, and P = 0.010; respectively) and control group (66.28, 66.96, and 68.42; P < 0.001, P < 0.001, and P = 0.001, respectively), and no difference was detected between the PCV and control group or between PCV subtypes. The AREDS classification and fellow eye diagnosis were correlated with CFD in univariate analysis; however, only the fellow eye diagnosis showed a significant correlation after multiple linear regression. CONCLUSIONS: The CFD of nAMD fellow eyes was significantly lower than that of PCV and control eyes, and no difference was detected between PCV and control group, indicating that CC loss plays a different role in the early pathogenesis of nAMD and PCV.

Optical coherence tomography angiography analysis of the choriocapillary layer in treatment-naïve diabetic eyes.

PURPOSE: To evaluate the capillary flow density (CFD) of choriocapillary (CC) microvasculature using optical coherence tomography angiography (OCT-A) in diabetic eyes and the association of CFD and systemic and metabolic factors. METHODS: Cross-sectional study. This study enrolled 282 eyes of 146 subjects, including 43 healthy control eyes, 56 diabetic eyes without diabetic retinopathy (DR), 43 eyes with mild nonproliferative DR (NPDR), 54 eyes with moderate NPDR, 38 eyes with severe NPDR, and 48 eyes with proliferative DR (PDR). CFD was measured in the CC layer. Clinical data were collected. Multiple linear regression analyses were performed to identify associated clinical variables. RESULTS: CFD in the CC layer presented a downward trend with DR progression. Comparisons of CFD in the CC layer between adjacent stages of DR revealed significant differences between severe NPDR and PDR using both 3-mm and 6-mm scan patterns (P = 0.003, P = 0.001). CFD in the CC layer in DR with diabetic macular edema (DME) was less than that in DR without DME using both 3-mm and 6-mm scan patterns (P < 0.001, P < 0.001). Coronary artery disease and atherosclerosis in other locations, estimated glomerular filtration rate, and increased HbA1c were associated with CFD in the CC layer using both 3-mm and 6-mm scan patterns (all P values < 0.05). CONCLUSIONS: OCT-A revealed decreased CFD in the CC layer in the PDR stage and the presence of DME. Diabetic patients with apparently decreased CFD should be assessed carefully under general conditions.

Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy.

PURPOSE: To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD). METHODS: Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD. RESULTS: Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch's membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity. CONCLUSIONS: Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.

Five-year real-world outcomes of anti-vascular endothelial growth factor monotherapy versus combination therapy for polypoidal choroidal vasculopathy in a Chinese population: a retrospective study.

BACKGROUND: To evaluate 5-year outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy and combination therapy of anti-VEGF agents and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in a real-world Chinese population. METHODS: Retrospective study. Fifty-three eyes of 46 patients with subtype 1 and 2 PCV followed up for at least 60 months were grouped into three regimens: anti-VEGF monotherapy, PDT combining with anti-VEGF therapy initially, and PDT combining with deferred anti-VEGF therapy. Main outcome measure was best-corrected visual acuity (BCVA) using logarithm of minimal angle of resolution (logMAR). RESULTS: The mean BCVA of eyes with subtype 1 PCV (n = 28) deteriorated from 0.69 logMAR at baseline to 1.25 logMAR at months 60 (P = 0.001), while the mean BCVA of eyes with subtype 2 PCV (n = 25) sustained stable from 0.62 logMAR at baseline to 0.57 at months 60 (P = 0.654). No significant differences of visual outcomes were found between the 3 treatment regimens for subtype 1 PCV. Anti-VEGF monotherapy and initial combination treatment had better visual outcomes in eyes with subtype 2 PCV than deferred combination group during part of follow-up significantly. Initial combination group needed a less number of PDT than deferred combination group (P < 0.001). CONCLUSIONS: Compared with subtype 1 PCV, subtype 2 PCV has a more favorable visual outcome in real world. All the regimens presented unfavorable visual outcomes for subtype 1 PCV. Anti-VEGF monotherapy and initial combination therapy should be superior to deferred combination therapy in the long-term management of subtype 2 PCV. Prospective randomized studies of larger size are needed to determine the long-term efficacy and safety of various treatment for PCV in real world.

Reduced bladder responses to capsaicin and GSK-1016790A in retired-breeder female rats with diminished volume sensitivity.

Literature documents an age-related reduction of bladder sensory function. Transient receptor potential vanilloid (TRPV)1 or TRPV4 channels have been implicated in bladder mechanotransduction. To investigate contributions of TRPV1 or TRPV4 to the age-related reduction of bladder sensory function, bladder responses to capsaicin (CAP; TRPV1 agonist) and GSK-1016790A (GSK; TRPV4 agonist) in retired breeder (RB; 12-15 mo) and young adult (2-3 mo) female rats were compared using multiple methods. Metabolic cage and continuous infusion cystometry [cystometrogram (CMG)] recordings revealed that RB rats exhibit larger bladder capacity and lower voiding frequency. RB rats also have a greater intravesical pressure threshold for micturition; however, the voiding contraction strength was equivalent to that in young rats. CAP (1 µM) or GSK (20 nM) administered intravesically evoked smaller changes in all CMG parameters in RB rats. In vitro, CAP (1 µM) or GSK (20 nM) evoked smaller enhancement of bladder strip contractions, while the muscarinic receptor agonist carbachol (at 100, 300, and 1,000 nM) elicited greater amplitude contractions in RB rats. Patch-clamp recording revealed smaller CAP (100 nM) induced inward currents in bladder primary sensory neurons, and Ca2+ imaging revealed smaller GSK (20 nM) evoked increases in intracellular Ca2+ concentration in urothelial cells in RB rats. These results suggest that RB rats have a decreased bladder sensory function commonly observed in elderly women, and could be used as an animal model to study the underling mechanisms. Reduced functional expression of TRPV1 in bladder afferents or reduced functional expression of urothelial TRPV4 may be associated with the diminished sensory function.

[Real-time transrectal ultrasonography in seminal vesiculoscopy].

OBJECTIVE: To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS). METHODS: We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches. RESULTS: Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula. CONCLUSIONS: Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.

The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures.

Erectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus re?ex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.

Morphologic measure of retrosigmoid approach using volume rendering with thin-section computed tomography.

OBJECTIVE: The objective of this study was to research the jugular foramen, internal auditory pore, and the turning point between its components using imageological methods and provide theoretical basis for retrosigmoid approach. METHODS: A total of 100 cases of adult hip computed tomographic scans were reconstructed. α, ß, AC, AB, BC, and the shortest distance were measured. RESULTS: The angle α was measured as 39.50 (4.74) degrees (range, 29.3-48.5 degrees; 95% confidence interval [CI], 38.64-40.35 degrees). The angle ß was measured as 46.35 (5.51) degrees (range, 31.09-64.74 degrees; 95% CI, 45.35-47.35 degrees). The distance of AC was measured as 44.94 (3.84) mm (range, 34.9-54.9 mm; 95% CI, 44.25-45.64 mm). The distance of AB was measured as 43.68 (4.56) mm (range, 33.8-54.7 mm; 95% CI, 42.86-44.51 mm). The distance of BC was measured as 6.15 (2.04) mm (range, 2.7-14.7 mm; 95% CI, 5.78-6.52 mm). The safe distance was measured as 5.21 (0.23) mm (range, 0.84-12.92 mm; 95% CI, 5.17-5.25 mm). CONCLUSIONS: These previously mentioned results can help to locate these structures in the measurement plane and provide reference for surgery.

Association between Fundus Tessellation and Contrast Sensitivity in Myopic Eyes.

PURPOSE: To assess the association of fundus tessellation with contrast sensitivity, Quality of Vision questionnaire, and other factors at five years postcorneal refractive surgery. METHODS: This is a cross-sectional study. Both eyes of 98 subjects (196 eyes) who received femtosecond laser in situ keratomileusis (FS-LASIK) or small incision lenticular extraction (SMILE) five years prior were enrolled in this study. Fundus tessellation was imaged using wide-angle fundus photographs and graded into four categories with the assistance of the ETDRS grid. Photopic and mesopic contrast sensitivity were measured under the best correction. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms. RESULTS: Fundus tessellation was classified as follows: 19 eyes were grade 0 (9.7%), 28 eyes were grade 1 (14.3%), 59 eyes were grade 2 (30.1%), and 90 eyes were grade 3 (45.9%). Higher degrees of fundus tessellation were associated with lower photopic contrast sensitivity, a significant difference was observed at spatial frequencies of 6cpd (p = 0.030, grade 1 >grade 3 p = 0.011). Higher degrees of fundus tessellation were also associated with lower mesopic contrast sensitivity, a significant difference was observed at spatial frequencies of 18cpd (p = 0.011, grade 0 >grade 3 p = 0.012). The preoperative degree of myopia was positively associated with fundus tessellation grade (p < 0.001). However, in linear mixed-effect model analysis, no significant influence of parameters (contrast sensitivity, preoperative myopia, and QoV scores) upon different tessellation grades was found (p > 0.05). CONCLUSIONS: Patients with moderate and high myopia were more likely to have higher grades of fundus tessellation. Higher degree of fundus tessellation associates with lower contrast sensitivity. Patients with moderate and high myopia should be concerned with retinal-choroidal changes. Contrast sensitivity could be a clinical sign for progression of tessellation and used to screen for early retinal-choroidal changes to prevent pathologic myopia.

Male reproductive function before and after the adjustment of the COVID-19 prevention policy: a multicenter study in China.

At the end of 2022, the adjustment of the coronavirus disease 2019 (COVID-19) pandemic control policy in China resulted in a large-scale increase in public infection. To compare the fertility parameters of male patients before and after the adjustments of the COVID-19 pandemic control policy in China, we collected data on patients' medical histories and laboratory examinations on their first visits between June 2022 and March 2023 in five different hospitals. Data were divided into five groups according to the timeline of the policy adjustment. The data we collected from male patients included semen quality and serum reproductive hormone levels, and intergroup comparisons were made using the Mann-Whitney U and Chi-square tests. In total, 16 784 cases underwent regular semen analysis, 11 180 had sperm morphology assessments, and 7200 had reproductive hormone analyses. The data showed declining trends in semen volume, sperm motility, and the progressive sperm motility rate after the policy adjustment. Subgroup comparison revealed an initial decrease and gradual recovery in progressive motility rate. Sperm morphology analysis showed increased neck and tail abnormalities after the policy adjustment. No significant change in hormone levels was observed. Following the adjustment of the COVID-19 prevention policy in China, a decline in sperm motility and morphology was observed. This trend may gradually recover over 2 months. After the policy adjustment, reproductive hormone levels were relatively stable throughout, except for an increase in luteinizing hormone (LH). These changes in semen parameters suggest that the policy adjustment had a short- to medium-term impact on male reproductive function.