[Attention should be paid to glaucoma following pediatric cataract surgery].

Glaucoma following cataract surgery is one of the common complications after pediatric cataract surgery, and it is the main cause of "second blindness" in children. Since this atypical disease is difficult to diagnose and evaluate, it has been gradually paid more attention by clinicians. There are still some controversies and challenges related to the characteristics of the disease, diagnostic criteria, and treatment options. This article discusses the definition, diagnostic criteria, related risk factors, treatment strategies, follow-up, and prognoses of glaucoma following cataract surgery. Establishment of a diagnosis and treatment system can better improve the visual rehabilitation of pediatric cataract children.

[Clinical characteristics and surgical effect observation of congenital aniridia combined with cataract].

Objective: To analyze the clinical manifestations, surgical approaches and postoperative prognosis for the cases of congenital aniridia combined with cataract. Methods: In this retrospective case series, 26 patients diagnosed with congenital aniridia combined with cataract were collected from Zhongshan Ophthalmic Center from February 2002 to August 2016. The Clinical data were collected to analyze the clinical features, surgical approaches and postoperative prognosis. T-test was used for statistical analysis. Results: Twenty-six bilateral congenital aniridia patients were included in the case series, with 50% male cases. The average age for the first visit was (8.72±8.06) years old. Hereditary patients constitutes 30.8% (8/26) of the total number. The proportions for bilateral and unilateral cataracts were 88.5% (23/26) and 11.5% (3/26) respectively, and 49 eyes suffering from both congenital aniridia and cataract were therefore included in the final analysis. The most common morphology cataract subtypes were lamellar cataract (24.5%, 12/49), posterior subcapsular cataract (22.4%, 11/49), and total cataract (18.4%,9/49). The observed ocular comorbidities included nystagmus (36.7%, 18/49), vitreous opacity (28.6%, 14/49), foveal hypoplasia (20.4%, 10/49), ametropia (12.2%, 6/49), exotropia (12.2%, 6/49), congenital glaucoma (12.2%, 6/49), esotropia (4.1%, 2/49), congenital ptosis (4.1%, 2/49), lens ectopia (4.1%, 2/49), scleral staphyloma (2.0%, 1/49) and pigmentary degeneration of retina (2.0%, 1/49). 30.6% (15/49) eyes were performed the cataract extraction surgery. The percentage of postoperative best corrected visual acuity (BCVA) for ≥0.1 and ≥0.3 were 93.3% (14/15) and 20.0% (3/15) respectively. Evaluated ocular pressure (33.3%, 5/15), severe posterior capsular opacification (PCO) (13.3%, 2/15) and choroidal hemorrhage combined with choroidal detachment (6.7%, 1/15) were detected as the postoperative complications. Followed by cataract extraction, 80.0% (12/15) eyes were sequentially performed the intraocular lens implantation, while, 20.0% (3/12) eyes remained aphakia due to ocular comorbidities. Conclusions: Congenital aniridia combined with cataract are rare diseases, calling for the precious retrospective researches. This disorder tended to affect both eyes and occurred hereditary. The clinical courses of the cases presented progressive features. Ocular comorbidities were the crucial factors to influence the surgical approaches and postoperative prognosis. (Chin J Ophthalmol, 2017, 53: 821-827).

Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia.

Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray) or group D (treated with distilled water spray). Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p < 0.001) and the pain intensity was significantly lower in group K than in group D at each time point (all p < 0.001). Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia.

Neuroprotective effects of Hu-Yi-Neng, a diet supplement, on SH-SY5Y human neuroblastoma cells.

OBJECTIVES: Oxidative stress is considered the potential risk to the development of dementia. Some medicines, vitamins, and diet supplements have been suggested to have possible benefits via the antioxidative effects to slow the decline of cognitive function in demented and non-demented individuals. However, few studies were conducted to examine their functions, especially in composite diet supplements. Hu-Yi-Neng is a composite diet supplement, including ginkgo biloba, extract of pine bark, phosphatidyl serine, docosahexaenoic acid, and folic acid, used extensively in Taiwan. Therefore, our aim is to investigate the potential protective effects of Hu-Yi-Neng on human neuron cells. MATERALS AND METHODS: H2O2-induced neuronal toxicity was characterized in SH-SY5Y human neuroblastoma cells by the decrease of cell viability using PrestoBlue™ assay and by the increase of intracellular reactive oxygen species (ROS) level using DCFH-DA (2', 7'-dichlorodihydrofluorescin diacetate) assays. HO-1 mRNA expression was detected by real-time PCR. Akt and Erk 1/2 proteins were detected by western blotting. RESULTS: Pretreatment with Hu-Yi-Neng significantly reversed the decrease in cell viability induced by H2O2 in SH-SY5Y cells. Furthermore, Hu-Yi-Neng dose-dependently suppressed the elevation of intracellular reactive oxygen species (ROS) level. Hu-Yi-Neng protected SH-SY5Y cells from oxidative stress may via the increase in mRNA expression of heme oxygenase-1 (HO-1), an antioxidant enzyme. In addition, Hu-Yi-Neng inhibited H2O2-induced phosphorylation of Akt kinase but further increased the phosphorylation of Erk 1/2. CONCLUSION: Our results suggest that Hu-Yi-Neng has protective effect against oxidative stress-induced neuron cell loss and it could be an ideal composite diet supplement for preventing neurodegenerative diseases.

Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases.

OBJECTIVES: To investigate the diagnostic value of contrast-enhanced computed tomography (CT) for the prediction of deep neck abscesses in different deep neck spaces and to evaluate the false-positive results. METHOD: We retrospectively analysed the clinical charts, CT examinations, surgical findings, bacteriology, pathological examinations and complications of hospitalised patients with a diagnosis of deep neck abscess from 2004 to 2010. The positive predictive values (PPV) for the prediction of abscesses by CT scan in different deep neck spaces were calculated individually on the basis of surgical findings. RESULTS: A total of 162 patients were included in this study. All patients received both intravenous antibiotics and surgical drainage. The parapharyngeal space was the most commonly involved space. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. In the false-positive group, cellulitis was the most common final result, followed by cystic degeneration of cervical metastases. Five specimens taken intra-operatively revealed malignancy and four of these were not infected. CONCLUSIONS: There are some limitations affecting the differentiation of abscesses and cellulitis, particularly in the retropharyngeal space. A central necrotic cervical metastatic lymph node may sometimes also mimic a simple pyogenic deep neck abscess on both clinical pictures and CT images. Routine biopsy of the tissue must be performed during surgical drainage.

Study of gastric fluid induced cytokine and chemokine expression in airway smooth muscle cells and airway remodeling.

Asthma is a chronic airway inflammatory disease. Chronic aspiration by gastric fluid in gastroesophageal reflux disease (GERD) is considered a primary inflammatory factor exacerbating or predisposing patients to asthma. Airway smooth muscle cells (SMCs) are considered an important component in airway remodeling. To investigate the role of gastric fluid in airway SMC inflammation and airway remodeling, we examined gastric fluid-induced cytokine and chemokine profiles, airway SMC migration and matrix metalloproteinase expression in rat primary rat airway SMCs. The T helper cell type 2 (Th2) cytokines interleukin 4, interleukin 6 and tumor necrosis factor 2 (TNF-α) and the chemokines, lipopolysaccharide-induced CXC chemokine (LIX/CXCL5), cytokine-induced neutrophil chemoattractant 2 (CINC-2), CINC-3, fractalkine, ciliary neurotrophic factor (CNTF), and vascular endothelial growth factor were induced by gastric fluid in primary cultured rat airway SMCs. Migration of rat airway SMCs was enhanced by gastric fluid and conditioned medium. The migration of rat airway SMCs enhanced by gastric fluid was associated with actin polymerization and activation of focal adhesion kinase. Matrix metalloproteinase 2 expressions in airway SMCs was enhanced by gastric fluid and conditioned medium. The results suggest potential mechanisms by which gastric fluid aspiration might influence SMC-mediated airway remodeling.

Characterization of interleukin 8 in woodchucks with chronic hepatitis B and hepatocellular carcinoma.

The eastern woodchuck, Marmota monax, represents a useful animal model to study hepatitis B virus infection in humans. However, immunological studies in this model have been impeded by a lack of basic information about the components of the immune system such as cytokines and chemokines. To clarify the role(s) of interleukin 8 (IL-8) in chronic hepatitis B and hepatocellular carcinoma (HCC) in the woodchuck model, we cloned and characterized the woodchuck IL-8 cDNA and genomic DNA. Sequence analysis revealed that the organization of the wk-IL-8 gene is similar to that of the human IL-8 gene and consists of four exons and three introns. Woodchuck IL-8 protein exhibits the conserved ELRCXC motif of IL-8 and shows 87, 82, 82 and 79% similarity with rabbit, ovine, bovine and human IL-8 proteins, respectively. The biological activity of wk-IL-8 was demonstrated using neutrophil chemotaxis assays. Wk-IL-8 could be readily detected in both tumor and non-tumor tissues with higher expression in the non-tumor tissues in most cases. The results from this study will facilitate the investigation of IL-8 in the immunopathogenesis of hepadnavirus-related diseases by the woodchuck model.

Fibronectin suppresses lipopolysaccharide-induced liver damage and promotes the cytoprotection abilities of hepatocyte-like cells derived from human bone marrow mesenchymal stem cells.

We isolated mesenchymal stem cells (MSCs) from adult human bone marrow. By using reverse-transcription polymerase chain reactions, we confirmed that MSCs possessed the potential to differentiate into hepatocyte-like cells (MSC-HLCs) with the expression of hepatocyte-specific marker genes. We further observed that fibronectin (FN) treatment significantly inhibited lipopolysaccharide (LPS)-induced apoptotic activities in FN-treated MSC-HLCs, as detected by caspase 3 enzyme-linked immunosorbent (ELISA) and terminal dUTP nick-end labeling (TUNEL) assays (P<.05). The FN-treated MSC-HLCs were transplanted into SCID mice with or without LPS injection. This study demonstrated that FN treatment improved liver function repair and survival rates among LPS-treated SCID mice.

Using gelatin scaffold with coated basic fibroblast growth factor as a transfer system for transplantation of human neural stem cells.

Gelatin scaffolds for ex vivo cell cultures are a promising development. These scaffolds can be used as three-dimensional skeletons for cell attachment and culture before transplantation. In this study, we isolated and cultivated neural stem cells from human brain tissues in serum-free medium (DMEM+F12 nutrient). Better neuron growth was observed using the tetrazolium assay (MTT) in the group when basic fibroblast growth factor (bFGF) was coated on the gelatin polymer scaffold. Further development of this nontoxic system may help the future development of transplantation of human neural stem cells.

Using human plasma supplemented medium to cultivate human bone marrow-derived mesenchymal stem cell and evaluation of its multiple-lineage potential.

The objective of this study was to evaluate the proliferation and the multiple-lineage differentiation capacity when bone marrow mesenchymal stem cells (BMSCs) were cultured short-term in autologous serum/plasma instead of fetal calf serum (FCS). The BMSCs from 12 donors were cultivated individually in 10% autogenic plasma or serum, with or without bFGF and EGF growth factors. Cell proliferation was examined by a Tetrazolium assay (MTT) after passages 1, 3, and 5. A medium supplemented with 10% human plasma or serum was sufficient to propagate BMSCs. However, no significant proliferation was shown when bFGF and EGF (20 ng/mL each) were added into the medium with autologous serum/plasma. We examined, inductions of adipogenesis, osteogenesis, and chondrocytogenesis, as capacities of multiple-lineage differentiation of cultivated BMSCs (passages 8). Differentiation was investigated by both RT-PCR and immunohistochemistry staining (IHC). Qualitative evidence demonstrated the differentiation capacity was preserved in cultivated BMSCs with autologous serum/plasma.

Quantitative analysis of mRNA encoding MUC1, MUC2, and MUC5AC genes: a correlation between specific mucin gene expression and sialomucin expression in non-small cell lung cancer.

The expression of mucins is important for tumor invasiveness and metastasis. In our previous report (Am. J. Respir. Crit. Care Med. 1997; 155:1419-1427), non-small cell lung cancers bearing sialomucin expression tended to relapse earlier than those without sialomucin. However, it remained unclear whether the expression of sialomucin in lung cancer is caused by an abnormal glycosylation process or by the expression of a specific mucin gene product. To address this problem, we established a modified quantitative competitive polymerase chain reaction (QC-PCR) analysis. RNA internal standards of MUC1, MUC2, and MUC5AC non-tandem repeat sequences were constructed, and known copy numbers of mucin RNA internal standards were introduced into reverse transcription-polymerase chain reactions (RT-PCR) for each mucin gene in order to compete with native mucin gene RNA during the reaction. The RNA of Gbeta-like gene (a housekeeping gene) was used as internal control for the RNA analysis. Twenty-five lung cancer tissues (13 adenocarcinomas and 12 squamous cell carcinomas) were used for analysis. Mann-Whitney rank sum test was applied to compare the expression amounts of different mucin genes in tissues. The results revealed that adenocarcinoma expressed higher amounts of MUC5AC gene than did squamous cell carcinoma (P = 0.03). The expression amount of MUC5AC correlated positively with the expression status of sialomucin (P = 0.012). Further studies are anticipated to elucidate the underlying mechanism contributing to this phenomenon.

99Tcm-HMPAO-labelled white blood cell scans to detect acute appendicitis in older patients with an atypical clinical presentation.

Forty-nine patients (age > 50 years) with an acute abdomen and suspected appendicitis, but with atypical findings, were included in the study. After the intravenous injection of 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled white blood cells (WBCs), serial anterior images of the abdomen and pelvis were obtained after 30, 60, 120 and 240 min. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen equal to or greater than bone marrow activity was considered positive. Twenty-five patients had positive WBC scans, all of whom underwent laparotomy. Twenty-three of these patients were shown to have appendicitis; the other 2 did not. The other 24 patients had a negative WBC scan, 2 of whom underwent laparotomy and were shown to have appendicitis; the other 22 patients did not undergo surgery and showed no evidence of appendicitis during follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values of WBC scans for diagnosing appendicitis were as follows: 92.0%, 91.7%, 91.8%, 92.0% and 91.7% respectively. In conclusion, 99Tcm-HMPAO-labelled WBC scans provide a rapid and highly accurate method for diagnosing appendicitis in older patients with equivocal clinical findings.

Tc-99m HMPAO-labeled WBC scans to detect appendicitis in women.

Fifty female patients with acute abdomen and suspected appendicitis but atypical findings were included in this study. After intravenous injection of Tc-99m HMPAO-labeled WBCs, serial anterior abdominal/pelvic images at 30, 60, 120, and 240 minutes were obtained by a gamma camera. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen with equal to or greater than bone marrow activity was considered as a positive scan. Thirty patients had positive WBC scans and underwent laparotomy, 28 had proven appendicitis, and 2 were not related to appendicitis. Twenty patients had negative WBC scans, 2 patients underwent laparotomy and were proved to have appendicitis. The remaining 18 patients did not undergo surgery and revealed no evidence of appendicitis after follow-up. The overall sensitivity, specificity, accuracy, and positive and negative predictive values for WBC scans to diagnose appendicitis is 93.3%, 90.0%, 92.0%, 93.3%, and 90.0%, respectively. In conclusion, Tc-99m HMPAO-labeled WBC imaging provides a rapid and highly accurate method for diagnosis of appendicitis in female patients with equivocal clinical examinations.

Surgical treatment of right atrial focal tachycardia in adults.

Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focal tachycardia was reproduced during electrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients. Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence. In all four patients after right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia after epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 months (mean 30). It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.

Surgical treatment of supraventricular arrhythmias. Results in 67 patients.

Over 6 years, recurrent drug-refractory supraventricular arrhythmias were treated by electrophysiologically guided surgical procedures in 67 patients. There were 57 patients, age 10-72 years, with accessory pathways who had 61 operations. The perioperative mortality rate was 3.5%, with deaths occurring in two patients with complex problems. Four patients with multiple but one or more silent accessory pathways had successful reoperation, and modified surgical technique has eliminated this problem. All patients are free of arrhythmias 2-70 months after operation. The survival and primary cure rates were 100% for 36 patients with solitary accessory pathways. Eight patients, age 10-53 years, were operated on for atrial focal tachycardia. Right atrial cryothermic lesions without excision or cardiopulmonary bypass were used in four patients: local excision was used in two patients and combined procedures were used in two patients. Because of recurrence in two of four patients treated by isolated cryoablation, a new technique was applied subsequently to one of these patients and two other patients: wide atrial excision and PTFE patch replacement during cardiopulmonary bypass. All patients are free of arrhythmias at a follow-up of 9-72 months. Intractable atrial flutter or fibrillation occurred in 11 patients who had 15 attempts at transvenous A-V node electroshock ablation. In three patients in whom this failed, subsequent open cryoablation of the A-V node during cardiopulmonary bypass and epicardial pacemaker implantation were performed successfully. Two patients had A-V nodal modification for control of A-V nodal re-entry tachycardia: one patient with cryothermia at the time of ablation of atrial focal tachycardia and the other patient with sharp dissection at the time of accessory pathway division. Of the initial 67 patients, 65 (97%) survived operation and all were cured of their presenting arrhythmia. Surgery for drug-refractory supraventricular arrhythmias is safe and effective in selected cases.