Development and validation of a clinical prediction model for early ventilator weaning in post-cardiac surgery.

Background: Weaning patients from mechanical ventilation is a critical clinical challenge post cardiac surgery. The effective liberation of patients from the ventilator significantly improves their recovery and survival rates. This study aimed to develop and validate a clinical prediction model to evaluate the likelihood of successful extubation in post-cardiac surgery patients. Method: A predictive nomogram was constructed for extubation success in individual patients, and receiver operating characteristic (ROC) and calibration curves were generated to assess its predictive capability. The superior performance of the model was confirmed using Delong's test in the ROC analysis. A decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram. Results: Among 270 adults included in our study, 107 (28.84%) experienced delayed extubation. A predictive nomogram system was derived based on five identified risk factors, including the proportion of male patients, EuroSCORE II, operation time, pump time, bleeding during operation, and brain natriuretic peptide (BNP) level. Based on the predictive system, five independent predictors were used to construct a full nomogram. The area under the curve values of the nomogram were 0.880 and 0.753 for the training and validation cohorts, respectively. The DCA and clinical impact curves showed good clinical utility of this model. Conclusion: Delayed extubation and weaning failure, common and potentially hazardous complications following cardiac surgery, vary in timing based on factors such as sex, EuroSCORE II, pump duration, bleeding, and postoperative BNP reduction. The nomogram developed and validated in this study can accurately predict when extubation should occur in these patients. This tool is vital for assessing risks on an individual basis and making well-informed clinical decisions.

Evaluation of radial artery pulse pressure effects on detection of stroke volume changes after volume loading maneuvers in cardiac surgical patients.

BACKGROUND: Fluid responsiveness is defined as an increase in cardiac output (CO) or stroke volume (SV) of >10-15% after fluid challenge (FC). However, CO or SV monitoring is often not available in clinical practice. The aim of this study was to evaluate whether changes in radial artery pulse pressure (rPP) induced by FC or passive leg raising (PLR) correlates with changes in SV in patients after cardiac surgery. METHODS: This prospective observational study included 102 patients undergoing cardiac surgery, in which rPP and SV were recorded before and immediately after a PLR test and FC with 250 mL of Gelofusine for 10 min. SV was measured using pulse contour analysis. Patients were divided into responders (≥15% increase in SV after FC) and non-responders. The hemodynamic variables between responders and non-responders were analyzed to assess the ability of rPP to track SV changes. RESULTS: A total of 52% patients were fluid responders in this study. An rPP increase induced by FC was significantly correlated with SV changes after a FC (ΔSV-FC, r=0.62, P<0.01). A fluid-induced increase in rPP (ΔrPP-FC) of >16% detected a fluid-induced increase in SV of >15%, with a sensitivity of 91% and a specificity of 73%. The area under the receiver operating characteristic curve (AUROC) for the fluid-induced changes in rPP identified fluid responsiveness was 0.881 (95% CI: 0.802-0.937). A grey zone of 16-34% included 30% of patients for ΔrPP-FC. The ΔrPP-PLR was weakly correlated with ΔSV-FC (r=0.30, P<0.01). An increase in rPP induced by PLR (ΔrPP-PLR) predicted fluid responsiveness with an AUROC of 0.734 (95% CI: 0.637-0.816). A grey zone of 10-23% included 52% of patients for ΔrPP-PLR. CONCLUSIONS: Changes in rPP might be used to detect changes in SV via FC in mechanically ventilated patients after cardiac surgery. In contrast, changes in rPP induced by PLR are unreliable predictors of fluid responsiveness.

Antidiabetic Effects of Tea.

Diabetes mellitus (DM) is a chronic endocrine disease resulted from insulin secretory defect or insulin resistance and it is a leading cause of death around the world. The care of DM patients consumes a huge budget due to the high frequency of consultations and long hospitalizations, making DM a serious threat to both human health and global economies. Tea contains abundant polyphenols and caffeine which showed antidiabetic activity, so the development of antidiabetic medications from tea and its extracts is increasingly receiving attention. However, the results claiming an association between tea consumption and reduced DM risk are inconsistent. The advances in the epidemiologic evidence and the underlying antidiabetic mechanisms of tea are reviewed in this paper. The inconsistent results and the possible causes behind them are also discussed.

Video-assisted thoracoscopic lobectomy: single-direction thoracoscopic lobectomy.

A 68-year-old male patient was presented due to "cough for more than 1 year". PET/CT showed a mass, 23 mm in diameter, in the right lower lobe of the lung. The radioactivity uptake of the mediastinal lymph nodes was not increased. No metastasis to other organs was found. Preoperative evaluation showed that the patient could tolerate lobectomy. Single-direction video-assisted thoracoscopic lobectomy was then performed. The operation was smooth, and the mass was pathologically confirmed to be an adenocarcinoma in the lower right lung. The postoperative recovery was good, and the patient was discharged on the 7th post-operative day.

[Expression and clinical significance of circadian gene Per2 in non-small cell lung cancer].

OBJECTIVE: To detect the expression of Per2 in non-small cell lung cancer (NSCLC), and analyze its clinical significance. METHODS: The expression of Per2 was determined in 60 NSCLC and 20 normal lung tissues by immunohistochemical assay, and the relationship between Per2 expression and clinicopathological features was analyzed. RESULTS: The positive expression rates of Per2 in NSCLC and normal lung tissues were 71.7% and 95.0%, respectively (P < 0.05). The expression of Per2 in NSCLC was correlated with pathological differentiation and TNM stage (P < 0.05). CONCLUSION: The expression of Per2 in NSCLC is decreased. The negative expression of Per2 may contribute to the development and invasion in NSCLC.

Primary pleural squamous cell carcinoma misdiagnosed as localized mesothelioma: a case report and review of the literature.

Primary pleural squamous cell carcinoma is very rare, and there is a lack of experience in the diagnosis and treatment of this condition. An asymptomatic 75-year-old man was referred to us after a right pleural nodule was found on computed tomography during a routine health examination. He underwent surgery for his pleural tumor twice over the following 2 years. Histopathological examination eventually led to a diagnosis of primary pleural squamous cell carcinoma.

Efficacy of an absorbable polyglycolic acid patch in surgery for pneumothorax due to silicosis.

BACKGROUND: We conducted a retrospective study to evaluate the efficacy and safety of an absorbable polyglycolic acid (PGA) patch in surgery for refractory pneumothorax due to silicosis. METHODS: A retrospective analysis was performed of 56 patients who received thoracotomy or thoracoscopic surgery for refractory pneumothorax due to silicosis between 1995 and 2010. An absorbable PGA patch was used as a reinforcement or repair material after resection of the bulla in 24 operations and it was not used in another 32 operations. Clinical outcomes were compared between the two groups (with a PGA and without a PGA). RESULTS: We found that the duration of postoperative chest drainage (5.04±1.12 days vs. 8.19±1.60 days, p<0.01) and hospital stay after the operation (8.33±1.34 days vs. 11.56±1.50 days, p<0.01) were significantly shorter in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. The incidence of initial air leakage (58.3% [14/24] vs. 93.8% [30/32], p<0.05) and relapse rate of pneumothorax in 6 months (4% [1/24] vs. 25% [8/32], p<0.05) were also significantly lower in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. No related adverse effects of the absorbable PGA patch occurred after the operations. CONCLUSIONS: Use of an absorbable PGA patch as a reinforcement or repair material in surgery for refractory pneumothorax due to silicosis can reduce postoperative air leakage and improve clinical outcome.

[Application of local Moran's I and GIS to identify hotspots of Ni, Cr of vegetable soils in high-incidence area of liver cancer from the Pearl River Delta, South China].

The index of local Moran's I is a useful tool for identifying hotspots of soil Ni and Cr, and for classifying them into spatial clusters and spatial outliers. To identify hotspots of vegetable soils Ni and Cr in high-incidence area of liver cancer, Shunde area of Foshan City, Pearl River Delta Economic Zone, 208 topsoil samples were collected from vegetable fields to measure the contents of nickel (Ni) and chromium (Cr). The results showed that the mean concentrations of two heavy metals Ni, Cr were 33.21 mg/kg, 80.84 mg/kg, respectively, Which were 130%, 60% higher than their soil background values of Guangdong Province, respectively. Generally, Ni is partly accumulated in soil but the accumulation of Cr is not obvious at all. The local Moran's I of Ni and Cr was calculated using 3 000, 6 000, 9 000 m as distance bands, respectively. The hotspots of Ni and Cr elements in soils were identified by local Moran's I which computed based on 6 000 m; "individual hotspots" are in the north which were affected by anthropogenic factors; "regional hotspots" are in the south which were controlled by parent materials. Moreover, the distributions of "regional hotspots" of Ni, Cr are the same as that of the highest mortality rate of liver cancer, this consistence could come up with a research direction that could reveal environmental etiologic factors of liver cancer.

Effects of lutein and zeaxanthin on aspects of eye health.

Lutein and zeaxanthin are members of the oxygenated carotenoids found particularly in egg yolks and dark-green leafy vegetables. A great deal of research has focused on their beneficial roles in eye health. The present article summarises the current literature related to the bioactivity of these carotenoids, emphasising their effects and possible mechanisms of action in relation to human eye health. Available evidence demonstrates that lutein and zeaxanthin are widely distributed in a number of body tissues and are uniquely concentrated in the retina and lens, indicating that each has a possible specific function in these two vital ocular tissues. Most of epidemiological studies and clinical trials support the notion that lutein and zeaxanthin have a potential role in the prevention and treatment of certain eye diseases such as age-related macular degeneration, cataract and retinitis pigmentosa. The biological mechanisms for the protective effects of these carotenoids may include powerful blue-light filtering activities and antioxidant properties. Although most studies point towards significant health benefits from lutein and zeaxanthin, further large-scale randomised supplementation trials are needed to define their effects on ocular function in health and disease.

Evaluation of serum transferrin receptor for iron deficiency in women of child-bearing age.

The objective was to study the evaluation of serum transferrin receptor (sTfR) for Fe deficiency in women of child-bearing age. Primary screening was performed in 942 women ranging in child-bearing age. Serum ferritin (SF), Zn protoporphyrin (ZPP) and Hb were determined. Then the subjects were divided into four groups: normal, Fe store depletion (IDs), Fe-deficiency erythropoiesis and Fe-deficiency anaemia. sTfR was determined and sTfR/SF (sTfR/logSF and log(sTfR/SF)) was calculated. Changes of sTfR in women of different Fe status were observed. A receiver-operating characteristic (ROC) curve was used to evaluate whether sTfR had proper diagnostic efficacy for functional Fe deficiency. The levels of sTfR increased significantly along with the aggravation of Fe deficiency. Increase of STfR/SF along with the aggravation of Fe deficiency was more significant than that of sTfR. STfR had a significant negative correlation with SF and Hb, while it had a significant positive correlation with ZPP. The ROC curve showed that the diagnostic effective rate of sTfR for Fe deficiency could reach 83 %. At this point, the sensitivity was 79 % and the specificity was 63 %. Log(sTfR/SF) could be considered to have the highest effective ratio in detecting IDs, since it reached 99 %. STfR and sTfR/SF could both reflect body Fe-deficiency status specifically. They could be used as reliable indicators for evaluating Fe status and diagnosing Fe deficiency in women of child-bearing age.

The responses of serum transferrin receptors to iron supplements in subjects with iron-deficiency erythropoiesis and iron-deficiency anaemia.

We aimed to study the response of serum transferrin receptors (sTfR) to Fe supplementation in women of childbearing age with Fe-deficiency erythropoiesis (IDE) and Fe-deficiency anaemia (IDA). Primary screening was performed in 942 women ranging in age from 18 to 45 years. After Fe-related biochemical indices such as serum ferritin, Zn protoporphyrin and Hb were determined, the subjects were divided into four groups: normal, Fe store depletion, IDE and IDA. A total of 131 women were randomly selected from the normal, IDE and IDA groups. Subsequently, seventy-six women with IDE and IDA were given various doses of Fe (14 mg/d for IDE; 28 mg/d for IDA) with ferrous l-threonate capsules for twelve consecutive weeks. After receiving Fe supplements, the levels of Fe and sTfR were determined at weeks 0, 3, 6, 9 and 12. The levels of sTfR in women of childbearing age with IDE and IDA were significantly higher than those in the normal group. After receiving Fe supplements, the levels of sTfR were significantly decreased in women of childbearing age with IDE and IDA, while the levels of serum ferritin were significantly increased. In conclusion, STfR can be used as a reliable indicator for assessing the efficacy of Fe supplements.

[The clinical features and surgical treatment of masked bilateral superior oblique palsy].

OBJECTIVE: To investigate the clinical features, diagnosis and the management of masked bilateral superior oblique palsy (MBSOP). METHODS: Retrospectively analyzed the records of all 7 patients that met the clinical criteria for MBSOP in Zhongshan Ophthalmic Center between 1999 and 2003. The head tilt, vertical deviation in primary position and the action of obliquus pre- and postoperatively were collected in detail. RESULTS: All 7 patients were diagnosed as unilateral SOP in the first time. The average hypertropia in primary position preoperatively was 19.7(Delta) (range 6(Delta) to 30(Delta)). All patients had a head tilt, obvious unilateral inferior oblique overaction (+2 to +4) and mild superior oblique underaction (-1 to -2), and normal action in contralateral superior and inferior obliquus. Initial surgery consisted of ipsilateral inferior oblique weakening with (5 patients) or without (2 patients) ipsilateral superior rectus recession. The average hypertropia in primary position was 12.0(Delta) (range 0(Delta) to 20(Delta)) after the first operation. In 1 week to 4 years, all of the previously masked eye presented the inferior oblique overaction (+2 to +3) and superior oblique underaction (0 to -1). All patients underwent a second surgery in 4 months to 4 years after the initial surgery. The average hypertropia in primary position was 2.3(Delta) (range 0(Delta) to 7(Delta)) after the second operation. Postoperative alignment was excellent in all patients. CONCLUSIONS: Masked bilateral superior oblique palsy is quite difficult to detect before surgical correction of the initial manifest palsy. The possibility of an occult contralateral palsy should be considered in all undergoing surgery for unilateral SOP. The superior rectus recession and the inferior oblique weakening procedure should be performed at different stages. When the masked palsy becomes evident, a successful surgical outcome can usually be expected.

[Effect of lycopene on immunity in rats with acute lung injury].

OBJECTIVE: To investigate the effects of lycopene on T lymphocyte subpopulations and pulmonary alveolar macrophagic (PAM) functions in rats with acute lung injury (ALI). METHODS: Rats were randomly divided into the following groups. (1) Control group, (2) ALI model group, (3) Low dose group,(4) Mid dose group and (5) High dose group. Control group and ALI model group were treated with solvent of lycopene, and the other groups were gastrically incubated with lycopene. Thirty-five days later, control group were given physiological saline, ALI model group and lycopene administrated groups were injected with lipopolysaccharide (LPS) (6.0 mg/kg) to induce ALI. One hour, four hours or six hours after LPS or physiological saline challenged, abdominal aorta blood for measuring lymphocyte subpopulations and bronchoalveolar lavage fluid for measuring function of PAM were gathered respectively. RESULTS: (1) At h 1, the percentages of CD3(+), CD4(+) and CD8(+) of lycopene administrated groups compared with control group were not significantly different. At h 4, the percentage of CD4(+) was similar to that at h 1. As for the percentages of CD3(+), except high dose group [(28.8+/-9.9)%] was significantly lower, low dose, mid dose and ALI model group showed no significant difference compared with control group[(39.5+/- 4.5)%]. The percentages of CD8(+) of ALI model and lycopene administrated rats, separately (10.2+/-3.9)%, (10.3+/-2.8)%, (9.8+/-2.8)%, (10.1+/-3.5)% , had been significantly reduced compared with control group[(15.1+/-2.5)%]; between ALI model and lycopene administrated groups there was no significant difference. The instance at h 6 was the same as that at h 4. The percentage ratios of CD4(+) T-lymphocyte to CD8(+) T-lymphocyte of ALI model rats were not significantly different compared with control group or lycopene administrated groups at h 1 and h 6. At h 4, the ratio of the CD4(+) and CD8(+) in Low dose and Mid dose groups had significant difference and ALI model, high dose hadn't when they were compared with control group. (2) Lycopene increased the phagocytic function of PAMs significantly at h 1(P<0.01), the optical density of PAM of control group, ALI model group, low dose group, mid dose group, high dose group was 0.136+/-0.025, 0.215+/-0.095, 0.239+/-0.052, 0.275+/-0.068 and 0.297+/-0.049; what happened at h 4 was similar to that at h 1; Phagocytic function of PAM of lycopene administrated groups was increased compared with control group. (3) The concentrations of tumor necrosis factor-alpha (TNF-alpha) in control group, ALI model group, low dose group, mid dose group, high dose groups were 1.50+/-0.30, 1.87+/-0.30, 1.76+/-0.40, 1.74+/- 0.38,1.62+/-0.35 microg/L;and those of IL-8 were 0.82+/-0.08, 0.99+/-0.14, 0.82+/-0.16, 0.84+/-0.16, 0.83+/-0.11 microg/L. The concentrations of TNF-alpha and interleukin-8 (IL-8) in BALF were decreased by lycopene, especially the levels of IL-8 were reduced significantly. CONCLUSION: Lycopene might attenuate lipopolysaccharide-induced impairment of lungs and improve ALI prognosis by increasing the phagocytic function of PAMs significantly and restraining the secretion of TNF-alpha and IL-8.

[The effect of weakening the overaction superior oblique muscles on the status of ocular torsion].

OBJECTIVE: To investigate the effect of weakening the superior oblique muscles on the status of ocular torsion. METHODS: Twenty-nine patients (58 eyes) underwent tenotomy or partial ectomy of bilateral superior oblique muscles for treatment of superior oblique overacting. Objective cyclodeviations were assessed by fundus photograph before and 7 days after the surgery. The photographs were transferred to a computer and then the fovea-disc angle was measured by a software for drawing pictures. Subjective cyclodeviations and binocular vision function were assessed by synoptophore. RESULTS: Fundus photography before surgery revealed that the intorsion was 10.48 degrees +/- 6.01 degrees for the right eye and was 9.37 degrees +/- 5.88 degrees for the left eye. The reduction of the cyclodeviations by weakening the superior oblique muscle for the right and left eye was 9.11 degrees +/- 7.09 degrees and 7.94 degrees +/- 4.76 degrees respectively. The comparisons of objective ocular torsion for both eyes showed high significant differences (P < 0.01) pre- and post-operatively. There were no significant differences (P > 0.05) between the effects of tenotomy or partial ectomy of bilateral superior oblique muscles. All patients showed no cyclotropia and normal binocular vision function was obtained with synoptophore before and after surgery. CONCLUSIONS: Weakening the overaction superior oblique could correct ocular incyclodeviation. Both tenotomy and partial ectomy of bilateral superior oblique muscles can treat ocular incyclodeviation effectively. The changes of subjective and objective cyclodeviations are inconsistent with each other.

[Clinical features of V patterns strabismus and its long-term effect of surgical treatment].

OBJECTIVE: To investigate the features and treatment of V patterns strabismus. METHODS: Pre- and post-operative deviation and oblique muscle action as well as binocular visual function were evaluated in sixty-three V pattern patients. The difference between upgaze and downgaze of deviation were recorded before and after operation. RESULTS: Sixty-two patients (98.4%) with binocular or unilateral inferior oblique overaction + 2 to + 3 were treated with inferior oblique weakening procedure and horizontal rectus recession-resection procedure. 1 patient with binocular inferior oblique overaction + 1 treated with horizontal recti recession-resection procedure. The difference between upgaze and downgaze is 25.6 prism diopters (PD) preoperatively and 4.5 PD postoperatively. The primary-position exotropia preoperatively of 48 V pattern exotropia is 37.2 PD, after surgery, the average deviation is 3.4 PD of esotropia [38 cases (79.2%) with deviation within +/- 10 PD]. 15 cases of V pattern esotropia had deviation 50.6 PD preoperatively, after surgery, the average deviation is 2.4 PD of esotropia [11 cases (73.3%) with deviation within 10 PD]. 21 patients (33.3%) obtained stereo visual function after surgery. CONCLUSION: V patterns always had inferior oblique over action and could be treated with the inferior oblique weakening procedure. The primary-position deviation should be treated by traditional horizontal rectus recession-resection procedure. The stereoscopic function had a good prognosis with surgery.

[Study of Qingciguo oil's function on blood lipid and other functions].

OBJECTIVE: To study Qingciguo Oil's function on blood lipid and other functions. METHODS: 84 male SD rats were randomly divided into seven groups (control group, high lipid group, low dose group, middle dose group, high dose group, combined dose group and combined control group) based on the level of TC. We respectively feed each group of rats with the normal food, high lipid high cholesterol food, Qingciguo Oil's 4 ml/kg BW food, Qingciguo Oil's 8 ml/kg BW food, Qingciguo Oil's 12 ml/kg BW food, Qingciguo Oil's 12 ml/kg BW + 0.8% soybean PL + 0.05% VitE food & 0.8% soybean PL + 0.05% VitE food ninth week. RESULTS: At the fourth week, the TC of each group rats (except lower dose group) began to decreasing, and at sixth week, the TC of middle dose group was significantly lower than the high lipid group. At sixth week, the TG of low, middle and high dose group was significantly lower than the TG of high lipid group, the HDL of high lipid group and middle dose group decreased significantly, and the HDL of combined control dose group significantly higher than high lipid group. At the ninth week, the level of SOD of all experimental groups significantly higher than the high lipid group and the MDA of each group have no significant differents between each other. In vitro, we test the effect of different dose Qingciguo oil and fish oil on platelet aggragation of each blood by tuibidimetry, the results show that the platelet aggregation of Qingciguo oil high dose group was significantly lower than the control group. CONCLUSION: Under our condition, Qingciguo oil has certain functions of decreasing the level of blood lipids modulating the function of antioxidants and restraining the platelet aggregation in vitro.

[Effects of iron supplementation on human serum level of transferrin receptor].

OBJECTIVE: To study trend of dynamic change in level of serum transferrin receptor (sTfR) in the process of iron supplementation to provide evidence for sTfR in evaluating the efficacy of iron supplementation. METHODS: Totally, 942 child-bearing-age women aged 18 to 45 years were selected from Longfang City, Hebei Province and Shunyi County, Beijing. Biochemical indicators of iron metabolism were measured for all of them, including serum levels of ferritin (SF) and zinc protoporphyrin (ZPP), and hemoglobin (Hb). According to the current criteria for assessing iron status, women were screened for iron deficiency erythropoiesis (IDE) or iron deficiency anemia (IDA). Seventy-two women agreed to participate in the study, and 59 of them finished whole dynamic observations with signed informed consent. Four capsules of ferrous L-threonate (containing 7 mg of iron element per capsule) were administered for women with IDE every other day and for women with IDA every day, respectively, for 12 weeks. Serum biochemical indicators and level of sTfR were measured in 0 wk, 3 wk, 6 wk, 9 wk and 12 wk, respectively, during the process of iron supplementation, and their dynamic changes were observed. RESULTS: Level of sTfR in women with IDE and IDA was (26.62 +/- 10.57) nmol/L and (41.25 +/- 21.96) nmol/L, respectively, significantly higher than normal level. During the process of iron supplementation, level of sTfR changed as the following characteristics. In women with IDE, level of sTfR kept stable within the first 3 weeks of iron supplementation, then dropped gradually and progressively, reached to normal, with (17.86 +/- 5.57) nmol/L, in the 12 wk after iron supplementation. In women with IDA, level of sTfR dropped quickly within the first 3 wk of iron supplementation, then dropped slowly until the 9th wk and kept stable, and reached to normal level in the 12 wk, with (19.54 +/- 5.94) nmol/L and a ratio of sTfR/SF of 12.23 +/- 4.34. Ratio of sTfR/SF changed as level of sTfR during the process of iron supplementation. Level of sTfR correlated reversely with levels of Hb and SF and positively with level of ZPP. CONCLUSION: Serum level of sTfR in child-bearing age women gradually decreased to normal with the restoration of their normal iron status during the process of iron supplementation and could be used as a specific indicator for assessing efficacy of iron supplementation.

[The effect of weakening inferior oblique muscles on the status of ocular torsion].

OBJECTIVE: To understand the clinical significance of subjective and objective examination of cyclodeviations and investigate the effect of weakening inferior oblique muscles on the status of ocular torsion. METHODS: Twenty patients (40 eyes) with overacting inferior oblique muscles underwent bilateral myotomy or partial myectomy of inferior oblique muscles. Subjective cyclodeviations were measured before surgery as well as one week, two months after surgery by double maddox rod test (DMRT). Objective cyclodeviations were assessed by fundus photography before and 7 days after surgery in 15 cases. The photograph was transferred to a computer, and the fovea-disc angle was measured by means of drawing picture software. RESULTS: Nine patients with primary overaction of inferior oblique muscles were negative with DMRT before surgery, and only one case revealed incyclotropia 5.0 degrees tested two months after surgery. Four out of 11 patients with secondary overaction of inferior oblique muscles showed excyclotropia 2.5 degrees - 5.0 degrees with DMRT before surgery, and all patients indicated no subjective cyclotropia with DMRT two months after surgery. Fundus photography determination of the right eye revealed extorsion 16.83 degrees +/- 6.39 degrees, the left eye 14.92 degrees +/- 4.51 degrees before surgery. The reduction of the cyclodeviations by weakening inferior oblique muscle for the right and left eye was 13.07 degrees +/- 3.38 degrees and 10.54 degrees +/- 3.75 degrees respectively. The comparison of objective ocular torsion for both eyes showed high significant differences (P < 0.01) pre- and post-operatively. CONCLUSIONS: The results of subjective and objective examination of cyclodeviations in patients with primary or secondary overacting inferior oblique muscle early after birth were not consistent. Weakening inferior oblique muscle could correct excyclodeviation. There exist complicated compensatory mechanisms for subjective change of ocular torsion after surgery. The changes of subjective and objective cyclodeviations are still inconsistent.

[The effect of preventing anterior segment ischemia by preservation of anterior ciliary vessels in rabbit].

OBJECTIVE: To investigate the effect of preserving anterior ciliary vessels (ACVs) on the prevention of anterior segment ischemia syndrome (ASI) during the surgery of extraocular muscles. METHODS: Thirty-two adult New Zealand white rabbits were randomly divided into four groups. ACVs of the right eyes were preserved among all of the rabbits, and were cut off in all of the left eyes. Group A: internal and external recti were cut off in two eyes; Group B: superior and inferior recti were cut off in two eyes; Group C: internal, external and superior or inferior recti were cut off in two eyes; Group D: all of the recti were cut off in two eyes. All rabbits were observed under slit microscope. The intraocular pressure (IOP), the total protein and lactic acid in the aqueous humor were recorded preoperatively and postoperatively. Eyes were enucleated at the forth week postoperatively to obtain the iris and the ciliary body for histopathologic study and electron microscopy. RESULTS: No signs of ASI were observed in the right eyes of all four groups under the slit lamp and under the light and election microscopes. The IOP and levels of ingredients of aqueous humor (total protein and lactic acid) showed no difference between preoperative and postoperative interval. No obvious ASI was observed in the left eyes of group A. Mild reactions of ASI were observed in the left eyes of group B. Moderate to severe reactions of ASI were observed in the left eyes in group C and group D. The IOP reduced from (17.21 +/- 3.76) mm Hg (1 mm Hg = 0.133 kPa) preoperatively to (14.48 +/- 3.36) mm Hg postoperatively in group C (P < 0.05); and from (16.68 +/- 2.33) mm Hg reduced to(3.17 +/- 0.92) mm Hg in group D. (P < 0.05). The level of total protein and lactic acid in the aqueous humor increased from (505.3 +/- 5.0) mg/L and (7.54 +/- 0.47) g/L preoperatively to (811.9 +/- 44.4) mg/L and (11.00 +/- 3.59) g/L postoperatively in group C, respectively (P < 0.05). In group D, the level of total protein and lactic acid in the aqueous humor increased from (504.6 +/- 4.1) mg/L and (7.17 +/- 1.44) g/L preoperatively to (1025. 8 +/- 78.3) mg/L, (8.23 +/- 1.68) g/L postoperatively, respectively (P < 0.05). There were various histopathological changes under the light and electron microscope in groups C and D. While no obvious ischemic changes were observed in group A. CONCLUSION: Two vertical muscles cut off at one eye simultaneously would produce mild reactions of ischemia, while three or more muscles cut off simultaneously could obstruct blood flow in eyes and induce ASI. Preservation of the ACVs could avoid the occurrence of ASI.

[Clinical features and surgical treatment of A-pattern exotropia].

OBJECTIVE: To investigate the clinical features of A-pattern exotropia and to evaluate the efficacy of surgical treatment for the correction of A-pattern exotropia (A-XT). METHODS: Pre- and post-operative eye position, superior oblique muscle function, clinical features and binocular function were examined and analyzed in 32 patients with A-pattern exotropia. RESULTS: Overaction of the superior oblique (SO) (31/32) and insufficiency of medial rectus muscle (20/32) were commonly seen in the group of patients. The tenectomy of the SO and the resection of the medial rectus muscle were effective in most of A-pattern exotropia. 87.5% (28/35) of A-pattern exotropia in our study were successfully corrected. Four cases got binocular function after surgery. CONCLUSIONS: Based on the clinical features and the effects of surgical treatment, we conclude that the superior oblique muscle overaction and medial rectus muscle insufficiency are the primary factors in the etiology of A-pattern exotropia that is the most common form of A-V syndrome. Weakening the overaction of superior oblique muscle combined with the correction of exotropia is an effective way to correct A-pattern exotropia.