Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention.

Background: Whether women have a higher risk of adverse events compared with men following coronary angiography (CAG) and percutaneous coronary intervention (PCI) remains controversial. We aimed to investigate the sex differences in characteristics, treatments and outcomes among patients undergoing CAG and PCI in a large Chinese cohort. Methods: We analyzed patients undergoing CAG and/or PCI in this multi-center registry cohort study Cardiorenal ImprovemeNt II (CIN-II) in 5 Chinese tertiary hospitals from 2007 to 2020. Clinical characteristics, treatment (discharge medication and PCI) and in-hospital outcomes (mortality and major bleeding) were compared between women and men. Results: Totally 141,459 patients underwent CAG (44,362 [31.4%] women), of which 69,345 patients underwent PCI (15,376 [22.2%] women). Women were older (64.4 vs. 60.8 years), had more chronic comorbidities and lower PCI rate for stable coronary artery disease (CAD) than men (52.8 vs. 64.2%). Women received less CAG and PCI procedures. Among women undergoing PCI they received similar discharge medication treatment. In addition, women undergoing PCI had mildly lower rate of major bleeding (0.2 vs. 0.3%, P = 0.033) but higher in-hospital mortality (1.2 vs. 0.8%, P < 0.001). After adjustment, women had a higher risk in the major bleeding (adjusted odds ratio, 2.04 [95% CI: 1.07 to 3.62]), and the in-hospital mortality (adjusted odds ratio, 1.87 [95% CI: 1.36 to 2.56]). Conclusion: Among our Chinese cohort, women are older with more chronic comorbidities, receiving less PCI procedure and similar discharge medication treatment. Women have nearly 90% higher risk of in-hospital mortality and over 1-fold increased risk of major bleeding after PCI compared with men.

Aging, rather than Parkinson's disease, affects the responsiveness of PBMCs to the immunosuppression of bone marrow mesenchymal stem cells.

Whether aging or Parkinson's disease (PD) affects the responses of peripheral blood mononuclear cells (PBMCs) to immunosuppression by bone marrow­derived mesenchymal stem cell (BM­MSCs) and which cytokines are more effective in inducing BM­MSCs to be immunosuppressive remains to be elucidated. PBMCs were isolated from healthy young (age 26­35), healthy middle­aged (age 56­60) and middle­aged PD­affected individuals. All the recruits were male. The mitogen­stimulated PBMCs and proinflammatory cytokine­pretreated BM­MSCs were co­cultured. The PBMC proliferation was measured using Cell Counting Kit­8, while the cytokine secretion was assayed by cytometric bead array technology. The immunosuppressive ability of BM­MSCs was confirmed in young healthy, middle­aged healthy and middle­aged PD­affected individuals. Among the three groups, the PBMC proliferation and cytokine secretion of the young healthy group were suppressed more significantly compared with those of the middle­aged healthy and middle­aged PD­affected group. No significant differences were identified in the PBMC proliferation and cytokine secretion between the patients with PD and the middle­aged healthy subjects. Interferon (IFN)­Î³ synergized with tumor necrosis factor (TNF)­α, interleukin (IL)­1α or IL­1ß was more effective than either one alone, and the combinations of IFN­Î³ + IL­1α and IFN­Î³ + IL­1ß were more effective than IFN­Î³ + TNF­α in inducing BM­MSCs to inhibit PBMC proliferation. The results of the present study suggested that aging, rather than PD, affects the response of PBMCs toward the suppression of BM­MSC, at least in middle­aged males. Patients with PD aged 56­60 remain eligible for anti­inflammatory BM­MSC­based therapy. Treatment of BM­MSCs with IFN­Î³ + IL­1α or IFN­Î³ + IL­1ß prior to transplantation may result in improved immunosuppressive effects.

[Emphasis treatment on eyelid during perioperation].

The eyelid and conjunctival sac of healthy individuals inherently supports a small population of bacteria. Alterations in the concentration and type of bacteria present in blepharitis and meibomian gland dysfunction have been reported. The most common sources of the bacteria causing endophthalmitis of postcataract surgery and corneal infections following laser in situ keratomileusis attribute to the eyelids and conjunctiva of the patients, It has become a routine admitting antibiotic eye drops during perioperation and irrigating conjunctival sac before operation, but it is not paid enough attention for dealing with eyelid. So, this article will discuss the impact of eyelid on surgical outcome, and it is helpful for reducing postoperative infection.

[Retrospective analysis of ocular cicatricial pemphigoid].

OBJECTIVE: To analyze the clinical characterization of ocular cicatricial pemphigoid (OCP). METHODS: It was a retrospective series case study. Five consecutive patients referred for the evaluation of possible OCP from January 2005 to October 2008 in Departments of Ophthalmology and Dermatology of Peking University First Hospital. History and clinical characterization of 5 cases (10 eyes) OCP having been misdiagnosed were analyzed to find the causes of misdiagnosis. RESULTS: All of cases were diagnosed as chronic conjunctivitis during the early stages of the diseases, one case was diagnosed as Stevens-Johnson syndrome and one as Sjögren syndrome during the later stage. It was two to five years from the first time to see a doctor to definite diagnosis. All of cases have been prescribed antibiotic eye drops for a long times, one case has been undergone three times trichiasis operation and made the disease progression. Among the five patients with OCP, 3 eyes were diagnosed Stage II, 5 eyes Stage III, 2 eyes Stage IV. Three cases were positive of bacterial culture. Only in 1 case, there was slight increase of iron protein as tumor mark. Inflammation was controlled by the end of the study, but cicatrization of 2 cases still progressed. CONCLUSION: Manifestation of OCP can mimic chronic conjunctivitis during the early stages, it is important to pay high attention to OCP, misdiagnosis may be stopped.

[Toxicity of topical ocular anti-allergic agents on human corneal epithelial cells in vitro].

OBJECTIVE: To investigate the cytotoxic effect of three kinds of topical ocular anti-allergic agent, including olopatadine 0.1% (A group), ketotifen fumarate 0.025% (B group) and pemirolast potassium 0.1% (C group), on cultured human corneal epithelial cells in vitro. METHODS: Primary human corneal epithelial cells were cultured with keratinocyte serum-free medium. The cells were exposed to three kinds of topical ocular anti-allergic agent for a period of 10 min, 30 min, 2 h, 6 h, 12 h and 24 h. Toxicity was examined in three ways. MTT assay was used to quantify cytotoxicity. Cell membrane permeability and intracellular esterase activity were analyzed with live-dead viability staining of fluorescent calcein-AM/ethidium homodimer. The morphologic analysis was performed by light and scanning electron microscopy. Statistical methods adopted one-way ANOVA (analysis of variance) and Student-Newman-Keuls q test between each group. The P-value of 0.05 was considered statistically significant. RESULTS: (1) Morphologic changes: The Findings under the light microscopy were demonstrated that cells became round or edematic and detached from dishes after exposure to topical ocular anti-allergic agent. The cellular damage was more severe with longer exposure time and increasing concentration. Likewise, the electron microscopy examination showed reduced microvilli with longer exposure time and increasing concentration. The cellular changes of 20.0% olopatadine 0.1% were reduced when compared to the other agents. (2) Live/dead viability/cytotoxicity assay: Ethidium homodimeric permeates damaged cell membranes and results in red fluorescence. These results indicated that cell membrane damage caused by 20.0% olopatadine 0.1% at 6, 12, 24 h was less than those of ketotifen fumarate 0.025% and pemirolast potassium 0.1%. The data of A group were (29.7 +/- 2.6)%, (36.9 +/- 3.2)%, (51.2 +/- 4.3)%, B group were (36.5 +/- 3.1)%, (48.5 +/- 4.3)%, (75.5 +/- 3.8)% and C group were (37.1 +/- 2.2)%, (52.7 +/- 3.4)%, (71.1 +/- 5.1)%, respectively. The q values of A to B group and A to C group at 6 h were 3.27, 4.31, respectively (P < 0.05). The green fluorescent staining of calcein-AM indicated intracellular esterase activity was decreased after incubation with increasing concentration and longer exposure time. There was no significantly different result between each group (P > 0.05). The proportion of green staining cell of A, B and C group at 24 h were 100.0% with 50.0% concentration and were (23.2 +/- 4.6)%, (29.5 +/- 5.2)%, (31.1 +/- 5.5)% respectively with 20.0% concentration (F = 1.97, P = 0.377). (3) MTT assay: The results of the three groups revealed cell viability decreased significantly with increasing concentration and longer exposure time at all the concentrations except 0.8%. MTT values for A, B and C group at the concentration of 20.0%, at 6 h were 0.429 +/- 0.028, 0.367 +/- 0.038, 0.379 +/- 0.012 and 4% at 24 h were 0.457 +/- 0.025, 0.401 +/- 0.008, 0.387 +/- 0.012, respectively. The data for olopatadine 0.1% were significantly improved over those of ketotifen fumarate 0.025% and pemirolast potassium 0.1%. The q value of A to B group, A to C group were 3.01, 3.77 (P < 0.05) at the concentration of 20.0%, 6 h and were 3.63, 4.11 (P < 0.05) at the concentration, 24 h. There were no statistical significant results at other concentrations. CONCLUSIONS: The topical ocular anti-allergic agent, olopatadine 0.1%, showed less toxic effects on human corneal epithelial cells compared to ketotifen fumarate 0.025% and pemirolast potassium 0.1%. Olopatadine 0.1% may offer a safer option to the corneal epithelium when used to treat allergic keratoconjunctivitis over an extended period of time.

[Retrospective analysis of clinical characteristics of toxic anterior segment syndrome].

OBJECTIVE: To investigate the etiology, clinical features, treatment and prognosis of toxic anterior segment syndrome (TASS). METHODS: It was a retrospective series case study. The clinical data of eight definite diagnosed TASS cases were retrospectively analyzed. RESULTS: Among eight TASS cases, seven were post cataract surgery cases and one was post cornea penetrating injury. Three cases were caused by residual povidone iodine on instruments, 2 cases resulted from the misuse of distilled water as intraocular irrigating liquid during cataract surgery, 2 cases were produced by the countercurrent of antibiotic solution via the cornea-scleral incision into anterior chamber during subconjunctival injection at the end of the surgery, and 1 case was induced by the injection of the distilled water into the anterior chamber at the end of the surgery. Three TASS cases occurred during operation and 5 cases occurred at 1 day after operation. All eight cases suffered from the painless blurred vision. Three cases occurred during operation presented with decrease of corneal transparency and depigmentation of iris. On the first day after operation, all cases had diffuse corneal stroma edema and severe anterior uveitis. Dexamethasone 0.1% or prednisolone acetate 1% eye drops, three times per day or one time per hour was used in all cases. Carteolol 2% eye drop, two times per day, was used for the cases with ocular hypertension. The cornea was clear in 6 cases, but corneal endothelial decompensation in 2 cases after therapy. CONCLUSION: Various toxic agents injected into anterior chamber by misuse can result in TASS. All these misuse can be avoided. Early diagnosis and proper management may be important to improve the prognosis of TASS.

[Changes of corneal limbus in long-term soft contact lens wearers by using laser confocal microscope].

OBJECTIVE: To investigate corneal limbus changes in long-term soft contact lens wearers using laser confocal microscope. METHODS: All examinees were chosen from people who received pre-refractive surgery examination or regular physical examination in Department of Ophthalmology of Peking University First Hospital during October to November, 2004 and May to October, 2006. The contact lens wearer (CLW) group consisted of 22 eyes of 22 patients (age distribution, 23 - 50 years) with a history of refractive errors and more than ten-year soft contact lens wear. Thirty-eight eyes of 38 patients (age distribution, 18 - 52 years) with refractive errors but no history of contact lens wear were observed as the controls. After detailed examinations of slit lamp biomicroscopy, superior and inferior limbus were examined by laser confocal microscope. Corneal microstructure and cell morphology were analyzed, and cell densities were measured. RESULTS: Images of corneal limbus could be observed clearly in both groups. The arrangement of limbal epithelium in CLW group showed irregular as compared to the control group. Epithelial microcystic changes and highly reflective dots among epithelium were found in CLW group which were not found in the control group. The Langerhans cell density of both superior limbus and inferior limbus in CLW group were higher than that of the control group (P < 0.05). There were highly reflective microdot deposits in the limbal corneal stroma in CLW group which were not appeared in the control group. Keratocyte density in anterior stroma of both superior and inferior limbus in CLW group was lower than that of the control group (P < 0.05). Keratocyte density in posterior stroma of both superior and inferior limbus in CLW group was lower than that of the control group (P < 0.05). The average stroma thickness of both superior and inferior limbus in CLW group was also lower than that of the control group (P < 0.05). CONCLUSIONS: Long-term soft contact lens wear can induce many changes in corneal limbus, such as microcystic changes in epithelial cells, microdot deposits in corneal stroma, increase of Langerhans cell density and decrease of keratocyte density, etc.

[Aware of glaucoma in the patients after excimer laser refractive surgery].

The prevalence of glaucoma in myopic patients is about two to three times than in general population, in which the prevalence of glaucoma is about 1%-2%. Millions of patients have been performed excimer laser refractive surgery for their refractive error. Thus, tens of thousands of the patients who received the refractive surgery will suffer from glaucoma in the next two decades. Some studies have found intraocular pressure (IOP) in patients with refractive surgery is lower, most likely due to the reduced central corneal thickness and intralamellar cyst syndrome. The use of steroid after the refractive surgery can increase IOP in the steroid responders. Therefore, the refractive surgeons should pay more attention to patient follow-up and surveillance of IOP.

[In vivo study of normal human limbal and central corneas using laser confocal microscope].

OBJECTIVE: To observe the microstructure and cellular populations of normal human limbal and central corneas using laser confocal microscope. METHODS: The study was consisted of 28 eyes of 15 examiners (age distribution, 16-61 years). After examinations with slit lamp biomicroscopy and ophthalmoscope, the images of superior, inferior limbus and central cornea were acquired by laser confocal microscope. Corneal microstructure and cell morphology were analyzed, and cell densities were measured. RESULTS: Lateral (x, y axis) and axial (z axis) images of limbal and central cornea were clear and vivid. Limbal palisades of Vogt were visible at the superior and inferior limbus. The red blood cells in the vessel of limbus were visible. The arrangement of surface epitheliums was rather loose, with bright borders and dark cell bodies. The surface epithelial cell density was (812 +/- 297) cells/mm(2) at the superior limbus and (785 +/- 263) cells/mm(2) at the inferior limbus. There was no statistical difference between the two group (P > 0.05). The bright and dendriform Langerhans cells were readily visible just under the epithelial cells. The Langerhans cell density was (288 +/- 102) cells/mm(2) at the superior limbus and (254 +/- 127) cells/mm(2) at the inferior limbus. There was no statistical difference between the two group (P > 0.05). At central cornea, the surface epithelial cells were loose, the borders of the cell were clear and bright, and the cell bodies were dark. The cell density was (1098 +/- 315) cells/mm(2), there were more cells in central cornea than other area of superior and inferior limbus (P < 0.05). The arrangement of basal epithelial cells was tight. Nerve plexus at subepithelium and anterior stroma were prominent with strong brightness. Langerhans cells were occasionally visible, and cell density cannot be measured. Subepithelial nerve fibers were thin with high tortuosity and a lot of branches, and deeper ones were thick with low tortuosity and few branch. In the stroma, separated keratocytes were visible under dark background, the boundaries were vague, the nucleis were bright and spindly. Hexagonal endothelial cells were arranged in order with light cell bodies and dark borders. The thickness of whole cornea, stroma or epithelium was (543.0 +/- 62.9), (462.0 +/- 69.5), (59.9 +/- 11.2) microm respectively. CONCLUSIONS: Laser confocal microscopy provides non-invasive, real-time, in vivo images of limbal and central corneas characterized with refined image definition, exact depth localization. It is valuable for basic research and clinical diagnosis of corneal disease.

[Effects of lens opacity on AccuMap multifocal objective perimetry in glaucoma].

OBJECTIVE: To investigate the effect of lens opacity on the performance of the multi-focal visual evoked potential (mfVEP) test in patients with glaucoma and its relationship with the Humphrey's automated static perimetry. METHODS: This is a prospective, non-randomized study. Twenty-two patients were enrolled with moderate cataract and primary glaucoma scheduled for cataract surgery with or without glaucoma surgery. Humphrey visual field and mfVEP test were preformed before surgery and after 6 - 8 weeks of post-operation. Lens opacity was evaluated with slit lamp according to LOCS III (lens opacity classification system, version III) by the same ophthalmologist. RESULTS: The improvement of AccuMap objective visual field was noted after lens removal in glaucoma patients. The amplitude of the AccuMap was significantly (P < 0.01) increased after cataract surgery compared to pre-operation (382.6 nV +/- 146.7 nV vs 308.0 nV +/- 96.6 nV). AccuMap severity index (ASI) was significantly (P < 0.001) decreased following lens removal compared with pre-operation (48.6 +/- 42.4 vs 90.0 +/- 54.8, P < 0.001). Latency was little changed before and after surgery (1207.5 ms +/- 67.7 ms, 1191.2 ms +/- 61.9 ms, respectively, P = 0.289). There were no correlations between the changes of amplitude and the degree of lens opacity (Spearman correction, P = 0.09). For Humphrey visual field, the mean deviation (MD) of pre- and post-operative was significantly (P < 0.001) affected by lens opacity (-12.2 +/- 7.8, -9.6 +/- 8.8, respectively, P < 0.001), but pattern standard deviation (PSD) had no such changes (6.5 +/- 3.2, 6.3 +/- 4.0, respectively, P = 0.748). There were well correlated between the ASI and the MD both pre- or post-operation (Pearson correction, P = 0.013, P < 0.001), and between the ASI changes and the MD changes after lens removal (Pearson correction, P = 0.017). CONCLUSIONS: Lens opacity affects the AccuMap objective visual field in patients with glaucoma, especially the amplitude of the AccuMap. The ASI is sensitively correlated with the MD of Humphrey perimetry.

[The long-term effect of phacoemulsification combined with trabeculectomy and intraoperative 5-fluorouracil in glaucoma patients].

OBJECTIVE: This study was designed to evaluate the long-term effect of phacoemulsification, lens implantation combined with trabeculectomy augmented with 5-Fluorouracil (phaco-trab-5-Fu) in Asian glaucoma patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: This retrospective study included 71 consecutive patients who underwent phaco-trab-5-Fu in Singapore National Eye Center between January 1996 and December 1998. Patients with follow-up time less than 6 months were excluded from the study. RESULTS: The mean follow-up time was (53.1 +/- 20.9) months. Postoperative IOP was significantly lower than preoperation [(15.0 +/- 4.0) mmHg (1 mmHg = 0.133 kPa), (20.3 +/- 5.4) mmHg, respectively, P < 0.01]. Postoperative number of antiglaucoma medications was also significantly decreased than preoperation (P < 0.01). IOP of 1 to 5 years postoperation dropped significantly from that of preoperation (P < 0.01). Complete success (CS) rate of phaco-trab-5-Fu was 84.2%, 62.7%, 55.3% for 1, 3, 5 years, respectively. There were neither significant difference found in PACG group and POAG group, or in single-incision and separate-incision of CS rate. But mean IOP of last follow-up was significantly different between PACG and POAG [mean IOP (13.8 +/- 4.6) mmHg, (16.2 +/- 3.7) mmHg, respectively, P = 0.02]. According to LogMAR chart, mean preoperative visual acuity (VA) and postoperative VA were 0.75 +/- 0.40 and 0.46 +/- 0.46, respectively. Postoperative VA was significantly improved (P < 0.01). In visual field, MD were (-16.6 +/- 8.8) dB and (-17.6 +/- 10.1) dB at preoperation and postoperation, respectively. PSD were (6.2 +/- 2.9) dB and (6.5 +/- 3.2) dB correspondingly. There were no significant difference in both MD and PSD (P = 0.55, 0.64, respectively). One patient had early endophthalmitis and required vitrectomy. Two late-onset of hypotony were due to choroidal effusion and wound leak. CONCLUSIONS: Phacoemulsification combined with trabeculectomy and 5-Fu could be a successful and safe treatment for patients with cataract and primary glaucoma in a long run. There is no difference in success rate in PACG and POAG, or in single incision or separate incision in such combined surgery.