[Several considerations on how to achieve perfect ophthalmic anesthesia].

The reality that most of ophthalmic surgeries are conducted under retrobulbar block or topic anesthesia performed by the ophthalmic surgeons themselves may affect the balance between quality and efficiency of ophthalmic anesthesia. The authors suggest that the key principle to perform ophthalmic anesthesia is to help the patients be well prepared preoperatively. In order to achieve this goal, we should make full use of the supraglottic airway device and awake sedation, improve ultrasound-guided regional block technique, strengthen cooperation with ophthalmic surgeons, thereby meeting the comfortable anesthesia requirements of ophthalmic surgery patients and adapting for the development trend of day surgery.

[The analgesic efficacy and safety of non-steroidal anti-inflammatory drugs combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy after orbital decompression].

Objective: To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression. Methods: This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (n=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery. Results: The NRS pain scores [M(Q1, Q3)] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(P=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (P=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all P>0.05). There were no obvious complications of medial canthus peribulbar block in group PB. Conclusions: NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.

Clinical characteristics of lip infantile haemangiomas and main risk factors for ulceration: an 8-year retrospective study of 69 Chinese infants.

BACKGROUND: Infantile haemangiomas (IHs) involving the lip are of special concern because of the susceptibility of complications, including ulceration, obstruction and disfigurement. The available data for the relationship between their clinical characteristics and ulcerations are limited. OBJECTIVES: To describe the clinical characteristics of lip IHs and to evaluate the main risk factors for ulceration. METHODS: A retrospective study was designed that included infants with lip IHs during an 8-year period, the clinical data of participants were collected, and univariable and multivariable logistic models were used to determine the relationships between the clinical characteristics of lip IHs and ulcerations. Location, size and type were investigated as potential independent factors influencing the development of ulceration. RESULTS: A total of 69 lip IHs were identified including 40 girls and 29 boys. Ulcerations were found in 37 (53.6%) lip IHs. Lip haemangiomas experiencing ulceration had a mean size (SD) of 3.49 (2.82) cm2 compared with 1.08 (0.96) cm2 for those without ulceration. Twenty-eight (52.8%) of the 53 localized haemangiomas and 9 (56.3%) of the 16 segmental haemangiomas experienced ulcerations. Univariable analyses of all investigated factors revealed significant associations of location and size with increased risk of ulceration, and these significant associations remained after adjusting for sex and age [OR 8.61 (95% CI, 2.24-33.13) and 2.62 (95% CI, 1.46-4.72), respectively]. The duration before ulceration was between 4 and 70 days after the occurrence of lip IHs, with a median of 28 (19.41) days. Most ulcers occurred within 45 days of IH occurrence. CONCLUSIONS: Ulceration is a common complication of lip IHs at an earlier stage. A swollen with pale or bright crimson appearance of the lip IH surface could be an important signal of subsequent ulceration. Location of the IH on the lower lip and lip IH size are risk factors for the occurrence of ulceration.

Intense nanosecond pulsed electric fields promote cancer cell apoptosis through centrosome-dependent pathway involving reduced level of PLK1.

BACKGROUND: Intense nanosecond pulsed electric fields (nsPEFs) have been known to promote apoptosis without physically changing membrane structure or damaging morphology of tumor cells. To determine the contribution of centrosome to the progression of apoptosis by nsPEFs, HeLa cells were exposed to high intensity (6 kV/cm) nsPEFs (8-32 ns) in normal culture condition and cell biology and molecular parameters of cells were investigated. MATERIALS AND METHODS: Apoptotic cell death was identified by TUNEL assay after being exposed to the nsPEFs with various pulse durations, while immunofluorescent staining was performed to detect the number and distribution of centrosomes. To clarify whether nsPEFs-induced centrosome over-duplication is the consequence of DNA damage, we used comet assay to detect simultaneous DNA damage. And additionally Western Blot was used to detect PLK1 protein level to explore the correlation between apoptotic cell death and nsPEFs-induced centrosome over-duplication. Correlation between nsPEFs and molecular parameters was statistically analyzed. RESULTS: NsPEFs induced a clear apoptosis reaching a maximum at 24ns, 24h after exposure (p < 0.05), where DNA fragmentation and over-duplicated centrosomes were observed. This apoptosis may be promoted in a time- and pulse duration-dependent manner. Polo-like kinase (PLK1) protein levels were significantly decreased by such nsPEFs (p < 0.05). Control treatment without the nsPEFs did not cause any damage to the cultured HeLa cells. CONCLUSIONS: Intense nsPEFs promote cell apoptosis through a centrosome-mediated pathway involving a reduction in the level of PLK1, which may provide new therapeutic targets for human cancer treatment.

[Strabismus and stereopsis].

104 strabismic patients successfully corrected surgically were followed up for 6 months to 13 years, averaging 2 1/2 years, and 55 obtained final stereopsis. These results suggest that early strabismus surgery is important in establishing stereopsis. Furthermore, the younger he onset of strabismus, the poorer are the chances of building up stereopsis, and congenital cases have the poorest prognosis.