Meta-analysis of unilateral resection-recession versus plication-recession for exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the effectiveness of unilateral lateral rectus recession-medial rectus resection(RR))and lateral rectus recession-medial rectus plication(RP)in the treatment of exotropia. METHODS: Evidence-based medicine research. A systematic database search was conducted Medline, Embase, Web of Science, the Cochrane Register of Controlled Trials and so on from August 2011 to August 2021. Related studies meeting the inclusion criteria were included in our study. The main outcome measures were as follows: success rate and postoperative deviation. Mean difference(MD)and odds ratio(OR)with 95% confidence interval(CI)were statistical analyzed as measurement data and continuous variables statistics. RESULTS: A total of two randomized controlled studies and five retrospective studies were included. The Meta-analysis results showed that the success rate of surgery was similar for RP group compared with RR group(OR=0.65, 95%CI:0.39-1.07, P=0.09). There was no difference in the incidence of poor postoperative prognosis of the two groups(the undercorrection and overcorrection rates)(OR=1.59; 95%CI: 0.92-2.74, P=0.10; OR=4.43; 95%CI: 0.69-28.18, P=0.12). There were no significant differences in postoperative deviation and the amount of external oblique drift(MD=0.75, 95%CI: -0.27-1.76, P=0.15; MD=-0.34, 95%CI: -1.30-0.63, P=0.50). CONCLUSION: The success rate of RP and RR surgery is close to the incidence of poor postoperative prognosis, moreover, there was no significant difference between the deviation and the amount of external oblique drift after the two surgeries, RP is an effective surgical procedure for the treatment of exotropia.

Evaluation of the quality of life in intermittent exotropia by the Chinese version of the intermittent exotropia questionnaires / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the effects of intermittent exotropia(IXT)on the quality of life of children and their parents using the Chinese version of intermittent exotropia questionnaires(CIXTQ).METHODS: The scores of CIXTQ were collected from IXT children and the same number of age-matched control children in department of ophthalmology, Nanjing Children's Hospital from June 2020 to June 2021. They were the Chinese version of intermittent exotropia questionnaires scores(CIXTQ, for children to assess their health related quality of life), the parental proxy CIXTQ(pp-CIXTQ, for parents to assess children's life quality)scores and the parent CIXTQ(p-CIXTQ, for parents to assess their life quality)scores. To explore: 1)The differences in the CIXTQ, pp-CIXTQ and p-CIXTQ scores between IXT children and the normal children; 2)The relationship between the CIXTQ and pp-CIXTQ scores in IXT children; 3)The factors affecting the quality of life in children with IXT.RESULTS: A total of 156 patients with IXT and 156 age-matched normal children were included. CIXTQ scores in the children with IXT group was lower than that in the control group(t=-12.915, P<0.001). In IXT group, there was no difference observed in CIXTQ or pp-CIXTQ scores(t=-0.718, P=0.473). As suggested by item-level analysis, children in the IXT group were more concerned about how others think of them and their vision, whereas parents were more concerned about whether the child needs surgery, and whether the permanent damage of strabism caused to the eyes of their children and whether strabismus affects their social life.CONCLUSION: The CIXTQ performed better in distinguishing the children with IXT and those with normal condition, and it can accurately predict the impact of IXT on children, and benefit to make personalized treatment regimens.

Value of amino-terminal pro-brain natriuretic peptide as a predictive marker of symptomatic patent ductus arteriosus in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (sPDA) in preterm infants.</p><p><b>METHODS</b>Preterm infants born at a gestational age (GA) of ≤ 32 weeks and diagnosed with patent ductus arteriosus (PDA) by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-proBNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into sPDA group and asymptomatic PDA (asPDA) group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-proBNP level and echocardiographic indices were analyzed. Serum NT-proBNP levels were compared between the two groups. The receiver operator characteristic (ROC) curve was applied to determine the sensitivity and specificity of serum NT-proBNP in the prediction of sPDA.</p><p><b>RESULTS</b>A total of 69 preterm infants were enrolled in this study, with 13 infants in the sPDA group and 56 infants in the asPDA group. Serum NT-proBNP level was positively correlated with the diameter of the arterial duct (r=0.856; P<0.05)and the ratio of left atrial diameter to aortic root diameter (LA/AO) (r=0.713; P<0.05). At 3 and 5 days after birth, the serum NT-proBNP levels in the sPDA group were significantly higher than those in the asPDA group (P<0.05). The area under the ROC curve (AUC) for the prediction of sPDA by NT-proBNP levels at 3 days after birth was 0.949 (95% CI: 0.892-1.000; P<0.001), with a cut-off value of 27 035 pg/mL (sensitivity: 92.3%; specificity: 94.6%); the AUC for the prediction of sPDA by NT-proBNP levels at 5 days after birth was 0.924 (95% CI: 0.848-1.000; P<0.001), with a cut-off value of 6 411 pg/mL (sensitivity: 92.3%; specificity: 92.9%).</p><p><b>CONCLUSIONS</b>NT-proBNP may be a quantitative index for shunt volume. The measurement of serum NT-proBNP levels on 3 and 5 days after birth may be useful to predict sPDA in preterm infants.</p>

Protective effects of IGF-1 on cortical nerve cells of neonatal rats under oxidative stress / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the protective effects of insulin-like growth factor-1 (IGF-1) on the nerve cells of neonatal rats under oxidative stress.</p><p><b>METHODS</b>Primary cortical neurons, oligodendrocytes, and astrocytes from newborn rats were cultured. An oxidative stress model was established with different concentrations of H2O2 (0-60 μmol/L); the degree of damage of nerve cells was evaluated by lactate dehydrogenase assay, and the viability of nerve cells was tested by MTT assay. An oxidative stress model was established with different concentration of H2O2 (0-80 μmol/L). Expression of Akt/p-Akt (Ser473) in neurons was measured by Western blot before and after IGF-1 (25 ng/mL) administration.</p><p><b>RESULTS</b>Compared with those not treated with H2O2, the cortical neurons, oligodendrocytes, and astrocytes treated with different concentrations of H2O2 for 24 hours showed increased damage and decreased cell viability; compared with oligodendrocytes and astrocytes, neurons showed significantly more changes (P<0.01). Compared with those not treated with H2O2, the cortical neurons treated with different concentrations of H2O2 for 5 minutes showed a significant decrease in p-Akt (Ser473) level (P<0.01), which was dependent on the concentration of H2O2. For the neurons treated with low-concentration H2O2, the addition of IGF-1 could reverse the inhibition of Akt phosphorylation, eliminating the difference in p-Akt level compared with the neurons not treated with H2O2, (P>0.05); however, it had no significant effect on the inhibition of Akt phosphorylation by high-concentration H2O2, and the treated neurons still had a lower p-Akt level than untreated neurons (P<0.01 for all). For the cortical neurons that had been treated with different concentration of H2O2 for 1 hour, the addition of IGF-1 (25 ng/mL) could eliminate thedifference in p-Akt level between the treated neurons and untreated neurons (P>0.05).</p><p><b>CONCLUSIONS</b>Cortical neurons are more sensitive to oxidative stress induced by H2O2 than other nerve cells. IGF-1 has protective effects on cortical nerve cells under oxidative stress.</p>

Oxidative stress inhibits the protective effects of insulin-like growth factor-1 on cortical neurons of neonatal rat / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the protective effects of insulin-like growth factor-1(IGF-1) on the survival and apoptosis of cortical neurons of neonatal rat under oxidative stress and its significance.</p><p><b>METHOD</b>Primary cortical neurons from newborn rat were cultured and the oxidative stress model was established. Then cells were randomly divided into IGF-1 group and control group. The concentration of LDH in supernatant was detected. Cell survival was determined with MTT assay and the expression of active Caspase-3 was measured using Western Blotting.</p><p><b>RESULT</b>(1) The values of LDH gradually decreased with the increasing IGF-1 added to the cells [(0.5065 ± 0.0064) to (0.435 ± 0.0065), (P < 0.01)], but when the concentration of IGF-1 reached a certain level (> 25 ng/ml), there were no longer obvious effects on the level of LDH [(0.42 ± 0.012) to (0.418 ± 0.0098), (P > 0.05)]; Western blot showed that the level of active Caspase-3 was significantly decreased after treatment with IGF-1 [(0.662 ± 0.033) to (0.199 ± 0.01), (P < 0.01)]. (2) Compared with control group, without or with low concentration of H2O2 (0 - 40 µM), the values of LDH and the expression of active Caspase-3 in IGF-1 group were significantly decreased[(1.518 ± 0.137) to (1.068 ± 0.067), (P < 0.05) and 0.850 ± 0.042 to 0.597 ± 0.03, P < 0.01, respectively] while the values of MTT obviously elevated [(0.773 ± 0.062) to (1.196 ± 0.057), (P < 0.05)]; but with higher concentration (≥ 60 µM) of H2O2, the values of LDH and MTT and the expression of active Caspase-3 in IGF-1 group all had no significant difference (P > 0.05). (3) When the concentration of H2O2 reached 60 µM and higher, whatever concentration of IGF-1 could not lower the level of LDH compared with control group [(2.376 ± 0.04) to (2.442 ± 0.046), (P > 0.05)].</p><p><b>CONCLUSIONS</b>Oxidative stress can induce IGF-1 resistance of cortical neurons in neonatal rat, and even increasing the concentration of IGF-1 can not restore their sensitivity to IGF-1.</p>

The value of somatosensory evoked potential in the clinical evaluation of congenital scoliosis with and without intraspinal malformations / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of somatosensory evoked potential (SEP) in the diagnosis of congenital scoliosis (CS) with intraspinal malformation.</p><p><b>METHODS</b>From September 2001 to September 2007 posterior tibial nerve SEP were performed on 187 operatively treated CS patients. There were 85 male and 102 female, and the average age was 13.8 years (range from 30 to 22 years). Patients with intraspinal malformations were diagnosed by MRI. Absence of SEP waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. The incidence of pathological SEP and clinical characteristics were compared between patients with and without intraspinal malformations.</p><p><b>RESULTS</b>Of 187 patients, intraspinal malformations were diagnosed in 32 patients (17.1%). The incidence of intraspinal malformations was higher in type III (30.8%) than in type I and II CS patients (P < 0.05). The mean Cobb angle of scoliosis in patients with intraspinal malformations was greater than without intraspinal malformations, but there was no difference in kyphosis between the two groups. The ratio of abnormal SEP in patients with intraspinal malformations was 75.0% (24/32), while it was 38.7% (60/155) in patients without intraspinal malformations, and it showed significant difference between the two groups (χ(2) = 4.70, P < 0.05).</p><p><b>CONCLUSIONS</b>SEP is a reliable tool for assessment of spinal cord function in patients with congenital scoliosis. It could be helpful for the diagnosis of intraspinal malformations, and also might provide an important reference for assessment and treatment of intraspinal malformations in congenital scoliosis.</p>

Association between polymorphism of Matrilin-1 gene (MATN1) with susceptibility to adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the association of matrilin-1 gene polymorphisms with adolescent idiopathic scoliosis (AIS) risk.</p><p><b>METHODS</b>This study population consisted of 419 patients with AIS and 460 healthy controls. The maximum Cobb angle of AIS patients was recorded. For initial screening, the 7 tagSNPs were genotyped in 197 cases and 172 controls. Next, we validated any significant associations in additional sample of 222 cases and 288 controls. Single-marker and haplotype analysis were employed. Genotyping was performed by PCR-RFLP method.</p><p><b>RESULTS</b>We found that allele G of rs1149048 was a significant predisposition allele of AIS (P = 0.0027, OR = 1.34 within 95% CI = 1.11 approximately 1.62), and individuals with genotype GG had a higher risk for AIS compared to AA + AG (P = 0.0008, OR = 1.61 within 95% CI = 1.22 approximately 2.12). Polymorphism of rs1149048 was also associated with curve severity in AIS patients. And a significantly higher in maximum Cobb angle was found in patients with GG genotype (P = 0.002).</p><p><b>CONCLUSIONS</b>It is concluded that the tagSNP rs1149048 polymorphism in the MATN1 promoter region is associated with both susceptibility and disease severity in AIS.</p>

Study of relationship between position of the cerebellar tonsil and abnormal somatosensory evoked potentials in adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the abnormality of position of the cerebellar tonsil and somatosensory evoked potentials (SEP) in adolescent idiopathic scoliosis (AIS), and to explore its clinical significance.</p><p><b>METHODS</b>Sagittal magnetic resonance imaging (MRI) of hindbrain and posterior tibial nerve SEP (PTN-SEP) were performed on 171 young operative treated AIS patients. The PTN-SEP obtained from 45 age-matched healthy control individuals were considered as standard values. Tonsillar ectopia (TE) was defined as any inferior displacement of the tonsils. Absence of SEP waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. The incidence of TE and pathological SEP was determined in all AIS patients. The association of TE and abnormal SEP for AIS patients was also assessed.</p><p><b>RESULTS</b>The incidence of TE and abnormal SEP in AIS patients was 36.8% (63/171) and 36.3% (62/171), respectively. It was shown the frequency of TE and abnormal SEP were not significantly different among AIS patients with different curve severity. Statistical analysis failed to show a correlation between TE and abnormal SEP.</p><p><b>CONCLUSIONS</b>TE and disorder of somatosensory pathways do exist in a subgroup of AIS patients. However, there is not a significant association between TE and abnormal somatosensory function. It is suggested that TE and disorder of somatosensory function might contributes to different etiopathogenesis of AIS.</p>

Characteristic of somatosensory evoked potentials in adolescent idiopathic scoliosis and relationship with Cobb angle / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS.</p><p><b>METHODS</b>Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle >40 degrees and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for AIS patients was also assessed.</p><p><b>RESULTS</b>Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Inter side difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant inter side difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity.</p><p><b>CONCLUSION</b>Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.</p>

Association between insulin-like growth factor-1 receptor gene polymorphisms and with susceptibility to adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the association of insulin-like growth factor-1 receptor (IGF-1R) gene polymorphisms and with susceptibility to adolescent idiopathic scoliosis (AIS).</p><p><b>METHODS</b>This study included 200 patients with AIS and 200 healthy controls. Height, menarche status, curve pattern, Cobb angle, and Risser sign in female patients were recorded. Blood samples were taken form each subject by venipuncture. Genetic DNA was extract from peripheral blood leukocytes using standard phenol/chloroform extraction. PCR-RFLP (polymerase chain reaction-restriction-fragment length polymorphism) was used for the genotyping.</p><p><b>RESULT</b>The genotype and allele frequency distribution were similar between AIS and normal control (P>0.05). The mean maximum Cobb angle, Risser sign, menarche status of different genotypes of IGF-1R gene were similar with each other among female AIS patients (P>0.05).</p><p><b>CONCLUSIONS</b>The IGF-1R gene is neither associated with the occurrence nor the curve severity of AIS.</p>