[Efficacy of sutureless intrascleral intraocular lens fixation with the modified Yamane technique].

Objective: To evaluate the efficacy of sutureless intrascleral intraocular lens (IOL) fixation with the modified Yamane technique. Methods: It was a retrospective case series study. Patients undergoing sutureless intrascleral IOL fixation with the modified Yamane technique were included at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from January 2022 to September 2023. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), recorded as the logarithm of the minimum angle of resolution (logMAR), were measured before surgery and at 1 day, 3 days, 1 week, 1 month, and 3 months postoperatively. Refractive error and intraocular pressure were also checked. Anterior segment examination with a slit lamp microscope, fundus examination, anterior segment and posterior segment optical coherence tomography were performed. Intraoperative and postoperative ocular complications were documented. Results: A total of 53 patients (53 eyes) were included in this study, comprising 40 males and 13 females, with a median age of 60 (49, 68) years. Among them, the proportion of a history of trauma was 22.6% (12/53). There was 1 eye with intraoperative vitreous hemorrhage (1.9%). All eyes had no obvious hypotony, no obvious inflammation in the anterior chamber, and no pupillary abnormalities at 1 week after surgery. The mean follow-up time was (8.0±3.3) months (range, 3 to 16 months). There was no iris capture, re-dislocation, or haptic exposure of the IOL during the follow-up. The corneal endothelial cell density was (2 236±704) cells/mm2 preoperatively and (1 964±628) cells/mm2 at 1 month, with significant difference (P<0.001). The UCVA (logMAR) was 1.53±0.75 preoperatively, 0.18±0.17 at 1 month, 0.15±0.14 at 3 months, and 0.14±0.13 at the final visit (P<0.001). The UCVA (logMAR) at 1 month was significantly different from that at 3 months and the final visit (both P<0.05). At 1 month, 50.9% (27/53) of the eyes had an UCVA (logMAR)≤0.1, and the rate was 56.6% (30/53) at 3 months. The BCVA (logMAR) was 0.25±0.21, 0.03±0.06, 0.02±0.06, and 0.02±0.06 before surgery, at postoperative1 month, 3 months, and the final visit, respectively (P<0.001). The BCVA (logMAR) at 1 month was not significantly different from that at 3 months and the final visit (both P>0.05). The rate of the eyes with a BCVA (logMAR)≤0 was 81.1% (43/53) at 1 month and 83.0% (44/53) at 3 months. The IOL tilt was (5.18±2.60)° at postoperative 1 month and (5.08±2.48)° at postoperative 3 months, without statistically significant difference (P>0.05). The IOL decentration was (0.35±0.24) mm at postoperative 1 month and (0.32±0.24) mm at postoperative 3 months, without statistically significant difference (P>0.05). Conclusion: Sutureless intrascleral IOL fixation with the modified Yamane technique is simpler and more minimally invasive to achieve a stable and centered IOL implantation with fewer complications and good visual prognosis.

[Comparison of corneal power assessment methods after small incision lenticule extraction].

Objective: To compare the accuracy of different corneal curvature parameters in assessing the corneal refractive status and tracking corneal power changes after small incision lenticule extraction (SMILE). Methods: This prospective cross-sectional study tracked and recorded total corneal curvature parameters measured by different instruments before and three months after SMILE for myopia. These parameters, including total keratometry (TK) from the IOLMaster 700, total corneal refractive power (TCRP) from the Pentacam AXL, real keratometry (RK) from the CASIA 2, and corrected parameters calculated using the Haigis, Shammas, and Maloney methods, were compared with data obtained using the clinical history method (CHM). Surgically induced changes in TK, TCRP, and RK were analyzed and compared with those in spherical equivalent on the corneal plane (ΔSEco). Results: The study included 40 eyes (40 participants). After SMILE, the difference was smallest between TK [(0.08±0.38) D] and CHM values (P>0.05). However, TCRP, RK, KHaigis, KShammas, and KMaloney were significantly different from CHM data (P<0.05). The width of the 95% limits of agreement of TK (1.49 D) was narrowest, followed by that of RK (1.57 D). Pearson analysis showed that each parameter had a good correlation with CHM data. The differences between the changes in TK, TCRP and RK caused by surgery and ΔSEco were (0.03±0.39) D, (0.17±0.43) D, and (-0.19±0.46) D, respectively. The width of the 95% limits of agreement of ΔTK (1.54 D) was narrowest, and the correlation coefficient of ΔTK (0.951) was highest. Conclusion: The parameter TK of the IOLMaster 700 can provide accurate and objective corneal power evaluation after SMILE.

[Ultrasonographic features of retinal pigment epithelial adenoma].

Objective: To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma. Methods: It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI). Results: Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification. Conclusion: The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

[Clinicopathological features of mature T/NK cell lymphoma with aberrant CD20 or CD79α expression].

Objective: To investigate the clinicopathological characteristics and prognosis of mature T/NK cell lymphomas with aberrant CD20 or CD79α expression. Methods: A retrospective analysis of 641 cases of mature T/NK cell lymphoma diagnosed from January 2014 to December 2020 was performed, and 14 cases of CD20-positive and one case of CD79α-positive mature T/NK-cell lymphoma were identified. Histological examination, immunohistochemical characterization, in situ hybridization for Epstein-Barr virus encoded early RNA (EBER), and PCR testing for immunoglobulin and T cell receptor (TCR) gene rearrangements were performed. Clinicopathological characteristics of these lymphomas were analyzed. Results: There were 13 males and 2 females, with a median age of 56 years. There were 8 cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), 3 cases of extranodal NK/T-cell lymphoma, nasal type (ENKTCL), 2 cases of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) and 2 cases of angioimmunoblastic T-cell lymphoma (AITL). Twelve cases were stage Ⅲ or Ⅳ lymphomas. The prognosis was overall poor. The histology, immunophenotype and TCR gene rearrangement were not significantly different from the corresponding types of lymphoma. Ki-67 proliferation index was over 70% in all cases. The expression of CD20 or CD79α was weak and heterogeneous. All 15 case of Ig gene rearrangement were polyclonal. Conclusions: Mature T/NK cell lymphoma with abnormal expression of CD20 or CD79α is rare, commonly found in advanced stage, and associated with poor prognosis. The expression of CD20 or CD79α in these cases is weaker than the corresponding mature T/NK cell lymphomas, while its proliferation index is higher. Histomorphology, extensive immunoprofiling and molecular detection are required for accurate diagnosis.

[Clinicopathological features and BRAF V600E and MYD88 L265P mutation status of nodal marginal zone lymphoma].

Objective: To investigate the clinicopathological features as well as BRAF V600E and MYD88 L265P mutation status of nodal marginal zone B cell lymphoma (NMZL). Methods: Thirty-two cases of NMZL were diagnosed from September 2009 to February 2021 at the Henan Provincial People's Hospital and Peking University School of Basic Medical Sciences. The clinicopathologic characteristics were obtained and analyzed. BRAF V600E and MYD88 L265P mutation status were identified using PCR and Sanger sequencing, respectively. Results: There were 20 males and 12 females patients with a median age of 69 years (ranging 36-82 years). The most prevalent clinical manifestation was multiple lymph nodes enlargement in head and neck (22/32, 68.8%), followed by inguinal (12/32, 37.5%), axillary (11/32, 34.4%), mediastinum (5/32, 15.6%) and retroperitoneal lymph nodes (4/32, 12.5%). Most of the patients were in Ann Arbor stage Ⅰ/Ⅱ (21 cases). The morphologic features included diffuse (24/32, 75.0%), nodular (5/32, 15.6%), interfollicular (2/32,6.3%) and perifollicular (1/32,3.1%) types. The tumor cells showed monocyte-like, centrocyte-like, small lymphocyte-like and plasma cell-like differentiation. Immunophenotyping revealed diffuse expression of CD20 in all tumor cells, whereas CD43 (11/32, 34.4%), bcl-2 (20/32, 62.5%), MNDA (13/32, 40.6%) and CD5 (2/32, 6.3%) were partially expressed. Ki-67 proliferation index varied from 10% to 40%. BRAF V600E mutation was found in two cases (2/32, 6.3%), but MYD88 L265P mutation was not detected. Eighteen patients survived and three died at the end of follow-up period which ranged 6 to 110 months. Conclusions: The morphologic features of NMZL varies across individuals, it should be differentiated from various B-cell lymphomas; however immunological biomarkers with high specificity for NMZL are still lacking. No MYD88 L265P mutation is found in NMZL. Some cases may harbor BRAF V600E mutation and yet the prevalence remains indeterminate; further researches are warranted.

[Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma].

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

[Correlation between heart rate index, SBPpeak-to-SBPrest ratio and peak oxygen consumption in patients with chronic heart failure].

Objective: To investigate the correlation between heart rate index (HRI), systolic blood pressure(SBP) peak-to-SBPrest ratio (SBPR) and peak oxygen consumption (peakVO2) in patients with chronic heart failure (CHF), and discuss the possibility of using HRI and SBPR collected during exercise to assess the exercise tolerance of CHF patients in the absence of gas analysis. Methods: In this cross-sectional study, a total of 547 patients with CHF who underwent cardiopulmonary exercise test(CPET) in Tongji Hospital Heart Rehabilitation Center Affiliated to Tongji University from March 2007 to December 2018 were collected retrospectively, focusing on their clinical data including age, gender, type of heart failure,BMI as well as data collected during their CPETs, such as peakVO2, HRI and SBPR. Spearman univariate correlation analysis was used for statistical analysis, to unveil the correlations between peakVO2 and those parameters, and multiple linear regression analysis was also conducted. Results: A total of 547 CHF patients conducting CPET were included in this research, of which 447 were male, at age of 63(56, 69). Univariate analysis indicates that HRI, SBPR and peakVO2 showed significant positive correlation (r=0.323, 0.263, respectively, all P<0.001); Age and peak VO2 showed significant negative correlation(r=-0.207, P<0.001); Male patients showed peakVO2 higher than female(r=-0.229, P<0.001); PeakVO2 of heart failure with reduced ejection fraction(HFrEF) was lower than heart failure with mid-range ejection fraction(HFmrEF)and heart failure with preserved ejection fraction(HFpEF) (r=0.181, P<0.001). Body mass index (BMI) had no significant correlation with peakVO2 (P>0.05). Multivariate linear regression analysis showed that the HRI, SBPR were positively correlated with peakVO2(t=7.68, 5.08, respectively, all P<0.05), while age and BMI showed negative correlation with peakVO2(t=-5.43, -0.31, respectively, all P<0.05). PeakVO2 of male was higher than female(t=-6.03, P<0.05), and peakVO2 of HFrEF was lower than those of HFmrEF and HFpEF(t=3.17, 4.48, respectively, all P<0.05). A linear equation (F=33.52, adjusted R2=0.29) could be constructed: peakVO2=10.65(male) or 8.53(female)+4.26HRI+3.31SBPR-0.07age-0.13BMI+0(HFrEF) or 1.05 (HFmrEF) or 1.62(HFpEF). Conclusion: HRI and SBPR are positively correlated with peakVO2. In the absence of gas analysis, it is possible to apply HRI and SBPR during exercise to predict exercise tolerance in patients with CHF.

[Epidemiological trend of cervical cancer].

Cervical cancer is the fourth most common malignant tumor in women worldwide, cervical cancer is also the only malignant tumor that is considered to be a known cause in human tumors, however, there is no significant decline in cervical cancer morbidity and mortality. It is estimated that there were about 570, 000 new cases of cervical cancer in the world in 2018, accounting for 3.15% of all cancer cases; and there were about 310, 000 deaths of cervical cancer, accounting for 3.26% of all cancer deaths. The burden of cervical cancer worldwide is severe. The article summarizes the epidemiological trends of cervical cancer worldwide with the latest data, and provides etiological basis and theoretical support for the prevention and treatment of cervical cancer in women.

[Role of up-regulated DDX3 in the proliferation of human cervical cancer cells].

Objective: To investigate the role of DDX3 up-regulation in the proliferation of human cervical cancer cells and its correlation with clinical prognosis. Methods: Expression levels of DDX3 in the 59 specimens of cervical cancer and adjacent non-neoplastic tissue collected at Henan Provincial People's Hospital from April 2012 to March 2013 were detected using immunohistochemistry. A lentivirus-mediated DDX3-over-expression cell line was constructed based on HeLa cells of cervical cancer. CCK-8 assay was used to evaluate cell survival rate. Boyden chamber was used to measure the cell migration and invasion. Real-time fluorescence quantitative PCR was used to detect DDX3 expression level and Western blot was used to detect the expression of EMT and PI3K/Akt signal pathway-related proteins. Results: DDX3 overexpression was associated with FIGO stage, depth of cervical invasion and lymph node metastasis (P<0.05). Kaplan-Meier analysis revealed that cervical cancer patients with high expression of DDX3 had a poor overall survival (P<0.05). Compared with the cells transfected with pLVX-Con vector, the expression of DDX3 protein and mRNA was significantly increased in the cells transfected with pLVX-DDX3 (all P<0.01). Cell proliferation was significantly increased following transfection with pLVX-DDX3 for 72 h in HeLa cells compared with that transfected with pLVX-Con (P<0.05). Compared with the controls, DDX3 overexpression significantly promoted the migration and invasion of HeLa cells (P<0.05), and increased the expression of N-Cadherin, vimentin and Snail in HeLa cells (P<0.05). In pLVX-DDX3 group, the expression levels of ß-catenin, phosphorylated Akt, and pAkt's downstream target p-GSK3ß were significantly higher than those of pLVX-Con group (P<0.05). The expression levels of p-Akt, p-GSK3ß and ß-catenin were decreased when the PI3K/Akt pathway was blocked using the PI3K inhibitor LY294002 (P<0.05), and the expression levels of N-Cadherin, vimentin and Snail were also significantly decreased (P<0.05). Conclusions: DDX3 overexpression promotes proliferation, migration and invasion of cervical cancer cells, and induces epithelial-mesenchymal transition (EMT). Its mechanism may be related to activation of the PI3K/Akt signaling pathway.

[Analysis of the relationship among maxillary anterior teeth width, anterior arch perimeter and anterior segment depth].

OBJECTIVE: To analyze the relationship between the width of the maxillary anterior teeth and the anterior arch perimeter, to analyze the change rule of the width of the anterior teeth and the anterior arch perimeter, when altered the convexity of the anterior arch, with the width of the maxillary anterior arch keeping constant, and to provide a reliable basis for later digitized and personalized aesthetic analysis of front teeth. METHODS: In the study, 61 front teeth complete and well-arranged models had been selected from the working models after the prostheses in Department of Prosthodontics, Peking University School and Hospital of Stomatology, including 22 male models and 39 female models. A photograph was taken from the occlusal surface of each model using the fixed magnification with a single lens reflex camera. The width of anterior teeth, the width of anterior arch and the convexity of anterior arch had been measured using the Photoshop software. The ratio of the width of the anterior teeth to the width of the anterior arch was calculated. Keeping the width of anterior arch unchanged, the layer free transformation function used to add or decrease the curvature of the anterior arch from 1-5 mm, each circumference of the anterior arch was measured. According to the proportion of their anterior teeth in the anterior arch perimeter, the width of each anterior teeth crown under different convexities of anterior arch was calculated. SPSS 23.0 was used to analyze the ratio of the width anterior teeth to the anterior arch perimeter and correlation between the convexity of the anterior arch and the width of the anterior teeth. RESULTS: The percentages of the median length of the anterior arch in the central incisor, lateral incisor and canine were 36.2%±1.3%, 30.2%±1.5%, and 33.6%±1.4%, respectively. The proportions were normal distributions and not related to the perimeter of the anterior arch. When the width of the anterior arch was constant, there was a positive correlation between the convexity of anterior arch in the range of 5 mm and the width of anterior teeth or the front arch circumference. With each increase or decrease of 1 mm of the convexity of anterior arch, the width of the middle incisor increased or decreased by about 0.18 mm, the half circumference of the anterior arch increased or decreased by about 0.50 mm. CONCLUSION: The width of the anterior teeth in the middle-distal direction remained stable in the anterior arch circumference. Within a certain range, when the width of the maxillary anterior arch remains unchanged, the width of the anterior teeth and the perimeter of the anterior teeth are positively correlated to the convexity of the anterior arch.

[Calcifying fibrous tumor: a clinicopathological analysis of 32 cases].

Objective: To investigate the clinicopathological characteristics, histogenesis, immunophenotypes, molecular genetic characteristics, diagnosis and differential diagnosis of calcifying fibrous tumors (CFT). Methods: A total of 32 cases of CFT (22 cases from Henan Provincial People's Hospital and 10 cases from PLA Army Medical Center) diagnosed between June 2009 and February 2019 were reviewed. The clinical and pathologic data were analyzed. Results: There were 12 male and 20 female patients, aged from 15 to 63 years (mean 40.8 years). Eleven cases occurred in stomach, four cases in retroperitoneum, four cases in ovary, two cases in scrotum, two cases in mediastinum, two cases in head and neck, one case each in thoracic cavity, lung, adrenal gland, kidney, sigmoid colon, epididymis and mesosalpinx. All the tumors were solid masses with clear boundaries. The maximal dimension of the tumors ranged from 0.6 to 10.0 cm. Microscopically, there was hypocellular stromal sclerosis and wavy storiform coarse collagen with superimposed scattered or patchy lymphocytes and plasma cells; calcification or gravel formation were also detected. Immunohistochemistry showed that spindle cells were positive for vimentin and some were positive for CD34; and they were negative for calponin, SMA, desmin, S-100 protein, SOX10, STAT6, ß-catenin, ALK, CD117, DOG1, CKpan, and EMA. No ALK rearrangement was detected by FISH in all cases. No C-KIT and PDGFRA mutation was detected in all the tested 11 cases of stomach, four cases of retroperitoneal and one case of sigmoid colon CFT. MDM2 was not amplified by FISH in all four tested cases of retroperitoneal CFT. Conclusions: CFT is a rare benign tumor of fibroblastic cell origin. The diagnosis mainly depends on histomorphologic analysis and immunophenotyping. CFT should be differentiated from other benign and malignant spindle cell mesenchymal tumors.

[Ocular manifestations and surgical treatment of the linear nevus sebaceous syndrome].

Objective: To report the clinical and pathological features and surgical treatment of the linear nevus sebaceous syndrome. Methods: It was a retrospective case series study. The clinical records of 11 patients (14 eyes) who were diagnosed as linear nevus sebaceous syndrome between April 2009 and February 2018 at Beijing Tongren Hospital were analyzed. Data collected included sex, age, clinical manifestations, disease site, pathological features, surgical treatment and therapeutic effects. Results: There were six males and five females, aged 6 months to 7 years (mean, 2.8 years). The nevus sebaceous was located at the head (9 patients), face (5 patients) and neck (3 patients). The most common ocular manifestations were blepharocoloboma (13 eyes) and external ocular mass (9 eyes). Surgical treatment was performed in 9 patients (11 eyes), including lid reconstruction in all these eyes, corneal and conjunctival mass resection in four patients (4 eyes), eyelid tumor resection in 5 patients (5 eyes), and symblepharon separation and conjunctival sac reconstruction in 3 patients (5 eyes). Pathological examinations of the external ocular, corneal and conjunctival masses (6 eyes) confirmed the diagnosis of complex choristoma. All operated patients had improved appearance. Conclusions: Linear nevus sebaceous syndrome has characteristic cutaneous lesions and ocular manifestations. Histopathologically, all epibulbar lesions prove to be complex choristomas. The appearance of patients with linear nevus sebaceous syndrome can be significantly improved by oculoplastic surgery. (Chin J Ophthalmol, 2020, 56: 846-852).

[The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma].

Objective: To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Methods: A cross-sectional study. Twenty-five patients (25 eyes) with choroidal melanoma treated in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from July to October 2016 were included in this study. There were 13 males and 12 females, with an average age of (48±12) years old. Twenty-five patients (25 eyes) with choroidal hemangioma treated in the same period were selected for differential diagnosis, including 12 males and 13 females, with an average age of (37±13) years. The lesions were examined by ultrasound elastography and scored, and the strain ratio of the tumor to the orbital tissue was measured. Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma. The sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Results: The elastography score of choroidal melanoma was (3.48±0.77) points, including 2 points in 3 cases, 3 points in 8 cases, 4 points in 13 cases, and 5 points in 1 case. The elastography score of hemangioma was (2.28±0.46) points, including 2 points in 18 cases and 3 points in 7 cases. The difference in the elasticity score between patients with the two kinds of tumors was statistically significant (t=6.694, P<0.01). The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma, respectively, and the difference was statistically significant (t=8.392, P<0.01). Using 3 points as the diagnostic critical point of the elastography score, the sensitivity was 88.0%, the specificity was 72.0%, and the area under the ROC curve was 0.80 (95% cofidence interval: 0.663 to 0.900, P<0.01). Using 21.67 as the diagnostic critical point of the strain ratio, the sensitivity was 92.0%, the specificity was 92.0%, and the area under the ROC curve was 0.92 (95% cofidence interval: 0.808 to 0.978, P<0.01). Conclusions: Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma. The differential diagnostic value of the strain ratio method is higher than the scoring method. (Chin J Ophthalmol, 2020, 56: 676-680).

[Clinical significance of CTP combined with ABIC score in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure].

Objective: To investigate the risk factors affecting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and establish a new scoring model to predict the short-term prognosis of patients. Methods: This study enrolled 222 patients with HBV-ACLF. According to their clinical outcomes during hospitalization and 90 days after discharge, they were divided into survival and death group. Clinical data were collected to calculate the Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), albumin-bilirubin (ALBI), and age-bilirubin-international normalized ratio-creatinine (ABIC) scores for prognosis. Multivariate logistic regression analysis was used to analyze the independent risk factors affecting 90-day mortality in HBV-ACLF patients. Cox regression model was used to establish a new prediction model. Area under the receiver operating characteristic curve was used to calculate short-term prognostic value of the models. K-M survival curve was used to predict the prognosis of patients. Results: CTP and ABIC scores were independent risk factors for 90-day mortality in HBV-ACLF patients, and the risk of death from liver failure had increased with increase of score. Cox regression model established a new predictive model CTP-ABIC = 0.551 × CTP + 0.297 × ABIC. Area under the receiver operating characteristic curve of all three scoring models (CTP, ABIC and CTP-ABIC) were 0.878, 0.829, 0.927, respectively. CTP-ABIC score was superior to the CTP and ABIC score (P value < 0.001). Patients with CTP-ABIC score ≥9.08 had higher mortality rate than patients with CTP-ABIC score < 9.08, and the difference was statistically significant (P < 0.001). Conclusion: All three scoring systems can predict short-term prognosis in patients with HBV-ACLF, but the accuracy of CTP-ABIC is superior.

[Comparison of biometry with the Pentacam AXL, IOLMaster 700 and IOLMaster 500 in cataract patients].

Objective: To compare biometry with new biometers of Pentacam AXL and IOLMaster 700 and the widely used biometer of IOLMaster 500 in cataract patients. Methods: Cross-sectional study. A total of 223 eyes of 147 cataract patients from Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University during 4-8 December 2017 were recruited. There were 67 males and 80 females with an age of (64±11) years.The axial length (AL), mean keratometry (Km), anterior chamber depth (ACD) and white-to-white corneal diameter (WTW) from each device were recorded. The difference and agreement between the measurements were evaluated by ANOVA, LSD test, intraclass correlation coefficient and Bland-Altman analysis. Results: The success rate of AL measurement was 85.2% (190/223) with the Pentacam AXL, 96.9% (216/223) with the IOLMaster 700 and 90.6% (202/223) with the IOLMaster 500. There was no difference among devices in measuring the AL, Km and ACD (all P>0.05). Significant difference was found in WTW [(11.36±0.42) vs. (11.69±0.45) vs. (11.45±0.42) mm; F=34.696, P=0.000]. Intraclass correlation coefficient was 0.859-1.000, and Bland-Altman analysis showed good agreement among three devices. Conclusions: The new biometers of Pentacam AXL and IOLMaster 700 and the widely used IOLMaster 500 show no difference in measuring AL, Km and ACD. All three devices show good agreement in biometry of cataract patients. (Chin J Ophthalmol, 2019, 55: 515-521).

[Incidence and mortality of bladder cancer in China, 2014].

Objective: To estimate the incidence and mortality of bladder cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry (NCCR). Methods: There were 449 cancer registries submitted bladder cancer new cases and deaths occurred in 2014 to NCCR. After evaluating the data quality, 339 registries' data were finally accepted for analysis. According to the national population data of 2014, the nationwide incidence and mortality of bladder cancer were estimated by stratification in the area (urban or rural), gender, and age. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality rates. Results: All 339 cancer registries covered a total of 288 243 347 populations (144 061 915 in urban and 144 181 432 in rural areas). The percentage of morphologically verified cases and death certificate-only cases were 74.86% and 1.45%, respectively. The mortality to incidence ratio was 0.41. The estimates of new bladder cancer cases were 78 100 in China in 2014, with a crude incidence rate of 5.71/100 000. The age-standardized incidence rates by China standard population (ASR China) and world standard population (ASR world) of bladder cancer were 3.61/100 000 and 3.56/100 000, respectively. Cumulative incidence rate of bladder cancer in China was 0.41%. The crude and ASR China incidence rates in urban areas were 6.88/100 000 and 4.07/100 000, respectively, whereas those were 4.29/100, 000 and 2.96/100 000 in rural areas. The estimates of bladder cancer deaths caused by bladder cancer were about 32 100 in China in 2014, with a crude mortality rate of 2.35/100 000. The ASR China and ASR world mortality rates were both 1.30/100 000 with a cumulative mortality rate (0-74 years old) of 0.12%. The crude and ASR China mortality rates were 2.79/100 000 and 1.41/100 000 in urban areas, respectively, whereas those were 1.81/100 000 and 1.14/100 000 in rural areas. Conclusions: The incidence and mortality pattern of bladder cancer were different in urban and rural areas. The incidence and mortality were higher in urban areas than that in rural areas, and higher for male than for female. We should focus on strengthening the prevention and control of bladder cancer in key population, especially men in urban areas.

[Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma].

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group(n=174), portal vein reconstruction group (n=47), hepatic artery reconstruction group (n=24), palliative group(n=27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD-t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly (P<0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them (P>0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly (P<0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy (RR=0.38, 95%CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion: Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.

[Comparison of swept source anterior segment optical coherence tomography and ultrasound biomicroscopy in measurement of anterior chamber depth and anterior chamber angle data in age-related cataract patients].

Objective: To explore the difference and agreement in the measurement of anterior chamber depth (ACD) and anterior chamber angle data in age-related cataract patients between swept source anterior segment optical coherence tomography (SS-AS-OCT) and ultrasound biomicroscopy (UBM). Methods: A prospective study. Forty-five eyes from 45 age-related cataract patients were selected at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from November to December 2016. There were 23 males and 22 females aged (51±19) years. SS-AS-OCT and UBM were used to measure the ACD, angle opening distance (AOD 500) and trabecular-iris angle (TIA 500). The paired samples t-test and Pearson linear correlation were used for statistical analysis, and the Bland-Altman analysis was used to evaluate the measurement consistency of the two tools. Results: The ACD measured by SS-AS-OCT and UBM was (2.750±0.544) mm and (2.775±0.531) mm, respectively, the difference was statistically significant (t=2.109, P=0.040), and the measurement results were positively correlated (r=0.989, P<0.001). In the nasal, temporal, upper and lower positions, the AOD 500 and TIA 500 values measured by SS-AS-OCT and UBM had a significant difference [AOD 500: (0.451±0.201) mm vs.(0.421±0.194) mm, (0.499±0.229) mm vs. (0.465±0.207) mm, (0.390±0.215) mm vs. (0.355±0.208) mm, (0.441±0.226) mm vs. (0.423±0.215) mm, t=4.262, 4.350, 5.355, 4.415; TIA 500: 39.587°±14.698°vs. 36.944°±13.790°, 42.149°±14.138°vs. 40.289°±13.041°, 36.482°±15.887°vs. 35.600°±15.215°, 38.504°±14.805°vs. 36.818°±14.931°, t=5.131, 4.658, 4.174, 5.731; all P<0.001] and a significant linear correlation (AOD 500: r=0.971, 0.975, 0.979, 0.973; TIA 500: r=0.972, 0.957, 0.956, 0.970; all P<0.001). The Bland-Altman method showed that the two modalities had comparable results for the ACD, AOD 500 and TIA 500 (2.22%-6.67% of the measured value outside the 95% consistency boundaries). Conclusion: SS-OCT and UBM show a good agreement in the measurement of ACD and anterior chamber angle data in age-related cataract patients, though there is difference between them in measurement results. (Chin J Ophthalmol, 2018, 54: 678-682).

[Ultrasound diagnosis and differential diagnosis of medium and small choroidal melanomas].

Objective: To analyze the ultrasound diagnosis and differential diagnosis of medium and small choroidal melanomas. Methods: It was a retrospective case series study. Thirty-six cases (36 eyes) with medium or small choroidal melanoma were collected between January 2016 and January 2017 in Beijing Tongren Hospital, including 16 males and 20 females aged (50±12) years old. All tumors' apical heights were within 5 mm and the largest basal diameter was within 15 mm. Sixty-nine cases (69 eyes) with choroidal hemangioma, including 45 males and 24 females aged (45±11) years old, and 16 cases (19 eyes) with choroidal metastasis, including 4 males and 12 females aged (50±11) years old, of equal size were also analyzed as differential diagnosis. Univariate (Chi-square test, Fisher's exact test, and analysis of variance) and multivariate analyses (Logistic regression) were used for statistical analysis. Results: There were significant differences in morphology, height, base-height ratio, internal echo, choroidal excavation and secondary retinal detachment among the three types of tumors(all P<0.05). Approximately 91.7% (33/36) of choroidal melanomas and 94.2% (65/69) of hemangiomas were flat or dome, while 63.2% (12/19) of metastatic tumors showed a polygonal shape and an irregular surface contour. The average height was (4.02±0.70) mm for choroidal melanoma, (3.10±1.08) mm for metastasis and (2.75±0.87) mm for hemangioma. The base-height ratio of choroidal melanoma, metastasis, and hemangioma was 2.62±0.48, 4.09±1.18 and 3.16±0.58, respectively. About 86.1% (31/36) of choroidal melanomas and 84.2% (16/19) of metastases showed lower echo than adjacent orbital tissue, while 92.8% (64/69) of hemangiomas had similar or higher echo. About 16.7% (6/36) of choroidal melanomas showed choroidal excavation, but no such signs were found in other tumors. Approximately 80.6% (29/36) of choroidal melanomas, 78.9% (15/19) of metastases and 52.2% (36/69) of hemangiomas showed secondary retinal detachment. The internal echo, height and base-height ratio were taken as significant independent influencing factors into the Logistic regression model. The low internal echo and large height were risk factors of choroidal melanoma (OR=0.016, 0.199, both P<0.05), while the low echo and large base-height ratio were risk factors of choroidal metastasis (OR=0.011, 0.073, both P<0.05). Conclusion: Ultrasonography plays an important role in the diagnosis of medium and small choroidal melanomas, and the echo, height, and base-height ratio of the lesion can be helpful for the diagnosis and differential diagnosis. (Chin J Ophthalmol, 2018, 54: 843-848).

[Comparative analysis on the significances of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging in uveal melanoma diagnosis].

Objective: To compare the significance of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of uveal melanoma. Methods: It was a retrospective case series study. Sixty-three cases (63 eyes) of uveal melanoma patients (confirmed by histopathology) who underwent CEUS and DCE-MRI examination at Beijing Tongren Hospital during January 2010 and May 2014 were collected, including 30 males and 33 females, with average age of 47 years (ranged from 27 to 69 years). The data and images of CEUS and DCE-MRI were analyzed and the findings were reviewed and compared to pathology results so as to evaluate the diagnosis coincidence rate of using CEUS, DCE-MRI and both (combined CEUS and DCE-MRI). Fisher's exact test method was used to explore the efficiency of diagnosing uveal melanoma with CEUS, DCE-MRI and the two combined. Results: Among the 63 cases of uveal melanoma, the coincidence rates of CEUS, DCE-MRI and combined diagnosis for uveal melanoma were 93.7% (59/63), 90.5% (57/63) and 100% (63/63) respectively. There was no significant difference between CEUS and DCE-MRI (P=0.663). Fifty-five cases showed fast wash in and fast wash out, and 8 cases showed fast wash in and slow wash out in time-intensity curve of CEUS. Fifty-four cases showed rapid increase and rapid decrease, and 7 cases showed rapid increase and slow decrease, and 2 cases showed sustain enhancement in signal intensity-time curve of DCE-MRI. Conclusions: CEUS is an effective method in diagnosis of uveal melanoma. CEUS and DCE-MRI are of similar value in the diagnosis of uveal melanoma, physicians may be able to acquire more diagnostic information when using the two methods in combination.(Chin J Ophthalmol, 2018, 54: 194-198).