CT and MRI features in 22 cases of primary malignant thymic germ cell tumours.

AIM: To analyse the computed tomography (CT) and magnetic resonance imaging (MRI) features of malignant thymic germ cell tumours (GCTs), in order to improve the accuracy of diagnosis of these tumours. MATERIALS AND METHODS: Twenty-two patients (20 men, two women; age, 28 ± 8.64 years) with malignant thymic GCTs confirmed at histopathology were enrolled retrospectively, and their CT and MRI findings were analysed. RESULTS: According to the CT findings, malignant thymic GCTs usually manifest as a bulky mass that typically grows to both sides of the midline (20/22, 90.9%), with irregular shape (15/22, 68.2%), lobulation (12/22, 50%), ill-defined margin (9/22, 40.9%), and incomplete capsule (21/22, 95.5%). Twenty masses revealed heterogeneous density with multifocal necrosis or cystic change in 19 (86.4%). Most cases (16/18, 88.9%) showed mild to moderate enhancement, and the branch-like vessel was found in 14 (14/18, 77.8%) cases. The minimum apparent diffusion coefficient (ADCmin) and mean apparent diffusion coefficient (ADCmean) values in 14 patients were (1.13 ± 0.45) and (1.37 ± 0.49) × 10-3 mm2/s, respectively. Compared with CT findings, the incidences of an incomplete capsule, heterogeneous signal, and necrotic or cystic change on MRI images occurred in all patients with malignant thymic GCT. In addition, peritumoural oedema was found in all 14 (100%) cases. CONCLUSION: MRI is superior to CT in showing incomplete capsule, peritumoural oedema, heterogeneous signal, and necrotic or cystic change of GCTs. Branch-like enhancement and multifocal necrosis may help the diagnosis of malignant thymic GCTs.

[Infectious complications following chimeric antigen receptor T-cell therapy for a hematologic malignancy within 28 days].

Objective: To explore the incidence, clinical and microbiological characteristics and risk factors of infection in patients with acute lymphoblastic (ALL) , non-Hodgkin lymphoma (NHL) , and multiple myeloma (MM) within 28 days after CAR-T cell infusion. It provides data support for early identification of infection and the rational use of antibacterial drugs in these patients. Methods: We retrospectively analyzed the baseline data of 170 patients with ALL, NHL and MM who received chimeric antigen receptor-modified T (CAR-T) -cell treatment in the Department of Hematology of Wuhan Union Hospital from January 2016 to December 2020, and the clinical characteristics of infection within 28 days after infusion, including 72 patients with ALL, 56 patients with NHL, and 42 patients with MM; we used Poisson regression and Cox proportional hazard regression models to assess high-risk factors for infection before and after infusion, respectively. Results: Among 170 patients, 119 infections occurred in 99 patients within 28 days, with a cumulative infection rate of 58.2%. Seventy-eight patients had 98 bacterial infections and the cumulative incidence of bacterial infection was 45.9%. The infection density was 2.01, and the median time for the first infection was about 12 days after infusion. The adjusted baseline characteristic model showed that ALL patients, previous 30 days of infection history, refractory disease, absolute neutrophil count (ANC) <0.5×10(9)/L before infusion and ≥4 prior antitumor treatment regimens had a higher infection density within 28 days; grade 3 or 4 CRS was the only high-risk factor related to infection after infusion in the multivariate analysis. Conclusion: Infection is a common complication of CAR-T cell therapy in patients with hematologic malignancy. Bacterial infections occur in most patients regardless of the type of disease. ALL patients, previous 30 days of infection history, refractory disease, ANC<0.5×10(9)/L before infusion and grade 3 or 4 CRS are risk factors for infection. Chinese Clinical Trial Register:: ChiCTR-OIC-17011180, ChiCTR1800018143.

[Amiodarone promotes heat-induced apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes].

OBJECTIVE: To investigate the injury types of atrial myocytes induced by heat exposure and the effect of amiodarone on heat-induced injuries in atrial myocytes. OBJECTIVE: The optimal temperature for heat exposure and optimal concentration of amiodarone were determined by measuring the cell viability exposed to different temperatures and different concentrations of amiodarone. Heat exposure of HL1 atrial myocytes was conducted using a water bath, and the effect of amiodarone on cell viability was assessed with MTS method; cell apoptosis was detected using flow cytometry, and the levels of IL-1ß, IL-6, TNF-α, SOD and MDA were detected with enzyme-linked immunosorbent assay (ELISA). OBJECTIVE: Compared with the blank control cells, the cells exposed to a temperature of 52 ℃ showed a significantly decreased survival rate and a lowered SOD activity (P < 0.001) with increased IL-1ß and MDA levels (P < 0.01) and markedly increased apoptosis rate and IL-6 level (P < 0.001). Compared with the heat exposure group, amiodarone resulted in significantly decreased survival rate of the atrial myocytes (P < 0.01), obviously decreased SOD activity (P < 0.05), and increased cell apoptosis rate (P < 0.05) and IL-1ß, IL-6, MDA and TNF-α levels (P < 0.01 or 0.001). OBJECTIVE: Heat exposure induces apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes, and amiodarone can enhance the effects of heat exposure to aggravate the cell injuries.

Clinical benefits of routine examination and synchronous repair of occult inguinal hernia during laparoscopic peritoneal dialysis catheter insertion: a single-center experience.

PURPOSE: Occult inguinal hernias (IH) predispose peritoneal dialysis (PD) patients to the symptomatic IH formation after starting PD, which may cause complications. We conducted a retrospective study to assess the benefit/risk profile of routine laparoscopic examination for occult IH (RLEOH) with a synchronous repair in patients receiving PD catheter placement. METHODS: 432 patients were enrolled in this study. Patients with an internal hernia sac at all sizes were deemed to have occult IH. We retrospectively reviewed data including demographic characteristics and operative details. We also measured incidence rates of symptomatic IH, metachronous IH repair, and catheter survival over a follow-up period after starting PD. RESULTS: These patients were classified into the RLEOH group (n = 365) and the non-RLEOH group (n = 67). The RLEOH group was subdivided into occult IH with a synchronous repair (n = 17; the subgroup A), no occult IH (n = 339; the subgroup B), and occult IH without a synchronous repair (n = 9; the subgroup C). The incidence rates of symptomatic IH developed after staring PD in subgroups A, B, and C were 0, 5.6, and 22.2%, respectively, whereas that in the non-RLEOH group was 13.4%. The RLEOH group had a reduced hazard ratio for metachronous IH repair compared with the non-RLEOH group (HR = 0.426; 95% CI 0.195-0.930, p = 0.032). None of our patients suffered from herniorrhaphy-related complications. CONCLUSION: RLEOH with a synchronous repair during PD catheter insertion confers clinical benefits in reducing the risk of developing IH after starting PD and the need for a metachronous repair. This is a safe and reasonable approach.

Tensile deformation mechanisms of an in-situ Ti-based metallic glass matrix composite at cryogenic temperature.

Remarkable tensile ductility was first obtained in an in-situ Ti-based bulk metallic glass (BMG) composite at cryogenic temperature (77 K). The novel cryogenic tensile plasticity is related to the effective accommodation of ductile body-centered cubic dendrites at 77 K, characteristic of the prevailing slip bands and dislocations, as well as lattice disorder, which can effectively hinder the propagation of critical shear bands. The greatly increased yield strength of dendrites contributes to the high yield strength of composite at 77 K. A trend of stronger softening is observed at low temperature, and a criterion is proposed to understand the softening behavior. The current research could also provide a guidance to the promising cryogenic application of these new advanced BMG composites.

Dissemination of methicillin-resistant Staphylococcus aureus sequence type 45 among nursing home residents and staff in Taiwan.

Unlike hospitals or the community, nursing homes provide a unique healthcare environment for patients. There have been no reports regarding methicillin-resistant Staphylococcus aureus (MRSA) carriage among nursing home residents and staff in Taiwan. From May to November 2012, a total of 523 subjects, including 360 residents and 163 staff, in 14 nursing homes in Taiwan were surveyed for nasal MRSA carriage. Overall, the nasal MRSA carriage rate was 20.1%, with 20.3% for residents and 19.6% for staff. For residents, age >60 years (adjusted OR 2.268; 95% CI 1.185-4.342; p 0.013) and the presence of chronic wounds (adjusted OR 2.449; 95% CI 1.082-5.544; p 0.032) were the significant risk factors for MRSA carriage in multivariate models. Among the 105 MRSA isolates, 11 pulsed-field gel electrophoresis (PFGE) patterns were identified, except for five isolates untypeable by SmaI digestion, with one major pattern; nine isolates (8.6%) possessed staphylococcal cassette chromosome (SCCmec) type II or III, 66 isolates type IV or V, and 21 isolates unidentified types. The clone characterized as PFGE pattern BM sequence type 45 was the most common clone, accounting for 50% of the isolates, and was multiresistant, including to ciprofloxacin. Intra-institutional and inter-institutional transmission of MRSA was documented by molecular methods. It was shown conclusively that one-fifth of residents and staff in nursing homes in Taiwan harboured MRSA, mostly ST45 strains, in their nares. Intra-institutional and inter-institutional transmission of MRSA was documented.

Prenatal ethanol exposure enhances the susceptibility to metabolic syndrome in offspring rats by HPA axis-associated neuroendocrine metabolic programming.

OBJECTIVE: The present study was designed to demonstrate that prenatal ethanol exposure (PEE) could enhance the susceptibility of high-fat diet-induced metabolic syndrome (MS) in adult male offspring via a hypothalamic-pituitary-adrenal (HPA) axis-associated neuroendocrine metabolic programmed mechanism. METHODS: Pregnant Wistar rats were intragastricly administrated ethanol 4 g/kg·d from gestational day 11 until term delivery. All male offspring were fed with high-fat diet after weaning, exposed to an unpredictable chronic stress at postnatal week (PW) 17 and sacrificed at PW20. RESULTS: In PEE group, body weight presented a "catch-up growth" pattern, and the HPA axis exhibited a lower basal activity but an enhanced sensitivity to chronic stress, leading to increased levels of serum glucose, insulin, insulin resistant index, total cholesterol and low-density lipoprotein-cholesterol, and decreased levels of high-density lipoprotein-cholesterol. Furthermore, many lipid droplets and vacuolar degeneration were observed in the hypothalamus, pituitary gland and liver. CONCLUSIONS: PEE induces enhanced susceptibility to MS in adult offspring fed with high-fat diet, and the underlying mechanism involves a HPA axis-associated neuroendocrine metabolic programming alteration.

Prenatal nicotine exposure induced a hypothalamic-pituitary-adrenal axis-associated neuroendocrine metabolic programmed alteration in intrauterine growth retardation offspring rats.

Prenatal nicotine exposure inhibits the functional development of the hypothalamic-pituitary-adrenal (HPA) axis and alters glucose and lipid metabolism in intrauterine growth retardation (IUGR) fetal rats, but the postnatal consequence is unknown. We aimed to verify a neuroendocrine metabolic programmed alteration in IUGR offspring whose mothers were subcutaneously treated with 2mg/kgd of nicotine from gestational day 11 to 20. In the nicotine group, blood adrenocorticotropic hormone (ACTH) and corticosterone (CORT) levels were higher before postnatal day 35 and then returned to lower than the respective control. The adult offspring showed unchanged blood glucose but increased blood total cholesterol (TCH) and triglyceride (TG) levels. However, after chronic stress, the mRNA expression levels of hippocampal glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) were lower, but gain rates of ACTH and CORT levels were greater compared to the control. Additionally, the level of blood glucose was increased, while the elevated levels of blood TCH and TG before stress were close to the control levels. These results suggested that prenatal nicotine exposure induced an HPA axis-associated neuroendocrine metabolic programmed alteration in adult offspring, which might be attributed to hippocampal functional injury in utero.

Heritable alteration in DNA methylation induced by nitrogen-deficiency stress accompanies enhanced tolerance by progenies to the stress in rice (Oryza sativa L.).

Cytosine methylation is responsive to various biotic- and abiotic-stresses, which may produce heritable epialleles. Nitrogen (N)-deficiency is an abiotic stress being repeatedly experienced by plants. To address possible epigenetic consequences of N-deficiency-stress, we investigated the stability of cytosine methylation in rice (Oryza sativa L.) subsequent to a chronic (a whole-generation) N-deficiency at two levels, moderate (20mg/L) and severe (10mg/L), under hydroponic culture. MSAP analysis revealed that locus-specific methylation alteration occurred in leaf-tissue of the stressed plants (S(0)) experiencing either level of N-deficiency, which was validated by gel-blotting. Analysis on three non-stressed self-fed progenies (S(1), S(2) and S(3)) by gel-blotting indicated that ca. 50% of the altered methylation patterns in somatic cells (leaf) of the stressed S(0) plants were recaptured in S(1), which were then stably inherited to S(2) and S(3). Bisulfite sequencing of two variant MSAP loci with homology to low-copy retrotransposons on one stressed plant (S(0)) and its non-stressed progenies (S(1) and S(2)) showed that whereas one locus exhibited limited and non-heritable CHH methylation alteration, the other locus manifested dramatic heritable hypermethylation at nearly all cytosine sites within the assayed region. Intriguingly, when two groups of S(2) plants descended from the same N-deficiency-stressed S(0) plant were re-subjected to the stress, the group inheriting the modified methylation patterns showed enhanced tolerance to the N-deficiency-stress compared with the group bearing the original patterns. Our results thus demonstrate heritability of an acquired adaptive trait in rice, which was accompanied by epigenetic inheritance of modified cytosine methylation patterns, implicating an epigenetic basis underlying the inheritance of an acquired trait in plants.

Magnetic characteristics of new cyano-bridged two-dimensional honeycomb-like bimetallic assemblies containing Ni(II)-N[triple bond]C-Cr(III) or Ni(II)-N[triple bond]C-Cr(I) linkages.

Three cyano-bridged bimetallic assemblies, [NiL(1)](3)[Cr(CN)(6)](2).7H(2)O (1), [NiL(2)](3)[Cr(CN)(6)](2).9H(2)O (2), and [NiL(2)](3)[Cr(CN)(5)(NO)](2).9H(2)O (3) (L(1) = 3,10-dimethyl-1,3,5,8,10,12-hexaazacycloctadecane and L(2) = 3,10-diethyl-1,3,5,8,10,12-hexaazacycloctadecane), have been prepared and characterized structurally and magnetically. Complex 1 crystallizes in the monoclinic space group of C2/c with a = 25.929 A, b = 15.442(3) A, c = 19.553(4) A, beta = 106.21(3) degrees, and Z = 4, while 2 and 3 are in the trigonal space group P3 with a = b = 14.919(2) A, c = 9.5246(19) A, gamma = 120 degrees, and Z = 1 for 2 and a = b = 14.863(2) A, c = 9.3134(19) A, gamma = 120 degrees, and Z = 1 for 3. The structures of 1-3 are similar and consist of cyano-bridged two-dimensional (2D) honeycomb-like neutral Ni(3)Cr(2) layers. In each complex, [Cr(CN)(6)](3-) or [Cr(CN)(5)(NO)](3-) coordinates to three trans-[Ni(macrocycle)](2+) groups using three fac-CN(-) ligands, providing a 2D layered network. The NO group in [Cr(CN)(5)(NO)](3-) remains monodentate. Magnetic studies show the existence of a short-range ferromagnetic interaction in all of the complexes. Complexes 1 and 2 exhibit long-range antiferromagnetic ordering at 13.0 and 11.9 K, respectively, and a metamagnetic transition with critical field of ca. 1.6 kOe for 1 and 1.5 kOe for 2 at 1.8 K. Complex 3 exhibits long-range ferromagnetic ordering below 4.3 K.

Synthesis, crystal structure, and magnetic properties of two cyano-bridged bimetallic 4f-3d arrays with one-dimensional chain and two-dimensional brick wall molecular structures.

The design, synthesis, and structural and magnetic properties of the two new bimetallic complexes [Sm(DMF)(4)(H(2)O)(2)Cr(CN)(6)].H(2)O and [Sm(DMF)(2)(H(2)O)(3)Cr(CN)(6)].H(2)O (DMF = N,N-dimethylformamide) are presented. [Sm(DMF)(4)(H(2)O)(2)Cr(CN)(6)].H(2)O was prepared by the reaction between Sm(3+) and [Cr(CN)(6)](3-) in a methanol-DMF solution, while [Sm(DMF)(2)(H(2)O)(3)Cr(CN)(6)].H(2)O was prepared by the reaction between Sm(3+), DMF, and [Cr(CN)(6)](3-) in the molar ratio of 1:2:1 in H(2)O. [Sm(DMF)(4)(H(2)O)(2)Cr(CN)(6)].H(2)O crystallizes in the monoclinic space group of P2(1)/c with a = 13.161(3) A, b = 12.928(3) A, c = 19.174(4) A, beta = 109.82(3) degrees, and Z = 4, while [Sm(DMF)(2)(H(2)O)(3)Cr(CN)(6)].H(2)O is in the triclinic space group P1 with a = 7.7535(1) A, b = 9.4307(3) A, c = 16.2905(5) A, alpha = 94.1590(14) degrees, beta = 100.0597(18) degrees, gamma = 100.9154(18) degrees, and Z = 2. The structure of [Sm(DMF)(4)(H(2)O)(2)Cr(CN)(6)].H(2)O possesses a cyano-bridged one-dimensional (1D) zigzag chain structure with alternating Sm(DMF)(4)(H(2)O)(2) and Cr(CN)(6) moieties. [Sm(DMF)(2)(H(2)O)(3)Cr(CN)(6)].H(2)O consists of cyano-bridged neutral brick wall-like layers in which each [Cr(CN)(6)](3-) unit uses three cyanide groups in the meridional arrangement to connect with three [Sm(DMF)(2)(H(2)O)(3)](3+) units. Each [Sm(DMF)(2)(H(2)O)(3)](3+) unit, in turn, links three [Cr(CN)(6)](3-), generating a flat brick wall-like structure. Magnetic studies on [Sm(DMF)(2)(H(2)O)(3)Cr(CN)(6)].H(2)O showed a magnetic-phase transition temperature below 4.2 K and a coercive field of 100 Oe at 1.85 K, while no long-range magnetic ordering was observed in the 1D complex [Sm(DMF)(4)(H(2)O)(2)Cr(CN)(6)].H(2)O.

Choroidal masses: a fourteen-year analysis.

BACKGROUND: Choroidal masses present much diversification in clinical features and incidence. The purpose of this study is to investigate the epidemiological and clinicopathological manifestations of different choroidal tumors in order to tabulate appropriate diagnostic approaches. METHODS: A retrospective analysis of patients with choroidal masses was conducted, the analysis being based upon the review of our medical records from January 1986 to December 1999 inclusively. A definite diagnosis of choroidal mass was confirmed by at least two experienced ophthalmologists. For patients who were enrolled in this study, an ophthalmic examination was conducted and medical history was recorded. Some ancillary tests, such as indirect ophthalmoscopy, ultrasonography, fluorescein angiography, computed tomography, and magnetic resonance imaging, were used to support the accuracy of our diagnoses. RESULTS: A total of 149 patients were enrolled in this study, of which 103 cases were excluded due to a loss of follow-up or incomplete medical records. Forty-six patients (51 eyes) included 12 cases (26%) of malignant metastases, 10 cases (22%) of hemangiomas, 2 cases (4%) of osteomas, 5 cases (11%) of melanocytomas, 8 cases (17%) of melanomas, and 9 cases (20%) of other melanocytic lesions. The male to female ratio was 21:25. The average length of follow-up was 20.5 months, and the average age of these patients was 42.8 years. Presenting with varied clinical incidence and pictures, each category of choroidal mass was investigated thoroughly. CONCLUSION: With more clinical experience and a better understanding of choroidal masses, we are able to propose an early differential diagnosis and therapeutic approach to the effective management of them in order to minimize ocular morbidity and improve patients' survival and quality of life.

Crystal structures and magnetic properties of new cyano-bridged two-dimensional grid-like bimetallic assemblies [Ni(tn)2]2[Cr(CN)5((NO)]OH*H2O and [NI(tn)2]2[Co(CN)6]NO3*2H2O (tn=1,3-propanediamine).

Two bimetallic assemblies, [Ni(tn)(2)](2)[Cr(CN)(5)(NO)]OH.H(2)O (1) and [Ni(tn)(2)](2)[Co(CN)(6)]NO(3).2H(2)O (2) (tn = 1,3-diaminopropane), have been prepared and structurally and magnetically characterized. Crystal data for 1 (2): space group P1 (P1), a = 8.698(3) (8.937(2)) A, b = 10.001(2) (9.863(1)) A, c = 10.158(2) (10.064(1)) A, alpha = 87.40(2) (86.064(10)) degrees, beta = 65.10(2) (65.489(10)) degrees, gamma = 81.63(2) (81.572(12)) degrees and Z = 1 (1). Both structures consist of two-dimensional grid-like polycations containing Ni-N triple bond C-M linkages (M = Cr or Co) and counteranions (OH, NO(3)). Magnetic studies of 1 showed that the complex displays a metamagnetic behavior originating from intralayer ferromagnetic and interlayer antiferromagnetic interactions. Long-range antiferromagnetic ordering was observed at T(N) = 3.3 K. Complex 2 exhibits intramolecular ferromagnetic interactions through the diamagnetic N triple bond C-Co-N triple bond C bridges, owing to superexchange involving the empty d(sigma) orbital of the diamagnetic Co(III) ion.

Clinicopathological report of Candida granuloma from an endogenous candidal endophthalmitis.

Fluconazole was reported to be an effective alternative to Amphotericin B for candidal endophthalmitis. However, the dose for systemic use had not been determined and few pathological reports on its use have been published. An epiretinal membrane harvested from a regressed candidal endophthalmitis in a patient treated with fluconazole (200 mg/day) was sent for pathologic study. On the inner side of the retina, a granuloma was found. Fungal debris was found within the center of the granuloma, but an intact fungus was seen next to the granuloma. Pathologic study showed incomplete treatment in this case, although systemic status had improved. The use of systemic fluconazole should be maintained for a longer period of time to treat candidal endophthalmitis.

[A case of relapsed small cell lung cancer recognized by simple metastasis to the duodenum].

We describe a case of relapsed small cell lung cancer (SCLC) recognized by a duodenal tumor, its probable metastasis. A 69-year-old man was admitted to Keio University Hospital complaining of persistent sputum production in September, 1996. A diagnosis of SCLC of the left lung invading the mediastinum was based on a transesophageal biopsy. Chemotherapy consisting of CDDP and VP-16 followed by thoracic irradiation at a total dose of 50 Gy was performed from October 1996 to August 1997, resulting in CR (Complete Response) of the tumor. In April of 1999, a mass surrounding the duodenum was found through an abdominal CT survey for tumor relapse, but no other tumors were detected in a series of CT scans or inbone scintigraphy. Subsequent fiberscopy of the upper gastrointestinal tract revealed an ulcerative tumor extensively invading the mucosa of the duodenal bulb. Biopsy specimens obtained from the duodenal tumor showed small-cell carcinoma with features similar to those of SCLC found in 1996, suggesting that SCLC of the left lung metastasized to the duodenal wall. Chemoradiotherapy with 4 cycles of CDDP and VP-16 followed by abdominal irradiation at a dose of 30 Gy was given again from May to September 1999, producing good PR (Partial Response). Although metastasis of SCLC to the duodenum seldom occurs, this report indicates that its early detection and effective treatment may prevent serious symptoms caused by obstruction of the duodenum or the papilla Vater.

Dehydrogenative coupling of phenanthroline under hydrothermal conditions: crystal structure of a novel layered vanadate complex constructed of 4,8,10-net sheets: [(2,2'-biphen)Co]V3O8.5.

2,2'-Biphenanthroline (2,2'-biphen) formed from 1,10-phenanthroline when a new two-dimensional layered vanadium oxide metal coordination complex, [(2,2'-biphen)Co]V3O8.5, which contains novel 4,8,10-net sheets, was hydrothermally synthesized.

Results of 12-year clinical study of giant retinal tear.

BACKGROUND: To evaluate the surgical results of scleral buckling alone on eyes with retinal detachment with giant retinal tears of less than 120 degrees, without inverted flap or proliferative vitreoretinopathy, and vitrectomy combined with scleral buckling with or without intraoperative usage of perfluorocarbon liquid (PFCL) in complicated cases. METHODS: Retrospectively, we reviewed giant retinal tear cases treated at Chang Gung Memorial Hospital, Kaohsiung, Taiwan between January 1, 1989 and August 31,2000. The surgical techniques consisted of standard three-port pars plana vitrectomy combined with scleral buckling in complicated cases, PFCL used intraoperatively in later cases, and scleral buckling alone in minor cases. RESULTS: A total of 47 consecutive eyes with giant retinal tears with retinal detachment in 45 patients with no previous history of ocular penetrating injury or vitreoretinal operations were enrolled in this study. The follow-up period was at least three months for all patients. Thirty-four eyes (72.3%) had giant retinal tears of less than 180 degrees, 12 eyes (25.5%) had tears between 180 degrees and 270 degrees, and one eye had two giant retinal tears. Scleral buckling combined with vitrectomy was performed in 36 complicated eyes (76.6%), PFCL was used intraoperatively later in 24 eyes, and scleral buckling was used alone in 11 minor cases (23.4%). Thirty eyes (63.8%) gained reattachment after the first surgery. Altogether, the retinas of 38 of 47 eyes (80.9%) remained attached at the last follow-up examination. CONCLUSION: In minor cases of giant retinal tear, scleral buckling alone without vitrectomy may be considered the primary surgical procedure. In complicated cases, using PFCL intraoperatively not only affords many advantages during surgery, but also raises the retinal reattachment rate.

Lens subluxation: 10-years' experience at Chang Gung Memorial Hospital, Kaohsiung.

BACKGROUND: This study aimed to describe the clinical manifestations and surgical outcomes of subluxated lens. METHODS: Reviewing charts from January 1991 to June 2000, we studied 110 patients (123 eyes) who had lens subluxation at Chang Gung Memorial Hospital, Kaohsiung. For 21 eyes, patients accepted conservative treatment, and 102 eyes underwent surgery (8 eyes had Marfan syndrome; 18 eyes had idiopathic dislocation; and 76 eyes had experienced trauma). Indications of surgery included reduction in visual acuity, uncorrectable refractive error, and secondary glaucoma. RESULTS: There were 81 male and 29 female patients. Their mean age was 47.6 years (range, 2-76 years). The mean post-operative follow-up period was 22.24 months (range, 2-118 months). In spite of the different lens statuses, similar visual results were found between the surgical treatment group and the nonsurgery group. In the surgery group, 47 eyes (46.1%) achieved best corrected visual acuity (BCVA) of 20/40 or better. A total of 80 eyes (78.4%) achieved an improvement (log MAR change >0.3) in BCVA. The major postoperative complications included glaucoma (11 eyes), retinal detachment (9 eyes) and intraocular lens dislocation into the vitreous cavity (3 eyes). CONCLUSIONS: Results indicate that the presence of a subluxated lens alone is not an absolute indication for surgical removal. The lens status had no significant influence on surgical outcome. Most cases can achieve an improvement in BCVA after appropriate management.

Prevalence of urinary incontinence and intention to seek treatment in the elderly.

BACKGROUND AND PURPOSE: Urinary incontinence (UI) is a common, distressing, and often disabling condition in the elderly. The objectives of this study were to estimate the prevalence and clinical characteristics of UI among elderly individuals living at home and to explore their perceptions of UI and intention to seek medical care. METHODS: A total of 504 elderly subjects aged 65 and older residing in Tungkang town (located in the southwestern part of Taiwan) were randomly sampled and surveyed face to face by registered nurses. The prevalence, clinical types, and perceptions of UI, and intention to seek treatment, were compared with chi-square statistics across various sociodemographic characteristics. Logistic regression analyses were conducted to identify factors associated with UI experience and intention to seek treatment. RESULTS: About 22% of respondents reported that they had experienced involuntary loss of urine in daily life. Women, people who were overweight, and those who were aged 70 years or older were at higher risk of UI. While women were more likely to suffer from stress incontinence, men were at higher risk of urge incontinence. Women, illiterate individuals, and those who perceived UI as a normal part of the aging process showed low intention to seek treatment for UI. CONCLUSIONS: The results of this study suggest that public awareness programs about UI and promotion of available treatment options are necessary to increase the intention to seek treatment among the elderly. Culturally sensitive programs should be designed, particularly for female and illiterate elderly, to provide incentives to seek medical care. The increasing availability of various treatment modalities coupled with education to correct commonly held misconceptions about UI might enable more elderly individuals to receive treatment for this common condition.