Surgical strategy and outcome in patients with bilateral proliferative diabetic retinopathy.

OBJECTIVES: To investigate the current surgery strategies for bilateral proliferative diabetic retinopathy (PDR), as well as the surgical outcomes of patients with bilateral PDR who underwent pars plana vitrectomy (PPV). MATERIALS: Patients undergoing bilateral vitrectomy for PDR from January 2019 to December 2020 at The Eye Hospital of Wenzhou Medical University were enrolled. Clinical data were collected from the electronic medical records. Factors associated with the time interval between the surgeries on two eyes and postoperative visual outcomes were analyzed. RESULTS: In total, 152 patients with bilateral PDR who underwent bilateral PPV were included in this analysis. Mean age was 53.7 ± 11.4 years. Compared with second-surgery eyes, 60.5% of first-surgery eyes had worse preoperative best-corrected visual acuity (BCVA). The overall PPV time (median, quartile range) between first and second surgeries eye was 1.40 (0.70, 3.15) months. Multivariate analysis showed that the preoperative BCVA of the second-surgery eye had a significant effect on the inter-surgery time interval (P = 0.048). First-surgery eyes had greater vision improvement than second-surgery eyes (Difference of the logarithm of the minimum angle of resolution [LogMAR] BCVA: - 1.00 [- 1.48, - 0.12] versus 0.00 [- 1.30, 0.00], respectively, P < 0.001), especially when eyes with poorer BCVA underwent PPV first (- 1.15 [- 1.87, - 0.54] versus 0.00 [- 0.70, 0.00], respectively, P < 0.001). CONCLUSIONS: Visual acuity is a significant factor that influences surgical strategies, including both surgery order and interval, for patients with bilateral PDR. The eyes operated upon first show more vision improvement due to prompt surgery.

Downregulation of miR­7 and miR­153 is involved in Helicobacter pylori CagA induced gastric carcinogenesis and progression.

Helicobacter pylori (H. pylori) infection plays a pivotal role in the development of gastric cancer (GC). However, the association between aberrant microRNAs (miRNAs/miRs) expression and H. pylori­induced GC remains poorly understood. The present study reported that repeated infection of H. pylori caused the oncogenicity of GES­1 cells in BALB/c Nude mice. miRNA sequencing revealed that both miR­7 and miR­153 were significantly decreased in the cytotoxin­associated gene A (CagA) positive GC tissues and this was further confirmed in a chronic infection model of GES­1/HP cells. Further biological function experiments and in vivo experiments validated that miR­7 and miR­153 can promote apoptosis and autophagy, inhibit proliferation and inflammatory response in GES­1/HP cells. All the associations between miR­7/miR­153 and their potential targets were revealed via bioinformatics prediction and dual­luciferase reporter assay. Particularly, downregulation of both miR­7 and miR­153 obtained an improved sensitivity and specificity in diagnosing H. pylori (CagA+)­induced GC. The present study identified that the combination of miR­7 and miR­153 may be regarded as novel therapeutic targets in H. pylori CagA (+)­associated GC.

Roles of microRNAs and exosomes in Helicobacter pylori associated gastric cancer.

Helicobacter pylori (H. pylori) is a common pathogen that infects more than half of the world's population. Its infection can not only lead to a variety of gastrointestinal diseases, such as chronic gastritis and gastric cancer (GC) but also be associated with many extra-gastrointestinal diseases. Exosomes, as a new intercellular information transmission medium, can carry biological signal molecules such as microRNAs (miRNAs) to regulate a variety of cellular physiological activities and are involved in multiple cancer processes. In this article, we provide a systematic review on the role of exosomal miRNAs in H. pylori-associated GC.

[Etiology and related clinical indicators of liver failure: an analysis of 3-year case data of Wuxi designated hospital for treatment of liver failure].

OBJECTIVE: To analyze the characteristics of etiology and clinical indicators of hepatitis B virus (HBV) and non-HBV liver failure, and to evaluate their potential roles in reflecting disease outcomes. METHODS: The clinical data of 369 patients with liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi which was the designated hospital for treatment of liver failure from January 2018 to December 2020 were retrospectively analyzed. The classification and comparison of etiology of non-HBV and HBV liver failure patients were performed according to the Guidelines on the Diagnosis and Treatment of Liver Failure (2018 edition). The indicators of liver failure related etiologies, including gender, age, anticoagulant enzyme III (AT III), total bilirubin (TBil), length of ICU stay, hepatic encephalopathy, underlying disease (liver cirrhosis and liver cancer, etc.) and usage of artificial liver were analyzed. According to the 6-month follow-up results after discharge, the differences in the etiological indicators of died and survival patients and the outcome of patients with different types of liver failure were analyzed. RESULTS: A total of 369 patients were enrolled, including 134 (36.3%) with liver failure not caused by HBV and 235 (63.7%) with liver failure caused by HBV. The male with HBV-related liver failure was 4.34 times higher than female (cases: 191 vs. 44), which was higher than non-HBV-related liver failure (1.03 times, cases: 68 vs. 66). The 6-month follow-up showed that the proportion of male with HBV-related liver failure who died and survived was significantly higher than that of female (78.76% vs. 21.24% in died patients, 92.86% vs. 7.14% in survival patients, both P < 0.01). The age of died patients in the non-HBV-related liver failure group was significantly higher than that of the survival patients (years: 58.53±0.15 vs. 54.38±3.01, P < 0.05), and the AT III level was significantly lower than that of the survival patients [(32.20±6.43)% vs. (38.63±2.74)%, P < 0.05]. The length of ICU stay of the died HBV-related liver failure group was significantly shorter than that of the survival patients (days: 23.77±11.74 vs. 35.51±2.85, P < 0.01). The 6-month mortality after discharge of HBV-related liver failure combined with liver cancer was significantly higher than that of non-HBV-related liver failure (12.34% vs. 2.24%, P < 0.01), but there was no significant difference in 6-month mortality after discharge of patients receiving artificial liver and those with hepatic encephalopathy and cirrhosis between different types of liver failure groups. CONCLUSIONS: HBV is the main cause of liver failure. Patients with HBV-related liver failure were younger and had a longer hospitalization period, which was conducive to the recovery of the disease. HBV-related liver failure accompanied with liver cancer is the main factors of death. The AT III has the potential value to reflect the disease outcome.

Secondhand smoking exposure and quality of life among pregnant and postnatal women: a network approach.

OBJECTIVE: This study examined the prevalence of exposure to secondhand smoke, its correlates and its association with quality of life (QOL) among pregnant and postnatal Chinese women. DESIGN: This was a multicentre, cross-sectional study. SETTING: Participants were consecutively recruited from eight tertiary hospitals located in eight municipalities or provinces in China. PARTICIPANTS: A total of 1140 women were invited to join this study and 992 (87.02%) completed all measures. PRIMARY AND SECONDARY OUTCOME: Measures women's secondhand smoking behaviour (frequency and location of exposure to secondhand smoking), and their QOL measured by the WHO Quality of Life Questionnaire. RESULTS: A total of 211 women (21.3%, 95% CI 18.7% to 23.8%) had been exposed to secondhand smoking. Exposure to secondhand smoking was most common in public areas (56.4%), and residential homes (20.5%), while workplaces had the lowest rate of exposure (13.7%). Women with physical comorbidities were more likely to report secondhand smoking exposure, while older women, women living in urban areas, those with college or higher education level, and women in their second trimester were less likely to report exposure to secondhand smoking. Network analysis revealed that there were six significant links between secondhand smoke and QOL items. The strongest negative edge was the connection between secondhand smoke and QOL9 ('physical environment health', edge weight=-0.060), while the strongest positive edge was the connection between secondhand smoke and QOL3 ('pain and discomfort', edge weight=0.037). CONCLUSION: The prevalence of exposure to secondhand smoking is becoming lower among pregnant and postnatal women in China compared with findings reported in previous studies. Legal legislation should be maintained and promptly enforced to establish smoke-free environments in both public and private urban/rural areas for protection of pregnant and postnatal women, especially those who are physically vulnerable and less educated.

Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women.

OBJECTIVE: Excessive Internet use is a common health problem globally. This study aimed to assess the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter) among Chinese pregnant and postpartum women. METHODS: This was a multicenter cross-sectional study using Internet Addiction Test (IAT) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate Internet addiction and quality of life (QOL), respectively. Univariate analyses, multivariate logistic regression analyses, and network analyses were performed. RESULTS: Of a total of 1,060 women who completed the study, 320 (30.19%, 95% CI=27.42%-32.96%) women reported Internet addiction during or after pregnancy. Women with previous adverse pregnancy experiences (OR=1.831, P=0.001) and physical comorbidities (OR=1.724, P=0.004) had a higher likelihood of developing Internet addiction. Internet addiction was significantly associated with poor QOL in all domains. Network analyses revealed that IAT item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also one of the strongest bridging symptoms linking the Internet addiction and QOL communities. LIMITATIONS: This was a cross-sectional study, all study findings were based on self-reported data, and possible recall bias and selection bias may exist. CONCLUSION: Internet addiction is common among Chinese pregnant and postpartum women, and is significantly associated with lower QOL. Effective strategies, especially focusing on central symptoms, are needed to reduce the impact of Internet addiction and improve QOL in pregnant and postpartum women.

The Prevalence of Depression and Its Association With Quality of Life Among Pregnant and Postnatal Women in China: A Multicenter Study.

Background: This study examined the prevalence of depressive symptoms (depression hereafter) and its association with quality of life (QOL) among pregnant and postnatal women in China. Methods: In this multi-center, cross-sectional study, 1,060 pregnant and postnatal women from eight hospitals were assessed. Depression and QOL were measured using the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Questionnaire - brief version, respectively. Results: The prevalence of depression was 7.45% (95% CI: 5.87-9.04%) in the sample. Women with depression had lower QOL in physical, psychological, social and environmental domains compared to those without. Women with physical comorbidities were more likely to suffer from depression (OR = 2.391, 95% CI = 1.384-4.130, P = 0.002). Conclusion: Due to its negative association with QOL, increased attention should be paid to depression in pregnant and postnatal women. Regular screening assessment and preventive measures should be adopted to reduce risk of depression in this population.

Effectiveness and Safety of Preoperative Oral Carbohydrates in Enhanced Recovery after Surgery Protocols for Patients with Diabetes Mellitus: A Systematic Review.

To evaluate the necessity and safety of preoperative oral carbohydrates in enhanced recovery after surgery (ERAS) protocols for diabetes mellitus patients. We searched PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG databases for articles published through September 2018. We used the Cochrane risk-of-bias tool to assess the methodological quality of included studies. Literature screening, data extraction, and quality evaluation were performed independently by two investigators. Of the 6328 retrieved articles, five eligible randomized controlled trials were included. Two were from China and three were from Germany, Sweden, and Canada. Preoperative oral carbohydrates may facilitate control of preoperative blood glucose, improve postoperative insulin resistance in diabetes patients, and decrease the occurrence of adverse reactions. However, the overall quality of the included studies was low. The available evidence shows that preoperative oral carbohydrates are probably beneficial for patients with diabetes mellitus. High-quality, large randomized controlled trials are needed to verify our findings and provide quantitative results.

Prognostic significance of preoperative serum albumin in epithelial ovarian cancer patients: a systematic review and dose-response meta-analysis of observational studies.

PURPOSE: To comprehensively assess the impact of preoperative serum albumin levels on survival of patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS: Two independent researchers searched the PubMed, Embase, and Web of Science databases to identify relevant studies from inception to October 20, 2017. The studies were independently reviewed and those deemed eligible were selected based on predetermined selection criteria. Summarized HRs and 95% CIs were calculated for overall survival (OS) with a profile likelihood random-effects model. RESULTS: Twelve cohort studies comprising 3884 EOC patients were included for analysis. Comparison of the highest vs the lowest categories of preoperative serum albumin yielded a summarized HR of 0.63 (95% CI=0.45-0.88, I2=88.8%). Although the results were robust in all subgroup analyses stratified by International Federation of Gynecology and Obstetrics (FIGO) stage, cutoff definition, geographical location, quality of study, number of EOC cases, followup time, and adjustments made for potential confounders, not all were statistically significant. Of note, dose-response analysis showed that for each 10 g/L increment in preoperative serum albumin level, the summary HR was 0.56 (95% CI=0.35-0.92, I2=78.6%). No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Sensitivity analyses showed no important differences in the estimates of effects. CONCLUSION: The present meta-analysis suggests that preoperative serum albumin can be used as an independent prognostic predictor of OS in EOC patients. Since the included studies had high heterogeneity and retrospective designs, these results require further validation with prospective cohort trials enrolling larger patient populations with longer follow-up examinations.

[Repeatability and agreement of corneal thickness measurement with Pentacam Scheimpflug photography and Visante optical coherence tomography].

OBJECTIVE: To evaluate the repeatability and agreement of central and peripheral corneal thickness (CT) measurements by high resolution Pentacam rotating Scheimpflug photography and Visante optical coherence tomography (OCT) in unoperated myopic eyes and eyes after Laser In Situ Keratomileusis (LASIK). METHODS: CT at central, thinnest, 1.0 mm and 2.5 mm superior, inferior, nasal and temporal periphery locations, and the location of the corneal thinnest thickness were measured using Pentacam and Visante OCT in 60 myopia patients (60 eyes) and 60 patients (60 eyes) after LASIK. The results were analyzed by paired-t test, Pearson correlation analysis and Bland-Altman method. RESULTS: Both Pentacam and Visante OCT demonstrated high intraobserver repeatability, with all intraclass correlation coefficients and Cronbach's alphas were more than 0.9, and coefficient of variation were less than 0.9%. Significantly higher CoV was measured with Pentacam than by Visante OCT in at central (0.46 ± 0.30), thinnest (0.43 ± 0.28) and 1.0 mm locations in both groups (t = 2.465, 2.226, P < 0.05), but no statistically significant difference were found at 2.5 mm locations in healthy subjects and all locations in post-LASIK eyes (t = -0.518, 1.542, -0.876, 0.756, P > 0.05). The thickness of central corneal with Pentacam was (543.01 ± 22.89) µm, the thinnest point was (540.61 ± 22.84) µm, they were greater than the value of Visante OCT (t = 17.946, 23.071, P < 0.05). The Pearson correlation coefficients were all more than 0.9 (all r > 0.9, P < 0.01). The Bland-Altman plots showed the 95% LoA between both devices were lower than 22 µm at central, thinnest and 1.0 mm locations. However, the 95% LoA were 24 µm to 44 µm at 2.5 mm locations. CONCLUSIONS: Pentacam and Visante OCT demonstrate high repeatability for central and peripheral CT measurements in young myopia and post-LASIK eyes. However, both devices can't be used interchangeably for measurements of peripheral CT.

[Submacular fluid after surgery for rhegmatogenous retinal detachment].

OBJECTIVE: To evaluate the accumulation of submacular fluid after surgery for retinal detachment. METHODS: It was a case control study. Sixty seven eyes of sixty six patients with rhegmatogenous retinal detachment which had undergone par plana vitrectomy (PPV) or buckle surgery for retinal detachment were recruited. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macular at the 1-month postoperative follow-up examination. RESULTS: Submacular fluid after PPV occurred in 21.7% eyes, and was significantly lower than that after buckle surgery(47.7%, chi2 = 4.296, P < 0.05). No significantly differences of submacular fluid rate were found between different surgical technique groups (cryotherapy, transscleral diode photocoagulation, with or without drainage of subretinal fluid) in our buckle surgery series (chi2 = 0.091, 1.588; P > 0.05). There was statistically significant difference in the rate of submacular fluid in cases of buckle surgery series with or without macular detachment (chi2 = 9.537, P < 0.01). Visual acuity improved for 2 lines or more accounted for 80.8% eyes in patients with submacular fluid and for 80.1% eyes in patients without submacular fluid. Comparison of pre- and postoperative LogMAR between these two groups showed no significant difference (F = 0.162, P = 0.688). CONCLUSIONS: The rate of submacular fluid is much lower after PPV than after buckle surgery. Different surgical techniques used in buckle surgery such as cryotherapy or transscleral diode photocoagulation and with or without drainage of subretinal fluid do not influence the rate of postoperative submacular fluid. The rate of submacular fluid is much lower in eyes without macular detachment than in eyes with macular detachment in buckle surgery series.

[Study on the status of pollution by Legionella species in hot spring vacation center and the related factors].

OBJECTIVE: To study the pollution status of Legionella species in hot spring vacation center and the related factors. METHODS: Field surveys were performed in four big hot spring vacation centers of Changping district. Uniform questionnaires was used and colony count was made together with the isolation of Legionella species from hot spring water based on mip gene typing. RESULTS: 47 isolates of Legionella pneumophila (Lp) from 87 samples showed 4 serotypes as Lp1, Lp6, Lp12, Lp5 with percent of 57.45%, 21.28%, 14.89%, 6.38% respectively. The hot spring centers controlled the temperature of recycled water between 34-47 degrees C by hot water heating and filtrating system. All the isolates were cultured from the hot water with temperature between 34-44 degrees C: 56.75% (21/37) in high temperature (40-47 degrees C) and 61.90% (26/42) in low temperature (34-39.9 degrees C). There were no statistically significant difference between the high and the low temperature samples (P > 0.05). In the four hot spring vacation centers, the pH value was under control at 6.4-7.3 and the ambient temperature was under control between 26-28 degrees C. The humidity was controlled between 56% -69% relative humidity, which were the best growing conditions for the Legionella species. Disinfectors as chlorine deviratives was used in the four hot spring vacation centers. Though the concentration of chlorine in the water was 0.3-0.5 mg/L, 14.29%-48.00% of the samples were still positive of having Legionella species. CONCLUSION: The pollution of Legionella species was considered to be quite serious in the four hot spring vacation centers and the predominant serotype was Lp1. The pH and temperature of the hot spring water, ambient temperature and humidity and the way of heating up the water were the best conditions for the growth of Legionella species in these centers. Because of the high temperature of the hot spring water, chlorine of the disinfector volatilized quickly, affecting the effect of disinfection. The result revealed that water temperature achieving 44 degrees C could have had the effect of prevention.