Prevalence and clinical characteristics of advanced portal vein thrombosis in cirrhotic patients with gastroesophageal variceal hemorrhage.

OBJECTIVES: Portal venous thrombosis (PVT) in cirrhotic patients is usually asymptomatic and diagnosed incidentally. In this study we aimed to investigate the prevalence and characteristics of advanced PVT in cirrhotic patients with a recent episode of gastroesophageal variceal hemorrhage (GVH). METHODS: Cirrhotic patients with recent GVH at one month before their admission for further treatment to prevent rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurements, contrast-enhanced computed tomography (CT) scan of the portal vein system, and endoscopy were performed. PVT was diagnosed by CT examination and classified as none, mild and advanced. RESULTS: Of the 356 patients enrolled, 80 (22.5%) had advanced PVT. Elevated levels of white blood cells (WBC) and serum D-dimer were observed in advanced PVT patients compared with those with no or mild PVT. Moreover, HVPG was lower in patients with advanced PVT, with fewer patients having HVPG exceeding 12 mmHg, while grade III esophageal varices and varices with red signs were more prevalent. Multivariate analysis showed that WBC count (odds ratio [OR] 1.401, 95% confidence interval [CI] 1.171-1.676, P < 0.001), D-dimer level (OR 1.228, 95% CI 1.117-1.361, P < 0.001), HVPG (OR 0.942, 95% CI 0.900-0.987, P = 0.011), and grade III esophageal varices (OR 4.243, 95% CI 1.420-12.684, P = 0.010) were associated with advanced PVT. CONCLUSIONS: Advanced PVT, which is associated with a more severe hypercoagulable and inflammatory status, causes severe prehepatic portal hypertension in cirrhotic patients with GVH.

Risk factors associated with failure of endoscopic combined treatment to prevent varices rebleeding in patients with liver cirrhosis.

BACKGROUND: The aim of this study is to investigate risk factors associated with gastroesophageal variceal rebleeding after endoscopic combined treatment. RESEARCH DESIGN AND METHODS: Patients who had liver cirrhosis and underwent endoscopic treatment to prevent variceal rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurement and CT examination of portal vein system were performed before endoscopic treatment. Endoscopic obturation for gastric varices and ligation for esophageal varices were performed simultaneously at the first treatment. RESULTS: One hundred and sixty-five patients were enrolled, and after the first endoscopic treatment, recurrent hemorrhage occurred in 39 patients (23.6%) during 1-year follow-up. Compared to the non-rebleeding group, HVPG was significantly higher (18 mmHg vs.14 mmHg, P = 0.024) and more patients had HVPG exceeding 18 mmHg (51.3% vs.31.0%, P = 0.021) in the rebleeding group. No significant difference was found in other clinical and laboratory data between two groups (P > 0.05 for all). By a logistic regression analysis, high HVPG was the only risk factor associated with failure of endoscopic combined therapy (OR = 1.071, 95%CI, 1.005-1.141, P = 0.035). CONCLUSIONS: The poor efficacy of endoscopic treatment to prevent variceal rebleeding was associated with high HVPG. Therefore, other therapeutic options should be considered for the rebleeding patients with high HVPG.

Evaluation of the Application Effect of WeChat Platform-based Communication Mode in Family Members of Patients after Partial Pulmonary Resection in the Anesthesia Intensive Care Unit.

Objectives: In this study, we explored the application effect of the communication mode based on WeChat platform in the family members of patients after partial pulmonary resection in the anesthesia intensive care unit. Methods: We selected 80 patients with elective general anesthesia for partial pulmonary resection and divided them into an observation group and a control group with 40 cases in each group according to the random number table method. We compared anxiety self-evaluation scores, medical service satisfaction scores, and family members' desire to visit between the 2 groups. Results: The anxiety score of the observation group was significantly lower than that of the control group (p<.05). The medical service satisfaction score of the observation group was significantly higher than that of the control group (p<.05). The desire for face-to-face visits of family members in the observation group was significantly lower than that in the control group (p<.05). Conclusion: The communication mode based on the WeChat platform can reduce the anxiety of patients, improve the satisfaction of patients with medical services, and reduce the desire of family members to visit. The method is simple and easy to implement and is worthy of clinical outreach.

Macular pucker, an atypical clinical presentation of ocular toxoplasmosis: a case report.

BACKGROUND: Ocular toxoplasmosis caused by Toxoplasma gondii is an infectious disease which is widely distributed around the world and can present with various clinic manifestations. We are here reporting an unusual case presented with epiretinal membrane (ERM), i.e., macular pucker. CASE PRESENTATION: A 16-year old male patient visited our outpatient clinic complaining of decreased vision for about 8 years in his left eye. The best-corrected visual acuity (BCVA) was 20/20 OD and 20/400 OS. There was sensory exotropia in his left eye. No inflammatory cells or flare were found in his anterior chamber or vitreous cavity OU. An ERM involving his left macular area was found on his dilated fundus exam, which was confirmed by Optical Coherence Tomography (OCT). The ERM was found to involve his left macular area with his foveal ellipsoid zone absent. The right eye was found to be within normal limit. After a thorough discussion with the patient and his parents about treatment options and surgical benefits, risks and alternatives, we performed vitrectomy, peeled off the ERM and collected the vitreous sample for parasite testing during the procedure. Patient's blood also was drawn for serological testing. Vitreous sample analysis and serological tests confirmed ocular toxoplasmosis OS as his final diagnosis. Unfortunately, the BCVA of this patient was not improved after the surgery, but the exotropia disappeared. CONCLUSION: ERM is an unusual clinical presentation of ocular toxoplasmosis. We may add Toxoplasma gondii infection as a differential diagnosis when encountering ERM cases.

Objective optical assessment of tear-film quality dynamics in patients with meibomian gland dysfunction and aqueous-deficient dry eye optical quality changes in different dry eye subtypes.

Purpose: To evaluate the optical quality and tear-film dynamics in patients with aqueous-deficient or evaporative subtype of dry eye disease (DED). Methods: Twenty-five aqueous-deficient dry eye (ADDE) patients, 25 DED patients with meibomian gland dysfunction (MGD), and 25 healthy subjects were included in this study. Vision-related health-targeted quality of life was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Dynamic recording with a double-pass system (Optical Quality Analysis System [OQAS]) was performed in right eyes. Scattered light was measured as the objective scatter index (OSI) at 0.5-second intervals over 20 seconds without blinking. Then, we recorded OSI every 0.5 seconds within a 20-second period with the subjects asked to blink freely. Several parameters were established to evaluate the dynamic alterations of optical quality and the effects of blinks: OSI, OSI standard deviation (SD), ΔOSI, ΔOSI/time, blinking change (BC), and blinking frequency (BF). Additional clinical examination included tear film break-up time (BUT), Schirmer I test (SIT), fluorescein staining grade (FL), meibomian gland quality, meibomian gland expressibility, and meibomian gland drop-out. Results: The OSI, SD, ΔOSI, ΔOSI/time, BC, and BF were significantly higher in DED patients than controls (P < 0.01, respectively). The OSI, SD, ΔOSI, ΔOSI/time, BC, and BF were significantly higher in patients with MGD than patients with ADDE (P < 0.01). In the MGD group, BUT, FL staining score, lid abnormality, meibomian gland expressibility, and meibomian gland drop-out were correlated with Δ OSI and Δ OSI/time. Conclusion: Dry eye patients with MGD had significant alterations of optical quality compared with ADDE patients. The double-pass system has potential to be a useful quantitative method to evaluate the optical quality and tear-film dynamics in patients with dry eye.

Comparison of femtosecond laser-assisted descemetic and predescemetic lamellar keratoplasty for keratoconus.

PURPOSE: The purpose of this study is to compare the outcomes following femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) with 75% of stromal dissection (predescemetic group) and femtosecond laser-assisted DALK using big-bubble technique with total stromal resection (descemetic group) for the treatment of keratoconus. SUBJECTS AND METHODS: Twenty eyes of 17 patients with keratoconus were studied. There were 10 eyes of 9 patients in predescemetic group and 10 eyes of 8 patients in descemetic group. The postoperative best-corrected visual acuity (BCVA), manifest refraction, keratometry, endothelial cell density (ECD), and central corneal thickness (CCT) were analyzed. RESULTS: All surgeries were performed uneventfully. At 1 year after surgery, the BCVA, corneal astigmatism, keratometry, CCT, and ECD between two groups were not statistically significant (all P > 0.05). However, the mean manifest refraction was -9.43 ± 7.44 diopter (D) and -1.03 ± 1.13D in predescemetic and descemetic groups, respectively, which was statistically significant between two groups (P < 0.05). CONCLUSIONS: The results of BCVA and corneal astigmatism, keratometry, ECD, and CCT were comparable between two groups. However, the mean postoperative manifest refraction was lower in descemetic group.

A novel P20R mutation in the alpha-B crystallin gene causes autosomal dominant congenital posterior polar cataracts in a Chinese family.

BACKGROUND: To identify the genetic defects and investigate the possible mechanism of cataract genesis in a five-generation family with autosomal dominant congenital posterior polar cataracts. METHODS: Clinical data were collected, and the lens phenotypes of the affected members in this family were recorded by slit lamp photography. Genomic DNA was isolated from peripheral blood using QIAamp DNA Blood Mini Kits. Twenty-three mutational hot spots associated with autosomal dominant congenital posterior polar cataracts were screened by PCR-based DNA sequencing. Properties and structural models of wild-type and mutant alpha-B (αB)-crystallin (CRYAB) were generated and analyzed using SWISS-MODEL. RESULTS: All affected individuals in this family started to exhibit poor vision at the age of 8-10 years. The lens opacity consisted of a single, well-defined plaque, 0.5-3 mm in diameter, which was confined to the posterior pole of the lens. DNA sequencing analysis of the affected members showed a novel, heterozygous missense mutation c.59C > G (P20R) in exon 1 of the CRYAB gene. This mutation was not found in 10 unaffected family members, or in 200 unaffected and unrelated individuals, thereby excluding the possibility that it is a rare polymorphism. Data generated using the ProtScale and PyMOL programs revealed that the mutation altered the stability and solubility of the αB-crystallin protein. CONCLUSIONS: This study reported a novel c.59C > G (P20R) missense mutation in CRYAB in a five-generation Chinese family with posterior polar cataract.

A novel COL4A1 gene mutation results in autosomal dominant non-syndromic congenital cataract in a Chinese family.

BACKGROUND: Almost one-third of congenital cataracts are primarily autosomal dominant disorders, which are also called autosomal dominant congenital cataract, resulting in blindness and clouding of the lens. The purpose of this study was to identify the disease-causing mutation in a Chinese family affected by bilateral, autosomal dominant congenital cataract. METHODS: The detection of candidate gene mutation and the linkage analysis of microsatellite markers were performed for the known candidate genes. Molecular mapping and cloning of candidate genes were used in all affected family members to screen for potential genetic mutations and the mutation was confirmed by single enzyme digestion. RESULTS: The proband was diagnosed with isolated, congenital cataract without the typical clinical manifestations of cataract, which include diabetes, porencephaly, sporadic intracerebral hemorrhage, and glomerulopathy. A novel mutation, c.2345 G > C (Gly782Ala), in exon 31 of the collagen type IV αlpha1 (COL4A1) gene, which encodes the collagen alpha-1(IV) chain, was found to be associated with autosomal dominant congenital cataract in a Chinese family. This mutation was not found in unaffected family members or in 200 unrelated controls. Sequence analysis confirmed that the Gly782 amino acid residue is highly conserved. CONCLUSIONS: The novel mutation (c.2345 G > C) of the COL4A1 gene is the first report of a non-syndromic, autosomal dominant congenital cataract, thereby highlighting the important role of type IV collagen in the physiological and optical properties of the lens.

Management of periorbital hemangioma by intralesional glucocorticoids and systemic propranolol: a single-center retrospective study.

Periorbital hemangioma may lead to the vision impairment so effective treatment should be adopted in time. In this study, we made a retrospective analysis of intralesional glucocorticoids and systemic propranolol in the management of periorbital hemangioma. From Jan. 2006 to Dec. 2013, twenty-five children with periorbital hemangioma were enrolled into this study. Among them, sixteen children accepted intralesional injection of compound betamethasone preparation. Eight children accepted systemic propranolol. One child accepted both of the two treatments. The follow-up period ranged from 6 months to 60 months. The results showed that in the patients with intralesional compound betamethasone preparation, 13/16 patients' tumors involuted completely. 3/16 patients' tumors didn't involute completely at the end of follow-up. In the patients with systemic propranolol, 8/8 patients' tumors involuted almost completely. One patient didn't respond to intralesional glucocorticoids, and so switched to systemic propranolol, which lead to the involution of tumor finally. The adverse effects in the patients with intralesional glucocorticoids included local soft tissue atrophy, local ulcer, and Cushing-like manifestations, which occurred in three patients respectively. In the patients with systemic propranolol, mild diarrhoea occurred in one child. According to our observation, both of intralesional glucocorticoids and systemic propranolol achieved good results in the management of periorbital hemangioma. Systemic propranolol showed superiority in efficacy and safety. We recommend systemic propranolol as the first-line therapy. However, for the children who can't tolerate systemic propranolol, intralesional glucocorticoids still is a feasible choice.

Curcumin protects against hyperosmoticity-induced IL-1beta elevation in human corneal epithelial cell via MAPK pathways.

Increased tear osmolarity is an essential feature of dry eye disease. Curcumin, a natural polyphenol extracted from herb turmeric, has recently been reported to have anti-inflammatory effects. However, its anti-inflammatory effects have not been investigated in dry eye disease. It has been reported that elevated osmolarity achieved by adding sodium chloride to the culture medium of corneal epithelial cells increased the production of IL-1beta, a proinflammation cytokine. This in vitro dry eye model was used to test the anti-inflammatory effects of curcumin. In the present study, a 450 mOsM hyperosmotic medium was produced by adding sodium chloride to the culture medium to reach a final concentration of 90mM. Human corneal epithelial cells cultured in this hyperosmotic medium for 24h showed an increase of IL-1beta, IL-6 and TNF-alpha levels in the conditioned medium. IL-1beta was also upregulated at mRNA levels. Activation of p38 MAP kinase (p38), JNK MAP kinase (JNK) and NF-kappaB in cultured corneal epithelial cells were also induced by hyperosmotic conditions. Curcumin at concentrations of 1-30muM did not affect the cell viability of cultured corneal epithelial cells. Pretreatment of curcumin (5muM) completely abolished the increased production of IL-1beta induced by the hyperosmotic medium. Increased phosphorylation of p38 caused by high osmolarity was also completely abolished by curcumin, whereas the phosphorylation of JNK was only partially inhibited. SB 203580 (p38 inhibitor), but not SP 600125 (JNK inhibitor), completely suppressed hyperosmoticity-induced IL-1beta production, indicating that the inhibition of production of IL-1beta by curcumin may be achieved through the p38 signal pathway. Curcumin completely abolished a hyperosmoticity-induced increase of NF-kappaB p65. NF-kappaB inhibitor suppressed hyperosmoticity-induced IL-1beta production. p38 inhibitor suppressed hyperosmoticity-induced NF-kappaB activation, indicating that NF-kappaB activation was dependent on p38 activation. The present study suggests that curcumin might have therapeutic potential for treating dry eye disease.

[Comparison of clinicopathologic characteristics and prognosis of triple-negative with Her-2-overexpressing breast cancer].

OBJECTIVE: The aim of this study is to compare the clinicopathologic characteristics and disease-free survival of triple-negative breast cancer with human epidermal growth factor receptor-2-overexpressing (Her-2-overexpressing) breast cancer. METHODS: 770 breast cancer patients were surgically treated between 1998 and 2003 in Changhai Hospital, Shanghai. Patients with triple negative phenotype were identified from those using immunochemistry and CISH. The differences between triple-negative breast cancer and Her-2-overexpressing breast cancers were analyzed in p53 and E-cadherin status, age, tumor size, tumor location, histological types and grading, lymph node metastasis, AJCC stage, chemotherapy and surgical procedures,as well as identified prognostic factors with regards to disease-free survival. RESULTS: Ninety-six (12.5%) patients with triple-negative phenotype, and 164 (21.3%) with Her-2-overexpressing one were identified from the 770 breast cancer patients. No significant difference between two phenotypes in p53 and E-cadherin expression was found (P>0.05). When compared with Her-2-overexpressing breast cancer patients, triple negative breast cancer patients experienced more lymph node metastases (71.9% vs. 58.5%, P = 0.034), and had a higher percentage of more than 10 lymph nodes metastases (26.0% vs. 12.2%, P = 0.034); and showed a higher percentage of histological grade 3 (67.7% vs. 42.1%, P<0.0001). Furthermore, the tumor size was found to be related to lymph node metastasis in triple-negative breast cancer patients (P = 0.024). No significant difference between the two phenotypes in the rates of local recurrence and distant metastasis was observed (P>0.05). However, 5-year disease-free survival in patients with triple negative phenotype was significantly shorter than that in the patients with Her-2-overexpressing phenotype (61.85 mon vs. 78.69 mon, P = 0.047). CONCLUSION: Compared with Her-2-overexpressing breast cancer, triple-negative breast cancer is more malignant and has a poorer disease-free survival.

[Experimental study of suppression of reactivation of herpes simplex virus type 1 by cyclooxygenase 2 inhibitor with acyclovir].

OBJECTIVE: To study whether the cyclooxygenase 2 (COX-2) inhibitor can block the herpes virus reactivation and whether the combination of COX-2 inhibitor with acyclovir can enhance the inhibition of virus reactivation. METHODS: It was a experimental study. Mice were randomly divided into six groups. Five groups were HSV-1 infected mice, which included: group A, treated with lornoxicam and acyclovir; groups B and C, treated with lornoxicam or acyclovir, respectively; groups E and F were injected with saline as the untreated control groups. The sixth group was uninfected mice as the control group. All groups were undergone to reactivate the herpes virus by UV-B except group F. The shedding of the virus was determined by cultures of ocular swab or ganglion homogenates with indicator cells. RESULTS: The rates of corneas and ganglia containing the infectious virus in the groups A, B and C were significantly lower than those in the control group D, (cornea: 2XA-D = 36.88, XB-D = 22.43, X2C-D = 20.32, P < 0.05, ganglia : X2A-D = 49.91 X2B-D =29. 16,X2C.D = 24.89, P < 0.05). Combined use of these two drugs in group A showed no significant statistical difference as compared with using them separately in the cornea culture (X2A-B= 2.75, X2A-C = 3.66, 0. 05 < P < 0.1), but there was significant difference in trigeminal ganglia culture (X2A-B = 4.78, 2XA-c = 6. 97, P < 0.05). CONCLUSIONS: These experiments demonstrate that a selective COX-2 inhibitor can suppress UV-B-induced herpes virus reactivation in the cornea and nervous system. A combination of acyclovir does not significantly enhance the inhibition of virus reactivation by lornoxicam. These results provide a new method to prevent the recurrence of HSK.