[Effects of three methods for correction of low-degree against-the-rule corneal astigmatism during cataract surgery].

Objective: To compare the clinical effects of and visual quality after correction of low-degree against-the-rule (ATR) corneal astigmatism by implantation of an astigmatism-corrected intraocular lens (IOL), femtosecond laser release and manual release in cataract surgery. Methods: It was a prospective cohort study. A total of 120 patients (120 eyes) with cataract combined with low-degree ATR corneal astigmatism diagnosed in Chongqing Aier Mega Eye Hospital from December 2017 to October 2020 were included and divided into 3 groups, each with 40 patients, according to their own selections of astigmatism correction methods during cataract surgery. In the astigmatism-corrected IOL group, phacoemulsification for cataract extraction combined with toric IOL implantation was performed. In the femtosecond laser release group, astigmatic keratotomy using a femtosecond laser was combined. In the manual release group, a limbal relaxing incision was made. Uncorrected distance visual acuity (UDVA) and corneal astigmatism were measured before surgery. At 3 months and 1 year after surgery, UDVA and best-corrected distance visual acuity were examined, as well as whole eye residual astigmatism by ARK-1, corneal astigmatism by the IOLMaster 500, whole eye high order aberration (HOA) and modulation transfer function (MTF) by the iTrace visual function analyzer. Analysis of variance was used for the comparison of data in a normal distribution. Repeated measures were used for the comparison within groups. The rank sum test was used for the comparison of data that were not normally distributed. Results: Of the 120 patients, 100 patients (100 eyes), including 44 males and 56 females, with an age of (66.48±6.20) years, completed the follow-up. Among the three groups, the differences were not statistically significant in terms of gender distribution, age, preoperative corneal astigmatism, UDVA and spherical equivalent of the IOL (all P>0.05). At 3 months and 1 year after surgery, the UDVA was significantly better than that before surgery in each group (Z=5.18, 5.04, 4.98, 4.99, 4.90, 4.89; all P<0.001). At the two time points, the differences in the whole eye residual astigmatism among the three groups were statistically significant (H=30.69, 31.23; both P<0.001). At 3 months, the whole eye residual astigmatism in the astigmatism-corrected IOL group was lower than that in the other two groups. At 1 year, the residual astigmatism in the astigmatism-corrected IOL group [0.25(0.00, 0.50) D] was also lower compared to that in the femtosecond laser release group [0.50(0.50, 0.75) D] and the manual release group [0.75(0.50, 0.75) D] (Z=-3.71, -5.18, -3.94, -5.15; all P<0.001). The differences in the HOA at 3 months and 1 year among the three groups were statistically significant (H=36.30, 34.38; both P<0.001). The HOA in the astigmatism-corrected IOL group was significantly higher than that in the other two groups at the two time points (Z=5.01, 4.73, 5.31, 5.27; all P<0.001). At 3 months and 1 year, the differences in the MTF value among the three groups were also statistically significant (H=30.02, 29.92; both P<0.001), and the MTF value in the femtosecond laser release group was significantly higher than that in the other two groups (Z=4.61, 4.67, 4.66, 4.69; all P<0.001). Conclusions: All the three astigmatism correction methods used at the time of cataract surgery can effectively correct low-degree ATR corneal astigmatism. The residual astigmatism in the whole eye after astigmatism-corrected IOL implantation is small and stable, while the HOA after release using the femtosecond laser is low with good visual quality.

[Analysis of occupational health input-output of a iron mine in Hebei province].

Objective: To explore the relationship between input and output of occupational health funds, and to provide basis for relevant departments to make decisions. Methods: In September 2018, a state-owned iron ore in Hebei Province (mining history of more than 10 years, which can represent the general type of iron ore) was selected as the research object. Through the investigation and collection of enterprise general situation, occupational health input, loss and output related indicators, the iron mine occupational health expenditure input-output table and model were established, and the digital relationship between the investment and output was solved by MATLAB software. Results: The labor consumption in the departments of underground mining, open pit mining, crushing and rock discharging, transportation, tailings and mineral processing (taking labor wages as reference) were 756.46, 1.281.78, 987.61, 1 570.71, 50.956 and 18.9116 million yuan/year respectively. The output value of each sector is 11 207.19, 18 989.95, 15 176.40, 25 294.00, 7.704.94 and 280.1797 million yuan/year respectively. The ratio of health input to total output was 0.004 5, and the ratio of occupational health input to output was 1/0.046. Conclusion: The input-output table model of occupational health in iron mine can reflect the relationship between input and output of occupational health funds. The input situation of the coal mine is poor, and the input does not bring obvious occupational health benefits.

Immunoglobulin G4-related thoracic aortitis.

Patients with immunoglobulin G4-related thoracic aortitis often have nonspecific symptoms, but pain in the chest or back is common. The rate of misdiagnosis of immunoglobulin G4-related thoracic aortitis is high, which may lead to mistreatment in extreme cases. A correct diagnosis should be based on comprehensive medical imaging, pathology, and laboratory and immunohistochemical results. Most patients' condition can be significantly improved using conservative or surgical treatment.

Syphilitic aortic aneurysm.

The aim of this study was to outline the clinical features of syphilitic aortic aneurysm. The study materials were based on a comprehensive literature review of publications on syphilitic aortic aneurysm published between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly in the ascending aorta in either a saccular or a fusiform shape. Syphilitic aortic aneurysm was often complicated by aortic valve insufficiency (in almost half of the patients), and by a coronary artery/ostium lesion in 16.5% of the patients. Aortic valve operation was necessary in one fourth, and coronary artery surgery accounted for less than one fifth of patients warranting a surgical treatment. Although there was no difference in the survival rates between the surgically and conservatively treated patients, an aggressive treatment should be performed when diagnosis is made due to the potential risks of aneurysm rupture and sudden death.

Fever of unknown origin in aortic dissection.

Aortic dissection is the most devastating sequela of thoracic aortic disorder. Patients with acute aortic dissection typically manifest as an acute onset of severe chest pain, but occasionally present with atypical symptoms including fever of unknown origin. A total of 50 patients from 41 articles based on a complete literature retrieval were included in this study. More patients had a fever prior to pain. The time to presentation was 40.7 ± 105.6 days, the time to diagnosis was 52.9 ± 110.1 days, and the time to surgery/intervention was 1.8 ± 5.6 days. The patients' temperature on admission was 38.2 ± 0.6 °C and the maximal temperature recorded was 38.8 ± 0.4 °C. Laboratory findings showed increased white blood cell counts, cardiac enzymes, and inflammatory biomarkers. More pronounced laboratory findings of the infectious type than the inflammatory type aortic dissection could be helpful in the differential diagnosis. Half of patients warrant aortic repair with or without valve replacement, less than half of patients were conservatively managed, and a few were interventionally treated or were being followed up. The mortality rate was 9.5 %. Physicians should always bear in mind aortic dissection when patients present with fever of unknown origin particularly in those without chest pain. Laboratory findings may offer inflammatory evidence for the diagnosis. An early diagnosis as well as subsequent treatment is indispensable for patients' outcomes.

Isolated costal cartilage fractures: the radiographically overlooked injuries.

Isolated costal cartilage fractures are benign and rare. A 65-year-old man had a sustained chest pain after a fist punch in the past month. A 3-dimensional computed tomography revealed left 7th and 8th costal cartilage fractures with fracture dislocations. As he refused an open fracture reduction, he was advised to have a rest with subsequent follow-up. Ultrasound screening is recommended in patients with sustained posttraumatic chest pains in order to rule out possible costal cartilage fractures. The therapeutic regimen generally depends on the location and severity of the fracture.

[Chorionic villus cell culture and karyotype analysis in 1 983 cases of spontaneous miscarriage].

Objective: To investigate the relationship between spontaneous miscarriage and embryonic chromosome abnormalities, and to evaluate the clinical application of karyotype analysis by chorionic villus cell culture. Methods: The chorionic villus karyotype of 1 983 cases of miscarriage from January 2010 to July 2016 in Guangzhou Women and Children's Mecical Center were analyzed retrospectively. The miscarried chorionic villi were obtained by curettage under sterilized condition. The chromosome specimens were prepared after chorionic villus cell culture. Karyotype analysis was performed by G-banding technique. Results: In the 1 983 samples, successful karyotype analysis was performed in 1 770 cases, with the successful rate of 89.98%. Chromosomal abnormalities were found in 1 038 cases (58.64%, 1 038/1 770). Chromosomal structural abnormalities were found in 37 cases. The numeral abnormalities were more common than structural abnormalities, and most of the numeral abnormalities were aneupoidies. In turn, they were trisomy 16, 45,X, trisomy 22, trisomy 2, trisomy 21, trisomy 15. The most common structural abnormality was balanced translocation, including Robersonian translocation. Female embryoes accounted for 61.02% (1 080/1 770) miscarriages and for 57.4%(596/1 770) of chromosomal abnormalities, while male embroyes acoounted for 61.02% (1 080/1 770) , 57.4% (596/1 770) respectively. The proportion of female embryoes was higher than male embryoes. The median age of the patients was 30 years old (16-46 years old) . As the maternal age increased, the proportion chromosomal abnormalities increased. The incidence of chromosomal abnormalities in the advanced age group (≥35 years) was 68.38% (240/351) , which was significantly higher than that in the younger group (56.24%, 798/1 419; χ(2)=17.10, P<0.01). Conclusions: Embryonic chromosomal abnormalities are the most common cause of early spontaneous miscarriage. The abnormalities centralize in some karyotypes. There is certain relationship between maternal age and the incidence of miscarriage, as well as the embryonic gender. Chorionic villus cell culture and karyotype analysis are helpful in finding the cause of miscarriage and counsel the patients.

Innovations of surgical techniques for the management of inferior vena cava tumor thrombus of renal cell carcinoma.

Surgery for renal cell carcinoma with inferior vena cava thrombus is challenging. Cardiopulmonary bypass and deep hypothermic circulatory arrest significantly decreased the morbidity and mortality but associated with considerable postoperative complications. Debates still exist in one- or two-stage operations on which of the cardiac and urologic parts should be performed first. Modified maneuvers with main pulmonary artery clamping, vena cystoscope, transesophageal echocardiographic incorporation, and inferior vena cava interruptions are good for reduced perioperative morbidities. Surgical innovations have greatly facilitated the resection of renal cell carcinoma and inferior vena cava involvement. The advantages have been remarkable in less trauma, more cosmetic advantages, shorter hospital stay, and quicker recovery over the conventional open surgery with or without the use of bypass techniques. Such procedures have brought about improved long-term survivals. However, novel minimally invasive techniques such as robotic-assisted and hybrid approaches remain to gain further popularity in larger patient population. This article aims at a collection of the innovations of the surgical techniques in relation to the management of inferior vena cava tumor thrombus.

Glandular cardiac myxoma: case report with literature review.

Glandular cardiac myxoma is rare, representing only 5% of cardiac myxomas. A 51-year-old female developed embolic events caused by left atrial myxoma. She underwent myxoma resection and had an uneventful postoperative course. Histology of the resected myxoma revealed a glandular cardiac myxoma. In this article, the peculiar case was presented and the origin of cardiac myxoma was discussed.

Giant coronary aneurysm and arterial tortuosity.

Giant coronary artery aneurysm is rare. A 71-year-old female was referred to our hospital 3 months after onset of symptoms. Work-up including coronary angiogram and computed tomographic angiogram helped a definite diagnosis of a giant aneurysm of the circumflex coronary artery. The patient was conservatively managed with a close follow-up. In this article, this rare lesion was presented with associated anomalies.

Cardiovascular dysphagia - anatomical and clinical implications.

Cardiovascular dysphagia is rare. The aetiologies can be congenital, acquired oriatrogenic. The severity of dysphagia can be mild or severe, consistent or progressive, depending on the nature of the cardiovascular disorder and the impact for oesophageal compressions. The diagnostic work-up includes standard chest radiography, chest computed tomography, endoscopy, barium swallow test and manometry. Treatment can be conservative, surgical or palliative according to the nature of the disorder and the severity of the symptom. Prognoses of the patients are always good. Although cardiovascular dysphagia is continuously reported as sporadic cases, there have not been any comprehensive declarations of the conditions in the literature. Present article aims to make a comprehensive review of cardiovascular dysphagia.

Woven coronary artery: a case report and literature review.

Woven coronary artery is extremely rare. It is characterised by thin channels arising from the coronary artery and reanastamosis at the distal portion. A 62-year-oldman was diagnosed of coronary artery disease. Coronary angiography showed 3-vessel coronary artery disease. The distal right coronary artery derived 3 twisting thin channels, and the inferior thin channel sprouted second-class thin channels,which then reanstomosed distally. He received off-pump coronary artery bypass.The present patient had woven coronary artery with a more complex configuration of thin channels different from the previously reported cases.

[Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle].

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

Transforming growth factor ß1/Smad signalling pathway of aortic disorders: histopathological and immunohistochemical studies.

BACKGROUND: The aim of the present study was to evaluate the expressions and biological functions of the TGF-ß(1)/Smad signalling pathway of aortic disorders by way of histopathological and immunohistochemical studies. MATERIAL AND METHODS: Aortic specimens of 20 patients with aortic dissection, 9 patients with aortic aneurysm, 9 patients with coronary artery disease, and 5 deceased healthy adults were collected. The samples were stained with haematoxylin -eosin, Masson's trichrome, van Gieson, and alcian blue, and with immunohistochemical stainings to detect TGF-ß(1), type I receptor (TßRI), Smad2/3, Smad4, and Smad7. RESULTS: Masson's trichrome and van Gieson stainings showed attenuated collagens in the aorta of the patients with aortic dissection and aortic aneurysm. TGF-ß(1), TßRI, and Smad2/3 mainly showed a cytoplasmic immunoreactivity in the aortic media, Smad4 immunoreactivity was predominantly located in the cytoplasm and/or the nucleus of the aortic media, and Smad7 immunoreactivity was present in the nucleus of the aortic media and intima. The TGF-ß(1) signalling pathway proteins were similarly expressed in the aorta of aortic dissection and aortic aneurysm patients, while they were less pronounced in the aorta of coronary artery disease patients, and weak or negative in the aorta of healthy control individuals. CONCLUSIONS: These observations support the notion that there is an association between the TGF-ß(1)/Smad pathway and the pathological events of the aorta. Dysregulation of the TGF-ß(1)/Smad pathway may predispose the pathologenesis of aortic disorders.

Mitral valve myxoma: a large-scale collective review.

PURPOSE: Despite the review articles repeatedly published with respect to mitral valve myxomas, hardly could we find one based upon complete literature retrieval. We took an effort on complete literature retrieval and made a comprehensive review of the mitral valve myxomas. METHODS: An instant thorough literature retrieval of the heart myxoma was made by using the MEDLINE and EMBASE databases, as well as secondary references cited in the articles obtained from the MEDLINE search. In addition, we searched the Google and HighWire Press. RESULTS: The patients with mitral valve myxoma were young. Their major symptoms were cerebrovascular, cardiovascular, or constitutional. The tumors had small sizes, predilection of mitral leaflet location, solitary and pedicled nature, and good response to surgical resection. CONCLUSION: These clinical characteristics of mitral valve myxoma may help the differential diagnosis between mitral valve myxoma and other valvular lesions, and help making a decision of a surgical treatment.

Transforming growth factor-ß signaling pathway in Marfan's syndrome: a preliminary histopathological study.

BACKGROUND: Marfan's syndrome is an inherited disorder that affects the connective tissue. It has been proposed that mutations of FBN1 gene or of transforming growth factor (TGF)-beta type II receptor may be responsible for its pathogenesis. However, the role of TGF-beta signaling pathway in the development of Marfan's syndrome has not been comprehensively investigated. MATERIALS AND METHODS: Surgical specimens of the aorta were obtained from two female Marfan patients, and the control aortic tissue was taken from an autopsy of a healthy individual. The aortic specimens were examined with hematoxylin-eosin, Masson's trichrome, von Gieson/victoria blue-van Gieson bichrome, and immunohistochemical stainings of TGF-beta1, TGF-beta type I receptor, Smad2/3, Smad4 and Smad7. RESULTS: Hematoxylin-eosin staining demonstrated severe elastic lamellar disruption and patchy vascular smooth muscle dissolution in the aortic media of the Marfan patients. Collagen deposition, interlamilar elastic fiber fragmentation, loss or proliferation, and acid mucopolysaccharide accumulation were observed in the disarrayed aortic wall structures of Marfan patients by Masson's trichrome, victoria blue-van Gieson bichrome, and Alcian blue and periodic schiff's (AB-PAS) stainings, respectively. By immunohistochemistry, structural disruptions with enhanced TGF-beta;1 in the cytoplasm, Smad2/3 in the interstices, Smad4 in the cytoplasm, nuclei or interstices, and OOO Smad7, in the nucleus along with attenuated TGF-beta type I receptor in the aortic tissues of Marfan patients in comparison to the healthy control. CONCLUSIONS: Marfan patients may have aberrant TGF-beta signaling pathway associated with increased collagen deposition, interlamilar elastic fiber degenerative changes, and acid mucopolysaccharide accumulation. The signaling dysregulation may play an important role in the pathogenesis of this genetic disorder.

The anatomopathology of bicuspid aortic valve.

The bicuspid aortic valve is a common congenital heart disease characterised by inequality of cusp size, a central raphe, and smooth cusp margins even in diseased valves. It may progress and become calcified, leading to varying degrees of aortic valve disorders, such as stenosis, regurgitation, or combined, which may eventually necessitate surgical intervention. The bicuspid aortic valve is not a disorder confined to the aortic valve, but a spectrum involving the aortic valve, aortic annulus, aortic root, ascending aorta, and the left ventricular outflow tract. Different types of bicuspid aortic valves may present with distinct aetiologies and morphologies. The anatomopathological features of the bicuspid aortic valve have not been sufficiently elucidated. Differences in the anatomy of the bicuspid aortic valve could reflect different pathogeneses and different needs for different therapeutic approaches. Debates still remain in terms of timing of surgery and surgical indications of this disorder. The aim of the present article is to make a review of the anatomy and the management strategies of the bicuspid aortic valve in order to draw inferences about the clinical implications.

Cardiovocal syndrome secondary to an aortic pseudoaneurysm.

Left recurrent laryngeal nerve palsy characterized by hoarseness due to a cardiovascular disorder, which is termed as cardiovocal syndrome or Ortner's syndrome, is an unusual condition. The syndrome might be associated with diverse cardiovascular diseases. However, it is rarely caused by an aortic pseudoaneurysm. The prominent clinical features of such patients are a history of trauma and the injury to or compression of the aortic isthmus involving the laryngeal nerve. Surgical or interventional treatment is necessary, and recurrent laryngeal nerve palsy is usually expected to recover after the surgical intervention of the aortic pseudoaneurysm.

Penetrating atherosclerotic ulcer aneurysm of the innominate artery.

Penetrating atherosclerotic ulcer of the aorta is uncommon, and usually develops in the descending thoracic aorta. Rarely this condition involves the branch vessels of the aorta. We report a case of ruptured aneurysm of the innominate artery resulting from penetrating atherosclerotic ulcer. Open surgery was the treatment of choice for the ruptured aneurysm, while conservative treatment was recommended for the associated penetrating atherosclerotic ulcers of the descending aorta.

Hypertrophic Cardiomyopathy in Infancy

ABSTRACT Objective: To report comprehensively the clinical features and the management strategies of hypertrophic cardiomyopathy in infancy. Methods: Comprehensively retrieved studies published from 2000 to present constituted the study materials for this article. Results: Signs of myocardial ischaemia and cardiomegaly are the predominate manifestations of this lesion. The spectrum of the aetiology and management of hypertrophic cardiomyopathy in infancy have been updated in the past several decades. Long-term small-dose digoxin combined with prednisone, supplemented by the angiotensin-converting enzyme inhibitor capto-pril, is an accepted therapy for endocardial fibroelastosis in infancy. The treatment with recombinant human α-glucosidase enzyme replacement therapy can reverse the electrocardiographic changes of infantile Pompe 's disease. Conclusion: Hypertrophic cardiomyopathy in infants of diabetic mothers is usually benign and transient, and the treatment is not needed unless heart failure occurs. Differential diagnosis of hypertrophic cardiomyopathy from congenital heart defects is important for subsequent management.