AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who u...AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.展开更多
Apolipoprotein（apo） A-V is a novel member of the class of exchangeable apo＇s involved in triacylglycerol（TG）homeostasis.Whereas a portion of hepatic-derived apoA-V is secreted into plasma and functions to facilit...Apolipoprotein（apo） A-V is a novel member of the class of exchangeable apo＇s involved in triacylglycerol（TG）homeostasis.Whereas a portion of hepatic-derived apoA-V is secreted into plasma and functions to facilitate lipoprotein Iipase-mediated TG hydrolysis,another portion is recovered intracellularly,in association with cytosolic lipid droplets.Loss of apo A-V function is positively correlated with elevated plasma TG and increased risk of cardiovascular disease.Single nucleotide polymorphisms（SNP） in the APOA5 locus can affect transcription efficiency or introduce deleterious amino acid substitutions.Likewise,rare mutations in APOA5 that compromise functionality are associated with increased plasma TG and premature myocardial infarction.Genetically engineered mouse models and human population studies suggest that,in certain instances,supplementation with wild type（WT） apoA-V may have therapeutic benefit.It is hypothesized that individuals that manifest elevated plasma TG owing to deleterious APOA5 SNPs or rare mutations would respond to WT apoA-V supplementation with improved plasma TG clearance.On the other hand,subjects with hypertriglyceridemia of independent origin（unrelated to apoA-V function） may not respond to apoA-V augmentation in this manner.Improvement in the ability to identify individuals predicted to benefit,advances in gene transfer technology and the strong connection between HTG and heart disease,point to apoA-V supplementation as a viable disease prevention / therapeutic strategy.Candidates would include individuals that manifest chronic TG elevation,have low plasma apoA-V due to an APOA5 mutation/polymorphism and not have deleterious mutations/polymorphisms in other genes known to influence plasma TG levels.展开更多
文摘AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.
文摘目的探讨动静脉二氧化碳分压差/氧含量差[P(v-a)CO2/C(a-v)O2]在早期重症急性胰腺炎(severe acute pancreatitis,SAP)患者中的预后评估价值.方法自2017年8月至2018年10月连续性纳入78例SAP患者,根据患者治疗后P(v-a)CO2/C(a-v)O2是否上升分为两组,研究组(上升组,n=32例)和对照组(下降组,n=46例).比较两组一般临床资料,病程中器官功能障碍并发症发生率、临床预后及氧代谢指标,并评估氧代谢指标对患者的预测价值.结果研究组病情危重度、CT评分、胰腺坏死范围及APACHEⅡ评分明显高于对照组(P<0.05);同时病程中研究组休克、急性呼吸窘迫综合征、急性肾损伤、胰腺坏死组织感染(IPN)等并发症发生率明显高于对照组(P<0.05).且与对照组比较,研究组IPN发生更早、ICU及住院天数更长、病死率更高(P<0.05).治疗前两组P(v-a)CO2/C(a-v)O2差异无统计学意义,但研究组治疗后P(v-a)CO2/C(a-v)O2(mm Hg/mL:2.51±1.37 vs.1.91±1.29,P=0.031)以及治疗前后P(v-a)CO2和乳酸明显高于对照组(P<0.05).多因素Logistics回归分析发现,治疗前患者住院死亡危险因素为P(v-a)CO2(P=0.017)及血乳酸(P=0.021),治疗后为P(v-a)CO2(P=0.009)、P(v-a)CO2/C(a-v)O2(P=0.019)及血乳酸(P=0.023).ROC曲线提示,治疗前P(v-a)CO2对SAP死亡预测价值最高,曲线下面积为0.762,最佳诊断界值为7.69 mm Hg;治疗后P(v-a)CO2/C(a-v)O2对SAP死亡预测价值最高,曲线下面积为0.840,最佳诊断界值为2.05 mm Hg/mL.结论P(v-a)CO2/C(a-v)O2在早期SAP患者预后评估中具有良好的临床应用价值,值得临床推广.
基金Supported by a grant from NIH(R37-HL64159)an AHA Postdoctoral Fellowship Award(VS)
文摘Apolipoprotein（apo） A-V is a novel member of the class of exchangeable apo＇s involved in triacylglycerol（TG）homeostasis.Whereas a portion of hepatic-derived apoA-V is secreted into plasma and functions to facilitate lipoprotein Iipase-mediated TG hydrolysis,another portion is recovered intracellularly,in association with cytosolic lipid droplets.Loss of apo A-V function is positively correlated with elevated plasma TG and increased risk of cardiovascular disease.Single nucleotide polymorphisms（SNP） in the APOA5 locus can affect transcription efficiency or introduce deleterious amino acid substitutions.Likewise,rare mutations in APOA5 that compromise functionality are associated with increased plasma TG and premature myocardial infarction.Genetically engineered mouse models and human population studies suggest that,in certain instances,supplementation with wild type（WT） apoA-V may have therapeutic benefit.It is hypothesized that individuals that manifest elevated plasma TG owing to deleterious APOA5 SNPs or rare mutations would respond to WT apoA-V supplementation with improved plasma TG clearance.On the other hand,subjects with hypertriglyceridemia of independent origin（unrelated to apoA-V function） may not respond to apoA-V augmentation in this manner.Improvement in the ability to identify individuals predicted to benefit,advances in gene transfer technology and the strong connection between HTG and heart disease,point to apoA-V supplementation as a viable disease prevention / therapeutic strategy.Candidates would include individuals that manifest chronic TG elevation,have low plasma apoA-V due to an APOA5 mutation/polymorphism and not have deleterious mutations/polymorphisms in other genes known to influence plasma TG levels.
