The Eighth Five-year Plan period wasa fast growing period for Jiangsu’sforeign economic and technical co-operation. Guided by the policy of seizingopportunities, expanding the opening driveand promoting development, ...The Eighth Five-year Plan period wasa fast growing period for Jiangsu’sforeign economic and technical co-operation. Guided by the policy of seizingopportunities, expanding the opening driveand promoting development, all the staff atthe provincial foreign economic front madeevery effort to fulfill the goal of the sus-tained, fast and healthy development in for-展开更多
General Secretary Xi Jinping has emphasized that reform and opening up is a crucial move in determining the destiny of contemporary China and is also crucial for the success of Chinese modernization.General Secretary ...General Secretary Xi Jinping has emphasized that reform and opening up is a crucial move in determining the destiny of contemporary China and is also crucial for the success of Chinese modernization.General Secretary Xi Jinping and the Central Committee of the Communist Party of China(CPC)deeply care about and have high expectations for Jiangsu as a pioneer in reform and opening up.展开更多
Spring returns with every thing growing.As the f irst high-level forum held after the Two Sessions,the China Development Forum(hereinaf ter refer red to as the Forum)brought together Chinese and foreign political and ...Spring returns with every thing growing.As the f irst high-level forum held after the Two Sessions,the China Development Forum(hereinaf ter refer red to as the Forum)brought together Chinese and foreign political and business people and became a weathervane for observing China’s economy.展开更多
BACKGROUND Orthodontic treatment for open bite and crossbite cases is always challenging.In this paper,we demonstrate a skeletal class III patient with anterior open bite and crossbite whose problem was successfully c...BACKGROUND Orthodontic treatment for open bite and crossbite cases is always challenging.In this paper,we demonstrate a skeletal class III patient with anterior open bite and crossbite whose problem was successfully corrected with improved super-elastic Ti-Ni alloy wire(ISW).CASE SUMMARY A 19 years old male came to our clinic with a chief complaint of anterior open bite and crossbite and not able to chew food well.Clinical examination revealed an angle class III malocclusion with anterior open bite,crossbite and spaced arch.Ra-diographic and clinical examination showed a skeletal class III pattern.We used ISW to level the upper and lower arch and to correct the anterior open bite and crossbite.Intermaxillary elastics were also used to achieve a better interdigitation.Finally,adequate overbite,overjet and a desirable occlusion were achieved.The active treatment time took 2 years and 2 months.CONCLUSION In a case of class III angular malocclusion with open bite and crossbite in the ante-rior teeth,ideal results were achieved using the ISW technique and the patient was satisfied with the outcome.展开更多
BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
GUANGZHOU,Nov.8(Xinhua)—Chinese President Xi Jinping has called for comprehensively deepening reform and opening up for high-quality development,and advancing the development of the Guangdong-Hong Kong-Macao Greater ...GUANGZHOU,Nov.8(Xinhua)—Chinese President Xi Jinping has called for comprehensively deepening reform and opening up for high-quality development,and advancing the development of the Guangdong-Hong Kong-Macao Greater Bay Area with sustained efforts.展开更多
AIM:To evaluate the clinical characteristics and risk factors associated with visual prognosis in patients with open globe injuries(OGIs)treated at Vietnam National Eye Hospital.METHODS:A prospective observational stu...AIM:To evaluate the clinical characteristics and risk factors associated with visual prognosis in patients with open globe injuries(OGIs)treated at Vietnam National Eye Hospital.METHODS:A prospective observational study included patients with OGIs treated between June 2023 and June 2024.Data on demographics,injury features,and clinical findings were extracted from medical records.Poor visual outcome was defined as final best-corrected visual acuity(BCVA)worse than 20/400 or no light perception.Multivariable logistic regression was performed to identify independent risk factors.RESULTS:Among 509 patients(636 eyes),the mean age was 35.13y(range 20–51y),and 67.6%were male.After treatment,the proportion of eyes achieving≥20/40 increased from 12.6%to 42.1%,while no light perception decreased from 29.1%to 9.4%.Independent predictors of poor visual outcomes included delayed admission[>4h,odds ratio(OR)=3.33,95%confidence intervals(CI):1.76–6.33,P<0.001],Zone III injury(OR=5.90,95%CI:2.85–12.24,P<0.001),wound length>10 mm(OR=2.59,95%CI:1.60–4.18,P<0.001),relative afferent pupillary defect(RAPD,OR=1.65,95%CI:1.03–2.64,P=0.039),endophthalmitis(OR=1.75,95%CI:1.01–3.03,P=0.047),retinal detachment(OR=3.32,95%CI:2.02–5.45,P<0.001),and eyelid lacerations(OR=1.94,95%CI:1.13–3.33,P=0.016)associated with OGIs.Vitreous hemorrhage(OR=0.44,95%CI:0.22–0.89,P=0.023)was associated with better outcomes,and female gender appeared protective.CONCLUSION:Poor visual outcomes remain common after OGIs,despite improve visual acuity in many cases.Several clinical and injury-related factors are strongly associated with prognosis.Early recognition of these predictors can support risk stratification and improve trauma care in similar settings.展开更多
AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF...AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF.METHODS:Twenty-four POAG patients and 24 healthy controls(HCs)underwent resting-state functional magnetic resonance imaging(rs-fMRI).Nonparametric rank-sum tests were used to compare the ALFF values in the slow-4 and slow-5 bands,and Spearman or Pearson correlation analysis was used to assess the correlation between ALFF changes and clinical ophthalmic parameters in POAG patients.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of the ALFF.RESULTS:There were 16 males in POAG patients(median age 48y)and 12 males in HCs(median age 39y).Compared with HCs,POAG patients presented increased or decreased ALFF values in different brain regions,and similar changes were observed in mild POAG patients.The ALFF values were correlated with retinal nerve fiber layer(RNFL)thickness,inner limiting membrane-retinal pigment epithelium thickness changes and the degree of visual field defects.Analysis of the diagnostic value of the ALFF via ROC curves revealed that the right medial frontal gyrus[area under the curve(AUC)=0.9063]and superior frontal gyrus(AUC=0.9097)had better diagnostic value than did the optic disc area(AUC=0.8019),visual field index(VFI%,AUC=0.8988)and macular parameters.CONCLUSION:POAG patients present altered cortical function that is significantly correlated with the optic nerve and retinal thickness and had good diagnostic value,which may reflect the underlying neuropathological mechanism of POAG.展开更多
BACKGROUND Laparoscopy has been widely used in general surgical procedures,but total laparoscopic pancreaticoduodenectomy(TLPD)is still a complex and challenging surgery that is only performed in a small number of pat...BACKGROUND Laparoscopy has been widely used in general surgical procedures,but total laparoscopic pancreaticoduodenectomy(TLPD)is still a complex and challenging surgery that is only performed in a small number of patients at a few large academic medical centers.Although the safety and feasibility of TLPD have been established,few studies have compared it with open pancreaticoduodenectomy(OPD)with regard to perioperative and oncological outcomes.Therefore,we carried out a meta-analysis to evaluate whether TLPD is superior to OPD.AIM To compare the treatment outcomes of TLPD and OPD in order to assess the safety and feasibility of TLPD.METHODS We conducted a systematic search of studies comparing TLPD with OPD that were published in the PubMed,EMBASE,and Cochrane Library databases through December 31,2018.The studies comparing TLPD and OPD with at least one of the outcomes we were interested in and with more than 10 cases in each group were included in this analysis.The Newcastle-Ottawa scale was used to assess the quality of the nonrandomized controlled trials and the Jadad scale was used to assess the randomized controlled trials.Intraoperative data,postoperative complications,and oncologic outcomes were evaluated.The metaanalysis was performed using Review Manager Software version 5.3.Random or fixed-effects meta-analyses were undertaken to measure the pooled estimates.RESULTS A total of 4790 articles were initially identified for our study.After screening,4762 articles were excluded and 28 studies representing 39771 patients(3543 undergoing TLPD and 36228 undergoing OPD)were eventually included.Patients who underwent TLPD had less intraoperative blood loss[weighted mean difference(WMD)=-260.08 mL,95%confidence interval(CI):(-336.02,-184.14)mL,P<0.00001],a lower blood transfusion rate[odds ratio(OR)=0.51,95%CI:0.36-0.72,P=0.0001],a lower perioperative overall morbidity(OR=0.82,95%CI:0.73-0.92,P=0.0008),a lower wound infection rate(OR=0.48,95%CI:0.34-0.67,P<0.0001),a lower pneumonia rate(OR=0.72,95%CI:0.60-0.85,P=0.0002),a shorter duration of intensive care unit(ICU)stay[WMD=-0.28 d,95%CI(-2.88,-1.29)d,P<0.00001]and a shorter length of hospital stay[WMD=-3.05 d,95%CI(-3.93,-2.17),P<0.00001],a lower rate of discharge to a new facility(OR=0.55,95%CI:0.39-0.78,P=0.0008),and a lower 30-d readmission rate(OR=0.81,95%CI:0.68-0.95,P=0.10)than those who underwent OPD.In addition,the TLPD group had a higher R0 rate(OR=1.28,95%CI:1.13-1.44,P=0.0001)and more lymph nodes harvested(WMD=1.32,95%CI:0.57-2.06,P=0.0005)than the OPD group.However,the patients who underwent TLPD experienced a significantly longer operative time(WMD=77.92 min,95%CI:40.89-114.95,P<0.0001)and had a smaller tumor size than those who underwent OPD[WMD=-0.32 cm,95%CI:(-0.58,-0.07)cm,P=0.01].There were no significant differences between the two groups in the major morbidity,postoperative pancreatic fistula,delayed gastric emptying,postpancreatectomy hemorrhage,bile leak,gastroenteric anastomosis fistula,intra-abdominal abscess,bowel obstruction,fluid collection,reoperation,ICU admission,or 30-d and 90-d mortality rates.For malignant tumors,the 1-,2-,3-,4-and 5-year overall survival rates were not significantly different between the two groups.CONCLUSION This meta-analysis indicates that TLPD is safe and feasible,and may be a desirable alternative to OPD,although a longer operative time is needed and only smaller tumors can be treated.展开更多
Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main a...Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.展开更多
The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carci...The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.展开更多
Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. ...Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.展开更多
AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interv...AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept(0.2 mL) or 5-FU(0.2 mL) on the 5th day post-operatively. The intraocular pressure(IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo(conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo(conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection(conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo(t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d(3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk(3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection(3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group(χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.展开更多
AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients wit...AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.展开更多
文摘The Eighth Five-year Plan period wasa fast growing period for Jiangsu’sforeign economic and technical co-operation. Guided by the policy of seizingopportunities, expanding the opening driveand promoting development, all the staff atthe provincial foreign economic front madeevery effort to fulfill the goal of the sus-tained, fast and healthy development in for-
文摘General Secretary Xi Jinping has emphasized that reform and opening up is a crucial move in determining the destiny of contemporary China and is also crucial for the success of Chinese modernization.General Secretary Xi Jinping and the Central Committee of the Communist Party of China(CPC)deeply care about and have high expectations for Jiangsu as a pioneer in reform and opening up.
文摘Spring returns with every thing growing.As the f irst high-level forum held after the Two Sessions,the China Development Forum(hereinaf ter refer red to as the Forum)brought together Chinese and foreign political and business people and became a weathervane for observing China’s economy.
文摘BACKGROUND Orthodontic treatment for open bite and crossbite cases is always challenging.In this paper,we demonstrate a skeletal class III patient with anterior open bite and crossbite whose problem was successfully corrected with improved super-elastic Ti-Ni alloy wire(ISW).CASE SUMMARY A 19 years old male came to our clinic with a chief complaint of anterior open bite and crossbite and not able to chew food well.Clinical examination revealed an angle class III malocclusion with anterior open bite,crossbite and spaced arch.Ra-diographic and clinical examination showed a skeletal class III pattern.We used ISW to level the upper and lower arch and to correct the anterior open bite and crossbite.Intermaxillary elastics were also used to achieve a better interdigitation.Finally,adequate overbite,overjet and a desirable occlusion were achieved.The active treatment time took 2 years and 2 months.CONCLUSION In a case of class III angular malocclusion with open bite and crossbite in the ante-rior teeth,ideal results were achieved using the ISW technique and the patient was satisfied with the outcome.
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘GUANGZHOU,Nov.8(Xinhua)—Chinese President Xi Jinping has called for comprehensively deepening reform and opening up for high-quality development,and advancing the development of the Guangdong-Hong Kong-Macao Greater Bay Area with sustained efforts.
文摘AIM:To evaluate the clinical characteristics and risk factors associated with visual prognosis in patients with open globe injuries(OGIs)treated at Vietnam National Eye Hospital.METHODS:A prospective observational study included patients with OGIs treated between June 2023 and June 2024.Data on demographics,injury features,and clinical findings were extracted from medical records.Poor visual outcome was defined as final best-corrected visual acuity(BCVA)worse than 20/400 or no light perception.Multivariable logistic regression was performed to identify independent risk factors.RESULTS:Among 509 patients(636 eyes),the mean age was 35.13y(range 20–51y),and 67.6%were male.After treatment,the proportion of eyes achieving≥20/40 increased from 12.6%to 42.1%,while no light perception decreased from 29.1%to 9.4%.Independent predictors of poor visual outcomes included delayed admission[>4h,odds ratio(OR)=3.33,95%confidence intervals(CI):1.76–6.33,P<0.001],Zone III injury(OR=5.90,95%CI:2.85–12.24,P<0.001),wound length>10 mm(OR=2.59,95%CI:1.60–4.18,P<0.001),relative afferent pupillary defect(RAPD,OR=1.65,95%CI:1.03–2.64,P=0.039),endophthalmitis(OR=1.75,95%CI:1.01–3.03,P=0.047),retinal detachment(OR=3.32,95%CI:2.02–5.45,P<0.001),and eyelid lacerations(OR=1.94,95%CI:1.13–3.33,P=0.016)associated with OGIs.Vitreous hemorrhage(OR=0.44,95%CI:0.22–0.89,P=0.023)was associated with better outcomes,and female gender appeared protective.CONCLUSION:Poor visual outcomes remain common after OGIs,despite improve visual acuity in many cases.Several clinical and injury-related factors are strongly associated with prognosis.Early recognition of these predictors can support risk stratification and improve trauma care in similar settings.
基金Supported by National Natural Science Foundation of China(No.82260203).
文摘AIM:To study the relationships between amplitude of low-frequency fluctuations(ALFF)changes and clinical ophthalmic parameters in patients with primary open angle glaucoma(POAG)and analyze the diagnostic value of ALFF.METHODS:Twenty-four POAG patients and 24 healthy controls(HCs)underwent resting-state functional magnetic resonance imaging(rs-fMRI).Nonparametric rank-sum tests were used to compare the ALFF values in the slow-4 and slow-5 bands,and Spearman or Pearson correlation analysis was used to assess the correlation between ALFF changes and clinical ophthalmic parameters in POAG patients.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of the ALFF.RESULTS:There were 16 males in POAG patients(median age 48y)and 12 males in HCs(median age 39y).Compared with HCs,POAG patients presented increased or decreased ALFF values in different brain regions,and similar changes were observed in mild POAG patients.The ALFF values were correlated with retinal nerve fiber layer(RNFL)thickness,inner limiting membrane-retinal pigment epithelium thickness changes and the degree of visual field defects.Analysis of the diagnostic value of the ALFF via ROC curves revealed that the right medial frontal gyrus[area under the curve(AUC)=0.9063]and superior frontal gyrus(AUC=0.9097)had better diagnostic value than did the optic disc area(AUC=0.8019),visual field index(VFI%,AUC=0.8988)and macular parameters.CONCLUSION:POAG patients present altered cortical function that is significantly correlated with the optic nerve and retinal thickness and had good diagnostic value,which may reflect the underlying neuropathological mechanism of POAG.
文摘BACKGROUND Laparoscopy has been widely used in general surgical procedures,but total laparoscopic pancreaticoduodenectomy(TLPD)is still a complex and challenging surgery that is only performed in a small number of patients at a few large academic medical centers.Although the safety and feasibility of TLPD have been established,few studies have compared it with open pancreaticoduodenectomy(OPD)with regard to perioperative and oncological outcomes.Therefore,we carried out a meta-analysis to evaluate whether TLPD is superior to OPD.AIM To compare the treatment outcomes of TLPD and OPD in order to assess the safety and feasibility of TLPD.METHODS We conducted a systematic search of studies comparing TLPD with OPD that were published in the PubMed,EMBASE,and Cochrane Library databases through December 31,2018.The studies comparing TLPD and OPD with at least one of the outcomes we were interested in and with more than 10 cases in each group were included in this analysis.The Newcastle-Ottawa scale was used to assess the quality of the nonrandomized controlled trials and the Jadad scale was used to assess the randomized controlled trials.Intraoperative data,postoperative complications,and oncologic outcomes were evaluated.The metaanalysis was performed using Review Manager Software version 5.3.Random or fixed-effects meta-analyses were undertaken to measure the pooled estimates.RESULTS A total of 4790 articles were initially identified for our study.After screening,4762 articles were excluded and 28 studies representing 39771 patients(3543 undergoing TLPD and 36228 undergoing OPD)were eventually included.Patients who underwent TLPD had less intraoperative blood loss[weighted mean difference(WMD)=-260.08 mL,95%confidence interval(CI):(-336.02,-184.14)mL,P<0.00001],a lower blood transfusion rate[odds ratio(OR)=0.51,95%CI:0.36-0.72,P=0.0001],a lower perioperative overall morbidity(OR=0.82,95%CI:0.73-0.92,P=0.0008),a lower wound infection rate(OR=0.48,95%CI:0.34-0.67,P<0.0001),a lower pneumonia rate(OR=0.72,95%CI:0.60-0.85,P=0.0002),a shorter duration of intensive care unit(ICU)stay[WMD=-0.28 d,95%CI(-2.88,-1.29)d,P<0.00001]and a shorter length of hospital stay[WMD=-3.05 d,95%CI(-3.93,-2.17),P<0.00001],a lower rate of discharge to a new facility(OR=0.55,95%CI:0.39-0.78,P=0.0008),and a lower 30-d readmission rate(OR=0.81,95%CI:0.68-0.95,P=0.10)than those who underwent OPD.In addition,the TLPD group had a higher R0 rate(OR=1.28,95%CI:1.13-1.44,P=0.0001)and more lymph nodes harvested(WMD=1.32,95%CI:0.57-2.06,P=0.0005)than the OPD group.However,the patients who underwent TLPD experienced a significantly longer operative time(WMD=77.92 min,95%CI:40.89-114.95,P<0.0001)and had a smaller tumor size than those who underwent OPD[WMD=-0.32 cm,95%CI:(-0.58,-0.07)cm,P=0.01].There were no significant differences between the two groups in the major morbidity,postoperative pancreatic fistula,delayed gastric emptying,postpancreatectomy hemorrhage,bile leak,gastroenteric anastomosis fistula,intra-abdominal abscess,bowel obstruction,fluid collection,reoperation,ICU admission,or 30-d and 90-d mortality rates.For malignant tumors,the 1-,2-,3-,4-and 5-year overall survival rates were not significantly different between the two groups.CONCLUSION This meta-analysis indicates that TLPD is safe and feasible,and may be a desirable alternative to OPD,although a longer operative time is needed and only smaller tumors can be treated.
基金supported by grants from the National Natural Science Foundation of China(81201621 and 81372455)Key Clinical Departments and Outstanding Physicians in Jiangsu Province。
文摘Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.
文摘The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.
文摘Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.
文摘AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept(0.2 mL) or 5-FU(0.2 mL) on the 5th day post-operatively. The intraocular pressure(IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo(conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo(conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection(conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo(t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d(3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk(3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection(3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group(χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.
文摘AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.
