简介：AIM:Toidentifyriskfactorsassociatedwithpost-cataractsurgeryendophthalmitis(PCE)intype2diabeticpatients.METHODS:Ahospital-basedretrospectivecase-controlstudywasconductedon194type2diabeticpatientsundergoingcataractsurgeryinRajavithiHospitalfromJanuary2007toDecember2015.FifteenpatientswithPCEwereincludedasthecasegroupand179patientswithoutPCEwereincludedasthecontrolgroup.PotentialfactorsassociatedwithPCEamongbothgroupsincludingdemographics,pre-operativecharacteristics,surgicalsettingsandcomplications,werestatisticallyanalyzedusingChi-squaretestingandalogisticregressionmodel.RESULTS:Withinthecasegroup,53%werefemalesandthemedianagewas68y.Univariateanalysisofpre-operativecharacteristics,surgicalsettingsandcomplicationsrevealedthatrecentpre-operativefastingplasmaglucose,insulintherapy,presenceofdiabeticretinopathy,andseverenon-proliferativeorproliferativediabeticretinopathyweresignificantlyassociatedwithPCE.Inamultivariateanalysisadjustingforbloodglucoselevel,insulintreatmentwastheonlysignificantfactorassociatedwithanincreasedriskofPCE(OR3.9,95%CI1.0-15.0,P=0.04)comparedtopatientswithoutinsulintreatment.Themostcommoncausativeorganismsweregram-positivebacteria(89%).Staphylococcusspeciesrepresentedthemostcommongroup(67%).Medianbestcorrectedvisualacuityat1-monthand3-monthfollow-upwasequalat0.7logMAR(20/100).CONCLUSION:Theauthorsidentifyinsulintreatmentastheonlyriskfactorassociatedwithendophthalmitisaftercataractsurgeryintype2diabeticpatients.Furtherstudieswithserumlevelsofpre-operativeglycatedhemoglobin(HbA1c)andpost-operativefastingplasmaglucoselevelareessentialtotrulydemonstratetheroleofperi-operativeglycemicmarkersasariskfactorforPCE.

简介：AIM:Toevaluatewhetherthelevelofthrombospondin-1(TSP-1)inaqueoushumorcanpredicttheprognosisoftrabeculectomyinpatientswithprimaryangle-closureglaucoma(PACG).METHODS:Thiscase-controlstudyinvolved26patientswithPACGwhoexperiencedafailedtrabeculectomy(casegroup)and78age-andsex-matchedpatientswithPACGwhounderwentsuccessfultrabeculectomy(controlgroup).AqueoushumorwascollectedatthetimeoftrabeculectomyandtestedforTSP-1andTGF-β2levelswithanenzyme-linkedimmunosorbentassaymethod.Logisticregressionmodelingwasusedtoassesstheriskfactorsforfailedtrabeculectomy.RESULTS:ThemeanTSP-1aqueousconcentrationsweresignificantlyhigherinthecasegroup(20.67±9.79ng/mL)thanthecontrolgroup(5.17±2.29ng/mL)(P<0.001).Thetransforminggrowthfactor-β2(TGF-β2)aqueousconcentrationsweresignificantlydifferentbetweenthecaseandcontrolgroup,at3633.25and1090.24pg/mL,respectively(P<0.001).LogisticregressionanalysisrevealedTSP-1levelasanindependentriskfactorforafailedtrabeculectomy(OR=3.540;95%CI=1.092-11.482).CONCLUSION:TheaqueoushumorTSP-1andTGF-β2levelsarehigherinPACGeyeswithfailedtrabeculectomythanwithsuccessfultrabeculectomyatoneyear.TheaqueoushumorTSP-1levelisanindependentriskfactorassociatedwithfailedtrabeculectomy.

简介：AIM:Todelineatethecharacteristicsofthedynamicstereopsistestandanalyzerelatedparametersinintermittentexotropia[X(T)]patients.METHODS:Fifty-sevenX(T)patientsand55normalsubjectswereenrolledinthisstudy.ThenormalandX(T)groupswereusedtotestthereproducibilityandreliabilityofthedynamicstereopsistest,andBangerterfilterswithdensitiesof0.2werethenusedtosimulatesuppressiontotestfortraditionalanddynamicstereopsis.IntheX(T)group,themeasurementsincluded1)dynamicstereopsistestcomprisingthreeparts:motion+disparity,motiononlyanddisparityonly;2)oculardeviationangle;3)Bagolinistriatedlenstest;4)diseasecourse;and5)Titmusstereopsistest.RESULTS:Thetest-retestreliabilityofthedynamicstereopsismethodwas0.901inthenormalandX(T)groups,andnoneoftheX(T)patientswereabletopassthestaticanddynamicstereopsistestsafterusingthe0.2Bangerterfilter.Theaccuracyratewasgreaterthan80%inthenormalgroupand31.81%,36.36%,and45.45%forthemotion+disparity,motion-onlyanddisparityonlycomponentsofthetraditionaltestforX(T)patientsdiagnosedwithstereoblindnessviatraditionaltests,respectively.Patientswithalongdiseasecourse(>1y)hadworsedynamicstereopsisthanthosewithashortdiseasecourse(<1y;P<0.05,Chi-squaretest).Thedeviationanglewasnotcorrelatedwiththemotion+disparity,disparityonly,orthemotion-onlytestcomponents(allP>0.05,Chisquaretest).CONCLUSION:DynamicstereopsisispreservedincertainX(T)patientsdiagnosedwithstereoblindnessviatraditionaltests.AlongdiseasecoursewasshowntobeanegativefactorfordynamicstereopsisinX(T)patientswhichmightbeassociatedwithworseprogression,andprovidegoodreferencesclinically.

简介：Objective:Secretorybreastcarcinoma(SBC)isararetypeofbreastmalignancy,accountingforlessthan0.02%ofallinfiltratingbreastmalignancies.ThepureSBC,atypeofSBCwithoutanothertypeofbreastmalignantneoplasm,isparticularlyrare.ThisstudyaimedtoinvestigatetheclinicopathologicandmolecularfeaturesofpureSBC.Methods:Themainpathologicalparameterssuchasestrogenreceptor(ER),progesteronereceptor(PR),andhumanepithelialgrowthfactorreceptor2(C-erbB-2)weredetectedbyimmunohistochemistry(IHC),andtheclinicopathologicandprognosticdifferencewerecomparedwithinvasiveductalcarcinoma(IDC).Fluorescentinsituhybridization(FISH)andreversetranscriptionpolymerasechainreaction(RT-PCR)wasperformedtoidentifytheETV6-NTRK3rearrangementofSBC.Results:WefoundthatthepositivityratesofER,PR,C-erbB-2,p53,andS-100were47.7%(21/44),52.3%(23/44),36.4%(16/44),27.3%(12/44),and95.5%(42/44),respectively,whichwerehigherthanthosereportedinpreviousstudies.Specialperiodicacid-Schiffanalysiswasperformedin36patients,andthevalueoftheKi-67indexrangedfrom1%to50%(meanvalue:10%).Interestingly,mostpatientswithpureSBCharboredanETV6-NTRK3rearrangementwithan88.6%(39/44)expressionrate.ComparedwithIDC,thetumorsizeofmostpatientswithSBCwaslargerthan2cm(P=0.024).Ultrasoundshowedbenignlesions,andthetotalmisdiagnosisratewashigher(P=0.020).Althoughthepathologicalclassificationwasmostlytriple-negativebreastcancers(P=0.036),therewaslessmetastasis(P=0.029),andtheoverallprognosiswasbetterthanthatoftheIDCgroup.Conclusions:Althoughaxillarylymphnodemetastasis,localrecurrence,ordistantmetastasismayoccur,SBCisalsoconsideredanindolentneoplasmwithagoodprognosis.Oncediagnosed,surgicaltreatmentshouldbeperformedassoonaspossible,followedbyappropriateadjuvantchemotherapy,irradiation,andendocrinetherapies.

简介：Palliativecareisthereliefofsymptomswithoutdealingwiththeunderlyingcause,e.g.useofanalgesia,torelievepain.Theuseofsuchanagentalleviatesthesymptomswithoutcuringtheunderlyingdisease.Thisisthetypeofcareforpatientswithseriousillnesses.Itfocusesonimprovingqualityoflife,notjustinyourbody,butalsoinyourmindandspirit.Thereisathinlinebetweenpalliativecareandhospicecare.

简介：AIM:ToinvestigatetheChineseversionoftheLowVisionQualityofLifeQuestionnaire(CLVQOL)asaninstrumentforobtainingclinicallyimportantchangesaftercataractsurgery.METHODS:PatientsunderwentcataractsurgeryinShanghaiGeneralHospital,ShanghaiJiaoTongUniversity,whofittheinclusioncriteriawererecruited.TwoCLVQOLswereadministered,includingapreoperativeCLVQOLandaCLVQOLattheendofthe3mofollow-upperiod,andwerecompletedusingface-to-faceinterviewsorphoneinterviewsconductedbytrainedinvestigators.Theminimalclinicallyimportantdifference(MCID)wascalculatedusingananchor-basedmethodandadistributionmethod.Inaddition,theresponsivenessofthequestionnairewasmeasured.RESULTS:Atotalof155residentswereenrolled.Theaveragevisualacuity(VA)preoperativelywas0.08(SD=0.05),anditincreasedto0.47(SD=0.28)attheendoffollowup.StatisticallysignificantpositivechangesintheCLVQOLscoresindicatedsignificantimprovementofvisionrelatedqualityoflifeaftercataractsurgery.Withthelargervaluebetweenthetworesultsasthefinalvalue,theMCIDvaluesoftheCLVQOL(scoresofthefourscalesaswellasthetotalscore)were8.94,2.61,4.34,3.10and17.63,respectively.TheCLVQOLhasbothgoodinternalandexternalresponsiveness.CONCLUSION:CLVQOLscoresareappropriateinstrumentsforobtainingclinicallyimportantchangesaftercataractsurgery.Thisstudyisaneffectiveexplorationforestablishingcataractsurgeryefficacystandards,whichhelpsclinicalandscientificresearchworkersinophthalmologytogainamorein-depthunderstandingwhenusingCLVQOL.

简介：AIM:Toinvestigatenasolacrimalduct(NLD)volumeinKoreanpatientsandtoexaminethecorrelationbetweenNLDvolumeandobstruction.METHODS:OfpatientswhounderwentorbitalcomputedtomographyfromMarch2013toJanuary2016,patientsdiagnosedwithNLDobstructionwereclassifiedintothepatientgroupandpatientswithoutobstructionwereclassifiedintothecontrolgroup.TheNLDvolumewasmeasuredusingtheImageJprogram,whichshowedtheNLDinaxial,coronal,andsagittalimagesoncomputedtomography.RESULTS:Theaveragevalueofmen’sNLDvolume,265.33±90.57mm^3,wassignificantlylargerthanwomen’s,211.87±68.61mm^3(P=0.009).Inthepatientgroup,theNLDvolumeoftheobstructedeyes,242.49±82.93mm3,andthenon-obstructedeyes,225.20±73.20mm3,weresignificantlyhigherthanthecontrolgroup,217.61±82.04mm^3(P<0.001,P<0.001).CONCLUSION:TheNLDvolumeislargerinmenthaninwomeninKoreanadults.IfthereisNLDobstructioninwomen,theNLDvolumeislargeranditisjudgedthatinflammatoryreactioncausedachronicchangeinthebonearoundtheNLDandaffectthemeasurementofNLDvolume.

简介：Objective:ThepurposesofthisstudyweretoidentifyriskfactorsforcervicallymphnodemetastasisandtoexaminetheassociationbetweenBRAFV600Estatusandclinicalfeaturesinpapillarythyroidmicrocarcinoma(PTMC).Methods:Atotalof1,587patientswithPTMC,treatedinTianjinMedicalUniversityCancerInstituteandHospitalfromJanuary2011toMarch2013,underwentretrospectiveanalysis.Wereviewedandanalyzedfactorsincludingclinicalresults,pathologyrecords,ultrasoundresults,andBRAFV600Estatus.Results:Multivariatelogisticregressionanalysesdemonstratedthatgender(male)[oddsratio(OR)=1.845,P=0.000],age(<45years)(OR=1.606,P=0.000),tumorsize(>6mm)(OR=2.137,P=0.000),bilateralism(OR=2.011,P=0.000)andextrathyroidalextension(OR=1.555,P=0.001)servedasindependentpredictorsofcentrallymphnodemetastasis(CLNM).Moreover,CLNM(OR=29.354,P=0.000)servedasanindependentpredictoroflaterallymphnodemetastasis(LLNM).Amongpatientswithasolitaryprimarytumor,thosewithtumorlocationinthelowerthirdofthethyroidlobeortheisthmusweremorelikelytoexperienceCLNM(P<0.05).UnivariateanalysesindicatedthatCLNM,LLNM,extrathyroidalextension,andmultifocalitywerenotsignificantlyassociatedwithBRAFV600Emutation.Conclusions:ThepresentstudysuggestedthatprophylacticneckdissectionofthecentralcompartmentshouldbeconsideredinpatientswithPTMC,particularlyinmenwithtumorsizegreaterthan6mm,agelessthan45years,extrathyroidalextension,andtumorbilaterality.AmongpatientswithPTMC,BRAFV600Emutationisnotsignificantlyassociatedwithprognosticfactors.ForabetterunderstandingofsurgicalmanagementofPTMCandtheriskfactors,werecommendmulticenterresearchandlong-termfollow-up.

简介：Objective:MemorystemTcells(Tscm)haveattractedattentionbecauseoftheirenhancedself-renewal,multipotentcapacity,andanti-tumorcapacities.However,littleisknownaboutTscminpatientswithrenalclearcellcarcinoma(RCC)andtheroleofWntsignalinginthesecells.WeevaluatedTscmfromRCCpatientsconcerningtheiractivationofWntsignalinginvitroandexploredthemechanismofpreferentialsurvival.Methods:FlowcytometryidentifiedsurfacemarkersandcytokinesproducedfromaccumulatedTscminthepresenceoftheglycogensynthasekinasebetainhibitorTWS119.Apoptosiswasevaluatedafterinductionusingtumornecrosisfactor-alpha.ImmunofluorescenceandWesternblotanalyseswereusedtoinvestigatetheactivationofthenuclearfactor-kappaB(NF-КB)pathway.Results:RCCpatientshadasimilarpercentageofCD4~+andCD8~+Tscmashealthydonors.ActivationofWntsignalingbyTWS119resultedintheaccumulationofTscminactivatedTcells,butreversalofdifferentiatedTcellstoTscmwasnotachieved.PreferentialsurvivalofTscmwasassociatedwithincreasedanti-apoptoticabilitymediateddownstreamoftheNF-КBactivationpathway.Conclusions:ThefindingthatTscmcanaccumulatebyWntsignalinginvitroinbloodfromRCCpatientswillhelpindevisingnewcancertherapystrategiesofTscm-basedadoptiveimmunotherapy,suchasdendriticcell-stimulatedTscm,andTcellreceptororchimericantigenreceptor-engineeredTscm.

简介：ThisstudydevelopedapopulationpharmacokineticmodelforsodiumtanshinoneIIAsulfonate(STS)inhealthyvolunteersandcoronaryheartdisease(CHD)patientsinordertoidentifysignificantcovariatesforthepharmacokineticsofSTS.Bloodsampleswereobtainedbyintensesamplingapproachfrom10healthyvolunteersandsparsesamplingfrom25CHDpatients,andapopulationpharmacokineticanalysiswasperformedbynonlinearmixed-effectmodeling.Thefinalmodelwasevaluatedbybootstrapandvisualpredictivecheck.Atotalof230plasmaconcentrationswereincluded,137fromhealthyvolunteersand93fromCHDpatients.Itwasatwo-compartmentmodelwithfirst-orderelimination.Thetypicalvalueoftheapparentclearance(CL)ofSTSinCHDpatientswithtotalbilirubin(TBIL)levelof10μmol(L?1was48.7L(h?1withinterindividualvariabilityof27.4%,whereasthatinhealthyvolunteerswiththesameTBILlevelwas63.1L(h?1.Residualvariabilitywasdescribedbyaproportionalerrormodelandestimatedat5.2%.TheCLofSTSinCHDpatientswaslowerthanthatinhealthyvolunteersanddecreasedwhenTBILlevelsincreased.Thebootstrapandvisualpredictivecheckconfirmedthestabilityandvalidityofthefinalmodel.TheseresultssuggestedthatSTSdosageadjustmentmightbeconsideredbasedonTBILlevelsinCHDpatients.

简介：Objective:Anti-angiogenicdrugsareanemergingtreatmentoptionagainstmalignanttumors.Theaimofthisstudywastodeterminewhethertheadditionofperioperativerh-endostatintochemotherapycouldimprovetheprobabilityofdistantmetastasis-freesurvival(DMFS)andoverallsurvival(OS)inpatientsnewlydiagnosedwithnon-metastaticconventionalosteosarcoma.Methods:Thiswasacontrollednon-randomizedclinicalstudythatincluded388patientswithoutclinicallydetectablemetastaticdiseaseenrolledfromJanuary2008toApril2012.Thecontroltreatmentgrouphad272patients;180weremaleand92,female,withamedianageof17years.Thetreatmentgrouphad58patients;36weremaleand22,female,withamedianageof16years.Thecontrolgroupreceivedpreoperativechemotherapyfollowedbysurgeryandpostoperativechemotherapy.Thetreatmentgroupreceived4cyclesofrh-endostatinperioperativelyinadditiontochemotherapyasperthecontrolgroup.Patientswerefollowedupfrom6-101monthswithamedianfollow-upperiodof50.2months.Results:The5-yearDMFSofthecontrolgroup(61%)wassignificantlylowerthanthatoftherh-endostatingroup(79%)(P=0.013).The5-yearOSofthecontrolgroup(74%)wassignificantlylowerthanthatoftherh-endostatintreatmentgroup(87%)(P=0.029).Nodifferenceinadversedrugreactionswasfoundbetweenthese2groups.Conclusions:Theadditionofperioperativerh-endostatintochemotherapycouldsignificantlyimprovetheDMFSandOSofpatientswithnon-metastaticosteosarcoma.

简介：Publicsafetyprovidesnewstatutoryprotectionsforwhistleblowers:Legislationenactedinordertoaddressmedicalerrorandfailuresofhospitalqualitysystemshasparadoxicallycreatedmechanismsthatareusedtosilencephysiciansandothercaregiverswhoseektoprotectpatientsafetybyreportingbreachesofprofessionalqualityandintegrity.Thelawsenactedtoprotectpatientscanbeandarecurrentlymisusedtosilencewhistleblowersthroughpunitivelegalproceedingsagainstpatientsafetyadvocates.Summarysuspensions,deprivationofdueprocess,andtransferofadjudicativeauthoritytothehandsoftheinstitutionsthatmostrequireoversightunderminestransparencyandpatientadvocacy.Amodestsetofstatutoryamendments,prophylacticandremedial,especiallytopreventprematurereportingofsummarysuspensions,cancounteracttheseinequitiesandrebalancetheHouseofMedicinesoastoprotectbothpatientsandthosewhowouldseektoensuretheirsafety,soitmaydonoharm.

简介：

简介：Objective:Prostatecancers(PCa)inAsianindividualsaremolecularlydistinctfromthosefoundintheirCaucasiancounterparts.ThereisnoriskstratificationtoolforAsianmenwithrapidbiochemicalrecurrence(BCR)followingradicalprostatectomy(RadP).Thisstudyaimstoassessthedetectionrateof^68Ga-prostate-specificmembraneantigen-positronemissiontomography/computedtomography(PSMA-PET/CT)fordiagnosisofclinicalrecurrenceandasatreatmentdecisionmakingtoolinAsianpatientswithBCRpost-RadP.Methods:^68GaPSMA-PETandCTbodywith/withoutbonescan[conventionalworkup(CWU)]wereperformedin55AsianpatientswithBCRwithin36monthspost-RadP.Twoblindedreviewersassessedtheimages.Detectionratesof^68GaPSMAPET/CTwereevaluated,andimpactonmanagementwasreviewedbycomparisonwithCWU.Results:MediantimetoBCRpost-RadPwas8.1months.Detectionratefor^68GaPSMA-PET/CTwas80%(44/55).Apositivescanwassignificantlyassociatedwithincreasingprostate-specificantigen(PSA)level[oddsratio(OR)=1.13(95%CI1.05–1.30),P=0.017],butnotwithhigherGleasongradeorshorterPSAdoublingtime.ComparedtoCWU,68GaPSMA-PET/CTdetectedanadditional106lesionsin33/44patientswithapositivescan,resultinginachangeinmanagementin25/44(56.8%)patients:10tohormonaltherapy(HT)andwholepelvisradiotherapy(RT)inadditiontobedRT,and15topalliativeHTalone.Conclusions:Inthepresentreport,wedemonstratedthediagnosticandtreatmentdecisionutilityof^68GaPSMA-PET/CTinAsianmenwithrapidBCR.DetectionofsmallvolumenodalandsystemicrecurrencesatlowPSAlevels(<1.0ng/mL)highlightstheroleofthetoolinassigningpatientstotreatmentintensificationwithHT-RTorpalliativeHTinpolymetastaticdisease.