AIM: To compare the efficacy and safety of bevacizumab with mitomycin ( MMC ) in augmenting trabeculectomy for glaucoma.
METHODS: Databases including PubMed, CBM, CNKI, VIP and WanFang Data were electronically searched for all randomized controlled trials ( RCTs) about comparing the efficacy and safety between bevacizumab and MMC in augmenting trabeculectomy for glaucoma before the date of Jun. 2016. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, and evaluated the included studies. Then, Meta-analysis was performed.
RESULTS: A total 4 RCT involving 286 eyes ( 143 for bevacizumab group, 143 for MMC group) were included. The results of Meta-analysis showed that there was no significant difference between bevacizumab and MMC in the last follow-up after surgery in IOP (WMD=2. 21, 95%CI: -0.17 to 4.58, P=0.07), complete success rate (OR=0. 69, 95%CI:0. 26 to 1. 81, P=0. 45) and the numbers of anti-glaucoma medicine ( OR= 0. 12, 95%CI: -0. 15 to 0.39,P=0. 39). And there was no significant difference between bevacizumab and MMC in postoperative complications:hypotony (OR=0.7, 95%CI:0.12 to 4.05, P=0.69), bleb leak (OR=1, 95%CI: 0. 21 to 4. 74,P=1), encapsulated bleb (OR=1. 15, 95%CI: 0. 38 to 3. 44, P=0.81), choroidal detachment (OR=1. 22, 95%CI: 0. 29 to 5.22, P=0. 78) and cataract (OR=1. 15, 95%CI: 0. 38 to 3.44, P=0. 81).
CONCLUSION: Bevacizumab and MMC in augmenting trabeculectomy for glaucoma have similar efficacy and safety. Bevacizumab can't result in better outcome in term of IOP reduction. Clinicians should choose suitable solution according to disease characteristics.

Objective To investigate the preoperative management and the clinical effeciency of Lichtenstein tension-free hernioplasty in adult patients with inguinal incarcerated hernia.Methods Clinical data of 86 patients with inguinal incarcerated hernia were analyzed retrospectively.Hernia was repaired with Lichtenstein tension free after reposition.Results There were 59 male patients and 27 female patients with median age of (63 ± 18) years.There were 8 patients with liver cirrhosis.The operation was performed successfully in all patients.Segmental bowel resection with end-to-end anastomosis was performed in 38 emergency cases.Operative time was 20-120 min,with an average time of 54 min.The postoperative hospitalization was 5-17 d,with an average of 8 d.There were 7 cases of skin ecchymosis at the scrotum,there were no intestinal perforation,hepatic encephalopathy and upper gastrointestinal hemorrhage after operation.In early series of 24 cases without drainage tube left in place,there were 10 cases of fat liquefaction,10 cases of hydrops of hernial sac,6 cases of seroma and 3 cases of wound infection after operation.After 12 to 48 months of follow-up,there was no mortality after 2 years,no hernia recurrence.Conclusions Tension free repair in the treatment of incarcerated inguinal hernia is safe and feasible.

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.

Objective: To examine the association between leukocyte telomere length and cataract using bidirectional Mendelian randomization (MR) approach, so as to provide the basis for early diagnosis and prevention of cataracts. Methods: Leukocyte telomere length data were collected through a meta analysis of genome-wide association studies (GWAS), including 78 952 participants, and the GWAS data of cataract were collected through the UK Biobank, including 8 890 cases and 454 120 controls. A bidirectional MR analysis was performed using the inverse-variance weighted (IVW) method, and single nucleotide polymorphisms (SNPs) which were associated with leukocyte telomere length were selected as instrumental variables. The heterogeneity was assessed using the Cochran's Q test, the horizontal pleiotropy was assessed using the MR-Egger regression and the outlier was verified with the leave-one-out and MR-PRESSO test. Results: Forward MR analysis results showed that shortened leukocyte telomere length had an increased risk of cataract (OR=0.991, 95%CI: 0.990-0.997). Reverse MR analysis results showed no statistically significant association between leukocyte telomere length and cataract (P>0.05). Cochran's Q test detected no heterogeneity, and neither the MR-Egger regression nor the MR-PRESSO test revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results. Conclusion Shorter leukocyte telomere length might be associated with increased risk of cataract.

Adult ; Aged ; Female ; Humans ; Infection ; Infection Control ; instrumentation ; methods ; Intubation, Intratracheal ; instrumentation ; methods ; Male ; Middle Aged ; Suction ; Tracheostomy ; adverse effects ; Young Adult

Objective To evaluate ligation of the intersphincteric fistula tract plus core-out fistulectomy for complex cryptoglandular anal fistulas.Methods Forty-one patients were divided into ligation and control group randomly.In ligation group (20 cases),patients underwent ligation of the intersphincteric fistula tract plus core-out fistulectomy procedure.While in control group (21 cases) fistulotomy on low sphincter with cutting-seton on high sphincter procedure was performed.The primary end points of the study were healing rate and continence by using the Wexner score.Secondary end points were postoperative pain in the third and seventh day with the use of the visual analog scale,length of hospital stay and followed measures for a recurrent fistula.Comparison of measurement data using independent samples t-test or paired samples t-test,compared with the count data using Fisher's exact test.Results There was no statistical difference in the healing rate between ligation group (90％) and control group (95％) (P ＞0.05).Postoperatively,one case in ligation group reported incontinence for gas,compared to 7 cases in control group,among these 7 cases 2 cases also had incontinence for watery stool.Statistical differences were found between two groups in Wexner scores,visual analog scale scores and length of hospital stay (P ＜0.05).Conclusion Ligation of the intersphincteric fistula tract plus core-out fistulectomy is an economical,safe,little painful,recovery enhanced and minimally invasive technique to treat complex anal fistulas.

Aim To investigate the protective effects of sphingosine 1-phosphate ( S1 P ) postconditioning on hypoxia/reoxygenation( H/R) injury in human umbili-cal vein endothelial cells ( HUVEC ) and its mecha-nisms. Methods HUVECs cells were divided into five groups: normal ( control) group, S1P low concentra-tion group ( L ) , S1 P medium concentration group (M), S1P high concentration group ( H) and H/R group. MTT method was used to measure cell survival. Using flow cytometric analysis, the rate of cell apopto-sis was determined. The activities of total superoxide dismutase ( T-SOD) , copper/zinc superoxide dismuta-se ( CuZn-SOD ) , manganese superoxide dismutase ( Mn-SOD) activity, nitric oxide ( NO) and malondial-dehyde ( MDA ) content in cell culture medium were measured with colorimetry. Mitochondrial membrane potential in cells was observed with fluorescence micro-scope. Bax/Bcl-2, eNOS protein expression levels in HUVECs cells were observed with Western blot. Re-sults Compared with H/R group, S1P low, medium and high concentrations in the intervention group could significantly increase the cell survival rate after H/R injury, and increase activity of T-SOD, CuZn-SOD, Mn-SOD and decrease content of MDA. Moreover, S1 P could significantly increase NO content and in-crease eNOS protein expression, decrease apoptosis rate and inhibit the reduction of mitochondrial mem-brane potential. Conclusions S1P can decrease cell apoptosis rate of HUVECs after H/R injury with a cer-tain concentration dependence. The protection of S1P for cell apoptosis of HUVECs after H/R injury may be related to decreasing the intracellular MDA content and improving intracellular SOD activity, increasing mito-chondrial membrane potential and enhancing expres-sion of Bcl-2, anti-apoptotic protein.

Objective To study the clinical features,diagnosis and treatment of eosinophilic granuloma of bone(EGB).Methods Twelve cases(8 male and 4 female)of EGB and their medical record,imaging examinations,follow-up data were reviewed,and the lesion sites,symptom and clinical features were analyzed with reference to relative literature.Results Nine unifocal cases were found in the cervical spine(3 cases),the thoracic spine(1 case),the lumber spine(1 case),the femur(1 case),the metacarpal bones(1 case),and the ilium(2 cases).Three multifocal cases were found in the thoracic and lumber spine(1 case),in the femur,the multiple ribs,the skull,the scapula(1 case)and in the skull,the femur,the ilium(1 case).The most common presenting symptom was pain at the lesion site and restricted motion was obviously in the cervical lesion.The case of the thoracic lesions was found neurologic deficit.Osteolytic destruction was found in the radiologic examination in EGB and the periosteal reaction was found in the long bone lesions,and vertebra plana was considered as typical cha-racteristics in the spine lesion.The lesions not in the spine were diagnosed by biopsy,exclusive methods and close following-up were performed in the spine lesions.Two unifocal were healed spontaneously and three were performed with curettage with one bone grafting.Multifocal and the lesions in the spine underwent chemotherapy.All cases were followed up and no recurrence was found.Conclusions EGB is commonly solitary and not seldom in the spine.Topical pain may be chief complaint.Osteolytic image was found in the radiologic examination.Biopsy and exclusive methods combining closely follow-up were used for diagnosis.EGB is self-limited observation,so curettage or chemotherapy can be used in treatment,and prognosis is good.

Adult ; Female ; Hearing Loss, Sensorineural ; complications ; Humans ; Mitochondrial Encephalomyopathies ; complications

Objective To study the characteristics of epidemiology among the emergency patients with acute drugs poisoning in emergency center of Fujian Province.Methods Retrospective study was used to collect data of patients with acute drugs poisoning from 2004 to 2009,and data of patients 'gender,age,cause of poisoning,poison type,emergency diagnosis,medical treatment,etc.were analyzed.Results The epidemiological reports of 744 cases of acute drugs poisoning patients were collcected from 2004 to 2009,the male-to-female ratio was 1:4.2,the average age was 33.0,high incidence group was at ages 18 ～29 (50.3％ ).The most visiting time was in Spring (April to June).Eighty-eight point three percentage of poisoning was intentional.Central nervous system drugs,in particular sedative/hypnotic drugs (64.5％ )was the most common agents associated with poisoning.The poisoned patients were divided into three groups with mild ( 51.5％ ),moderate ( 33.2％ ) and severe ( 15.3％ ) according to the patient' s condition.Thirty-seven percentage poisoned patients were discharged after treatment followed up for observation,and 28.3％ patients were hospitalized,no patients died.Conclusions The majority of acute drugs poisoning among patients from city were sedative/hypnotic drugs.Reasonable grading and different treatment according to the condition of acute drugs poisoning would be helpful to improve the survival rates of acute poisoning and reduce medical costs.