Objective To investigate the sensitivity of Heidelberg Retina Tomography (HRT-Ⅱ)parameters on the early optic nerve change of glaucoma head. Design Cross-sectional study. Participants Twenty-one patients (36 eyes) with big cupped disc(C/ D≥0.7) and twenty-seven patients (31 eyes) with early glaucoma (C/D≥0.7, MD≤3dB) were studied. Methods All patients underwent visual field and HRT-Ⅱ examination to get parameters of optic nerve head. T test was used to compare the parameters of optic disc between big cupped disc and early glaucoma. Main Outcome Measures HRT Ⅱ parameters included disc area, cup area, rim area, cup volume, rim volume, C/D area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean RNFL thickness and RNFL cross sectional area. Results Statistics analysis with T test (t=2.247-3.714, P=0.000-0.028) showed there were significant differences of rim area, rim volume, mean retinal nerve fiber layer thickness, sectional area of retinal nerve fiber layer between big cupped disc and early glaucoma. Conclusions We can pay attention to those parameters with HRT- Ⅱ to distinguish patients with big cupped disc and early glaucoma.

Objective:To systematically evaluate the effect of early ambulation on the rehabilitation of patients after hepatectomy.Methods:Computer was used to search randomized controlled trial (RCT) literature on the effect of early ambulation on the rehabilitation of patients after hepatectomy in Chinese and English databases, such as China National Knowledge Infrastructure (CNKI) , Wanfang Data, VIP, China Biology Medicine, Ovid, PubMed, Web of Science, Embase, Cochrane Library. The retrieval time was from the establishment of database to May 10, 2020. RevMan 5.3 software was used to conduct Meta-analysis on literature that met the inclusion criteria.Results:A total of 8 RCT articles were included, with a total sample size of 936 cases, including 474 cases in intervention group (early ambulation) and 462 cases in control group (routine activity care) . The results of the systematic review showed that compared with control group, intervention group shorted the first exhaust time [weighted mean difference ( WMD) =-21.01, 95% confidence interval ( CI) (-25.98, -16.04) , P<0.05]and first defecation time [ WMD=-31.97, 95% CI (-54.69, -9.25) , P<0.05]after surgery, decreased gastrointestinal discomfort [relative risk ( RR) =0.44, 95% CI (0.34, 0.56) , P<0.05]and complications [ RR=0.76, 95% CI (0.56, 1.02) , P<0.05]after surgery, and had earlier time to early ambulation [ WMD=-20.64, 95% CI (-21.71, -19.56) , P<0.05], the differences were statistically significant. Conclusions:It is safe and effective to implement early ambulation in patients after hepatectomy, which is beneficial to the recovery of gastrointestinal function of patients, reduces the occurrence of gastrointestinal discomfort and complications, and promotes the recovery of patients.

Objective To investigate the influence of family resilience on patients with ischemic stroke and provide references for promoting positive handling of patients and the family adaptation.Methods Objective sampling was employed to conduct the semi-structured interviews among 20 patients with ischemic stroke in a Grade ⅢA hospital in Hunan Province between June and September 2021.The data acquired from the interviews were analysed and summarised following Colaizzi analysis method.Results A total of three themes with 10 dimensions were extracted,including promoting post-traumatic growth of patients with 3 dimensions(accepting and attaching importance to the disease to develop a right recognition of the disease,enhancing the will to combat the disease and increasing rehabilitative awareness to develop a healthy life style,cultivating spiritual believes to increase the sense of adversity;stabilising family function and providing emotional support with 4 dimensions in creating safe and satisfactory family settings,facilitating active communications among family members to jointly make decisions fighting against the disease,optimising the roles of family members,and fortifying the cohesion among family members;and proving spiritual comfort and material support with 3 dimensions of providing mutual support among family members to reduce the costs of treatment,improving family intimacy and adaptive support to reduce negative emotions,and seeking support from society to reduce financial burdens.Conclusions Family resilience brings influences to the patients with ischemic stroke from multiple perspectives.It can promote post-traumatic growth,stabilise family functions,provide emotional support,and provide spiritual consolation as well as financial support.Therefore,healthcare workers should enhance the family resilience and ensure the role of family functions to promote an early recovery of patients.

Objective:To explore the long-term influence of donor central graft thickness (CGT) and donor graft size on corneal endothelial cell density (ECD) after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:An observational case series study was conducted.One hundred and forty-four eyes of 134 patients who underwent DSAEK in Peking University Third Hospital from January 2013 to December 2017 with at least 24-month follow-up were enrolled.Preoperative donor ECD was evaluated by specular microscopy, and ECD was determined by in vivo confocal microscopy at 1, 3, 6, 12, and 24 months postoperatively.Donor CGT was measured by anterior segment optical coherence tomography.According to the 3-month postoperative donor CGT, the subjects were divided into thinner graft group (45 eyes with CGT<100 μm), medium-thick graft group (66 eyes with CGT≥100-<150 μm) and thicker graft group (33 eyes with CGT≥150 μm). According to the donor trephination size, the subjects were divided into smaller graft group (31 eyes with trephination size≥7-<8 mm) and larger graft group (113 eyes with trephination size≥8-<9 mm). The changes of the donor CGT and corneal endothelial cell loss rate were compared at different time points after surgery.The relationships between 24-month postoperative ECD and donor ECD, donor graft size and donor CGT were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University Third Hospital (No.IRB00006761-2008025). Written informed consent was obtained from each subject prior to any medical examination. Results:The donor CGT was 129.0 (90.8, 160.8), 115.5 (93.0, 146.0), 115.5 (89.0, 151.0), 112.5 (94.3, 146.8) and 114.0 (89.0, 144.5) μm at 1, 3, 6, 12 and 24 months after surgery, showing a statistically significant difference ( H=37.369, P<0.001). There was a statistically significant difference between 1-month and 3-month postoperative CGT ( P<0.001). There was no statistically significant difference in the endothelial cell loss rate among the three different donor CGT groups and between the two different donor graft size groups at any postoperative time points (all at P>0.05). Spearman correlation analysis showed that the 24-month postoperative ECD was strongly positively correlated with the preoperative donor ECD( rs=0.783, P<0.001), which was not associated with donor graft size and donor CGT ( rs=0.141, P=0.093; rs=-0.044, P=0.600). Conclusions:Larger postoperative ECD is correlated with larger preoperative ECD of donor graft.Lower long-term corneal endothelial cell loss rate after DSAEK is associated with thinner and larger diameter of donor graft.

Objective:To investigate the distribution of herpesvirus DNA in the corneal layers of herpesvirus-positive corneal transplantation patients and to compare the efficiency of viral DNA detection in corneal and aqueous humor samples in these patients.Methods:A diagnostic test study was conducted.Data from patients, who underwent keratoplasty in Peking University Third Hospital from May 2015 to August 2021 and tested positive for herpesvirus in corneal tissue and/or aqueous humor samples obtained during surgery, were collected through the clinical medical record system.The demographic data and virus distribution layers of these patients were analyzed.The rate of herpesvirus detection in different samples was analyzed.The sensitivity of different samples for viral DNA detection was analyzed by receiver operating characteristic curves, and area under the curve (AUC) and 95% confidence interval ( CI) were recorded.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Peking University Third Hospital (No.M2021283).Written informed consent was obtained from each patient before entering the cohort. Results:A total of 166 herpesvirus-positive patients (166 eyes) were collected.Of the 166 eyes, 75 eyes (45.2%) were positive for cytomegalovirus (CMV), 34 eyes (20.5%) for herpes simplex virus 1 (HSV-1), 30 eyes (18.1%) for varicella zoster virus (VZV), and 27 eyes (16.3%) for Epstein-Barr virus (EBV).CMV DNA and VZV DNA were detected in the endothelial layers of 47 eyes (62.7%) and 26 eyes (86.7%), respectively, which were significantly higher than the 28 eyes (37.3%) and 4 eyes (13.3%) with virus located in stromal layers ( χ2=4.813, 16.133; both at P<0.05).HSV-1 DNA and EBV DNA were detected in the endothelial layer of 8 eyes (23.5%) and 5 eyes (18.5%), respectively, which were less than the 26 eyes (76.5%) and 22 eyes (81.5%) with virus located in stromal layers, and the differences were statistically significant ( χ2=9.529, 10.704; both at P<0.001).The sensitivity of corneal samples for herpesvirus DNA positivity was 71.6%, which was higher than 54.1% of aqueous humor.The detection sensitivities of corneal samples for CMV DNA and VZV DNA positivity were 64.3%(AUC=0.821, 95% CI: 0.705-0.938) and 35.7%(AUC=0.679, 95% CI: 0.475-0.882), respectively, which were lower than 71.4%(AUC=0.875, 95% CI: 0.750-0.964) and 85.7%(AUC=0.929, 95% CI: 0.816-1.000) of aqueous humor samples.The detection sensitivities of corneal samples for HSV-1 DNA and EBV DNA were 100%(AUC=1.000, 95% CI: 1.000-1.000) and 92.3%(AUC=0.962, 95% CI: 0.875-1.000), respectively, which were higher than 27.8%(AUC=0.639, 95% CI: 0.455-0.823) and 23.1%(AUC=0.615, 95% CI: 0.395-0.835) of aqueous humor samples. Conclusions:The detection rate of CMV DNA is highest among herpesvirus-positive keratoplasty patients.CMV DNA and VZV DNA are primarily located in the corneal endothelial layers, while HSV-1 DNA and EBV DNA are more predominant in the corneal stromal layer.The sensitivity of virus DNA detection is higher in the cornea than in aqueous humor.