Background Toric intraocular lens (Toric IOL) is a well accepted method of correct of corneal astigmatism.Axial misalignment,including the error of intraocular lens alignment during surgery and rotation of Toric IOL,is the main barrier to the precise alignment of Toric intraocular lenses.Therefore,the angle of axial misalignment is a main index to evaluate the effectiveness of Toric IOL implantation.Objective The present study is to describe a method of precisely detecting Toric IOL misalignment using postoperative digital photograph.Methods A measuring template (polar coordinates) was constructed using Adobe Photoshop software.Minimum graduate to detect the Toric axis was 1° (maximum error 0.5°).The clinical data of 24 eyes undergone Toric IOL implantation was retrospectively analyzed.Corneal astigmatism was detected by rotating Scheimpflug camera (Pentacam) or slit scan (Orbscan).Digital retro illumination picture was photographed after mydriasis.The picture was analyzed by our derived template.The steepest corneal axis and the axis of Toric IOL were then determined.The misalignment of Toric IOL was determined as the angle between the steepest corneal axis and the axis of Toric IOL.Misalignment of Toric IOL and its distribution were analyzed by statistical means.Results A method using polar coordinates and digital photo to precisely detect Toric IOL misalignment was derived.Mean Toric IOL misalignment was 10.93±6.90 degrees (0-24 degrees) in the 24 cases.The axial misalignment in all of cases were within 25 degrees,including clockwise in 14 eyes(58.33%),anticlockwise in 10 eyes (41.67%).In this study,the misalignment angle of 4 eyes were within 5 degrees;11 eyes were 5 to 10 degrees;1 eye was 10 to 15 degrees;6 eyes were 15 to 20 degrees;2 eyes were 20 to 25 degrees.Conclusion The method is feasible to the direction of Toric IOL misalignment in clinic.

Background Artisan phakic intraocular lens (pIOL) implantation was demonstrated to be safe and effective for the correction of high myopia in short-term.However,long-term corneal endothelium status after operation should be concerned.Objective This study was to investigate the long-term changes of corneal endothelial cell density (ECD) and morphology following Artisan pIOL implantation for the correction of high myopia.Methods Fifty-one eyes of 27 patients who received Artisan PIOL implantation for high myopia from January 2005 to December 2008 were retrospectively analyzed.The central corneal ECDs were detected by corneal endothelial cell counter before surgery and 6 months and 1 year,2,3,4,5,6 years after surgery,and the coefficient of variation (CV) and standard deviation (SD) of cellular area were evaluated.ECD loss rate with time lapse was calculated ([preoperative ECD-postoperative ECD]/preoperative ECD× 100％).Results Six years after surgery,there were 34 eyes with BCVA ≥ 1.0,14 eyes with BCVA higher than preoperative and 8 eyes with BCVA lower than preoperative.The mean intraocular pressure was (14.23±2.14)mmHg 6 years postoperative.The preoperative mean ECD was (3 184.05±233.55)/mm2,and the ECD was gradually reduced over time with the cell loss 2.34％ in 6 months,5.32％ in 1 year,6.32％ in 2 years,8.06％ in 3 years,12.59％ in 4 years,15.63％ in 5 years and 19.49％ in 6 years after operation.Before surgery,The mean CV of cellular area was 37.17±7.12,and the SD of cellular area was 118.77±21.39,and those 6 years after surgery were 32.24 ±4.62 and 125.60± 18.49,respectively.The mean CV and SD of cellular area were significantly different among different time points (P =0.000,0.036).Eight eyes with localized iris depigmentation,6 eyes with IOL dyssymmetry,3 eyes with transient high intraocular pressure and 2 eyes with Macular hemorrhage were obtained after surgery.Conclusions Corneal endothelial cells appear obvious changes in both number and morphology after Artisan pIOL implantation in high myopia.ECD is gradually reduced with time lapse,and the shape of the cells occur remodeling during 6-year fellow-up duration.Overall,endothelial specular microscopy is mandatory before and after surgery for a long term.

Objective To compare intraindividual higher-order aberrations(HOA)after implantation of aspherical and spherical intraocular lenses(IOL).Design Prospective,case-controlled study.Participants 33 patients(66 eyes)were between 50 and 76 years of ages.The patients with bilateral senile cataracts were operated with phacoemulsification and IOL implantation.All the patients had no other ocular pathologies and no previous ophthalmic surgery.Patients with keratometric astigmatism higher than-2.0 diopters(D)were excluded from the study.Methods Wavefront aberration measurements of 33 patients(66 eyes)after implantation of a spherical IOL(Canon Staar KS-3)in one eye and an aspherical IOL(Cannon Staar KS-3Ai)in the contralateral eye were analyzed.The eyes were randomly assigned to groups of the spherical IOL or the aspherical IOL.Third-order,4th-order,5th-order,total HOA root-mean-squares(RMS),and 4th-order spherical aberrations(Z40)were compared 3 months after surgery.Main Outcome Measures Visual acuity(VA),the best corrected visual acuity(BCVA),the centrality of IOL,refraction data,diameter of pupil size,3rd-order,4th-order,5th-order and total HOA RMS,and 4th-order spherical aberration(Z40)RMS were measured.Results Fourth-order aberration RMS(0.193?0.098?m),Z40 RMS(0.037?0.099?m),total HOA RMS(0.498?0.072?m)in the aspherical IOL group were lower than those with the spherical IOL(0.403?0.155?m,0.381?0.142?m,0.737?0.164?m,respectively)at 6mm pupil diameter.For 3rd-and 5th-order RMS at 6mm pupil diameter,total HOA RMS(at 5mm pupil diameter),no significant difference was found in both IOLs.Under mesopic conditions,ten patients(30%)with an aspheric IOL had better contrast sensitivity.The average myopic shift were(-0.29?0.09)D and(-0.87?0.16)D in the aspherical and spherical IOL groups at 6mm pupil diameter(P

Objective To produce an experimental information for the safety assessment of Vero cells during subculture. Methods Passage and freeze on Vero cells, and Vero cells in different passages in vitro and in vivo tumorigenicity were tested. The protein expression of different Vero cell passages was analyzed. Results Vero cells passaged to p270 and 14 cell banks were developed and stored for future evaluation. In vitro and in vivo tumorigenicity Lest results of Vero cells in different passages were negative. Conclusion Although the tumorigenicity test results in vitro and in vivo process were negative, the protein expression of more than p200 Vero cells were changed, which produced the experimental reference for the safety evaluation of the process during the Vero cell passage.

OBJECTIVETo develop an LC-MS method for identification of flavonoids in Chinese hawthorn fruits and an HPLC method for quantification of 5 flavonoids.

METHODAccurate molecular weights of the target flavonoids were acquired by time-of-flight mass spectrometer (TOF-MS) in both positive and negative ion modes. The flavoniods were then further confirmed by standards. An RP-HPLC method was established to quantitatively analysis five major flavonoids (chlorogenic acid, procyanidin B2, epicatechin, hyperoside and isoquercitrin) in hawthorn fruits from ten different regions.

RESULTSThe molecular formulae of 8 components were determined by TOF-MS. In the quantitative method validation, the method is linear over the studied range of 1.8-178.5, 2.2-284.8, 2.7-270. 6,1.5-150.0, 1.5-150.0 mg x L(-1) for chlorogenic acid, procyanidin B2, epicatechin, hyperoside and isoquercitrin, respectively. The correlation coefficient for each analyze was greater than 0.999. The inter-day precision of the analysis was lower than 4%, The RSDs of precision and stability were lower than 5%. The recovery rate was from 98.5% to 102.5%, and RSDs were less than 3.5%.

CONCLUSIONThe method is simple, specific and reliable, and is suitable for quality control of Chinese hawthorn.

Chromatography, High Pressure Liquid ; methods ; Crataegus ; chemistry ; Flavonoids ; analysis ; Fruit ; chemistry ; Mass Spectrometry ; Quality Control

Objective:To investigate possible neuromodulatory mechanisms involved in the involvement of parvalbu-min(PV)expression in the basal ganglia output nuclei,entopeduncular nucleus(EPN)and substantia nigra pars etic-ulata(SNr),in exercise-induced chronic fatigue impairs working memory capacity.Methods:Male SD rats were divid-ed into control group and Fatigue group by random number method,and a three-stage incremental load treadmill training program was selected to establish a chronic exhaustion exercise-induced fatigue rat model.The working memory ability of rats was assessed by the Y-maze autonomous alternation experiment.Immunohistochemical staining was used to ob-serve the expression of parvalbumin(PV)positive neurons and cysteine aspartate-specific protease-3(caspase-3)in EPN and SNr of rats.Results:The accuracy of voluntary alternation in the fatigue group was obviously lower than that in control group(P＜0.05).The results of immunohistochemical staining showed that the density of PV positive neu-rons and the degree of positive fiber staining in EPN and SNr in the fatigue group were obviously lower than those in the control group(P＜0.05,P＜0.01).The number of caspase-3 positive cells per unit area of EPN and SNr in the fa-tigue group was obviously higher than that in the control group(P＜0.05,P＜0.01).Conclusion:The mechanism of impairing working memory in rats caused by exercise-induced chronic fatigue may be related to the apoptosis of PV posi-tive neurons in EPN and SNr.

Objective:The purpose of this study was to explore new method for evaluating the severity of extravascular lung water in patients after bilateral lung transplantation.Methods:The study was performed in 50 patients after bilateral lung transplantation in our hospital from 2017 to 2018. Picco were implanted during the operation .Two hours after the operation, a doctor monitored the index of EVLWI and PVPI.At the same time, another doctor carried out examination of lung ultrasonography and Calculated the numbers of B line. After ultrasonography, the doctor used ELISA to determine the level of SDC-1.Results:EVLWI were significantly correlated with the number of B-line and the level of SDC-1 ( RS=0.833, RS=0.747, P<0.05), PVPI were significantly correlated with the number of B-line and the level of SDC-1 ( RS=0.738, RS=0.626, P<0.05). Conclusion:The number of B-line and the level of SDC-1 have a good correlation with extravascular lung water. The combination of the two indicators might be used as a reliable index for evaluating the degree of extravascular lung water after bilateral lung transplantation.

Objective In view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer ( SCLC), a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis. Methods After 2 cycles of EP chemotherapy,patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis. Results Between June 2002 and December 2017,159 and 150 patients were randomly assigned to study arm and control respectively. The 1-,2-,and 5-year local/regional control rates were 79. 4%,61. 5% and 60. 1% respectively in the study arm versus 79. 8%,66. 5%,and 57. 3% in the control arm (P=0. 73). The median OS time was 22. 1 months in the study arm (95%CI,18. 2-26. 0 months) and 26. 9 months (95%CI,23. 5-30. 3 months) in the control arm,the 1-,3-,5-,and 7-year OS rates were 81. 1%,31. 6%, 23. 9% and 22. 2% respectively in the study arm versus 85. 3%,36. 6%,26. 1% and 20. 0% in the control arm (P=0. 51).Grade 2-3 acute esophagitis was developed in 32. 9% and 43. 2% of patients respectively in study arm and control arm (P=0. 01),while grade 2-3 pulmonary fibrosis was observed in 2. 0% and 10. 9% of patients ( P= 0. 01 ) respectively. Conclusions For patients with limited-stage SCLC who received induction chemotherapy,thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.

Objective:To investigate the diagnosis, treatment and prognosis of squamous cell carcinoma of renal pelvis.Methods:The clinic data of 28 cases with squamous cell carcinoma of renal pelvis confirmed by pathologic examination treated during June 2007 and September 2019 was retrospectively analyzed. There were 19 male and 9 female patients, with a median age of 56 years. Hematuria was present in 18 cases, flank pain was present in 11 cases, and abdominal mass was present in 1 case. All 28 cases accepted CT or MRI examination. Renal pelvis or renal tumors were found in 26 cases, and severe hydronephrosis was observed in 2 cases. 2 cases underwent PET/CT, and bone metastasis was found in 1 case. Preoperative diagnoses were renal pelvic tumor in 13 cases, renal tumor in 13 cases and renal abscess in 2 cases. Coexisting renal calculi or renal pelvic calculus was detected in 19 cases. All 28 cases underwent surgical excision, including radical nephroureterectomy in 13 cases, radical nephrectomy in 12 cases, palliative resection in 1 case, and pyonephrenectomy in 2 cases. Enlarged lymph nodes were found in 9 cases during the surgery, and local lymph node dissection was performed in these cases.Results:The mean diameter of the tumors was 8.5 cm. Histopathological examination revealed that 9 cases were well differentiated, 11 cases were moderately differentiated, and 8 case was poorly differentiated. 1 case had pT 2 stage, 15 cases had pT 3 stage and 12 cases had pT 4 stage. 9 cases had lymph node metastasis. 5 cases had renal vein thrombosis. Immunohistochemistry staining exhibited consistent characteristics including CK5(+ ), 34βE12(+ ), p63(+ ), CK20(-) and GATA3(-). Postoperatively, 12 cases received adjuvant therapy including chemotherapy, radiotherapy and/or immunotherapy. Within a median follow-up of 6.0 months (ranging 1-80 months), median overall survival was 10.0 months. 15 cases died of tumor progression. Conclusion:Squamous cell carcinoma is a rare and highly aggressive neoplasm, typically associated with long-lasting renal calculi, hydronephrosis and chronic inflammation. The diagnosis should be established on pathologic examination.CK5, 34βE12 and p63 positivity contribute to the diagnosis of squamous cell carcinoma. Surgery is the foremost choice of treatment, but the risk of recurrence and metastasis is high. The prognosis is extremely poor as the majority of patients are diagnosed with advanced stages.

Objective:To study the pathological characteristics, diagnosis and treatment of primary adenocarcinoma of renal pelvis and ureter.Methods:The clinical pathological characteristics, treatment and prognosis of 5 patients with adenocarcinoma of upper urinary tract treated between January 2007 and May 2019 was retrospectively reviewed. There were 4 male and 1 female patients, with a median age of 60 years. The major symptoms were hematuria in 5 cases and low back pain in 4 cases. All cases underwent B-ultrasound and CT examination, and 4 cases accepted cystoscopy. Preoperative diagnoses were ureter tumor in 2 cases, renal pelvis tumor in 1 case, renal tumor in 1 case and renal calculus in 1 case.Results:5 cases were treated with surgery. Radical nephroureterectomy was performed in 3 cases, and nephrectomy in one case. 1 case underwent first-stage percutaneous nephrolithotomy and second-stage radical nephroureterectomy due to the discovery of tumor. 1 case was treated with radiotherapy and immune checkpoint inhibitor postoperatively. The mean diameter of the tumors was 4.4 cm. There were 3 renal pelvis adenocarcinomas and 2 ureter adenocarcinomas confirmed by pathologic examination, including 3 cases of pT 3 stage and 1 case of pT 4 stage. Lymph node metastasis was found in 2 cases. Immunohistochemistry revealed that CDX2(+ ), p63(-), GATA3(-), β-catenin(-)were the common features of five cases. The median survival was 12 months with a median follow-up of 6 months. 2 cases died of tumor progression within 1 year. Conclusions:Adenocarcinoma is an extremely rare malignancy, typically associated with long-standing calculi and chronic inflammation. Given the fact that clinical and imaging findings are nonspecific, the diagnosis is based on pathologic examination, supported by glandular structure of histology. Immunohistochemical staining exhibited CDX2 and CK20 positivity and β-catenin negativity, moreover, GATA3, p63 and CK7 was usually negative or partially positive. Surgery is the foremost choice of treatment. The prognosis is correlated with subtypes, whereas the overall prognosis is poor due to high rates of recurrence and metastasis.