AIM: To investigate the efficiency of intravitreal ranibizumab therapy ( IVR ) for polypoidal choroidal vasculopathy ( PCV) in single or multiple polyps.
METHODS: A total 63 patients diagnosed with PCV in Shaoxing City People's Hospital from May 2013 to May 2015 were enrolled and divided into single polyp group and multiple polyps group. All patients received intravitreal ranibizumab 3 monthly and were followed up for 12mo. Observe the changes of best corrected visual acuity ( BCVA ) and central retinal thickness ( CRT ) at different time points.
RESULTS: The single polyps group exhibited a better BCVA, shorter greatest linear dimension, and lower prevalence of fibro - vascular pigment epithelial detachment compared with the multiple polyp group before treatment (P<0. 05). Significant difference of BCVA were observed at 3, 6 and 12mo between the two groups (P<0. 05). BCVA at 3, 6, 12mo was significantly better than that at baseline in single polyps group. The single polyp group exhibited a significantly thinner CRT at 6 and 12mo compared with multiple polyps group (P<0. 05). The single polyp group showed improvement in CRT over the followed up period(P<0. 05). The CRT in multiple polyps group at 3 and 6mo significantly decreased compared with preoperative (P<0. 05).
CONCLUSION: IVR meet better result in PCV patients with multiple polyp and polyp numbers may be valuable to prognosis.

OBJECTIVE: To evaluate factor XII deficiency in patients with recurrent spontaneous abortion and its relation to aPTT. MATERIAL AND METHOD: Factor XII was analyzed by clotting method. RESULTS: Of 70 patients with recurrent spontaneous abortion, there were 35 cases of factor XII deficiency. Among them, there were only 3 cases of prolonged aPTT. CONCLUSIONS: It is still unclear whether factor XII deficiency is related to recurrent spontaneous abortion. Molecular approaches should be used to understand further the causal relationship. But based on this result, in the workup of patients with recurrent spontaneous abortion, factor XII should be included. aPTT is not likely to represent the abnormality of factor XII.
Abortion, Spontaneous* ; Factor XII Deficiency* ; Factor XII* ; Female ; Humans ; Pregnancy

Trinucleotide repeat (TNR) instability can cause a variety of human genetic diseases including myotonic dystrophy and Huntington's disease. Recent genetic data show that instability of the CAG/CTG repeat DNA is dependent on its length and replication origin. In yeast, the RAD27 (human FEN-1 homologue) null mutant has a high expansion frequency at the TNR loci. We demonstrate here that FEN-1 processes the 5'-flap DNA of CTG/CAG repeats, which is dependent on the length in vitro. FEN-1 protein can cleave the 5'-flap DNA containing triplet repeating sequence up to 21 repeats, but the activity decreases with increasing size of flap above 11 repeats. In addition, FEN-1 processing of 5'-flap DNA depends on sequence, which play a role in the replication origin-dependent TNR instability. Interestingly, FEN-1 can cleave the 5'-flap DNA of CTG repeats better than CAG repeats possibly through the flap-structure. Our biochemical data of FEN-1's activity with triplet repeat DNA clearly shows length dependence, and aids our understanding on the mechanism of TNR instability.
Base Sequence ; DNA, Single-Stranded/*metabolism ; Endodeoxyribonucleases/genetics/*metabolism ; Flap Endonucleases ; Gene Expression Regulation ; Genetic Diseases, Inborn/*genetics ; Human ; Nucleic Acid Conformation ; Trinucleotide Repeat Expansion ; *Trinucleotide Repeats

Trinucleotide repeat (TNR) instability can cause a variety of human genetic diseases including myotonic dystrophy and Huntington's disease. Recent genetic data show that instability of the CAG/CTG repeat DNA is dependent on its length and replication origin. In yeast, the RAD27 (human FEN-1 homologue) null mutant has a high expansion frequency at the TNR loci. We demonstrate here that FEN-1 processes the 5'-flap DNA of CTG/CAG repeats, which is dependent on the length in vitro. FEN-1 protein can cleave the 5'-flap DNA containing triplet repeating sequence up to 21 repeats, but the activity decreases with increasing size of flap above 11 repeats. In addition, FEN-1 processing of 5'-flap DNA depends on sequence, which play a role in the replication origin-dependent TNR instability. Interestingly, FEN-1 can cleave the 5'-flap DNA of CTG repeats better than CAG repeats possibly through the flap-structure. Our biochemical data of FEN-1's activity with triplet repeat DNA clearly shows length dependence, and aids our understanding on the mechanism of TNR instability.
Base Sequence ; DNA, Single-Stranded/*metabolism ; Endodeoxyribonucleases/genetics/*metabolism ; Flap Endonucleases ; Gene Expression Regulation ; Genetic Diseases, Inborn/*genetics ; Human ; Nucleic Acid Conformation ; Trinucleotide Repeat Expansion ; *Trinucleotide Repeats

BACKGROUND: The Pentax-AWS is a newly developed rigid video laryngoscope. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Pentax-AWS systems during endotracheal intubation. METHODS: This study included 120 patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups: Pentax-AWS (group P) and Macintosh (group M). Induction of anesthesia was performed using fentanyl, thiopental and succinylcholine intravenously. Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to induction, 1, 3, and 5 minutes after intubation. RESULTS: There were no significant differences in SBP, MBP, DBP and HR between both groups. However, group P showed a higher POGO (Percentage of Glottic Opening) score than group M during endotracheal intubation. CONCLUSIONS: Use of Pentax-AWS in endotracheal intubation did not increase hemodynamic changes compared to the use of Macintosh laryngoscope. Furthermore, Pentax-AWS offered an improved laryngeal view during endotracheal intubation.
Anesthesia ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Succinylcholine ; Thiopental

A 23-year-old woman with MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) underwent a laparoscopy-assisted appendectomy. MELAS syndrome is a multisystemic disease caused by mitochondrial dysfunction. General anesthesia has several potential hazards to patients with MELAS syndrome, such as malignant hyperthermia, hypothermia, and metabolic acidosis. In this case, anesthesia was performed with propofol, remifentanil TCI, and atracurium without any surgical or anesthetic complications. We discuss the anesthetic effects of MELAS syndrome.
Acidosis ; Acidosis, Lactic ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Appendectomy ; Atracurium ; Female ; Humans ; Hypothermia ; Malignant Hyperthermia ; MELAS Syndrome ; Muscular Diseases ; Piperidines ; Propofol ; Young Adult

Pneumothorax associated with a pneumoperitonium in laparoscopic surgery is rare but can cause life-threatening complications. A 62-year-old man was scheduled for a laparoscopy-assisted Billroth-I gastrectomy under general anesthesia. Approximately 70 minutes after insufflating carbon dioxide into the intraabdominal cavity at a pressure of 12 mmHg, the peak inspiratory pressure increased, while the oxygen saturation decreased. The pneumothorax of the left lung was evident on the intraoperative chest radiograph. The pneumothorax improved after inserting a catheter into the affected area. The cause of the pneumothorax was unknown but an anatomical defect is believed responsible. This report shows that pneumothorax developed under an intraabdominal pressure in the conventional safety range. Careful monitoring and immediate treatment is necessary to prevent the condition from worsening.
Anesthesia, General ; Carbon Dioxide ; Catheters ; Gastrectomy ; Humans ; Laparoscopy ; Lung ; Middle Aged ; Oxygen ; Pneumoperitoneum ; Pneumothorax ; Thorax

BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Prognosis

BACKGROUND: Emergence agitation frequently occurs after desflurane anesthesia in children. We designed this study to find the optimal dose of fentanyl for the prevention of emergence agitation after desflurane anesthesia in children for tonsillectomy. METHODS: Eighty-one patients (3-10 yr) receiving desflurane anesthesia for tonsillectomy was randomly allocated to one of 3 groups. Fentanyl 1 microg/kg (group 1, n = 26), 2 microg/kg (group 2, n = 27), 3 microg/kg (group 3, n = 28) was administered intravenously just before inducing anesthesia. Anesthesia was maintained with desflurane. The recovery characteristics, such as the time to first movement, extubation and discharge from the recovery room were assessed. And patients reported their frequency of emergence agitation and severity of postoperative pain at recovery room. RESULTS: There were no significant differences between the three groups regarding the time to extubation and discharge from the recovery room. The incidence of emergence agitation was 42% in group 1, 25% in group 2, 10% in group 3 and that was significantly lower in group 3 than in group 1 (P < 0.05). The incidence of severe pain was lower in group 3 than in group 1 and group 2 (P < 0.05). CONCLUSIONS: In children undergoing tonsillectomy with desflurane anesthesia, 2 microg/kg and 3 microg/kg of fentanyl given just before induction had a reduced incidence of emergence agitation without a delay in recovery.
Anesthesia ; Child ; Dihydroergotamine ; Fentanyl ; Humans ; Incidence ; Isoflurane ; Pain, Postoperative ; Recovery Room ; Tonsillectomy

BACKGROUND: The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal(TM) (PLMA) during general anesthesia. METHODS: Sixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications. RESULTS: First attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA. CONCLUSIONS: The SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia.
Anesthesia ; Anesthesia, General ; Blood Stains ; Bronchoscopy ; Hemodynamics ; Humans ; Incidence ; Laryngeal Masks ; Lung ; Mechanics ; Pharyngitis ; Pharynx ; Rivers ; Spirometry