OBJECTIVEThis study aimed to review the available literature on vitreomacular traction (VMT) syndrome and propose the future study prospect in this field.

DATA SOURCESThe data used in this review were mainly obtained from articles listed in Medline and Pubmed (1970-2013). The search terms were "vitreomacular traction", "optical coherence tomography", "vitrectomy", and "ocriplasmin".

STUDY SELECTIONArticles regarding the pathophysiology, diagnosis, and treatments of VMT were selected and reviewed.

RESULTSVMT syndrome is a persistent attachment of vitreous to the macula in eyes with an incomplete posterior vitreous detachment and considered to be an uncommon status which correlated with some other macular disorders. Optical coherence tomography (OCT) can support a new way to examine and classify VMT. Nonoperative and operative intervenes on this disease have been developed recently, especially the intravitreal medical therapy.

CONCLUSIONSVMT syndrome may be associated with various disorders in the macular region, depending in part on the size and strength of the residual vitreomacular adhesion. Regular OCT monitoring is recommended to detect it. Patients with asymptomatic VMT should be observed for at least 2-3 months; nonoperative treatment with ocriplasmin should be considered when disorders persist; surgery is recommended if VMT-related disease is significant.

Eye Diseases ; diagnosis ; epidemiology ; surgery ; Humans ; Retinal Diseases ; diagnosis ; epidemiology ; surgery ; Risk Factors ; Tomography, Optical Coherence ; Vitreous Detachment ; diagnosis ; epidemiology ; surgery

Standardized residency training is an important way to improve the professional level and competence of physicians. Under the overall framework of national standardized residency training and with reference to the actual training requirements for military general physicians, it is necessary to establish a perfect training system including training contents and standards, process assessment, and graduation assessment. This study summarizes the experience in the implementation of national residency training system, deeply analyzes the practical needs of establishing a military residency training system from the aspects of practical security needs and system design background, summarizes the specific problems existing in the implementation process, and forms the general idea suitable for the design of the military residency training system. In addition, based on the training objectives, this study defines the specific requirements for preparing the training plan and clarifies the specific measures such as organizational management, planning, and assessment, so as to provide theoretical guidance for the implementation of the system.

BACKGROUNDAlthough neuroradiological findings of Möbius syndrome have been reported as a result of brain and brainstem abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of the cranial nerve (CN) and branches in the orbits. This study presents the MRI findings in patients with sporadic Möbius syndrome.

METHODSProspectively, CNs were imaged in the cistern using head coils and three dimensional fast imaging employing steady-state acquisition (3D-FIESTA), yielding a 0.5 mm(2) resolution in planes of 0.8 mm thickness in seven patients with sporadic Möbius syndrome. The cavernous and intraorbital segment of the CN and the extraocular muscles (EOMs) were imaged with T1 weighting in all patients. The cavernous segment was imaged in coronal planes, while the intraorbit in quasicoronal planes were imaged using surface coils. Intraorbital resolution was 0.16 mm(2) within 2.0 mm thick planes.

RESULTSIn the seven patients, the CN were absent or showed hypoplasia in the cistern, cavernous sinus, and orbit. Abducens (CN VI) and facial (CN VII) nerves were absent on the affected sides. Unilateral CN IX (glossopharyngeal nerve) in two cases displayed dysplasia. Branches from the inferior division of CN III were observed to innervate the lateral rectus (LR) bilaterally in three cases and unilaterally in one case, and had intimate continuity with the LR muscle in two cases bilaterally and two cases unilaterally. Hypoplasia of EOMs was shown in five cases. Dysplasia of the medulla on the left side was found in one patient.

CONCLUSIONSDirect imaging of CNs and EOMs by MRI is useful in diagnosis of Möbius syndrome. It can directly demonstrate the abnormalities of the CN and orbital structures. The absence or hypoplasia of CN VI and CN VII may be the most common radiologic features in sporadic Möbius syndrome, and hypoplasia of CN IX may be an associated feature. The abnormality of EOMs and aberrant innervations in the orbit should be observed, and may be important for the study of the etiology.

Cranial Nerves ; pathology ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; methods ; Mobius Syndrome ; pathology ; Oculomotor Nerve ; pathology

Aged ; Creatinine ; blood ; Crystallization ; Embolism, Cholesterol ; blood ; diagnosis ; drug therapy ; Humans ; Kidney ; metabolism ; pathology ; Male

BACKGROUNDLocal resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation.

METHODSTotally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality.

RESULTSThere were statistically significant differences in the largest basal diameter of the tumor (t = -3.441), the tumor thickness (t = -4.140), the ciliary body infiltration (χ(2) = 8.391), and the duration of follow-up (Z = 3.995) between the two groups (P < 0.05). The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis (RR = 1.752, 95% CI 1.066-2.880, P = 0.027), the largest basal diameter of the tumor (RR = 3.508, 95% CI 1.934-6.336, P = 0.000), and the histological type (RR = 2.444, 95% CI 1.106-5.877, P = 0.046). The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation (χ(2) = 1.214, P > 0.05); the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation (χ(2) = 1.304, P > 0.05). The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 (92.60%) among persons retaining eye.

CONCLUSIONSThe survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.

Adult ; Eye Enucleation ; methods ; Female ; Humans ; Male ; Melanoma ; surgery ; Treatment Outcome ; Uveal Neoplasms ; surgery ; Visual Acuity ; physiology

OBJECTIVETo investigate the morphological changes and regeneration mechanism of sinusoidal endothelial cell.

METHODSSixty male Wistar rats (bought from SLC company limited of Japan) were divided into three groups. Fifty of them belonged to experiment group, five rats belonged to untreated group, and the rest five ones belonged to normal saline treated group. The experiment group was then divided into ten subgroups. All the rats of the experiment group were killed under anaesthesia using aether at 12, 24, 36 hrs, and 2, 3, 5, 7, 8, 10 and 14 days subsequently after an one-off injection of dimethylnitrosamine (DMN) (50 mg/kg). The liver tissues, bone marrows and peripheral blood of the rats were taken out rapidly. All the tissues received with HE staining, immunohistochemistry staining and double immunofluorescence labelings, and they were observed under a light microscope and electron microscope. The livers, bone marrows and peripheral blood from the rats at 24 hrs to 14 days after an injection of DMN were examined by light microscopic, immunohistochemical, and ultrastructural methods.

RESULTSSmall focal necrosis of the liver tissues was found at 12 hrs after the DMN injection, and gradually becomes more obvious from the 24 hrs. The most obvious necrosis, with lots of ED-1 (monocyte/phagocyte marker of rats) positive cells infiltration, was observed at 36 hrs. On the 2nd day and 3rd day after injection, the necrotic fragments and red cells were phagocyted by ED-1 positive macrophages. On the 5th day, some of the ED-1-positive cells were transformed from round to spindle in shape. On the 7th day, these cells contacted with residual reticulin fibers and became positive for SE-1, a marker of hepatic sinusoidal endothelial cells and Tie-1, an endothelial cell-specific surface receptor, associated with frequent occurrence of ED-1/SE-1 and ED-1/Tie-1 double positive spindle cells. On the 8th day, the histomorphology of liver tissue was similar with that on day 7, except that the range of the lesions had become smaller. On the 10th day, the regeneration of liver tissue increased, filling in the necrosis. On the 14th day, the necrotic tissues were almost replaced by regenerated liver tissues and thin bundles of central-to-central bridging fibrosis. 12 hrs after the DMN injection, bone marrow studies showed an increase in the number of ED-1 positive mononuclear cells, some of which were both BrdU/ED-1 positive. The number of ED-1 positive mononuclear cells reach their highest level at 36 hrs. These cells are morphologically similar to round mononuclear cells in bone marrows and could be found in the peripheral blood from 24 hrs to the 10 days. They reached their highest level in peripheral blood at the same time as in the bone marrow. These cells morphologically resembled ED-1 positive cells in necrotic tissues of the liver.

CONCLUSIONSThese findings suggest that round mononuclear ED-1-positive cells proliferate first in the bone marrow after DMN treatment, reach necrotic areas of livers through circulation, and differentiate to sinusoidal endothelial cells. Namely, hepatic sinusoids in DMN-induced necrotic areas may partly be reorganized possibly by vasculogenesis.

Animals ; Chemical and Drug Induced Liver Injury ; pathology ; Dimethylnitrosamine ; Endothelial Cells ; pathology ; ultrastructure ; Liver ; blood supply ; metabolism ; pathology ; ultrastructure ; Liver Regeneration ; Male ; Necrosis ; chemically induced ; pathology ; Neovascularization, Physiologic ; Rats ; Rats, Wistar

Based on the analysis of the urgent tasks faced by the rapid evacuation team to assist Hubei medical team under the COVID-19 epidemic situation, the authors elaborated the specific practices such as the establishment of organization and leadership, the implementation of emergency response plan and the deployment of logistic forces; and explored the necessity of improving the emergency response mechanism, so as to provide reference for further improving the emergency treatment process.

Abstract OBJECTIVE To establish an efficient and simple HPLC-MS/MS method for determination of flucloxacillin in newborn plasma, and to investigate the interaction between ambroxol and flucloxacillin in newborns. METHODS The samples were analyzed by API4000 HPLC-MS/MS. Ultimate XB-C18 column(2.1 mm×100 mm, 5 μm) were carried out. The mobile phase was composed of water-0.1% formic acid(A) and acetonitrile-0.1% formic acid(B). The quantitative analysis of the ion transitions were monitored at m/z 452.6→284.2 for flucloxacillin and m/z 821.4→397.3 for rifampicin(internal standard). RESULTS The linear range of flucloxacillin under this analysis method was 0.20-80 ng·mL-1, and the lower limit of quantification was 0.20 ng·mL-1; The intra-day and inter-day precision of flucloxacillin were both less than 8.23%; The extraction recovery was in the range of 85.3%-89.2%, and the matrix effect was between 89.3%-92.3%; The stability of plasma samples was good under conditions of 12 h at room temperature, 4 h at room temperature after treatment, repeated freeze-thaw for 3 times, and -20 ℃ freezing for 30 d. The results of clinical samples indicated that the combination of ambroxol could significantly increase the blood concentration of flucloxacillin. CONCLUSION The established HPLC-MS/MS method is accurate, sensitive and can be used for the determination of flucloxacillin concentration in neonatal plasma. The results of clinical samples indicate that ambroxol can significantly increase the blood concentration of flucloxacillin. There are drug interactions between ambroxol and flucloxacillin.

BACKGROUNDMany studies indicated that short-term and long-term intraocular pressure (IOP) fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty.

METHODSA total of 158 patients with primary angle closure suspect (PACS, n = 21), primary angle closure (PAC, n = 81) and primary angle closure glaucoma (PACG, n = 55) had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation (GEE) regression models was used to evaluate the association of long-term IOP fluctuation (maximum IOP minus minimum IOP) with gender, age, baseline IOP, baseline peripheral anterior synechia (PAS), baseline vertical cup/disc ratio (VCDR), baseline mean deviation (MD), need for IOP-lowering medications.

RESULTSIOP fluctuation during follow-up in PACS, PAC and PACG groups were (4.83 ± 2.90), (5.67 ± 3.35), and (9.40 ± 7.14) mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP (r = 0.356, P < 0.001), PAS (r = 0.374, P < 0.001). IOP fluctuation was higher in patients with higher baseline IOP (0.18 mmHg per unit increase, 95%CI: 0.05 - 0.31 mmHg).

CONCLUSIONSLong-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.

Follow-Up Studies ; Glaucoma, Angle-Closure ; physiopathology ; therapy ; Humans ; Intraocular Pressure ; Iridectomy ; Iris ; surgery ; Laser Therapy ; Middle Aged