Objective To explore the feasibility and effectiveness of Commando procedure for mechanical valve dysfunction requiring reoperation. Methods The clinical data of patients who received Commando surgery (aortic/mitral curtain enlargement+valve replacement surgery) in the Department of Cardiovascular Surgery of Gaozhou People's Hospital from December 2021 to September 2022 were retrospectively analyzed. These patients who had undergone mechanical mitral or aortic valve replacement and then had mechanical valve dysfunction with mitral or aortic valve lesions requiring repeat combined valve replacement surgery were selected. Results Eleven patients were enrolled, including 2 males and 9 females, aged 63.63±11.64 years. All 11 patients successfully underwent the Commando operation, and were implanted with suitable artificial valves, among which the aortic valve size was 27.00±2.00 mm, and the mitral valve size was 27.72±3.13 mm. Cardiopulmonary bypass time was 195.81±39.29 min, aortic cross-clamping time was 121.81±28.60 min, mechanical ventilation time was 15.09±3.72 h, ICU stay time was 3.09±0.70 days, and total postoperative thoracic drainage volume was 417.18±68.65 mL. There was no perioperative death. Conclusion Commando procedure is a safe and effective method to perform combined valve operation for mechanical valve dysfunction. A larger artificial valve can be implanted during the procedure to obtain sound hemodynamic effects. In addition, for elderly patients, a suitable type of bioprosthetic valve can be implanted to improve the patient's quality of life. The early surgical effect is satisfactory, and the long-term impact needs further follow-up.

Breast cancer is the most common malignancy and the fifth leading cause of cancer-related mortality in the world. Breast cancer is a global health problem that poses a heavy burden on patients and their families as well as socioeconomic development. As an important component in the management of breast cancer, radiotherapy plays a vital role in its comprehensive treatment. This review describes advances made toward the application of adjuvant radiotherapy in the treatment of breast cancer.

AIM:To analyze the efficacy and safety of pterygium resection respectively combined with Ologen collagen matrix implantation and autologous conjunctival flap transplantation.METHODS:A total of 80 patients(87 eyes)with pterygium admitted to the hospital between January 2017 and January 2020 were selected, and randomly divided into observation group(40 patients, 44 eyes)treated with pterygium resection combined with Ologen collagen matrix implantation and control group(40 patients, 43 eyes)treated with pterygium resection combined with autologous conjunctival flap transplantation. The patients were followed up till 12mo after operation. The best corrected visual acuity, corneal astigmatism, surface asymmetry index(SAI), surface regularity index(SRI), corneal epithelial healing, pterygium recurrence and the incidence of complications were compared between the two groups. RESULTS:Visual changes of the two groups were similar at 6 and 12mo after operation(P>0.05). Corneal astigmatism, SAI and SRI were reduced in the two groups at 1 and 3mo after operation. The corneal astigmatismat 3mo after operation and SAI, SRI at 1 and 3mo after operation were significantly lower in the observation group than in the control group(all P<0.05). The corneal epithelial healing rate in observation group at 1wk after operation was significantly higher than that in the control group(73% vs 46%, P<0.05), and corneal epithelium of the two groups healed at 2wk after operation. No pterygium recurrence was observed in the two groups within 12mo after operation. The situation of pterygium recurrence was similar in the two groups at 6 and 12mo after operation(P>0.05). There was no significant difference in the incidence of complications between the two groups(7% vs 14%, P>0.05).CONCLUSION:Both pterygium resection combined with Ologen collagen matrix implantation and pterygium resection combined with autologous conjunctival flap transplantation are effective in the treatment of pterygium, with equivalent safety. However, the former has more advantages in improving corneal astigmatism and regular shape of corneal wound.

Pachydrusen is found in pachychoroid diseases such as polypoid choroidal vasculopathy disease, central serous chorioretinopathy, pachychoroid pigment epitheliopathy and pachychoroid neovasculopathy. The typical choroidal changes of the spectrum are abnormally dilated pachyvessels, choroidal thickening with overlying retinal pigmentary epithelium changes. In this paper, we summarized the clinical manifestations, epidemiology, genetics, and histopathology of the newly named type of drusen, in order to provide the direction for diagnosis and treatment in clinical ophthalmic diseases.

Objective To explore the best way of rearing children guarded by welfare  in stitutions. Methods Grouping the rearing methods into two categories randomly, traditional orphanages and foster care, then using their height, weight, Gesell development schedules and Ages and Stages Questionnaires-Third Edition to compare their physical development, psychological health, behaviour, and cognition progress from the data collected when they were 12 months old in both categories. Results For children between age 0.5 month to 1.5 month old,  by comparing the data collected when they were 12 month old,  the study found that there was no statistical difference in physical development between these two groups of children in main indicators of height (t=0.94, P=0.349>0.05) and weight(t=1.843, P=0.068>0.05).  However, children in family foster care shown advantage in area of motor ability(t =2.102, P=0.037<0.05) ,  gross motor skill (t=2.566, P=0.011<0.05), fine motor skill (t=2.825,P=0.005<0.01), which had statistical significance. Foster care children also shown big advantage in area of cognitive ability (t=2.479 ,P=0.014<0.05), behaviour(t=2.535，P=0.012＜0.05), problem resolving ability(t=3.241, P=0.001<0.01), personal-social(t=3.173，P=0.001<0.01), the differences were statistically significant. Especially for verbal ability, foster care children had significant advantage in both measurements (t=6.329、4.886，P=0.000<0.01).  Conclusion Family foster care should be chosen as much as possible in rearing children whose guardians are welfare institutions.

AIM: To investigate the advantages of ultra-wide-field fluorescein angiography(UWFA)over the standard fundus examination in the evaluation of diabetic retinopathy(DR).

METHODS: Forty-five cases(90 eyes)with DR in Xi&#39;an No.3 Hospital from October 2016 to June 2018 were analyzed retrospectively, including 25 males and 20 females, aged from 45-76(59.52±15.78)years. There were 25 males and 20 females. Average age were 59.5 years. All patients were examined with ophthalmoscope and UWFA.

RESULTS: Depending on ophthalmoscope, 12 eyes with no DR, 42 eyes with nonproliferative diabetic retinopathy(NPDR), and 36 eyes with proliferative diabetic retinopathy(PDR), diagnosed by the standard method. 22 eyes of 90 eyes received retinal photocoagulation, including 8 eyes received panretinal photocoagulation(PRP). Depending on UWFA images, peripheral microaneurysms were demonstrated in 8(67%)of 12 eyes with no DR. Peripheral retinal neovascularizations were detected in 4(10%)of 42 eyes with NPDR and in 12(33%)of 36 eyes with PDR. Peripheral vascular nonperfusions were found in 28(67%)of 42 eyes with NPDR and in 26(72%)of 36 eyes with PDR. Peripheral vascular nonperfusions and peripheral retinal neovascularizations also were found in 4(50%)of 8 eyes, which treated by PRP.

CONCLUSION: UWFA demonstrates peripheral lesions beyond standard fields, which can allow early detection of DR, and a close evaluation of eyes with retinal photocoagulation.

Central serous chorioretinopathy(CSC)is a disease that associated with multifactors. The specific pathogenesis is not yet clear. Except for subthreshold micropulse laser treatment and reduced dose photodynamic therapy(PDT), drugs based on etiology of CSC, such as anti-vascular endothelial growth factor(VEGF), methotrexate, eplerenone, anti-helicobacter pylori, have been applied to experimental treatment. The purpose of this article is to review the literature in the treatment of CSC, and to provide reference for clinical treatment of CSC.

AIM: To investigate the relationship among sleep apnea hypopnea syndrome(SAHS), nocturnal hypotension(NHP)and nonarteritic anterior ischmic optic neuropathy(NAION).

METHODS:The retrospective study participants included 31 patients with NAION and 31 age- and sex-matched controls. Twenty-four hour ambulatory blood pressure monitoring was used to evaluate the presence of NHP in NAION group and in control group. Berlin questionnaire was involved to evaluate the risk of SAHS. All participants underwent full-night respiratory polysomnography for monitoring apnea-hypopnea index(AHI), minimum oxygen saturation(MOS).

RESULTS: Totally 23 NAION patients(74%)presented with NHP, which was found in 14 control subjects(45%). The incidence of NHP was significantly higher among NAION patients compared to the controls(P=0.020). Of the 31 NAION patients, 22 patients(71%)had SAHS, compared to 13(42%)control subjects. Logistic regression analysis showed that NHP(OR=2.762, 95% CI: 1.275-3.746), AHI(OR=2.959, 95% CI: 1.478-6.432)and MOS(OR=3.058, 95% CI: 1.734-7.743)were risk factors for NAION.

CONCLUSION: SAHS and NHP were related with NAION. Taking precautions against SAHS and NHP may be crucial to the prevention and cure of NAION.

Objective     To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods     From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results     There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed  combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39 vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion     Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.

AIM: To investigate the clinical characteristics and surgical effects in patients with Duane retraction syndrome(DRS).

METHODS: Totally 13 patients with DRS during June 2011 to December 2015 were analyzed retrospectively. The data including clinical types and manifestations, surgical methods and outcomes were reviewed and analyzed.

RESULTS: There were 11 male cases and 2 female cases who all had no ocular and systemic anomalies. The left eye was involved in 9 cases, the right eye was involved in 3 cases and 1 case involved in both eyes. Six cases were type Ⅰ,1 case was typeⅡand 6 cases were type Ⅲ. Eleven cases had abnormal head posture(AHP), 9 cases had the up- or down-shoot phenomenon. The surgical treatment was designed according to subtypes and clinical features which included medial rectus recession, lateral rectus recession, recession of both horizontal rectus muscles and lateral rectus recession combined with Y splitting. After surgery, horizontal deviation was less than ±10^△ in all patients, and AHP disappeared in 4 cases and improved in 7 cases. The up- or down-shoot and global retraction disappeared in 5 cases and improved in 4 cases. Simultaneously, the restriction of ocular motility was improved in all patients.

CONCLUSION: The clinical features of DRS are variant in different types. Detailed examination before surgery and reasonable surgical design are important in treatment of patients with DRS.