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20 March 2022 Volume 36 Issue 2
  
Endoscopic anatomy and variation observation of the retrotympanum and hypotympanum
WU Junyi, LU Yongtian, LI Jianxing, ZHOU Junwei
2022, 36(2):  1-6.  doi:10.6040/j.issn.1673-3770.0.2021.313
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Objective To explore the relationship between bone crest and crypt of the retrotympanum and hypotympanum and to provide anatomical data for clinical use. Methods Eighty sides of the middle ears were selected(20 adult patients with fresh frozen caddies and 40 cases of endoscopic surgery). The middle ears were accessed through the external auditory canal using 0° and 30° endoscopes, and the relevant areas of the retrotympanum and hypotympanum were dissected and observed. The morphology of bone crest and crypt in the retrotympanum and hypotympanum were recorded and made into charts. Results (1)The incidence of ponticulus was 62.50%(50/80; solid bone ridge, 52.50%; bridge-like bone ridge, 10.00%); (2)Subiculum was 52.50%(42/80; solid bone ridge, 41.25%; bridge-like bone ridge, 11.25%); (3)Funiculus was 52.50%(42/80; solid bone ridge, 46.25%; bridge-like bone ridge, 6.25%); (4) Based on structural variation, the position of posterior sinus and sinus tympanic was classified as classical shape(50%), confluent shape(47.50%), partitioned shape(1.25%), and restricted shape(1.25%); (5) The proportion of chordal, vertebral, and styloid crests was 67.50%(54/80), 75.00%(60/80), and 57.50%(46/80), respectively. Conclusion The endoscopic vision of the ear could provide a full range of visual field to observe these hidden anatomical regions, bone crests, and sinus of the retrotympanum and hypotympanum varied.
A case of middle-ear anaplastic large T- cell lymphoma and literature review
ZHAO Xiaobing,ZHANG Dawei, CHEN Renjie
2022, 36(2):  7-14.  doi:10.6040/j.issn.1673-3770.0.2021.318
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Objective To investigate the clinical characteristics, diagnosis and treatment methods of middle ear anaplastic large T-cell lymphoma, to enable its early diagnosis. Methods A patient with middle ear anaplastic large T-cell lymphoma was retrospectively reviewed,along with previous cases of middle ear lymphoma found in the literature. Results Lymphoma mostly occurs in the bones, bone marrow, subcutaneous tissue and spleen, but rarely in the middle ear. There is no superficial lymphadenopathy at the onset of middle ear lymphoma, which usually presents as earache, hearing loss, and ear discharge(serous, purulent, or bloody). Disease progression, peripheral facial nerve paralysis and extra cranial-intracranial complications may occur. The lesion appeared as a high and uneven soft tissue density on the CT and the bone destruction was irregular and worm-eaten. The lesion area was wide and the enhanced scan showed obvious enhancement. Diagnosis requires pathological biopsy and immunohistochemistry. Chemotherapy is the main treatment. Conclusion Middle ear anaplastic large T-cell lymphoma is extremely rare and its clinical and imaging findings are non-specific. Therefore it is imperative to carefully consider the patient’s medical history, systemic examination findings, pathological biopsy findings and immunohistochemistry to diagnose middle ear anaplastic large T-cell lymphoma at an early stage.
The application of REDCap to design interactive electronic database for olfactory disorder patients
YU Chao, CHEN Jingguo, MI Baibing, ZHU Kang, XIA Cui, GAO Tianxi, ZHANG Yanni, SUN Bin, REN Xiaoyong
2022, 36(2):  15-19.  doi:10.6040/j.issn.1673-3770.0.2021.051
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Objective The application of REDCap to design an interactive shared electronic database for long-term follow-up management of olfactory disorder patients. Methods Based on the actual needs of follow-up management of patients with olfactory disorders, the Chinese version of REDCap clinical research data collection system provided by Xi'an Jiaotong University open research data platform was used. The main contents of the database include basic information of patients, olfactory dysfunction self-assessment form, examination results, physician assessment form and treatment. The database contains five event collection points, including before treatment, 1 month after treatment, 3 months after treatment, 6 months after treatment and 1 year after treatment. According to the above contents, set up and create questionnaire tool form, data quality control program, user permissions, and establish interactive sharing electronic database. Results According to the predetermined goal, the interactive sharing electronic database for olfactory disorder patients was designed and put into clinical use. The database can realize multi locations and multi terminal inputs at the same time, realize medical data entry, quality control and authority management, and construct follow-up work calendar. Conclusion The applicatiom of REDCap to build an interactive sharing electronic database for olfactory disorders patients has the advantages of simple design process, easy operation and comprehensive information collection. It provides a free, convenient, efficient and standardized data management tool for otolaryngologists to carry out olfactory disorders related clinical research.
Laryngoscopy observation and voice acoustic analysis of elderly patients with benign laryngopharyngeal lesions in an ENT out-patient clinic
HOU Bo, LIANG Chengcheng, WEI Dongmin, YONG Rong, LEI Dapeng, LI Mei
2022, 36(2):  20-25.  doi:10.6040/j.issn.1673-3770.1.2020.111
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Objective To investigate the morphological characteristics of the larynx and the acoustic characteristics of the voice of elderly patients with benign laryngopharyngeal lesions. Methods We included 101 elderly patients with benign laryngopharyngeal lesions(age ≥60 years, 54 males, 47 females)from July 14, 2020 to November 30, 2020 in our outpatient clinic. All the patients underwent an electronic nasopharyngolaryngoscope, RSI(Reflux Symptoms Index), RFS(Reflux Findings Score), dynamic laryngoscope, and voice acoustic analysis. Results Elderly males significantly complained more of hoarseness than elderly females(53.7% in males and 29.8% in females), and the number of elderly males with complaints of pharyngeal pain or pharyngeal foreign body sensation was slightly lower than females(8.5%∶13.0%, 16.7%∶27.7%, respectively). The proportion of elderly patients with gastric diseases was 53.7% for men and 48.9% for women. The proportion of elderly men and women with hypertension or other complications was almost equal. A relatively higher proportion of elderly men had vocal cord insufficiency or mucosal wave attenuation dynamic laryngoscopic examination than women(27.8%∶10.6%, 48.1%∶38.3% respectively). There was no difference between the RSI scores of elderly patients with a history of smoking or drinking and those without, whereas the RFS scores of elderly patients with a history of smoking and drinking were significantly higher than those without(P=0.001, P=0.001). The vocal analysis of elderly patients revealed that sex, nasal diseases, and bad habits of smoking and drinking influence the acoustic parameters of the voice. Conclusion There were more characteristic morphological laryngeal changes in elderly men with benign laryngopharyngeal lesions than in women. The abnormal acoustic parameters of the aged voice are affected by multiple factors.
Transcriptomic analysis of glutamine deprivation on laryngeal carcinoma cells
WANG Xiaoting, CHEN Zhengnong, YI Hongliang
2022, 36(2):  26-31.  doi:10.6040/j.issn.1673-3770.0.2021.090
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Objective Glutamine is necessary for head and neck cancer cells to maintain maximum proliferation rate, this article used RNA sequence to explore the effect of glutamine deprivation on laryngeal cancer cell gene expression Changes. Methods The CCK8 assay measured laryngeal cancer cell proliferation rate, RNA sequence measured transcriptome changes of laryngeal cancer cells after glutamine deprivation, bioinformatics methods analyzed gene enrichment. Results Glutamine deprivation restricted laryngeal cancer cell proliferation, transcriptome analysis found that glutamine deprivation leads to 328 gene up-regulated and 210 genes down-regulated. GO analysis showed that the differentially expressed genes were mainly related to cell metabolism, organelle synthesis, protein and nucleotide synthesis. KEGG signaling pathway analysis showed that signaling pathways changes were mainly related to O-polysaccharides and glycosylphosphatidylinositol biosynthesis, fructose mannacil amino acids and nucleotides metabolism, and the P53 signaling pathway. Disease enrichment found that the differentially expressed genes were mainly related to head and neck carcinoma. Conclusion Glutamine deprivation restricts nucleic acid metabolism, RNA and protein binding, and affects the P53 signaling pathway.
CHD1L promotes proliferation, invasion and metastasis of laryngeal squamous cell carcinoma cells by EMT
LIU Yong, YUAN Cunli, CAO Hui, ZHENG Chengcai, CHAO Fang, XU Fenglei
2022, 36(2):  32-39.  doi:10.6040/j.issn.1673-3770.0.2021.119
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Objective To investigate the mechanism of chromodomain helicase DNA binding protein 1-like gene(CHD1L )in the proliferation, invasion and metastasis of laryngeal squamous cell carcinoma cells and to provide molecular targets for the treatment of laryngeal squamous cell carcinoma(LSCC). Methods Immunohistochemistry was conducted to measure the expression of CHD1L, E-cadherin and Vimentin in 60 pairs of LSCC and its adjacent normal mucosa. The expression of CHD1L in human bronchial epithelial cell(HBE)and human laryngeal epithelioid carcinoma cell(HEp-2)was detected by Western blotting. CHD1L in HEp-2 cells was knocked out, and Western blotting was used to detect the expression of CHD1L, E-cadherin and Vimentin in HEp-2 cells. The proliferation of cells in each group was detected by CCK-8 kit, and the invasion of cells in each group was detected by Transwell invasion test. Results Immunohistochemical results showed that the positive expression rate of CHD1L in laryngeal squamous cell carcinoma tissue was significantly higher than that of normal paracaner mucosa tissues. In addition, the expression of CHD1L was positively correlated with the degree of differentiation of laryngeal squamous cell carcinoma, the lymph node metastasis, the clinical stage and the expression of Vimentin, but negatively correlated with the expression of E-cadherin(P<0.05). The results of Western blotting showed that the expression of CHD1L in HEp-2 cell was significantly higher than that in HBE cell. CHD1L in HEp-2 cells was knocked down by interfering plasmid in vitro. The proliferation and invasion ability of the HEp-2 cells with CHD1L knockdown in vitro were significantly decreased, while the expression of E-cadherin was significantly increased and the expression of Vimentin was also significantly decreased. Conclusion The high expression of CHD1L in LSCC was closely related to pathological grades, clinical stage and risk of lymph node metastasis of LSCC, suggesting that CHD1L may play an oncogene role in LSCC; CHD1L could promote the proliferation, invasion and metastasis of LSCC cells by promoting the EMT of LSCC cells.
Expression and clinical significance of CIP2A in hypopharyngeal carcinoma
CHENG Yao, ZHANG Zhen, YANG Ji, FENG Chengmin, DENG Qicheng, ZHANG Xi, ZHAO Rui, ZHU Xin, WU Junzhi, LIU Hai, DENG Shishan
2022, 36(2):  40-44.  doi:10.6040/j.issn.1673-3770.0.2021.368
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Objective To investigate the relationship between the expression of protein phosphatase 2A(CIP2A)and the clinicopathological features and prognosis of hypopharyngeal carcinoma. Methods Tissue samples from 58 patients with hypopharyngeal cancer, including 20 cases with paired paracarcinoma tissue samples, were collected in the Department of Pathology, Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2020; 30 normal hypopharyngeal tissue samples were selected for comparison. Results Immunohistochemical SP showed that the expression level of CIP2A in hypopharyngeal carcinoma tissue was significantly higher than that in paracarcinoma and normal hypopharyngeal tissue(P<0.001). CIP2A expression was significantly related to alcohol consumption, pathological differentiation, clinical stage and lymph node metastasis(P<0.05), but had no significant relationship with gender, age, smoking status, or clinical type. Univariate log-rank analysis showed that age, clinical stage and CIP2A expression were correlated with prognosis(P<0.05). Cox proportional regression model analysis revealed that CIP2A expression was an independent risk factor for the prognosis of hypopharyngeal cancer. Conclusion The abnormal expression of CIP2A in hypopharyngeal cancer tissue suggests that this protein may be involved in the occurrence and development of tumors. Patients with hypopharyngeal cancer with high expression of CIP2A have a poor prognosis. Therefore, CIP2A may be a useful molecular marker for diagnosis, treatment and prognosis of hypopharyngeal cancer patients.
Correlation between allergy factors and maxillofacial malformation in children with tonsil and adenoid hypertrophy in denture replacement period
JIN Xiaoxue, HAN Yingying, GUO Ruixiang, NI Shoujie, ZOU Juanjuan, WANG Yan, LI Yanzhong
2022, 36(2):  45-50.  doi:10.6040/j.issn.1673-3770.0.2021.531
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Objective To study the correlation between allergy factors and maxillofacial malformation in children with tonsil and adenoid hypertrophy during tooth replacement. Methods A total of 207 children(6-12 years old)undergoing tonsillectomy and adenoidectomy from 2018 to 2021 were enrolled. Allergen detection was performed on all children, and general data, clinical data and cephalometric indicators were collected. T-test or non-parametric test was used for comparison between groups. Spearman correlation analysis was used for correlation analysis, and polynomial linear trend test was used for inter-group linear trend test of allergen classification. Results There were statistically significant differences in SNA and SNB reflecting maxillary relative position in male children with and without allergic factors(P=0.032; P=0.019)(Table 3). In female children, there was no significant difference in head measurement indexes between those with and without allergic factors. In addition, the score of allergy factors was negatively correlated with SNA and SNB, but had no significant correlation with other indexes.(Table 4)Both SNA and SNB showed a linear decreasing trend with the increase of allergen score(linear trend =0.003; Linear trend =0.015)(FIG. 2, FIG. 3). Conclusion In children with tonsillar adenoid hypertrophy, males with allergic factors are more likely to develop sagittal underdevelopment of the upper jaw and retraction of the mandibular, suggesting that allergy is one of the risk factors for maxillofacial deformity in male children with tonsillar adenoid hypertrophy.
Clinical analysis of 220 cases of deep neck space infection
FENG Yiyuan, YANG Jing, YANG Hongbin
2022, 36(2):  51-57.  doi:10.6040/j.issn.1673-3770.0.2021.105
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Objective This study aimed to explore the clinical characteristics, treatment experience, and lessons learned in the treatment of DNI and improve DNI diagnosis and treatment. Methods The clinical characteristics, treatment measures, and prognosis of 220 patients with DNI were retrospectively analyzed. Results Among the 220 patients, 98 with deep cervical space cellulitis were cured by simple anti-infection and symptomatic supportive treatment in 88 cases, whereas 10 cases progressed to deep cervical space abscesses that were cured by further abscess puncture or incision and drainage. The other 122 patients with deep neck space abscesses were treated with anti-infection combined with abscess puncture or incision and drainage and symptomatic supportive treatment. Among them, 12 cases of tuberculosis infectious abscess were administered anti-tuberculosis treatment, 25 were treated with tracheotomy due to complicated severe laryngeal obstruction, and 118 healed. A total of 4 patients died of severe complications. Conclusion DNI is a critical illness. Effective anti-infective measures combined with abscess puncture or incision and drainage is the key to successful treatment. Tuberculosis or other special infections require combination anti-tuberculosis and other special treatments. The timely and correct treatment of comorbidities and complications can reduce mortality and disability rates.
Effect of microwave ablation on solid thyroid nodules with different initial volumes
LI Siyao, BAO Yuhan, LI Xinying, SUN Xiaojing, CAO Xiaoli
2022, 36(2):  58-63.  doi:10.6040/j.issn.1673-3770.0.2021.336
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Objective This research aimed to investigate the effects of ultrasound-guided microwave ablation(MWA)on benign solid thyroid nodules with different initial volumes. Methods Eighty-two benign solid nodules that had received MWA were divided into four groups according to the initial volume(>12, 9-12, 4-8, and <4 cm3). The ablation parameter and volume reduction rate(VRR)for the four groups were calculated, and the recurrence rate and complication rate were recorded. Results The volume of nodules gradually reduced after 1, 3, 6, and 12 months; the VRR was 37.93±19.48%, 61.69±14.76%, 74.27±12.93%, and 84.92±10.35%, respectively(P<0.05). Compared with those of other groups, for the initial volume ≥ 12 cm3 group, the ablation time was longer and ablation power was higher(P<0.05); the pain score was higher(P<0.05); and the VRR was significantly lower at 3, 6, and 12 months(P<0.05). The recurrence rate was 14.6%(12/82). One case of transient hoarseness was recorded in the largest volume group. Conclusion Microwave ablation is a safe and effective treatment for benign solid thyroid nodules, and the curative effect of relatively small nodules is more significant.
Dysphagia due to left atrial enlargement: a case report and literature review
SONG Qing, WANG Xiaoyong, JIA Chuanliang, MOU Yakui, SONG Xicheng
2022, 36(2):  64-67.  doi:10.6040/j.issn.1673-3770.1.2021.246
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Objective To report and review the clinical features and treatment experienceof dysphagia caused by left atrial enlargement. Methods We examined a patient presenting with dysphagia for left atrial hypertrophy and searched for relevant reports of patients with dysphagia caused by left atrial enlargement in the past ten years. The clinical characteristics, diagnosis, and treatment of these patients were summarized. Results Fifteen articles comprising seven men and eight women were included. The patients mainly presented with lose weight、 dyspnea、 voice hoarseness. Chest CT, upper gastrointestinal angiography and ultrasonic cardiogram? are commonly adjunct examination. Of the 14 patients with available data of diagnosis and treatment diagnosis, half underwent surgical treatment and postoperative dysphagia improved. Conclusion Although dysphagia has several etiologies, dysphagia caused by left atrial hypertrophy is rare and only reported in individual cases. Therefore, clinicians need to carefully observation、evaluation and use the best way for the etiologies of dysphagia, especially in older age patients as they are more likely to have underlying chronic disease.
Subfoveal choroidal thickness changes following intravitreal ranibizumab treatment in choroidal neovascularization due to pathological myopia
ZHANG Taoran, WANG Wei, LI Mingming, HUANG Yingxiang
2022, 36(2):  68-71.  doi:10.6040/j.issn.1673-3770.0.2021.059
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Objective To observe the safety and effectiveness of intravitreal injection of ranizumab(IVR)on choroidal neovascularization due to pathological myopia(mCNV), and the changes of subfoveal choroidal thickness. Methods Retrospective case series study. 42 eyes of 38 patients from November 2014 to December 2018 with treatment-naïve active mCNV treatment by IVR were enrolled in the study. All patients were divided into single treatment group and retreatment group according to the injection numbers of IVR. The differences of best corrected visual acuity and subfoveal central choroidal thickness were observed. Results In the repeated treatment group, the injection numbers were 3.77±1.21. The baseline choroidal thickness of the single treatment group was(59.15±10.57)μm, and that of the retreatment group was(49.33±12.76)μm(P=0.023), in which central choroidal thickness(CCT)before retreatment increased to(55.22±7.63)μm(P=0.131). Conclusion 1+PRN regimen of IVR can effectively treat choroidal neovascularization due to pathological myopia. CCT may be a prognostic factor for retreatment.
Effect of intravitreal injection of HGF-MSCs on the expression of HGF in retina tissue of diabetic rats
WANG Hui, WANG Jun, SUN Yi, YU Tengfei, ZHU Yuguang, ZHU Yan
2022, 36(2):  72-77.  doi:10.6040/j.issn.1673-3770.0.2021.121
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Objective To observe the effect of intravitreal injection of human umbilical cord mesenchymal stem cells(hUCMSCs)modified by the hepatocyte growth factor gene(HGF-MSCs)on the hepatocyte growth factor(HGF)expression in retina tissue of diabetic rats, and to explore the effect of HGF-MSCs on diabetic retinopathy in rats. Methods hUCMSCs were isolated, cultured, and identified. hUCMSCs were transfected with lentiviral vectors with a multiplicity of infection(MOI)of 50. Four-week-old Sprague-Dawley rats were randomly divided into the normal(15 rats)and diabetes(60 rats)groups. The diabetic rat models were established by intraperitoneal injection of streptozotocin(STZ). Three months after the diabetic rat models were confirmed successfully, the diabetes group was further divided into the diabetes control(no injection), PBS(intravitreal injection of PBS), MSCs(intravitreal injection of MSCs), and HGF-MSCs(intravitreal injection of HGF-MSCs)groups. After 2, 4, and 6 weeks of intravitreal injection, the HGF mRNA expression in rat retina was detected through real-time PCR. The expression of HGF in the rat retina was assessed through Western blot. Results The cultured hUCMSCs can be differentiated into osteoblasts and adipocytes. MOI 50 lentivirus successfully transfected hUCMSCs. Two weeks after intravitreal injection, quantitative real-time PCR and Western blot showed that, at the same time point, the expression of HGF and HGF mRNA in the normal group decreased compared to that of the other groups, and the difference was statistically significant(P<0.05). Compared with other groups at the same time point, the expression of HGF and HGF mRNA in HGF-MSCs group increased, and the difference was statistically significant(P<0.05). No significant difference in the expression of HGF and HGF mRNA was observed in the same group at different time points(P>0.05). Conclusion The HGF and HGF mRNA expression increased in diabetic rat retina. Intravitreal injection of hUCMSCs did not affect the HGF and HGF mRNA expression in diabetic rat retina. Intravitreal injection of hUCMSCs modified by HGF increased the HGF and HGF mRNA expression in diabetic rats. HGF-MSCs may interact with HGF to alleviate early diabetic retinopathy.
Effect of absorbable lacrimal plug combined with artificial tears on the treatment of moderate to severe dry eye and its impact on vision-related quality of life
BAI Lingling, WANG Hongxing, WANG Lichun
2022, 36(2):  78-82.  doi:10.6040/j.issn.1673-3770.0.2021.238
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Objective To evaluate the effect of absorbable lacrimal plugs combined with artificial tears on the treatment of moderate to severe dry eye and assess its impact on vision-related quality of life. Methods In total, 32 patients(64 eyes)diagnosed as having moderate to severe dry eye were enrolled. All patients were randomly divided into two groups; one group received absorbable lacrimal plugs combined with artificial tears, whereas the other one received only artificial tears for routine treatment. Schirmer's test results, tear film break-up time, corneal fluorescein staining, personal symptom and vision-related quality of life scores before and at 1, 3, and 5 months after treatment were analyzed and compared between the groups. Results There were no significant between-group differences in tear film break-up time(P=0.803), Schirmer's test results(P=0.758), corneal fluorescein staining(P=0.735), personal symptom(P=0.385)and vision-related quality of life scores(P=0.883)before treatment. Both groups exhibited significant improvements in all the observed parameters at 1 month(P<0.001), 3 month(P<0.001), and 5 month(P<0.001)after treatment. However, the experimental group exhibited significantly better improvement than the control group in all parameters, except for the Schirmer's test results at 5 months after treatment(P=0.141),the other parameters at 1 month(P<0.001)(<0.001)(<0.001)(0.014)<0.001), 3 month(P<0.001)(0.007)(<0.001)(<0.001)(<0.001), and 5 month(P<0.001)(0.141)(<0.001)(<0.001)(<0.001)were significant differences. Conclusion Treatment with absorbable lacrimal plugs combined with the application of artificial tears evidently alleviated symptoms and improved vision-related quality of life in patients with moderate to severe dry eye.
Changes of kappa angle and alpha angle before and after cataract surgery
HU Yingfeng, JIA Yuye, WANG Yan, ZHANG Rong, WANG Zheng, YE Xiangyu
2022, 36(2):  83-89.  doi:10.6040/j.issn.1673-3770.0.2021.365
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Objective To compare and analyze the changes of kappa angle and alpha angle in patients before and after cataract surgery. Methods 101 patients who underwent phacoemulsification in our hospital in 2020 were analyzed retrospectively. OPD scan Ⅲ was used to measure the size and direction of kappa angle(PDist、 MDist)and alpha angle(LDist)before and after the surgery. The pupil diameter of bright and dark environment were also measured by OPD scan Ⅲ. Preoperative biological parameters such as axial(AL), mean keratometry(Km), anterior chamber depth(ACD)and lens thickness(LT)were measured by OA-2000. The centroid kappa angle and centroid alpha angle before and after surgery were calculated. Paired sample t-test was used to analyze the difference of kappa angle and alpha angle before and after surgery. The correlation of preoperative kappa angle, postoperative kappa angle, preoperative alpha angle, postoperative alpha angle was analyzed by pearson correlations, and the correlation of pupil diameter, AL, Km, ACD, LT, DPDist, DMDist, DLDist was analyzed by pearson correlations. Results The preoperative PDist was(0.24±0.15)mm, the preoperative MDist was(0.27±0.14)mm, the preoperative LDist was(0.41±0.20)mm. The postoperative PDist was(0.21±0.14)mm, the postoperative MDist was(0.22±0.14)mm, the postoperative LDist was(0.41±0.22)mm. There was significant difference in PDist and MDist before and after surgery. PDist and MDist were decreased after surgery. There was no significant difference in LDist before and after surgery. There was no significant correlation between PDist and MDist before and after surgery. Postoperative LDist was positively correlated with preoperative LDist.DPDist was positively correlated with LT. DMDist was positively correlated with bright pupil diameter and dark pupil diameter. DLDist was positively correlated with age. Conclusion There was no significant change in the size and distribution of alpha angle before and after surgery,and was a positive correlation between preoperative and postoperative alpha angle. Compared with kappa angle, preoperative alpha angle evaluation is more reliable. However, patients with poor uncorrected visual acuity or abnormal pupil diameter before the surgery may cause large changes in kappa angle and alpha angle after surgery.
A clinical study on the effect of using different intraocular lens implants on visual quality
LI Jing, ZHANG Hui, WANG Jing
2022, 36(2):  90-95.  doi:10.6040/j.issn.1673-3770.0.2021.392
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Objective The objective of this study is to evaluate and compare the visual quality between bifocal intraocular lens(IOL)(AT LISA 809MP; Zeiss)and extended depth IOL(Tecnis Symfony)implantation. Methods Thirty-five patients(43 eyes)who underwent cataract phacoemulsification with IOL implantation from 2020 to 2021 were randomly divided into groups A and B according to the type of implanted IOL. Twenty-seven eyes implanted with the AT LISA 809MP IOL and were assigned to group A, and 16 eyes implanted with the Tecnis Symfony IOL were assigned to group B. Three months after surgery, the uncorrected distant visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), best corrected distant visual acuity(BCDVA), distant corrected intermediate visual acuity(DCIVA), distant corrected near visual acuity(DCNVA), objective scatter index(OSI), modulation transfer function(MTF)cutoff, Strehl ratio(SR), contrast visual acuity(CVA), and defocus curve were measured and analyzed, and a subjective questionnaire was administered. Results Three months after surgery, there was no statistical difference in UDVA and BCDVA between the two groups(P>0.05). The UNVA and DCNVA of group A were better than that of group B(P<0.05), and the UIVA and DCIVA of group B were better than that of group A(P<0.05). There were no significant differences in OSI, SR, and visual acuity under 100% contrast between the two groups(P>0.05), and the visual acuity under 20% and 9% contrast under cutoff spatial frequency of MTF in group A was slightly lower than that in group B(P<0.05). There was no significant difference between the two groups at the defocus curve at 0D(far distance)(P>0.05); the visual acuity at -1.5D(middle distance)was better in group B than in group A, and the visual acuity at -2.5D(near distance)was better in group A than in group B, and is statistically significant(P<0.05). The rate of spectacle independence and postoperative satisfaction were good in both groups. There was no statistical difference in the probability of glare phenomenon. Conclusion Both types of IOLs can provide patients with better overall visual acuity and spectacle independence. Bifocal IOLs have better near visual acuity, and Symfony continuous IOLs have better middle visual acuity.
Treatment of pseudygium with anti-VEGF corneal matrix injection combined with operation: a case report
PAN Yanli, LI Yuanbin
2022, 36(2):  96-99.  doi:10.6040/j.issn.1673-3770.0.2021.400
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Objective The objective of the study is to investigate the clinical efficacy of anti-vascular endothelial growth factor(VEGF)corneal matrix injection combined with operation in the treatment of pseudygium. Methods The case data of one elderly male patient, who developed palpebral adhesion and pterygium after scalding with molten iron in the left eye, were reviewed. The patient underwent left pterygium excision, autologous limbal stem cell conjunctival flap transplantation, oral mucosa transplantation, amniotic membrane covering, and blepharoplasty. Prior to these, the left eye was treated with two amniotic membrane transplantations, an eyelid fissure, and three subconjunctival and intrastromal anti-VEGF injections. Results One month after the operation, the visual acuity of the left eye was 0.2, the blood supply of the transplanted labial mucosa and bulbar conjunctiva was restored, the cornea was locally cloudy, the anterior chamber was deep, the iris had no adhesion, the lens was slightly cloudy, fundus(-). Conclusion This is a rare case of severe palpebral adhesion and pseudopterygium secondary to a heat scald, which is difficult to treat. For hypertrophic pseudopterygium, anti-VEGF corneal matrix injection can be administered first, and operation after pterygium thinning can achieve good clinical efficacy.
The effect of the relationship between the diameter of the optical zone and the diameter of the dark pupil on the visual quality of patients with different degrees of myopia after SMILE
PENG Jiao, ZHONG Dingjuan, CHEN Jiao, ZUO Jun, WANG Hua
2022, 36(2):  100-107.  doi:10.6040/j.issn.1673-3770.0.2021.539
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Objective The objective of this study is to observe the effect of the relationship between the diameter of the optical zone and the diameter of the dark pupil on the visual quality of patients with different degrees of myopia after small incision lenticule extraction(SMILE). Methods A retrospective analysis was performed on 96 eyes from 49 myopic and astigmatic patients aged 18 to 35 years(average age of 25.76±5.75 years)who underwent SMILE surgery in our ophthalmology center in July 2021. Based on the difference between the diameter of the optical zone and the diameter of the dark pupil, they were divided into three groups: group A, <0 mm(30 eyes); group B, 0-1 mm(36 eyes); and group C, > 1 mm(30 eyes). Each group was then divided into mild to moderate myopic groups(<-6.00D)and high myopic groups(≥-6.00D)according to spherical equivalent refraction(SE). The patients' uncorrected visual acuity(UCVA), SE, high-order corneal aberration, modulation transfer function(MTF)cutoff, object scatter index(OSI), and responses to the subjective visual quality questionnaire were recorded before and 3 months after surgery. Parameter variation was represented by Δ, which was calculated by subtracting the preoperative parameter value from that obtained 3 months postoperatively. Results Preoperative baseline optical zone diameter, dark pupil diameter, and their differences were statistically significant(all P<0.01), whereas age, sex, UCVA, SE, corneal higher-order aberration, MTF cutoff, OSI, and subjective visual quality were not statistically significant(all P>0.05). There were no significant differences in UCVA and SE between the three groups at 3 months after operation(all P>0.05), whereas significant differences were noted in the corneal coma, spherical aberration, and total higher-order aberration(all P<0.05). Pairwise comparisons showed that the values in group A was higher than those in groups B and C, and the differences were statistically significant(all P<0.05). Postoperative corneal aberration in all three groups were higher than that before surgery(all P<0.05). A pairwise comparison of Δspherical aberration in patients with high myopia showed that the values of group C were lower than those of groups A and B, and the differences were statistically significant(P=0.045 and 0.047, respectively). A pairwise comparison of Δspherical aberration and Δtotal high-order aberration in patients with mild to moderate myopia showed that the values of group A were higher than those of group B, with statistically significant differences(P=0.003 and 0.006, respectively), and no statistically significant differences were found between groups B and C(P=0.464 and 0.962, respectively). The patients' MTF cutoff values at 3 months after surgery were restored to the preoperative level (P>0.05). When the difference between the diameter of the optical zone and the diameter of the dark pupil was less than 0 mm, the OSI at 3 months after surgery was higher than that before surgery(P=0.007). The subjective visual quality scores of groups B and C after surgery(7.53±3.81 and 7.73±3.88, respectively)were lower than those before surgery(9.75±4.05 and 11.00±6.35, respectively)(P=0.002 and 0.003, respectively). Conclusion When the optical zone diameter was larger than the dark pupil diameter, the subjective satisfaction of myopia patients significantly improved, and the increase in comas, spherical aberration, and total high-order aberration decreased. On this basis, patients with high myopia require a larger optical zone diameter to reduce the increase in postoperative corneal spherical aberration.
Advances in the role of bone morphogenetic protein-4 in inner ear development and regeneration of hair and spiral ganglion cells
LI Zhen, CUI LimeiOverview,SUN YanGuidance
2022, 36(2):  108-112.  doi:10.6040/j.issn.1673-3770.1.2021.430
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Hearing loss, the most common sensory defect in humans, involves the loss of hair cells(HCs)and spiral ganglion cells(SGCs). During the development of the inner ear, the specific and temporal expression of(bone morphogenetic protein-4, BMP4)regulates the expression of the Tsukushin and gender determination-related gene cluster 2 proteins and other cytokines. BMP4 interacts with the Wnt and Shh signaling pathways and is involved in the induction of ear vesicles, formation of vestibular and cochlear organs, and differentiation of HCs and SGCs. Furthermore, in recent years BMP4 has been found to play an important role in the regeneration of HCs and SGCs in both mammalian and non-mammalian cochlear explants. This study reviews the role of BMP4 in regulating inner ear development and inducing the regeneration of HCs and SGCs, as well as progress in related research, to lay a foundation for elucidating mechanisms related to regeneration and bring developing new strategies to treat hearing loss.
Research progress of artificial intelligence in the diagnosis and treatment of nasopharyngeal carcinoma
HUA Hongli, LI SongOverview,TAO ZezhangGuidance
2022, 36(2):  113-119.  doi:10.6040/j.issn.1673-3770.0.2021.175
Abstract ( 52 )   PDF (455KB) ( 10 )   Save
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To explore the use of artificial intelligence(AI)technology to establish a learning model based on massive medical image big data such as nasopharyngeal pathology, imaging and endoscopy to realize the AI-assisted diagnosis and treatment decision system of medical image of nasopharyngeal cancer, so as to assist doctors to diagnose nasopharyngeal cancer more accurately and make treatment more personalized.AI is still in the research stage in the diagnosis and treatment of nasopharyngeal cancer, and has not been really carried out and applied in the clinic. This paper reviews the current research on AI in the diagnosis and treatment of nasopharyngeal carcinoma, and further discusses its existing problems and future development direction.
The relationship between central obesity and head and neck cancer
LI Chaoyou, WANG AnyangOverview,XUE GangGuidance
2022, 36(2):  120-125.  doi:10.6040/j.issn.1673-3770.0.2021.137
Abstract ( 37 )   PDF (437KB) ( 2 )   Save
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With the increasing number and proportion of obese and overweight people worldwide, obesity has become one of the most globally serious health care problems. Obesity has also been thought to be the cause of many diseases, including hypertension, hyperlipemia, diabetes and insulin resistance. Interestingly, a high risk and mortality rate in head and neck cancer patients have been associated with obesity. Thus, this review focused on the relationship between obesity and head and neck cancer, investigating the molecular mechanism of abnormal lipid metabolism in these patients. Therefore, preventive obesity may be as a new insight in the management of patients with head and neck cancer.
Obstructive sleep apnea hypopnea syndrome and subclinical arteriosclerosis
HAN YingyingOverview,LI YanzhongGuidance
2022, 36(2):  126-132.  doi:10.6040/j.issn.1673-3770.0.2022.011
Abstract ( 38 )   PDF (468KB) ( 5 )   Save
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Objective sleep apnea hypopnea syndrome is an independent risk factor for cardiovascular disease, and seriously affects the quality of life and even survival time of patients. It is one of the modifiable risk factors for cardiovascular disease. Atherosclerosis is involved in the pathogenesis of cardiovascular disorders. While a large number of studies have found that obstructive sleep apnea hypopnea syndrome is associated with subclinical atherosclerosis. Our study aims to understand the clear role of obstructive sleep apnea hypopnea syndrome in subclinical arteriosclerosis, and therefore provide evidence for the prevention and early intervention of atherosclerosis in patients with obstructive sleep apnea hypopnea syndrome.
Research progress on the relationship between obstructive sleep apnea-hypopnea syndrome and dyslipidemia
YANG Xijun, GUAN JianOverview,WU HaiyingGuidance
2022, 36(2):  133-138.  doi:10.6040/j.issn.1673-3770.0.2021.078
Abstract ( 41 )   PDF (437KB) ( 5 )   Save
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Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a common sleep apnea disorder. Both OSAHS and lipid metabolism disorders are important chronic conditions affecting human health, and they are closely related to the development of cardiovascular and cerebrovascular diseases. This article will review the possible pathophysiological mechanisms underlying the effect of OSAHS on dyslipidemia and the progress of related clinical research.
Tetrandrine regulates autophagy in tumor cells
YAO ZhouzhouOverview
2022, 36(2):  139-143.  doi:10.6040/j.issn.1673-3770.0.2021.052
Abstract ( 38 )   PDF (401KB) ( 3 )   Save
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Autophagy is a highly conserved cellular process mediated by lysosomes, which is important to maintain cell homeostasis. It is closely related to the occurrence and development of many diseases and plays a dual role in tumor.Tetrandrine, a bisbenzylisoquinoline alkaloid isolated from the traditional Chinese medicine, exhibits the antitumor activity with multiple bioactivities in vivo and in vitro. Recently, the activity of tetrandrine in regulating autophagy has attracted much attention. This paper reviews the research progress of tetrandrine in the regulation of tumor autophagy in recent 10 years to provide a new way in the use of tetrandrine as an antitumor drug.
Research progress in the inflammatory reaction and anti-inflammatory treatments in dry eye
DI YuOverview,LI YingGuidance
2022, 36(2):  144-150.  doi:10.6040/j.issn.1673-3770.0.2020.484
Abstract ( 42 )   PDF (446KB) ( 4 )   Save
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Dry eye is a multifactorial disease of the tear film and ocular surface. In recent years, it has become one of the most common ocular surface diseases, with its prevalence increasing every year. Inflammation plays a key role in the pathogenesis of dry eye. It can stimulate ocular surface cells, activate the local immune response, lead to unstable tear films, increase the osmolality of tears, and then cause local ocular surface damage. Multiple inflammatory mediators and immune cells participate in the development of dry eye. There is increasing research on the inflammatory reaction involved in dry eye, and this paper reviews the inflammatory mediators, immune cells, immune response, and anti-inflammatory treatments to systematically understand the inflammatory reaction mechanism of dry eye and its clinical significance.
Research progress of SIRT1 activation by resveratrol in ocular diseases
ZHANG Yi, WANG WenjunOverview,YANG AnhuaiGuidance
2022, 36(2):  151-156.  doi:10.6040/j.issn.1673-3770.0.2021.070
Abstract ( 39 )   PDF (433KB) ( 1 )   Save
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Sirtuins are a class of histone deacetylases that regulate a variety of activities through the control of gene expression, DNA repair, metabolism, oxidative stress response, mitochondrial function, and other biological processes. Sirtuin 1(SIRT1)has been most widely studied. Resveratrol is a natural polyphenolic compound that upregulates SIRT1 activity. Resveratrol has strong antioxidant and anti-inflammatory activities, and has been widely studied in cardiac protection, neuroprotection, chemotherapy, and anti-aging. Oxidative stress and inflammation play key roles in the development and progression of eye diseases, which can lead to progressive vision loss and even blindness. This article briefly reviews the potential use of resveratrol in ocular diseases and the limitations of its applications.
Research progress of optical coherence tomography and angiography in the diagnosis of Alzheimer's disease
ZHANG MinOverview,LI YanGuidance
2022, 36(2):  157-162.  doi:10.6040/j.issn.1673-3770.0.2021.141
Abstract ( 73 )   PDF (427KB) ( 21 )   Save
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Alzheimer's disease(AD)is a progressive and irreversible neurological disease characterized by changes in neurons and blood vessels of the brain. Its etiology is unknown, and there is no feasible non-invasive technique for early diagnosis. Because the retina and the central nervous system have similar embryonic origins and physiological characteristics, an ophthalmic examination may provide a simple and non-invasive diagnostic method. Optical coherence tomography(OCT)can accurately measure the thickness of various tissue layers of the retina to assess degenerative changes of the retina. Optical coherence tomography angiography(OCTA)can provide high-resolution three-dimensional imaging, which can more directly detect the changes in retinal vessels and reflect the pathological characteristics of brain neurons and blood vessels noninvasively. This article mainly reviews the research progress of retinal thickness measured by means of OCT and retinal blood flow measured using OCTA in the diagnosis of AD.
Effects of ischemic stroke and other neurodegenerative diseases on RNFL thickness
LI Yingying, FENG JieOverview,LI Wei, DING TianjiaoGuidance
2022, 36(2):  163-168.  doi:10.6040/j.issn.1673-3770.0.2021.273
Abstract ( 34 )   PDF (457KB) ( 19 )   Save
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The retina and the brain have similar embryonic origin and anatomical and physiological characteristics. The retinal nerve fiber layer(RNFL)is mainly composed of axons of retinal ganglion cells, which can be observed and quantified in vivo by optical coherence tomography(OCT). RNFL thinning is a part of normal aging, it can also be seen in neurodegenerative diseases such as ischemic stroke, Alzheimer's disease, Parkinson's disease,multiple sclerosis. With the rapid development of ophthalmic imaging techniques such as OCT, RNFL thickness is widely used in clinic,which provides clinical data of retinal ganglion cell loss in patients with ischemic stroke and other neurodegenerative diseases. Clinicians can intervene as soon as possible to delay the progress of retinal nerve fiber layer defect and further improve the quality of life of patients.

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