[Correlation of posterior segment lesions with anterior segment biometric parameters and FBN1 genotype in patients with Marfan syndrome]

Objective: To investigate the characteristics of posterior segment lesions in Marfan syndrome (MFS) patients and their relationship with anterior segment biometric parameters and FBN1 genotype. Methods: A cross-sectional study was conducted. A total of 121 MFS patients, 76 males and 45 females, with an average age of (11.72±11.66) years, who visited the Department of Ophthalmology, Eye & ENT Hospital of Fudan University from January 2013 to March 2023 were included. The presence of posterior scleral staphyloma was observed using B-mode ultrasound, and macular lesions were identified and classified using the atrophy-traction-neovascularization system based on ultra-widefield fundus images, color fundus images, and optical coherence tomography scans. Anterior segment biometric parameters, including axial length of the eye, average corneal curvature, corneal astigmatism, horizontal corneal diameter, anterior chamber depth, and lens thickness, were collected, and the direction and extent of lens dislocation were observed. Molecular genetic analysis of FBN1 gene mutations in patients was performed using next-generation sequencing based on a panel of ocular genetic diseases, and the impact of the genotype and anterior segment biometric parameters on the posterior segment manifestations was analyzed. Results: Sixty patients exhibited posterior segment lesions, including retinal detachment (4 cases, 3.31%), macular lesions (47 cases, 38.84%), and posterior scleral staphyloma (54 cases, 44.63%). There was statistically significant difference in axial length of the eye between patients with and without posterior scleral staphyloma [23.09 (22.24, 24.43) and 27.04 (25.44, 28.88) mm], between patients with and without macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.78) mm], and between patients with and without atrophic macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.79) mm] (all P<0.001). There was statistically significant difference in anterior chamber depth between patients with and without macular lesions [3.11 (2.75, 3.30) and 3.34 (3.09, 3.60) mm] (P<0.05). There was also statistically significant difference in corneal astigmatism between patients with and without posterior scleral staphyloma [2.15 (1.20, 2.93) and 1.40 (1.00, 2.20) diopters] (P<0.05). The location and region of the FBN1 gene mutation not only showed statistically significant difference from the positive rates of posterior scleral staphyloma and macular lesions (all P<0.05), but also influenced the occurrence of atrophic macular lesions (both P<0.05). Patients with FBN1 mutations located in the transforming growth factor β regulatory sequence had the highest proportion of posterior scleral staphyloma and macular lesions (both 10/11). Conclusions: Posterior scleral staphyloma and macular lesions have a relatively high incidence in MFS patients and tend to progress to more severe grades. The age, axial length of the eye, anterior chamber depth, corneal astigmatism, and location and region of the FBN1 gene mutation are factors affecting the posterior segment lesions in MFS patients.

The generation of genuine quadripartite Einstein-Podolsky-Rosen steering in an optical superlattice

Einstein-Podolsky-Rosen (EPR) steering is a quantum effect based on quantum entanglement and it is the key resource for building quantum networks because of its useful properties. Based on the criterion for genuine multipartite EPR steering, the genuine quadripartite EPR steering is confirmed and it can be generated by a spontaneous parametric down-conversion cascaded process with two sum-frequency generations in an optical superlattice. This occurs either below the oscillation threshold and without oscillation threshold. The influence of the parameters of cascaded nonlinear process on the quadripartite EPR steering among signal, idler, and two sum-frequency beams are also discussed. Choosing appropriate nonlinear parameters can achieve good quadripartite quantum steering. This scheme of the generation of genuine quadripartite EPR steering has potential applications in quantum communication and computing.

Cardiopulmonary Protection for Bilateral Breast Irradiation: A Dosimetric Comparison between Proton and Photon Plans

PURPOSE/OBJECTIVE(S)

Recent advances in cancer treatment improve cancer survivorship. Cardiovascular disease has become the leading cause of non-cancer death in breast cancer survivors. Therefore, risk of cardiopulmonary toxicities during multimodality treatment should be assessed carefully. It remains to be defined the best scenario for proton therapy to confer meaningful cardiovascular protection in the setting of breast irradiation. We hypothesized proton therapy plan provides optimal cardiopulmonary protection during bilateral breast irradiation. The study aimed to compare cardiopulmonary dosimetric parameters of proton and photon radiotherapy plans.

MATERIALS/METHODS

We conducted a retrospective study and patients with bilateral breast cancer indicated for radiotherapy between January 01, 2010 and December 31, 2020 were included. All patients received whole breast or chest wall irradiation with or without regional nodal irradiation. The dose scheme was 50-50.4 Gy in 25-28 fractions. Boost was allowed if patients receiving breast conserving surgery or known risk factors. The dosimetric parameters included planning target volume, mean dose to the heart, the volume of whole lung receiving 5 Gy, 10 Gy, and 20 Gy. For photon therapy, volumetric modulated arc therapy using double partial arc plans was generated with Pinnacle 9.8, Elekta Synergy and tomotherapy helical plan was generated with Tomo Hi-Art planning system. For proton therapy, treatment planning was generated with Ray station 9A. All data was managed using SAS v.9.4 software. Analysis of variance (α = 0.05) was used to compute the dosimetry of different treatment modalities. The statistical significance was considered with a p-value <0.05.

RESULTS

Thirty-one patients with bilateral breast cancer were included, including 12 bilateral breast irradiation patients and 6 bilateral chest wall irradiation patients. The mean dose of heart was 53.0±43.3 cGy in proton therapy while 736.6±225.1 cGy and 869.67±241.0 cGy in Tomotherapy and volumetric modulated arc therapy respectively. The volume of whole lung receiving 5 Gy was 15.4±7.91% in proton therapy while 46.1±10.8% and 46.3±2.5% in Tomotherapy and volumetric modulated arc therapy respectively. The volume of whole lung receiving 20 Gy was 7.7±4.3% in proton therapy while 15.4±5.6% and 19±3.5% in Tomotherapy and volumetric modulated arc therapy respectively. The effects of cardiopulmonary protection were more significant for chest wall irradiation over breast irradiation.

CONCLUSION

Proton radiotherapy provided significant dose reduction for bilateral breast irradiation. The benefit is more significant is patients receiving bilateral chest wall irradiation. Further clinical validations will be warranted to confirm the clinical relevance of the finding.

Analysis of Skin Dose and Position Stability for a New Personalized Device for Breast Radiotherapy

PURPOSE/OBJECTIVE(S)

Whole breast irradiation is the standard treatment for patients with early-stage breast cancer. We previously developed a personalized breast support device (PERSBRA) that reduced heart and lung radiation exposure. However, the skin dose was concerned for the device due to its thickness. In this study, we designed the new honeycomb structures to reduce the dose to the skin and maintain stable breast position with this device.

MATERIALS/METHODS

Three different structures of PERSBRA were designed. They were solid structure, honeycomb structures with 3.5 mm wall thickness and honeycomb structures with 4.5 mm wall thickness respectively. Those patients who scheduled to receive whole breast irradiation were enrolled for anthropometric breast position analysis. Stability of breast position in supine with PERSBRA were analyzed by scanning with a 3D infrared scanner. The distances between the nipples, between the nipple and the xiphoid process, and between the nipple and the inframammary fold were used to be the index. 32 patients were enrolled for anthropometric breast position analysis. The skin dose was simulated using the thermoluminescent dosimeter (TLD) positioned on the phantom with PERSBRA in the treatment scenario.

RESULTS

The displacements between two nipples, the nipple and the infra mammary point, and the nipple and the xiphoid process were 1.4%, 1.2%, and 0.4% for 3.5 mm honeycomb structure. Meanwhile, these displacements were 0.8%, 0.7% and 0.2% for solid 10% structure. Compared to these results, there were no significant difference for the two designations. The surface dose simulating the treatment scenario were 78.27%, 89.39% and 91.9% of prescribed dose for the 3.5mm, 4.5 mm honeycomb structure and the solid 10% filled structure, respectively. The 3.5 mm honeycomb structure reduce the surface dose significantly compared to another two designations.

CONCLUSION

The honeycomb structures do not jeopardize mechanical properties of PERSBRA or the breast positional stability support. Moreover, honeycomb structure with 3.5 mm thickness effectively reduces skin surface dose on a breast phantom. These data encourage further clinical studies to investigate the effects of such design on radiation dermatitis during whole breast irradiation.

[A case of malignant peritoneal mesothelioma]

Malignant mesothelioma is a highly malignant disease that most often occurs in the pleural cavity, followed by the peritoneum and pericardium. Malignant peritoneal mesothelioma (MPM) accounts for 10%-15% of all mesothelioma. The most important risk factor for MPM is exposure to asbestos. MPM has no specific clinical symptoms, imaging and histopathology are critical for the diagnosis. There are currently no generally accepted guidelines for curative treatment of MPM. The patient mainly presented with abdominal pain, abdominal distension and discomfort. Due to extensive omentum metastasis, no further surgical treatment was performed. Pemetrexed combined with cisplatin chemotherapy was given for 2 cycles, and the patient is still alive.

[Blood pressure control and influencing factors in hypertension patients with metabolic syndrome]

Objective: To investigate the blood pressure control and its influencing factors in hypertension patients with MS. Methods: Between January 2017 and December 2018, more than 78 000 residents aged 35-75 years selected through convenient sampling were invited to participant in China Patient-Centered Evaluative Assessment of Cardiac Event Million Persons Project in Fujian province, physical and laboratory tests were conducted for them, and their basic information were recorded. A total of 5 281 hypertension patients with MS were included in the study. Results: The treatment rate of hypertension patients with MS was 55.5%, and the control rate was 7.2%. The control rate was higher in patients who were older, women, had advanced education level, had history or family history of cardiovascular disease. The results of multivariate analysis indicated that living area (urban or rural), cardiovascular history, diabetes, urine protein, BMI had impacts on both treatment and control of hypertension. Family history of cardiovascular disease, age, self-management of hypertension, dyslipidemia, waist circumference and drinking had impacts on the treatments, and gender had effects on the control. Conclusions: The treatment rate of hypertension patients with MS was unsatisfactory and the control rate was low. Intervention should be strengthened in rural area, males and young age groups, and activity of self-management group of hypertension should be conducted regularly.

Multicentre study of the prognostic impact of preoperative bodyweight on long-term prognosis of hepatocellular carcinoma

BACKGROUND

Whether preoperative bodyweight is associated with long-term prognosis in patients after liver resection for hepatocellular carcinoma (HCC) is controversial. This study aimed to investigate the relationship of patient weight with long-term recurrence and overall survival (OS) after curative liver resection for HCC.

METHODS

Data for patients with HCC who underwent curative liver resection between 2000 and 2015 in five centres in China were analysed retrospectively in three groups according to their preoperative BMI: underweight (BMI 18·4 kg/m² or less), normal weight (BMI 18·5-24·9 kg/m² ) and overweight (BMI 25·0 kg/m² or above). Patients' baseline characteristics, operative variables and long-term survival outcomes were compared. Univariable and multivariable Cox regression analyses were performed to identify risk factors for OS and recurrence-free survival (RFS) after resection.

RESULTS

Of 1524 patients, 107 (7·0 per cent) were underweight, 891 (58·5 per cent) were of normal weight and 526 (34·5 per cent) were overweight. Univariable analyses showed that underweight and overweight patients had poorer OS (both P < 0·001) and RFS (both P < 0·001) than patients of normal weight. Multivariable Cox regression analysis also identified both underweight and overweight to be independent risk factors for OS (hazard ratio (HR) 1·22, 95 per cent c.i. 1·19 to 1·56, P = 0·019; and HR 1·57, 1·36 to 1·81, P < 0·001, respectively) and RFS (HR 1·28, 1·16 to 1·53, P = 0·028; and HR 1·34, 1·17 to 1·54, P < 0·001).

CONCLUSION

Underweight and overweight patients appear to have a worse prognosis than those of normal weight following liver resection for HCC.

[Clinical effects of pediatric penetrating keratoplasty for congenital corneal opacity]

Objective: To report the clinical results of pediatric penetrating keratoplasty (PKP) in patients under 3 years old with congenital corneal opacity. Methods: Retrospective study. Sixteen eyes of 12 patients who were treated with PKP in Aier Eye Hospital Group from June 2009 to December 2016 were enrolled in this study. All the patients were diagnosed as congenital corneal opacities: 8 cases (11 eyes) with Peter's anomaly I, 2 cases (3 eyes) with sclerocornea, and 2 cases (2 eyes) with corneal dermoid tumor combined with iris synechia. Seven cases (7 eyes) were under 1 year old. Eight cases (10 eyes) could not follow the light. Only 1 case (2 eyes) received PKP with extracapsular cataract extraction, and the others only had PKP. Postoperative examinations were performed more frequently than in adults, and sometimes general anesthesia was needed. Results: The follow-up period was from 8 months to 6 years (33.17±22.60 months). The postoperative visual acuity improvement was found in all eyes from 1 week to 1 month after surgery except a 3-year-old patient with corneal dermoid tumor with serious esotropia. All the surgeries were successful without intraoperative complications. Graft rejection occurred in 4 cases (4 eyes). The graft of a 33-month-old patient became semitransparent. The grafts of 2 cases under 1 year old were clear after drug therapy. And the vision of a 3-year-old patient with Peter anomaly improved obviously, but immune rejection occurred 2 years after surgery. The second PKP was performed, but rejection occurred again. Secondary glaucoma was found in the other eye early after operation; anti-glaucoma surgery failed, and the graft became cloudy. Graft infection associated with loosened sutures was observed in one case (2 eyes) of sclerocornea, and the second PKP failed. Conclusions: For the patients with congenital corneal opacities, there is often a noticeable visual improvement after PKP. Good postoperative care, appropriate amblyopia treatment and timely examination are the keys to success. (Chin J Ophthalmol, 2017, 53: 941-946).

[Estimation of underreporting rate of death cases in disease surveillance system of Fujian province using propensity score weighting method, 2012-2014]

Objective: To understand the underreporting of death cases and related factors in disease surveillance system of Fujian province. Methods: We carried out a field underreporting survey in 20 disease surveillance sites selected through stratified cluster random sampling during 2012-2014. The related factors of underreporting were analyzed by using logistic regression method. Propensity score weighting method was used to calculate the underreporting rate in different groups classified by year, urban/rural areas, gender, age and death cause variables. Results: The overall underreporting rate was 9.21%(95%CI: 9.06%-9.39%) after adjusting by propensity score weighting method. The underreporting rate was higher in rural area (11.55%, 95%CI: 11.30%-11.81%) than in urban area (6.64%, 95%CI: 6.50%-6.78%). The underreporting rate was highest in age group 0-14 years (36.29%, 95% CI: 34.23%-38.67%) and lowest in age group ≥65 years (7.91%, 95% CI: 7.78%-8.03%). The underreporting rate was higher in people died of perinatal disease, congenital anomalies and injury. Conclusion: The underreporting rates were different between different groups classified by urban/rural areas, age and death cause variables. Propensity score weighting method can be used to adjust underreporting rate of death cases in mortality surveillance in Fujian.

The effects of cleanroom noise intensity and frequency on physiological measures and subjective responses

BACKGROUND

Workplace noise exposure gains growing attention in high tech industry.

OBJECTIVE

This study investigated the noise effect on physiological and subjective responses in semiconductor manufacturing clean room environment.

METHODS

Twenty subjects including 10 males and 10 females completed all phases of the experiment. Each subject was asked to participate in four treatment combinations of two noise intensities [65 dB(A) and 80 dB(A)] × two frequency levels [high and low]. For each treatment condition, the subject was exposed to the specified noise condition in a sound proof cabin for one hour. The physiological measures included blood pressure and heart rate. The subjective measures included noise sensitivity, fatigue and annoyance.

RESULTS

The ANOVA results indicate that long-time noise exposure caused significant increase in blood pressure (p< 0.001). Furthermore, the noise intensity by time interaction effect was found to be significant on annoyance and fatigue.

CONCLUSIONS

The findings suggest that prolonged exposure to noise intensity at 80 dB(A) would result in a significant increase in physiological cost and subjective discomfort feeling. Thus, some countermeasures should be taken to reduce noise exposure and to promote health, and quality of working life.

Changes in graves' ophthalmopathy after radioiodine and anti-thyroid drug treatment of Graves' disease from 2 prospective, randomized, open-label, blinded end point studies

AIMS

A significant association between radioiodine therapy (RIT) and the development or the worsening of pre-existing Graves' ophthalmopathy (GO) has been reported. This post-hoc analysis of 2 studies attempted to describe the changes observed in pre-existing or new-onset GO following RIT with the goal of euthyroidism rather than hypothyroidism and to describe the relationship GO changes and the final outcome.

PATIENTS AND METHODS

In 2 prospective, randomized open-label blinded endpoint trials, patients received radioiodine alone; or, patients received radioiodine or antithyroid drug therapy (ATD). The severity and activity of GO were assessed during a 9-12-year follow-up. The study end points in study 1 were euthyroidism, hyperthyroidism, hypothyroidism, and changes in GO. In study 2, the end points were euthyroidism, hyperthyroidism, hypothyroidism, relapse, and changes in GO.

RESULTS

Both RIT and ATD were associated with worsening GO and new-onset GO. Both RIT and ATD led to similar aggravation of pre-existing GO or the development to new-onset GO. After RIT or ATD, the euthyroid patients (without levothyroxine substitution) demonstrated an improvement in GO, with 78-89% patients with preexisting GO exhibiting improvement, whereas hyperthyroid, hypothyroid and relapsed patients had worsening or new-onset GO.

CONCLUSIONS

Thyroid function is a dominant risk factor. Thyroid function may be the most important determinant in worsening or new-onset GO in both the natural disease course and in treated patients, independent of the kind of treatment. Therefore, we recommend euthyroidism as a goal of treatment.

Mental health status and factors that influence the course of Graves' disease and antithyroid treatments

AIMS

Biological, psychological and social factors may interact with the mental health status of Graves' disease (GD) patients before and after antithyroid drug (ATD) treatment. Our aim was to quantify the impact of supportive and risk factors after recovery from GD which may enhance cure rates.

PATIENTS AND METHODS

300 patients were recruited for a 6-year prospective cohort study. Before and after treatment, we assessed the impact of biopsychosocial factors on the success of ATD treatment and mental health using the Symptom Checklist 90, the Eysenck Personality Questionnaire, the Life Event Scale, Simplified Coping Styles and the Perceived Social Support Scale. The patients routinely received ATD at least over 18 months. End-point was defined as cured (at least 2 years without a relapse after the withdrawal of ATD), otherwise as not cured.

RESULTS

Regression analysis explained 80.5% of the influences affecting mental health. The odds ratios (OR) revealed positive coping styles (OR: 2.90, 95% CI, 1.09-7.68), negative events (OR: 1.04, 95% CI, 1.01-1.07) and social support (OR: 5.10, 95% CI, 2.77-9.40) as protective factors, predicting a cure for GD patients. These variables explained 61.7% of the influences leading to a cure or no cure. Large thyroid volume was a risk factor, predicting failure (OR: 0.865, 95% CI, 0.83-0.90, P<0.000).

CONCLUSIONS

Enhancing positive coping strategies and social support is important to improve mental health in GD patients, to avoid compromising work-related performance and endangering a patient's social status.

Quantitative trait loci on barley (Hordeum vulgare L.) chromosome 7 associated with components of winterhardiness

Quantitative trait loci (QTL) controlling traits associated with winterhardiness in barley (field survival, LT50, growth habit, and crown fructan content) were mapped to chromosome 7 in a population of 100 F1-derived doubled haploid lines. The largest QTL effects for all traits were detected in a 21% recombination interval on the long arm of chromosome 7. QTL in this region accounted for 37-68% of the variation for three measures of cold tolerance, 47% of the variation for growth habit, and 28% of the variation in crown fructan content. Trait association may be due to linkage rather than pleiotropy.

Combined ventriculoperitoneal shunt blockage, viscus perforation and migration into urethra, presenting with repeated urinary tract infection

We present an extremely rare case of delayed and combined ventriculoperitoneal shunt blockage, viscus perforation and migration into the urethra manifested by a repeated urinary tract infection. This was discovered six months after the shunt was inserted. Although there were various other transient symptoms, the patient did not show obvious peritoneal signs. This complication could have been lethal if the discovery had been delayed. One of the best ways of preventing such migration is possibly the use of a softer catheter. However, making sure of appropriate redundancy for the abdominal part of the catheter may be of equal importance.

Forensic Science in Support of Wildlife Conservation Efforts - Developments in Morphological and Chemical Approaches in Taiwan

Parts from animals that are now endangered species (such as bear bile, rhino horn, and tiger bone) have long been important ingredients of traditional Chinese medicine (TCM). Deeply believing in the potency of these ingredients and coupled with substantial gains in wealth of the population in Taiwan in the 1980s, ugly scenarios came to light. Taiwan quickly became the target of investigation pursued by international wildlife conservationists. To provide scientific bases for the government's investigation efforts, morphological, chemical/physical, and genetic methods were developed to characterize TCM products. This review focuses on Taiwanese scientists' efforts on the following topic matters: (a) morphological approach to identify CITES-listed species from the turtle shells traded in the TCM market; (b) chromatographic and spectrophotometric methods for the identification and differentiation of bile products of different animal origins; and (c) gas chromatography-mass spectrometry method for the analysis of deer musk components and alleged musk products.

Genetic evaluation and management of fetal chylothorax: review and insights from a case of Noonan syndrome

Fetal chylothorax is one of a very few syndromes that can be treated in utero with thoracoamniotic shunting or pleurodesis by OK-432 as two major therapeutic modalities. We report on a fetus with Noonan syndrome and a missense mutation c.182A > C (p.Asp61Ala) of PTPN11 who responded poorly to antenatal pleurodesis by OK-432. Based on our previous publication and this case study, we propose that fetal chylothorax of a distinct genetic origin may respond poorly to OK-432 pleurodesis.