Trends in operating room-based glaucoma procedures at a single eye center from 2016-2020

AIM

To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016-2020.

METHODS

A retrospective search of all glaucoma procedures performed at our institution were performed. Data were analyzed by calculating the absolute numbers and relative weightage of each procedure per year.

RESULTS

The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y, and 55% were women. From 2016 to 2019, the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460, although it decreased slightly in 2020 (n=1393), probably due to the COVID-19 pandemic. The number of trabeculectomies did not change significantly in 2016 (n=161) to 2018 (n=164) but decreased in 2019 (n=139) to 2020 (n=121), indicating a reduction in its relative weightage among glaucoma procedures (from 21.50% to 8.69%). The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased (50 and 58 respectively in 2019), except in 2020. The number of transscleral cyclophotocoagulation procedures was relatively stable, increasing until 2017 (n=218) and then decreasing. Cataract surgeries with or without glaucoma procedures accounted for a large number of the total surgeries, increasing from 247 (32.97%) in 2016 to 967 (69.42%), among which cataract extraction combined with goniosynechialysis was the most frequent.

CONCLUSION

The overall increase in the number of operating room-based surgical procedures is significant. Trabeculectomy is one of the most commonly performed procedures, despite the relative decline in its weightage. Other procedures, including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries, are gaining greater acceptance. Notably, lens-related surgery plays an important role in glaucoma management.

A randomized controlled study of bedside electrocardiograph-guided tip location technique & the traditional chest radiography tip location technique for peripherally inserted central venous catheter in cancer patients

Background & objectives:

The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique.

Methods:

Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion.

Results:

Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P <0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively).

Interpretation & conclusions:

The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.

Clinical effects of thermotherapy in combination with intracavitary infusion of traditional Chinese medicine in the treatment of malignant pleural effusion

Malignant fluid, a commonly seen tumor associated complication, mainly includes peritoneal effusion, malignant pleural effusion and pericardial effusion. It can produce huge negative influence on the quality of life of patients and even lead to death. Treatment of malignant effusion is one of the effective measures for improving life expectancy of patients. To evaluate the effect of thermotherapy in combination with intracavitary infusion of Kangai injection in treating malignant pleural effusion, 195 patients who received treatment from April 2010 to October 2014 in the First Affiliated Hospital of Zhengzhou University were selected and divided into an observation group and two control groups (group A and B). The observation group was treated by thermotherapy in combination with intracavitary infusion of kangai injection. Control group A was treated by intracavitary infusion of kangai injection and control group B was treated by hyperthermal perfusion in combination with intracavity chemotherapy. Clinical effects, quality of life, treatment safety and untoward reactions were compared between the groups. It was found that differences of WBC, RBC and PLT levels before and after treatment had no statistical significance comparisons within group and comparisons between groups (P>0.05); hepatic and renal functions of the groups had no remarkable difference before or after treatment (P>0.05). The clinical effect of the observation group was superior to that of control groups A and B (P less than 0.05); the Karnofsky performance status (KPS) score of the observation group was much higher than that of control groups A and B (79.34±10.58 vs 71.11±9.64), but the difference of the ZPS score between groups had no statistical significance (P>0.05). It can be concluded that thermotherapy in combination with intracavitary infusion of traditional Chinese medicine can be safely applied as it has positive effects and remarkably improves quality of life, therefore it is clinically worth promoting.

Evaluating ECG-aided tip localization of peripherally inserted central catheter in patients with cancer

OBJECTIVE

To evaluate ECG-aided tip localization of peripherally inserted central catheter (PICC) in the patients with cancer.

METHODS

Between September and December 2014, 170 patients undergoing PICC were divided into observation group and control group (each group with 85 patients). In observation group, patients received ECG-aided tip localization of PICC. In control group, PICC was performed with conventional method. After PICC was performed, all patients took orthophoria chest radiograph (OCR) to check whether the tip position of PICC was appropriate. Finally, successful rate of the first PICC was compared between the two groups.

RESULTS

In observation group, OCR showed that the tip of PICC was located in middle and low one-third of superior vena cava in 85 patients. In control group, OCR showed that the tip of PICC was located between superior vena cava and right atrium in 75 patients. The successful rate of the first PICC was significantly higher in observation group than in control group (P < 0.05).

CONCLUSION

ECG-aided tip localization of PICC is accurate and safe, and is worth clinically recommending.

Drug-induced skin toxicity and clinical nursing of VitK cream on colorectal cancer patients

To discuss the impact of 0.1% vitamin K1 (VitK1) cream on cetuximab-induced skin toxicity for colorectal cancer patients. 60 colorectal cancer patients with cetuximab therapy after hospitalization, were divided into experimental group (Ward A) and control group (Ward B) according to personnel sequential number, with 30 cases in each group. Routine nursing was implemented on control group. For experimental group, on the routine nursing basis, 0.1% VitK1 cream was smeared on face, neck, chest, back and nail (toenail) edge with three times one day at the application of cetuximab day. After cetuximab applied in 8 weeks, both skin itch and dry skin for patients in experimental group were significantly improved compared those in control group, showing statistically significant difference (W=708.000, P=0.001: W=662. 500, P=0.000). 0.1% VitK1 cream was conducive to improve both skin itch and dry skin symptoms in the cetuximab-induced skin toxicity for colorectal cancer patients.

Comparison of short-term efficacy and safety of TIROX and DCF regimens for advanced gastric cancer

OBJECTIVE

To compare the short-term efficacy and safety profile of the S-1 + irinotecan + oxaliplatin (TIROX) and docetaxel + cisplatin + flurouracil (DCF) anticancer regimens in patients with advanced gastric cancer.

METHODS

Patients with recurrent or metastatic gastric cancer diagnosed by pathology were randomly divided into two groups to receive six cycles of either the TIROX regimen (21-day cycle) or the DCF regimen (21-day cycle). After six chemotherapy cycles, the short-term efficacy was evaluated according to the Response Evaluation Criteria in Solid Tumors guidelines and adverse reactions were recorded according to National Cancer Institute Common Toxicity Criteria 2.0 standards.

RESULTS

A total of 60 patients were enrolled in the study. The response rate (complete response + partial response) was significantly higher in the TIROX group (18/30 patients; 60.0%) compared with the DCF group (10/30 patients; 33.3%). The rates of grade III-IV leucopenia and neurotoxicity were significantly higher in the TIROX group than the DCF group.

CONCLUSION

The TIROX regimen was effective for the treatment of advanced gastric cancer, but it was associated with leucopenia and neurotoxicity.

First Report of Corynespora cassiicola Causing Leaf Spot on Akebia trifoliate

Akebia species have been used for centuries in medicinal practices in a few Asian countries such as China and Japan. The dried stems of Akebia trifoliata are known as mutong in the Chinese pharmacopoeia (4) and mokutsu in Kampo, the traditional Chinese medicine developed in Japan (2). In China, the plant is grown in the provinces of Shandong, Hebei, Shanxi, Henan, Gansu, and some provinces in the south of the Yangtze River basin. During the summer of 2012, a leaf spot disease was detected on A. trifoliata grown in Nanning, Guangxi, China. The disease occurred and spread rapidly in July under conditions of high temperature and high humidity. The symptoms appeared on three sites that we inspected; disease incidences were higher than 80%. Initial symptoms consisted of small (less than 5 mm in diameter), circular, purple-brown leaf spots. Spots later enlarged and became elliptical, circular, or irregular with gray-white centers and dark brown rims. The centers were slightly concave. The spots could coalesce with each other, resulting in leaf desiccation and wilting. A fungal isolate was obtained from symptomatic leaf tissue that taken from a field (22°50'N, 108°22'E) in Nanning, Guangxi, China. Single-spore culture of the isolate was incubated on potato dextrose agar (PDA) for 7 days in the dark at 28°C. Conidiophores were straight to slightly curved, unbranched, and pale brown. Conidia (19.0 to 140.5 μm long and 7.0 to 11.0 μm wide) were formed singly or in chains, obclavate to cylindrical, straight or curved, pale brown, with a rounded apex and truncate base, and 1 to 13 pseudosepta. Morphological characteristics of the isolate were similar to the descriptions of Corynespora cassiicola (Berk. & M.A. Curtis) C.T. Wei (1). Genomic DNA of the isolate was extracted and used for PCR amplification of rDNA-ITS (internal transcribed spacer) sequence with primers ITS1 and ITS4. The PCR products were purified and sequenced. The sequence (GenBank Accession No. KC977496) was used in BLAST searches to interrogate GenBank for sequence similarity. High sequence similarity of 100% was obtained with several C. cassiicola strains. Pathogenicity of the isolate was investigated to demonstrate Koch's postulate. Young, healthy, fully expanded green leaves of A. trifoliata were surface sterilized. Fifteen leaves were inoculated with 10-μl drops of conidia suspension (10⁵ conidia per ml) and 10 leaves were inoculated with the same volume of sterile water to serve as controls. All the leaves were placed in a humid chamber for 5 days. Spots with similar symptoms to those observed in the field developed on all inoculated leaves. The pathogen was reisolated and identified as C. cassiicola. The controls remained symptomless. According to previous reports, A. trifoliata was infected by Alternaria tenuissima in China and by Colletotrichum acutatum in Japan (3). To our knowledge, this is the first report of C. cassiicola found on Akebia species worldwide. Furthermore, this new disease primarily affects plantations and reduces the quality and yield of the medicine. Some effective measures should be taken to control this disease. References: (1) M. B. Ellis and P. Holliday. CMI Description of Pathogenic Fungi and Bacteria, 303, 1971. (2) F. Kitaoka et al. J. Nat. Med. 63:374, 2009. (3) Y. Kobayshi et al. J. Gen. Plant Pathol. 70:295, 2004. (4) L. Li et al. HortScience 45:4, 2010.

First Report of Leaf Spot Caused by Alternaria porri on Velvet Bean (Mucuna pruriens) in China

Mucuna pruriens is a tropical legume known as velvet bean. It has many traditional and medicinal usages in treating Parkinson's disease (1), abdominal pain, cholera, infertility, scorpion bites, diabetes (3) and is found in tropical Africa, India, the Caribbean and China. During the fall of 2011, the velvet bean plants in Longan County, Guangxi, China, were damaged by a leaf disease previously unreported in China. Field inspections revealed disease incidences as high as 80%. Symptoms consisted of large spots developing between the leaf veins that ranged in length from 1 to 3 cm. Spots were dark brown, generally rectangular, and were visible from both sides of the leaf. Lots of black mycelia and conidia were found on the backs of the lesions. Lesions typically expanded and affected the entire leaf, resulting in leaves withered and killed. An Alternaria sp. having conidia with prominent beaks and spores produced singly was consistently observed on and isolated from symptomatic leaf tissue. The conidia body was brown, ovoid, obclavate, muriform, and septate, with transverse and longitudinal septa that varied from 6 to 9 and 0 to 2, respectively, and its dimensions varied from 60 to 120 × 15 to 20 μm. The beaks were 10 to 70 × 3 to 6 μm and were filamentous, slender, and unbranched. Pure culture of the fungus was made from a single spore. DNA was extracted and used in an internal transcribed spacer (ITS) PCR used ITS1 and ITS4 primers. The PCR products were purified and sequenced. The sequences were used in BLAST searches to interrogate the GenBank for sequence similarity. High sequence similarity of 100% was obtained with Alternaria porri isolate AP-18. Based on the morphological and molecular characterization, the isolate was identified as A. porri (Ellis) Ciferri (GenBank Accession No. JX556683) (2). The pathogenicity of five isolates was investigated to demonstrate Koch's postulates. Forty 8-week-old seedlings of M. pruriens, without wounding on their leaves, were sprayed with the spore suspension (10⁵ spores per ml), prepared by using 10-day-old cultures of the isolates grown on potato dextrose agar at 28°C in the dark. Every plant was sprayed with 4 ml of spore suspension. The inoculated plants were incubated in a humid chamber for 48 h and then maintained in a greenhouse. After 5 to 7 days, leaf spots similar to those observed in the field developed on all inoculated plants. The pathogen was reisolated and identified as A. porri. Control plants sprayed with distilled water remained symptomless. The inoculation test was repeated and results were the same. Because A. porri was reported to infect plants of Allium spp and cause purple blotch, we also inoculated this isolate to small onion plants, and the symptoms of purple blotch appeared after 13 days at 25 to 28°C in a greenhouse. To our knowledge, this is the first report of leaf spot caused by A. porri on velvet bean in China. References: (1) R. Katzenschlager et al. J. Neurol. Neurosurg Psychiatry. 75:1672, 2004. (2) S. T. Koike and D. H. Henderson. Plant Dis. 82:710, 1998. (3) S. O. Majekodunmi et al. Asian Pac. J. Trop. Med. 4:632, 2011.

International migration in China: a survey of emigrants from Shanghai

"Migration trends have been largely unexamined in China, due to restrictive government policies and lack of data. This article presents the results of two surveys on emigrants from Shanghai, the largest source of emigrants and the only province with official migration records since 1958. Using information from the 1990 census, passport applications, and a survey of emigrant families in one city ward, the study concludes that migration policies, structural economic and social factors, and individual characteristics and needs shape migration patterns in Shanghai."