[Triamcinolone acetonide deep fornix injection for the treatment of upper eyelid retraction in patients with thyroid-associated ophthalmopathy]

Objective: To evaluate the efficacy of triamcinolone acetonide deep fornix injection for the treatment of upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). Methods: Case-control study. A retrospective analysis was conducted on 64 eyes in 53 patients with upper eyelid retraction caused by TAO from October 2015 to December 2018. Thirty-nine eyes in 33 patients diagnosed with TAO with upper eyelid retraction were treated with triamcinolone acetonide deep fornix injection (20 mg), once per month until the therapeutic effect was stable, as the treatment group. Twenty-five eyes in 20 patients were not treated (the observation group). The ocular examination indexes of the two groups were compared. Paired t-test and independent sample t-test were used for statistical analysis. Results: There were 6 males and 27 females in the treatment group, aged (43±12) years, and 5 males and 15 females in the observation group, aged (40±13) years. There was no significant difference in gender, age, history and baseline ocular examination indexes between the two groups (all P>0.05). In the treatment group, the number of injections was (2.18±0.94) times (range, 1 to 5 times). After (6.74±3.89) months of follow-up, the marginal reflex distance (MRD1) was reduced from (6.85±0.88) mm to (4.38±1.04) mm, the score of quality of life in thyroid eye disease (TED-QOL) was reduced from 22.03±4.33 to 7.91±3.25, and the clinical activity score (CAS) was reduced from 2.82±0.39 to 0.97±0.39 (t=14.68, 21.36, 20.92; all P<0.01). There was no statistically significant difference in the degree of exophthalmos, intraocular pressure, the diameter of the rectus muscle measured by B-ultrasound before and after treatment (all P>0.05). After (8.65±5.15) months of follow-up, the eyelid retraction also improved in the observation group, but the improvement was more obvious in the treatment group. The differences of MRD₁, TED-QOL and CAS before and after treatment in the treatment group were (2.46±1.05) mm, 14.06±3.80 and 1.85±0.51 respectively, which were significantly higher than those before and after the follow-up in the observation group [(0.32±0.75) mm, 3.24±2.86 and 0.56±0.58, respectively; t=8.86, 11.90, 8.98; all P<0.01]. There was no recurrence in the two groups. In the treatment group, 5 patients (6 eyes) showed a transient intraocular pressure rise, which was controlled after medication; 3 women had menstrual changes. Conclusions: Deep fornix injection of triamcinolone acetonide for treating upper eyelid retraction is convenient and effective. It can significantly reduce symptoms and improve patients' quality of life. (Chin J Ophthalmol, 2020, 56:524-529).

Are Meniere's disease patients with otolith organ impairment more likely to have balance dysfunction?

Background: Patients with Meniere's disease (MD) may present with peripheral vestibular end organ dysfunction and balance dysfunction. Objective: This study aimed to compare the results of vestibular evoked myogenic potential (VEMP) tests with those of the sensory organization test (SOT) in patients with MD to determine whether they are correlated. Material and methods: In total, 132 patients with unilateral MD were evaluated using an audiometric test, the SOT, a caloric test and VEMP tests. Results: Cervical VEMP and ocular VEMP tests were conducted in 132 patients with MD, and the response rates of the affected side were lower than those of the unaffected side. The composite score, C5^ES, and C6^ES of the SOT were significantly decreased in patients with no VEMP responses compared to those with VEMP responses. Conclusions and significance: MD patients with no VEMP responses are more likely to develop balance impairment than those with VEMP responses. MD patients with otolith organ impairment may therefore have balance disorders, and should exercise caution to prevent falls and subsequent injuries.

[Etiology analysis and vestibular assessment of bilateral vestibular vestibulopathy]

Objective:To define clinical and laboratory characteristics of bilateral vestibulopathy(BVP) and to propose diagnostic criteria of this disorder based on clinical and laboratory vestibular function test findings.Method:Forty-two case series with a clinical suspicion of BVP were retrospectively analyzed, in an attempt to determine etiology. Presenting auditory-vestibular symptoms, bedside dynamic visual acuity tests and laboratory test were reviewed, including bithermal caloric test, rotatory chair tests, video head impulse test (vHIT), vestibular-evoked myogenic potentials (VEMP).Result:Among these 42 patients, dizziness was seen in 42 cases(100%), oscillopsia was seen in 21 cases(50%), hearing loss was seen in 30(71.4%). Eight cases(19%) had tinnitus. Twenty-five cases showed vestibular loss in dynamic visual acuity test (69.4%). Definite diagnosis of complete BVP was made in 36 patients when the patients showed abnormal findings on caloric test, rotatory chair test and vHIT in addition to the symptoms. Whereas probable diagnosis of partial BVP was obtained in 6 patients with abnormal caloric test and rotatory chair test but no pathological vHIT. VEMP (ocular or cervical) could be recorded in 20 patients. Fourteen cases were caused by ototoxic drugs while no causes could be determined in 6 cases among these 42 cases.Conclusion:The diagnosis of BVP is a challenge. Vestibular laboratory test battery which reflect full frequency function of VOR has great value to confirming the diagnosis and differentiate complete BVP to partial BVP. Diagnosis standard shall be made combining clinical history, characteristic symptoms and the results of auditory-vestibular function testing. Ototoxic drugs contribute most considering etiology.

[Horizontal semicircular canalvideo head impulse test in normaladults:normal value and age distribution]

Objective:To study the parameters of video head impulse test (vHIT) for horizontal semicircular canal and explore its application when evaluating angular vestibular-ocular reflex (VOR) in adults.Method:vHIT were applied to 80 adults without prior vertigo or dizziness history.Parameters provided by the software included instantaneous gain(40 ms,60 ms,80 ms),regression gain,asymmetry value,corrective saccades(latency,peak velocity,occurrence rate).Result:The mean horizontal VOR velocity gain of normal subjects was 0.877±0.171,0.944±0.133,0.967±0.130 at 40 ms,60 ms,80 ms respectively.Regression gain of horizontal VOR is 0.944±0.090.The lower limit of normal horizontal VOR velocity gain was 0.73 at 60 ms and 0.80 as regression gain.All velocity gains declined by age,although there were no statistically significant difference(P>0.05).Asymmetry value was 5.60±3.46.Corrective saccades occurred in 28±15 of normal subjects,while latency and peak velocity was (200.87±0.34)ms and (97.7±40.1)°/s.Conclusion:The study found that horizontal VOR instantaneous gain value and regression gain value decreases slightly with age,which should be considered in clinical application.

Prediction of digestible energy of feed ingredients for growing pigs using a computer-controlled simulated digestion system

The objectives of this experiment were to evaluate in vitro DE (IVDE) of selected feed ingredients using a computer-controlled simulated digestion system (CCSDS) and predict DE of ingredients for growing pigs. Samples of 6 ingredients with a wide range in energy and nutrient profile were collected. The CP and GE contents ranged from 9.9 to 50.9% and 4,493 to 4,841 kcal/kg (DM basis), respectively. Two control diets were formulated to achieve different CP contents (12.5 and 20.0%). Three experimental diets were formulated by replacing 20% of the high-CP control diet with corn, wheat, or wheat bran, whereas 3 additional diets were formulated by replacing 20% of the low-CP control diet with soybean meal, rapeseed meal, or cottonseed meal. The DE was determined using barrows (n = 24; initial BW = 35.9 ± 1.9 kg) in 2 periods with 6 observations per diet treatment and ranged from 2,769 to 4,368 kcal/kg. The equation for the DE content (kcal/kg of DM) using chemical components as independent variables was DE = 4,186 + 0.06 × CP + 79.33 × ether extract - 14.57 × NDF - 47.99 × ADF, with R(2) = 0.995, residual SD (RSD) = 89.5 kcal/kg, CV = 2.4%, and P = 0.10 (chemical component values; %). The IVDE ranged from 2,289 to 3,724 kcal/kg and was highly related to the determined DE content of the ingredients (R(2) = 0.91, RSD = 193 kcal/kg, and CV = 5.2%). The relationship between IVDE:GE and DE:GE was very high (R(2) = 0.93, RSD = 3.8%, and CV = 4.7%). The average values of CV for IVDE (0.75%) and IVDE:GE (0.73%) were less than that for determined DE (2.58%) and DE:GE (2.54%), respectively. In conclusion, the IVDE content determined, using a CCSDS with relatively high accuracy and acceptable repeatability, might be used to predict DE of feed ingredients for growing pigs.

Protection of branched-chain amino acids against ischemic myocardial injury in rats

The protective effects of Branched-Chain Amino Acids (BCAA) on ischemic myocardium in rats were studied. Thirty Wistar rats (15 female and 15 male) were randomly divided into 3 groups of 10 animals each. Group A: control; group B: isoproternol (ISO); group C: ISO + BCAA. The rats in groups A and B received normal synthetic rat chow while those in group C received BCAA as supplement. After two weeks of dietary treatment, the rats in group A were injected with saline while those of groups B and C were injected with ISO which induced acute ischemic myocardial injury. After 4 days of injections with either saline or ISO, the rats were sacrificed. The activities of lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), creatine kinase (CK), pyruvate kinase (PK) in the serum and in the myocardium, and the concentrations of potassium (K+), magnesium (Mg2+), calcium (Ca2+) in the myocardium were measured. The results showed that the activities of LDH, GOT, alpha-HBDH, CK, PK in the serum and in the myocardium were significantly increased in group B. In addition, the concentrations of Ca2+ in the myocardium were significantly increased. However, the concentrations of Mg2+ in the myocardium were substantially decreased while those of K+ in group B were slightly lowered. In the group C animals both the activities of LDH, alpha-HBDH, PK, CK in the serum and the activities of LDH, GOT, alpha-HBDH, CK in the myocardium were significantly lower than those of the rats in group B, and were not significantly different from those of the control group. More significant was the concentrations of Ca2+ in the myocardium of the rats in group C were comparable to those of the control rats but were significantly lower than those of the rats in group B. It appeared that BCAA was effectively blocking the increase of Ca2+ in the myocardium without raising the level of Mg2+. It was concluded that dietary supplement with BCAA provided some protective effects against ischemic myocardium in rats.

Comparative observation of the changes in serum lipid peroxides influenced by the supplementation of vitamin E in burn patients and healthy controls

A microfluorescence analytical method was used to determine the contents of serum lipid peroxides and vitamin E in 35 severely burned patients, among whom 18 had been given vitamin E, and in 113 healthy blood donors. A comparative survey showed that the serum vitamin E decreased most significantly from days 6 to 8 postburn in both groups of burned patients, while the concomitant serum lipid peroxides increased significantly and reached a peak value. In control patients, the serum vitamin E levels were lower and lipid peroxides higher than those of healthy people (P less than 0.05) from days 20 to 22 postburn. At this time in the vitamin E-treated patients, the serum vitamin E levels increased and lipid peroxides decreased to the levels of healthy people (P greater than 0.05). Therefore, appropriate supplementation with vitamin E in burn patients is necessary.

[Preliminary study on red cell immune adherence inhibitory activities in serums of myasthenia gravis patients]

The serum inhibitory activities on RBC-C3b receptor rosette of healthy individuals were studied in myasthenia gravis (MG) patients. The serum inhibitory activities appeared in 65% of MG patients. The serum inhibitory activities of generalized type MG were higher than those of ocular type MG. It was also found that the serum inhibitory activities were correlated with the RBC-C3b receptor rosette rate and immune complex (CIC). Furthermore, it was identified that the CIC of MG serums possessed the inhibitory activity on RBC-C3b receptor rosette.

[A preliminary study on immune complexes in myasthenia gravis]

The levels of circulating immune complex from 43 patients with myasthenia gravis (MG) and 50 normal controls were detected by using ELISA based on bovine conglutinin. The levels of circulating immune complex in MG patients were higher than those in normal controls (P less than 0.01). Although the levels of circulating immune complex in generalized type MG were higher than those in ocular type MG, the difference showed no statistically significant. It was found that the levels of circulating immune complex, both generalized type MG and ocular type MG, were higher than those in normal controls respectively (P less than 0.01).

[Clinicopathologic analysis of 487 thyroid tumors]

In this paper, 487 cases of thyroid tumor, 387 (79.5%) benign and 100 (20.5%) malignant, were analysed clinicopathologically. Benign thyroid tumor was divided into three types: papillary, follicular and atypical adenomas; malignant thyroid tumor into five types: papillary, follicular, undifferentiated, medullary and squamous cancers. In the benign variety, follicular adenoma had the highest incidence (98.2%) and in the malignant tumors, papillary cancer ranked first (62%). In this series, there were two cases of carcino-sarcoma. The sex ratio of male and female was 1:1.62 for the whole series, 1:1.70 for benign and 1:1.38 for malignant tumors. The peak age was 21 to 40 years with a median of 35 for benign and 31 to 50 years with a median of 43 for malignant tumors. For papillary carcinoma, the patients over 40 years of age comprised 50%. The typing of benign and malignant tumors is discussed. It is proposed that the occult cancer be classified according to histomorphology. Calcitonin by immunohistochemical technic or neural secretory granules by electron microscopy gives the most reliable evidence to diagnosis of the medullary carcinoma.

[Clinicopathologic study of 374 cases of intracranial tumors]

In this paper, 374 cases of intracranial tumor were studied retrospectively. The incidence of glioma (45.6%) was the highest, next was meningioma (19%) and pituitary tumor (12.3%). Astrocytoma comprised 73.5% of glioma. 75% of medulloblastoma and 54% of ependymoma occurred under 20 years of age, whereas 71.8% of meningioma, 44% of astrocytoma and 47.4% of metastatic tumor occurred between 21 to 50. The ratio of male and female was 1.69:1 except 0.8:1 of meningioma. 73.8% of all the lesions was located above the tentorium of cerebellum, the rest under it. Ninety one cases were followed. The 5 year survival rate was 25.3% (23/91). According to Kernohan's classification, the authors believe that astrocytoma can be divided into four grades, which is of great use in clinical diagnosis and prognosis. The other gliomas are only divided into benign and malignant. The results of surgery are related to tumor type and differentiation. Pituitary adenoma, meningioma, neurilemmoma and astrocytoma grades I and II have a good result by operation, while medulloblastoma, astrocytoma grades III and IV and metastatic cancer have a higher mortality.