Corrigendum: Use of autologous cord blood mononuclear cells infusion for the prevention of bronchopulmonary dysplasia in extremely preterm neonates: a study protocol for a placebo-controlled randomized multicenter trial [NCT03053076]

[This corrects the article DOI: 10.3389/fped.2020.00136.].

[Clinical and experimental study of late postoperative opacification of hydrophilic acrylic intraocular lenses]

Objective: To analyze the cause of late postoperative opacification of hydrophilic acrylic intraocular lenses (IOLs) and the effect of IOL replacement surgery. Methods: This retrospective case series study comprised 15 eyes of 15 patients who were diagnosed as late postoperative opacification of hydrophilic acrylic IOLs from January 2019 to June 2020 at Qingdao Eye Hospital of Shandong First Medical University. The clinical data of patients were reviewed, and two IOLs were examined by scanning electron microscopy and energy dispersive X-ray spectroscopy. The intraoperative and postoperative complications of IOL replacement surgery were evaluated, and best corrected visual acuity was compared before and after surgery. Preoperative and postoperative data were compared using the paired t test. Results: The interval between the first IOL implantation and the detection of IOL opacification in 15 patients was (27.3±5.9) months. All the 15 patients had unilateral IOL opacification, and 9 patients had hypertension. Glycosylated hemoglobin A1c was significantly higher than the normal value in 4 of the 10 patients who underwent cataract surgery at our hospital. Confocal microscopy disclosed coralliform deposits on the superficial IOL optic. Scanning electron microscopy and energy dispersive X-ray spectroscopy showed the presence of calcium and phosphorus crystals in the opacification region of IOLs. Visual acuity in all 13 eyes receiving IOL exchange was significantly improved from 1.03±0.64 (logarithm of the minimum angle of resolution) to 0.39±0.21 (P<0.05). Posterior capsule rupture (4 eyes), new IOL implanted in the ciliary sulcus (3 eyes) and zonule breaking (1 eye) occurred during IOL replacement. Conclusions: IOL opacification is related with the IOL material and calcium ion concentration on the IOL surface. IOL replacement surgery can improve visual acuity safely and effectively. (Chin J Ophthalmol, 2021, 57: 512-518).

Use of Autologous Cord Blood Mononuclear Cells Infusion for the Prevention of Bronchopulmonary Dysplasia in Extremely Preterm Neonates: A Study Protocol for a Placebo-Controlled Randomized Multicenter Trial [NCT03053076]

Background: Despite the rapid advance of neonatal care, bronchopulmonary dysplasia (BPD) remains a significant burden for the preterm population, and there is a lack of effective intervention. Stem cell depletion because of preterm birth is regarded as one of the underlying pathological mechanisms for the arrest of alveolar and vascular development. Preclinical and small-sample clinical studies have proven the efficacy and safety of stem cells in treating and preventing lung injury. However, there are currently no randomized clinical trials (RCTs) investigating the use of autologous cord blood mononuclear cells (ACBMNC) for the prevention of BPD in premature infants. The purpose of this study is to investigate the effects of infusion of ACBMNC for the prevention of BPD in preterm neonates <28 weeks. Methods: In this prospective, randomized controlled double-blind multi-center clinical trial, 200 preterm neonates <28 weeks gestation will be randomly assigned to receive intravenous ACBMNC infusion (5 × 107 cells/kg) or placebo (normal saline) within 24 h after birth in a 1:1 ratio using a central randomization system. The primary outcome will be survival without BPD at 36 weeks of postmenstrual age or at discharge, whichever comes first. The secondary outcomes will include the mortality rate, other common preterm complication rates, respiratory support duration, length, and cost of hospitalization, and long-term outcomes after a 2-year follow-up. Conclusion: This will be the first randomized, controlled, blinded trial to evaluate the efficacy of ACBMNC infusion as a prevention therapy for BPD. The results of this trial will provide valuable clinical evidence for recommendations on the management of BPD in extremely preterm infants. Clinical Trial Registration: ClinicalTrials.gov, NCT03053076, registered 02/14/2017, retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0006WN4&selectaction=Edit&uid=U0002PLA&ts=2&cx=9y23d4 (Additional File 2).

[Advances and clinical application of lens regeneration in mammal]

Regeneration of the lens is an ideal strategy for cataract patients to restore their adjustable vision and to acquire excellent visual quality. However, mammalian lens regeneration is slow and incomplete, and functional lens regeneration cannot be achieved. The ability of lower amphibians (such as newts) to regenerate the lens provides the impetus for research on the regeneration of the lens of mammal. At present, the main form of mammalian lens regeneration is the differentiation of lens epithelial cells by capsular bag as a scaffold. In recent years, the continuous development of stem cell technology, tissue engineering and biological materials have made great progress in lens regeneration. This article describes the processes in the normal development of the lens, and reviews the research results of lens regeneration at home and abroad, and discusses the possibility of the new techniques and methods related to regenerative medicine applied to lens regeneration. It is hoped to help in the realization of rapid and complete regeneration of functional lens.(Chin J Ophthalmol, 2019, 55: 549-553).

[Analysis of prognostic factors in patients with refractory sudden sensorineural hearing loss]

Objective:To explore the relationships between glucocorticoid (GC) sensitivity and the prognosis of refractory sudden sensorineural hearing loss (SSNHL), and to analyze the related factors being affected the prognosis of SSNHL. Method:Ninety-one refractory SSNHL patients were enrolled in the present investigation. Peripheral blood mononuclear cells (PBMCs) from the refractory SSNHL were extracted to conduct GC proliferation dexamethasone (DEX) inhibition experiments. All patients accepted comprehensive treatment with methylprednisolone. Result:Total effective rate was 40.66% in refractory SSNHL patients. Gender, number of affected ear, age, accompanying with vertigo, tinnitus or not and the procedure of methylprednisolone treatment were irrelevant to the efficacy. Only the inhibitory rate of DEX and the time from onset to visit were related to GC treatment effect, especially for inhibitory rate of DEX. The DEX inhibition rate of the effective group was higher than that of the ineffective group. Conclusion:DEX inhibition rate can predict GC sensitivity and prognosis of SSNHL. GC sensitivity and the time from onset to treatment are two important factors affecting the prognosis of refractory SSNHL patients..

[Experiences of second type Ⅰ tympanoplasty]

Objective:To analyze the failure reasons of the typeⅠtympanoplasty and to summarize the successful experiences of the reoperation. Method: A retrospective clinical study of 42 patients undergoing second type Ⅰtympanoplasty in the ENT department of Nanjing Drum Tower Hospital from 2007 to 2017 was performed. By reviewing the perioperative clinical data and by following up the patients for 3 months to summarize the failure reasons of the first tympanoplasty and successful experiences of the second tympanoplasty. Result:All of the 42 patients received second tympanoplasty under general anesthesia using the post auricular approach, harvesting the temporalis fascia as the graft material, enlarging the external canal to optimize of the operation vision and using underlay tympanoplasty technique. During the operation calcification was found in 12 cases, tympanosclerosis in 6 cases, handle of malleus attached to promontorium tympani in 7 cases, and remnant tympanic membrane adhered to promontorium tympani in 10 cases. Three months after the second tympanoplasty all of the perforations were closed. The air-bone gap(ABG) between 0.5-4.0 kHz before and after the second tympanoplasty were(26.4±8.7) dB HL and(14.0±7.3) dB HL, respectively. The difference is statistically significant(P=0.000). ABG less than 20 dB HL was found in 35 cases (83.3%) after the second tympanoplasty. Conclusion:Type Ⅰtympanoplasty is a delicate operation. Poor surgical outcomes of the first operation were due to inadequate exposure, mucosal lesion of the promontory, and inadequate gelatin sponge filling in the middle cavity. Post auricular approach, enlarged and straight external canal could optimize the operation vision, resolve the adhesion of the tympanum easily and acquire the adequate anterior overlap, which are benefit for success closure of the perforation and better hearing after surgery.

[Clinical observation on the effect of glucocorticoid insensitivity on sudden sensorineural hearing loss patients]

Objective: To investigate the correlation between the proliferation inhibition effect of glucocorticoid (GC) on peripheral blood mononuclear cell (PBMC) and the pure tone average (PTA) improvement in SSNHL patients. Methods: Sixty inpatients with SSNHL were included from July 2013 to October 2015 in Nanjing Drum Tower Hospital, Medical School of Nanjing University. Peripheral venous blood was collected before receiving treatment, then the PBMC was isolated for GC proliferation inhibition. PBMCs of each patient were cultivated into 4 groups: Group A: PBMCs+ Medium; Group B: PBMCs+ Medium+ lipopolysaccharide (LPS, 1 μmol/L); Group C: PBMCs+ Medium+ LPS+ Dexamethasone; Group D: Medium. PBMCs were maintained in a humidified 5% CO(2) atmosphere at 37°C and were observed after 24 hours. 5-diphenyltetrazolium bromide (MTT) was used to measure PBMC proliferation inhibition rate. The PBMC proliferation inhibition rates were calculated according to the absorbance at 490 nm wavelength under a microtiter plate reader. Independent sample t tests of PBMC proliferation inhibition rate were performed between different groups. χ(2) tests were performed between gender, affected ear side, accompanied by vertigo or not, audiometric curve, time period from onset to treatment, PBMC proliferation inhibition rate and the improvement of pure tone average (PTA). Linear correlation analyses were performed between PBMC proliferation inhibition rate, the time period from onset to treatment and the hearing improvement. Results: The proliferation inhibition effect of GC on PBMC varied significantly among patients. The PBMC proliferation inhibition rate in GC insensitive group was lower than that in GC sensitive group (26.72%±21.82% vs 64.44%±25.48%, t=6.113, P<0.05). The PBMC proliferation inhibition rate in refractory group was lower than that in initial group (40.93%±28.57% vs 57.04%±31.19%, t=2.035, P=0.046). There was no statistical significance between gender, affected ear side, accompanied by vertigo or not, audiometric curve and the hearing improvement (χ(2) value was 2.320, 0.031, 2.143, 0.106, respectively, all P>0.05). Both in initial group and refractory group, the linear correlation analyses showed a significant positive correlation between PBMC proliferation inhibition rate and the PTA improvement (r value was 0.615, 0.657, respectively, all P<0.05), as well as a significant negative correlation between time period from onset to treatment and the PTA improvement(r value was -0.542, 0.370, respectively, all P<0.05). Conclusions: The proliferation inhibition rate of PBMC in vitro by GC is correlated with patients' hearing improvement. The proliferation inhibition test might be used to predict the sensitivity to GC treatment and be helpful for individualized treatment of SSNHLin clinical practice.

Diaper dermatitis: a survey of risk factors for children aged 1-24 months in China

OBJECTIVES

To measure the prevalence of diaper dermatitis and identify risk factors relating to diaper dermatitis in Chinese children aged 1-24 months.

METHODS

This was a cross-sectional study that used structured questionnaires during face-to-face interviews with parents to determine the risk factors associated with diaper dermatitis. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and 15 potential risk factors.

RESULTS

A total of 43.8% (454/1036) of infants in the study had experienced diaper dermatitis in the 6 weeks prior to enrolment. Multivariate logistic regression analyses showed that the risk of diaper dermatitis was significantly decreased by solid foods (eggs), home location (urban) and frequency of diaper changing (≥ 6 changes/day), whereas the risk was increased by diarrhoea.

CONCLUSIONS

Diarrhoea was a major risk factor for diaper dermatitis. Confirmation of the risk factors could lead to better understanding of the aetiology of diaper dermatitis and to new prevention strategies in Chinese infants.

A clinical study on insomnia in patients with cancer during chemotherapy containing high-dose glucocorticoids

In this prospective, open-labeled study, 240 cancer patients were assigned to either a high-dose glucocorticoids (HDG) group that received chemotherapy containing HDG, or a control group that received chemotherapy without glucocorticoids. The Pittsburgh Sleep Quality Index (PSQI) was chosen to assess insomnia. The results of the study showed that dimensions of sleep latency, sleep duration, and sleep efficiency had the three largest differences in values and numbers of patients, with a score increase in the HDG group compared to the control group (p < 0.001). After chemotherapy in the HDG group, the PSQI score significantly increased in patients with stage II cancer (both p < 0.05), and patients diagnosed with lymphoma (p < 0.01), whereas the complete response and partial response rates (p < 0.05) had the smallest elevations. The average score of each dimension did not significantly decrease after hypnotics (p > 0.05). Our study suggests that the major clinical manifestations of insomnia in cancer patients receiving chemotherapy containing HDG include difficulty falling asleep, short sleep duration, and low sleep efficiency. however, we cannot definitively state that hypnotics can improve poor sleep quality.

Age determination of plutonium material by alpha spectrometry and thermal ionization mass spectrometry

Age is a key parameter to deduce the history of a plutonium material. An experimental method using both alpha spectrometry and thermal ionization mass spectrometry has been developed for the age determination of plutonium material. This method is based on the parent/daughter pair 241Pu/241Am ratio and has been validated using several plutonium source of known age. The results obtained are in good agreement with the last purification date of plutonium source.

Possible effects of the Three Gorges dam on the transmission of Schistosoma japonicum on the Jiang Han plain, China

The Three Gorges dam, under construction on the Yangtze River in China, might affect the transmission of Schistosoma japonicum on the Jiang Han plain, which is downstream of the dam. To study this possibility, the prevalence of schistosomiasis was investigated in relation to a range of malacological, hydrological and meteorological factors. The general water level in the Yangzte over a year had a marked effect on the distribution of the intermediate host (Oncomelania hupensis) and the prevalence of human schistosomiasis in that year. Disease prevalence showed significant correlations with the density of the snail hosts, the level of the water table, annual rainfall, yearly evaporation, and altitude. Once the dam is complete, the flow of water downstream will probably be maintained at a level between those currently occurring in flood and dry weather, and this may have implications for schistosome transmission. Systematic monitoring is necessary to investigate the impact of the environmental changes brought about by the dam on transmission.

[Reconstruction acusticus back wall and tympanoplasty with homograft costal cartilage]

OBJECTIVE

To eliminate the back wall defect of external canal and opened mastoid cavity which was remained from radical mastoidectomy.

METHOD

We performed the operation on 17 cases after radical mastoidectomy by using reconstruction of the canal wall and fill-in opened mastoid cavity and ossicular replacement prostheses made of homograft costal cartilage. The tympanoplasty had been made operated for all patients, 8 ears were PORP, the others were TORP.

RESULT

All cases were followed-up for 6 months-2 years. The external canal of all patients are normal in appearance. The total effective rate of gain (> 15 dB) was 14 ears (82.4%). Only one patient whose tympanic membrane was perforated postoperation 3 months.

CONCLUSION

Reconstruction of acusticus back wall and hearing after radical mastoidectomy with homograft costal cartilage is effective to prevent mastoid cavity infection and improve hearing.

Impact of environmental change and schistosomiasis transmission in the middle reaches of the Yangtze River following the Three Gorges construction project

With the construction of the Three Gorges high dam on the Yangtze River in China in mind, a serious of ecological environmental factors that might affect the transmission of Schistosoma japonicum in Jian Han Plain were investigated by means of data collection, field surveys and observation in Hubei Province. Several ecological factors including water level of the Yangtze River; riparian water table, annual rainfall and yearly evaporation were investigated in relation to the prevalence of schistosomiasis. The results suggest that after the dam construction, middle water level flows (ie between flood flows and dry-weather flows) will persist in the flood season due to a rise in the water table. The investigation indicated that snail distribution and human schistosomiasis prevalence differed significantly between years which had typically high, middle and low typical water levels in the Yangzte. Moreover, the prevalence of the disease showed a significant linear regression relationship with density of snail intermediate hosts, water table, annual rainfall, yearly evaporation and ground altitude in the survey area. Systematic and careful monitoring and surveillance is necessary to investigate the impact of the environmental changes brought about by the dam construction on schistosomiasis transmission.

Patterns and determinants of use of antibiotics for acute respiratory tract infection in children in China

BACKGROUND

Use of antibiotics for acute respiratory infection (ARI) of presumed viral etiology is a worldwide problem. The World Health Organization (WHO) has provided guidelines for diagnosis and treatment of ARI for developing countries.

METHODS

Specially trained observers applied the WHO criteria to study the diagnosis and treatment of ARI given by 100 randomly selected health care workers (HCWs) in a rural county in China. A total of 750 cases of ARI were evaluated.

RESULTS

Before the parents sought medical care, 47% of children in the county hospitals, 25% of those in the townships and 18% of those in the villages had already received antibiotics, available without prescription. Among the HCWs antibiotic abuse (antibiotics for presumably viral disease) was detected in the treatment of 97% of cases, and severe abuse (such as prescription of two incompatible antibiotics) was detected in 37%. Most (197 of 200) patients with bacterial disease received antibiotics, but inappropriate antibiotic treatment (dose or type) was observed in 63% of these cases. HCWs with university training and those with higher test scores on knowledge and attitude prescribed antibiotics more judiciously than those lacking those attributes.

CONCLUSIONS

Abuse of antibiotics for ARI is a serious and costly problem in rural China, potentially leading to widespread antibiotic resistance. Educating HCWs in the management of ARI and proper use of antibiotics has high priority in China.

Serial thallium-201 imaging after dipyridamole for coronary disease detection: quantitative analysis using myocardial clearance

After dipyridamole, canine studies have demonstrated a slower rate of myocardial thallium-201 clearance from zones distal to a coronary artery stenosis compared to normal zones. To determine if criteria based on canine myocardial thallium-201 clearance rates could be applied clinically, 40 patients with and 26 patients without coronary artery disease (CAD) had serial thallium-201 images obtained for 2 to 5 hours after dipyridamole. Regions of interest were manually placed over six left ventricular segments in two projections for each of three imaging times. The myocardial thallium-201 clearance rate was calculated for each of the six segments and, using the clearance rate criterion found in canine studies, was considered abnormal if less than 6.5%/hr. Using this criterion alone, 22 of 26 patients (85%) without CAD had normal and 30 of 40 patients (75%) with CAD had abnormal myocardial thallium-201 clearance rates. A quantitative analysis of regional inhomogeneity in tracer distribution (normal was greater than or equal to 25% difference between segments) was negative in 24 of 26 patients (92%) without CAD and positive in 20 of 40 patients (50%) with CAD. When both clearance rate and regional inhomogeneity were considered, 21 of 26 patients (81%) without CAD had negative and 36 of 40 patients (90%) with CAD had positive results. Thus, post-dipyridamole myocardial clearance rate criteria derived from canine studies can be applied to clinical thallium imaging. Quantitative analysis of serial thallium-201 images after dipyridamole is optimized by using myocardial thallium-201 clearance rates. Such an approach is independent of regional inhomogeneities in tracer distribution.

Significance of increased lung thallium-201 activity on serial cardiac images after dipyridamole treatment in coronary heart disease

Increased lung thallium-201 (Tl-201) activity occurs in patients with severe coronary artery disease (CAD) on initial postexercise images. To determine the significance of assessing lung Tl-201 on serial imaging after dipyridamole therapy, initial and delayed (2 to 3 hours) Tl-201 imaging was performed in 40 patients with CAD and 26 normal control subjects. Lung Tl-201 activity was quantitated as a percentage of maximal myocardial activity for each imaging time (lung Tl-201 index). The mean initial lung Tl-201 activity was 42 +/- 2% (+/- standard error of the mean) in 26 control subjects, 56 +/- 2% in 25 patients with 2- or 3-vessel CAD (p less than 0.001) and 53 +/- 2% in 15 patients with 1-vessel CAD (p less than 0.005 compared with control subjects) (difference not significant between 1-vessel and multivessel CAD). Dipyridamole lung Tl-201 activity decreased relative to the myocardium from initial to delayed images (p less than 0.001) in patients with CAD but not in control subjects. When a dipyridamole lung Tl-201 index of 58% (mean +/- 2 standard deviations for control subjects) was chosen as the upper limit of normal, 14 of 40 of the CAD patients (35%) had abnormal values and all control patients had values within normal limits. These 14 patients with CAD and abnormal initial lung Tl-201 indexes had rest ejection fractions that were not significantly different from those in patients with CAD, and normal initial dipyridamole lung Tl-201 index (58 +/- 4% and 63 +/- 2%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)