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Epithelial cysts run a high risk of recurrence and conversion to sheet-like ingrowth after surgical intervention. In this retrospective study, we introduced a modified iridectomy for treatment of secondary epithelial iris cysts (EICs) in the anterior chamber. Twenty-nine patients (29 eyes) aged 2–61 years received “open iridectomy” for EICs between April 1995 and July 2019. After viscodissection, most of the cyst wall was cut using a 20-gauge aspiration cutter via a 2.5-mm clear corneal incision. The residue closely adhering to the iris stroma was remained to avoid photophobia and diplopia. At 3 months, best corrected visual acuity was ≥ 20/100 in 55.5% (15/27, except two pediatric patients with poor cooperation) of patients. Among the eight patients suffering partial corneal edema preoperatively, six patients received surgery treatment at 3–6.5 months, and the cornea in the other two patients became transparent after medication. In a mean follow-up of 47.4 months, recurrence occurred in 3 patients at 7, 37, and 118 months, respectively. The percentage of treatment success was 96%, 87%, and 65% at 1, 5, and 10 years, respectively. “Open iridectomy” was effective for EICs, with a minimal invasion, less damage to the corneal endothelium, and a low recurrence rate.

A postcataract surgery complication in patients with retinitis pigmentosa (RP) is lens capsular contraction. To identify potential proteins contributing to this phenomenon, high-performance liquid chromatography/mass spectrometry-based proteomic analysis was conducted with aqueous humor samples collected from 11 patients who underwent cataract surgeries, with four patients diagnosed as RP and cataract (RP group) and the other seven with only senile cataract group. The upregulated proteins in the RP group were enriched in wound response, while downregulated proteins were enriched in cell adhesion and lens crystallins. Receptors of two dramatically upregulated proteins tenascin-C (TNC) and serotransferrin were found expressed in human lens epithelial cells (HLEs). TNC can promote primary HLEs proliferation and cell line HLE-B3 migration. This study indicates aqueous humor proteomic analysis serves as an effective way to unveil the pathogenesis of RP complications. TNC is a potential target of stimulating HLEs proliferation in RP concomitant cataract patients that worth further research.

BACKGROUND Extended-field (EF) bone marrow-sparing (BMS) radiotherapy is attracting interest for cervical cancer patients with para-aortic lymphadenopathy. OBJECTIVE To compare dosimetric quality of volumetric-modulated arc therapy (VMAT) vs. helical tomotherapy (HT) during EF BMS radiotherapy. METHODS HT dose-volume histogram parameters including (1) coverage, homogeneity, and conformity of target volumes, (2) sparing of organs-at-risk, (3) monitor units, and (4) estimated treatment time were compared with those of VMAT in 20 cervical cancer patients who underwent EF BMS radiotherapy. The pelvic and para-aortic regions received 45-Gy dose (25 fractions), with simultaneous integrated boost of 55 Gy (25 fractions) for pelvic and para-aortic lymphadenopathy, followed by a parametrial boost of 9 Gy (5 fractions). RESULTS The HT-based and VMAT techniques achieved adequate and similar target volume coverage with good dose homogeneity and conformity, while sparing all organs-at-risk, including the rectum, bladder, bowel, bone marrow, femoral head, kidney, and spinal cord. The HT treatment plan had significantly higher monitor units (p

BACKGROUND We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) with smoking cessation during curative chemoradiotherapy (CRT) had fewer complications and lower tumor progression risks. METHODS Sixty-three patients with nonmetastatic HNSCC who were smokers at diagnosis (carbon monoxide [CO] breath concentrations ≥3 ppm) and underwent curative CRT were prospectively enrolled. Successful smoking cessation throughout CRT was confirmed by CO breath concentrations

We investigated whether radiologic parameters by dynamic contrast-enhanced (DCE) integrated magnetic resonance–positron-emission tomography (MR-PET) predicts tumor response to treatment and survival in non-metastatic non-small-cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT). Patients underwent DCE integrated MR-PET imaging 1 week before CRT. The following parameters were analyzed: primary tumor size, gross tumor volume, maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), reverse reflux rate constant (kep), extracellular extravascular volume fraction (ve), blood plasma volume fraction (vp), and initial area under the time-concentration curve defined over the first 60 s post-enhancement (iAUC60). CRT responses were defined using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Thirty patients were included. Non-responders demonstrated higher baseline TLG (p = 0.012), and lower baseline Ktrans (p = 0.020) and iAUC60 (p = 0.016) compared to responders, indicating the usefulness of DCE integrated MR-PET to predict treatment responses. Receiver operating characteristic curve indicated that TLG has the best differentiation capability to predict responders. By setting the threshold of TLG to 277, the sensitivity, specificity, and accuracy were 66.7%, 83.3%, and 75.0%, respectively, with an area under the curve of 0.776. The median follow-up time was 19.6 (range 7.8–32.0) months. In univariate analyses, baseline TLG >277 (p = 0.005) and baseline Ktrans 277 remained the significant factor in predicting progression (p = 0.012) and death (p = 0.031). The radiologic parameters derived from DCE integrated MR-PET scans are useful for predicting treatment response in NSCLC patients treated with CRT; furthermore, these parameters are correlated with clinical and survival outcomes including tumor progression and death.

Background Angiogenesis assessment is important for personalized therapeutic intervention in patients with non-small-cell lung cancer (NSCLC). This study investigated whether radiologic parameters obtained by dynamic contrast-enhanced (DCE)-integrated magnetic resonance-positron emission tomography (MR-PET) could be used to quantitatively assess tumor angiogenesis in NSCLC. Methods This prospective cohort study included 75 patients with NSCLC who underwent DCE-integrated MR-PET at diagnosis. The following parameters were analyzed: metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax), reverse reflux rate constant (kep), volume transfer constant (Ktrans), blood plasma volume fraction (vp), extracellular extravascular volume fraction (ve), apparent diffusion coefficient (ADC), and initial area under the time-to-signal intensity curve at 60 s post enhancement (iAUC60). Serum biomarkers of tumor angiogenesis, including vascular endothelial growth factor-A (VEGF-A), angiogenin, and angiopoietin-1, were measured by enzyme-linked immunosorbent assays simultaneously. Results Serum VEGF-A (p = 0.002), angiogenin (p = 0.023), and Ang-1 (p Ktrans, and kep, showed strong linear correlations (p p = 0.004), MTV values (p kep values (p = 0.029) were significantly higher in patients with advanced-stage disease (stage III or IV) than in those with early-stage disease (stage I or II). Patients with initial higher values of angiogenesis-related MR-PET parameters, including MTV > 30 cm3 (p = 0.046), Ktrans > 200 10− 3/min (p = 0.069), and kep > 900 10− 3/min (p = 0.048), may have benefited from angiogenesis inhibitor therapy, which thus led to significantly longer overall survival. Conclusions The present findings suggest that DCE-integrated MR-PET provides a reliable, non-invasive, quantitative assessment of tumor angiogenesis; can guide the use of angiogenesis inhibitors toward longer survival; and will play an important role in the personalized treatment of NSCLC.

Background Cardiovascular magnetic resonance (CMR)–derived extracellular volume (ECV) requires a hematocrit (Hct) to correct contrast volume distributions in blood. However, the timely assessment of Hct can be challenging and has limited the routine clinical application of ECV. The goal of the present study was to evaluate whether ECV measurements lead to significant error if a venous Hct was unavailable on the day of CMR. Methods 109 patients with CMR T1 mapping and two venous Hcts (Hct0: a Hct from the day of CMR, and Hct1: a Hct from a different day) were retrospectively identified. A synthetic Hct (Hctsyn) derived from native blood T1 was also assessed. The study used two different ECV methods, (1) a conventional method in which ECV was estimated from native and postcontrast T1 maps using a region-based method, and (2) an inline method in which ECV was directly measured from inline ECV mapping. ECVs measured with Hct0, Hct1, and Hctsyn were compared for each method, and the reference ECV (ECV0) was defined using the Hct0. The error between synthetic (ECVsyn) and ECV0was analyzed for the two ECV methods. Results ECV measured using Hct1 and Hctsyn were significantly correlated with ECV0 for each method. No significant differences were observed between ECV0 and ECV measured with Hct1 (ECV1; 28.4 ± 6.6% vs. 28.3 ± 6.1%, p = 0.789) and between ECV0 and ECV calculated with Hctsyn (ECVsyn; 28.4 ± 6.6% vs. 28.2 ± 6.2%, p = 0.45) using the conventional method. Similarly, ECV0 was not significantly different from ECV1 (28.5 ± 6.7% vs. 28.5 ± 6.2, p = 0.801) and ECVsyn (28.5 ± 6.7% vs. 28.4 ± 6.0, p = 0.974) using inline method. ECVsyn values revealed relatively large discrepancies in patients with lower Hcts compared with those with higher Hcts. Conclusions Venous Hcts measured on a different day from that of the CMR examination can still be used to measure ECV. ECVsyn can provide an alternative method to quantify ECV without needing a blood sample, but significant ECV errors occur in patients with severe anemia.

Background The optimal adjuvant treatment for stage III endometrial cancer in the era of modern radiotherapy remains undefined. We investigated the benefit of adjuvant radiotherapy for women who underwent optimal resection for stage III endometrial cancer in the era of modern radiotherapy. Methods We retrospectively reviewed patients with endometrial cancer who were treated between 2010 and 2018. Adjuvant treatment included radiotherapy by modern radiotherapy techniques (intensity-modulated or volumetric modulated arc radiotherapy), chemotherapy, or both. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and analyzed via multivariate Cox proportional hazards models. Results One hundred sixty-one patients were initially included (52, 9, and 100 with stages IIIA, IIIB, and IIIC cancer, respectively); 154 patients (96%) received adjuvant therapy. Such adjuvant treatment was associated with improved RFS (p = 0.014) and OS (p = 0.044) over surgery alone. Adjuvant radiotherapy by modern radiotherapy techniques led to low incidence of acute (25%) and chronic (7%) grade ≥ 2 gastrointestinal toxicity. On univariate analysis, non-endometrioid histology and grade 3 status were associated with higher risks of tumor recurrence and death, whereas adjuvant radiotherapy alone or in combination chemotherapy reduced their risks. On multivariate analysis, non-endometrioid histology was associated with increased recurrence (hazard ratio [HR], 2.95; p = 0.009), whereas adjuvant radiotherapy alone or with chemotherapy was associated with lower recurrence (HR, 0.62; p = 0.042). Patients > 60 years of age (p = 0.038) as well as those with endometrioid histology (p = 0.045), lymphovascular space invasion (p = 0.031), and ≥ 2 positive lymph nodes (p = 0.044) benefited most from adjuvant radiotherapy. Conclusions Modern adjuvant radiotherapy (intensity-modulated or volumetric modulated arc radiotherapy) alone or with chemotherapy should be considered for women with optimally resected stage III endometrial cancer. Trial registration ClinicalTrials.gov, NCT04251676. Registered 24 January 2020. Retrospectively registered.

We evaluated the prognostic significance of immunologic inhibitory biomarkers in head and neck squamous cell carcinoma (HNSCC) patients undergoing definitive chemoradiotherapy (CRT). Thirty patients were prospectively enrolled. Plasma levels of soluble MHC class I polypeptide-related sequence A (sMICA) and transforming growth factor-β1 (TGF-β1) were measured before and 2 weeks after CRT. The median follow-up was 32.9 months (range: 12.4-40.6 months). The pre-treatment sMICA (p < 0.001) and TGF-β1 (p < 0.001) levels were significantly increased in HNSCC patients, compared to healthy controls. In HNSCC patients, the median pre-CRT and post-CRT sMICA levels were 43.1 pg/mL and 65.3 pg/mL, respectively, while the median pre-CRT and post-CRT TGF-β1 levels were 57.7 ng/mL and 36.0 ng/mL, respectively. After CRT, 19 patients (63.3%) exhibited persistently elevated sMICA, six patients (20.0%) exhibited persistently elevated TGF-β1, and five patients (16.7%) exhibited persistently elevated sMICA and TGF-β1. Patients with persistently elevated sMICA and TGF-β1 after CRT experienced an earlier tumor progression (p = 0.030), and poor overall survival (p = 0.010). Our results suggest that HNSCC patients who exhibit persistently elevated sMICA and TGF-β1 levels after CRT are at higher risk of tumor progression or death.

To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC).We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, KSBRT treatment led to tumor changes including significant decreases in the SUVIn patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome.2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:191-199.

Objective: This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Materials and Methods: Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Results: Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R 2 = 0.340, p = 0.023), RV stroke volume (R 2 = 0.406, p = 0.011), and RV cardiac output (R 2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. Conclusion: The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients. Index terms: Pulmonary hypertension; Chronic obstructive pulmonary disease; Emphysema; Right ventricular function

Since December 2009, after breast-conserving surgery for Stage 0–I cancer of the left breast, 21 women with relatively pendulous breasts underwent computed tomography prone and supine simulations. The adjuvant radiotherapy was 50 Gy in 25 fractions to the left breast alone. Four plans—conventional wedged tangents and forward intensity-modulated radiotherapy (fIMRT) in supine and prone positions—were generated. fIMRT generated better homogeneity in both positions. Prone position centralized the breast tissue by gravity and also shortened the breast width which led to better conformity in both planning techniques. Prone fIMRT significantly reduced doses to left lung, Level I and Level II axilla. The mean cardiac doses did not differ between positions. Among the four plans, prone fIMRT produced the best target dosimetry and normal organ sparing. In subgroup analysis, patients with absolute breast depth > 7 cm in the prone position or breast depth difference > 3 cm between positions had significant cardiac sparing with prone fIMRT. Sixteen patients with significant cardiac sparing in prone position were treated using prone fIMRT and the others using supine fIMRT. All patients received a supine electron tumor bed boost of 10 Gy in 5 fractions. No patients developed Grade 2 or worse acute or late toxicities. There was no difference in the number of segments or beams, monitor units, treatment time, or positioning reproducibility between prone and supine positions. At a median follow-up time of 26.8 months, no locoregional or distant recurrence or death was noted.

// Jenny Ling-Yu Chen 1,2 , Yu-Sen Huang 3,4 , Sung-Hsin Kuo 1,5 , Ruey-Long Hong 1 , Jenq-Yuh Ko 6 , Pei-Jen Lou 6 and Chun-Wei Wang 1 1 Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 2 Department of Radiation Oncology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan 3 Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Medical Imaging, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan 5 Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan 6 Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Correspondence to: Chun-Wei Wang, email: // Keywords : intensity-modulated radiation therapy; conformal radiation therapy; nasopharyngeal carcinoma; survival outcomes; late toxicities Received : May 23, 2016 Accepted : October 12, 2016 Published : October 18, 2016 Abstract Purpose: To examine the survival outcomes and late toxicity profiles of three-dimensional conformal radiation therapy (3DCRT) vs . intensity-modulated radiation therapy (IMRT) for patients with nasopharyngeal carcinoma (NPC). Methods: Three hundred and seventy-four patients with newly diagnosed, non-metastatic, NPC who were curatively treated with 3DCRT between 2004 and 2006 and 481 patients treated with IMRT between 2007 and 2009 were analyzed. Patients were categorized as having advanced-stage disease (stage III, IVA, and IVB disease; n = 709) or early-stage disease (stage I and II; n = 146). The median follow-up time was 90.3 months for patients treated with 3DCRT and 86.3 months for patients treated with IMRT. Results: For early-stage patients, the outcomes of IMRT vs . 3DCRT were similar considering locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS). For advanced-stage patients, IMRT was associated with better LRC compared with 3DCRT (5-year LRC rate: 85.6% vs . 76.6%, respectively; p = 0.035) and OS (5-year OS rate: 82.3% vs . 71.8%, respectively; p = 0.002), whereas DMFS was similar for both treatments (5-year DMFS rate: 80.9% vs . 79.0%, respectively; p = 0.324). Furthermore, the IMRT technique was more beneficial for patients with T4 disease. Late toxicities occurred more frequently in patients treated with 3DCRT than in those treated with IMRT (grade ≥3 neck fibrosis: 6.7% vs . 3.7%, respectively, p = 0.036; radiographic temporal lobe necrosis: 10.2% vs . 4.4%, respectively, p < 0.001). Conclusions: Compared with 3DCRT, IMRT offered better LRC in patients with advanced-stage non-metastatic NPC, which corresponded with better OS.

To evaluate the clinical, pathologic, and imaging findings of solid pseudopapillary neoplasm (SPN) of the pancreas in order to differentiate benign from malignant pancreatic neoplasms.We retrospectively identified 23 patients with 24 SPNs confirmed by pathology at National Taiwan University Hospital between January, 2001 and March, 2012. All computed tomography and magnetic resonance imaging were reviewed by two radiologists in consensus. Each tumor was analyzed for location of tumor, tumor margin, proportion of solid component, capsule morphology, growth pattern, presence of calcification, presence of upstream pancreatic duct dilatation, and enhancement pattern.SPN of the pancreas demonstrated variable degrees of hemorrhagic degeneration and calcification. Focal discontinuity of capsule was consistently observed in five malignant tumors (p = 0.004). There were no statistical differences between benign and malignant tumors based on location of tumor, tumor margin, proportion of solid component, growth pattern, presence of calcification, presence of upstream pancreatic duct dilatation, or enhancement patternAmong the various imaging features, we found that focal discontinuity of the capsule may suggest malignancy.

Two three-piece hydrophobic acrylic intraocular lenses (IOLs) were explanted from two patients at 7 and 9 years, respectively, after implantation, because of poor fundus visualisation and/or a clinically significant decrease in visual acuity related to their opacified IOLs. In addition to light microscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy, confocal laser scanning microscopy was used for the first time to observe the explanted IOLs. The clinical aspect seemed to correspond to the phenomenon of surface light scattering, while laboratory analyses showed dense glistenings in the central layer of the IOL optic, which had no change next to the surface. Further studies on these phenomena are needed.

To compare the clinical performances of patients in different ages with implantation of a accommodating IOLs.It was a retrospective study. Forty-seven eyes (47 patients) were enrolled in 3 groups for phacoemulsification and a accommodating IOL implantation. According to their ages, they were divided into 3 groups: ≤ 45 years, 46 - 59 years, and ≥ 60 years. Parameters analyzed after more than 3 months postoperation were uncorrected distance, best-corrected distance, uncorrected near, and distance-corrected near visual acuities; changes of anterior chamber depth(ACD) during accommodative measured using the ultrasound biomicroscopy (UBM);changes of ACD by instilling 2% pilocarpine using the A-ultrasonic scan; and the amplitude of accommodation using the pushing-up test.No significant difference was observed between distance and near visual acuities of IOL groups. The mean changes of ACD measured with UBM in the group of ≤ 45 years [(0.16 ± 0.12) mm] was significantly higher than the other age groups [46 - 59 years, (0.06 ± 0.06) mm, P = 0.00; ≥ 60 years, (0.07 ± 0.05) mm, P = 0.008)]. The mean changes of ACD stimulated by pilocarpine measured with A-ultrasonic scan in the group of ≥ 60 years [(0.17 ± 0.14) mm] was significantly lower than the other age groups [≤ 45 years, (0.68 ± 0.44) mm, P = 0.00; 46 - 59 years, (0.43 ± 0.20) mm, P = 0.00]. The accommodative amplitude of the ≥ 60 years groups ((2.32 ± 0.88) D) was lower than the group of ≤ 45 years [(2.87 ± 0.52) D, P = 0.005].The accommodative amplitude of patients implanted with accommodating IOLs stepped down following the increase of age. However, no statistical differences were found in distance and near visual acuities between the different age groups.

To analyze the cause of flexible open-loop anterior chamber intraocular lenses (AC-IOL) extraction and to evaluate the safety of these lenses implantation.This retrospective study comprised 28 patients (28 eyes) who had received open-loop AC-IOL extraction from 1999 to 2009 in our hospital. Several factors of these patients were analyzed, including the type of AC-IOL, primary disease, the intraocular duration of AC-IOL, the cause of AC-IOL extraction and therapeutic result.All of the AC-IOL used were modern flexible open-loop AC-IOL. Twenty one patients were implanted AC-IOL because of ocular trauma; the average intraocular duration of the AC-IOL was (6.1 ± 3.1) years. In the causes of AC-IOL extraction, bullous keratopathy was the most common cause, accounted for 42.9% (12/28); secondary glaucoma, retinal detachment and lens dislocation accounted for 32.1% (9/28), 17.9% (5/28) and 7.1% (2/28), respectively. In the 12 cases with bullous keratopathy, 6 cases just received AC-IOL extraction and the others received penetrate corneal transplantation. Six cases with secondary glaucoma received AC-IOL extraction combined with trabeculectomy.Bullous keratopathy and secondary glaucoma are the two most common causes for open-loop AC-IOL extraction. The patients who will receive AC-IOL implantation need an adequate selection and must be followed properly.

To study the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and determine the efficacy of reducing conjunctival bacteria with different methods.A total of 135 eyes of 135 patients scheduled to undergo cataract surgery were randomized into 3 groups (45 each). They received topical prophylactic treatment with three different kinds of antibiotics (0.5% levofloxacin, 0.3% levofloxacin and 0.3% tobramycin). Each group was randomized into one-day group and three-day group. All the eyes underwent irrigation of fornices with 2.5% povidone-iodine (PVI) before surgery. Conjunctival cultures were obtained at various time points.The total positive rate of conjunctival cultures was 66.7%. The eliminating rate of conjunctival bacteria in one-day groups were 72.7%, 72.7% and 61.1% (P = 0.667) while 70.0%, 70.0% and 55.5% in the three-day groups respectively (P = 0.751). Immediately after PVI irrigation, the eliminating rate in one-day groups added up to 86.4%, 77.3% and 88.9% (P = 0.564) as compared with 90.0%, 80.0% and 66.7% in the three-day groups respectively (P = 0.749). And there was no statistically significant difference between one-day groups and three-day groups in the eliminating rate of conjunctival bacterial after the topical antibiotic application. The MIC test revealed that the antibiotic sensitivity of Gram-positive cocci (G(+)C) to levofloxacin was 94.8% versus 74.1% to tobramycin (P = 0.000) while the antibiotic sensitivity of Gram-negative bacillus (G(-)B) to levofloxacin was 94.4% versus 83.3% to tobramycin (P = 0.289).G(+)C accounts for the most among the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and there is no statistically significant difference in the efficacy of reducing conjunctival bacteria between the application of topical antibiotic for one day and for three days. Both G(+)C and G(-)B retain a high sensitivity to levofloxacin. Topical antibiotic in combination with 2.5% PVI irrigation further reduces conjunctival bacteria.

To evaluate and compare the visual performance between the patients with the diffractive multifocal and monofocal intraocular lens (IOL).It was a prospective nonrandomized controlled study. Sixty-five patients (80 eyes) received phacoemulsification and IOL implantation were divided into two groups, 41 patients (50 eyes) in the multifocal group, and 24 patients (30 eyes) in the monofocal group. Three months or longer after surgery, the results of the uncorrected distance, intermediate and near vision; the best-corrected distance, intermediate and near vision; the intermediate and near vision after the distance vision corrected; the contrast sensitivity and the wave-front aberrations were recorded. The subjective visual performance after surgery was evaluated by the questionnaire. The chi-square test was applied to compare categorical variables, and the independent-samples t test was used to compare the measure data.The difference of the uncorrected distance, intermediate vision; the best-corrected distance, intermediate and near vision; intermediate vision after the distance vision corrected between the multifocal and monofocal groups was no statistical significance. The uncorrected near vision (0.82 +/- 0.20 vs 0.33 +/- 0.14, t = 8.99, P = 0.000) and the near vision after the distance vision corrected (0.83 +/- 0.17 vs 0.32 +/- 0.11, t = 9.83, P = 0.000) were statistically better in the multifocal group than the monofocal group. Photopic contrast sensitivity at high spatial frequency (18 c/d) and mesopic sensitivity with glare at medium frequency (6 c/d) was statistically lower in the multifocal group (P0.05). The total aberration and spherical aberration of the multifocal group were smaller than the monofocal group (t = 3.74, P = 0.00; t = 3.56, P = 0.00). The spectacle independent rate of multifocal and monofocal group were 70.73% (29/41) and 8.33% (2/24) respectively (chi(2) = 23.63, P = 0.00). The mild and moderate glare and halo were existent in both groups (chi(2) = 0.50, P = 0.78).Moderate visual disturbances were reported 24% (12/50) in the multifocal group and 26.67% (8/30) in the monofocal group.No serious glare and halo phenomenon were reported.Compared with the monofocal intraocular lens, the diffractive multifocal intraocular lens could provide a satisfactory recovery of vision function and good visual performance except the slight decrease of the contrast sensitivity.

To evaluate the long-term outcome in eyes had flexible open-loop anterior chamber intraocular lens (ACIOL) implantation.Cataract extraction with primary flexible open-loop ACIOL and anterior vitrectomy were performed in 34 eyes (group I), and secondary AC IOL implantation were performed in 49 eyes (group II). Visual acuity, intraocular pressure (IOP), corneal endothelial cell, anterior chamber angle and the presence of associated complication were examined in a mean follow up of 4.8 years (range 3 to 7 years).The final best correct visual acuity was 0.5 or better in 65 eyes (78.3%). The IOP were (13.55 +/- 3.21) mm Hg preoperatively and (13.40 +/- 4.29) mm Hg (1 mm Hg = 0.133 kPa) at the last follow-up (t = 0.5427, P = 0.5888). In group I, the corneal endothelial cell density were (2497 +/- 629)/mm(2) preoperatively, while at the last follow-up it was (1995 +/- 648)/mm(2) and the rate of endothelial cell loss was (20.6 +/- 14.1)%; In group II, the corneal endothelial cell density before and after operation was (2459 +/- 681)/mm(2) and (2238 +/- 817)/mm(2) respectively. The rate endothelial cell loss was higher in group I compared with group II (P = 0.023). Postoperative complication include transient secondary glaucoma caused by block of pupil in 4 eyes and remain of viscoelastic substance in 3 eyes, hypotension in 5 eyes, persistent glaucoma in 2 eyes, hyphema in 2 eyes, IOLs slightly dislocation and shift in 3 eyes, pupil deformation in 1 eye, retina detachment in 2 eyes, and corneal decompensation in 2 eyes.Flexible open-loop ACIOL is relatively safe and effective in selected cataract surgery. Postoperative complication could be reduced if operative indication and surgical technique were emphasized.

To investigate the reasons why patients suffering hypermature or mature cataract in the urban Qingdao city do not undergo cataract surgery in time.104 inpatients with mature or hypermature age-related cataract were interviewed with a questionnaire concerning medical, economic, social and psychological factors.The factors related with the surgery delay were medical factor 44.3%, economic factor 7.1%, social factor 20.7% and psychological factor 27.9%. In the lists of detailed reasons, 'cataract being not mature' ranked the first (17.1%), 'unaware of cataract' (14.3%) and "still able to see something" (10.0%) were followed. The history of cataract surgery, age, degree of education, the knowledge of cataract and individual income all played some roles in the delay of cataract surgery (P0.05).It is important to educate people about cataract knowledge and clarify the role of cataract surgery in order to convince patients to have cataract surgery done in time and improve life quality.

To introduce a grading system for corneal edema after phacoemulsification and to study the corneal endothelial damage and its repair after phacoemulsification.One hundred and five senile cataracts after phacoemulsification were included. Corneal edema was categorized into grades 0 to 4. Endothelial densities at various locations of the cornea were measured with specular microscopy before and three months after surgery.The corneal endothelial cell loss rate was 4.6%, 14.9%, 40.8%, 67.0% and 84.4% in eyes with corneal edema from grades 0 to 4, respectively. Time required for resolution of corneal edema was (2.1 +/- 0.7) days (grade 1), (5.6 +/- 1.9) days (grade 2) and (21.8 +/- 7.1) days (grade 3). The endothelial cell densities at superior, mid and inferior portions of the cornea were (2006 +/- 546) cells/mm(2), (1979 +/- 545) cells/mm(2) and (1754 +/- 543) cells/mm(2) respectively at 3 months after phacoemulsification. Postoperative endothelial cell loss at superior, mid and inferior portions of the cornea was (627 +/- 496) cells/mm(2), (656 +/- 492) cells/mm(2) and (1026 +/- 509) cells/mm(2) respectively. The difference in postoperative endothelial cell densities between the superior and inferior portions of the cornea was statistically significant (P = 0.017), so was the difference between mid and inferior portions of the corneas (P = 0.027). There was no statistically significant difference between the superior and mid portions of the cornea (P = 0.867).The grading system for corneal edema is helpful in evaluating the severity of endothelial damage after phacoemulsification and can be used to predict the outcome of the cornea. The major area of endothelial injury after phacoemulsification occurs at the inferior portion of the cornea.

To evaluate the result of surgery for senile cataract with Fuchs' endothelial dystrophy and emphasize the importance of the preoperative examination by specular microscopy.In the review of 2,026 consecutive senile cataract cases, 17 Fuchs' endothelial dystrophy cases were found before cataract surgery by specular microscopy. Operative procedures and corneal endothelial protective measures were recorded, and postoperative corneal transparency was observed. The examination of specular microscopy was performed 3 months after the cataract surgery.The incidence of Fuchs' endothelial dystrophy in senile cataract was 0.8% (17/2,026) in our study. The loss rate of endothelial cells was 16.2%. No bullous keratopathy occurred in all cases during follow-up period.Reasonable measures to protect the endothelium in the surgery by an experienced operator is helpful to the success of surgery. Observing the endothelium by specular microscopy before cataract surgery is very important.

A 45-year-old woman had an asymptomatic abnormality on a screening abdominal radiograph. The radiopaque mass in her right upper abdomen was surrounded by numerous "pearls" and resembled an abalone on the supine abdominal radiograph. We advised an additional upright abdominal radiograph, which showed a calcium fluid level. We also clarified the location of the cystic lesion at the right floating kidney, which changed its location between the supine and upright positions. Computed tomography of the abdomen revealed a right renal cyst with a calcium-fluid interface owing to the milk of calcium. The patient was then followed up without additional investigation or the need for intervention.

We aimed to evaluate the influence of mammographic breast density at diagnosis on the risk of cancer recurrence and survival outcomes in patients with invasive breast cancer after modified radical mastectomy. This case-control study included 121 case-control pairs of women diagnosed with invasive breast cancer between 2004 and 2009, and who had undergone modified radical mastectomy and had mammographic breast density measured before or at diagnosis. Women with known locoregional recurrence or distant metastasis were matched by pathological disease stage, age, and year of diagnosis to women without recurrence. Locoregional recurrence was defined as recurrence in the ipsilateral chest wall, or axillary, internal mammary, or supraclavicular nodes. The median follow-up duration was 84.0 months for case patients and 92.9 months for control patients. Patients with heterogeneously dense (50–75% density) and extremely dense (>75% density) breasts had an increased risk of locoregional recurrence (hazard ratios 3.1 and 5.7, 95% confidence intervals 1.1–9.8 and 1.2–34.9, p = 0.043 and 0.048, respectively) than did women with less dense breasts. Positive margins after surgery also increased the risk of locoregional recurrence (hazard ratio 3.3, 95% confidence interval 1.3–8.3, p = 0.010). Multivariate analysis that included dense breasts (>50% density), positive margin, no adjuvant radiotherapy, and no adjuvant chemotherapy revealed that dense breasts were significant factors for predicting locoregional recurrence risk (hazard ratio 3.6, 95% confidence interval 1.2–11.1, p = 0.025). Our results demonstrate that dense breast tissue (>50% density) increased the risk of locoregional recurrence after modified radical mastectomy in patients with invasive breast cancer. Additional prospective studies are necessary to validate these findings. The study is retrospectively registered with ClinicalTrials.gov, number NCT02771665 , on May 11, 2016.