Dry eye rate and its relationship with disease stage in patients with primary hypertension:a cross-sectional study in Vietnam

AIM:To determine the dry eye(DE)rate and its relationship with disease stage in patients with primary hypertension.METHODS:A cross-sectional study included 432 patients with primary hypertension(with an equal number of patients in each group:144 in stage Ⅰ,Ⅱ,and Ⅲ hypertension)and 144 healthy subjects as a control group.The Ocular Surface Disease Index(OSDI)and Schirmer Ⅰ test without anesthetics were conducted on all 576 subjects.Subjects with OSDI scores<13 and Schirmer Ⅰ values equal to or under 10 mm were diagnosed with DE.RESULTS:The ratio of DE in hypertension patients was higher than in the control group(41.7%versus 18.8%;P<0.001).The proportion of patients with DE increased gradually according to the hypertension stage:27.1% in stage Ⅰ,40.3% in stage Ⅱ,and 57.6% in stage Ⅲ,P<0.001.Age,duration of hypertension,plasma urea,creatinine,and high-sensitivity C-reactive protein(CRP-hs)levels in hypertension patients with DE were higher than those without DE,P<0.001.Advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma creatinine,and CRP-hs levels were independent factors associated with DE in primary hypertension patients,P<0.001.CONCLUSION:DE is a common disorder associated with advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma CRP-hs,and creatinine levels in patients with primary hypertension.

Recent advances in promising drugs for primary prevention of gastroesophageal variceal bleeding with cirrhotic portal hypertension

Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.

Intracranial hypertension as the primary symptom of malignant melanoma:A case report

BACKGROUND The etiological diagnosis of intracranial hypertension is quite complicated but important in clinical practice.Some common causes are craniocerebral injury,intracranial space-occupying lesion,subarachnoid hemorrhage,and hydrocephalus.When a patient presents with intracranial hypertension,the common causes are to be considered first so that other causes would be dismissed.With the morbidity lower than 9%,neuromelanin is very rare.Common symp-toms include nerve damage symptoms,epilepsy,psychiatric symptoms,and cognitive disorders.CASE SUMMARY We present a patient with melanoma which manifested with isolated intracranial hypertension without any other neurological signs.A 22-year-old male had repeated nausea and vomiting for 2 mo with Babinski sign(+)on both sides,nuchal rigidity,and subarachnoid hemorrhage.He had been diagnosed with melanoma and was given surgery and whole-brain radiation.Ultimately,the patient died 2 mo later.CONCLUSION Malignant melanoma should be taken into consideration in the differential diagnosis of intracranial hypertension.

Acute upper gastrointestinal bleeding due to portal hypertension in a patient with primary myelofibrosis:A case report

BACKGROUND Acute upper gastrointestinal bleeding is a common medical emergency that has a 10%hospital mortality rate.According to the etiology,this disease can be divided into acute varicose veins and nonvaricose veins.Bleeding from esophageal varices is a life-threatening complication of portal hypertension.Portal hypertension is a clinical syndrome defined as a portal venous pressure that exceeds 10 mmHg.Cirrhosis is the most common cause of portal hypertension,and thrombosis of the portal system not associated with liver cirrhosis is the second most common cause of portal hypertension in the Western world.Primary myeloproliferative disorders are the main cause of portal venous thrombosis,and somatic mutations in the Janus kinase 2 gene(JAK2 V617F)can be found in approximately 90% of polycythemia vera,50% of essential thrombocyrosis and 50% of primary myelofibrosis.CASE SUMMARY We present a rare case of primary myelofibrosis with gastrointestinal bleeding as the primary manifestation that presented as portal-superior-splenic mesenteric vein thrombosis.Peripheral blood tests revealed the presence of the JAK2 V617F mutation.Bone marrow biopsy ultimately confirmed the diagnosis of myelofibrosis(MF-2 grade).CONCLUSION In patients with acute esophageal variceal bleeding due to portal hypertension and vein thrombosis without cirrhosis,the possibility of myeloproliferative neoplasms should be considered,and the JAK2 mutation test should be performed.

Relevant detection indicator of prethrombotic state in patients with primary hypertension

BACKGROUND Hypertension is a common chronic disease that affects many people worldwide.Only a few reports related to the exploration of relevant indicators of the prethrombotic state in patients with primary hypertension(PH)in clinical settings were available.AIM To detect prethrombotic state-related indicators in patients with PH and analyze their differences in different patient populations to provide a laboratory basis for the clinical prevention and control of hypertensive thrombotic diseases.METHODS The general data of patients with PH who attended the Department of Cardiovascular Medicine,The First Affiliated Hospital of Jiangxi Medical College,from January 2022 to December 2022 were collected retrospectively.The patients were divided into three groups of 40 patients each according to the Grade of PH:Grade 1,Grade 2,and Grade 3 hypertension experimental group.The baseline data of 40 volunteers,who underwent physical examination in our hospital but were not diagnosed with PH during the same period,were included in the control group.The relevant indicators of prethrombotic state of the participants were compared,and mainly included inflammation-related indicators,hemorheology-related indicators,and coagulation function related indicators.The relationship between the aforementioned indicators and the progression of PH was analyzed.RESULTS No significant differences were observed in age,sex,diabetes mellitus,smoking history,drinking history,body mass index,New York Heart Association functional classification,or the course of hypertension among the four groups(P>0.05).The expressions of high-sensitivity C-reactive protein(hs-CRP),thrombomodulin(TM),hematocrit(Hct),erythrocyte sedimentation rate(ESR),P-selectin on platelet surface(CD62P),and fibrinogen(FIB)in the control group were<Grade 1 hypertension group<Grade 2 hypertension group<Grade 3 hypertension group,and the expressions of platelet(PLT),activated partial thromboplastin time(APTT),prothrombin(PT),and plasma thrombin time(TT)in the control group was>Grade 1 hypertension group>Grade 2 hypertension group>Grade 3 hypertension group,and the difference was statistically significant(P<0.05).The results of the multivariate logistic regression model showed that the expression of hs-CRP,TM,Hct,ESR,CD62P,PLT,APTT,PT,TT,and FIB in the included participants was related to the progression of PH.Among these,high expression of hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT,and low expression of PLT and FIB were risk factors for PH(OR>1,P<0.05).The results of the receiver operating characteristic curve analysis showed that the area under the curve of hs-CRP,TM,ESR,CD62P,APTT,PT,TT,and FIB for the prediction of PH were>0.80,and the prediction value was ideal.Linear correlation analysis with bivariate Spearman showed that hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT were positively correlated with each other(r>0,P<0.05);PLT and FIB were negatively correlated with hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT(r<0,P<0.05);and PLT and FIB were positively correlated(r>0,P<0.05).Linear correlation analysis using bivariate Spearman showed that hs-CRP,TM,Hct,ESR,CD62P,and FIB were positively correlated with each other(r>0,P<0.05),whereas PLT,APTT,PT,and TT were negatively correlated with hs-CRP,TM,Hct,ESR,CD62P,and FIB(r<0,P<0.05).There was a positive correlation between PLT,APTT,PT,and TT(r>0,P<0.05).CONCLUSION The relevant indicators of the prethrombotic state in patients with PH,such as hs-CRP,TM,Hct,ESR,CD62P,PLT,APTT,PT,TT,and FIB,showed differences.High expression of hs-CRP,TM,Hct,ESR,CD62P,and FIB,and low expression of PLT,APTT,PT,and TT are the keys to the occurrence,progression,and thrombotic state of PH.Based on the above serum indicators’expression in patients,targeted interventions can be administered to patients with abnormal expression levels to control the progression of their disease and reduce the risk of developing a prethrombotic state.

Pulmonary Hypertension Crisis in Patient with Tetralogy of Fallot and Mixed Total Anomalous Pulmonary Vein Connection after the Primary Correction:A Rare Case Report

Tetralogy of Fallot(TOF)with total anomalous pulmonary vein connections(TAPVC)is a rare type of complex congenital heart disease among all TOF cases.Co-presentation of major aortopulmonary collateral arteries(MAPCAs)compensates for the lack of central pulmonary bloodflow and decreases the severity of right-to-left shunting in TOF.We present a case of a 2-year-old child with complex diagnoses of TOF,TAPVC,a large secun-dum atrial septal defect(ASD),and intraoperatively identified MAPCAs.She underwent surgery to repair the TAPVC,valve-sparing reconstruction of the right ventricular outflow tract,interventricular defect closure,and the creation of patent foramen ovale(PFO).After the operation,hemodynamic instability happened along with sudden blood pressure drop,desaturation,and increased central venous pressure,which subsided after adminis-tering inhalational nitric oxide(NO).A postoperative pulmonary hypertension crisis was suggested when the patient experienced recurrent symptoms after the termination of NO.Echocardiographicfindings of a D-shaped left ventricle(LV),right-to-left PFO shunt and high tricuspid valve gradientfirmly established the diagnosis.It was subsequently managed with continuous NO inhalation and sildenafil,which rendered a satisfactory outcome.Repaired TOF and TAPVC could be at particular risk of developing pulmonary hypertension crisis,especially in the presence of MAPCAs due to possible remodeling of the pulmonary vasculature.Furthermore,a relatively non-compliant LV function and small left atrial size may exacerbate the risk of developing postcapillary pulmonary hypertension after TAPVC repair.A successful postoperative outcome calls for a meticulous preoperative analysis of the anatomical lesions,as well as careful monitoring.

Correlation between angiotensinogen gene and primary hypertension with cerebral infarction in the Li nationality of China

Objective To investigate the relationship of four single nucleotide polymorphism （SNP） haplotypes in the angiotensinogen （AGT） gene to the primary hypertension with or without cerebral infarction in the Li nationality of Hainan, China. Methods Total 300 subjects were allocated into three different groups： Groupl, 100 patients who have primary hypertension; Group 2, 100 patients who have primary hypertension with cerebral infarction; and control group, 100 healthy individuals. The genotypes of all subjects were determined by PCR-sequencing to analyze the four poly- morphisms at position - 152 （G-A）, -20 （A-C）, - 18 （C-T）, and -6 （A-G） in the promoter region of AGT. Results The frequen- cies ofCT genotype of AGT-18 and T allele in Group 1 （P = 0.003, P = 0.004） and Group 2 （P = 0.002, P = 0.002） were both significantly higher than in healthy controls. The frequency of G allele of AGT-6 was significantly higher in Group 2 than in the control group （P = 0.016）, while there is no significant difference between Group 1 and the control. Haplotype analysis revealed that H6 haplotype frequency which included -20C and -6G was significantly increased in Group 2 （P = 0.003） compared with the control group, while H5 haplotype frequency which included -20C and -18T was signifi- cantly increased in Group 1 （P = 0.006） versus the control. Conclusion The -20 （A-C） and - 18 （C-T） of the AGT may play an important role in pathogenesis of primary hypertension; and -20 （A-C）, -18 （C-T）, and -6 （A-G） may be the genetic risk factors for the onset of primary hypertension with cerebral infarction in the Li nationality of Halnan, China.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Management of hypertension in primary aldosteronism

Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approxi-mately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic re-section, while bilateral hyperplasia is treated with min-eralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemo-dynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medica-tions in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, asmanifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the im-portance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalec-tomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifac-torial model convenient for use in daily clinical practice.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China＇s recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

Clinical relevance of the glucocorticoid receptor gene polymorphisms in glucocorticoid-induced ocular hypertension and primary open angle glaucoma

AIM: To avoid the side effects of ocular hypertension of glucocorticoid(GC) usage in eye, we must identify susceptible individuals, which exists in about one-third of all population. Further, the majority of all primary open angle glaucoma(POAG) patients show this phenotype.Glucocorticoid receptor(GR) regulates C responsiveness in trabecular meshwork(TM) cells. In this study, single nucleotide polymorphism(SNP) genotyping was used to determine whether there are differences in the Bcl I(rs41423247) and N363S(rs6195) polymorphisms of the GR gene in healthy and POAG patients, and glucocorticoid-induced ocular hypertension(GIOH)populations.METHODS: Three hundred and twenty-seven unrelated Chinese adults, including 111 normal controls, 117 GIOH subjects and 99 POAG patients, were recruited. DNA samples were prepared and the Bcl I and N363 S polymorphisms were screened using real-time polymerase chain reaction(RT-PCR)-restriction fragment length polymorphism(RFLP) analysis. Frequencies of the Bcl I and N363 S polymorphisms were determined and compared using Fisher’s exact test and the Chi-squared test.RESULTS: Only the Bcl I polymorphism was identified in the Chinese Han population. The frequency of the G allele was 21.6 % in normal controls, 18.3% in GIOH patients, and 13.64% in the POAG patients. There was no significant difference in polymorphism or allele frequency in the 3 groups. Furthermore, no N363 S polymorphism was found in the study subjects.CONCLUSION: The Bcl I polymorphisms in GR gene had no association with GIOH and POAG patients, and N363 S polymorphism might not exist in the Chinese Han population. Therefore, the Bcl I polymorphism might not be responsible for the development of GC-induced ocular hypertension or POAG.

Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension:a systematic review and meta-analysis

AIM:To assess the effects of the fixed combination of0.005% latanoprost and 0.5% timolol(FCLT) vs their individual components for primary open angle glaucoma(POAG) and ocular hypertension(OHT).· METHODS:After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials(RCTs) and cross-over studies were included. The control groups were the monotherapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure(IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software.RESULTS:Thepost-interventionmeanIOPofFCLTwas significantly lower compared to timolol [mean difference(MD)-2.92, 95%CI-3.28 to-2.55, P 【0.00001] and latanoprost(MD-1.11, 95%CI-1.51 to-0.72, P 【0.00001). The postintervention IOP fluctuation was also significantly lower compared to timolol(MD-0.88, 95%CI-1.23 to-0.53, P 【0. 00001) and latanoprost( MD- 0. 63, 95 % CI- 1. 04to-0.22, P =0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol(UFCLT)(MD1.10, 95% CI 0.81 to 1.39, P 【0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT(MD 0.34, 95% CI-0.01 to 0.69, P =0.06).There was no statistical difference for the incidence ofvisual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.visual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.

Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above

Objective To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. Methods Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. Results About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7% reported never visiting a clinic during the past I year and 60.4% of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion; odds ratios of 35-, 45-, 55-, and 〉65 years were 1.7 （95% CI： 1.5-1.9）, 1.5 （95% CI： 1.3-1.7）, 1.3 （95% CI： 1.2-1.4）, and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past I year. Conclusion Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

The assessment of structural changes on optic nerve head and macula in primary open angle glaucoma and ocular hypertension

AIM：To assess morphological changes in macula, retinal nerve fiber layer （RNFL） and optic nevre head （ONH） of cases with primary open angle glaucoma （POAG） and ocular hypertension （OH） with spectral domain optic coherence tomography （OCT）.METHODS：This study included 109 eyes from 62 POAG patients, 50 eyes from 30 OH patients, and 101 eyes from 53 healthy volunteers. Data gained by OCT were compared with perimetry indexes. ONH, RNFL and macula analysis were performed for all subjects. Rim area, disc area,average cup/disc （C/D） ratio, vertical C/D ratio, cup volume data were recorded during ONH analysis. Average RNFL thickness and the thickness of four quadrants （superior,inferior, nasal and temporal） was established in microns.In total, nine macular quadrants involving the foveal region mentioned in the Early Treatment Diabetic Treatment Study（ETDRS） template were measured, and average macular thickness and macular volume data were recorded during macula analysis. Differences between groups were evaluated with the one-way ANOVA test. Tukey’s multiple comparison test was performed to detect difference between groups.Receiver-operating characteristic （ROC） analysis was done for early stage POAG patients to establish sensitivity and specificity of chosen parameters in early stage POAG.Area under the receiver operating characteristic （AUROC）values were calculated to compare ROC areas.RESULTS：Statistically significant differences were found in all ONH parameters, except optic disc area. Neuroretinal rim area was identified as the parameter with the highest difference between groups （F=21.72, P〈0.05）. The highest correlation between ONH parameters and perimetry was observed at neuroretinal rim region （r=0.487）. Inferior RNFL thickness was established as the parameter with the highest difference between groups among RNFL parameters. In the mean of all glaucoma patients, the highest correlation between data handled with OCT and mean deviation was observed in RNFL thickness. Average macular thickness was detected as the parameter with the highest difference between groups among macular parameters. The highest correlation between macula parameters and perimetry indexes was observed between average macular thickness and perimetry indexes （r=0.514）.CONCLUSION：Although the assessment of ONH and the analysis of macular thickness are important in diagnosis and treatment, RNFL assessment is the most valuable parameter.

Simultaneous operative treatment of patients with primary liver cancer associated with portal hypertension

Objective: To explore the operative procedure for pa-tients with primary liver cancer associated with portalhypertension (PLCPH).Methods: We analyzed retrospectively the effect of op-erative procedure for 9 patients with PLCPH compli-cated by severe esophageal varicosity and hyper-splenism.Results: All patients underwent liver resection andpericardiac devascularization with splenectomy. Of the9 patients, 2 died from liver cancer recurrence sepa-rately 13 and 16 months after operation, and 1 diedfrom massive duodenal ulcer bleeding and multipleorgans failure. Six patients survived 3, 4, 8, 10, 12 and25 months after operation.Conclusions: The patients with PLCPH undergoing si-multaneous operation could acquire curative effect ascompared with those who underwent liver resec-tion. This operation is beneficial to the patients withpoor liver function.

Bimatoprost/timolol fixed combination(BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

AIM：To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03%and timolol 0.5%（BTFC）in patients in Greece with primary open angle glaucoma（POAG）or ocular hypertension（OHT）whose previous therapy provided insufficient lowering of intraocular pressure（IOP）.·METHODS：A multicenter,prospective,open-label,non-interventional,observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece.The primary endpoint was the reduction in IOP from baseline at study end,approximately 12wk after initiation of BTFC therapy.·RESULTS：A total of 785 eligible patients were enrolled in the study and 97.6%completed the study.The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg（=764;〈0.001）.In patients（=680）who replaced their previous IOP-lowering monotherapy（a single drug,or a fixed combination of 2drugs in a single ophthalmic drop）with once-daily BTFC,the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg（〈0.001）.IOP was reduced from baseline in 99.2%of patients,and 58.0%of patients reached or exceeded their target IOP.Substantial mean IOP reductions were observed regardless of the previous therapy.BTFC was well tolerated,with 96.0%of patients who completed the study rating the tolerability of BTFC as＂good＂or＂very good.＂Adverse events were reported in 8.3%of patients;only 0.6%of patients discontinued the study due to adverse events.·C ONCLUSION：In clinical practice in Greece,BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy.

Clinical Study of the Ascending Aorta Wall Motion by Velocity Vector Imaging in Patients with Primary Hypertension

We studied the wall motion characteristics of the ascending aorta by velocity vector imaging （VVI） in primary hypertension patients. The ascending aortas both in 30 patients with primary hypertension and 30 normal controls were examined by Acuson sequoia 512 equiped with VVI. The maximum velocity （Vs, Ve） of every point on the anterior wall of ascending aorta both in systole and diastole was measured. The aortic diameter was wider in the hypertension patients than that in the healthy subjects （P〈0.05）. The movement amplitude of the anterior wall of the ascending aorta in long axis view in the hypertension patients was lower than that in the healthy subjects （P〈0.05）. The motion and time to peak in systole of each point of the ascending aorta in the healthy subjects had no significant difference （P〉0.05）. The velocity curves of the anterior wall of ascending aorta both in the hypertension and healthy subjects were regular, and the curve in systole was named S wave and that in diastole named E wave. The velocity of S wave and E wave was slower in the hypertension patients than that in the healthy subjects （P〈0.05）. The time to peak of S wave on the anterior wall of ascending aorta in systole was shorter in the hypertension patients than in the healthy subjects （P〈0.05）. VVI could be used to accurately and directly observe the movement character of the ascending aorta walls, which would help us understand the elasticity of great arteries in patients with hypertension.

Efficacy and safety of 0.0015% tafluprost versus 0.005% latanoprost in primary open angle glaucoma, ocular hypertension: a Meta-analysis

AIM:To evaluate the intraocular pressure(IOP)-lowering efficacy and safety of tafluprost 0.0015%eye drops[benzalkonium chloride(BAK)0.1 mg/mL]compared with that of latanoprost 0.005%eye drops(BAK 0.2 mg/mL)for primary open angle glaucoma(POAG)and ocular hypertension(OHT).METHODS:All the randomized controlled trials(RCTs)about treating POAG and OHT comparing tafluprost and latanoprost were collected by searching PubMed,Embase,Cochrane Library,CNKI and VIP.The outcomes of interest to evaluate the clinical efficacy and adverse effects included IOP and patient-related drop discomfort.RESULTS:Five RCTs involving 888 glaucoma patients were included.The results showed that,1)at the end of the study,no statistically significant differences were observed in IOP reduction[standard mean difference(SMD)=0.48,95%CI 0.07 to 0.88,P=0.085]between tafluprost and latanoprost;2)No statistically significant differences were observed in adverse events of foreign-body sensation[relative risk(RR)=0.62,95%CI 0.26 to 1.46,P=0.269],eye irritation(RR=1.16,95%CI 0.49 to 2.75,P=0.744),eye pain(RR=2.000,95%CI 0.949 to 4.216,P=0.07),iris hyperpigmentation(RR=0.741,95%CI 0.235 to 2.334,P=0.61),dry eye(RR=1.154,95%CI 0.409 to 3.256,P=0.79)and eye pruritus(RR=1.600,95%CI 0.536 to 4.774,P=0.4)between tafluprost and latanoprost.However,tafluprost showed more reported incidence of conjunctival hyperaemia than latanoprost(RR=2.11,95%CI 1.24 to 3.59,P=0.006).CONCLUSION:Tafluprost 0.0015%eye drops(BAK 0.1 mg/mL)and latanoprost 0.005%eye drops(BAK 0.2 mg/mL)are comparable in lowering IOP for open angle glaucoma(OAG)and OHT.It does not differ in the incidence of foreign-body sensation,eye irritation,eye pain,iris hyper-pigmentation,dry eye and eye pruritus,but tafluprost shows less ocular tolerability because of more incidence of conjunctival hyperaemia.

Prevalence of Primary Open Angle Glaucoma among Patients with Diagnosis of Systemic Hypertension and Diabetes Mellitus: The Colombian Glaucoma Study

Objective: To establish the prevalence and risk factors of Primary Open Angle Glaucoma (POAG) among patients with Systemic Hypertension (SH) and Diabetes Mellitus (DM) in six cities of Colombia. Methods: A cross-sectional study among hypertensive and diabetic patients was conducted in Colombia. This study included 2067 subjects older than 50 years of age diagnosed with SH and/or DM. Participants underwent a complete ophthalmic examination including intraocular pressure (IOP) measurement by Goldmann tonometry and blood pressure measurement. The glaucoma diagnosis was confirmed by structural and functional evidence. Interviews and standardized questionnaires were used to evaluate participants’ lifestyle and other health conditions. Results: Among participants with DM/SH, 142 cases of POAG were confirmed for a prevalence of 5.6% [95% CI: 4.6 - 6.6], while 9.1% were glaucoma suspects [95% CI: 7.8% - 10.4%]. The majority of confirmed cases (77.5%) were undiagnosed. The prevalence of POAG was significantly higher with male gender, greater age, and diastolic blood pressure > 90 mmHg as risk factors. Conclusion: We found a high prevalence of POAG in patients with adequate SH and DM care in a novel Latino population. We also found great unawareness of the disease in this population. Our results have potentially enormous public health implications for Colombia and other Latino populations.

Kidney and cardiovascular risk in primary hypertension

In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in definingindividual risk.Given the high prevalence of hypertension in the population at large,however,extensive diagnostic evaluation is often impractical or unfeasible in clinical practice.Low cost,easy to use markers of risk are needed to improve the clinical management of patients with hypertension.Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful,low cost tools to optimize cardiovascular risk assessment.A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.