Efficacy of adjuvant mitomycin-C and triamcinoloneimpregnated nasal packing for endoscopic dacryocystorhinostomy

●AIM:To compare the success rate and complications of adjuvant use of mitomycin C and triamcinoloneimpregnated biodegradable nasal packing(TABP)in endoscopic dacryocystorhinostomy(DCR).And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR.●METHODS:A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed.The patients were randomly divided into three groups:Group A included patients treated without intraoperative mitomycin C but with TABP,Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing,and Group C included patients treated with intraoperative mitomycin C and TABP.●RESULTS:The results revealed no significant difference in the overall success rates between Groups A(86.8%)and B(89.2%;P=0.377).However,Group C(97.5%)showed a significantly higher overall success rate than Groups A and B.The incidence of granulomas was significantly lower in group C(5%)than in Groups A(20.8%)and B(15.2%;P=0.009).Other complications,such as crust,synechiae,and revision surgery,did not differ significantly among the three groups.●CONCLUSION:The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate.Additionally,there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

Studies on Mitomycin C Dextran-microspheres

In this paper,the preparation and properties of mitomycin C dextran-microspheres(MMC-DMS)were reported.The characteristics of pharmacokinetics and embolization effects of MMC-DMS in vivo were studied in dogs.The average diameter of the microspheres was 75±19μm and the content was 5% of MMC.In in vitro experiment, the release rate of drug demonstrated that the microspheres had sustained-release properties. The microspheres and conventional MMC were infused into the hepatic artery of dogs through a catheter for embolization,respectively.The plasma concentration of MMC was de- termined by HPLC.Results showed that the peak concentration of conventional MMC was 2.6 times as much as MMC-DMS.Angiograms revealed that peripheral blood vessels de- creased obviously in liver.The histopathologic examination showed that the microspheres lodged in the hepatic artery and displayed nodular necrosis in the embolized segment.The MMC-DMS were used in clinical trial in 100 patients with hepatic cancer.The tumor reduc- tion and improvement of symptoms in patients were observed after hepatic arterial embolization.The survival duration was prolonged.Results showed that the MMC-DMS is a promising embolic agent for treatment of hepatic cancer.It could aid in the use of intensive chemotherapy with minimum systemic side effect.

Interaction between Mitomycin C and DNA at Paraffined Graphite Electrode

Aim To investigate the electrochemical behaviors of Mitomycin C （MC） and its interaction with calf thymus DNA （ctDNA）. Methods The cyclic vohammetry （CV） was carried out at a paraffined graphite electrode. Results MC showed a well-defined oxidation-reduction peak. As a result of reaction with ctDNA, the peak current of MC decreased apparently. According to corresponding electrochemical equations, the diffusion coefficient of both free and MC-DNA complex have been determined, and the heterogeneous rate constants were also obtained simultaneously. Conclusion The solid paraffined graphite electrode could be used to estimate parameters of the interaction between DNA and MC, and provide the convenient and sensitive analysis.

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery

AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes(15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age 【40y [P =0.085, odds ratio(OR) 3.609, 95% confidence interval(CI) 0.838-15.540]and amniotic membrane graft instead of conjunctival autograft(P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence.Multivariate analysis revealed that intraoperative mitomycin C(MMC)(P =0.072, OR 0.298, 95% CI 0.080-1.115)decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation(AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.

Study of Low-intensity 2450-MHz Microwave Exposure Enhancing the Genotoxic Effects of Mitomycin C Using Micronucleus Test and Comet Assay in vitro

Objective To determine the interaction between 2450-MHz microwaves (MW) radiation and mitomycin C (MMC). Methods The synergistic genotoxic effects of low-intensity 2450-MHz microwave and MMC on human lymphocytes were studied using single cell gel electrophoresis (SCGE) assay (comet assay) and cytokinesis-blocked micronucleus (CBMN) test in vitro. The whole blood cells from a male donor and a female donor were either only exposed to 2450-MHz microwaves (5.0 mW/cm2) for 2 h or only exposed to MMC (0.0125 μ/mL, 0.025 μg/mL, 0.05μg/mL and 0.1 μg/mL) for 24 h; and the samples were exposed to MMC for 24 h after exposure to MW for 2 h. Results In the comet assay, the comet lengths ( 29.1 μm and 25.9 μm) of MW were not significantly longer than those (26.3 μrn and 24.1 μm) of controls (P>0.05). The comet lengths (57.4 μm, 68.9 μm, 91.4 μm, 150.6μm and 50.6 μm, 71.7μm, 100.1 μm, 145.1 μm) of 4 MMC groups were significantly longer than those of controls (P<0.01). The comet lengths (59.1 μm, 92.3 μm, 124.5 μm, 182.7 μm and 57.4 μm, 85.5 μm, 137.5 μm, 178.3 μm) of 4 MW plus MMC groups were significantly longer than those of controls too (P<0.01). The comet lengths of MW plus MMC groups were significantly longer than those of the corresponding MMC doses (P<0.05 or P<0.01) when the doses of MMC were ≥50.025 μg/mL. In the CBMN, the micronucleated cell (MNC) rates of MW were 5% and 6%, which showed no difference compared with those (4‰ and 4‰) of controls (P>0.05). The MNC rates of 4 MMC groups were 8‰, 9‰, 14‰, 23‰ and 8‰, 8‰, 16‰, 30‰ respectively. When the doses of MMC were 3≥0.05 μg/mL, MNC rates of MMC were higher than those of controls (P<0.05). MNC rates of 4 MW plus MMC groups were 12‰, 13‰, 20‰, 32‰ and 8‰, 9‰, 23‰, 40‰. When the doses of MMC were 5≥0.05 μg/mL, MNC rates of MW plus MMC groups were much higher than those of controls (P<0.01). MNC rates of 4 MW plus MMC groups were not significantly higher than those of the corresponding MMC doses. Conclusion The low-intensity 2450-MHz microwave radiation can not induce DNA and chromosome damage, but can increase DNA damage effect induced by MMC in comet assay.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium:a Meta-analysis

AIM: To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium. METHODS: Meta -analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. RESULTS: Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (10) MMC was higher than that with ALC (OR=2.38,95% confidence interval 1.45-3.91, I-2=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR= 0.66, 95% confidence interval 0.30-1.42, I-2=0%), and 10 MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR =0.41, 95% confidence interval 0.16-1.01, I-2=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC. CONCLUSION: The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Mitomycin C induces apoptosis in human epidural scar fibroblasts after surgical decompression for spinal cord injury

Numerous studies have shown that topical application of mitomycin C after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the effect of mitomycin C on the proliferation and apoptosis of human epidural scar fibroblasts. Human epidural scar fibroblasts were treated with various concentrations of mitomycin C （1, 5, 10, 20, 40 μg/mL） for 12, 24 and 48 hours. Mitomycin C suppressed the growth of these cells in a dose- and time-dependent manner. Mitomycin C upregulated the expression levels of Fas, DR4, DR5, cleaved caspase-8/9, Bax, Bim and cleaved caspase-3 proteins, and it downregulated Bcl-2 and Bcl-xL expression. In addition, inhibitors of caspase-8 and caspase-9 （Z-IETD-FMK and Z-LEHD-FMK, respectively） did not fully inhibit mitomycin C-induced apoptosis. Furthermore, mitomycin C induced endoplasmic reticulum stress by increasing the expression of glucose-regulated protein 78, CAAT/enhancer-binding protein homologous protein （CHOP） and caspase 4 in a dose-dependent manner. Salubrinal significantly inhibited the mitomycin C-induced cell viability loss and apoptosis, and these effects were accompanied by a reduction in CHOP expression. Our results support the hypothesis that mitomycin C induces human epidural scar fibroblast apoptosis, at least in part, via the endoplasmic reticulum stress pathway.

Mitomycin C in pterygium treatment

Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea.Most cases of pterygium does not cause problem or requires specific treatment.The exact cause of pterygium is not clear yet,but some factors are pointed as causes,being the most important the long-term ultraviolet ray exposure.Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment.Recurrence is the main complication of the surgery,and much has been done to avoid it.Mitomycin C（MMC） has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium.This review describes the use of MMC as an adjunctive,the optimal dosage,the duration of administration of MMC and possible complications,when used during,after and before the surgery.Most studies suggest that increased exposure（dose or duration） of MMC is associated with a lower recurrence,but with higher risks of complications.

Stable transfection of extrinsic Smac gene enhances apoptosis-inducing effects of chemotherapeutic drugs on gastric cancer cells

AIM: To explore the feasibility of enhancing apoptosis-inducing effects of chemotherapeutic drugs on human gastric cancer cells by stable transfection of extrinsic Smac gene. METHODS: After Smac gene was transferred into gastric cancer cell line MKN-45, subclone cells were obtained by persistent G_(418) selection. Cellular Smac gene expression was determined by RT-PCR and Western blotting. After treatment with mitomycin (MMC) as an apoptotic inducer, in vitro cell growth activities were investigated by trypan blue-staining method and MTT colorimetry. Cell apoptosis and its rates were determined by electronic microscopy, annexin V-FTTC and propidium iodide staining flow cytometry. Cellular caspase-3 protein expression and its activities were assayed by Western blotting and colorimetry. RESULTS: When compared with MKN-45 cells, the selected subclone cell line MKN-45/Smac had significantly higher Smac mRNA (3.12±0.21 vs 0.82±0.14, t=7.52, P＜0.01) and protein levels (4.02±0.24 vs0.98±0.11, t=8.32, P＜0.01). After treatment with 10 μg/mL MMC for 6-24 h, growth inhibition rate of MKN-45/Smac (15.8±1.2-54.8±2.9%) was significantly higher than that of MKN-45 (5.8±0.4-24.0±1.5%, t=6.42, P＜0.01). Partial MKN-45/Smac cancer cells presented characteristic morphological changes of apoptosis under the electronic microscope with an apoptosis rate of 36.4±2.1%, which was significantly higher than that of MKN-45 (15.2±0.8%, t=9.25, P＜0.01). Compared with MKN-45, caspase-3 expression levels in MKN-45/Smac were improved significantly (3.39±0.42 vs0.96±0.14, t=8.63, P＜0.01), while its activities were 3.25 times as many as those of MKN-45 (0.364±0.010 vs0.112±0.007, t=6.34, P＜0.01). CONCLUSION: Stable transfection of extrinsic Smac gene and its over-expression in gastric cancer cell line can significantly enhance cellular caspase-3 expression and activities, ameliorate apoptosis-inducing effects of mitomycin C on cancer cells, which is a novel strategy to improve chemotherapeutic effects on gastric cancer.

Safety and efficacy of photodynamic therapy using BCECF-AM compared to mitomycin C in controlling post-operative fibrosis in a rabbit model of subscleral trabeculectomy

AIM： To evaluate the safety and efficacy of cellular photoablation using BCECF-AM [2, T-bis-（2-carboxyethyl） -5-（and-6）-carboxyfluorescein, acetoxymethyl ester mixed isomersl as a method to control postoperative fibrosis in subscleral trabeculectomy （SST） compared to mitomycin C （MMC） in a rabbit model. METHODS： A comparative prospective case-control animal study was conducted. Fourteen rabbits were subjected to SST with intraoperaUve use of wound modulating agents （MMC or BCECF-AM） of the right eye （study groups I and II respectively） and SST without use of intraoperative wound modulating agents for the left eye （control group II）. Two rabbits 4 eyes were considered as control group I with no surgical intervention. BCECF-AM was injected subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. Clinical response was assessed by measuring intraocular pressure （lOP） at day 1, 3, 5, 7, 14, 21 postoperatively, Success was defined by 〉20.0% reduction in lOP from the preoperative values without anti-glaucoma medications. RESULTS： The mean percentage of reduction was 35.0% in the study group I with only one eye （14.3%） had 12.5% reduction. The mean percentage of reduction was 28.0% in the study group U with two eyes （28.6%） in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3% with 64.3% eyes had 〈20.0% reduction. There was a highly statistically significant difference between each of the study groups （right eyes） and the corresponding control group II （left eyes） as regards the mean postoperative lOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period. Histologically, MMC treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control. Marked sub-epithelial edema was seen along with variable collagen dispersion. Mild cellularity was noted in sub-epithelial tissue. BCECF-AM treated blebs showed normal conjunctival epithelial thickness with abundant goblet cells. Mild sub- epithelial edema was noted along with moderate collagen dispersion. No histological abnormality was noted in the ciliary body or the cornea in any of the studied groups. CONCLUSION： Cellular photoablation using BCECF-AM is a safe and effective wound modulating agent to control postoperative fibrosis in trabeculectomy. However MMC considered as a more potent adjuvant to trabeculectomy than BCECF-AM in promoting IOP reduction.

Risk factors for flat anterior chamber after glaucoma filtration surgery

AIM： To investigate the incidence rate and risk factors for grade Ⅲ flat anterior chamber（FAC） after glaucoma filtration surgery based on 5-year data.METHODS： Patients who underwent glaucoma filtration surgery in Daping hospital from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of grade Ⅲ FAC following glaucoma filtration surgery was determined. Regression analysis was performed to investigate the influence of glaucoma type, surgical approach, age, and preoperative intraocular pressure（IOP） on the risk of postoperative FAC.RESULTS： A total of 2179 eyes receiving anti-glaucoma surgery were included. Ninety-one eyes suffered from postoperative FAC, with an overall incidence rate of 4.18%. Of 471 eyes with primary open angle glaucoma（POAG）, grade Ⅲ FAC occurred in only 3 eyes（0.64%）. Primary angleclosure glaucoma（PACG） was diagnosed in 1076 eyes, 39（3.62%） of which developed grade Ⅲ FAC, including 12 eyes（12/300, 4%） with acute PACG（aP ACG） and 27 eyes（27/776, 3.48%） with chronic PACG（c PACG）. Six of 259 eyes（2.32%） with secondary glaucoma, 28 of 186 eyes（15.05%） with neovasular glaucoma, 1 of 66 eyes（1.52%） with congenital glaucoma, and 14 of 115 eyes（12.17%） with remnant glaucoma suffered from grade Ⅲ FAC. Of 6 eyes with mixed glaucoma, none developed grade Ⅲ FAC after surgery. When stratified by surgical approach, 24 of 766 eyes（3.13%） undergoing trabeculectomy, 21 of 924 eyes（2.27%） treated by trabeculectomy plus mitomycin C（MMC）, 18 of 109 eyes（16.51%） undergoing Ahmed glaucoma valve implantation, 23 of 201 eyes（11.44%） managed by Ahmed implantation plus MMC, and 5 of 133 eyes（3.76%） treated by Ahmed implantation plus lens extraction or vitrectomy developed grade Ⅲ FAC. Logistic regression analysis revealed that factors including neovasular glaucoma, remnant glaucoma, glaucoma valve implantation, glaucoma valve implantation＋MMC, glaucoma valve implantation＋vitrectomy, age〉60 y, and IOP at admission 〉50 mm Hg were significantly associated with an increased risk for grade Ⅲ FAC.CONCLUSION： The overall incidence of grade Ⅲ FAC after glaucoma filtration surgery is 4.18%. Patients with neovasular glaucoma and remnant glaucoma are at a higher risk of developing FAC. Ahmed glaucoma valve implantation is associated with a higher risk for grade Ⅲ FAC compared with trabeculectomy. No significant correlation was observed between the use of MMC in glaucoma filtration surgery and the risk of postoperative FAC. Higher IOP at admission（〉50 mm Hg） and old age（〉60 y） are risk factors for grade Ⅲ FAC.

Factors affecting recurrence after surgical treatment in cases with ocular surface squamous neoplasia

AIM: To evaluate the risk factors leading to recurrence in patients with ocular surface squamous neoplasia(OSSN)METHODS: The records of 112 patients with OSSN who underwent treatment and follow-up between February 1999 and August 2018 were reviewed retrospectively.RESULTS: Totally 67 patients(59.8%) were male and 45 patients(40.2%) were female. The mean age at presentation was 63.7 y(range 22-87 y). Partial lamellar scleroconjunctivectomy(PLSC) was performed in 105(93.7%) cases and enucleation was performed in 7(6.3%) cases due to bulbus invasion as the first step treatment. Treatments used in addition to PLSC included cryotherapy in 78 eyes(74.3%), alcohol epitheliectomy in 57 eyes(54.3%) for presence of corneal involvement, and amniotic membrane transplantation in 17 eyes(16.2%) for ocular surface reconstruction. Topical mitomycin C was used in 10 patients(9.5%) and strontium-90(Str-90) treatment in 4(3.8%) patients because surgical margins were tumor positive at the histopathological examination. Postoperative histopathologic diagnoses were squamous cell carcinoma(52 cases), carcinoma in situ(44 cases), moderate conjunctival intraepithelial neoplasia(11 cases), and mild conjunctiva intraepithelial neoplasia(5 cases). At a mean follow-up of 20.1 mo, tumor recurrence was observed in 21(18.8%) cases. The rate of recurrence was found to be lower in cases that underwent supplemental cryotherapy compared to those that did not(P<0.001). There was no metastasis in any case. CONCLUSION: In our series, the recurrence rate is 18.8% and overall globe salvage rate is 90.2% for OSSN at relatively short-term follow-up.

A Study in vitro on the Synergetic Cytocidal Effect ofAscorbic Acid and Mitomycin C against the Ehrlich As-cites Tumor Cells in Culture

The synergetic cytocidal effect of ascorbic acid and mitomycin C on Ehrlich as-cites tumor cells in culture was studied. The chain scission of DNA by Cu(Ⅱ)mitomycin C/ascorbic acid system,and the chemical kinetics of the Cu(Ⅱ) catalyzed aerobic oxidation of ascorbic acid in the presence of mitomycin C were also discussed. Experimental results showed that ascorbic acid and mitomycin C were synergetic in destroying Ehrlich ascites tumor cells.The effect is related to the breaking action of the Cu(Ⅱ)mitomycin C/ascorbic acid system on the DNA chain, and to the quantity of the system produced ·OH, and the speed of production which are both directly proportional to the concentration of ascorbic aci.These results imply that the ·OH produced in the aerobic oxidation of ascorbic acid,and·OH induced scission of DNA chain, are important factors to he synergetic cytocidal effect of ascorbic acid and mitomycin C on Ehrlich ascites tumor cells.

Smac/DIABLO Promotes Mitomycin C-induced Apoptosis of Bladder Cancer T24 Cells

The enhancing effects of Smac gene on the mitomycin C-induced apoptosis of the bladder cancer cell line T24 were investigated. The Smac gene was transfected into bladder cancer cell line T24 under the induction of liposome. The intrinsic Smac level was detected by using immunohistochemistry and RT-PCR. The in vitro cellular growth activities were assayed by MTT colorimetry. Apoptosis was assayed by the flow cytometry. The results showed that as compared with the control cells, the apoptosis rate of T24 cells induced by mitomycin C was enhanced by transfected Smac gene. Flow cytometry revealed that, the apoptosis rate was 18.84 % and 33.52 %, and 10.72 % and 26.24 % respectively in blank and transfected cells treated with 0.05 or 0. 005 mg/mL mitomycin C （P〈0.05）. It was concluded that Smac could enhance the apoptosis of T24 by mitomycin C, which could provide a useful experimental evidence for bladder cancer therapy.

Potential risk of mitomycin C at high concentrations on peripheral nerve structure

Although the local application of mitomycin C may prevent epidural adhesion after laminectomy, mitomycin C can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin C, cotton pads soaked with mitomycin C at different concentrations （0.1, 0.3, 0.5, and 0.7 mg/mL） were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin C at 0.1-0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin C signiifcantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concen-trations, though no functional change was found. These experimental ifndings indicate that the local application of mitomycin C at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin C at high concentrations （＆gt;0.7 mg/mL） has potential safety risks to peripheral nerve structures.

Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma:postoperative long-term results

AIM:To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy(DST)with mitomycin C(MMC)in the treatment of glaucoma.METHODS:Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study.Complete success was defined as postoperative intraocular pressure(IOP)≤21 mm Hg or 30%reduction of IOP from baseline without any topical IOP-lowering agent,and qualified success defined as IOP≤21 mm Hg or 30%reduction of IOP from baseline with/without single topical agent.We evaluated the surgical success rates and complication rates of this procedure,as well as described the IOP profiles,best corrected visual acuity(BCVA)profiles and mean deviations(MD)of Humphrey visual field(HVF)24-2 performance at each follow-up time point.Mixed linear regression models were constructed to determine estimated predictive values of demographic data,use of topical IOPlowering agents,baseline and postoperative IOP and optical profiles(e.g.,BCVA and MD).RESULTS:Totally 98 eyes(mean postoperative followup 67.5mo)showed mean IOP reduction at every followup interval.Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline.The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7(P=0.068).Totally 84(85.7%)eyes achieved complete success at final follow-up.Transient hyphaema and transient choroidal effusion developed in 15 eyes(15.3%)and 11 eyes(11.2%)respectively.Other complications included shallow anterior chamber in 5 eyes(5.1%),bleb leak in 4 eyes(4.1%),bleb revision in 7 eyes(7.1%),bleb needling in 9 eyes(9.2%)and repeat trabeculectomy in 1 eye(1.0%).There was no endophthalmitis,blebitis or macular oedema.There was no significant correlation between postoperative IOP control and postoperative BCVA.CONCLUSION:DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.

Study on the Interaction of Mitomycin C with ct-DNA by Pd-Porphin Room Temperature Phosphorescence Probe

Anticancer drug Mitomycin C (MMC) quenches remarkably phosphorescence and reduces lifetime of phosphorescence probe, Pd-meso-tetrakis-(4-trimethylaminophenyl)porphin (Pd-TAPP), in the presence of calf thymus DNA. These results may be attributed to the site competition of MMC with the probe and electron transfer between MMC and probe. MMC also increases polarization degree of the probe by covalent drug-DNA or DNA-drug-DNA crosslinking.

Modulatory Effect of Distillate of Ocimum sanctum Leaf Extract (Tulsi) on Human Lymphocytes Against Genotoxicants

Objective To study the modulatory effect of distillate of Ocimum sanctum （traditionally known as Tulsi） leaf extract （DTLE） on genotoxicants. Methods In the present investigation, we studied the antigenotoxic and anticlastogenic effect of distillate of Tulsi leaf extract on （i） human polymorphonuclear leukocytes by evaluating the DNA strand break without metabolic activation against mitomycin C （MMC） and hexavalent chromium （Cr^＋6） and （ii） human peripheral lymphocytes （in vitro） with or without metabolic activation against mitomycin C （MMC）, hexavalent chromium （Cr^＋6） and B[a]P by evaluating chromosomal aberration （CA） and micronucleus assay （MN）. Three different doses of DTLE, 50 μL/mL, 100 μL/mL, and 200 μL/mL were selected on the basis of cytotoxicity assay and used for studying DNA strand break, chromosomal aberration and micronucleus emergence. The following positive controls were used for inducing genotoxicity and clastogenicity MMC （0.29 μmol/L） for DNA strand break, chromosomal aberration and 0.51 μmol/L for micronucleus assay; Potassium dichromate （Cr^＋6） 600 μmol/L for DNA strand break and 5 μmol/L for chromosomal aberration and micronucleus assay; Benzo[a]pyrene （30 μmol/L） for chromosomal aberration and 40 μmol/L for micronucleus assay. The active ingredients present in the distillate of Tulsi leaf extract were identified by HPLC and LC-MS. Results Mitomycin C （MMC） and hexavalent chromium （Cr^＋6） induced statistically significant DNA strand break of respectively 69% and 71% （P〈0.001） as revealed by fluorometric analysis of DNA unwinding. Furthermore, the damage could be protected with DTLE （50 μL/mL, 100 μL/mL, and 200 μL/mL） on simultaneous treatment. Chromosomal aberration and micronucleus formation induced by MMC, Cr^＋6 and B[a]P were significantly protected （P〈0.001） by DTLE with and without metabolic activation. Conclusion Distillate of Tulsi leaf extract possesses antioxidants contributed mainly by eugenol, luteolin and apigenin as identified by LC-MS. These active ingredients may have the protective effect against genotoxicants.

Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome

AIM： To compare the efficacy and safety of collagen matrix implant [Ologen（OLO） implant] versus mitomycin C（MMC） with subscleral trabeculectomy（SST） for the surgical treatment of congenital glaucoma（CG） in SturgeWeber Syndrome（SWS）.METHODS： A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group（MMC Group） included 10 eyes that were subjected to SST with MMC. The second group（OLO Group） included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant（OLO implant）. Postoperative evaluation included intraocular pressure（IOP） level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS： The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups（57.9% and 56.3%）. At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes（60%）, blebitis in only one eye（10%） treated with topical antibiotics, shallow anterior chamber in two eyes（20%）.CONCLUSION： This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Comprehensive management of epithelial ovarian cancer with peritoneal metastases

Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.