Evaluation of the Anterior Chamber Angle Structures in Perinatal Infants Using a Wide-Field Digital Fundus Camera

Objective This study aimed to evaluate the ability of a digital fundus camera to observe the development of the anterior chamber angle(ACA)in premature infants.Methods Forty-eight eyes of preterm infants(n=48)were examined by a digital fundus camera to observe the development of the ACA.ACA grading was performed based on the visualization of the anterior chamber structures according to the Scheie Angle Depth Evaluating System.Results ACA images from all 48 infants were successfully acquired using RetCam3.The corrected gestational age ranged from 30 weeks to 49 weeks,which covered the period from 2 months preterm to>2 months post-term.As the corrected gestational age increased,the corrected gestational age grading was significantly decreased.The mean corrected gestational ages of the infants corresponding to the ACA classification from grade IV to grade 0 were 32.75±1.89,37.20±1.30,39.75±2.38,40.56±2.24,and 44.23±2.14 weeks,respectively,which were all significantly different(P<0.05).The regression analysis showed a linear correlation between the grading of the ACA and the corrected gestational age(R2=0.724,P=0.0001).Conclusion The ACA of a full-term newborn can be fully detected and evaluated by a digital fundus camera.For premature infants,part of the ACA is not visible physiologically;however,it should not be misdiagnosed as angle closure or a narrow angle.

Pharmaceutical care of a patient with antibiotic-associated encephalopathy

Objective:To provide reference of pharmaceutical care for the clinical treatment of a severe patient with antibiotic-associated encephalopathy.Methods:Clinical pharmacists participated in the clinical treatment of the patient with antibiotic-associated encephalopathy,provided pharmaceutical care for clinicians,including the evaluation of adverse drug events and the prevention of adverse drug interaction and development of anti-infection programs by using Pharmacokinetics/pharmacodynamics theory and therapeutic drug monitoring technique.Results:Through active clinical treatment and pharmaceutical care,the symptoms of patients with encephalopathy were relieved,and the infection was effectively controlled.Conclusion:Clinical pharmacists play a positive role in the treatment for the case with antibiotic associated encephalopathy.

Clinical Study of Double Contrast-Enhanced Ultrasound Combined with Dye Method and Marker Placement to Identify and Locate Sentinel Lymph Nodes in Patients with Breast Cancer

Objective: To explore the value of percutaneous ultrasonography combined with transvenous ultrasonography for accurate localization of sentinel lymph nodes and diagnosis of metastatic lymph nodes in patients with breast cancer. Methods: 18 cases of patients with breast cancer attending the Hainan General Hospital from May 2022 to June 2024 who were proposed to undergo axillary lymph node dissection were selected, and the ultrasonographic agent was injected subcutaneously through the areola on the 1st day before the operation, and the marker localization of the manifestation of the Sentinel lymph nodes and draw the lymphatic vessel alignment for drainage on the body surface, and record the manifestation of SLN by conventional ultrasound and dual ultrasonography. At the time of surgery, intraoperative melphalan localization was used to identify the SLN, the difference between the number of ultrasound and melphalan localization was observed, and resection was performed for pathological examination to determine whether they were metastatic or not. Results: There were 8 metastatic lymph nodes and 18 non-metastatic lymph nodes among 31 SLN. A total of 62 SLN were localized by intraoperative melphalan, of which 31 were consistent with ultrasound localization and 31 were not identified by ultrasound. The diagnostic sensitivity of SLN metastasis diagnosed by transcutaneous ultrasonography was 62.50%, specificity was 91.30%, positive predictive value was 71.43%, negative predictive value 87.50%, accuracy was 83.87%, and the AUC was 0.769;the diagnostic sensitivityof transvenous ultrasonography diagnosed was 75.00%, specificity was 75.00%, and the accuracy was 83.87%, 75.00%, specificity 91.30%, positive predictive value 75.00%, negative predictive value 91.30%, accuracy 87.10%, AUC 0.832;dual ultrasonography diagnostic sensitivity 87.50%, specificity 91.30%, positive predictive value 77.78%, negative predictive value 95.45%, accuracy 90.32%. The AUC was 0.894. Conclusion: Transcutaneous ultrasonography combined with transvenous ultrasonography can accurately localize sentinel lymph nodes and improve the sensitivity and accuracy of the diagnosis of metastatic SLN.

Reconstructing abdominal wall defects with a free composite tissue flap:A case report

BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.

Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit

BACKGROUND Postoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury.However,there is no specific medical test to predict postoperative delirium to date.AIM To explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit(ICU).METHODS A retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University,The First Affiliated Hospital of Hainan Medical University,and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020.The patients were categorized into groups based on whether delirium occurred.Of them,25 patients with delirium were included in the delirium group,and 95 patients without delirium were included in the observation group.Logistic regression analysis was used to explore the association between sex,age,educational level,Glasgow coma scale(GCS),complications(with or without concussion,cerebral contusion,hypoxemia and ventricular compression)and site of injury and delirium.RESULTS The GCS score above 8 and concomitant disease of cerebral concussion,cerebral contusion,hypoxemia and ventricular compression,and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit(ICU)(all P<0.05).However,age,sex,administration more than three medicines,and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU(P<0.05).Multivariate logistic regression analysis showed that GCS score above 8,cerebral concussion,cerebral contusion,hypoxemia,ventricle compression,and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU(P<0.05).CONCLUSION GCS score,concussive concussion,cerebral contusion,hypoxemia,ventricle compression,and damage to frontal lobe are risk factors of postoperative delirium.

Small molecule metabolites:discovery of biomarkers and therapeutic targets

Metabolic abnormalities lead to the dysfunction of metabolic pathways and metabolite accumulation or deficiency which is wellrecognizedhallmarks of diseases. Metabolite signatures that have close proximity to subject’s phenotypic informative dimension,are useful for predicting diagnosis and prognosis of diseases as well as monitoring treatments. The lack of early biomarkers couldlead to poor diagnosis and serious outcomes. Therefore, noninvasive diagnosis and monitoring methods with high specificity andselectivity are desperately needed. Small molecule metabolites-based metabolomics has become a specialized tool for metabolicbiomarker and pathway analysis, for revealing possible mechanisms of human various diseases and deciphering therapeuticpotentials. It could help identify functional biomarkers related to phenotypic variation and delineate biochemical pathwayschanges as early indicators of pathological dysfunction and damage prior to disease development. Recently, scientists haveestablished a large number of metabolic profiles to reveal the underlying mechanisms and metabolic networks for therapeutictarget exploration in biomedicine. This review summarized the metabolic analysis on the potential value of small-moleculecandidate metabolites as biomarkers with clinical events, which may lead to better diagnosis, prognosis, drug screening andtreatment. We also discuss challenges that need to be addressed to fuel the next wave of breakthroughs.