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To evaluate the long-term efficacy of Coflex dynamic stabilization device in the treatment of lumbar spinal stenosis.The clinical and imaging data of 73 patients undergoing Coflex dynamic stabilization surgery from July 2008 to June 2012 were retrospectively analyzed. All patients had a minimum of 8 years of follow-up. Clinical data were used to assess the clinical efficacy, and radiographic parameters were measured for evaluation of ASD.56 Patients were followed up for 107.6 ± 13.3 months. The visual analogue scale of pain (VAS), Owestry disability index (ODI) and Japanese Orthopedic Association Scores (JOA) improved significantly after surgery. At 6 months after surgery and the last follow-up, lumbar range of motion (ROM) was significantly lower than that before surgery (P 0.001). ROM was slightly increased at the last follow-up compared with that 6 months after operation (P 0.05). ROM of adjacent segments increased at 6 months and at the last follow-up compared with that before surgery (P 0.05). At 6 months after surgery, intervertebral space height (ISH) and intervertebral foramen height (IFH) of implanted segment was significantly higher than that before surgery (P 0.05). At the last follow-up, there was a decrease in ISH and IFH (P 0.05). During the follow-up period, a total of 11 patients (19.6%) experienced complications and 6 patients (10.7%) underwent secondary surgery.Coflex interspinous process dynamic stabilization is effective in the long-term treatment of lumbar spinal stenosis, the ISH and IFH of implanted segment could be increased in a short period of time.

Purpose: To study the risk grade of gastrointestinal stromal tumors (GISTs) with conventional MR imaging and diffusion-weighted imaging (DWI). Materials and Methods: The abdominal MR images with DWI of 23 patients with pathologically proven GISTs during January 2010 to May 2011 were retrospectively reviewed. The conventional MR imaging findings and apparent diffusion coefficient (ADC) values of the tumors related to the risk grade were analyzed. Results: In the 23 patients, there were 13 patients with high-risk, 5 with medium-risk, 5 with low-risk, and 0 with very low-risk GISTs. Most of the conventional MR findings of the tumors did not correlate with the risk grade. The only exception to this was the correlation between risk grade and the enhancement degree of the tumor after Gd-DTPA. The ADC values were, respectively, (1.04 ± 0.13) × 10−3 mm2·s−1, (1.59 ± 0.06) × 10−3 mm2·s−1 and (1.94 ± 0.08) × 10−3 mm2·s−1 (P < 0.05) in the high-, medium-, and low-risk grade groups. The ADC values of GISTs decreased with the increase of the risk grade of the tumors (r = −0.957; P < 0.05). Conclusion: DWI can be used to assess the risk grade of GISTs, but conventional MR imaging is of limited use. J. Magn. Reson. Imaging 2012; 36:1395–1401. © 2012 Wiley Periodicals, Inc.

To determine associations of patterns of portosystemic collaterals and diameters of portal venous system in cirrhotic patients with hepatitis B on magnetic resonance (MR) imaging with Child-Pugh classification.Eighty-eight consecutive patients with cirrhosis resulting from chronic hepatitis B graded by Child-Pugh classifications were recruited and undergone MR portography. Patterns of the collaterals (presented as no collateral, isolated esophageal varices, and esophageal varices combined with other shunts), and diameters of portal venous system including portal vein (PV), left portal vein (LPV), right portal vein (RPV), splenic vein (SV) and superior mesenteric vein (SMV) were assessed statistically to determine associations of patterns of collaterals and diameters of the portal veins with Child-Pugh classification.From no collateral, to isolated esophageal varices, and to the varices combined with other shunts, the Child-Pugh classifications tended to increase (r=0.516, P0.001). Diameters of PV, LPV, RPV, SV and SMV tended to increase from Child-Pugh A to B but decrease from B to C. Differences in diameter of LPV and SV were significant between Child-Pugh A-B and C (all P0.05) while no differences in diameters of other portal veins were found (all P0.05). For discriminating Child-Pugh A-B from C, either a cut-off LPV diameter of 8.98mm or SV diameter of 9.10mm achieved a sensitivity of 67%-70%, specificity of 51%-53%.Patterns of portosystemic collaterals and diameters of LPV and SV tend to be associated with Child-Pugh classifications of cirrhosis.

To determine the interaction of susceptibility genes in patients with exudative age-related macular degeneration (AMD) in a Chinese case-control cohort.It was a case-control study. Six single nucleotide polymorphisms (SNPs) previously genotyped in cases with exudative AMD and control individuals, including complement factor H (CFH) non-coding variant rs1410996, CFH rs1061170 (Y402H), LOC387715 rs10490924, C3 rs2230199 (R102G), C3 rs1047286 (P314L), and HTRA1 rs11200638, were selected for analyzing the interactions among susceptibility genes. The numerical data were examined by Student t test. The genotype distributions between cases and controls were compared using the Chi2 test. Genetic interactions were examined using logistic regression model and synergy index (SI) value based on crossover analysis table.A total of 150 cases with exudative AMD (88 male, 62 female) and 161 control individuals (84 male, 77 female) were included in this study. There was no significant difference in age (t = 0.91, P = 0.37) or gender (Chi2 = 1.32, P = 0.25) between the AMD cases and the controls. SNPs associated with the risk of exudative AMD included CFH non-coding variant rs1410996 (Chi2 = 17.83, P0.05), LOC387715 rs10490924 (Chi2 = 17.71, P0.05) and HTRA1 rs11200138 (Chi2 = 2.77, P0.05). No interaction was observed between CFH rs1410996 and LOC387715 rs10490924 (logistic regression, P = 0.41; SI = 1.04, P = 0.45) or between CFH rs1410996 and HTRA1 rs 11200138 (logistic regression, P = 0.91; SI = 1.42, P = 0.17).The data suggest that LOC387715 rs10490924 / HTRA1 rs11200138 and CFH rs1410996 are independently associated with the risk of exudative AMD in Chinese.

The collection of buccal cells with swabs provides a noninvasive method for obtaining genomic DNA for genetic screening. We aimed to study the feasibility of using buccal swabs for genetic screening in patients with exudative age-related macular degeneration (AMD).Blood and buccal swabs were collected for genetic analysis from 65 patients with exudative AMD. Genomic DNA was isolated from either blood or buccal swabs. The yield of genomic DNA from both sources was determined by spectrophotometer. Genotyping for CFH, LOC387715, and HTRA1 Polymorphisms was performed using a method of polymerase chain reaction (PCR) followed by restriction enzyme digestion. Results using genomic DNA from blood or buccal swabs were compared.Three swabs were obtained from each patient, 2 from each side of buccal mucosa, and 1 from both upper and inferior gingival mucosa. From swabs with genomic DNA extracted within a week after sample collection, an average of (3.17 ± 1.46) µg genomic DNA was obtained from swab collected from the left or right side buccal mucosa, and (3.94 ± 1.04) µg from swab collected from the upper and inferior gingival mucosa, with relatively higher yield of genomic DNA from the upper and inferior gingival mucosa (t = 6.79, P0.05). From swabs of the left or right side buccal mucosa after being stored at -20°C for 12 months, an average of (3.10 ± 1.17) µg genomic DNA was obtained, which showed no statistically significant difference as compared to the yield of genomic DNA extracted from newly collected swabs (t = 0.59, P0.05). In all 65 patients, genomic DNA isolated from either buccal swabs or blood samples showed exactly the same results regarding the genotypes of CFH, LOC387715, and HTRA1 Polymorphisms.Buccal swab is a simple, noninvasive, and reliable source for obtaining genomic DNA. Swabs stored for 12 months at -20°C provide similar amount of genomic DNA as the freshly collected swabs.

OBJECTIVE: The aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. METHODS: A total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. Patients with and without esophageal and gastric fundic varices were enrolled in Group 1 and Group 2, respectively. Group 1 was composed of Subgroup A, consisting of patients with varices, and Subgroup B consisted of patients with varices in combination with portal vein-inferior vena cava shunts. The diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. RESULTS: The originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. The splenic vein diameter in Group 1 was larger than that in Group 2, whereas no differences in portal vein diameters were found between groups. In Group 1, the splenic vein diameter in Subgroup A was larger than that in Subgroup B. A cut-off splenic vein diameter of 8.5 mm achieved a sensitivity of 83.3% and specificity of 58.1% for predicting the varices. For discrimination of the varices in combination with and without portal vein-inferior vena cava shunts, a cut-off diameter of 9.5 mm achieved a sensitivity of 66.7% and specificity of 60.0%. CONCLUSION: The diameter of the splenic vein can be used to predict esophageal and gastric fundic varices and their patterns.

To use CT to identify renal damage in patients with liver cirrhosis.Sixty patients with liver cirrhosis confirmed by clinical, laboratory and imaging examinations and 20 patients without liver and kidney diseases (control group) were recruited in this study. The participants underwent double-stage enhanced scanning. The thickness of renal cortex (C) and parenchyma (P), and enhancement of renal cortex and medulla on cortical phase were measured. The association between renal damage and Child-Pugh grades, ascites capacities, liver cirrhosis types, opened portal collateral vessels, and opened collateral vessels between splenic venous and renal venous in the patients with liver cirrhosis were analysed.The patients with liver cirrhosis had lower C/P and enhancement of cortex on cortical phase and greater enhancement of medulla than the controls (P0.05). The enhancement of cortex decreased with the increase of Child-Pugh grade, opened portal collateral vessels and opened collateral vessels between splenic venous and renal venous (P0.05), but the differences of enhancement of medulla and C/P had no statistical significance (P0.05). No differences in the measured indicators were found between patients with different capacities of ascites and patients with different types of liver cirrhosis (P0.05).The CT findings on renal damage in patients with liver cirrhosis include decrease in C/P and enhancement of cortex on cortical phase, and increase in enhancement of medulla on cortical phase. The enhancement of cortex on cortical phase is the most important change, which is associated with Child-Pugh grades, opened portal collateral vessels and opened collateral vessels between splenic venous and renal venous.

To study the consistency of the color fundus photography and fluorescein angiography for grading the diabetic retinopathy.It was a retrospective case series. The agreement study was conducted in a series of diabetic patients, who were excluded from the mild non-proliferative diabetic retinopathy (NPDR) and the severe proliferative diabetic retinopathy (PDR). Ninety-nine cases (188 eyes) met the selected criteria Five 50 degrees non-stereoscopic photography for each eye were taken in all cases before FFA was performed. The diabetic retinopathy was graded from the fundus photography and FFA images according to international diabetic retinopathy disease severity scale. The kappa value was calculated according to the grading outcomes from the fundus photography and FFA images to estimate the agreement of the grading outcomes.The fundus photography showed 59 moderate NPDR (31.4%), 76 severe NPDR (40.4%) and 53 PDR eyes (28.2%) respectively, FFA showed 50 moderate NPDR (26.6%), 72 severe NPDR (38.3%) and 66 PDR (35.1%) respectively. The agreement for the grading of DR by the fundus photography and FFA was substantial (K = 0.601). In the evaluation whether it was necessary to implement PRP (more serious than NPDR and PDR), there was higher agreement between them (K = 0.652).Five 50 degrees photography can provides the support of the application of PRP for diabetic patients, FFA may be earlier and relatively accuracy in the diagnose of diabetic retinopathy.

To evaluate the effects of photodynamic therapy on subfoveal choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD).93 patients (98 eyes) with subfoveal CNV secondary to AMD treated with verteporfin PDT from August 2000 to February 2006 were retrospectively analyzed. All patients received verteporfin PDT and were followed clinically with visual acuity testing, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA).The visual acuity was stabilized in 59 eyes (60.2%), improved in 21 eyes (21.4%), and decreased in 18 eyes (18.3%) 6 months after PDT. 54 patients (54 eyes, 55.1%) received multiple sessions of PDT because the recurrence of CNV leakage. The intervals of additional courses of treatment were variable from 1 month (1 eye), 3 months (24 eyes), 6 months (15 eyes), 9 months (6 eyes) to more than 12 months (8 eyes). 40 eyes received two sessions, 12 received three courses and 2 received 4 times repeated treatment. All patients received the 1.7 treatments in average. The Mean time of follow-up was 14 months (6 - 58 months). No serious side effect was recorded.PDT is a safe and effective treatment for patients with CNV from AMD, however, retreatments are required.

Importance A randomized clinical trial is needed to evaluate what is the best photodynamic therapy (PDT) protocol to use for acute central serous chorioretinopathy. Objective To compare the efficacy and safety of a 50% dose of verteporfin (a method of PDT) with the efficacy and safety of a 30% dose for acute central serous chorioretinopathy. Design, Setting, and Participants A multicenter, noninferiority, double-masked, randomized, controlled, clinical trial in which 131 patients (131 eyes) with acute central serous chorioretinopathy for less than 6 months were recruited with a follow-up of 12 months from university-based ophthalmology practices. Interventions Patients were randomly assigned to either a 50% dose of verteporfin (the 50%-dose PDT group) or a 30% dose (the 30%-dose PDT group). Main Outcomes and Measures The 2 primary outcome measures were the proportion of eyes with complete absorption of subretinal fluid and the proportion of eyes with complete disappearance of fluorescein leakage at 6 and 12 months. The secondary outcome measures included the subretinal fluid recurrent rate, the fluorescein leakage recurrent rate at 12 months, the mean best-corrected visual acuity, the retinal thickness of the foveal center, and the maximum retinal thickness at each scheduled visit. Results The noninferiority of the 30%-dose PDT compared with the 50%-dose PDT for the primary outcomes was not demonstrated. The optical coherence tomography–based improvement rate in the 30%-dose PDT group was less than that in the 50%-dose PDT group both at 6 months (73.8% vs 92.9%; α = 0.0125, P = .006) and at 12 months (75.4% vs 94.6%; α = 0.0125, P = .004). The fluorescein angiography–based improvement rate in the 30%-dose PDT group was less than that in the 50%-dose PDT group both at 6 months (68.9% vs 91.1%; α = 0.0125, P = .003) and at 12 months (68.9% vs 92.9%; α = 0.0125, P = .001). The subretinal fluid recurrence rate in the 30%-dose PDT group was greater than that in the 50%-dose PDT group (24.0% vs 5.7% at 12 months; P = .010, determined by use of the log-rank test). The fluorescein leakage recurrent rate in the 30%-dose PDT group was significantly higher than that in the 50%-dose PDT group (16.7% vs 3.8% at 12 months; P = .03, determined by use of the log-rank test). No ocular adverse event was encountered in the study. Conclusions and Relevance A 50% dose of verteporfin may be more effective at resolving subretinal fluid and fluorescein leakage, and with better visual outcomes, than a 30% dose for acute central serous chorioretinopathy. Trial Registration clinicaltrials.gov Identifier:NCT01574430

In this study, the clinical effect of the Nd: YAG laser embolysis on branch retinal artery occlusion was evaluated.A fundus contact lens was used to focus the Nd: YAG laser on the embolus within the retinal arteriole. 0.8 to 0.9 mJ of laser pulse was delivered directly to the embolus. Fundus photographs were taken before and immediately after the treatment. Follow-up time ranged from 2 weeks to 4 months, average about 7 weeks. Seven cases received the treatment, including 5 male and 2 female patients. Age of those cases ranged from 49 to 73, average 61 years. The duration of the disease ranged from 1 to 60 days, average 13 days.Before treatment, visual acuity ranged from 0.06 to 0.8. Embolus can be detected in all the 7 cases. After treatment, all the cases showed immediate recovery of blood flow in the occluded arteriole both in fundus examination and fundus fluorescein angiography. The vision in the patients was improved in the follow-up. Visual acuity ranged from 0.2 approximately 1.0. In most cases, visual field defect still existed in the ischemic area. Complications included local retinal hemorrhages in some cases and vitreous hemorrhage, but those hemorrhages were gradually absorbed and did not affect the final visual prognosis.Nd: YAG laser embolysis for branch retinal artery occlusion is an effective treatment and the treatment is relatively safe.