Kinetic analysis of topographical parameters and interference pattern of tear lipid layer in normal subjects

Purpose: To investigate the post‐blink changes of the topographical regularity indices, the corneal wavefront aberrations and the tear lipid layer’s interference pattern, and analyze the relationship between these parameters’ changes. Methods: Sequential topographical measurements were recorded on 23 normal participants. The surface regularity index (SRI), surface asymmetry index (SAI), corneal total higher order aberrations (HOA) root mean square (RMS), Coma RMS and Spherical RMS were calculated from the topographical measurement. The incidence of the type 1 (with an initial decrease after blink) alteration trend, and the times to the initial minimum were determined in every parameter. The movement of the tear lipid layer’s interference pattern was recorded, and the spreading time of the lipid layer was measured subjectively by three independent observers. Results: The incidence of the type 1 SRI trend (82%) was the most common among those measured. The average time to the type 1 SRI trends’ minimum was 4.05 ± 1.46 s. There was no correlation between the time to the minimum of type 1 trends of the topographical indices, the HOA, Coma and Spherical RMS. The mean lipid layer spreading time was 5.09 ± 1.90 s. We found weak but significant correlation between the times to the minimum of type 1 SRI trends and the lipid spreading time (r = 0.540, p = 0.021).The minimum of the SRI index occurred before the stoppage of superficial lipid layer’s motion. Conclusion: Relatively long lipid layer spreading time was observed suggesting that the tear film build‐up process did not finish completely at the end of the initial rapid tear film alteration phase. The detected initial decrease of the SRI after blink related to the post‐blink tear film motion. This initial pattern is characteristic of the majority of the normal population in spite of the post‐blink alteration pattern of the topographical SAI or corneal aberrations. The SRI seems to be the most useful indirect topographical parameter of the tear film dynamics.     

玻璃体平坦部切除术后后囊膜缺损患者1例的白内障手术治疗

目的:评价1例54岁女性糖尿病性视网膜病变患者玻璃体平坦部切除术后后囊膜缺损的手术治疗效果。方法:我们使用"内外水轮廓分离"技术进行白内障超声乳化术对此例患者进行手术。结果:使用后房型人工晶状体植入后,手术进展顺利。结论:仔细散瞳检查后的精确诊断和详细讨论患者的病情,对于晶状体后囊缺损患者的成功治疗是必要的。     

The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer

We investigated the association between the risk of locoregional recurrence (LRR) and biological subtypes defined by hormonal receptors (HR) and HER-2 status in women with invasive breast cancer (BC). A total of 618 newly diagnosed BC patients were identified from a cancer registry within a single institution with standardized methods of tumor assessment for estrogen receptor (ER), progesterone receptor (PR), and HER-2. Patients were stratified based on surgical treatment, breast-conserving therapy (BCT) versus modified radical mastectomy (MRM), as well as biological subtypes: HR+/HER-2− (ER-positive or PR-positive, HER-2-negative), HR+/HER-2+ (ER-positive or PR-positive, HER-2-positive), HR−/HER-2+ (ER-negative and PR-negative, HER-2-positive) and TN (ER-negative, PR-negative and HER-2-negative). The association between clinicopathological factors, biological subtype and LRR was evaluated with univariate and multivariate Cox analysis. With a median follow-up of 4.8 years, the rate of LRR was 7.5%. On multivariate analysis, TN, tumor size ≥2 cm and lymph node (LN) positivity were associated with increased risk of LRR (P = 0.023, P = 0.048, and P = 0.0034, respectively). In BCT group, HR−/HER-2+ and LN positivity were associated with increased risk of LRR (HR 11.13; 95% CI 2.78–44.53; P = 0.0007 and HR 5.40; 95% CI 1.67–17.43; P = 0.0048, respectively). In MRM group, TN subtype and LN positivity were associated with increased risk of LRR (HR 4.72; 95% CI 1.53–14.52; P = 0.0069 and HR 3.23; 95% CI 1.44–7.29; P = 0.0047, respectively). Compared to HR+/HER-2−, HR−/HER-2+ treated by BCT and TN treated by MRM showed a significant decrease of 5-year LRR free survival (P = 0.0002 and P = 0.002, respectively). Tumor profiling using ER, PR, and HER-2 biomarkers is a promising tool to identify patients at high risk of LRR based on surgical treatment. Our findings suggest a different follow-up and locoregional treatment for patients with HR−/HER-2+ and TN subtypes.     

Giant cell arteritis on 18F‐FDG PET/CT

Purpose: We present a case of incidentally noted giant cell arteritis in a patient undergoing 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. The patient was originally referred to PET/CT for staging of his renal transitional cell carcinoma. Methods: The patient was injected intravenously with 370 MBq of 18F‐FDG. After a 60 min uptake period, PET/CT imaging was performed from the skull base to the mid thighs. Results: A small para‐aortic node in the region of the surgical bed showed increased tracer uptake of concern for malignancy. In addition, there were several non‐calcified pulmonary nodules present, also concerning for malignancy. Incidentally noted was diffusely increased tracer uptake throughout the aorta and a thickened aortic wall on CT images. Diffuse tracer uptake was also present in the proximal branches of the aorta, including the carotid, iliac, femoral, and subclavian arteries. The patient had biopsy proven giant cell arteritis. Conclusion: Increased 18F‐FDG uptake by the aorta on PET/CT imaging is an abnormal finding that prompts a more thorough assessment for malignancy, and also can indentify important co‐morbidities in cancer patients. Evaluation of aortic uptake should be a routine practice in the interpretation of 18F‐FDG PET/CT scans.     

Detection of human papillomavirus DNA in cutaneous squamous cell carcinoma among immunocompetent individuals

The presence of certain types of human papillomavirus (HPV) is a known risk factor for the development of anogenital squamous cell carcinomas (SCCs). A similar association has been hypothesized for cutaneous SCCs, although, to our knowledge, no studies to date have combined sensitive HPV DNA detection techniques with epidemiologic data controlling for known risk factors to explore the association. We designed a case-control study examining HPV prevalence using highly sensitive PCR-detection assays in tissue samples from 85 immunocompetent patients with histologically confirmed SCCs and 95 age-matched individuals without a prior history of skin cancer. A standardized interview was administered to all study subjects to collect information pertaining to potential confounding variables. The overall detection rate of HPV DNA was high in case lesions (54%) and perilesions (50%) and in both sun-exposed normal tissue (59%) and non-sun-exposed normal tissue (49%) from controls. In comparing case tissue to control tissue, there was no differential detection of HPV DNA across various HPV species. However, HPV DNA from beta-papillomavirus species 2 was more likely to be identified in tumors than in adjacent healthy tissue among cases (paired analysis, odds ratio=4.0, confidence interval=1.3-12.0). The high prevalence of HPV DNA detected among controls suggests that HPV DNA is widely distributed among the general population. However, the differential detection of HPV beta-papillomavirus species in tumors among cases suggests that certain HPV types may be involved in the progression of cutaneous SCCs.