Objective To observe the clinical and pathological features of uveal melanomas, and to analyze the relationship between tumor metastases or tumorinduced death and those features. Methods 53 patients with uveal melanoma diagnosed by pathological examination were enrolled. The clinical and pathological data of patients were recorded, including the age, sex, visual acuity, intraocular pressure, iris neovascularization, tumor shape, tumor size, secondary retinal detachment, tumor cell type, ciliary body invasion, sclera emissary canal invasion, optic disc invasion, extraocular spaces involvement and sclera infiltration. The follow-up was ranged from 7.2 to 66.7 months, with the mean of 37.1 months. Kaplan-Meier Method and Cox proportional hazards modeling were used to study the relationship between various factors and tumor prognosis by univariate and multivariate analysis, and draw survival curves. Results The univariate analysis showed that the largest tumor diameter (chi;2=10.084), tumor cell type (chi;2=18.974), the ciliary body invasion (chi;2=12.968), sclera emissary canal invasion (chi;2=17.814), extraocular spaces (chi;2=4.050), the occurrence of iris neovascularization (chi;2=9.318) and high intraocular pressure (chi;2=9.318) are closely related to tumor metastases or tumor-induced death (P＜0.05). In multivariate analysis, the ciliary body invasion was closely related to the tumor metastases (chi;2=4.334，P=0.037). The cell type (chi;2=5.260) and the iris neovascularization (chi;2=5.145) were related to tumorinduced death (P＜0.05). Cox regression survival curve showed that the risk of tumor metastases and death increased at 20-40 months after enucleation. Conclusions The prognosis of uveal melanoma is related to the tumor size, cell type, and the expansion area of tumor. We should pay close attentions to patients 20 months after surgery to detect the occurrence of metastases.
ObjectiveTo analyze the clinical pathological features of mushroom shaped uveal melanoma.MethodsRetrospective clinical study. From June 2001 to Aprilh 2013, pathological sections from 102 eyes of 102 patients with uveal melanoma diagnosed in Beijing Tongren Eye Center were included in the study. The sections were divided into group A (mushroom shaped uveal melanoma, 30 eyes) and group B (flat, hemisperical and spherical uveal melanoma, 72 eyes). The height-to-base ratio was calculated. The tumors size was divided into small, medium and large according to the standards of American Multicentre Study of Ocular Melanoma. The tumor cell type was divided into spindle, epithelioid, mixed and others by Improved Callender taxonomy. Motic Med 6.0 software was used to collect and measure the images. The retinal thinning rate of group A and B was compared by χ2 test.ResultsIn group A, large size in 19 eyes (63.3%), medium size in 11 eyes (36.7%). In group B, large size in 49 eyes (68.1%), medium size in 16 eyes (22.%), small size in 7 eyes (9.7%). In group A and B, the average tumor base diameter were 14.2±5.1 mm and 18.7±6.4 mm, respectively; the average tumor height were 10.0±2.1 mm and 7.6±3.9, respectively; the height-to-base ratio were 0.77±0.29 and 0.44±0.28, respectively. In group A, spindle type in 24 eyes (80.0%), epithelioid type in 1 eye (3.3%), mixed type in 5 eyes (16.7%). In group B, spindle type in 52 eyes (72.2%), epithelioid type in 5 eyes (6.9%), mixed type in 11 eyes (15.3%), and others in 4 eyes (5.6%). The proportion of retinal thinning were 73.3% (22 eyes) and 29.2% (21 eyes) in group A and B, respectively. The difference in the proportion of retinal thinning between group A and B was significant (χ2=16.94, P=0.000).ConclusionThe height of the tumor increased rapidly and the retinal thinning rate is high in mushroom shaped uveal melanoma.
Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.