ObjectiveTo evaluate the clinical value of detecting specific IgG against Toxocara canis in intraocular fluid for the diagnosis of ocular toxocariasis(OT). MethodsFifty patients diagnosed as having OT(OT group), 152 otolaryngology patients (serum control group) and 70 other oculopathy patients (intraocular fluid control group) were enrolled in the study. Intraocular fluids(28 aqueous humor and 22 vitreous humor) and serum samples of OT group were analyzed for specific IgG against Toxocara canis by enzymelinked immunosorbent assay, so were the intraocular fluids(46 aqueous humor and 24 vitreous humor) and 152 serum samples of two control group. Specific IgG level was compared between paired serum and intraocular fluids of OT group. Results68.00% serum samples of OT group were positive for specific IgG against Toxocara canis and the U value was 20.42±17.01. The positive rate was 88.00% and U value 25.72±23.04 in intraocular fluids. In serum control group, it was 2.63% and 2.37±2.71 respectively. The intraocular fluids were negative and U value 0.69±0.34 in intraocular fluid control group. The difference of specific IgG level was proved significant between OT group and control group in both serum and intraocular fluid (Z=8.962, 8.120; P=0.000, 0.000). Twenty-eight patients (56.00%) were positive for specific IgG in both serum and intraocular fluid. Six patients (12.00%) were positive only in serum, and 16 patients (32.00%) only in intraocular fluid. The positive rate was significantly higher in intraocular fluid than in serum (χ2=4.720, P=0.028). Moreover, 64.00% intraocular fluid showed higher specific IgG level than pared serum. ConclusionThe complementary detection of intraocular specific IgG have referential value in diagnosing ocular toxocariasis.
ObjectiveTo investigate the role of dynamic monitoring procalcitonin (PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia (CAP). MethodsFour hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group (the research group) and a standard guideline group (the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein (CRP)were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. ResultsThe hospitalization time [(9.6±1.7)days vs. (10.9±1.6)days],hospitalization cost [(6 957.11±1 009.46) yuan vs. (8 011.35±1 049.77) yuan],chest CT examination rate (56.96% vs. 89.40%),the application time of antibiotics [(16.5±2.3)days vs. (20.0±1.2)days],and the rate of required antibiotics upgrade (6.96% vs. 11.06%) in the research group were all significantly lower than the control group (P<0.05). There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics (14.78% vs. 15.20%),the rate of transfer into ICU (2.61% vs. 3.69%) or the mortality (1.74% vs. 2.30%)(P>0.05). ConclusionOn the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.
ObjectiveTo evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). MethodsRetrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). ResultsTwenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. ConclusionsPVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.