Comparative study of Epi-LASIK and LASIK for myopic astigmatism

AIM: To analyze the effects of epipolis laser <i>in situ</i> keratomileusis(Epi-LASIK)and laser <i>in situ </i>keratomileusis(LASIK)for treatment of myopic astigmatism. <p>METHODS: For treatment of myopic astigmatism, 32 patients(64 eyes)treated by Epi-LASIK and 63 patients(126 eyes)received LASIK. By their degree of astigmatism, the eyes were divided into Group Ⅰ(-0.25～-2.75)DC and Group Ⅱ(-3.0～-5.0)DC. During the 6-month follow-up, the early effects of the two operations were observed and compared in terms of uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), residual astigmatism, corneal healing, intraocular pressure(IOP), corneal topography. <p>RESULTS: In Group Ⅱ, UCVA better than 20/20 was achieved in 87.5% of the eyes subjected to Epi-LASIK and in 63.3% of the eyes subjected to LASIK, with significant difference between them(<i>χ</i>²=4.055, <i>P</i><0.05); residual astigmatism was -0.41±0.30D for the Epi-LASIK eyes and -0.74±0.36D for the LASIK eyes, with significant difference between them(<i>t</i>=2.672, <i>P</i><0.05); postoperative corneal astigmatism was 0.63±0.34D for the Epi-LASIK eyes and 0.81±0.52D for the LASIK eyes with significant difference between them(<i>t</i>=2.234, <i>P</i><0.05). <p>CONCLUSION: For treatment of high astigmatism(≥-3.00D), Epi-LASIK is more effective and predictive than LASIK

Expanded CURB-65: A new score system predicts severity of community-acquired pneumonia with superior efficiency

Aim of this study was to develop a new simpler and more effective severity score for communityacquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age≥ 65 years, LDH>230u/L, albumin<3.5g/dL, platelet count<100×109/L, confusion, urea>7mmol/L, respiratory rate≥30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65. The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95%CI, 0.807–0.844), 0.801 (95%CI, 0.781–0.820), 0.756 (95%CI, 0.735–0.777), 0.793 (95%CI, 0.773–0.813) and 0.759 (95%CI, 0.737–0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems

The management of a duodenal fistula involving the right hepatic duct: a rare case report

The formation of an internal fistula between the biliary system and the gastrointestinal tract is a rare condition with various etiologies, predominantly associated with recurrent chronic inflammation of the biliary system and tumors. Patients with this condition may lack specific clinical manifestations, presenting with symptoms such as abdominal pain, fever, jaundice, or may show no clinical signs at all. Common types of internal fistulas include cholecystoduodenal fistula, cholecystocolonic fistula, and choledochoduodenal fistula. Among these, the right hepaticoduodenal fistula is extremely rare and seldom reported in clinical literature. We herein report a case of right hepaticoduodenal fistula and analyze its mechanism, treatment principles, and preventive measures through a literature review