骨髓瘤是常见的血液系统恶性肿瘤，并呈年逐年递增趋势。多发性骨髓瘤通常会影响身体多个部位，如脊柱、头骨、盆骨和肋骨。在该疾病中，浆细胞转化为癌细胞，这些癌细胞生长失控，排挤掉正常细胞。这会导致红细胞，白细胞和血小板的空间和数量也减少。血细胞的减少会引发贫血、出血过多、免疫功能下降，并且骨髓瘤细胞可能会破坏骨质，损害骨髓，从而导致骨痛同时增加骨折的风险。骨质破坏使钙进入血中进而导致高钙血症。

目前尚不清楚多发性骨髓瘤的确切病因，但一些风险因素可能包括年龄（超过50岁以上）、超重，有长期接接触某些化学品、家族遗传都会增加患有多发性骨髓瘤的风险。值得一提的是，多发性骨髓瘤起病比较隐匿，诊断的时候都是比较晚期，但90%患者有贫血，73%的患者早期都是以贫血为首发症状。

大多数骨髓瘤患者常常面临复发难题，传统的治疗方案疗效有限。如今，CAR-T细胞免疫疗法是近些年最有前景的肿瘤免疫疗法之一，凭借特异性好、杀伤力强的显著成果，为复发难治性多发性骨髓瘤患者带来全新曙光。统计数据显示，CAR-T细胞疗法在多发性骨髓瘤患者中也取得了显著的成果，实验结果显示总体缓解率为73%-98%[1]。

为了延长患者的生存期，早发现和早治疗是关键，定期体检和寻求医疗专业人员的建议也是非常重要的。同时随着针对多发性骨髓瘤的新药不断涌现，患者的临床疗效有了大幅提高，这也意味着更长的生存期和更好的生活质量[2]。


Reference list
[1]Cappell, KM & Kochenderfer, JN 2023, ‘Long-term outcomes following CAR T cell therapy: what we know so far’, Nature Reviews Clinical Oncology, vol. 20, pp. 1–13.
[2]Gerecke, C, Fuhrmann, S, Strifler, S, Schmidt-Hieber, M, Einsele, H & Knop, S 2016, ‘The Diagnosis and Treatment of Multiple Myeloma’, Deutsches Aerzteblatt Online, vol. 113, no. 27-28.

据世界卫生组织统计，淋巴瘤发病率年增长率为7.5%，成为近10十年来增速较快的恶性肿瘤之一，而且趋于年轻化发展态势。淋巴瘤可以发生在淋巴系统的任何部位[1]，临床表现多样，对免疫系统和整体健康造成影响。其体征和症状可能包括发热、贫血、出血表现。

淋巴瘤有多种类型。主要可以分为两大类：霍奇金淋巴瘤和非霍奇金淋巴瘤[2][3]。根据研究结果显示，结节性硬化症霍奇金淋巴瘤在年轻人中更常见，而混合细胞霍奇金淋巴瘤则常见于老年人[4]。霍奇金淋巴瘤的确切病因尚不清楚，但EB病毒感染、自身免疫性疾病和免疫抑制状态会增加患病风险，有霍奇金淋巴瘤家族史者患病风险比其他人高[4]。

非霍奇金淋巴瘤最常见的肿瘤是滤泡性淋巴瘤、伯基特淋巴瘤、弥漫性大 B 细胞淋巴瘤等。 不同亚型的发病率在不同地区存在差异，滤泡性淋巴瘤在西方国家更常见，而T细胞淋巴瘤在亚 洲更常见。据统计，非霍奇金淋巴男性发病率略高于女性，中位发病年龄为50-70 岁[5]。

不同类型的淋巴瘤多以无痛性的淋巴结肿大为首发症状；不明原因的发热也是常见的症状之一。淋巴瘤的的治疗差异很大，具体因肿瘤分期、分级、淋巴瘤类型以及各种患者因素（例如症状、年龄、体能状态）而异。对于淋巴瘤的治疗方法，应该由专业医生根据患者的具体情况来确定，传统的血液肿瘤治疗方法包括化疗、放疗，但这些方法的效果有限且副作用比较大。因此，免疫疗法和靶向药物成为了治疗血液肿瘤新的研究热点。此外，CAR-T细胞免疫疗法已在国内获批使用于淋巴瘤的临床应用。根据研究显示，接受CAR-T细胞疗法之后的淋巴瘤患者，83%的患者有缓解，其中53%的患者达到了完全缓解的状态[6]。对于某些复杂病例，可能会采用多种治疗方法的组合治疗[7]。

同时保持健康的生活习惯，如均衡饮食、适量运动、避免吸烟和限制酒精摄入，有助于维持免疫系统的健康。此外，避免接触有毒物质和化学物质，以及与病毒感染相关的风险因素，也有助于预防淋巴瘤的发生。同时做好规范化诊断和治疗也是决定淋巴瘤是否能有效控制并最终得到治愈的关键[8]。

Reference list
[1]medtextfree 2012, CHAPTER 103 LYMPHOMAS, Free Medical Textbook.
[2]Lees, C, Keane, C, Gandhi, MK & Gunawardana, J 2019, ‘Biology and therapy of primary mediastinal B‐cell lymphoma: current status and future directions’, British Journal of Haematology, vol. 185, no. 1, pp. 25–41, viewed 17 May 2020, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594147/?report=reader#__ffn_sectitle>.
[3]Amraee, A, Evazi, MR, Shakeri, M, Roozbeh, N, Ghazanfarpour, M, Ghorbani, M, Ansari, J & Darvish, L 2019, ‘Efficacy of nivolumab as checkpoint inhibitor drug on survival rate of patients with relapsed/refractory classical Hodgkin lymphoma: a meta-analysis of prospective clinical study’, Clinical and Translational Oncology, vol. 21, no. 8, pp. 1093–1103.
[4]Kaseb, H & Babiker, HM 2023, Hodgkin Lymphoma, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 16 October 2023, <https://www.ncbi.nlm.nih.gov/books/NBK499969/#article-22957.r1>.
[5]Sapkota, S & Shaikh, H 2020, Non-Hodgkin Lymphoma, PubMed, StatPearls Publishing, Treasure Island (FL).
[6]Locke, FL, Ghobadi, A, Jacobson, CA, Miklos, DB, Lekakis, LJ, Oluwole, OO, Lin, Y, Braunschweig, I, Hill, BT, Timmerman, JM, Deol, A, Reagan, PM, Stiff, P, Flinn, IW, Farooq, U, Goy, A, McSweeney, PA, Munoz, J, Siddiqi, T & Chavez, JC 2019, ‘Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1–2 trial’, The Lancet Oncology, vol. 20, no. 1, pp. 31–42.
[7]‘[The guidelines for diagnosis and treatment of Hodgkin lymphoma in China (2022)].’ 2022, PubMed, vol. 43, National Institutes of Health, no. 9, pp. 705–715, viewed 16 October 2023, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613489/>.
[8]李颖 2013, 科学生活：淋巴癌为何‘看上’年轻人？, www.gov.cn, viewed 16 October 2023, <https://www.gov.cn/govweb/fwxx/kp/2013-09/10/content_2485054.htm>.

CAR-T (Chimeric Antigen Receptor T-Cell Therapy) 即“嵌合抗原受体T细胞疗法”，是针对人类癌症个体化细胞免疫治疗的重大突破，被认为是治疗复发或难治性肿瘤的有效解决方案之一，已被获批应用于治疗血液系统肿瘤[1]。CAR-T中的T，指的是所有人体内都有的一种免疫细胞——T细胞。而这种疗法，就是通过采集患者的T细胞，进行体外基因工程修饰，使得 T 细胞获得特异性地识别特定肿瘤靶点的能力，成为CAR-T细胞；随后，将大量扩增“被武装过的” T细胞（即CAR-T细胞）回输给患者，CAR-T细胞在患者体内繁殖并精 准击杀肿瘤。

CAR-T 细胞疗法具有革命性意义，因为它产生了非常有效且持久的临床反应。简单来说，T细胞是在实验室中经过基因改造（改变）的细胞，可以发现并对抗全身的疾病和感染。每个T细胞都可以识别抗原受体，当免疫系统识别出来或抗原异常时可以消灭它们。

CAR-T细胞疗法的应用为患者提供了新的治疗选择。临床显示，CAR-T细胞疗法在血液系统肿瘤中取得了显著的疗效，一些患者甚至达到了完全缓解的状态，以及目前批准的细胞产品均报告这些长期持久缓解效果。根据研究显示，接受CAR-T细胞疗法之后的淋巴瘤患者，83%的患者有缓解，其中53%的患者达到了完全缓解的状态[2]。此外，统计数据显示CAR-T细胞疗法在多发性骨髓瘤患者中也取得了显著的成果，实验结果显示总体缓解率为73%-98%[3]。

CAR-T细胞的“活体药物”性质，能够在患者体内扩增和持久存在，从而提供持续的抗肿瘤反应[4]。随着科技的发展，CAR-T细胞疗法不断取得进步，不断提高了该疗法的安全性和有效性[5]。尽管目前在实体肿瘤的实际应用中仍然存在一些阻碍，然而随着进一步的研究和临床实践，相信未来CAR-T细胞疗法的发展有望为更多患者提供治愈的希望。

Reference list
[1]Huang, R, Li, X, He, Y, Zhu, W, Gao, L, Liu, Y, Gao, L, Wen, Q, Zhong, JF, Zhang, C & Zhang, X 2020, ‘Recent advances in CAR-T cell engineering’, Journal of Hematology & Oncology, vol. 13, no. 1.
[2]Locke, FL, Ghobadi, A, Jacobson, CA, Miklos, DB, Lekakis, LJ, Oluwole, OO, Lin, Y, Braunschweig, I, Hill, BT, Timmerman, JM, Deol, A, Reagan, PM, Stiff, P, Flinn, IW, Farooq, U, Goy, A, McSweeney, PA, Munoz, J, Siddiqi, T & Chavez, JC 2019, ‘Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1–2 trial’, The Lancet Oncology, vol. 20, no. 1, pp. 31–42.
[3]Cappell, KM & Kochenderfer, JN 2023, ‘Long-term outcomes following CAR T cell therapy: what we know so far’, Nature Reviews Clinical Oncology, vol. 20, pp. 1–13.
[4]De Marco, RC, Monzo, HJ & Ojala, PM 2023, ‘CAR T Cell Therapy: A Versatile Living Drug’, International Journal of Molecular Sciences, vol. 24, no. 7, p. 6300.
[5]Lim, WA & June, CH 2017, ‘The Principles of Engineering Immune Cells to Treat Cancer’, Cell, vol. 168, no. 4, pp. 724–740, viewed 26 April 2019, <https://www.sciencedirect.com/science/article/pii/S0092867417300648>.

Time-lapse is an imaging technique used to create videos using a series of pictures taken at particular time intervals. It allows us to see in greater detail the development that occurs in certain intervals, which take place so slowly which are invisible to the naked eye. Thanks to time-lapse technology, we can see them more rapidly and in full detail. In time-lapse incubator, pictures of embryos will be takes at different time intervals (every 10 or 20 minutes, for instance), from different viewpoints. With the visual obtained the embryologist now can see the entire development process of each embryo individually or collectively - from the moment insemination is carried out until they are transferred, frozen, or thrown away.

One of the most remarkable advancements achieved in the past few years in the field of Assisted Reproduction is precisely the use of this technology to monitor embryo development in vitro.

The application of Time-lapse technology in the field of IVF are include three indispensable parts:
1. Time-lapse embryo culture - providing a stable and safe culture environment for embryo development
2. Time-lapse embryo monitoring - using high-resolution cameras to obtain rich embryo development data
3. Time-lapse consistent evaluation of embryos - to evaluate the developmental potential of embryos

The main limitation of traditional methods was that the evaluation of embryos was conducted only at particular stages of development. In other words, embryologist gather static information from a dynamic process. Subsequently, embryologist miss material information about the embryo development process.

Furthermore, evaluating the quality of embryos under the conventional microscope is not a recommended practice, as quality diminishes each time the embryos leave the incubator.

Thanks to time-lapse technology, embryologist can monitor embryo development without taking the embryos out of the incubator, thereby maintaining them in ideal culture conditions.

The use of time-lapse significantly improves live birth rates and reduced early pregnancy loss rates.

Reference：
1. Kovacs: Embryo selection: the role of time-lapse monitoring. Reproductive Biology and Endocrinology 2014 12:124.
2. Alpha scientists in reproductive medicine and ESHRE special interest group of embryology: The Istanbul consensus workshop on embryo assessments: proceedings of an expert meeting. Hum Reprod 2011, 26:1270–1283.
3. Kirkegaard K, Agerholm IE, Ingerslev HJ: Time-lapse monitoring as a tool for clinical embryo assessment. Hum Reprod 2012, 27:1277–1285.
4. Wong C, Chen AA, Behr B, Shen S: Time-lapse microscopy and image analysis in basic and clinical embryo development research. Reprod Biomed Online 2013, 26:120–129.

Many patient who has undergone in vitro fertilization (IVF) will have heard of the blastocyst culture techniques that can be used to improve the clinical pregnancy rate. When blastocyst culture processes are applied to in vitro cultures, further screening is possible. This ensures that the embryos are of high quality and have optimum developmental potential, thereby improving the clinical pregnancy rate.

After the eggs and sperm have been retrieved, insemination (IVF or ICSI) is performed in an embryology laboratory to create a fertilized egg, called a zygote. The zygote develops over three days until it has cleaved into 8-10 cells on Day 3. At this point, it is called a Day 3 cleavage embryo.

If the embryo continues to develop for an additional 2-3 days, the embryo will develop into a blastocyst. The process of development from a Day 3 cleavage embryo to a blastocyst is called blastocyst culture.

Blastocyst culture requires an optimal and constant culture environment. This includes a culture microenvironment with stable parameters such as temperature, osmotic pressure, and pH value, as well as a stable incubator and laboratory environment that is equipped with a high-efficiency laminar flow filtration system。

The process whereby blastocysts are transferred into the mother's uterus is called blastocyst transfer. Typically, under controlled physical conditions, the greater the success rate of blastocyst culture, the higher the success rate of IVF. 

Reference:

1.      中华医学会，2009，临床诊疗指南-辅助生殖技术与精子库分册，北京人民卫生出版社。

2.      American Society for Reproductive Medicine. Revised guidelines for human embryology and andrology laboratories. FertilSteril 2008; 90:S45-59

Considering the high cost, success rates, and possible side effects of assisted reproduction techniques (ART), early efforts to improve male fertility appear to be an attainable and worthwhile primary goal. Having healthy sperm is essential to the success of your fertility treatment. Since a full sperm regeneration cycle (spermatogenesis) takes about 76 days (about 3 months to be ejaculated), the quality of the sperm reflects the state of sperm health 3 months earlier. Therefore, it is beneficial for the husband to begin his preparation sooner rather than later.

1. Balanced diet 

 A dad-to-be’s diet should include a variety of fresh fruits and vegetables, especially greens, as well as a moderate intake of vegetable protein and healthy fats, as well as foods rich in folic acids, such as soybeans, eggs, asparagus, lentils, and sprouts. Reduce intake of refined sugar, alcohol, fruit juice, etc., and eat less takeout, fast food, fried food, and sweet desserts. For irregular diet, man can properly supplement some multivitamin preparations, including vitamins A, C, and E, and trace elements zinc, selenium, etc. Advice to quit smoking and minimize alcohol consumption, to supplement folic acid in an appropriate amount if the husband has a folic acid deficiency or tobacco and alcohol addiction, in turn, improves the quality of the husband's sperm.

2. Healthy lifestyle 

 Avoiding sedentary and appropriate exercise can balance hormones in the body, reduce body fat and decrease psychological stress and enhance libido. Find the amount of exercise that works for you, and do not over-exercise which leads to fatigue. Increasing outdoor activities and exposure to sunshine were associated with higher vitamin D levels in men, thereby improving sperm quality.

3. Regular work and rest 

Studies have shown that sleep quality affects the quantity and quality of sperm directly. The male who falls asleep between 20:00 – 22:00 has higher sperm quality and greater fertility. In addition, regular work and rest are also in line with the characteristics of male sex hormone secretion, which is conducive to improving hormone levels, thereby improving male fertility.

4. Prepare before semen collection 

 To ensure the quality of sperm, avoiding exposure to a high-temperature environment is advised, for example, no sauna or no hot sitting baths. Abstain from intercourse for 2-7 days. Pay attention to personal hygiene. Wash hands and clean the genitals before semen collection.

Compare to the wife, the husband is easier to cope with during IVF treatment, as the wife bears most of the treatment and emotional stress. Therefore the husband should take further steps to support their wife thus reducing the stress caused by drugs and procedures. This is very important to get a positive outcome from IVF treatment.

In addition, the husband should take care of his health. Consult professional advice if you have the underlying disease and take medicine for a long time.

Reference
[1]Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion [J]. Fertil Steril. 2022 Jan;117(1):53-63.
[2] The effect of cigarette smoking, alcohol consumption and fruit and vegetable consumption on IVF outcomes: a review and presentation of original data[J]. Reproductive Biology & Endocrinology, 2015, 13(1):134.Daniel M .
[3] Can Male Fertility Be Improved Prior to Assisted Reproduction through The Control of Uncommonly Considered Factors?[J]. International Journal of Fertility & Sterility, 2013, 6(4):214-223.

1. What is surgical abortion?

Surgical abortion (Dilation and Curettage also known as D&C) is a commonly used method to terminate the first trimester of pregnancy. It is suitable for those who are less than 10 weeks pregnant. The procedure involves the extraction of pregnancy tissue (such as villi, sacs, etc.) from the uterus by surgical measure to terminate the pregnancy.

In order to facilitate the suction device and other instruments into the uterine cavity, the need to use a cervical dilator to gradually expand the cervix, plus the negative pressure suction process and the final curettage process, these will bring discomfort to you, even pain. During the operation, the patient’s relaxed mood and active cooperation with the surgeon can reduce discomfort to a certain extent. Many hospitals now have the option of performing a D&C under anesthetic analgesia, which can reduce discomfort but also increase the additional risk of anesthesia.

2. What is the effect of D&C on the body?

All operations have the potential for complications. Although the procedure is generally safe, it can lead to uterine damage in special circumstances, such as many time miscarriages, only a few months after the last delivery (or miscarriage), or excessive uterine forward flexion.

Artificial abortion too soon and too many, will cause greater damage to the endometrium, adverse impact on the future pregnancy. Therefore, unwanted pregnancies should be avoided as much as possible, and when they do occur, early termination is less damaging.

3. What should be paid attention to before the D&C?

Preoperative medical history should be truthfully provided, and necessary preoperative examinations should be completed to determine whether surgery can be performed and whether there are any high-risk factors (such as the presence of genital tract infection, lactation, etc.). You can ask your doctor about the operation and sign the informed consent form after you are fully informed.

The day before the operation should do a good personal hygiene, better take a bath, change clothes, wash perineum area. Do not have intercourse, pay attention to rest, appropriate nutritional diet.

If the patient is selected to receive D&C under anesthesia, on the date of surgery: before the operation, solid food (including milk and granular drinks) should be avoided for 6 hours, water should be forbidden for 2 hours, and empty your bladder.

4. Consider the contraceptive measures implementing after the operation to avoid another accidental pregnancy

Make full use of the time before the operation to communicate with the doctor, understand the various contraceptive options available after the operation and how to use them effectively;

• IUD can be placed at the same time of operation.

• or start taking short-acting oral contraceptives immediately after surgery;

• or use a condom when having sex again

Post-Surgical Abortion education

Will I have symptoms after a surgical abortion?

• Pain and cramping in the lower belly. This lasts for a few hours.

• Bleeding from the vagina. This is usually lighter than after a medication abortion. The bleeding can last for up to 2 weeks.

Should I call my doctor or nurse after an abortion?

Call right away if:

• Your bleeding is heavy enough to soak through 1 menstrual pad each hour, for at least 2 hours, and you are still bleeding

• Your pain is really bad (it makes you double over or makes it hard to move), and you don’t feel better with pain medicines, such as ibuprofen (sample brand names: Motrin, Advil)

• You have a fever higher than 100.4°F (38°C)

• Bad-smelling discharge comes out of your vagina

Incomplete abortion

In some cases, abortion does not work completely. In other words, they do not always get rid of all the pregnancy tissue. If that happens to you, you will need to take additional medicine or have a procedure to remove any leftover tissue. Signs that an abortion was not complete include:

• Not bleeding after a medication abortion

• Still having pregnancy symptoms, such as nausea and tender breasts, 1 week or more after your abortion

• Bleeding for more than 2 weeks after an abortion

• Not having a period in the first 6 weeks after an abortion

Is there anything I should do differently after an abortion?

Do not have sex or put anything into your vagina for 2 weeks after an abortion. If you do, you could get a very serious infection.

What if I want to get pregnant again someday?

Having an abortion does not make it harder to get pregnant again. Abortions do not harm your health, and they do not harm the health of your future babies.

Reference:
Shanghai maternal and child health center
UpToDate

Medical abortion is a non-operative approach to termination of pregnancy. This approach allows the pregnant woman to have an abortion with light pain and avoid the risk of surgery. However medical abortion still can do harm to your uterine membrane. Furthermore, about 10% patients will probably experience incomplete abortion or failed abortion. Therefore that follow-up after a medical abortion is helpful for recovery.

What respects should be pay attention after medical abortion?

Observation

One hour observation is necessary after the expelling of gestational sac, and can be discharged home if you are not having discomfort. If there is abdominal pain, vaginal bleeding more, your doctor will take appropriate measures to control it.

What may happen after leaving the hospital?

• Vaginal bleeding: A small amount of vaginal bleeding may occur for a period of time after a medical abortion, lasting longer than after a surgical abortion. If the bleeding is larger than the normal amount of menstruation (compared with the amount of bleeding on the same day of menstruation), or the time of vaginal bleeding is more than 2 weeks, you should go to the hospital in time.

• Abdominal pain: mild lower abdominal pain within a few days after the procedure. If there is more severe abdominal pain. Need to go to the hospital in time.

• Fever: there should be no fever under normal conditions. If you feel cold or uncomfortable, take your temperature. Such as a significant increase in body temperature, or accompanied by severe abdominal pain, or accompanied by a large number of vaginal bleeding, timely return to the hospital.

Follow-up visits:

• Those who did not discharge the pregnancy sac during observation should return to the hospital for further consultation 1 week after medication.

• If the pregnancy sac has been discharged during observation, the patient should return to the hospital 2 weeks after the procedure.

• All patients for medical abortion are expected to have a 6th week follow-up visit especially when your Menstruation did not recover in time.

Prevention of infection:

• Before menstruation returns back, do not have a sexual life, avoid the use of vaginal tampon, tub bath, etc., especially after a medical abortion.

• Keep the perineum clean, change sanitary pad and underwear frequently.

Back to normal life:

• Two weeks of rest is recommended after medical abortion.

• Pay attention to nutrition. Add foods rich in protein, iron and vitamins.

• Avoid early post-abortion intense exercise and heavy physical activity, so as not to increase abdominal pain and vaginal bleeding.

• If you plan to have another pregnancy, you should wait 6 months after the abortion to recover well. Because the endometrium after abortion by different degrees of damage, and need to have a recovery process, such early pregnancy is adverse to fertilized eggs implantation and development, easy to cause spontaneous abortion.

Implement contraceptive measures to avoid another unwanted pregnancy:

• There is no safe period after an abortion, and once sex is restored, another unwanted pregnancy may occur.

• After resuming sex, reliable contraceptive methods:

• Short-acting oral contraceptives: they can be used once the abortion is successful.

• Intrauterine device: can be placed after menstruation recovery.

• Condoms: can be used once sex resumes.

• Calendar calculate method, before menstruation did not restore regularly, or cannot be mastered correctly, is not recommended to use.

Reference:
Shanghai maternal and child health center

The recommendations that follow are intended as a general guide to you at home.

• Pain Control

It is common to have discomfort after surgery. You may have discomfort from the incision and muscle aches. Getting up and moving around can ease some of the discomfort. Take your pain medicine as ordered. Some medicine may upset an empty stomach. To prevent nausea, you should take the medicine with food.

Some of your pain medicine may contain acetaminophen. Acetaminophen can cause liver damage if you take too much. Do not take more than 3000mg in 24 hours. If you are taking narcotic pain medication or sleeping medication, do not drink any alcohol. You should not drive any vehicles while taking narcotics.

• Constipation

It is common to not have a bowel movement for several days after surgery. Some pain medications can also cause constipation. To help your bowels stay regular:

◦ Drink more liquids

◦ Eat more whole grains, fruits and vegetables

◦ Get regular exercise(a 15-minute walk is a good start)

◦ Take stool softeners

• Activity

The most important thing is to use good common sense in planning your activities. If it hurts, do not do it. Do not do anything to the point of exhaustion. Rest if you get tired. After minimally invasive procedures (such as laparoscopy, hysteroscopy, vaginal surgeries, and robotic procedures), you should be up and moving about freely soon after the surgery. Gradually increase your activities as follows:

◦ You are allowed to climb stairs, but try not to become too tired.

◦ Avoid heavy lifting, not more than a 4 liter bottle of water.

◦ Avoid strenuous exercise or sports for 6 weeks after major surgery.

◦ You should not drive for 24 hours after receiving general anesthesia. After that, do not drive until you can do so without discomfort and without using prescription pain medicine. This can take from 3 to 7 days.

◦ You may shower and wash your hair.

◦ No intercourse, douching, or tampons for at least 2 weeks. You may be restricted longer (6 weeks or more) if you had vaginal surgery or a hysterectomy.

• Caring for Your Incision

It is important to keep your incision clean and dry to prevent infection. Leave any covering over the incision in place for a week unless otherwise instructed. Call immediately if a large amount of fluid starts to drain or redness develops. You should wear comfortable clothing. Do not wear soiled or tight clothing over the wound. If you have paper strips of tape (Steri-Strips®) on the skin over your incision, leave them on until they fall off. These may offer extra support as your incision heals.

Once home, you may shower and care for the incision as follows:

◦ Always wash your hands before and after touching your incision.

◦ Soapy water can run over the incision.

◦ Rinse well.

◦ Pat the incision dry with a clean towel, rather than rubbing.

You may use a hair dryer on low heat to dry your incisions.

◦ Do not soak the incisions in a tub until you are told you may do so.

◦ Starting on the 4th day following surgery, restart washing the incision with CHG every day for 2 weeks unless instructed otherwise by your surgeon.

◦ Do not use lotions, cream or ointments on the wound unless they have been ordered by your doctor.

• Diet

You may eat and drink as tolerated. Go easy at first, with clear liquids, soup or broth, and crackers, before you progress to solid food. Eat foods that are easy to digest while avoiding fatty foods until your digestion returns to normal. Increase fiber and fluids if you get constipated.

• Follow-up Visit

Please plan to return for a postoperative check 1 to 2 weeks after your procedure. If an appointment has not been made for you, call your doctor’s office to be scheduled.

When to Call Your Doctor

Contact your doctor if you notice any of the following:

• Temperature over 38 ℃ (100.2℉), chills or sweats

• Drainage or fluid from the incision that continues or is foul-smelling

• Increased tenderness or soreness at the wound

• Wound edges that are no longer together

• Redness or swelling at the wound site

• Vaginal bleeding heavier than a period or foul-smelling discharge

• Difficulty urinating or urinary frequency, urgency, or burning

• Worsening pain

• Chest pain, shortness of breath, dizziness

• Pain in the calves or legs

• Nausea or vomiting

• Unable to drink fluids or keep fluids down

• If any symptom is getting worse with time

• If you do not feel well, or just aren’t sure whether your symptoms are normal

Dear Mr./Ms.                 :

Thank you for choosing the Ophthalmology Clinic of Jiahui Health for your eye surgery. We will give you a brief introduction to the preoperative preparations required, preoperative medications and postoperative precautions you need to understand for the purposes of promoting a smooth procedure and helping you understand the postoperative precautions to accelerate recovery.

1. What is vitrectomy:

• It is a method to treat diseases of the vitreous and retina under an operating microscope with the help of a vitreous cutter.

2. Preoperative preparations:
1）Preoperative irrigation of the conjunctival sac will be performed to remove intraocular foreign bodies and secretions and reduce postoperative infection.

2）Preoperatively, we will cut off the eyelashes for skin preparation to provide a better surgical field and reduce intraoperative and postoperative infections.

3. Medication instructions

1）Apply Tobramycin and Dexamethasone Eye Drops to the operative eye: 6 times daily for the first three days, followed by QID since the forth day, discontinuing two weeks later.

2）Apply Tobramycin and Dexamethasone Ophthalmic Ointment to the operative eye: QN, discontinuing two weeks later.

3）Additionally apply Gatifloxacin Eye Gel to the operative eye: QN, discontinuing two weeks later.

4）Apply Pranoprofen Eye Drops to the operative eye: TID two weeks later, discontinuing after it is used up

5）Apply Tropicamide Eye Drops to the operative eye: 6 times daily for the first three days, followed by 4 times a day since the forth day.

6）Each eye drop should be applied alternately, with an interval of more than 10 minutes. Eye drops should be applied at 1 drop/time. Intraocular water intake should be avoided within one month after surgery, and all drugs should be administered after the gauze is opened on the second morning of surgery.

7）Time for postoperative routine follow-up visit: one week, two weeks, one month, two months, and three months after surgery.

4. Postoperative precautions

1）Generally, absolute bed rest is not required for patients undergoing vitrectomy (without intraocular fillers); they may lie supine, but eyeball movements should be restricted in case of postoperative bleeding. Patients with intraocular fillers (gas or silicone oil fillers) pressing against retinal tears need to face down while resting for 8-10 hours daily for the fillers are lighter than water; the extent and specific position should be adjusted depending on the condition under the doctor’s guidance. Special emphasis should be placed on that: correct resting and sleeping postures directly affect the effect of surgery and can reduce the occurrence and exacerbation of postoperative cataracts. Please be sure to follow the doctor's guidance.

2）The eyelids are the lowest in prone position, so surgery-induced inflammatory edema is most evident in the eyelids, and the affected eye will be severely swollen, which gradually relieves 3-5 days after surgery when observation or cold compresses may be performed. A prone position should be maintained 1-2 weeks postoperatively, and it may be shifted as instructed by your doctor. Long-acting gas is generally absorbed slowly 1-2 months after surgery, while silicone oil often needs to be removed surgically.

3）Patients should apply eye drops regularly and correctly, take medicine in time, eat more vegetables, and avoid spicy, stimulating and hard food to keep bowels open. The medical staff should be informed of headache, nausea, vomiting, eye pain, eye distension, severe wound pain, insomnia, etc. (if any) in time. Eyes should not be touched or rubbed with hands casually; hands should be washed before applying eye drops, and at least 10 minutes of rest with eyes closed is required after applying eye drops. It is necessary to avoid strong light stimulation, keep indoor light soft, and possibly wear colored safety glasses when going out. Doctor’s instructions should be followed to adjust medication frequency or reduce dosage in time. There is no need to worry in case of increased intraocular pressure; please communicate with doctor timely, adjust medication and apply intraocular tension-lowering drugs.

4）Regular reviews are required to monitor visual acuity, intraocular tension, retinal fundus and visual field. Please seek medical attention timely to prevent recurrence in case of any abnormality. A review is required 1 week after gas filling, and the intervals between subsequent reviews are gradually extended after the gas is completely absorbed. For patients with silicone oil fillers, it takes 3 months to half a year before taking out the silicone oil in hospital. The specific time for oil removal should be recommended by the doctor according to ordinary follow-ups, and discussed with the doctor. Long-term retention of silicone oil in the eyes may induce emulsification, cataract, glaucoma, corneal zonal degeneration and other complications, but there are significant individual differences - some people develop significant complications in a relatively short period of time, while others, especially the elderly who are less active, may not develop significant complications for a long time. Please pay timely visits to hospital for examination in case of eye pain, significant decline of vision, and other symptoms, to prevent the vision from damage by silicone oil emulsification and other complications in the later stage.

5）Activities should be restricted: excessive activities should be restricted for half a year after surgery, and heavy physical labor should be restricted for one year. For patients filled with C3F8, before the gas is fully absorbed, they should avoid working at height, taking an airplane or traveling to the plateau, so as to avoid a series of complications such as central retinal artery/vein occlusion. Strenuous exercises such as running and jumping should be avoided in 3 months after surgery, and diving, boxing and other sports that may hurt the eyes are strictly prohibited; regular reviews are required.

6）Patients should keep optimistic and comfortable; be prepared to fight the disease for a long time. It is important to realize that if cataracts are not removed at the time of vitrectomy, they may appear earlier or worsen in your intraoperative eye.

7）Please seek medical attention timely in case of severe headache, nausea, vomiting, eye pain, severe wound pain, insomnia and other conditions, and call the hospital prior to your visits.