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Objective To explore the predictive ability of the revised cardiac risk index(RCRI)in elderly patients with coronary heart disease(CHD)undergoing non-cardiac surgery. Methods We performed a retrospective study including a total of 2100 patients,aged≥65 with a history of CHD who underwent non-cardiac surgery form January 2013 to September 2019.The preoperative,intraoperative and postoperative clinical data were extracted from an electronic database.The RCRI and reconstructed-RCRI(R-RCRI)score of each patient were calculated.The primary end point was defined as an occurrence of perioperative MACE.Multivariate logistic regression analysis was performed to evaluate the risk factors of perioperative MACE.The area under the receiver operating characteristic(ROC)curve was used to compare the predictive value of RCRI,R-RCRI,and the new risk scoring system of the study for perioperative MACE. Results The incidence of perioperative MACE in elderly patients with CHD was 5.4%.Six independent risk factors of perioperative MACE for this population were identified:age≥80 years;female;history of heart failure;insulin-depended diabetes mellitus;preoperative ST segment abnormality;American Society of Anesthesiologists grade≥Ⅲ,and the risk index was 2,2,2,2,2 and 3 respectively.The area under ROC curve of RCRI,R-RCRI and risk scoring system in this study were 0.586,0.552 and 0.741. Conclusion The correlation between RCRI score and perioperative MACE was poor in elderly patients with CHD undergoing non-cardiac surgery,and a better cardiac risk assessment method should be established for this population.
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Aged , Female , Humans , Male , Middle Aged , Coronary Disease/complications , Logistic Models , Multivariate Analysis , Postoperative Complications/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Surgical Procedures, OperativeABSTRACT
Objective To evaluate the clinical efficacy of intravitreal ranibizumab injection and panretinal photocoagulation for neovascular glaucoma.Methods Totally 8 patients (40 eyes) with neovascular glaucoma in the First Affiliated Hospital of Zhengzhou university from January 2016 to October 2016 were collected in this study,and the patients were randomly divided into two groups according to the different treatments:trabeculectomy group (18 eyes),in which the patients were treated with intravitreal injection of ranibizumab + trabeculectomy + panretinal photocoagulation,and cyclophotocoagulation group (22 eyes),subjects undergoing cyclophotocoagulation + panretinal photocoagulation.All patients were followed up for 6 months.And there was no significant difference in the general data of the two groups (all P ＞ 0.05).Finally,variables including iris neovascularization,the best corrected visual acuity (BCVA),the preoperative and postoperative 1 month,3 months and 6 months intraocular pressure,the operation successful rate and complications in both groups were evaluated and compared.Results In the trabeculectomy group,1 week after treatment,neovascularization in all patients was disappeared,and 6 months of follow-up,a small amount of neovascular recurrence occurred;in the cyclophotocoagulation group,2 weeks after treatment,neovascularization disappeared in 18 eyes,decreased in 3 eyes,and did not change in 1 eye;additionally,6 months of follow-up,some eyes presented neovascularization recurrence.The postoperative BCVA in the trabeculectomy group was significantly higher than that before operation,and the difference was statistically significant (P =0.026),But there was no significant difference between preoperative and postoperative BCVA in the cyclophotocoagulation group (P =0.438).Preoperative BCVA in the trabecuiectomy group was significantly higher than that in the cyclophotocoagulation group,and the difference was statistically significant (P =O.039).The intraocular pressures of the both groups were decreased at 1 month,3 months and 6 months after operation,and the differences were statistically significant (all P ＜ 0.05).There was significant difference in the success rate of operation between the two groups (P =0.047).The efficacy of the trabeculectomy group was better than that of the cyclophotocoagulation group.The incidence of complications in the trabeculectomy group was lower than that in the cyclophotocoagulation group,and the difference was statistically significant (P =O.024).Conclusion It is safe and effective for intravitreal ranibizumab injection + trabeculectomy + panretinal photocoagulation in the treatment of iris neovascularization,of which the clinical efficacy is better than cyclophotocoagulation + pamretinal photocoagulation.
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Background Epithelial-mesenchymal transition (EMT) is a major event in the pathogenesis of posterior capsular opacification (PCO),and the expressions of α-smooth muscle actin (α-SMA) is the marker of EMT.Previous studies showed that breviscapine plays an important role in anti-fibrosis and suppression EMT,however,the mechanism of its effect on EMT in LECs is unclear.Objective Present study was to investigate the effect of breviscapine on the expression of α-SMA and fibronectin (FN) in human LECs induced by transforming growth factor-β2 (TGF-β2).Methods Human LECs strain,HLE-B3,was cultured and passaged in DMEM containing 10％ fetal bovine serum.Different concentrations of breviscapine (6.75,12.75,25.00,50.00 and 100.00 mg/L)were added into the medium for 24,48 and 72 hours respectively,and then cell cunting kit-8 (CCK-8) was used to evaluate the half maximal inhibitory concentration (IC50) of breviscapine to HLE-B3.In addition,HLE-B3 was subcultured at the density of 1 × 106/hole and divided into 4 groups.The cells were in free-serum medium as the normal control;the cells were exposed in 10 μg/L TGF-β2 as TGF-β2 group;while in the breviscapine group,10 mg/L of breviscapine was added into the culture medium and another group was the combination of 10 mg/L breviscapine and 10 μg/L of TGF-β2 treatment.Real-time PCR and Western blot were used to detect the mRNA expressions of α-SMA and FN as well as their protein in HLE-B3 72 hours after cultured.Results The inhibitory rate of breviscapine to HLE-B3 proliferation was gradually elevated with the increase of concentration of breviscapine,showing a significant inhibition of the cell proliferation among the different groups and at various time points (F =292.851,P=0.000;F =65.037,P=0.000).IC50 of HLE-B3 at 72 hours was 22 mg/L,and therefore,in rest of experiment 10 mg/L of breviscapine was used which was 1/2 only half of the IC50.α-SMA and FN were expressed in cultured normal HLE-B3.The expressing level of α-SMA mRNA and FN mRNA in the HLE-B3 was significantly different among the normal group,TGF-β22 group,breviscapine treatment group and combination group as well as at various time points (F =105.490,P =0.000 ; F =1041.414,P =0.000).Similarly,the protein expressions of α-SM A and FN in the HLE-B3 was significantly different among the four groups and different time points (F=136.872,P=0.000;F=119.820,P=0.000).The expression levels of α-SMA and FN mRNA and their proteins in HLE-B3 were remarkably increased in the 10 μg/L TGF-β2 group compared with the normal control group (at all P=0.000),and those in the combination group were obviously declined in comparison to the TGF-β2 group (P =0.001,0.001,0.001,0.010).No significant difference was found in the expressions of α-SMA and FN in the HLE-B3 between the breviscapine group and normal control group in both transcriptional level and protein level (P =0.551,0.292,0.551,0.360).Conclusions 10 mg/L breviscapine can arrest the proliferation and EMT of human LECs.This result suggests that using breviscapine may be a potential prophylactic approach in the prevention of PCO.