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AIM: To compare the outcome of C3F8 versus silicone oil tamponade after pars plana vitrectomy(PPV)and inverted internal limiting membrane(ILM)for the treatment of highly myopic macular hole retinal detachment(MHRD).METHODS: Retrospective clinical study. Totally 45 patients(45 eyes)with highly myopic MHRD who visited our hospital between January 2019 and August 2022 were selected as the research subjects. The patients were divided into two groups according to different intraocular tamponade agents: C3F8(22 eyes)and silicone oil(23 eyes)groups. All patients underwent conventional three-incision PPV, ILM was tamped, a venous blood clot was placed on the tamped ILM, and 15% C3F8 and silicone oil were used as tamponade, respectively. The best corrected visual acuity(BCVA), multifocal electroretinogram(mfERG), the closure of the macular hole, retinal reattachment and the complications were observed.RESULTS: The macular hole closure rate was 77% in the C3F8 group and 83% in the silicone oil group, respectively(P>0.05), and retinal reattachment rates were 95% and 96%, respectively(P>0.05). The visual acuity of the two groups significantly improved, which was 0.99±0.34 and 1.22±0.37, respectively, and the C3F8 group was better than that of the silicone oil group(t=-2.156, P=0.037). After operation, the response density of the first ring of P1 wave in the first order kernel in mfERG was 114.27±26.37 nV/deg2 for the C3F8 group and 98.08±24.36 nV/deg2 for the silicone oil group, and the response density of the second ring of P1 wave was 80.45±14.94 nV/deg2 for the C3F8 group and 67.73±15.33 nV/deg2 for the silicone oil group, all of which were significantly higher compared to pre-operation [the response density of the first ring of P1 wave: 58.13±13.96 nV/deg2 for the C3F8 group and 55.30±10.48 nV/deg2 for the silicone oil group, the response density of the second ring of P1 wave: 51.18±8.19 nV/deg2 for the C3F8 group and 47.43±11.97 nV/deg2 for the silicone oil group](all P<0.05). It was found that the response density of the first ring of P1 wave was lower in the silicone oil group than in the C3F8 group(P<0.05). There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).CONCLUSION: Silicone oil tamponade or C3F8 tamponade after PPV combined with ILM can both promote retinal reattachment and macular hole closure in patients with MHRD, and the C3F8 tamponade was superior to silicone oil in visual function recovery.
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AIM: To investigate the mechanism of elemene synergistic bortezomib against multiple myeloma based on ROS-NF-κB-p38MAPK signaling pathway. METHODS: CCK-8 assay was used to detect cell activity. Nude mice were randomly divided into control group, bortezomib (BTZ) group, elemene (ELE) group and combination group. Each group was treated with BTZ, ELE and BTZ combined with ELE, respectively. Tunel staining was performed to observe the apoptosis of tumor tissues. The expressions of Caspase-3, Bcl-2, NF-κB and p38 MAPK were detected by Western Blot. Cell cycle, apoptosis and reactive oxygen species (ROS) expression were detected by flow cytometry using human myeloma U266 cells. RESULTS: When 4.0 μmol/L ELE combined with 50 nmol/L BTZ treated U266, the cell activity was significantly reduced compared with that of NC, BTZ and ELE groups (P< 0.05). The tumor volume of nude mice in BTZ group, ELE group and combined group was significantly reduced compared with the control group (P <0.05), and the combined group was the smallest. Tunel staining results showed that the apoptosis level in the control group was lower than that in the BTZ group, ELE group and the combined group (P<0.05), and the combined group had the lowest apoptosis level. Compared with the control group, the expressions of Caspase-3 and p38 MAPK in BTZ group, ELE group and combination group were significantly increased, while the expression of Bcl-2 was significantly decreased. The apoptosis level and expression of ROS in BTZ group, ELE group and the combined group was significantly increased compared with the control group (P<0.05). CONCLUSION: ELE can enhance the role of BTZ in promoting apoptosis of myeloma cells, which may be achieved by regulating ROS/NF-κB/p38 MAPK signaling pathway to enhance the level of apoptosis of tumor cells to achieve anti-tumor effect.
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Objective:To analyze the effect of vitrectomy combined with internal limiting membrane (ILM) peeling on the prevention of post-vitrectomy epiretinal membrane (ERM) in macular-off rhegmatogenous retinal detachment (RRD) and its influence on visual outcomes.Methods:A cohort study was conducted.Seventy-four patients (74 eyes) with macular-off RRD, who realized retinal reattachment after vitrectomy and silicone oil tamponade from January 2015 to January 2018 in Baoding NO.1 Central Hospital, were enrolled.The patients were divided into the non-ILM peeling group (36 cases, 36 eyes) and ILM peeling group (38 cases, 38 eyes) according to whether they received ILM peeling or not.The patients underwent silicone oil removal within 3 to 5 months after the surgery.Best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were examined before and at 1, 6 and 12 months after the surgery.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Baoding NO.1 Central Hospital (No.[2019]042). Written informed consent was obtained from each patient.Results:There was no ERM found in the two groups at 1 month after the operation.There were 3 eyes (8.33%) with ERM in the non-ILM peeling group and 2 eyes (5.26%) in the ILM peeling group at 6 months after the operation, with no statistically significant difference between them ( P=0.067). There were 9 eyes (25.00%) with ERM in the non-ILM peeling group and 4 eyes (10.53%) in the ILM peeling group at 12 months postoperatively, with no statistically significant difference between them ( χ2=2.674, P=0.102). There was a significant difference in BCVA between before and after the operation in the two groups ( Ftime=31.692, P<0.001). Postoperative 1-, 6-and 12-month BCVA were all significantly better than the preoperative BCVA in the two groups (all at P<0.05). There was no significant difference in BCVA between the two groups ( Fgroup=0.117, P=0.773). OCT images showed that there were 25 eyes (77.78%) and 30 eyes (78.95%) with the intact ellipsoid zone in the non-ILM peeling group and ILM peeling group at 12 months after the operation, respectively, with no statistically significant difference between them ( χ2=0.875, P=0.350). Conclusions:Compared with vitrectomy alone, the vitrectomy combined with ILM peeling does not show better efficacy in the prevention of ERM occurrence in macula-off RRD patients and has no obvious influence on postoperative visual acuity.
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Objective:To observe the effect of intravitreal injection of anti-vascular endothelial growth factor drugs on the subfoveal choroid thickness (SFCT) of patients with retinal vein occlusion (RVO) and macular edema (ME).Methods:A prospective clinical study. From January 2017 to January 2019, 59 monocular RVO-ME patients with 59 eyes diagnosed in the eye examination of The First Central Hospital of Baoding were included in the study. Among them, there were 31 males with 31 eyes and 28 females with 28 eyes; the average age was 57.4±10.3 years old. The course of the disease was 5 days to 1 month, all of whom had the first-onset disease. Branch retinal vein occlusion (BRVO) was found in 35 eyes (BRVO-ME group); non-ischemic central retinal vein occlusion (CRVO) was found in 24 eyes (CRVO-ME group). Best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (OCT) were performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. The Cirrus HD-OCT 5000 instrument from Carl Zeiss company of Germany was used to measure the central macular thickness (CMT) and SFCT. All eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drugs. The follow-up time after treatment was 6 months, and the changes of BCVA, CMT and SFCT of eyes before treatment and 2 weeks after treatment were compared and observed, as well as the occurrence of treatment-related complications. The comparison of BCVA, CMT, and SFCT at different times before and after treatment were adopted repeated measures analysis of variance; pairwise comparison of differences at different time points adopts the least significant difference t test. Results:Before treatment, the average logMAR BCVA and CMT of RVO-ME eyes were 0.92±0.46 and 604.71±169.35 μm, respectively. At 2 weeks, 1, 3, and 6 months after treatment, the average logMAR BCVA of the affected eye was significantly improved compared with that before treatment, and the CMT was significantly decreased. The difference was statistically significant ( F=55.664, 59.518; P<0.05). Before treatment, the average SFCT of the affected eye and the contralateral eye of RVO-ME patients were 306.3±65.8 and 241.3±59.8 μm, respectively. The SFCT of the affected eye was significantly thicker than that of the contralateral healthy eye, and the difference was statistically significant ( t=25.772, P<0.05). At 2 weeks, 1, 3, and 6 months after treatment, the average SFCT of the eyes were 267.7±81.4, 252.3±57.3, 239.2±46.5, 240.6±48.3 μm, respectively. Compared with before treatment, treatment SFCT decreased significantly at different times afterwards, and the difference was statistically significant ( F=924.341, P<0.001). There was no significant difference in SFCT between CRVO-ME group and BRVO-ME group at 2 weeks, 1, 3, and 6 months after treatment ( P>0.05). No complications such as endophthalmitis, cataract progression and neovascular glaucoma occurred during the follow-up period of all eyes. Conclusion:The SFCT of eyes with short course of disease and first-onset RVO-ME is thickened; anti-VEGF drug treatment can effectively reduce SFCT, improve ME, and increase BCVA.
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Objective@#To understand the situation of school health staff and the allocation of health equipment in primary and secondary schools in Jinan.@*Methods@#A questionnaire survey was conducted in CDC and public primary and secondary schools to describe the situation of the school health staff and health equipment in primary and secondary schools.@*Results@#There were 23 school health staffs in CDC, among which 26.1% were full time. The total staffing ratio of school doctors was 13.9%, with the compliance rate of 19.8%. The total allocation rate of health care teachers was 74.7%, 92.2% of them were part time. The total staffing ratio of school doctors in boarding schools was 20.0%, with a staffing compliance rate of 12.5%. The total allocation rate of school doctors and health care teachers in boarding schools was 66.7%. 16.8% of public primary and secondary schools and 23.3% of public boarding primary and secondary schools did not have any health staffs. 27.6% of public primary and secondary schools are equipped with infirmary, 70.8% with health rooms, and 10.3% without any. The configuration of necessary equipment in infirmary and health care rooms were less than 100%.@*Conclusion@#There is a serious shortage of school health staffs and health equipment in primary and secondary schools in Jinan. Attention and investment in school health should be strengthened, and resources should be rationally allocated to ensure the health of primary and secondary school students.
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Objective:To evaluate the changes of metamorphopsia in patients with rhegmatogenous retinal detachment (RRD) who underwent primary vitrectomy and to analyze the correlation between macular microstructure changes and metamorphopsia.Methods:It was a retrospective clinical study. From January 2017 to January 2019, 57 patients (57 eyes) with RRD were examined and diagnosed in the Department of Ophthalmology of Baoding First Central Hospital were enrolled in this study. All patients underwent 23G PPV. All patients had retinal anatomical reduction after the first PPV. The best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscope, indirect ophthalmoscope, changes of metamorphopsia, and optical coherence tomography (OCT) were examined before PPV and 1, 6, 12 months after the operation. The BCVA examination was performed using the international standard visual acuity chart, which was converted into a logarithm of the minimum angle of resolution (logMAR) BCVA for the record. The macular fovea retinal thickness (CRT) was measured by Carl Zeiss Cirrus HD-OCT5000 instrument from Carl Zeiss Company, Germany, and the microstructural changes in the macular area were recorded, including the presence of the anterior macular membrane (ERM), cystic macular edema (CME), subretinal fluid (SRF), and the integrity of the ellipsoid zone (EZ) and outer membrane (ELM). The value of metamorphopsia (M value) was measured by the M-Chart table. The changes of BCVA, M value, and the microstructure of the macular area before and after operation were analyzed. The correlation between BCVA and M value was analyzed by Pearson correlation. Spearman correlation analysis was used to analyze the correlation between the changes of macular microstructure and BCVA and M values.Results:The mean logMAR BCVA before the operation was 1.15±0.43. At 1, 6, and 12 months after the operation, the mean logMAR BCVA was 0.62±0.17, 0.39±0.18, and 0.34±0.13, respectively. The visual acuity improved significantly after operation compared with before operation, and the difference was statistically significant ( F=119.731, P=0.000). The mean CRT before the operation was 476.0±104.1 μm. At 1, 6, and 12 months after the operation, the average CRT were 299.8±29.9, 272.2±17.8, and 261.0±19.3 μm, respectively. The average CRT after the operation was significantly lower than those before the operation ( F=185.518, P=0.000). At 1, 6, and 12 months after the operation, the mean M values were 0.62±0.54, 0.43±0.41, and 0.32±0.36, respectively; the difference was statistically significant ( F=6.568, P=0.020). After the operation, 48 eyes (84.2%, 48/57) had microstructural abnormalities in the macular area, including EZ and ELM integrity disruption, SRF, CME, and ERM. Correlation analysis showed that M value was significantly positively correlated with BCVA, CRT, and SRF height before operation ( r/ rs=0.672, 0.385, 0.932; P<0.05). There was no correlation between M value and BCVA ( r/ rs=0.503), EZ and ELM integrity ( r/ rs=0.497, 0.472), SRF ( r/ rs=0.416), CME ( r/ rs=0.821) and ERM ( r/ rs=0.632) after operation ( P>0.05). Conclusions:The BCVA is significantly increased and the metamorphopsia is improved after anatomically successful RRD surgery. Postoperative M value is highly correlated with preoperative BCVA, CRT, and SRF.
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Objective:To evaluate the changes in foveal avascular zone (FAZ) size and foveal microstructures in patients with rhegmatogenous retinal detachment (RRD) and to analyze the correlation between FAZ size, foveal microstructure changes and visual outcomes.Methods:A retrospective study. From January 2017 to January 2019, 79 RRD patients (79 eyes) diagnosed in Department of Ophthalmology in Baoding First Central Hospital were included in the study. The patients were divided into macula-off group (51 eyes), macula-on group (28 eyes). The unaffected fellow eyes were used as a control group. The retinas were reattachment in all eyes after first standard 23G PPV combined with silicone oil filling. Before and 3 months after surgery, all patients underwent a comprehensive ophthalmologic examination, including the measurement of BCVA and OCT angiography (OCTA) examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The FAZ areas were evaluated with OCTA in the superficial capillary plexus layers by using 3 mm×3 mm images of the macular.The following postoperative foveal microstructures were evaluated:epiretinal membranes, macular edema, subretinal fluids, integrity of ellipsoidal zone and external limiting membrane. Pearson correlation analysis was used to analyze the correlation between FAZ area and BCVA. The correlation between macular microstructures and BCVA was analyzed by Spearman correlation analysis.Results:At 3 months after the removal of silicone oil, the FAZ area in the macula-off group, macula-on group and the control group were 0.447±0.041, 0.409±0.034, 0.335±0.027 mm 2, respectively. Compared with the control group, the FAZ area in the macula-off group and macula-on group were enlarged, the difference was statistically significant ( F=184.148, P<0.05). The logMAR BCVA in the macula-off group and macula-on group were 0.800±0.180 and 0.386±0.160, respectively. There was significant difference in ellipsoidal zone rupture between the two groups ( χ 2=7.577, P=0.006). The results of correlation analysis showed that the area of FAZ and the incidence of ellipsoidal zone fracture after surgery were positively correlated with BCVA after surgery ( r=0.329, 0.290; P=0.003, 0.010). Conclusions:The FAZ area of RRD is enlarged after surgery. FAZ area and ellipsoid zone fracture are positively correlated with BCVA after surgery.
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Objective To observe the efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane.Methods Forty-two patients (42 eyes) with secondary epiretinal membrane underwent vitretinal surgery in our hospital from June 2011 to June 2015 were retrospectively studied.All patients underwent pars plana vitrectomy + epiretinal membrane peeling + retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide.The follow-up time was from 3.0 months to 18.0 months,averaged (8.3 ± 2.4) months.Postoperative best corrected visual acuity (BCVA),macular morphology and complications were observed.Resules At the final follow-up,BCVA improved in 30 eyes,unchanged in 8 eyes and decreased in 4 eyes,and there was significant difference compared with that before operation (t =3.145,P =0.000).The preoperative and postoperative thickness of meuroepithelium in the centual macular area were(315.62 ±132.12) μm and (233.42 ± 146.32) μm,and there was significant difference(t =4.322,P =0.000).Small amount of retinal hemorrhage happened in 6 eyes after operation,vitreous hemorrhage was in 1 eye,transient high intraocular pressure was in 6 eyes;Prepheral retinal hole occurred in 3 eyes,which were cured by laser treatment and C3F8 tamponade.Conclusion Intravitreal injection of triamcinolone acetonide can reduce the macular edema,decrease the reoccurrence of epiretinal membrane and imporve the visual acuity.The retinal inner limiting membrane peeling in secondary macular epiretinal membrane surgery can release the macular pucker,lifting and traction on the fovea,improve the metabolism of macular local,is conducive to the recovery of macular function.
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@#Objective To apply the WeChat in family rehabilitation after anterior cruciate ligament (ACL) reconstruction. Methods 126 patients accepted ACL reconstruction using quadrupled semitendinosus and gracilis tendons were divided into observation group (n=69) and control group (n=57). The control group received conventional rehabilitation program, and the observation group joined the WeChat group. They were assessed with knee range of motion (ROM), knee stability test, thigh perimeter, Lysholm score and the International Knee Documentation Committee (IKDC) score 3 and 6 months after operation. Results There was a significant difference between groups in ROM of knee flexion (P<0.05) 3 and 6 months after operation, but not in ROM of knee extension (P>0.05). There was no significant difference in thigh perimeter 3 months after operation, but it was significant 6 months after operation. There was significant difference in Lysholm score and IKDC score (P<0.05), but not in the joint stability (P>0.05). Conclusion Direction of rehabilitation with the WeChat Group can significantly improve the compliance, accelerate the rehabilitation process and reduce complications in patients after ACL reconstruction.
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Objective To apply the WeChat in family rehabilitation after anterior cruciate ligament (ACL) reconstruction. Methods 126 patients accepted ACL reconstruction using quadrupled semitendinosus and gracilis tendons were divided into observation group (n=69) and control group (n=57). The control group received conventional rehabilitation program, and the observation group joined the WeChat group. They were assessed with knee range of motion (ROM), knee stability test, thigh perimeter, Lysholm score and the International Knee Docu-mentation Committee (IKDC) score 3 and 6 months after operation. Results There was a significant difference between groups in ROM of knee flexion (P0.05). There was no significant difference in thigh perimeter 3 months after operation, but it was significant 6 months after operation. There was significant difference in Lysholm score and IKDC score (P0.05). Conclusion Direction of rehabilitation with the WeChat Group can signifi-cantly improve the compliance, accelerate the rehabilitation process and reduce complications in patients after ACL reconstruction.
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Objective To investigate the interference causes of indwelling gastric tube for patients undergoing laryngeal tumor surgery,and explore the appropriate clinical nursing countermeasures.Methods 60 cases of laryngeal cancer patients with indwelling gastric tube were divided into the control group and the observation group with 30 cases in each group.The control group used indwelling gastric tube with routine nursing,while in the observation group,the influencing factors for indwelling gastric tube were analyzed and per-tinent neasures were adopted timely.The satisfaction degree of patients,incidence of postoperative compli-cations,hospitalization time and effective rate of treatment were compared.Results The factors influ-encing use of indwelling gastric tube were tracheal extubation by patients,trachea cannula exodus,pipe blockage and postoperative complications.After timely expectant treatment and positive nursing,the nutri-tion intake and postoperative recovery were not affected.The related indexes of the observation group were better than those of the control group.Conclusions Patients after laryngeal cancer surgery need longtime indwelling gastric tube.Measures such as strengthening of education and propaganda,close observation of patients′ condition and timely expectant treatment should be given in order to ensure the normal use of gastric tube and reach desirable treatment effect.
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Objective To investigate the self-efficacy for the nursing activities of nurses in the operation room and explore the ways of improving the self-efficacy of nursing activities of nurses in the operation room.Methods 160 nnrses in the operation rooms of four hospitals in Binzhou city were chosen as the observation group.160 non-operation room nurses in these four hospitals were chosen as the control group.The self-efficacy of nursing activities questionnaires were used to survey the self-efficacy of nurses.According to the analysis of survey results,measures to improve the self-efficacy of nursing activities were discussed.Results The self-efficacy scores for 160 operation room nurses were lower than those non-operation room nurses.Among 5 dimensions,nursing skill was with the lowest score in 160 nurses who had been investigated.The difference of self-efficacy scores of care activities for nurses in operation rooms of different hospitals was significant.Conclusions Nursing activity in the operation room has its own specialty.The self-efficacy of nursing activities was lower than non-operation room nurses generally,especially in nursing skills.Improving leadership and working environment of nurses,giving positive social support and re-education programs are the scientific ways to improve self-efficacy of nursing activities in the operation room.
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Objective To explore the clinical effect of holistic nursing in the operation room for surgical children patients. Methods 120 patients required surgical treatment were selected and divided into the control group(45 cases)and the observation group(75 cases)randomly.The control group was given routine nursing,the observation group was given holistic nursing including preoperative interview,psychological care and all the preparations,strict check upon going into the operation room and before surgery,to help children keep graceful position,to cooperate closely with the anesthetist and surgeon,to observe the condition of patients and give good infusion management,to give continued observation of the disease condition after surgery,to make children safe escort back to the ward,and to make transfer with ward nurses.The treatment effect was compared between two groups. Results Two groups of children passed the period of operation and anesthesia safely,without appearing accidental situation.The satisfaction degree of the observation group was significantly higher than the control group.One case appeared operation accident and two cases appeared anesthesia awareness in the control group,and they were correctly handled.No one appeared operation accident and anesthesia awareness in the observation group.The differences between the two groups were significant. Conclusions Application of holistic nursing in the operation room for children patients puts forward higher requirements for nurses.It can help children cooperate with surgery better to achieve better surgical results,which is worthy of promotion.
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@# Objective To investigate the cerebral ischemia/reperfusion protection mechanism of viper venom nerve growth factor(vNGF) by the change of expression of growth associated protein-43 (GAP-43) and neurological function.Methods 45 adult male Wistar rats (weight 220～280 g) were divided randomly into 3 groups: sham group(S, n=9), balanced salt solution group (BSS, n=9) and venom nerve growth factor group (vNGF, n=27). Each group was observed for 7 days. vNGF group was divided into 25 U, 50 U and 100 U subgroups respectively. The following indexes in 3 groups were observed respectively: neurologic deficits and the expression of GAP-43 (immunohistochemistry method).Results Neurological function: The scores of neurological function was 0 in S group. The neurological deficits score was lower at the same time in vNGF group than that in BSS group (P<0.05). Immunohistochemistry: GAP-43 expressed in both BSS group and vNGF group. The expression of GAP-43 in vNGF group increased in 25 U, and to maximum in 100 U. The expression of GAP-43 in BSS group was significantly lower than in vNGF group (P<0.05). Conclusion vNGF can effectively enhance and prolong the expression of GAP-43, increase the survival rats of nerve cells, and has the protection effect on nerve cells after cerebral ischemia injured.