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Objective:To explore the role of bedside cardiopulmonary ultrasound in the evaluation of non-invasive positive pressure ventilation (NPPV) in patients with cardiaogenic pulmonary edema in emergency department.Methods:The clinical data and characteristics of bedside rapid cardiopulmonary ultrasound in patients withcardiaogenic pulmonary edema treated with NPPV in the emergency department were retrospectively analyzed. The following ultrasound parameters, including lung ultrasound score, the ratio of lung consolidation, diameter of inferior vena cava, left ventricular ejection fraction (LVEF), the mitral annular systolic displacement (MAPSE) and tricuspid annular systolic displacement (TAPSE), the peak Doppler velocities of the early diastolic mitral (E), the tissue velocity imaging of left ventricular and right ventricular (Sm), the tissue Doppler of the early diastolic velocity of the mitral annulus (e’), the average E/e’ ratio of left ventricular, systolic pulmonary artery pressure (SPAP) and the ratio of atrial fibrillation,, were determined. All of the parameters combined with clinical parameters were compared between the non-invasive ventilation success group and non-invasive ventilation failure group. Univariate and multivariate logistic regression analysis were used to screen out the risk factors by taking the failure of NPPV treatment as the dependent variable. The area under the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators above.Results:A total of 66 patients, included 44 (66.%) of NPPV success and 22 (33.3%) of NPPV failure revealed by bedside cardiopulmonary ultrasound. In comparison with the NPPV success group, the lung ultrasound score, ratio of lung consolidation, E/e’ of LV , SPAP, the ratio of right ventricular dysfunction, the ratio of atrial fibrillation and the level of Ccr were significantly evaluated, but the Sm of right ventricular and PaO2/FiO2 were significantly lower in the NPPV failure group (all P< 0.05). There were no differences in LVEF, MAPSE, TPASE, diameter of inferior vena cava and the Sm of left ventricular between groups (all P> 0.05). Multivariate logistic regression analysis showed that lung ultrasound score, E/e’ and SPAP were independent predictors of NPPV failure in patients with cardiaogenic pulmonary edema. The AUCs of lung ultrasound score, E/e’ of LV and SPAP for predicting NPPV failure was 0.802, 0.783 and 0.852, respectively. . Conclusions:The lung ultrasound score, right ventricular diastolic function and SPAP evaluated by bedside cardiopulmonary ultrasound could provide predictive values for the non-invasive positive ventilation failure in patients with cardiaogenic pulmonary edema.
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Objective@#To observe the clinical efficacy of minimally invasive vitreous surgery (MIVS) for special rhegmatogenous retinal detachment (RRD) in children and adolescents.@*Methods@#A retrospective clinical comparative study. Fourteen eyes with special type of RRD in 14 children and adolescents who received the MIVS treatment from January 2014 to January 2019 in Ophthalmology Department of The First Affiliated Hospital Ophthalmology of Air Force Military Medical University, were included in this study. Among them, 8 eyes from 8 males and 6 eyes from 6 females. The age of them ranged from 5 to 17, with the mean age of 12.64±4.11 years. The course of disease was ranged from 1 d to 1 year, and the average of it was 30 d. All the eyes developed the special type RRD, including pseudophakic and aphakic retinal detachment, giant retinal tear with retinal detachment, choroidal detachment associated with retinal detachment, and RRD with ocular dysplasia. In the 14 eyes, there was 2 eyes with retinal detachment in 1 quadrant, 4 eyes in 2 quadrants, 1 eye in 3 quadrants and 7 eyes in total 4 quadrants. All the eyes were treated with 23G or 25G MIVS and filled with irrigation solution, air and silicone oil. In addition, 10.4 months' follow-up for average after surgery were taken to observe the occurrence of retinal reattachment, BCVA and related complications in the eyes.@*Results@#In the 14 eyes, 13 (92.9%) of them attained retinal reattachment and 1 eye (7.1%) got a poor retinal reattachment after one operation. At the last follow-up, all the 14 eyes (100.0%) attained retinal reattachment and 5 of them at the filling state of silicone oil. The vision of 8 eyes (57.1%) were improved, 4 eyes (28.6%) have no notable changes and 2 eyes decreased (14.3%). During the operation, iatrogenic retinal breaks were occurred in 1 eye, and silicone oil entered underneath the retina in 1 eye. After the operation, 1 eye suffered a relapse of retinal detachment after the removal of silicone oil and then were filled with it again.@*Conclusions@#MIVS is a safe and effective way to treat the special type RRD among the children and adolescents. The rate of retinal reattachment is 92.9% after one surgery and 100.0% at the last follow-up. Therefore, MIVS can help most of eyes with special type RRD to get a stable and improved vision.
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Objective To observe the clinical efficacy of minimally invasive vitreous surgery (MIVS) for special rhegmatogenous retinal detachment (RRD) in children and adolescents.Methods A retrospective clinical comparative study.Fourteen eyes with special type of RRD in 14 children and adolescents who received the MIVS treatment from January 2014 to January 2019 in Ophthalmology Department of The First Affiliated Hospital Ophthalmology of Air Force Military Medical University,were included in this study.Among them,8 eyes from 8 males and 6 eyes from 6 females.The age of them ranged from 5 to 17,with the mean age of 12.64 44.11 years.The course of disease was ranged from 1 d to 1 year,and the average of it was 30 d.All the eyes developed the special type RRD,including pseudophakic and aphakic retinal detachment,giant retinal tear with retinal detachment,choroidal detachment associated with retinal detachment,and RRD with ocular dysplasia.In the 14 eyes,there was 2 eyes with retinal detachment in 1 quadrant,4 eyes in 2 quadrants,1 eye in 3 quadrants and 7 eyes in total 4 quadrants.All the eyes were treated with 23G or 25G MIVS and filled with irrigation solution,air and silicone oil.In addition,10.4 months' follow-up for average after surgery were taken to observe the occurrence of retinal reattachment,BCVA and related complications in the eyes.Results In the 14 eyes,13 (92.9％) of them attained retinal reattachment and 1 eye (7.1％) got a poor retinal reattachment after one operation.At the last follow-up,all the 14 eyes (100.0％) attained retinal reattachment and 5 of them at the filling state of silicone oil.The vision of 8 eyes (57.1％) were improved,4 eyes (28.6％) have no notable changes and 2 eyes decreased (14.3％).During the operation,iatrogenic retinal breaks were occurred in 1 eye,and silicone oil entered underneath the retina in 1 eye.After the operation,1 eye suffered a relapse of retinal detachment after the removal of silicone oil and then were filled with it again.Conclusions MIVS is a safe and effective way to treat the special type RRD among the children and adolescents.The rate of retinal reattachment is 92.9％ after one surgery and 100.0％ at the last follow-up.Therefore,MIVS can help most of eyes with special type RRD to get a stable and improved vision.
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Objective To investigate the effects of the polymorphisms in the promoter of ATP binding cassette transporter (ABCG1) on the transcription activity,and the relationship of the polymorphisms with the susceptibility to coronary artery disease (CAD).Methods A case-control study was conducted,217 CADpatients and 142 controls were enrolled in this study.Thesingle nucleotide polymorphisms (SNPs) in the promoter of ABCG1 were identified by sequencing.The promoter haplotypes of ABCG1 were determined with allele specific primer sequencing or Gene cloning sequencing.The transcription activity of the promoter haplotypes were evaluated with dual luciferase reporter system.The frequency of SNPs and haplotypes were analyzed between CAD group and the control group,premature CAD and non-premature CAD group,as well as multivessel lesion and single vessel lesion group.The frequency distribution was compared between two groups with x2 test or Fisher exact test.The difference of the luciferase activity was compared between groups by t-test or one-way analysis of variance.Results Only 3 SNPs were found in ABCG1 promoter sequence of about 1 000 bp upstream of the transcription start site,which are-384 (A/G),-204 (A/C) and-134 (T/G),respectively.The 3 SNPs are in strong linkage disequilibrium,Tajima's D =2.655 (P ＜ 0.01),which constituted 3 haplotypes.There was no significant difference in SNPs and haplotype frequency between the CAD group and the normal control group,and the severity of vascular disease and the early onset of coronary heart disease were not associated with the polymorphisms in ABCG1 promoter.There was no significant difference in the transcriptional activity of the three constitutive promoter haplotypes,but the transcriptional activity was notably elevated as the GAT haplotype was mutated into GAG (P ＜ 0.05).Conclusions The 3 SNPs identified in ABCG1 promoter region A did not alter the promoter activity.There was no significant correlation between the frequency distribution of SNPs and promoter haplotypes and the susceptibility to CAD.
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Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.
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Objective investigate the correlation between plasma soluble receptor for advanced glycation endproducts (sRAGE) and arterial stiffness in patients with different types of metabolic syndrome (MS).Methods A total of 180 subjects were drawn from a epidemiologic follow-up study,including 60 cases non-metabolic syndrome (NMS),60 cases metabolic syndrome without diabetes mellitus (NDMMS),60 cases metabolic syndrome with diabetes mellitus (DMMS).Carotid femoral arterial pulse wave velocity (CFPWV) was assessed by the French KangPuLe atherosclerosis measurement instrument,and plasma sRAGE levels were measured by ELISA.Comparison of mean in multiple groups was conducted by analysis of variance.Multivariate analysis was done with multiple linear stepwise regression analysis.P ＜ 0.05 was considered as statistically significant difference.Results Compared with NMS group,plasma sRAGE levels were significantly lower in DMMS and NDMMS groups [(635.07 ± 229.20) pg/mL vs.(671.17 ± 358.16) pg/mL vs.(992.99 ± 427.83) pg/mL,P =0.001].CFPWV of DMMS group was significantly higher than that of NMDMS and NMS groups (14.22 ±3.14) m/s vs.(12.15 ±2.79) m/s vs.(11.66 ± 2.52) m/s,P =0.002).Plasma sRAGE level was negatively correlated with CFPWV (r =-0.278,P =0.005).(3) Multiple linear regression analysis demonstrated that age (β =-0.091,95％ CI-0.096 ～-0.095,P =0.031),HDL-C (β =1.295,95％ CI 1.231 ～ 1.360,P =0.022) and sRAGE (β =0.119,95％ CI 0.118 ～ 0.130,P =0.032) had a significant effect on CFPWV.Conclusions The increased arterial stiffness is closely related to the discreased plasma sRAGE levels in MS.Plasma sRAGE maybe a novel target for vascular disease prevention and treatment in patients with metabolic syndrome.
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AIM:To study the correlation of serum uric acid ( UA) level with carotid plaques and arterial stiff-ness in the patients with essential hypertension ( EH) , and to explore the predictive value of serum UA for evaluating EH preclinically .METHODS:A total of 92 patients with EH and 30 healthy individuals were enrolled .The value of UA and other indicators were detected .B-mode ultrasound examination was performed to measure the common carotid artery intima -media thickness ( IMT) and the sites of plaque in the internal carotid-artery, external carotid artery and carotid bifurca-tions.Carotid-femoral arterial pulse wave velocity ( CFPWV) was assessed by Complior?atherosclerosis measurement in-strument.RESULTS:The serum level of UA in the patients with EH was higher than that in control group [(361.51 ± 83.81) μmol/L vs (317.03 ±62.22) μmol/L, P<0.05].The mean value and abnormal rate of IMT between hyperten-sion group and control group were significant difference [(0.69 ±0.14) mm vs (0.60 ±0.12) mm, 42.39%vs 10.00%, P<0.05].In 92 EH patients, 45 cases had carotid plaques .These 45 cases were divided into 3 groups according to the plaque severity, among which the serum UA level had statistically significant differences [(285.25 ±78.41) μmol/L, (341.19 ±63.99) μmol/L and (401.33 ±88.49) μmol/L, P<0.05].Compared with rigid plaque group ( n=34), the serum UA level in soft plaque group (n=11) was significantly higher [(389.00 ±69.45) μmol/L vs (323.03 ± 72.71) μmol/L, P<0.05].A stepwise multiple linear regression analysis demonstrated that age ( r=0.414), systolic blood pressure (r=0.224), pulse pressure (r=0.270) and uric acid (r=0.219) were predisposed factors for higher CFP-WV (P<0.05).CONCLUSION:UA is one of the risk factors causing hypertension .Serum UA level may reflect the sever-ity and stability of carotid plaques .The increased arterial stiffness is closely related to the increased serum UA level in EH .
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Objective To observe the therapeutic effect of scleral buckling procedure on old retinal detachment. Methods The clinical data of 42 patients (46 eyes), including 24 males (27 eyes) and 18 females (19 eyes), with old retinal detachment treated by scleral buckling procedure in our department were retrospectively reviewed. The duration of the disease ranged from 1 month to 2 years. All the patients were with rhegmatogenous retinal detachment and combined with mainly predominantly-subretinal proliferative vitreoretinopathy (PVR) (stage C), including stage C1 of PVR in 16 eyes (34.8%), stage C2 in 19 eyes (41.3%), and stage C3 in 11 eyes (23.9%). Scleral buckling was performed on 13 eyes (283%) and cerclage combined buckling on 33 eyes (71.7%). Sterile air was injected into 36 eyes (78.3%) during the operation, and C3F8 was introvitreal injected into 7 eyes (15.2%) after the operation. Results The follow-up duration was from 6 months to 1 year (mean 7.3 months). Retina was completely reattached in 31 eyes (67.4%), and was alleviated obviously in 12 eyes (26.1%). The subretinal fluid increased after the operation with un-reattached retina and vitrectomy was performed in 2 eyes. One eye underwent vitrectomy due to the development of PVR. After the first operation, the curative ratio of retinal detachment was 67.4%, and effective ratio (cure and alleviation) was 93.5%. The visual acuity improved in 28 eyes (60.9%), kept no change in 11 eyes (23.9%), and decreased in 7 eyes (15.2%). Conclusion Reattachment of retina and improvement of visual acuity can be achieved in some degree in some patients with old retinal detachment who undergo simple scleral buckling procedure without vitrectomy.