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Objective:To evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD).Methods:A prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10± 0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. Results:At 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes.Conclusion:Amniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.
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Objective:To observe the demographic data, disease composition and convenience of remote consultation in ophthalmology.Methods:A retrospective study. From 2015 to 2021, the demographic data, changing trends, disease classification of teleconsultation patients, and hospitals participating in teleconsultation, and the waiting time of patients for teleconsultation was analyzed retrospectively; remote consultation physician level composition and other data was analyzed.Results:During the 7-year period, 1 216 patients with remote consultation were obtained through the platform of the telemedicine center. Among them, there were 680 males and 536 females; the average age was 50.8 years. In 2016 and 2017, the number of patients participating in telemedicine consultations reached a peak of 260 and 221 cases, respectively. Among the ophthalmic diseases, there were 490 cases (40.30%, 490/1 216) of retinal and optic nerve-related diseases, 212 cases (17.43%, 212/1 216) of ocular trauma. 678 cases (56.27%, 678/1 205) of remote consultation waiting time were less than 24 hours, 991 cases (82.24%, 991/1 205) were less than 48 hours. Among the physicians who participated in the remote consultation, there were 733 chief physicians (60.3%, 733/1 216) and 466 deputy chief physicians (38.3%, 466/1 216).Conclusions:During the seven-year period from 2015 to 2021, there are relatively few patients with ophthalmology teleconsultation; retinal and optic nerve-related diseases accounted for a high proportion. Remote consultation has high convenience.
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Objective:To observe the changes in the biomechanical properties of the cornea of diabetic retinopathy (DR), and analyze its relationship with the degree of DR.Methods:A retrospective study. From September 2020 to February 2021, 83 patients with type 2 diabetes (T2DM) combined with DR treated in the Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, 83 eyes (DR group), 30 patients with T2DM without DR recruited from the outpatient clinic 30 eyes (NDR group) and 30 eyes of non-diabetes patients (NDM group) were included in the study. All left eyes were chose as the study eye. Among the 83 eyes in the DR group, 39 eyes were non-proliferative DR (NPDR) and 44 eyes were proliferative DR (PDR). Based on this, they were divided into NPDR group and PDR group. There was no statistically significant difference in age ( t=1.10) and sex ratio ( χ2=0.46) among patients in the DR group, NDR group, and NDM group ( P>0.05); body mass index ( t=3.74), glycosylated hemoglobin ( t=35.02) and the length of the eye axis ( t=5.51), the difference was statistically significant ( P<0.05). The eye response analyzer (ORA) was used to measure the corneal hysteresis (CH), corneal resistance factor (CRF), Goldman related intraocular pressure (IOPg), and corneal compensatory intraocular pressure (IOPcc). The corneal topography was used to measure the central corneal thickness (CCT) of the examined eye. The differences of CCT, IOPcc, IOPg, CH, CRF among multiple groups were compared by one-way analysis of variance. Multiple linear regression was used to analyze the relationship between CH, CRF and related influencing factors in DR patients. Results:There were statistically significant differences in CCT, IOPcc, IOPg, CH, and CRF among the eyes of the DR group, NDR group, and NDM group ( F=3.71, 5.60, 9.72, 9.02, 21.97; P<0.05). Pairwise comparisons were between groups, CH, CRF: the difference between the DR group and the NDM group and the NDR group was statistically significant ( P<0.05); CCT: the difference between the DR group and the NDM group was statistically significant ( P<0.05), and The difference in the NDR group was not statistically significant ( P>0.05). CCT, CH, CRF: the difference between the NDR group and the NDM group was not statistically significant ( P>0.05). The results of multiple linear regression analysis showed that CCT and IOPcc in DR patients were independent influencing factors of CH [CCT: β=0.01, 95% confidence interval ( CI) 0.01-0.03, P=0.013; IOPcc: β=-0.15, 95% CI -0.25--0.05, P=0.005]; Age, CCT, IOPcc were independent influencing factors of CRF [Age: β=-0.06, 95% CI -0.09--0.03, P<0.001; CCT: β=0.01, 95% CI 0.00-0.02, P=0.049; IOPcc: β=0.16, 95% CI 0.07-0.25, P=0.001]. The comparison of CCT, CH, CRF, adjusted CH, and adjusted CRF of the eyes in the NDR group, NPDR group, and PDR group were statistically significant ( F=3.76, 5.36, 12.61, 6.59, 10.41; P<0.05). Pairwise comparison between groups, CH, CRF, adjusted CH, adjusted CRF: the difference between the NPDR group, the PDR group and the NDR group was statistically significant ( P<0.05), and the difference between the PDR group and the NPDR group was not statistically significant ( P>0.05); CCT: The difference between NPDR group and NDR group, PDR group and NPDR group was not statistically significant ( P>0.05), and the difference between PDR group and NDR group was statistically significant ( P<0.05). Conclusion:The CH and CRF of eyes with T2DM and DR are elevated; CCT and IOPcc are independent influencing factors of CH, and age, CCT and IOPcc are independent influencing factors of CRF.
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Objective:To investigate the factors related to the occurrence of submacular fluid (SMF) after pars plana vitrectomy (PPV) in the treatment of rhegmatogenous retinal detachment (RRD).Methods:A retrospective case series observational study was performed.A total of 103 patients (103 eyes) with RRD who underwent 23G vitrectomy combined with silicone oil tamponade in The First Affiliated Hospital of Zhengzhou University from May 2017 to August 2019 were included.There were 55 males and 48 females, aged from 17 to 77, with an average of (48.65±15.80) years.The macular morphology was observed by optical coherence tomography (OCT) before surgery and 1 month and 3 months after surgery.The patients were divided into SMF group and no SMF group according to OCT results at 1 month after surgery.Clinical data were compared and analyzed, including age, gender, duration of symptoms, axial length, the preoperative status of macula (on or off), retinal detachment caused by inferior retinal break or not, the way to drain subretinal fluid intraoperative, best corrected visual acuity (BCVA). FFA was performed in 3 eyes and microperimeter examination in 2 eyes with SMF according to patients' willingness.A multivariate binary Logistic regression was used to analyze the risk factors of SMF after vitrectomy in RRD patients.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2020-KY-334). Written informed consent was obtained from each subject prior to surgery.Results:Postoperative optical fundus examination and ocular ultrasound indicated that retinas of all eyes were completely anatomically reattached.There were 10.7% (11/103) of eyes developed SMF.The microperimeter examination results of 2 patients showed that their visual functions were worse at 3 months than those at 1 month after operation.The BCVA of patients with SMF at 1 month and 3 months after operation were worse than those without SMF, and the differences were statistically significant (both at P<0.05). Logistic regression analysis showed that macula-off RD before surgery and RD caused by inferior break of retina were risk factors for the occurrence of SMF (OR=6.401, P=0.041; OR=19.819, P=0.005), while the increasing age and the drainage of subretinal fluid through draining hole were protective factors (OR=0.939, P=0.016; OR=0.123, P=0.040).Conclusions:Macula-off RD before surgery, and RD caused by inferior break of retina may be the risk factors of SMF after PPV combined with silicone oil tamponade for RRD.Nevertheless, the increasing age and the drainage of subretinal fluid through draining hole may decrease the occurrence of SMF.And SMF after PPV may delay visual recovery.
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Atrophic age-related macular degeneration (AMD) does not show obvious loss of visual function in the early stage,so it is not easy to be taken seriously.In the advanced stage,most of the patients suffered from macular area retinal map atrophy,which affected night vision and central vision.Drugs currently used in clinical or clinical trials to treat atrophic AMD include drugs for improving choroidal perfusion,reducing the accumulation of harmful substances,preventing oxidative stress injury,inhibiting inflammatory reactions,as well as neuroprotectants and lipid metabolism drugs.Stem cell transplantation for atrophic AMD is currently the most promising treatment.In theory,it is feasible to replace atrophic AMD with retinal photoreceptor cells and RPE cells derived from human stem cell differentiation.However,there are still many problems to be solved,such as how to improve the efficiency of directional differentiation of seed cells and how to ensure the safe and effective RPE cell transplantation and survival after transplantation.At present,several studies have found that multiple locus mutations are associated with atrophic AMD,so gene therapy also plays an important role in the development of the disease.
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Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer,to create evidence for improved clinical care.Methods A cross-sectional observational study design was adopted.Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors.Results The prevalence of MARSI was 31.5％ (63/200),and mechanical trauma accounted for 50.8％ of all cases (32/63).Age,diabetes and anaphylaxis were significantly related to MARSI.Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients.
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Objective To investigate the optimal self care in lung cancer patients with peripherally inserted central catheter (PICC) in ladder-type nursing training,network education,continuing nursing care clinics,and other forms of nursing mode care.Methods Based on the baselien data of patients in the control group and observation group,PICC self management ability,PICC quantitative data,PICC-related infections,thrombosis,and other complications were compared,and the impact of continued nursing platform on lung cancer patients with indwelling PICC was analyzed.Results In the observation group self management ability and health behavior is higher than that of the control group (P＜0.001).PICC catheter -related complications no difference with the control group (P＞0.05),Patient satisfaction of the observation group than the control group,the difference was statistically significant (92.18％ vs.79.00％,P=0.015).Conclusion The self care based on the continued nursing mode established by PICC speciality nurses can improve the self-management level of patients with PICC,reduce PICC-related complications,and increase the patient's satisfaction.
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Objective To evaluate the application of Autar scale in the assessment of the risk of thrombosis related to peripherally inserted central catheter (PICC) in patients with lung cancer.Methods 1 252 cases of lung cancer with PICC between January 2008 and December 2012 in Shanghai Chest Hospital were enrolled as the control group,who received routine PICC insertion and maintenance.1 322 cases of lung cancer patients with PICC catheterization between January 2013 to May 2016 in the same hospital were recruited as the observation group,who were divided into low-risk,middle-risk and high-risk groups based on the scores of Autar scale,and given grading nursing intervention accordingly.Results In the control group,PICC-related thrombosis occurred in 38 cases (3.04％).In the observation group,PICC-related thrombosis occurred in 12 cases (0.91％),the incidence in the low-risk,middle-risk,and high-risk groups was 1.25％ (5 cases),1.04％ (5 cases),and 0.45％ (2 cases),respectively.The incidence of thrombosis is lower in the observation group than in the control group (P ＜ 0.05).Conclusions Aurar scale may help anticipate the risk of PICC-related upper extremity venous thrombosis in patients with lung cancer.Preventive nursing and treatment measures in lung cancer patients at high risk may effectively reduce the incidence of PICC catheter-related thrombosis.
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<p><b>OBJECTIVE</b>To explore the improvement the dingle technology through the PICC catheter puncture point elbow hemostatic effect. Selection.</p><p><b>METHODS</b>Between January 2013 and December 2013, chest hospital affiliated to Shanghai jiaotong university under the guidance of ultrasound improved the Ding Gehang PICC catheter patients of 997 cases were randomly divided into three groups A, B, C, respectively, using gauze pad, calcium alginate wound dressings, calcium alginate wound dressings with hemostatic gauze pad three methods to puncture point, compare the three groups within 48 h after puncture biopsy in patients with some local bleeding, treatment times and catheter after 1 week of the maintenance costs of the catheter.</p><p><b>RESULTS</b>Compared with A, B two groups, patients of group C tube after 48 hours the puncture point local oppression hemostasis effect is better than that of group A and B, the difference was statistically significant (all P < 0.05); Catheter maintenance: group C within 1 week after catheter tube after local lowest maintenance cost.</p><p><b>CONCLUSION</b>PICC for surgery after the puncture point of oppression hemostasis method choice, the effect of calcium alginate dressings hemostatic gauze pad is better than that of gauze pads and calcium alginate dressings, calcium alginate dressings and gauze pad is more effective and economic, in clinical use.</p>
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Humans , Alginates , Bandages , Catheters , China , Glucuronic Acid , Hemorrhage , Hemostatic Techniques , Hexuronic Acids , PuncturesABSTRACT
Objective To evaluate the effect of risk early warning management in preventing peripherally inserted central catheter (PICC)-related thrombosis in lung cancer patients,in order to improve the efficacy and safety of PICC application in lung cancer patients.Methods A total of 761 patients receiving PICC in Shanghai Chest Hospital between January 2012 and December 2013 were observed.Based on the assessment of PICC-related thrombosis risk using Autar scale,the patients were divided into 3 groups,namely low risk group (n =332),medium risk group (n =364),and high risk group (n =65).Patients in the 3 groups were given grading nursing intervention,physical intervention and basic drug intervention for low and medium risk groups,compared with physical intervention,basic drug intervention plus emergency intervention for high risk group.873 lung cancer patients with PICC in the period from January 2008 to December 2011 served as controls.Results 32 cases in the control group (3.66％) developed PICC-related thrombosis,compared with 12 cases in the observation group (1.58％) (P =0.009).The incidence of PICC-related thrombosis was 1.51％ (5/ 332),1.37％ (5/364),and 1.54 (1/65) in low,medium,and high risk groups,respectively.None of the patients developed pulmonary embolism.Conclusion Risk early warning management can help reduce the risk of PICC-related thrombosis in lung cancer patients in hypercoagulable state.
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Background Diabetic retinopathy (DR) seems to be rarely found in high myopia patients with diabetes mellitus.This finding suggests that myopia,especially high myopia,plays a protective effect against DR.It is well-known that the primary pathological base of DR is neovescularization,and the changes of vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) are associated with DR.Objective This study was to analyze the expressions of VEGF and PEDF in retina and investigate the influence of high myopia on the pathogenesis of DR.Methods Forty-eight 3-day-old guinea pigs were randomly divided into normal control group,high myopia group,diabetic group and diabetes with high myopia group.Translucent goggles were worn in the right eyes of the guinea pigs for consecutive 8 weeks to induce high myopia,and streptozocin (STZ) was intraperitoneally injected at a dose of 60 mg/kg for four times,every three days for once,to establish diabetic models in the corresponding groups.Twelve weeks after modeling,the animals were sacrificed by excessive anesthesia,and the retinas were isolated for the histopathological examination.Expressions of VEGF and PEDF in the retinas were detected by immunohistochemistry.The use and care of experimental animals conformed to Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results The diopter of the normal control group,high myopia group,diabetic group and diabetes with high myopia group were (+0.25±0.07),(-7.50±0.04),(+0.25±0.03) and (-7.50±0.02) D,the fasting glucose of the four groups were (5.3 ±0.1),(5.1 ±0.2),(19.7 ±0.4) and (18.5±0.3)mmol/L,respectively.Compared with the normal control group,the retinas of high myopia group were thin,and the ganglion cells were less.The retinas of diabetic group were loose and oedematous.The retinas of diabetes with high myopia group were thin and oedematous.The expressing level of VEGF in retinas (absorbance value,A) were 128.61 ±5.57,118.24±2.59,155.60±9.70 and 135.15±5.22 in the normal control group,high myopia group,diabetic group and diabetes with high myopia group,respectively,showing a significant difference among the groups (F=17.365,P=0.032),and the VEGF level was significantly lower in the diabetes with high myopia group than that of the diabetic group (t =5.210,P＜0.05).The expressing level of PEDF in retinas (A value) were 145.57± 8.35,149.54±6.20,127.71±2.45 and 137.53±7.38,in the normal control group,high myopia group,diabetic group and diabetes with high myopia group,respectively,with a statistically significant difference among the four groups (F =19.210,P =0.019),and the PEDF level was significantly higher in the diabetes with high myopia group than that of the diabetic group (t=4.521,P＜0.05).Conclusions The expression of VEGF is downregulated and PEDF is upregulated in the retinas of diabetes with high myopia guinea pigs,which may be an accountable mechanism for the low incidence of DR in high myopia eyes.
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Objective To observe the effect of aspirin intervention on thrombosis in lung cancer patients with peripherally inserted central catheter (PICC).Methods From December 2007 to June 2012,a total of 997 cases of lung cancer received PICC insertion in Shanghai Chest Hospital.The patients admitted from December 2007 to October 2011 were in the control group (n =562),while those admitted from November 2011to June 2012 were in the intervention group (n =435).The control group received conventional catheterization and saline tube sealing; the study group was treated with the modified Seldinger technique,oral administration of aspirin enteric tablets,and diluted heparin sodium tube sealing.Results The incidence of thrombosis was4.09％ (23/562) in the control group and 2.99％ (13/435) in the intervention group.In the control group,17 cases of thrombosis occurred within 1 week after catheter insertion,3 between 1 week to 1 month,and 3 after 1 month ; in the intervention group,4 cases of thrombosis occurred within 1 week after catheter insertion,5between 1 week to 1 month,and 4 after 1 month,presenting a significant difference compared with the control group (Z =-2.221,P =0.026).A significant intergroup difference was also observed in terms of thrombus location (Z =-2.066,P =0.039):in the control group,17 cases had thrombus in peripheral superficial vein,and 6 in supraclavicular vein or internal jugular vein; while in the intervention group,5 cases had thrombus in peripheral superficial vein,and 8 in supraclavicular vein or internal jugular vein.Conclusion The prophylactic oral administration of aspirin could effectively reduce the thrombosis in lung cancer patients treated with chemotherapy via PICC.
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Purpose To study the possibility of prevention of proliferative vitreoretinopathy(PVR) by transduction of exogenous gene in vivo. Methods PVR model of rabbits was induced by intravitreal injection of fibroblasts.? galactosidase (lacZ) gene as a reporter gene was transfered into the vitreous of PVR model eyes mediated by retroviral vector, and the expression of the gene in eye tissues was determined. Gene transfection was done on the 6th day after fibroblasts injection,and the dosage of intravitreal injection of reporter gene was 0.1ml PLXSN/lacZ serum free supernatant (1.1?10 6 cfu/ml). Results lacZ gene expression was seen in proliferative membranes after gene transfection, and the expression was located maily at the surface of PVR membrane. The reporter gene expression lasted at least more than 30 days. No expression was found in retinal tissues. Conclusions Retrovirus mediated gene can be directionally transducted in PVR membrane,and might possess the feasibility of gene therapy for PVR. [