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Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.
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Diabetic macular edema (DME) is one of the common causes of visual impairment. Anti-vascular endothelial growth factor (VEGF) has become the preferred therapy for DME because of significant visual improvement. Early and intensive anti-VEGF therapy combined with other individualized treatments are currently the main strategy for DME treatment. Considering the complexity of DME and limitations of anti-VEGF therapy, there are still many problems and difficulties in the treatment of DME. Optimizing treatment strategies, strengthening management of the clinical course and developing new drugs, could improve the efficacy and maintain the improvement of visual acuity and visual performance.
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OBJECTIVES@#To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents.@*METHODS@#A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups.@*RESULTS@#The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria.@*CONCLUSIONS@#For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.
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Child , Humans , Anti-Bacterial Agents/therapeutic use , Drowning , Gram-Negative Bacteria , Pneumonia, Aspiration/drug therapy , Retrospective Studies , WaterABSTRACT
Objective:To observe the clinical efficacy and safety of full macular coverage micropulse laser in the treatment of refractory macular edema secondary to Irvine-Gass syndrome.Methods:A retrospective case study. From April 2018 to November 2019, 21 cases of Irvine-Gass syndrome patients with 24 eyes were included in the study. Among them, there were 11 females with 12 eyes and 10 males with 12 eyes; the average age was 54.5±10.1 years. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA was performed using a standard logarithmic visual acuity chart, and the results were converted into the logarithmic minimum angle of resolution (logMAR) visual acuity when recording. The frequency domain OCT instrument was used to measure the foveal retinal thickness (CMT) and the retinal volume (MRV) of the macular area with a diameter of 1, 6 mm. All the affected eyes were treated with a micropulse laser under the threshold of 577 nm, with a spot diameter of 200 μm, an exposure time of 200 ms, a power of 400 mW, and a 5% duty cycle. The treatment scope was in the upper and lower vascular arches of the macula, covering the entire macula (including the fovea). One or 3 months after treatment, the eyes with macular edema were treated twice with micropulse laser, the method was the same as before. 1, 3, and 6 months after the treatment, the same equipment and methods as before the treatment were used for related inspections. The changes of BCVA, CMT, MRV and the occurrence of complications in the affected eye were observed.Results:The average logMAR BCVA of the eyes before treatment and 1, 3, and 6 months after treatment were 0.440±0.320, 0.333±0.286, 0.250±0.245, 0.166±0.184, and the average CMT were 395.88±79.21, 349.17±78.07, 317.67±53.72, 285.29±37.03 μm, respectively; the average MRV of diameter 1, 6 mm were 0.310±0.063, 0.275±0.060, 0.245±0.035, 0.221±0.219 mm 3 and 9.866±0.846, 9.494±1.002, 9.005±0.885, 8.190±0.850 mm 3. Compared with before treatment, the BCVA of the eyes at 1, 3, and 6 months after treatment was significantly increased ( t=5.060, 5.564, 6.466), and CMT was significantly decreased ( t=4.854, 5.777, 7.349), and the differences were statistically significant ( P<0.01); the average MRV of diameters 1, 6 mm decreased significantly, and the difference was statistically significant (1 mm diameter: t=4.527, 5.394, 7.380; P<0.01; diameter 6 mm: t=4.577, 7.980, 11.209; P<0.01). The average number of micropulse laser treatments for the affected eye was 1.25 times. Conclusion:Full macular coverage micropulse laser can safely and effectively treat refractory macular edema secondary to Irvine-Gass syndrome and can be used as an alternative treatment.
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Objective:To investigate the changes of blood pressure and heart rate in patients aged over 80 years undergoing intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs under topical anesthesia without anesthetic monitoring in ophthalmology surgery, and to analyze the potential risk for surgery-induced acute cardiovascular and cerebrovascular events.Methods:This was a prospective observational cohort study.A total of 100 patients(aged 80 to 95 years, 47 males and 53 females)included 85 cases of wet age-related macular degeneration, 14 cases of retinal vein occlusion with macular edema, and 1 case of diabetic macular edema.These patients received anti-VEGF drugs injection, with accumulated injections of 1 to 36 times per patient.Blood pressure and heart rate were measured at visit to a medical clinic(as baseline), before operation, 0 min and 30 min after operation.The operation anxiety and pain scores were investigated by questionnaires.Comparison of systolic blood pressure, diastolic blood pressure and heart rate among four different time points was performed by Wilcoxon symbol rank test.Results:At four different time points i. e.at the baseline, before injection, 0 min and 30 min after injection, systolic blood pressure, diastolic blood pressure and heart rate showed an important regularity.The median systolic blood pressure at the four time points was 130(120-140)mmHg(1 mmHg=0.133 kPa), 142(129-149)mmHg, 153(139-164)mmHg and 143(130-151)mmHg, with ranges of 100-160 mmHg, 106-176 mmHg, 118-197 mmHg and 115-187 mmHg, respectively.The median diastolic blood pressure at the four time points was 70(65-75)mmHg, 76(69-83)mmHg, 81(73-87)mmHg and 75(69~81)mmHg, with ranges of 45-90 mmHg, 55-98 mmHg, 58-99 mmHg and 50-93 mmHg, respectively.The median heart rate at the four time-points was 70(65-80)beats/min, 72.5(65-81)beats/min, 73(66-80)beats/min and 70(65-76)times/min, with ranges of 50-95 beats/min, 48-101 beats/min, 51-93 beats/min and 50-87 beats/min, respectively.Systolic blood pressure and diastolic blood pressure were significantly increased from preoperative time to 0 min and 30 min after operation( P<0.01). Compared to the baseline, heart rate was increased before operation( P<0.01)and was decreased at 30 minutes after operation( P<0.01). Conclusions:Blood pressure fluctuation may exceed the safe range with an obvious increase of systolic blood pressure during the current intravitreal injection of anti-VEGF drugs in the patients aged over 80 years.Systolic blood pressure rises significantly before operation and falls back after operation, but it may last till 30 minutes after operation.The range of heart rate change is relatively small.Perioperative management and monitoring measures should be strengthened to reduce the risk of acute cardiovascular and cerebrovascular events.
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Objective:To compare the effects of volume-controlled ventilation (VCV),pressure-controlled ventilation (PCV) and pressure controlled ventilation-volume guarantee (PCV-VG) on respiratory mechanics and respiratory function index in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods:Seventy-five patients who underwent EBUS-TBNA under general anesthesia during February to December in 2019 in Lishui City People's Hospital,China were included in this study.They were randomly assigned to undergo VCV (Group V),PCV (Group P) or PCV-VG (Group G),with 25 patients in each group during EBUS-TBNA.After exclusion because of different reasons,25,24 and 24 patients from the Groups V,P and G respectively were included in the final analysis.Peak airway pressure (P peak),pulmonary dynamic compliance (C dyn),the partial pressure of carbon dioxide in arterial blood (PaCO 2),and oxygenation index (OI) at baseline (T 0),at the time of EBUS-TBNA for 30 (T 1) and 60 min (T 2) and immediately after EBUS-TBNA (T 3). Results:At T 2 and T 3,P peak in the Group P was (22.5 ±5.2) cmH 2O and (16.2 ± 2.8) cmH 2O respectively,which was significantly lower than that in the Group V [(25.8 ± 3.5) cmH 2O,(18.2 ± 3.2) cmH 2O, q = 3.672,3.454, P = 0.031,0.045).At T 1,T 2 and T 3,C dyn in the Group P was (26.4 ± 5.0) mL/cmH 2O,(24.1 ± 4.5) mL/cmH 2O and (32.5 ± 4.2) mL/cmH 2O,respectively,which was significantly higher than that in the Group V [(23.0 ± 2.7) mL/cmH 2O,(19.9 ± 2.1) mL/cmH 2O,(28.5 ± 3.7) mL/cmH 2O, q = 3.732,4.795,4.118, P = 0.027,0.004,0.013).At T 2 and T 3,P peak in the Group G was (21.7 ± 4.3) cmH 2O,(15.6 ± 2.6) cmH 2O,respectively,which was significantly lower than that in the Group V [(25.8 ± 3.5) cmH 2O,(18.2 ± 3.2) cmH 2O, q = 4.493,4.332, P = 0.006,0.009]. At T 1,T 2,and T 3,C ydn in the Group G was (26.6 ± 5.6) mL/cmH 2O,(24.3 ± 5.6) mL/cmH 2O,(33.2 ± 6.3) mL/cmH 2O,which was higher than that in the Group V [(23.0 ± 2.7) mL/cmH 2O,(19.9 ± 2.1) mL/cmH 2O,(28.5 ± 3.7) mL/cmH 2O, q = 3.852,4.936,4.791, P = 0.022,0.002,0.003]. At T 2 and T 3,PaCO 2 in the Group G was (41.1 ± 3.8) mmHg,(38.4 ± 3.4) mmHg,respectively,which was significantly lower than that in the group V [(45.7 ± 3.4) mmHg,(41.0 ± 3.0) mmHg, q = 5.969,3.682, P = 0.000,0.030].At T 2,OI in the group G was significantly higher than that in the group V [(358.0 ± 32.8) mmHg vs.(326.6 ± 29.7) mmHg, q = 4.782, P = 0.030].There were no significant differences in indexes between groups P and G (all P>0.05). Conclusion:During EBUS-TBNA for>60 min,PCV combined with VG can not only reduce airway pressure and improve lung compliance,but also prevent respiratory acidosis and improve oxygenation.
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Objective:To evaluate the effectiveness and safety of 3.5% lidocaine hydrochloride ophthalmic gel for eye surface anesthesia.Methods:A multicenter, randomized, double-blind, placebo controlled clinical trial was conducted in 10 hospitals in China from August 2018 to April 2019 under the approval of an Ethics Committee of Beijing Hospital (No.2018BJYYEC-014-02). A total of 220 fellow eyes of 220 subjects who received ocular surgery in one eye were actually enrolled according to a same included criteria in different institutes.The 220 eyes were randomly divided into control group and trail group.Two drops of lidocaine hydrochloride gel were dropped at about 5 mm away from corneal limbus at 6 o'clock direction of experimental eye of the trail group, and the blank gel was used in the eyes of the control group in the same way.The pain sensation was assessed with a 0.3 mm toothless micro forceps on conjunctiva within a specified time, and ''pain'' or ''no pain'' was answered by the subjects.The primary effective indexes, namely the number of eyes and percentage of ''no pain'' within 5 minutes following dropping, as well as the secondary indexes including the onset time point of the drug and the duration of anesthesia were recorded and evaluated.Safety evaluation took ocular and system adverse events into account.Results:Within 5 minutes after dropping, ''no pain'' occurred in 104 eyes (94.55%) and 29 eyes (26.36%) in the trail group and control group, respectively, showing a significant difference between the two groups ( χ2=106.948, P<0.001). And there was a significant difference in anesthesia onset time between the trail group and control group (40.0 seconds vs. 300.0 seconds) ( Z=-15.17, P<0.001). The duration of anesthesia was 860.5 (577.5, 1 180.0) seconds in the trail group and 676.0 (280.0, 1 401.0) seconds in the control group, with no statistically significant difference between the two groups ( Z=0.898, P>0.05). The incidence of adverse events in the trail group and control group were 5.45% (6/110) and 4.55% (5/110), respectively, without statistical significance between them ( P=1.000). Conclusions:The 3.5% lidocaine hydrochloride is a safe, effective, easy to use and high-quality surface anesthesia drug for eye surgery.
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OBJECTIVES@#To study the consistency between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in pathogen detection in children with pneumonia@*METHODS@#A retrospective analysis was performed on the data of pathogens detected in 533 children with pneumonia from February 2017 to March 2020. The paired McNemar's test was used to compare the difference in pathogen detection between NPA and BALF groups. The @*RESULTS@#NPA had a sensitivity of 28%, a specificity of 74%, a positive predictive value of 14%, and a negative predictive value of 91% in detecting bacteria, and a @*CONCLUSIONS@#There is poor consistency between NPA and BALF in the detection of bacteria and viruses, and clinicians should be cautious in diagnosing lower respiratory tract infection based on bacteria or viruses detected in NPA. There is moderate consistency between NPA and BALF in the detection of
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Child , Humans , Bronchoalveolar Lavage Fluid , Mycoplasma pneumoniae , Pneumonia , Pneumonia, Mycoplasma , Respiratory Tract Infections , Retrospective StudiesABSTRACT
Previous researches about the brain mechanism of aphasia mainly focused on the correspondence between cortical brain regions and language function. Now, more and more researches have found that the connection of white matter tracts in the brain plays an important role in language function. Dual-stream language model hypothesizes that the process of language can be considered as two parallel pathways, dorsal and ventral. The white matter fibers of dorsal stream include arcuate fasciculus and superior longitudinal fasciculi, which are mainly involved in the production of language. The white matter fibers of ventral stream include the inferior frontal-occipital fasciculus, inferior longitudinal fasciculus and uncinate fasciculus, which are mainly responsible for language understanding. The conception of connection mode and specific functional role of these fibers in the language network of patients with aphasia is helpful for the assessment of the features and severity of the patient's language dysfunction and outcome, to guide clinical precision rehabilitation. More researches are needed to elaborate the interaction between the dorsal and ventral streams to well know the brain's language network processing mechanism.
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Objective:To investigate the changes of gray matter volume in patients with chronic nonfluent aphasia after cortical cerebral infarction and the relationship between gray matter volume and language function. Methods:From June, 2016 to June, 2019, 19 patients with chronic nonfluent aphasia after cortical cerebral infarction from the First Affiliated Hospital of Ji'nan University and 28 healthy subjects (controls) were scanned with structural magnetic resonance imaging. The data were analyzed using voxel-based morphological measurement to measure the gray matter volumes of the brain regions, and the differences between patients and controls were compared. The correlation between volumes of brain regions with difference and scores of items of Aphasia Battery of Chinese (ABC) was analyzed. Results:The gray matter volumes increased in the brain regions of right inferior frontal gyrus triangle, right inferior frontal gyrus island cover, right angular gyrus, the right medial frontal gyrus, left insula, left medial frontal gyrus in the patients; while decreased in right globus pallidus. The volumes of left insular lobe correlated with the scores of repeating (r = 0.665, P = 0.001) and naming (r = 0.638, P = 0.003); and the volumes of right inferior frontal gyrus triangle correlated with the scores of hearing comprehension (r = 0.493, P = 0.031), repeating (r = 0.576, P = 0.009) and naming (r = 0.674, P = 0.001) in the patients. Conclusion:The cortex volumes of left insula and right inferior frontal gyrus triangle increase in patients with chronic nonfluent aphasia after cerebral infarction, which may play a role in the language dysfunction.
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Objective:To investigate the effect of vascular endothelial growth factor-A ( VEGF- A) gene mutation to neovascular age-related macular degeneration (nAMD) and the response to ranibizumab with this mutation in Chinese. Methods:This was a case-control study.We recruited 127 cases (diagnosed as nAMD) and 101 ethical, age and geographical area matched unrelated healthy controls in Beijing Hospital from February 2017 to January 2018.The patients with nAMD were divided into two subgroups: good response to intravitreal ranibizumab (IVR) and poor response to IVR based on whether gain 5 letters 3 months after therapy.Phenol chloroform method was used in purification of genomic DNA in the peripheral venous blood of each individual.All exons and 2 kb upstream and downstream sequence of VEGF-A was sequenced by using Sanger Sequenced method, and candidate variations were screened out.Restriction fragment length polymorphism (RFLP) method was used in genotyping of the case-control study.Hardy-Weinberg equilibrium was used to test the representativeness of the sample group.The differences of allele distribution frequency and genotype distribution frequency between the case group and control group, good response group and poor response group were compared.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Beijing Hospital (No.2017S-012).Results:The mutation (rs3025018) was located in 7th intron of VEGF-A.The allele were C, G, T and the genotype were CC, CT, CG, TT and TG.The allele distribution frequency between the case and control group were significantly different ( χ2=7.492, P=0.024). The allele G vs. C+ T distribution frequency between the case and control group were significantly different ( χ2=7.490, P=0.006). The genotype distribution frequency between the case group and control group were significantly different ( χ2=13.376, P=0.010). The genotype (CG+ GT vs. CC+ CT+ TT) distribution frequency between the case group and control group were significantly different ( χ2=8.335, P=0.004). The allele frequencies or genotype frequency were not significantly different between the good response group and poor response group (all at P>0.05). Conclusions:G allele of VEGF- A (rs3025018) carriers were less possible to occur nAMD compared with C and T allele.However, there is no effect of VEGF- A gene mutations (rs3025018) on response to ranibizumab for nAMD.
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The prevention and control of novel coronavirus pneumonia is the most priority recently, and various measures during the prevention and control period will have varying degrees of impact on the implement of clinical trials.However, various examinations in ophthalmological clinical trials need close contact between operators and patients, which put us at risk of cross-infection.This paper indicated some suggestions based on the criteria of clinical trials under major public health emergencies, the management of clinical trials during epidemic period, including the follow-up of subjects, the treatment of epidemic serious adverse event (SAE) and the management requirements of co-sponsors, as well as the requirements and management principles for environment, subjects, examiners and inspection equipment in the process of ophthalmic clinical trials.It may be helpful to the ophthalmic clinical trial researchers and subjects during the period of novel coronavirus infection.
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Retinal vein occlusion (RVO) is one of the most common diseases severely threatening visual acuity.There is not a complete consensus on the clinical treatment strategies and schemes,and no guideline or consensus has been published in China.The publication of the latest international guidelines has provided more comprehensive and clear suggestions and advices for treatment and management strategies for RVO.Reading and understanding those guidelines could provide references for clinical practice,and offer help for standard diagnosis and treatment.
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Objective To determine the relationship between abnormal blood glucose and lipid levels and body mass index in patients with chronic respiratory diseases. Methods This research was conducted in Urumqi baseline survey population from "Xinjiang multi-ethnic cohort study" in which patients with chronic bronchitis, emphysema and chronic obstructive pulmonary disease (COPD) were screened.The patients were defined as angular, normal, overweight, obesity groups according to body mass index (BMI), and were compared with blood levels of lipid and glucose, and rate of abnormal metabolism. Results A total of 6 046 subjects were included in the 2018 Urumqi cohort study, including 545 patients with chronic respiratory diseases.The prevalence of chronic respiratory diseases in different age groups and at different physical activity levels was different, and the prevalence of emaciation group was significantly higher than that of the other three groups.However, there were no statistically significant differences among people with different genders, nationalities, educational levels and whether they smoked or not.There were statistically significant differences in fasting glucose, serum cholesterol (TC) and serum high-density lipoprotein (HDL) levels among respiratory patients with different BMI (P < 0.05).The detection rates of hyperglycemia, high TG and low HDL increased with the increase of BMI.The result of multi-factor analysis showed that blood glucose, TG and HDL were the influencing factors of BMI. Conclusion Increase of body mass index in patients with chronic respiratory diseases is associated with abnormal glucose and lipid metabolism, which is not significantly different from that in patients with non-respiratory diseases.However, the body mass index and nutritional status of patients with long-term diseases should be closely monitored, and timely intervention measures should be taken to delay the disease process.
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Objective To analyze the association of the behaviors of playing mahjong and watching mobile phone with depression in rural women in Hubei Province, so as to provide suggestions for improving their physical and mental health. Methods A stratified cluster sampling method was used to investigate 1367 adult women in 8 administrative villages of 7 counties/cities in Hubei Province. The depression status was measured by the Center for Epidemiological Studies Depression Scale-10 (CESD-10) and the percentage conversion was carried out. The higher the score was, the lower the degree of depression was, and the better the mental health status was. Results The CESD-10 scores of 15-44 years old women（77.63±13.95)were higher than those of 45-64 years old (73.17+17.01) and over 65 years old (69.25+18.16) (P0.05). Conclusions There is a correlation between watching mobile phone and depression of rural women in Hubei Province, reducing the use of mobile phones by rural women, especially middle-aged women, is worthy of attention in the future work of health education and Women’s Federation.
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The prevention and control of novel coronavirus pneumonia is the most priority recently, and various measures during the prevention and control period will have varying degrees of impact on the implement of clinical trials. However, various examinations in ophthalmological clinical trials need close contact between operators and patients, which put us at risk of cross-infection. This paper indicated some suggestions based on the criteria of clinical trials under major public health emergencies, the management of clinical trials during epidemic period including the follow-up of subjects, the treatment of epidemic serious adverse event (SAE) and the management requirements of co-sponsors, as well as the requirements and management principles for environment, subjects, examiners and inspection equipment in the process of ophthalmic clinical trials. It may be helpful to the ophthalmic clinical trial researchers and subjects during the period of novel coronavirus infection.
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Retinal vein occlusion (RVO) is one of the most common diseases severely threatening visual acuity.There is not a complete consensus on the clinical treatment strategies and schemes, and no guideline or consensus has been published in China.The publication of the latest international guidelines has provided more comprehensive and clear suggestions and advices for treatment and management strategies for RVO.Reading and understanding those guidelines could provide references for clinical practice, and offer help for standard diagnosis and treatment.
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OBJECTIVE@#To study the value of lactate dehydrogenase (LDH) in predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children.@*METHODS@#Propensity score matching was used to select 73 children with RMPP (refractory group) and 146 children with non-refractory Mycoplasma pneumoniae pneumonia (common group). The logistic regression analysis, restricted cubic spline model, and decision curve analysis were used to analyze the clinical value of LDH in predicting RMPP.@*RESULTS@#There were significant differences in the incidence of high fever, white blood cell count, platelet count, percentage of neutrophils, and serum levels of C-reactive protein, procalcitonin, hemoglobin, albumin, glutamic-pyruvic transaminase, aspartate aminotransferase and LDH (P<0.05). There were also significant differences between the two groups in the Mycoplasma pneumoniae-DNA load in nasopharyngeal aspirates and the incidences of pleural effusion, pulmonary consolidation, atelectasis, shortness of breath and skin lesions (P<0.05). The multivariate logistic regression analysis showed that high fever, hemoglobin level, LDH level, and pulmonary consolidation were independent predictive factors for RMPP (OR=10.097, 0.956, 1.006, and 3.756; P<0.05). The results of the restricted cubic spline analysis showed a non-linear dose-response relationship between the continuous changes of LDH and the development of RMPP (P<0.01). The decision curve analysis showed that LDH had an important clinical value in predicting RMPP.@*CONCLUSIONS@#LDH is an independent predictive factor for the development of RMPP and its intensity of association with the development of RMPP exhibits a non-linear dose-response relationship.
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Objective:To observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.Methods:This is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.Results:The average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant ( P<0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation ( P=0.140, 0.280). Conclusions:There is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.
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OBJECTIVE@#To compare clinical effects of inside-out technique and outside-in technique for the treatment of idiopathic frozen shoulder under arthroscopy.@*METHODS@#From April 2015 to July 2019, 65 patients with primary frozen shoulder were divided into observation group and control group according to different treatment methods. In observation group, there were 32 cases, including 14 males and 18 females, aged 48 to 64 (54.82±5.35) years old, 18 cases on the right side and 14 cases on the left side. The course of disease was 4 to 10 (7.76±1.19) months. The patients were treated with outside in technique. In control group, there were 33 cases, 16 males and 17 females, aged 45 to 62 (54.64±4.16) years old, 18 cases on the right side and 15 cases on the left side. The course of disease was 5 to 9 (7.65±1.24) months. The patients were treated with inside out technique. The operation time, hospitalization days and treatment cost were compared between the two groups. Constant-Murley function score before and after the operation andthe shoulder joint range of motion one month after operation were compared to evaluate the clinical efficacy.@*RESULTS@#All 65 patients were followed up for 9 to 17 months with an average follow up time of (11.34±2.24) months. Compared with control group, operation time in observation group was shorter[(55.53± 10.23) min vs (85.58±13.39) min], and functional scores of Constant-Murley after surgery were significantly changed in both groups compared with that before surgery(@*CONCLUSION@#The two arthroscopic release schemes have achieved satisfactory results for thetreatment of primary frozen shoulder, and the shoulder joint function and pain degree have been effectively improved. Compared with the inside-out technique, the outside in release technique is more direct, the operation is simpler and the operation time is shorter. It has certain advantages in releasing operation for primary frozen shoulder.