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Objective:To explore the damage of panretinal photocoagulation (PRP) to the subbasal nerve plexus (SNP) and its related mechanisms by comparing SNP changes in wide-field mosaic between before and after PRP treatment in diabetic patients.Methods:A randomized controlled study was conducted.Fifty-seven patients (114 eyes) with type 2 diabetes mellitus and binocular diabetic retinopathy (DR) stage IV to receive PRP treatment in Shanxi Eye Hospital from April to November 2019 were enrolled.The subjects were randomly divided into horizontal-vertical laser group and vertical-horizontal laser group according to a random number table.Twenty-nine eyes from 29 patients were assigned to the horizontal-vertical laser group with the photocoagulation sequence of temporal-nasal-inferior-superior.Twenty-eight eyes from 28 patients were assigned to the vertical-horizontal laser group with the photocoagulation sequence of inferior-superior-temporal-nasal.The severer eyes of each subject were chosen as the treatment eye and the contralateral eyes were chosen as the control eye.Corneal confocal laser scanning microscopy (CCM) was performed before PRP treatment, 1 week after each photocoagulation, and 1 month after the completion of PRP treatment to collect images of the SNP over an area of 2-3 mm around the whorl-like pattern.Captured images at each time were merged into one image by using the Photoshop CC 2017 image processing software, and then the nerve fiber length (NFL) of whorl-like pattern was measured by Neuron J image analysis software.McGill pain questionnaire was used to investigate the pain of patients after each photocoagulation.The NFL changes of SNP at different time points were compared between different eyes and different photocoagulation sequence groups.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Shanxi Eye Hospital (No.201804b). Written informed consent was obtained from each patient prior to entering the study cohort.Results:After PRP treatment, there were different degrees of neural structure loss of SNP nerve fibers in 11 treatment eyes, but there was no significant change in SNP nerve fibers in the control eyes.There were significant differences in NFL between the treatment eyes and the control eyes at various time points ( Feyes=2.020, P=0.039; Ftime=4.062, P=0.001). In the horizontal-vertical laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the first and second photocoagulation.In the vertical-horizontal laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the third and fourth photocoagulation.There was no significant difference in NFL of treatment eyes between the two groups ( Fgroup=0.099, P=0.754), but there was a significant difference in NFL at various time points before and after treatment ( Ftime=5.231, P<0.001). There were 9 (9/57) patients who complained of pain after PRP, which occurred at the first time of photocoagulation in 7 of them. Conclusions:SNP damage may occur after PRP in patients with DR, and SNP is prone to be damaged on the photocoagulation side when performing horizontal photocoagulation.
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Objective:To estimate the correlation between DR and diabetic corneal nerve damage by comparing changes of corneal sub-basal nerve plexus (SNP) in the whorl-like region in different DR stages.Methods:In this cross-sectional study, 66 eyes of 66 type 2 diabetes patients aged 50-65 years old in Shanxi Eye Hospital from September 2018 to January 2019 were included.The subjects were divided into non-diabetic retinopathy group (NDR), non-proliferative diabetic retinopathy group (NPDR) and proliferative diabetic retinopathy group (PDR) accordingly, the right eyes were enrolled.20 eyes of 20 age and gender matched age-related cataract patients were also included as control group.All the subjects underwent confocal corneal microscopy to observe the morphology of SNP in the whorl-like region and measure the nerve fiber length (NFL) in this area.Covariance analysis using disease course as the covariate was used to analyze the differences of NFL value among groups, and Spearman rank correlation analysis was used to analyze the correlation between NFL value and DR stages.The study protocol was approved by the Ethics Committee of Shanxi Eye Hospital.Written informed consent was obtained from each patient prior to entering the study cohort.Results:The whorl-like region were observed in all the eyes.In the control group, nerve fibers were uniform in thickness, densely distributed with regular course, and most of the tested eyes had intact whorl-like structure.Nerve fibers in different DR groups all showed generally decrease in diameter and density, with increase in tortuosity, accompanied by different degrees of whorl-like structure loss.Eyes in the NDR group and NPDR group mainly showed nerve structure loss in the whorl-like center; while some eyes in the PDR group also showed nerve structure loss in the inferior and temporal of the whorl-like region.The NFL values were (21.08±4.74), (16.47±6.35), (14.95±3.90), and (11.61±3.24)mm/mm 2 in the control group, the NDR group, the NPDR group, and the PDR group, respectively, the overall difference was statistically significant ( F=10.541, P<0.001). The NFL value in the control group was significantly higher than those in the different DR groups, the differences were statistically significant (all at P<0.01). Spearman rank correlation analysis showed that there was a significant negative correlation between NFL value and DR stages ( rs=-0.356, P=0.003). Conclusions:Diabetic SNP damage occurs earlier than DR, and progress gradually with the development of DR; Different stages of DR are accompanied by different degrees of nerve structure loss; The structure loss begins at the whorl-like center and gradually develops to downward and the temporal side.The ophthalmologists should take the condition of ocular surface into account when treating ocular fundus diseases of diabetic patients.
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Objective To investigate the comparison of the clinical treatment efficacy of propafenone and amiodarone in patients with paroxysmal supraventricular tachycardia ( PSVT ) .Methods Retrospective a total of 89 patients with PSVT from June 2013 to June 2015 in our hospital were selected.According to the different administration methods, the patients were divided into the propafenone group of 46 cases and the amiodarone group of 43 cases.The changes of left ventricular end-systolic volume, left ventricular end-diastolic volume, ejection fraction, cardioversion success rate, mean cardioversion time, heart rate and side effects were compared.Results After treatment, the left ventricular end-systolic volume (52.31 ±8.34) mL/m2 , (54.28 ±7.23) mL/m2, left ventricular end-diastolic volume (47.31 ±8.56) mL/m2, (45.28 ±7.16) mL/m2 and ejection fraction (61.57 ± 0.76)%, (61.39 ±0.69)% were without significant differences.After treatment, the heart rates of the two groups were significantly decreased, the propafenone group ( 85.31 ±12.84 ) times/min, amiodarone group ( 87.26 ±11.95 ) times/min, and there were not significant differences.The recovery time of propafenone group was ( 19.34 ±4.76 ) , higher than the amiodarone group ( 25.69 ±6.09 ) ( P <0.05 ).But the success rate of cardioversion (52.17%) was lower than the amiodarone group (88.37%) (P<0.05).The side effect rates in the propafenone group (21.74%) was significantly higher than that in the amiodarone group ( 4.65%) ( P <0.05 ) .Conclusion Propafenone and amiodarone cardioversion PSVT have achieved good results, but propafenone rapid onset, the average cardioversion time is short, which is only suitable for acute tachycardia and without serious organic heart disease patients.Amiodarone onset is slower,but the cardioversion success rate is higher.
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Objective To discover new method studying renal deficiency and syndrome of blood stasis by gemellary research method.Methods Through clinical investigation of 300 instances of twins,we choice three twins,include mistress Yang from Qionglai city who is being later stage of older;mistress Yu from Chengdu city who is being presenium;mistress Lu from Beijing who is being Middle-age using five species of ovi-type appraisement methods,and syndrome-penthemeron investigation by blood stasis,stagnation of blood measuring scale,renal deficiency measuring scale,and eight principles measuring scale,in this text.Results(1)Get three family constellation graphs,which provide inspiration for syndrome-penthemeron studing.(2)Though investigating to three twins,we discover that this relative value of eight principles measuring scale has augmented tendency with time-lapse.3.There haven’t regularity from the stagnation of blood measuring scale and renal deficiency measuring scale.Conclusion Using gemellary research method to study Diabetes Mellitus is perfect.In spite of there haven’t ideal result,but it provid prospective thinking and suggestion for us.
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BACKGROUND: Abnormal hemorheologic index was often observed in patients with ischemic cerebrovascular disease. Although this alteration is not the main cause for the onset of cerebral infarction (CI), the changes of hemorrheology should not be ignored.OBJECTIVE: To study the hemorrheologic alterations of patients in different sexes with CI and transient ischemic attack (TIA), and investigate the significance of hemorrheologic index on the treatment of disease and the value of prognostic assessment.DESIGN: Non-randomized controlled and homochronous study based on patients and healthy people.SETTING: Medical physics institute in a university and a neurological department in a university hospital.PARTICIPANTS: Totally 91 CI patients, including 64 males and 27 females with the mean age of (64 ± 9), and 40 TIA patients, including 20 males and 20 females with the mean age of (58 ± 11 ), were selected from the Neurological Department of Qilu Hospital, Shandong University from January to December 2000. Another 84 healthy volunteers, including 52 males and 32 females with the mean age of (56 ± 10), were selected as the control group homochronously.METHODS: 2 mL fasting venous blood from elbow was taken in the morning and heparin was used against coagulation. Blood viscosity was assayed with NXE-1 cone-plate viscometer (made in Chengdu, China).MAIN OUTCOME MEASURES: High blood viscosity, low blood viscosity,plasma viscosity, hematocrit, erythrocyte aggregation index and fibrinogen content of CI or TIA patients in different sexes and the controls.RESULTS: Each item of hemorrheologic index of male CI or TIA patients was significant higher than that of the controls, and the differences were significant (P ＜ 0.05 -0.01 ). Each item of hemorrheologic index of female CI patients was significant higher than that of the controls, and the differences were significant ( P ＜ 0.05 - 0.01). Blood viscosity, plasma viscosity and fibrinogen content of female TIA patients were significant differences from those of the controls ( P ＜ 0.05).CONCLUSION: The increase of hematocrit and fibrinogen content are the main factor causing the increase in blood viscosity.
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OBJECTIVE: To observe the therapeutic effect of Wuling Powder extract on rats with renal hypertension and to evaluate the influence of it on the volume of urine and the concentrations of Na(+), K(+), Cl(-). METHODS: Reformed Gold-blatt hypertension rat model (G-2K1C) was established. The rats were divided into 6 groups as follows: sham-operation group; model group, Wuling Powder high dosage group (80 g/kg), Wuling Powder middle dosage group (40 g/kg), Wuling Powder low dosage group (20 g/kg), and hydrochlorothiazide (HCT) group (25 mg/kg). Urine volume of the rats was measured during the experiment. Tail arterial pressure and [Na(+)], [K(+)], [Cl(-)] in serum of the rats were detected after 30 days of treatment. RESULTS: The blood pressure of the G-2K1C rats was decreased in the three Wuling Powder groups (P0.05). Diuretic effect of the three dosages of Wuling Powder was weaker than that of the HCT (P0.05), but [K(+)] of the HCT group was significantly decreased compared with that of the false-operation group and the three Wuling Powder groups (P<0.01). CONCLUSION: Wuling Powder extract had satisfying therapeutic effects in increasing the discharge of urine, decreasing the blood pressure and keeping the balance of the serum electrolyte contents in rats with renal hypertension.
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Objective To study the importance of back pain-lassitude as the key symptom in the differentiation of kidney-deficiency syndrome in diabetes patients.Methods Totally 460 diabetics were divided into the pain group(154 cases)and non-pain group(306 cases).The 39 symptoms,signs and behavior were abstracted and each patient was scored according to the details of kidney deficiency scale to analyze the constitution and distribution of kidney-deficiency syndrome.Results There was a significant difference in the total symptom score of the two groups(P
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Objective To evaluate the therapeutic effect of Wuling Powder (WLP) on adriamycin-induced nephrotic syndrome in rats. Methods Rat models of nephrotic syndrome were established by injection of adriamycin into tail veins of rats. The rats were divided into 7 groups: group A(normal control),group B (high-dosage WLP),group C (moderate-dosage WLP),group D (low-dosage WLP),group E (hydrocortisone),group F (hydrocortisone and moderate-dosage WLP extractive) and group G (model control). The influence of 4-week treatment of WLP on 24-hour urinary protein volume,serum levels of albumin,cholesterol and triglycerides as well as pathological changes of kidney tissue were assayed. Results 24-hour urinary protein volume of group B,C,E and F were significanuly lower than that of group G;Serum albumin level of group B,C,E and F differed from that of group G; Serum albumin level of group E and F were higher than that of group B and C;Serum cholesterol level of WLP groups (group B,C,E,F) was much lower than that of group G and the difference was insignificant between group B,F and group A;As for serum triglycerides level,three WLP groups and group F differed from group E while the group G not. Conclusion WLP not only can eliminate tissue edema and decrease urinary protein volume and blood lipid content,but also can increase serum albumin levels,thus it can protect the kidney from injury. There also have been showen that a synergistic action of WLP and hydrocortisone has been shown in the treatment of nephrotic syndrome.