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Objective:To observe the effect of scleral buckling surgery (SB) in the treatment of rhegmatogenous retinal detachment (RRD) with subretinal hyperplasia (SRP).Methods:A retrospective case study. From January 2016 to December 2018, 31 patients with old RRD with SRP who were treated with SB in Department of Ophthalmology, Central Theater Command General Hospital were included in the study. There were 18 males with 20 eyes and 13 females with 15 eyes. Age was (26.5±8.7) years. The course of disease was (12.6±10.3) months. The best corrected visual acuity (BCVA) test was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of recording. Retinal detachment ranges ≤2, >2-<3, ≥3 quadrants were 10 (28.6%, 10/35), 20 (57.1%, 20/35), and 5 (14.3%, 5/35) eyes, respectively. All affected eyes were treated with SB. Among them, 22 eyes (63.0%, 22/35) underwent local Scleral buckling, 11 eyes (31.4%, 11/35) underwent combined encircling buckle, and 2 eyes (5.7%, 2/35) underwent encircling buckle alone. Subretinal fluid drainage was performed in 33 eyes (94.3%, 33/35). The mean follow-up time was 18.2 months. Relevant examinations were performed with the same equipment and methods before operation to observe BCVA and retinal reattachment. Paired sample t test was used to compare logMAR BCVA before and after operation. Results:At the last follow-up, retinal reattachment occurred in 32 eyes (91.4%, 32/35) of 35 eyes. The retina did not reset in 3 eyes (8.6%, 3/35). logMAR BCVA of affected eye was 0.67±0.29 (finger counting-1.0). The difference of logMAR BCVA before and after operation was statistically significant ( t=5.133, P=0.036). In 35 eyes, visual acuity improved, stabilized and decreased in 19 (54.3%, 19/35), 13 (37.1%, 13/35) and 3 (8.6%, 3/35) eyes, respectively. Ten months after surgery, the silicone tape was exposed and infected 1 eye. After the silicone tape was removed, the infection subsided and the retina was in place. There were no intraocular hemorrhage, vitreoretinal impaction, endophthalmitis and other complications during and after operation. Conclusion:SB treatment of RRD with SRP can achieve good retinal reposition and improve visual acuity to some extent.
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【Objective】 To assess the trend of hepatitis B virus (HBV) prevalence and associated risk factors among voluntary blood donors in Guangzhou area from 2011 to 2020, and to explore the impact of hepatitis B vaccination in neonates on the risk of HBV infection. 【Methods】 Blood samples of 2 624 434 voluntary blood donors from 2011 to 2020 in Guangzhou were tested by HBV surface antigen (HBsAg) enzyme-linked immunosorbent assay (ELISA) reagents twice and nucleic acid test (NAT) reagent once. Samples reactive to ELISA twice, or ELISA once + NAT were considered as HBV infection. The gender, age, ethnicity and region of HBV infected blood donors were collected, and the incidence of HBV infection in blood donors born before and after 1992 (when HBV vaccination was conducted in neonates) was compared. The trend and risk factors of HBV infection in blood donors in Guangzhou from 2011 to 2020 were analyzed. 【Results】 An overall HBV prevalence of 0.75% was found in voluntary blood donors in Guangzhou area from 2010 to 2020, showing an overall downward trend(P0.05), but both were significantly higher than that in Hong Kong, Macao, Taiwan and foreign countries (P<0.05). HBV prevalence in Han nationality donors was significantly higher than the ethnic minority donors (P<0.05). Gender, age, ethnicity and birth vaccination are the main risk factors for HBV infection among blood donors. 【Conclusion】 The overall HBV prevalence among voluntary blood donors in Guangzhou area from 2011 to 2020 has shown a decreasing trend, and differences have been found in gender, age, region, ethnicity and birth vaccination, which is helpful to formulate targeted recruitment strategies, thus reducing the risk of transfusion transmitted HBV.
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With the further increase of the global cancer burden, various cancers are increasingly challenging human health status and quality of life. Thus, early screening of cancer is crucial. Urinary volatile organic compounds (VOCs) detection techniques have the advantages of easy access to samples, high acceptance of patients, non-invasive, and so on, which have been favored and concerned by researchers. In this paper, existing techniques and methods for cancer diagnosis based on urine VOCs were described, relevant studies on the use of urine VOCs for cancer diagnosis were reviewed, and the barriers and future perspectives of the technique were discussed. This paper can be a reference for researchers working in the direction of urinary VOCs detection, a multidisciplinary field that spans medicine and materials science.
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Objective:To observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia.Methods:A retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm 2 and 0.202±0.03 mm 2, respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia. Results:At 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm 2 and 0.240±0.019 mm 2, respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased ( F=8.484, 14.346; P<0.001,<0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline ( F=5.044, 17.763, 13.545; P=0.001, <0.001, <0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score ( r=-0.816, P<0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score ( r=-0.422, -0.882; P=0.005,<0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score ( r=-0.791,-0.716; P<0.001,<0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score ( r=-0.343, -0.330, -0.732, -0.694; P=0.026, 0.033,<0.001,<0.001). Conclusions:PPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA.
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Objective:To evaluate the therapeutic efficacy of vitrectomy with internal limiting membrane (ILM) peeling and subretinal injection of balance salt solution (BSS) for refractory diabetic macular edema (DME).Methods:A retrospective case series study. From November 2017 to August 2018, 24 eyes of 19 patients affected with DME resistant to anti-VEGF therapy [central macualar thickness (CMT) more than 275 μm despite undergoing anti-VEGF therapy at least 3 times] in Ophtalmology Department of Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent 25G pars plana vitrectomy with ILM peeling and subretinal injection of BSS. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The CMT and the macular volume (MV) were assessed with swept-source optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT and MV before and after surgery were analyzed.Results:The mean BCVA was 0.74±0.29 at baseline, which increased significantly to 0.62±0.28, 0.56±0.25, 0.47±0.26, 0.46±0.23 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=4.828, P=0.001). At 6 months, BCVA improved by more than 0.3 logMAR units in 16 eyes (66.7%). The mean CMT was 554.58±102.86 μm at baseline, which reduced to 338.17±58.09 μm,299.42±52.66 μm, 275.75±41.24 μm and 270.96±38.33 μm at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=84.867, P<0.001). The mean MV was 13.01±0.88 mm 3 at baseline, which decreased to 11.50±0.73 mm 3, 11.00±0.74 mm 3, 10.68±0.61 mm 3 and 10.52±0.56 mm 3 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=47.364, P<0.001). Macular edema recurred in 5 eyes(20.8%) 6 months after surgery. No severe systemic or ocular side effect was reported during the follow-up. Conclusions:25G vitrectomy with ILM peeling and subretinal injection of BSS for refractory DME can improve the visual acuity, facilitate a rapid resolution of macular edema.
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Objective:To observe and compare the outcomes of vitrectomy (PPV) combined with complete internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling for the high myopic foveoschisis (MF).Methods:A retrospective case study was performed. From June 2016 to June 2018, 31 eyes of 31 patients with high myopic MF diagnosed in Department of Ophthalmology of Central Theater Command General Hospital were included in the study. There were 9 males and 22 females, who were monocular. The mean age was 57.55±9.45 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. Snellen visual acuity chart was used for BCVA examination, and which was converted into logMAR visual acuity. According to the surgical method, patients were divided into PPV combined with ILM complete removal group (group A) and PPV combined with retained fovea ILM group (group B), which were 16 patients (16 eyes) and 15 patients (15 eyes ), respectively. The mean logMAR BCVA was 1.03±0.33 in group A and 1.11±0.35 in group B. The mean CFT was 596.51±196.69 μm in group A and 578.33±200.18 μm. There were no statistically significant differences in age ( t=0.649, P=0.527), AL ( t=-0.639, P=0.533), logMAR BCVA ( t=-0.368, P=0.718), CFT ( t=0.228, P=0.823) and MF type ( P=0.576) between the two groups. The mean follow-up time after operation was 18.65±5.15 months. At 7 d, 1, 3, 6 and 12 months after surgery, and at the last follow-up, the same equipment and methods for relevant examinations. The changes of BCVA, CFT, macular hole and other complications were compared between the two groups. Comparison of BCVA and CFT between the two groups before and after operation was performed by paired t test. The count data were compared by using Fisher exact probability method. Results:At the last follow-up, MF was completely restored in 27 eyes (87.1%) of 31 eyes, partially restored in 4 eyes (12.9%). The mean logMAR BCVA of group A and Group B was 0.67±0.24 and 0.64±0.21, respectively. The average CFT was 126.25±36.61 μm and 134.27±25.29 μm, respectively. Compared with pre-operation, BCVA was obviously improved in both groups ( t=6.630, 9.260; P=0.000, 0.000), CFT was significantly decreased in both groups ( t=10.206, 8.799; P=0.000, 0.000). There were no statistically significant differences in logMAR BCVA and CFT between the two groups ( t=0.156, -0.924; P=0.878, 0.371). In group A, full-thickness macular hole occurred in 1 eye (6.3%), while no macular hole occurred in group B. There was no significant difference in macular hole incidence between two groups ( χ2=0.969, P=0.516). No intraocular hemorrhage, endophthalmitis and other complications occurred during the follow-up period. Conclusions:PPV combined with ILM peeling or fovea-sparing ILM peeling is effective in the treatment of high myopic MF. Both may contribute to improved MF closure rate and BCVA.
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Objective To analyze the performance of contrast-enhanced uhrasound(CEUS) in the evaluation of response to neoadjuvant chemotherapy (NAC) for breast cancer in different periods.Methods A prospective study consisting of 46 patients with invasive ductal carcinoma who received NAC and surgery subsequently was conducted.One patient underwent CEUS before NAC,after the second cycle of NAC and before surgery.CEUS outcomes were compared with histopathologic response by Kappa test using the Miller-Payne Grading(MPG) system.The changes of CEUS quantitative parameters in different periods of NAC were compared.Results 31 patients showed a good response by histopathology while 29 patients by CEUS,which showed good consistence.Kappa value was 0.713.The peak intensity (PI) of the lesions decreased significantly after the second cycle of NAC compared with that before NAC (P＜0.05).The peak intensity (PI),wash-in slope (WIS),and area under curve(AUC) of the lesions decreased significantly before surgery compared with those before NAC (P＜0.05).Conclusion CEUS shows good consistence with histopathologic outcomes.The peak intensity (PI) is a sensitive indicator of early changes after NAC.
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Objective To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs.The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spotdyloarthritis (axSpA) before and after treatment was explored.In addition,the contribution of the two MRI scoring method in evaluating conditions was also explored.Methods According to the inclusion criteria,24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc),sulfasalazine and thalidomide for 12 weeks.Subjects were scored at week 0 and 12 by SPARCC/SSS scores.Bath ankylosing spondylitis disease activity index (BASDAI),Assessment of Spondyloarthritis Intemational Society (ASAS)-endorsed disease activity score (ASDAS)-CRP,bath ankylosing spondylitis functional index (BASFI).Bath ankylosing spondylitis metrology index (BASMI),ESR and CRP.The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed.Paired sample t test,Wilcoxon signedrank test,Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis,and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment.Results ① Compared with baseline,after 12 weeks treatment,SPARCC scores [(15±4) and (33±10)],BASDAI [(3.2±0.9) and (5.2±1.1)],BASFI [(2.3±0.6) and (4.6±1.0)],BASMI [(2.3±0.7) and (4.1±1.1)],ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)],ESR [(16±12) mm/1 h and (49±26) mm/1 h],CRP [(7.2t2.8) mg/Land (30.4±19.3) mg/L] were significantly decreased (t values were 7.822,6.950,10.707,7.204,6.281,-4.015 and-4.257,respectively),and the differences were statistically significant (P=0.000).There was no significant difference in SSS scores between baseline [(20±6) and (19±7)] and after 12 weeks treatment (t=-0.761,P=0.455).② Before treatment,SPARCC score showed positive linear correlation with BASDAI (r=0.630,P=0.001),ASDAS-CRP (r=0.646,P=0.001),CRP (r=0.574,P=0.003) and ESR (r=0.559,P=0.004),and the correlation of the above indexes disappeared after treatment (P＞0.05).The association between SPARCC structral scores and the above indicators was not significant before and after treatment.③ Areas under curve(AUC) of ROC for assessing treatment response by reduced SPARCC scores was 0.809.The cut-off value for response to treatment was 20.5,with the sensitivity of 68.8％ and specificity of 75.0％.Conclusion The SPARCC MRI SIJ inflammation score has certain value in evaluating disease activity and efficacy,while the SPARCC SSS is not.
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Objective@#To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs. The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spondyloarthritis (axSpA) before and after treatment was explored. In addition, the contribution of the two MRI scoring method in evaluating conditions was also explored.@*Methods@#According to the inclusion criteria, 24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ: IgG Fc fusion protein(rhTNFR:Fc), sulfasalazine and thalidomide for 12 weeks. Subjects were scored at week 0 and 12 by SPARCC/SSS scores. Bath ankylosing spondylitis disease activity index (BASDAI), Assessment of Spondyloarthritis Intemational Society (ASAS)-endorsed disease activity score(ASDAS)-CRP, bath ankylosing spondylitis functional index (BASFI). Bath ankylosing spondylitis metrology index(BASMI), ESR and CRP. The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed. Paired sample t test, Wilcoxon signedrank test, Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis, and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment.@*Results@#① Compared with baseline, after 12 weeks treatment, SPARCC scores [(15±4) and(33±10)], BASDAI [(3.2±0.9) and (5.2±1.1)], BASFI [(2.3±0.6) and (4.6±1.0)], BASMI [(2.3±0.7) and (4.1±1.1)], ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)], ESR [(16±12) mm/1 h and (49±26) mm/1 h], CRP [(7.2±2.8) mg/L and (30.4±19.3) mg/L] were significantly decreased (t values were 7.822, 6.950, 10.707, 7.204, 6.281,-4.015 and-4.257, respectively), and the differences were statistically significant (P=0.000). There was no significant difference in SSS scores between baseline [(20±6) and (19±7)] and after 12 weeks treatment (t=-0.761, P=0.455). ② Before treatment, SPARCC score showed positive linear correlation with BASDAI (r=0.630, P=0.001), ASDAS-CRP (r=0.646, P=0.001), CRP (r=0.574, P=0.003) and ESR (r=0.559, P=0.004), and the correlation of the above indexes disappeared after treatment (P>0.05). The association between SPARCC structral scores and the above indicators was not significant before and after treatment. ③ Areas under curve(AUC) of ROC for assessing treatment response by reduced SPARCC scores was 0.809. The cut-off value for response to treatment was 20.5, with the sensitivity of 68.8% and specificity of 75.0%.@*Conclusion@#The SPARCC MRI SIJ inflamm-ation score has certain value in evaluating disease activity and efficacy, while the SPARCC SSS is not.
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Objective To analyze the correlation between foveal avascular zone (FAZ) size and foveal morphology in patients with idiopathic macular epiretinal membrane (IMEM) using OCT angiography (OCTA).Methods A retrospective case series study contained of 54 eyes of 54 patients affected with IMEM (IEM group) and 50 eyes of 50 normal persons as the control group.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logMAR visual acuity.The FAZ areas were evaluated with OCTA in both the superficial and deep capillary plexus layers by using 3 mm × 3 mm images of the macular.The central macular thickness (CMT),inner retinal layer thickness (IRT),outer retinal layer thickness (ORT),subfoveal choroidal thickness (SFCT),and the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography.The differences of FAZ areas between the two groups were analyzed.The correlative analysis was performed to investigate the relationship between areas and foveal morphology.Results Compared with control group,the FAZ area in superficial and deep capillary plexus in the IMEM group were significantly smaller (t=-29.095,-28.743;P＜0.001,＜0.001);the mean CMT,IRT,ORT and SFCT were significantly thickening in the IMEM group (Z=-8.784,-8.524,-7.709,-7.535;P＜0.001,＜0.001,＜0.001,＜0.001).In the IMEM group,the FAZ area in superficial capillary plexus correlated inversely with the CMT,IRT,and the integrity of EZ (r=-0.464,-0.536,-0.293;P＜ 0.001,＜ 0.001,0.039),no significant correlation of superficial plexus FAZ areas with ORT and SFCT (r=-0.218,-0.165;P=0.172,0.157).The FAZ area in deep capillary plexus correlated inversely with the CMT,IRT,and the integrity of EZ (r=-0.306,-0.694,-0.468;P=0.037,＜0.001,＜0.001),no significant correlation with ORT and SFCT (r=-0.242,-0.227;P=-0.079,0.094).Conclusions The FAZ areas is significantly decreased in IMEM eyes compared with normal eyes.Both superficial and deep FAZ area are correlated with the CMT,IRT,and the integrity of EZ.
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Objective To evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.Methods A retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology,Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study.There were 16 males (16 eyes) and 20 females (22 eyes),with the mean age of 64.1 1 ± 9.49 years and the mean courses of 151.55 ± 127.87 days.All the patients received an intravitreal injection of 0.3 ml of 100％ C3F8 within one week.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The severity of metamorphopsia was detected using M-charts.The extent of vitreomacular adhesion (VMA),central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment.The average BCVA was 0.58± 0.22.The mean horizontal metamorphopsia (MH)and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42,respectively.The mean CMT was 415.15 ± 89.59 μm.The mean horizontal VMA was 1168.68± 400.61 μm (30 eyes with VMA ≤ 1500 μtm and 8 eyes with VMA＞ 1500 μm).The mean vertical VMA was 976.89±295.92 μtm.There were 22 eyes with integrity EZ and 16 eyes without integrity EZ,33 eyes with crystalline lens and 5 eyes with IOL.The mean follow-up time was 10.7 months.The differences in BCVA,MH,MV,CMT,the integrity of EZ before and after treatment were analyzed.The VMT release rates were assessed.The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.Results Vitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit,the VMT release rate was 76.3％.VMT release occurred and the average time of VMT release occurred was 2.2 weeks.VMT persisted in 7 eyes,in the rest two eyes,one eye developed a retinal detachment and another eye formed macular hole,both eyes responded to vitrectomy.At 6 months after treatment,the average logMAR BCVA was 0.43±0.23,the mean MH and MV were 0.25± 0.23 and 0.24± 0.23,the mean CMT was 310.61 ± 63.10 pm.Among 16 eyes without integrity EZ before treatment,there were 9 eyes with integrity EZ at 6 months after treatment.There were 16 eyes with integrity EZ and 9 Compared with baseline,the mean BCVA at 6 months after treatment was significantly increased (F=3.779,P=0.037),but the MV (F=4.958,P =0.003) and CMT (F=13.419,P＜0.001) were significantly decreased,the integrity of EZ was improved significantly (22=5.050,P=0.025).The VMT release correlated inversely with the extent of horizontal VMA,BCVA,and CMT at baseline (r=-0.514,-0.348,-0.429;P=0.009,0.001,0.038).Conclusion Intravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction,it is an efficient and safe treatment for VMT syndrome.It can improve the visual acuity,metamorphopsia and foveal morphology in patients with VMT syndrome.
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Objective To investigate the clinical value of thrombelastogram (TEG) in prediction for the cause of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods In this study, there were 30 patients with DCI (group DCI) and 45 patients without DCI (group No-DCI). TEG was performed in all the patients at post-bleeding day 1, 5, 10 and 15 after aSAH(PBDn, n=1,5,10,15). The changes of reaction time (R value), coagulation time (K value),coagulation angle (α value),maximum thrombus consistency (MA value) and coagulation index (CI value) were examined at different time points after aSAH. Results Thirty of 75 aSAH patients developed DCI and the incidence of DCI was 40 percent. According to linear mixed model, both MA value and CI value were significantly statistical different at different time points within each group (P<0.05,for all) as well as between No-DCI group and DCI group.MA value and CI were significantly statistical different at same time point (P<0.05,for all). The results of logistic regression analysis showed that modified Fisher levelⅢ-Ⅳ,△MA5-1(OR=1.124,P=0.024,95% CI=1.015~1.244), PBD5 MA>70(OR=5.605,P=0.011,95% CI=1.464~21.457)were the independent risk factors of DCI.By using ROC curve to define a threshold for prediction of the occurrence of DCI,the rate of DCI was significantly increased when △MA5-1>3.05.Conclusion aSAH Patients, especially those with DCI have severe hypercoagulation. The MA value in PBD5 has an important predictive value for DCI.
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Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy,and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed. Among them,Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group ), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy ( control group) . The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume,postoperative hospitalization time,number of lymph node dissection,lymph node metastasis degree,perioperative complications of the two groups were analyzed and compared. The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups. The number of recurrence and death were recorded in the two groups. Results Compared with the control group,the operation time was longer in the observation group((264. 9±32. 9) min vs. (233. 5±30. 4) min,t= -5. 56,P<0. 001),but blood loss was less((152. 7±26. 4) ml vs. (235. 5± 30. 6) ml,t = 16. 27,P<0. 001). There was no significant difference in the indwelling time of thoracic drainage tube, postoperative drainage volume or postoperative hospitalization time between the two groups (P>0. 05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32. 7±15. 5) pieces vs. (20. 9±11. 2) pieces,t = - 4. 93,P< 0. 001),and lymph node metastasis degree in the observation group was smaller than that of the control group ( 6. 7% vs. 9. 3%, χ2 = 7. 22, P < 0. 01) . There were no significant differences in perioperative complications such as pulmonary complications, arrhythmia, anastomotic fistula, chylothorax,hemorrhage,recurrent laryngeal nerve injury,tracheal injury and perioperative death (P>0. 05). Left and right recurrent laryngeal nerve,thoracic esophagus,celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4. 7 ± 3. 2) pieces vs. (1. 5 ± 1. 4) pieces, t= -7. 25;(6. 0±2. 7) pieces vs. (3. 1±1. 7) pieces,t = -7. 12;(5. 7± 2. 4) pieces vs. (3. 2± 1. 9) pieces,t= -6. 48;P<0. 001). Left and right recurrent laryngeal nerve,thoracic esophagus lymph node metastasis degree in the observation group was smaller than that in the control group (8. 7%(26/ 300) vs. 18. 1%(17/ 94),χ2= 6. 53;8. 9%(34/ 382) vs. 17. 9%(35/ 195),χ2 = 10. 04;P<0. 05) . There were no significant differences in the recurrence rate of tumor recurrence at 1 and 24 months after operation in the observation group and the control group(3 cases(4. 7%) vs. 4 cases(6. 5%),χ2 = 0. 92,P > 0. 05) . There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible,the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up. A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis,and is beneficial for the prognosis of patients with esophageal cancer.
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Objective To analyze the correlation of foveal avascular zone (FAZ) size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane (IMEM) eyes.Methods This is a cross-sectional study, including 43 patients (43 eyes) with IMEM (IMEM group) and 35 health subjects (35 eyes) as control group. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were estimated with optical coherence tomography angiography (OCTA) in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) was assessed with spectral-domain optical coherence tomography. There was no difference of logMAR BCVA and CMT between two groups (Z=?7.379, ?7.560;P<0.001). The differences of FAZ areas between the two groups were analyzed. The correlative analysis was performed to investigate the relationship between FAZ areas and visual acuity as well as metamorphopsia.Results The FAZ area in superficial and deep capillary plexus in IMEM group were smaller than those in control group (t=?30.316, ?27.606;P<0.001). In IMEM group, the mean M-score was 0.41±0.32; the horizontal and vertical M-score were 0.49±0.40 and 0.32±0.29, respectively. The horizontal M-score was higher than vertical M-score with the significant difference (Z=?2.000,P=0.046). In IMEM group, the FAZ area in superficial capillary plexus correlated inversely with metamorphopsia (r=?0.709,P<0.001); the FAZ area in deep capillary plexus correlated inversely with metamorphopsia and BCVA (r=?0.533, ?0.838;P<0.001).Conclusions The FAZ areas are significantly decreased in IMEM eyes compared with normal eyes. Both superficial and deep FAZ areas are correlated with metamorphopsia, and deep FAZ area is also correlated with BCVA.
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Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery.Methods A retrospective case series of 64 eyes of 64 patients affected with IMH.All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade.In 35 eyes of 35 patients,the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group).In 29 eyes of 29 patients,the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group).The follow-up was ranged from 6 to 11 months,with the mean follow-up time was 8.4 months.The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test.The duration of the facedown positioning and complications were compared between two groups.Results The period of facedown position was (1.67± 1.28) and (7.65 ± 1.42) days in the SS-OCT group and control group,respectively.The difference of the period of facedown position between the two groups was significant (Z=-6.784,P＜ 0.05).At 6 months after surgery,the hole closure was detected in 30 eyes (85.71％) in the SS-OCT group and in 27 eyes (93.10％) in the control group.There was no difference of hole closure rate between the two groups (x2=0.889,P＞0.05).There was no ocular serious side effect during the follow up,such as leakage of sclera incision,retinal hemorrhage,choroidal hemorrhage and endophthalmitis.In the control group,there were two patients with mild dizziness who underwent symptomatic treatment.There was no systemic side effect during the follow-up in the SS-OCT group.Conclusion Confirming with SS-OCT imaging early closure of macular hole ofIMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning,while achieved a high hole closure rate.
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Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO),guided by optic coherence tomography (OCT).Methods It is a retrospective case study.Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study.There were 19 males (19 eyes) and 21 females (21 eyes),with the mean age of (53.58 ± 13.19) years and the mean course of 1.5 months.The best corrected visual acuity (BCVA),indirect ophthalmoscopy,fundus fluorescein angiography (FFA) and OCT were performed.The mean baseline of BCVA,central macular thickness (CMT) were 0.25 ± 0.18 and (509.48 ± 170.13) μm respectively.All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg).Follow-up of these patients was 1 to 6 months after treatments,the BCVA,fundus manifestations,OCT were retrospectively observed by every month,the FFA was retrospectively observed by every 3 months.When there was retinal edema or CMT ≥ 50 μm by OCT during follow-up,those patients were retreated with intravitreal conbercept injection.The changes of the BCVA,CMT were evaluated before and after treatment.Meanwhile,complications in eyes related to medicine and treatment methods were evaluated too.Results At the 6 months,the BCVA was improved (increase≥2 lines) in 25 eyes (62.50％),stabilized (± 1 line) in 13 eyes (32.50％) and decreased 2 lines in 2 eyes (5.00％).Retinal hemorrhage and exudates were absorbed in most patients.FFA showed no fluorescein leakage in 1 1 eyes (27.50％),minor fluorescein leakage in 26 eyes (65.00％),and retinal capillary non-perfusion in 3 eyes (7.50％).OCT showed absorption of the subretinal fluid.The mean CMT were (235.20± 100.44) μm at 6 months.Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00％),3 times for 18 eyes (45.00％),and 2 times for 14 eyes (35.00％).The mean number of intravitreal injection was 2.85 times.There were no ocular or systemic adverse events observed in all patients.Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT.It can stabilize and improve the visual acuity.
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Objective To evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods 23 patients (23 eyes) were retrospectively reviewed,who were diagnosed as MHRD through examination of the ocular ftmdus,optic coherence tomography (OCT) and B-mode ultrasonography.There were 5 males (5 eyes) and 18 females (18 eyes).The mean age was (62.35 ± 8.28) years.The mean course of disease was 1.1 months.The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31 ± 0.72.The mean axial length was (28.66 ± 1.99) mm.All patients underwent 23G microincision vitrectomy.After vitreous gel and cortex were gently resected,the ILM around the edges of the macular hole was stained with indocyanine green,and was folded and pushed to fill the macular hole gently.Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes,respectively.The silicone oil was removed after 3 months.The follow-up was 6 months.The BCVA,macular hole closure,retinal anatomical reattachment were retrospectively observed,and were used to evaluate the safety and effectiveness of the surgery.Results At the 6 months after surgery,the logMAR BCVA was improved to 1.13 ± 0.38,the difference was significant (t=l 5.33,P=0.00).The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100％.There were no ocular or systemic adverse events observed in all patients.Conclusion Vitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.
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Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes.Methods This is a retrospective case series of 47 IMEM patients (49 eyes).All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP.The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity.The severity of metamorphopsia was measured using M-charts.The central macular thickness (CMT),inner nuclear layer thickness (INT),inner retinal layer thickness (IRT),outer retinal layer thickness (ORT),the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively.The differences in BCVA,CMT,INT,IRT,ORT and status of EZ before and after surgery were analyzed,so did the correlations between these indexes at the same time.Results Compared with baseline,the postoperative BCVA was significantly increased (F=6.133,P＜0.001),but the M value,CMT,INT,IRT,ORT were significantly decreased (F=12.481,10.565,15.739,6.046,10.569;P＜0.001);the integrity of EZ was improved significantly (x2=12.309,P＜0.001).Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720,0.887;P＜0.05),while negatively related to preoperative integrity of EZ (r=-0.295,P＜0.05).The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT,ORT (r=0.774,0.754,0.842;P＜0.05),while negatively related to postoperative integrity of EZ (r=-0.676,P＜0.05).The preoperative M value was positively related to the preoperative CMT,INT,IRT,and ORT (r=0.931,0.668,0.840,0.637;P＜ 0.05).The postoperative M value was positively related to the preoperative M value and postoperative CMT,INT,IRT,and ORT (r=0.723,0.722,0.767,0.825,0.387;P＜0.05).Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity,metamorphopsia and foveal morphology.Both visual acuity and metamorphopsia correlate with foveal morphology.
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<p><b>OBJECTIVE</b>To investigate the epidemiology, internal opening location, and risk factors associated with recurrence of anal fistula.</p><p><b>METHODS</b>Clinical data of 1783 hospitalized patients admitted for anal fistula treatment to Shanghai Shuguang Hospital from January 2013 to September 2015 were retrospectively analyzed. Fistula passing through anorectal ring or locating above was defined as high anal fistula (n=125). Internal opening location was defined as follows: posterior (5 to 7 o'clock), front(11 to 1 o'clock), left (2 to 4 o'clock) and right (8 to 10 o'clock).</p><p><b>RESULTS</b>Among 1783 cases, 1526 were male with a median age of 36 years, 257 were female with a median age of 35 years, and the ratio of male to female was 5.9 vs 1.0. In high anal fistula cases, this ratio of male to female was 7.3 vs 1.0. Posterior internal opening accounted for 51.4%(884/1720), while this percentage was 66.4%(83/125) in high anal fistula cases, which was significantly higher than 50.2%(801/1595) in low anal fistula cases(P=0.002). Postoperative recurrence rate was 2.6%(45/1720) and the rates in high anal fistula and low anal fistula were 13.6%(17/125) and 1.8%(28/1595) respectively, with significant difference(P=0.000). Multivariate logistic regression analysis showed that fistula height(OR=5.475, 95%CI:2.230 to 13.445, P=0.000), treatment history(OR=2.671, 95% CI:1.315 to 5.424, P=0.007), seton placement history (OR=4.707, 95%CI:1.675 to 13.232, P=0.003) and concomitant colitis(OR=10.300, 95%CI:1.187 to 89.412, P=0.034) were independent risk factors for anal fistula recurrence. Seton placement history was an independent risk factor for high anal fistula recurrence (OR=6.476, 95%CI:1.116 to 37.589, P=0.037).</p><p><b>CONCLUSIONS</b>Anal fistula occurs in young and middle-aged male patient. Internal opening locates in posterior more commonly, especially in high anal fistula patients. Postoperative recurrence rate of high anal fistula is quite high. Patient with both high anal fistula and seton placement history has significantly high rate of postoperative recurrence.</p>
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Objective To observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR).Methods This is a prospective non-randomized controlled clinical study.A total of 62 patients (70 eyes) who underwent vitrectomy for PDR were enrolled and divided into IVR group (30 patients,34 eyes) and control group (32 patients,36 eyes).IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) 3 or 5 days before surgery.The follow-up time was 3 to 18 months with an average of (4.5± 1.8) months.The surgical time,intraoperative bleeding,iatrogenic retinal breaks,use of silicone oil,the best corrected visual acuity (BCVA) and the incidence of postoperative complications were comparatively analyzed.Results The difference of mean surgical time (t=6.136) and the number of endodiathermy during vitrectomy (t=6.128) between IVR group and control group was statistically significant (P=0.000,0.036).The number of iatrogenic retinal break in IVR group is 8.8 ％ and control group is 27.8％,the difference was statistically significant (x2 =4.154,P=0.032).Use of silicone oil of IVR group is 14.7％ and control group is 38.9％,the difference was statistically significant (x2 =5.171,P=0.023).The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8％ and 30.6 ％ respectively in IVR group and control group.The differences were statistically significant (x2=3.932,P=0.047).The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA,the difference was statistically significant (t=4.414,8.234;P=0.000).But there was no difference between the mean postoperative BCVA of two groups (t=0.111,P=0.190).There was no topical and systemic adverse reactions associated with the drug after injection in IVR group.Conclusions Microincision vitreoretinal surgery assisted by IVR for PDR shorten surgical time,reduces the intraoperative bleeding and iatrogenic retinal breaks,reduces the use of silicon oil and the postoperative recurrent vitreous hemorrhage.But there was no significant relationship between vision improvement and IVR.