Diabetic macular edema (DME) is the main cause of visual impairment in patients with diabetic retinopathy (DR). Currently, the main treatment methods of DME include intravitreal injection of anti-VEGF drugs, glucocorticoids and laser photocoagulation, but there are still some patients who do not respond or respond poorly to non-surgical treatments. Clinical and basic studies have confirmed that the abnormality of the vitreous-retinal interface plays an important role in the pathogenesis of DME. Par plana vitrectomy (PPV) can relieve macular traction, clear the vitreous cavity VEGF and other inflammatory cytokines, increase the vitreous cavity oxygen concentration, improve retinal oxygen supply, reduce retinal thickness of traction and non-traction DME, and improve patients' vision. However, how to choose and apply PPV to treat DME in specific practice, and to further improve the efficacy of PPV, including the innovation of surgical technology, combined treatment and the choice of surgical timing, still needs more clinical studies to explore.
Twentytwo patients with deviation of nasal septum were treated by modified septorhinoplasty. The main points in the modification were:(1) The incision was curved instead of "L" shaped. It would avoid the disadvantage of having tension on the suture line and poor exposure;(2) Using triangle osteotomy to correct deviation of nasal septum, it was less traumatic and lessbleeding and better correction. The results from followup were as follows:18 good and 4 fair. The techniques and advantages of the modified procedure were discussed.
【摘要】 目的 评估吉非替尼治疗终末期（PS评分≥3分）非小细胞肺癌（NSCLC）的临床效果和生活质量改善情况。 方法 2008年5月-2010年6月共收治终末期NSCLC患者40例，其中19例患者采用吉非替尼治疗（治疗组），21例采用支持治疗+中药治疗（对照组）。 结果 治疗6个月后，治疗组19例患者中，CR 1例，PR 5例，SD 10例，PD 3例。治疗组有效率为31.5%（6/19），临床受益率为84.2%（16/19）。对照组21例中，SD 5例，PD 16例，无CR。对照组有效率为23.8%（5/21），临床受益率为 23.8%（5/21）。两组间有效率和临床受益率比较，差异均有统计学意义（Plt;0.05）。治疗组中位生存期为13.2个月，对照组中位生存期为4.5个月。 结论 吉非替尼可延长NSCLC患者的生存期，改善其生活质量。【Abstract】 Objective To evaluate the curative effect and life improvement of gefitinib on non-small cell lung cancer (NSCLC) which in the end stage. Methods Forty patients with end-stage NSCLC were treated from May 2008 to June 2010. Nineteen patients of them were treated with gefitinib (treatment group), 21 patients were treated with supportive care and traditional Chinese medicine treatment (control group). Results Six months after treatment, there are one patient with CR, five patients with PR, 10 patients with SD and three patients with PD in the treatment group. The effective rate of treatment group was 31.5% (6/19), clinical benefit rate was 84.2% (16/19). There are five patients with SD, 16 patients with PD, and no one with CR in the control group. The effective rate of the control group was 23.8% (5/21), clinical benefit rate was 23.8% (5/21). The differences of effective rate and clinical benefit rate between two groups were statistically significant (Plt;0.05). The median survival period of the treatment group and control group were 13.2 and 4.5 months respectively. Conclusion Gefitinib can extend the lifetime of NSCLC patients and improve their quality of life.
ObjectiveTo investigate the operation of transcatheter aortic valve replacement (TAVR), the use of TAVR instruments and the current situation of TAVR-related nursing in our country, to reveal the characteristics of TAVR in various hospitals in our country, and to provide reference data for improving perioperative nursing and industry development of TAVR. MethodsA questionnaire survey was conducted among the head nurses of the cardiac catheterization laboratories of 51 hospitals in China that carried out TAVR operations, with a total of 5 items and 23 questions. The current situation of TAVR operation methods, intraoperative instruments and nursing care in China were analyzed. ResultsThe number of hospitals in China which started conducting TAVR and the beginning year were: 2 in 2010, 1 in 2012, 1 in 2013, 1 in 2015, 11 in 2016, 13 in 2017, 15 in 2018 and 7 in 2019; the number of transfemoral TAVR in 2019: 32 (62.75%) hospitals conducted on less than 20 patients, 7 (13.73%) hospitals 20-<50 patients, 6 (11.76%) hospitals 50-100 patients and 6 (11.76%) hospitals more than 100 patients; TAVR strategies adopted by most hospitals were: general anesthesia (90.20%), the use of vascular sealers (80.39%), backing by cardiac surgeon (74.51%) and using homemade prosthetic valves. Conclusion At present, the number of TAVR carried out in Chinese hospitals is still far behind that of developed countries in Europe and the United States. Our country has adopted the form of multidisciplinary cardiac team cooperation and formed a TAVR nursing model with Chinese characteristics.
ObjectiveTo observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). MethodsThis 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. ResultsThe 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 (χ2=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 (χ2=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 (χ2=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. ConclusionsMicroincision 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.
ObjectiveTo observe the effect of scleral buckling surgery (SB) in the treatment of rhegmatogenous retinal detachment (RRD) with subretinal hyperplasia (SRP). MethodsA 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. ResultsAt 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. ConclusionSB treatment of RRD with SRP can achieve good retinal reposition and improve visual acuity to some extent.
ObjectiveTo compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). MethodsFollowing the clinical detection of a macula-off RRD with peripheral retinal breaks, patients were offered the opportunity to enroll in the study, and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study, and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 1:1) using a random number table. Seventy-two eyes of 72 patients were enrolled and studied. Patients were treated with 25G plus vitrectomy, endolaser or transscleral cryopexy, either complete (n=36), or partial (n=36) subretinal fluid drainage, and 14%C3F8 (PFO) was used for intraocular tamponade. After surgery, all patients were kept in a supine position for 24 hours, and then in a clinically optimal position for 6-10 days. The study patients were examined at 1, 3 and 6 months after surgery with thorough ophthalmic examinations. Macular optical coherence tomography (OCT) imaging was acquired in 1 month. Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared. Furthermore, the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded. The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point. ResultsThe preoperative baseline characteristics between the two groups were not significantly different. The single-operation success rates were 88.9% and 91.6% respectively for the CSFD and the PSFD groups (χ2=0.158, P>0.05). The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99±0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564). The mean operative time was longer in the CSFD group (62.25±4.32) minutes than that in the PSFD group (47.9±5.0) minutes (t=0.580, P=0.564). seven of 29 (24.1%) phakic eyes in the CSFD group had lens injury during SRF drainage, and none of the 31-phakic eyes in the PSFD group sustained lens damage. Residual PFO was present in 6 of 36 CSFD cases (16.7%). Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid. Among these patients, 22 patients (62.5%) in the CSFD group and 23(69.7%) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00). ConclusionsPartial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective. The success rates are not statistically different. Additionally, PSFD procedures can simplify the surgery procedure, shorten operative time and, and to some extent, reduce the incidence of complications relevant to the CSFD approach.
Objective To explore the relationship between immune state and disease progression or severity of patients with hepatitis B virus (HBV). Methods A total of 332 patients infected with HBV diagnosed and treated from January 2012 to December 2013 were divided into acute hepatitis B (AHB) group (n=25), chronic hepatitis B (CHB) group (n=237) and cirrhosis group (n=70) according to disease progression. Moreover, CHB group was divided into mild (n=24), moderate (n=103), serious (n=72) and severe group (liver failure group,n=38) according to disease severity, while cirrhosis group was divided into hepatocellular carcinoma (HCC) group (n=13) and non-HCC group (n=57). The immune indexes including immunoglobulin (Ig), complement (C) and T-lymphocyte subsets were tested and compared. Results The immune indexes were not significantly different between AHB group and CHB group (P>0.05). Compared with AHB group and CHB group, cirrhosis group had higher levels of IgG and IgA, and lower levels of CD3+, CD4+ and CD8+ T cells count (P<0.05). Compared with non-HCC group, HCC group had more male patients without antiviral therapy, who had higher levels of C3 and C4 (P<0.05). As disease progressed, the levels of alanine fcell couaminotransferase, aspartate aminotransferase, total cholesterol, Fibroscan index, IgG, and IgA of CHB patients all gradually increased, while the levels of C3 and C4 and the counts of CD3+ and CD4+ T cells gradually declined. Conclusions The immune state of patients infected with HBV has a certain relationship with disease progression or severity, and immunoglobulin, complement and T cells count can partly reflect the severity of the disease. Cirrhosis patients accompanied with high levels of C3 and C4 should pay high attention to antiviral therapy and be vigilant on HCC.
Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination, fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and Bultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of fingercounting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twentyone patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included: Iris 810 nm infra red diode laser，7001200 mW,60 s,and 1-3 spots. Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent. After 15 minutes of intravenous injection with Visudyne, laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s. The followup period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group, the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with greywhite organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period；the results of OCT indicated disappeared retinal detachment, completely absorbed subretinal liquid and increased reflection of choroid tumor with scar；the results of Bultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9, unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation；the results of FFA revealed disappeared fluorescence leakage；the results of OCT indicated completely absorbed subretinal liquid；the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.