Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma. Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study. The eyes included 34 eyes with primary open-angle glaucoma (POAG group), 33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group). Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group. The differences of age (t=1.197), sex (chi;2=3.548), average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05). The differences of age (F=2.645), sex (F=1.984), average diopter (F=2.621), and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significan(P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects. The watershed zones were classified into three types according to its location relative to the optic disc: in type Ⅰ, the watershed zone did not include the optic disc or could not be observed; in type Ⅱ, the watershed zone partially included the optic disc; in type Ⅲ, the watershed zone completely included the optic disc. The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed. The relationship between watershed zones, type and age, and MD were also analyzed by Pearson analysis method. Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6% and 56.8% in glaucoma group and control group, respectively; with a statistically significant difference (chi;2=8.756,P＜0.003). The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4%, 90.9%, 71.1% in POAG, NTG and CACG group, respectively. No significant differences were found between POAG and NTG group (chi;2=1.039), POAG and CACG group (chi;2=1.039, 1.166;P＞0.05). But there was significant difference between NTG and CACG group (chi;2=4.107,P＜0.05). Significant differences were found between POAG and control group, NTG and control group (chi;2=5.352, 10.141;P＜0.05). No significant difference was found between CACG and control group (chi;2=1.444,P＞0.05). There was no correlation between age and watershed zone type (r=0.114,P＞0.05). The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000). Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.
ObjectiveTo observe the characteristics of macular optical coherence tomography (OCT) changes before and after silicone oil removal in patients who had undergone pars plana vitrectomy with silicone oil tamponade for macula-off rhegmatogenous retinal detachment (RRD). MethodsThirty-nine eyes that underwent silicone oil removal were enrolled in this retrospective study. The patients included 24 males and 15 females, with an average age of (53.05±4.03) years, the duration of silicone oil tamponade ranged from 3 to 7 months. Best-corrected visual acuity, intraocular pressure, slit lamp microscope and pre-lens, indirect ophthalmoscopy and fourier domain OCT were measured for all patients before and at months 1, 3 and 6 after silicone oil removal. The macular microstructure were observed before and after silicone oil removal. ResultsSubmacular fluid was detected in 6 eyes (15.38%), at the last time of follow-up, submacular fluid resolved completely in 2 eyes with disrupted ellipsoid zone, and resolved partly in 2 eyes. Disrupted ellipsoid zone were observed before silicone oil removal in 16 eyes (41.02%), 6 eyes showed simultaneous disrupted ellipsoid zone and disrupted external limiting membrane, and there were 2 eyes that external limiting membrane was not identified, at the last time of follow-up, disrupted ellipsoid zone restored in 2 eyes and the extent of disrupted ellipsoid zone became reduced in 4 eyes. Cystoids macular edema were found in 2 eyes (5.12%), it resolved completely in 1 eye and resolved partly in 1 eye at the last time of follow-up. Macular epiretinal membrane was detected in 10 eyes (25.64%), and macular epiretinal membrane was found before silicone oil removal in 5 eyes, at the last time of follow-up, the membrane became thickened in 2 eye; 5 eyes developed macular epiretinal membrane after silicone oil removal, at the last time of follow-up, the membrane became thickened in 1 eye. Secondary macular hole were noted in 2 eyes. Microcystic macular changes were observed in 9 eyes (23.07%), it was observed in 7 eyes before silicone oil removal, and was observed in 2 eyes after silicone oil removal, at the last time of follow-up, the cysts reduced in 1 eye. ConclusionSubmacular fluid, disrupted ellipsoid zone and microcystic macular are the main macular ultrastructural changes that developed in patients with RRD before and after silicone oil removal.
Objective To compare chordal transposition and chordal shortening in repairing anterior leaflet prolapse (ALP)， and explore the surgical indications as well as merits and demerits of these two techniques. 〖WTHZ〗Methods We retrospectively reviewed the data of 90 ALP patients recruited into Anzhen Hospital between March 1986 and March 2008, and classified them into chordal shortening group (n=23) and chordal transposition group (n=67). KaplanMeier survival curve and freedom from reoperation curve were established to compare the two groups. Univariate analysis and multivariate logistic analysis regression were used to identify independent risk factors for early death and late cardiac events. 〖WTHZ〗Results There were three perioperative deaths in chordal shortening group（13.0%）, and three deaths in chordal transposition group (4.4%), and the difference was not significant (χ2=2.019，P=0.155). The follow-up time ranged from 1 month to 18 yrs（7.70±5.41 yrs）. There were 5 late deaths, of which 3 were in chordal shortening group and 2 in chordal transposition group. The KaplanMeier survival curve showed that 5-year survival rate of chordal shortening group was significantly lower than chordal transposition group (70.00%±18.24% vs.98.00%±1.98%,χ2=12.50, P=0.000); And the KaplanMeier freedom from reoperation curve showed [CM(159mm]that 5-year reoperation rate of chordal shortening group was also significantly lower than chordal transposition group (83.30%±15.20% vs.96.10%±2.71%,χ2=10.27，P≤0.001). By the univariate analysis, we found that age＞55 yrs old, concomitant CABG procedure, New York Heart Association (NYHA) function class Ⅲ-Ⅳ, preoperative heart failure history, aortic clamping time＞90 min, and preoperative lefe ventricular ejection fraction (LVEF)＜45% were the risk factors for perioperative death and risk factors for late cardiac events included postoperative mitral regurgitation＞2+, chordal shortening technique, preoperative heart failure history, and aortic clamping time＞90 min. The multivariate logistic analysis regression showed that aortic clamping time＞90 min, concomitant CABG procedure, preoperative LVEF＜45% were the independent predictors for perioperative death, and NYHA class ⅢⅣ, chordalshortening technique and residual mitral regurgitation＞2+ were the independent predictors for the late cardiac events. Conclusion （1） There is no statistically difference between chordal transposition and chordal shortening in the perioperative survival rate. (2) Chordal transposition has a relative superiority to chordal shortening in terms of 5-year survival rate. (3) Chordal transposition has a higher mid and longterm rate of freedom from reoperation than chordal shortening. （4） Although chordal transposition has a lower incidence of reoperation and ahigher mid and longterm survival rate, the indication for it is restricted to less extensive ALP and patients with transferrable chord in the posterior leaflet. Chordal shortening is an independent risk factor for late events.
ObjectiveTo review the research progress of pathogenesis and genetics of alcohol-induced osteonecrosis of the femoral head (AIONFH). MethodsThe relevant domestic and foreign literature in recent years was extensively reviewed. The pathogenesis, the relationship between gene polymorphism and susceptibility, the related factors of disease progression, and the potential therapeutic targets of AIONFH were summarized. ResultsAIONFH is a refractory orthopedic disease caused by excessive drinking, seriously affecting the daily life of patients due to its high disability rate. The pathogenesis of AIONFH includes lipid metabolism disorder, endothelial dysfunction, bone homeostasis imbalance, and et al. Gene polymorphism and non-coding RNA are also involved. The hematological and molecular changes involved in AIONFH may be used as early diagnostic markers and potential therapeutic targets of the disease. ConclusionThe pathogenesis of AIONFH has not been fully elucidated. Research based on genetics, including gene polymorphism and non-coding RNA, combined with next-generation sequencing technology, may provide directions for future research on the mechanism and discovery of potential therapeutic targets.
ObjectiveTo explore the effect of different doses of low molecular weight heparin (LMWH) on the patency rate of cuffed central venous catheter used by patients for hemodialysis therapy.MethodsFrom June 2012 to January 2018, patients who received long-term hemodialysis in 363 Hospital with cuffed central venous catheter were enrolled in this retrospective study. According to the dose of LMWH used in hemodialysis, they were divided into below 60 U/kg group and greater than or equal to 60 U/kg group. The general parameters, frequency of urokinase use, bleeding events, severe coagulation in dialysis line and occurrence of catheter dysfunction were collected and compared between two groups.ResultsA total of 48 cases were enrolled. Of these, the doses of LMWH of 31 cases were below 60 U/kg and 17 cases were greater than or equal to 60 U/kg. There was no significant difference between the two groups in terms of age, sex, diabetes, hemoglobin, platelets, albumin, low-density lipoprotein cholesterol, or hypersensitive C-reactive protein parameters (P>0.05). Between the below 60 U/kg group and the greater than or equal to 60 U/kg group, there was no statistically significant difference in the incidence of catheter dysfunction (16.1% vs. 29.4%; χ2=0.507, P=0.476) or the incidence of bleeding events (1.77 vs. 2.81 times per 1 000 catheter-days; χ2=1.500, P=0.221). The frequency of urokinase used in the two group were 27.89 and 36.18 times per 1 000 catheter-days, respectively (χ2=5.927, P=0.015) and the frequency of severe coagulation were 6.88 and 2.30 times per 1 000 catheter-days, respectively (χ2=5.140, P=0.023). The differences were statistically significant.ConclusionThe lower dose of LMWH used in hemodialysis for preventing extra-corporeal circuit thrombosis does not result in the decrease of the patency rate of cuffed central venous catheter.