Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.
ObjectiveTo improve the diagnosis and treatment of pulmonary alveolar proteinosis (PAP). MethodsThe clinical data of 34 PAP cases diagnosed between May 2008 and June 2015 in Hunan Prevention and Treatment Center for Occupational Diseases were retrospectively analyzed. ResultsThere were 34(52.9%)patients with a history of dust exposure. Cough and progressive dyspnea were common clinical symptoms. The incidence rate of hypoxemia and lung function damage was 87.9% and 90.9%,respectively. High resolution CT clearly demonstrated the characteristic map-like changing and paving-stone sign. Arterial blood oxygen partial pressure increased from (62.5±12.9)mm Hg to (73.0±12.2)mm Hg,and DLCO%pred increased from (50.1±14.9)% to (64.6±14.4)% after large-volume whole lung lavage. The recurrence rate was 38.2%. ConclusionThe etiology of PAP is unknown,dust exposure may be associated with secondary PAP. The effect of whole lung lavage is remarkable but the recurrence rate is high. It is needed to study further on etiological treatment of PAP.
Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
In this paper, the Fourier transform based minimum mean square error (FT-based MMSE) method is used to calculate the regional cerebral blood volume (rCBV) in magnetic resonance (MR) perfusion imaging, and the method is improved to handle the existing noise in the imaging process. In the experiments with signal-to-noise ratio (SNR) of 50 dB, the rCBV values were compared with the results using MMSE method. The effects of different SNRs on the estimation of rCBV were analyzed. The experimental results showed that MMSE was a simple way to filter the measurement noise, and could calculate rCBV accurately. Compared with other existing methods, the present method is not sensitive to environment, and furthermore, it is suitable to deal with the perfusion images acquired from the environment with larger SNR.
ObjectiveTo explore the effectiveness of levosimendan versus dobutamine for the patients with severe valvular disease in perioperative period. Methods A randomized, single-blind, and controlled study was conducted in 59 patients with severe valvular disease in perioperative period. There were 48 males and 11 females at average age of 51±14 years (ranged from 18 to 70 years). The patients received Swan-Ganz catheterization with pulmonary capillary wedge pressure (PCWP)≥15 mm Hg, cardiac index (CI)≤2.5 L/(min·m2), and hemodynamic stability. They were divided into a levosimendan group (n=25) and a dobutamine group (n=34) to receive levosimendan or dobutamine injection intravenously for 24 hours on base of anti-heart failure treatment by random digital table. ResultsIn the levosimendan group, the level of PCWP was lower than the baseline level with a statistical difference(12.51±8.76 mm Hg vs. 20.11±8.04 mm Hg, P < 0.01) after 24 hours' treatment, and the level of CI was higher than the baseline level with a statistical difference (2.58±0.72 L/(min·m2) vs. 2.01±0.54 L/(min·m2), P < 0.05) after 24 hours' treatment. In the levosimendan group, the changes of pulmonary capillary wedge pressure (PCWP), pulmonary arterial mean pressure (PAMP), sequential vascular response (SVR), and left ventricular ejection fraction (LVEF) were more obvious compared with those in the dobutamine group with statistical differences (all P < 0.05) after 24 hours' treatment. The offline time and ICU stay in the levosimendan group reduced compared with those of the dobutamine group with statistical differences (47.3±10.4 h vs. 52.5±7.6 h, P < 0.05; 5.3±2.2 d vs. 6.8±3.5 d, P < 0.05). There was no statistical difference in the incidence of adverse events between the two groups (P > 0.05). ConclusionCompared with dobutamine, levosimendan can improve hemodynamic stability of patients with severe valvular disease in perioperative period with good tolerability and safety.
ObjectiveTo explore the reason of failure in noninvasive positive pressure ventilation (NPPV) for treatment of postoperative hypoxemia, in order to better guide use of NPPV after cardiac surgery. MethodsWe retrospectively analyzed the clinical data of 64 patients after heart surgery with undergoing NPPV treatment due to hypoxemia in our hospital between January 2012 and December 2013 year.There were 49 males and 15 females at age of 28 to 87 years. There were 17 patients with NPPV failure. The related factors for failure of NPPV were analyzed. ResultsFactors associated with failure of NPPV included smoking history, preoperative pulmonary function abnormalities, blood transfusion amount > 1 000 ml, simplified acute physiology score Ⅱ(SAPS Ⅱ) before NPPV > 35 points, oxygenation index (PaO2/FiO2) < 100 mm Hg before NPPV, PaO2/FiO2 < 150 mm Hg after NPPV treatment for 1 h, mechanical ventilation time > 72 h at the first time, and pneumonia (P < 0.05). The SAPS Ⅱ > 35 points before NPPV and pneumonia were the independent risk factors for NPPV treatment failure for postoperative hypoxemia. ConclusionPostoperative NPPV for heart disease should be according to the cause of low oxygen and severity. For patients with SAPS less than 35 points before NPPV or patients with pneumonia, NPPV should not be used. In the process of NPPV, if clinical effect is not satisfied, it should be converted to invasive ventilation immediately.
ObjectiveTo investigate the clinical efficacy and safety of carvedilol in the treatment of arrhythmia in patients with hypertension complicated with diabetes mellitus. MethodsWe selected the patients with hypertension complicated with diabetes mellitus who were hospitalized in the Harrison International Peace Hospital Affiliated to Hebei Medical University for treatment from Oct. 2011 to Oct. 2013. The cases were divided into a trial group and a control group. The control group was given routine treatment (eg., hypoglycaemic drugs, angiotensin converting enzyme inhibitors). On the basis of the same treatment of the control group, the trial group was given carvedilol. The efficacy and adverse reaction were observed, recorded and then analyzed between the two groups. ResultsA total of 140 patients were included (70 cases in each group). With the loss of 10 cases in the control group, the data of 70 cases in the trial group and 60 cases in the control group were finally analyzed. The results showed that the trial group was superior to the control group in the total effectiveness (χ2=8.320, P=0.004) and the dynamic ECG improvement of premature ventricular contraction (χ2=5.333, P=0.014) with significant differences. Both groups were significantly improved in blood pressure and heart beats compared with the situation before treatment (Both P < 0.05), and the trial group was better than the control group with a significant difference. During the treatment, three cases in the trial group had mild gastrointestinal symptoms which spontaneously disappeared later. ConclusionThe clinical effectiveness of carvedilol for arrhythmia in patients with hypertension complicated with diabetes mellitus is significant. It is safe and effective which is recommended in clinical application.
ObjectiveTo systematically review the diagnostic value between serum human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125) for endometrial cancer (EC). MethodsWe electronically searched databases including PubMed, The Cochrane Library, Web of Science, ScienceDirect, EBSCO, CNKI and VIP to collect diagnostic accuracy studies of serum HE4 and/or CA125 versus golden standard (pathology) for EC from inception to August 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS-2 tool. Then, meta-analysis was performed by Meta-Disc 1.4 software. ResultsA total of 20 studies involving 4 351 participants were included. The results of meta-analysis showed that:the pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), and negative likelihood ratio (-LR), and diagnostic odds ratio (DOR) of HE4 in the diagnosis of EC were 0.56 (95%CI 0.54 to 0.58), 0.89 (95%CI 0.88 to 0.90), 6.19 (95%CI 4.31 to 8.88), 0.49 (95%CI 0.44 to 0.56), and 14.27 (95%CI 9.50 to 21.42), respectively. The area under the curve (AUC) of SROC was 0.855 9. The pooled Sen, Spe, +LR,-LR, and DOR of CA125 in the diagnosis of EC were 0.33 (95%CI 0.31 to 0.34), 0.80 (95%CI 0.78 to 0.82), 2.07 (95%CI 1.45 to 2.95), 0.83 (95%CI 0.76 to 0.91), and 2.65 (95%CI 1.63 to 4.32), respectively. The SROC AUC was 0.657 5. ConclusionCompared with CA125, HE4 has higher diagnostic accuracy for EC. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.