Abstract： Objective To investigate the effects of βreceptor blocker on intraventricular pressure gradient and left ventricle remodeling after valve replacement for critical aortic stenosis. Methods Fifty-six patients with critical aortic stenosis underwent aortic valve replacement surgery from January 2008 to January 2010 in the First Affiliated Hospital of Zhengzhou University. Thirtytwo of them who were followed up were selected to be enrolled in this study. The patients were divided into two groups under the same basis of clinical features. Twelve patients in the experimental group received oral βreceptor blocker (Metoprolol, 6.2525.00 mg once, twice daily). The rest 20 patients in the control group had no βreceptor blocker. The various indicators of ultrasound cardiogram (UCG) shortly after operation (within a week) and long after operation (6-24 months) were compared between the two groups. Results No death occurred in both groups, and chest distress, shortness of breath and other symptoms were obviously alleviated. Although left ventricular endsystolic dimension (LVESD) and left ventricular outflow tract dimension (LVOTD) of both groups increased 6-24 months after operation, compared with the early postoperative period, only the increase of LVOTD in the experimental group showed statistical difference (t=-47.937, P=0.001). In both groups, interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), filament band velocity of left ventricular outflow tract (V), intraventricular pressure gradient (G) and left ventricular mass index (LVMI) of the later period after operation were significantly lower than those of the early postoperative period. All these indicators in the experimental group showed significant differences (t=7.781, P=0.001；t=5.749, P=0.001; t=2.637, P=0.023; t=7.167, P=0.001; t=100.061, P0.001), while only V, G， and LVMI showed statistical differences in the control group (t=4.051, P=0.001; t= 4.759, P= 0.001; t=-0.166,P=0.001). EF in the experimental group also indicated significant difference compared with early period after aortic valve replacement (t=-6.621, P=0.001). EF between two groups indicated no significant difference (t=-0.354,P=0.726). But differences between the two groups in LVEDD, IVS, G， and LVMI were all statistically significant in the later period after surgery (t=-2.494, P=0.018; t=-3.434, P=0.002;t=-2.171,P=0.038; t=-2.316, P=0.028). Conclusion β-receptor blocker is a safe and reliable drug for those patients who have undergone aortic valve replacement surgery for critical aortic stenosis, and can decrease significantly the residual intraventricular pressure gradient and accelerate left ventricular cardiac remodeling.
Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.
Objective To observe the fundus lesions in the unilateral rhegmatogenous retinal detachment (RRD) eyes and contralateral eyes in non-traumatic emmetropia patients, and explore the risks of lateral eyes. Methods This is a retrospective case analysis. A total of 426 patients of unilateral RRD diagnosed by clinical examination were enrolled in this study. There were 273 males and 74 females. The average age of onset was 54.7 years. 81.46% of them (347 patients) were 51 - 70 years old. The average detachment time was 2.12 months. They were divided into two groups, equal or lesser than 50 years old group and more than 50 years old group. A total of 100 patients (200 eyes) with ocular surface disorders were randomly selected as control. The lattice-like degeneration, cystic degeneration and dry retinal holes were treated with prophylactic laser photocoagulation. Follow-up period was 6 to 24 months. The age, gender, proliferative vitreous retinopathy (PVR) grading, best corrected visual acuity (BCVA), distribution and quantity of retinal holes, and posterior vitreous detachment (PVD) were retrospectively analyzed. The incidence of PVD among different age groups was compared with Chi square. Results Among 426 RRD eyes, there were 239 eyes (56.10%) with PVD. Among them, there were 30 eyes with age equal or lesser than 50 years old (12.55%) and 209 eyes with age more than 50 years old (84.75%). There were 187 eyes (43.90%) without PVD, which including 38 eyes with age equal or lesser than 50 years old (20.32%) and 149 eyes with age more than 50 years old (79.68%). The incidence of PVD among different age groups was statistically significant (χ2=4.72, P＜0.05). There were 10, 254, 40 and 5 eyes in class A, B, C and D of PVR, respectively; 117 eyes without PVR. The retinal hole was located in superior temporal, inferior temporal, superior nasal, inferior nasal and macular in 305, 91, 22, 4 and 4 eyes, respectively. The number of holes was 1, 2, and more than 3 in 297, 89 and 40 eyes, respectively. The retinal detachment range of 1, 2, 3 quadrants and total dissociation were 92, 230, 71, 33 eyes, respectively. The fundus lesion was found in 47 eyes (11.03%) in the lateral eyes. There were 20 RRD eyes in class B of PVR, and 27 RRD eyes in class C of PVR. Retinal degenerated area was found. Among them, the degeneration of 41 eyes was located in the temporal retina, 45 eyes involved in a quadrant. There were 16 eyes with peripheral retinal dry holes; the holes diameter was less than 1, 1 - 2, greater than 2 optic-discs in 6, 11 and 5 retinal holes. At the end of the follow-up, there were 47 eyes with almost normal visual field, 16 eyes with decreased visual acuity, no eyes with retinal detachment. In the control group, 4 patients (5 eyes, 2.50%) had fundus lesions. Conclusion The unilateral RRD in non-traumatic emmetropia mostly occurs in elderly patients; 11.03% of patients had fundus lesions in the contralateral eyes, higher than the general population.