Objective To investigate the change characteristics of brain natriuretic peptide(BNP) after offpump coronary artery bypass grafting (OPCAB), and observe the relationship of BNP with atrial fibrillation, intensive care unit(ICU) stay time, time of withdrawing trachea tube, and usage of intraaortic balloon pump(IABP). Methods We retrospectively analyzed the clinical data of 168 consecutive patients with coronary artery diseases who underwent OPCAB in Beijing Anzhen Hospital from September 2009 to March 2010. There were 133 males and 35 females with an age of 60.77±9.32 years. BNP was determined before operation, on the operative day just after operation, and day 1, 2 and 3 after operation. At the same time, the relationship between BNP and ICU stay time, time of withdrawing trachea tube, occurrence of atrial fibrillation, and usage of IABP were also recorded. Results There were two inhospital deaths, due to low cardiac output syndrome, infection and circulatory failure respectively. BNP increased significantly after operation with the peak level occurring 1 day after operation, after which it decreased gradually. BNP level in patients with their left ventricular ejection fraction(LVEF) under 50% was significantly higher than that in patients with LVEF equal to or above 50% before and after operation(the median BNP level at the second postoperative day: 2 198.20 pg/ml vs. 531.65 pg/ml, Plt;0.05). BNP in patients using IABP was significantly higher than that in patients without using IABP before and after operation(the median BNP level at the first postoperative day: 5 066.75 pg/ml vs. 745.20 pg/ml, Plt;0.05). The ROC value was 0.834 when perioperative BNP was used to predict the possibility of using IABP. BNP in patients with postoperative atrial fibrillation was also significantly higher than that in patients without atrial fibrillation(the median BNP level at the first postoperative day: 1 070.60 pg/ml vs. 747.80 pg/ml, Plt;0.05). BNP was positively correlated with using IABP(at the third postoperative day: r=0.437, Plt;0.05), prognosis(at the first postoperative day:r=0.224, Plt;0.05), time of withdrawing trachea tube(at the third postoperative day: r=0.440, Plt;0.05), ICU stay time(at the third postoperative day: r=0.477, Plt;0.05). Conclusion BNP can be considered as one of the diagnostic criteria for ventricular dysfunction, and preoperative high BNP level is a risk factor for using IABP and ICU stay time equal to or longer than 3 days.
Objective To observed and analyze the clinical features of patients with nonarteritic anterior ischemic optic neuropathy (NAION) causes of misdiagnosis. MethodsA retrospective case study. From November 2014 to July 2022, 49 NAION patients with 49 eyes diagnosed in Department of Ophthalmology, The First People’s Hospital of Lanzhou were included in the study. All patients were misdiagnosed with other eye diseases at first diagnosis. All eyes were examined by best corrected visual acuity (BCVA), relative afferent pupil defect (RAPD), orbital magnetic resonance imaging (MRI), visual field, optical coherence tomography (OCT), and graphic visual evoked potential (P-VEP). Fluorescein fundus angiography (FFA) was performed in 32 eyes. Clinical and MRI, visual field, P-VEP、FFA features of the patients were retrospectively analyzed. ResultsThere were 31 males and 18 females among the 49 patients. All cases were monocular. Age was (59.3±7.8) years. All of them complained of painless visual acuity loss or occlusion sensation in one eye. There were 12 (24.5%, 12/49) and 37 (75.6%, 37/49) cases with disease duration ＞2 months and ≤2 months, respectively. In 49 eyes, misdiagnosed as optic neuritis, normal tension glaucoma (NTG) or suspected glaucoma, optic disc vasculitis, cataract, diabetic retinopathy, traumatic optic neuropathy and toxic optic neuropathy were 28 (57.1%, 28/49), 11 (22.4%, 11/49), 5 (10.2%, 5/49), 2 (4.1%, 2/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49) eyes. 24 (49.0%, 24/49), 16 (32.7%, 16/49) and 9 (18.4%, 9/49) eyes had BCVA＜0.1, 0.1-0.5 and＞0.5, respectively. RAPD was positive in 45 eyes (91.8%, 45/49). There were 37 (75.6%, 37/49) and 12 (24.5%, 12/49) eyes with and without optic disc edema, respectively. Bleeding was observed on and around the optic disc in 15 eyes (30.6%, 15/49). MRI examination showed no obvious abnormality in the optic nerve segments of all affected eyes. OCT showed an increase in retinal nerve fiber layer thickness (307.1±62.1) μm in 37 patients with optic disc edema. The visual field examination showed that 24 eyes (49.0%, 24/49) had typical lower visual field defect connected with the physiological blind spot and circumvented the central fixation point, 6 eyes (12.2%, 6/49) had limited visual field defect connected with the physiological blind spot, and 19 eyes (38.8%, 19/49) had diffuse visual field defect. By P-VEP examination, the amplitude of P100 wave decreased moderately to severely in all affected eyes. There were 24 eyes (49.0%, 24/49) with mild peak delay and 11 eyes (22.4%, 11/49) with moderate peak delay. In 32 eyes examined by FFA, the arteries had early peridisk limitation or diffuse delayed filling, and mid-course fluorescein leakage in the corresponding area. ConclusionsThe main symptoms of NAION patients are painless visual acuity loss in one eye or occlusion of vision. The main clinical features of NAION patients are visual field defect, retinal nerve fiber layer thickening and visual electrophysiological abnormalities. NAION patients with acute or subacute visual loss accompanied by optic disc edema and/or bleeding are often misdiagnosed as optic neuritis, optic neurovasculitis and other types of optic neuropathy. NAION patients with a disease course of ＞2 months are easily misdiagnosed as NTG.
Objective To investigate the neuroprotective effect of epigallocatechingallate (EGCG), the major catechin found in green tea, in an optic nerve crush (ONC) rat model.Methods Seventytwo Wistar rats were divided randomly into four groups: normal control, shamoperation+EGCG, ONC+vehicle, and ONC+EGCG groups. Animals were treated intraperitoneally and orally with either vehicle (normal saline) or EGCG (25 mg/kg, injected daily for up to five days, and orally 2 mg/kg daily afterwards). Two days after the first injection, an ONC injury using a micro optic nerve clipper was performed at approximately 2 mm from the optic nerve head for 60 seconds. Fluorogold was injected into bilateral superior colliculi five days before sacrifice and fluorescent gold labeled retinal ganglion cells (RGC) were counted under fluorescence microscopy on days seven, 14 and 28 after optic nerve crush. Meanwhile, the expression of neurofilament triplet L (NF-L) was measured by immunohistochemistry and Western blotting.Results In the ONC+vehicle group, a progressive loss of RGC was observed; however, compared with the ONC+vehicle group, RGC density was significantly higher on day seven (t=3.216, P=0.009), day 14(t=2.609, P=0.026) and day 28 (t=2.792, P=0.019) , and a significant increase of the NF-L protein expression has been observed on days seven, 14 and 28 after optic nerve crush in the ONC+EGCG group. Conclusions EGCG has a protective effect to the bodies and axons of the RGC after optic nerve crush.
E-health is regarded as a strategic tool to achieve a human-oriented integrated service model. This study introduced the e-health framework of the World Health Organization, and conducted a comparative study of the different e-health development characteristics in the United Kingdom, United States, Australia, Canada and other countries. Based on the results, we analyzed the practical problems in e-health development in China, and suggested possible policy approaches for strategies of e-health development to support the policy of e-health development in China.
ObjectiveTo observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION).MethodsA prospective clinical study. From December 2017 to June 2020, 40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination of optic disc; 35 eyes (BCVA≥0.1) underwent visual field examination at the same time. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation (MD) value. The thickness of peripapillary retinal nerve fire layer (pRNFL) around the optic disc of the affected eye was measured with an OCT instrument. According to the wishes of patients, they were divided into hormone treatment group and control group. All were given vitamin B1 and methylcobalamin orally; the hormone treatment group was given oral prednisone acetate treatment, 60 mg/d (regardless of body weight); after 2 weeks, the dose was reduced by 5 mg every 5 days, and the dose was reduced to 40 mg and maintained until optic disc edema subsides; thereafter, the dose was quickly reduced until the drug was stopped. Three and 6 months after treatment, the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA, MD, and pRNFL. The thickness of BCVA, MD, and pRNFL between the two groups was compared by Mann-Whitney U test. The thickness of BCVA, MD, and pRNFL before and after treatment within the group was compared by rank analysis of variance. ResultsAmong 40 eyes of 40 cases, 21 eyes were in the hormone treatment group, and 19 eyes were in the control group. There were differences in age, sex composition, course of disease, associated systemic risk factors, BCVA, MD, and pRNFL thickness between the two groups. There was no statistical significance (P＞0.05). At 3 and 6 months after treatment, the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32, 0.26±0.34, 0.28±0.30, 0.25±0.32, respectively. The visual field MD were －15.52±6.87, －15.55±6.04 dB and －14.82±7.48, －15.18±6.40 dB; pRNFL thickness was 70.38±10.22, 73.79±11.82 μm and 65.67±10.07, 69.26±10.85 μm. LogMAR BCVA (Z=－0.014, －0.315; P=1.000, 0.768), visual field MD (Z=－0.041, －0.068; P=0.979, 0.957), pRNFL thickness (Z= －0.965, －1.112; P=0.347, 0.270), the difference was not statistically significant. ConclusionCompared with the control group, oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.
ObjectiveTo investigate the changes in the nerve fiber layer of the cornea in patients with demyelinating optic neuritis (DON) and its correlation with visual acuity. MethodsA cross-sectional study. From March 2021 to July 2022, 27 cases (39 eyes) of DON patients diagnosed in the Department of Neurology and Ophthalmology of Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled in this study. According to the serological test results, the patients were divided into aquaporin 4 antibody associated optic neuritis (AQP4-ON group) and myelin oligodendrocyte glycoprotein antibody associated optic neuritis (MOG-ON group), with 15 cases (19 eyes) and 12 cases (20 eyes) respectively. According to previous history of glucocorticoid treatment, the patients were divided into glucocorticoid treated group and non-glucocorticoid treated group, with 17 cases (27 eyes) and 10 cases (12 eyes) respectively. Twenty healthy volunteers (20 eyes) with age- and gender-matched were selected as the control group. All eyes underwent best corrected visual acuity (BCVA) and in vivo confocal microscopy (IVCM) examinations. BCVA was performed using Snellen's standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle resolution (logMAR) visual acuity during statistics. The corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve fiber branch length (CNBL), corneal nerve fiber branch density (CNBD) and the density of corneal dendritic cells (DC) were detected by IVCM examination. Parameter comparison between groups by t-test and Kruskal-Wallis rank sum test. The correlation between logMAR BCVA and pamameters of corneal nerve fibers were analyzed using Spearman analysis. ResultsThe CNFL, CNFD, and CNBL of the DON group and the control group were (10.67±2.55) mm/mm2, (57.78±12.35) root/mm2, (3.27±1.34) mm/mm2, and (13.74±3.05) mm/mm2, (70.95±13.14) root/mm2, and (4.22±1.03) mm/mm2, respectively; the difference in CNFL, CNFD, and CNBL between the two groups were statistically significant (t=4.089, 3.795, 2.773; P＜0.05). The CNFL, CNBL, and CNBD of the affected eyes in the MOG-ON group and AQP4-ON group were (12.02±2.13) mm/mm2, (3.80±1.19) mm/mm2, (47.97±8.86) fibers/mm2, and (9.25±2.19) mm/mm2, (2.72±1.19) mm/mm2, (39.43±13.86) fibers/mm2, respectively; the differences in CNFL, CNBL, and CNBD between the two groups were statistically significant (t=－4.002, －2.706, －2.306; P＜0.05). The corneal DC density of the patients in the hormone treated group and the non-hormone treated group was (24.43±8.32) and (41.22±9.86) cells/mm2, respectively. The difference in corneal DC density between the two subgroups was statistically significant (P＜0.001). Correlation analysis showed that there was a significant negative correlation between logMAR BCVA and CNBL and CNFL in patients with DON (r=－0.422, －0.456; P＜0.05). ConclusionsThere are different degrees of corneal nerve fiber damage in patients with different types of DON. There was a negative correlation between BCVA and the length of corneal nerve fibers.