Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ObjectiveTo observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole, and analyze the influencing factors.MethodsA retrospective study. From August 2016 to June 2018, 302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study. There were 130 males and 172 females, with the mean age of 63.36±6.91 years. There were 158 left eyes and 144 right eyes. The logMAR BCVA was 1.13±0.45. The minimum diameter (422.92±211.73 μm) and basal diameter (835.47±366.42 μm) of macular hole and choroid thickness under fovea (244.84±60.68 μm) were measured by OCT. According to the minimum diameter, the holes were divided into small hole group (≤250 μm), middle hole group (＞250 μm and ≤400 μm) and large hole group (＞400 μm). The logMAR BCVA at 1, 3 and 6 months after surgery in 3 groups were observed. Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups. The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery.ResultsOne month after surgery, all the holes were closed. One, 3 and 6 months after surgery, the logMAR BCVA were 0.33±0.25, 0.23±0.18, 0.16±0.17 in the small hole group; the logMAR BCVA were 0.46±0.25, 0.35±0.26, 0.27±0.28 in the middle hole group; the logMAR BCVA were 0.81±0.51, 0.61±0.48, 0.53±0.37 in the large hole group. Through repeated measurement variance analysis of two factors, it was found that there was an interaction between different groups and different time nodes (F=23.133, P＜0.01). All data were segmented and one-way repeated measure ANOVA was performed. The results showed that there was a statistically significant difference in visual acuity between the small hole group and the middle hole group among preoperative and 1 month after surgery (P＜0.05), while there was no statistically significant difference in visual acuity between 1, 3 and 6 months after surgery (P＞0.05). In the large hole group, among preoperative, 1 months after surgery, 3 months after surgery, the visual acuity difference was statistically significant (P＜0.05), while the visual acuity difference between 3 months after surgery and 6 months after surgery was not statistically significant (P＞0.05). The results of GEE analysis showed that hole size (χ2=4.17, P=0.04), basal diameter (χ2=7.25, P=0.01), disease course (χ2=19.26, P=0.00), and choroid thickness (χ2=4.19, P=0.04) were the influencing factors of postoperative visual acuity.ConclusionsAfter vitrectomy of macular holes of different sizes, the visual recovery trend is different. The visual recovery of small holes and middle holes is faster and basically restored at 1 month. The large holes requires a slow recovery process and stabilizes vision at 3 months. Hole size, basal diameter, course of disease and choroid thickness are the influencing factors of visual acuity recovery.
Objective To investigate the prevalence and related factors of diabetic retinopathy (DR) among residents with type 2 diabetes mellitus (T2DM) in Culai Town of Tai'an City in Shandong Province. Methods According to the DM management file database for community, 785 patients with T2DM were randomly selected by cluster sampling method. The questionnaires, routine general examinations, visual and fundus-free fluoroscopy were performed on all the patients. DR diagnosis and classification was according to the guidelines for clinical diagnosis and treatment of DR in China (2014). Both monocular and binocular DR were selected as DR patients, and the worse eye for binocular DR were treated as the DR classification of the patient. The patients were grouped by presence or absence of DR. GraphPad Prism 6, SigmaPlot 12.5, SPSS 20.0 and Excel were used to achieve data analysis. Also, SPSS 20.0 was used for multi-factor logistic regression analysis. Results A total of 699 patients (89.04%) were actually recorded. There were 122 eyes of 63 patients (9.01%) with DR (DR group), 1272 eyes of 636 patients (90.99%) without DR (NDR group). Among the 122 eyes of DR, there were 19 (15.57%), 17 (13.93%), 70 (57.38%), 10 (8.20%), 6 (4.92%) eyes in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, respectively. The differences of mean age (t=15 290, P=0.002), DM duration (t=9075, P＜0.000) and diastolic blood pressure (t=15 810, P=0.006) between the two groups were statistically significant. There were 23 (36.51%) and 394 (61.95%) patients with hypertension history in the DR group and the NDR group, with the significant difference ( χ2=15.42, OR=0.35, 95%CI 0.21-0.60). There were 57 (90.48%) and 500 (78.62%) patients with fasting blood glucose larger than 6.11 mmol/L in the DR group and the NDR group, with the significant difference (OR=2.51, 95%CI 1.06-5.95, P=0.031). Logistic regression analysis showed that the age, fasting blood glucose and DM duration were influencing factors for DR (OR=1.039, 0.864, 0.898; P=0.021, ＜0.000, ＜0.000). Conclusion The prevalence of DR in patients with T2DM in Culai Town of Tai'an City is 9.01%. Age, DM duration, fasting blood glucose are associated to DR. Those with a history of hypertension may have a lower risk of DR than those without a history of hypertension.
ObjectiveTo explore the application and effect of root cause analysis (RCA) in the management of adverse nursing events. MethodsNursing staff members were trained to establish the team of root cause analysis. They collected related materials of adverse nursing events in the infusion room of the Department of Pediatrics, found out the proximal causes and root causes, developed and implemented the corrective measures. RCA was carried out between January 2013 and December 2014. The efficacy was evaluated and the adverse events rate was compared before and after the practice. ResultsAfter the performance of RCA, the reporting rate of adverse events increased, the rate of adverse events decreased, and the reporting rate of potential safety problems also increased. All those changes were significant (P<0.01). ConclusionRoot cause analysis can decrease the rate of adverse nursing events, raise the reporting rate of adverse events. It is an effective guarantee to improve the nursing safety management.
ObjectiveIn order to provide guidance for early interference of diabetic retinopathy (DR) in patients with diabetes mellitus (DM), we surveyed the prevalence and analysis the related factors of DR in Shanghai Songnan community. MethodsBased on an established resident health database, an epidemiology study was performed on the residents with DM in Shanghai Songnan community.1177 patients completed questionnaire survey, and received physical examination and laboratory tests. The diagnosis and grading of DR were established based on the ocular fundus images acquired by digital non-mydriasis fundus camera. Patients with incomplete questionnaires were excluded. ResultsThere were 1120 DM patients with valid questionnaires. DR was found in 264 (23.57%) patients. The prevalence of mild, moderate, severe non-proliferative DR and proliferative DR was 17.05%, 5.09%, 1.16% and 0.27% respectively. There was significant differences in age, disease course, systolic blood pressure, insulin usage between the DR group and NDR group(t=-2.647, 2.688, 2.204, 2.291;χ2=12.527;P=0.008, 0.007, 0.028, 0.022, 0.000). There was significant differences in fasting blood-glucose and insulin usage between the mild, the moderate and the severe DR group(t=21.964, χ2=14.996;P=0.000, 0.001). Stepwise logistic analysis identified that age, DM course, and insulin usage were the related factors of DR (OR=0.769, 1.239, 1.100, 1.071, 1.682;P=0.001, 0.043, 0.176, 0.097, 0.005). ConclusionThe age, DM course, and insulin usage were the related factors of DR. The high prevalence of DR indicated the importance of the management of diabetic patients.
Objective To analyze the death cause of residents in Zigong from 1985 to 2009, so as to provide the government with scientific information of health strategies, and disease prevention and control. Methods The death surveillance data in Zigong residents from 1985 to 2009 were collected, and the indexes such as all death mortality rate, infant mortality rate, maternal mortality rate, disease-specific mortality rate, age-specific mortality rate, and life expectancy were analyzed. Results The all death mortality rate had fluctuation of plus or minus 6‰, and the male mortality rate was higher than the female (χ2=8 059.769, P=0.000). The six main influencing factors of the death of Zigong residents were as follows: respiratory system diseases, circulatory system diseases, tumour, injury and poisoning regarded as external cause diseases, digestive system diseases, and infectious diseases and parasitic diseases. The mortality rates of different districts were statistically different (χ2=1 643.926, P=0.000), and Fushun County was the highest among them after standardization. The curve of mortality rate in different sex and age groups was changed alike letter “U”. The mortality rate was ascending with the age in the group of over 15 years old, the ascending trend was more evident especially after 50 years old. The infant mortality declined steadily and was well controlled. The maternal mortality declined obviously. The average life expectancy for the whole city was 74.72, which showed an ascending trend. Conclusion The chronic diseases are the main death cause of residents in Zigong. The prevention and controlling of acute infectious diseases and parasitic diseases should be persistently performed for declining both incidence rate and mortality rate. The Zigong city is gradually stepping into aging society, which requires the great development of senior work.
ObjectiveTo observe and preliminary investigate the influencing factors of exudative retinal detachment in patients with severe preeclampsia (S-PE) and its influence on pregnancy outcome.MethodsA total of 89 patients of S-PE patients diagnosed in Department of Obstetrics in The Third Central Hospital of Tianjin from July 2018 to June 2020 were included in this study. According to whether the patients were complicated with exudative retinal detachment, they were divided into retinal detachment group (43 cases) and non retinal detachment group (46 cases). All patients underwent direct ophthalmoscopy, and those with suspected or definite retinal detachment underwent optical coherence tomography or B-mode ultrasonography. The age, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, laboratory serum albumin level, 24 h urinary protein, platelet count, mean platelet volume, platelet distribution width and serum uric acid content were collected. The average age (t=−1.01), body mass index (t=−1.799), course of disease (t=−1.657) and constituent ratio of primipara and multipara in the two groups were compared (χ2=1.411), the difference was not statistically significant (P＞0.05). The end of pregnancy time, systemic complications, fetal outcomes and neonatal Apgar scores were analyzed, retrospectively. Independent sample t test was used to compare the quantitative data between the two groups; Chi square test was used to compare qualitative data. Binary logistic regression analysis to screen the influencing factors of exudative retinal detachment in S-PE.ResultsSystolic blood pressure and diastolic blood pressure were higher in the retinal detachment group than in the non retinal detachment group, and the difference was statistically significant (t=2.087, 2.810; P=0.040, 0.006). Serum albumin (t=−10.404), 24-hour urinary protein quantification (t=6.401), blood uric acid (t=3.910), platelet count (t=−6.124) and platelet distribution width (t=2.992) were compared between the two groups, and the differences were statistically significant (P＜0.05). There were 30 (69.77%, 30/43) cases in retinal detachment group and 14 (30.43%, 14/46) cases in non retinal detachment group with severe systemic complications; The average time of ending pregnancy was 34.66±3.29 and 38.25±1.62 weeks; The average Apgar scores at birth were 7.28±3.40 and 9.46±1.59. The incidence of severe systemic complications in two groups (χ2=13.755), the end of pregnancy time (t=−6.448), Apgar score at birth (t=−3.824), the differences were statistically significant (P=0.000、0.000、0.000). Fetal distress and death were 8 (18.60%, 8/43), 7 (16.28%, 7/43) and 7 (15.22%, 7/46), 1 (2.17%, 1/46) in retinal detachment group and non retinal detachment group respectively. There was no significant difference in the incidence of fetal distress between the two groups (χ2=0.182, P=0.670). The difference of fetal mortality was statistically significant (P= 0.027). Logistic regression analysis showed that serum albumin and uric acid were associated with exudative retinal detachment in patients with S-PE (P＜0.05).ConclusionsSerum albumin and uric acid are the influencing factors of exudative retinal detachment in patients with S-PE. Patients with exudative retinal detachment are prone to adverse pregnancy outcomes.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
ObjectiveTo investigate the related factors of the retina1 hemorrhage in newborns. Methods9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCamⅢat 0-4 days after born. According to the literature, retinal hemorrhage was classified into degreeⅠ, ⅡandⅢ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intracranial hemorrhage, maternal age, first-time mom, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy-induced hypertension, gestational diabetes, oxytocin, prenatal body mass index (BMI). Multivariate logistic regression analysis was used. ResultsIn 9558 cases of newborns, retinal hemorrhages were found in 2753 infants (28.8%), including 1137 degreeⅠ(41.3%), 895 degreeⅡ(32.5%) and 721 degreeⅢ(26.2%). Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage (r=0.146, 5.841, 1.847, 0.071, 0.246, 0.965;P < 0.05). The degree of fundus hemorrhage was not related to birth weight and BMI (P > 0.05). ConclusionsThe neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.
Objective To observe the emulsification of silicone oil in eyes with rhegmatogenous retinal detachment (RRD) after silicone oil filling surgery, and to preliminarily analyze the possible clinical factors related to it. MethodsA cross-sectional clinical study. From January 2019 to April 2022, 50 eyes of 50 patients with RRD who underwent pans plana vitrectomy (PPV) combined with silicone oil filling surgery in Eye and ENT Hospital of Fudan University were included in the study. Among them, there were 25 males with 25 eyes and 25 females with 25 eyes; the age was 54.86±11.79 years old. The retina was in place 3 months after surgery. Before silicone oil removal surgery, intraocular pressure ＞21 mm Hg (1 mm Hg=0.133 kPa) or treated with≥1 anti-glaucoma drug (high intraocular pressure) in 20 eyes; intraocular pressure ≤21 mm Hg and no anti-glaucoma drug treatment in 30 eyes (normal intraocular pressure). During follow-up after surgery, silicone oil emulsification was found and those who met the indications for silicone oil removal were subjected to silicone oil removal surgery. The first 2 ml of lavage fluid was collected immediately after removal of the silicone oil, and the particle diameter and number of emulsified silicone oil were measured using a Multisizer® 3 particle/cell counter and particle size analyzer. The measuring range was 0.4-12.0 μm, and the diameter is accordingly divided into 0.4-＜1.0, 1.0-＜3.0, 3.0-＜5.0, 5.0-＜7.0, 7.0-12.0 μm. Each sample was measured 3 times and the average value was taken. Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation between the number of emulsified silicone oil particles and clinical factors. ResultsThe number of emulsified silicone oil particles was (1.74±2.94)×107/ml (0.96×107-14.11×107/ml), of which the diameter of 0.4-＜1.0 μm emulsified silicone oil particle was (1.25±2.41)×107/ml, accounted for (64.26±12.70)% [(1.25±2.41)×107/(1.74±2.94)×107]. The results of correlation analysis showed that there was no correlation between the total particle number of emulsified silicone oil and various clinical factors (P＞0.05). The number of emulsified silicone oil particles with a diameter of 7.0-12.0 μm was negatively correlated with age (r=－0.298, P=0.036), and positively correlated with axial length (r=0.325, P=0.021). There was no correlation between the previous ocular trauma, choroidal detachment and different lens states and the number of emulsified silicone oil particles (P＞0.05). Multiple linear regression analysis showed that eye axis (β=1 570.868, P=0.023) and age (β=－316.128, P=0.039) were the risk predictors of silicone oil emulsification into large diameter particles (7-＜12 μm). The number of emulsified silicone oil particles with a diameter of 7-12 μmin the patients with high intraocular pressure was significantly higher than that in the patients with normal intraocular pressure, and the difference was statistically significant (U=195.00, P=0.037). ConclusionsMost of the emulsified silicone oil particles in the eyes of RRD patients after silicone oil filling surgery are small-diameter particles; the silicone oil emulsification is more serious in young patients and patients with long ocular axis, and young patients are more prone to high intraocular pressure.