Critical guiding role of OCT angiography in long-term treatment and follow-up of neovascular AMD / 中华实验眼科杂志

The pathogenesis of neovascular age-related macular degeneration (nAMD) is complex and macular neovascularization (MNV), a key pathogenic factor in nAMD, is prone to recurrence.Vitreous injection of anti-VEGF drugs is the main therapy of nAMD.In recent years, a lot of progress has been made in fundus imaging techniques and optical coherence tomography angiography (OCTA) with non-invasive, rapid, stratified and high-definition functions has shown strong advantages in diagnosis, differential diagnosis, disease dynamic monitoring and follow-up of nAMD.Clinicians have had a certain understanding of the important role of OCTA in the diagnosis of nAMD and other diseases, and its clinical application value has been recognized gradually.However, its application value in follow-up of patients with nAMD and polypoid choroidal vasculopathy (PCV) is still not well understood.By reviewing a large number of recent relevant literature on OCTA, and combining the clinical practice of our research team in monitoring the course of AMD and PCV disease by OCTA, we have gained new knowledge and understanding of the pathological mechanism of AMD and PCV.In this paper, we elucidated the latest understanding of the diagnostic value of OCTA in AMD based on long-term series of OCTA studies, the new findings of OCTA in AMD management of our team, as well as its impact on ophthalmology clinical practice.Then we forecasted the role of OCTA in the prediction of recurrence and anti-VEGF treatment response, as well as the clinical value of OCTA in the optimization of nAMD treatment and follow-up plan.It is recommended that clinicians pay more attention to the clinical value and guiding role of OCTA in long-term treatment monitoring and follow-up of AMD.

A simple predictive factor for mortality in fontan surgery: serum hypo-osmolality

Abstract Objective: Close follow-up is important after the Fontan procedure, which is a palliative surgical method for a single ventricle. In this period, serum osmolality is an important parameter with the advantages of easy to obtain and poor outcome prediction. Methods: Patients who had undergone Fontan operation between May 2011 and February 2017 were retrospectively evaluated. Patients were divided into three groups based on their serum osmolality values: hypoosmolar (Group 1), isosmolar (Group 2), and hyperosmolar (Group 3). Demographics, clinical information and postoperative data of the groups were compared. Results: Forty-three patients had undergone extracardiac Fontan operation in the study period. There were 8, 19 and 16 patients in Groups 1, 2 and 3, respectively. Among the three groups, postoperative intubation and length of hospital stay, prolonged pleural effusion, need for inotropic support and mortality were statistically significantly higher in Group 1. Conclusion: After the Fontan procedure, one of the determinants of cardiac output might be affected by serum osmolality. Decreased serum osmolality might be associated with poor prognosis after Fontan procedure. Serum osmolality monitoring may be beneficial to improve postoperative outcomes in these patients.

Quantitative analysis of biochemical components in the suprachoroidal space fluid of choriodal detachment associated with rhegmatogenous retinal detachment / 中华眼底病杂志

Objective To investigate the nature of the suprachoroidal fluid by detecting the concentration of total protein (TP), lactate dehydrogenase (LDH), albumin (ALB), total cholesterol (CHOL), total bilirubin (TBIL) in suprachoroidal liquid of patients who have rhegmatogenous retinal detachment with choroid detachment (RRDCD). Methods Eighteen RRDCD patients (18 eyes) who underwent vitrectomy were enrolled in this study. There were 10 males (10 eyes) and 8 females (8 eyes), 8 right eyes and 10 left eyes. There were 8 patients with age of ≤55 years, 10 patients with age of >55 years. There were 7 patients with duration of≤30 days, 11 patients with duration of >30 days. There were 7 eyes with diopters of ≥-6.0 D, 11 eyes with diopters of <-6.0 D. There were 11 eyes with class C proliferative vitreoretinopathy (PVR), 7 eyes with class D PVR. Suprachoroidal fluid samples were collected from all the patients, and took preoperative serum samples as RRDCD group. Ten serum samples of normal people were set as control group. The concentration of TP, LDH, ALB, CHOL, TBIL in all the subjects were measured. The properties of the suprachoroidal fluid were identified by Light standard and concentration standard of ALB, CHOL, TBIL. Results There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from suprachoroidal fluid samples in the patients with different age, sex, eyes, diopter, PVR grade (P>0.05). There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from preoperative serum samples in the patients between RRDCD group and control group (P>0.05). There was no difference on the concentration of ALB and CHOL from suprachoroidal fluid samples and preoperative serum samples in the RRDCD patients (P>0.05), but there were significant differences on the concentration of TP, LDH, TBIL (P<0.05). According to the Light standard, there were 17 cases of exudates and 1 case of transudate. According to the concentration standard of ALB, CHOL and TBIL, there were 14, 18, and 16 cases of exudates, and 4, 0, and 2 cases of transudate, respectively. There was no difference on the identification result of Light standard and concentration standard of ALB, CHOL, TBIL (χ2=2.090, 1.029, 0.364;P>0.05). Conclusion The suprachoroidal fluid of RRDCD patients composed of TP, LDH, CHOL and TBIL. The suprachoroidal fluid is more likely to be exudate.

Quantitative analysis of biochemical components in the suprachoroidal space fluid of choriodal detachment associated with rhegmatogenous retinal detachment / 中华眼底病杂志

Objective To investigate the nature of the suprachoroidal fluid by detecting the concentration of total protein (TP), lactate dehydrogenase (LDH), albumin (ALB), total cholesterol (CHOL), total bilirubin (TBIL) in suprachoroidal liquid of patients who have rhegmatogenous retinal detachment with choroid detachment (RRDCD). Methods Eighteen RRDCD patients (18 eyes) who underwent vitrectomy were enrolled in this study. There were 10 males (10 eyes) and 8 females (8 eyes), 8 right eyes and 10 left eyes. There were 8 patients with age of ≤55 years, 10 patients with age of >55 years. There were 7 patients with duration of≤30 days, 11 patients with duration of >30 days. There were 7 eyes with diopters of ≥-6.0 D, 11 eyes with diopters of <-6.0 D. There were 11 eyes with class C proliferative vitreoretinopathy (PVR), 7 eyes with class D PVR. Suprachoroidal fluid samples were collected from all the patients, and took preoperative serum samples as RRDCD group. Ten serum samples of normal people were set as control group. The concentration of TP, LDH, ALB, CHOL, TBIL in all the subjects were measured. The properties of the suprachoroidal fluid were identified by Light standard and concentration standard of ALB, CHOL, TBIL. Results There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from suprachoroidal fluid samples in the patients with different age, sex, eyes, diopter, PVR grade (P>0.05). There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from preoperative serum samples in the patients between RRDCD group and control group (P>0.05). There was no difference on the concentration of ALB and CHOL from suprachoroidal fluid samples and preoperative serum samples in the RRDCD patients (P>0.05), but there were significant differences on the concentration of TP, LDH, TBIL (P<0.05). According to the Light standard, there were 17 cases of exudates and 1 case of transudate. According to the concentration standard of ALB, CHOL and TBIL, there were 14, 18, and 16 cases of exudates, and 4, 0, and 2 cases of transudate, respectively. There was no difference on the identification result of Light standard and concentration standard of ALB, CHOL, TBIL (χ2=2.090, 1.029, 0.364;P>0.05). Conclusion The suprachoroidal fluid of RRDCD patients composed of TP, LDH, CHOL and TBIL. The suprachoroidal fluid is more likely to be exudate.

Associação entre odor, exsudato e isolamento social em pacientes com feridas neoplásicas: um estudo transversal / Association between odor, exudate and social isolation in patients with neoplastic wounds: a cross-sectional study

A ferida neoplásica acomete cerca de 5% a 10% dos pacientes com câncer em cuidados paliativos. O foco central do cuidado dessas feridas é o controle dos sintomas, em que o odor está presente em 10,4% e o exsudato em 14,6% dos casos, sendo responsáveis pelo impacto no aspecto psicossocial do paciente. O estudo teve como objetivo de avaliar as associações entre odor, exsudato e isolamento social em pacientes com feridas neoplásicas. Trata-se de uma pesquisa quantitativa do tipo transversal prospectivo realizado com os pacientes com feridas neoplásicas no Ambulatório de cuidados paliativos do Núcleo de Atenção Oncológica do Hospital Universitário Antônio Pedro, aprovada pelo Comitê de Ética do HUAP c/nº: 183.757. A coleta de dados foi realizada durante a consulta de enfermagem pela da aplicação das escalas de odor, exsudação (Push) e escala de Likert de três dimensões para avaliação dos aspectos sociais do paciente, bem como dados contidos em prontuário para caracterização da clientela. Para a análise estatística aplicou-se o teste de normalidade Shapiro wilk, verificando que a amostra não é paramétrica (p valor ≤ 0,05) para as variáveis: tamanho da lesão, ferida total, odor total e exsudato total (escala likert) e paramétrica (p valor > 0,05) para a variável idade. Os dados foram apresentados em forma de mediana e intervalo interquartil (x̃± Q3-Q1) para análises das variáveis não paramétricas; média e desvio padrão (x̅ ± D. P) para variável paramétrica. Realizou-se o teste de Kruskal Wallis para verificação de associação multivariada entre os dados clínicos e da escala e o teste de Spearman para verificar se o grau do odor, quantidade de exsudato, tamanho e localização da lesão apresentam correlação com a interferência da socialização do paciente. A confiabilidade da ISPOE foi medida pelo coeficiente Alfa de Cronbach. Constatou-se, então a correlação entre o grau de odor e as perguntas 1 e 5 da escala da dimensão odor. Assim, o odor interfere no constrangimento (p; 0,0053) e frequentar locais públicos (p; 0,0495). A quantidade de exsudato apresentou correlação com a primeira questão da escala da dimensão exsudato, interferindo no constrangimento (p; 0,0453). A variável tipo de ferida apresentou correlação com as questões 3 e 5, logo, interferindo na relação com a família e em frequentar locais públicos, fatores esses que favorecem o isolamento social em pacientes com feridas neoplásicas As variáveis: tamanho da lesão e local da lesão não apresentaram correlação significativa com as questões da escala na dimensão ferida. As três dimensões da escala apresentaram consistência interna satisfatória com alfa: 0,82 (dimensão ferida); 0,94 (dimensão exsudato) e 0,88 (dimensão odor). Com isso, o odor e o exsudato interferem negativamente fatores sociais e psicológicos que podem favorecer, diretamente, o isolamento social. Além do conhecimento sobre as particularidades dessas lesões e dos produtos adequados ao cuidados, é fulcral que o profissional de enfermagem conheça os principais queixas relacionadas à lesão e o impacto que causam ao cotidiano do paciente. Conhecer esse conflito social e psicológico fará toda a diferença no cuidado de enfermagem, pois, dessa forma, poderá atuar de maneira assertiva e holística no cuidado no cotidiano do paciente, enxergando-o para além dos sintomas: seus anseios psicológicos e sociais. A constatação da associação entre as variáveis poderá auxiliar a avaliação dos aspectos que podem interferir na qualidade de vida e no cuidado prestado aos pacientes com feridas neoplásicas

Neoplastic wound affects about 5% to 10% of cancer patients in palliative care. The central focus of the care of these wounds is to control the symptoms, where the odor is present in 10.4% and exudate in 14.6% of cases, being responsible for the impact on the psychosocial aspect of the patient. The study aimed to evaluate the association between odor, exudate and social isolation in patients with neoplastic wounds. This is a quantitative study of the kind prospective cross-sectional with patients with neoplastic wounds in outpatient palliative care in Oncology Attention Core of University Hospital Antonio Pedro, approved by HUAP Ethics Committee c / No: 183757. Data collection was performed during the nursing consultation by the application of odor scales, exudation (Push) and Likert scale of three dimensions to assess the social aspects of the patient, as well as data contained in records for population. The statistical analysis was applied to the normality test Shapiro Wilk, verifying that the sample is not parametric (p value ≤ 0.05) for the variables: size of the lesion, the total wound, the total odor and overall exudate (Likert scale) and parametric (p value> 0.05) for the age variable. Data were presented as median and interquartile range ((x) ± Q3-Q1) for analysis of nonparametric variables; mean and standard deviation (x ̅ ± S.P) for parametric variable. He held the Kruskal Wallis test for multivariate association check between clinical data and scale and the Spearman test to see if the odor degree, amount of exudate, size and location of the lesion correlate with the interference of socialization patient. The reliability of ISPOE was measured by Cronbach alpha coefficient. It was found, then the correlation between the degree of odor and the questions 1 to 5 scale of the odor scale. Thus, the odor interferes with the constraint (p, 0.0053) and attend public places (p; 0.0495). The amount of exudate correlated with the first issue of exudate size scale, interfering with embarrassment (p; 0.0453). The variable type of injury correlated with the issues 3:05, so interfering with the relationship with the family and attend public places, factors that favor social isolation in patients with neoplastic Variables wounds: lesion size and location of injury no significant correlation with the range of issues in the wound size. The three dimensions of the scale showed satisfactory internal consistency with alpha: 0.82 (wound size); 0.94 (exudate dimension) and 0.88 (size odor). Thus, the odor and exudate negatively affect social and psychological factors that may contribute, directly, social isolation. In addition to the knowledge about the characteristics of these injuries and products suitable for care, it is crucial that nursing professionals know the main complaints related to the injury and the impact they cause to the daily life of the patient. Knowing that social and psychological conflict will make all the difference in nursing care, because thus may act assertively and holistic care in the patient's daily life, seeing it beyond the symptoms: their psychological and social aspirations. The finding of association between variables may assist the evaluation of aspects that can interfere with quality of life and care provided to patients with neoplastic wounds

A comparison study on the detection of anti-human immunodeficiency virus type 1 (HTV-1) antibodies in different populations with a new rapid test using oral mucosal transudate samples versus enzyme linked immunosorbent assay (ELISA) using serum samples / 中华皮肤科杂志

Objective To evaluate the consistence in the detection of antibodies against HIV-1 between a new rapid test using oral mucosal transudate (OMT) samples and ELISA using serum samples. Methods Two-hundred patients who were positive for anti-HIV-1 antibodies by serum ELISA and confirmed by Western blot to be infected with HIV, and 600 healthy human controls negative for anti-HIV-1 antibodies by serum ELISA, were eligible for this study. OMT samples were collected from these subjects and subjected to a rapid test for anti-HIV-1 antibodies. The factors influencing the performance of the rapid test were analyzed. Results Of the 200 OMT specimens from HIV-infected patients, 198 showed positive reaction, 2 showed negative reaction. Among the 198 positive reactions, 192 (96%) were "clear" and easy to make decisions, 4 (2%) were "faint", 2(1%) were "very faint" and required professionals to make decisions. The rapid test was negative in all the 600 OMT specimens from the control group. Conclusions The consistence in the detection of anti-HIV-1 antibodies between the OMT rapid test and serum ELISA was 99% in HIV-positive specimens, 100% in HIV-negative specimens, and 99.75% in all the specimens.

The use of spectral CT imaging in characterization of pleural fluid: a new method to differentiate transudates from exudates / 中华放射学杂志

Objective To assess the feasibility of characterizing pleural fluid on the basis of spectral imaging features utilizing spectral CT imaging. Methods Gemstone spectral imaging(GSI) was used to examine 20 pleural fluids filled tubes (11 exudates and 9 transudates ) following diagnostic thoracentesis. Effusions were classified as transudates or exudates using laboratory markers based on Light criteria. CT values on 140 kVp QC image were compared between two groups. Using GSI viewer, various CT spectral imaging parameters (CT values on different energy level, effective-Z, iodine-water concentration,calcium-water concentration and calcium-fat concentration ) were calculated and compared between two groups. The difference of these spectral characteristic parameters was evaluated statistically by independent-samples t test. Results According to Light criteria, the mean CT value on QC image of exudates [ ( 19. 56 ±4. 10) HU ] was higher than that of transudates [ ( 13.44 ±3.46) HU] (t =3.002,P =0. 010).Difference of CT value was found more obvious in the lower keV. On 40 keV images, the difference of CT value of two groups was the largest, the mean value of exudates [ (47.49 ± 14. 60) HU ] was significantly higher than that of transudates[ ( 19. 76 ± 6. 85) HU ] ( t = 5.520, P = 0. 000). While On 140 keV, the mean CT value were (9.76 ±4. 16)and (6.22 ±3. 17) HU and the difference of the two group has no statistically significant difference (t =2. 107,P =0. 050). The mean slope rates of exudates (0.51 ± 0.23)was significantly larger than that of transudates (0. 18 ± 0. 08 ) ( t= 4. 287, P = 0. 001 ). The effective-Z (7. 89 ± 0. 16), iodine-water concentration [ (5. 74 ± 1.28 ) g/L], calcium-water concentration[ (7. 89 ±1.78) g/L] and calcium-fat concentration [ (25.95 ± 1.74) g/L] of exudates were significantly higher than those of transudates [ 7.67 ± 0. 07, ( 1.70 ± 0. 95 ) g/L, (2. 53 ± 1.37 ) g/L, ( 20. 82 ± 1.40 ) g/L ] ( t = 4. 080,6. 998,6. 546,6. 301 ,P ＜ 0. 05 ). Conclusions The spectral curve and spectral imaging parameters of exudates is found to be different from transudates. The low energy spectral imaging plays an important role in the characterization of pleural fluid. Gemstone spectral CT imaging provides a new multiparameter method to differentiate transudates and exudates.

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística / Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach

OBJETIVO: Propor um novo critério de classificação para a diferenciação entre exsudatos e transudatos pleurais através da dosagem de proteínas totais no líquido pleural (PT-LP) e de desidrogenase lática no líquido pleural (DHL-LP) exclusivamente, assim como comparar o rendimento diagnóstico entre esse novo critério com o critério clássico. MÉTODOS: Estudo observacional, transversal de tipo individualizado, no qual foram selecionados 181 pacientes com derrame pleural tratados em dois hospitais universitários no estado do Rio de Janeiro (RJ) entre 2003 e 2006. Os parâmetros diagnósticos incluídos no critério clássico, assim como os do novo critério, foram determinados. RESULTADOS: Dos 181 pacientes, 152 e 29 foram diagnosticados, respectivamente, com exsudato pleural e transudato pleural. A sensibilidade, especificidade e acurácia do critério clássico para o diagnóstico de exsudato pleural foram, respectivamente, de 99,8 por cento, 68,6 por cento e 94,5 por cento, enquanto, para o diagnóstico de transudato pleural, essas foram de 76,1 por cento, 90,1 por cento e 87,6 por cento. Utilizando-se os pontos de corte de 3,4 g/dL para a dosagem de PT-LP e de 328,0 U/L para aquela de DHL-LP (novo critério), a sensibilidade, especificidade e acurácia foram de, respectivamente, 99,4 por cento, 72,6 por cento e 99,2 por cento, para o diagnóstico de exsudato, e de 98,5 por cento, 83,4 por cento e 90,0 por cento, para o diagnóstico de transudato. A acurácia do novo critério proposto para o diagnóstico de exsudato pleural foi significativamente maior que aquela do critério clássico (p = 0,0022). CONCLUSÕES: O rendimento diagnóstico dos dois critérios estudados foi semelhante. Portanto, esse novo critério de classificação pode ser utilizado na prática diária.

OBJECTIVE: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. METHODS: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. RESULTS: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8 percent, 68.6 percent, and 94.5 percent, whereas the corresponding values for the diagnosis of pleural transudates were 76.1 percent, 90.1 percent, and 87.6 percent. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4 percent, 72.6 percent, and 99.2 percent, whereas the corresponding values for the diagnosis of transudates were 98.5 percent, 83.4 percent, and 90.0 percent. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). CONCLUSIONS: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.

Interleukin-1? concentration in apical exudates of periapical periodontitis and its correlations with the clinical findings / 实用口腔医学杂志

Objective: To compare the concentration of IL-1? in the apical exudates of phoenix abscess of chronic periapical periodontitis and to examine the correlation of IL-I? concentration with clinical and radiographic findings of the involved teeth. Methods: 35 single-rooted teeth diagnosed as phoenix abscess and 35 as chronic periapical periodontitis were examined. The periapical signs and symptoms were recorded. Radiographs were taken and periapical radiolucent areas were calculated with the help of the AutoCAD software. The standard paper-point sampling method was used to collect and quantify the periapical exudates. IL-1? in the exudates was detected by enzyme-linked immunosorbent assay (ELISA). All statistical analyses were finished with SPSS 10.0 software. Results: The phoenix abscess group showed significantly lower concentration(5.65?2.76) ng/ml of IL-1? in the exudates and larger radiolucent areas(32.10?13.82) mm 2 on the X-ray films than the chronic periapical periodontitis group[(12.51?5.15) ng/ml and (6.51?3.56) mm 2 respectively] (P

Detection of IL-1? and PGE_2 in periapical exudates in the patients with periapical periodontitis and their correlations with clinical findings / 实用口腔医学杂志

Objective: ①To detect the concentrations of interleukin 1?(IL 1?) and prostaglandin E 2 (PGE 2) in periapical exudates in the patients with acute or chronic periapical periodontitis; ② To examine their correlations with clinical and radiographic findings of the involved teeth.Methods: The volume of periapical exudates was quantified using the standard paper point sampling method; the concentration of IL 1? and PGE 2 was detected using enzyme linked immunosorbent assay(ELISA) or radioimmunoassay(RIA) in 40 cases with acute and in 40 with chronic periapical periodentitis. Results: ①The volume(?l) of the exudates in the cases with acute periapical periodontitis and chronic were 27.10?15.70 and 3.12?2.88( P

Derrame pleural: marcadores bioquímicos en el enfoque diagnóstico

Se describieron las principales características del líquido pleural normal y los diferentes mecanismos que conducen a la formación de un derrame pleural. Se presentó una estrategia diagnóstica a partir de la diferenciación de trasudados y exudados. Se definieron sus criterios diagnósticos. Se revisaron los marcadores bioquímicos de uso más frecuente en la práctica médica y se especificó la utilidad de cada uno para el diagnóstico de las diferentes entidades que causan derrame pleural. Se aclararon las limitaciones de estos marcadores y la importancia de su uso racional a partir de los datos clínicos de cada caso.

The main characteristics of the normal pleural fluid, as well as the different mechanisms leading to the formation of a pleural effusion were described. A diagnostic strategy was presented starting from the separation of transudates and exudates. Their diagnostic criteria were also defined. Those biochemical markers that are most commonly used in the medical practice were reviewed, and the utility of each of them for the diagnosis of different diseases causing pleural effusion was specified. The limitations of these markers and the importance of their rational use according to the clinical data of every case were explained.