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Objective:To observe the changes of macular structure and microvessels in eyes with diabetes macular ischemia (DMI).Methods:A retrospective case study. From January 2023 to July 2023, 23 patients of 31 eyes diagnosed with DMI at Tangshan Ophthalmological Hospital were included in this study. Among them, there were 14 males with 23 eyes; Female cases with 8 eyes. Age were (59.5±4.6) years old. According to the DMI grading standard formulated by the research group for early treatment of diabetes retinopathy, the patients were divided into mild DMI group, moderate DMI group, and severe DMI group, with 8, 12, and 11 eyes respectively. The blood flow density (VD), perfusion area (FA), small vessel VD (SVD), inner retinal capillary plexus VD, FA, and outer retinal, choroidal, and ganglion cell complex (GCC) thickness within 1 mm of the macular fovea in retinal superficial vascular plexus (SVP)were measured using a scanning frequency light source optical coherence tomography instrument. The changes in macular structure and microvasculature in the affected eyes of different degrees of DMI groups were compared and observed. Inter group comparisons were conducted using one-way ANOVA or Kruskal Wallis H-test. Spearman correlation analysis was used to analyze the correlation between DMI severity and GCC, outer retina, choroid thickness, VD, FA and SVP VD, SVD and FA in inner retina. Results:The GCC ( F=70.670), outer retinal thickness ( H=12.393), VD ( F=105.506), SVD ( H=25.300), FA ( F=107.655), and VD ( H=24.098) and FA ( H=25.300) of the retinal SVP in the mild, moderate, and severe DMI groups were compared, and the differences were statistically significant ( P<0.05). There was no statistically significant difference in choroidal thickness ( H=2.441, P>0.05). Pairwise comparison between groups: VD, SVD, FA of GCC thickness and SVP, and VD of inner retina were statistically significant between severe DMI group and moderate DMI group, and between moderate DMI group and mild DMI group ( P<0.05). The thickness of outer retina was statistically significant between severe DMI group and moderate DMI group ( P<0.05). Inner retinal FA: there were statistically significant differences between severe DMI group, moderate DMI group and mild DMI group ( P<0.05). The correlation analysis results showed that GCC ( r s=-0.918), outer retinal thickness ( r s=-0.448), and inner retinal VD ( r s=-0.894) and FA ( r s=-0.918), as well as VD ( r s=-0.919), SVD ( r s=-0.924), and FA ( r s=-0.939) of retinal SVP, were all negatively correlated with the degree of DMI ( P<0.05). There was no correlation between choroidal thickness and degree of DMI ( r s=-0.081, P>0.05). Conclusion:The thickness of GCC, outer retina and choroid, the VD, SVD, and FA of the retinal SVP, the VD and FA of inner retina are all reduced in eyes with different degrees of DMI, while all of them are negatively correlated with the degree of DMI, except for choroid thickness.
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Objective:To systematically review the prevalence, influencing factors of financial toxicity and coping strategies in cancer patients.Methods:The studies on financial toxicity among cancer patients were searched in PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, WangFang Data, CNKI, Sinomed, VIP from inception to June 2022. Stata14.0 software was used to analyze the prevalence of financial toxicity and coping strategies with a single group meta-analysis. Descriptive analysis was used to analyze the influencing factors.Results:A total of 25 papers including 2 939 cancer patients were included. Meta-analysis results showed that the prevalence of financial toxicity in cancer patients was 47% (95% CI 39%-55%). The influencing factors of financial toxicity included sociodemographic factors, disease related factors, medical insurance related factors and psychological factors. Conclusions:The high incidence of financial toxicity in cancer patients is associated with a variety of factors. Health care professionals should pay attention to early screening of cancer patients, dynamically collect relevant data such as patient expenditure items, continuously assess patients' economic status, and make relevant preventive efforts.
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Objective:To observe the multimodal imaging characteristics of tamoxifen retinopathy.Methods:A retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed.Results:The yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia.Conclusion:Deposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.
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Objective:To observe and analyze the detection rate of optical disc and retinal neovascularization in stage Ⅳ diabetic retinopathy by multidirectional OCT angiography (OCTA).Methods:A retrospective study. From September to October 2018, 50 eyes of 46 patients with diabetic retinopathy of stage Ⅳ diagnosed in Tangshan Ophthalmological Hospital were included in the study. Among them, there were 18 males (19 eyes) and 28 females (31 eyes). The age ranged from 31 to 78 years, with an average age of 56.64±10.64 years. All patients underwent medical optometry, mydriasis fundus examination and FFA examination. All patients met the diagnostic criteria of stage Ⅳ diabetic retinopathy. All patients underwent multidirectional OCTA examination on the same day after mydriasis fundus examination and FFA examination. Angiography 6 mm × 6 mm scanning mode was selected for OCTA examination. The retinal areas of macular area, optic disc, superior nasal disc, superior optic disc, superior macular area, superior temporal macular area, temporal macular area, inferior nasal disc, inferior optic disc, inferior macular area and inferior temporal macular area were scanned respectively. All images were taken by the same physician and read by two physicians independently. Cases with inconsistent opinions between the two physicians were not included in this study. The optical disc and retinal neovascularization in patients with stage Ⅳ diabetic retinopathy were observed on FFA and multidirectional OCTA images.Results:In 50 eyes, the positive number of screening optic disc neovascularization using FFA was 8 eyes, OCTA was 15 eyes (100%). In the 42 eyes without optic disc neovascularization detected by FFA, OCTA detected 7 eyes, all located on the optic disc surface. Four of the eyes were located in the optic cup, linear and branching, with an area of less than 1/4 optic disc. In 50 eyes, the positive number of screening retinal neovascularization using FFA was 50 eyes, the positive number of OCTA was 43 eyes. In 43 eyes with detected by OCTA, retinal neovascularization buds were detected in 3 eyes, but not in FFA. The retinal neovascularization not detected by OCTA was located in the mid-peripheral part of the retina, which is beyond the inspection range of multi-directional OCTA.Conclusion:The positive rate of optic disc neovascularization and retinal neovascularization in stage Ⅳ DR by multidirectional OCTA is 100.0% and 86.0%, respectively.
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OBJECTIVE:To provide reference for improving the work quality of Pharmacy intravenous admixture service(PIV-AS). METHODS:The quality control monitoring system for PIVAS established and implemented in our hospital was introduced, the monitoring system was tracked and checked from initial stage of implementation (Jan. 2016) to implemented for 12 months (Dec. 2016),and the effect was evaluated. RESULTS:PIVAS in our hospital had developed quality control monitoring system that included medication error and critical error monitoring system,auditing medical order homogenization monitoring system,hand hy-giene monitoring system,high-alarm drug management monitoring system and drug liquid residue monitoring system. In initial stage of implementation,the relevant checking indexes including incidence of medication error and critical error,standardization rate of auditing medical orders,awareness rate of hand hygiene knowledge,compliance rate of hand hygiene,correct rate of hand hygiene,pass rate of high-alarm drug management and pass rate of drug liquid residue were 0.14%,57%,85%,70%,86%, 98%,75%;and after implemented 12 months,the indexes were 0.01%,87%,97%,81%,95%,100%,93%,respectively (P<0.05). CONCLUSIONS:The quality control monitoring system in PIVAS established and implemented in our hospital has ef-fectively improved the work quality of PIVAS.
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@#Objective To evaluate the efficacy and safety of butylphthalide combined with aspirin in treatment of acute cerebral infarction.Methods CNKI,Wanfang,VIP,sinomed,PubMed,Cochrane library databases were searched by computer from the building time to October 2019.According to the inclusion and exclusion criteria,the eligible RCT was selected and Meta-analysis was carried out by Revman 5.3 soft ware.Results A total of 1375 cases were included in 15 articles.The results from Meta-analysis demonstrated that the cure rate of the treatment group was superior to that of the single drug ［RR=1.56,95% CI (1.16,2.10),Z=2.93 (P=0.003)］,additional other treatments［RR=1.99,95% CI(1.30,3.05),Z=3.16(P=0.002)］;the effective rate of the treatment group was superior to that of the single drug［RR=1.41,95%CI(1.22,1.64),Z=4.52(P<0.00001)］,additional other treatments［RR=1.24,95%CI(1.12,1.38),Z=4.07(P<0.0001)］;the NHISS score of the treatment group was lower than that of the single drug［MD=-2.79,95%CI(-3.72,-1.86),Z=5.86(P<0.00001)］,additional other treatments［MD=-2.70,95%CI(-3.54,-1.85),Z=6.26(P<0.00001)］.There was no significant difference in safety between the two groups.Conclusion Butylphthalide combined with aspirin is effective and safe in the treatment of acute cerebral infarction.
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Objective:With the development of science and technology, large medical equipments have been universally applied in clinical diagnosis. It is important in hospital management to search for the way to obtain the maximum economic and social benefits by efficiently analyzing cost benefit of large medical equipment. Methods:To ascertain cost benefit of medical equipment by profit margin of investments and cost-redemption periods. Results:Proposals on purchase and management of department medical equipment were presented. Conclusion:Scientific evaluation and analysis on large medical equipment would play a positive role in purchase, use and economic returns of department medical equipment.
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OBJECTIVE:To explore regularity and characteristics of ADR in our hospital,and to provide reference for ratio-nal drug use in the clinic. METHODS:A total of 368 ADR collected from Zhengzhou People's Hospital during 2013-2014 were an-alyzed statistically in respects of patient's gender,age,drug types,route of administration,dosage form,organs or systems in-volved in ADR,clinical manifestations,ADR outcome,etc. RESULTS:Of 368 ADR reports,female was more than male (52.99% vs. 47.01%);the number of patients aged more than 50 years was the most(36.14%);most of ADR cases were induced by antibiotics and TCM preparations,accounting for 40.22%,21.47%,respectively;among route of administration,most of ADR cases were induced by intravenous administration (85.60%);main clinical manifestations were lesion of skin and its appendants (39.95%),followed by digestive system (21.47%). After treatment,all patients were cured or improved,no death case was found. CONCLUSIONS:Clinic should strengthen ADR monitoring and analysis and evaluarion,strengthen the rational use of anti-biotics and TCM injections and adopt measures to reduce drug risk.