Abstract: Objective To investigate changes of left ventricularregional systolic function after surgical treatment of left ventricular aneurysm (LVA) by realtime threedimensional echocardiography (RT-3DE). Methods From February 2009 to February 2010, 14 consecutive patients who were diagnosed to have coronary artery diseases with LVA underwent surgical repair and coronary artery bypass grafting (LVA group) in our hospital. All patients of the LVA group were followed up for a mean period of 4 months. Twodimensional echocardiography (2DE) and RT-3DE were performed before operation and during the follow-up. Left ventricular regional ejection fraction (EF) was acquired by Qlab software analysis. At the same time, 12 healthy persons were included as controls (control group). Statistical analyses were carried out to compare left ventricular regional EF between the LVA group (before operation and 4 months after operation) and the control group. Results Contrary to the control group, preoperative regional EF of the LVA group increased from apex to base. In addition to the inferior basal segment, lateralinferior basal segment and anteriorinferior basal segment, regional EF in the remaining 14 segments were significantly lower than that of the control group (P＜0.05). At postoperative followup, regional EF recovered the increase from base to apex, and there was no significant difference between anteriorinferior segment and lateral segment regional EF of the LVA group and those of the control group (P＞0.05), while regional EF of other segments in the LVA group was lower than that in the control group (P＜0.05). Conclusion RT-3DE is an effective method to assess left ventricular regional systolic function in patients with LVA. After LVA repair and coronary artery bypass grafting, regional systolic function will restore to the normal direction of progressive increase, and some nonaneurysm segments systolic function will go back to normal.
Day surgery is regarded as a breakthrough in promoting the construction of hierarchical diagnosis and treatment because of its advantages such as effectively shortening the length of hospital stay and making full use of medical resources. In order to comply with the national policies, medical development, patient needs, and other factors, as a comprehensive tertiary hospital, Zhengzhou Central Hospital Affiliated to Zhengzhou University taking regional synergy as a carrier, combining with 92 medical units, actively explores the rational flow of patients with day surgery in the region, through implementing clinical path management, controlling surgery expenses and drug and consumables proportions, purchasing medical health insurance for day surgery patients to ensure patient safety, opening a green channel for patients at the grassroots level, effectively using the medical insurance to co-ordinate funds, and rationally planning medical treatment procedures, ect.
Safe and effective anticoagulation is the key to successful blood purification. Compared with traditional systemic anticoagulation, regional citrate anticoagulation (RCA) has the advantages of prolonging the life of extracorporeal circulation and reducing bleeding complications. However, the complex protocol, the disorder of electrolyte and acid-base status and the accumulation risk in special populations have dissuaded many clinicians. This review starts with the clinical monitoring of RCA, then analyzes the causes and treatments of complications. The risk assessments in special populations were also introduced in order to the widely promotion of RCA in critically ill patients.
ObjectiveTo observe the changes of choroidal capillary flow area (CBFA) and density in patients with idiopathic macular hole (IMH) before and after surgery.MethodsA prospective clinical study. Thirty patients (60 eyes) with unilateral IMH diagnosed in Department of Ophthalmology of The Second Hospital of Hebei Medical University from February 2017 to March 2018 and 30 age-and sex- matched normal controls were included in this study. All eyes were divided into group A (30 affected eyes), group B (30 fellow eyes) and group C (30 normal eyes of controls). Among 30 eyes in group A, there were 5, 14, 11 eyes with hole in stage Ⅱ, Ⅲ, Ⅳ, respecitvely. The eyes in group A were divided into two subgroups according to the diameter of the holes: group D: hole diameter less than or equal to 500 μm (11 eyes), group E: hole diameter over than 500 μm (19 eyes). All eyes in group A underwent vitrectomy. Spectral-domain OCT was used to observe the diameter size of macular hole and the closure of the hole after vitrectomy in eyes of group A. The CBFA and blood flow density of superficial choroidal capillaries were measured by OCT angiography before and 3 months after vitrectomy in groups A, B and C. Univariate analysis of variance and t test were used for statistical analysis.ResultsBefore surgery, in group A, B and C, the CBFA were 2.84±0.35, 3.19±0.23, 3.26±0.24 mm2, the blood flow density were (20.74±8.26)%, (35.18±5.20)%, (35.20±6.49)%, respectively. The CBFA and blood flow density in group A were significantly lower than those in group B and C (F=19.768, 45.583; P = 0.000, 0.000), but there was no significant difference between group B and C (F=19.768, 45.583; P=0.332, 0.994). The CBFA and blood flow density in group D were higher than those in group E (t=2.230, 2.202; P=0.034, 0.036). The diameter of macular hole was negatively correlated with CBFA and blood flow density (r=－0.377, －0.477; P=0.044, 0.009). Three months after surgery, the macular holes in group A were closed; CBFA and blood flow density in macular area were significantly higher than before surgery (t=－4.126, －4.912; P=0.000, 0.000).ConclusionsCBFA and blood flow density decreased in the macular area of IMH. CBFA and blood flow density can be recovered after vitrectomy.
ObjectiveTo observe the changes of retinal blood flow density and thickness in the macular region of eyes with high myopia (HM) combined with peripapillary intrachoroidal cavitation (PICC). MethodsA cross-sectional study. From March 2019 to May 2021, 65 patients (65 eyes) diagnosed as PICC (HM+PICC group) in Eye Hospital, China Academy of Chinese Medical Sciences, sex-and age-matched 69 HM patients of 69 eyes (HM group) and 65 healthy people of 65 eyes (control group) were enrolled in this study. The optical coherence tomography angiography was used to scan macular areas in 3 mm×3 mm, and measure the macular fovea and optic disc on superior, inferior, nasal, temporal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density in the foveal and parafoveal region, and macular retinal ganglion cell complex (mGCC) thickness, full retinal thickness. One-way analysis of variance were used to test the difference of the index values among three groups, and then two groups were compared with Bonferroni test. A paired t-test was used to test the difference of the macular vessel density and thickness between the superior and inferior hemifield in three groups. Pearson partial regression analysis was used to calculate the correlations between them at same sites. ResultsPICC was located most frequently at the inferior temporal disc border, followed by the inferior nasal region, superior temporal region, and superior nasal region in the HM+PICC group on 57(87.7%, 57/65), 25(38.5%, 25/65), 3(4.6%, 3/65) and 1(1.5%, 1/65 ) eye. There were significant differences in the global and regional full retinal thickness, mGCC thickness, SCP and DCP vessel density among 3 groups (F=29.097, 51.929, 16.253, 6.135; P＜0.001). The macular SCP and DCP vessel density except in the fovea, all regional macular full retinal thickness and mGCC thickness in the HM+PICC group were significantly lower than those in the normal group (P＜0.05). Compared to the HM group, the HM+PICC group had lower all regional mGCC thickness and SCP vessel density, as well as full retinal thickness in the inferior hemifield and DCP vessel density in the foveal region (P＜0.05). Macular vessel density and thickness in the inferior hemifield were significantly lower than those in the superior hemifield (t=6.356, 11.693, 6.212, 2.936; P＜0.01). Pearson partial regression analysis showed the SCP vessel density was positively correlated with corresponding mGCC thickness and full retinal thickness (r=0.584, 0.534, 0.592, 0.496, 0.485, 0.517; P＜0.001). However, there was no significant correlation between the DCP vascular density and mGCC thickness (P＞0.05), and only a weak positive correlation between the DCP vascular density and the full retinal thickness in the inferior hemifield (r=0.319, P=0.014). However, no association with average and superior full retinal thickness (r=0.066, 0.002, 0.125, 0.184, 0.016, 0.319; P＞0.05). ConclusionThe macular SCP vessel density, mGCC thickness and the full retinal thickness in the inferior hemifield in PICC eyes are lower than those in the HM eyes, especially the mGCC thickness and SCP vessel density in the inferior hemifield, and there is a strong positive correlation between them.
ObjectiveTo observe the changes of macular blood flow density in patients of macular telangiectasis type 1 (Mac-Tel type 1) with macular edema before and after the treatment of anti-VEGF.MethodsA retrospective clinical study. From January 2016 to December 2017, 14 Mac-Tel type 1 patients (14 eyes) diagnosed in Nanjing Medical University Eye Hospital were included in the study. There were 6 males (6 eyes) and 8 females (8 eyes), with the mean age of 35.3±9.3 years. All patients underwent BCVA and OCT angiography examinations. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. All the patients were received anti-VEGF injection treatment once a month for 3 consecutive months. The OCTA scanning region in the macular area was 3 mm × 3 mm. Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the vessel density within a 300 μm width ring surrounding the foveal avascular area (FD-300) and central macular thickness (CMT) were measured in all eyes. Paired samples t-test and Pearson correlation analysis were used in this study.ResultsAt the baseline, logMAR BCVA was 0.69±0.07, CMT was 468.43±26.59 μm, SCP blood flow density was (50.99±1.19)%, DCP blood flow density was (43.79±1.44)%, FD-300 was (50.73±1.16)%. Compared with the baseline, there were significant differences between logMAR BCVA, CMT, DCP blood flow density and FD-300 in 1 week, 1 month, 3 months after treatment and 2 months after cessation of treatment (logMAR BCVA: t=6.77, 13.30, 16.99, 9.51; P=0.00, 0.01, 0.00, 0.01. CMT: t=6.99, 15.88, 26.10, 6.50; P=0.00, 0.01, 0.01, 0.00. DCP: t=6.75, 8.61, 15.12, 7.63; P=0.00, 0.01, 0.01, 0.00. FD-300: t=11.86, 13.08, 14.36, 4.41; P=0.00, 0.01, 0.01, 0.03). There was no significant difference in blood flow density of SCP between baseline and 2 months after cessation of treatment (t=1.36, P=0.19), but there was significant difference at the other time points after treatment (t=5.50, 6.84, 6.27; P=0.00, 0.01, 0.01). The Pearson's correlation analysis showed that there was a significant positive correlation between FD-300 and CMT (r2=0.54, P=0.04).ConclusionsThere is no significant change in the SCP blood flow density in the patients of Mac-Tel type 1 with macular edema, while the DCP blood flow density decreased and FD-300 increased. After anti-VEGF treatment, DCP blood flow density increased and FD-300 decreased. FD-300 is positively correlated with CMT.
ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.
The segmentation of dental models is a crucial step in computer-aided diagnosis and treatment systems for oral healthcare. To address the issues of poor universality and under-segmentation in tooth segmentation techniques, an intelligent tooth segmentation method combining multiple seed region growth and boundary extension is proposed. This method utilized the distribution characteristics of negative curvature meshes in teeth to obtain new seed points and effectively adapted to the structural differences between the top and sides of teeth through differential region growth. Additionally, the boundaries of the initial segmentation were extended based on geometric features, which was effectively compensated for under-segmentation issues in region growth. Ablation experiments and comparative experiments with current state-of-the-art algorithms demonstrated that the proposed method achieved better segmentation of crowded dental models and exhibited strong algorithm universality, thus possessing the capability to meet the practical segmentation needs in oral healthcare.
ObjectiveTo observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease. MethodsA prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; ＞12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, ＞24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex. ResultsThe wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, ＞24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses (F=8.939, P＜0.001). The average difference of wiVD between 12-24 weeks and ＞24 weeks in the chronic phase was －0.984, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in diVD of patients with different courses of disease (F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant (F=8.816, 6.069, 8.943; P＜0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was －0.984, －0.230, －0.198, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease (F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance (F=47.122, 14.954; P＜0.001, ＜0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD (r=－0.225, －0.268; P＜0.05), and the average thickness of GCC (r=0.480, 0.436; P＜0.01) were all related. ConclusionThe blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.
Objective To observe the choroidal blood flow and morphological changes in patients with severe stenosis of internal carotid artery stenosis (ICAS). Methods A retrospective case-control study. Forty-six patients (46 eyes) with ICAS were enrolled in this study. There was severe stenosis in one side (the eyes in this side were set as case group) and mild or no stenosis in other side (the eyes in this side were set as control group). Color doppler ultrasound (CDI) was used to observe the changes of hemodynamic parameters of the ophthalmic artery (OA) and posterior ciliary artery (PCA), the main parameters of ultrasound Doppler imaging are peak systolic velocity (PSV), end diastolic velocity (EDV), resistance indices (RI) and the calculation of the pulsation indices (PI) through the use of a formula. Enhanced binarization of deep imaging coherence tomography (EDI-OCT) was used to measure the subfoveal choroidal thickness (SFCT). The total subfoveal choroidal area (TCA), luminal (LA), stromal (SA) and choroidal vascularity index (CVI) were obtained by modified image binarization technique. Results In the case group, the PSV in the OA and PCA was significantly lower than that of the control group (t=−2.200, −2.612; P=0.030, 0.011). There were no significant differences in EDV, RI, PI of OA (t=0.337, −1.810, −1.848; P=0.737, 0.074, 0.068) and PCA (t=−1.160, 1.400, 0.815; P=0.249, 0.165, 0.417). The SFCT (t=−3.711, P＜0.001), TCA (t=−2.736, P=0.007), LA (t=−3.188, P=0.002) and CVI (t=−2.096, P=0.039) of the case group was significantly lower than that of the control group. There were no significant differences in SA (t=−1.262, P=0.210) and LA/SA (t=−1.696, P=0.093). Conclusion In severe stenosis ICAS eyes, the PSV in the PCA and SFCT, TCA, LA, CVI are decreased.