Background Myopic maculopathy leads to visual function damage.Conventional methods for the identification of choroidal neovascularization (CNV) of myopic maculopathy are fundus fluorescine angiography (FFA) and spectral-domain OCT (SD-OCT),but FFA is an invasive process and SD-OCT is incapable to image CNV well.OCT angiography (OCTA),a novel and non-invasive vascular technique,appears to be dominant in enface imaging of CNV,however,its clinical value remains to be evaluated.Objective This study was to evaluate the application of OCTA in imaging CNV of myopic maculopathy.Methods A prospective serial cases-observational study was performed.Forty-two eyes of 40 patients of myopic maculopathy were included in Ophthalmic Center,Renmin Hospital of Wuhan University from January to October 2015,with the diopter (-10.5 ± 3.74) D.Comperehensive optical and imaginal examinations were carried out in all the eyes,including fundus photography,FFA,SD-OCT and OCTA.Ranibizumab (0.5 mg/0.05 ml) was intravitreally injected in 35 eyes of 35 patients under the informed consent and SD-OCT and OCTA were examined 1 day,1 week and subsequent each month after injection.FFA was examined 1 month after injection.The patients were followed-up for 1-6 months to evaluate the clinical values of OCTA in monitoring the CNV of myopic maculopathy.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Renmin Hospital of Wuhan University.Written informed consent was obtained from each patient prior to any medical examination.Results All the affected eyes showed dye leakage in CNV lesions by FFA and high reflection signal of abnormal choroidal vascular network throughout retinal pigment epithelium by SD-OCT.Clusters of high signal CNV image was clearly visible in the lesions by OCTA,and these signals were able to be displayed on both choriocapillary layer and outer layer of retina more clearly than FFA in 31 eyes of 31 patients.In 35 eyes of 35 patients received intravitreal injection of ranibizumab,CNV images on both choriocapillary layer and outer layer of retina from OCTA shrinked 1 week after injection and the lesions were stable 1 month after injection.Conclusions OCTA can display CNV of myopic maculopathy on the retinal outer layer and choriocapillary layer more clearly than FFA.Significant changes in the CNV net can be observed by OCTA 1 week after intravitreal injection of ranibizumab.OCTA plays an important role during the following-up of CNV therapy.

Objective To explore the relationship of the expression, regulation and adhesion of PTA1 in pregnancy induced hypertension(PIH). Methods The expression,regulation and adhesion of PTA1 on vascular en- dothelial cells incubated by sera from 10 PIH patients and 10 normal pregnant women repectively was detected by flow cytometry. Results The positive rate of PTA1 15.51% (24h) and 6.32 % (48h) in PIH group is significantly higher than that 7.81% (24h) and 4.72 % (48h) in normal pregnant woman group( P < 0.01 ). After the incubation with platelets,the positive rate of PTA1 6.64% (24h) and 4.13% (48h) in PIH group is lower than before(P< 0.05). The PTA1 expression 8.11% (24h) and 4.28% (48h) in PIH group is much lower after blocking with PTA1/IgG than that before(P < 0.01 ). Conclusion There are some abnormal stimulated factors in PIH patients, which activate vascular endothelial cells. PTA1 plays an important role in the adhesion of platelets to vascular en- dothelial cells, PTA1 is closely related to the progress of PIH which indicates that PTA1 directly or indirectly takes part in the pathophysiologic consequences of PIH.

Objective To clarify the clinical features of dysthyroid optic neuropathy (DON), so as to provide evidence for early diagnosis and treatment of DON. Methods The general characteristics and data of thyroid function conditions, ophthalmologic and imaging examinations were retrospectively analyzed in 98 patients (196 eyes) with DON diagnosed from Jan. 2015 to Dec. 2017 in our hospital. According to relevant references, the 196 eyes were diagnosed as having definite, equivocal, or no DON. All patients with equivocal or definite DON in at least one eye were recruited. Results Among 98 DON patients, 59 were male and 39 were female, and the ratio of male to female was 1.51: 1. The average age of 98 patients was (52.51 ±10.25) years old, ranging from 34 to 74 years old. All patients had a history of smoking or passive smoking. Ninetysix patients had hyperthyrea. Of 98 patients, 80 had definite DON and 18 equivocal, with 122 eyes being definite, 56 being equivocal and 18 having no DON. The mean clinical activity score was (4.44±1.53) in all patients, of whom 30 cases scored≤3. Of 178 definite and equivocal DON eyes, 142 eyes had best corrected visual acuity≤0.6, 130 had reduced colour vision, 38 had optic disc oedema, 56 had optic disc pallor, and 84 had normal optic disc. Seventeen out of 18 eyes without DON had normal optic disc. The exophthalmos≤21 mm was found in 38 definite DON eyes. Orbital imaging examination showed that all 80 definite DON patients had crowded orbital apex syndrome, with 67 cases (83.75%) having bilateral and 13 (16.25%) having unilateral one. Conclusion Older age, male, smoking and hyperthyrea are risk factors of DON. Crowded orbital apex syndrome is the most important pathological basis of DON. Impaired visual acuity, reduced colour vision and optic disc swelling are the most specific clinical features of DON.

Objective To observe the characteristics of optical coherence tomography (OCT) angiography (OCTA) in retinal vein occlusion (RVO).Methods Prospective and observational study.Clinical examination of 81 consecutive patients (86 eyes) diagnosed with RVO were included in the study,in which the branch retinal vein occlusion in 47 eyes,central retinal vein occlusion in 39 eyes.Forty-five patients were male and 36 patients were female.Aged from 28 to 76 years old,the mean age was (55.36±10.01) years old.Comprehensive optical and imaging examination were performed,including fundus photography,fundus fluorescein angiography (FFA),spectral domain OCT,en face OCT and OCTA.The retinal blood flow imaging scan mode and the optic disc blood flow imaging scan mode were performed,the scanning region in the macular area were 3 mm × 3 mm,6 mm × 6 mm,8 mm × 8 mm respectively,around the optic disc were 3 mm × 3 mm and 4.5 mm × 4.5 mm.Each region scans 2 times.The characteristics of foveal avascular zone change,macular edema,non-perfusion and optical disc edema in OCTA and their corresponding FFA and en face OCT were observed.Results By OCTA,67 eyes (77.9％) for foveal avascular zone change,23 eyes (26.7％) for macular edema,40 eyes (46.5％) for non-perfusion,and 33 eyes (38.4％) for optical disc edema can be detected.The foveal avascular zone change can be indentified as the tranformation,destruction and even vanish of the arch in superfacial layer of retinal macular area,acompanied with the dilatation and thickening of capillary vessels,the occlusion and expanding of capillary vessels arounded the foveal avascular zone in the deep layer of macular area.Those performances were more clear than FFA.The main expression of macular edema was low signal and was not as clear as en face OCT.The tortuosity and expansion of retinal vessels,density decreasing and even occlusion or abnormal traffic branch of capillary vessels can be observed in non-perfusion.These observations were similar to FFA.However,pieces of highly signal identical with non-perfusion area can b.e detected in chroid capillary.The representation of optical disc edema was the brush-like expanding of capillary vessels aroud optical disc.Conclusions OCTA can help for observing the abnormal changing of capillary vessels in foveal avascular zone and macular edema,non-perfusion and optical disc edema.Foveal avascular zone change showed occlusion and expanding of capillary vessels around the foveal avascular zone in the deep layer of macular area.Macular edema showed the weak signal.Non-perfusion showed tortuosity and expansion of retinal vessels,density decreasing and even occlusion or abnormal traffic branch of capillary vessels.Optical disc edema showed brush-like expanding of capillary vessels around optical disc.

Objective To observe the angiographic features of patients with retinal vein occlusion (RVO) by ultra-wide-field fluorescein angiography (UWFA) and compare with the conventional 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Fifty-eight eyes of 56 RVO patients were included. There were 25 males (26 eyes) and 31 females (32 eyes). The age ranged from 25 to 69 years, with a mean age of (48.12±18.56) years. The course of disease was from 2 days to 25 months, with a mean course of (12.78±11.35) months. Thirty eyes were diagnosed with central RVO (51.72%), 26 eyes were diagnosed with branch RVO (44.83%) and 2 eyes were diagnosed with hemicentral RVO (3.45%). Retinal laser photocoagulation was performed in 11 eyes (18.97%). All patients received examinations of UWFA (British Optomap 200Tx imaging system) and optical coherence tomography (OCT). Using the protocol for obtaining 7SF images as described in the Early Treatment Diabetic Retinopathy Study, 7 circular regions with a range of 30 degrees were combined as the 7SF template to determine the observation area. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. The visualized retinal area, retinal non-perfusion area, retinal neovascularization area, and laser spot area of UWFA and 7SF were quantified by a retinal specialist. In addition, the OCT images of the affected eye were observed and analyzed to confirm the existence of macular edema. Correlation analysis was done between retinal non-perfusion, retinal neovascularization and macular edema detected by UWFA. Results The results of UWFA and 7SF examination were the same. Compared with 7SF, UWFA showed 3.53 times more retinal visual area, 3.31 times more non-perfusion area, 1.94 times more neovascularization area, and 3.59 times more laser spots (t=72.13, 4.69, 1.76, 5.78;P=0.000, 0.005, 0.102, 0.000). Lesions of 11 eyes (18.97%) were found outside the range of 7SF images. By UWFA, non-perfusion area correlated with neovascularization and macular edema (χ2=12.13, 4.82;P=0.000, 0.028;C=0.42, 0.28). Non-perfusion area anterior to the equator have significantly correlations with macular edema (χ2=6.32, P=0.012, C=0.31), but non-perfusion posterior to the globe equator have no relevance with macular edema (χ2=2.88, P=0.090, C=0.22). Conclusions UWFA can detect more peripheral retinal lesions than 7SF images. By UWFA, non-perfusion area has correlation with neovascularization and macular edema.

Objective To observe the ocular fundus features and consistency of classification of diabetic retinopathy (DR) by ultra-wide-field fluorescein angiography (UWFA) and the simulated early treatment diabetic retinopathy study (ETDRS) 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Ninety-six eyes of 55 DR patients were included. The ages ranged from 25 to 73 years, with a mean age of (41.34±15.07) years. UWFA examination (British Optos 200Tx imaging system) using the protocol for obtaining 7SF images as described in the ETDRS, 7 circular regions with a range of 30 degrees are spliced as 7SF templates to determine the observation range. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. And the visualized area of the retina, retinal non-perfusion (NP) area, retinal neovascularization (NV) area, and pan-retinal photocoagulation (PRP) area of UWFA and 7SF were quantified by a retinal specialist. Results UWFA imaging and 7SF imaging have a high degree of consistency in judging DR classification (kappa=0.851, P=0.000). The retinal visual area, NP area, NV area and PRP area of the UWFA imaging were 3.16, 3.38, 2.22 and 3.15 times more comparing with the simulated 7SF imaging (t=213.430, 45.013, 22.644, 142.665;P=0.000, 0.000, 0.003, 0.000). The lesions of 8 eyes were found outside the range of simulated 7SF imaging, including peripheral NP in 5 eyes, NV areas in 3 eyes, respectively. Conclusion UWFA imaging and simulated 7SF imaging are consistent to judge DR classification, but UWFA can find more peripheral retinal lesions.

Animals ; Carnitine ; therapeutic use ; Fatty Liver ; drug therapy ; Hepatitis, Viral, Human ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy

Dopamine ; therapeutic use ; Hepatorenal Syndrome ; blood ; therapy ; Humans ; Liver Transplantation ; Vasoconstrictor Agents ; therapeutic use

BACKGROUND: Reducing perioperative blood loss in total hip arthroplasty is a hot topic for joint surgeons. Both intravenous infusion and intra-articular injection of tranexamic acid significantly reduce perioperative blood loss, blood transfusion volume, and need for blood transfusion in patients undergoing total hip arthroplasty. However, differences between the intravenous and intra-articular methods are not clear.OBJECTIVE: To evaluate the effects of these two tranexamic acid administration methods on perioperative blood loss in patients undergoing total hip arthroplasty.METHODS: We are conducting a prospective, single-center, open-label, randomized, controlled clinical trial at the Tengzhou Central People's Hospital, China. Ninety patients undergoing unilateral total hip arthroplasty have been randomized into three groups. In the intravenous infusion group (n=30), 15 mg/kg tranexamic acid diluted in 100 mL physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. In the intra-articular injection group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and a mixture of 1.5 g tranexamic acid and 20 mL physiological saline was injected intra-articularly after deep fascia suturing. In the control group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. The primary outcome is hidden blood loss at 1 and 3 days postoperatively. The secondary outcomes are visible blood loss, need for blood transfusion, and mean blood transfusion volume intraoperatively and on days 1 and 3 postoperatively. Other outcomes are the incidence of adverse reactions and complications within 3 months of surgery. The study protocol has been approved by the Ethics Committee of Tengzhou Central People's Hospital of China, approval number 2015-026. All protocols will be performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects in the Declaration of Helsinki. Written informed consent was provided by each patient and their family members after they indicated that they fully understood the treatment plan.DISCUSSION: This trial was designed in April 2015. Cases were collected in July 2015. Data analysis will be finished in December 2017. This study is designed to investigate the effects of intravenous infusion versus intra-articular injection of tranexamic acid on perioperative blood loss in patients undergoing total hip arthroplasty to determine the more effective mode of administration.

BACKGROUND:Increasing reports have focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial.
OBJECTIVE:To explore the impact of topical articular application of tranexamic acid and intravenous application of tranexamic acid on blood loss during primary unilateral total knee arthroplasty.
METHODS:According to randomized control ed principle, 90 patients who received unilateral total knee arthroplasty in the Tengzhou Central People’s Hospital from October 2013 to December 2014 were enrol ed in this study, and randomly assigned to intravenous injection group and topical injection group (n=45). Patients in the intravenous injection group were given tranexamic acid by intravenous injection (10 mg/kg, maximum 1.2 g) during the induction of anaesthesia. Patients in the topical injection group were given intraarticularly tranexamic acid (2 g dissolved in 50 mL physiological saline) before articular capsule suture and after prosthesis fixation. Drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, and the number of blood transfusion population were compared between the two groups. Simultaneously, clinical symptoms of pulmonary embolism and deep vein thrombosis in the lower limb were observed. If necessary, lower extremity vascular Doppler ultrasound was conducted.
RESULTS AND CONCLUSION:No significant differences in drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, the number of blood transfusion population, and the proportion of blood transfusion were detected between the two groups (P>0.05). No deep vein thrombosis was found in the lower limbs at 14 days after replacement in both groups. These findings confirm that compared with intravenous systemic application, periarticular topical application of tranexamic acid during total knee replacement could obtain identical effects on reducing blood loss and blood transfusion after surgery, and could avoid relevant complications of intravenous application of tranexamic acid.