Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.

OBJECTIVE To identify the mental state of laryngopharyngeal reflux disease (LPRD) patients by analyzing anxiety scale and depression scale. METHODS The LPRD patients who received treatment in Fuzhou General Hospital were studied. The healthy volunteers were recruited as control group. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to get the individual scores. Mental states of LPRD patients were finally studied through statistical analysis. RESULTS The scores of anxiety and depression in patients with LPRD were significantly higher than those in control group (anxiety score 50.59±7.24 vs 38.76±7.70, depression score 52.90±7.14 vs 40.63±8.17). The incidence of anxiety and depression in patients with LPRD were significantly higher than that in control group (anxiety rate 56.68％ vs 9.80％, depression rate 50.98％ vs 11.76％). Significant association was detected between ref lux symptom index score and anxiety or depression score in patients with LPRD(r =0.786, r =0.736, P ＜0.05). Significant association between LPRD and anxiety and depression were concluded. CONCLUSION The results showed that the patients with LPRD are more prone to be anxiety and depression mental state than healthy control group, and the severity of LPRD symptoms is significantly correlated with the anxiety and depression. This suggests that the patient's mental state should also be emphasized as well as antacids treatment.

Objective To assess changes of blood flow density of idiopathic choroidal neovascularization (ICNV) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF).Methods Retrospective case analysis.Sixteen eyes of 16 patients with ICNV diagnosed with FFA and OCT were included in this study.Among them,12 were female and 4 were male.The mean age was 33.94±9.83 years.The mean course of diseases was 5.13 ±4.44 weeks.The BCVA,indirect ophthalmoscope,OCT and OCT angiography (OCTA) were performed at the first diagnosis in all patients.The BCVA was converted to logMAR.The macular fovea retinal thickness (CMT) was measured by OCT,and the selected area of CNV (CSA) and flow area of CNV (CFA) were measured by OCTA.The mean logMAR BCVA,CMT,CSA and CFA were 0.336±0.163,268.500±57.927 μm,0.651 ±0.521 mm2,0.327±0.278 mm2,respectively.All patients were treated with intravitreal ranibizumab (IVR,10 mg/ml,0.05 ml).Follow-up results including the BCVA,fundus color photography,OCT and OCTA were obtained 1 month after treatment.To compare the changes ofBCVA,CMT,CSA,CFA of ICNV treated with anti-VEGF.Pearson method was used to analyze the correlation between logMAR BCVA and CMT,CSA and CFA before and after the treatment.Results One month after treatment,the average logMAR BCVA,CMT,CSA and CFA were 0.176±0.111,232.500± 18.910 μm,0.420±0.439 mm2,0.215 ± 0.274 mm2.The mean logMAR BCVA (t=5.471,P＜ 0.001),CMT (t=2.527,P=0.023),CSA (t=4.039,P=0.001),CFA (t=4.214,P=0.001) significantly decreased at 1 month after injection compared to baseline,and the difference had statistical significance.The results of correlation analysis showed that the post-logMAR BCVA was moderately positively correlated with pre-CSA and post-CSA (r=0.553,0.560;P=0.026,0.024),and strongly correlated with pre-CFA and post-CFA (r=0.669,0.606;P=0.005,0.013),but not correlated with preCMT and post-CMT (r=0.553,0.560;P=0.026,0.024).Conclusion The blood flow density of ICNV measured by OCTA were significantly decreased in the treatment of anti-VEGF drugs.

Objective To observe the imaging features of cystoid macular edema (CME) in multicolor imaging (MC),and to evaluate the value of MC in the diagnosis of CME.Methods Descriptive case series study.From August 2017 to June 2018,42 eyes of 37 patients with CME diagnosed in the people's Hospital of Wuhan University were included in the study.Among them,there were 24 males and 13 females,with an average age of 48.51 ± 10.29 years.There were 14 eyes with diabetic retinopathy,14 eyes with central retinal vein occlusion,8 eyes with branch retinal vein occlusion,4 eyes with uveitis,and 2 eyes with Eales disease.The macular color fundus photography (CFP) was performed with Visucam 200 non-mydriatic fundus camera of Zeiss company in Germany.MC,frequnce domainoptical OCT (SD-OCT) and FFA were examined by Spectralis HRA2 + OCT of Heidelberg company in Germany.According to the MC standard method,five images,including 488 nm blue reflection (BR),515 nm green reflection (GR),820 nm infrared reflection (IR) imaging and standard MC and blue-green enhancement (BG),were obtained at the same time.Compared with SD-OCT,CFP and MC images were scored.Friedman M test and Wilcoxon signed rank test were used for statistical analysis.Results The standard MC and BG images showed blue-green uplift area or petal-shaped appearance,surrounded by green reflection areas with clear boundaries.BR image can be seen in the low reflexes area.On the GR image,there were patches or cystic low reflection areas,surrounded by a slightly high reflection.On the IR image,patches or cystoid high reflexes can be seen,surrounded by low reflection dark areas with clear boundaries.The average scores of CFP,standard MC,GB,IR,GR and BR were 1.20± 0.94,3.05± 0.99,2.90± 1.04,2.55± 1.27,2.00± 0.94,0.51 ± 0.85 respectively,and the differences were statistically significant (χ2=151.61,P=0.000).The score of CFP were significantly lower than that of standard MC (Z=-5.421),BG (Z=-5.354),IR (Z=-4.714),GR (Z=-4.438) and higher than that of BR (Z=-3.435).The differences were statistically significant (P=0.000,0.000,0.000,0.000,0.001).Conclusions The quality of MC imaging is better than that of CFP.Combined with SD-OCT,it can be used as an assistant method to diagnose CME.

Objective:To analyze the peripheral retinal fluorescence characteristics of normal fundus on ultra-wide field fluorescein angiography (UWFA) images.Methods:A cross-sectional study was conducted.Ninety-five patients (190 eyes) who underwent normal UWFA in Renmin Hospital of Wuhan University from July 2016 to January 2019 were enrolled.There were 94 (49.47%) male eyes and 96 (50.53%) female eyes.Among them, there were 72 (37.89%) mild cataract eyes, 60 (31.58%) moderate and low myopia eyes and 58 (30.53%) subjective blurred vision eyes.The peripheral retinal fluorescence characteristics were divided into vascular-associated feature or non-vascular feature according to whether the retinal vessel involved or not.The subjects were divided into ≤40 years old group and >40 years old group, and the differences in various features between the two groups were compared and analyzed.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each patient prior to any examination.Results:Four non-vascular and five vascular-associated fluorescence features were found in normal peripheral retina.Non-vascular features contained glass hyperfluorescence in 158 (83.16%) eyes, far peripheral retina with mottled florescent band in 82 (43.16%) eyes, granular ground hyperfluorescence in 24 (12.63%) eyes and local mottled fluorescence in 21 (11.05%) eyes.Vascular-associated fluorescence features included peripheral avascular area in 92 (48.42%) eyes, vessels passing through the ora serrata in 66 (34.74%) eyes, microaneurysm in 60 (31.58%) eyes, slight leakage within 10 minutes after angiography in 56 (29.47%) eyes and angiotelectasis in 30 (15.79%) eyes.There were 19.61% (20/102) of eyes with peripheral retinal vessels passing through the ora serrata and 43.10% (44/102) of eyes with microaneurysm and 19.61% (20/102) of eyes with angiotelectasis in >40 years old group, and there were 52.27% (46/88), 18.23% (16/88) and 11.36% (10/88) correspondingly in ≤40 years old group, and the differences were statistically significant ( χ2=22.235, 10.451, 9.259; all at P<0.01). Conclusions:UWFA reveals four non-vascular and five vascular-associated fluorescence characteristics of normal fundus and age might be associated with the distribution of microaneurysm and angiotelectasis.

Objective:To investigate the features of multicolor imaging in the macular region of central serous chorioretinopathy (CSC) patients.Methods:A cross-sectional study was conducted.Thirty-four acute CSC patients (34 eyes) treated in Renmin Hospital of Wuhan University from August 2017 to January 2018 were enrolled.Among the 34 subjects, there were 21 males (21 eyes) and 13 females (13 eyes). The subjects were 26 to 61 years old, with an average age of (37.41±9.35) years.The course of the disease was 5 to 45 days, with an average course of (12.00±2.29) days.All the subjects were examined by color fundus photography, fluorescein angiography (FFA), indocyanine green angiography (ICGA), multicolor imaging, spectral-domain optical coherence tomography (SD-OCT). The image features of each patient were compared and analyzed.The diagnostic accordance rate for leakage point and serous retinal neuroepithelial detachment of multicolor imaging and color fundus photography was calculated according to FFA/ICGA and OCT.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037).Results:The serous retinal detachment region showed green light reflection area with clear boundary in 33 eyes (97.06%) in the standard as well as blue and green enhanced multicolor image, with not clear boundary in 1 eye (2.94%). The serous retinal detachment region showed weakly reflective area in 17 eyes (50%) in blue reflectance image, showed weak reflection with clear boundary in 32 eyes (94.11%) in green reflectance image, showed weakly reflection with clear boundary in 33 eyes (97.06%) in infrared reflectance image.The fluorescein leakage point in FFA image was found micro retinal pigment epithelium detachment (PED) in 19 eyes (55.88%), rough light band of retinal pigment epithelium (RPE) in 12 eyes (35.29%), and large PED in 3 eyes (8.82%) in SD-OCT image.The RPE leakage showed red mottled changes in the area of neuroepithelial detachment in 29 eyes (85.29%) in the standard as well as blue and green enhanced multicolor images, presented strong reflection spots in blue reflectance images in 2 eyes (5.88%), showed strong reflective spots in green reflectance in 5 eyes (14.70%), showed strong reflection spot in the weakly reflective area in 33 eyes (97.06%) in infrared reflectance images.Taking FFA/ICGA and OCT as the gold standard, the diagnostic accordance rate of standard multicolor, blue and green enhanced multicolor and infrared reflectance images for serous retinal neuroepithelial detachment and leakage points was higher than that of color fundus photography, and the differences were statistically significant (all at P<0.05). Conclusions:Standard multicolor, blue and green enhanced multicolor and infrared reflectance images can reflect the leakage point and retinal neuroepithelial detachment of acute CSC.Green reflectance image can show serous retinal neuroepithelial detachment of acute CSC.Multicolor imaging can be used as the auxiliary diagnosis method of acute CSC.

Objective:To explore the application of multispectral fundus imaging (MSI) in central serous chorioretinopathy (CSC).Methods:A diagnostic test study was conducted.Eighty-five eyes from 69 patients with macular diseases were enrolled in Renmin Hospital of Wuhan University from September 2017 to May 2018.There were 62 males (77 eyes) and 7 females (8 eyes) among the 69 patients with an average age of (48.0±11.2) years.The patients were divided into CSC group (45 cases, 61 eyes) and non-CSC group (24 cases, 24 eyes) according to whether suffering from CSC or not.Color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography, spectral domain-optical coherence tomography and MSI were performed in the two groups and the images were collected.With FFA as the gold standard, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI in the diagnosis of CSC were calculated.Kappa consistency test was used to evaluate the consistency of MSI and FFA in diagnosing CSC, and to evaluate the diagnostic value of MSI in CSC.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each subject prior to any medical examination.Results:The sensitivity, specicity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI for identifying CSC were 88.5%, 91.7%, 8.3%, 11.5%, 96.4% and 75.9%, respectively.The Kappa coefficient of agreement was 0.754.There was no significant difference in the identification of CSC between MSI and FFA ( χ2=1.780, P=0.180). Hyper-reflective signals corresponding to the leakage points were better detected with MSI images at 620-850 nm wavelength.The clear boundary of serous neuroepithelial detachment area was better detected with MSI images at 590-810 nm wavelength.The retinal pigment epithelium damage was better detected with MSI images at 660-850 nm wavelength. Conclusions:There is a good consistency between MSI and FFA.MSI can be an effective noninvasive inspection method for CSC.

Objective:To evaluate the application of Moorehead-Ardelt Ⅱ questionnaire (MA Ⅱ) in assessment of the quality of life (QOL) among obese patients after bariatric surgery.Methods:One hundred and five patients with obesity were enrolled, the weight, body mass index (BMI), comorbidities and MA Ⅱ scores before and after operation were counted. The difference between the QOL of pre- and post-operation was analyzed.Results:All the patients completed the questionnaire. The Cronbach α coefficient of the questionnaire was higher than 0.7. The post-operational scores of 6 items were significantly higher than that of pre-operation. ( P<0.001). The proportion of "poor" and "very poor" QOL in the pre-operational patients was 43.8%, compared with 0 in the post-operative patients;the proportion of "good" and "very good" QOL in the pre-operatve patients was 4.7%, compared to 86.7% in the post-operative patients ( χ2=146.863, P<0.001). Conclusions:MA Ⅱ questionnaire is a professional, easy oprated tool for assessment of QOL associated with obesity.

Objective To investigate the application value of neutrophil count(N),neutrophil percentage(N％),neutrophil to lymphocyte ratio(NLR)and neutrophil to albumin ratio(NAR)in the evaluation of ul-cerative colitis(UC)patients.Methods A total of 87 UC patients admitted to the hospital from May 2022 to July 2023 were collected as the UC group,and 42 healthy people in the same hospital during the same period were selected as the control group.Blood routine and biochemical routine related inflammatory indicators in-cluding lymphocyte count(L),N,lymphocyte percentage(L％),N％,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),albumin(ALB)were collected,NLR and NAR were calculated.The clinical data of UC patients were collected.According to medical history,modified Mayo scoring system and Montreal classifi-cation criteria,UC patients were divided into clinical types,disease activity and lesion extent.The levels of N,N％,NLR and NAR in the control group and UC group and different subgroups of UC were evaluated.Spearman correlation analysis was used to analyze the correlation between the four indexes and ESR and CRP.The receiver operating characteristic curve was drawn to test the diagnostic efficacy of the four indicators a-lone and in combination in the detection of UC patients,and the best cut-off value,sensitivity and specificity were calculated.Results The levels of N,N％,NLR and NAR in UC group were higher than those in control group,and the differences were statistically significant(P＜0.05).There were significant differences in N,N％,NLR and NAR levels between UC patients with different activity and lesion range(P＜0.05).Spearman correlation analysis showed that CRP level was positively correlated with N,N％,NLR and NAR in UC pa-tients(r=0.392,0.343,0.354,0.503,P＜0.001).ESR level was positively correlated with N,NLR and NAR(r=0.383,0.233,0.475,P＜0.05).The area under the curve of N,N％,NLR and NAR alone and in combi-nation were 0.668,0.702,0.723,0.741 and 0.882,respectively.The sensitivity and specificity of the combina-tion of the four were higher(80.5％and 88.1％,respectively).Conclusion N,N％,NLR and NAR have cer-tain clinical value in the diagnosis,disease activity and lesion extent prediction of UC patients.

Objective To establish a method using supramolecular solvent and gas chromatography-tandem mass spectrometry （GC-MS/MS） to analyze 9 benzodiazepines in urines. Methods Urine samples containing 9 benzodiazepines reference substance were subjected to liquid-liquid extractions with supramolecular solvent, which consisted of tetrahydrofuran and 1-hexanol. The solvent layer was evaporated to dryness by stream of nitrogen. The residue was reconstituted with methanol, and GC-MS/MS analysis was performed on it. The way of data collection was multiple reaction monitoring （MRM） mode; internal standard method was employed for quantification. Results In urine samples, when the range of mass concentration was 1-100 ng/mL for diazepam, midazolam, flunitrazepam and clozapine, 5-100 ng/mL for lorazepam and alprazolam, 2-100 ng/mL for nitrazepam and clonazepam, and 0.2-100 ng/mL for estazolam, respectively, good linearities were obtained, correlation coefficients were 0.999 1-0.999 9, the lower limits of the quantifications ranged from 0.2 to 5 ng/mL, the extraction recovery rates were 81.12%-99.52%. The intra-day precision ［relative standard deviation （RSD）］ and accuracy （bias） were lower than 9.86% and 9.51%, respectively; the inter-day precision （RSD） and accuracy （bias） were lower than 8.74% and 9.98%, respectively. Nine drugs in urine samples showed good stability at ambient temperature and -20 ℃ within 15 days. The mass concentrations of alprazolam in urine samples obtained from 8 volunteers who took alprazolam tablets orally within 8-72 h after ingestions ranged from 6.54 to 88.28 ng/mL. Conclusion The supramolecular solvent extraction GC-MS/MS method for analysis of 9 benzodiazepines in urines provided by this study is simple, fast, accurate and sensitive, which can provide technical support for monitoring of poisoning by benzodiazepines for clinical treatment and judicial identification.
Benzodiazepines ; Chromatography, Liquid ; Gas Chromatography-Mass Spectrometry ; Humans ; Solvents ; Tandem Mass Spectrometry