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.
During the medical rescue of Wenchuan earthquake, in accordance with the instruction of the Chinese Ministry of Health, West China Hospital set up the Medical Supply Center for Medical Teams from Other Provinces, put up standard storehouses within 10 hours, performed professional purchase, precisely distributed medical materials according to relevant demands, and decided the scientific route based on the distribution of medical teams from other provinces, so as to ensure the medical materials’ being delivered to the medical teams safely, promptly and accurately.
A 7.1-magnitude earthquake hit china again, 702 days after Wenchuan Earthquake at Yushu prefecture of Qinghai province, 4000 meters above sea level. Up to April 19th, the death toll climbed to 1706, with 256 missing and 12128 injured. West China Hospital, as a regional state-level hospital of Ministry of Health, organized the first batch of medical team with relief supplies at the first day after Yushu earthquake and rushed to Yushu taking part into the rescue effort in golden seventy-two hours. The second day after Yushu earthquake, medical apparatus and drugs valued 5,000,000 RMB were delivered to the rescue site and the second batch of medical team were positioned. Within thirty three hours after the earthquake, 102 people, including 93 earthquake related injuries and 9 armed police with severe altitude illness, were sent to our hospital by air in four batches successively. Based on the first-hand experience of medical rescue in Wenchuan Earthquake, a series of diagnosis and treatment criteria which were built and developed with evidence-based method, and “four concentration principles”, namely concentrating the wounded, concentrating the experts, concentrating resources, and concentrating treatments, our medical rescue in Yushu earthquake were carried out appropriately. Up to 12 am., April 19th, 93 cases from the disaster area have been treated, of whom 54 seriously wounded, 58 underwent operations and none death. The experience learnt from Wenchuan Earthquake have been used, improved and sublimated more rapidly, more appropriately, more effectively in the Yushu earthquake medical rescue.
With the establishment and development of regional healthcare big data platforms, regional healthcare big data is playing an increasingly important role in health policy program evaluations. Regional healthcare big data is usually structured hierarchically. Traditional statistical models have limitations in analyzing hierarchical data, and multilevel models are powerful statistical analysis tools for processing hierarchical data. This method has frequently been used by healthcare researchers overseas, however, it lacks application in China. This paper aimed to introduce the multilevel model and several common application scenarios in medicine policy evaluations. We expected to provide a methodological framework for medicine policy evaluation using regional healthcare big data or hierarchical data.
ObjectiveTo observe the changes of peripapillary vessel density and retinal nerve fiber layer parameters (RNFL) in diabetic mellitus (DM) patients with early diabetic retinopathy (DR).MethodsA retrospective clinical study. From January to December 2018, twenty-eight DM patients (47 eyes, DM group) and 20 normal subjects (40 eyes, control group) in Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. There was no significant difference between the two groups in age (t=－1.397, P=0.169) and sex composition ratio (χ2=0.039, P=0.843). The optic nerve head was scanned by OCT angiography (OCTA) with HD 4.5 mm ×4.5 mm imaging scanning mode for all subjects. The peripapillary radial peripapillary capillaries vessel density (ppVD) and peripapillary retinal nerve fiber layer (pRNFL) thickness were measured. The changes of ppVD and pRNFL thickness between the two groups were observed. Pearson correlation analysis was used to analyze the correlation between ppVD and pRNFL in each quadrant.ResultsCompared with the control group, the mean ppVD and superior-hemi part, inferior-hemi part, superior, nasal, inferior and temporal quadrant ppVDs of DM group were all significantly lower than those of control group (t=5.107, 4.360, 3.713, 4.007, 2.806, 4.046, 2.214; P＜0.05). The mean and all quadrants pRNFL thickness were lower in eyes of DM group compared with the control, and the superior and inferior quadrant pRNFL thickness were statistically significant (t=2.117, 2.349; P＜0.05), while the mean pRNFL and superior-hemi, inferior-hemi part, nasal and temporal quadrant were not statistically significant (t=1.867, 1.717, 1.869, 0.720, 0.303; P＞0.05). Pearson correlation analysis showed that the significant high-positive correlation was found between ppVD and pRNFL thickness in the nasal quadrant (r=0.734, P＜0.001).ConclusionIn early DR patients, ppVD decreased and pRNFL thinned.
ObjectiveTo evaluate macular microvessel changes in familial exudative vitreoretinopathy (FEVR) by optical coherence tomography angiography. MethodsCross-sectional clinical case-control study. From November 2019 to November 2020, 21 FEVR patients (41 eyes) from Weifang Eye Hospital were selected; 17 healthy volunteers (28 eyes) with the same age and gender as FEVR group were selected as normal control group. According to the best corrected visual acuity (BCVA) 1.0 and ＜1.0, FEVR group was divided into normal visual acuity group (27 eyes) and visual acuity decreased group (14 eyes). All enrollees received BCVA and OCTA. BCVA was performed with an international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) vision. The OCTA instrument was used to scan the macular area of all the examined eyes in the range of 3 mm×3 mm, 6 mm×6 mm, and the blood vessel density (VD) and blood perfusion density (PD) within the range of 3 mm×3 mm, 6 mm×6 mm were measured and the area, circumference, and morphological index of the foveal avascular zone (FAZ) within the range of 6 mm×6 mm. Quantitative data were compared between groups by independent sample t test. Statistical data were compared by χ2 test. The area under curve (AUC) of each index was determined according to receiver operating characteristic curve (ROC curve), and the predictive value of each index was evaluated. ResultsIn the macular area of 6 mm×6 mm, VD, PD, FAZ area and FAZ perimeter of FEVR group were all lower than those of normal control group, and the differences were statistically significant (t=−3.350, −2.387, −3.519, −3.029; P＜0.05). In macular area of 3 mm×3 mm and 6 mm×6 mm, compared with normal vision group and vision loss group, both VD and PD decreased. The differences were statistically significant (t=2.088, 2.114, 2.160, 2.545; P＜0.05). In the macular area of 6 mm×6 mm , the FAZ morphological index of the two groups was significantly different (t=2.409, P＜0.05). ROC curve analysis showed that all the indicators had low diagnostic value for FEVR (AUC＜0.5). ConclusionThere are microvascular abnormalities in macular area in FEVR patients, and the decrease of blood vessels and the change of FAZ shape may be related to the loss of visual acuity.
ObjectiveTo explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center.MethodsWe retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT.ResultsA total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but benign nodules were still considered as lung cancer at the first diagnosis in 10 patients.ConclusionAI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.
Six patients with moderate to advanced primary carcinoma of the liver were treated in this hospital with perfusion chemotherapy and embolization through the regional portal vein under the guidance of B-ultrasongraph rather than (with) operatie catheteization of the portal vein. The results show that all the tumor masses were reduced in size after the treatment (1.2-3.2cm, average value 1.9cm). It might be a new way for treating the primary carcinom of liver. The detailed procedure is descibed and the effects are also discussed in this article.
ObjectiveTo observe the blood perfusion changes of peripapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).MethodsRetrospective cohort study. Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People’s Hospital of Wuhan University from November 2017 to January 2019 were included in this study. There were 10 males and 9 females, with the mean age of 55.05±7.11 years. Forty eyes of 20 normal subjects matched with NAION patients were included as controls. BCVA, fundus color photography, SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks, 1-2 months, 3-5 months intervals. OCT quantitative measurements: average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL), average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC). OCTA quantitative measurements: average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC), average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD), average vascular density of deep layer retina (aDVD), areas of foveal avascular zone (FAZ). The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed. Independent sample t test, paired sample t test or nonparametric rank sum test were performed for comparison among three groups. Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC, GCC and SVD, RNFL and GCC, RPC and SVD.ResultsAt baseline, the aRNFL, aRPC and aDVD of NAION patients were significantly higher than those of normal controls. Compared with the fellow eyes, the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes. The overall differences of aRNFL, aRPC, aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05). The average sRNFL, sRPC, sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL, iRPC, iGCC and iSVD (P＜0.05). Correlation analysis: at 1-2 months interval, aGCC was positively correlated with aSVD (r=0.482, P=0.037); at 3-5 months interval, aRNFL was positively correlated with aRPC (r=0.631, P=0.037).ConclusionThere is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.
Objective To observe the optic disc perfusion in anterior ischemic optic neuropathy (AION) patients. Methods Forty eyes of 40 AION patients and 30 eyes of 30 normal subjects were included. The stage of the diseases was defined based on the course of the disease, including acute stage (less than 3 weeks) and recovery stage (more than 3 months). Optic disc blood flow area, outer vascular density and blood flow index were measured by optical coherence tomography angiography in all the subjects. Optic disc perfusion was observed in acute and recovery stage of disease. Results The optic disc blood flow area, outer vascular density and blood flow index were decreased of AION eyes in acute stage compared with the normal subjects, the difference was statistically significant (P < 0.05); while the optic disc blood flow area, outer vascular density and blood flow index of AION eyes in the recovery stage showed no significant difference compared with normal subjects (P > 0.05). ConclusionDisc perfusion is reduced in AION at the acute stage, but recovered at the recovery stage.