Objective To investigate the early influences of laser photocoagulation on retinal function in diabetic retinopathy(DR)． Methods The multifocal electroretinograms (MERG) of 30 eyes with DR (phase Ⅲ～Ⅳ) were tested with visual evoked response image system IV b efore,and the 3rd day and the 7th day after laser photocoagulation． Results Three days after photocoagulation, the latency of N1 prolonged in the central macula 5deg; area and superionasal quadrant．Th e response densities of N1,P1 and N2 markedly reduced, and most significant changes occurred in the central macula 5deg; area and then in the central 10deg;area． There were also differences in the changes of the amplitude of N1 and P1 in diff erent quadrants ．The changes of visual acuity were positively related to the de crease of amplitudes of N1,P1 and N2 in the macula． Conclusion The reduction of response densities in MERG reveals functional damage in diabetic retina occurring early after photocoagulation．The functional damage in macula induced indirectly by photocoagulation may explain the reduction of visual acuity after panretinal photocoagulation in some degree． (Chin J Ocul Fundus Dis, 2001,17:181-183)
Platelet aggregation test (PAgT), platelet adhesion test (PAdT), thromboplastic activity of factor Ⅷ (FⅧ∶c), antithrombin Ⅲ activity (AT-Ⅲ∶a), antithrombin Ⅲ antigen (AT-Ⅲ∶Ag), von willebrand factor (vWF) and fibrinogen (Fg) were measured in 33 patients with biliary tract diseases and 24 normal individuals. The results showed that there was no significant difference in PAgT, PAdT, AT-Ⅲ∶a and AT-Ⅲ∶Ag between the two groups (Ｐ＞0.05). Fg increased more significantly in biliary tract disease than in the controls (Ｐ＜0.01). FⅧ∶c increased more significantly in patients with obstructive jaundice than in that of nonjaundiced and the controls (Ｐ＜0.01). The levels of vWF increased higher and higher in the sequence of patients with no jaundice, obstructive jaundice due to benign diseases and obstructive jaundice due to malignancy(Ｐ＜0.01). In conclusion, Fg, FⅧ∶c and vWF increased in patients with biliary tract disease.
Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P＜0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P＜0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P＜0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.
ObjectiveTo analyze the global status, hotspots, and trends in atrial fibrillation anticoagulation research.MethodsWe searched Web of Science Core Collection to collect relevant literature on atrial fibrillation anticoagulation from 2006 to 2020. The visualization software CiteSpace and VOSviewer were used to analyze co-citation, co-occurrence, and emergence analysis on publishing organizations, journals, and keywords and to explore the research hotspots and frontiers.ResultsA total of 11764 related studies were retrieved. In recent years, research on anticoagulation of atrial fibrillation has become increasingly popular. Most of the published researches were from North America, and the primary institution was the University of Birmingham. Research hotspots mainly focused on warfarin, stroke prevention, new oral anticoagulants, antithrombotic and anticoagulants, and complicating diseases. The research frontiers were the new oral anticoagulants, and the antithrombotic management of atrial fibrillation with coronary heart disease.ConclusionsThe global hotspot in atrial fibrillation anticoagulant research is warfarin, stroke prevention, new oral anticoagulants, antithrombotic and antiplatelet therapy, and complicated diseases. The research focuses on the study of novel oral anticoagulants and the antithrombotic management of atrial fibrillation complicated with coronary heart disease.
Objective To investigate the effects of component blood transfusion combined with heparin therapy on coagulation function and clinical outcomes in pregnant women with acute disseminated intravascular coagulation (DIC). Methods A retrospective analysis was conducted on the clinical data of 65 pregnant women with acute DIC who were treated in Obstetrics Department of Luzhou People’ s Hospital between March 2020 and March 2022. Pregnant women treated with component blood transfusion were included in the control group, while those treated with component blood transfusion combined with heparin were included in the observation group. Before and after treatment, the DIC scoring system was used for score evaluation. Coagulation function indicators and routine blood indicators were compared between the two groups of pregnant women. Adverse clinical outcomes and adverse reactions were observed in both groups of pregnant women. Results The study enrolled 65 pregnant women, comprising 30 in the observation group and 35 in the control group. Before treatment, there was no statistical difference in DIC score, coagulation function indicators, or routine blood indicators between the two groups (P>0.05). After treatment, the DIC score, prothrombin time, activated partial thromboplastin time, thrombin time, and D-dimer significantly decreased in both groups (P<0.05), and the above indicators in the observation group [3.39±0.48, (13.28±2.28) s, (24.68±2.06) s, (14.27±1.82) s, and (2.23±0.88) mg/L, respectively] were lower than those in the control group [4.11±1.56, (15.02±2.45) s, (26.79±3.18) s, (15.61±1.91) s, and (2.87±0.74) mg/L, respectively] (P<0.05). The levels of fibrinogen, platelet count, hemoglobin, and hematocrit significantly increased in both groups (P<0.05), and the levels in the observation group [(4.29±1.05) g/L, (175.36±20.46)×109/L, (84.09±7.27) g/L, and (25.49±3.13)%, respectively] were higher than those in the control group [(3.44±1.27) g/L, (145.77±21.12)×109/L, (76.58±7.13) g/L, and (23.03±3.05)%, respectively] (P<0.05). The observation group had a lower incidence rate of adverse clinical outcomes compared to the control group (33.3% vs. 74.3%, P<0.05). The incidence rates of adverse reactions were not statistically different between the two groups (P>0.05). Conclusions Component blood transfusion combined with heparin therapy for pregnant women with acute DIC can effectively improve their coagulation function, reduce the risk of bleeding, and further improve adverse clinical outcomes such as postpartum hemorrhage and hysterectomy. Additionally, this treatment approach demonstrates a high safety profile.
Objective To evaluate the single-use of laser photocoagulation (LP) and the combined-use of laser photocoagulation plus intravitreal triamcinolone (LP+IVTA) for diabetic macular edema (DME) in terms of clinical therapeutic effect and safety. Methods Such databases as The Cochrane Library, Medline, Embase, CBM, CNKI and Wanfang Data were searched from the date of their establishment to September 2011, and the references of all included studies were also traced, so as to identify the randomized controlled trials (RCTs) on LP vs. LP+IVTA for DME. The quality assessment and data extraction were conducted in accordance with the Cochrane Handbook 5.0 by two reviewers independently, and then Meta-analyses were conducted using RevMan 5.0 software. Results Ten RCTs involving 525 ill eyes were included, and all of them were classified as Grade B in methodological quality. Results of meta-analysis showed that: at the end of follow-up, there were significant differences between the LP+IVTA group and the LP group in the best corrected visual acuity (BCVA) (RR=–0.14, 95%CI –0.20 to –0.08, Plt;0.000 01), and the central macular thickness (CMT) (RR=–56.78, 95%CI –84.03 to –29.54, Plt;0.000 1). In comparison with the LP group, there were more people in the LP+IVTA group who needed to be treated for their elevated intraocular pressure and to have surgery for the progression of cataract. But no significant difference was found between the two groups in vitreous hemorrhage, retinal detachment, retinal vein occlusion and macular epiretinal membrane. Conclusion Current evidence of clinical research shows that the LP+IVTA is superior to LP in reducing macular edema and improving vision in the treatment of diabetic macular edema, but it may also result in a high incidence of elevated intraocular pressure and cataract. Because the methodological quality limitation of included studies may affect the authenticity of outcomes, this conclusion has to be further proved by more high-quality and large-scale clinical trials.
ObjectiveTo investigate the effects of intraoperative intermittent pneumatic compression (IPC) treatment on coagulation and fibrinolysis, lower extremity venous blood flow velocity, and deep venous thrombosis (DVT) in patients with gastric cancer (GC) after radical gastrectomy. MethodsThe patients with GC who underwent radical gastrectomy at Hebei Provincial People’s Hospital from July 2021 to July 2024 were retrospectively enrolled, then the patients were assigned into control group (the patients who did not receive intraoperative IPC) and study group (the patients who received intraoperative IPC), and the propensity score matching (PSM) method was used to conduct 1∶1 matching based on the basic characteristics such as age, gender, body mass index, comorbidities to ensure baseline comparability between the two groups. The incidences of postoperative DVT and lower extremity swelling, and coagulations [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT)] and fibrinolysis [D-dimer (D-D), fibrinogen (FIB), and fibrin degradation products (FDP)], as well as lower extremity venous blood flow velocity were analyzed after PSM. The locally weighted regression was used to analyze the correlation between the coagulation and fibrinolytic functions indexes and the lower extremity venous blood flow velocity. ResultsA total of 120 patients were matched (60 cases per group). The baseline characteristics of both groups were comparable (P>0.05). The incidences of DVT on day 7 and lower extremity swelling on day 1, 3, and 7 after surgery in the study group were significantly lower than those in the control group (P<0.05). The results of repeated-measures analysis of variance showed that there were statistically significant differences in the inter-group, time-related, and group-by-time interaction effects of coagulation and fibrinolysis indexes as well as lower extrimety venous blood flow velocities (P<0.05). The impact of the time factor on coagulation and fibrinolysis indexes and lower extrimety venous blood flow velocities varied with intraoperative IPC intervention measures. After surgery, the PT, TT, APTT, and lower extrimety venous blood flow velocities in the study group first decreased and then increased as compared with those before surgery, and the decrease degree was smaller and the increase degree was larger than those in the control group. After surgery, the D-D, FIB, and FDP in the study group first increased and then decreased as compared with those before surgery, and the increase degree was smaller and the decrease degree was larger than those in the control group. Both PT and TT were significantly positively correlated with femoral vein blood flow velocity (r=0.21, P=0.042; r=0.22, P=0.040), and both also showed significant positive correlations with popliteal vein blood flow velocity (r=0.25, P＜0.001; r=0.20, P=0.032). APTT was only significantly positively correlated with popliteal vein blood flow velocity (r=0.33, P＜0.001). D-D was negatively correlated with the flow velocities of the femoral vein, external iliac vein, and popliteal vein (r=–0.23, P=0.012; r=–0.22, P=0.047; r=–0.37, P<0.001). Both FIB and FDP were negatively correlated with the flow velocity of the femoral vein (r=–0.23, P=0.036; r=–0.27, P=0.002). FIB was also negatively correlated with the flow velocity of the popliteal vein (r=–0.26, P=0.038), and FDP was negatively correlated with the flow velocity of the external iliac vein (r=–0.31, P<0.001). ConclusionBased on the results of this study, intraoperative IPC treatment could improve coagulation and fibrinolytic functions of patients with GC after surgery, and has a certain preventive effect on occurrence DVT of lower extremity.
Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years, ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132 (98.5±35.7) minutes, and average aortic cross-clamping time was 56-97 (68.40±23.78) minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.
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.
Objective To show the changes of coagulation function in patients with esophageal carcinoma, and to explore the clinical significance of the changes. Methods We retrospectively analyzed the clinical data of 202 patients(as a trial group, 114 males, 88 females, aged from 36 to 69 years, median age at 49 years) with esophageal carcinoma confirmed by pathological examination in Gansu Provincial Hospital from January 2010 through May 2014. The prothrombin time (PT), prothrombin time activity (PTA), international activated partial thromboplastin time (APTT), fibrinogen (Fib), D-Dimer, and platelet count, pathological type, TNM stage, gender were recorded. Eighty patients (38 males, 42 females, with aged of 39 to 71 years, median age of 51 years) without cancer were selected as a control group. Results Compared with the control group, coagulation parameters including PT, APTT, PLT, Fib, TT, D-Dimer were statistically higher in the trial group (P<0.05). Higher Fib level was found in the squamous cell esophageal carcinoma patients than adenocarcinoma cell esophageal carcinoma patients (P<0.05). Fib increased significantly (P<0.05) and APTT shorten (P<0.05) in the patients at stage Ⅲ and stage Ⅳ compared with those of patients at stage Ⅰ and stage Ⅱ. Fib and D-Dimer levels increased (P<0.05) in N1-3 patients compared with those of N0 patients. There was no statistical difference in gender or age (P>0.05) between the two groups. Conclusion Most of the patients with esophageal carcinoma have abnormal changes of coagulation and fibrinolysis system. Patients with squamous subtype and/or lymph node metastasis at advanced stages of esophageal carcinoma are prone to thrombophilia. So monitoring the coagulation parameters of cancer patients can be used as an effective measure to prevent blood clot.