目的 探讨不典型胎盘早剥的临床特点。 方法 对2008年5月－2009年5月收治的55例胎盘早剥患者的临床资料进行回顾性分析。其中产前漏诊30例，疑诊15例，确诊10例。胎盘早剥的产前确诊率为18.2%，漏诊率为54.5%。所有患者均经产后证实。 结果 重度子痫前期（25.5%）、胎膜早破（12.7%）是胎盘早剥的主要发病诱因；阴道流血（52.7%）、腰腹痛（47.3%）及胎心异常（36.4%）是其常见的临床表现。胎盘早剥者，剖宫产率、胎儿窘迫及早产率均增加。 结论 不典型胎盘早剥病情隐匿。后壁胎盘、早剥面积小及B型超声检查阴性是漏诊的主要原因。对此患者应提高认识，动态监测，及时处理，以改善母婴结局。
Objective To investigate and analyze the cognition of intraspinal labor analgesia (ILA) of women in labor and its influencing factors. Methods A total of 322 women in labor in West China Second University Hospital of Sichuan University between May and September 2015 were investigated by questionnaire, which included the general situation, the pregnancy status, the understanding for labor pain, and the cognition of ILA. Investigator introduced the knowledge of ILA to them after the investigation, and then they were re-investigated for the choice of ILA. Results Only 22.67% of these women in labor knowed ILA clearly, 53.42% heared it but did not understand, and 49.38% liked to use it. The proportion of women in labor who liked to use it increased to 81.89% after introduction, and the difference was significant (P<0.001). Among all factors, the acknowledgement level of ILA and the choice to use it were mainly related to the family awareness concept for labor pain. Conclusions The cognition of ILA of women in labor is not enough, and their using desire is not strong. The family awareness concept is one of the important factors. The education and advertise to the women in labor and their family members after admiting to labor room can increase the choice rate of ILA significantly.
Objective To provide evidence for establ ishing a health care system for pregnant women after disasters by evidence-based evaluation on the comparison of programs in different countries of the world. Methods We electronically searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966 to June 2008), EMbase (1984 to June 2008), VIP ( 1989 to June 2008), CBM ( 1978 to June 2008), Wangfang database (1997 to June 2008), CNKI (1994 to June 2008) and handsearched Journals such as Chinese Journal of Obstetrics and Gynecology to identify l iteratures and guidel ines on pregnant women healthy care system after calamity. The qual ity of l iteratures and guidel ines was assessed. Results A total of 293 studies were searched, of which 25 studies were identified with the focuses on the consequence of pregnancy, development of fetus and first-aid of injuries of pregnant women. We found the studies on pregnant women’s health care were l imited, and most of them were retrospective and cohort studies, which was related to the paroxysmal ity, rarity and complexity of the disaster.? Conclusions The high proportion of pregnant women among displaced persons underscores the importance of examining how behavioral changes and difficulties in access to health care influencing the maternal and infant health, which needs comprehensive planning and arrangement.
Objective To investigate the clinical manifestations and spectral-domain optical coherence tomography (SD-OCT) imaging features of acute zonal occult outer retinopahy (AZOOR) and to explore the role of SD-OCT in the diagnosis and follow-up of AZOOR. Methods Retrospective analysis of clinical data of 52 cases (66 eyes) who were diagnosed through comprehensive eye examinations including best corrected visual acuity, fundus exam, OCT, electroretinogram (ERG), fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Results A total of 52 cases of AZOOR (66 eyes) were collected. The majority of patients complained of blurred vision, photopsia and acute onset of a scotoma. In this group, 24 cases (28 eyes) with normal fundus were defined as AZOOR typeⅠ, while the other 28 cases (38 eyes) with fundus changes were AZOOR type Ⅱ, including 9 eyes of multiple evanescent white dot syndrome (MEWDS), 25 eyes of punctate inner choroidopathy (PIC),4 eyes of multifocal choroiditis (MC). All typeⅠcases went through visual field, ERG and OCT tests. The most common visual field defect was central and paracentral scotoma, which was seen in 15 eyes (53.6%). Nine eyes (32.1%) presented with blind spot enlargement or even associated with other visual field defects. Four eyes (14.3%) showed scattered scotoma. In the series of 24 typeⅠcases （28 eyes）, 12 eyes (42.9%) demonstrated depressed scotopic and photopic amplitudes, and nine eyes only yielded reduced scotopic amplitudes, while seven eyes showed normal. All OCT showed an absence of both the inner and outer segment (IS/OS) line, and (or) the cone outer segment tip (COST) line between the IS/OS line and RPE. Many grey-white or yellowish white punctuate lesion of different sizes were found in posterior pole of the fundus in all of type Ⅱ AZOOR which were more obvious in FFA. The manifestations of OCT showed IS/OS irregularity or absence in the area corresponding to the lesions. At final follow up from 15 days to two years, the IS/OS line became discernible in 13 of 24 typeⅠcases got discernible IS/OS line, while it was still absent in the other 11 case. During one to two month follow up period, nine eyes of MEWDS and four eyes of MC showed the presence of the a continuous IS/OS line in their OCT images after treatment, but there is no significant change for 25 eyes of PIC. ConclusionsOCT showed abnormalities in the microstructures of the outer retina, e.g., IS/OS line. The high resolution of OCT images has allowed better evaluations of the intraretinal IS/OS line in AZOOR, which presented a significant correlation with different stage in the course of AZOOR. In conclusions, OCT plays an important role in the diagnosis and follow up in AZOOR.
Objective To observe the characteristics of spectraldomain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) in acute and chronic central serous chorioretinopathy (CSC).Methods Seven-three eyes of 67 patients with CSC diagnosed by slit-lamp microscopy, fundus photochromy, fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study. All the patients were examined for FAF and SD-OCT. The patients were divided into acute CSC group (37 patients, 37 eyes) and chronic CSC group (30 patients,36 eyes) according to the clinical features and FFA images. According to the OCT feature in retinal detachment area, they were divided into three categories, which including intact, non-intact and atrophy outer segment, respectively. According to the FAF characteristics, they were divided into hyper-FAF, hypo-FAF and mixed type, respectively. The characteristics of SD-OCT and FAF of both acute and chronic CSC patients were evaluated and analyzed. Results In acute CSC group, 19 eyes (51.35%) were hypo-FAF, 18 eyes (48.65%) were hyper-FAF. In chronic CSC group, two eyes (5.56%) were hypo-FAF, 16 eyes (44.44%) were hyper-FAF, and 18 eyes (50.00%) were mixed type. There was significant difference between both groups (chi;2=31.872,P=0.000). The SD-OCT results showed that in acute group, 15 eyes (40.54%) were intact outer segment, 18 eyes (48.65%) were non-intact outer segment, and four eyes (10.81%) were atrophy outer segment. In chronic group, five eyes (13.89%) were intact outer segment, 17 eyes (47.22%) were non-intact outer segment, and 14 eyes (38.89%) were atrophy outer segment. There was significant difference between both groups (chi;2=10.572,P=0.005). Conclusions The FAF characteristics of acute and chronic CSC mainly manifests hypo-FAF and mixed type, respectively. The OCT characteristics of acute CSC mainly manifests intact outer segment and non-intact outer segment, but non-intact outer segment and atrophy outer segment in chronic CSC.
Objective To investigate the role of adenosine A2A receptor plays in retinal pathological neovascularization in mice. Methods A total of 202 mice were divided into room-air group (n=66) and oxygen induced retinopathy (OIR) group (n=136). Among room-air group, there were 18 A2A knock-out (KO) mice (KO subgroup) and 24 C57BL/6 mice as wide type (wide type subgroup). OIR group were divided into OIR control subgroup (n=48), A2A-OIR subgroup (n=24) and Caffeine-OIR subgroup (n=64). The retinal neovascularization of OIR group was induced by oxygen. The pathological neovascularization was determined by retinal sections. Fluorescent quantitative polymerase chain reaction (PCR) was used to measure the mRNA expression of A2A and vascular endothelial growth factor (VEGF). 0.1, 0.3, 1.0 g/L Caffeine was dissolve in drinking water of lactating females in Caffeine-OIR subgroup, non-perfusion areas of retina in mice at the age of 0 - 17, 0 - 7, 7- 17, 7-12, and 12- 17 days were analyzed in different dosage and when the dosage as 1.0 g/L. Results Compared with OIR control subgroup, the retinal non-perfusion areas and the numbers of endothelial cell nuclei breaking through the internal limiting membrane in A2A- OIR subgroup were reduced significantly (t=7.694, 7.747;P＜0.001). Compared with wide type subgroup, the level of A2A and VEGF mRNA in OIR control subgroup increased significantly (t=4.036, 2.230;P＜0.05). Compared with OIR control subgroup, the level of VEGF mRNA in A2A- OIR subgroup decreased significantly (t=3.122,P＜0.01). Compared with OIR control subgroup, the retinal non-perfusion areas in mice at the dosage of 0.1 and 1.0 g/L (t=2.397, 4.533) and at the age of 0 -17, 0 -7 days when the dosage as 1.0 g/L (t=4.070, 2.399) were reduced significantly (P＜0.05). Conclusions The expression of adenosine A2A receptor increases in oxygen-induced retinal pathological neovascularization. Adenosine A2A receptor may regulate the expression of VEGF. A2A receptor inactivation can inhibit oxygen-induced retinal pathological neovascularization.
Objective To observe the types and features of Bruchprime;s membrane (BM) in the choriocapillarioBruchprime;s membraneretinal pigment epithelium complex (CBRP-C) in central serous chorioretinopathy (CSC) by optical coherence tomography (OCT). Methods This is a retrospective case control study. Sixty eyes of 60 patients (43 males, 17 females) with CSC who underwent laser photocoagulation (51 eyes) or half-dose verteporfin photodynamic therapy (9 eyes) were enrolled. The macular area of all the patients was scanned by SpectralisOCT before and after the treatment, BM was observed as the core indicators of CBRP-C. According to the reflection band,BM was classified into distinguishable BM and indistinguishable BM. The distinguishable BM was classified into phenotype BM (with a subRPE fluid cavity) and cryptotype BM (without a sub-RPE fluid cavity). The types and features of BM in CBRPC of CSC patients before and after the treatment were comparatively analyzed. Results Before the treatment, distinguishable BM were observed in all patients, including 59 eyes (98.3％) with phenotype BM and 1 eye (1.7％) with cryptotype BM. At 1 month after laser photocoagulation, there were, 1/51 eye (2.0%) with indistinguishable BM, and 50/51 eyes (98.0%) with distinguishable BM, including 34 eyes (68.0%) with phenotype BM and 16 eyes (32.0%) with cryptotype BM. At 1 month after half-dose PDT, there were 1/9 eye (11.1%) with indistinguishable BM and 8/9 eyes (88.9%) with distinguishable BM, including 1 eye (12.5%) with phenotype BM and 7 eyes (87.5%) with cryptotype BM. Conclusion The phenotype BM exists in CSC patients before and after the treatment, but it has been improved after treatment.
ObjectiveTo observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV). MethodsEighty-six eyes of 79 patients with PCV were enrolled in this study. There were 60 males (65 eyes) and 19 females (21 eyes). The average age was (64.48±13.15) years old. Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured. The average BCVA was 0.19±0..20. There were three groups in this study including photodynamic therapy (PDT) group (group A, 45 eyes), PDT and intravitreal ranibizumab injection group (group B, 31 eyes), and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C, 10 eyes). Follow up begun at 1 month after the treatment. 40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months. 9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months. Patients with recurrent or worsen lesions were followed by FFA or ICGA. Pre- and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed. ResultsAll eyes (100.0%) in group A, 20 eyes (64.52%) in group B and 9 eyes (90.00%) in group C received treatment only once. The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061, 3.262, 3.258; P<0.05), but no significant difference was found between the 3 groups (t=1.345, 0.683, 0.168; P>0.05). Compared to pre-treatment measures, the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239, 4.334; P<0.05), but not changed in group C (t=2.286, P>0.05) at 1 month after treatment. Thirteen eyes in group A were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED), 4 eyes with partial closed PCV, 3 eyes with stable PCV and 3 eyes with worsen PCV. Ten eyes in group B were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV, 3 eyes with partial closed PCV, 4 eyes with recurrence PCV. Five eyes in group C were followed by FFA and (or) ICGA, which showed that there were 4 eyes with complete closed PCV, 1 eyes with recurrence PCV. ConclusionAll 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.