Objective To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO). MethodsA single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients’ comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (＜6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke. ResultsAmong the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio (HR)=1.76, 95% confidence interval (CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke (HR=0.66, 95%CI 0.33-1.33, P=0.247). ConclusionsaCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.
Objective To verifying the characteristics of optical coherence tomography(OCT) in exudative age-related macular degeneration (AMD). Methods The patients being investigated in this series included 16 cases (19 eyes) of exudative age-related macular degeneration diagnosed by FFA and OCT examinations, among them 4 cases (6 eyes) were examined with ICGA. The color photographs of ocular fundi, FFA, ICGA and OCT were investigated by contrasting each other. Results As compared with the FFA and ICGA examinations, the characteristic findings found in OCT in patients with exudative AMD in this series were as the following:①serous detachment of neurosensory epithelium in 11 eyes,②retinal hemorrhage in 2 eyes,③serous detachment of retinal pigment epithelium in 5 eyes,④hemorrhagic detachment of retinal pigment epithelium in 10 eyes,⑤disciform scar in 4 eyes,⑥fibrovascular pigment epithelial detachment and occult CNV in 12 eyes. Conclusion OCT can supply a comprehensive survey of exudative AMD, in making the diagnosis as an important complementary examination of FFA and ICGA. (Chin J Ocul Fundus Dis,2000,16:220-223)
Objective To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP). Methods According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW2). Each had 5 decision thresholds (gt;97th percentile, gt;90th percentile, gt;75th percentile, gt;50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold. Results ① Both sensitivity and specificity of the four decision thresholds were relatively higher, including gt;90th percentile of RUS (sensitivity 0.836, specificity 0.916), gt;90th percentile of carpale (sensitivity 0.746, specificity 0.916), gt;90th and gt;75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F=2.03, P=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and between-observer reliability was 80.3% (Kappa 0.68, u=6.87, P＜0.01). Conclusions RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that ＞90th percentile of RUS is the best decision threshold.
Age-related macular degeneration (AMD) is an age-related neurodegenerative eye disease characterized by degeneration and progressive death of retinal pigment epithelium (RPE) and photoreceptor cells. In recent years, as a new treatment for AMD, stem cell therapy has attracted wide attention in the field of AMD, and has become a current research hotspot. Although stem cell therapy carries risks such as increased incidence of cancer and immune rejection, it significantly promotes damaged photoreceptor cells and retinal cells by differentiating into RPE cells and other retinal cell types, as well as secreting neurotrophic factors and extracellular vesicles. In particular, the development of embryonic stem cell-derived RPE cells, its cryopreservation technology and the advancement of plasmid, adeno-associated virus, Sendai virus and other delivery technologies have laid a solid foundation for stem cell therapy of AMD. As a new method to prevent retinal damage and photoreceptor degeneration, stem cell neuroprotective therapy has shown great potential, and with the continuous maturity and improvement of these technologies, stem cell therapy is expected to provide new ideas for the prevention and treatment of AMD in the future.
ObjectivesTo investigate the level of ankle-brachial index (ABI) of health examination population in Chongqing municipality and analyze the risk factors related to the level of ABI, so as to provide basis for effective evaluation of atherosclerotic lesions and their severity, as well as early detection, intervention and treatment of clinical cardiovascular diseases. MethodsA total of 22 886 subjects aged from 20 to 85 undergoing health examination in the medical examination center of First Affiliated Hospital of Chongqing Medical University in Chongqing municipality from January to December in 2016 were retrospectively analyzed. ABI and related physiological and biochemical data were collected. The relationship between ABI and age was analyzed using stepwise logistic regression model combined with restricted cubic splines. ResultsThe detection rate of abnormal ABI was 3.31% in 22 886 subjects undergoing health examination with 2.90% in males and 3.92% in females. The subjects aged below 40 presented the highest detection rate of abnormal ABI (6.17%) with 4.72% in males and 8.66% in females. The subjects were divided into two groups, one with ABI≤0.9 and one with ABI>0.9; the differences in age and levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) between the two groups were statistically significant (allP<0.05). Multivariate stepwise logistic regression combined with restricted cubic splines showed that age, gender and BMI were presented as independent factors affecting ABI, among which the age below 40 (OR=2.885, 95%CI (2.445, 3.404),P<0.0001) was the main risk factor. A curve relating age to probability of abnormal ABI was produced after correcting for the influences of sex and BMI, stratified by gender and BMI into different subgroups, showing a U-shaped curve of decreasing initially and then increasing between the probability of abnormal ABI and age. ConclusionsThe detection rate of abnormal ABI based on individuals undergoing health examination in Chongqing municipality was 3.31%. A U-shaped curve of downward trend followed by an upward one was shown between probability of abnormal ABI and age after correcting for the influences of gender and BMI. The clinical significance of ABI≤0.9 for youth population (20 to 40 years old) without cardiovascular risk factors requires further exploration.
Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as “Xinjiang Region”) in diagnosing fundus diseases. MethodsThe three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. ResultsAll the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination (P＜0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance (P＜0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance (P＜0.05). There was no significant correlation (P＞0.05) between the improvement of diagnostic level of participating physicians and educational background (Rho=0.07), professional title (Rho=0.13), age (r=0.20), and working time of ophthalmofundus disease specialty (r=0.26).ConclusionsRelying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.
ObjectivesTo analyze the trend of incidence and mortality of bladder cancer from 1990 to 2017 and the effects of age, time period and birth cohort on bladder cancer incidence and mortality.MethodsData on age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of bladder cancer from 1990 to 2017 were extracted from the Global Burden of Disease 2017 (GBD 2017) database. Joinpoint regression model was used to analyze the average annual percentage change of ASIR and ASDR of bladder cancer. The age-period-cohort model was established to analyze the age, period and birth cohort effects on ASIR and ASDR of bladder cancer.ResultsFrom 1990 to 2017, both ASIR and ASDR of bladder cancer decreased slightly. ASIR decreased from 6.42 per 100 000 in 1990 to 6.04 per 100 000 in 2017, with an average annual percentage change of −0.9% (−1.0% to −0.8%), and ASDR decreased from 3.15 per 100 000 in 1990 to 2017 2.57/100 000, with an average annual percentage change of −0.4% (−0.4% to −0.3%). The age-period-cohort model results showed that as age increased, the risk of bladder cancer incidence and mortality increased; as the birth cohort progressed, the risk of bladder cancer morbidity and mortality decreased. The time period had little effect on the incidence and mortality of bladder cancer.ConclusionsThe incidence and mortality of bladder cancer are declining globally. On the other hand, the increase of the aging global population could reverse the incidence and mortality trend, active measures should be taken to address the adverse effects of aging.
Objective To investigate the impact of peripheral artery disease (PAD) on the short-term prognosis after coronary artery bypass grafting (CABG) in patients of different age groups. MethodsRetrospective inclusion of patients who underwent CABG at Tongji Medical College Affiliated Union Hospital of Huazhong University of Science and Technology from 2016 to 2020. Divided into four groups by age (<50 years, 50-60 years, 60-70 years, >70 years). Propensity score matching (PSM) was used to balance the baseline characteristics of PAD and non PAD patients across different age groups. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) during the perioperative period. ResultsTotally, 1 516 patients were enrolled, including the GroupⅠ (<50 years, n=167), Group Ⅱ (50-60 years, n=477), Group Ⅲ (60-70 years, n=688), and Group Ⅳ (>70 years, n=184). After PSM treatment, a total of 375 pairs of patients (75.2% male) were successfully matched. Only in the age group of 60-70 years, the in-hospital mortality rate (7.73% vs. 1.45%, P＜0.01) and MACCE incidence rate (21.26% vs. 13.04%, P=0.02) of PAD patients were significantly higher than those of the non PAD group. Further multivariate analysis suggests that PAD is an independent risk factor for in-hospital mortality (OR=3.96, P＜0.01) and MACCE (OR=1.58, P=0.04) in this group, while there is no statistically significant difference in other age groups. Conclusion: PAD significantly increases the risk of recent mortality and MACCE in CABG patients aged 60-70 years, and perioperative management needs to be optimized for this population.