AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA scree...AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.展开更多
BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in pr...BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).展开更多
Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usua...Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.展开更多
Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to...Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to control beam profiles,but the spacer length should be well controlled to obtain desired beam profiles and thus it sets an obstacle in mass catheter fabrication.Besides,although GRIN lens with large gradient constant can provide tight focus spot,it has short depth of focus and fast-expanded beam which leads to poor lateral resolution for deep tissue.In this paper,a type of spacer-removed probe is demonstrated with a small gradient constant GRIN lens.This design simplifies the fabrica-tion process and is suitable for mass production.The output beam of the catheter is a narrow nearly collimated light beam,referred to as pencil beam here.The full width at half maximum beam size varies from 35.1μm to 75.3μm in air over 3-mm range.Probe design principles are elaborated with probe/catheter fabrication and performance test.The in vivo imaging of the catheter was verified by a clinical ICOCT system.Those results prove that this novel pencil-beam scanning catheter is potentially a good choice for ICOCT systems.展开更多
Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibro...Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.展开更多
Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atheroscleroti...Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.展开更多
Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT an...Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.展开更多
Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with u...Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.展开更多
PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more a...PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.展开更多
Familial hypercholesterolemia(FH)is an autosomal dominant genetic disorder,which resulted in severe elevations in low-density lipoprotein cholesterol(LDL-C)and a markedly increased risk of early-onset coronary disease...Familial hypercholesterolemia(FH)is an autosomal dominant genetic disorder,which resulted in severe elevations in low-density lipoprotein cholesterol(LDL-C)and a markedly increased risk of early-onset coronary disease.[1]t is most frequently caused by loss-of-function mutations in genes affecting the LDL receptor,which clears LDL particles from plasma.展开更多
A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast...A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast-enhanced computed tomography showed right renal artery stenosis suspicious of FMD.展开更多
文摘AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.
基金funded by grants from National Natural Science Foundation of China(81100141 and 81570322 for JJ,81320108003 for JW)jointly supported by Boston Scientific
文摘BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.
基金financial supports from the National Natural Science Foundation of China(Grant No.81927805)Shenzhen Municipal Science and Technology Plan Project,China(Grant No.JCYJ20160427183803458)。
文摘Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to control beam profiles,but the spacer length should be well controlled to obtain desired beam profiles and thus it sets an obstacle in mass catheter fabrication.Besides,although GRIN lens with large gradient constant can provide tight focus spot,it has short depth of focus and fast-expanded beam which leads to poor lateral resolution for deep tissue.In this paper,a type of spacer-removed probe is demonstrated with a small gradient constant GRIN lens.This design simplifies the fabrica-tion process and is suitable for mass production.The output beam of the catheter is a narrow nearly collimated light beam,referred to as pencil beam here.The full width at half maximum beam size varies from 35.1μm to 75.3μm in air over 3-mm range.Probe design principles are elaborated with probe/catheter fabrication and performance test.The in vivo imaging of the catheter was verified by a clinical ICOCT system.Those results prove that this novel pencil-beam scanning catheter is potentially a good choice for ICOCT systems.
基金supported by Zhejiang Natural Science Foundation (LY18H020007 and LQ16H020001)National Natural Science Foundation of China (81500212 and 81800212)。
文摘Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.
文摘Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
文摘Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.
基金This work is supported by China Capital Medical Development Fund(C03030201).
文摘Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.
文摘PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.
基金the National Natural Science Foundation of China(No.81370443&No.81170793).
文摘Familial hypercholesterolemia(FH)is an autosomal dominant genetic disorder,which resulted in severe elevations in low-density lipoprotein cholesterol(LDL-C)and a markedly increased risk of early-onset coronary disease.[1]t is most frequently caused by loss-of-function mutations in genes affecting the LDL receptor,which clears LDL particles from plasma.
文摘A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast-enhanced computed tomography showed right renal artery stenosis suspicious of FMD.
