Predictors for attending annual eye screening for diabetic retinopathy amongst patients with diabetes in an urban community of Beijing

AIM： To gain a better understanding of possible factors that may influence the decision of diabetes persons to participate in annual eye screening in an urban community setting of China.METHODS： A structured interview including questions on attendance of eye screening, knowledge and awareness of diabetic retinopathy was conducted. The presence and degree of retinopathy were assessed using two field nonmydriatic retinal photography. RESULTS： Totally 720 diabetes persons were recruited and 519 were enrolled in this cross-sectional study. In this urban setting of Beijing, among diabetes patients of average of 10 y duration, 77% confirmed having undergone at least one eye examination and 61% reported having at least one eye examination with dilated pupil. As for the last 12 mo, the number decreased to 210（47%） and 131（30%） separately. Most of the participants（95%） were aware that diabetes could affect their vision and that regular eye examination was necessary. Very few of them（12%） however were aware that the early stages of diabetic retinopathy presented without symptoms of vision loss. Having attended patient education on diabetes was effective in building awareness about diabetic eye disease and was a significant positive predictor for attending eye screening [education in a year, Adj. OR=0.47（0.29-0.74）, P〈0.001, education years ago, Adj. OR=0.56（0.33-0.96）, P=0.036]. The duration of disease also increasedthe likelihood of having undergone eye screening（Adj. OR=0.96, P〈0.05）. CONCLUSION： Being exposed to education about the complications of diabetes increases the probability of attending diabetic eye screening. An appropriate patient knowledge building strategy should be made available to patients from the time of diagnosis.

Dose response and time course of manganeseenhanced magnetic resonance imaging for visual pathway tracing in vivo

Axonal tracing is useful for detecting optic nerve injury and regeneration,but many commonly used methods cannot be used to observe axoplasmic flow and synaptic transmission in vivo.Manganese（Mn^2＋）-enhanced magnetic resonance imaging（MEMRI） can be used for in vivo longitudinal tracing of the visual pathway.Here,we explored the dose response and time course of an intravitreal injection of Mn Cl2 for tracing the visual pathway in rabbits in vivo using MEMRI.We found that 2 m M Mn Cl2 enhanced images of the optic nerve but not the lateral geniculate body or superior colliculus,whereas at all other doses tested（5–40 m M）,images of the visual pathway from the retina to the contralateral superior colliculus were significantly enhanced.The images were brightest at 24 hours,and then decreased in brightness until the end of the experiment（7 days）.No signal enhancement was observed in the visual cortex at any concentration of Mn Cl2.These results suggest that MEMRI is a viable method for temporospatial tracing of the visual pathway in vivo.Signal enhancement in MEMRI depends on the dose of Mn Cl2,and the strongest signals appear 24 hours after intravitreal injection.

Surgical Treatment of Double Outlet Right Ventricle Complicated by Pulmonary Hypertension

Background： Double outlet right ventricle （DORV） is a group of complex congenital heart abnormalities. Preoperative pulmonary hypertension （PH） is considered an important risk factor for early death during the surgical treatment of DORV. The aim of this study was to report our experience on surgical treatment of DORV complicated by PH. Methods： From June 2004 to November 2016, 61 patients （36 males and 25 females） aged 2 weeks to 26 years （median： 0.67 years and interquartile range： 0.42-1.67 years） with DORV （two great arteries overriding at least 50%） complicated by PH underwent surgical treatment in our center. All patients were categorized according to surgical age and lesion type, respectively. Pulmonary artery systolic pressure （PASP）, pulmonary artery diastolic pressure （PADP）, and mean pulmonary artery pressure （mPAP） were measured directly before cardiopulmonary bypass （CPB） was established and after CPB was removed. An intracardiac channel procedure was performed in 37 patients, arterial switch procedure in 19 patients, Rastelli procedure in three patient, Senning procedure in one patients, and Mustard procedure in one patient. The Student＇s t-test and Chi-squared test were performed to evaluate clinical outcomes of the surgical timing and operation choice. Results： Fifty-five patients had uneventful recovery. PASP fell from 55.3 ± 11.2 mmHg to 34.7±11.6 mmHg （t = 14.05, P 〈 0.001）, PADP fell from 29.7 ± 12.5 mmHgto 18.6± 7.9 mmHg （t = 7.39,P〈 0.001）, and mPAP fell from 40.3 ± 10.6 mmHgto25.7 ± 8.3 mmHg （t= 11.85, P 〈 0.001）. Six （9.8%） patients died owing to complications including low cardiac output syndrome in two patients, respiratory failure in two, pulmonary hemorrhage in one, and sudden death in one patient. Pulmonary artery pressure （PAP） dropped significantly in infant and child patients. Mortality of both infants （13.9%） and adults （33.3%） was high. Conclusions： PAP of patients with DORV complicated by PH can be expected to fall significantly after surgery. An arterial switch procedure can achieve excellent results in patients with transposition of the great arteries type. Higher incidence of complications may occur in patients with ventricular septal defect （VSD） type before 1 year of age. For those with remote VSD type, VSD enlargement and right ventricle outflow tract reconstruction are usually required with acceptable results. The degree of aortic overriding does not influence surgical outcome.

Surgical Treatment of Complete Transposition of the Great Arteries in Newborn

INTRODUCTION Complete transposition of the great arteries （TGAs）is a common cyanotic congenital heart defect,with an incidence rate of 0.02%,accounting for 5-7% of congenital heart diseases.[1] After birth,infants with TGA largely rely on ventricular septal defect （VSD）,atrial septal defect （ASD）,and patent ductus arteriosus （PDA）to sustain life.Without systemic-pulmonary shunt and surgical correction,these infants will probably die on the day after birth.