Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare...Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare.^([1]) HAE symptoms include recurrent episodes of skin and mucosal edema that can occur anywhere in the body.^([1-4]) Laryngeal edema is life-threatening,as it can lead to airway obstruction and potentially fatal suffocation.^([1-3])Edema of the gastrointestinal mucosa may cause abdominal pain,vomiting,and symptoms that are often misdiagnosed as acute abdomen.^([1-4]) This study included four patients,including one with HAE-nC1-INH (genetic testing revealed a heterozygous mutation in the KNG1 gene (c.1404G>C:p.Q468H)) and three with HAE due to C1 inhibitor deficiency (HAE-C1-INH).This case series aims to increase knowledge of HAE by illustrating its diverse clinical presentations and emphasizing features that may prompt clinical suspicion and facilitate timely diagnosis.展开更多
BACKGROUND At present,the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography(CT)and magnetic resonance imaging(MRI),which can evaluate the location and degree of peripheral...BACKGROUND At present,the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography(CT)and magnetic resonance imaging(MRI),which can evaluate the location and degree of peripheral cerebral edema,but cannot realize quantification.When patients have symptoms of diffuse cerebral edema or high cranial pressure,CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time.Intracranial pressure monitoring is the gold standard,but it is an invasive operation with high cost and complications.For clinical purposes,the ideal cerebral edema monitoring should be non-invasive,real-time,bedside,and continuous dynamic monitoring.The dis-turbance coefficient(DC)was used in this study to dynamically monitor the occu-rrence,development,and evolution of cerebral edema in patients with cerebral hemorrhage in real time,and review head CT or MRI to evaluate the development of the disease and guide further treatment,so as to improve the prognosis of patients with cerebral hemorrhage.AIM To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.METHODS A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery,Second Affiliated Hospital of Xi’an Medical University from September 2018 to September 2019 were recruited.The patients were randomly divided into a control group(n=80)and an experimental group(n=80).Patients in the control group received conventional empirical treatment,while those in the experimental group were treated with mannitol dehydration under the guidance of DC.Subsequently,we compared the two groups with regards to the total dosage of mannitol,the total course of treatment,the incidence of complications,and prognosis.RESULTS The mean daily consumption of mannitol,the total course of treatment,and the mean hospitalization days were 362.7±117.7 mL,14.8±5.2 days,and 29.4±7.9 in the control group and 283.1±93.6 mL,11.8±4.2 days,and 23.9±8.3 in the experimental group(P<0.05).In the control group,there were 20 patients with pulmonary infection(25%),30 with electrolyte disturbance(37.5%),20 with renal impairment(25%),and 16 with stress ulcer(20%).In the experimental group,pulmonary infection occurred in 18 patients(22.5%),electrolyte disturbance in 6(7.5%),renal impairment in 2(2.5%),and stress ulcers in 15(18.8%)(P<0.05).According to the Glasgow coma scale score 6 months after discharge,the prognosis of the control group was good in 20 patients(25%),fair in 26(32.5%),and poor in 34(42.5%);the prognosis of the experimental group was good in 32(40%),fair in 36(45%),and poor in 12(15%)(P<0.05).CONCLUSION Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential.It reduces mannitol dosage,treatment duration,complication rates,and hospital stays,ultimately lowering hospital-ization costs.Additionally,it improves overall patient prognosis,offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.展开更多
Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in th...Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.展开更多
AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This...AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This retrospective study involved 65 RVO patients(65 eyes)who received IVR and were followedup for more than 3mo.ME was categorized into cystoid macular edema(CME),diffuse retinal thickening(DRT),and serous retinal detachment(SRD)according to optical coherence tomography(OCT)images.The comparison of best corrected visual acuity(BCVA;logMAR)and central macular thickness(CMT)among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test.The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.RESULTS:BCVA tended to improve in all groups,with marked improvement in CME and DRT groups.CMT showed the greatest reduction after 1wk,and remained stable over the following 3mo.DRT patients had the worst BCVA and the highest CMT at baseline,but the differences became smaller after IVR treatment.CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR.Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up.DRT patients were most likely to transform into the other morphological groups,while SRD patients showed minimal transitions.BCVA at baseline was identified as the most important prognostic indicator in all 3 groups.Additionally,DRT patients with a longer clinical course,higher CMT and central retinal vein occlusion(CRVO)tend to exhibit worse BCVA after treatment.In addition,CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion(BRVO)patients in CME group.SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.CONCLUSION:The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups.Baseline parameters including clinical course,CMT,and RVO position are also useful in predicting the BCVA at different time points after treatment.展开更多
目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得...目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得到三期骨髓水肿标准化CT值增量与VNCa标准化CT值增量。对数值变量行统计学描述,并对三期骨髓水肿标准化CT值增量、VNCa标准化CT值增量进行各自组间比较及两两间比较,对有差异的组别行诊断效能比较,由接受者工作特征(ROC)曲线下面积(AUC)进行评估,并计算Cut-off值。结果三期骨髓水肿标准化CT值增量及VNCa标准化CT值增量组间均有统计学意义(H=10.788,p=0.005;F=115.787,p=0.000),其中,软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量有统计学意义(H=54.958,p=0.003),其余两两间无统计学意义(分别为H=-25.603,p=0.183;H=29.354,p=0.113)。而三期VNCa标准化CT值增量两两间均有统计学意义(P均为0.000)。ROC曲线鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量曲线下面积为0.652,Cut-off值为81.575 Hu,鉴别血肿炎症机化期与软骨痂期(纤维性骨痂期)VNCa标准化CT值增量曲线下面积为0.668,Cut-off值为55.700 Hu,鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期VNCa标准化CT值增量曲线下面积为0.905,Cut-off值为37.625 Hu。结论通过双能量CT Bone Marrow Edema可定量评估肋骨骨折演变时间节点,骨折时间演变的标准化CT值增量差异性可为法医鉴定骨折处于不同时间段提供理论依据。通过标准化CT值增量Cut-off值可一定程度上预测骨折所处时间阶段,为法医在鉴定肋骨骨折方面提供定量依据。展开更多
Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous ma...Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.展开更多
OBJECTIVE:To observe and analysis of the influence of the 12 meridians on edema,the constant value of the detection of the thermal sensitivity was further verified,which provided a basis for the diagnosis and identifi...OBJECTIVE:To observe and analysis of the influence of the 12 meridians on edema,the constant value of the detection of the thermal sensitivity was further verified,which provided a basis for the diagnosis and identification of edema by the thermal sensitivity measurement method.METHODS:A total of 1426 patients who attended Doshisha University in Japan and Xi'an Chengxintang Clinic from March 2019 to March 2023 were selected for observation and analysis and divided into 3 groups according to their diseases;112 patients with edema in Group 1,488 symptomatic patients with non-edema in Group 2,and 826 asymptomatic subjects in Group 3.The Thermal Sensitivity Measurement was conducted in the twelve meridians and compared among the groups.Multivariate analysis was performed to estimate meridians useful for diagnosing edema.RESULTS:In the healthy physiological state,the value of thermal sensitivity is relatively constant,which may be affected by age factors.Through the stepwise analysis,left Taiyin lung,right Jueyin pericardium,left Shaoyang Sanjiao,bilateral Jueyin liver,right Shaoyang gallbladder,right Taiyang bladder,and right Shaoyin kidney were extracted as effective meridians for diagnosing edema.Its accuracy was high,with receiver operating characteristic,area under the curve(ROC AUC)of 96%.These findings were not incompatible with the edema-associated meridians in the Traditional Chinese Medicine.CONCLUSION:The thermal sensitivity measurement is thought to be useful in diagnosing edema and predicting prognosis by combining appropriate meridians.In the future,we will conduct more detailed research on how this method is useful for evaluating medical care and acupuncture treatments.展开更多
Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohuma...Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohumans.However,large ingestions can cause severe,life-threatening complications,with no establishedtreatment protocols.Though rarely fatal,imidaclopridpoisoning is increasingly reported in agricultural regions,particularly in Southeast Asia,with most cases involvingsuicide attempts.展开更多
Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who requ...Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.展开更多
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
Background:Spontaneous intracerebral hemorrhage(ICH)is a severe cerebrovascular disease with high mortality,frequently accompanied by cerebral edema and acute kidney injury(AKI).Current treatment options remain limite...Background:Spontaneous intracerebral hemorrhage(ICH)is a severe cerebrovascular disease with high mortality,frequently accompanied by cerebral edema and acute kidney injury(AKI).Current treatment options remain limited.Methods:Active components and potential targets of Zhenwu Decoction(ZWD)were identified using multi-database screening.Protein-protein interaction(PPI)networks were constructed,and differentially expressed genes(DEGs)were analyzed using GEO datasets.Molecular docking and bioinformatics tools identified interactions between ZWD components and key targets,particularly AQP4 and AVPR1.Animal and cellular experiments validated the effects of ZWD on inflammation,oxidative stress,and apoptosis.Results:ZWD demonstrated significant modulation of AQP4 and AVPR1 expression,improving cerebral edema and renal function.Molecular docking confirmed ZWD’s active compounds interact strongly with these targets.In vivo studies revealed ZWD reduced oxidative stress and inflammatory responses,while in vitro experiments confirmed AVPR1’s role in apoptosis and inflammation,with ZWD significantly mitigating these adverse effects.Conclusion:This study is the first to demonstrate that ZWD alleviates cerebral edema following ICH by targeting AQP4 and AVPR1,offering new therapeutic insights for ICH management.展开更多
AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retr...AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.展开更多
AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic r...AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.展开更多
Murine subarachnoid hemorrhage(SAH)induced using the filament perforation method is a useful in vivo experimental model to investigate the pathophysiological mechanisms in the brain underlying SAH.However,identifying ...Murine subarachnoid hemorrhage(SAH)induced using the filament perforation method is a useful in vivo experimental model to investigate the pathophysiological mechanisms in the brain underlying SAH.However,identifying mice with comorbid acute neurogenic pulmonary edema(NPE),a life-threatening systemic consequence often induced by SAH,in this model is difficult without histopathological investiga-tions.Herein,we present an imaging procedure involving dual-energy X-ray absorp-tiometry(DXA)to identify NPE in a murine model of SAH.We quantified the lung lean mass(LM)and compared the relationship between micro-computed tomography(CT)evidence of Hounsfield unit(HU)values and histopathological findings of PE.Of the 85 mice with successful induction of SAH by filament perforation,16(19%)had NPE,as verified by postmortem histology.The DXA-LM values correlate well with CT-HU levels(r=0.63,p<0.0001).Regarding the relationship between LM and HU in mice with post-SAH NPE,the LM was positively associated with HU values(r2=0.43;p=0.0056).A receiver operating characteristics curve of LM revealed a sensitivity of 87%and specificity of 57%for detecting PE,with a similar area under the curve as the HU(0.79±0.06 vs.0.84±0.07;p=0.21).These data suggest that confirming acute NPE using DXA-LM is a valuable method for selecting a clinically relevant murine NPE model that could be used in future experimental SAH studies.展开更多
Background:Traumatic cerebral edema(TCE)is a life-threatening condition caused by excessive fluid accumulation in the brain,leading to elevated intracranial pressure and potential brain damage.Current treatments,inclu...Background:Traumatic cerebral edema(TCE)is a life-threatening condition caused by excessive fluid accumulation in the brain,leading to elevated intracranial pressure and potential brain damage.Current treatments,including osmotic diuretics and antihypertensive medications,have limitations.Zhenwu Decoction,a traditional Chinese medicine formulation,has shown promise due to its multi-target pharmacological effects,including modulation of inflammation and regulation of aquaporins.Methods:Active components and targets of Zhenwu Decoction were identified using databases such as SymMap and TCMID.Protein-protein interaction networks and gene expression data related to toxic chemical exposure were analyzed through the GEO database and gene set enrichment analysis.Weighted gene co-expression network analysis(WGCNA)was used to identify TCE-associated gene modules.Molecular docking and in vivo validation using a traumatic brain injury model were conducted.Results:A total of 880 active components and 235 potential targets of Zhenwu Decoction were identified.Protein-protein interaction network analysis and WGCNA revealed key gene modules and inflammatory response-related DEGs.Molecular docking suggested lactiflorin and poricoic acid A as potential drug candidates targeting ATP2A2 and ATP2C1.Experimental results confirmed that Zhenwu Decoction improved TCE outcomes by upregulating these proteins.Conclusion:This study provides molecular evidence for the efficacy of Zhenwu Decoction in treating TCE,highlighting its mechanisms.The integration of WGCNA and molecular docking offers new insights into drug development and precision medicine for TCE.展开更多
AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).ME...AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.展开更多
Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter le...Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.展开更多
AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RV...AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.展开更多
AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 ...AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 to March 2024,72 patients diagnosed with DME at the outpatient clinic were enrolled.The patients were divided into two groups:the simple group(treated with conbercept alone)and the combination group(treated with 577 nm STML combined with conbercept).The following itmes were compared between the two groups:best corrected visual acuity(BCVA),central macular thickness(CMT),foveal avascular zone(FAZ),vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP),retinal mean sensitivity(RMS),injection numbers,and the number of cases with adverse effects.RESULTS:The mean age of patients was 57.13±8.76(range 34-77)y with DR history of 0.89±0.55y.With the progression of treatment,both groups showed significant improvements in BCVA,CMT,DCP vessel density,and RMS compared to baselines(all,P<0.05).At 3 and 6mo after treatment,the combination group exhibited significantly better outcomes in BCVA,CMT,DCP vessel density,and RMS than the simple group(P<0.05).During the treatment period,neither group showed significant improvements in FAZ and SCP vessel density(P>0.05),and no significant differences in FAZ and SCP vessel density were observed between the two groups(P>0.05).The average number of injections required in the combination group was lower than that in the simple group(3.33±0.68 vs 4.06±0.96,P<0.05).No other serious ophthalmic adverse events were observed in either group.CONCLUSION:Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.展开更多
AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients wit...AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients with type 2 diabetes.METHODS:Data were retrospectively collected from the medical records of patients with diabetic retinopathy(DR)taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022.We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i.Propensity score matching was performed using the following variables:age,duration of diabetes,blood glucose control(HbA1c)level,and severity of DR.RESULTS:A total of 268 patients with DR were included in this study.More DPP4i users needed IVT than SGLT2i users(35.3%vs 18.0%,P=0.011),while the prevalence of DME was not different.The use of SGLT2i was associated with a lower need for IVT than DPP4i[odds ratio(OR)0.404,95%confidence interval(CI)0.198-0.823],and similar trends were observed after propensity score matching(OR 0.419,95%CI 0.181-0.970).However,this tendency was not significant in multiple logistic regressions.For DME,the use of DPP4i was not a significant risk factor compared to SGLT2i.CONCLUSION:The use of SGLT2i may be associated with a lower need for IVT for overall DR complications,while other factors may contribute to this effect.The effect of SGLT2i on the prevention of DME is not evident.展开更多
基金supported by the National Social Science Fund of China (19VJX168)。
文摘Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare.^([1]) HAE symptoms include recurrent episodes of skin and mucosal edema that can occur anywhere in the body.^([1-4]) Laryngeal edema is life-threatening,as it can lead to airway obstruction and potentially fatal suffocation.^([1-3])Edema of the gastrointestinal mucosa may cause abdominal pain,vomiting,and symptoms that are often misdiagnosed as acute abdomen.^([1-4]) This study included four patients,including one with HAE-nC1-INH (genetic testing revealed a heterozygous mutation in the KNG1 gene (c.1404G>C:p.Q468H)) and three with HAE due to C1 inhibitor deficiency (HAE-C1-INH).This case series aims to increase knowledge of HAE by illustrating its diverse clinical presentations and emphasizing features that may prompt clinical suspicion and facilitate timely diagnosis.
基金Supported by the Shaanxi Provincial Key Research and Development Plan Project,No.2020ZDLSF01-02.
文摘BACKGROUND At present,the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography(CT)and magnetic resonance imaging(MRI),which can evaluate the location and degree of peripheral cerebral edema,but cannot realize quantification.When patients have symptoms of diffuse cerebral edema or high cranial pressure,CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time.Intracranial pressure monitoring is the gold standard,but it is an invasive operation with high cost and complications.For clinical purposes,the ideal cerebral edema monitoring should be non-invasive,real-time,bedside,and continuous dynamic monitoring.The dis-turbance coefficient(DC)was used in this study to dynamically monitor the occu-rrence,development,and evolution of cerebral edema in patients with cerebral hemorrhage in real time,and review head CT or MRI to evaluate the development of the disease and guide further treatment,so as to improve the prognosis of patients with cerebral hemorrhage.AIM To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.METHODS A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery,Second Affiliated Hospital of Xi’an Medical University from September 2018 to September 2019 were recruited.The patients were randomly divided into a control group(n=80)and an experimental group(n=80).Patients in the control group received conventional empirical treatment,while those in the experimental group were treated with mannitol dehydration under the guidance of DC.Subsequently,we compared the two groups with regards to the total dosage of mannitol,the total course of treatment,the incidence of complications,and prognosis.RESULTS The mean daily consumption of mannitol,the total course of treatment,and the mean hospitalization days were 362.7±117.7 mL,14.8±5.2 days,and 29.4±7.9 in the control group and 283.1±93.6 mL,11.8±4.2 days,and 23.9±8.3 in the experimental group(P<0.05).In the control group,there were 20 patients with pulmonary infection(25%),30 with electrolyte disturbance(37.5%),20 with renal impairment(25%),and 16 with stress ulcer(20%).In the experimental group,pulmonary infection occurred in 18 patients(22.5%),electrolyte disturbance in 6(7.5%),renal impairment in 2(2.5%),and stress ulcers in 15(18.8%)(P<0.05).According to the Glasgow coma scale score 6 months after discharge,the prognosis of the control group was good in 20 patients(25%),fair in 26(32.5%),and poor in 34(42.5%);the prognosis of the experimental group was good in 32(40%),fair in 36(45%),and poor in 12(15%)(P<0.05).CONCLUSION Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential.It reduces mannitol dosage,treatment duration,complication rates,and hospital stays,ultimately lowering hospital-ization costs.Additionally,it improves overall patient prognosis,offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.
基金Supported by National Natural Science Foundation of China(No.82171062No.82301222)Zhejiang Provincial Natural Science Foundation of China(No.LY20H120002).
文摘Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.
基金Supported by the Suzhou Medical Innovation Application Research Project(SZM2023027).
文摘AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This retrospective study involved 65 RVO patients(65 eyes)who received IVR and were followedup for more than 3mo.ME was categorized into cystoid macular edema(CME),diffuse retinal thickening(DRT),and serous retinal detachment(SRD)according to optical coherence tomography(OCT)images.The comparison of best corrected visual acuity(BCVA;logMAR)and central macular thickness(CMT)among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test.The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.RESULTS:BCVA tended to improve in all groups,with marked improvement in CME and DRT groups.CMT showed the greatest reduction after 1wk,and remained stable over the following 3mo.DRT patients had the worst BCVA and the highest CMT at baseline,but the differences became smaller after IVR treatment.CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR.Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up.DRT patients were most likely to transform into the other morphological groups,while SRD patients showed minimal transitions.BCVA at baseline was identified as the most important prognostic indicator in all 3 groups.Additionally,DRT patients with a longer clinical course,higher CMT and central retinal vein occlusion(CRVO)tend to exhibit worse BCVA after treatment.In addition,CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion(BRVO)patients in CME group.SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.CONCLUSION:The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups.Baseline parameters including clinical course,CMT,and RVO position are also useful in predicting the BCVA at different time points after treatment.
文摘目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得到三期骨髓水肿标准化CT值增量与VNCa标准化CT值增量。对数值变量行统计学描述,并对三期骨髓水肿标准化CT值增量、VNCa标准化CT值增量进行各自组间比较及两两间比较,对有差异的组别行诊断效能比较,由接受者工作特征(ROC)曲线下面积(AUC)进行评估,并计算Cut-off值。结果三期骨髓水肿标准化CT值增量及VNCa标准化CT值增量组间均有统计学意义(H=10.788,p=0.005;F=115.787,p=0.000),其中,软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量有统计学意义(H=54.958,p=0.003),其余两两间无统计学意义(分别为H=-25.603,p=0.183;H=29.354,p=0.113)。而三期VNCa标准化CT值增量两两间均有统计学意义(P均为0.000)。ROC曲线鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量曲线下面积为0.652,Cut-off值为81.575 Hu,鉴别血肿炎症机化期与软骨痂期(纤维性骨痂期)VNCa标准化CT值增量曲线下面积为0.668,Cut-off值为55.700 Hu,鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期VNCa标准化CT值增量曲线下面积为0.905,Cut-off值为37.625 Hu。结论通过双能量CT Bone Marrow Edema可定量评估肋骨骨折演变时间节点,骨折时间演变的标准化CT值增量差异性可为法医鉴定骨折处于不同时间段提供理论依据。通过标准化CT值增量Cut-off值可一定程度上预测骨折所处时间阶段,为法医在鉴定肋骨骨折方面提供定量依据。
文摘Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.
文摘OBJECTIVE:To observe and analysis of the influence of the 12 meridians on edema,the constant value of the detection of the thermal sensitivity was further verified,which provided a basis for the diagnosis and identification of edema by the thermal sensitivity measurement method.METHODS:A total of 1426 patients who attended Doshisha University in Japan and Xi'an Chengxintang Clinic from March 2019 to March 2023 were selected for observation and analysis and divided into 3 groups according to their diseases;112 patients with edema in Group 1,488 symptomatic patients with non-edema in Group 2,and 826 asymptomatic subjects in Group 3.The Thermal Sensitivity Measurement was conducted in the twelve meridians and compared among the groups.Multivariate analysis was performed to estimate meridians useful for diagnosing edema.RESULTS:In the healthy physiological state,the value of thermal sensitivity is relatively constant,which may be affected by age factors.Through the stepwise analysis,left Taiyin lung,right Jueyin pericardium,left Shaoyang Sanjiao,bilateral Jueyin liver,right Shaoyang gallbladder,right Taiyang bladder,and right Shaoyin kidney were extracted as effective meridians for diagnosing edema.Its accuracy was high,with receiver operating characteristic,area under the curve(ROC AUC)of 96%.These findings were not incompatible with the edema-associated meridians in the Traditional Chinese Medicine.CONCLUSION:The thermal sensitivity measurement is thought to be useful in diagnosing edema and predicting prognosis by combining appropriate meridians.In the future,we will conduct more detailed research on how this method is useful for evaluating medical care and acupuncture treatments.
文摘Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohumans.However,large ingestions can cause severe,life-threatening complications,with no establishedtreatment protocols.Though rarely fatal,imidaclopridpoisoning is increasingly reported in agricultural regions,particularly in Southeast Asia,with most cases involvingsuicide attempts.
文摘Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
基金support from the Medical Discipline Construction Program of Shanghai Pudong New Area Health Commission(the Specialty Program)(Grant Number:PWZzb2022-21)The Academic Leaders Training Program of Shanghai Pudong New Area Health Commission(Grant Number:PWRd2022-14)+1 种基金The Scientific Research Program of Shanghai Pudong New Area Health Commission(the Achievement Transformation Program)(Grant Number:PW2023A-51)the Shanghai Pudong New Area Gongli Hospital Youth Fund Project(Grant Number:2020YQNJJ-16).
文摘Background:Spontaneous intracerebral hemorrhage(ICH)is a severe cerebrovascular disease with high mortality,frequently accompanied by cerebral edema and acute kidney injury(AKI).Current treatment options remain limited.Methods:Active components and potential targets of Zhenwu Decoction(ZWD)were identified using multi-database screening.Protein-protein interaction(PPI)networks were constructed,and differentially expressed genes(DEGs)were analyzed using GEO datasets.Molecular docking and bioinformatics tools identified interactions between ZWD components and key targets,particularly AQP4 and AVPR1.Animal and cellular experiments validated the effects of ZWD on inflammation,oxidative stress,and apoptosis.Results:ZWD demonstrated significant modulation of AQP4 and AVPR1 expression,improving cerebral edema and renal function.Molecular docking confirmed ZWD’s active compounds interact strongly with these targets.In vivo studies revealed ZWD reduced oxidative stress and inflammatory responses,while in vitro experiments confirmed AVPR1’s role in apoptosis and inflammation,with ZWD significantly mitigating these adverse effects.Conclusion:This study is the first to demonstrate that ZWD alleviates cerebral edema following ICH by targeting AQP4 and AVPR1,offering new therapeutic insights for ICH management.
文摘AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.
基金Supported by Zhejiang Provincial Highlevel Health Talents Training Project(No.CZ-RC2022010)Wenzhou Basic Medical and Health Technology Project(No.Y2023173)Innovation Project of School of Ophthalmology and Optometry,Eye Hospital of Wenzhou Medical University(No.YNCX3201905).
文摘AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.
基金supported by the Grants-in-Aid for Scientific Research from Japan Society for the Promotion of Science KAKENHI 22K09110.
文摘Murine subarachnoid hemorrhage(SAH)induced using the filament perforation method is a useful in vivo experimental model to investigate the pathophysiological mechanisms in the brain underlying SAH.However,identifying mice with comorbid acute neurogenic pulmonary edema(NPE),a life-threatening systemic consequence often induced by SAH,in this model is difficult without histopathological investiga-tions.Herein,we present an imaging procedure involving dual-energy X-ray absorp-tiometry(DXA)to identify NPE in a murine model of SAH.We quantified the lung lean mass(LM)and compared the relationship between micro-computed tomography(CT)evidence of Hounsfield unit(HU)values and histopathological findings of PE.Of the 85 mice with successful induction of SAH by filament perforation,16(19%)had NPE,as verified by postmortem histology.The DXA-LM values correlate well with CT-HU levels(r=0.63,p<0.0001).Regarding the relationship between LM and HU in mice with post-SAH NPE,the LM was positively associated with HU values(r2=0.43;p=0.0056).A receiver operating characteristics curve of LM revealed a sensitivity of 87%and specificity of 57%for detecting PE,with a similar area under the curve as the HU(0.79±0.06 vs.0.84±0.07;p=0.21).These data suggest that confirming acute NPE using DXA-LM is a valuable method for selecting a clinically relevant murine NPE model that could be used in future experimental SAH studies.
基金the financial support provided by the Discipline Construction Project of Shanghai Pudong New Area Health Commission(Grant Number:PWZzb2022-21)the Shanghai Pudong New Area Health System Discipline Leader Training Project(Grant Number:PWRd2022-14)+1 种基金the Health Science and Technology Project of Shanghai Pudong New Area Health Committee(Grant Number:PW2023A-51)the Shanghai Pudong New Area Gongli Hospital Youth Fund Project(Grant Number:2020YQNJJ-16).
文摘Background:Traumatic cerebral edema(TCE)is a life-threatening condition caused by excessive fluid accumulation in the brain,leading to elevated intracranial pressure and potential brain damage.Current treatments,including osmotic diuretics and antihypertensive medications,have limitations.Zhenwu Decoction,a traditional Chinese medicine formulation,has shown promise due to its multi-target pharmacological effects,including modulation of inflammation and regulation of aquaporins.Methods:Active components and targets of Zhenwu Decoction were identified using databases such as SymMap and TCMID.Protein-protein interaction networks and gene expression data related to toxic chemical exposure were analyzed through the GEO database and gene set enrichment analysis.Weighted gene co-expression network analysis(WGCNA)was used to identify TCE-associated gene modules.Molecular docking and in vivo validation using a traumatic brain injury model were conducted.Results:A total of 880 active components and 235 potential targets of Zhenwu Decoction were identified.Protein-protein interaction network analysis and WGCNA revealed key gene modules and inflammatory response-related DEGs.Molecular docking suggested lactiflorin and poricoic acid A as potential drug candidates targeting ATP2A2 and ATP2C1.Experimental results confirmed that Zhenwu Decoction improved TCE outcomes by upregulating these proteins.Conclusion:This study provides molecular evidence for the efficacy of Zhenwu Decoction in treating TCE,highlighting its mechanisms.The integration of WGCNA and molecular docking offers new insights into drug development and precision medicine for TCE.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-037A)Tianjin Key Laboratory of Retinal Functions and Diseases Independent and Open Project(No.2023tjswmm004)Tianjin Medical University Eye Hospital High-level Innovative Talent Programme(No.YDYYRCXM-B2023-02).
文摘AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.
文摘Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.
基金Supported by the National Nature Science Foundation of China(No.82301211)Beijing Natural Science Foundation(No.J230028).
文摘AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.
基金Supported by Henan Province Youth Health Science and Technology Innovation Talent Training Project(No.LJRC2023008)The Key Scientific Research Projects Plan of Universities in Henan Province(No.24A320040).
文摘AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 to March 2024,72 patients diagnosed with DME at the outpatient clinic were enrolled.The patients were divided into two groups:the simple group(treated with conbercept alone)and the combination group(treated with 577 nm STML combined with conbercept).The following itmes were compared between the two groups:best corrected visual acuity(BCVA),central macular thickness(CMT),foveal avascular zone(FAZ),vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP),retinal mean sensitivity(RMS),injection numbers,and the number of cases with adverse effects.RESULTS:The mean age of patients was 57.13±8.76(range 34-77)y with DR history of 0.89±0.55y.With the progression of treatment,both groups showed significant improvements in BCVA,CMT,DCP vessel density,and RMS compared to baselines(all,P<0.05).At 3 and 6mo after treatment,the combination group exhibited significantly better outcomes in BCVA,CMT,DCP vessel density,and RMS than the simple group(P<0.05).During the treatment period,neither group showed significant improvements in FAZ and SCP vessel density(P>0.05),and no significant differences in FAZ and SCP vessel density were observed between the two groups(P>0.05).The average number of injections required in the combination group was lower than that in the simple group(3.33±0.68 vs 4.06±0.96,P<0.05).No other serious ophthalmic adverse events were observed in either group.CONCLUSION:Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.
文摘AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients with type 2 diabetes.METHODS:Data were retrospectively collected from the medical records of patients with diabetic retinopathy(DR)taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022.We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i.Propensity score matching was performed using the following variables:age,duration of diabetes,blood glucose control(HbA1c)level,and severity of DR.RESULTS:A total of 268 patients with DR were included in this study.More DPP4i users needed IVT than SGLT2i users(35.3%vs 18.0%,P=0.011),while the prevalence of DME was not different.The use of SGLT2i was associated with a lower need for IVT than DPP4i[odds ratio(OR)0.404,95%confidence interval(CI)0.198-0.823],and similar trends were observed after propensity score matching(OR 0.419,95%CI 0.181-0.970).However,this tendency was not significant in multiple logistic regressions.For DME,the use of DPP4i was not a significant risk factor compared to SGLT2i.CONCLUSION:The use of SGLT2i may be associated with a lower need for IVT for overall DR complications,while other factors may contribute to this effect.The effect of SGLT2i on the prevention of DME is not evident.
