BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice t...BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.展开更多
Objective. To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals (MDS) and with Guglielmi detachable coils (GDC).Methods. One hundred and twenty cases with 125 intracranial a...Objective. To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals (MDS) and with Guglielmi detachable coils (GDC).Methods. One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999. Sixty - six aneurysms in 64 cases were embolized with MDS, 51 in 48 with GDC, and 8 in 8 with both MDS and GDC. Clinical data including sex, age, subarachnoid hemorrhage (SAH), Hunt & Hess grading, diameter and neck width of aneurysms, number and length of coils used per aneurysm, occlusive ratio, and complications were compared between MDS and GDC groups.Results. MDS and GDC groups were comparable (t-test or x2 -test, all P value > 0. 10) in terms of age, sex, diameter of aneurysms [ (8. 46 ± 3. 42) mm vs. (7. 38 ± 3. 45) mm], neck width [ (3. 49 ± 1. 50) mm vs. (3. 26 ± 1. 52) mm], coils number[ (4. 65 ± 3. 01) vs. (4. 24 ± 2. 65) ] and their length[ (460. 2 ± 398. 5) mm vs. (422. 9 ±387. 1) mm] used per aneurysm, occlusive ratio in aneurysms embolized ≥80% [ (95. 00% ± 6. 32% ) vs. (94. 19% ± 7. 63% ) ], mortality and permanent complications (7. 8% vs. 4. 2% ).Conclusions. MDS and GDC are all materials for embolization of intracranial aneurysms. MDS is less expensive, but more difficult to control and of propensity to complications while GDC is more compliant, easier to be used, safer, and have many alternative types for use as well as more extensive indications.展开更多
Background Coronary artery fistula （CAF） is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil （GDC）.The advantage...Background Coronary artery fistula （CAF） is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil （GDC）.The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods ＆ Results From 2002 to 2007,there were 10 patients with CAFs （age range：28 to 56 year-old,7 males） who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary （n =5）,left circumflex （n =3）,left anterior descending artery （n =10） and left main trunk （n =1）.Median number of coil deployment for each fistula was 3 （range：1 to 6）.The pulmonary artery was the most common site of the distal communication of CAFs （n =14）,followed by right atrium （n =3）,left atrium （n =1） and left ventricle （n =1）.Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 （63.2％） CAFs,significant reduction of the flow in 5 （26.3％）,while 2 （10.5％） could not be closed due to small size.Nine （90％） patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 （70.5％） CAFs were occluded completely and 5 （29.5％） CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.展开更多
BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being ...BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.展开更多
Silicon and glass are two of the most ideal materials for micro/nanofluidic devices,which have been widely used for research in multidisciplinary fields.However,many micro/nanofluidic devices enable only single use du...Silicon and glass are two of the most ideal materials for micro/nanofluidic devices,which have been widely used for research in multidisciplinary fields.However,many micro/nanofluidic devices enable only single use due to the irreversible bonding between Si/glass or glass/glass chips.If the silicon-and glass-based devices are fabricated to be detachable,the substrates can be reused and bonded again without repeating expensive micro/nanofabrication processes.Herein,we present a recycled direct bonding method for Si/glass and glass/glass chips based on oxygen plasma activation and low-temperature annealing processes.Strong bonding strength and void-free bonding interface are obtained after annealing at 150℃.The surfaces and the bonding interfaces are characterized to elucidate the bonding mechanisms.Moreover,immersion tests are carried out to investigate the interfacial corrosion resistance in various chemical and biological solutions as well as explore a detachable method.The bonding strengths are controlled to meet the demand for micro/nanofluidic devices and the bonding interfaces can be separated in ethanol.As a result,we succeed in the experiment of bonding and detaching of glass substrates without fracturing,which is repeated for three times.展开更多
Embolization of collateral veins is often treated with rigid coils(Gianturco and interlocking detachable coils type).However,when dealing with tortuous and dilated collateral veins,there is a high risk for technical f...Embolization of collateral veins is often treated with rigid coils(Gianturco and interlocking detachable coils type).However,when dealing with tortuous and dilated collateral veins,there is a high risk for technical failure and coil migration due to inflexibility of the coils.To safely and successfully solve this problem,Guglielmi detachable coils(GDC) can be used for embolization.Their flexibility allows for easy navigation in tortuous veins,low risk of unintended coil release or coil migration,and safe deployment.A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure.The symp-toms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein,forming a right-to-left shunt.The collateral,which had a large diameter and high flow,and therefore a high risk of coil migration,was successfully embolized with 8 GDC.There were no complications such as coil migration or cerebral infarction.Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%,and increased her ability to exercise.The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.展开更多
Electrolytic detachable coils (EDC) have been the main embolic materi als for intracranial aneurysms. Liquid aneurysmal embolic materials represented by cellulose acetate polymer (CAP) are still in controversy. In thi...Electrolytic detachable coils (EDC) have been the main embolic materi als for intracranial aneurysms. Liquid aneurysmal embolic materials represented by cellulose acetate polymer (CAP) are still in controversy. In this research, t he embolization results and pathological reactions after embolization of canine aneurysmal models with EDC or CAP were observed and compared. Methods. The canine aneurysmal models constructed by anastomosis of venous pouch es were randomly grouped. The aneurysms were respectively occluded with CAP and electrolytic detachable coils that was named by Wu electrolytic detachable coil (WEDC) and made by us. Angiogram follow ups were performed at 24 hour, 2 week , and 2 month after embolization. The occluded aneurysms were dissected in each stage for light microscopic, electron microscopic, and histochemical research. Results. The effect of embolization was significantly better with WEDC than that with CAP . Post embolized complications such as aneurysm rupture and stenosis of parent arteries could only be found in CAP group. Pathol ogical research showed that CAP mass could packed the aneurysms more densely tha n coils. Acute chemical damage of aneurysmal wall and inflammatory cell infiltra tion was prominently found in early stage after CAP embolization. Organization of thrombus inside aneurysms and formation of endothelial tissue over the orific es of aneurysmal necks could be found in both groups 2 months after embolization . But parts of coils might be exposed outside endothelial layer. Conclusions. EDC are still the most safe, efficient, and reliable instruments to embolize aneurysm. CAP should be improved further to solve the problem of stron g chemical corrosion and difficulty in control before it is widely used.展开更多
BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular ...BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.展开更多
Introduction Helicobacter pylori(H.pylori)infection is a common infectious disease.Rapid and significant increase in antibiotic resistance and concurrent decline in the efficacy of empiric eradication regimens have be...Introduction Helicobacter pylori(H.pylori)infection is a common infectious disease.Rapid and significant increase in antibiotic resistance and concurrent decline in the efficacy of empiric eradication regimens have been consistently reported[1,2].The latest Maastricht VI/Florence consensus recommends that optimized treatment should be guided by antibiotic susceptibility tests[3].展开更多
Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, ...Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization. Conclusions Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.展开更多
Obejctive To develop a Chinese-made electrolytic detachable coil (CEDC) that would allow patients to enjoy the benefit of electrolytic detachable coil without having to rely on the expensive Guglielmi detachable coil...Obejctive To develop a Chinese-made electrolytic detachable coil (CEDC) that would allow patients to enjoy the benefit of electrolytic detachable coil without having to rely on the expensive Guglielmi detachable coil (GDC), and to test the safety and efficiency of CEDC Methods Radiopacity of the marker of the CEDC was tested The anti strain force of coils and connection points were measured In vitro and in vivo electrolyses were conducted We produced 21 aneurysm models including lateral, bifurcation, and terminal aneurysm models, and embolized 18 models with CEDC Results Radiopacity of the marker was satisfactory Anti strain of the coil and the connection point have shown the safety and efficiency of CEDC Electrolysis in vitro and vivo, was similar to that of GDC 83% of the aneurysm models were completely occluded Coils were found to induce thrombosis in the aneurysm cavity, and could lead to a new endothelium over the entrance of the aneurysm, with organized tissue replacing thrombosis in 2 months Conclusions CEDC is as efficient and safe as GDC The marker, the ability to induce thrombosis inside the sac and the growth of new endothelium over the orifice are very satisfactory展开更多
PEGylation has been widely applied to prolong the circulation times of nanomedicines via the steric shielding effect,which consequently improves the intratumoral accumulation.However,cell uptake of PEGylated nanoformu...PEGylation has been widely applied to prolong the circulation times of nanomedicines via the steric shielding effect,which consequently improves the intratumoral accumulation.However,cell uptake of PEGylated nanoformulations is always blocked by the steric repulsion of PEG,which limits their therapeutic effect.To this end,we designed and prepared two kinds of poly(L-glutamic acid)-cisplatin(PLG-CDDP)nanoformulations with detachable PEG,which is responsive to specific tumor tissue microenvironments for prolonged circulation time and enhanced cell internalization.The extracellular pH(pHe)-responsive cleavage 2-propionic-3-methylmaleic anhydride(CDM)-derived amide bond and matrix metalloproteinases-2/9(MMP-2/9)-sensitive degradable peptide PLGLAG were utilized to link PLG and PEG,yielding pHe-responsive PEG-pHe-PLG and MMP-sensitive PEG-MMP-PLG.The corresponding smart nanoformulations PEG-pHe-PLG-Pt and PEG-MMP-PLG-Pt were then prepared by the complexation of polypeptides and cisplatin(CDDP).The circulation half-lives of PEG-pHe-PLG-Pt and PEG-MMP-PLG-Pt were about 4.6 and 4.2 times higher than that of the control PLG-Pt,respectively.Upon reaching tumor tissue,PEG on the surface of nanomedicines was detached as triggered by pHe or MMP,which increased intratumoral CDDP retention,enhanced cell uptake,and improved antitumor efficacy toward a fatal high-grade serous ovarian cancer(HGSOC)mouse model,indicating the promising prospects for clinical application of detachable PEGylated nanoformulations.展开更多
AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a...AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.展开更多
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.展开更多
Intrinsic decomposition,the process of decomposing an image into reflectance and shading,is widely used in virtual and augmented reality tasks.Reflectance and shading often exhibit large gradients at the object edges,...Intrinsic decomposition,the process of decomposing an image into reflectance and shading,is widely used in virtual and augmented reality tasks.Reflectance and shading often exhibit large gradients at the object edges,and the intrinsic properties on the same object tend to be similar.This spatial coherence is closely related to semantic consistency because objects within the same semantic category often exhibit similar intrinsic properties.Therefore,incorporating semantic segmentation into a deep intrinsic decomposition framework helps the network distinguish between different object instances and understand high-level scene structures.To this end,we design an intrinsic decomposition network jointly trained with a dedicated semantic segmentation module,allowing semantic cues to enhance the decomposition of reflectance and shading.The semantic module provides guidance during training but is removed during inference,improving performance without increasing the inference cost.Additionally,to capture the global contextual dependencies critical for intrinsic decomposition,we adopt a Transformer-based backbone.The proposed backbone enables the model to associate distant regions with similar material properties,thereby maintaining consistency in reflectance and learning smooth illumination patterns across a scene.A convolutional decoder is also designed to output predictions with improved details.Experiments demonstrate that our approach achieves state-of-the-art performance in the quantitative evaluations on the Intrinsic Images in the Wild(IIW)and Shading Annotations in the wild(SAW)datasets.展开更多
Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual fu...Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual function.The incidence of metamorphopsia remains the most common postoperative complaint,from 24% to 88.6%.Currently,the risk factors of metamorphopsia are categorized into macular involvement,retinal shift,outer retinal folds,subretinal fluid,secondary epiretinal membrane,outer retinal layer damage,and surgical approach.The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial.The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts.Most treatments cannot progress beyond the management of negative visual sensations,through methods such as occlusion therapy and aniseikonia-correcting spectacles.The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair.Additional research concerning metamorphopsia treatment,further upgrades of auxiliary inspection methods,and more accurate microstructural assessments are needed to address this common complication.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
Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Desc...Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].展开更多
AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case seri...AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.展开更多
Purpose:To summarize and analyze the clinical features and management of postoperative choroidal detachment in glaucoma.Methods:Ten cases of choroidal detachment that occurred after glaucoma surgery were collected fro...Purpose:To summarize and analyze the clinical features and management of postoperative choroidal detachment in glaucoma.Methods:Ten cases of choroidal detachment that occurred after glaucoma surgery were collected from March 2023 to February 2024 in the hospital.Their clinical characteristics and treatment effects were observed and their causes were analyzed.Results:After the operations,the eyes with choroidal detachment after glaucoma surgery had 2 cases of true microphthalmos,6 cases of advanced glaucoma,and 2 cases of glaucoma secondary to vitreoretinal surgery.The postoperative manifestations were persistent shallow anterior chamber,the formation of anterior chamber,and then suddenly became shallow or disappeared.Meanwhile,the intraocular pressure was lower than 6 mmHg.Ultrasound and funduscopic examination showed that the choroid and retina were partially elevated,and the choroidal detachment recovered after treatment.Conclusion:Choroidal detachment is one of the common postoperative complications in glaucoma,especially in some special types of refractory glaucoma.Adequate perioperative management before surgery,cautious and delicate operation during surgery,and close observation and treatment after surgery can obviously decrease the occurrence and damage.展开更多
基金Supported by Natural Science Foundation of Fujian Province,China,No.2021J01545.
文摘BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.
基金This work was originally published in the Chinese Journal of Neuro-surgery (2001 17(2): 87-90) in Chinese.
文摘Objective. To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals (MDS) and with Guglielmi detachable coils (GDC).Methods. One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999. Sixty - six aneurysms in 64 cases were embolized with MDS, 51 in 48 with GDC, and 8 in 8 with both MDS and GDC. Clinical data including sex, age, subarachnoid hemorrhage (SAH), Hunt & Hess grading, diameter and neck width of aneurysms, number and length of coils used per aneurysm, occlusive ratio, and complications were compared between MDS and GDC groups.Results. MDS and GDC groups were comparable (t-test or x2 -test, all P value > 0. 10) in terms of age, sex, diameter of aneurysms [ (8. 46 ± 3. 42) mm vs. (7. 38 ± 3. 45) mm], neck width [ (3. 49 ± 1. 50) mm vs. (3. 26 ± 1. 52) mm], coils number[ (4. 65 ± 3. 01) vs. (4. 24 ± 2. 65) ] and their length[ (460. 2 ± 398. 5) mm vs. (422. 9 ±387. 1) mm] used per aneurysm, occlusive ratio in aneurysms embolized ≥80% [ (95. 00% ± 6. 32% ) vs. (94. 19% ± 7. 63% ) ], mortality and permanent complications (7. 8% vs. 4. 2% ).Conclusions. MDS and GDC are all materials for embolization of intracranial aneurysms. MDS is less expensive, but more difficult to control and of propensity to complications while GDC is more compliant, easier to be used, safer, and have many alternative types for use as well as more extensive indications.
文摘Background Coronary artery fistula （CAF） is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil （GDC）.The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods ＆ Results From 2002 to 2007,there were 10 patients with CAFs （age range：28 to 56 year-old,7 males） who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary （n =5）,left circumflex （n =3）,left anterior descending artery （n =10） and left main trunk （n =1）.Median number of coil deployment for each fistula was 3 （range：1 to 6）.The pulmonary artery was the most common site of the distal communication of CAFs （n =14）,followed by right atrium （n =3）,left atrium （n =1） and left ventricle （n =1）.Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 （63.2％） CAFs,significant reduction of the flow in 5 （26.3％）,while 2 （10.5％） could not be closed due to small size.Nine （90％） patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 （70.5％） CAFs were occluded completely and 5 （29.5％） CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.
基金the Science and Technology Commission of Shanghai,No.18DZ1930309.
文摘BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.
基金the National Natural Science Foundation of China(Grant No.51975151)the China Postdoctoral Science Foundation(Grant No.2017M610207)the Heilongjiang Provincial Natural Science Foundation of China(Grant No.LH2019E041)。
文摘Silicon and glass are two of the most ideal materials for micro/nanofluidic devices,which have been widely used for research in multidisciplinary fields.However,many micro/nanofluidic devices enable only single use due to the irreversible bonding between Si/glass or glass/glass chips.If the silicon-and glass-based devices are fabricated to be detachable,the substrates can be reused and bonded again without repeating expensive micro/nanofabrication processes.Herein,we present a recycled direct bonding method for Si/glass and glass/glass chips based on oxygen plasma activation and low-temperature annealing processes.Strong bonding strength and void-free bonding interface are obtained after annealing at 150℃.The surfaces and the bonding interfaces are characterized to elucidate the bonding mechanisms.Moreover,immersion tests are carried out to investigate the interfacial corrosion resistance in various chemical and biological solutions as well as explore a detachable method.The bonding strengths are controlled to meet the demand for micro/nanofluidic devices and the bonding interfaces can be separated in ethanol.As a result,we succeed in the experiment of bonding and detaching of glass substrates without fracturing,which is repeated for three times.
文摘Embolization of collateral veins is often treated with rigid coils(Gianturco and interlocking detachable coils type).However,when dealing with tortuous and dilated collateral veins,there is a high risk for technical failure and coil migration due to inflexibility of the coils.To safely and successfully solve this problem,Guglielmi detachable coils(GDC) can be used for embolization.Their flexibility allows for easy navigation in tortuous veins,low risk of unintended coil release or coil migration,and safe deployment.A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure.The symp-toms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein,forming a right-to-left shunt.The collateral,which had a large diameter and high flow,and therefore a high risk of coil migration,was successfully embolized with 8 GDC.There were no complications such as coil migration or cerebral infarction.Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%,and increased her ability to exercise.The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.
文摘Electrolytic detachable coils (EDC) have been the main embolic materi als for intracranial aneurysms. Liquid aneurysmal embolic materials represented by cellulose acetate polymer (CAP) are still in controversy. In this research, t he embolization results and pathological reactions after embolization of canine aneurysmal models with EDC or CAP were observed and compared. Methods. The canine aneurysmal models constructed by anastomosis of venous pouch es were randomly grouped. The aneurysms were respectively occluded with CAP and electrolytic detachable coils that was named by Wu electrolytic detachable coil (WEDC) and made by us. Angiogram follow ups were performed at 24 hour, 2 week , and 2 month after embolization. The occluded aneurysms were dissected in each stage for light microscopic, electron microscopic, and histochemical research. Results. The effect of embolization was significantly better with WEDC than that with CAP . Post embolized complications such as aneurysm rupture and stenosis of parent arteries could only be found in CAP group. Pathol ogical research showed that CAP mass could packed the aneurysms more densely tha n coils. Acute chemical damage of aneurysmal wall and inflammatory cell infiltra tion was prominently found in early stage after CAP embolization. Organization of thrombus inside aneurysms and formation of endothelial tissue over the orific es of aneurysmal necks could be found in both groups 2 months after embolization . But parts of coils might be exposed outside endothelial layer. Conclusions. EDC are still the most safe, efficient, and reliable instruments to embolize aneurysm. CAP should be improved further to solve the problem of stron g chemical corrosion and difficulty in control before it is widely used.
文摘BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.
基金funded by National Natural Science Foundation of China[grant number 92268108]the Natural Science Foundation of Hubei Province[grant number 2023AFB807]。
文摘Introduction Helicobacter pylori(H.pylori)infection is a common infectious disease.Rapid and significant increase in antibiotic resistance and concurrent decline in the efficacy of empiric eradication regimens have been consistently reported[1,2].The latest Maastricht VI/Florence consensus recommends that optimized treatment should be guided by antibiotic susceptibility tests[3].
文摘Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization. Conclusions Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.
文摘Obejctive To develop a Chinese-made electrolytic detachable coil (CEDC) that would allow patients to enjoy the benefit of electrolytic detachable coil without having to rely on the expensive Guglielmi detachable coil (GDC), and to test the safety and efficiency of CEDC Methods Radiopacity of the marker of the CEDC was tested The anti strain force of coils and connection points were measured In vitro and in vivo electrolyses were conducted We produced 21 aneurysm models including lateral, bifurcation, and terminal aneurysm models, and embolized 18 models with CEDC Results Radiopacity of the marker was satisfactory Anti strain of the coil and the connection point have shown the safety and efficiency of CEDC Electrolysis in vitro and vivo, was similar to that of GDC 83% of the aneurysm models were completely occluded Coils were found to induce thrombosis in the aneurysm cavity, and could lead to a new endothelium over the entrance of the aneurysm, with organized tissue replacing thrombosis in 2 months Conclusions CEDC is as efficient and safe as GDC The marker, the ability to induce thrombosis inside the sac and the growth of new endothelium over the orifice are very satisfactory
基金The study was financially supported by the National Natural Science Foundation of China(Grant Nos.52073280,51973216,and 51673187).
文摘PEGylation has been widely applied to prolong the circulation times of nanomedicines via the steric shielding effect,which consequently improves the intratumoral accumulation.However,cell uptake of PEGylated nanoformulations is always blocked by the steric repulsion of PEG,which limits their therapeutic effect.To this end,we designed and prepared two kinds of poly(L-glutamic acid)-cisplatin(PLG-CDDP)nanoformulations with detachable PEG,which is responsive to specific tumor tissue microenvironments for prolonged circulation time and enhanced cell internalization.The extracellular pH(pHe)-responsive cleavage 2-propionic-3-methylmaleic anhydride(CDM)-derived amide bond and matrix metalloproteinases-2/9(MMP-2/9)-sensitive degradable peptide PLGLAG were utilized to link PLG and PEG,yielding pHe-responsive PEG-pHe-PLG and MMP-sensitive PEG-MMP-PLG.The corresponding smart nanoformulations PEG-pHe-PLG-Pt and PEG-MMP-PLG-Pt were then prepared by the complexation of polypeptides and cisplatin(CDDP).The circulation half-lives of PEG-pHe-PLG-Pt and PEG-MMP-PLG-Pt were about 4.6 and 4.2 times higher than that of the control PLG-Pt,respectively.Upon reaching tumor tissue,PEG on the surface of nanomedicines was detached as triggered by pHe or MMP,which increased intratumoral CDDP retention,enhanced cell uptake,and improved antitumor efficacy toward a fatal high-grade serous ovarian cancer(HGSOC)mouse model,indicating the promising prospects for clinical application of detachable PEGylated nanoformulations.
文摘AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.
文摘BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.
基金Supported by Science and Technology Innovation 2030:Major Project of“New Generation Artificial Intelligence”(No.2022ZD0115901)the National Natural Science Foundation of China(No.62332003).
文摘Intrinsic decomposition,the process of decomposing an image into reflectance and shading,is widely used in virtual and augmented reality tasks.Reflectance and shading often exhibit large gradients at the object edges,and the intrinsic properties on the same object tend to be similar.This spatial coherence is closely related to semantic consistency because objects within the same semantic category often exhibit similar intrinsic properties.Therefore,incorporating semantic segmentation into a deep intrinsic decomposition framework helps the network distinguish between different object instances and understand high-level scene structures.To this end,we design an intrinsic decomposition network jointly trained with a dedicated semantic segmentation module,allowing semantic cues to enhance the decomposition of reflectance and shading.The semantic module provides guidance during training but is removed during inference,improving performance without increasing the inference cost.Additionally,to capture the global contextual dependencies critical for intrinsic decomposition,we adopt a Transformer-based backbone.The proposed backbone enables the model to associate distant regions with similar material properties,thereby maintaining consistency in reflectance and learning smooth illumination patterns across a scene.A convolutional decoder is also designed to output predictions with improved details.Experiments demonstrate that our approach achieves state-of-the-art performance in the quantitative evaluations on the Intrinsic Images in the Wild(IIW)and Shading Annotations in the wild(SAW)datasets.
文摘Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual function.The incidence of metamorphopsia remains the most common postoperative complaint,from 24% to 88.6%.Currently,the risk factors of metamorphopsia are categorized into macular involvement,retinal shift,outer retinal folds,subretinal fluid,secondary epiretinal membrane,outer retinal layer damage,and surgical approach.The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial.The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts.Most treatments cannot progress beyond the management of negative visual sensations,through methods such as occlusion therapy and aniseikonia-correcting spectacles.The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair.Additional research concerning metamorphopsia treatment,further upgrades of auxiliary inspection methods,and more accurate microstructural assessments are needed to address this common complication.
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.
基金Supported by the Natural Science Foundation of Fujian Province(No.2024J011318No.2024J011321)Fuzhou Science and Technology Program(No.2023-S-005).
文摘Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].
文摘AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.
基金Key Research and Development Program of Hubei Province(Project No.:2021BCA125)。
文摘Purpose:To summarize and analyze the clinical features and management of postoperative choroidal detachment in glaucoma.Methods:Ten cases of choroidal detachment that occurred after glaucoma surgery were collected from March 2023 to February 2024 in the hospital.Their clinical characteristics and treatment effects were observed and their causes were analyzed.Results:After the operations,the eyes with choroidal detachment after glaucoma surgery had 2 cases of true microphthalmos,6 cases of advanced glaucoma,and 2 cases of glaucoma secondary to vitreoretinal surgery.The postoperative manifestations were persistent shallow anterior chamber,the formation of anterior chamber,and then suddenly became shallow or disappeared.Meanwhile,the intraocular pressure was lower than 6 mmHg.Ultrasound and funduscopic examination showed that the choroid and retina were partially elevated,and the choroidal detachment recovered after treatment.Conclusion:Choroidal detachment is one of the common postoperative complications in glaucoma,especially in some special types of refractory glaucoma.Adequate perioperative management before surgery,cautious and delicate operation during surgery,and close observation and treatment after surgery can obviously decrease the occurrence and damage.
