AIM:To determine whether paeonol(Pae),a naturally occurring phenolic compound,can serve as an effective pharmacological inhibitor of posterior capsular opacification(PCO).METHODS:A rat model of cataract surgery—induc...AIM:To determine whether paeonol(Pae),a naturally occurring phenolic compound,can serve as an effective pharmacological inhibitor of posterior capsular opacification(PCO).METHODS:A rat model of cataract surgery—induced PCO was established,and Pae was administered via anterior chamber injection to evaluate its preventive effect on capsular opacification and fibrotic remodeling.Histological and immunohistochemical analyses were performed to assess epithelial-mesenchymal transition(EMT)—related changes in lens epithelial cells(LECs).Ex vivo lens capsule cultures were employed to examine the expression of Vimentin and Zonula Occludens-1(ZO-1)by immunofluorescence and immunohistochemistry.In the human LEC line SRA01/04,EMT marker expression at both mRNA and protein levels was analyzed following transforming growth factor beta 2(TGF-β2)stimulation,with Pae treatment.Western blotting and immunofluorescence were used to investigate the effect of Pae on TGF-β/Smad signaling and AMP-activated protein kinase(AMPK)activation.Molecular docking was performed to predict Pae–AMPK binding,and rescue experiments with AMPK inhibition were conducted to validate the mechanistic pathway.RESULTS:Pae significantly reduced capsular opacification and fibrotic remodeling in the rat PCO model compared with controls.In LECs,Pae markedly suppressed TGF-β2–induced EMT,evidenced by decreased expression of mesenchymal markers,such as Vimentin,Fibronectin,Collagen 1A1,α-SMA and preserved epithelial junctional protein ZO-1.Mechanistically,Pae was predicted to directly interact with the catalytic pocket of AMPK,which was experimentally confirmed by enhanced AMPK phosphorylation and nuclear translocation(P<0.05).This activation disrupted canonical TGF-β/Smad signaling,leading to suppression of EMT.Rescue experiments using AMPK inhibition abrogated the anti-EMT effect of Pae,further validating the AMPK-dependent mechanism.CONCLUSION:Pae exerts a potent inhibitory effect on PCO formation by blocking EMT of LECs through direct activation of AMPK and subsequent disruption of TGF-β/Smad signaling.展开更多
BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is a complex neurological disorder characterized by symptoms such as headaches,seizures,confusion,and visual disturbances.The pathophysiology of PRES involv...BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is a complex neurological disorder characterized by symptoms such as headaches,seizures,confusion,and visual disturbances.The pathophysiology of PRES involves endothelial dysfunction,disrupted cerebral autoregulation,and resulting vasogenic edema.Hypertension and other factors that alter cerebral autoregulation are critical in its development.Corticosteroids,widely used for their anti-inflammatory and immunosuppressive properties,play a controversial role in PRES.AIM To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature.Specifically,it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES.By synthesizing case reports and series,this review aims to provide a comprehensive understanding of the mechanisms,clinical presentations,and management strategies associated with corticosteroid-related PRES.METHODS The review was carried out according to the PRISMA guidelines.The databases searched included Science Direct,PubMed,and Hinari.The search strategy encompassed terms related to corticosteroids and PRES.Studies were included if they were peer-reviewed articles examining corticosteroids in PRES,excluding non-English publications,reviews,and editorials.Data on patient demographics,clinical characteristics,imaging findings,corticosteroid regimens,and outcomes were extracted.The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.RESULTS A total of 56 cases of PRES(66.1%women,33.9%men)potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified.Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years,with seizures,headaches,hypertension,and visual disturbances being common clinical sequelae.Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes.High-dose or prolonged corticosteroid therapy was a significant risk factor.On the contrary,in the treatment cases,corticosteroids were associated with positive outcomes,including resolution of vasogenic edema and stabilization of symptoms,particularly in patients with underlying inflammatory or autoimmune diseases.CONCLUSION Corticosteroids have a dual role in PRES,capable of both inducing and treating the condition.The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating.Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation.Corticosteroids may aid in the management of PRES:(1)Enhancing endothelial stability;(2)Antiinflammatory properties;and(3)Improving blood-brain barrier integrity.Mechanisms which may reduce or mitigate vasogenic edema formation.展开更多
Objective:To evaluate the therapeutic effect of Tianma Gouteng Decoction combined with Betahistine Mesylate in patients with posterior circulation ischemic vertigo(PCI).Methods:Eighty-two patients with PCI who visited...Objective:To evaluate the therapeutic effect of Tianma Gouteng Decoction combined with Betahistine Mesylate in patients with posterior circulation ischemic vertigo(PCI).Methods:Eighty-two patients with PCI who visited the hospital from February 2024 to February 2025 were selected as samples and randomly divided into two groups.Group A received Tianma Gouteng Decoction combined with Betahistine Mesylate,while Group B received only Betahistine Mesylate.The efficacy,syndrome scores,hemodynamics,and quality of life indicators were compared between the two groups.Results:The efficacy of PCI treatment in Group A was higher than that in Group B(P<0.05).The syndrome scores in Group A were lower than those in Group B(P<0.05).The peak systolic velocity(PSV)of the basilar artery and left and right vertebral arteries in Group A were higher than those in Group B(P<0.05).The quality of life(SF-36)score in Group A was higher than that in Group B(P<0.05).Conclusion:Tianma Gouteng Decoction combined with Betahistine Mesylate is effective and feasible in the treatment of PCI,with improved hemodynamic indicators and reduced disease scores.展开更多
Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and revers...Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.展开更多
BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the...BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.展开更多
AIM:To investigate the refractive and the histological changes in guinea pig eyes after posterior scleral reinforcement with scleral allografts.METHODS:Four-week-old guinea pigs were implanted with scleral allografts,...AIM:To investigate the refractive and the histological changes in guinea pig eyes after posterior scleral reinforcement with scleral allografts.METHODS:Four-week-old guinea pigs were implanted with scleral allografts,and the changes of refraction,corneal curvature and axis length were monitored for 51d.The effects of methylprednisolone(MPS)on refraction parameters were also evaluated.And the microstructure and ultra-microstructure of eyes were observed on the 9d and 51d after operation.Repeated-measures analysis of variance and one-way analysis of variance were used.RESULTS:The refraction outcome of the implanted eye decreased after operation,and the refraction change of the 3 mm scleral allografts group was significantly different with control group(P=0.005)and the sham surgical group(P=0.004).After the application of MPS solution,the reduction of refraction outcome was statistically suppressed(P=0.008).The inflammatory encapsulation appeared 9d after surgery.On 51d after operation,the loose implanted materials were absorbed,while the adherent implanted materials with MPS group were still tightly attached to the recipient’s eyeball.CONCLUSION:After implantation of scleral allografts,the refraction of guinea pig eyes fluctuated from a decrease to an increase.The outcome of the scleral allografts is affected by implantation methods and the inflammatory response.Stability of the material can be improved by MPS.展开更多
BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;ho...BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.展开更多
BACKGROUND Simultanagnosia is a neurological disorder that impairs an individual's ability to perceive more than one object at a time visually.While the individual may acknowledge the presence of multiple objects ...BACKGROUND Simultanagnosia is a neurological disorder that impairs an individual's ability to perceive more than one object at a time visually.While the individual may acknowledge the presence of multiple objects in his field of view,he cannot generally summarize the overall percept.CASE SUMMARY We describe a case of simultanagnosia in Posterior Cortical Atrophy,evidenced by the Ishihara color test.A 54-year-old woman complained of reading problems despite normal visual acuity and a structural eye exam.The patient failed to identify any of the Ishihara color plates in either eye despite adequate naming of colors.Automated visual field testing showed a homonymous hemianopia.Structural and functional neuroimaging and cerebrospinal fluid analysis were consistent with posterior cortical atrophy.CONCLUSION Simultanagnosia can be tested with the Ishihara pseudoisochromatic plates because the recognition of embedded number patterns in the test requires appreciation of a collection of individual stimuli.展开更多
BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Pos...BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.展开更多
BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in p...BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.展开更多
While multiple step saccades(MSS)are occasionally reported in the healthy population,they are more evident in patients with Parkinson’s disease(PD).Therefore,MSS has been suggested as a biological marker for the diag...While multiple step saccades(MSS)are occasionally reported in the healthy population,they are more evident in patients with Parkinson’s disease(PD).Therefore,MSS has been suggested as a biological marker for the diagnosis of PD.However,the lack of clarity on the neural mechanism underlying the generation of MSS largely impedes their application in the clinic.We have proposed recently that MSS are triggered by the discrepancy between desired and executed saccades.Accordingly,brain regions involved in saccadic planning and execution might play a role in the generation of MSS.To test this hypothesis,we explored the role of the prefrontal(PFC)and posterior parietal cortex(PPC)in generating MSS by conducting two experiments:electroencephalographic recording and single-pulse transcranial magnetic stimulation in the PFC or PPC of humans while participants were performing a gap saccade task.We found that the PFC and PPC are involved in the generation of MSS.展开更多
Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bo...Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bowel tissue,thus in the setting of a megaureter,ureterocystoplasty is favorable.Methods:We present a case of Teapot ureterocystoplasty,which improves vascular protection of the ureter by leaving the distal 3 cm of the ureter tubularized.Cystograms demonstrated bladder capacity improvement from 50 mL to 180 mL post-operatively.Additionally,Creatinine stabilized after a peak of 250 umol/L.Result and Conclusion:This patient is doing well at 4.5-year surveillance and has avoided renal transplant,a common fate for these children.展开更多
AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective st...AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.展开更多
AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the struct...AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the structure of the optic nerve,the peripapillary nerve fiber layer(RNFL)and the Bruch’s membrane opening-minimum rim width(BMO-MRW).METHODS:This nonrandomized prospective pre-post study included 86 eyes of 48 patients(age,20-47y;axial length:23.10-28.95 mm)scheduled for myopia or myopic astigmatism correction with implantation of the implantable collamer lens(ICL).Eyes with glaucoma or any other ocular disease that could alter OCT results were excluded.RNFL,BMO-MRW and MT were measured preoperatively,and at 1 and 6mo after surgery using spectral-domain OCT.Changes between preoperative and postoperative values were evaluated.RESULTS:There was a significant increase in BMOMRW at 1mo(mean change:3.48±15.07μm,P=0.041).No significant changes were found during the rest of followup(1-6mo postop.,P=0.623).There was also a significant increase in RNFL thickness at 1mo af ter surger y(1.45±2.18μm,P<0.001),but with a significant reduction from 1 to 6mo postoperatively(P=0.002).Regarding MT,it increased significantly at 1mo(2.46±3.76μm,P<0.001),with a significant decrease afterwards(P=0.048).Measurements of the three parameters at 6mo were slightly superior to preoperative values(P<0.01).CONCLUSION:Minimal changes are induced in BMOMRW,RNFL and MT after ICL implantation in healthy eyes,confirming the safety of the surgical procedure regarding the structure of the optic nerve head and the macula,and indicating that this phakic intraocular lens seems to have a slight impact on OCT measurements.展开更多
AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total ...AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total of 22 participants(22 eyes)with high myopia[axial length(AL)≥26.5 mm]and MHRD who underwent PSC combined with intravitreal C_(3)F_(8)injection,with at least 6mo of follow-up were retrospectively recruited.Outcome measures included best-corrected visual acuity(BCVA),AL,optical coherence tomography(OCT)findings,and adverse events.Retinal recovery was categorized as type Ⅰ(macular hole bridging with retinal reattachment)or type Ⅱ(reattachment without hole bridging).RESULTS:The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo.Complete retinal reattachment was observed in 11 eyes(50%)at postoperative day 1,19 eyes(86.3%)at week 1,and all 22 eyes at month 1.Ten eyes(45.5%)achieved type Ⅰ recovery and 12 eyes(54.5%)achieved type Ⅱ.Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery(P<0.001),and AL was significantly reduced compared to baseline(29.07±2.05 vs 30.8±2.2 mm;P<0.001).No serious complications were reported.CONCLUSION:PSC combined with intravitreal C_(3)F_(8)injection is a safe and effective treatment for MHRD in highly myopic eyes,especially for retinal detachment limited within the vascular arcade.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
BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spi...BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spinal cord.Surgical treatment is difficult,risky and complicated;thus,clinical treatment is difficult at present.CASE SUMMARY A case of severe multi-segmental T-OPLL treated with thoracic anterior controllable antedisplacement fusion(TACAF)is reported,including the surgical procedures and analysis of the clinical data.The modified-Japanese Orthopaedic Association score in this patient was 4 before surgery,and it was raised to 9 after the operation.The symptoms of spinal canal compression were subsequently relieved.Three months after surgery,digital radiography showed good healing and recovery of limb sensory function.CONCLUSION This case report suggests that TACAF is feasible for the treatment of long-segment T-OPLL,and has the advantages of low risk and reduced trauma.However,this operation still needs to be verified by clinical research with a larger sample size.展开更多
A 31-year-old woman with untreated hypertension presented with a progressively worsening occipital headache for 3 months.In the last 4 days,she developed a pulsating holocranial headache that awakened her nocturnally ...A 31-year-old woman with untreated hypertension presented with a progressively worsening occipital headache for 3 months.In the last 4 days,she developed a pulsating holocranial headache that awakened her nocturnally and worsened with Valsalva maneuver.Neurological examination revealed no focal deficits.The patient reported decreased visual acuity,and fundoscopic examination demonstrated grade III hypertensive retinopathy,but no optic disc edema.Blood pressure was 230/160 mmHg and laboratory analysis showed elevated serum creatinine(3.42 mg/dL).Autoimmune and infectious markers were negative.展开更多
An 81-year-old man with a history of central retinal artery occlusion(CRAO),under follow-up for neovascular glaucoma,presented with an unusual vitreous detachment in which a prior vitreous hemorrhage had formed a dist...An 81-year-old man with a history of central retinal artery occlusion(CRAO),under follow-up for neovascular glaucoma,presented with an unusual vitreous detachment in which a prior vitreous hemorrhage had formed a distinctive heart-shaped Weiss ring(Figure 1)(1).Although such floaters can often be bothersome,especially during reading or in bright lighting,the patient reported no symptoms due to his severely reduced visual acuity,which was limited to hand motion following the CRAO.This case serves as a lighthearted reminder that,even in ophthalmology and in patients with a poor visual prognosis,love can appear in the most unexpected places.展开更多
BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associat...BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associated clinical,imaging,and treat-ment options remain unclear.CASE SUMMARY A 39-year-old man was admitted for dizziness and unstable gait for two days.Ph-ysical examination revealed decreased right-limb muscle strength and right-sided ataxia.Brain magnetic resonance imaging(MRI)showed a massive acute right cerebellar infarction,but other modalities,including head and neck computed tomographic angiography(CTA)and magnetic resonance angiography(MRA),showed no obvious abnormalities.High-resolution vessel wall MRI(HR-VW-MRI)revealed right PICAD.The patient was diagnosed with massive cerebellar infarction caused by PICAD and active conservative treatment was initiated.The initial PICAD lesion disappeared 1.5 months after discharge,after which the patient experienced only slight weakness in his right limb for three months.CONCLUSION Since MRA and CTA may fail to identify PICAD,HR-VW-MRI is key in diagnosis and follow-up evaluation.Aggressive medication may be effective and safe for treating PICAD.展开更多
基金Supported by the Projects of Medical and Health Technology Development Program in Shandong Province(No.202107021009)Shandong Provincial Traditional Chinese Medicine Science and Technology Project(No.M-2023118).
文摘AIM:To determine whether paeonol(Pae),a naturally occurring phenolic compound,can serve as an effective pharmacological inhibitor of posterior capsular opacification(PCO).METHODS:A rat model of cataract surgery—induced PCO was established,and Pae was administered via anterior chamber injection to evaluate its preventive effect on capsular opacification and fibrotic remodeling.Histological and immunohistochemical analyses were performed to assess epithelial-mesenchymal transition(EMT)—related changes in lens epithelial cells(LECs).Ex vivo lens capsule cultures were employed to examine the expression of Vimentin and Zonula Occludens-1(ZO-1)by immunofluorescence and immunohistochemistry.In the human LEC line SRA01/04,EMT marker expression at both mRNA and protein levels was analyzed following transforming growth factor beta 2(TGF-β2)stimulation,with Pae treatment.Western blotting and immunofluorescence were used to investigate the effect of Pae on TGF-β/Smad signaling and AMP-activated protein kinase(AMPK)activation.Molecular docking was performed to predict Pae–AMPK binding,and rescue experiments with AMPK inhibition were conducted to validate the mechanistic pathway.RESULTS:Pae significantly reduced capsular opacification and fibrotic remodeling in the rat PCO model compared with controls.In LECs,Pae markedly suppressed TGF-β2–induced EMT,evidenced by decreased expression of mesenchymal markers,such as Vimentin,Fibronectin,Collagen 1A1,α-SMA and preserved epithelial junctional protein ZO-1.Mechanistically,Pae was predicted to directly interact with the catalytic pocket of AMPK,which was experimentally confirmed by enhanced AMPK phosphorylation and nuclear translocation(P<0.05).This activation disrupted canonical TGF-β/Smad signaling,leading to suppression of EMT.Rescue experiments using AMPK inhibition abrogated the anti-EMT effect of Pae,further validating the AMPK-dependent mechanism.CONCLUSION:Pae exerts a potent inhibitory effect on PCO formation by blocking EMT of LECs through direct activation of AMPK and subsequent disruption of TGF-β/Smad signaling.
文摘BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is a complex neurological disorder characterized by symptoms such as headaches,seizures,confusion,and visual disturbances.The pathophysiology of PRES involves endothelial dysfunction,disrupted cerebral autoregulation,and resulting vasogenic edema.Hypertension and other factors that alter cerebral autoregulation are critical in its development.Corticosteroids,widely used for their anti-inflammatory and immunosuppressive properties,play a controversial role in PRES.AIM To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature.Specifically,it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES.By synthesizing case reports and series,this review aims to provide a comprehensive understanding of the mechanisms,clinical presentations,and management strategies associated with corticosteroid-related PRES.METHODS The review was carried out according to the PRISMA guidelines.The databases searched included Science Direct,PubMed,and Hinari.The search strategy encompassed terms related to corticosteroids and PRES.Studies were included if they were peer-reviewed articles examining corticosteroids in PRES,excluding non-English publications,reviews,and editorials.Data on patient demographics,clinical characteristics,imaging findings,corticosteroid regimens,and outcomes were extracted.The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.RESULTS A total of 56 cases of PRES(66.1%women,33.9%men)potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified.Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years,with seizures,headaches,hypertension,and visual disturbances being common clinical sequelae.Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes.High-dose or prolonged corticosteroid therapy was a significant risk factor.On the contrary,in the treatment cases,corticosteroids were associated with positive outcomes,including resolution of vasogenic edema and stabilization of symptoms,particularly in patients with underlying inflammatory or autoimmune diseases.CONCLUSION Corticosteroids have a dual role in PRES,capable of both inducing and treating the condition.The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating.Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation.Corticosteroids may aid in the management of PRES:(1)Enhancing endothelial stability;(2)Antiinflammatory properties;and(3)Improving blood-brain barrier integrity.Mechanisms which may reduce or mitigate vasogenic edema formation.
文摘Objective:To evaluate the therapeutic effect of Tianma Gouteng Decoction combined with Betahistine Mesylate in patients with posterior circulation ischemic vertigo(PCI).Methods:Eighty-two patients with PCI who visited the hospital from February 2024 to February 2025 were selected as samples and randomly divided into two groups.Group A received Tianma Gouteng Decoction combined with Betahistine Mesylate,while Group B received only Betahistine Mesylate.The efficacy,syndrome scores,hemodynamics,and quality of life indicators were compared between the two groups.Results:The efficacy of PCI treatment in Group A was higher than that in Group B(P<0.05).The syndrome scores in Group A were lower than those in Group B(P<0.05).The peak systolic velocity(PSV)of the basilar artery and left and right vertebral arteries in Group A were higher than those in Group B(P<0.05).The quality of life(SF-36)score in Group A was higher than that in Group B(P<0.05).Conclusion:Tianma Gouteng Decoction combined with Betahistine Mesylate is effective and feasible in the treatment of PCI,with improved hemodynamic indicators and reduced disease scores.
文摘Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.
文摘BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.
基金Supported by the Scientific Research Project of Shanghai Municipal Health Commission(No.202140416)the Clinical Research Boosting Program of the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(No.JYLJ202117).
文摘AIM:To investigate the refractive and the histological changes in guinea pig eyes after posterior scleral reinforcement with scleral allografts.METHODS:Four-week-old guinea pigs were implanted with scleral allografts,and the changes of refraction,corneal curvature and axis length were monitored for 51d.The effects of methylprednisolone(MPS)on refraction parameters were also evaluated.And the microstructure and ultra-microstructure of eyes were observed on the 9d and 51d after operation.Repeated-measures analysis of variance and one-way analysis of variance were used.RESULTS:The refraction outcome of the implanted eye decreased after operation,and the refraction change of the 3 mm scleral allografts group was significantly different with control group(P=0.005)and the sham surgical group(P=0.004).After the application of MPS solution,the reduction of refraction outcome was statistically suppressed(P=0.008).The inflammatory encapsulation appeared 9d after surgery.On 51d after operation,the loose implanted materials were absorbed,while the adherent implanted materials with MPS group were still tightly attached to the recipient’s eyeball.CONCLUSION:After implantation of scleral allografts,the refraction of guinea pig eyes fluctuated from a decrease to an increase.The outcome of the scleral allografts is affected by implantation methods and the inflammatory response.Stability of the material can be improved by MPS.
文摘BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.
文摘BACKGROUND Simultanagnosia is a neurological disorder that impairs an individual's ability to perceive more than one object at a time visually.While the individual may acknowledge the presence of multiple objects in his field of view,he cannot generally summarize the overall percept.CASE SUMMARY We describe a case of simultanagnosia in Posterior Cortical Atrophy,evidenced by the Ishihara color test.A 54-year-old woman complained of reading problems despite normal visual acuity and a structural eye exam.The patient failed to identify any of the Ishihara color plates in either eye despite adequate naming of colors.Automated visual field testing showed a homonymous hemianopia.Structural and functional neuroimaging and cerebrospinal fluid analysis were consistent with posterior cortical atrophy.CONCLUSION Simultanagnosia can be tested with the Ishihara pseudoisochromatic plates because the recognition of embedded number patterns in the test requires appreciation of a collection of individual stimuli.
文摘BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.
文摘BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.
基金supported by North Sichuan Medical College(CBY23-QDA14)the National Natural Science Foundation of China(32030045 and 82071454)+4 种基金Nanchong Federation of Social Science Associations(NC24C145)the Sichuan Science and Technology Program(2024NSFSC2017,2024ZYD0086)the Sichuan Students'Platform for Innovation Training Program(S202410634035)the Health Commission of Sichuan Province(24WSXT044)funded by the Open Research Fund of the State Key Laboratory of Cognitive Neuroscience and Learning(CNLYB2403).
文摘While multiple step saccades(MSS)are occasionally reported in the healthy population,they are more evident in patients with Parkinson’s disease(PD).Therefore,MSS has been suggested as a biological marker for the diagnosis of PD.However,the lack of clarity on the neural mechanism underlying the generation of MSS largely impedes their application in the clinic.We have proposed recently that MSS are triggered by the discrepancy between desired and executed saccades.Accordingly,brain regions involved in saccadic planning and execution might play a role in the generation of MSS.To test this hypothesis,we explored the role of the prefrontal(PFC)and posterior parietal cortex(PPC)in generating MSS by conducting two experiments:electroencephalographic recording and single-pulse transcranial magnetic stimulation in the PFC or PPC of humans while participants were performing a gap saccade task.We found that the PFC and PPC are involved in the generation of MSS.
文摘Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bowel tissue,thus in the setting of a megaureter,ureterocystoplasty is favorable.Methods:We present a case of Teapot ureterocystoplasty,which improves vascular protection of the ureter by leaving the distal 3 cm of the ureter tubularized.Cystograms demonstrated bladder capacity improvement from 50 mL to 180 mL post-operatively.Additionally,Creatinine stabilized after a peak of 250 umol/L.Result and Conclusion:This patient is doing well at 4.5-year surveillance and has avoided renal transplant,a common fate for these children.
文摘AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.
文摘AIM:To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography(OCT)measurements of macular thickness(MT)and two parameters that define the structure of the optic nerve,the peripapillary nerve fiber layer(RNFL)and the Bruch’s membrane opening-minimum rim width(BMO-MRW).METHODS:This nonrandomized prospective pre-post study included 86 eyes of 48 patients(age,20-47y;axial length:23.10-28.95 mm)scheduled for myopia or myopic astigmatism correction with implantation of the implantable collamer lens(ICL).Eyes with glaucoma or any other ocular disease that could alter OCT results were excluded.RNFL,BMO-MRW and MT were measured preoperatively,and at 1 and 6mo after surgery using spectral-domain OCT.Changes between preoperative and postoperative values were evaluated.RESULTS:There was a significant increase in BMOMRW at 1mo(mean change:3.48±15.07μm,P=0.041).No significant changes were found during the rest of followup(1-6mo postop.,P=0.623).There was also a significant increase in RNFL thickness at 1mo af ter surger y(1.45±2.18μm,P<0.001),but with a significant reduction from 1 to 6mo postoperatively(P=0.002).Regarding MT,it increased significantly at 1mo(2.46±3.76μm,P<0.001),with a significant decrease afterwards(P=0.048).Measurements of the three parameters at 6mo were slightly superior to preoperative values(P<0.01).CONCLUSION:Minimal changes are induced in BMOMRW,RNFL and MT after ICL implantation in healthy eyes,confirming the safety of the surgical procedure regarding the structure of the optic nerve head and the macula,and indicating that this phakic intraocular lens seems to have a slight impact on OCT measurements.
文摘AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total of 22 participants(22 eyes)with high myopia[axial length(AL)≥26.5 mm]and MHRD who underwent PSC combined with intravitreal C_(3)F_(8)injection,with at least 6mo of follow-up were retrospectively recruited.Outcome measures included best-corrected visual acuity(BCVA),AL,optical coherence tomography(OCT)findings,and adverse events.Retinal recovery was categorized as type Ⅰ(macular hole bridging with retinal reattachment)or type Ⅱ(reattachment without hole bridging).RESULTS:The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo.Complete retinal reattachment was observed in 11 eyes(50%)at postoperative day 1,19 eyes(86.3%)at week 1,and all 22 eyes at month 1.Ten eyes(45.5%)achieved type Ⅰ recovery and 12 eyes(54.5%)achieved type Ⅱ.Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery(P<0.001),and AL was significantly reduced compared to baseline(29.07±2.05 vs 30.8±2.2 mm;P<0.001).No serious complications were reported.CONCLUSION:PSC combined with intravitreal C_(3)F_(8)injection is a safe and effective treatment for MHRD in highly myopic eyes,especially for retinal detachment limited within the vascular arcade.
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.
文摘BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spinal cord.Surgical treatment is difficult,risky and complicated;thus,clinical treatment is difficult at present.CASE SUMMARY A case of severe multi-segmental T-OPLL treated with thoracic anterior controllable antedisplacement fusion(TACAF)is reported,including the surgical procedures and analysis of the clinical data.The modified-Japanese Orthopaedic Association score in this patient was 4 before surgery,and it was raised to 9 after the operation.The symptoms of spinal canal compression were subsequently relieved.Three months after surgery,digital radiography showed good healing and recovery of limb sensory function.CONCLUSION This case report suggests that TACAF is feasible for the treatment of long-segment T-OPLL,and has the advantages of low risk and reduced trauma.However,this operation still needs to be verified by clinical research with a larger sample size.
文摘A 31-year-old woman with untreated hypertension presented with a progressively worsening occipital headache for 3 months.In the last 4 days,she developed a pulsating holocranial headache that awakened her nocturnally and worsened with Valsalva maneuver.Neurological examination revealed no focal deficits.The patient reported decreased visual acuity,and fundoscopic examination demonstrated grade III hypertensive retinopathy,but no optic disc edema.Blood pressure was 230/160 mmHg and laboratory analysis showed elevated serum creatinine(3.42 mg/dL).Autoimmune and infectious markers were negative.
文摘An 81-year-old man with a history of central retinal artery occlusion(CRAO),under follow-up for neovascular glaucoma,presented with an unusual vitreous detachment in which a prior vitreous hemorrhage had formed a distinctive heart-shaped Weiss ring(Figure 1)(1).Although such floaters can often be bothersome,especially during reading or in bright lighting,the patient reported no symptoms due to his severely reduced visual acuity,which was limited to hand motion following the CRAO.This case serves as a lighthearted reminder that,even in ophthalmology and in patients with a poor visual prognosis,love can appear in the most unexpected places.
基金Supported by Shenzhen Second People’s Hospital Clinical Research Fund of Shenzhen High-level Hospital Construction Project,No.20243357001.
文摘BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associated clinical,imaging,and treat-ment options remain unclear.CASE SUMMARY A 39-year-old man was admitted for dizziness and unstable gait for two days.Ph-ysical examination revealed decreased right-limb muscle strength and right-sided ataxia.Brain magnetic resonance imaging(MRI)showed a massive acute right cerebellar infarction,but other modalities,including head and neck computed tomographic angiography(CTA)and magnetic resonance angiography(MRA),showed no obvious abnormalities.High-resolution vessel wall MRI(HR-VW-MRI)revealed right PICAD.The patient was diagnosed with massive cerebellar infarction caused by PICAD and active conservative treatment was initiated.The initial PICAD lesion disappeared 1.5 months after discharge,after which the patient experienced only slight weakness in his right limb for three months.CONCLUSION Since MRA and CTA may fail to identify PICAD,HR-VW-MRI is key in diagnosis and follow-up evaluation.Aggressive medication may be effective and safe for treating PICAD.
