Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oilfilled eyes

AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

Initial clinical experience with Xpert-Pro peripheral self-expanding stent system for internal carotid artery dissection:Two case reports

Background:The standard treatment for internal carotid artery(ICA)dissection is obscure.Current therapeutic strategies include the use of antiplatelet drugs,anticoagulant drugs,intravenous thrombolysis,and endovascular treatment.Endovascular treatment is important in acute internal carotid artery dissection.This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral selfexpanding stent system.Case summary:The first case was of a 38-year-old male patient with transient speechlessness and paralysis of the right limb in July 2021.Cervical computed tomographic angiography(CTA)showed ICA occlusion on the left side.Digital subtraction angiography(DSA)showed severe stenosis of the C1 segment of the left internal carotid artery with intermural hematoma.The patient subsequently underwent Xpert-Pro peripheral self-expanding stent implantation,and his condition stabilized.The second case was of a 56-year-old male patient with speechlessness and paralysis of the right limb.Cervical CTA showed a dissected left ICA,and DSA showed an occluded left ICA and middle cerebral artery.The patient subsequently underwent stent implantation,and his condition stabilized.

Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images

AIM:To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy(DR)and in patients with or without diabetic macular edema(DME).METHODS:The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study.The severity of DR patients was graded as mild,moderate and severe non-proliferative diabetic retinopathy(NPDR)according to the international clinical diabetic retinopathy(ICDR)disease severity scale classification,and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods.The presence of DME was determined by optical coherence tomography(OCT),and differences in vascular morphological characteristics were compared between patients with and without DME.RESULTS:Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99%and a Dice metric of 0.76.Compared with the healthy group,the DR group had smaller vessel angles(33.68±3.01 vs 37.78±1.60),smaller fractal dimension(Df)values(1.33±0.05 vs 1.41±0.03),less vessel density(1.12±0.44 vs 2.09±0.36)and fewer vascular branches(206.1±88.8 vs 396.5±91.3),all P<0.001.As the severity of DR increased,Df values decreased,P=0.031.No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics.CONCLUSION:In this study,an artificial intelligence retinal vessel segmentation system is used with 99%accuracy,thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology.DR patients have a tendency of vascular occlusion and dropout.The presence of DME does not compromise the integral retinal vascular pattern.

Treatment of acute dacryocystitis by translacrimal canalicular drainage and D-silicone intubation

AIM:To demonstrate the outcomes of translacrimal canalicular drainage using a lacrimal probe and intranasal drainage by D-silicone intubation for acute dacryocystitis(AD).METHODS:This retrospective study included 23 patients with AD and had undergone abscess decompression with the use of lacrimal probe and intranasal drainage by D-silicone intubation between January 2019 and December 2022.Patients received abscess decompression and systemic antibiotic-corticosteroid from the time of diagnosis.D-silicone tube was inserted within 10d after diagnosis and removed 3-6mo after intubation.The procedure and outcomes of this method were evaluated.RESULTS:All patients showed improvement of signs and symptoms of AD within 72h.No intraoperative and postoperative complications were observed.No recurrence of lacrimal sac abscesses occurred after D-silicone tube removed.CONCLUSION:Lacrimal probe and D-silicone intubation appear to be a feasible,minimally invasive,safe,and effective method,which could be a reasonable choice in the treatment of AD.

Assessment of rehabilitation treatment for patients with acute poisoning-induced toxic encephalopathy

BACKGROUND:Poisoned patients often suffer damage to multiple systems,and those experiencing central nervous system disorders present more severe conditions,prolonged hospital stays,and increased mortality rates.We aimed to assess the efficacy of rehabilitation interventions for patients with toxic encephalopathy.METHODS:This retrospective,observational,comparative cohort study was performed at the teaching hospital affiliated of Nanjing Medical University,from October 2020 to December 2022.Patients who met the diagnostic criteria for toxic encephalopathy and exclusion criteria were included,and patients were divided into three subgroups according to Glasgow Coma Scale(GCS).Demographic and clinical characteristics were collected.The effect of the rehabilitation intervention on patients were assessed in the improvement of consciousness status(Glasgow Coma Scale[GCS]score),muscle strength and movement and swallowing function(Fugl-Meyer Assessment[FMA]scale,Water Swallow Test[WST],and Standardized Swallowing Assessment[SSA]).Subgroup analysis was based on different toxic species.RESULTS:Out of the 464 patients with toxic encephalopathy,184 cases received rehabilitation treatments.For the severe toxic encephalopathy patients,patients without rehabilitation intervention have a 2.21 times higher risk of death compared to patients with rehabilitation intervention(Hazard ratio[HR]=2.21).Subgroup analysis revealed that rehabilitation intervention significantly increased the survival rate of patients with pesticide poisoning(P=0.02),while no significant improvement was observed in patients with drug/biological agent poisoning(P=0.44).After rehabilitation intervention,significant improvement in GCS and FMA were observed in severe patients with toxic encephalopathy(P<0.01).CONCLUSION:Active rehabilitation intervention for patients exposed to poisons that can potentially cause toxic encephalopathy may improve the prognosis and reduce the mortality rate in clinical practice.

Effects of Custom-made Insoles on Plantar Biomechanics and Upper Extremity Muscle Performance

Objective:To investigate the effectiveness of molding custom-made insoles for female patients with foot pain.Methods:The study included 20 patients whose insoles were prescribed according to biomechanical evaluations and molded by repositioning the subtalar joint in its neutral position using a simple set of tools.

The role of purinergic receptors in neural repair and regeneration after spinal cord injury

Spinal cord injury is a serious injury of the central nervous system that results in neurological deficits.The pathophysiological mechanisms underlying spinal cord injury,as well as the mechanisms involved in neural repair and regeneration,are highly complex.Although there have been many studies on these mechanisms,there is no effective intervention for such injury.In spinal cord injury,neural repair and regeneration is an important part of improving neurological function after injury,although the low regenerative ability of nerve cells and the difficulty in axonal and myelin regeneration after spinal cord injury hamper functional recovery.Large amounts of ATP and its metabolites are released after spinal cord injury and participate in various aspects of functional regulation by acting on purinergic receptors which are widely expressed in the spinal cord.These processes mediate intracellular and extracellular signalling pathways to improve neural repair and regeneration after spinal cord injury.This article reviews research on the mechanistic roles of purinergic receptors in spinal cord injury,highlighting the potential role of purinergic receptors as interventional targets for neural repair and regeneration after spinal cord injury.

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT

AIM:To describe the clinical and radiologic features of retrolaminar migration silicone oil(SiO)and observe the dynamic position of ventricular oil accumulation in supine and prone.METHODS:For this retrospective study,29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography(CT)were included from January 2019 to October 2022.The patients were divided into migration-positive and negative groups.Clinical history and CT features were compared using Whitney U and Fisher’s exact tests.The dynamic position of SiO was observed within the ventricular system in supine and prone.CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision(optic nerve,chiasm,and tract)and ventricular system.RESULTS:Intraocular SiO migration was found in 5 of the 29 patients(17.24%),with SiO at the optic nerve head(n=1),optic nerve(n=4),optic chiasm(n=1),optic tract(n=1),and within lateral ventricles(n=1).The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients(22.8±16.5mo vs 13.1±2.6mo,P<0.001).The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone.CONCLUSION:Although SiO retrolaminar migration is unusual,the clinician and radiologist should be aware of migration routes.The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.

Aza-BODIPY dye with unexpected bromination and high singlet oxygen quantum yield for photoacoustic imaging-guided synergetic photodynamic/photothermal therapy

Introducing heavy halogen atoms into organic small molecules is a practical strategy for efficient singlet oxygen(^(1)O_(2))generation.Generally,bromine or iodine atoms are introduced on the aza-borondipyrromethene(aza-BODIPY)core,rather than on the periphery aryl rings for efficient~1O_(2) generation.Herein,an aza-BODIPY dye NBDPBr with unexpected bromination on the periphery aryl rings was synthesized for photoacoustic(PA)imaging-guided synergistic photothermal therapy(PTT)and photodynamic therapy(PDT)in tumor cells.Owing to unexcepted bromination at the periphery aryl rings,NBDPBr demonstrated an outstanding singlet oxygen quantum yield(Φ_(Δ))of 66% which was superior to similar brominated photosensitizers previously reported.After encapsulation with amphiphilic polymer F-127,hydrophilic NBDPBr nanoparticles(NPs)were fabricated and exhibited an excellent photothermal conversion efficiency(η)of 43.0% under 660 nm photoirradiation.In vivo PA imaging results demonstrated that NBDPBr NPs could specifically accumulate at tumor sites and realized the maximum tumor retention at 7 h post-injection.All the in vitro and in vivo results indicated the significant potence of NBDPBr with unexpected bis-bromination for PA imaging-guided synergetic PDT/PTT.

Tenecteplase thrombolysis for stroke up to 24 hours after onset with perfusion imaging selection:the umbrella phase IIa CHABLIS-T randomised clinical trial

Background The performance of intravenous tenecteplase in patients who had an acute ischaemic stroke with large/medium vessel occlusion or severe stenosis in an extended time window remains unknown. We investigated the promise of efficacy and safety of different doses of tenecteplase manufactured in China, in patients who had an acute ischaemic stroke with large/ medium vessel occlusion beyond 4.5- hour time window. Methods The CHinese Acute tissue- Based imaging selection for Lysis In Stroke- Tenecteplase was an investigator- initiated, umbrella phase IIa, open- label, blinded- endpoint, Simon’s two- stage randomised clinical trial in 13 centres across China's Mainland. Participants who had salvageable brain tissue on automated perfusion imaging and presented within 4.5-24 hours from time of last seen well were randomised to receive 0.25 mg/ kg tenecteplase or 0.32 mg/kg tenecteplase, both with a bolus infusion over 5-10 s. The primary outcome was proportion of patients with promise of efficacy and safety defined as reaching major reperfusion without symptomatic intracranial haemorrhage at 24-48 hours after thrombolysis. Assessors were blinded to treatment allocation. All participants who received tenecteplase were included in the analysis. Results A total of 86 patients who had an acute ischaemic stroke identified with anterior large/medium vessel occlusion or severe stenosis were included in this study from November 2019 to December 2021. All of the 86 patients enrolled either received 0.25 mg/kg (n=43) or 0.32 mg/kg (n=43) tenecteplase, and were available for primary outcome analysis. Fourteen out of 43 patients in the 0.25 mg/kg tenecteplase group and 10 out of 43 patients in the 0.32 mg/kg tenecteplase group reached the primary outcome, providing promise of efficacy and safety for both doses based on Simon’s two- stage design. Discussion Among patients with anterior large/medium vessel occlusion and significant penumbral mismatch presented within 4.5-24 hours from time of last seen well, tenecteplase 0.25 mg/kg and 0.32 mg/kg both provided sufficient promise of efficacy and safety.

Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation

Gait disorders drastically affect the quality of life of stroke survivors,making post-stroke rehabilitation an important research focus.Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment.However,a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized.We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery,and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery.While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity,it evolves over time,is idiosyncratic,and may develop maladaptive elements.Furthermore,noninvasive brain stimulation has limited reach capability and is facilitative-only in nature.Therefore,we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques.Additionally,when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors,stimulation montages should be customized according to the specific types of neuroplasticity found in each individual.This could be done using multiple mapping techniques.

百会长时间留针配合风池穴多方向透刺抖针疗法治疗颈性眩晕的疗效观察

目的:观察百会长时间留针配合风池穴多方向透刺抖针疗法治疗颈性眩晕(CV)的临床疗效以及对椎-基底动脉血流速度的影响。方法:将70例CV患者根据随机数字表法分为治疗组(35例,脱落1例)和对照组(35例,脱落2例)。治疗组采用百会长时间留针配合风池穴多方向透刺抖针疗法,对照组采用常规针刺,隔日1次,7次为1个疗程,共治疗2个疗程。观察两组治疗前后颈性眩晕症状与功能评估量表(ESCV)评分及椎-基底动脉平均血流速度(Vm)的变化情况,比较两组临床疗效。结果:治疗组总有效率和愈显率分别为91.2%和79.4%,对照组分别为78.8%和54.5%。两组愈显率比较差异具有统计学意义(P<0.05)。治疗后两组患者的ESCV评分和椎-基底动脉Vm均较治疗前有明显改善。低流速和正常流速患者的左侧椎动脉(LVA)、右侧椎动脉(RVA)和基底动脉(BA)的Vm增加,而高流速者的LVA、RVA和BA的Vm降低(P<0.05);治疗组的结果显著优于对照组(P<0.05)。结论:百会长时间留针配合风池穴多方向透刺抖针疗法能明显减轻CV患者的临床症状,双向调节椎-基底动脉血流速度,是治疗CV的有效方法。

Brief ICF Core Set for Obstructive Pulmonary Diseases: Validation from the Perspective of Chinese Respiratory Physicians

Obstructive pulmonary diseases(OPDs)are the leading causes of mortality and disability worldwide.The International Classification of Functioning,Disability and Health(ICF)provides a framework for systemat-ically assessing functioning and disability in patients with chronic diseases.To date,the ICF core sets for OPDs have not been validated by respiratory physicians in China’s mainland.This study was aimed at validating the brief ICF core set for OPDs from the perspective of Chinese respiratory physicians.A three-round,consensus-building survey was conducted with Chinese respiratory physicians from Shanghai,Jiangsu,and Zhejiang from December 2 to December 16,2017,using the Delphi technique.Their answers were analyzed for consensus degree.In this study,52 experts(about 67.3%men)with a mean working experience of(19.3±6.3)years completed the consensus process.After 3 rounds,the following 13 ICF categories were considered crucial for the assessment of OPDs,with an agreement of over 70%:4 in body functions(b410-heart functions,b440-respiratory functions,b455-exercise tolerance functions,and b460-sensations associated with cardiovascular and respiratory functions),2 in body structures(s410-structure of cardiovascular system,and s430-structure of respiratory system),4 in activities and participation(d230-carrying out daily routine,d450-walking,d455-moving around,and d640-doing housework),and 3 in environmental factors(e110-products or substances for personal consumption,e225-climate,and e260-air quality).Twelve(70.6%)categories in the current brief ICF core set were validated,and one additional category,b410-heart functions,was added.In conclusion,Chinese respiratory physicians largely supported the current brief ICF core set for OPDs.However,the newly added and unconfirmed categories need further investigation.