Nomogram for predicting short-term response to anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration:An observational study

BACKGROUND Anti-vascular endothelial growth factor(anti-VEGF)therapy is critical for managing neovascular age-related macular degeneration(nAMD),but understanding factors influencing treatment efficacy is essential for optimizing patient outcomes.AIM To identify the risk factors affecting anti-VEGF treatment efficacy in nAMD and develop a predictive model for short-term response.METHODS In this study,65 eyes of exudative AMD patients after anti-VEGF treatment for≥1 mo were observed using optical coherence tomography angiography.Patients were classified into non-responders(n=22)and responders(n=43).Logistic regression was used to determine independent risk factors for treatment response.A predictive model was created using the Akaike Information Criterion,and its performance was assessed with the area under the receiver operating characteristic curve,calibration curves,and decision curve analysis(DCA)with 500 bootstrap re-samples.RESULTS Multivariable logistic regression analysis identified the number of junction voxels[odds ratio=0.997,95%confidence interval(CI):0.993-0.999,P=0.010]as an independent predictor of positive anti-VEGF treatment outcomes.The predictive model incorporating the fractal dimension,number of junction voxels,and longest shortest path,achieved an area under the curve of 0.753(95%CI:0.622-0.873).Calibration curves confirmed a high agreement between predicted and actual outcomes,and DCA validated the model's clinical utility.CONCLUSION The predictive model effectively forecasts 1-mo therapeutic outcomes for nAMD patients undergoing anti-VEGF therapy,enhancing personalized treatment planning.

Biomimetic construction of oriented lamellar Col/nHAP composite scaffolds and mediation of macrophages to promote angiogenesis and bone regeneration

Pore characteristics have been identified as key design parameters for osteoimmunomodulation.The strategy reported here is to create an appropriate immune microenvironment by regulating pore characteristics of scaffolds,thereby promoting early angiogenesis and enhancing osteogenesis.A series of collagen/nanohydroxyapatite(Col/nHAP)composite scaffolds with ordered lamellar structures and different layer spacings were prepared by mimicking the ordered lamellar topology of the bone matrix.Our research indicated that the layer spacing and ordered topology of the scaffold exerted an important influence on phenotype transformation of macrophages and the secretion of angiogenic factors.The Col/nHAP-O(135)with large layer spacing not only supported cell attachment and diffusion in vitro,but also promoted early angiogenesis by timely switching from M1 to M2 macrophage phenotype.In vivo data showed that the layer spacing and the ordered structure of the scaffold synergistically regulated the inflammatory response and triggered macrophages to secrete more angiogenesis related cytokines.Col/nHAP-O(135)considerably promoted the neovascularization and new bone formation in the defect site,indicating that Col/nHAPO(135)could significantly enhance the osteogenic activity of stem cells with the involvement of macrophages.

Comparison of Clinical Efficacy of Three Methods for Cervical Ripening followed by Surgical Evacuation in Early Missed Abortion

Objective To compare clinical efficacy of three cervical preparations for surgical evacuation in first trimester missed abortion. Methods Two hundred and ten women with early missed abortion were equally randomized into three groups. Three cervical preparations, Dilapan-dilator method （group A, n= 70）, mifepristone method （group B, n= 70）, and misoprostol method （group C, n= 70）, were used 24 h before curettage for terminating missed abortion, respectively. Clinical outcomes and complications for these three methods were compared. Results No differences were found in rates of successful treatment among the three groups （P〉O.05）. The incidence of fitting number 8 Hegar dilator was slightly high in group A, but it was not different compared with that in group B or group C （P〉0.05）. Bleeding in previous 24 h in group C was significantly greater than that in group A or group B （P〈0.01）. The cases of blood loss （〉50 ml） during evacuation in group B were more than those in group A （P〉0.05）. Women in group B had less abdominal pain than those in group A or group C （P〈0.01）. Side effects in group C were more than those in group A on nausea （P〈0.01）, vomiting （P〈0.05）, and diarrhea （P〈0.01）. Group B had the highest acceptability among the three groups （P〈0.05）. Conclusion Three methods have the similar clinical efficacies in cervical ripening for surgical treatment of early missed abortion. Based on individual characteristics, different approach would be chosen to avoid some adverse events and improve the clinical application of Dilapan-dilator.

Comparison of Preliminary Clinical Efficacy for Two Cervical Preparations for Early Second-trimester Pregnancy Termination at 12-17 Weeks Gestation

Objective To compare clinical efficacy for two cervical preparations for early secondtrimester pregnancy termination at 12-17 weeks gestation. Methods Seventy healthy women aged 18-41 years requesting legal termination of pregnancy at 12-17 weeks of gestation were equally randomized into two groups. Two cervical preparations, the Dilapan-STM combined with mifepristone and misoprostol （DMM） method, and the mifepristone combined with misoprostol （MM） method, were used to end early second-trimester pregnancy for group DMM and group MM, respectively. Clinical outcomes and complications for these two methods were compared. Results No differences were found on rates of successful abortion within 48 h and blood loss after abortion at 2 h between the two groups （P〉0.05）. DMM group had significant shorter induction-to-abortion interval and hospital stay compared with group MM （P〈0.01）. In both DMM and MM groups, side effects including nausea/vomiting, diarrhea, chills and rigors, and fever occurred, and incidences of these side effects were no difference （P〉0.05）. Conclusion DMM method would have similar clinical efficacies with MM method for early second-trimester pregnancy termination. Besides,DMM method has shorter induction-to-abortion interval and hospital stay, which benefits its clinical application.

Construction of physical crosslink-based chitosan/liquid crystal composite hydrogel and evaluation on their cytocompatibility

In order to provide a novel biomimetic composite substrate for tissue engineering and explore the interaction between cells and this type of material,we developed chitosan/liquid crystal(CS/LC)composite hydrogel with embedded LC phases by composing of cholesterol hydroxypropyl cellulose ester liquid crystalline material and CS.The micromorphology of CS/LC composite hydrogels exhibited‘islands-sea’phase separation structures similar to the‘fluid mosaic model’of biomembrane.In vitro cell compatibility study suggested that 3T3 is fibroblasts exhibited better initial cell adhesions and higher proliferation rates on the composite hydrogel than on the polystyrene control plate and the pure LC membrane.This novel CS/LC composite hydrogel provides more favorable interface for cell growth and proliferation and may serve as potentially active substrate for engineering interfaces to live cells.