AIM: To compare the efficacy of prophylactic vitrectomy for acute retinal necrosis syndrome(ARN) with routine treatment in Chinese patients, thereby investigate the necessity of prophylactic vitrectomy for ARN. METHOD...AIM: To compare the efficacy of prophylactic vitrectomy for acute retinal necrosis syndrome(ARN) with routine treatment in Chinese patients, thereby investigate the necessity of prophylactic vitrectomy for ARN. METHODS: Thirty patients (37 eyes) were retrospectively included in this study. The eyes were divided into 2 groups by treatment, including routine treatment, which consisted of antiviral medication and vitrectomy after retinal detachment (RD) (n=21), and prophylactic vitrectomy, which consisted of antiviral medication and vitrectomy for the prevention of RD performed during the active inflammatory phase (n=16). The extent of necrosis was determined by fundus photographs at the time of presentation (for eyes with mild vitreous opacity) or the drawings in the operation records. Necrosis of the 37 eyes was divided into 3 grades, including peripheral, middle-peripheral and extensive. The follow-up period ranged from 8 to 57 months. Differences in visual acuity and necrosis between groups were identified using independent samples t-test. RESULTS: Necrosis was more extensive in the routine treatment group than in the prophylactic vitrectomy group (P<0.05). In the routine treatment group, conservative treatment improved necrosis and prevented RD in 6 eyes (29%). Seven eyes (33%) obtained anatomical success, but retinal redetachment occurred in 8 eyes (57%). There were also 5 eyes (24%) developed ocular hypotony or atrophy. Ten eyes (48%) achieved equal or increased visual acuity. In the prophylactic vitrectomy group, RD occurred in 2 eyes (13%). Twelve eyes (75%) were completely anatomically successful, and 10 eyes underwent silicone oil removal. Only one eye (6%) became ocular hypotony. Fourteen eyes (88%) achieved equal or increased visual acuity. The prophylactic vitrectomy group achieved better vision trends than the routine treatment group (P<0.05). Eyes with peripheral necrosis had better visual outcomes than those with mid-peripheral (P<0.05) or extensive (P<0.05) necrosis. However, there was no significant difference between eyes with mid-peripheral and extensive necrosis (P=0.3008) CONCLUSION: Prophylactic vitrectomy can prevent RD and improve the prognosis of ARN, making it an option for cases with rapidly progressing necrosis despite antiviral treatment and cases with moderate to extensive necrosis and severe vitreous opacity.展开更多
Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN...Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN is most commonly caused by viruses within the herpesvirus family.Etiologies include varicella-zoster virus,herpes simplex virus,and cytomegalovirus,and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid.The true incidence of ARN is not known due to its rarity;as a result,clinical treatment is often guided by retrospective case series,case reports,and expert opinion.Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed.Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain,although further studies are needed in this area.In particular for patients with mild to moderate disease,combination therapy may reduce the rate of retinal detachment.Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied,but corticosteroid in particular,may reduce inflammation,which also is involved in the severe disease pathogenesis observed in ARN.This review discusses the advances in diagnosis and treatment of ARN,including management with combination antiviral medication and surgical interventions.展开更多
<strong>Objective:</strong> Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). <strong>Methods:</strong> Retrospective ana...<strong>Objective:</strong> Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). <strong>Methods:</strong> Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. <strong>Results: </strong>The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity < 0.05 in 3 cases, >0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. <strong>Conclusion: </strong>The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.展开更多
BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case...BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case reports with diabetic ketoacidosis(DKA)and is commonly associated with GI bleeding(GIB).CASE SUMMARY We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain.Interestingly,there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset.A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist(GLP-1 RA),though they have not been previously connected to DKA or AEN.The patient was subsequently treated with high dose proton pump inhibitors,GLP-1 RA was discontinued,and an insulin regimen was instituted.The patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.CONCLUSION This report highlights AEN in the absence of overt GIB,emphasizing the importance of early consideration of EGD.展开更多
Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patient...Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)¢=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.展开更多
The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)alg...The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)algorithms in these areas of clinical research has not been reported previously.The present study aims to create a computational algorithm for the automated detection and evaluation of retinal necrosis from retinal fundus photographs.A total of 149 wide-angle fundus photographs from40 eyes of 32 ARN patients were collected,and the U-Net method was used to construct the AI algorithm.Thereby,a novel algorithm based on deep machine learning in detection and evaluation of retinal necrosis was constructed for the first time.This algorithm had an area under the receiver operating curve of 0.92,with 86%sensitivity and 88%specificity in the detection of retinal necrosis.For the purpose of retinal necrosis evaluation,necrotic areas calculated by the AI algorithm were significantly positively correlated with viral load in aqueous humor samples(R2=0.7444,P<0.0001)and therapeutic response of ARN(R2=0.999,P<0.0001).Therefore,our AI algorithm has a potential application in the clinical aided diagnosis of ARN,evaluation of ARN severity,and treatment response monitoring.展开更多
To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome (ARDS) and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 gro...To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome (ARDS) and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 groups: group Ⅰ (saline control group), group Ⅱ (LPS intravenous "single-hit" group), group Ⅲ (LPS intratracheal "single-hit" group) and Group IV (LPS "two-hit" group). Rats were intravenously injected or intratracheally instilled with a large dose of LPS (10 mg/kg in 0.5 mL) to simulate a single attack of ARDS, or intraperitoneally injected with a small dose of LPS (1 mg/kg) followed by tracheal instillation with median dose of LPS (5 mg/kg) to establish a "two-hit" model. Rats in each group were monitored by arterial blood gas analysis and visual inspection for three consecutive days. Arterial blood gas values, lung wet/dry weight ratio and pathological pulmonary changes were analyzed to determine the effects of each ALI/ARDS model. Concentrations of TNF-α, IL-1 and IL-10 in the bronchoalveolar lavage fluid (BALF) and blood plasma were meastired by using enzyme-linked immunosorbent assays (ELISA). Our resulsts showed that single LPS-stimulation, whether through intravenous injection or tracheal instillation, could only induce ALl and temporary hypoxemia in rats. A two-hit LPS stimulation induces prolonged hypoxemia and specific pulmonary injury in rats, and is therefore a more ideal approximation of ARDS in the animal model. The pathogenesis of LPS two-hit-induced ARDS is associated with an uncontrolled systemic inflammatory response and inflammatory injury. It is concluded that the rat ARDS model produced by our LPS two-hit method is more stable and reliable than previous models, and closer to the diagnostic criteria of ARDS, and better mimics the pathological process of ARDS.展开更多
Background Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purp...Background Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Methods One hundred and fifteen patients with NSTEACS were randomized into two groups: group A (aspirin alone, n=58) and group B (aspirin plus clopidogrel, n=57). Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α ) were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls (group C). Results Baseline levels of hs-CRP and TNF-α in group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A: (6.15 ± 1.39) mg/L vs (9.18 ± 1.62) rag/L, P 〈0.01; Group B:(4.99 ± 1.62) mg/L vs (10.29 ± 1.47) rag/L, P〈0.01]. Similarly, levels of TNF-α in both groups decreased at 7 days compared to baseline [Group A: (90.99 ± 28.91) pg/ml vs (117.20 ± 37.13) pg/ml, P 〈0.01; Group B: (74.32± 21.83) pg/ml vs (115.27 ± 32.11) pg/ml, P 〈0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to (3.49 ± 1.53) rag/L, and (2.40 ± 1.17) mg/L respectively (P 〈0.01 for both comparisons). Levels of TNF-α in groups A and B also decreased significantly between 7 and 30 days, to 63.28 ± 29.01 pg/ml (group A) and (43.95 ± 17.10) pg/ml (group B; P 〈0.01 for both comparisons). Significantly lower levels of hs-CRP and TNF-α were observed in group B compared to Group A at thirty days after initiating drug treatment (P 〈0.05). Conclusions Aspirin plus clopidogrel treatment reduced levels of serum hs-CRP and TNF-α in patients with NSTEACS significantly more than aspirin alone. Because both aspirin and clopidogrel produce important anti-inflammatory effects, these results suggest the possibility that long-term treatment with aspirin plus clopidogrel may produce greater clinical benefits compared to treatment with aspirin alone.展开更多
Acute esophageal necrosis,also known as "black esophagus syndrome",is a rare acute esophageal disease that is often associated with vomiting and upper gastrointestinal haemorrhage.At present,little is known ...Acute esophageal necrosis,also known as "black esophagus syndrome",is a rare acute esophageal disease that is often associated with vomiting and upper gastrointestinal haemorrhage.At present,little is known regarding the pathogenesis of this disease.We present the case of a 50-year-old white male patient with diabetic ketoacidosis suffering from acute esophageal necrosis with nausea and vomiting but without any clinical signs of upper gastrointestinal bleeding.展开更多
Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) ...Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) patients.Methods Sixty-one cases of SARS with positive antibodies to SARS coronavirus (SARS-CoV) were classified into the following categories: initial stage (3-7 days), peak stage (8-14 days), and remission and recovery stage (15 -27 days). Forty-four healthy individuals were used as controls. Serum levels of ILs, TNF-a and TGF-p, were measured in all subjects. Serum antibodies to SARS-CoV were detected only in SARS cases.Results The mean concentration of serum IL - 6 in SARS patients did not differ from that in the control group in initial and peak stages, but became significantly higher in remission and recovery stage compared with the control group, initial and peak stages ( P<0. 01). The mean concentration of serum IL-8 in SARS patients did not differ from that of the control group in initial stage, but was significantly higher than control group in peak stage and remission and recovery stage ( P < 0. 05). And it was more significantly higher in remission and recovery stage than in peak stage ( P<0. 01). The mean concentrations of IL-16 and TNF-αin SARS patients were higher than those of the control group for every length of the clinical courses investigated, and were especially high in remission and recovery stage (P<0. 01). SARS patients experienced higher concentration of serum IL-13 compared with the controls in initial stage ( P < 0. 01), but returned to normal levels in peak stage and in remission and recovery stage. The mean concentration of serum IL-18 in SARS patients was significantly lower than that of the control group during all clinical courses ( P < 0. 05). The mean concentration of serum TGF-β1, in SARS patients was higher than that of the control group during all clinical courses. Although TGF-bbbbb1 in serum decreased in remission and recovery stage in SARS patients, the average was still higher than that of the control group (P<0. 01). Conclusions Most proinflammatory cytokines and TGF-β1, were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation. Concurrently, the mean concentration of serum IL-13 decreased gradually, and the mean concentration of serum IL-18 level in SARS patients was lower than that of the control group during all the courses of SARS, suggesting that the immune state of the patients with SARS was obviously abnormal. Observing the dynamic changes in blood cytokine levels can provide a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS.展开更多
Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study w...Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study was to investigate which pro-inflammatory factors involved in the early phase of ARDS.Ten patients underwent valve replacement surgery with or without ARDS were enrolled for analysis of pulmonary function and inflammatory factors release including white blood cell(WBC),neutrophils,CD11b,CD18,interleukin(IL)-8 and tumor necrosis factor-α(TNF-α).The results demonstrated that the ratio of arterial oxygen tension/fraction of inspire oxygen(PaO_(2)/FiO_(2))was greatly reduced in ARDS patients,but only the release of TNF-α was significantly increased,which was reversely correlated to the values of PaO_(2)/FiO_(2).Also,the count of neutrophils adhesive to pulmonary endothelial cells was significantly increased in ARDS patients.Therefore,we concluded that TNF-α was quickly up-regulated and involved in the pathogenesis of CPB-induced ARDS via guiding primed neutrophils to pulmonary interstitium.展开更多
Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologica...Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.展开更多
文摘AIM: To compare the efficacy of prophylactic vitrectomy for acute retinal necrosis syndrome(ARN) with routine treatment in Chinese patients, thereby investigate the necessity of prophylactic vitrectomy for ARN. METHODS: Thirty patients (37 eyes) were retrospectively included in this study. The eyes were divided into 2 groups by treatment, including routine treatment, which consisted of antiviral medication and vitrectomy after retinal detachment (RD) (n=21), and prophylactic vitrectomy, which consisted of antiviral medication and vitrectomy for the prevention of RD performed during the active inflammatory phase (n=16). The extent of necrosis was determined by fundus photographs at the time of presentation (for eyes with mild vitreous opacity) or the drawings in the operation records. Necrosis of the 37 eyes was divided into 3 grades, including peripheral, middle-peripheral and extensive. The follow-up period ranged from 8 to 57 months. Differences in visual acuity and necrosis between groups were identified using independent samples t-test. RESULTS: Necrosis was more extensive in the routine treatment group than in the prophylactic vitrectomy group (P<0.05). In the routine treatment group, conservative treatment improved necrosis and prevented RD in 6 eyes (29%). Seven eyes (33%) obtained anatomical success, but retinal redetachment occurred in 8 eyes (57%). There were also 5 eyes (24%) developed ocular hypotony or atrophy. Ten eyes (48%) achieved equal or increased visual acuity. In the prophylactic vitrectomy group, RD occurred in 2 eyes (13%). Twelve eyes (75%) were completely anatomically successful, and 10 eyes underwent silicone oil removal. Only one eye (6%) became ocular hypotony. Fourteen eyes (88%) achieved equal or increased visual acuity. The prophylactic vitrectomy group achieved better vision trends than the routine treatment group (P<0.05). Eyes with peripheral necrosis had better visual outcomes than those with mid-peripheral (P<0.05) or extensive (P<0.05) necrosis. However, there was no significant difference between eyes with mid-peripheral and extensive necrosis (P=0.3008) CONCLUSION: Prophylactic vitrectomy can prevent RD and improve the prognosis of ARN, making it an option for cases with rapidly progressing necrosis despite antiviral treatment and cases with moderate to extensive necrosis and severe vitreous opacity.
基金This project was supported by the National Eye Institute/National Institutes of Health core grant P30-EY06360(Department of Ophthalmology,Emory University School of Medicine)National Eye Institute of the National Institutes of Health under award RO1 EY029594(SY)+1 种基金The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services,nor does mention of trade names,commercial products,or organizations imply endorsement by the U.S.GovernmentThis research was also supported an unrestricted departmental grant from Research to Prevent Blindness,Inc.to the Emory Eye Center,Emory University School of Medicine and Association for Research in Vision and Ophthalmology Mallinckrodt Young Investigator Award(SY).
文摘Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN is most commonly caused by viruses within the herpesvirus family.Etiologies include varicella-zoster virus,herpes simplex virus,and cytomegalovirus,and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid.The true incidence of ARN is not known due to its rarity;as a result,clinical treatment is often guided by retrospective case series,case reports,and expert opinion.Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed.Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain,although further studies are needed in this area.In particular for patients with mild to moderate disease,combination therapy may reduce the rate of retinal detachment.Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied,but corticosteroid in particular,may reduce inflammation,which also is involved in the severe disease pathogenesis observed in ARN.This review discusses the advances in diagnosis and treatment of ARN,including management with combination antiviral medication and surgical interventions.
文摘<strong>Objective:</strong> Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). <strong>Methods:</strong> Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. <strong>Results: </strong>The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity < 0.05 in 3 cases, >0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. <strong>Conclusion: </strong>The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.
文摘BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case reports with diabetic ketoacidosis(DKA)and is commonly associated with GI bleeding(GIB).CASE SUMMARY We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain.Interestingly,there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset.A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist(GLP-1 RA),though they have not been previously connected to DKA or AEN.The patient was subsequently treated with high dose proton pump inhibitors,GLP-1 RA was discontinued,and an insulin regimen was instituted.The patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.CONCLUSION This report highlights AEN in the absence of overt GIB,emphasizing the importance of early consideration of EGD.
文摘Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)¢=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.
基金the National Natural Science Foundation of China(Nos.81870648 and 82070949)。
文摘The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)algorithms in these areas of clinical research has not been reported previously.The present study aims to create a computational algorithm for the automated detection and evaluation of retinal necrosis from retinal fundus photographs.A total of 149 wide-angle fundus photographs from40 eyes of 32 ARN patients were collected,and the U-Net method was used to construct the AI algorithm.Thereby,a novel algorithm based on deep machine learning in detection and evaluation of retinal necrosis was constructed for the first time.This algorithm had an area under the receiver operating curve of 0.92,with 86%sensitivity and 88%specificity in the detection of retinal necrosis.For the purpose of retinal necrosis evaluation,necrotic areas calculated by the AI algorithm were significantly positively correlated with viral load in aqueous humor samples(R2=0.7444,P<0.0001)and therapeutic response of ARN(R2=0.999,P<0.0001).Therefore,our AI algorithm has a potential application in the clinical aided diagnosis of ARN,evaluation of ARN severity,and treatment response monitoring.
基金supported by a grant from the Shanghai Education Committee(No.2005-81)
文摘To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome (ARDS) and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 groups: group Ⅰ (saline control group), group Ⅱ (LPS intravenous "single-hit" group), group Ⅲ (LPS intratracheal "single-hit" group) and Group IV (LPS "two-hit" group). Rats were intravenously injected or intratracheally instilled with a large dose of LPS (10 mg/kg in 0.5 mL) to simulate a single attack of ARDS, or intraperitoneally injected with a small dose of LPS (1 mg/kg) followed by tracheal instillation with median dose of LPS (5 mg/kg) to establish a "two-hit" model. Rats in each group were monitored by arterial blood gas analysis and visual inspection for three consecutive days. Arterial blood gas values, lung wet/dry weight ratio and pathological pulmonary changes were analyzed to determine the effects of each ALI/ARDS model. Concentrations of TNF-α, IL-1 and IL-10 in the bronchoalveolar lavage fluid (BALF) and blood plasma were meastired by using enzyme-linked immunosorbent assays (ELISA). Our resulsts showed that single LPS-stimulation, whether through intravenous injection or tracheal instillation, could only induce ALl and temporary hypoxemia in rats. A two-hit LPS stimulation induces prolonged hypoxemia and specific pulmonary injury in rats, and is therefore a more ideal approximation of ARDS in the animal model. The pathogenesis of LPS two-hit-induced ARDS is associated with an uncontrolled systemic inflammatory response and inflammatory injury. It is concluded that the rat ARDS model produced by our LPS two-hit method is more stable and reliable than previous models, and closer to the diagnostic criteria of ARDS, and better mimics the pathological process of ARDS.
基金THIS STUDY WAS SUPPORTED BY THE KEY CLINICAL PROJECT OF THE CHINESE MINISTRY OF HEALTH(NO.20012943) AND THE NATIONAL SCIENCE FOUNDATION OF SHANDONG PROVINCE(NO.2002BB1CJA1)
文摘Background Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Methods One hundred and fifteen patients with NSTEACS were randomized into two groups: group A (aspirin alone, n=58) and group B (aspirin plus clopidogrel, n=57). Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α ) were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls (group C). Results Baseline levels of hs-CRP and TNF-α in group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A: (6.15 ± 1.39) mg/L vs (9.18 ± 1.62) rag/L, P 〈0.01; Group B:(4.99 ± 1.62) mg/L vs (10.29 ± 1.47) rag/L, P〈0.01]. Similarly, levels of TNF-α in both groups decreased at 7 days compared to baseline [Group A: (90.99 ± 28.91) pg/ml vs (117.20 ± 37.13) pg/ml, P 〈0.01; Group B: (74.32± 21.83) pg/ml vs (115.27 ± 32.11) pg/ml, P 〈0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to (3.49 ± 1.53) rag/L, and (2.40 ± 1.17) mg/L respectively (P 〈0.01 for both comparisons). Levels of TNF-α in groups A and B also decreased significantly between 7 and 30 days, to 63.28 ± 29.01 pg/ml (group A) and (43.95 ± 17.10) pg/ml (group B; P 〈0.01 for both comparisons). Significantly lower levels of hs-CRP and TNF-α were observed in group B compared to Group A at thirty days after initiating drug treatment (P 〈0.05). Conclusions Aspirin plus clopidogrel treatment reduced levels of serum hs-CRP and TNF-α in patients with NSTEACS significantly more than aspirin alone. Because both aspirin and clopidogrel produce important anti-inflammatory effects, these results suggest the possibility that long-term treatment with aspirin plus clopidogrel may produce greater clinical benefits compared to treatment with aspirin alone.
文摘Acute esophageal necrosis,also known as "black esophagus syndrome",is a rare acute esophageal disease that is often associated with vomiting and upper gastrointestinal haemorrhage.At present,little is known regarding the pathogenesis of this disease.We present the case of a 50-year-old white male patient with diabetic ketoacidosis suffering from acute esophageal necrosis with nausea and vomiting but without any clinical signs of upper gastrointestinal bleeding.
基金The study was sponsored by the National Research Project for SARS (No. 2003AA208102).
文摘Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) patients.Methods Sixty-one cases of SARS with positive antibodies to SARS coronavirus (SARS-CoV) were classified into the following categories: initial stage (3-7 days), peak stage (8-14 days), and remission and recovery stage (15 -27 days). Forty-four healthy individuals were used as controls. Serum levels of ILs, TNF-a and TGF-p, were measured in all subjects. Serum antibodies to SARS-CoV were detected only in SARS cases.Results The mean concentration of serum IL - 6 in SARS patients did not differ from that in the control group in initial and peak stages, but became significantly higher in remission and recovery stage compared with the control group, initial and peak stages ( P<0. 01). The mean concentration of serum IL-8 in SARS patients did not differ from that of the control group in initial stage, but was significantly higher than control group in peak stage and remission and recovery stage ( P < 0. 05). And it was more significantly higher in remission and recovery stage than in peak stage ( P<0. 01). The mean concentrations of IL-16 and TNF-αin SARS patients were higher than those of the control group for every length of the clinical courses investigated, and were especially high in remission and recovery stage (P<0. 01). SARS patients experienced higher concentration of serum IL-13 compared with the controls in initial stage ( P < 0. 01), but returned to normal levels in peak stage and in remission and recovery stage. The mean concentration of serum IL-18 in SARS patients was significantly lower than that of the control group during all clinical courses ( P < 0. 05). The mean concentration of serum TGF-β1, in SARS patients was higher than that of the control group during all clinical courses. Although TGF-bbbbb1 in serum decreased in remission and recovery stage in SARS patients, the average was still higher than that of the control group (P<0. 01). Conclusions Most proinflammatory cytokines and TGF-β1, were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation. Concurrently, the mean concentration of serum IL-13 decreased gradually, and the mean concentration of serum IL-18 level in SARS patients was lower than that of the control group during all the courses of SARS, suggesting that the immune state of the patients with SARS was obviously abnormal. Observing the dynamic changes in blood cytokine levels can provide a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS.
基金supported by National Natural Science Foundation of China(Grant No.81070117 to Dr.Jin Liu,Grant No.81100180 to Dr.Tao Li and Grant No.30872455 to Dr.Lei Du).
文摘Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study was to investigate which pro-inflammatory factors involved in the early phase of ARDS.Ten patients underwent valve replacement surgery with or without ARDS were enrolled for analysis of pulmonary function and inflammatory factors release including white blood cell(WBC),neutrophils,CD11b,CD18,interleukin(IL)-8 and tumor necrosis factor-α(TNF-α).The results demonstrated that the ratio of arterial oxygen tension/fraction of inspire oxygen(PaO_(2)/FiO_(2))was greatly reduced in ARDS patients,but only the release of TNF-α was significantly increased,which was reversely correlated to the values of PaO_(2)/FiO_(2).Also,the count of neutrophils adhesive to pulmonary endothelial cells was significantly increased in ARDS patients.Therefore,we concluded that TNF-α was quickly up-regulated and involved in the pathogenesis of CPB-induced ARDS via guiding primed neutrophils to pulmonary interstitium.
文摘Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.