Total suprarenal aortic occlusion with cardiac disease: a case series of three cases

Acute aortic occlusion(AAO)has been very rarely reported in the literature and is a potentially life-threatening emergency.[1-5]AAO mostly occurs in cardiac disease patients,[1-4,6,7]and leads to cardiac complications.[1,2,5,6]Suprarenal aortic occlusion(SAO)is a very rare type of AAO,and infrarenal aortic occlusion(IAO)accounts for 75.8%-97.8%.[1,3,5-7]SAO is different from IAO in some clinical manifestations,treatment strategies,and prognoses.[3,6-8]SAO with cardiac disease will make the condition more complex and could easily cause a delay in diagnosis and portend worse outcomes with amputation and mortality rates.[1,3,6]Early and fast diagnosis and positive revascularization treatment are necessary to prevent cases from becoming fatal.[1-3]Herein,we present a case series of SAO with cardiac disease.

The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention

BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013.All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 vs.grade 0–1)or Rentrop(grade 3 vs.grade 0–2)grading system.The primary endpoint was 5-year cardiac death.RESULTS Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade 3.According to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading system.CONCLUSIONS In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death.Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.

Unilateral branch retinal artery occlusion in association with COVID-19:a case report

Dear Editor,I am Kunihiko Hirosawa of the Department of Ophthalmology at Juntendo University Hospital.I am writing to present a case of concomitant Coronavirus Disease 2019(COVID-19)with branch retinal artery occlusion(BRAO).BRAO presents as a sudden,painless loss of vision on the afflicted side and is most often focal in nature[1].

Intelligent diagnosis of retinal vein occlusion based on color fundus photographs

AIM:To develop an artificial intelligence(AI)diagnosis model based on deep learning(DL)algorithm to diagnose different types of retinal vein occlusion(RVO)by recognizing color fundus photographs(CFPs).METHODS:Totally 914 CFPs of healthy people and patients with RVO were collected as experimental data sets,and used to train,verify and test the diagnostic model of RVO.All the images were divided into four categories[normal,central retinal vein occlusion(CRVO),branch retinal vein occlusion(BRVO),and macular retinal vein occlusion(MRVO)]by three fundus disease experts.Swin Transformer was used to build the RVO diagnosis model,and different types of RVO diagnosis experiments were conducted.The model’s performance was compared to that of the experts.RESULTS:The accuracy of the model in the diagnosis of normal,CRVO,BRVO,and MRVO reached 1.000,0.978,0.957,and 0.978;the specificity reached 1.000,0.986,0.982,and 0.976;the sensitivity reached 1.000,0.955,0.917,and 1.000;the F1-Sore reached 1.000,0.9550.943,and 0.887 respectively.In addition,the area under curve of normal,CRVO,BRVO,and MRVO diagnosed by the diagnostic model were 1.000,0.900,0.959 and 0.970,respectively.The diagnostic results were highly consistent with those of fundus disease experts,and the diagnostic performance was superior.CONCLUSION:The diagnostic model developed in this study can well diagnose different types of RVO,effectively relieve the work pressure of clinicians,and provide help for the follow-up clinical diagnosis and treatment of RVO patients.

Effi cacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion

AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

OCTA characteristics in non-arteritic central retinal artery occlusion and correlation with visual acuity

AIM:To observe the retinal and choroidal circulations in patients with non-arteritic permanent central retinal artery occlusion(NA-CRAO)via optical coherence tomography angiography(OCTA)and analyze their correlation with visual acuity.METHODS:Sixty-two eyes with clinically confirmed acute NA-CRAO were included in the study and divided into:A type(mild n=29),B type(moderate n=27)and C type(severe n=6)based on the degree of visual loss,retinal edema,and arterial blood flow delay in fundus fluorescence angiography(FFA).Contralateral healthy eyes were used as the control group.Best-corrected visual acuity(BCVA),slit lamp microscopy,indirect ophthalmoscopy,fundus color photography,OCTA,and FFA were performed.Spearman’s correlation analysis was used to determine the correlations between retinal and choroidal vessels and visual acuity.RESULTS:There were no statistically significant differences in age,gender,and intraocular pressure among the three types and the control group(P>0.05).Vessel density in deep capillary plexus(VD-DCP)significantly decreased(P<0.05)in all three types of NA-CRAO patients compared to the control group.Vessel density in superficial vascular plexus(VD-SVP)significantly decreased(P<0.05)in type A patients and choriocapillaris flow area significantly decreased(P<0.05)in type B and type C patients compared to the control group;while outer retinal flow areas significantly increased in the type A(P<0.05)and decreased in type C patients(P<0.05).The retinal thickness significantly increased in type C group(P<0.05).The VD-SVP at fovea in the type A was significantly lower than both of type B and C.The VD-SVP at nasal parafovea in type A and B was significantly lower than type C(P<0.05).The logMAR BCVA of type A was significantly better than that of type B and C groups(P<0.05).Spearman’s correlation analysis showed that the logMAR BCVA was positively correlated with VD-SVP at fovea(r=0.679,P=0.031)and nasal parafovea(r=0.826,P=0.013).CONCLUSION:OCTA is valuable for assessing retinal ischemia,and evaluating visual impairment.Deep retinal vasculature is commonly affected in all NA-CRAO types.VDSVPs at fovea and nasal parafovea can serve as reliable markers of visual impairment in NA-CRAO.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture:Three case reports

BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.

An Application of RGBD-Based Skeleton Reconstruction for Pedestrian Detection and Occlusion Handling

This study explores the challenges posed by pedestrian detection and occlusion in AR applications, employing a novel approach that utilizes RGB-D-based skeleton reconstruction to reduce the overhead of classical pedestrian detection algorithms during training. Furthermore, it is dedicated to addressing occlusion issues in pedestrian detection by using Azure Kinect for body tracking and integrating a robust occlusion management algorithm, significantly enhancing detection efficiency. In experiments, an average latency of 204 milliseconds was measured, and the detection accuracy reached an outstanding level of 97%. Additionally, this approach has been successfully applied in creating a simple yet captivating augmented reality game, demonstrating the practical application of the algorithm.

Stranched Internal Hernia Revealed by Occlusion of the Large Libra: A Propos of a Case

The left para-duodenal internal hernia, whose origin is generally embryological, is a rare etiology of intestinal obstruction found mainly in young adults. We report here the case of acute intestinal obstruction by left para-duodenal internal hernia in a 36-year-old young man. It was a patient who consulted urgently for occlusive syndrome with cessation of materials and gases. Abdominal percussion noted abdominal tympanism and pre-hepatic dullness was preserved. The flow and icicle signs were negative. Palpation did not objectify hepatosplenomegaly and did not find any organomegaly either. On the other hand, she found an epigastric defense. The abdominal X-ray without preparation showed water levels that were wider than high, hail-like. We performed a median above and below umbilical laparotomy and intraoperatively, it was an internal hernia with incarceration of small loops in a voluminous left paraduodenal sac of 12 cm. They were not necrotic and quickly recolored after extrication. We resected the hernial sac and closed the hernial orifice with separate stitches with absorbable suture 0. The postoperative course was simple. The patient was discharged from the hospital on the 4th postoperative day. After 18 months of hindsight, he is doing well.

Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

电针神庭、百会穴对MCAO/R大鼠γ-氨基丁酸受体Gabbr1表达的影响

目的通过观察电针神庭、百会穴对大脑中动脉缺血再灌注模型(middle cerebral artery occlusion and reperfusion,MCAO/R)认知功能障碍大鼠海马区γ-氨基丁酸B受体gabbr1表达的影响,探讨电针改善MCAO/R大鼠学习记忆能力的可能机制。方法27只雄性健康SD大鼠随机分为假手术组、模型组、电针组;模型组、电针组采用longa线栓法制备MCAO/R模型,假手术组仅分离颈总、颈内及颈外动脉,不插入线栓,造模后通过longa五分法验证模型。电针组取神庭、百会穴在造模后24 h进行干预,治疗7 d;干预第3 d采用Morris水迷宫实验检测各组大鼠学习记忆能力,为期4 d;干预第7 d断头取大鼠完整海马组织,采用实时荧光定量PCR(qRT-PCR)检测各组大鼠海马组织中gabbr1 mRNA的表达。结果与假手术组相比,模型组水迷宫实验的第三象限距离比显著减小(P<0.05),穿越平台次数减少(P<0.01);与模型组相比,电针组经治疗后第三象限距离比扩大(P<0.05),穿越平台次数增加(P<0.05)。与假手术组相比,模型组海马区gabbr1 mRNA表达量显著增高(P<0.01);与模型组相比,电针组海马区gabbr1 mRNA表达降低(P<0.01)。结论电针神庭、百会穴能改善脑缺血再灌注大鼠的学习记忆能力,其机制可能与调节gabbr1 mRNA在海马中的表达有关。

巨刺阳陵泉穴对MCAO模型大鼠运动功能作用机制研究

目的:观察巨刺阳陵泉穴对大脑中动脉栓塞(MCAO)模型大鼠运动功能障碍的疗效和对胼胝体髓鞘碱性蛋白(MBP)的影响,探讨巨刺阳陵泉穴改善脑梗死运动障碍的机制。方法:将68只雄性SD大鼠随机分为假手术组、模型组、巨刺组和非经非穴组,每组17只。除假手术组外,其余三组均用线栓法制备右侧MCAO模型,术后第2天开始干预,巨刺组电针刺激右侧阳陵泉,非经非穴组电针刺激双侧胁下非经非穴位置,每天1次,每次20 min,连续14 d。测定大鼠抓力、神经功能缺损得分;2,3,5-三苯基氯化四氮唑(TTC)染色计算脑梗死体积百分比,苏木精-伊红染色法(HE)观察胼胝体组织形态,免疫组化、酶联免疫吸附测定(ELISA)法、蛋白质印迹(WB)法、反转录聚合酶链反应(RT-PCR)法分别检测右脑胼胝体MBP蛋白及mRNA表达水平。结果:与假手术组相比,模型组大鼠抓力下降,神经功能缺损得分增加,脑梗死体积百分比增加,胼胝体髓鞘结构崩解,右脑胼胝体MBP蛋白及mRNA表达水平降低,差异均有统计学意义(P<0.05)。与模型组、非经非穴组比,巨刺组大鼠抓力增大,神经功能缺损得分降低,脑梗死体积百分比降低,髓鞘结构较为完整,右脑胼胝体MBP蛋白及mRNA表达水平升高,差异均有统计学意义(P<0.05)。结论:巨刺阳陵泉穴可能通过提高胼胝体MBP蛋白表达水平促进MCAO大鼠运动功能康复。

铜砭刮痧联合耳穴压豆对MCAO大鼠脑缺血损伤改善效果及炎性因子的影响

目的 探讨铜砭刮痧联合耳穴压豆对大脑中动脉闭塞(MCAO)大鼠脑缺血损伤改善效果及炎症因子的影响。方法 将50只雄性SD大鼠随机分为假手术组、模型组、刮痧组、耳穴组、联合组,每组10只,采用大脑中动脉线栓法建立MCAO模型。与造模d1开始,对大鼠进行刮痧及耳穴等干预,于干预14 d后,采用mNSS评分表评估大鼠神经功能缺损程度,ELISA检测血清中炎性因子TNF-α、IL-1β、IL-6、IL-10的含量,TTC染色法测定脑梗死面积,Western blot法检测脑组织IL-6、IL-10蛋白含量,RT-qPCR检测IL-6、IL-10 m RNA表达水平。结果 刮痧组、耳穴组、联合组在mNSS评分、脑梗死面积方面均优于模型组(P<0.05)。刮痧组、联合组血清TNF-α、IL-1β、IL-6含量低于模型组(P<0.05),IL-10高于模型组(P<0.05),蛋白含量及mRNA表达IL-6低于模型组(P<0.05),IL-10高于模型组(P<0.05)。耳穴组血清TNF-α、IL-1β、IL-6含量低于模型组(P<0.05),但IL-10含量差异无统计学意义(P>0.05);蛋白含量及mRNA表达IL-6低于模型组(P<0.05),但IL-10差异无统计学意义(P>0.05)。结论 铜砭刮痧联合耳穴压豆可改善MCAO大鼠神经功能,及作用可能与免疫调节机制有关。

内源性FGF21通过FGFR1/PI3K/Akt通路减轻MCAO大鼠延迟血管再通后半暗带的血脑屏障损伤

目的:在“时间窗”内恢复闭塞大动脉的血流是急性缺血性卒中的主要治疗策略。既往研究表明“时间窗”后的血管再通治疗可导致严重的缺血/再灌注损伤。然而,大量临床证据提示“时间窗”后的血管再通治疗仍可改善急性缺血性卒中的神经功能转归。本研究探讨大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)后血管再通治疗对缺血半暗带血脑屏障(blood-brain barrier,BBB)的影响及分子机制。方法:MCAO后第3天行血管再通治疗术,通过蛋白质印迹法、伊文思蓝染色和免疫荧光染色检测BBB损伤。MCAO后第7天评估梗死体积和神经功能转归。采用免疫荧光染色和/或蛋白质印迹法观察缺血半暗带中成纤维细胞生长因子21(fibroblast growth factor 21,FGF21)、成纤维细胞生长因子受体1(fibroblast growth factor receptor 1,FGFR1)、磷脂酰肌醇3激酶(phosphatidylinositol-3-kinase,PI3K)和丝氨酸/苏氨酸激酶(serine/threonine kinase,Akt)的表达及其对BBB的影响。结果:MCAO后缺血半暗带伊文思蓝、IgG和白蛋白的外渗增加,但在血管再通后显著下降;Claudin-5、Occludin和紧密连接蛋白ZO-1表达降低,但在血管再通后表达升高,与FGF21、p-FGFR1、PI3K和p-Akt蛋白升高一致。MCAO后第7天,梗死体积缩小,神经功能改善。侧脑室注射FGFR1抑制剂SU5402可下调缺血半暗带区PI3K、p-Akt、Occludin、Claudin-5和ZO-1的表达,减弱血管再通治疗对MCAO大鼠神经功能转归的有利作用。结论:MCAO后第3天的血管再通治疗增加缺血半暗带内源性FGF21的表达,并可通过激活FGFR1/PI3K/Akt通路减轻缺血半暗带BBB损伤,改善MCAO大鼠的神经功能。

红景天苷预防给药对MCAO大鼠的神经保护作用

目的研究红景天苷(salidroside,Sal)预防给药对MCAO大鼠的神经保护作用。方法SD成年雄性大鼠52只,随机分:假手术组(Sham)、模型组(MCAO)、红景天苷预给药组(MCAO+Sal)。Sal给药剂量为50 mg·kg^(-1)。连续腹腔注射给药7 d,d 7给药0.5 h后,线栓法制作MCAO模型,24 h后麻醉取材。TTC染色检测大鼠脑梗死体积,TUNEL染色测定神经细胞凋亡数,Western blot测定脑组织中Bax、Bcl-2、cleaved Caspase-3和总Caspase-3蛋白的表达,萘酚AS-D氯乙酸酯酶检测脑组织中性粒细胞的表达,RT-qPCR法分析IL-1β、IL-6、TNF-α的mRNA表达,免疫荧光法分析脑组织中NeuN的表达。结果Sal预给药7 d明显减少了MCAO大鼠脑梗死体积和TUNEL阳性细胞数,促进Bcl-2蛋白的表达,抑制Bax、cleaved Caspase-3蛋白的表达,但对总Caspase-3蛋白无明显作用,减少缺血侧脑组织中性粒细胞的募集,降低炎症因子IL-1β、IL-6、TNF-α的mRNA表达,上调NeuN的表达。结论Sal预给药7 d能明显降低MCAO大鼠脑梗死体积,抑制神经细胞凋亡,减轻炎症,促进NeuN的表达,进而起到神经保护作用。

Comparison of efficacy of conbercept,aflibercept,and ranibizumab ophthalmic injection in the treatment of macular edema caused by retinal vein occlusion:a Meta-analysis

AIM:To evaluate and compare the anatomical and functional outcomes and negative effects of the three anti-vascular endothelial growth factor(VEGF)drugs in the treatment of macular edema(ME)due to retinal vein occlusion(RVO)based on the evidence pooled from current clinical trials and observational studies.METHODS:A systematic literature search was conducted on nine online databases from inception until April 30,2022.The main endpoints were best corrected visual acuity(BCVA),central macular thickness(CMT),and adverse events(AEs).Cumulative Meta-analysis was conducted to synthesize the outcomes of the drugs.The retrieved data were analyzed using Stata software(version 12.0).RESULTS:A total of 20 studies comprising 1674 eyes met the inclusion criteria to the Meta-analysis.It was observed that conbercept and aflibercept had better visual acuity effects compared with ranibizumab at 1mo[weight mean difference(WMD)=-0.03,P=0.001;WMD=-0.05,P=0.019],but the effects were not different from that of ranibizumab at 6mo.Moreover,there was not statistically significant dif ference in the propor tion of patients gaining≥15 letters at 12-24mo between aflibercept and ranibizumab[odds ratio(OR)=1.16,P=0.427].Conbercept had higher mean CMT change effects at 1mo(WMD=-14.43,P=0.014)and 6mo(WMD=-35.63,P≤0.001)compared with ranibizumab.Meanwhile,the mean CMT change effects at 1mo(WMD=-10.14,P=0.170),6mo(WMD=-26.98,P=0.140)and 12-24mo(WMD=-12.34,P=0.071)were comparable among the groups.Similarly,AEs were not significantly different among the treatments(OR=0.75,P=0.305;OR=1.04,P=0.89).The stability of effect size of mean BCVA and CMT improved with the increase in sample size.Aflibercept and conbercept required fewer injections compared with ranibizumab.CONCLUSION:This is the first study to evaluate the efficacy and AEs of intravitreal administration of conbercept,ranibizumab,and aflibercept in the treatment of RVOME.Intravitreal aflibercept or conbercept results in better mean change in vision and CMT reduction compared with ranibizumab.Conbercept can be considered to be a promising and innovative drug with good anti-VEGF effects.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.

电针心包经穴对MCAO大鼠急性期D-ser及NMDAR的影响

目的:观察电针心包经穴对大脑中动脉闭塞(MCAO)大鼠神经功能缺损、缺血脑组织D-丝氨酸(D-Ser)含量、NMDAR表达的影响。方法:将36只SD大鼠随机分为正常组、假手术组、模型组、电针心包经组、模型+D-Ser组、电针心包经+D-Ser组。采用Zea Longa法制备MCAO模型,模型+D-Ser组、电针心包经+D-Ser组在插入线栓成功后30 min予外源性D-Ser试剂(160 mg/kg i.p.);电针心包经组、电针心包经+D-Ser组于次日行电针治疗30 min;其余组仅捆绑固定30 min。在大鼠造模成功后6 h和第2天干预后分别进行2次行为学评定,随后处死取材。应用液相色谱串联质谱法测缺血脑组织D-Ser含量、Western Blot测NR1、NR2A、NR2B的蛋白表达。结果:处理前与正常组、假手术组比,造模后各组的行为学评分均升高(P<0.05);与模型组相比,模型+D-Ser组和电针心包经+D-Ser组的行为学评分均升高(P<0.05)。处理后与模型组相比,电针心包经组差异无统计学意义(P>0.05),模型+D-Ser组和电针心包经+D-Ser组的行为学评分仍升高(P<0.05);与模型+D-Ser组相比,电针心包经+D-Ser组行为学评分无统计学意义(P>0.05)。组内处理前后比较,除正常组和假手术组外,各组行为学评分均略升高,差异无统计学意义(P>0.05)。与模型组相比,模型+D-Ser组的脑组织D-Ser含量及NR1、NR2A、NR2B的蛋白表达显著增加(P<0.05);电针心包经组的NR1、NR2A、NR2B的蛋白表达下降(P<0.05);与模型+D-Ser组相比,电针心包经+D-Ser组的D-Ser含量及NR1、NR2A、NR2B的蛋白表达均下降(P<0.05)。结论:电针心包经穴可降低急性期MCAO大鼠脑组织中D-Ser含量,调控NR1、NR2A、NR2B蛋白表达下降,抑制NMDA受体活性,发挥神经保护作用。

Endovascular Therapy of Internal Carotid Artery Tandem Occlusions and Literature Review

Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of patients with large vessel occlusion of the anterior circulation in acute ischemic stroke. The low rate of recanalization by intravenous thrombolysis in AIS due to internal carotid artery tandem occlusion, the poor establishment of collateral circulation within a short time, and the complex pathogenesis often suggest a poor prognosis for patients. Mechanical thrombectomy (MT) is beneficial for the opening of intracranial large vessel occlusion with internal carotid artery tandem occlusion, there are many problems regarding the emergency management of carotid artery occlusion or stenosis after mechanical thrombectomy, and there are currently no standardized treatment recommendations;The sequential approach to the management of carotid tandem occlusion, the timing of carotid stenting, and the use of antiplatelet agents remain controversial. The current state of research on carotid tandem occlusion is analyzed in the literature to promote clinical understanding of endovascular treatment for patients with acute ischemic stroke due to carotid tandem occlusion.