Neutrophil-to-lymphocyte ratio in occlusive vascular diseases： the literature review of the past 10 years

BACKGROUND: This study aims to evaluate the results of studies investigating neutrophilto-lymphocyte ratio(NLR) and to identify the prognostic and diagnostic value of NLR in occlusive vascular diseases.METHODS: With the aim of identifying the studies related to NLR, a search was performed on http://www.ncbi.nlm.nih.gov/pubmed by using the key words "neutrophil lymphocyte ratio" between January 2005 and December 2014. All of the original articles were evaluated according to date of publications, countries, clinics and topics. Studies about occlusive vascular diseases were evaluated according to their qualifications, review methods and results. SPSS for Windows 16.0 was used in data analysis and data were expressed as mean, standard deviation and percentage.RESULTS: A total of 735 original research articles were investigated. The number of publications have shown a regular logarithmic increase over the years. Thirty-two percent of all publications were performed by clinics in Turkey and 56.4% were performed by general-oncological surgery and cardiology clinics. A total of 107 publications were identified to be about occlusive vascular diseases, 80.3% of these publications were found to be prognostic and 19.6% to be diagnostic, 82.2% of them were found to be planned as retrospective and 17.7% as prospective. In 95.3% of prognostic publications, there was a positive correlation between high NLR values at admission and poor prognosis. In 95.3% of diagnostic publications high NLR values at admission were identifi ed to be signifi cant diagnostically.CONCLUSION: Elevated neutrophil-to-lymphocyte ratio at admission, could be used as a diagnostic and/or prognostic parameter in occlusive vascular diseases.

Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC): Occlusive Effect and Penetration Enhancement Ability

Objective: This work compares the occlusive effect and the penetration enhancement ability of solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), through in vitro skin. Methods: SLN and NLC were prepared by high shear homogenization and characterized by size, polydispersity index, zeta potential, morphology and physical stability. Occlusive effect was assessed by an in vitro test and by measuring TEWL using pig skin. Skin treated with the lipid carriers was visualized by SEM. A penetration test through skin, followed by tape stripping, was carried out using Nile red as a marker. Results: SLN (200 ± 6 nm) and NLC (192 ± 11 nm) were obtained. An occlusion factor of 36% - 39% was observed for both systems, while a reduction in TEWL of 34.3% ± 14.8% and 26.2% ± 6.5% was seen after treatment with SLN and NLC, respectively. SEM images showed a film formed by the lipid carriers, responsible for the occlusion observed. No differences were found between the occlusive effect produced by SLN and NLC in both tests. NLC allowed the penetration of a greater amount of Nile red than SLN: 4.7 ± 1.3 μg and 1.7 ± 0.4 μg, respectively. Conclusion: Both carriers form a film on the skin, providing an occlusive effect with no differences between these two systems. The penetration of a marker (Nile red) into the stratum corneum was quite higher for NLC than for SLN, suggesting an influence of the composition of these particles on their penetration enhancing ability.

Transplantation of mobilized peripheral blood mononuclear cells for peripheral arterial occlusive disease of the lower extremity

Objectives To assess the clinical efficacy, safety, and feasibility of autologous transplantation of mobilized peripheral blood mononuclear cells (PBMNCs) for patients with peripheral arterial occlusive disease (PAOD) of the lower extremity. Methods A total of 152 patients with PAOD of the lower extremity were enrolled into this non-controlled observational study from November 2003 to March 2006. All patients received subcutaneous injections of recombinant human granulocyte colony-stimulating factor (G-CSF, 450- 600 μg/day) for 5 days in order to mobilize stem/progenitor cells; their PBMNCs were collected and transplanted by multiple intramuscular injections into ischemic limbs. Patients were followed up for at least 12 weeks. Results At 12 weeks, primary manifestations, including lower limb pain and coldness, were significantly improved in 137 (90.1%) of the patients; limb ulcers improved or healed in 46 (86.8%) of the 53 patients, while 25 of the 48 (47.9%) patients with limb gangrene remained steady or improved. Ankle-brachial index (ABI) improved in 33 (22%) of the cases, and TcPO2 increased in 45 (30%) of the cases. Angiography before treatment, and at 12 weeks after treatment, was performed in 10 of the patients and showed formation of new collateral vessels. No severe adverse effects or complications specifically related to cell transplantation were observed. Conclusion Autologous transplantation of G-CSF–mobilized PBMNCs might be a safe and effective treatment for lower limb ischemic disorder.

Meta-analysis on clinical efficacy of Simiao Yong'an decoction in treatment of peripheral arterial occlusive diseases

Objective:To systematically evaluate the clinical efficacy and safety of Simiao Yong'an Decoction in the treatment of peripheral occlusive disease(PAOD).Methods:Eight randomized controlled clinical trials(RCT)of Simiao Yong'an Decoction in the treatment of PAOD were searched and screened from domestic and foreign databases(all from database construction to March 2020).The quality of the retrieved original studies was evaluated according to the evaluation criteria of Cochrane Handbook 5.1.0,and the included studies were meta-analyzed by RevMan5.3 software.Results:A total of 350 articles were retrieved,among which 14 studies met the inclusion criteria,with a total sample size of 1254 cases.The results of meta-analysis showed that:compared with conventional western Med,combined with Simiao Yong'an Decoction on the basis of western Med treatment can significantly improve the total clinical response rate of patients[RR=1.20,95%CI(1.14,1.27),P<0.00001],improve ankle brachial index(ABI)level[MD=0.79,95%CI(0.66,0.92),P<0.00001]and toe brachial index(TBI)level[RR=0.13,95%CI(0.10,0.16),P<0.00001],decreased c-reactive protein levels[MD=-8.55,95%CI(-8.99,-8.11),P<0.00001]and LDL levels[MD=-0.41,95%CI(-0.62,-0.19),P=0.0002],and increased HDL levels[MD=0.32(0.22,0.43),P<0.00001].There was no statistically significant difference in the incidence of adverse reactions[RR=0.50,95%CI(1.15,1.64),P=0.25].Conclusion:Simiao Yong'an Decoction combined with conventional western Med is more effective than conventional western Med in the treatment of PAOD.However,in view of the limitations of the quality of the analyzed literature,the positive results obtained in this study still need to be further verified by a large sample and multi-center clinical trial with a reliable research program.

Can Endarterectomy Be Useful in Peripheral Arterial Occlusive Disease with Critical Limb Ischemia?

Importance of?thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative?morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.

Digestive Manifestation in COVID-19 Patient Complicated by Occlusive Syndrome Admitted to Intensive Care in a Case

We report the case of a 39-year-old patient with a history of chronic gastritis, functional colopathy and appendectomy, referred by another public institution for severe abdominal pain. He had been admitted 6 days previously for nausea, vomiting, diarrhea, fever, asthenia since the onset of dyspnea with 89% desaturation in ambient air and a dry cough. A diagnosis of gastroenteritis was made and treated without success. The appearance of abdominal distension and bloating motivated his transfer to the CTPI where the rRT-PCR was carried out positive and an X-ray of the abdomen without preparation which had demonstrated a significant aerocoly with agglutination of handle. Surgical management under general anesthesia found a clean cavity after coeliotomy, multiple intestino-intestinal, intestino-parietal and omentum-parietal adhesions. The gesture consisted of an adhesiolysis, omentectomy. The postoperative follow-up was favorable with resumption of transit on D5 postoperative. Put under the COVID-19 treatment protocol, the rRT-PCR was negative on D13, output on D14 and removal of the D19 files without postoperative complications.

Benefits of Simple Exchange Transfusion in Sickle Cell Disease (HbSS) with Vaso-Occlusive Crisis Not Responding to Standard Therapy

Sickle cell disease is an autosomal recessive genetic disease. Vaso occlusive crisis (VOC) is frequently seen in such patients. Painful VOC is usually recurrent, of variable severity due to many factors and its management poses important challenge in the clinical practice. Few patients do not respond to standard therapies and continue to suffer severe pain for prolonged period or land to serious life threatening situation. The red cell exchange by aphaeresis is presumed to be one efficient alternative in this situation which can reduce the level of HbS below 40% - 50%. However, it is costly and not available everywhere. Both circumstances are common in our state where incidence of sickle cell disease is quite high. In such situations simple red cell exchange i.e. removing 1 unit (350 ml) of blood manually (by phlebotomy) and replacement with one unit normal red cell is effective. All of our four cases of SCA with severe acute VOC, are not responding to standard therapy but responded efficiently to this simple red cell exchange transfusion. Our present observation may pave the way of one simple, affordable, and effective measure to reduce the pain of severe acute VOC not responding to standard therapy. Moderate reduction of HbS by 8% - 14% by simple red cell exchange transfusion was associated with relief of pain of acute VOC;a new observation was reported in all our 4 cases which need to be validated by larger controlled studies.

Convulsive-like movements as the first symptom of basilar artery occlusive brainstem infarction:A case report

BACKGROUND Convulsive-like movements are rare in basilar artery occlusive cerebral infarction(BAOCI).These manifestations may easily be mistaken for epileptic seizures caused by compromised anterior circulation or by cortical lesions.Delayed diagnosis of this condition affects its subsequent treatment and prognosis.Therefore,it is critical to recognize this type of phenomenon in the early stage.CASE SUMMARY A 55-year-old male patient presented with unconsciousness,rigidity,and a paroxysmal twitch in both lower limbs.These conditions lasted for nearly 2 h and resembled status epilepticus.After the initial conditions subsided,hemiplegia occurred and then subsided rapidly.The family refused thrombolytic therapy because the symptoms were similar to Todd paralysis after epilepsy.However,magnetic resonance imaging showed left pontine infarction.No abnormality was observed in a video electroencephalogram during the interictal period.Digital subtraction angiography revealed that the basilar artery was occluded and that the posterior communicating arteries were patent.Fortunately,the patient received a good prognosis after antiplatelet therapy,lipid regulation,balloon dilatation of the basilar artery,and rehabilitation.CONCLUSION Convulsive-like movements may be an early sign of basilar artery occlusive brainstem infarction.It is important to identify this phenomenon in a timely manner.

Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery

Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb.Endovascular procedures are currently preferred for these patients.We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb.The patient had history of left femoral popliteal bypass surgery,femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago.Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery(SFA) and popliteal artery and of all three infra-popliteal arteries.Due to severe comorbidities,the patient was scheduled for a digital subtraction angiography.An antegrade approach was first attempted,however the occlusion could not be passed.After revision of the angiography acquisition,a stent was identified at the level of the mid SFA,which was subsequently directly punctured,facilitating the retrograde crossing of the occlusion.Thereafter,balloon angioplasty was performed in the SFA,popliteal artery and posterior tibial artery.The result was considered suboptimal,but due to the large amount of contrast agent used,a second angiography was planned in 4 wk.In the second session,drug coated balloons were used to optimize treatment of the SFA,combined with recanalization of the left fibular artery,to optimize outflow.The post-procedural course was uneventful.Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.

Hepatic amyloidosis leading to hepatic venular occlusive disease and Budd-Chiari syndrome: A case report

BACKGROUND Systemic amyloidosis in which multiple systems can be involved has become a common clinical disease.When the liver is affected,symptoms such as abdominal distension,fatigue,edema,liver,and jaundice could appear.To date,hepatic amyloidosis combined with hepatic venular occlusive disease and Budd-Chiari syndrome has not been reported.CASE SUMMARY A 54-year-old female patient was admitted to the Beijing Shijitan Hospital with hepatic amyloidosis leading to hepatic venular occlusion and Budd-Chiari syndrome in 2018.The patient underwent surgery 1 mo previously for liver rupture and hemorrhage after Budd-Chiari syndrome was diagnosed.She was diagnosed with hepatic venular occlusion,liver amyloidosis,and Budd-Chiari syndrome(i.e.extensive hepatic vein occlusion).Transjugular intrahepatic portosystem shunt was performed.After the treatment,the clinical symptoms improved markedly with increase in urine volume.CONCLUSION Hepatic amyloidosis with hepatic venous occlusion and Budd-Chiari syndrome is relatively rare clinically,and transjugular intrahepatic portosystem shunt is an effective treatment for this disease.

Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus Ⅱ D Aortoiliac Occlusive Lesions： What Determines the Rate of Restenosis？

Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors ofrestenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions （AIOLs）. Methods： Fifty-six patients （82 limbs） who underwent open repair and endovascular treatment （ET） for symptomatic TASC II D AlOEs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results： The mean duration of follow-up was 42.8 ± 23.5 months （ranging from 3 to 90 months）. Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 1 ） limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion： This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AlOEs.

Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China

Background Totally laparoscopic aortic surgery is still in its infancy in China.One of the factors preventing adoption of this technique is its steep learning curve.The objective of this study was to evaluate the feasibility and safety of laparoscopic surgery for aortoiliac occlusive disease （AIOD）.Methods From November 2008 to November 2012,12 patients were treated for severe AIOD with a totally laparoscopic bypass surgery at our university hospital.The demographic data,operative data,postoperative recovery data,morbidity and mortality were analyzed and compared with those of conventional open approach.Results Twelve totally laparoscopic aortic surgery procedures,including two iliofemoral bypasses （IFB）,three unilateral aortofemoral bypasses （UAFB）,and seven aortobifemoral bypasses （ABFB）,were performed.Conversion to open procedures was required in three patients.The mean operation time was 518 （range,325-840） minutes,mean blood loss was 962 （range,400-2500） ml,and mean aortic anastomosis time was 75 （range,40-150） minutes.Compared with conventional open approach for aortofemoral bypasses performed concomitantly during this period,laparoscopic patients required fewer narcotics and a shorter in-hospital stay and earlier recovery.Postoperative complications developed in four patients,including a single patient with transient left hydronephrosis,ischemic colonic fistula and pneumonia,residual aortic stenosis proximal to the anastomotic site,and asymptomatic partial left renal infarction.All patients recovered and were discharged on postoperative Days 7-14 except one patient that died of respiratory failure on Day 46.All grafts were patent with follow-up imaging performed by Duplex examination,with a mean follow-up time of 10.7 （range,2-61） months.Conclusion Totally laparoscopic bypass surgery is a feasible and safe procedure forAIOD,but attention needs to be paid to improve laparoscopic skills of vascular surgery in order to minimize morbidity during the learning curve of this advanced procedure.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD)per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR)exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE)with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of<15 mL/min/1.73 m^(2)).The RE+BFR session consisted of 50%arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s)and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL)displayed increased risk of elevating D-dimer over the normal range(-500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

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].

Development of a new cerebral ischemia reperfusion model of Mongolian gerbils and standardized evaluation system

Background:The Mongolian gerbil is an excellent laboratory animal for preparing the cerebral ischemia model due to its inherent deficiency in the circle of Willis.However,the low incidence and unpredictability of symptoms are caused by numerous complex variant types of the circle.Additionally,the lack of an evaluation system for the cer-ebral ischemia/reperfusion(I/R)model of gerbils has shackled the application of this model.Methods:We created a symptom-oriented principle and detailed neurobehavioral scoring criteria.At different time points of reperfusion,we analyzed the alteration in locomotion by rotarod test and grip force score,infarct volume by triphenyltetrazo-lium chloride(TTC)staining,neuron loss using Nissl staining,and histological charac-teristics using hematoxylin-eosin(H&E)straining.Results:With a successful model rate of 56%,32 of the 57 gerbils operated by our method harbored typical features of cerebral I/R injury,and the mortality rate in the male gerbils was significantly higher than that in the female gerbils.The suc-cessfully prepared I/R gerbils demonstrated a significant reduction in motility and grip strength at 1 day after reperfusion;formed obvious infarction;exhibited typi-cal pathological features,such as tissue edema,neuronal atrophy and death,and vacuolated structures;and were partially recovered with the extension of reperfu-sion time.Conclusion:This study developed a new method for the unilateral common carotid artery ligation I/R model of gerbil and established a standardized evaluation system for this model,which could provide a new cerebral I/R model of gerbils with more practical applications.

Prognostic factors and clinical features of rhino-orbitalmucormycosis cases:an update for patient and visual survivals

AIM:To determine the frequency of patients’vision survival and prognostic factors and evaluate clinical features in rhino-orbital mucormycosis.METHODS:Forty-three eyes of 43 patients followed up with orbital mucormycosis infections were included in the study.Demographic characteristics of the patients,symptoms at admission,ophthalmologic and non-ophthalmologic examination findings,clinical findings during follow-up,medical and surgical procedures,and complications were recorded.Patient survival was determined by assessing the incidence of mortality,and vision survival was defined as achieving a final visual acuity of at least light perception.RESULTS:Twenty-seven(62.8%)patients were male,and 16(37.2%)were female.When the underlying disease status of the patients was examined,it was observed that all patients had an underlying disease and diabetes constituted the majority(65.2%).Periorbital swelling(69.8%)and ophthalmoplegia(53.5%)were the most common symptoms and findings at the admission of patients with mucormycosis infection.The disease resulted in death in 22(51.2%)patients.The presence of fever and shorter duration of antifungal therapy were associated with lower patient survival.Exenteration surgery was not found to be associated with the survival of the patients.Frozen eye,loss of pupillary light reflex,and development of central retinal artery occlusion were associated with lower vision survival.CONCLUSION:This study presents one of the most extensive patient series in the literature on rhino-orbital mucormycosis.Knowing the patients’symptoms at the time of admission and the clinical findings during the infection process will increase awareness about the disease.

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.