AGTR1 A1166C gene polymorphism is associated with the effectiveness of valsartan monotherapy in Chinese patients with essential hypertension:A retrospective analysis

Objective:To investigate whether angiotensinⅡtype 1 receptor(AGTR1 A1166C)gene polymorphism was associated with the effectiveness of valsartan monotherapy in Chinese patients with essential hypertension.Methods:This retrospective analysis included 198 patients(≥18 years of age)who received valsartan monotherapy(80 mg/day)for newly developed essential hypertension at the authors’center between January 1,2020 and December 31,2023.Genotyping for AGTR1 A1166C gene polymorphism was done by polymerase chain reaction(PCR)-melting curve analysis of genomic DNA from peripheral blood samples.A dominant genetic model for AGTR1 A1166C(AA genotype versus AC+CC genotype)was used.Multivariate regression analysis of baseline variables and AGTR1 polymorphism was conducted to identify predictors of target blood pressure attainment(<140/90 mmHg)at the 4-week follow-up.Results:The median age of the 198 patients was(53.7±13.5)years,and 58%were men.Genotyping assays showed that 164 patients had the AA genotype,and 34 patients were of the AC/CC genotype,including 30 with the AC genotype and 4 with the CC genotype.Allele distribution was consistent with Hardy Weinberg equilibrium.109 Patients(55.1%)attained the blood pressure target.Multivariate analysis showed that smoking(versus no smoking,HR 0.314,95%CI 0.159-0.619,P=0.001)and AGTR1 A1166C AA genotype(versus AC/CC,HR 2.927,95%CI 1.296-6.611,P=0.023)were significant and independent predictors of target attainment.25 Patients(73.5%)with AGTR1 A1166C AC/CC genotype attained the target versus 51.2%(51/164)of patients with AGTR1 A1166C AA genotype(P=0.017).Patients with AGTR1 A1166C AC/CC genotype had a significantly greater reduction in systolic blood pressure[(33.1±10.8)mmHg versus(29.2±11.7)mmHg in AA carriers;(P=0.029)].Conclusions:Hypertensive patients carrying one or two C alleles of the AGTR1 A1166C gene were more responsive to valsartan treatment.

Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle

●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.

Risk factors and clinical significance of posterior slip of the proximal vertebral body after lower lumbar fusion

BACKGROUND Adjacent segment disease(ASD)after fusion surgery is frequently manifests as a cranial segment instability,disc herniation,spinal canal stenosis,spondylolisthesis or retrolisthesis.The risk factors and mechanisms of ASD have been widely discussed but never clearly defined.AIM To investigate the risk factors and clinical significance of retrograde movement of the proximal vertebral body after lower lumbar fusion.METHODS This was a retrospective analysis of the clinical data of patients who underwent transforaminal lumbar interbody fusion surgery between September 2015 and July 2021 and who were followed up for more than 2 years.Ninety-one patients with degenerative lumbar diseases were included(22 males and 69 females),with an average age of 52.3 years(40-73 years).According to whether there was retrograde movement of the adjacent vertebral body on postoperative X-rays,the patients were divided into retrograde and nonretrograde groups.The sagittal parameters of the spine and pelvis were evaluated before surgery,after surgery,and at the final follow-up.At the same time,the Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)were used to evaluate the patients’quality of life.RESULTS Nineteen patients(20.9%)who experienced retrograde movement of proximal adjacent segments were included in this study.The pelvic incidence(PI)of the patients in the retrograde group were significantly higher than those of the patients in the nonretrograde group before surgery,after surgery and at the final follow-up(P<0.05).There was no significant difference in lumbar lordosis(LL)between the two groups before the operation,but LL in the retrograde group was significantly greater than that in the nonretrograde group postoperatively and at the final follow-up.No significant differences were detected in terms of the|PI–LL|,and there was no significant difference in the preoperative lordosis distribution index(LDI)between the two groups.The LDIs of the retrograde group were 68.1%±11.5%and 67.2%±11.9%,respectively,which were significantly lower than those of the nonretrograde group(75.7%±10.4%and 74.3%±9.4%,respectively)(P<0.05).Moreover,the patients in the retrograde group had a greater incidence of a LDI<50%than those in the nonretrograde group(P<0.05).There were no significant differences in the ODI or VAS scores between the two groups before the operation,but the ODI and VAS scores in the retrograde group were significantly worse than those in the nonretrograde group after the operation and at the last follow-up,(P<0.05).CONCLUSION The incidence of posterior slippage after lower lumbar fusion was approximately 20.9%.The risk factors are related to a higher PI and distribution of lumbar lordosis.When a patient has a high PI and insufficient reconstruction of the lower lumbar spine,adjacent segment compensation via posterior vertebral body slippage is one of the factors that significantly affects surgical outcomes.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

Development and Validation of an Automatic Ultrawide-Field Fundus Imaging Enhancement System for Facilitating Clinical Diagnosis:A Cross-Sectional Multicenter Study

In ophthalmology,the quality of fundus images is critical for accurate diagnosis,both in clinical practice and in artificial intelligence(AI)-assisted diagnostics.Despite the broad view provided by ultrawide-field(UWF)imaging,pseudocolor images may conceal critical lesions necessary for precise diagnosis.To address this,we introduce UWF-Net,a sophisticated image enhancement algorithm that takes disease characteristics into consideration.Using the Fudan University ultra-wide-field image(FDUWI)dataset,which includes 11294 Optos pseudocolor and 2415 Zeiss true-color UWF images,each of which is rigorously annotated,UWF-Net combines global style modeling with feature-level lesion enhancement.Pathological consistency loss is also applied to maintain fundus feature integrity,significantly improving image quality.Quantitative and qualitative evaluations demonstrated that UWF-Net outperforms existing methods such as contrast limited adaptive histogram equalization(CLAHE)and structure and illumination constrained generative adversarial network(StillGAN),delivering superior retinal image quality,higher quality scores,and preserved feature details after enhancement.In disease classification tasks,images enhanced by UWF-Net showed notable improvements when processed with existing classification systems over those enhanced by StillGAN,demonstrating a 4.62%increase in sensitivity(SEN)and a 3.97%increase in accuracy(ACC).In a multicenter clinical setting,UWF-Net-enhanced images were preferred by ophthalmologic technicians and doctors,and yielded a significant reduction in diagnostic time((13.17±8.40)s for UWF-Net enhanced images vs(19.54±12.40)s for original images)and an increase in diagnostic accuracy(87.71%for UWF-Net enhanced images vs 80.40%for original images).Our research verifies that UWF-Net markedly improves the quality of UWF imaging,facilitating better clinical outcomes and more reliable AI-assisted disease classification.The clinical integration of UWF-Net holds great promise for enhancing diagnostic processes and patient care in ophthalmology.

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

AIM:To assess the effect of age at diabetes onset and uncontrollable high Hb A1 c levels on the development of diabetic retinopathy(DR)among Chinese type 2 diabetes mellitus(DM)patients.METHODS:This was a cross-sectional survey of diabetic patients in Subei district,China.Data covering physical measurements,fasting blood-glucose(FBG),glycosylated hemoglobin(Hb A1 c),blood lipid,urinary albumin/creatinine ratio(UACR),ocular fundus examination,and diabetes treatment records were collected.An independent sample t-test were used to analyze differences.A Logistic regression analysis was applied to study the independent risk factors of DR.RESULTS:A total of 1282 patients with type 2 DM were enrolled,and 191 cases had DR(14.9%).The age at diabetes onset,education level,alcohol consumption,Hb A1 c level,UACR level,and hypoglycemic drugs were independent influencing factors for DR.The older the onset of diabetes,the less likely to develop DR(OR:0.958,95%CI:0.942-0.975,P=0.000).Patients were then divided in terms of age at diabetes onset as follows:<50 y,50-59 y,60-69 y,and≥70 y.Compared with diabetes onset age<50 y,50-59 y(OR:0.463,95%CI:0.306-0.699,P=0.000),60-69 y(OR:0.329,95%CI:0.203-0.535,P=0.000)and≥70 y(OR:0.232,95%CI:0.094-0.577,P=0.002)were at a lower risk of DR.The prevalence of DR was highest in patients with diabetes onset age<50 y(29.5%,P<0.05).The Hb A1 c level(8.67±1.97)%and proportion of insulin injection(52.5%)in patients with diabetes onset<40 y were higher than in patients with older diabetes onset age(P<0.05).CONCLUSION:Diabetes onset at an earlier age and uncontrollable high Hb A1 c level could be independent risk factors for DR.

β2-Microglobulin exacerbates neuroinflammation,brain damage,and cognitive impairment after stroke in rats

β2-Microglobulin(β2M),a component of the major histocompatibility complex class I molecule,is associated with aging-related cognitive impairment and Alzheimer’s disease.Although upregulation ofβ2M is considered to be highly related to ischemic stroke,the specific role and underlying mechanistic action ofβ2M are poorly understood.In this study,we established a rat model of focal cerebral ischemia by occlusion of the middle cerebral artery.We found thatβ2M levels in the cerebral spinal fluid,serum,and brain tissue were significantly increased in the acute period but gradually decreased during the recovery period.RNA interference was used to inhibitβ2M expression in the acute period of cerebral stroke.Tissue staining with 2,3,5-triphenyltetrazolium chloride and evaluation of cognitive function using the Morris water maze test demonstrated that decreasedβ2M expression in the ischemic penumbra reduced infarct volume and alleviated cognitive deficits,respectively.Notably,glial cell,caspase-1(p20),and Nod-like receptor pyrin domain containing 3(NLRP3)inflammasome activation as well as production of the inflammatory cytokines interleukin-1β,interleukin-6,and tumor necrosis factor-αwere also effectively inhibited byβ2M silencing.These findings suggest thatβ2M participates in brain injury and cognitive impairment in a rat model of ischemic stroke through activation of neuroinflammation associated with the NLRP3 inflammasome.