Research progress on the mechanism of subthreshold micropulse laser photocoagulation in central serous chorioretinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Central serous chorioretinopathy(CSC)is a common macular degeneration that primarily affects young patients. While the disease may resolve on its own to some extent, delayed or inadequate treatment can result in recurrence and progression to chronic CSC. This can lead to complications such as retinal pigment epithelium(RPE)atrophy and choroidal neovascularization, ultimately causing irreversible damage to central vision. Subthreshold micropulse laser photocoagulation(SMLP)is a type of laser therapy that differs from traditional lasers in that it does not cause damage or thermal injury to RPE cells and photoreceptors. SMLP has become widely used in clinical treatment of CSC due to its effectiveness, safety, and reproducibility, particularly in cases where verteporfin is not available in photodynamic therapy(PDT). The purpose of this review is to explain the mechanism of SMLP in CSC and summarize the effector cells, cytokines, and mechanisms of action involved in its treatment. This will provide a theoretical basis for promoting and rationalizing the use of SMLP in clinical practice.

Investigation of endothelial cell pathological characteristics in murine choroidal neovascularization model based on single-cell RNA sequencing / 中华实验眼科杂志

Objective:To investigate the molecular expression and pathological features of endothelial cell (EC) in a murine model of choroidal neovascularization (CNV) based on single-cell RNA sequencing (scRNA-seq).Methods:Six C57BL/6 mice aged 6-8 weeks were randomly divided into two groups, with 3 mice in each group.Bilateral eyeballs were enucleated.The choroidal tissues from the two groups were isolated by shearing the complex and scraping the choroid, respectively.Single-cell suspension was prepared by continuous digestion with trypsin/type Ⅰ collagenase at 37 ℃, and the cell viability and EC ratio were detected by flow cytometry to determine the preparation method of single-cell suspension.Another 6 mice were randomly assigned into the control group and the CNV group, with 3 mice in each group.The CNV model was induced by laser photocoagulation and single-cell suspensions were prepared 7 days after modeling.Gene expression library construction was performed using the Chromi-um (10x Genomics) instrument.High throughput sequencing was performed using the Illumina Novaseq6000 to obtain the expression matrix.The EC subpopulations were classified according to previous researches and the Cellmarker database.Pseudo-time analysis was performed in EC, revealing the gene expression matrix of different states.CNV-EC were further selected with preliminary analysis of the expression characteristics.Another 6 mice were selected to establish the CNV model and eyeball frozen sections were prepared 7 days after modeling.Expression and distribution as well as the area percentage of EC marker Pecam1, mitochondrial outer membrane proteins Tomm20 and mt-Co1, and capillary markers Kdr and Plvap were observed by immunofluorescence staining, and the vascular diameter was calculated.The use and care of animals followed the ARVO statement.This study protocol was approved by the Experimental Animal Welfare and Ethics Committee of Air Force Military Medical University (No.20200181).Results:The cell viability of the single-cell suspension prepared from choroidal-scleral fragments and choroidal scrapings was 99.4% and 99.1%, respectively, both of which met the sequencing requirements.The percentage of EC detected by flow cytometry was approximately 1.58%.The scRNA-seq result revealed that both the normal control and CNV groups contained 13 choroidal cell clusters.Compared with the normal control group, the proportions of rod/cone photoreceptor cells, EC and hematopoietic cells all increased, while the retinal pigment epithelium (RPE) and Schwan cells reduced in the CNV group.Among all clusters, EC constituted 18.4%.The pseudo-time analysis demonstrated that EC could be further divided into 4 states.The percentage of state 2 EC was 29.1% in the CNV group, which was significantly higher than 9.5% in the normal control group.Differentially expressed gene analysis showed that the expression of mitochondrion-related genes, including mt-Nd4 and mt-Atp6, were upregulated in state 2 EC, while capillary-related genes, including Kdr and Esm1, were downregulated.Immunofluorescent staining revealed that the area of Tomm20 and mt-Co1 in Pecam1-positive EC in the CNV area was (19.50±4.68)% and (4.64±2.82)%, respectively, which were both higher than (3.00±2.09)% and (0.18±0.34)% in normal area ( t=7.88, 3.84; both at P<0.01). The area of Kdr and Plvap in Pecam1-positive EC in the CNV area was (1.50±0.29)% and (0.79±0.97)%, respectively, which were both lower than (31.30±5.44)% and (10.43±2.28)% in the normal area ( t=13.40, 9.48; both at P<0.01). The vascular diameter in the CNV area was (5.52±1.85)μm, which was larger than (4.21±1.84)μm in the normal area ( t=9.57, P<0.001). Conclusions:When CNV occurs, the proportion of EC in choroid increases, and CNV-EC shows pathologic features of mitochondrial metabolic activation and loss of capillary properties, suggesting the mitochondrial activation of EC may play a role in the formation of CNV.

Study about renal injury of unilateral ureteral obstruction model with time / 中国医师杂志

Objective:The unilateral (left) ureteral obstruction (UUO) model was established in mice to explore the changes of renal injury with time and the related mechanisms.Methods:Fifty mice were randomly divided into two groups: sham group and UUO group (UUO model was made by unilateral ureteral ligation). The biochemical indexes, left kidney weight/final weight (LR/BW) and right kidney weight/final weight (RR/BW) of the two groups at different time points were observed, and the left kidney weight/right kidney weight ratio (LR/RR) was calculated. Hematoxylin-eosin (HE), Masson and periodic acid-Schiff (PAS) staining were used to detect the pathological changes of the kidney in mice. Immunofluorescence staining was used to observe the loss of peritubular capillaries (PTC), proliferation of renal parenchymal cells (Ki67 + cells), macrophages (CD68 + markers), infiltration of fibroblasts and expression of Wnt/β-catenin in the kidney of mice. Results:The weight of mice in UUO group decreased rapidly [(18.2±1.1)g vs (22.4±1.2)g] on the third day of modeling, then slowly increased until the 28th day, and significantly decreased [(17.5±0.8)g] on the 60th day; LR/RR and LR/BW increased significantly in the third day, and then decreased gradually; Renal function of mice in UUO group deteriorated significantly on the 60th day [serum creatinine (0.89±0.09)mg/dl, urea nitrogen (41.26±5.65)mg/dl]. In UUO group, renal tubulointerstitial fibrosis and glomerulosclerosis were observed under light microscope in the obstructed kidney; with the passage of time, PTC loss gradually increased; macrophages increased significantly in the left renal parenchyma at first, but began to decrease 28 days later; the number of fibroblasts increased significantly in the first 14 days of the obstructed side (left side) kidney, and then decreased to the normal level; There was no significant difference in the cell number of the non obstructive kidney between UUO group and sham group; The immunofluorescence intensity expression of Wnt/β- catenin of obstructive side (left side) in UUO group was significantly up-regulated in the first 14 days after renal injury, and decreased after 28 days.Conclusions:The development of UUO renal fibrosis involves many changes, including PTC loss, macrophage infiltration, fibroblast activation and expression, but these changes weaken with time.

Research progress of clinical application of optical coherence tomography angiography in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Optical coherence tomography angiography(OCTA), as a new imaging technology that has emerged in recent years, is characterized by non-invasiveness, high speed and high resolution. Compared with traditional contrast examination, OCTA is faster, safer and avoids the side effects and risks of traditional contrast agents. Now, OCTA has been gradually applied in the diagnosis, treatment and follow-up of eye diseases. Through real-time imaging of retinal choroidal blood vessels, this article reviews the research progress of clinical application of OCTA in diabetic retinopathy.

Association between disorganization of the retinal inner layers and capillary nonperfusion area in patients with retinal vein occlusion / Associação entre a desorganização das camadas internas da retina e areas sem perfusão capilar em pacientes com oclusão de veia retiniana

ABSTRACT Purpose: To determine the correlation between the extent of disorganization of the retinal inner layers (a parameter of spectral domain optical coherence tomography) and optical coherence tomography angiography parameters in eyes with center-involved macular edema associated with retinal vein occlusion. Methods: This retrospective observational study included 34 eyes of 34 patients with newly diagnosed macular edema associated with retinal vein occlusion and evidence of center-involved macular edema. Optical coherence tomography angiography and spectral domain optical coherence tomography were evaluated after resolution of the macular edema. Disorganization of the retinal inner layers was determined via spectral domain optical coherence tomography and optical coherence tomography angiography parameters, including foveal avascular zone area in the superficial capillary plexus and capillary nonperfusion areas, foveal avascular zone area in full retinal vasculature, foveal avascular zone perimeter, acircularity index of the foveal avascular zone, and foveal density. Results: The mean disorganization of the retinal inner layers extent was 512.72 ± 238.47 microns, and the mean capillary nonperfusion area was 4.98 ± 2.85 mm2. There was a positive correlation between the extent of disorganization of the retinal inner layers and capillary nonperfusion area (p<0.001, r=0.901). Greater extent of disorganization of the retinal inner layers and the capillary nonperfusion area was correlated with wider foveal avascular zone area (p=0.014 and p=0.036, respectively) in the superficial capillary plexus and decreased foveal density (vessel density in 300 microns around the foveal avascular zone) (p=0.031 and p=0.022, respectively). These parameters were also correlated with decreased vessel density in both the superficial capillary plexus and deep capillary plexus in the parafoveal and peri­foveal regions (p<0.05 for all). Conclusions: Disorganization of the retinal inner layers appears to be a correlated biomarker of capillary ischemia in retinal vein occlusion. The extent of disorganization of the retinal inner layers was strongly correlated with the capillary nonperfusion area. This may support the notion that the extent of disorganization of the retinal inner layers can be used as an easily obtainable and crucial surrogate marker of capillary ischemia.

RESUMO Objetivo: Determinar a correlação entre a ex­tensão da desorganização das camadas internas da retina, que constitui um parâmetro da tomografia de coerência óptica de domínio espectral, e os parâmetros da angiografia por tomografia de coerência óptica em olhos com edema macular com envolvimento central associado à oclusão da veia retiniana. Métodos: Este estudo retrospectivo observacional incluiu 34 olhos de 34 pacientes com edema macular recém-diag­nosticado associado à oclusão da veia retiniana e com evidência de edema macular com envolvimento central. Após a resolução do edema macular, foram avaliadas a tomografia de coerência óptica de domínio espectral e a angiografia por tomografia de coerência óptica. A desorganização das camadas internas da retina foi determinada através de parâmetros da tomografia de coerência óptica de domínio espectral e da angiografia por tomografia de coerência óptica, incluindo a área da zona avascular foveal no plexo capilar superficial e nas regiões sem perfusão capilar, a área da zona avascular foveal na vascularização total da retina, o perímetro da zona avascular foveal, o índice de não circularidade da zona avascular foveal e a densidade foveal. Resultados: A extensão média da desorganização das camadas internas da retina foi de 512,72 ± 238,47 mm e a área média da região sem perfusão capilar foi de 4,98 ± 2,85 mm2. Houve uma correlação positiva entre a extensão da desorganização das camadas internas da retina e a área da região sem perfusão capilar (p<0,001, r=0,901). Maior extensão da desorganização das camadas internas da retina e da região sem perfusão capilar correlacionaram-se a uma área maior da zona avascular foveal (respectivamente, p=0,014 e p=0,036) no plexo capilar superficial e a uma menor densidade foveal (a densidade vascular nos 300 μm à volta da zona avascular foveal; respectivamente, p=0,031 e p=0,022), e também se correlacionaram a uma menor densidade vascular tanto no plexo capilar superficial como no profundo, nas regiões parafoveal e perifoveal (p<0,05 em todas as correlações). Conclusão: A desorganização das camadas internas da retina parece ser um biomarcador correlacionado com a isquemia capilar na oclusão da veia retiniana. O fato de que a extensão dessa desorganização se correlacionou fortemente com a área sem perfusão capilar sugere o uso da extensão da desorganização das camadas internas da retina como um marcador substituto de isquemia capilar, sendo este um marcador importante e facilmente obtido.

Evaluation of the retinal vasculature of patients with branch retinal vein occlusion using optical coherence tomography angiography / Avaliação da vasculatura da retina em pacientes com oclusão de ramo da veia central da retina utilizando a angiografia por tomografia de coerência óptica

ABSTRACT Purpose: To evaluate vascular density in super­ficial and deep capillary plexuses of the retina, measured using optical coherence tomography angiography in patients with branch retinal vein occlusion. Affected eyes were compared with the contralateral eye of the same patient and both were compared with normal eyes. Methods: A cross-sectional study including 16 previously untreated patients with branch retinal vein occlusion. Patients with poor quality examinations, bilateral disease, high refractive error, or any other retinal or choroidal disease were excluded. A total of 31 patients without eye disease were also selected as a comparison group. All participants underwent five optical coherence tomography angiographies, and only those with at least two good quality examinations were selected. The Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were used for the statistical analysis. Results: Vascular density was lower in affected eyes compared with contralateral eyes: whole density (p=0.020 for capillary plexuses superficial; p=0.049 for deep capillary plexuses) and parafoveal density (p=0.020 for capillary plexuses superficial; p=0.011 for deep capillary plexuses). Vascular density was also lower in affected eyes compared with normal eyes: whole density (p<0.001 for capillary plexuses superficial and deep) and parafoveal density (p<0.001 for capillary plexuses superficial and deep). Whole density (p=0.001 for capillary plexuses superficial and deep) and parafoveal density (p=0.001 for capillary plexuses superficial; p<0.001 for deep capillary plexuses) were both lower in the contralateral eyes compared with normal eyes. Following adjustment for arterial hypertension, this difference was no longer observed. Conclusions: Vascular density in capillary plexuses and deep capillary plexuses was lower in the eyes affected by branch retinal vein occlusion. Furthermore, the lower vascular density noted in the contralateral eyes indicates that changes most likely occurred in these eyes prior to the appearance of any clinically detectable alterations, reflecting the early signs of hypertensive retinopathy.

RESUMO Objetivo: Avaliar a densidade vascular do plexo capilar superficial e profundo da retina, usando angiografia por tomografia de coerência óptica em pacientes com oclusão de ramo da veia central da retina, comparando o olho afetado com o contralateral do mesmo paciente e ambos com olhos normais. Métodos: Estudo transversal. Incluídos dezesseis pacientes com oclusão de ramo da veia central da retina sem tratamento prévio. Pacientes com exames de baixa qualidade, altas ametropias, outras patologias de retina ou coróide foram excluídos. Para comparação, trinta e um pacientes sem doença ocular foram selecionados. Todos foram submetidos a cinco exames angiografia por tomografia de coerência óptica, apenas aqueles com pelo menos dois exames de boa qualidade permaneceram no estudo. Os testes Kruskal-Wallis, Wilcoxon, e Mann-Whitney foram utilizados. Resultados: Densidades vasculares mais baixas do plexo capilar superficial e plexo capilar profundo foram observadas quando olhos com oclusão de ramo da veia central da retina foram comparados com os contralaterais: densidade total (p=0,02 para plexo capilar superficial, p=0,049 para plexo capilar profundo), densidade parafoveal (p=0,02 para plexo capilar superficial, p=0,011 para plexo capilar profundo). Comparando olhos acometidos com olhos normais, também foram observadas densidades vasculares mais baixas de plexo capilar superficial e plexo capilar profundo: densidade total (ambos com p<0,001) e densidade parafoveal (ambos com p<0,001). Quando os olhos contralaterais foram comparados aos normais, tanto a densidade total do plexo capilar superficial e plexo capilar profundo (ambos com p=0,001) quanto a densidade parafoveal (plexo capilar superficial com p=0,001, plexo capilar profundo com p<0,001) foram menores. Ao se realizar uma subanálise, minimizando o fator hipertensão arterial, esta diferença não se manteve. Conclusões: Densidades vasculares mais baixas do plexo capilar superficial e do plexo capilar profundo foram observadas em olhos com oclusão de ramo da veia central da retina. Além disso, a presença de densidades vasculares mais baixas nos olhos contralaterais mostra que já existem altera­ções nesses olhos antes das alterações clínicas, devido a al­terações inicias da retinopatia hipertensiva.

Clinical study of retinal vein occlusion papillary area with quantified OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical application value of optical coherence tomography angiography(OCTA)in patients with retinal vein occlusion(RVO). <p>METHODS:Retrospective case study. From January 2018 to December 2019, 40 cases with 40 eyes of RVO patients diagnosed in the Eye Center of the Affiliated Hospital of Weifang Medical University were selected, and 40 healthy subjects with 42 eyes matching the age and gender of RVO patients were selected as normal control group. OCTA was used to measure the papillary vessel density of the two groups, differences in parameters were evaluated. <p>RESULTS: The blood vessel density in the areas of the whole image blood vessels(<i>t</i>=-2.953, <i>P</i><0.001), the peripapillary blood vessels(<i>t</i>=-3.533, <i>P</i>=0.001), the whole image capillaries(<i>t</i>=-3.192, <i>P</i>=0.003), the peripapillary capillaries(<i>t</i>=-3.930, <i>P</i><0.001), inferior nasal(<i>t</i>=-2.854, <i>P</i>=0.007), inferior tempo(<i>t</i>=-3.696, <i>P</i>=0.001), tempo inferior(<i>t</i>=-3.418, <i>P</i>=0.002), tempo superior(<i>t</i>=-3.170, <i>P</i>=0.003), superior tempo(<i>t</i>=-3.082, <i>P</i>=0.004)and superior nasal(<i>t</i>=-2.912, <i>P</i>=0.006)in the eyes of patients with RVO was significantly lower than that of the fellow eyes of patients with RVO. The blood vessel flow density in the all areas of in the eyes of patients with RVO was significantly lower than that of the normal control group. The blood vessel density in the areas of the whole image blood vessels(<i>t</i>=-2.213, <i>P</i>=0.032), the blood vessels inside disc(<i>t</i>=-2.270, <i>P</i>=0.028), the whole image capillaries(<i>t</i>=-2.192, <i>P</i>=0.033), capillaries inside disc(<i>t</i>=-2.449, <i>P</i>=0.018)and tempo superior(<i>t</i>=-2.147, <i>P</i>=0.037)in the fellow eyes of patients with RVO was significantly lower than that of the normal control group.<p>CONCLUSION:Quantitative OCTA reveals a decrease in the vessel density of papillary area of patients with retinal vein occlusion, suggesting that papillary area with quantified OCTA has clinicalapplication value for the assessment of the severity and prevention of the fellow eyes with retinal vein occlusion disease.

The role of liver sinusoidal endothelial cells in the progression of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a clinical metabolic syndrome characterized by hepatic steatosis, inflammation, and fibrosis and has become a common chronic liver disease with great impact on public health. Liver sinusoidal endothelial cells (LSECs) are specialized vascular endothelium of liver tissue, and as an important vascular barrier, LSECs play an important role in regulating the absorption and metabolism of nutrients and substances from the blood of the intestines in hepatocytes. This article reviews the research advances in LSEC capillarization, vascular dysfunction, and its involvement in the regulation of liver inflammation, angiogenesis, and liver fibrosis during the development and progression of NAFLD.

Interpretation:recommendations of the 6st World Symposium on Pulmonary Hypertension（Ⅱ）——haemodynamic definitions and updated clinical classification of pulmonary hypertension / 中国实用内科杂志

Pulmonary hypertension(PH)has been defined as mean pulmonary arterial pressure(mPAP）≥25 mmHg at rest,measured by right heart catheterisation. The 6 th WSPH suggested a new pressure level to define an abnormal elevation as the mPAP>20 mmHg and the need for PVR≥3 WU to define the presence of pre-capillary PH. Regarding clinical classification,the main changes were the inclusion in group 1 of a subgroup“pulmonary arterial hypertension(PAH)long-term responders to calcium channel blockers”and a subgroup“PAH with overt features of venous/capillaries involvement“.

The changes of choriocapillaris blood flow in chronic central serous chorioretinopathy before and after photodynamic therapy / 中华眼底病杂志

Objective To quantitatively analyze the changes ofchoroidal capillaries in chronic central serous chorioretinopathy (CCSC) before and after half-dose photodynamic therapy (PDT).Methods A retrospective cohort study.Nineteen patients (21 eyes) with CCSC were enrolled in this study from November 2017 to September 2018 in People's Hospital of Wuhan University.Among them,there were 14 males (15 eyes) and 5 females (6 eyes),with diseases course over than 6 months.All patients underwent half-dose PDT.Twenty normal subjects (40 eyes) matched with age and sex in CCSC group were taken as controls.The subfoveal choroidal thickness (SFCT) was measured by Heidelberg depth enhanced imaging-OCT before and after PDT treatment in CCSC patients and in normal subjects.Spectral-domain OCT (Retina map) and Angio-OCT angiography (3 mm × 3 mm) were arranged for all subjects at the same time.Macular fovea retinal thickness (CMT) was recorded under OCT-Retina map mode,and Angio-OCT 3 mm × 3 mm choroidal capillary images were binarized using Image J software,and calculating the area ratio of low pixel area as flow signal void (FSV).BCVA,spectral-domain OCT and Angio-OCT were performed 1 week and 1,3 months after PDT with the same equipment and methods before PDT.The changes of CMT,SFCT,FSV and BCVA in CCSC patients before and after PDT treatment were compared.Pearson correlation analysis was used to analyze the correlation between FSV and SFCT,age.Results The average CMT,SFCT and FSV in CCSC patients increased significantly compared with the controls (P＜0.05).The average SFCT and FSV in CCSC patients 3 months after treatment were higher and the average CMT decreased compared with the controls (P=0.000,0.000,0.000).Comparison before and after PDT in CCSC patients:there were significant differences in average CMT,SFCT and FSV before and after PDT (P=0.000,0.000,0.000).Post Hoc multiple comparisons showed that the average CMT (P=0.000,0.000,0.000,0.000,0.000) and FSV (P=0.010,0.000,0.000,0.001,0.000) decreased significantly in all time points except for 1 month and 3 months after treatment,so as the average FSV (P=0.788,0.702).The average SFCT decreased 1 month and 3 months after treatment compared with the baseline (P=0.024,0.008),and there was no significant difference between before treatment and 1 week after treatment (P=0.162),and between 1 month and 3 months after treatment (P=0.687).The correlation analysis showed that there was no correlation between FSV and age in CCSC patients (r=0.052,P=0.822),but there was a correlation between FSV and age in controls (r=0.716,P=0.000).Conclusion Quantitative analysis of OCTA showes the degree of choriocapillary ischemia in the form of FSV in CCSC patients decreased after PDT treatment,however,which is still higher than normal controls.

Anastomosing hemangioma with extensive fatty stroma in the retroperitoneum

Anastomosing hemangiomas are a recently recognized benign vascular neoplasm, first described by Montgomery and Epstein in 2009. A few cases have been described in the genitourinary tract, especially in the renal hilum. These are fairly well-demarcated lesions with lobules of sinusoidal-like capillaries lined by hobnail endothelial cells containing eosinophilic hyaline globules in the cytoplasm. Extramedullary hematopoiesis has been described in a few cases, along with large feeding vessels. A predominant adipocytic component has been described in only one case.[9] We describe a case of a retroperitoneal anastomosing hemangioma occurring in an extrarenal site in a 53-year-old female, followed by a review of the current literature.

Study on the Mechanism of Artemisia capillaries Based on Systems Pharmacology / 中国药房

OBJECTIVE:To investigate the possible mechanism of Artemisia capillaries,and to provide reference for further development and utilization of it. METHODS:The effective components and related target protein of A. capillaries were screened by Traditional Chinese Medicine Systems Pharmacology (TCMSP) analysis platform database. The effective compound-target protein visual network of A. capillaries was established by using Cytoscape 3.5.1 software,topology analysis was also performed. The protein-protein interaction (PPI) network was constructed and analyzed by STRING database. KEGG pathway enrichment of target protein coding gene was analyzed by DAVID bioinformatics resource database. RESULTS:A total of 13 kinds of effective compounds,189 target proteins and 34 enrichment pathways were selected. Quercetin,β-glutamol,isorhamnetin and artepillin C were main effective compounds. Prostaglandin G/H sythase 2(PTGS 2),heat shock protein 90(HSP 90),dipeptidyl peptidase Ⅳ, protein kinase A catalytic subunit Cα were main target proteins. Transcription factor AP-1 and cell tumor antigen p53 played a key role in PPI network. The target protein coding gene was rich in TNF-α signaling pathway,HIF-1 signaling pathway,Toll-like receptor signaling pathway,PI3K/Akt signaling pathway,T cell receptor signaling pathway,thyroid hormone signaling pathway, apoptotic signaling pathway,etc. CONCLUSIONS:Quercetin,β-glutamol and isorhamnetin of A. capillaries play an effect on PTGS2,HSP90,transcription factor AP-1 and other target proteins through TNF-α signaling pathway,HIF-1 signaling pathway and PI3K/Akt signaling pathway,so as to play anti-inflammatory and antitumor effect.

Correlation between capillary index score and outcome of endovascular treatment for acute anterior circulation ischemic stroke / 国际脑血管病杂志

Objective To investigate the capillary index score (CIS) and clinical outcome after endovascular treatment in patients with anterior circulation acute ischemic stroke (AIS). Methods From March 2014 to March 2017,patients with anterior circulation AIS received endovascular treatment in Jinling Hospital and Wuhu Yijishan Hospital were enrolled retrospectively. The data of intraoperative digital subtraction angiography were collected and CIS was calculated. They were divided into either a poor CIS group (score 0-1) or a good CIS group (scores 2-3). Univariate analysis was used to compare the baseline data, clinical data, and outcomes between the 2 groups. Multivariate logistic regression analysis was used to determine the correlation between CIS and symptomatic intracerebral hemorrhage (sICH), death, and functional outcome at 90 d after endovascular treatment(modified Rankin Scale score 0 to 2 was defined as good outcome). Results A total of 157 patients were enrolled, including 91 (58.0％) had poor CIS and 66 (42.0％) had good CIS.Age(P=0.020),baseline systolic pressure(P=0.014),baseline National Institutes of Health Stroke Scale score (P=0.011), early infarct size (P<0.001), as well as the proportions of internal carotid artery occlusion(P<0.001)and embolectomy >3 times(P=0.042)of the poor CIS group were significantly higher than those of the good CIS group.The vascular successful recanalization rate(P<0.001) and good outcome rate (P<0.001) at 90 d in the good CIS group were significantly higher than those in the poor CIS group, while the incidence of sICH (P=0.002) and mortality (P<0.001) were significantly lower than those of the poor CIS group. Multivariate logistic regression analysis showed that CIS were significantly correlated with the functional outcome at 90 d (odd ratio [OR] 0.581, 95％ confidence interval[CI]0.419-0.805;P=0.001)and the risk of sICH at 72 h(OR 0.611,95％ CI 0.407-0.919; P=0.018) after endovascular treatment in patients with anterior circulation AIS,but it did not have a significant correlation with the risk of death (OR 0.783, 95％ CI 0.492-1.246; P=0.301). Conclusions CIS was significantly correlated with the clinical outcome in patients with anterior circulation AIS after endovascular treatment. It can be used as a tool to select patients for endovascular treatment.

Long-Term Quality Control Program Plan for Cord Blood Banks in Korea: A Pilot Study for Cryopreservation Stability

BACKGROUND: Maintaining the quality of cryopreserved cord blood is crucial. In this pilot study, we describe the results of the internal quality control program for a cord blood bank thus far. METHODS: Donated cord blood units unsuitable for transplantation were selected for internal quality control once a month. One unit of cord blood, aliquoted into 21 capillaries, was cryopreserved and thawed annually to analyze the total nucleated cell count, CD34⁺ cell count, cell viability test, and colony-forming units assay. RESULTS: No significant differences in the variables (total nucleated cell count, cell viability, CD34⁺ cell count) were observed between samples cryopreserved for one and two years. Upon comparing the variables before cryopreservation and post thawing with the capillaries of one year of storage, cell viability and CD34⁺ cell counts decreased significantly. The use of cord blood samples in capillaries, which can be easily stored for a long period, was similar to the methods used for testing segments attached to the cord blood unit. CONCLUSIONS: The results of this study may be useful for determining the period during which the quality of cryopreserved cord blood units used for transplantation is maintained.

Clinical application of OCTA in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Optical coherence tomography angiography (OCTA) is a noninvasive angiography technique developed in recent years.Without using contrast medium,this technology can quickly and safely get retinal vascular images with relatively high-resolution.It has been widely used in the diagnosis and management of eye diseases,especially in the vascular diseases,such as diabetic retinopathy (DR),age-related macular degeneration (AMD),retinal central/branch venous obstruction (CRVO/BRVO),choroidal neovascularization(CNV),etc.This article reviews the clinical application of OCTA in diabetic retinopathy.

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients / 中华肾脏病杂志

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival.Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical data and renal biopsy samples were carefully studied.CD34 staining was performed to evaluate the PTC area,using Benign nephrosclerosis (BN,n=17) patients and glomerular minimal lesions (GML,n=19) patients as controls.Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival.Results Fifty-two MN patients were enrolled.The sex ratio of male to female was 12:1 and the average age was (34.0±8.2) years.The maximum blood pressure (SBP/DBP) was (230.4 ± 25.0)/(156.4 ± 20.6) mmHg,companied with significant loss of eGFR and proteinuria.Glomerular sclerosis index,tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria (P ＜ 0.05).After aggressive treatment,BP control rate improved significantly (76.9％ vs 3.7％,P ＜0.01),Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L,Wilcoxon test,P＜ 0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04± 1.26) g/24 h,P ＜ 0.01,n=21] also improved.PTC area in MN patients was significantly lower than those in BN patients and GML patients,and it correlated well with Scr (r=-0.553,P=0.001) and eGFR (r=0.476,P=0.004).The median follow-up time was 74 months,the cumulative renal survival rate at 1 year,5 year and 10 year was 90％,64％ and 23％,respectively.Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8± 12.4) months vs (63.0±8.3) months, x2=5.312,P ＜ 0.05].Univariate Cox proportional hazard model found that unsatisfied BP control,eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge,lower PTC area,severer tubular-interstitial damage and anemia were associated with poor renal outcome.Multivariate Cox model showed that unsatisfied BP control (RR=3.89,95％ CI 1.75-8.65,P=0.001),eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge (RR=4.27,95％ CI 1.40-13.09,P=0.011) were independent risk factors for long-term renal survival.Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes.Unsatisfied BP control and eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients / 中华肾脏病杂志

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival.Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical data and renal biopsy samples were carefully studied.CD34 staining was performed to evaluate the PTC area,using Benign nephrosclerosis (BN,n=17) patients and glomerular minimal lesions (GML,n=19) patients as controls.Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival.Results Fifty-two MN patients were enrolled.The sex ratio of male to female was 12:1 and the average age was (34.0±8.2) years.The maximum blood pressure (SBP/DBP) was (230.4 ± 25.0)/(156.4 ± 20.6) mmHg,companied with significant loss of eGFR and proteinuria.Glomerular sclerosis index,tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria (P ＜ 0.05).After aggressive treatment,BP control rate improved significantly (76.9％ vs 3.7％,P ＜0.01),Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L,Wilcoxon test,P＜ 0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04± 1.26) g/24 h,P ＜ 0.01,n=21] also improved.PTC area in MN patients was significantly lower than those in BN patients and GML patients,and it correlated well with Scr (r=-0.553,P=0.001) and eGFR (r=0.476,P=0.004).The median follow-up time was 74 months,the cumulative renal survival rate at 1 year,5 year and 10 year was 90％,64％ and 23％,respectively.Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8± 12.4) months vs (63.0±8.3) months, x2=5.312,P ＜ 0.05].Univariate Cox proportional hazard model found that unsatisfied BP control,eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge,lower PTC area,severer tubular-interstitial damage and anemia were associated with poor renal outcome.Multivariate Cox model showed that unsatisfied BP control (RR=3.89,95％ CI 1.75-8.65,P=0.001),eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge (RR=4.27,95％ CI 1.40-13.09,P=0.011) were independent risk factors for long-term renal survival.Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes.Unsatisfied BP control and eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.

Hemorragia alveolar difusa, desafío diagnóstico y terapéutico / Diffuse alveolar hemorrhage: a diagnostic and therapeutic challenge

Diffuse alveolar hemorrhage is a syndrome causing catastrophic respiratory failure, secondary to pathophysiological processes within the natural history of a variety of diseases and clinical conditions. Should be considered a medical emergency due to the significant morbidity and mortality associated. It represents a diagnostic challenge because symptoms and signs are often nonspecific. It requires a highlevel of suspicion to early recognition, essential step towards the establishment of supportive measures and specific therapy for survival.

La hemorragia alveolar difusa es un síndrome causante de falla respiratoria catastrófica, secundario a los procesos fisiopatológicos presentes en la historia natural de varias enfermedades y condiciones clínicas. Debe considerarse como una emergencia médica debido a la significativa morbi-mortalidad asociada. Representa un desafío diagnóstico ya que a menudo los síntomas y signos son inespecíficos, requiere un alto nivel de sospecha para el reconocimiento precoz, paso esencial para la instauración de medidas de soporte vital y terapia específica requerida para la sobrevida.

Manifestações oftalmológicas de Síndrome de Klippel Trenaunay / Ophthalmological manifestation of the Klippel Trenaunay Syndrome

RESUMO A Síndrome de Klippel-Trenaunay (SKT) é uma doença congênita rara, com maior prevalência no sexo masculino e incidência de 2-5:100.000. Apresenta-se, na forma clássica, como a tríade de manchas vinho porto, hipertrofia de membros e malformação venosa e/ou linfática. O diagnóstico é essencialmente clínico e devido à complexidade da síndrome, de natureza progressiva e ampla variedade de apresentações clínicas, os pacientes devem ser tratados de forma individualizada por uma equipe multidisciplinar. Alterações oftalmológicas associadas à SKT incluem anormalidades vasculares da órbita, íris, retina, coroide e nervo óptico. Relato de caso: Paciente de 23 anos, sexo feminino, portadora de SKT, em acompanhamento no Centro da Visão - Universidade Federal do Paraná, com queixa de diminuição da acuidade visual em olho direito. A paciente apresentava manchas vinho porto em dimidio direito e hipertrofia de membros ipsilateral. Foi diagnosticado glaucoma e realizados exames complementares oftalmológicos a fim de avaliar o grau de comprometimento dos campos visuais e o fundo de olho. A visão com a melhor correção foi de 20/100 OD e foi de 20/20 OE. À fundoscopia, constatou-se aumento da escavação do nervo óptico à direita - 0,75 x 0,90 mm. Optou-se por tratamento clínico com Cloridrato de Dorzolamida, Latanoprosta, Brimonidina e Timolol, com bons resultados a longo prazo - a tonometria de aplanação mostrou 19 mmHg OD e 15 mmHg OE, apesar da dificuldade na estabilização da doença. Conclusão: Relatos demonstram que os resultados dos tratamentos clínico e cirúrgico do glaucoma em associação à SKT são insatisfatórios quando comparados a outros tipos de glaucoma - o controle clínico não é possível em cerca de 1/3 dos pacientes, e o manejo cirúrgico tem alto índice de complicações. São necessários estudos mais expressivos que estabeleçam a correlação entre glaucoma e SKT e embasem o tratamento de escolha.

ABSTRACT The Klippel-Trenaunay Syndrome (KTS) is a rare congenital disease, which the prevalence is higher in males, and its incidence of 25:100,000. It is presented in its classic form as the triad of port-wine stains, enlarged limbs and venous and / or lymphatic malformation. The diagnosis is essentially clinical and due to the complexity of the syndrome, the progressive characteristic and the wide variety of clinical presentations, a multidisciplinary team should treat patients individually. The ocular changes associated with KTS include vascular, orbit, iris, retina, choroid and optic nerve abnormalities. Case report: A 23-year-old female patient, carrier KTS, being followed at Vision Center - Federal University of Paraná, complaining of decreased visual acuity in the right eye. The patient had port-wine stains in right hemibody and hypertrophy of ipsilateral members. Glaucoma was diagnosed and eye exams were performed to assess the degree of impairment of visual fields and fundus. The best correction was checked at 20/100 OD and 20/20 OS. At fundoscopy, there was increased excavation of the optic nerve right - 0.75 x 0.90 mm. Clinical treatment was chosen with Dorzolamide Hydrochloride, Latanoprost, Brimonidine and Timolol, presenting good long-term results - the tonometry showed 19 mmHg OD and 15 mmHg OS, despite the difficulty in stabilizing the disease. Conclusion: Reports have shown that the results of clinical and surgical treatments of glaucoma in association with KTS are unsatisfactory compared to other types of glaucoma - clinical control is not possible in about 1/ 3 of patients and the surgical management has a high rate of complications. Significant studies are needed to establish the correlation between glaucoma and KTS, and base the treatment of choice.