The efficacy and safety of anti-vascular endothelial growth factor combined with Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma: a systematic review and meta-analysis.

Background: The intraocular injections of anti-vascular endothelial growth factor (anti-VEGF) demonstrates significant efficacy in inhibiting the formation of ocular neovascularization in neovascular glaucoma (NVG). Ahmed glaucoma valve implantation (AGVI) is extensively employed for the management of diverse glaucoma types. Objective: To further evaluate the efficacy and safety of anti-VEGF combined with AGVI in the treatment of neovascular glaucoma. Methods: A thorough search for randomized controlled trials (RCTs) was conducted across eight databases: PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed, and VIP. The search period was set from the inception of each database until March 2, 2024, to identify RCTs investigating the effectiveness and safety of combining AGVI with anti-VEGF therapy for NVG. We used the Cochrane Risk of Bias Assessment Tool to evaluate the quality of the literature and performed statistical analysis using Stata 15.0 software. Results: Fourteen RCTs were included in this study. Compared with AGVI alone, the combination of anti-VEGF drugs and AGVI can reduce postoperative intraocular pressure (IOP) at 1 week [WMD = -4.03, 95% CI (-5.73, -2.34), p < 0.001], 1 month [WMD = -5.39, 95% CI (-7.05, -3.74), p < 0.001], 3 months [WMD = -6.59, 95% CI (-7.85, -5.32), p < 0.001], 6 months [WMD = -4.99, 95% CI (-9.56, -0.43), p = 0.032], and more than 12 months [WMD = -3.86, 95% CI (-6.82, -0.90), p = 0.011], with a higher Effective rate [RR = 1.27, 95% CI (1.18, 1.37), p < 0.001], decreased incidence of postoperative hyphema [RR = 0.24, 95% CI (0.15, 0.39), p < 0.001], reduced use of postoperative antiglaucoma medications [WMD = -0.48, 95% CI (-0.61, -0.35), p < 0.001], and decreased aqueous humor VEGF levels [SMD = -2.84, 95% CI (-4.37, -1.31), p < 0.001]. Conclusion: In comparison to AGVI alone, the combination of AGVI with anti-VEGF therapy has better effects in reducing IOP at various time intervals, diminishing postoperative antiglaucoma medication requirements and reducing aqueous humor VEGF levels. Furthermore, it effectively minimizes the incidence of postoperative hyphema. Nevertheless, due to the variability in the quality of the trials included, further high-quality experiments will be required in the future to substantiate this conclusion. Systematic review registration: PROSPERO, identifier CRD42024519862, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024519862.

The glycolysis/HIF-1α axis defines the inflammatory role of IL-4-primed macrophages.

T helper type 2 (Th2) cytokine-activated M2 macrophages contribute to inflammation resolution and wound healing. This study shows that IL-4-primed macrophages exhibit a stronger response to lipopolysaccharide stimulation while maintaining M2 signature gene expression. Metabolic divergence between canonical M2 and non-canonical proinflammatory-prone M2 (M2INF) macrophages occurs after the IL-4Rα/Stat6 axis. Glycolysis supports Hif-1α stabilization and proinflammatory phenotype of M2INF macrophages. Inhibiting glycolysis blunts Hif-1α accumulation and M2INF phenotype. Wdr5-dependent H3K4me3 mediates the long-lasting effect of IL-4, with Wdr5 knockdown inhibiting M2INF macrophages. Our results also show that the induction of M2INF macrophages by IL-4 intraperitoneal injection and transferring of M2INF macrophages confer a survival advantage against bacterial infection in vivo. In conclusion, our findings highlight the previously neglected non-canonical role of M2INF macrophages and broaden our understanding of IL-4-mediated physiological changes. These results have immediate implications for how Th2-skewed infections could redirect disease progression in response to pathogen infection.

Relationship between attentional bias, anxiety, depression and post traumatic stress disorder in primary and middle school students / 中国学校卫生

Objective@#To investigate the relationship between negative attentional bias and post traumatic stress disorder(PTSD) in the context of higher depression and anxiety symptoms after the outbreak of COVID 19, so as to provide scientific basis for mental health education in primary and secondary schools.@*Methods@#From March to April 2021, a total of 708 students from primary school and junior high school (grade 6 through grade 9) in Beijing,Shanxi,Hunan,Shandong,Hebei,Hubei of China were selected. The Children s Revised Impact of Event Scale(CRIES), the Attention to Positive and Negative Information Scale （APNI）and Depression, Anxiety and Stress Scale-21(DASS-21) were used in a questionnaire survey.@*Results@#A total of 242 students were diagnosed with PTSD, and the detection rate was 34.2%.The scores of intrusion and high arousal of boys（7.92±5.33,8.60± 5.41 ） were lower than those of girls（8.72±4.85,9.50±4.76），and the difference was statistically significant ( t =-2.04, -2.32, P < 0.05 ). There were statistically significant differences of negative attention bias,CRIES score, intrusion,debarb and high arousal among primary and middle school students of different grades ( F =3.57,5.99,4.45,4.60,7.40, P <0.05). Negative attention bias, anxiety, depression and post traumatic stress symptoms were significantly positively correlated ( r =0.27-0.84, P <0.05). Logistic regression analysis showed that anxiety ( OR =1.13, 95% CI =1.06-1.20) and negative attention bias ( OR =1.10, 95% CI =1.07- 1.12 ) were positively associated with PTSD symptoms in primary and middle school students( P <0.01).@*Conclusion@#Anxiety and depressive symptoms show impacts on negative attention bias and might exacerbate the symptoms of post traumatic stress disorder. Therefore, emotional adjustments can help reduce the post traumatic stress response in the post epidemic period.