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ABSTRACT Purpose: As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. Methods: This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant--Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. Results: Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). Conclusion: The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.
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Background: Zonular weakness is a known complication that a surgeon can encounter during cataract surgery. Purpose: The purpose of this video is to make surgeons aware about the different tools and techniques available to handle zonulopathy. Synopsis: This video describes the various causes of zonular weakness and different tools available to manage zonular weakness intraoperatively. The surgical technique of using the tools is also demonstrated in the video. Highlights: Causes of zonular weakness and surgical techniques to handle it intraoperatively.
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Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.
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Purpose: To evaluate the visual and surgical outcomes of cataract surgery in patients with posterior polar cataract (PPC) and to evaluate the benefits of preoperative anterior segment optical coherence tomography (AS?OCT). Methods: This was a retrospective, single?center study. Case records of patients diagnosed with PPC who underwent cataract surgery either by phacoemulsification or manual small?incision cataract surgery (MSICS) from January to December 2019 were analyzed. Data collected include demographic details, preoperative best corrected visual acuity (BCVA), AS?OCT, type of cataract surgery, intraoperative and postoperative complications, and visual outcome at 1?month follow?up. Results: One hundred patients were included in the study. Preoperative posterior capsular defect was noted on AS?OCT in 14 patients (14%). Seventy?eight underwent phacoemulsification and 22 underwent MSICS. Intraoperatively, posterior capsular rupture (PCR) was seen in 13 patients (13%) and cortex drop was noted in one among them (1%). Out of 13 PCRs, 12 were found to have posterior capsular dehiscence preoperatively in AS?OCT. The sensitivity of AS?OCT for detecting posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value and negative predictive value were 85.7% and 98.8%, respectively. There was no significant difference in the incidence of PCR between phacoemulsification and MSICS (P = 0.475). The mean BCVA at 1 month was found to be better with phacoemulsification than MSICS (P = 0.004). Conclusion: Preoperative AS?OCT has excellent specificity and negative predictive value in identifying posterior capsular dehiscence. It thus helps to plan the surgery and counsel patients appropriately. Both phacoemulsification and MSICS provide good visual outcome with similar complication rates.
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Small perforations are often managed with cyanoacrylate glue - bandage contact lens (BCL). An additional layer with substances like sterile drape often enhances the strength of the glue. Herein, we describe a novel method of using anterior lens capsule as biological drape to secure perforation. The anterior capsule was secured from femtosecond laser–assisted cataract surgery (FLACS) and placed over the perforation after folding it twice. The area was dried and a small aliquot of cyanoacrylate glue was applied over it. The BCL was applied over it after the glue was dry. In our series of five patients, none of them needed repeat surgery and all cases healed by three months without vascularization. It is a unique technique to secure small corneal perforations.
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Introduction: The study was conducted to evaluate IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. Vision impairment is a major public health problem and the burden is increasing with increase in aged population. This study wasAims And Objectives: undertaken for study the IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. A pre-designed prospective study was conducted at the OPD of upgraded Department of Ophthalmology at LLRM Medical College, Meerut. A total of 60 patients were divided in to two equal groups randomly and studied. Majority of the patients in both the groups wereObservation And Result: aged between 61 – 70 years. Females outnumbered males in this study which was statistically significant between the two groups. The mean pre- operative intra ocular pressure was 23.3 mm Hg in combined surgery group and 23.9 mm Hg in cataract surgery alone group. Mean Intra ocular pressure decreased regularly in each follow up more in combined group than the cataract surgery alone group. The mean intra ocular pressure after 1 years follow up in combined surgery group was 10.8 mm Hg and 13.4 mm Hg in the cataract surgery alone groups which was statistically significant. Mean BCVA before the operation was 3.2 in combined surgery group and 3.8 in cataract surgery before surgery. Mean BCVA declined after 1 year of follow up in combined surgery group was 1.9 and 2.7 in cataract surgery alone group which was statistically significant. The surgery success was complete in 80.0% of the combined surgery group and 60% of the cataract alone group. Criteria For Failure Of Surgeries Ÿ The IOP >23 MMHG at the end of 1 year or Ÿ The IOP not reduced by 20 % from base line at the end of 1 year Conclusion: This study was mainly undertaken to study the efficacy of combined trabeculectomy with cataract extraction and cataract only on primary angle closure glaucoma. This study had found that, the reduction of intra ocular pressure in both the groups but more prominent in combined surgery group than cataract alone surgery group.
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Purpose : To report a case of late opacification of the hydrophilic acrylic Intraocular Lens (IOL) after uneventful Cataract Surgery. Methods : A 60-year-old male presented with chief complaint of gradual diminution of vision in right eye over the past one year. He was Normotensive, Non-diabetic and had a normal Lipid Profile. History revealed that he underwent uneventful phacoemulsification with posterior chamber hydrophilic intraocular in the bag implantation for pre-senile cataract in his Right Eye ten years ago. He had the best corrected visual acuity of 6/6 in his Right Eye for nine years Post Cataract Surgery. Slit-lamp examination confirmed Intraocular Lens Opacification. Results : Intraocular Lens exchange was performed in his Right Eye. The hydrophilic IOL was replaced with poly methyl methacrylate intraocular lens. The explanted IOL showed uniform grayish-white opacification. Post operative period was uneventful. Intraocular pressure by applanation tonometry was 16.4 mm Hg in both the eyes. Patient抯 best corrected visual acuity was 6/6 with -1 D Cyl. at 90 degree, Postoperatively. Over a follow up period of one year, the patient did not develop complications like posterior capsular IOL opacification. Conclusion: Intraocular Lens opacification is an extremely rare late postoperative complication of Phacoemulsification which can be managed effectively by IOL exchange procedure in cases of opacified IOL optics causing visual morbidity
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For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.
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Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17–14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59–8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64–12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60–4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20–3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher?risk cases can reduce complications
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Se presentan dos pacientes con diarrea crónica, con múltiples estudios negativos, y que tenían en común la deficiencia de vitamina B12. Ambos pacientes tenían estudios repetitivos de parásitos en heces negativos. Sólo al realizarse colonoscopía en el primer caso y la cápsula endoscópica en el segundo, se pudo diagnosticar formas adultas de Diphyllobotrium spp. Luego del tratamiento antiparasitario, ambos pacientes remitieron completamente sus síntomas.
We present two patients with chronic diarrhea, with multiple negative studies, both had in common vitamin B12 deficiency. Both patients had multiple studies of parasites in negative stool. Only after colonoscopy in the first case and capsule endoscopy in the second case, it was possible to diagnose the adult forms of Diphyllobotrium spp. After treatment, both patients completely resolved their symptoms.
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Despite the continuous improvement and development of modern cataract surgery technology, posterior capsule opacification (PCO) is still the common long-term complication causing secondary visual acuity decline after cataract surgery.Previous studies have shown that the occurrence of PCO is closely related to the proliferation, migration, epithelial-mesenchymal transition (EMT) and myofibroblast fibrosis of lens epithelial cells in the anterior capsule and lens equator.In terms of pathogenesis, recent research focuses on the role of cytokines, especially various growth factors.Vascular endothelial growth factor (VEGF) is a kind of growth factor that can promote vascular endothelial cell proliferation and migration, extracellular matrix degeneration and angiogenesis.In addition, there is increasing evidence showing that VEGF plays an important role in fibrosis, inflammation, neuroprotection and other aspects.In recent years, VEGF has been found to promote PCO formation directly or cooperatively with transforming growth factor-β2.Based on the function of VEGF and the relationship between VEGF and EMT, this paper mainly reviewed the advances in the role of VEGF in the eye and the pathogenesis of posterior capsule opacification.
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Objective:To study the effect and mechanism of angiotensin type 1 receptor (AGTR1) blocker olmesartan (OMS) on the apoptosis of human Tenon capsule fibroblasts (HTF).Methods:Tenon capsule tissues were obtained from patients during strabismus surgery in the Second Affiliated Hospital of Xi'an Jiaotong University.Primary HTF were cultured by explant culture.Primary cells were identified by vimentin immunofluorescence staining and flow cytometry.The fibrosis model of HTF was established using 10 ng/ml transforming growth factor-β2 (TGF-β2). The cells were divided into normal control group cultured in culture medium, TGF-β2 group in culture medium containing TGF-β2, TGF-β2+ OMS group in culture medium containing TGF-β2 and OMS, and OMS group in culture medium containing OMS, and were cultured for 48 hours.Cell apoptosis was detected by flow cytometry with annexin V/PI staining.The early apoptosis, late apoptosis, and total apoptosis rates were analyzed.The protein expression of procaspase-9, cleaved caspase-9, bax and bcl-2 in the mitochondrial apoptosis pathway was detected by Western blot.The activity of lactate dehydrogenase (LDH) and superoxide dismutase (SOD) was detected by colorimetry.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University (No.2019-014).Results:Primary HTF were successfully isolated and cultured.The cultured cells were long spindle-shaped and positive for vimentin.The expression rate of vimentin in the primary cells was greater than 99%.A statistically statistical difference was found in the early apoptosis rate, late apoptosis rate, and total apoptosis rate among the four groups ( F=24.92, 3.96, 41.82; all at P<0.05). The early and total apoptosis rates were significantly higher in TGF-β2+ OMS group than normal control group and TGF-β2 group, and the late apoptosis rate in TGF-β2+ OMS group was significantly higher than that of normal control group (all at P<0.05). There were statistically significant differences in cleaved caspase-9/procaspase-9, bax, and bax/bcl-2 among the four groups ( F=4.40, 7.98, 4.61; all at P<0.05). The bax/bcl-2 expression was significantly increased in TGF-β2+ OMS group in comparison with normal control group, and the expressions of cleaved caspase-9/procaspase-9, bax, and bax/bcl-2 were significantly elevated in TGF-β2+ OMS group compared with TGF-β2 group (all at P<0.05). LDH activity in the normal control group, TGF-β2 group, TGF-β2+ OMS group and OMS group was (783.99±79.97), (913.16±196.86), (2 529.06±240.21), and (2 134.29±138.96) μmol/(min·L), respectively, showing a statistically significant difference ( F=24.95, P<0.05). Compared with normal control group and TGF-β2 group, LDH activity in TGF-β2+ OMS group was increased, and the differences were statistically significant (both at P<0.05). SOD activity in the normal control group, TGF-β2 group, TGF-β2+ OMS group and OMS group was (50.35±0.97), (41.61±4.56), (28.88±3.26), and (37.61±4.83) μmol/(min·L), respectively, showing a statistically significant difference ( F=5.71, P<0.05). SOD activity was reduced in TGF-β2+ OMS group compared with normal control group and TGF-β2 group, reduced in OMS group compared with normal control group, and the differences were statistically significant (all at P<0.05). Conclusions:AGTR1 blocker OMS can promote the apoptosis of HTF effectively.Mitochondrial apoptosis pathway mediated by bax/bcl-2/caspase-9 and oxidative stress pathway are the potential mechanisms that OMS regulates the apoptosis of HTF.
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Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparos-copic right hemi-hepatectomy successfully, with the surgical margin as negative. The operation time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases under-going dissection of the trunk of right anterior hepatic pedicle and its operation time, cases under-going dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic pedicle injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient under-going postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.
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Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann?Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi?square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparoscopic right hemi-hepatectomy successfully, with the surgical margin as negative. The operative time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases undergoing dissection of the trunk of right anterior hepatic pedicle and its operation time, cases undergoing dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient undergoing postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, cases with postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.
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Objective:To systematically evaluate the clinical efficacy and safety of Xixian Tongshuan Capsules/Pills combined with Western medicine in treating cerebral infarction.Methods:All RCTs about Xixian Tongshuan Capsules/Pills combined with Western medicine in treating cerebral infarction were retrieved from CNKI, Wanfang Database, VIP database, PubMed and CBM. The search period was from the database establishment to December 31, 2021. Two researchers independently extracted the basic literature data and evaluated the methodological quality, then used RevMan5.4 software for meta-analysis.Results:Totally 9 articles were included, involving a total of 988 patients, including 505 cases in the observation group and 483 cases in the control group. Meta-analysis showed that the total effective rate of Xixian Tongshuan Capsules/Pills combined with Western medicine in treating cerebral infarction was higher than that of conventional Western medicine [ RR=1.20, 95% CI (1.13, 1.27), P<0.05]. At the same time, the effect of NIHSS score, Barthel score and FIB were better than those of conventional Western medicine [respectively: MD=-3.21, 95% CI (-4.45, -1.97), P<0.05; MD=11.83, 95% CI (10.66, 13.00), P<0.05; MD=-0.95, 95% CI (-1.36, -0.54), P<0.05]. After treatment with Xixian Tongshuan Capsules/Pills combined with Western medicine, the adverse reactions mainly included dizziness, nausea, indigestion, rash, facial blushing, etc. There was no statistically significant difference in safety between the two groups [ RR=1.50, 95% CI (0.75, 3.01), P>0.05]. Conclusions:Under the treatment of conventional Western medicine, the addition of Xixian Tongshuan Capsules/Pills can improve the clinical efficacy of cerebral infarction treatment, effectively improve the symptoms of neurological impairment, improve the ability of daily life, and promote the prognosis and recovery, and without increasing the incidence of adverse reactions. However, large sample and high quality studies are still needed to support the conclusion.
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Objective:To observe the clinical efficacy of Mahuang Fuzi Xixin Decoction combined with balanced acupuncture in the treatment of migraine with yang deficiency and cold congealing syndrome.Methods:Randomized controlled trial. Totally 91 cases of migraine with yang deficiency and cold congealing syndrome in our hospital from March 2021 to May 2022 were selected and divided into 45 cases in the Western medicine group and 46 cases in the integrated Chinese and Western medicine group according to random number table method. The Western medicine group took flunarizine hydrochloride capsules orally, and the integrated Chinese and Western medicine group combined ephedrine and aconiti asarum decoction + balanced acupuncture treatment on the basis of the Western medicine group. Both groups were treated for 1 month. Traditional Chinese Medicine syndrome score was performed before and after treatment, the degree of headache was assessed by VAS scale, and the impact of headache on life was assessed by Headache Impact Test-6 (HIT-6); the levels of 5-hydroxytryptamine (5-HT) and calcitonin gene related peptide (CGRP) were determined by radioimmunoassay. The adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 82.22% (37/45) in the Western medicine group and 95.65% (44/46) in the integrated Chinese and Western medicine group, with statistical significance ( χ2=4.20, P=0.041). After treatment, the scores of headache, hair, urine and cold limbs in the integrated Chinese and Western medicine group were lower than those in the Western medicine group ( t values were 18.49, 22.29, 21.31, 27.49, P<0.01), and the scores of VAS and HIT-6 were lower than those in the Western medicine group ( t values were 23.20, 9.33, P<0.01). After treatment, the level of 5-HT in the integrated Chinese and Western medicine group [(98.34±6.23) μg/L vs. (85.23±4.21) μg/L, t=11.74] was higher than that of the Western medicine group ( P<0.01); CGRP [(11.24±1.99) ng/L vs. (15.22±2.52) ng/L, t=8.37] was lower than that of the Western medicine group ( P<0.01). During treatment, the incidence of adverse reactions was 2.22% (1/45) in the Western medicine group and 2.17% (1/46) in the integrated Chinese and Western medicine group, without statistical significance ( P>0.05). Conclusion:Mahuang Fuzi Xixin Decoction combined with balanced acupuncture can effectively improve the clinical symptoms and life quality of patients of migraine with yang deficiency and cold congealing, and the clinical efficacy can be promoted.
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Objective:To explore the risk factors analysis and validation of anemia after triple-negative breast cancer (TNBC) and risk prediction model, to provide reference for reducing the incidence of anemia after TNBC-NAC.Methods:Retrospectively, 316 female TNBC-NAC patients in the breast department of our hospital from January 2016 to July 2021 were selected as the study subjects (modeling set), and the condition of anemia after the last chemotherapy was set as the observation group. In addition, 98 breast cancer patients in 2022 were selected for validation. Multivariate Logistic regression was used to analyze the effect of Fukangning capsule on TNBC-NAC anemia. We established the risk nomogram prediction model and calibration curve of anemia after chemotherapy by using R software and conducted internal and external verification. Hosmer-Lemeshow test was used to evaluate the prediction deviation between the risk prediction value of the nomogram model and the actual observed value, and the ROC curve was used to evaluate the prediction effect of the model.Results:A total of 75 (23.73%) among 316 patients developed anemia. The results of multivariate Logistic regression analysis showed that menopause [ OR (95% CI)=26.739 (5.063-141.227)], RBC [ OR (95% CI)=0.168 (0.098-0.286)], Hb level [ OR (95% CI)=0.952 (0.929-0.976)], and pathological stage Ⅲ[ OR (95% CI)=4.182 (1.759-9.946)] were independent risk factors for anemia after TNBC-NAC ( P<0.05). The nomogram prediction model established based on the above factors. Hosmer-Lemeshow test results showed that the difference between the risk prediction value and the actual observed value is ( χ2=3.68, P=0.885). The correction curve approaches to the ideal curve and the average absolute error was 0.012. The area under the ROC curve was 0.945, 95% CI was 0.918-0.972, sensitivity was 0.921 and specificity was 0.853, suggesting that the model has good differentiation and calibration degree. The external validation results showed that the nomogram predicted anemia with sensitivity of 88.7%, spectificity of 85.45% and accuracy of 86.73%. Conclusion:Menopausal status, RBC, Hb level before chemotherapy and pathological stage are independent risk factors for anemia after taking TNBC-NAC. The nomogram prediction model based on the above indicators had good discrimination and calibration, and accurately predicted the possibility of anemia after TNBC-NAC.
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Objective:To explore the mechanism of Shuerjing Capsule in treating primary dysmenorrhea based on molecular docking of network pharmacology and in vivo experiment.Methods:By using TCMSP to screen the active components and targets of Shuerjing Capsule; by using GeneCards and DrungBank databases to retrieve targeted proteins of primary dysmenorrhea, and the intersection targets of drugs and diseases were obtained through Weishengxin online platform; by using Cytoscape 3.9.1 software to produce component-target network of Shuerjing Capsule for the treatment of primary dysmenorrhea; by STRING databases to construct drug-disease target PPI network; by DAVID database to perform GO and KEGG pathway enrichment analysis.The key active components of the drug and the core targets of the disease were obtained with molecular docking. The rats were randomly divided into control group, model group, the low-dose group, medium-dose group and high-dose group of Shujing Capsule (0.15, 0.21, 0.42 g/kg), and ibuprofen group (20 mg/kg), with 10 rats in each group. The animal model of primary dysmenorrhea was established by subcutaneous injection of estradiol benzoate and intervented by drugs. The number of writhing reaction, uterine contractile inhibition rate and uterine index of rats were observed. The expressions of TNF-α, IL-6 and IL-1 in serum and the levels of PTGS2 and VEGFA in uterine tissue were detected by ELISA.Results:A total of 188 active ingredients of Shuerjing Capsule were screened, and 51 targets of Shuerjing Capsule and primary dysmenorrhea were identified. TNF, IL-6, AKT1 and TP53 may be the key targets of Shuerjing Capsule in the treatment of primary dysmenorrhea. A total of 519 GO biological processes and 119 related signaling pathways were obtained, among which estrogen, IL-17, HIF-1 and other signaling pathways were closely related to the treatment of primary dysmenorrhea. The results of molecular docking were good, among which stigmasterol had the strongest binding ability to TP53. The experimental results showed that compared with the model group, the uterine index and the number of torsion were decreased in the low -, medium - and high-dose Shuojing Capsule groups ( P<0.05), the uterine contraction inhibition rate increased ( P<0.05); Serum levels of TNF-α, IL-6 and IL-1 of medium and high dose group decreased ( P<0.05), the levels of PTGS2 and VEGFA in uterine tissues decreased ( P<0.05). Conclusion:Shuerjing Capsule has the effect of anti-inflammatation and improveing hypoxia, which may be related to the inhibition of TNF-α, IL-6 and IL-1 inflammatory factors in serum and the expression of PTGS2 and VEGFA proteins in uterine tissues.
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@#To investigate the pharmacodynamic effects and mechanism of Zhuling Jianpi capsule(Zhuling) on 2,4, 6-trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis in rats.The experimental colitis model was established by enema with 2.5% TNBS.The rats were randomly divided into normal group,model group,Changyanning (180 mg/kg) group and Zhuling low-dose (40 mg/kg) group and Zhuling high-dose (120 mg/kg) group.After modeling,the rats were executed after 7 days of drug treatment.During this period,the disease activity status of the rats was observed,and the body weights of the rats were recorded daily.At the end of the experiment,the colonic tissues were obtained for the analysis of the expression of hematoxylin-eosin(HE) staining.The myeloperoxidase (MPO) enzyme activity,mRNA expression levels of inducible nitric oxide synthase (iNOS) and inflammatory cytokines (IL-6, IL-1β, IFN-γ, IL-10) were determined, and the levels of intestinal tight junction proteins and serum inflammatory factor levels were measured.The results showed that compared with model group, the administration of Zhuling significantly alleviated the weight loss and elevated the disease activity index (DAI) caused by TNBS, relieved the shortening, edema and pathological damage of colonic tissue, reduced inflammatory cell infiltration, destruction of crypt and loss of goblet cells, decreased the MPO enzyme activity of colonic tissue, iNOS and pro-inflammatory cytokines in colon, increased the levels of colonic tight junction protein (occludin, ZO-1), and decreased serum levels of inflammatory factors (IL-6,IL-1β).The results suggest that Zhuling administration ameliorates TNBS-induced experimental colitis in rats by decreasing the level of inflammatory factors and increasing the expression of intestinal tight junction proteins.This experiment could provide a theoretical basis for the clinical application of Zhuling.
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Objective To evaluate the efficacy and safety of tacrolimus extended-release (Tac-ER) in the early stage after kidney transplantation. Methods Clinical data of 68 recipients undergoing kidney transplantation from 34 pairs of renal allografts were retrospectively analyzed. Two recipients who received bilateral kidneys from the same donor were treated with Tac-ER (Tac-ER group) and tacrolimus immediate-release (Tac-IR) (Tac-IR group) as one of the basic immunosuppressant. The changes of tacrolimus dosage and blood concentration, intra-patient variability (IPV), renal function, incidence of acute rejection, recipient and allograft survival rates and adverse events were statistically compared between two groups. Results The average daily dose of tacrolimus in the Tac-ER group was significantly higher than that in the Tac-IR group (F=8.386, P=0.005). In the Tac-ER group, the mean trough concentration at postoperative 4 d was (6.14±4.04) ng/mL, did not reach the target concentration, significantly lower than (9.41±5.47) ng/mL in the Tac-IR group (F=7.854, P=0.007). In the Tac-ER group, the IPV of trough concentration of tacrolimus within postoperative 1 month was significantly higher than that in the Tac-IR group (0.44±0.15 vs. 0.36±0.12, P=0.032). At postoperative 6 months, there was no significant difference in the renal function between two groups [serum creatinine level was (126±26) μmol/L vs. (120±28) μmol/L, and the estimated glomerular filtration rate was (56±13) mL/(min·1.73 m2) vs. (60±15) mL/(min·1.73 m2), both P > 0.05]. The allograft and recipient survival rates were 100% in both groups. The incidence of acute rejection within postoperative 1 month was 18% in the Tac-ER group and 3% in the Tac-IR group, with no significant difference (P > 0.05). The overall incidence of adverse events was 94% in the Tac-ER group and 97% in the Tac-IR group, with no significant difference (P > 0.05). Conclusions The efficacy and safety of Tac-ER are equivalent to those of Tac-IR, whereas a higher dose of Tac-ER should be orally given to reach the blood concentration similar to that of Tac-IR. During early-stage drug treatment, Tac-ER should be orally given before kidney transplantation or inittally with loading dose, aiming to increase the systemic exposure to tacrolimus early after kidney transplantation and prevent acute rejection caused by insufficient exposure.