Research Progress in the Effect of His-Purkinje Conduction System Pacing on Cardiac Function / 中山大学学报(医学科学版)

Cardiac pacing is an effective treatment for cardiac pacing and conduction dysfunction and severe heart failure. However， the conventional right ventricular pacing may increase the incidences of heart failure and atrial fibrillation， and biventricular pacing has a relatively high non-response rate. As a new technique of physiological pacing， a number of studies in recent years have been conducted to show the stability of pacing parameters and good cardiac synchronization of his-purkinje system pacing. This article reviews the current status of research and progress in the effects of his-purkinje conduction system pacing on cardiac function， so as to provide a theoretical basis for promoting the development of this technology.

Prepapillary vascular loops – A new classification

Background: Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral. Purpose: To discuss the new proposed classification of prepapillary capillary loops. Synopsis: Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction. Highlights: The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic

A Clinical and Anatomical Study on the Localization of the Temporal Branch of the Facial Nerve Crossing the Zygomatic Arch / Estudio Clínico y Anatómico sobre la Localización del Ramo Temporal del Nervio Facial que Cruza el Arco Cigomático

SUMMARY: To clarify the path of the temporal branch of facial nerve (TB) crossing the zygomatic arch (ZA). Eighteen fresh adult heads specimens were carefully dissected in the zygomatic region, with the location of TB as well as its number documented. The hierarchical relationship between the temporal branch and the soft tissue in this region was observed on 64 P45 plastinated slices. 1. TB crosses the ZA as type I (21.8 %), type II (50.0 %,), and type III (28.1 %) twigs. 2. At the level of the superior edge of the ZA, the average distance between the anterior trunk of TB and the anterior part of the auricle is 36.36±6.56 mm, for the posterior trunk is 25.59±5.29 mm. At the level of the inferior edge of the ZA, the average distance between the anterior trunk of TB and the anterior part of the auricle is 25.77±6.19 mm, for the posterior trunk is 19.16±4.71 mm. 3. The average length of ZA is 62.06±5.36 mm. TB crosses the inferior edge of the ZA at an average of 14.67±6.45 mm. TB crosses the superior edge of the ZA at an average of 9.08±4.54 mm. 4. At the level of the ZA, TB passes on the surface of the pericranium while below the SMAS. The TB obliquely crosses the middle 1/3 part of the superior margin of the ZA and the junction of the middle 1/3 part and the posterior 1/3 part of the inferior margin of the ZA below the SMAS while beyond the periosteum. It is suggested that this area should be avoided in clinical operation to avoid the injury of TB.

El objetivo de estudio fue esclarecer el trayecto del ramo temporal del nervio facial (RT) que cruza el arco cigomático (AC). Se disecaron la región cigomática de 18 especímenes de cabezas sin fijar de individuos adultas y se documentó la ubicación del RT y su número de ramos. La relación jerárquica entre el ramo temporal y el tejido blando en esta región se observó en 64 cortes plastinados o P45. 1º El RT cruza el AC como tipo I (21,8 %), tipo II (50,0 %) y tipo III (28,1 %). 2º A nivel del margen superior del AC, la distancia promedio entre el tronco anterior de RT y la parte anterior de la aurícula fue de 36,36±6,56 mm, para el tronco posterior fue de 25,59±5,29 mm. A nivel del margen inferior del AC, la distancia promedio entre el tronco anterior del RT y la parte anterior de la aurícula era de 25,77±6,19 mm, para el tronco posterior era de 19,16±4,71 mm. 3º La longitud media de RT fue de 62,06±5,36 mm. EL RT cruzaba el margen inferior del AC a una distancia media de 14,67±6,45 mm. El RT cruzaba el margen superior del AC a una distancia media de 9,08±4,54 mm. 4º Anivel del AC, el RT pasaba por la superficie del pericráneo mientras se encuentra por debajo del SMAS. El RT cruza oblicuamente el tercio medio del margen superior del AC y la unión del tercio medio y el tercio posterior del margen inferior del AC por debajo del SMAS, más allá del periostio. Se sugiere que esta área debe evitarse en la operación clínica para evitar la lesión de la RT.

Case of acute vision loss after injectable remdesivir with anticoagulants and overdose of antibiotics: A late report

A woman reported decreased vision in the right eye since hospitalization for COVID-19. Vision in the right eye was 6/18 and in the left eye was counting fingers. Her left eye had cataract and right eye was pseudophakic with earlier documented good recovery. In the right eye, she had branch retinal vein occlusion (BRVO) with macular edema documented on optical coherence tomography (OCT). It was suspected that it might be an ocular manifestation of COVID-19 which had not been reported and had worsened. An overdose of antibiotics or remdesivir might also be responsible for the same. She was advised anti-VEGF injections and was kept under treatment.

Análise estratégica da atuação do governo federal brasileiro na pandemia de COVID-19: 2020-2021 / Strategic analysis of the Brazilian federal government's performance in the COVID-19 pandemic: 2020-2021

Resumo O objetivo é analisar a atuação do governo federal (GF) na pandemia de COVID-19 e identificar as tensões e conflitos entre atores e instituições dos três poderes e do GF com governadores estaduais. A produção de dados incluiu revisão de artigos, publicações e documentos que analisam a pandemia e registram pronunciamentos, decisões, ações, debates e controvérsias entre esses atores no período 2020-2021. Os resultados contemplam a análise do estilo de ação do ator central e dos conflitos entre a Presidência, Ministério da Saúde, Anvisa, governos estaduais, Câmara, Senado e Supremo Tribunal Federal, buscando correlacioná-los com os projetos políticos para a saúde em disputa na atual conjuntura. Conclui-se que o ator central utilizou largamente uma ação comunicativa dirigida a seus apoiadores e uma ação estratégica caracterizada pela imposição, coação e confronto nas relações que manteve com outros atores institucionais, sobretudo quando estes divergiram da sua visão acerca do enfrentamento da crise sanitária, coerentemente com sua vinculação ao projeto político ultra neoliberal e autoritário do GF, que inclui o desmonte do SUS.

Abstract The study aim is to analyze the performance of the Brazilian federal government (FG) in the COVID-19 pandemic, seeking to identify tensions and conflicts between actors and institutions of the three branches of the government and the FG with state governors. Data production included a review of articles, publications and documents that analyze the pandemic evolution and record announcements, decisions, actions, debates and controversies between these actors in the period of 2020 to 2021. The results include the characterization of the action style of the central Actor and the analysis of conflicts between the Presidency, the Ministry of Health, ANVISA, state governments, the House of Representatives and the Senate and the Federal Supreme Court, seeking to correlate them with the debate around the political projects for health in dispute under the current circumstances. It is concluded that the central actor largely used a communicative action aimed at his supporters and strategic action characterized by imposition, coercion and confrontation in the relationships he maintained with other institutional actors, especially when they diverged from his viewpoints about how to face the health crisis, consistently with his connection to the ultra-neoliberal and authoritarian political project of the FG, which includes the deconstruction of the Brazilian Unified Health System.

Mejoría clínica, hemodinámica y de marcadores bioquímicos tras estimulación ventricular desde el área de la rama izquierda / Clinical, hemodynamic and biochemical improvement related to left bundle branch area pacing

Resumen Introducción: La estimulación ventricular derecha puede provocar insuficiencia cardiaca y disfunción ventricular. La estimulación en el área de la rama izquierda (ERI) permite capturar el sistema His-Purkinje. La ERI se ha estudiado en la estimulación ventricular y en la terapia de resincronización cardiaca. La evolución de los péptidos natriuréticos (NT-proBNP) asociada a la ERI no ha sido estudiada hasta el momento. Métodos: Se incluyeron pacientes consecutivos remitidos para implante de marcapasos o terapia de resincronización cardiaca. El implante del electrodo de ERI se realizó siguiendo la técnica descrita por Huang et al. Los pacientes eran sometidos a ecocardiograma y determinación de NT-proBNP antes y cuatro semanas después del procedimiento. Resultados: Se analizaron 50 pacientes con implante exitoso y seguimiento completo. No hubo diferencias significativas entre los umbrales medidos durante el procedimiento y los obtenidos al cabo de 12 semanas. La ERI logró una reducción significativa de la anchura del complejo QRS (148 ± 21 vs. 107 ± 11 ms; p = 0.029). La ERI logró una reducción significativa de la clasificación funcional en el conjunto de la muestra y una reducción significativa de NT-proBNP (2,888.2 ± 510 vs. 1,181 ± 130 pg/ml; p = 0.04). En pacientes con fracción de eyección del ventrículo izquierdo (FEVI) < 50% y asincronía se logró un incremento significativo de la FEVI con la ERI (40.2 ± 7 vs. 55.2 ± 7%; p < 0.001). Conclusiones: La ERI es factible en la mayoría de pacientes y se asocia con una reducción de la duración del complejo QRS. La ERI no condiciona un efecto deletéreo sobre la FEVI a corto-medio plazo; además, en aquellos pacientes con FEVI deprimida y asincronía ventricular permite incrementar la FEVI.

Abstract Background: Right ventricular pacing is associated with risk of heart failure and left ventricular dysfunction. Left bundle branch area pacing (LBBP) has emerged as an alternative method for delivering physiological pacing. The effect of LBBP on N-terminal pro-brain natriuretic peptide (NT-proBNP) has not been investigated. Method: Finally, 50 patients referred for pacemaker implantation were included. LBBP was performed as described previously by Huang et al. Transthoracic echocardiogram and NT-proBNP were performed before and four weeks after the procedure. Results: 50 patients were analyzed. There were not differences between ventricular thresholds during the procedure and 3 months later, LBBP significantly reduced QRS complex duration (148 ± 21 vs. 107 ± 11 ms; p = 0.029). LBBP significantly improved NYHA functional class and reduced NT-proBNP concentration (2888.2 ± 510 vs. 1181 ± 130 pg/ml; p = 0.04). In patients showing left ventricular ejection fraction (LVEF) < 50% and ventricular desynchrony LBBP showed a significant LVEF increase (40.2 ± 7 vs. 55.2 ± 7%; p < 0.001). Conclusions: LBBP was feasible and safe in most of patients. LBBP was associated with reduction in QRS width and with increase in LVEF in patients with ventricular desynchrony, while in patients with normal LVEF it remained unchanged during follow-up.

Fila única de leitos e a pandemia de COVID-19: atuação do Poder Legislativo Federal no ano de 2020 / Single waiting list for hospital beds during the COVID-19 pandemic: performance of the Federal Legislative Branch in 2020

Resumo A pesquisa investigou proposições legislativas sobre fila única de internações e leitos de UTI no âmbito do Poder Legislativo Federal no primeiro ano da pandemia. Tratou-se de estudo exploratório, qualitativo e de base documental que analisou projetos de leis sobre o tema. Os resultados foram organizados conforme o perfil dos autores e o conteúdo qualitativo dos projetos. Preponderaram parlamentares do sexo masculino, filiados a partidos de esquerda e com formação profissional em áreas que não a da saúde. A maioria das proposições tratou de fila única geral, especificando leitos hospitalares, gestão mista e indenização mediante tabela SUS. A Câmara dos Deputados apresentou mais projetos, porém pouco tem avançado em suas tramitações. Entre os projetos analisados, apenas um foi priorizado na Comissão Externa de Enfrentamento à COVID-19. Concluiu-se que o Poder Legislativo Federal perdeu, uma vez mais, oportunidade valiosa de legislar para o futuro e preparar o país com um arcabouço normativo capaz de enfrentar emergências sanitárias ainda desconhecidas, mas que exigirão muito dos gestores e do SUS.

Abstract This study investigated legislative proposals on the single waiting list for hospitalizations and ICU beds within the scope of the Federal Legislative Branch in the first year of the pandemic (2020). This was an exploratory, qualitative, and document- based study, which analyzed bills analyzed in the Brazilian National Congress on the subject. The results were organized according to the authors' profile and qualitative content of the bills. There was a predominance of male parliamentarians, affiliated with left-wing parties and professional training in areas other than health. Most bills dealt with a general single waiting list, specifying hospital beds, the mixed management of hospital beds, and indemnity through the Brazilian Unified Health System's (SUS, in Portuguese) price table. The House of Representatives presented more bills, but no progress was made in their processing. Among the analyzed bills, only one was prioritized in the External Commission to Combat COVID-19. It was concluded that the Federal Legislative Branch once again missed the chance to legislate for the future and prepare the country with a normative framework capable of confronting health emergencies, which will demand much from health managers and SUS itself.

Ramo comunicante entre los nervios mediano y ulnar en el antebrazo humano / Communicanting branch between median and ulnar nerves in the human forearm

El ramo comunicante mediano-ulnar (RCMU) es la conexión que se origina del nervio mediano (NM) o alguno de sus ramos, para unirse al nervio ulnar (NU) en el antebrazo humano. Cuando este RCMU está presente, determina una prevalencia que oscila entre un 8 % y un 32 %, de tal manera los axones del NM se trasladen al NU, modificando la inervación habitual de los músculos de la mano. Nuestro objetivo fue determinar la prevalencia, biometría, topografía y relaciones anatómicas del RCMU. Adicionalmente, se estableció la coexistencia de otras conexiones entre los NM y NU en el antebrazo y la mano. Se realizó un estudio descriptivo, cuantitativo, no experimental y transeccional. Disecamos 30 antebrazos humanos de individuos adultos, pertenecientes al programa de donación cadavérica de la Pontificia Universidad Católicade Chile. Las muestras estaban fijadas en formalina y a 4 °C. El RCMU se presentó en 5 casos (17 %). De estos ramos, tres surgieron del nervio interóseo anterior (NIA) (60 %) y dos (40 %) del ramo que el NM aporta a los músculos superficiales del compartimiento anterior del antebrazo. Estos se clasificaron de acuerdo a la literatura, así el tipo Ic se presentó en tres casos (60 %), y el tipo Ia en dos (40 %). La longitud promedio del RCMU fue de 53,9 mm. El origen del RCMU se ubicó en el tercio proximal y la conexión de este con el NU se estableció en el tercio medio del antebrazo. En tres casos (60 %) se observó la coexistencia del RCMU y una conexión entre los ramos digitales palmares comunes. Estos hallazgos confirman que el RCMU mayoritariamente se extiende entre el nervio interóseo anterior y el NU, y su presencia podría modificar la distribución nerviosa de la mano.

SUMMARY: The median-ulnar communicating branch (MUCB) is the communication that originates from the median nerve (MN) or one of its branches, to join the ulnar nerve (UN) in the human forearm. With a prevalence that oscillates between 8% and 32%, when this MUCB is present, it establishes that axons from the MN move to the UN, modifying the normal innervation of the muscles of the hand. Our aim was to determine the prevalence, biometry and topography and anatomical relationships of the MUCB. Additionally, the coexistence of this MUCB with other connections between the MN and UN was established. A descriptive, quantitative, non experimental and transectional study was conducted. Thirty adult human forearms belonging to the cadaveric donation program of the Pontificia Universidad Católica de Chile were dissected. The samples were fixed in formalin and stored at 4 °C. The MUCB appeared in 5 cases (17%). Of these, three originated from the anterior interosseous nerve (60%) and two (40%) arose from the branch that the MN gives it to the superficial muscles of the anterior compartment of the forearm. These were classified according to the literature consulted, obtaining that Group Ic occurred in three cases (60%), and Group Ia in two (40%). The average MUCB length was 53.9 mm. The origin of the MUCB was on average 21% of the length of the forearm from the biepicondylar line. The connection of this MUCB with the UN was located on average at 44% from this line. In three cases (60%) the coexistence of the MUCB and a connection between the common palmar digital nerves was observed. These findings confirm that the RCMU is generally established between the anterior interosseous nerve of forearm and NU, and its presence could modify the nerve distribution of the hand.

Evaluation of the predictive effect of parafoveal blood flow density of macula on the number of intravitreal Conbercept injections in patients with branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate blood flow density within 300μm(FD-300)around the foveal avascular zone(FAZ)in optical coherence tomography angiography(OCTA)of patients with macular edema(ME)complicated with non-ischemic branch retinal vein occlusion(BRVO), and to explore and evaluate the predictive effect of this parameter on the number of intraocular drug injections.METHODS: A retrospective case study. A total of 50 patients(50 eyes)who were diagnosed as non-ischemic BRVO combined with ME and received intravitreal conbercept(IVC)in the Affiliated Eye Hospital of Nanjing Medical University from January 2021 to March 2022 were selected, and they were treated with 3+PRN regimen. The 25 cases(25 eyes)treated with intraocular injection ≤5 times were classified as group B, and 25 cases(25 eyes)treated with intraocular injection &#x003E;5 times were classified as group C, and 25 fellow eyes were randomly selected as control group A. OCTA was used to scan the macular area in 3mm×3mm to collect images of retinal blood flow, the central macular thickness(CMT)and FD-300. The CMT, best-corrected visual acuity(BCVA), and FD-300 were compared between the two groups at baseline, 1, 3, 6 and 12mo after the third injection.RESULTS: The BCVA(LogMAR)of the affected eye in both groups B and C at 1, 3, 6 and 12mo after the third injection was significantly lower than baseline(all P&#x003C;0.05); the CMT and FD-300 were significantly lower than baseline(all P&#x003C;0.05). Pearson correlation analysis showed that the change of BCVA(LogMAR)was positively correlated with the baseline FD-300 and CMT(group B: r=0.77, 0.70, all P&#x003C;0.01; group C: r=0.89, 0.78, all P&#x003C;0.01). The number of intraocular injections was negatively correlated with the baseline FD-300(group B: r=-0.63, P&#x003C;0.01; group C: r=-0.71, P&#x003C;0.01). Logistic regression analysis showed that the FD-300 at baseline is a factor that affects the number of intraocular drug injection.CONCLUSION: IVC can effectively alleviate macular edema of the affected eye,improve visual acuity and reduce FD-300. The eyes with worse BCVA and lower FD-300 at baseline may require more injections of anti-VEGF. Observation of FD-300 with OCTA can better predict eventual vision recovery of non-ischemic BRVO with ME before treatment.

Micropulse laser combined with intravitreal injection of Ranibizumab in the treatment of macular edema secondary to non-ischemic branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of micropulse laser combined with intravitreal injection of ranibizumab in the treatment of macular edema(ME)secondary to non-ischemic branch retinal vein occlusion(BRVO).METHODS: A total of 200 cases(200 eyes)of non-ischemic BRVO secondary to ME who were treated in our hospital from January 2020 to March 2022 were selected and divided into the control group(100 cases, 100 eyes)and the observation group(100 cases, 100 eyes)by random number table. The control group was given intravitreal injection of ranibizumab, and the observation group was given micropulse laser combined with intravitreal injection of ranibizumab. The best corrected visual acuity(BCVA), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), total number of injections, macular leakage and complications were compared between two groups.RESULTS: After treatment, the BCVA of the two groups were improved, and the BCVA of the observation group was better than those in the control group at 1, 3, 6 and 12mo after treatment(all P&#x0026;#x003C;0.05). After treatment, the CMT and SFCT of the two groups decreased, and the CMT and SFCT of the observation group was lower than those in the control group at 1, 3, 6 and 12mo after treatment(all P&#x0026;#x003C;0.05). The total number of injections in the observation group during the treatment period was less than that in the control group [(4.06±1.12)times vs.(5.32±1.15)times](t=5.852, P&#x0026;#x003C;0.001). The leakage rates of the control group and the observation group after 12mo of treatment were 69.0% and 27.0% respectively, with statistical significance between the two groups(χ2=35.337, P&#x0026;#x003C;0.001). The incidence of complications in the control group and observation group were 11.0% and 5.0% respectively, with no statistical significance between the two groups(χ2=2.446, P=0.118).CONCLUSION: Micropulse laser combined with intravitreal injection of ranibizumab has a significant clinical efficacy in the treatment of ME secondary to non-ischemic BRVO, which is safe and can improve patients' vision and ME, reduce the total doses of ranibizumab without increasing the incidence of complications.

Practical research on the construction of assessment index system for the Party branch in public hospitals: taking West China Hospital, Sichuan University as an example / 中华医院管理杂志

The assessment of the Party branch is conducive to improving the quality of Party building, giving full play of the role of Party branch, and better realizing the two-way integration of Party building and health care, to promote the high-quality development of public hospitals. Oriented by problems, West China Hospital, Sichuan University comprehensively adopted a series of methods, such as literature research, Delphi method and in-depth interview and so on, to construct the index system of the Party branch assessment and explored an effective operation mechanism. As a result, the basic management was consolidated, the normalization and standardization of Party branch work was advanced, and the roles of Party branch became more prominent, which is expected to provide decision-making and work references for health authorities and national counterparts.

Establishment and validation of nomogram model for visual prognosis of macular edema secondary to retinal branch vein occlusion treated with ranibizumab / 中华眼底病杂志

Objective:To explore the influencing factors of visual prognosis of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after treatment with ranibizumab, and construct and verify the nomogram model.Methods:A retrospective study. A total of 130 patients with BRVO-ME diagnosed by ophthalmology examination in the Department of Ophthalmology, Liuzhou Red Cross Hospital from January 2019 to December 2021 were selected in this study. All patients received intravitreal injection of ranibizumab. According to the random number table method, the patients were divided into the training set and the test set with a ratio of 3:1, which were 98 patients (98 eyes) and 32 patients (32 eyes), respectively. According to the difference of logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) at 6 months after treatment and logMAR BCVA before treatment, 98 patients (98 eyes) in the training set were divided into good prognosis group (difference ≤-0.3) and poor prognosis group (difference >-0.3), which were 58 patients (58 eyes) and 40 patients (40 eyes), respectively. The clinical data of patients in the two groups were analyzed, univariate and multivariate logistic regression analysis were carried out for the different indicators, and the visualization regression analysis results were obtained by using R software. The consistency index (C-index), convolutional neural network (CNN), calibration curve and receiver operating characteristic (ROC) curve were used to verify the accuracy of the nomogram model.Results:Univariate analysis showed that age, disease course, outer membrane (ELM) integrity, elliptical zone (EZ) integrity, BCVA, center macular thickness (CMT), outer hyperreflective retinal foci (HRF), inner retina HRF, and the blood flow density of retinal deep capillary plexus (DCP) were risk factors affecting the visual prognosis after treatment with ranibizumab in BRVO-ME patients ( P<0.05). Multivariate logistic regression analysis showed that course of disease, ELM integrity, BCVA and outer HRF were independent risk factors for visual prognosis after ranibizumab treatment for BRVO-ME patients ( P<0.05). The ROC area under the curve of the training set and the test set were 0.846[95% confidence interval ( CI) 0.789-0.887) and 0.852 (95% CI 0.794 -0.873)], respectively; C-index were 0.836 (95% CI 0.793-0.865) and 0.845 (95% CI 0.780-0.872), respectively. CNN showed that the error rate gradually stabilized after 300 cycles, with good model accuracy and strong prediction ability. Conclusions:Course of disease, ELM integrity, BCVA and outer HRF were independent risk factors of visual prognosis after ranibizumab treatment in BRVO-ME patients. The nomogram model based on risk factors has good differentiation and accuracy.

Preliminary results of anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion in Lhasa Tibet / 中华眼底病杂志

Objective:To observe and evaluate the safety and efficacy of anti-vascular endothelial growth factor (VEGF) in the treatment of eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in Lhasa, Tibet.Methods:A retrospective case series. From September 2018 to January 2022, a total of 41 patients (41 eyes) with BRVO-ME, who were diagnosed in Department of Ophthalmology of Tibet Autonomous Region People’s Hospital, were included in this study. There were 21 eyes in 21 males and 20 eyes in 20 females. The median age was 53 (31,75) years. There were 24 patients with hypertension (58.8%, 24/41). Best corrected visual acuity (BCVA), ocular pressure, fundus color photography and optical coherence tomography (OCT) were performed in all eyes. The BCVA was performed using the international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The foveal macular thickness (CMT) was measured by OCT. All eyes were treated with intravitreous injection of anti-VEGF drugs, once a month, among which 23 eyes (56.1%, 23/41) received intravitreous injection of ranibizumab (IVR), and 18 eyes (43.9%, 18/41) received intravitreous injection of conbercept (IVC), and were grouped accordingly. There was no significant difference in age ( Z=-0.447), gender composition ( Z=-0.485), logMAR BCVA ( t=-1.591), intraocular pressure ( t=-0.167) and CMT ( t=-1.290) between two groups ( P>0.05). During the follow-up, the same devices and methods were used at baseline to perform relevant examinations, and the changes of BCVA, intraocular pressure, CMT and new cardiovascular and cerebrovascular events were compared between baseline and the last follow-up. logMAR BCVA, intraocular pressure and CMT were compared between baseline and last follow-up using Student t test. The comparison of injection times and follow-up time between IVR group and IVC group was conducted by Mann-Whitney U test. Results:At baseline, logMAR BCVA, intraocular pressure, and CMT were 0.852±0.431, (12.5±2.5) mm Hg (1 mm Hg= 0.133 kPa), and (578.1±191.1) μm, respectively. At the last follow-up, the number of anti-VEGF drug treatments was (2.7±1.2) times; logMAR BCVA and CMT were 0.488±0.366 and (207.4±108.7) μm, respectively, with CMT > 250 μm in 14 eyes (34.1%, 14/41). Compared with baseline, BCVA ( t=4.129) and CMT ( t=-0.713) were significantly improved, with statistical significance ( P<0.001). The injection times of IVR group and IVC group were (2.6±0.9) and (3.0±1.5) times, respectively. There were no significant differences in the number of injection times ( t=-1.275), logMAR BCVA ( t=-0.492), intraocular pressure ( t=0.351) and CMT ( t=-1.783) between the two groups ( P>0.05). No new hypertension, cardiovascular and cerebrovascular events occurred in all patients during follow-up. At the last follow-up, there were no eye complications related to treatment modalities and drugs. Conclusion:Short-term anti-VEGF treatment can improve the visual acuity of BRVO secondary ME patients and alleviate ME in Lhasa, Tibet. The safety and efficacy of ranibizumab and conbercept were similar.

Make full use of the new imaging technology to further explore the key problems of retinal branch vein occlusion / 中华眼底病杂志

With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.

Applied anatomy of recurrent branch of median nerve and microsurgical treatment of its compression syndrome / 中华显微外科杂志

Objective:To observe the anatomy of the recurrent branch of median nerve, summarize the injury mechanism of the recurrent branch of median nerve, and explore the surgical method and clinical effect of the compression.Methods:From February 2018 to October 2021, 12 fresh hand specimens were used in Department of Hand Surgery in the Second Hospital of Tangshan, including 6 male specimens, 3 left and 3 right hands, and 6 female specimens, 3 left and 3 right hands. Anatomy of the recurrent branch of median nerve and observation of its location, measurement of the length of each muscle branch innervating thenar muscle and the easy-to-jam position of the recurrent branch of median nerve in the course of running. The measurement results uses nonparametric test of statistical analysis by side and gender. P<0.05 was considered statistically significant. From January 2020 to January 2022, 21 patients with entrapment of the recurrent median nerve of wrist were treated, 14 males and 7 females. The age ranged from 31 to 65 years old, with an average of 46.2 years old. All patients developed thenar muscular atrophy. Before operation, the recurrent branch of median nerve was marked into the muscle point, and the thenar projection on palm surface was pressed, which caused fatigue and soreness. Electromyography examination: the motor latency of median nerve endings was more than 4.5 ms, and both fibrillation potential and positive potential appeared. The motor conduction velocity of all patients was less than 30 m/s, and the motor nerve amplitude was less than 10 mV. Surgical exploration of the recurrent branch of median nerve revealed that the trunk of the recurrent branch of median nerve made the tendon arch thickened at the starting point of the superficial head of flexor pollicis brevis, and there was compression between the deep layer of the palmar aponeurosis and the thenar musculocutaneous membrane, which was completely released during the operation to relieve the compression factor. All 21 patients had followed-up in outpatient. Results:Distance from the origin of the recurrent branch of median nerve to the distal edge of transverse carpal ligament. The distance from the origin of the recurrent branch of median nerve to the distal edge of transverse carpal ligament were (0.30, 0.31, 0.32) cm and (0.31, 0.32, 0.32) cm in male left and right groups, respectively, with no statistical significance ( Z=-0.943, P=0.346); The female left and right groups were (0.28, 0.28, 0.28) cm and (0.29, 0.30, 0.30) cm, respectively, and the difference was statistically significant ( Z=-2.121, P=0.034). The length and transverse diameter of the trunk of the recurrent branch of the median nerve, the length of the superficial head branch of flexor pollicis brevis and the length of the palmar muscle branch of the thumb had no significant difference between the left and right sides of males and females( P > 0.05). The length of abductor pollicis brevis muscle branch: the male left and right groups were (1.45, 1.27, 1.31) cm and (1.54, 1.38, 1.47) cm, respectively, and there was no statistical difference ( Z=-1.528, P = 0.127); The female left and right groups were (1.21, 1.18, 1.15) cm and (1.25, 1.24, 1.25) cm respectively, and the difference was statistically significant ( Z=-1.993, P=0.046). All the 21 patients were entered in follow-up for 9-24 (average 15) months. After operation, the wounds of all patients healed in the first stage, the soreness at thenar disappeared, and the thenar muscle was full in appearance. In 21 patients, the thumb abduction function returned to normal, the thumb to palm opposition returned to normal in 19 cases, and was slightly limited in 2 cases. After operation, thenar muscle strength recovered to grade 5 in 19 cases and grade 4 in 2 cases. At the last follow-up, electromyography showed that the motor latency of median nerve endings was less than 4.5 ms, and the motor conduction velocity was greater than 40 m/s; Motor nerve amplitudes were all greater than 10 mV. According to the functional evaluation standard of carpal tunnel syndrome recommended by Gu Yudong, 19 cases were excellent, 2 cases were good, and the excellent and good rate was 100%. Conclusion:The length of each nerve branch of the recurrent median nerve innervates thenar muscle is different, and there are many factors that cause the recurrent median nerve to get stuck. It is of high clinical value to master the anatomical structure of the recurrent median nerve and the mechanism of the entrapment, and to completely loosen vulnerable parts by surgery.

Comparison of two types of flaps based on dorsal cutaneous branch of proper palmar digital artery for repair of wound of fingertip or finger-pulp / 中华显微外科杂志

Objective:To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods:From April 2018 to May 2021, a total of 55 patients (55 fingers) with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery, the Second Hospital of Tangshan. The patients were randomly divided into 2 groups by the method of drawing lots. The wounds of 29 patients (29 fingers) were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery (propeller group) and that of 26 patients(26 fingers) were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group). Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups. The operation and follow-up time in both groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At final follow-up, the static TPD of the flaps, patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM) of the injured fingers were recorded. The measurement and count data of both groups were compared by independent sample t-test, χ2 tests or Fisher's exact test, respectively. P<0.05 was considered a statistically significant. Results:All the flaps and skin grafts survived primarily in both groups. The operation time in propeller group was 57.55 minutes±4.35 minutes. It was less than what in the vascular chain group (61.12 minutes±4.58 minutes) and with statistically significant difference( P<0.05). The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group. There was no significant difference between the 2 groups( P>0.05). At final follow-up, the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59±0.50, which were better than 7.46 mm±1.27 mm and 4.31±0.47 in the vascular chain group with a statistically significant difference( P<0.05). The patient satisfaction with the appearance of donor sites and ROM of the injured digital joints in propeller group were 4.45±0.57 and 190.86°±8.56°, while what in the vascular chain group were 4.35±0.56 and 185.96°±10.58°. There was no significant difference between the 2 groups( P>0.05). Conclusion:The propeller flap and vascular chain flap are both based on dorsal cutaneous branch of proper palmar digital artery and are both suitable for repair of wounds of fingertip or finger-pulp. Compared with the vascular chain flap, the propeller flap has the advantages in shorter operation time, better flap sensation and appearance.

Comparison between free wrist crease flap pedicled with superficial palmar branch of radial artery and traditional free toe flap in reconstruction of hand soft tissue defects: A study on clinical efficacy / 中华显微外科杂志

Objective:To compare the difference in clinical efficacy between a free wrist crease flap pedicled with superficial palmar branch of the radial artery flap (SPBRAF) and a traditional free toe flap (TFTF) in reconstruction of hand soft tissue defects, and to provide reference for the treatment of small-to medium-sized hand soft tissue defects.Methods:Data of 37 patients who received hand surgery in Department of Hand Surgery, No.971 Hospital of the PLA Navy from December 2016 to December 2019 for small-to medium-sized hand soft tissue defects were retrospectively studied. Among the 37 patients, there were 32 males and 5 females, aged between 18 and 65 years old, with 41.5 years old in average. According to the reconstructive surgical procedure, patients were divided into SPBRAF group (22 cases) and TFTF group (15 cases). Regular follow-ups were conducted after surgery. The difference in curative effect at the last follow-up between the 2 groups was evaluated by the comparison of data acquired in follow-up. SPSS 25.0 was used to analyse the data statistically. The evaluation indicators included flap survival, long-term recovery of flap, recovery effect at donor site, total active movement(TAM) of the affected digit, time of hospital stay and the time return to work. P<0.05 was considered a statistically significant. Results:All free flaps survived. All patients were entered 6-18 (mean, 10) months of postoperative follow-up to comprehensively evaluate the therapeutic effect. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, in the SPBRAF group, 20 flaps were found in excellent, and 2 in good; in the TFTF group, 14 flaps were found in excellent, 1 in good. There was no statistical difference between the 2 groups( P>0.05). The colour, texture and thickness of flaps between the 2 groups were either in excellent or good. There was no statistical difference between the 2 groups( P>0.05). TPD in the TFTF group (5-6 mm) was better than that in SPBRAF group (6-7 mm) with statistical difference between the 2 groups ( P<0.05). Texture at donor sites between the 2 groups was either in excellent or good ( P>0.05). In terms of appearance, sensation and recovery time of donor site, it was found that the SPBRAF group(mean, 6 weeks) was significantly better than those in the TFTF group(mean, 8 weeks) and there was statistical difference between the 2 groups ( P<0.05). In terms of recovery of TAM in single-digit, excellent or good were shown in both groups and there was no statistical difference between the 2 groups ( P>0.05). In terms of hospitalisation and time for return to work, the SPBRAF group(mean, 8 days and 17 weeks) was significantly better than that of TFTF group(mean, 12 days and 24 weeks), and there was statistical difference between the 2 groups ( P<0.05). Conclusion:SPBRAF has an ideal effect on reconstruction of small-to medium-sized hand soft tissue defects in hand. Although the flap is still inferior in sensation and appearance compared with the TFTF, the advantages in terms of donor site recovery, patient satisfaction of the donor site and reduced time of hospitalisation and return to original work are more obvious. SPBRAF provides a good complement to surgical procedures reconstructing a digit defect.

Changes of ventricular septal myocardial injury current in left bundle branch area pacing / 中国综合临床

Objective:Explore the characteristics of injury current changes in ventricular septal myocardium during left bundle branch area pacing (LBBAP) surgery.Methods:Retrospective analysis of clinical data of patients who underwent permanent pacemaker implantation at The Second People's Hospital of Wuxi in Jiangsu Province from January 2020 to November 2022. Among them, 42 patients were treated with LBBAP (LBBAP group) and 56 patients with Right ventricle septum pacing (RVSP group). Compare the conventional parameters such as threshold, perception, impedance during electrode implantation, damage current values at 0, 5, and 10 minutes before and after electrode rotation, and the correlation between damage current and conventional parameters. The measurement data is represented by xˉ± s, analysis of variance is used for comparison between multiple groups, t-test is used for comparison between two groups, and repeated measurement analysis of variance is used for comparison between two groups at multiple time points; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection; Pearson correlation analysis was used to analyze the correlation between the two variables. Results:There was no statistically significant difference in pacing threshold, perception, and impedance between the two groups of electrode implantation surgery (all P>0.05). The damage current values at 0, 5, and 10 minutes before and after electrode rotation in the LBBAP group were higher than those in the RVSP group [(7.19±1.26) mV compared to (5.33±0.79) mV, (22.50±3.06) mV compared to (10.85±1.70) mV, (15.75±2.63) mV compared to (8.01±1.09) mV, (9.24±2.00) mV compared to (5.51±0.98) mV]. The damage current values at 0 minutes after electrode rotation in both groups were higher than before electrode rotation, and gradually decreased thereafter, After 10 minutes of electrode placement, the damage current value of the LBBAP group was still higher than the level before electrode rotation (all P<0.05), while there was no statistically significant difference between the RVSP group and the level before electrode rotation ( P>0.05). The damage current value at 0 minutes after the LBBAP group electrode was in place was positively correlated with ventricular septal thickness and left ventricular posterior wall thickness ( r values 0.45 and 0.46, P values 0.003 and 0.002, respectively), and negatively correlated with conventional pacing parameter impedance ( r=-0.32, P=0.037). There was no correlation with threshold and perception ( r values 0.08 and 0.01, P values 0.604 and 0.968, respectively). The damage current value at 0 minutes after the RVSP group electrode was in place was negatively correlated with the threshold ( r=-0.28, P=0.036). Conclusions:The COI value of LBBAP interventricular septum myocardium increased significantly after the electrode was rotated out. The COI value at 0 min after the electrode put in place was positively correlated with the interventricular septum thickness and left ventricular posterior wall thickness, and negatively correlated with the electrode impedance, but there was no correlation with threshold and perception.

Treatment of Hepatic Osteodystrophy by Stages based on Root Deficiency and Branch Excess / 中医杂志

Hepatic osteodystrophy （HO） should be treated by stages based on the differentiation of root deficiency and branch excess. The root cause of HO is the insufficiency of the liver， spleen， and kidney， and the branch onset should be differentiated by stages that in the incubation， the pathogenesis is shaoyang （少阳） constraint and block and cardinal disturbance， while in the attack period， it is turbid toxin， static heat， scorching marrow and withering bones. In treatment， attention should be paid to regulating and tonifying the depletion of the liver， spleen， and kidney to cultivate the foundation. In the incubation period， it is suggested to put focus on unblocking cardinal disturbance of shaoyang liver and gallbladder so as to regulate and harmonize qi and blood. In the attack period， the focus should be on dissolving stasis， removing turbidity， and clearing the source to promote gallbladder function and bone strength. In clinical practice， medication should be modified according to individual symptoms， and the root and the branch， the primary and the secondary should be differentiated to closely follow the pathogenesis and be tailored according to the symptoms. At the same time， reasonable and safe medication should be emphasized to protect liver function.

Surgical technique and effectiveness of titanium elastic nail assisted retrograde channel screw implantation in superior pubic branch / 中国修复重建外科杂志

OBJECTIVE@#To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch.@*METHODS@#The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D'Aubigne Postel score system at last follow-up.@*RESULTS@#Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group ( P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant ( P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups ( P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups ( P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D'Aubigne Postel scoring system between the two groups was not significant ( P>0.05).@*CONCLUSION@#TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.