Non-arteritic anterior ischemic optic neuropathy (NAION) is one of the most common acute optic neuropathy in adult characterized with impaired visual acuity and visual fields. The pathogenesis of NAION mostly result from the interactions between the systemic risk factors (such as diabetes mellitus, night hypotension, hereditary) and the local ocular risk factors (such as small optic disc and vitreo-papillary traction). A fully promoted diagnosis and treatment of NAION are based on the higher levels of clinical evidence, as well as the comprehensive assessment of relationship between the systemic and ocular risk factors in the pathogenesis of NAION. Secondary optic neuropathy of NAION and the early diagnosis with effective treatment of the fellow eye would be highly emphasized.
ObjectiveTo observe the clinical profile and risk factors of non-arteritic anterior ischemic optic neuropathy (NAION). MethodsProspective study was conducted to consecutively recruit 73 patients with NAION from October 2013 through September 2015. A detailed history of previous systemic diseases, smoking and drinking was collected, and a comprehensive ophthalmic evaluation was performed. The prevalence of associated risk factors in NAION patients were compared to the 146 age-and gender-matched normal subjects, and assessed in logistic regression model. ResultsOf the 73 patients, 65.75% were males, 34.25% were females. The mean age was (55.18±9.89) years. 21.92% were bilateral and 78.08% were unilateral. Arcuate visual field defect (31.58%) was the most prevalent defect detected in unilateral NAION, and there were 8.93% fellow eyes with abnormal optic disc formation in incipient stage. Concentric visual field contraction (40.63%) was the most common in bilateral NAION. Obesity (OR=8.09, 95% CI: 2.94-22.23, P < 0.001) and diabetes (OR=4.72, 95% CI: 1.57-14.25, P=0.006) were significantly associated with NAION. While smoking was marginally associated with NAION (OR=2.76, 95% CI: 1.02-7.53, P=0.047). ConclusionsThe gender predisposition should be reconsidered in NAION. We should pay attention to the fellow eye in case of the incipient NAION patients. Diabetes and obesity are associated with NAION.
Objective To establish and evaluate a rat model of nonarteritic anterior ischemic optic neuropathy (NAION). Methods The rats were randomly divided into control group (n=13), sham laser group (n=11) and NAION group (n=23). The right eye was set as the experimental eye. NAION model was induced by directly illuminating the optic nerve (ON) of the right eye with 532 nm green laser, after intravenous infusion with the photosensitizing agent Rose Bengal. Sham laser treatment consisted of illuminating the ON region with 532 nm laser without Rose Bengal injection. Rats in control group underwent no intervention. The appearance of optic disc was observed with funduscope at 12 hours, 1, 3, 7, 28 days post-illumination. The histologic changes in the retina and ON of the NAION model were evaluated qualitatively with hematoxylin and eosin (HE) staining and transmission electron microscopy. The retrograde-labeled retinal ganglion cells (RGC) were counted on photographs taken from retinal flat mounts in a masked fashion. Results The optic disc in NAION eyes were swollen 3 days after photodynamic treatment. HE-stained longitudinal ON sections of NAION revealed vacuolar degeneration on day 3 after induction. Besides, ultrastructural study showed axonal edema and collapsed sheaths in the ischemic optic nerve at the same time point after modeling. ON edema resolved 7 days after induction. The final results revealed optic disc atrophy, extensive axonal loss, severe glial scar, and RGC death in large numbers 4 weeks after modeling. There were no aforementioned manifestations in control and sham laser group. The RGC density of the right eyes was statistically significantly lower in NAION group than that in control group and in sham laser group (t=−14.142, −14.088; P=0.000, 0.000). The survival rate of RGC was statistically significantly lower in NAION group than in control group and in sham laser group (t=−17.048, −16.667; P=0.000, 0.000). There was no difference of RGC density and survival rate of RGC between control and sham laser group (t=0.050, 0.348; P=0.961, 0.731). Conclusion A rat model of NAION was established successfully by photodynamic treatments with Rose Bengal, which induce optic nerve damage and RGC death.
Noninfectious uveitic macular edema (NIU-ME) is a major cause of visual impairment in patients with uveitis. Intravitreal route can control inflammation rapidly, reduce macular edema, and improve vision with relatively lower doses of the drug. Currently, several intravitreal injection drugs have been used for the treatment of NIU-ME. Cataract and elevated intraocular pressure are the major complications. Due to its efficacy and safety, intravitreal drugs have gradually become an effective alternative to systemic treatment, especially in patients with unilateral disease. However, more studies are needed on drug selection, timing of injection and combination therapy in clinical practice. There are various treatments for NIU-ME, and the ultimate treatment should be individualized based on the severity of the disease, the risk/benefit ratio of each therapy, and the patient's tolerance.
ObjectiveTo summarize the diagnosis and treatment progress of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) in recent years, in order to provide a reference for clinical diagnosis and treatment decision-making. MethodThe recent literature related to the diagnosis and treatment of cHCC-CCA was reviewed. ResultsThere was no specific guideline or consensus on the diagnosis and management of cHCC-CCA. The diagnosis of the cHCC-CCA was challenging by imaging alone, and the tumor markers such as alpha fetoprotein and carbohydrate antigen 19-9 were of particular value in clinical diagnosis, but it was ultimately relied on the pathological examination results. For the patients with early cHCC-CCA, the radical surgery was recommended to undergo if possible, but there was some controversy regarding the efficacy of liver transplantation and the mode of recurrence and metastasis. For the patients with advanced cHCC-CCA, the systemic therapy was being explored further, and some retrospective analyses of small samples suggested that the gemcitabine and platinum-containing chemotherapy regimens might be beneficial. With the better success of immunotherapy and targeted therapies in hepatocellular carcinoma and cholangiocarcinoma, it might provide some experiences for treatment selection of cHCC-CCA. ConclusionscHCC-CCA has a lower incidence rate and stronger heterogeneity. Its diagnosis mainly relies on surgical pathology, and treatment strategy is lack of high-level evidence-based medical evidence and rigorously designed clinical studies are still needed to explore its efficacy and safety in the future.
Acute kidney injury (AKI) is a systemic inflammatory disease with limited treatment options. Irisin is a novel actin protein produced by skeletal muscle movement and exerts anti-inflammatory, anti-apoptotic, and antioxidant effects by participating in multiple signaling pathways. In recent years, the protective effect of irisin on AKI has attracted much attention, and its regulatory mechanism involves a complex network of signaling pathways, which can reduce oxidative stress, inhibit apoptosis, inhibit inflammation, and inhibit ferroptosis under pathological conditions. This pathway alleviates kidney injury by enhancing the metabolic reprogramming of tubular cells while attenuating fibrosis. Irisin is expected to be a new treatment option for AKI.
目的 调查极重灾区某中学学生的创伤后应激障碍（PTSD）症状检出率及影响因素，为进一步开展灾后心理卫生服务提供依据。 方法 2008年9月下旬，对汶川地震的极重灾区都江堰某镇中学1 500名同学进行调查，获有效问卷1 498份。采用一般情况调查问卷、儿童事件影响量表（CRIES-13）中文版进行集体施测。 结果 某镇中学学生灾后4个月PTSD症状检出率29.71%（445/1 498）。经非条件逐步logistic回归筛选PTSD症状的影响因素有：地震时是否受伤（OR=1.995，P=0.000）、性别（OR=1.785，P=0.000）、绝望感（OR=1.597，P=0.000）、是否目睹死亡（OR=1.344，P=0.000）、年龄（OR=1.308，P=0.000）、是否目睹受伤（OR=1.262，P=0.000）、地震时是否被困（OR=1.209，P=0.011）、震后居住地点（OR=1.182，P=0.000）、是否目睹垮塌（OR=1.176，P=0.000）、家人情况（OR=1.104，P=0.000）、地震后是否住院（OR=0.828，P=0.041）12个因素。 结论 在灾后重建过程中，该中学的学生PTSD症状检出率较高，其与地震时是否受伤、性别、绝望感、是否目睹死亡、年龄、是否目睹受伤、地震时是否被困、震后居住地点、是否目睹垮塌、家人情况、地震后是否住院呈显著相关。