BACKGROUND: Inflammation plays a critical role in severe cerebral venous thrombosis (CVT) pathogenesis, but the benefits of anti-inflammatory therapies remain unclear. This study aimed to investigate the association between steroid therapy combined with anticoagulation and the prognosis of acute/subacute severe CVT patients. METHODS: A prospective cohort study enrolled patients with acute/subacute severe CVT at Xuanwu Hospital (July 2020-January 2024). Patients were allocated into steroid and non-steroid groups based on the treatment they received. Functional outcomes (modified Rankin scale [mRS]) were evaluated at admission, discharge, and 6 months after discharge. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), cerebrospinal fluid (CSF) IL-6, and intracranial pressure were measured at admission and discharge in the steroid group. Fundoscopic Frisén grades were assessed at admission and 6 months after discharge. Univariate and multivariate logistic regression were used to evaluat associations between steroid use and favorable outcomes (mRS ≤2) at the 6-month follow-up. Paired tests assessed changes in hs-CRP and other variables before and after treatment, and Spearman's correlations were used to analyze relationships between these changes and functional improvements. RESULTS: A total of 107 and 58 patients in the steroid and non-steroid groups, respectively, were included in the analysis. Compared with the non-steroid group, the steroid group had a higher likelihood of achieving an mRS score of 0-2 (93.5% vs . 82.5%, odds ratio [OR] = 2.98, P  = 0.037) at the 6-month follow-up. After adjusting for confounding factors, the result remained consistent. Pulsed steroid therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications (all P  >0.05). Patients in the steroid group showed a significant reduction in serum hs-CRP, IL-6, CSF IL-6, and intracranial pressure at discharge compared to at admission, as well as a significant reduction in the fundoscopic Frisén grade at the 6-month follow-up compare to at admission (all P  <0.001). A reduction in serum inflammatory marker levels during hospitalization positively correlated with improvements in functional outcomes ( P  <0.05). CONCLUSION: Short-term steroid use may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatments, which are likely due to suppression of the inflammatory response. However, these findings require further validation in randomized controlled trials. TRAIL REGISTRATION ClinicalTrials.gov , NCT05990894.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Anticoagulants/therapeutic use* ; C-Reactive Protein/metabolism* ; Interleukin-6/metabolism* ; Intracranial Thrombosis/drug therapy* ; Prospective Studies ; Steroids/therapeutic use* ; Venous Thrombosis/drug therapy*

Objective To evaluate the correlation between the changes of vascular density in deep and shallow layers,retinal hyperreflexia and the therapeutic response of diabetic macular edema(DME).Methods Retrospectively selected DME patients(45 cases and 59 eyes)who visited the Department of Ophthalmology from April 2020 to November 2023 as the experimental group.Compare the change of deep and superficial blood vessel density and retinal hyperreflective points before and after treatment of the patients.The correlation between each index and poor response to anti-vascular endothelial growth factor(VEGF)treatment with DME was analyzed using the Pearson test.The value of baseline deep retinal capillary plexus(DCP),central macular retinal thickness(CMT),number of high-reflective foci(HRF)in the retina,and blood flow density(FD300-VD)in diagnosing poor response to anti-VEGF therapy in DME was analyzed using the subject operating characteristic curve(ROC).Results Compared with pre-treatment,patients'superficial retinal capillary plexus(SCP),DCP,FD300-VD,and deep-superficial flow ratio(DSFR)increased and CMT thickness significantly decreased after treatment(P<0.05).Pearson's correlation test showed that the outcome of patients with poor response to anti-VEGF therapy was negatively correlated with baseline SCP-VD,DCP-VD,DSFR,and FD300-VD(r=-0.458,-0.433,-0.604,and-0.452,P<0.05)and positively correlated with CMT(r=0.427,P<0.05).The results of multifactorial logistic regression analysis showed that a rise in SCP,DCP,FD300-VD,and DSFR,and a decrease in CMT were corre-lates affecting the response to anti-VEGF therapy in DME(OR=0.285,0.272,0.291,0.268,2.821,P<0.05).The results of ROC curve analysis showed that the AUCs of baseline DCP,CMT,HRF quantity,and FD300-VD were 0.918,0.934,0.947,and 0.927,respectively,which were of good value in diagnosing poor response to anti-VEGF therapy in DME.Conclusion Morphologic indicators such as changes in the density of deep and superfi-cial blood vessels and retinal hyperreflective spots have good application value in assessing the response to DME treatment and can assist in clinical treatment.

Objective To evaluate the correlation between the changes of vascular density in deep and shallow layers,retinal hyperreflexia and the therapeutic response of diabetic macular edema(DME).Methods Retrospectively selected DME patients(45 cases and 59 eyes)who visited the Department of Ophthalmology from April 2020 to November 2023 as the experimental group.Compare the change of deep and superficial blood vessel density and retinal hyperreflective points before and after treatment of the patients.The correlation between each index and poor response to anti-vascular endothelial growth factor(VEGF)treatment with DME was analyzed using the Pearson test.The value of baseline deep retinal capillary plexus(DCP),central macular retinal thickness(CMT),number of high-reflective foci(HRF)in the retina,and blood flow density(FD300-VD)in diagnosing poor response to anti-VEGF therapy in DME was analyzed using the subject operating characteristic curve(ROC).Results Compared with pre-treatment,patients'superficial retinal capillary plexus(SCP),DCP,FD300-VD,and deep-superficial flow ratio(DSFR)increased and CMT thickness significantly decreased after treatment(P<0.05).Pearson's correlation test showed that the outcome of patients with poor response to anti-VEGF therapy was negatively correlated with baseline SCP-VD,DCP-VD,DSFR,and FD300-VD(r=-0.458,-0.433,-0.604,and-0.452,P<0.05)and positively correlated with CMT(r=0.427,P<0.05).The results of multifactorial logistic regression analysis showed that a rise in SCP,DCP,FD300-VD,and DSFR,and a decrease in CMT were corre-lates affecting the response to anti-VEGF therapy in DME(OR=0.285,0.272,0.291,0.268,2.821,P<0.05).The results of ROC curve analysis showed that the AUCs of baseline DCP,CMT,HRF quantity,and FD300-VD were 0.918,0.934,0.947,and 0.927,respectively,which were of good value in diagnosing poor response to anti-VEGF therapy in DME.Conclusion Morphologic indicators such as changes in the density of deep and superfi-cial blood vessels and retinal hyperreflective spots have good application value in assessing the response to DME treatment and can assist in clinical treatment.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.

Taking the scope of outpatient special disease,the level of protection and the fixed-point management as the entry point.Under the"N+X"policy background,it reviewed the policies related to outpatient special diseases in 13 co-ordinated districts of Jiangsu Province to explore the similarities and differences and the existing problems,and provide relevant suggestions.Jiangsu Province has issued a guiding document to establish a unified outpatient special disease system,the differences in the scope of outpatient special disease and the medical insurance benefit level in the 13 cities should not be ignored.These differences may affect the fairness of patients and hinder the establishment of a unified outpatient special disease system in the province.In addition,there are still some problems in the selection of diseases,hierarchical medical,and disease identification.It is recommended to establish a dynamic selection mechanism for outpatient special diseases,to fully utilize the role of primary healthcare institutions in providing outpatient services for special diseases,and to develop objective and unified criteria for identifying outpatient special diseases.