1.Professor SUN Shentian's experience in the theoretical basis and practice of Ningshen point.
Yihao ZHOU ; Dongyan WANG ; Rongyu XU ; Danping LI ; Hong HUO ; Ying ZHANG ; Xingyan ZHU ; Shentian SUN
Chinese Acupuncture & Moxibustion 2025;45(3):361-364
The paper introduces Professor SUN Shentian's experience in clinical practice of Ningshen (tranquilizing the mind) point. This point is an empirical point discovered by Professor SUN on the basis of meridian differentiation, nerve function and anatomic location, and in association with the years of clinical practice. The point is located in the prefrontal area, jointed with the distribution of the governor vessel, and responded to the body surface projection area of the frontal pole. It works on regulating the mind, regaining consciousness, improving cognition, alleviating depression, mutually treating physical and mental disorders, as well as unblocking collaterals, regulating the tendons and relieving spasm. This point is widely used in treatment of mental disorders, stroke and extrapyramidal diseases and obtains the reliable therapeutic effect in clinical practice.
Humans
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Acupuncture Points
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Acupuncture Therapy/history*
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China
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Meridians
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History, 20th Century
2.Mechanism of vanillic acid against cardiac fibrosis induced by isoproterenol in mice based on Drp1/HK1/NLRP3 and mitochondrial apoptosis signaling pathways.
Hai-Bo HE ; Mian WU ; Jie XU ; Qian-Qian XU ; Fang-Zhu WAN ; Hua-Qiao ZHONG ; Ji-Hong ZHANG ; Gang ZHOU ; Hui-Lin QIN ; Hao-Ran LI ; Hai-Ming TANG
China Journal of Chinese Materia Medica 2025;50(8):2193-2208
This study investigated the effects and underlying mechanisms of vanillic acid(VA) against cardiac fibrosis(CF) induced by isoproterenol(ISO) in mice. Male C57BL/6J mice were randomly divided into control group, VA group(100 mg·kg~(-1), ig), ISO group(10 mg·kg~(-1), sc), ISO + VA group(10 mg·kg~(-1), sc + 100 mg·kg~(-1), ig), ISO + dynamin-related protein 1(Drp1) inhibitor(Mdivi-1) group(10 mg·kg~(-1), sc + 50 mg·kg~(-1), ip), and ISO + VA + Mdivi-1 group(10 mg·kg~(-1), sc + 100 mg·kg~(-1), ig + 50 mg·kg~(-1), ip). The treatment groups received the corresponding medications once daily for 14 consecutive days. On the day after the last administration, cardiac functions were evaluated, and serum and cardiac tissue samples were collected. These samples were analyzed for serum aspartate aminotransferase(AST), lactate dehydrogenase(LDH), creatine kinase-MB(CK-MB), cardiac troponin I(cTnI), reactive oxygen species(ROS), interleukin(IL)-1β, IL-4, IL-6, IL-10, IL-18, and tumor necrosis factor-α(TNF-α) levels, as well as cardiac tissue catalase(CAT), glutathione(GSH), malondialdehyde(MDA), myeloperoxidase(MPO), superoxide dismutase(SOD), total antioxidant capacity(T-AOC) activities, and cytochrome C levels in mitochondria and cytoplasm. Hematoxylin-eosin, Masson, uranium acetate and lead citrate staining were used to observe morphological and mitochondrial ultrastructural changes in the cardiac tissues, and myocardial injury area and collagen volume fraction were calculated. Flow cytometry was applied to detect the relative content and M1/M2 polarization of cardiac macrophages. The mRNA expression levels of macrophage polarization markers [CD86, CD206, arginase 1(Arg-1), inducible nitric oxide synthase(iNOS)], CF markers [type Ⅰ collagen(Coll Ⅰ), Coll Ⅲ, α-smooth muscle actin(α-SMA)], and cytokines(IL-1β, IL-4, IL-6, IL-10, IL-18, TNF-α) in cardiac tissues were determined by quantitative real-time PCR. Western blot was used to detect the protein expression levels of Coll Ⅰ, Coll Ⅲ, α-SMA, Drp1, p-Drp1, voltage-dependent anion channel(VDAC), hexokinase 1(HK1), NOD-like receptor protein 3(NLRP3), apoptosis-associated speck-like protein(ASC), caspase-1, cleaved-caspase-1, gasdermin D(GSDMD), cleaved N-terminal gasdermin D(GSDMD-N), IL-1β, IL-18, B-cell lymphoma-2(Bcl-2), B-cell lymphoma-xl(Bcl-xl), Bcl-2-associated death promoter(Bad), Bcl-2-associated X protein(Bax), apoptotic protease activating factor-1(Apaf-1), pro-caspase-3, cleaved-caspase-3, pro-caspase-9, cleaved-caspase-9, poly(ADP-ribose) polymerase-1(PARP-1), and cleaved-PARP-1 in cardiac tissues. The results showed that VA significantly improved cardiac function in mice with CF, reduced myocardial injury area and cardiac index, and decreased serum levels of AST, CK-MB, cTnI, LDH, ROS, IL-1β, IL-6, IL-18, and TNF-α. VA also lowered MDA and MPO levels, mRNA expressions of IL-1β, IL-6, IL-18, and TNF-α, and mRNA and protein expressions of Coll Ⅰ, Coll Ⅲ, and α-SMA in cardiac tissues, and increased serum levels of IL-4 and IL-10, cardiac tissue levels of CAT, GSH, SOD, and T-AOC, and mRNA expressions of IL-4 and IL-10. Additionally, VA ameliorated cardiac pathological damage, inhibited myocardial cell apoptosis, inflammatory infiltration, and collagen fiber deposition, reduced collagen volume fraction, and alleviated mitochondrial damage. VA decreased the ratio of F4/80~+CD86~+ M1 cells and the mRNA expressions of CD86 and iNOS in cardiac tissue, and increased the ratio of F4/80~+CD206~+ M2 cells and the mRNA expressions of CD206 and Arg-1. VA also reduced protein expressions of p-Drp1, VDAC, NLRP3, ASC, caspase-1, cleaved-caspase-1, GSDMD, GSDMD-N, IL-1β, IL-18, Bad, Bax, Apaf-1, cleaved-caspase-3, cleaved-caspase-9, cleaved-PARP-1, and cytoplasmic cytochrome C, and increased the expressions of HK1, Bcl-2, Bcl-xl, pro-caspase-3, pro-caspase-9 proteins, as well as the Bcl-2/Bax and Bcl-xl/Bad ratios and mitochondrial cytochrome C content. These results indicate that VA has a significant ameliorative effect on ISO-induced CF in mice, alleviates ISO-induced oxidative damage and inflammatory response, and its mechanism may be closely related to the inhibition of Drp1/HK1/NLRP3 and mitochondrial apoptosis signaling pathways, suppression of myocardial cell inflammatory infiltration and collagen fiber deposition, reduction of collagen volume fraction and CollⅠ, Coll Ⅲ, and α-SMA expressions, thus mitigating CF.
Animals
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Isoproterenol/adverse effects*
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Male
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Mice
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Signal Transduction/drug effects*
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Vanillic Acid/administration & dosage*
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Dynamins/genetics*
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Mice, Inbred C57BL
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Fibrosis/genetics*
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Apoptosis/drug effects*
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Mitochondria/metabolism*
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NLR Family, Pyrin Domain-Containing 3 Protein/genetics*
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Myocardium/metabolism*
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Humans
3.Establishment of a canine model of vascularized allogeneic spinal cord transplantation and preliminary study on spinal cord continuity reconstruction.
Jiayang CHEN ; Rongyu LAN ; Weihua ZHANG ; Jie QIN ; Weijun HU ; Jiaxing WANG ; Xiaoping REN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(9):1196-1202
OBJECTIVE:
To explore the construction of a canine model of vascularized allogeneic spinal cord transplantation (vASCT) and preliminarily evaluate its therapeutic efficacy for spinal cord injury (SCI).
METHODS:
Sixteen female Beagle dogs aged 8-12 months were randomly selected, with 8 dogs serving as donors for the harvesting of spinal cord tissue with a vascular pedicle [dorsal intercostal artery (DIA) at the T10 level and accompanying vein]. The remaining 8 dogs underwent a 1.5-cm-length spinal cord defect at the T10 level, followed by transplantation of the donor spinal cord tissue for repair. Polyethylene glycol (PEG) was applied to both ends to spinal cord graft; then, using a random number table method, the dogs were divided into an experimental group (n=4) and a control group (n=4). The experimental group received immunosuppressive intervention with oral tacrolimus [0.1 mg/(kg∙d)] postoperatively, while the control group received no treatment. The operation time and ischemia-reperfusion time of two groups were recorded. The recovery of hind limb function was estimated by Olby score within 2 months after operation; the motor evoked potentials (MEP) was measured through neuroelectrophysiological examination, and the spinal cord integrity was observed through MRI.
RESULTS:
There was no significant difference in the operation time and ischemia-reperfusion time between the two groups (P>0.05). All dogs survived until the completion of the experiment. Within 2 months after operation, all dogs in the control group failed to regain the movement function of hind limbs, and Olby scores were all 0. In the experimental group, the movement and weight-bearing, as well as walking abilities of the hind limbs gradually recovered, and the Olby scores also showed a gradually increasing trend. There was a significant difference between the two groups from 3 to 8 weeks after operation (P<0.05). Neuroelectrophysiological examination indicated that the electrical signals of the experimental group passed through the transplanted area, and the latency was shortened compared to that at 1 month after operation (P<0.05), showing continuous improvement, but the amplitude did not show significant improvement (P>0.05). The control group was unable to detect any MEP changes after operation. MRI examination showed that the transplanted spinal cord in the experimental group survived and had good continuity with normal spinal cord tissue, while no relevant change was observed in the control group.
CONCLUSION
The vASCT model of dogs was successfully constructed. This surgical procedure can restore the continuity of the spinal cord. The combination of tacrolimus anti-immunity is a key factor for the success of transplantation.
Animals
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Dogs
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Female
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Spinal Cord/blood supply*
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Spinal Cord Injuries/surgery*
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Transplantation, Homologous
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Disease Models, Animal
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Recovery of Function
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Plastic Surgery Procedures/methods*
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Tacrolimus
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Immunosuppressive Agents
4.A Case of Metastatic Non-small Cell Lung Cancer with Rare BRAF p.L485_T488delinsF Mutation Treated with Dabrafenib and Trametinib.
Yunfei WANG ; Wen ZHAO ; Chuang YANG ; Rongyu ZHANG ; Chengjun WANG ; Chunyan HAN ; Jisheng LI
Chinese Journal of Lung Cancer 2025;28(8):638-643
The v-Raf murine sarcoma viral oncogene homolog B (BRAF) gene is one of the most critical proto-oncogenes and functions as a key regulator in the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) signaling pathway. The incidence of BRAF mutations in non-small cell lung cancer (NSCLC) patients ranges from 1.5% to 5.5%, with BRAF V600 mutations accounting for approximately 30%-50% of all BRAF mutations, among which BRAF V600E represents the most prevalent mutation type. Currently, the combination of Dabrafenib and Trametinib has been recommended as first-line therapy for BRAF V600-mutant NSCLC by multiple domestic and international guidelines including National Comprehensive Cancer Network (NCCN), European Society of Medical Oncology (ESMO), and Chinese Society of Clinical Oncology (CSCO). However, there are no clear targeted treatment recommendations for BRAF non-V600 mutations. Although case reports suggest that Dabrafenib combined with Trametinib may be effective for patients with BRAF non-V600 mutations, the efficacy and safety require further validation due to limited sample size and lack of large-scale clinical trial data. This article reports a case of NSCLC with a rare BRAF insertion and deletion mutation that responded well to the treatment of Dabrafenib in combination with Trametinib, aiming to enhance clinicians' understanding of such NSCLC cases with extremely rare mutation and provide a reference for future treatment strategies.
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Humans
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Carcinoma, Non-Small-Cell Lung/pathology*
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Imidazoles/administration & dosage*
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Lung Neoplasms/pathology*
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Mutation
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Neoplasm Metastasis
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Oximes/administration & dosage*
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Proto-Oncogene Mas
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Proto-Oncogene Proteins B-raf/genetics*
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Pyridones/administration & dosage*
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Pyrimidinones/administration & dosage*
5.Characteristics of the third round of medical education curriculum reforms and enlightenment
Shouhua ZHANG ; Yutong QIN ; Chunji HUANG ; Hongyan ZHANG ; Yuanxu XU ; Fangfang WANG ; Peng SUN ; Juan SHEN ; Geng NI ; Rongyu SHANG
Chinese Journal of Medical Education Research 2024;23(4):438-442
To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.
6.Comparison of non-intubated spontaneous breathing and endotracheal intubation with one-lung ventilation in uniportal thoracoscopic surgery in elderly patients
Shaogeng CHEN ; Xianzuan LIN ; Rongqi HE ; Wanfei ZHANG ; Heshan CHEN ; Jingliang FU ; Hongbo CHEN ; Rongyu XU
Chinese Journal of Geriatrics 2023;42(7):826-830
Objective:To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.Methods:Clinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method, they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group), with 43 cases in each group.Data were compared on the inflammatory indexes, preparation time for anesthesia, time to awakening after anesthesia, intraoperative lung collapse score, mediastinal flutter score, time to postoperative feeding, digestive tract complications, sore throat, postoperative pulmonary atelectasis, and hospitalization time.Results:Compared with the OLV-VATS group, the NI-VATS group had a shorter anesthesia preparation time [(19.8±2.6)min vs.(32.3±4.5)min, t=-15.77, P<0.001]and a shorter time to awakening [(6.8±2.1)min vs.(11.9±2.9)min, t=-9.485, P<0.001], slightly poorer operating field during surgery, an unfavorable lung collapse score [(2.5±0.7) vs.(1.8±0.7) t=4.704, P<0.001], worse mediastinal flutter [(2.1±0.6) vs.(1.3±0.5), t=6.514, P<0.001]. Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L, t=-2.744, P=0.007), a shorter time to postoperative feeding [(3.4±1.0)h vs.(5.5±1.0)h, t=-9.55, P<0.001], and lower rates of digestive tract reactions(4.7% vs.20.9%, χ2=5.108, P=0.024)and throat pain(4.7% vs.23.3%, χ2=6.198, P=0.013), and a shorter length of hospital stay [(3.8±0.3)d vs.(4.9±0.8)d, t=-7.266, P<0.001]. Conclusions:For the elderly patients undergoing uniportal thoracoscopic surgery, non-intubated spontaneous breathing may somewhat obstruct the operating field, but it can shorten the time of anesthesia and the time to awakening, does not increase complications from anesthesia and surgery, favors rapid postoperative recovery for patients and therefore should be promoted.
7.Diagnostic value of a combined serology-based model for minimal hepatic encephalopathy in patients with compensated cirrhosis
Shanghao LIU ; Hongmei ZU ; Yan HUANG ; Xiaoqing GUO ; Huiling XIANG ; Tong DANG ; Xiaoyan LI ; Zhaolan YAN ; Yajing LI ; Fei LIU ; Jia SUN ; Ruixin SONG ; Junqing YAN ; Qing YE ; Jing WANG ; Xianmei MENG ; Haiying WANG ; Zhenyu JIANG ; Lei HUANG ; Fanping MENG ; Guo ZHANG ; Wenjuan WANG ; Shaoqi YANG ; Shengjuan HU ; Jigang RUAN ; Chuang LEI ; Qinghai WANG ; Hongling TIAN ; Qi ZHENG ; Yiling LI ; Ningning WANG ; Huipeng CUI ; Yanmeng WANG ; Zhangshu QU ; Min YUAN ; Yijun LIU ; Ying CHEN ; Yuxiang XIA ; Yayuan LIU ; Ying LIU ; Suxuan QU ; Hong TAO ; Ruichun SHI ; Xiaoting YANG ; Dan JIN ; Dan SU ; Yongfeng YANG ; Wei YE ; Na LIU ; Rongyu TANG ; Quan ZHANG ; Qin LIU ; Gaoliang ZOU ; Ziyue LI ; Caiyan ZHAO ; Qian ZHAO ; Qingge ZHANG ; Huafang GAO ; Tao MENG ; Jie LI ; Weihua WU ; Jian WANG ; Chuanlong YANG ; Hui LYU ; Chuan LIU ; Fusheng WANG ; Junliang FU ; Xiaolong QI
Chinese Journal of Laboratory Medicine 2023;46(1):52-61
Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.
8.Clinical observation of subretinal injection of compound electrolyte intraocular irrigation solution in the treatment of diabetic macular edema with hard exudate
Jiangling LI ; Lu CHANG ; Jie ZHANG ; Rongyu GAO ; Qing DAI ; Xianyong SUN
Chinese Journal of Ocular Fundus Diseases 2023;39(12):979-985
Objective:To observe the clinical effect of vitrectomy, inner limiting membrane (ILM) peeling, subretinal injection of compound electrolyte intraocular irrigation solution (CEIIS) and conbercept in the treatment of diabetic macular edema (DME) with hard exudate (HE) (DME-HE).Methods:A prospective clinical study. Thirty-three patients with DME-HE diagnosed by examination in Weifang Eye Hospital from June 2020 to February 2022 were included in the study. Among them, there were 15 males (16 eyes) and 18 females(20 eyes), with the mean age of (62.00±6.54) years. All patients underwent the examinations of best corrected visual acuity (BCVA), scanning laser ophthalmoscope, optical coherence tomography (OCT), and multifocal electroretinography (mf-ERG). Snellen visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistic analysis. Macular foveal retinal thickness (CMT) and macular volume (MV) were measured by OCT. The 1 ring P1 wave amplitude density was measured by mf-ERG. The patients were randomly divided into group A and group B, with 17 patients (18 eyes) and 16 patients (18 eyes), respectively. There were no significant differences in age, logMAR BCVA, HE area, CMT, MV, and 1 ring P1 wave amplitude density between the two groups ( t=0.403, 0.972, 0.291, 0.023, -0.268, -0.206; P>0.05). Group A was treated with vitrectomy, ILM peeling, and subretinal injection of CEIIS and conbercept (combined therapy). Group B was treated with intravitreal injection of conbercept (IVC). Follow-up was 12 months after treatment. The changes of BCVA, HE area, CMT, MV, 1 ring P1 wave amplitude density were compared between groups and groups after treatment. The times of injection and complications after treatment were observed. Independent sample t test was used for comparison between the two groups. Results:At 12 months after treatment, compared to before treatment, there were significant differences in logMAR BCVA ( F=14.837), HE area ( χ2=94.522), CMT ( χ2=199.212), MV ( χ2=81.914) and 1 ring P1 wave amplitude density ( F=8.933) in group A ( P<0.05); there were significant differences in CMT ( F=5.540) and MV ( F=7.836) in group B ( P<0.05). Compared between the two groups, logMAR BCVA: 1 week and 6 and 12 months after treatment, the difference was statistically significant ( t=2.231, -2.122, -3.196; P<0.05); HE area: except 1 week after treatment, there were statistically significant differences at other times after treatment ( t=-2.422, -3.107, -3.540, -4.119; P<0.05). CMT, MV, 1 ring P1 wave amplitude density: 12 months after treatment, the differences were statistically significant ( t=-2.653,-2.455, 2.204; P<0.05). During the follow-up period, the injection times of group A and group B were (3.06±1.89) and (5.56±2.04), respectively, and the difference was statistically significant ( t=-3.815, P<0.05). Macular hole and vitreous hematoma were found in 1 eye in group A and 1 eye in group B. Conclusion:Vitrectomy, ILM peeling, subretinal injection of CEIIS and conbercept to treat DME-HE can effectively remove HE, alleviate macular edema, improve BCVA, and reduce CMT and MV. Combination therapy can reduce the number of IVC re-treatments.
9.Effect of vascularized lymph node transplantation combined with lymphatico-venous anastomosis in the treatment of lymphedema after breast cancer surgery
Rongyu LAN ; Weihua ZHANG ; Linxuan HAN ; Xiaofei WU ; Zhuotan WU ; Jie QIN ; Xiaoping REN
Chinese Journal of Plastic Surgery 2023;39(11):1183-1191
Objective:To investigate the effect of vascularized lymph node transfer (VLNT) combined with lymphatico-venous anastomosis (LVA) in the treatment of lymphedema after breast cancer surgery.Methods:The data of patients with upper limb lymphedema after breast cancer surgery who were treated in the Department of Reconstructive and Reconstructive Microsurgery, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2021 to July 2022 were retrospectively analyzed. According to different treatment methods, the patients were divided into LVA group and VLNT combined LVA group. Indocyanine green (ICG) near-infrared lymphography was performed on all affected limbs before surgery. In the LVA group, according to the results of ICG lymphography, 4 to 5 levels of the affected limb were selected, Z shaped incisions were made and dissescted until the subcutaneous fat layer. End-to-end or end-to-side anastomosis was performed between lymphatic vessels and subcutaneous venules under the microscope. In the VLNT combined LVA group, the branches of brachial artery and vein in the axillary region were marked. The inguinal flap with the superficial iliac circumflex vessel pedicle and 4-5 lymph nodes was dissected. End-to-end anastomoses of the superficial iliac circumflex vessel pedicle with the branches of brachial artery and vein were performed in the axillary region of the affected limb. LVA was performed according to ICG lymphography, the same as in the LVA group. The skin and soft tissue condition of the affected limb and the blood supply of the flap in the VLNT combined LVA group were observed after operation. The circumference of the upper arm (from the wrist to 32 cm above the wrist, every 4 cm, a total of 9 levels of circumference) and upper limb volume were measured before and after operation. SPSS 24.0 was used for data processing and analysis. Measurement data were expressed Mean±SD. The data before and after operation in the same group were compared by paired samples t test, and the comparison between the two groups was conducted by independent samples t test. P<0.05 was considered statistically significant. Results:A total of 14 female patients were enrolled, with 7 patients in each group. All cases were unilateral lymphedema. There were no significant differences in age, stage of disease, limb circumference and limb volume between the two groups before operation ( P>0.05). After operation, the skin and soft tissue condition of the affected limbs were good, and no complications such as erysipelas, cellulitis, or lymphangitis occurred. All flaps in the VLNT combined LVA group survived successfully, and the operation wounds healed well. There were no complications such as infection and necrosis of the flaps. One year after operation, the circumference and volume of the affected limb in the two groups were improved to varying degrees, and the circumference of the affected limb (wrist, upper wrist 4, 8, 12, 16, 20, 24, 28, 32 cm levels) in the VLNT combined LVA group was significantly smaller than that before operation ( P<0.01). In the LVA group, the circumference of the affected limb (wrist, upper wrist 4, 8, 12, 16, 20 cm levels) after operation was significantly smaller than that before operation ( P<0.05). The limb volumes of both groups were significantly reduced ( P<0.05). The comparison between the two groups showed that the reduction degree of postoperative affected limb cricumference (at the levels of 24, 28 and 32 cm above the wrist) and volume in the VLNT combined LVA group were more significant than those in the LVA group ( P<0.05). Conclusion:Compared with LVA alone, VLNT combined with LVA is more effective in the treatment of patients with upper limb lymphedema after breast cancer surgery.
10.Effect of vascularized lymph node transplantation combined with lymphatico-venous anastomosis in the treatment of lymphedema after breast cancer surgery
Rongyu LAN ; Weihua ZHANG ; Linxuan HAN ; Xiaofei WU ; Zhuotan WU ; Jie QIN ; Xiaoping REN
Chinese Journal of Plastic Surgery 2023;39(11):1183-1191
Objective:To investigate the effect of vascularized lymph node transfer (VLNT) combined with lymphatico-venous anastomosis (LVA) in the treatment of lymphedema after breast cancer surgery.Methods:The data of patients with upper limb lymphedema after breast cancer surgery who were treated in the Department of Reconstructive and Reconstructive Microsurgery, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2021 to July 2022 were retrospectively analyzed. According to different treatment methods, the patients were divided into LVA group and VLNT combined LVA group. Indocyanine green (ICG) near-infrared lymphography was performed on all affected limbs before surgery. In the LVA group, according to the results of ICG lymphography, 4 to 5 levels of the affected limb were selected, Z shaped incisions were made and dissescted until the subcutaneous fat layer. End-to-end or end-to-side anastomosis was performed between lymphatic vessels and subcutaneous venules under the microscope. In the VLNT combined LVA group, the branches of brachial artery and vein in the axillary region were marked. The inguinal flap with the superficial iliac circumflex vessel pedicle and 4-5 lymph nodes was dissected. End-to-end anastomoses of the superficial iliac circumflex vessel pedicle with the branches of brachial artery and vein were performed in the axillary region of the affected limb. LVA was performed according to ICG lymphography, the same as in the LVA group. The skin and soft tissue condition of the affected limb and the blood supply of the flap in the VLNT combined LVA group were observed after operation. The circumference of the upper arm (from the wrist to 32 cm above the wrist, every 4 cm, a total of 9 levels of circumference) and upper limb volume were measured before and after operation. SPSS 24.0 was used for data processing and analysis. Measurement data were expressed Mean±SD. The data before and after operation in the same group were compared by paired samples t test, and the comparison between the two groups was conducted by independent samples t test. P<0.05 was considered statistically significant. Results:A total of 14 female patients were enrolled, with 7 patients in each group. All cases were unilateral lymphedema. There were no significant differences in age, stage of disease, limb circumference and limb volume between the two groups before operation ( P>0.05). After operation, the skin and soft tissue condition of the affected limbs were good, and no complications such as erysipelas, cellulitis, or lymphangitis occurred. All flaps in the VLNT combined LVA group survived successfully, and the operation wounds healed well. There were no complications such as infection and necrosis of the flaps. One year after operation, the circumference and volume of the affected limb in the two groups were improved to varying degrees, and the circumference of the affected limb (wrist, upper wrist 4, 8, 12, 16, 20, 24, 28, 32 cm levels) in the VLNT combined LVA group was significantly smaller than that before operation ( P<0.01). In the LVA group, the circumference of the affected limb (wrist, upper wrist 4, 8, 12, 16, 20 cm levels) after operation was significantly smaller than that before operation ( P<0.05). The limb volumes of both groups were significantly reduced ( P<0.05). The comparison between the two groups showed that the reduction degree of postoperative affected limb cricumference (at the levels of 24, 28 and 32 cm above the wrist) and volume in the VLNT combined LVA group were more significant than those in the LVA group ( P<0.05). Conclusion:Compared with LVA alone, VLNT combined with LVA is more effective in the treatment of patients with upper limb lymphedema after breast cancer surgery.

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