AIM:To investigate the effect of ranibizumab on blood flow density in different regions of the macula in patients with macular edema(ME)secondary to ischemic and non-ischemic branch retinal vein occlusion(BRVO).METHODS:This retrospective study enrolled patients with BRVO-ME who were treated at the hospital from September 2019 to March 2021. Patients were divided into ischemic and non-ischemic groups based on fundus findings. All patients received intravitreal injections of ranibizumab once monthly for three consecutive months. Best corrected visual acuity(BCVA), central macular thickness(CMT), and macular blood flow density were measured before treatment and at 1 d, 1 wk, 1 and 3 mo after treatment.RESULTS: A total of 46 patients(46 eyes)with BRVO-ME were included, comprising 21 eyes in the ischemic group(7 males, 14 females; mean age 55.81±10.36 y)and 25 eyes in the non-ischemic group(11 males, 14 females; mean age 54.84±9.81 y). At 3 mo after treatment, BCVA(LogMAR)in the non-ischemic group was superior to that in the ischemic group(0.19±0.19 vs 0.38±0.27, P=0.009). Analysis of CMT changes showed that the reduction amplitude in the ischemic group was significantly greater than that in the non-ischemic group at both 1 and 3 mo after treatment(all P<0.05). Blood flow densities in the whole, parafoveal, and perifoveal regions of the superficial capillary plexus(SCP), as well as in the whole and perifoveal regions of the deep capillary plexus(DCP), were significantly lower in ischemic patients than in non-ischemic patients, while blood flow density in the foveal region of DCP was significantly higher in the ischemic group(all P<0.05).CONCLUSION: Ranibizumab is effective for both types of patients. Non-ischemic patients have a better long-term visual prognosis, and the advantage may be related to better blood flow perfusion patterns in specific areas 3 mo after treatment. Monitoring changes in blood flow density in these areas can help provide personalized treatment for patients.

ObjectiveTo establish a high-performance liquid chromatography（HPLC） for the quantitative analysis of multiple components in Gegen Qinlian tablets， and to comprehensively evaluate the quality of samples from different manufacturers by integrating chemical pattern recognition and technique for order preference by similarity to ideal solution（TOPSIS）， in order to provide a reference basis for quality evaluation and control of Gegen Qinlian tablets. MethodsHPLC was employed to determine the contents of 10 components in 28 batches of Gegen Qinlian tablets collected from 6 manufacturers， and taking the detection results as variables， SIMCA 14.1 and SPSS 26.0 were employed for cluster analysis（CA）， principal component analysis（PCA）， and orthogonal partial least squares-discriminant analysis（OPLS-DA） to identify key components affecting the quality. Then， TOPSIS analysis was employed to rank the quality of Gegen Qinlian tablets from the 6 manufacturers and establish a comprehensive quality evaluation method. ResultsA quantitative method for Gegen Qinlian tablets was established. After methodological validation， the method was found to be stable and reliable， and could be used for the quantitative analysis of this preparation. The contents of 3′-hydroxy puerarin， puerarin， 3′-methoxy puerarin， daidzein， coptisine hydrochloride， epiberberine， jatrorrhizine hydrochloride， berberine hydrochloride， palmatine hydrochloride and baicalin in 28 batches of samples were 3.58-7.35， 24.88-42.32， 4.20-9.36， 4.33-7.60， 2.52-6.44， 0.93-4.10， 0.58-3.05， 10.68-22.92， 0.82-4.82， 11.73-60.16 mg·g^-1， respectively. Among them， puerarin， berberine hydrochloride and baicalin all met the limit requirements for this preparation specified in the 2025 edition of the Pharmacopoeia of the People's Republic of China. CA and PCA clustered the 28 batches of samples into 5 categories， PCA extracted 2 principal components with a cumulative variance contribution rate of 90.588%， and OPLS-DA screened out 4 differential markers with variable importance in the projection（VIP） values>1.0， namely baicalin， 3′-hydroxy puerarin， coptisine hydrochloride and palmatine hydrochloride， which might be the main components affecting the quality of Gegen Qinlian tablets. TOPSIS analysis showed that the comprehensive score of each evaluation index（C_i） values of different manufacturers were different. Among them， the C_i of manufacturer B was ranked higher， indicating potentially superior quality， while the C_i of manufacturer A was ranked lower， suggesting potentially inferior quality. ConclusionThis study establishes a quantitative method for Gegen Qinlian tablets， and the content uniformity of the same manufacturer is good， while there are differences in the contents of active components among different manufacturers. Through the chemical pattern recognition analysis， it is found that the content differences of Gegen Qinlian tablets may be related to baicalin， 3′-hydroxy puerarin， coptisine hydrochloride and palmatine hydrochloride.

AIM: To investigate the risk factors associated with the recurrence of macular edema secondary to branch retinal vein occlusion(BRVO-ME)after anti-vascular endothelial growth factor(anti-VEGF)therapy.METHODS:A total of 32 patients(32 eyes)with BRVO-ME who were treated at the ophthalmology department of the Affiliated Hospital of Shandong Second Medical University from February 2021 to June 2022 were selected. They were treated with a 3+pro re nata (PRN)anti-VEGF regimen and followed up for 6 mo. Following 3 consecutive anti-VEGF injections, patients were categorized into a non-recurrence group and a recurrence group based on central macular thickness(CMT)measured by optical coherence tomography(OCT)at 6 mo post-treatment. Aqueous humor levels of various cytokines levels were quantified using suspension assay method. Demographic characteristics, CMT, and cytokine levels were compared between the two groups, and their correlations with the recurrence of BRVO-ME after anti-VEGF treatment were analyzed.RESULTS:At 6 months post-treatment, ME resolved in 19 eyes(no recurrence group), while 13 eyes showed persistent or recurrent ME(recurrence group). Compared to baseline, the CMT significantly improved in both groups at 1 d, 1, and 6 mo post-treatment(all P<0.05). However, the recurrence group exhibited significantly higher baseline, 1 d and 6 mo post-treatment CMT values than the non-recurrence group(all P<0.05). The aqueous humor levels of VEGF and monocyte chemoattractant protein-1(MCP-1)at baseline were significantly higher in the recurrence group than the non-recurrence group(all P<0.05). Spearman correlation analysis revealed positive associations between baseline CMT and interlukin IL-1β, IL-5, IL-12, MCP-1 and IP-10 levels(all P<0.05). Multivariable Logistic regression analysis identified baseline CMT and MCP-1 levels as independent risk factors for BRVO-ME recurrence(OR>1, P<0.05).CONCLUSION: Elevated baseline CMT and aqueous humor MCP-1 levels were identified as independent risk factors for BRVO-ME recurrence after anti-VEGF therapy. Patients exhibiting higher baseline CMT and MCP-1 levels demonstrated significantly increased susceptibility to recurrence.

Objective To investigate the impact of blood sampling from different sites on coagula-tion results during systemic heparin anticoagulation period treated by continuous renal replacement therapy(CRRT).Methods Seventy-eight patients undergoing CRRT with systemic heparin anticoag-ulation were selected.Using a self-control method,blood samples were simultaneously collected from sampling port at input end of the CRRT extracorporeal circuit,the arterial pressure monitoring cathe-ter,and the peripheral vein of the patients.The four coagulation parameters were tested,and the differences in coagulation results among the blood sampling sites were compared.Results During CRRT with systemic heparin anticoagulation,the four coagulation parameters using blood samples col-lected from the sampling port at the input end of the CRRT extracorporeal circuit,the arterial pressure monitoring catheter,and the peripheral vein showed no statistically significant differences(P＞0.05).Subgroup analyses based on different hemofiltration machines and heparin doses also showed no statisti-cally significant differences(P＞0.05).Conclusion During CRRT,blood sampling from the sam-pling port at the input end of the circuit or the arterial pressure monitoring catheter can be used as an alternative to peripheral venous blood sampling,with no impact on coagulation results.

Objective:To investigate the therapeutic efficacy of programmed death-1(PD-1)inhibitors in combination with drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)and radiofrequency ablation(RFA), as well as their impact on the prognosis of older patients with primary hepatocellular carcinoma(HCC).Methods:In this prospective cohort study, 120 patients aged 65 years and older with HCC at stage Ⅱb-Ⅲb were randomly assigned to an observation group (n=60)and a control group (n=60)between January 2021 and January 2024.The control group received DEB-TACE followed by RFA, while the observation group received a PD-1 inhibitor in combination with DEB-TACE followed by RFA, with both interventions lasting for 12 weeks.The clinical efficacy of the treatments in both groups was assessed, and changes in serum tumor markers before and after treatment were compared between the two groups.Safety was evaluated, survival data were recorded during follow-up, and the effects of different therapeutic regimens on patient prognosis were analyzed.Results:The disease control rate(DCR)and objective response rate(ORR)in the observation group were 88.33% and 78.33%, respectively, which were higher than those in the control group (71.67% and 28.33%, χ2=5.208, 30.134, P=0.022, <0.001). After treatment, levels of serum tumor markers (alpha fetoprotein, carbohydrate antigen 125, vascular endothelial growth factor)decreased in both groups (all P<0.05), with levels in the observation group being lower than those in the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P>0.05). By the end of follow-up, which ranged from 2 to 33 months, there were 15 death cases in the observation group, resulting in a cumulative survival rate of 75.00%(45/60) and a mean survival of 25.95 months.In the control group, there were 25 death cases, with a cumulative survival rate of 58.33%(35/60)and a mean survival of 20.33 months.The results of the Kaplan-Meier function analysis were as follows: Log-rank χ2=5.747, P=0.017; Breslow χ2=3.124, P=0.077.The results of the multivariate Cox regression analysis indicated that PD-1 inhibitor combined with DEB-TACE sequential RFA was a protective factor against death in older patients with primary HCC( HR=0.680, 95% CI: 0.463-0.998, P=0.014). Conclusions:The curative effect and safety of PD-1 inhibitor combined with DEB-TACE and RFA are favorable in older patients with advanced HCC.

BACKGROUND:The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body,which may affect cardiopulmonary function and compress nerves in severe cases.Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise,bracing,and surgery.However,the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.OBJECTIVE:To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.METHODS:Based on the CT images of an adolescent idiopathic scoliosis patient,a scoliosis model(C7-L5)was reconstructed in Mimics software in three dimensions,and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20,40,60,80,100,and 120 N.The intervertebral disc stress and vertebral displacement in concave and convex sides,and Cobb angle of the spine were analyzed under two orthopedic modalities.RESULTS AND CONCLUSION:(1)With lateral thrust,there was no significant change in the C7T1-T7T8 intervertebral disc.The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force.The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends.At 120 N of lateral thrust,the thoracic Cobb angle changed from 53.2° to 32.5° and the lumbar Cobb angle changed from 50.2° to 43.9°.(2)With the vertical distraction,the thoracic intervertebral disc stresses first decreased and then increased,and all the lumbar disc stresses decreased.The C7 displacement was the most obvious,and the correction effect gradually diminished with the segment extended to the caudal end.At a vertical distraction force of 120 N,the thoracic Cobb angle changed from 53.2° to 39.4° and the lumbar Cobb angle changed from 50.2° to 47.6°.(3)It is concluded that both orthopedic modalities provide improvement in the degree of scoliosis,with the thoracic correction being greater than the lumbar correction.Also,the asymmetric stress distribution on the concave and convex sides is improved,which contributes to normal bone growth.A vertical distraction approach is appropriate for larger Cobb angles,and a lateral thrust approach is appropriate for smaller Cobb angles.The results of this study help to understand the mechanism of spinal orthosis and provide a theoretical basis for the choice of orthopedic approach.

BACKGROUND:The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body,which may affect cardiopulmonary function and compress nerves in severe cases.Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise,bracing,and surgery.However,the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.OBJECTIVE:To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.METHODS:Based on the CT images of an adolescent idiopathic scoliosis patient,a scoliosis model(C7-L5)was reconstructed in Mimics software in three dimensions,and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20,40,60,80,100,and 120 N.The intervertebral disc stress and vertebral displacement in concave and convex sides,and Cobb angle of the spine were analyzed under two orthopedic modalities.RESULTS AND CONCLUSION:(1)With lateral thrust,there was no significant change in the C7T1-T7T8 intervertebral disc.The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force.The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends.At 120 N of lateral thrust,the thoracic Cobb angle changed from 53.2° to 32.5° and the lumbar Cobb angle changed from 50.2° to 43.9°.(2)With the vertical distraction,the thoracic intervertebral disc stresses first decreased and then increased,and all the lumbar disc stresses decreased.The C7 displacement was the most obvious,and the correction effect gradually diminished with the segment extended to the caudal end.At a vertical distraction force of 120 N,the thoracic Cobb angle changed from 53.2° to 39.4° and the lumbar Cobb angle changed from 50.2° to 47.6°.(3)It is concluded that both orthopedic modalities provide improvement in the degree of scoliosis,with the thoracic correction being greater than the lumbar correction.Also,the asymmetric stress distribution on the concave and convex sides is improved,which contributes to normal bone growth.A vertical distraction approach is appropriate for larger Cobb angles,and a lateral thrust approach is appropriate for smaller Cobb angles.The results of this study help to understand the mechanism of spinal orthosis and provide a theoretical basis for the choice of orthopedic approach.

Objective:To investigate the therapeutic efficacy of programmed death-1(PD-1)inhibitors in combination with drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)and radiofrequency ablation(RFA), as well as their impact on the prognosis of older patients with primary hepatocellular carcinoma(HCC).Methods:In this prospective cohort study, 120 patients aged 65 years and older with HCC at stage Ⅱb-Ⅲb were randomly assigned to an observation group (n=60)and a control group (n=60)between January 2021 and January 2024.The control group received DEB-TACE followed by RFA, while the observation group received a PD-1 inhibitor in combination with DEB-TACE followed by RFA, with both interventions lasting for 12 weeks.The clinical efficacy of the treatments in both groups was assessed, and changes in serum tumor markers before and after treatment were compared between the two groups.Safety was evaluated, survival data were recorded during follow-up, and the effects of different therapeutic regimens on patient prognosis were analyzed.Results:The disease control rate(DCR)and objective response rate(ORR)in the observation group were 88.33% and 78.33%, respectively, which were higher than those in the control group (71.67% and 28.33%, χ2=5.208, 30.134, P=0.022, <0.001). After treatment, levels of serum tumor markers (alpha fetoprotein, carbohydrate antigen 125, vascular endothelial growth factor)decreased in both groups (all P<0.05), with levels in the observation group being lower than those in the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P>0.05). By the end of follow-up, which ranged from 2 to 33 months, there were 15 death cases in the observation group, resulting in a cumulative survival rate of 75.00%(45/60) and a mean survival of 25.95 months.In the control group, there were 25 death cases, with a cumulative survival rate of 58.33%(35/60)and a mean survival of 20.33 months.The results of the Kaplan-Meier function analysis were as follows: Log-rank χ2=5.747, P=0.017; Breslow χ2=3.124, P=0.077.The results of the multivariate Cox regression analysis indicated that PD-1 inhibitor combined with DEB-TACE sequential RFA was a protective factor against death in older patients with primary HCC( HR=0.680, 95% CI: 0.463-0.998, P=0.014). Conclusions:The curative effect and safety of PD-1 inhibitor combined with DEB-TACE and RFA are favorable in older patients with advanced HCC.

Objective To observe the effects of different administration doses of dexmedetomidine on the circulatory system and stress response in patients undergoing extracorporeal coronary artery bypass grafting(OPCABG).Methods Ninety-six patients who underwent OPCABG in our hospital from October 2021 to October 2023 were selected and divided into two groups using simple randomization method.Group A was administered dexmedetomi-dine at a dose of 0.5 μg/kg over 10 minutes before anesthesia induction,followed by a maintenance dose of 0.5 μg/(kg·h)infused until the end of the surgery,while group B was administered dexmedetomidine at a dose of 0.8 μg/kg for 10 min before anesthesia induction,followed by a maintenance dose of 0.8 μg/(kg·h)until the end of the operation.The two groups were compared in terms of cardiac index(CI),heart rate,mean arterial pressure(MAP),intrathoracic blood volume index(ITBI),bispectral index(BIS),and systemic peripheral vascular resistance index(SVRI)before anesthesia started(T0),at the immediate moment of intubation(T1),at the immediate moment of the start of the surgery(T2),at the time of sawing of the sternum(T3),and at the immediate moment of extubation(T4).Additionally,the two groups were compared in terms of cortisol(Cor),Angiotensin Ⅱ(Ang Ⅱ)levels,safety and postoperative awakening time.Results The two groups showed no differences in operation time,anaesthesia time,bleeding and urine volume(P＞0.05),but group B demonstrated less intraoperative use of cisatracurium compared to group A(P＜0.05).At T0,the two groups showed no difference in heart rate and MAP(P＞0.05),but higher heart rate and MAP at T1 and T3 than at T0.Group A was observed to have higher heart rate and MAP at T4 than at T0,while group B showed no significant differences in heart rate and MAP at T4 com-pared to them at T0(P＞0.05).At T2 and T4,Group B showed significantly lower heart rate and MAP compared to group A(P＜0.05).At T0,the two group had no differences in terms of CI,CO,ITBI,and SVRI(P＞0.05).Both groups showed significantly lowered levels of CI,CO,ITBI,and SVRI at T1-T4 than at T0(P＜0.05),but demonstrated no differences in the levels of CI,CO,ITBI,SVRI at T0-T4(P＞0.05).At T0,both groups had no difference in BIS values(P＞0.05),but showed significantly decreased BIS values at T1-T4 compared with those at T0(P＜0.05).At T2-T4,group A showed significantly lower BIS values compared with group A(P＜0.05).The two groups had no difference in postoperative awakening time compared with group A(8.12±1.88 min vs.8.05±1.97 min,P＞0.05).Preoperatively,the two groups had no differences in Cor and Ang Ⅱ(P＞0.05).However,at 6 h postoperatively,both groups showed significantly elevated Cor and AngⅡ values compared to preoperatively(P＜0.05),and group B showed signifantly lower values of Cor and AngⅡ compared to group A(P＜0.05).The two groups had no difference in the adverse reactions(6.25%vs.8.33%,P＞0.05).Conclusion Dexmedetomidine administered at the dose of 0.8 μg/(k·h)rather than at the dose of 0.5 μg/(k·h)for managing OPCABG results in more stable hemodynamics during surgery,yielding better sedative effect,milder postoperative stress response,and no increase in adverse reactions.

Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.