Background:Numerous studies have demonstrated that both cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are often associated with adverse outcomes or immune dysregulation when platelet counts decline during support. Moreover, the severity of thrombocytopenia generally correlates with a worse clinical prognosis. However, the underlying mechanisms remain incompletely understood. Previous research has attributed this phenomenon to hemodynamic alterations during CPB and ECMO, as well as anticoagulant-induced abnormal platelet activation. Based on our clinical observations, we question the completeness of this explanation and propose an alternative hypothesis: sustained platelet activation during ECMO serves as an initiating factor that contributes to both progressive thrombocytopenia and immune dysfunction throughout the support period.Methods:We investigated platelet activation status, degranulation capacity, and T cell subset dynamics in patients receiving ECMO support. Flow cytometry was used to assess platelet surface markers, reticulated platelet proportions, and T cell subset distributions.Results:We demonstrate that platelets exhibit excessive activation during ECMO, accompanied by a gradual decline in their degranulation capacity. Notably, even with an increased proportion of newly formed platelets, this functional impairment persists. Furthermore, we observed significant alterations in Helper T cell Type 1 (Th1) and CD8+ T cell populations during ECMO support.Conclusions:Our findings suggest that aberrantly activated platelets during ECMO amplify the specific recognition of platelet antigens by CD8+ T cells via modulating the differentiation bias of CD4+ T cells, particularly Th1 cells, ultimately leading to platelet depletion. These results suggest that early interventions targeting abnormal platelet activation may represent a potentially effective therapeutic strategy to mitigate ECMO-associated thrombocytopenia.

OBJECTIVES:To establish practical, clinically meaningful criteria for identifying significant platelet aggregation in suspected samples, defined by a platelet-count deviation exceeding the reference change value (RCV). METHODS:Suspected aggregated samples were collected. Venous blood anticoagulated with citrate/EDTA underwent platelet counting via impedance method (PLT-I) and blood smear analysis at 5-, 30-, 60-, and 120-min intervals. Manual microscopy (30-min smears) assessed aggregation cluster size/number, while digital cytomorphology (PLT-pro) quantified clusters at all time points. Using 5-min citrate platelet counts as reference, relative deviations (d%) of EDTA PLT-I were calculated. Clinically significant aggregation-positive samples were defined as d% exceeding the negative RCV (30.02% for PLT < 100 × 10(Zhang et al., 20259)/L; 20.92% for PLT ≥ 100 × 10(Zhang et al., 20259)/L). Samples were randomly split into training (70%) and test (30%) sets to develop logistic regression and decision-tree models. RESULTS:A total of 86 patients contributed 338 time-point results; 183 were classified as positive and 155 as negative. Manual microscopy showed that counting clusters with ≥5 platelets (vs. ≥ 3) improved specificity (p = 0.083). A criterion of ≥3 clusters, each containing ≥5 platelets, achieved 100% sensitivity and 33.3% specificity. PLT-I and PLT-pro were key discriminators via the Boruta algorithm. In the test set, the decision-tree model outperformed logistic regression (sensitivity: 92.42% vs. 89.39%; specificity: 94.29% vs. 94.29%; accuracy: 93.07% vs. 91.09%). CONCLUSION:Criteria were established for manual microscopy (≥ 3 clusters with ≥5 platelets) and digital analysis (PLT-pro 27-97 with PLT-I < 58 × 10(Zhang et al., 20259)/L, or PLT-pro ≥97 with PLT-I < 164 × 10(Zhang et al., 20259)/L). However, these thresholds are merely exploratory results, and independent validation must be performed in this laboratory before they can be used for clinical decision-making.

BACKGROUND:Carotid artery stenting (CAS) is a common treatment for carotid artery stenosis, but it can lead to new ischemic brain lesions on diffusion-weighted images (DWI) during the perioperative period. Identifying these lesions early is crucial to preventing recurrent ischemic strokes. METHODS:This retrospective study included 47 patients who underwent CAS. Preoperative carotid PET/MR examinations and postoperative brain MRI were performed. Clinicians identified the responsible carotid artery based on symptoms and records. Vessel morphology, plaque characteristics, and inflammatory uptake were analyzed. The standardized uptake value and tissue-to-background ratio quantified 18F-fluorodeoxyglucose(18F-FDG) uptake. The symptomatic carotid atheroma inflammation lumen-stenosis(SCAIL) score assessed stenosis severity and inflammation. The primary outcome was the presence of new ischemic lesions on DWI. RESULTS:Among the 47 patients (mean age, 65 ± 7 years; 44 males), 30 (63.8%) exhibited new ischemic lesions. These patients had a higher prevalence of AHA type VI plaques (50.0% vs. 17.6%, p = 0.028), higher PET uptake (43.3% vs. 11.8%, p = 0.026), and higher SCAIL scores (63.3% vs. 23.5%, p = 0.009). The most common distribution pattern of new ischemic lesions was located in the mixed (in and beyond of the treated artery) territory (36.2%). Of the 30 participants with new ischemic lesions, 15 (50%) had lesions located in both peripheral brain areas and deep brain areas. In the adjusted model, high PET uptake and SCAIL scores were independently associated with new ischemic lesions (aOR = 7.26, 95% CI: 1.22, 73.59; p = 0.049 and aOR = 7.06 [95% CI: 1.50, 44.18]; p = 0.020). CONCLUSION:Carotid PET/MR-related indicators can effectively predict the risk of new ischemic lesions on DWI during the perioperative period after carotid artery stenting, providing important references for early identification of high-risk patients for recurrent ischemic stroke. Further large-scale randomized controlled studies are necessary to validate the clinical application value of these indicators.

ABSTRACT:Introduction : Elevated cell-free DNA (cfDNA) was observed in patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO), but the clinical relevance of cfDNA is still not clear. We aimed to establish a predictive model based on the cfDNA to predict the prognosis for patients on ECMO, and reveal the values of cfDNA for complications of limb ischemia and bleeding/thromboembolic events. Methods : Single-center, retrospective evaluation of patients with ECMO support from 2018 through 2023. The derivation cohort included 133 adults diagnosed with cardiogenic shock who received VA-ECMO for circulatory support. We developed three independent features and combined them with a logistic model to predict mortality. Predictive performance was assessed through Bootstrap analysis and validated by another cohort of 27 patients. The values of cfDNA for complications were analyzed by restricted cubic spline analysis, receiver-operating characteristic curves and multivariate regression analyses. Results : A total of 133 adults who underwent VA-ECMO for refractory cardiogenic shock were entered into the derivation cohort. The logistic model, consisted of cfDNA, the worst mean arterial pressure (MAP) before ECMO and the worst lactate within 24 h of VA-ECMO implantation was predictive and performed similarly for validation cohorts (area under the receiver operating characteristic curve: 0.768 vs. 0.747). Restricted cubic spline analysis revealed a positive linear relationship for the risk of limb ischemia (linear, P = 0.006; area under the receiver operating characteristic curve of 0.75 [95% CI, 0.656-0.848]), a U-shaped trend for bleeding events (nonlinear, P = 0.214), and a negative trend for thrombotic events (linear, P = 0.552). Conclusions: In addition to MAP and lactate levels, elevated cfDNA levels within 48 h of ECMO support were highly associated with mortality for patients. Additionally, cfDNA is predictive of limb ischemia.

ObjectiveVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide temporary circulatory and respiratory support allowing hemodynamic stabilization during high-risk transcatheter aortic valve replacement (TAVR). However, the optimal timing of VA-ECMO use in high-risk TAVR remains controversial. We aimed to report our experience using a novel standby ECMO strategy during high-risk TAVR.MethodsWe retrospectively evaluated consecutive patients who received high-risk TAVR with standby ECMO between March 1,2023 and March 1,2024 at the Beijing Anzhen Hospital. Small, 5F or 6F sheaths were placed in ipsilateral femoral vein and artery before TAVR procedures. The primary outcome of this study was survival to hospital discharge with good neurological recovery defined as cerebral performance category (CPC) 1-2.ResultsA total of 24 patients undergoing high-risk TAVR with standby ECMO were included. Six (25.0%) of the 24 patients with standby ECMO suffered from cardiogenic shock or cardiac arrest and required emergency VA-ECMO institution. The median (IQR) cannulation time was 8 (6-11) minutes, and the median (IQR) ECMO duration was 35 (24-48) hours. All of the 24 patients underwent successful TAVR procedures and survival to hospital discharge with CPC1-2.ConclusionsStandby ECMO with preset femoral vascular sheaths was feasible and effective for refractory cardiogenic shock and cardiac arrest during high-risk TAVR.

AbstractAimsTo assess the stage of acute kidney injury (AKI), as an index of organ perfusion, combined with shock severity, measured by the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification, to stratify the risk of mortality in patients diagnosed with cardiogenic shock (CS) and supported with venoarterial extracorporeal membrane oxygenation (VA ECMO).Methods ans resultsFrom January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in‐hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in‐hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in‐hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO.ConclusionsIn this single‐center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in‐hospital mortality.

Background Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery. Methods Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups. Results Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group. Conclusions Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery.

AbstractAimsTo investigate the impact of intra‐aortic balloon pump (IABP) on the regional haemodynamics of patients with severe cardiogenic shock undergoing femoro‐femoral veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO).Methods and resultsFrom July 2017 to April 2018, a total of 39 adult patients with cardiogenic shock receiving both IABP and ECMO for circulatory support were enrolled consecutively in a university‐affiliated cardiac surgery intensive care unit. The blood flow rates (BFRs) of the bilateral femoral artery (IABP side: iFA, ECMO side: eFA) and carotid artery (left: LCA, right: RCA) and the velocity time integral (VTI) of aortic root were assessed by ultrasonography and compared when IABP was on and off. Seventeen of 39 (43.6%) patients survived to discharge, and 29 (74.4%) survived on ECMO. A total of 172 pairs of data (IABP on and off) were collected in this study, measured on the median of 2.0 (1.0, 4.5) days after patients received VA‐ECMO. The BFR on both sides of FA (iFA: 176.4 ± 104.5 vs. 152.2 ± 139.8 mL/min, P < 0.01; eFA: 299.3 ± 279.9 vs. 242.4 ± 258.8 mL/min, P < 0.01) and the aortic VTI (10.1 ± 4.4 vs. 8.5 ± 4.4 cm, P < 0.01) decreased significantly when turning the IABP off, while the BFR on both sides of CA remained unchanged (LCA: 555.7 ± 326.9 vs. 578.6 ± 328.0 mL/min, P = 0.27; RCA: 550.0 ± 331.1 vs. 533.0 ± 303.5 mL/min, P = 0.30). The LCA BFR dramatically increased after turning the IABP off (296.8 ± 129.7 vs. 401.4 ± 278.1 mL/min, P = 0.02) in patients with cardiac stunning (defined as pulse pressure ≤ 5 mmHg). However, there was no significant difference in LCA BFR between IABP‐On and IABD‐Off (359.6 ± 105.4 mL/min vs. 389.6 ± 139.3 mL/min, P = 0.31) in patients with cardiac stunning receiving a higher ECMO blood flow (> 3.5 L/min).ConclusionsConcomitant IABP used in patients undergoing femoro‐femoral VA‐ECMO was associated with increased aortic VTI and BFR in bilateral FA. The change in CA BFR depended on cardiac function. A decreased LCA BFR was observed in patients with cardiac stunning when IABP was turned on, which might be compensated by a higher ECMO blood flow. Further study is needed to confirm the relationship between BFR and extremities and neurological complications.

Objective To investigate the feasibility of drainage from the superior vena cava (SVC) to improve upper body oxygenation in patients with cardiogenic shock undergoing femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods Seventeen adult patients receiving peripheral femoral VA ECMO for circulatory support were enrolled. The femoral drainage cannula was shifted three times (from the inferior vena cava (IVC) level to the SVC level and then the IVC level again), all under ultrasound guidance, at an interval of 15 minutes. The blood gas levels of the right radial artery (RA) and SVC and cerebral oxygen saturation (ScO2) were measured and compared. Results Fifteen patients (88.2%) were successfully weaned from ECMO, and 12 patients (70.6%) survived to discharge. The oxygen saturation (SO2) and oxygen partial pressure (PO2) of the RA (97.0 ± 3.5% to 98.3 ± 1.5%, P < 0.05, SO2; 127.4 ± 58.2 mmHg to 153.1 ± 67.8 mmHg, P < 0.05, PO2) and SVC (69.5 ± 9.0% to 75.7 ± 8.5%, P < 0.05, SO2; 38.5 ± 5.6 mmHg to 43.6 ± 6.4 mmHg, P < 0.05, PO2) were increased; ScO2 was also increased on both sides (left: 50.6 ± 8.6% to 55.0 ± 9.0%, P < 0.05; right: 48.7 ± 9.2% to 52.3 ± 9.8%, P < 0.05) when the femoral drainage cannula was shifted from the IVC level to the SVC level. When the femoral drainage cannula was shifted from SVC level to the IVC level again, the SO2 and PO2 of RA (98.3 ± 1.5% to 96.9 ± 3.2%, P <0.05, SO2; 153.1 ± 67.8 mmHg to 125.8 ± 63.3 mmHg, P <0.05, PO2) and SVC (75.7 ± 38.5% to 70.4 ± 7.6%, P <0.05, SO2; 43.6 ± 6.4 mmHg to 38.9 ± 4.5 mmHg, P <0.05, PO2) were decreased; ScO2 was also reduced on both sides (left: 55.0 ± 9.0% to 50.7 ± 8.2%, P < 0.05; right: 52.3 ± 9.8% to 48.7 ± 9.3%, P <0.05). Conclusion Drainage from the SVC by shifting the cannula upward could improve upper body oxygenation in patients with cardiogenic shock undergoing femoral VA ECMO. This cannulation strategy provides an alternative solution for differential hypoxia.

Background: Reduction in L-type Ca2+ current (I-Ca,I-L) density is a hallmark of the electrical remodeling in atrial fibrillation (AF). The expression of miR-155, whose predicted target gene is the alpha 1c subunit of the calcium channel (CACNA1C), was upregulated in atrial cardiomyocytes (aCMs) from patients with paroxysmal AF.The study is to determine miR-155 could target the gene expression of I-Ca,I-L and contribute to electrical remodeling in AF. Methods: The expression of miR-155 and CACNA1C was assessed in aCMs from patients with paroxysmal AF and healthy control. I-Ca,I-L properties were observed after miR-155 transfection in human induced pluripotent stem cell derived atrial cardiomyocytes (hiPSC-aCMs). Furthermore, an miR-155 transgene (Tg) and knock-out (KO) mouse model was generated to determine whether miR-155 was involved in I-Ca,I-L-related electrical remodeling in AF by targeting CACNA1C. Results: The expression level of miR-155 was increased, while the expression level of CACNA1C reduced in the aCMs of patients with AF. miR-155 transfection in hiPSC-aCMs produced changes in I-Ca,I-L properties qualitatively similar to those produced by AF. miR-155/Tg mice developed a shortened action potential duration and increased vulnerability to AF, which was associated with decreased I-Ca,I-L and attenuated by an miR-155 inhibitor. Finally, the genetic inhibition of miR-155 prevented AF induction in miR-155/KO mice with no changes in I-Ca,I-L properties. Conclusions: The increased miR-155 expression in aCMs was sufficient for the reduction in the density of I-Ca,I-L and the underlying electronic remodeling. The inhibition of miR-155 prevented I-Ca,I-L-related electric remodeling in AF and might constitute a novel anti-AF approach targeting electrical remodeling.

Alteration of tissue inhibitors of matrix metalloproteinases (TIMP)/matrix metalloproteinases (MMP) associated with collagen upregulation has an important role in sustained atrial fibrillation (AF). The expression of miR-146b-5p, whose the targeted gene is TIMPs, is upregulated in atrial cardiomyocytes during AF. This study was to determine whether miR-146b-5p could regulate the gene expression of TIMP4 and the contribution of miRNA to atrial fibrosis in AF. Collagen synthesis was observed after miR-146b-5p transfection in human induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCMs)-fibroblast co-culture cellular model in vitro. Furthermore, a myocardial infarction (MI) mouse model was used to confirm the protective effect of miR-146b-5p downregulation on atrial fibrosis. The expression level of miR-146b-5p was upregulated, while the expression level of TIMP4 was downregulated in the fibrotic atrium of canine with AF. miR-146b-5p transfection in hiPSC-aCMs-fibroblast co-culture cellular model increased collagen synthesis by regulating TIMP4/MMP9 mediated extracellular matrix proteins synthesis. The inhibition of miR-146b-5p expression reduced the phenotypes of cardiac fibrosis in the MI mouse model. Fibrotic marker MMP9, TGFB1 and COL1A1 were significantly downregulated, while TIMP4 was significantly upregulated (at both mRNA and protein levels) by miR-146b-5p inhibition in cardiomyocytes of MI heart. We concluded that collagen fibres were accumulated in extracellular space on miR-146b-5p overexpressed co-culture cellular model. Moreover, the cardiac fibrosis induced by MI was attenuated in antagomiR-146 treated mice by increasing the expression of TIMP4, which indicated that the inhibition of miR-146b-5p might become an effective therapeutic approach for preventing atrial fibrosis.

Background: Limited research is available on the pattern of double distal perfusion catheters in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with an intra-aortic balloon pump(IABP). Here, we compared the outcomes of a double distal perfusion catheter and conventional treatment in patients who received VA-ECMO with IABP and had severe lower limb ischemia on the IABP side.Methods: We reviewed the data of 15 adult patients with postcardiotomy cardiogenic shock who received VA-ECMO via femoral cannulation combined with an IABP in the contralateral artery that was complicated with severe acute limb ischemia (ALI) on the same side as the IABP between January 2004 and December 2016. Patients underwent symptomatic treatment (conventional group, n = 9) and double distal perfusion catheterization treatment (DDPC group, n = 6). ALI was monitored using near-infrared spectroscopy placed on both calves after double distal perfusion catheters. The outcomes were compared.Results: All 6 patients who underwent double distal perfusion catheters were successfully decannulated without the development of osteofascial compartment syndrome, amputation, or bleeding and infection of the double distal perfusion catheters. The number of patients who weaned from extracorporeal membrane oxygenation successfully in the DDPC and conventional groups was 6 (100%) and 3 (33%, p = 0.028), respectively. The in-hospital mortality rates were 17% and 89% for the DDPC and conventional groups, respectively (p = 0.011).Conclusions: DDPC can be considered a strategy for severe limb ischemia on the IABP side in patients who received femoro-femoral VA-ECMO with IABP.

Background: The target of this study was to explore the outcomes of percutaneous coronary intervention (PCI) in diabetic versus non-diabetic patients with prior coronary artery bypass grafting (CABG) surgery.Methods: Seven hundred and twenty four patients who had previously received CABG and had been treated using PCI combined with drug-eluting stents (DES) between 2009 and 2017 were selected for a retrospective study and allocated into either a diabetes mellitus (DM) or non-diabetes mellitus (No DM) group. A 1:1 propensity score-matched evaluation was conducted and risk adjusted for analysis. The primary outcomes were cardiac death, myocardial infarction, heart failure and revascularization, with a median follow-up duration of 5.13 years.Results: After matching, two-, 5- and 8-year event rate of overall major adverse cardiac events (MACEs) were found to be higher in the DM group (No DM vs DM:15.3%, 30.9%, 38.5% vs 19.8%, 37.8%, 52.2%, respectively), although no significant difference was found in the event rate of overall MACEs (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.83 for DM vs No DM; P=0.052), cardiac death (HR: 0.94; 95% CI: 0.45 to 1.95; P=0.871), MI (HR: 1.49; 95% CI: 0.95 to 2.32; P=0.080), HF (HR: 1.54; 95% CI: 0.90 to 2.63 for; P=0.120) or revascularization (HR: 1.07; 95% CI: 0.72 to 1.59; P=0.747). Subgroup analysis of PCI in only the NCA showed MACEs (adjusted HR: 1.13; 95% CI: 0.85 to 1.49 for DM vs No DM; P=0.325), cardiac death (adjusted HR: 0.85; 95% CI: 0.41 to 1.78 for DM vs No DM; P=0.781), MI (adjusted HR: 1.32; 95% CI: 0.84 to 2.01 for DM vs No DM; P=0.069), HF (adjusted HR: 1.41; 95% CI: 0.87 to 2.27 for DM vs No DM; P=0.211) or repeated revascularization (adjusted HR: 0.93; 95% CI: 0.64 to 1.37 for DM vs No DM; P=0.836).Conclusions : Compared with non-diabetic patients with prior CABG, subsequent implantation of DES in the native coronary artery of diabetic patients resulted in apparently similar outcomes.Trial registration : This study was not registered in an open access database.Key Words: Percutaneous coronary intervention; Diabetic; Non-diabetic; Coronary artery bypass grafting.

Background: Using spectral-domain optical coherence tomography (SD-OCT) to investigate choroidal vascular sublayers in Chinese pre-eclampsia (PE) and healthy pregnancy. Methods: This was an observational, cross-sectional study, including 20 normal subjects, 23 healthy pregnancy and 37 patients with PE. Using SD-OCT, subfoveal choroidal thickness (SFCT)， 750μm nasal and temporal to the fovea, 1500μm nasal and temporal to the fovea（T1500, T750, SFCT, N750, N1500）and sublayers (choriocapillaris/Sattler layer and Haller layer) were measured. Results: There was no significant difference in mean age, spherical equivalent among the three groups ( P =0.532). Additionally, no significant difference in the gestational age between the healthy pregnancy and PE group was found ( P =0.783). Significant differences were seen in large choroid vessel thickness(LCVT), medium choroidal vessel thickness (MCVT) and choroidal thickness (CT) at 5 locations among three groups ( P <0.05). There was significant increase in healthy pregnancy group than in normal subjects at N1500-CT, N750-CT, SFCT, T750-CT and MCVT ( P <0.05), while no significant difference was observed at T1500CT and LCVT ( P >0.05). Meanwhile, significant increase was detected in PE group than in healthy pregnancy group at N1500-CT, N750-CT, SFCT, T750-CT, T1500CT and LCVT ( P <0.05), whereas no significant difference was observed at MCVT( P =0.709). Conclusion: Our study revealed the variation of choroidal vascular sublayers during pregnancy and PE. Key words: Pre-eclampsia, subfoveal choroidal thickness, choroidal sublayers, optical coherence tomography

Objectives. The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). Methods. Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. Results. Patients in the MT group were older and more likely to have chronic lung disease (6.6% vs 3.4%, P=0.026) while patients in the PCI group were more likely to have prior MI (8.8% vs 17.0%, P<0.001). In the MT group, 54.4% of patients had newly developed lesions both in the graft and native coronary artery while 58.1% in the PCI group (P=0.003), and in the MT group, 80.6% had type C coronary artery disease while 60.1% in the PCI group (P<0.001). Patients in the MT group presented higher proportion of diffuse lesions (49.3% vs 15.0%, P<0.001) in native coronary arteries. Conclusion. Patients receiving MT (35.3%) likely had occluded grafts and type C coronary artery disease featuring as diffuse lesions.

Objective To analyze the effect of obstructive sleep apnea syndrome (OSAS) on fundus structure and function.Methods Ninety-nine patients who had polysomnography from March to September 2013 in Beijing Anzhen Hospital,Capital Medical University were divided into 4 groups according to the apnea/hypopnea index(AHI):normal group(n =12,AHI ＜5 times/h),mild group(n =24,AHI 5-15 times/h),moderate group (n =25,AHI 15-30 times/h) and severe group(n =38,AHI ＞30 times/h).Visual field,optic disk,retina and choroid of the right eye were examined in all patients.Relation between fundus indexes and OSAS indexes was analyzed.Prevalence rate of primary open angle glaucoma (POAG) was calculated.Results Mean defect of visual field in severe group was more severe than that in normal group,mild group and moderate group[(-6.2 ±6.0) dB vs (-1.5 ± 1.3),(-2.0 ± 1.5),(-2.2 ± 2.9) dB] (P ＜ 0.05).Pattern standard deviation (PSD) in severe group was significantly higher than that in normal group,mild group and moderate group [(6.1 ± 4.1) dB vs (2.3 ± 1.1),(3.1 ± 2.2),(3.4 ± 2.4) dB] (P ＜ 0.05).Thickness of inferior retinal nerve fiber layer in mild group and moderate group was significantly thinner than that in normal group [(119 ± 18),(112 ± 30) μm vs (136 ± 13) μm];thickness of inferior retinal nerve fiber layer in severe group [(124 ± 22) μm] was significantly thicker than that in moderate group(P ＜ 0.05).Thickness of macula central fovea in severe group was significantly thicker than that in normal group[(252 ± 27) μm vs (231 ± 27) μm] (P ＜ 0.05).Thickness of subfoveal chorioid and thickness of chorioid 1 μm to the nasal side of macula central fovea in moderate group and severe group were significantly thinner than those in normal group [(249 ± 39),(223 ± 57) μm vs (287 ± 39) μm;(239 ± 58),(227 ± 59) μm vs (282 ± 46) μm] (P ＜ 0.05).Orbital intracranial pressure in severe group was significantly higher than that in mild group and moderate group [(16.4 ± 3.9) mmHg vs (15.1 ± 4.2),(15.1 ± 2.9) mmHg] (P ＜0.05).Diastolic pressure in the morning and PSD was positively related to oxygen desaturation index(r =0.343,P =0.001;r =0.429,P ＜0.001).Thickness of subfoveal chorioid and thickness of chorioid 1 μm to the nasal side of macula central fovea were negatively related to oxygen desaturation index(r =-0.395,P ＜ 0.001;r =-0.198,P =0.049).Mean defect of visual field was positively related to nocturnal mean oxygen saturation (r =0.436,P ＜ 0.001).The prevalence rate of POAG was 4.6％ (4/87).Conclusion OSAS can damage visual field,optic disk,retina and choroid.

目的 评估长期服用阿司匹林的老年人在进行非复杂白内障微创手术围手术期中的出血倾向.方法 回顾性分析2014-2016年在我院接受白内障手术的病例资料.病例选择为白内障核Ⅲ级及以下的非复杂老年性白内障病例.手术方法为表面麻醉下经清亮角膜切口行白内障超声乳化摘除联合人工晶体植入术.比较无抗血栓药物服用史的病例(对照组)与长期服用阿司匹林病例(观察组)在术中的出血相关并发症及术后1d、1周出血相关并发症的发生情况.结果 总计纳入625例,625只眼.两组病例均有在术中出现结膜下出血的情况,但差异无统计学意义(P＞0.05).两组术中均未出现其他严重的出血相关并发症.术后1d,两组出血相关并发症的发生率比较差异无统计学意义(P＞0.05).结论 长期服用阿司匹林药物的患者,在接受非复杂白内障微创手术时,出血相关并发症的发生率较小,具有一定的安全性.

Objective To compare different layers of subfoveal choroidal thickness (SFCT) in normal subjects,healthy pregnant women and patients with pre-eclampsia (PE) using optical coherence tomography (OCT).Methods Twenty-two normal subjects,22 healthy pregnant women and 22 PE patients were included.All patients underwent the examinations including the best corrected visual acuity (BCVA),intraocular pressure,slit lamp,and OCT.The OCT examination was performed to measure SFCT,large choroidal vessel thickness (LCVT),and choroidal capillaries/medium choroidal vessel thickness (MCVT),and the differences between the three groups were compared.Results The differences in age and spherical equivalent among normal subjects,healthy pregnant women and patients with pre-eclampsia were not significant (all P ＞ 0.05).The differences in the gestational weeks between healthy pregnant women and PE patients was not significant (P ＞ 0.05).The mean SFCT of the normal group,healthy pregnant group and PE patient group was (263.45 ± 69.66) μm,(310.55 ±55.63) μm,and (350.41 ± 54.32) μm,accordingly,the mean LCVT of the normal group,healthy pregnant group and PE patient group was (188.25 ± 60.88) μm,(213.27 ±65.31) lμm,and (264.77 ± 56.21) μm,respectively;the mean MCVT of the normal group,healthy pregnant goup and PE patient group was (75.20 ± 33.65) μm,(97.27 ±22.14) μm,(85.64 ± 20.93) μm,respectively,with statistically significance in pairwise comparison (all P ＜ 0.05).The mean SFCT and MCVT of healthy pregnant women was significantly increased than that of the normal subjects (both P ＜ 0.05),but not for LCVT (P ＞ 0.05);whereas SFCT and LCVT of PE patients were significantly increased than those of healthy pregnant women (both P ＜ 0.05),but not for MCVT (P ＞ 0.05).Conclusion The SFCT and LCVT in PE patients are both higher than those in healthy pregnant women,and there is no significant difference in MCVT.

为培养学生带着问题学习,在学习中发现和解决问题的自主学习能力,建立"依人治病"的理念,将整合医学理念引入眼科临床教学中,以"青光眼"教学内容为例,从课程准备、内容设计、教学形式3个方面进行改进,结果 显示学生知识掌握度好,对授课满意度提高,有效调动学生积极性,初步培养科研思路,取得较好的实践效果.

Objectlve To assess the clinical effects and safety of intravitreal injection of conbercept and macular photocoagulation for non-ischemic macular edema secondary to branch retinal vein occlusion (BRVO).Methods A total of 50 patients (50 eyes) with non-ischemic macular edema following BRVO were retrospectively analyzed.Patients were divided into 2 groups:ICI group (26 eyes) received intravitreal injection of conbercept,laser group (24 eyes) received standard-of-care grid laser for macular edema.The best-corrected visual acuity (BCVA) and central macular thickness (CMT) were observed before and 1 week,1 month,2 months and 3 months after treatment.Then,the changes in pre-treatment and post-treatment were compared,and the related complications were recorded.Results The difference of BCVA before treatment was not significant between two groups (P ＞ 0.05).BCVA at 1 week,1 month,2 months and 3 months after treatment in two groups were all improved,the differences were statistically significant compared with before treatment (all P ＜ 0.05),and the differences were statistically significant between two groups after treatment (all P ＜0.05).At 3 months after treatment,BCVA of 18 patients (69.23％) in ICI group and 8 patients (33.33％) in ICI group improved 2 lines.The difference of CMT before treatment was not significant between two groups (P ＞ 0.05),CMT at 1 week,1 month,2 months and 3 months after treatment in two groups were all decreased,the differences were statistically significant compared with before treatment (all P ＜ 0.05),and the differences were statistically significant between two groups after treatment (all P ＜0.05).13 eyes received repeat intravitreal injection in ICI group,including 2 eyes at 1 month,7 eyes at 2 months with CMT ＞250 μm,and 3 eyes at 3 months.No severe side effect related with drug and intravitreal injection occurred in the two groups.Conclusion Mean BCVA change and CMT change are significantly greater in the intravitreal injection of conbercept than the standard-of-care grid laser group for the macuiar edema secondary to non-ischemic BRVO.