PurposeRhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is known for its rapid progression and poor prognosis, making it a subject of significant clinical interest due to its complex pathogenesis. This study aims to utilize mass spectrometry for proteomic analysis of vitreous humor to identify proteins and biomarkers critical to the pathophysiology of RRDCD.MethodsData-independent acquisition (DIA) mass spectrometry was employed to analyze vitreous humor samples from RRDCD and Rhegmatogenous retinal detachment (RRD) patients. The analysis focused on identifying differentially expressed proteins (DEPs) and determining their functional roles. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to explore the biological processes and pathways associated with these DEPs. DEPs were validated using ELISA to confirm the reliability of the mass spectrometry results.ResultsA total of 237 DEPs were identified, including 63 upregulated and 174 downregulated proteins. GO functional analysis showed enrichment in terms related to molecular function regulators, biological adhesion, and the extracellular region. KEGG pathway analysis revealed significant associations with the Extracellular environment (ECM)-receptor interaction, complement and coagulation cascades, and lysosome pathways. Receiver operating characteristic (ROC) analysis further confirmed that Serum amyloid A-4 protein (SAA4), Inter-alpha-trypsin inhibitor heavy chain H1 (ITIH1), and Vitronectin (VTN) exhibit excellent performance in the diagnosis of RRDCD. Both VTN and SAA4 showed positive correlations with BCVA at 6 months post-surgery.ConclusionRRDCD activates a variety of cellular pathways, not only complement and inflammation, but also the remodeling of the extracellular matrix and the activation of lysosome-related pathways disrupt normal retinal cell function. SAA4, ITIH1, and VTN in vitreous fluid can serve as effective biomarkers for diagnosing patients with RRDCD. Additionally, both VTN and SAA4 are correlated with post-operative visual outcomes.

PURPOSE:Glucocorticoids are widely used for their anti-inflammatory properties, but their specific molecular mechanisms in treating rhegmatogenous retinal detachment with choroidal detachment (RRDCD) remain unclear. This study aims to identify key regulatory factors in the vitreous humor of RRDCD patients and analyze protein changes after hormonal intervention. METHODS:Vitreous fluid samples were collected during surgery from patients with rhegmatogenous retinal detachment (RRD, n = 40), non-glucocorticoid treated RRDCD (nT-RRDCD, n = 35), and glucocorticoid-treated RRDCD (T-RRDCD, n = 32). Primary outcomes were retinal reattachment status and best-corrected visual acuity (BCVA) at 6 months postoperatively. Proteomic analysis was performed using data-independent acquisition (DIA), with differentially expressed proteins validated by parallel reaction monitoring (PRM) and ELISA. RESULTS:Between RRD and nT-RRDCD, 203 differentially expressed proteins were identified, while 295 proteins were differentially expressed between nT-RRDCD and T-RRDCD. These proteins were involved in complement activation, immune response, blood coagulation, and MAPK signaling. Apolipoprotein D (APOD) and vitronectin (VTN) positively correlated with postoperative BCVA. APOD, serum amyloid A-4 (SAA4), and ubiquitin-conjugating enzyme E2 variant emerged as potential diagnostic biomarkers for RRDCD. CONCLUSIONS:RRDCD development involves multiple factors. Glucocorticoids mitigate retinal damage by suppressing inflammation, regulating oxidative stress, and promoting cell repair. APOD and VTN correlate with BCVA, while APOD, SAA4, and ubiquitin-conjugating enzyme E2 show promise as diagnostic biomarkers for RRDCD.

Objective:To investigate the trends in cataract-related blindness and vision impairment burden among cataract patients in China, the largest developing country, from 1990 to 2021, providing evidence to inform future cataract prevention and control strategies in developing countries. Patients and methods:This study utilized data from the Global Burden of Disease (GBD) 2021 database to assess the prevalence, age-standardized prevalence rates (ASPR), and years lived with disability (YLDs) associated with cataract-related blindness and visual impairment in China and other regions from 1990 to 2021. Joinpoint regression, decomposition analysis, and ARIMA modeling were employed to analyze trends and predict future disease burden. Results:From 1990 to 2021, the number and crude rate for cataract related blindness and visual impairment increasing significantly in China. The age-standardizes rate increased from 878.30 to 989.58 per 100,000 population for cataract prevalence, and from 73.40 to 61.39 per 100,000 population for cataract YLDs. The majority of number of prevalence and YLDs are concentrated in the 65-89 age range. Women had higher cataract prevalence and YLDs than men. Population aging is the primary driver of the growing burden of cataract, contributing 73.12% and 98.3% to the increases in prevalence and YLDs, respectively. By 2035, the crude prevalence rate and crude YLDs rate of cataracts are projected to increase by 26.06% and 23.03%, respectively, compared to 2021. The age-standardized prevalence and YLDs rate attribute to cataract in China were lower than global averages and ranked third among neighboring countries. Conclusion:Despite advancements in cataract treatment that have alleviated some of the disease burden, population growth and aging continue to drive the increasing prevalence of cataract-related vision impairment in China. Addressing gender disparities and improving access to cataract surgery and preventive care are crucial for reducing this growing burden.

Background:Malnutrition poses a significant public health challenge, particularly as the global population ages. However, there is a notable lack of comprehensive literature analyzing the global burden of malnutrition among the elderly. Methods:Data on nutritional deficiencies indicators-prevalence, incidence, and disability-adjusted life years (DALYs)-for individuals aged 70 and older were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) database from 1990 to 2021. The estimated annual percentage change (EAPC) was used to assess trends in malnutrition burden. Predictions for new cases over the next 25 years were also made. Results:In 2021, over 97.60 million cases of malnutrition among the elderly were reported globally, a 1.2-fold increase from 44.36 million cases in 1990. The global prevalence rate of malnutrition has decreased with an EAPC of -0.32%. Women experienced more cases than men but had a lower prevalence rate. Furthermore, in high socio-demographic index (SDI) regions, both prevalence rate and DALYs rates increased from 1990 to 2021, with EAPCs of 0.33% and 1.34%, respectively. The burden of malnutrition in the elderly was negatively correlated with SDI. Predictions from 2022 to 2046 estimated approximately 29.64 million new cases of malnutrition by 2046, despite a declining incidence rate. Conclusion:Despite a decline in malnutrition prevalence rate and DALYs rate since 1990, the burden remains high, particularly in high SDI regions where rates have increased. With a projected rise in new cases, effective prevention and management strategies are urgently needed to support the health of older adults.

Introduction:Retinopathy is a multifactorial disease influenced by metabolism, immunity, inflammation, and other factors. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional score that has shown promise in various health contexts. This study aims to investigate the association between the CALLY index and retinopathy risk, and to compare its predictive performance with other established inflammatory markers. Methods:Data from 5,439 participants in the 2005-2008 National Health and Nutrition Examination Survey (NHANES) were utilized. Multivariable-weighted logistic regression was employed to assess the association between the CALLY index and retinopathy risk. Additionally, the predictive performance of the CALLY index was compared with other inflammatory markers. Mediation analysis was conducted to explore potential mediating factors in the association between the CALLY index and retinopathy. Results:Multivariable-weighted logistic regression revealed a significant inverse association between the CALLY index and retinopathy risk (OR = 0.96, 95% CI = 0.94-0.98, P = 0.002). Participants in the highest CALLY index quartile exhibited a markedly lower risk of retinopathy (P < 0.001). The CALLY index demonstrated superior predictive performance compared to other inflammatory markers, with an area under the curve (AUC) of 0.672 (95% CI = 0.643-0.701). Mediation analysis indicated that high-density lipoprotein (HDL) levels partially mediated the association between the CALLY index and retinopathy. Discussion:These findings highlight the CALLY index as a reliable, independent biomarker for retinopathy risk assessment, outperforming traditional inflammatory markers and oering potential clinical value for early identification of retinopathy in individuals with chronic diseases.

Previous observational studies have reported inconsistent associations between air pollution and autoimmune eye diseases (AEDs). The primary objective of this Mendelian randomization (MR) study was to investigate the causal link of air pollution with AEDs risk. The instrumental variables were selected based on genome-wide association study data. Univariable and multivariable MR analyses were conducted to disentangle the causality of air pollutants with AEDs. The estimates of univariable MR analysis revealed a suggestively causal link between NO2 or NOx exposure and diabetic retinopathy (OR=1.29, 95% CI=1.05-1.58, P=0.015; OR=1.33, 95% CI=1.05-1.69, P=0.019, respectively). A suggestive association was observed between PM2.5 exposure and age-related macular degeneration (OR=1.46, 95% CI=1.09-1.97, P=0.013). In addition, multivariable MR indicated that the observed association was remained consistent and robust. Rigorous sensitivity analyses confirmed the robustness and consistency of these findings. Our study firstly provided the genetic evidence linking air pollution, specially NO2, NOx and PM2.5, to AEDs susceptibility.

PurposeThis meta-analysis discusses the effectiveness of steroid intervention before vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment.MethodsWe searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies published until August 2023. We included studies involving: patients with rhegmatogenous retinal detachment associated with choroidal detachment with proliferative vitreoretinopathy; an experimental group that was not administered steroids and a control group that was administered steroids; and assessment of visual acuity, retinal reattachment rate, and complications. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis.ResultsTwo randomized controlled trials and four case-control studies involving 490 eyes were included in the meta-analysis. There were no significant differences in the primary and final retinal reattachment rates after surgery between the steroid and non-steroid groups (primary retinal reattachment rate: odds ratio = 1.01, 95% confidence interval = 0.63-1.63, p = .41; final retinal reattachment rate: odds ratio = 0.82, 95% confidence interval = 0.43-1.59, p = .33). There was no statistically significant difference in postoperative visual acuity improvement between the two groups (odds ratio = 1.19, confidence interval = 0.63-2.25, p = .69). In addition, subgroup analyses of different types of steroids showed that systemic and local administration of steroids had similar results for retinal reattachment rate and visual acuity improvement.ConclusionPatients with rhegmatogenous retinal detachment associated with choroidal detachment who did not receive preoperative steroids achieved the same effect as patients with rhegmatogenous retinal detachment associated with choroidal detachment who did receive preoperative steroids in terms of retinal reattachment rate and visual acuity. It is recommended that patients with rhegmatogenous retinal detachment associated with choroidal detachment undergo surgery as promptly as possible.

Acute kidney injury (AKI) is a common complication in patients supported by extracorporeal membrane oxygenation (ECMO). Vasoactive-Inotropic Score (VIS) serves as an indicator of the extent of cardiovascular drug support provided. Our objective is to assess the relationship between the VIS and ECMO-associated AKI (EAKI). This single-center retrospective study extracted adult patients treated with ECMO between August 2016 and September 2022 from an intensive care unit (ICU) in a university hospital. A total of 126 patients requiring ECMO support were included in the study, of which 76% developed AKI. Multivariate logistic regression analysis identified VIS-max Day1 (odds ratio [OR]: 1.025, 95% confidence interval [CI]: 1.007-1.044, p = 0.006), VIS-max Day2 (OR: 1.038, 95% CI: 1.007-1.069, p = 0.015), VIS-mean Day1 (OR: 1.048, 95% CI: 1.013-1.084, p = 0.007), and VIS-mean Day2 (OR: 1.059, 95% CI: 1.014-1.107, p = 0.010) as independent risk factors for EAKI. VIS-max Day1 showing the best predictive effect (Area under the receiver operating characteristic curve (AUROC): 0.80, sensitivity: 71.87%, specificity: 80.00%) for EAKI with a cutoff value of 33.33. Surprisingly, VIS-mean Day2 was also excellent at predicting 7 day mortality (AUROC: 0.77, sensitivity: 87.50%, specificity: 56.38%) with a cutoff value of 8.67. In conclusion, VIS could independently predict EAKI and 7 day mortality in patients with ECMO implantation, which may help clinicians to recognize the poor prognosis in time for early intervention.

Purpose To explore short-term changes in corneal astigmatism after combined silicone oil removal and cataract (SORC) surgery. Methods We enrolled 89 patients (43 men and 46 women). Zeiss IOLMaster was used to measure corneal astigmatism status and axial length on the day before and after the SORC surgery. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded. The results were compared to the outcomes at 3 days, 1 week, and 1 month postoperatively. Results Compared to baseline, K1 decreased significantly at 3 days postoperatively (P = 0.016), 1 week (P = 0.009), and 1 month (P = 0.035), while K2 increased significantly at 3 days postoperatively (P = 0.002), 1 week (P < 0.001), and 1 month (P = 0.001), as well as corneal astigmatism (all P < 0.001). Compared to that at the baseline, BCVA significantly improved at 3 days, 1 week, and 1 month postoperatively (all P < 0.001). Meanwhile, IOP decreased significantly at 3 days postoperatively (P < 0.001), 1 week (P = 0.005), and 1 month (P = 0.007). Similarly, axial length decreased at all follow-up time points (all P < 0.001). Conclusion Corneal astigmatism increased in the short term after the SORC operation but gradually decreased at 1 month postoperatively. BCVA improved steadily, and SORC was widely used in the clinic.

Background: Dietary fiber is a functional substance with strong antioxidant activity that plays an important role in human health. Dietary fiber has been shown to reduce the risks of many types of cancers, but whether it can reduce the risk of death in cancer survivors remains undetermined. Methods: This study included the dietary data of cancer survivors who participated in the National Health and Nutrition Examination Surveys from 2001 to 2018. Firstly, the relationship between fiber intake and composite dietary antioxidant index (CDAI) was explored by weighted multiple regression and smooth curve. Subsequently, multivariable Cox proportional hazards regression models were used to explore the effects of dietary fiber intake and CDAI level on the risks of all-cause, tumor, and cardiovascular death among cancer survivors. Results: A total of 2077 participants were included in the study, representing approximately 11,854,509 cancer survivors in the United States. The dietary fiber intake of tumor survivors had a nonlinear positive relationship with CDAI levels (β = 0.24, 95% CI: 0.08–0.40, p = 0.004). Multivariable Cox proportional hazards regression models showed that high dietary fiber intake and CDAI levels were associated with reduced risks of all-cause and tumor death in tumor survivors, but were not associated with the risk of cardiovascular death. Conclusion: An increased dietary fiber intake can enhance the body’s antioxidant capacity. A higher dietary fiber intake and CDAI level may reduce the risk of all-cause and tumor death in tumor survivors.

Purpose Several recent studies have reported a possible association between gut microbiota and intervertebral disc degeneration; however, no studies have shown a causal relationship between gut microbiota and disc degeneration. This study was dedicated to investigate the causal relationship between the gut microbiota and intervertebral disc degeneration and the presence of potentially bacterial traits using two-sample Mendelian randomization. Methods A two-sample Mendelian randomization study was performed using the summary statistics of the gut microbiota from the largest available genome-wide association study meta-analysis conducted by the MiBioGen consortium. Summary statistics of intervertebral disc degeneration were obtained from the FinnGen consortium R8 release data. Five basic methods and MR-PRESSO were used to examine causal associations. The results of the study were used to examine the causal association between gut microbiota and intervertebral disc degeneration. Cochran's Q statistics were used to quantify the heterogeneity of instrumental variables. Results By using Mendelian randomization analysis, 10 bacterial traits potentially associated with intervertebral disc degeneration were identified: genus Eubacterium coprostanoligenes group, genus Lachnoclostridium, unknown genus id.2755, genus Marvinbryantia, genus Ruminococcaceae UCG003, family Rhodospirillaceae, unknown genus id.959, order Rhodospirillales, genus Lachnospiraceae NK4A136 grou, genus Eubacterium brachy group. Conclusion This Mendelian Randomization study found a causal effect between 10 gut microbiota and intervertebral disc degeneration, and we summarize the possible mechanisms of action in the context of existing studies. However, additional research is essential to fully understand the contribution of genetic factors to the dynamics of gut microbiota and its impact on disc degeneration.

BackgroundAutoimmunity and inflammation are the main characteristics of rheumatic diseases and have both been found to be related to glaucoma. However, it remains unclear whether rheumatic diseases increase the risk of glaucoma. Here, we performed a Mendelian randomization (MR) analysis to investigate the causal effects of six common rheumatic diseases on glaucoma.MethodsSix rheumatic diseases were included: ankylosing spondylitis (AS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sicca syndrome/Sjögren’s sydrome (SS), dermatomyositis (DM), and gout. Glaucoma included primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Genetic variants associated with these rheumatic diseases and glaucoma were extracted from the genome-wide association studies and FinnGen8 database, respectively. First, a two-sample MR was used to investigate the potential causal association. Then, a multivariable MR was conducted to further verify the results. Inverse-variance weighted MR analysis was used as the main method, together with several sensitivity analyses.ResultsTwo-sample MR suggests that AS is related to a higher risk of both POAG [odds ratio (OR): 1.28, 95% confidence interval (CI) 1.13–1.44; p = 1.1 × 10−4] and PACG (OR: 1.55, 95% CI: 1.09–2.09, p = 1.4 × 10−2). Multivariable MR shows a similar trend of the effect of AS on POAG (OR: 1.52, 95% CI: 1.22–1.90, p = 1.9 × 10−4) and PACG (OR: 2.05, 95% CI: 1.06–3.95, p = 3.2 × 10−2). No significant association was observed between the other five rheumatic diseases and glaucoma.ConclusionsAS is related to an increased risk of POAG and PACG. We stress the importance of glaucoma screening for AS patients.

BackgroundCortisol plays a role in the pathogenesis of central serous chorioretinopathy (CSC). CSC patients have abnormal time-dependent changes in cortisol levels. Here we report a rare case of a patient with central serous chorioretinopathy whose pigment epithelial detachment (PED) exhibited time-dependent recurrence and resolution.Case presentationA 47-year-old man presented in 2016 for vision loss in the left eye related to recurrent CSC. During follow-up, his PED was observed to resolve spontaneously while he was still in our clinic and recurred the next morning. Such time-dependent changes of the PED were observed in several next follow-ups without any intervention. After excluding possible external factors, the abnormal diurnal variation of cortisol was considered as the internal factor affecting PED.ConclusionsThis is the first article that described the spontaneous time-dependent recurrence and resolution of PED without external interference, where endogenous cortisol may be responsible. Interventions against the abnormal cortisol level might be a potential treatment strategy for CSC. More research is urged to explore the impact of the diurnal change in cortisol levels on eyes with CSC.

INTRODUCTION:The inverted internal limiting membrane (ILM) flap technique was initially developed for the closure of large macular holes (MHs). However, its efficacy in treating small holes has been a matter of debate. This study aimed to compare the anatomical and visual outcomes of vitrectomy (PPV) combined with the inverted ILM flap and ILM peeling in cases of small and medium-sized MHs.METHODS:A meta-analysis was conducted by searching the relevant literature in databases, including PubMed, Web of Science, Embase, and Cochrane Library. The search included articles published from the inception of the databases up until January 2023. The inclusion criteria limited the studies to only experimental-based research. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis.RESULTS:Five studies, including two non-randomized concurrent control trials and three non-randomized concurrent control trials, comprising a total of 269 eyes, were analysed. The results showed no significant difference in the MH closure rate between the two groups (odds ratio (OR) = 0.29, 95% confidence interval: 0.04-1.96, p = 0.33). Furthermore, there were no significant differences observed in visual acuity, external limiting membrane (ELM), and ellipsoid zone (EZ) integrity at 3 months (ELM OR = 0.88, EZ OR = 0.85) or 12 months (ELM OR = 0.96, EZ OR = 1.39) post-operation between the two groups.CONCLUSION:The surgical repair of MHs smaller than 400 μm with ILM flap seems to be similar in visual acuity improvement and anatomical recovery compared to the traditional technique.

PURPOSE:To present and compare the clinical features and multimodal imaging (MMI) findings of the primary form of multiple evanescent white dot syndrome (MEWDS) and MEWDS secondary to multifocal choroiditis/punctate inner choroidopathy (MFC/PIC).METHODS:A prospective case series. Thirty eyes of 30 MEWDS patients were included and divided into the primary MEWDS group and MEWDS secondary to MFC/PIC group. Demographic, epidemiologic, and clinical characteristics and MEWDS-related MMI findings of the two groups were compared.RESULTS:Seventeen eyes from 17 patients with primary MEWDS and 13 eyes from 13 patients with MEWDS secondary to MFC/PIC were evaluated. Patients with MEWDS secondary to MFC/PIC tended to have a higher degree of myopia than those with primary MEWDS. No other significant differences in demographic, epidemiologic, and clinical characteristics and MMI findings were found between the two groups.CONCLUSION:"MEWDS-like reaction" hypothesis seems to be correct for MEWDS secondary to MFC/PIC, and the authors highlight the importance of MMI examinations in MEWDS. Further research is needed to confirm whether the hypothesis is applicable to other forms of secondary MEWDS.

OBJECTIVE:The aim of the study was to quantify the macular vascular density and retinal thickness in the eyes of young myopic people with myopia without pathological changes using optical coherence tomography angiography (OCTA).PATIENTS AND METHODS:In this cross-sectional study, 160 eyes of 80 myopia subjects without pathological changes were classified into three groups: mild myopia (N=40 eyes), moderate myopia (N=66 eyes), and high myopia (N=54 eyes). Macular vascular density (VD), retinal thickness, area of the foveal avascular zone, the flow area of the outer retina and choriocapillaris (CC) were measured using OCTA. The effects of other confounding factors including axial length, the spherical equivalent, and some systemic factors (blood pressure, height, weight, etc.) were also considered.RESULTS:As the severity of myopia increases, the CC flow area decreased (p=0.029). The superficial VD in the temporal, superior, nasal, and inferior regions was significantly lower in high myopia group compared to moderate and low myopia groups (all p<0.001). With increasing myopia, a significant reduction of deep VD was found in the superior region of the macula (p=0.007). In the fovea, there was no difference in the superficial or deep VD across groups (p=0.268 and p=0.413, respectively). Parafoveal retinal thickness was thinnest in the high myopia group and thickest in the mild myopia group (all p<0.05). The fovea was thickest in the high myopia group and thinnest in the mild myopia group (p=0.030).CONCLUSIONS:In young myopic people without pathological changes, superficial VD and retinal thickness decreased with myopia progression, except in the fovea. The CC flow area decreased with increasing myopia.

Background:The coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods:In this retrospective, single-center, case series study, patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8th, 2020, to March 24th, 2020, with the final follow-up date of April 20th, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results:The study included 46 COVID-19-associated ARDS patients who required IMV. The median age of the 46 patients was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR]: 6.0-27.3) days, and the median respiratory support decision score was 11.0 (IQR: 7.8-16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3-17.0] vs. 8.5 (6.0-10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657-0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions:For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

目的:研究长春胺对非动脉炎性前部缺血性视神经病变(NAION)大鼠模型的潜在神经保护作用.方法:90只SD大鼠随机分为正常组、单纯模型组、造模羧甲基纤维素钠灌胃组(NaCMC)组、长春胺组、造模PI3K抑制剂LY294002玻璃体腔注射(IVT LY)+长春胺组、造模DMSO玻璃体腔注射(IVT DMSO)+长春胺组.对各组进行眼底照相,眼底荧光血管造影,血清一氧化氮(N0)浓度检测,HE染色观察视网膜形态,甲苯胺蓝染色观察视神经轴突形态,免疫荧光染色计数视网膜神经节细胞(RGCs),实时定量PCR检测p-AKT、eNOS含量.结果:rNAION大鼠(rNAION)造模成功后第1天即可见大鼠视盘水肿,边界模糊.造模后第28天,长春胺组的NO浓度显著高于正常对照组、单纯模型组及NaCMC组.与单纯模型组相比,长春胺组RGCs数量明显增加(P＜0.05),p-AKT、eNOS含量明显增加(P＜0.05).IVT LY+长春胺组RGCs数量及p-AKT、eNOS含量较长春胺组明显减少(P＜0.05).结论:长春胺可能通过PI3K/AKT/eNOS信号通路发挥视神经保护作用,有望成为NAION的有效治疗药物.

Background Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature. Case presentation A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole. Conclusions This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.

Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA).Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4 mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively).Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023).Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.