Central nervous system vascular disease can be combined with a variety of ocular signs, such as orbital pain, flash, visual field defects, vision loss, eye muscle paralysis. Therefore, some patients were first diagnosed in ophthalmology, including aneurysm rupture, arterial dissection, cerebral apoplexy and other critical nervous system diseases that need rapid treatment. If the doctors didn't know enough, the diagnosis and treatment might be delayed. Most of the vascular diseases of the central nervous system related to ophthalmology have clinical manifestations that cannot be explained by ophthalmology. In the face of chronic conjunctivitis, unexplained visual field defect or cranial nerve paralysis with local ineffective treatment, it is necessary to broaden the thinking of differential diagnosis. To understand the characteristics of vascular diseases of the central nervous system that are prone to ocular manifestations can provide references for the clinical diagnosis and treatment of ophthalmology.
ObjectiveTo systematically review the risk factors in elderly patients with primary hypertension with morning blood pressure surge in China, so asto provide references for clinical treatment and prevention of complications. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CNKI, VIP and WanFang Data were electronically searched for the case-control studies about morning blood pressure surge (MBPS) among elderly patients with primary hypertension in China from January 2006 to June 2014 were collected. Literature was screened according to inclusion and exclusion criteria, data were extracted and the methodological quality of the included studies was assessed, and then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 16 studies involving 2 007 cases were finally included, of which 956 cases were detected with MBPS. The results of meta-analysis showed that significant differences were found in glucose levels (MD=0.42, 95%CI 0.04 to 0.81, P=0.03), urinary microalbumin levels (MD=23.85, 95%CI 6.64 to 41.07, P=0.007), incidences of cerebrovascular events (OR=1.96, 95%CI 1.25 to 3.08, P=0.004), carotid atherosclerosis (OR=5.13, 95%CI 1.70 to 15.45, P=0.004) and left ventricular hypertrophy (OR=2.49, 95%CI 1.70 to 3.64, P < 0.000 01), left ventricular mass (MD=12.89, 95%CI 3.94 to 21.84, P=0.005), and carotid artery intima-media thickness (MD=0.08, 95%CI 0.02 to 0.14, P=0.009); while no significant difference was found in gender (OR=1.12, 95%CI 0.84 to 1.49, P=0.44), total cholesterol levels (MD=0.01, 95%CI-0.11 to 0.12, P=0.92), and creatinine levels (MD=1.77, 95%CI-1.16 to 4.70, P=0.24) between patients with or without MBPS. ConclusionCurrent evidence shows that glucose levels, early kidney damage, emergent cerebrovascular events and the reconstruction of the artery and the left ventricle are risk factors of abnormal MBPS in China. However, the above conclusion needs to be verified by further conducting high quality prospective studies.
Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.
ObjectiveTo systematically review the association between insomnia and the risk of hypertension. MethodsThe EMbase, PubMed, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect cohort studies on the association between insomnia and hypertension from inception to October 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 13.0 software. ResultsA total of 20 cohort studies involving 607 409 participants were included. The results of meta-analysis showed that insomnia increased the risk of hypertension (RR=1.24, 95%CI 1.15 to 1.34, P<0.000 1). Subgroup analysis showed that insomnia increased the risk of hypertension in North American, European and Oceanian population, but not in Asian population. The difficulty falling asleep, difficulty maintaining sleep and early awakening all increased the risk of hypertension. ConclusionCurrent evidence suggests that insomnia increases the risk of hypertension.
ObjectiveTo explore the prognostic value of serum cystatin C (Cys C) in patients with congenital heart disease-associated pulmonary arterial hypertension (PAH-CHD).MethodsA retrospective cohort study was conducted on adult PAH-CHD patients who were hospitalized for the first time in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2020. The serum Cys C and other related data of patients were collected. The median follow-up time was 57 months. The main end event was all-cause death. According to the prognosis, the patients were divided into a survival group and a death group. Cox regression was used to analyze the risk factors for all-cause death in patients with PAH-CHD.ResultsA total of 456 patients were enrolled, including 160 males and 296 females, aged 38.99±14.72 years. The baseline data showed that there were statistical differences in resting heart rate, serum Cys C, creatinine, NT-proB-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), high-sensitivity C reactive protein (hs-CRP), New York Heart Association (NYHA) cardiac function classification and serum potassium between the survival group and the death group. Univariate Cox regression analysis showed that serum Cys C, NT-proBNP, hs-cTnT, creatinine and NYHA cardiac function classification were related risk factors for all-cause death in patients with PAH-CHD. Multivariate Cox regression analysis showed that serum Cys C (HR=3.820, 95%CI 2.053-7.108, P<0.001), NYHA grade Ⅲ (HR=2.234, 95%CI 1.316-3.521, P=0.010), NYHA grade Ⅳ (HR=4.037, 95%CI 1.899-7.810, P=0.002) and NT-proBNP (HR=1.026, 95%CI 1.013-1.039, P<0.001) were independent risk factors for all-cause death in patients with PAH-CHD and had a good predictive value.ConclusionAs a new cardiac marker, serum Cys C can predict all-cause death in patients with PAH-CHD and is an independent risk factor.
Objective To observe the incidence of ciliary detachment and its relationship with intraocular hypotension soon after vitrectomy. Methods A total of 46 eyes of 46 patients who underwent vitrectomy were examined by ultrasound biomicroscope (UBM). The patients were divided into three groups according to different tamponade: gas group (11 eyes), silicone oil group (8 eyes) and balanced saline solution (BSS) group (27 eyes). Basing on the postoperative intraocular pressure (IOP), the patients were divided into two groups: IOPlt; 10 mm Hg (25 eyes) and IOPge;10 mm Hg (21 eyes). UBM was applied to determine the tomographic features of the ciliary body 3 days after the surgery. IOP were monitored by noncontact tonometer daily after the surgery. The eyes with ciliary detachment were then examined once a week till the ciliary detachment reattached. The followup period was from 14 to 35 days. Results After vitrectomy, ciliary detachment was observed in 20 eyes of 46 eyes (43.5%), The incidence of ciliary detachment was 27.3％ in gas group, 25.0％ in silicone oil group, and 55.6％in BSS group. The average IOP in eyes with ciliary detachment ［(6.47plusmn;4.49) mm Hg （1 mm Hg=0.133 kPa）］ was significantly lower than that in the eyes without ciliary detachmen ［(15.61plusmn;7.72) mm Hg］ (t=8.031,Plt;0.001). The incidence of ciliary detachment was higher in eyes with postoperative IOP lt;10 mm Hg (68.0％) than that in the eyes with postoperative IOP ge;10 mm Hg (14.3%) (chi;2＝15.60, Plt;0.001). All eyes with postoperative ciliary detachment got spontaneous reattachment within 30 days after the surgery except that one eye had optic disc edema due to severe intraocular hypotension. Conclusions Early postoperative ciliary detachment is a common complication after vitrectomy. Eyes filled with BSS have the highest incidence of postoperative ciliary detachment. Most of the patients with ciliary detachment may get spontaneous reattahment within 30 days after the surgery.
ObjectiveTo analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.MethodsThe clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.ResultsThe rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.ConclusionFor patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.
【Abstract】Objective To explore the dynamic expression of TNF-α and VEGF in the development of esophageal varices in rats with portal hypertension. Methods Sixty male SD rats were randomly divided into the experimental group and the control group. In the experimental group, a two-stage ligation of portal vein plus ligation of the left adrenal vein was performed.After establishment of the model, the expression of TNF-α、VEGF and PCNA in the lower esophagus was detected with immunohistochemical SP technique on 7 d、14 d、21 d and comparision of these data with control group was performed respectively. In the control group, a sham-operation was performed, was also divided.Results The portal venous pressure in the experimental group was significantly higher than that of the control, so did the vessel number and the total vascular area of the submucosal veins in the lower esophagus. Compared with the control subgroups, the expression of TNF-α and VEGF on the 21 d subgroup was ber, while PCNA was ber on the 14 d and 21 d. Conclusion In the development of esophageal varices of portal hypertension, VEGF possibly plays a role in the varices developemt, and TNF-α may be responsible for the damage of esophageal mucosa.