Comparison of multiple imaging modalities for measuring orifice diameter and selecting occluder size in patients undergoing left atrial appendage closure

BackgroundLeft atrial appendage (LAA) closure (LAAC) can safely and effectively prevent stroke events caused by atrial fibrillation. However, the structure of the LAA is highly variable among individuals, and the optimal method for obtaining measurements remains unknown.HypothesisWe aimed to study the accuracy of left atrial computed tomography angiography (CTA), three‐dimensional (3D) reconstruction using CTA, two‐dimensional transesophageal echocardiography (2D‐TEE), and digital subtraction angiography (DSA) for measuring the diameter of the LAA and compare their value for selecting occluder size.MethodsWe retrospectively evaluated data for 148 patients with nonvalvular atrial fibrillation who underwent successful LAAC. CTA and 2D‐TEE of the left atrium and pulmonary vein were performed before LAAC. We performed 3D reconstruction of the left atrium and LAA using Mimics and 3‐matics software. DSA of the LAA was performed during surgery.ResultsValues measured via CTA 3D reconstruction were significantly higher than those measured using other methods. DSA‐measured values were significantly lower than those measured via CTA and CTA 3D reconstruction. Occluder size was positively correlated with LAA orifice diameter. The differences between occluder size and DSA, 2D‐TEE, CTA, CTA 3D reconstruction measurements were 4.96 ± 2.58, 4.64 ± 2.50, 4.04 ± 1.37, and 2.92 ± 1.38 mm, respectively. Intraclass correlation coefficients for these methods were −.067, .006, .241, and .519, respectively.ConclusionCTA 3D reconstruction provides the best correlation and consistency between the measured LAA orifice diameter and occluder size. Adding 2–4 mm to the maximum LAA orifice diameter based on 3D‐CTA may aid in selecting the appropriate WATCHMAN device.     

Retinal venous occlusion following COVID-19 vaccination: Report of a case after third dose and review of the literature

A 28-year-old, healthy male presented with blurring of vision in the right eye following third dose of the AstraZeneca/COVISHIELD vaccine. Further examination revealed ischemic central retinal vein occlusion, and subsequent laboratory investigations were inconclusive for his eye disease. He responded to pulse corticosteroid and tapering doses of oral corticosteroids without requiring any intra-vitreal injection. Twelve articles were identified with the help of a PubMed literature search, and a short review of these patients was performed. Retinal vein occlusion can occur because of inflammation-induced thrombosis after coronavirus disease 2019 vaccination and may respond to anti-inflammatory therapy.     

超选择眼动脉插管局部溶栓治疗视网膜中央动脉阻塞

目的　观察超选择眼动脉插管灌注尿激酶溶栓治疗视网膜中央动脉阻塞的疗效。方法　经股动脉或颈动脉插管 ,应用微导管技术将导管插入眼动脉局部溶栓治疗 12例中央动脉血栓形成致视力障碍患者。结果　治疗后 ,患者视力有不同程度提高 ,获得了比较满意的效果。结论　正确诊断 ,早期应用超选择局部溶栓、扩血管并尽可能应用较大剂量溶栓药物 ,可能比其他治疗方法更为有效     

冠状动脉慢性闭塞病变介入治疗成功的因素及其对预后的影响

目的　探讨影响冠状动脉 (冠脉 )慢性闭塞病变介入治疗成功的因素及其对预后的影响。方法　在 2 0 0 0年 6月至 2 0 0 3年 4月间对 5 2例冠脉慢性闭塞病变患者行经皮冠脉介入治疗 (PCI) ,其中 30例闭塞冠脉成功开通 (开通组 ) ,2 2例闭塞冠脉无法开通 (未开通组 )。比较两组的临床特点和预后。结果　与未开通组比 ,开通组高血压的发生率 (5 3%对 2 3% )较高 (P <0 .0 5 )。推测的血管堵塞时间较短 (P <0 .0 1) ,总胆固醇含量较低 ,分别为 (4 .8± 0 .85 )和 (5 .6± 1.5 )mmol/L(P <0 .0 5 ) ,闭塞病变呈平齐截断或有桥侧支或在分支开口附近或病变长度较长者比例较低 (17%对 4 5 % ,P <0 .0 5 ) ;随访期无胸痛胸闷者比例较高 (73%对 5 0 % ,P <0 .0 5 ) ;再次PCI ,外科冠脉旁路手术和再次住院的联合终点少 (13%对 36 % ,P <0 .0 5 )。结论　冠脉慢性闭塞病变的PCI成功率与推测的堵塞时间和闭塞病变的形态有关。闭塞病变开通者临床预后较好     

短期视网膜静脉阻塞抗VEGF治疗后黄斑区形态结构分析

通过使用光学相干断层扫描技术（OCT）观察分析视网膜静脉阻塞（RVO）继发黄斑水肿（ME）患者通过玻璃体腔球内注射抗VEGF药物后短期内黄斑区形态结构的变化。     

护理干预对脑血管病患者生活质量的影响

目的探讨影响脑血管病患者生活质量的因素及提高其生活质量的方法,对患者进行相应的护理干预,提高患者的生活质量。方法选择2006年8月-2008年8月在我科住院,经系统治疗后出院的104例脑血管病患者,随机分为干预组和对照组,各52例。干预组：制定个体化的康复训练计划,并对患者及其家属实施为期3个月的系统化护理干预;对照组：实施一般性的出院健康指导。3个月后应用生活质量综合评定问卷（GQOLI）评定并比较两组患者的生活质量。结果干预组的总体生活质量及躯体功能、心理功能、社会功能均较对照组好,物质生活方面两组比较差异无显著性。结论脑血管病患者的生活质量涉及到心身健康多个方面,护理干预可以提高脑血管病患者的生活质量,值得推广。     

新型支架取栓术治疗急性脑动脉闭塞的疗效评估

目的观察新型支架取栓术(Solitaire AB型支架)对急性脑动脉闭塞的疗效。方法收集2016年1月~2017年3月就诊于我院并拟行急诊新型支架取栓术的急性脑动脉闭塞患者32例,观察术后脑血管闭塞再通情况,比较患者术前、术后14 d NIHSS评分,NDS、Fugl-Meyer评定量表(FMA)及日常生活能力Barthel指数。观察术后并发症及死亡率情况。结果 32例脑动脉闭塞患者经过1~3次取栓,30例成功再通,再通率为93.75%。术后14 d NIHSS评分和NDS评分均较术前下降、FMA评分较术前升高(P0.05)。术前术后Barthel指数评分变化较小,差异无统计学意义(P0.05)。术后并发症及不良反应少,死亡率低。结论新型支架取栓术治疗急性脑动脉闭塞再通率较高,神经功能及日常生活能力恢复良好,并发症及不良反应少,死亡率低,总体获益显著。