Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus

ObjectiveTransvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. MethodsIn this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. ResultsDespite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. ConclusionThe use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.     

Effects of 10-Day Complete Fasting on Physiological Homeostasis,Nutrition and Health Markers in Male Adults

Fasting shows great potential in preventing chronic diseases and has to be surmounted under some extraordinary circumstances. This study aimed to investigate the safety, time effects of metabolic homeostasis and health indexes during prolonged fasting. Thirteen participants were recruited to conduct a 10-day complete fasting (CF) in a controlled health research building under medical supervision including 3-day Baseline (BL), 10-day CF, 4-day calorie restriction (CR) and 5-day full recovery (FR). Body healthy status was assessed by surveying pulse, blood pressure, body weight (BW), blood glucose and ketones, body composition and nutritional and biochemistry indexes at different times. BW declined about 7.28 kg (−9.8%) after 10-day CF, accompanied by increased pulse and decreased systolic blood pressure, but there were no changes to the myocardial enzymogram. Body composition analysis showed fat mass was constantly lost, but lean mass could recover after CR. The energy substrate switch from glucose to ketone occurred and formed a stable dynamic balance between 3–6 days of CF. The lipid metabolism presented increased total cholesterol, LDL-C, ApoA1 and almost no changes to TG and HDL-C. Prolonged CF did not influence liver function, but induced a slight decrease of kidney function. The interesting results came from the marked increase of lipid-soluble vitamins and a significant decrease of sodium and chlorine. Adults could well tol-erate a 10-day CF. A new metabolic homeostasis was achieved. No vitamins but NaCl supplement should be considered. These findings provide evidence to design a new fasting strategy for clinical practice.     

MicroRNAs in laser-induced choroidal neovascularization in mice and rats: their expression and potential therapeutic targets

Choroidal neovascularization characterizes wet age-related macular degeneration. Choroidal neovascularization formation involves a primarily angiogenic process that is combined with both inflammation and proteolysis. A primary cause of choroidal neovascularization pathogenesis is alterations in pro-and anti-angiogenic factors derived from the retinal pigment epithelium, with vascular endothelium growth factor being mainly responsible for both clinical and experimental choroidal neovascularization. MicroRNAs(miRNAs) which are short, non-coding, endogenous RNA molecules have a major role in regulating various pathological processes, including inflammation and angiogenesis. A review of recent studies with the mouse laser-induced choroidal neovascularization model has shown alterations in miRNA expression in choroidal neovascularization tissues and could be potential therapeutic targets for wet age-related macular degeneration. Upregulation of miR-505(days 1 and 3 post-laser), miR-155(day 14) occurred in retina; miR-342-5 p(days 3 and 7), miR-126-3 p(day 14) in choroid; miR-23 a, miR-24, miR-27 a(day 7) in retina/choroid; miR-505(days 1 and 3) in retinal pigment epithelium/choroid; downregulation of miR-155(days 1 and 3), miR-29 a, miR-29 b, miR-29 c(day 5), miR-93(day 14), miR-126(day 14) occurred in retinal pigment epithelium/choroid. Therapies using miRNA mimics or inhibitors were found to decrease choroidal neovascularization lesions. Choroidal neovascularization development was reduced by overexpression of miR-155, miR-188-5 p, miR-(5,B,7), miR-126-3 p, miR-342-5 p, miR-93, miR-126, miR-195 a-3 p, miR-24, miR-21, miR-31, miR-150, and miR-184, or suppression of miR-505, miR-126-3 p, miR-155, and miR-23/27. Further studies are warranted to determine miRNA expression in mouse laser-induced choroidal neovascularization models in order to validate and extend the reported findings. Important experimental variables need to be standardized; these include the strain and age of animals, gender, number and position of laser burns to the eye, laser parameters to induce choroidal neovascularization lesions including wavelength, power, spot size, and duration.     

Reaching the Final Endgame for Constant Waves of COVID-19

Despite intramuscular vaccines saving millions of lives, constant devastating waves of SARS-CoV-2 infections continue. The elimination of COVID-19 is challenging, but necessary in order to avoid millions more people who would suffer from long COVID if we fail. Our paper describes rapidly advancing and innovative therapeutic strategies for the early stage of infection with COVID-19 so that tolerating continuing cycles of infection should be unnecessary in the future. These therapies include new vaccines with broader specificities, nasal therapies and antiviral drugs some targeting COVID-19 at the first stage of infection and preventing the virus entering the body in the first place. Our article describes the advantages and disadvantages of each of these therapeutic options which in various combinations could eventually prevent renewed waves of infection. Finally, important consideration is given to political, social and economic barriers that since 2020 hindered vaccine application and are likely to interfere again with any COVID-19 endgame.     

三氧化二砷治疗急性早幼粒细胞白血病过程中高白细胞血症和维甲酸综合征的特点

目的:为明确三氧化二砷(亚砷酸,ATO)在初治和全反式维甲酸(all trans retinoicacid,AT RA)治疗后复发的急性早幼粒细胞白血病(acute promyelocyticleukemia,APL)的诱导缓解时,引起高白细胞血症(leukocytosis)和维甲酸综合征(reti noicacidsyndrome,RAS)的发生规律。方法:初治和复发的APL共30例,ATO10mg/d进行诱导缓解治疗。结果:30例患者中23例(77%)达到完全缓解,达到缓解平均时间37.1d。发生高白细胞血症有14例(47%),出现高白细胞血症平均时间为12.9d,发生高白细胞血症患者的白细胞平均基础值为3.1×109L-1,未发生高白细胞血症患者的白细胞平均基础值为2.6×109L-1,两者差异有统计学意义,z=-2.635,P=0.008,所有患者均未采用细胞毒药物治疗,白细胞均恢复至正常水平。RAS有9例(30%),发生RAS的平均时间为13.9d,发生RAS患者的白细胞平均基础值为3.6×109L-1,未发生RAS患者的白细胞平均基础值为2.6×109L-1,z=-1.909,P=0.046,无1例因RAS死亡。结论:ATO对初治和复发的APL诱导缓解安全有效,ATO诱导APL缓解时引起的高白细胞血症及RAS与白细胞基础水平有关,在诱导缓解过程中发生的RAS与高白细胞血症有一定相关性。高白细胞血症可以通过继续应用ATO逐渐恢复。     

胰岛素对人乳腺癌细胞株化疗增效作用的体外研究

目的：探讨用胰岛素提高肿瘤细胞生长代谢水平对化疗药物敏感性的影响。方法：以体外培养的人乳腺癌细胞株（MBA-MD-543）为靶细胞,以胰岛素作为代谢促进剂,运用四氮唑盐、直接细胞计数等方法观察化疗药物诺维本与胰岛素对MBA-MD-543细胞活力及细胞代谢,细胞总数等的影响。结果：胰岛素（0．5～16mU／mL,8～18h）使MBA—MD-543的细胞活力及细胞代谢增加,胰岛素（7．5mU／mL）可以增加诺维本的细胞毒作用。结论：在体外,胰岛素可诱导人乳腺癌细胞株MBA-MD-543增殖,胰岛素对诺维本有一定的化疗增效作用,其用药时机和浓度的选择是实现增效的关键。“提高癌细胞的生长代谢水平,继之给予化疗,可提高化疗药物细胞毒作用”是可行的。     

血管内皮细胞功能紊乱与动脉粥样硬化研究进展

血管内皮细胞的功能状态在局部血管舒张、氧自由基产生和维持血管稳态中起重要作用。内皮细胞的功能紊乱是导致动脉粥样硬化的重要因素之一。因此,维持内皮功能的常态,对预防和治疗动脉粥样硬化具有重要意义。简介导致血管内皮细胞功能紊乱的因素和相关临床治疗策略,旨在为预防和治疗动脉粥样硬化提供新思路。     

慢性乙型肝炎治疗性疫苗研究进展

目前慢性乙型肝炎（CHB）抗病毒治疗的预定目标是“功能性治愈”。用目前可及的治疗药物,只有小部分CHB患者得以实现。针对乙肝病毒（HBV）的特异性免疫反应功能失调被认为是导致HBV持续感染的主要原因,调节宿主免疫系统以加强特定的细胞免疫反应可能有助于清除HBV。治疗性疫苗,包括蛋白质（HBsAg/preS和HBcAg）、DNA和基于病毒载体的疫苗,能够诱导和加强针对HBV的特异性免疫反应。至今已进行50多项临床试验来评估CHB治疗中的治疗性疫苗,其中一些结果显示出免疫治疗的潜力。综述慢性HBV感染治疗性疫苗有关的基础和临床研究进展,讨论目前临床试验不理想的结果和未来策略。     

温经通胞饮联合宫腹腔镜对输卵管阻塞性不孕症患者的疗效研究

目的 探讨温经通胞饮联合宫腹腔镜对输卵管阻塞性不孕症患者的疗效。方法 选取2017年5月—2019年5月66例在河南中医药大学第一附属医院妇科住院治疗的通过宫腹腔镜联合手术获得输卵管复通的输卵管阻塞性不孕症（寒凝血瘀型）患者作为研究对象,采用简单随机法分组,将其分为2组,对照组予以常规治疗,观察组予以常规治疗+温经通胞饮治疗。比较2组患者治疗效果、输卵管通畅情况、妊娠情况、不良反应发生情况以及治疗前后炎性指标和血流变指标。结果 2组患者治疗有效率分别为66.67%,93.94%,观察组患者治疗有效率高于对照组（P<0.05）。2组患者治疗后输卵管通畅比较具有统计学差异（P<0.05）,观察组患者输卵管通畅率高于对照组。观察组患者宫内妊娠率高于对照组,未孕率低于对照组（P<0.05）;2组患者异位妊娠率比较无统计学差异。2组患者治疗后白细胞介素6（interleukin,IL-6）、肿瘤坏死因子a （tumor necrosis factor-a,TNF-a）、血浆黏度、高切全血黏度、低切全血黏度水平均低于治疗前（P<0.05）;观察组患者治疗后IL-6、TNF-α、血浆黏度、高切全血黏度、低切全血黏度水平均低于对照组（P<0.05）。2组患者治疗期间均无不良反应情况发生。结论 温经通胞饮联合宫腹腔镜应用于输卵管阻塞性不孕症,可提高治疗效果,提高妊娠率,改善机体炎性状态及血流变。