Blood Reflux Research Articles

Totally endoscopic mitral valve repair with Loop technique

Objective To investigate the clinical effect of totally thoracoscopic Loop technique in the treatment of mitral valve prolapse. Methods From October 2014 to October 2018, 27 patients with mitral valve prolapse in Wuhan Asia Heart Hospital and PKU care Zhuzhou Kind Cardiovascular Disease Hospital were treated with totally thoracoscopic Loop technique (n=27). According to the preoperative computed tomography (CT) measurements of the patients, the artificial chordae tendineae were prefabricated, and the artificial chordae tendineae were placed under the total thoracoscopy and the pericardial annulus was used to shrink the mitral valve. The number of chordae tendineae used, the length of chordae tendineae, aorta occlusion time, transit time and operation time were recorded. The left ventricle diameter, left atrium diameter and cardiac blood reflux before and after treatment were observed. In addition, the overall incidence of complications from thromboembolism and infective endocarditis was monitored. Results After treatment, all patients had no operative deaths, no reoperation, and no important organ complications. After total thoracoscopic Loop technique, the indexes of left ventricular diameter (5.01±0.21) cm and left atrial diameter (3.91±0.21) cm were significantly lower than those before surgery LV (6.17±0.16) cm, LA (5.33±0.18) cm, with significant statistical significance (t=10.100, P<0.01). Transesophageal echocardiography (TEE) examination was performed immediately after surgery. All the cases had mild reflux or no reflux. No postoperative thromboembolism and complications of infective endocarditis occurred, and the overall incidence was significantly lower than that of 7 cases (25.93%) before surgery (χ2=8.043, P<0.05). Conclusion Thoracoscopy can better expose the mitral valve and papillary muscle, and totally thoracoscopy Loop technique is more effective in the treatment of mitral valve prolapse. Key words: Thoracoscopy; Loop technique; Mitral valve prolapse

Aortic Regurgitation.

Aortic regurgitation (AR) is a common form of valvular disease which is characterized by reflux of blood from the aorta into the left ventricle (LV) during diastole. AR results from various etiologies, affecting the aortic valve cusps or the aortic root. The clinical presentation of patients with AR depends on the severity of the regurgitation and differs whether AR develops acutely or if it progresses over a prolonged period, allowing the cardiac chambers to adapt. Echocardiography is the primary method to determine the etiology of AR and to define its severity. We review the current data regarding the diagnosis and treatment of AR. No single parameter is sufficient to determine AR severity; thus, an integrative, multi-parametric approach is required. Echocardiography is key for imaging the aortic valve morphology and flow as well as aortic root and ascending aorta. Determining LV ejection fraction and dimensions is essential for patient management and optimizing timing for intervention. Three-dimensional (3D) echocardiography is useful in the evaluation of AR etiology and severity. The use of Trasncatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery in patients at high operative risk. The diagnosis and management of AR requires a comprehensive approach and routine clinical and echocardiographic follow-up. Surgical or percutaneous therapy is indicated when symptoms develop and in those who have LV dysfunction or LV dilation.

Ultrasound Characteristics of the Nutcracker Syndrome

The article presents the results of color Doppler ultrasonography of the left renal vein and gonadal vein with the determination of the peak systolic velocity of blood flow and abnormal blood reflux in patients with left-sided varicocele.&#x0D; The objective of the research was to compare preoperative ultrasound characteristics of the left renal vein, left gonadal vein, peak systolic velocity of blood flow and the presence of abnormal blood reflux, the formation of ultrasound criteria for the selection of patients for surgical correction of phlebohypertension.&#x0D; Results. Ultrasound signs of aorta mesenteric compression were absent in 24 (24.5%) patients; the signs of aorta mesenteric compression without critical left renal vein stenosis were observed in 64 (65.3%) patients; critical stenosis of the left renal vein was diagnosed in 10 (10.2 %) patients. The patients with critical stenosis of the left renal vein underwent left renal vein transposition.&#x0D; Conclusions. Ivanissevich surgery with prognostically low risk of relapse is recommended for the patients with left-sided varicocele without any signs of aorta mesenteric compression. Patients with the signs of aorta mesenteric compression require clear determination of the degree of left renal vein stenosis. We consider the transposition of the left renal vein to be indicated in case of critical stenosis when the correlation of the diameters of the distal and proximal segments of the left renal vein is ≥ 3 and the ratio of peak systolic velocities in the proximal and distal segments is ≥ 6. Thus, the diagnosis of phleborenohypertension in the patients with varicocele by means of color Doppler ultrasonography with the determination of blood flow velocity indicators in the left renal vein circulation and the determination of the critical stenosis of the left renal vein is decisive in choosing the surgical method of treatment. This provides an opportunity to evaluate the cause of varicocele occurrence and choose the optimal method of surgical treatment.&#x0D;

Repair of large area of soft tissue defect of calf by the retrograde anterolateral thigh flap with single high cutaneous perforator

Objective To explore the clinical effect of repairing the large area of soft tissue defect of the calf by the retrograde anterolateral thigh flap with single high cutaneous perforator. Methods From January, 2014 to July, 2017, 9 cases of large area of soft tissue defects were repaired by the retrograde anterolateral thigh flap with single high cutaneous perforator. There were 7 males and 2 females, aged 24-48 years. Soft tissue defects area of the calf was 10.0 cm×7.0 cm to 35.0 cm×15.0 cm, including skin grafting and skin stretch to repair the area. The perforating point of the high cutaneous artery branches was designed at the proximal end of the flap, which was used as the single nutrient vessel of the flap. The rotation point of the flap was moved upward to the proximal thigh, which not only increased the blood supply of the flap, but also made the flap repair range to the distal calf. The flap range was 15.0 cm×10.0 cm to 22.0 cm×12.0 cm. Results All flaps were cut smoothly, and no vascular crisis occurred. All flaps survived smoothly. All patients were followed-up for 6-12 months. The appearance of flaps was plump, slightly bloated, and their color was similar to the recipient area. The texture was soft, and no active disorder in the donor site. Conclusion The retrograde anterolateral thigh flap with single high cutaneous perforator can be designed at a high rotation point. By increasing the number and caliber of the anastomotic branch between the pedicle and lateral superior genicular artery, the blood supply and reflux of flap can be improved, and the survival rate is not affected. Compared with the traditional anterolateral thigh flap, it has great advantages. Key words: Anterolateral thigh flap; High cutaneous perforator; Lower leg; Soft tissue defect

Advances in surgical diagnosis and treatment of mitral valve prolapse in children

Mitral valve prolapse is a disease which causes mitral regurgitation, which is one of the common causes of mitral insufficiency.With the aggravation of blood reflux, mitral valve prolapse will eventually lead to pulmonary hypertension, heart failure and even death in children.The main diagnostic methods include chest X-ray, echocardiography, spiral CT and magnetic resonance imaging.Mitral valvuloplasty is the main surgical method for mitral valve prolapse in children.It includes valvuloplasty, annuloplasty, tendon chordoplasty, edge-to-edge mitral valve repair, and so on.Now, the progress in surgical diagnosis and treatment of mitral valve prolapse in children were reviewed in order to provide a meaningful reference for its individual treatment. Key words: Mitral valve prolapse; Child; Surgical treatment; Valvuloplasty

Development of automated intravenous blood infusion monitoring system using load cell sensor

This paper presents an automated intravenous blood infusion unit to prevent a reflux using a load cell sensor. Intravenous infusion is frequently used in the hospital for patients’ management and treatments such as dehydration and surgical operations. The sensor measures initial weight (500mls) of initial content of intravenous bag and set a threshold of 20mls or less, and then sends a signal through transmitter to receiver as an alarm indicating current state of the intravenous infusion. This is to support monitoring system by biomedical professionals and avoid blood reflux. The sensor has a strain gauge transducer that converts force into an electric signal in millivolts; two-18 pin microcontroller was deplored to modulate signals from the transmitter to the receiver, a buzzer indicator for sound notification, and LCD display monitor screen node station.Keywords: Intravenous infusion, hospital information system, reflux, intravenous therapy

Clinical and anatomical variants of varicose veins in the basin of small subcutaneous vein

The aim — to distinguish variants of the topography of the small subcutaneous vein (SSV) and its femoral branch (FB) according to the ultrasound scan, as well as to determine the pathways for the spread of venous reflux and to develop anatomical and hemodynamic classification of varicose veins (VV) types. Materials and methods. We analyzed the results of the study of SSV topography variants in 474 patients of the general population and ways of distribution of blood reflux in SSV basin in 126 patients with VV, who were diagnosed and treated at O. O. Shalimov National Institute of Surgery and Transplantology of NAMS of Ukraine within the period of 2003 — 2007. Results and discussion. 6 variants of topography of SSV and 5 variants of topography of its FB were singled out. The most common variant, which occurs in 47.0 % of patients, is the influx of SSV into the popliteal vein with an isolated trunk. In the total number of the examined patients, SSVs had hip extension in the form of FB in 40.9 % and had no fistula with popliteal vein in 17.9 % of cases. The study of ways of venous reflux spreading made it possible to distinguish the following types of FB in the SSV basin: 1) the trunk type — in 76.2 %; 2) the inflow type — in 17.5 %; 3) the perforation type — in 6.3 % of patients. Conclusions. The most common type that occurs in 76.2 % of patients is the formation of blood reflux at the level of sapheno­popliteal fistula and its spread along the SSV trunk. Of the total number of patients with VV, an «atypical» distribution of blood reflux was registered in 23.8 % of cases.

Catheter-assisted 360-Degree Trabeculotomy for Congenital Glaucoma.

To determine feasibility, efficacy, and safety of ab externo 360-degree trabeculotomy with illuminated microcatheter for congenital glaucoma. The postoperative results of 36 eyes in 23 consecutive patients who underwent 360-degree trabeculotomy for primary congenital glaucoma (PCG) or secondary congenital glaucoma using an illuminated microcatheter were retrospectively analyzed. Success criteria were defined as intraocular pressure (IOP) ≤18 mm Hg without (complete success) and with medication (qualified success). In all previously nonoperated eyes with PCG (group 1), the Schlemm's canal was identified and circumferentially cannulated for 360-degree trabeculotomy. In group 2 comprising of operated eyes with PCG and eyes with secondary congenital glaucoma, the performance of 360-degree trabeculotomy failed in 4 eyes because of the Schlemm's canal occlusion or high tissue resistance of the trabecular meshwork. Mean preoperative IOP was 28.6±5 and 29.6±9 mm Hg with 7 of 20 eyes and 7 of 9 eyes receiving IOP-lowering medication in group 1 and group 2, respectively. Mean postoperative IOP was reduced to 13±2.7 and 20.2±7.1 mm Hg after a mean follow-up of 15.3 and 12.7 months with 4 of 20 eyes and 5 of 9 eyes receiving medication in group 1 and group 2, respectively. Four eyes underwent further surgery. Complete success was achieved in 16 and 3 eyes, whereas qualified success was achieved in 20 and 4 eyes from group 1 and group 2, respectively. In all eyes, a mild to moderate postoperative hyphema was observed. Ab externo catheter-assisted 360-degree trabeculotomy controls IOP in a majority of patients with congenital glaucoma after a single operation. Moderate blood reflux in the anterior chamber is considered as a common postoperative finding. We did not observe hypotony or other severe complications in our series. In 1 patient, we experienced catheter misdirection in an eye that had previously undergone trabeculotomy.

Studies on the relationship between perforating vein insufficiency and iliac compression syndrome.

To study correlation among number(n), diameter (D), and blood reflux time(t) and the left common iliac vein stenosis degree of the expansion of perforating veins, so as to guide the clinical formulation and adjust the treatment plan. Retrospective analysis of 45 PVs patients with left common iliac vein in different degrees of compression in our hospital from 2010 to 2012 was performed. Left common iliac vein was divided into 50%-69%, 70%-99%, 30%-49% and occlusion of the stenosis to avoid the error of the left iliac vein stenosis. Pearson's correlation analysis among the number, diameter, and blood reflux time of perforating veins and left common iliac vein was performed. Pearson's correlation analysis among the number, diameter, and blood back flow time of perforating veins, and the degree of stenosis was performed, and these results showed that correlation coefficients among the number, diameter, and blood return the PVs between flow time and the degree of stenosis were rp-n=0.784, rp-d=0.893, rp-t=0.845 (P<.001), respectively. The two variables exist positive correlation and correlation was significant. With the increase in left common iliac vein stenosis, the number of perforating veins and the diameter increased, and the time of blood flow were prolonged.

Positive correlation between blood reflux in Schlemm's canal and the decrease of intraocular pressure after selective laser trabeculoplasty in primary open-angle glaucoma.

The aim of the present study was to investigate the association between blood reflux in Schlemm's canal (SC) and the decrease of intraocular pressure (IOP) after selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG). To verify this, 35 eyes from 25 POAG patients were enrolled. All eyes underwent 360° whole-circle gonioscopy via a three-mirror lens, prior to undergoing 360° SLT. The four quadrants of the examined eye were individually compressed by the lens, and the presence of blood reflux in SC after removal of the pressure was recorded. Eyes with no blood reflux in any quadrant were assigned to the negative group, while the others were assigned to the positive group. Patients were evaluated at baseline, at 1 and 2 weeks, and at 1, 3 and 6 months after SLT. The results indicated that in the reflux-positive (21 eyes) and -negative (14 eyes) group, a significant IOP decrease was seen at 1 and 2 weeks, and at 1 and 3 months after SLT as compared with that pre-SLT IOP (P<0.01). In the negative group, the IOP at 6 months after SLT was not significantly different (P>0.05), while the positive group still exhibited a significant decrease in IOP compared with that at baseline (P<0.01). The positive group also presented with a greater decline in IOP at 1, 3 and 6 months compared with that in the negative group (P<0.05). A positive correlation between the number of quadrants with blood reflux in SC and the percentage decrease in IOP after SLT was identified in the positive group (P<0.05). In conclusion, blood reflux in SC was positively correlated with the decrease in IOP after SLT in POAG (Trialapproval number, K-2014-013).

Haemodynamical aspects of the recurrence development of the lower extremities varicose veins in women–patients, suffering pelvic varicose veins

Objective. To study up the haemodynamical mechanisms of the recurrence development of the lower extremities varicose veins in women–patients, suffering pelvic varicose veins.&#x0D; Маerials and methods. Analysis of the operative treatment results was conducted in 50 patients of reproductive age, in whom in 2012 – 2014 yrs endovenous laser ablation (ЕVLA) of large saphenous vein (LSV) was performed. In 3 patients the lower extremities varicosities recurrence was observed while the 3–year follow–up.&#x0D; Results. Reflux from internal iliac veins through v.obturatoria extends on v. pudenda externa and the LSV mouth. Because the LSV trunk is occluded after previously performed ЕVLA, the pathological reflux is drained into lateral branches – anterior additional vein or Giacomini vein. Some forms of primary extrasystemic varicosities of the lower extremities are developed in accordance to the same haemodynamical mechanisms.&#x0D; Conclusion. Pelvic venous reflux promotes the lower extremities varicosities in 6% patients (95%–trustworthy іnterval 1,1% – 14,4%) after ЕVLA in the 3 years follow–up period. While presence of the blood reflux into internal iliac veins the crossectomy performance is recommended with the objective to lower the occurrence risk for recurrence of the lower extremities varicosities in future.

A non-hydrocephalic goat experimental model to evaluate a ventriculosinus shunt.

The ventriculosinus shunt is a promising treatment for hydrocephalus. Currently, different shunt techniques exist, and it is not clear whether one is preferable. This pilot study reports on a non-hydrocephalic goat model (Saanen breed) that provides opportunities to evaluate and optimize several aspects of the ventriculosinus shunt technique. Analysis of the coagulation properties of 14 goats by a viscoelastic coagulation monitor showed that goats have a hypercoagulable state compared to humans. This property can be partially counteracted by antiplatelet drugs. During implantation of a ventriculosinus shunt, a pulsatile reflux of blood was observed. After implantation, the animals recovered to their preoperative state, and none of them developed a superior sagittal sinus thrombosis. Evaluation of the shunts after 16 days showed an obstructing luminal clot. Several model-related factors may have promoted this obstruction: the absence of hydrocephalus, the hypercoagulability of caprine blood and the smaller dimensions of the caprine superior sagittal sinus. However, the pulsatile reflux of blood, which is caused by the compliance of the shunt system distal to the valve, may have been an important factor as well. In conclusion, the non-hydrocephalic goat model limits animal suffering and simplifies the study protocol. This model allows researchers to evaluate their implantation technique and shunt hardware but not the efficacy of the treatment or shunt survival.

Update on Microinvasive Glaucoma Surgery.

Update on Microinvasive Glaucoma Surgery.

Underwater Sonography of Leg Veins.

ObjectivesHydrostatic compression (HC) occurring during body immersion is considered beneficial for venous return from the lower limbs. No study has evaluated the effects of HC on the veins of the lower limbs using duplex ultrasound (DU). The purpose of this study was to use DU to evaluate the morphology and flow of the leg veins during immersion.DesignThe femoral and great saphenous veins were evaluated before and during immersion in a specifically built pool, in normal and varicose limbs.ResultsHC reduces vein size in both normal and varicose limbs. During immersion spontaneous flow increases whereas when present, blood reflux decreases.DiscussionThis pilot, proof of concept study has demonstrated the feasibility of DU investigation of leg veins during immersion. Larger series of underwater DU evaluations of normal and varicose legs are necessary to quantify and better explain the effects of HC on the veins of the lower limb.

Pathophysiological mechanisms of chronic venous disease and their role in C0s clinical class

The aim of this review is to provide a clear understanding of the pathophysiological mechanisms of chronic venous disease (CVD) at different clinical stages and the possible role of these mechanisms in the development of symptoms in C0s clinical class of the Clinical, Etiologic, Anatomic, and Pathophysiologic classification, which consists of symptomatic patients without any visible or palpable signs of venous disease. The prevalence of C0s class in several epidemiological studies varies between 13% and 23% of the general population. Wall remodeling and valve destruction due to white cell endothelial interaction is the main cause of primary varicose veins, while deep vein thrombosis produces secondary changes leading to the postthrombotic syndrome. The underlying mechanism of the skin changes and ulceration is venous hypertension, which is transmitted to the skin microcirculation. Over the last 10 years, an improved videocapillaroscopic technique, the orthogonal polarization spectral imaging technique demonstrated that quantitative measurements in the skin microcirculation are progressively altered from C1 to C6 patients and that values in CVD patients are significantly different from healthy individuals (P < 0.05): capillary diameter increases and capillary morphology worsens from C2 to C5; diameter of the dermal papilla and diameter of the capillary bulk increase from C3 to C5; and functional capillary density (FCD) decreases from C4 to C5. In addition, significant changes have been shown between C0a and C0s patients despite the presence of normal conventional duplex scans in the latter: a decrease of FCD and an increase in the diameter of the dermal papilla. Functional abnormalities found to be present in C0s patients by recent studies include increased compliance of the venous wall (hypotonic phlebopathy), dilatation of deep veins in the calf producing an abnormally increased venous volume, reduction in emptying of venous reservoir, reduction in the venoarteriolar response on standing, and blood reflux in small venules despite a normal conventional duplex scan. However, most of the studies are small, and their findings need to be confirmed by larger series. It remains to be seen whether functional changes and microcirculatory changes respond to venoactive medications in parallel to the relief of symptoms.

Triptan-responsive migraine-like headache caused by cavernous sinus dural arteriovenous fistula in a 69-year-old woman with a history of migraine without aura

A 69-year-old woman with a previous history of migraine without aura developed throbbing headache in the right frontal region accompanied by nausea, lasting more than 4 hours a day. The headache intensity was more severe than that of usual her migraine headaches. Administration of eletriptan in the previous hospital improved her headaches. However, one month later the patient experienced more intense headaches in the same region and then was referred to our hospital. MR angiography showed abnormal signal intensities in the cavernous sinus. Cerebral angiography revealed blood reflux to the cavernous sinus, leading to diagnosis of cavernous sinus dural arteriovenous fistula. Transvenous embolization of cavernous sinus dural arteriovenous fistula was performed, which resulted in resolution of the patient's headache. We should be aware that patients with cavernous sinus dural arteriovenous fistula can manifest migraine-like headaches without being accompanied by cranial nerve palsies.

Ethanol Embolotherapy for the Management of Refractory Chronic Skin Ulcers Caused by Arteriovenous Malformations

PurposeTo describe the clinical features and treatment outcomes of ethanol embolotherapy in refractory chronic skin ulcers caused by arteriovenous malformations (AVMs). Materials and MethodsFrom October 2011 to October 2015, 12 patients (5 male; mean age, 26.2 y) with refractory chronic skin ulcers caused by AVMs were treated at a single institution. Ethanol embolotherapy was performed by direct puncture techniques. Needles were directly inserted toward the nidus of the lesion based on imaging analysis. When fast blood reflux was noted, angiography was performed to ensure only the nidus and draining vein were opacified. Symptoms before and after treatment, previous treatment of AVMs and ulcers, embolotherapy sessions, follow-up time, complications, and degree of devascularization were recorded. Treatment outcomes were established by evaluating symptom outcomes and the degree of devascularization on follow-up angiography. ResultsFifty embolotherapy procedures were performed in 12 patients: 6 underwent procedures on the head and neck, 4 on the feet, and 2 on the hands. Four patients (33.3%) experienced complete resolution of abnormal angioarchitecture according to follow-up angiography. Complete control of ulcers was achieved in all 12 patients. Two procedures (4%) in 2 patients (16.7%) caused superficial skin necrosis that healed spontaneously within 4 weeks. Thirteen procedures (26%) in 9 patients (75%) caused blistering immediately after treatment. There were no major complications. ConclusionsIn a limited series, ethanol embolotherapy was effective and safe in the treatment of refractory chronic skin ulcers caused by AVMs.

Analysis on the Curative Effect of Improved Radial Artery and Cephalic Vein Anastomosis in the Fistulation for the Hemodialysis in Patients

To investigate the application of improved radial arteryand cephalic vein anastomosis in the fistulation for the hemodialysis in patients, 80 cases of patients with chronic renal failure were randomly divided into two groups, a control group and an improved group. The procedure for the wrist radial arteryand cephalic vein anastomosis was improved, in which in a way of continuously everted full-thickness suture, the distal end of radial artery and the proximal end of cephalic vein were anastomosed. The patients were examined by the different methods before the surgery to evaluate the patients’conditions. Patients in the improved group underwent the anastomosis of the wrist radial artery and cephalic vein in a way of continuously everted full-thickness suture, and those in the control group underwent the anastomosis in the conventional way. The improved procedure showed some advantages, such as reduced anastomotic blood leakage, good alignment of the arteryand veinwalls, shortened vascular suture time, and less knot of sutures at the anastomotic junction. The improved procedure should be appropriated for the patients whose Allen's test is negative and cephalic vein is good in the blood flow and filling. However, the weak blood reflux of the distal end of radial artery should bethe contraindication for the improved procedure.

Correlation of quantitative parameters of magnetic resonance perfusion-weighted imaging with vascular endothelial growth factor, microvessel density and hypoxia-inducible factor-1α in nasopharyngeal carcinoma: Evaluation on radiosensitivity study.

To investigate the correlation of parameters of magnetic resonance perfusion-weighted imaging (MR-PWI) with the expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1α (HIF-1α) and microvessel density (MVD) in nasopharyngeal carcinoma (NPC) so as to explore the value of predicting radiosensitivity. A prospective study. Department of Head-and-neck radiotherapy in Hunan Cancer Hospital. Ninety-four patients of NPC were included between December 2013 and December 2014. The expression of VEGF, MVD and HIF-1α was studied by immunohistochemistry, and magnetic resonance perfusion-weighted imaging (MR-PWI) was performed before and after undergoing radiotherapy (20Gy dose). Parameters of MR-PWI, volume of primary tumour and rate of tumour remission were measured and calculated. Patients with primary local tumour were then divided into completely response group (CR group) and partially response group (non-CR group) according to tumour regression condition. Relevant parameters were analysed by Spearman, and diagnostic efficiency of radiosensitivity was analysed by receiver operating characteristic curve (ROC). The expression of VEGF was positively correlated with MVD (r=.322,P<.05), but the expression of HIF-1α was no significant correlations with VEGF and MVD. The expression VEGF was in positive correlation with fractional plasma volume (fpv) (r=.339, P=.05) before radiotherapy. There was a significant difference in the quantitative parameters of MR-PWI between CR group and non-CR group during the course of radiotherapy and at the end of radiotherapy treatment. The change of blood reflux constant (Δkep20) and extravascular extracellular space volume fraction (ΔVe20) before and after treatment was positively correlated with primary local tumour remission condition after 3month treatment; Δkep and ΔVe were negatively correlated with primary local tumour remission condition after 3months. Tumour regression rate was only positively correlated with Ve and the average volume of primary tumour after 2week treatment (V1). ROC curve showed that R20≥65.69%, and was considered as a threshold to predict primary local tumour remission, with a sensitivity of 0.84 and specificity of 0.69, and area under the curve was 0.819 (P=.000). The parameters of MR-PWI with the expression of VEGF, HIF-1α and MVD could be guidance for predicting radiosensitivity in NPC.

Goniotomy with a single-use dual blade: Short-term results

To evaluate the intraocular pressure (IOP)-lowering efficacyand safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma. International multicenter ophthalmic care centers. Prospective interventional case series. Consecutive patients with glaucoma who had phacoemulsification plus goniotomy with the single-use dual blade were enrolled in this study. Each center collected deidentified clinical data, including preoperative and postoperative IOP, medication use, adverse events, and whether additional surgery was required during a 6-month follow-up. Of the 71 eyes included in this study, 70% had primary open-angle glaucoma. Other diagnoses included angle-closure, pigmentary, pseudoexfoliative, and normal-tension glaucoma. Sixty-five percent of eyes were classified as having mild to moderate glaucoma and 35%, severe glaucoma. The mean baseline IOP decreased from 17.4mm Hg±5.2 (SD) to 12.8±2.6mm Hg 6months postoperatively and the hypotensive medication use decreased from 1.6±1.3 to 0.9±1.0, respectively (P<.001 and P = .005, respectively). The most common observation was blood reflux during surgery (39.4%). Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6months of follow-up.