Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts: Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts.</p><p><b>METHODS</b>A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty (PKP) eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD.</p><p><b>RESULTS</b>Of the 54 eyes included in this study, extracapsular cataract extraction (ECCE) was performed in 34 eyes of 33 patients (ECCE group) whereas phacoemulsification was performed in 20 eyes of 20 patients (phacoemulsification group). There was no significant difference in the median age (P = 0.081) or preoperative ECD (P = 0.585) between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group (P = 0.043). In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months (P = 0.018), 4 months (P < 0.001), and 6 months (P < 0.001) after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group (P < 0.001) and phacoemulsification group (P < 0.001), but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts (P < 0.001). There was no significant difference in postoperative BCVA between the two groups (P = 0.065).</p><p><b>CONCLUSION</b>ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.</p>

New biomarkers for sepsis / 解放军医学杂志

There is a higher sepsis rate in the intensive care unit (ICU) patients, which is one of the most important causes for patient death, but the sepsis lacks specific clinical manifestations. Exploring sensitive and specific molecular markers for infection that accurately reflect infection severity and prognosis is very clinically important. In this article, based on our previous study, we introduce some new biomarkers with high sensitivity and specificity for the diagnosis and predicting the prognosis and severity of sepsis. Increase of serum soluble(s) triggering receptor expressed on myeloid cells-1 (sTREM-1) suggests a poor prognosis of septic patients, and changes of locus rs2234237 of sTREM-1 may be the one of important mechanisms. Additionally, urine sTREM-1 can provide an early warning of possible secondary acute kidney injury (AKI) in sepsis patients. Serum sCD163 level was found to be a more important factor than procalcitonin (PCT) and C-reactive protein (CRP) in prognosis of sepsis, especially severe sepsis. Moreover, urine sCD163 also shows excellent performance in the diagnosis of sepsis and sepsis-associated AKI. Circulating microRNAs, such as miR-150, miR-297, miR-574-5p, miR-146a, miR-223, miR -15a and miR-16, also play important roles in the evaluation of status of septic patients. In the foreseeable future, newly-emerging technologies, including proteomics, metabonomics and trans-omics, may exert profound effects on the discovery of valuable biomarkers for sepsis.

Significance of low serum vitamin D for infection risk, disease severity and mortality in critically ill patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hospitalized patients often have higher rate of vitamin D deficiency than healthy people. Vitamin D levels below normal are associated with hospital stay, increased incidence of adverse prognosis and increased mortality of a number of diseases. Whether there is a relationship between vitamin D levels and infection or sepsis in the critically ill is still unclear. This study will explore the relationship between vitamin D levels and risk of infection, assessment for disease severity, and predictor of mortality.</p><p><b>METHODS</b>To evaluate the value of vitamin D in intensive care unit (ICU) cases to sepsis, severity and prognosis assessment, high performance liquid chromatography and tandem mass spectrometry were used to measure the concentrations of vitamin D in sera of critically ill patients. The serum samples were drawn within the first 24 hours of ICU admission.</p><p><b>RESULTS</b>The study included 206 people, 50 healthy controls, 51 ICU control patients and 105 ICU diagnosed with sepsis. Critically ill ICU patients (ICU sepsis and ICU control group) had lower vitamin D concentration than normal people, but septic patients showed no significant reduction of vitamin D concentration when compared with critically ill patients with no positive etiological evidence. For assessment of disease severity, there were very low negative correlations between APACHE II, SAPS II and SOFA scores and vitamin D level. Additionally, patients of different 25-(OH)D levels showed no difference whether in terms of 28-day survival (X(2) = 1.78, P = 0.776) or 90-day survival (X(2) = 4.12, P = 0.389). Multivariate Logistic regression demonstrated that APECHE II and SAPS II scores were independent risk factors to deaths caused by sepsis.</p><p><b>CONCLUSION</b>Clinically, serum concentration of vitamin D is not an indicator for diagnosis and assessment in critically ill patients (ClinicalTrial.gov identifier NCT01636232).</p>

Association between serum homocysteine and in-hospital death in patients with acute pulmonary embolism / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association between serum homocysteine (Hcy) level and in-hospital death in patients with acute pulmonary embolism.</p><p><b>METHODS</b>A total of 186 acute pulmonary embolism patients [ (66.8 ± 12.7) years, 89 male] hospitalized in our department between June 2008 and June 2011 were included in this prospective study. Patients were divided into high Hcy group (Hcy ≥ 15.2 µmol/L, n = 95) and low Hcy group (Hcy < 15.2 µmol/L, n = 91). Patients were followed-up for 1 year for the incidence rate of early death associated with acute pulmonary embolism. The Cox proportional hazard model was used to analyze the relationship between serum Hcy level and early death in acute pulmonary embolism patients.</p><p><b>RESULTS</b>Patients were hospitalized for 1-37 days [(10 ± 6) days]. In-hospital death rate was 14.5% (27/186) and was significantly higher in high Hcy group than in low Hcy group [25.3% (24/95) vs. 3.3% (3/91) , P = 0.001]. Univariate Cox regression analysis indicated that admission heart rate, oxygen saturation, enlargement of right ventricle, Hcy ≥ 15.2 µmol/L, serum creatinine level, peak TnT level and deep venous thrombosis (P < 0.05) were independent risk factors for in-hospital death. Multivariate Cox regression analysis showed that Hcy ≥ 15.2 µmol/L (HR = 4.10, 95%CI:3.00-4.98, P = 0.017), admission heart rate (HR = 1.10, 95%CI:1.01-1.20, P = 0.031) , deep venous thrombosis (HR = 1.65, 95%CI:1.45-1.76, P = 0.034) and age (HR = 1.10, 95%CI:1.02-1.19, P = 0.010) were independent predictors of in-hospital death for acute pulmonary embolism patients. One-year follow up was finished in 142 patients (89.3%). There were 19 deaths ( 5 due to repeat pulmonary embolism, 4 due to decompensated respiratory and /or cardiac diseases, 6 due to malignant tumors, 2 due to fatal bleeding and 2 due to pneumonia) . Death rate was similar between the two groups during follow up.</p><p><b>CONCLUSION</b>Higher serum homocysteine is an independent for in-hospital death for patients with acute pulmonary embolism.</p>

Genetic characterization of a Chinese family with familial idiopathic pulmonary fibrosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Idiopathic pulmonary fibrosis (IPF) is a chronic inflammatory interstitial lung disease with an unknown cause. Recent studies have shown that genetic factors play an important role in the pathogenesis of IPF.</p><p><b>METHODS</b>To explore the genetic background of patients with IPF, a candidate gene approach was employed to screen for mutations in seven genes among members with familial IPF in mainland of China.</p><p><b>RESULTS</b>Within six of the candidate genes, a total of 31 point mutations were identified. Among the missense mutations, the SFTPA1 exon 6 CAG > AAG (Gln238Lys) and SFTPB exon 2 CAC > CCC (His2Pro) mutations caused changes in the physical and chemical properties of amino acids. Each sequence alteration was identified in sporadic IPF patients, control specimens (pneumonia patients and healthy persons). Genotype frequencies and allele frequencies of codon 238 in exon 6 of SFTPA1 were noted significantly higher in patients with IPF than those in other two control subjects. The computational protein structure prediction by protein homology modeling confirmed differences in three-dimensional structure between mutant SFTPA1 and original SFTPA1.</p><p><b>CONCLUSIONS</b>Although the functions of the mutant candidate genes vary, these genes may ultimately result in damage to alveolar epithelial cells, initiating the progress of pulmonary fibrosis. In particular, while pathophysiological mechanisms need to be illustrated, the Gln238Lys missense variant of exon 6 in the SFTPA1 may have potential susceptibility in the development of IPF, which was shown in patients with sporadic IPF with a statistically higher frequency.</p>

Hypopyon in patients with fungal keratitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions.</p><p><b>METHODS</b>The medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined.</p><p><b>RESULTS</b>We identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P < 0.001). Risk factors for incident hypopyon included long duration of symptoms (P < 0.001), large lesion size (P < 0.001) and infection caused by the Fusarium and Aspergillus species (P < 0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P < 0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P = 0.002).</p><p><b>CONCLUSIONS</b>Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention.</p>

"Paying attention to lens regeneration and research of ""lens stem cell"" in mammal" / 中华实验眼科杂志

With the existence of capsules,lens regeneration occurs in some mammals after extracapsular lens extraction.It is usually thought that lens regenerates from resident lens epithelial cells (LECs) in the capsule.However,lens regeneration dose not mean simple redupilication of development,and transparency of the lens is affected by irregular growth,migration and transdifferention of the resident LECs.Previous studies mainly focus on the dysplasia of LECs,but update theory about lens regeneration is proposed to be associated with stem cells.Some views and suggestions in lens regeneration are concerned in current researches to better illuminate the mechanism and therapy of posterior capsular opacity.

Expression and significance of silence signal regulating factor 1 in cornea and trigeminal ganglion in type 1 diabetes model mice / 中华实验眼科杂志

Background Diabetes is one of the risk factors that leads to corneal neuropathy.Silent signal regulatory factor 1 (Sirt1) plays an important role in glucose metabolism,lipid metabolism,regulation of insulin secretion and is closely related to the nervous system disease.The relationship between Sirt1 and diabetic corneal neuropathy is not fully understood.Objective This study was to detect the expression of Sirtl in cornea and trigeminal ganglion with type 1 diabetes model mice and explore the association of Sirt1 expression with diabetic corneal neuropathy.Methods Eight C57BL/6-Ins2Akita/J male mice and eight wild-type C57BL/6 male mice in the same litter were selected as type 1 diabetes model group and control group,respectively.The mice of two groups were sacrificed in overdose anesthesia method at 12-month old.Histological examination of cornea and trigeminal ganglion was performed using hematoxylin and eosin staining.Expression and localization of Sift1 protein in cornea and trigeminal ganglion were detected using immunohistochemistry.Western blot assay and fluorescine quantitative PCR were respectively used to quantitatively analyze the expression of Sirt1 protein and Sirt1 mRNA.Results Trigeminal ganglion cells were uneven in size and shape with the loosened cellular arrangement and disorder neurofibrosis alignment,and the corneal epithelial cells were less in the C57BL/6-Ins2Akita/J mice,but the trigeminal ganglion cells and corneal epithelial cells were normal in wild-type C57BL/6 mice.Immunochemisty exhibited that Sirtl protein was expressed mainly in corneal epithelium and the expression of Sirtl protein was stronger in the C57BL/6 mice than that in C57BL/6-Ins2Akita/J mice.Fluorescine quantitative PCR assay showed that the gray scale value of Sirt1 mRNA in cornea in C57BL/6-Ins2Akita/J mice was lower than that of the wild-type C57BL/6 mice(0.56±0.03 vs.0.98±0.13) with significant difference (t =5.853,P =0.010).Western blot showed that the expression of Sirt1 protein in cornea was lower in C57BL/6-Ins2Akita/J mice than that of the wild-type C57BL/6 mice(0.78±0.017 vs.1.300±0.012) with significant difference(t =33.140,P =0.001).However,no significant differences were seen in the gray scale value of Sirt1 mRNA(2.45±0.18 vs.2.51±0.22) (t=0.587,P=0.599) and protein level(1.100±0.015 vs.1.110±0.017) (t =0.430,P=0.709) in trigeminal ganglion tissues between C57BL/6-Ins2Akita/J mice and wide-type C57BL/6 mice.Conclusions The corneal nerve and structure is abnormal in 12-month-old C57BL/6-Ins2Akita/J mouse.Sirt1 is involved in the pathogenesis of diabetic keratoneuropathy,suggesting that it may be a potential target.

Ocular surface reconstruction and cultivated stem cell transplantation:new progresses and challenges / 中华实验眼科杂志

Recent years,progress has been made on the basic researches and clinical applications of ocular surface reconstruction with autologous or allogeneic limbal stem cells,oral mucosa epithelium and ex vivo cultured limbal stem cells.However,there are several issues,including the successful treatment for severe ocular damage,longterm follow-up and evaluation of clinical outcome,and the in vivo tracking of donor stem cells,remained to have definitive conclusions.Future studies should address the questions and challenges based on the basic research of limbal stem cell deficiency and standardized evaluation of clinical outcome.

Rabbit model of aspergillus keratitis induced by modified corneal surface lens method / 中华实验眼科杂志

Background Animal model of fungal keratitis is an available tool to the experimental study of the pathogenesis mechanism of fungal keratitis. Current modeling methods of fungal keratitis include corneal scratching, corneal stroma injection and corneal surface lens methods. But these methods still have their own shortages. Objective This experiment was to create a fungal keratitis animal model by modifying corneal surface lens method. Methods Modified animal models of fungal keratitis were created by modified corneal surface lens method in 12 general adult New Zealand white rabbits. The filter papers soaked 108 spores / ml or A106spores / ml of spergillus fumigatus suspension were attached on the de-epithelial cornea surface and fixed with contact lens and tarsorrhaphy for 2 days, and the filter paper with physiological saline was used as control group. The symptoms of anterior segment were examined under the slit lamp in 3 ,7 and 14 days after surgery and scored based on the criteria of Dong. Corneal scraping was stained with 10% potassium hydroxide and calcofluor white stain to observed mycelium under the fluorescence microscope. Corneal tissue sections were examined by hematoxylin-eosin staining and periodic acid Schiff staining under the light microscope. The use of animal followed the Standard of Association for Research in Vision and Ophthalmology. Results Fungal keratitis models were successfully established in 6 eyes and 4 eyes in 108 spores/ml group (6/6) and 106 spores/ml group respectively. The symptom was more severer and score was higher in the eyes of 108 spores/ml group than that in 106 spores/ml group. At 3 and 7 days after surgery,the symptom scores of fungal keratitis models were higher than those of control group from 3 through 7 days with the statistically significant difference (P<0. 01) and the symptom scores of 108 spores/ml group were significantly higher than those of 106 spores/ml group (P<0. 01). At 14 days after surgery, the symptom scores of 108 spores/ml group were still higher than those of control group (P<0. 05). Fungal hyphae was seen in the corneal scrapes in 108 spores/ml group and 106 spores/ml group respectively from 3 through 7 days after surgery. Inflammatory cell infiltration, stroma cells necrosis and fungal hyphae were presented in 108 spores/ml group, and the corneal neovascularization could be observed in 108 spores / ml group 14 days later. Fungal culture revealed the positive outcome in both 3 and 7 days after surgery in 108 spores/ml group,but in 106 spores/ml group,the positive result was only in the 3rd day. Conclusion Modified corneal surface lens method is more feasible and sample in the model of Aspergillus keratitis. This animal model of Aspergillus keratitis is practical for the further study of fungal keratitis.

Changing indications for lamellar keratoplasty in Shandong, 1993 - 2008 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the advancement of microsurgical techniques, lamellar keratoplasty (LK) has been more valued and performed to treat corneal blindness. This study aimed to evaluate the indications and changing trends for LK during the past 16 years in Shandong Eye Institute, an eye center in China.</p><p><b>METHODS</b>A total of 1529 eyes, predominantly from male (70.7%) patients undergoing LK between January 1993 and December 2008, were enrolled in this study. Data were collected by reviewing patient medical records for demographic characteristics, clinical diagnosis, laboratory findings and risk factors. Surgical times, initial diagnoses and causes of regrafting were recorded. All LKs were sequentially divided into period 1 (from 1993 to 2000) and period 2 (from 2001 to 2008).</p><p><b>RESULTS</b>Rural-dwelling patients in this study numbered 1089 (71.2%); in all cases of infectious keratitis, rural patients accounted for 90.5%. The leading indications for LK were infectious keratitis (31.0%), corneal trauma (21.1%), keratoconus (18.7%), corneal dystrophy and degeneration (7.3%), regrafting (7.1%), immunologic disorders (6.7%), congenital abnormalities and corneal tumor (4.1%) and corneal scarring (3.1%). The most common subcategory of infectious keratitis was fungal keratitis (67.5%). Fusarium solani was the most morbigenous fungi. Among the patients, 73.1% of thermal burns were caused by hot molten metal, and 47.8% of alkali burns by lime. Dermoid was the most common indication for congenital abnormalities. The two main initial diagnoses from 109 regrafting cases were corneal trauma (45.9%) and Mooren's ulcer (27.5%). The most common cause for regrafting was immune rejection (35.8%). Infectious keratitis was the most common indication for LK from 16.0% in period 1 to 41.1% in period 2, followed by keratoconus (16.8%) and corneal trauma (14.5%).</p><p><b>CONCLUSIONS</b>During the past 16 years, there have been major changes in the constituent ratios of leading indications for LK in Shangdong. Infectious keratitis has become the most common indication for LK. Fungal keratitis was the most common subcategory of infectious keratitis.</p>

Effect of obstructive sleep apnea hypopnea syndrome on arterial stiffness / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on brachial-ankle pulse wave velocity (b-aPWV) in untreated diagnosed patients.</p><p><b>METHODS</b>This study involved 24 consecutive male patients with newly diagnosed untreated OSAHS (aged 39.13±8.31 years) and 22 normal male individuals (aged 39.59±10.86 years) matched for age and body mass index. Carotid and extremities ultrasound were performed in all the subjects, and none of them had atherosclerosis, arterial calcification, or aneurysm. No subject had a history of hypertension, coronary heart disease or stroke. All the subjects underwent arterial stiffness evaluation by means of b-aPWV measurements.</p><p><b>RESULTS</b>The b-aPWV in OSAHS patients was significantly higher than that in normal subjects (1346.86±123.48 vs 1237.91±84.46, P<0.01), and the rate of positive b-aPWV in OSAHS patients was significantly higher (13/24 vs 1/22, P<0.01).</p><p><b>CONCLUSION</b>The value and positive rate of b-aPWV in OSAHS patients are higher than those in normal people, suggesting increased arterial stiffness in OSAHS patients.</p>

Peripheral radial chop technique for phacoemulsification of hard cataracts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Phacoemulsification yields successful outcomes in eyes with standard cataract. Though techniques have been improved, it is still challenging to perform phacoemulsification in cases of hard cataracts for difficulty in nuclear management and much more complications. This study aimed at describing and evaluating the efficacy and safety of a peripheral radial chop technique to remove hard cataracts.</p><p><b>METHODS</b>In this prospective study conducted between January 2003 and January 2004, 107 consecutive eyes with hard cataract underwent modified phacoemulsification surgery with peripheral radial chop technique by the Bausch & Lomb Millennium phacoemulsifier with preset parameters of power less than 30%; vaccum, 150 mmHg; and bottle height, 85 cm when a DP8145 phaco tip was used, and vaccum, 380 mmHg; bottle height, 95 cm when a DP8245 phaco tip was used.</p><p><b>RESULTS</b>The mean ultrasonic power was 14.7% (range 9% to 19%), ultrasonic time was 1.98 minutes (range 1.55 to 3.18 minutes). At 1, 7 and 30 days postoperatively, the eyes with uncorrected visual acuity 0.5 or better accounted for 76.42%, 87.16% and 90.67% respectively. At 1 month, the endothelial cell loss rate was 9.74% (range 8% to 17%). There were 6 cases of posterior capsule rupture in an early period of study. No serious intraoperative or postoperative complications were noted.</p><p><b>CONCLUSIONS</b>The peripheral radial chop technique was effective without serious complications in hands of an experienced surgeon.</p>

Comparison of lung function measurement values with two different apparatus / 中国医疗器械杂志

This paper introduces a random measurement analysis of, lung function measurement values with two different apparatus. in 41 patients. It shows that the differences are not statistically significant (P>0.05) between two apparatus measurement values except DLCO, FEF25, FEF75 in the group of normal ventilation, FVC in the group of abnormal ventilation. The two groups are both correlated closely (r> 0.9) except MMF(r=0.7725, RV r=0.808) in the normal group of ventilation, and FEF75 (r=0.58) in the abnormal group of ventilation (p<0.001). The two apparatus with different measuring theories have a good correlation.

Study on the dynamics of IgG antibody in 311 patients with severe acute respiratory syndrome / 中华流行病学杂志

<p><b>OBJECTIVE</b>To detect the level and dynamic change of severe acute respiratory syndrome (SARS)-coronavirus-specific IgG antibody in conavalescent SARS patients, and to provide information for prevention and vaccine development.</p><p><b>METHODS</b>IgG antibody against coronavirus was detected by ELISA in the blood of 311 convalescent SARS patients for every 2 - 4 weeks. Stata 7.0 statistics software was used to analyse the results.</p><p><b>RESULTS</b>IgG antibody was detected positive on each testing of all the convalescent patients and its peak appeared 35 days after recovery. IgG antibody level showed a 35.8% decrease within one year.</p><p><b>CONCLUSION</b>Data showed that all the SARS convalescent patients had generated high level of specific IgG antibody against coronavirus in the early stage of recovery, but the antibody level declined along with the progress of convalescence, suggesting that the detection of the IgG antibody should go on until it disappeared.</p>