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OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.
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Female , Humans , Infant , Infant, Newborn , Pregnancy , Bronchopulmonary Dysplasia/epidemiology , Gestational Age , Infant, Extremely Premature , Respiratory Distress Syndrome, Newborn/epidemiology , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To compare and observe the efficacy and safety of different administration methods of conbercept in the treatment of diabetic macular edema (DME).Methods:A retrospective clinical study. From November 2016 to November 2020, 135 eyes of 92 patients with foveal DME who were diagnosed in the Department of Ophthalmology of General Hospital of Central Theater Command received conbercept treatment were included in the study. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. All the affected eyes received intravitreal injection of conbercept once a month for 3 months or 5 months, and then pro re nata (PRN) treatment based on the patient’s visual acuity and OCT examination results, namely 3+PRN or 5+PRN treatment plan, and divided into 3+PRN group (84 eyes) and 5+PRN group (51 eyes), respectively. There was no statistically significant difference in baseline information between the two groups of patients ( P>0.05). The changes of BCVA, centre retinal thickness (CRT), the number of intravitreal injections and the occurrence of complications in the two groups were compared and observed at the end of 12 months after treatment. The independent sample Mann-Whitney test was used to compare continuous variables between groups; the χ2 test was used to compare categorical variables. Results:At the end of 12 months after treatment, compared with baseline, the BCVA of 3+PRN group and 5+PRN group increased by 8.8±4.4, 9.2±6.1 letters, and CRT decreased by 145.1±50.5, 148.5±82.5 μm; there was no statistically significant difference between the two groups of eyes with BCVA increasing letter number and CRT decreasing value ( P=0.295, 0.548). In the 3+PRN group and 5+PRN group, the BCVA increased by more than 10 and 15 letters were 40 (47.6%, 40/84), 21 (25.0%, 21/84) eyes and 27 (52.9%, 27/51), 16 (31.4%, 16/51) eyes; there was no statistically significant difference in the proportion of the two groups with BCVA improvement> 10, 15 letters ( χ2=0.360, 0.648; P=0.549, 0.421). During PRN, in the eyes of 3+PRN group and 5+PRN group, the prognosis of eyesight was unstable in 22 (26.2%, 22/84) and 6 (11.8%, 6/51) eyes; the prognosis of eyes in the two groups was unstable. Compared with the number of eyes, the difference was statistically significant ( χ2=4.017, P=0.045). The number of injections into the vitreous cavity of the two groups of eyes were 4.1±2.9 and 2.4±1.8, the difference was statistically significant ( P<0.001); the times of remedial photocoagulation were 1.9±1.0, 1.5±0.8 times, the difference was statistically significant ( P=0.034). During the follow-up period, the overall incidence of ocular adverse events and serious adverse events in the 3+PRN group and 5+PRN group were similar, being 22.6% (19/84), 25.5% (13/51), and 8.3% (7/84), 7.8% (4/51), respectively. Conclusion:Both the 3+PRN and 5+PRN regimens of conbercept can treat DME safely and effectively; the 5+PRN regimen only requires fewer PRNs to maintain a more stable therapeutic effect.
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Objective:To explore the effect of radiofrequency heating on the morphology of articular cartilage in the knee and the expression of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the synovium using a rabbit model of knee osteoarthritis (OA).Methods:Fifty-four male rabbits had OA induced in their right hind limbs using the modified Hulth method. They were then randomly divided into a model group, a cervus and cucumis polypeptide (CCP) group and a radiofrequency thermotherapy (RT) group, each of 18. The CCP group was injected with deer melon peptide intramuscularly every day, while the RT group was given daily radiofrequency hyperthermia treatment at 36.5-38.5 ℃. The model group was not provided with any special treatment. On the 6th, 12th and 18th day of the treatment, 6 rabbits in each group were sacrificed to resect the right femur′s medial condyle cartilage. The morphological characteristics of the cartilage were evaluated using modified Mankins scoring, while the contents of lL-1B and TNF-a in the synovial membrane were detected using enzyme-linked immuno-sorbent assays.Results:The average Mankins scores and the levels of IL-1β and TNF-α decreased significantly at each time point, and significant differences were observed among the three groups. In the RT group the average Mankins score as well as the IL-1β and TNF-α levels decreased significantly with time throughout the experiment.Conclusions:Radiofrequency hyperthermia is superior to the injection of deer melon polypeptide in knee osteoarthritis, at least in rabbits. The therapeutic mechanism may be related to the control of IL-1β and TNF- α levels in the synovial membrane.
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When this paper was first published the following ethical statement was omitted in error: The studies were approved by the Animal Ethics Committee of Tianjin University of Traditional Chinese Medicine. The animals were cared according to the regulations of the Animal Ethics Committee. The authors would like to apologise for any inconvenience caused.
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Objective:To observe the changes of the inner-retinal irregularity index (IRII) of eyes with idiopathic macular epiretinal membrane (IMEM) before and after surgery and its correlation with visual function.Methods:retrospective series of studies. From March 2017 to May 2018, 46 IMEM patients (46 eyes) diagnosed in the Department of Ophthalmology of Central Theater Command General Hospital were included in the study. BCVA, visual deformation degree (M), OCT inspection with swept source were all performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logMAR visual acuity for record. The average IRII was 1.255±0.048, the average logMAR BCVA was 0.63±0.21, the average M value was 0.68±0.38, the average of central macular thickness (CMT) was 353.57±73.92 μm, the average inner retinal layer thickness (IRT) was 181.50±40.91 μm. The complete and incomplete ellipsoid zone (EZ) were 17 and 29 eyes, respectively. All eyes underwent a 25G three-incision closed vitrectomy through the flat part of the ciliary body, and the epiretinal membrane and inner limiting membrane were removed at the same time. The changes of IRII, M value, BCVA, CMT, IRT and EZ were observed at 1, 3, 6, and 12 months after surgery, and the correlation were analyzed between IRII and M value and BCVA before and after surgery. Single-factor repeated measurement data analysis of variance was used for the comparison of BCVA, M value, CMT, and IRT before and after surgery. Spearman rank correlation analysis were adopted for the correlation analysis between IRII and BCVA, M value, CMT, IRT and EZ integrity before and after surgery.Results:Twelve months after surgery, the average IRII and logMAR BCVA were 1.175±0.032 and 0.47±0.16, respectively. Compared with those before surgery, they were significantly improved, and the difference was statistically significant ( F=22.273, 5.453; P<0.001, <0.001). The average M value ( F=20.109), CMT ( F=14.273), IRN ( F=13.665) were significantly lower than those before the operation, and the difference was statistically significant ( P<0.001, 0.001, <0.001). The integrity of EZ was significantly improved compared with that before surgery, and the difference was statistically significant ( χ 2=12.715, P<0.001). The results of correlation analysis showed that preoperative IRII was positively correlated with preoperative M value and CMT ( r=0.951, 0.701; P<0.001, <0.001). It was positively correlated with postoperative M value, logMAR BCVA, CMT and EZ integrity ( r=0.650, 0.369, 0.720, 0.293; P<0.001,<0.001, P=0.048). It was not correlated with preoperative logMAR BCVA and EZ integrity ( r=0.283, 0.001; P=0.056, 0.996). Conclusion:The IRII of IMEM eyes before surgery is significantly correlated with the BCVA and M values after surgery.
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Objective:To investigate the potential effect of hyperopia status on subfoveal choroidal thickness (SFCT) in silicone oil (SO)-filled eyes.Methods:This self-comparative study was conducted in Department of Ophthalmology, Central Theater Command General Hospital. The 50 patients (100 eyes) were collected with unilateral macula-on rhegmatogenous retinal detachment from January 2019 to July 2019, who successfully underwent pars plana vitrectomy (PPV) and SO tamponade. Retinal reattachment was observed after surgery in all patients. One month after PPV, the affected eye was wore soft, contact lenses for 24 hours to correct refractive error (RE), depending on its optometry value. The SFCT of the affected eyes was measured using OCT before and after lenses wear. The fellow eyes also received OCT examination at the same time. T test was used to compare SFCT between SO-filled eyes and fellow eyes.Results:The mean RE of the SO-filled eyes was +6.38±1.12 D. The mean SFCT of SO-filled eyes (247.12±17.63 μm) was significantly thinner than that of the fellow eyes (276.32.55±17.63 μm) ( P<0.001). The SFCT of the SO-filled eyes was significantly thinner than fellow eyes, and the difference was statistically significant ( t=-3.95, P<0.001). After lenses wear, the mean SFCT of the SO-filled eyes increased to 276.32±24.86 μm. Compared with before lenses wear, the difference was statistically significant ( t=-4.30, P<0.001). Compared with the fellow eye, the difference was not statistically significant ( t=0.05, P>0.05). Conclusion:SFCT reduction in the SO-filled eyes may be due to the hyperopia status caused by SO, which can be reserved by RE correction.
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Objective:To observe and compare the outcomes of vitrectomy (PPV) combined with complete internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling for the high myopic foveoschisis (MF).Methods:A retrospective case study was performed. From June 2016 to June 2018, 31 eyes of 31 patients with high myopic MF diagnosed in Department of Ophthalmology of Central Theater Command General Hospital were included in the study. There were 9 males and 22 females, who were monocular. The mean age was 57.55±9.45 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. Snellen visual acuity chart was used for BCVA examination, and which was converted into logMAR visual acuity. According to the surgical method, patients were divided into PPV combined with ILM complete removal group (group A) and PPV combined with retained fovea ILM group (group B), which were 16 patients (16 eyes) and 15 patients (15 eyes ), respectively. The mean logMAR BCVA was 1.03±0.33 in group A and 1.11±0.35 in group B. The mean CFT was 596.51±196.69 μm in group A and 578.33±200.18 μm. There were no statistically significant differences in age ( t=0.649, P=0.527), AL ( t=-0.639, P=0.533), logMAR BCVA ( t=-0.368, P=0.718), CFT ( t=0.228, P=0.823) and MF type ( P=0.576) between the two groups. The mean follow-up time after operation was 18.65±5.15 months. At 7 d, 1, 3, 6 and 12 months after surgery, and at the last follow-up, the same equipment and methods for relevant examinations. The changes of BCVA, CFT, macular hole and other complications were compared between the two groups. Comparison of BCVA and CFT between the two groups before and after operation was performed by paired t test. The count data were compared by using Fisher exact probability method. Results:At the last follow-up, MF was completely restored in 27 eyes (87.1%) of 31 eyes, partially restored in 4 eyes (12.9%). The mean logMAR BCVA of group A and Group B was 0.67±0.24 and 0.64±0.21, respectively. The average CFT was 126.25±36.61 μm and 134.27±25.29 μm, respectively. Compared with pre-operation, BCVA was obviously improved in both groups ( t=6.630, 9.260; P=0.000, 0.000), CFT was significantly decreased in both groups ( t=10.206, 8.799; P=0.000, 0.000). There were no statistically significant differences in logMAR BCVA and CFT between the two groups ( t=0.156, -0.924; P=0.878, 0.371). In group A, full-thickness macular hole occurred in 1 eye (6.3%), while no macular hole occurred in group B. There was no significant difference in macular hole incidence between two groups ( χ2=0.969, P=0.516). No intraocular hemorrhage, endophthalmitis and other complications occurred during the follow-up period. Conclusions:PPV combined with ILM peeling or fovea-sparing ILM peeling is effective in the treatment of high myopic MF. Both may contribute to improved MF closure rate and BCVA.
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Objective:To evaluate the therapeutic efficacy of vitrectomy with internal limiting membrane (ILM) peeling and subretinal injection of balance salt solution (BSS) for refractory diabetic macular edema (DME).Methods:A retrospective case series study. From November 2017 to August 2018, 24 eyes of 19 patients affected with DME resistant to anti-VEGF therapy [central macualar thickness (CMT) more than 275 μm despite undergoing anti-VEGF therapy at least 3 times] in Ophtalmology Department of Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent 25G pars plana vitrectomy with ILM peeling and subretinal injection of BSS. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The CMT and the macular volume (MV) were assessed with swept-source optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT and MV before and after surgery were analyzed.Results:The mean BCVA was 0.74±0.29 at baseline, which increased significantly to 0.62±0.28, 0.56±0.25, 0.47±0.26, 0.46±0.23 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=4.828, P=0.001). At 6 months, BCVA improved by more than 0.3 logMAR units in 16 eyes (66.7%). The mean CMT was 554.58±102.86 μm at baseline, which reduced to 338.17±58.09 μm,299.42±52.66 μm, 275.75±41.24 μm and 270.96±38.33 μm at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=84.867, P<0.001). The mean MV was 13.01±0.88 mm 3 at baseline, which decreased to 11.50±0.73 mm 3, 11.00±0.74 mm 3, 10.68±0.61 mm 3 and 10.52±0.56 mm 3 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively ( F=47.364, P<0.001). Macular edema recurred in 5 eyes(20.8%) 6 months after surgery. No severe systemic or ocular side effect was reported during the follow-up. Conclusions:25G vitrectomy with ILM peeling and subretinal injection of BSS for refractory DME can improve the visual acuity, facilitate a rapid resolution of macular edema.
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Objective:To observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia.Methods:A retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm 2 and 0.202±0.03 mm 2, respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia. Results:At 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm 2 and 0.240±0.019 mm 2, respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased ( F=8.484, 14.346; P<0.001,<0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline ( F=5.044, 17.763, 13.545; P=0.001, <0.001, <0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score ( r=-0.816, P<0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score ( r=-0.422, -0.882; P=0.005,<0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score ( r=-0.791,-0.716; P<0.001,<0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score ( r=-0.343, -0.330, -0.732, -0.694; P=0.026, 0.033,<0.001,<0.001). Conclusions:PPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA.
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Objective:To observe the preliminary clinical application value of the handheld non-mydriatic visual electrophysiological diagnostic system RETeval in screening for diabetic retinopathy (DR).Methods:Retrospective clinical study. Fifty-eight patients with type 2 diabetes mellitus and 16 normal subjects who were admitted to Wuhan General Hospital of the PLA from November 2017 to May 2018 were enrolled in this study. All patients had not received any ophthalmologic treatment. All patients were examined by the default "DR assessment protocol" model of the RETeval device, and the "DR score" were measured by the system. The FFA results were used as the gold standard, and the DR was graded according to the international DR grading standard established in 2002. Patients were divided into vision threatening DR (VTDR) positive group and VTDR (?) group, DR (+) group and DR (?) group. Two independent sample t tests was used to compare the implicit time, amplitude, and pupil area ratio between eyes of different groups. Spearman correlation analysis was used to analyze the relationship between "DR score" and DR severity. The receiver operating characteristic area under the curve (AUC) assesses the sensitivity and specificity of RETeval in detecting DR and VTDR. The threshold of sensitivity and specificity was determined by using the maximum Youden index as a standard. Results:The AUC of DR was 0.936, the sensitivity was 81%, the specificity was 92%; the AUC of VTDR was 0.976, the sensitivity was 96% and the specificity was 70%. Compared with DR (?) group, the implicit time of DR (+) group was delayed and the amplitude and pupil area were decreased ( t=-13.43, 5.49, 6.09; P=0.000, 0.000, 0.000). Compared with VTDR (?) group, the implicit time of VTDR (+) group was delayed and the amplitude and pupil area were decreased ( t=-11.05, 7.46, 5.73; P=0.000, 0.000, 0.000). The "DR score" was significantly correlated with the severity of DR ( r=0.89, P<0.05). Conclusions:The "DR score" measured by the RETeval instrument has a high degree of specificity and sensitivity in the diagnosis of DR and VTDR. It is highly correlated with the severity of DR.
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Objective To observe the effect ofconbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME).Methods A prospective randomized controlled clinical study.From June 2016 to June 2017,68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study.The patients were randomly assigned to two different treatment groups:36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group).All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before.BCVA was measured by ETDRS charts.The central macular thickness (CMT),total macular volume (TMV) were measured by Topcon 3D-OCT 2000.The BCVA,CMT and TMV in the combined treatment group and the drug treatment group were 57.9 ± 12.4 letters,427.8± 129.4 μm,10.14± 1.50 mm3 and 59.0± 16.0 letters,441.0 ±135.7 μm,10.43 ±2.10 mm3,respectively.There was no significant difference (t=0.321,0.410,0.641;P=0.749,0.683,0.524).The follow-up period was more than 12 months.The changes of BCVA,CMT and TMV were compared between the two groups.Comparison ofBCVA,CMT,TMV before and after treatment in and between groups using repeated measures analysis of variance.Results The average annual injection times was 5.8 ± 1.9 in the combined treatment group and 8.5± 2.4 in the drug treatment group.The difference was statistically significant (t=5.12,P=0.000).The BCVA in the 3rd,6th,9th and 12th month were 64.9± 11.1,65.6± 10.5,67.0± 10.8,66.6± 10.7 letters and 65.7± 15.8,66.9 ± 15.7,66.4 ± 13.0,67.3 ± 16.4 letters,respectively,and there were significant differences compared with BCVA before treatment (F=34.234,10.137;P=0.000,0.000).The CMT were 335.2± 105.9,352.6± 106.6,336.2± 120.8,305.9±97.0 μm and 323.9±92.8,325.5±90.2,327.6± 108.2,312.2± 106.8 μm,respectively.The TMV were 9.20± 1.08,9.26± 1.20,9.20± 1.63,9.05± 1.18 mm3 and 9.19± 1.21,9.35± 1.69,9.09± 1.20,8.92± 1.10 mm3,respectively.Compared with the CMT (F=12.152,12.917;P=0.000,0.000) and TMV (F=11.198,11.008;P=0.000,0.000) before treatment,the differences were statistically significant.Conclusion Conbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT,TMV and improve BCVA in patients with DME,but combination therapy can reduce the injection times of conbercept.
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Objective To analyze the expression of VEGF,IL-33 and NO concentration after laser photocoagulation and subthreshold micropulse laser photocoagulation conventional in proliferative diabetic retinopathy (PDR) patients.Methods A case control study.The clinical data of 39 patients of PDR and 11 patients of idiopathic macular pucker (IMP) from Department of Ophthalmology,Central Theater General Hospital during November 2015 were collected in this study.PDR patients were assigned randomly into three groups.Fifteen PDR patients with 15 eyes were treated with conventional laser as group A.Thirteen PDR patients with 13 eyes were treated with subthreshold micropulse laser as group B.Eleven PDR patients with 11 eyes without any laser therapy were grouped as C.Eleven IMP patients were grouped as D.There was no difference of age (F=0.53,P=0.23),gender ratio (x2=0.55,P=0.91),body mass index (F=2.62,P=0.07),duration diabetes (F=0.29,P=0.75),glycoslated hemglobin (F=1.72,P=0.19) in four groups.All PDR patients were examined with FFA.Total protein was quantified by a bicinchoninic acid assay kit.Levels of VEGF,IL-33,NO were determined using enzyme-linked immunosorbent assay kits.Results There was no difference of total protein in four groups (F=1.78,P=0.17).Group C had a higher VEGF level than group A and B (F=7.84,P=0.002).Group A had a higher IL-33 level than group C (t=4.15,P=0.02).There was no difference of IL-33level in group B and C (t=1.34,P=0.20).Group D had a lower NO level than group A,B,C (F=38.42,P＜0.001).There was no difference of NO level in group A,B and C (F=3.29,P=0.06).Conclusions Both conventional laser photocoagulation and subthreshold micropulse laser photocoagulation can decrease vitreous VEGF level and subthreshold micropulse laser photocoagulation can induce less IL-33 level.
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Objective To observe the effect of acupuncture-moxibustion plus Zhi Ge Tong Mai granules on the traditional Chinese medicine (TCM) syndrome score, level of homocysteine (Hcy) and nerve conduction in patients with diabetic peripheral neuropathy (DPN). Method Ninety DPN patients were enrolled and randomized into a control group and an observation group. The control group only received Zhi Ge Tong Mai granules, and the observation group was intervened by acupuncture-moxibustion plus Zhi Ge Tong Mai granules. The clinical efficacy, TCM syndrome score, and levels of Hcy, nerve growth factor (NGF), insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF), and nerve conduction function were observed for the two groups. Result The observation group had a higher total effective rate than the control group (P<0.05); the TCM syndrome score in the observation group was lower than that in the control group after treatment (P<0.05); the levels of Hcy and VEGF in the observation group were lower than those in the control group, and the levels of NGF and IGF-1 in the observation group were higher than those in the control group (P<0.05); after treatment, the motor and sensory conduction velocities of both left and right tibial nerves in the observation group were higher than those in the control group (P<0.05). Conclusion Acupuncture-moxibustion plus Zhi Ge Tong Mai granules can boost the clinical efficacy, and improve the TCM syndrome score, and the levels of factors such as Hcy and VEGF in patients with DPN.It can produce better efficacy than Zhi Ge Tong Mai granules alone.
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The bitter taste is one of the important properties among five flavors of Chinese materia medica (CMM), characterized by downbearing and discharging, drying dampness, and consolidating Yin. In common CMM, bitter-taste CMM accounts for a large proportion, indicating the importance of it. Through the efficacy of clearing away heat and dampness, reducing fire and removing toxin, bitter-taste CMM has achieved good results in treating diabetes in clinical application, proving their definite therapeutic effect on regulating glucose and lipid metabolism (main features of diabetes). At present, there are many reports about the chemical constituents and pharmacological effects of CMM on diabetes, but there are few reviews on the chemistry and biology of bitter-taste CMM. This study summarized the properties and compatibility characteristics of bitter-taste CMM for treating diabetes, and mainly analyzed the chemistry and biology basis of bitter-taste CMM with function of regulating glycolipid metabolism, laying foundation for further researches on properties theory of CMM.
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Glycolipids , Metabolism , Materia Medica , Chemistry , Medicine, Chinese Traditional , Research , TasteABSTRACT
<p><b>Objective</b>To study the expression of CLAUDIN-11 in the testis tissue of non-obstructive azoospermia (NOA) patients with different severities and investigate its clinical significance.</p><p><b>METHODS</b>Sixty-two NOA patients were divided into a hypospermatogenesis (HS) group (n = 30) and a Sertoli cell only syndrome (SCO) group (n =32). The expression of CLAUDIN-11 in the testicular tissue of the patients was detected by immunohistochemistry, that of CLAUDIN-11 mRNA determined by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and the levels of serum reproductive hormones measured by chemiluminescent immunoassay.</p><p><b>RESULTS</b>Immunohistochemistry showed that the expression of CLAUDIN-11 was mainly in the cytoplasm of the Sertoli cells around the seminiferous tubule wall in the HS group, but diffusely distributed in the membrane of the Sertoli cells in the SCO group. RT-qPCR revealed a significantly lower expression of CLAUDIN-11 mRNA in the HS than in the SCO group (0.008 ± 0.001 vs 0.013 ± 0.002, t = 10.616, P<0.01). The level of serum luteotropic hormone (LH) was also markedly lower in the HS than in the SCO group (［3.62 ± 1.34］ vs ［4.96 ± 3.10］ IU/L, P<0.05) and so was that of follicle-stimulating hormone (FSH) (［5.36 ± 2.80］ vs ［10.65 ± 9.18］ IU/L, P<0.05).</p><p><b>CONCLUSIONS</b>The up-regulated expression of CLAUDIN-11 in Sertoli cells may play an important role in the development and progression of spermatogenic dysfunction in NOA patients.</p>
Subject(s)
Humans , Male , Azoospermia , Genetics , Metabolism , Claudins , Metabolism , Follicle Stimulating Hormone , Metabolism , Oligospermia , Genetics , Metabolism , RNA, Messenger , Metabolism , Seminiferous Tubules , Metabolism , Sertoli Cell-Only Syndrome , Genetics , Metabolism , Sertoli Cells , Metabolism , Spermatogenesis , Testis , MetabolismABSTRACT
Objective To report a postoperative complication of corneal invasion of filtering bleb (CIFB) and the analysis of its diagnosis and treatment.Methods A retrospective analysis was conducted in 17 patients with CIFB collected from March 2006 to April 2017.They were treated according to the classification standards.Patients suffering the mild type with no obvious conjunctival post-adhesion received conservative observation;but patients with obvious adhesion were given acupuncture separation combined with 5-Fluorouracil filter follicular subconjunctival injection and eye massage.The moderate type with no progress was treated with the mild and mediumpartial filtration and amniotic membrane transplantation.For the severe ones,the conjunctiva filtering bleb was excised with lamellar keratoplasty and filtering bleb reconstruction.Finally,the clinical features,classification standards and the follow-up results were summarized.Results As for the clinical features,17 patients were treated with domeas the basement of the conjunctival incision,and received intraoperative mitomycin administration.For the patients with CIFB growing rapidly,the posterior synechiae of their filtering blebs had occurred and timely actions could slow down or stop its development.As for the classification standards,according to the degree of corneal invasion,there were 11 patients being mild type,5 patients being moderate types,and only 1 patients being severe type.After treatment,the progress stopped in all mild patients,while the moderate and severe types were not relapsed after treatment.Conclusion CIFB is different from overhanging filtering bleb.As a less common kind of filtering bleb complication,timely identification and appropriate treatments can effectively delay or even stop the progress of corneal damage to maintain the filtering surgery effects.
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Objective To evaluate the clinical efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema (DME).Methods Retrospective case series study.A total of 30 patients (35 eyes) with center-involving DME were enrolled in this study.All the patients received the examinations of best corrected visual acuity (BCVA),fundus colorized photography,fluorescein fundus angiography (FFA) and optical coherence tomography (OCT).BCVA was measured by Early Treatment Diabetic Retinopathy Study charts.The average retinal thickness (ART),total macular volume (TMV) and the retinal thickness (RT) and macular volume (MV) of 9 ETDRS domains were measured by the Japanese Topcon 3D-OCT 2000 instrument.The mean BCVA was 62.4± 10.5 letters.The mean ART was 327.3± 41.2 μm.The mean TMV was 9.24 ± 1.17 mm3.All patients were treated with 577 nm subthreshold micropulse laser treatment.Subthreshold micropulse laser were performed in the micropulse mode,using a 200 μm spot diameter,a 0.2 s duration with 5％ duty cycle and its treatment energy was 6-7 times of threshold energy.Three months after treatment,re-treatment was performed on patients with incomplete absorption of macular edema.The treatment was the same as before.The BCVA,ART,TMV and the RT and MV of each ETDRS domain were compared and analyzed before and after treatment.The possible complications of micropulse laser treatment were also observed and the safety was evaluated.Results The difference of BCVA were statistically significant in month 3 and month 6 (t=-5.58,-7.24;P＜0.05),but not in month 1 (t=-1.82,P＞0.05).The average CRT (t=4.11,4.17,5.96),CMV (t=3.92,4.05,5.80) significantly decreased in 1,3 and 6 months after treatment,the difference was statistically significant (P＜0.05).At sixth months,the average retinal thickness (t=3.53,5.07,5.02,4.87,4.94,3.48,4.03,3.17,3.73) and retinal volume (t=3.54,5.16,4.99,4.91,5.05,3.47,4.08,3.10,3.70) of the 9 ETDRS subdomains significantly decreased,and the difference was statistically significant (P＜0.05).There was no visible laser spots,changes in the outer retina and complications of neovascularization and subretinal fibrosis in the fundus of all patients.Conclusion 577 nm subthreshold micropulse laser can reduce the CMT,CMV and improve the BCVA of DME patients with high security.
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Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery.Methods A retrospective case series of 64 eyes of 64 patients affected with IMH.All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade.In 35 eyes of 35 patients,the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group).In 29 eyes of 29 patients,the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group).The follow-up was ranged from 6 to 11 months,with the mean follow-up time was 8.4 months.The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test.The duration of the facedown positioning and complications were compared between two groups.Results The period of facedown position was (1.67± 1.28) and (7.65 ± 1.42) days in the SS-OCT group and control group,respectively.The difference of the period of facedown position between the two groups was significant (Z=-6.784,P＜ 0.05).At 6 months after surgery,the hole closure was detected in 30 eyes (85.71％) in the SS-OCT group and in 27 eyes (93.10％) in the control group.There was no difference of hole closure rate between the two groups (x2=0.889,P＞0.05).There was no ocular serious side effect during the follow up,such as leakage of sclera incision,retinal hemorrhage,choroidal hemorrhage and endophthalmitis.In the control group,there were two patients with mild dizziness who underwent symptomatic treatment.There was no systemic side effect during the follow-up in the SS-OCT group.Conclusion Confirming with SS-OCT imaging early closure of macular hole ofIMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning,while achieved a high hole closure rate.
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Objective To observe the baseline characteristics and visual outcomes after two years follow-up of exudative age-related macular degeneration (AMD) patients treated with ranibizumb. Methods Forty-four eyes of 44 patients with exudative AMD were enrolled into this retrospective study, 19 were men and 25 were women. The mean age was 78 years (range 64–92 years). All patients were underwent best corrected visual acuity (BCVA, Early Treatment of Diabetic Retinopathy Study), fundus color photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The mean BCVA was (50.36±14.43) letters, the mean central foveal thickness (CFT) was (291.95± 82.19)μm, and the fluorescence leakage area of choroidal neovascularization (CNV) was (7.61±5.84) mm2. All patients received three initial intravitreous injection of ranibizumb (IVR) and were retreated with monthly IVR when needed. The mean follow up time was 25.6 months (range 24–29 months). On 1, 2, 3, 6, 12, 18 and 24 months after treatment, BCVA and OCT were repeated. On 3, 6, 12, 18 and 24 months after treatment, FFA and ICGA were repeated. The change of BCVA, CFT and fluorescence leakage area of CNV were observed. The association of baseline characteristics and two year visual outcomes were analyzed. Results On 1, 2, 3, 6, 12, 18 and 24 months after treatment, the BCVA were improved significantly (t=?1.89,?3.51,?4.61,?4.04,?5.77,?4.69;P0.05). Conclusion Two year visual outcomes of exudative AMD patients treated with ranibizumb is negative correlated with baseline BCVA and fluorescence leakage area of CNV, but not correlated with baseline CFT.
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In the process of responding to public health emergencies,the conflicts between the principles of management and ethics are constantly revealed.Combining with a unit's practical experiences of participating in several major public health emergencies,this paper put forward that it should take into account both the rescue and notification to achieve the unity of effective rescue and informed consent;take into account both the enforcement and obedience to achieve the unity of the interest of groups and individuals;take into account both the equality and priority to achieve the unity of urgency priority and equal opportunity;take into account both the rescuing and suf-fering to achieve the unity of interest between the rescuers and the victims,and thus to provide references for the reasonable solution of the ethical conflicts in the process of responding to public health emergencies.