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Objective To explore the clinical characteristics and liver injury-related risk factors of thyroid-associated ophthalmopathy(TAO)patients with liver function impairment.Methods In this retrospective cohort study,the clinical data of 1 030 TAO patients who visited Henan Provincial People's Hospital from July 2017 to May 2023 was collected.These patients were divided into TAO patients with liver injury(Group A,132 patients)and TAO patients with normal liver func-tion(Group B,898 patients).The age,gender,smoking history,liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(γ-GT),total bilirubin(TBil),direct bilirubin(DBil),and alkaline phosphatase(ALP)],thyroid function-related indicators[free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),thyrotropin receptor antibody(TRAb),thyroid peroxidase antibody(TPO-Ab),and thyroglobulin antibody],and eye signs[eye protrusion degree,intraocular pressure,absence or occurrence of upper eyelid retraction,NOSPECS grading,clinical activity score(CAS),and number of affected ocular muscles of both eyes]of two groups were collected and compared.Multivariate logistic regression analysis was used to identify the risk fac-tors for liver injury in TAO patients.Results The proportion of liver injury in patients who were initially diagnosed with TAO and received no treatment was 12.82％.There was no statistically significant difference in the gender distribution and the proportion of smokers between the two groups(both P＞0.05).The age of patients in Group A[(44.63+13.64)years]was higher than that in Group B[(40.25±14.04)years],and the difference was statistically significant(t=3.718,P＜0.05).The levels of ALT,AST,γ-GT,ALP,TBil and DBil in Group A were higher than those in Group B,and the differences were statistically significant(allP＜0.01).The FT3,FT4,TPOAb and TRAb levels in Group A were higher than those in Group B,while the TSH level was lower than that in Group B(all P＜0.01).The number of affected ocular mus-cles of both eyes and the proportion of patients with a CAS score≥3 in Group A were higher than those in Group B(both P＜0.05).The regression analysis results showed that the higher the FT4 and TRAb levels,the older the age,and the lower the TSH level,the higher the risk of liver injury in TAO patients.Conclusion High levels of FT4 and TRAb,as well as low TSH level and advanced age,are independent risk factors for liver injury in TAO patients.The direct toxic effects of immune factors and high thyroxine level on the liver are jointly involved in the mechanism of liver injury in TAO patients.
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Objective:To investigate influencing factors of persistent diplopia after orbital floor blowout fracture reconstruction surgery.Methods:A case control study was conducted.Data of 146 eyes of 146 orbital floor blowout fracture patients with diplopia occurring 1 day after operation were collected in Henan Eye Hospital from July 2011 to July 2020.The patients were divided into two groups, persistent diplopia group (14 cases 14 eyes) and disappeared diplopia group (132 cases 132 eyes), according to the persistence of diplopia in the follow-up.Differences in sex, right or left eye, age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, operation approach, postoperative eyeball rotation exercise compliance, the number of eyes with postoperative inferior rectus muscle damage level were compared between the two groups to select factors with P<0.05 for multifactor logistic regression analysis.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2021[15]). Results:All eyes were successfully operated and no complications such as infection or dislocation of the orbital implant occurred in any of the eyes during the postoperative follow-up period.There were statistically significant differences in age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, postoperative eyeball rotation exercise compliance and postoperative inferior rectus muscle injury between the two groups ( χ 2=9.443, P=0.002; χ 2=29.041, P<0.001; H=53.943, P<0.001; H=34.583, P<0.001; χ 2=46.041, P<0.001; H=101.438, P<0.001). The multiple logistic regression analysis indicated that the long preoperative course of disease ( OR=8.678, 95% CI=1.013-74.304, P=0.031), preoperative intraorbital soft tissue hernia (Severe: OR=32.963, 95% CI=7.647-142.084, P<0.001.Moderate: OR=11.852, 95% CI=2.679-52.436, P=0.001), and postoperative inferior rectus muscle injury (Severe: OR=511.000, 95% CI=42.815-6 110.808, P<0.001.Moderate: OR=132.000, 95% CI=12.442-1 400.458, P<0.001) were independent risk factors for postoperative persistent diplopia.Advanced operation methods (Individualized shaped titanium mesh method: OR=0.020, 95% CI=0.002-0.127, P<0.001.Manufacturers prefabricated titanium mesh method: OR=0.031, 95% CI=0.004-0.257, P=0.001), and the postoperative eyeball rotation exercise ( OR=0.015, 95% CI=0.001-0.197, P<0.001) were independent protective factors for postoperative persistent diplopia. Conclusions:Severe preoperative intraorbital soft tissue hernia and postoperative inferior rectus muscle injury are the main risk factors for persistent postoperative diplopia after orbital floor blowout fracture repair surgery.Shortening the preoperative course of disease, improving the operation methods, and enhancing postoperative ocular functional exercises may reduce the incidence of postoperative persistent diplopia.
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Objective:To investigate the inhibitory effect of phloretin on inflammation and oxidative stress in interleukin (IL)-1β induced orbital fibroblasts (OFs) from Graves orbitopathy (GO) patients and its mechanism.Methods:The orbital fat and connective tissue from 6 eyes of 6 patients diagnosed as inactive GO who underwent orbital decompression in Henan Eye Hospital from January 2019 to December 2020 were collected.Primary OFs were isolated and passaged by explant culture and were identified by cell immunofluorescence assay.OFs were divided into control group, IL-1β induced group, and groups of various phloretin concentrations (25, 50, 75, 100 and 200 μmol/L). The viability of OFs after 24- and 48-hour treatment of the various phloretin concentrations was determined by cell counting kit-8 (CCK-8). OFs were induced by IL-1β to simulate an inflammatory environment of GO in vitro.Intracellular reactive oxygen species (ROS) levels of the normal control group, IL-1β induced group, 50 μmol/L phloretin group and 100 μmol/L phloretin group were detected by fluorescent probe (H 2DCF-DA). The concentrations of pro-inflammatory cytokines IL-6, IL-8 and monocyte chemoattractant protein-1 (MCP-1) in cell culture supernatant of the normal control group, IL-1β induced group and phloretin treated groups (25, 50, 75, and 100 μmol/L) were examined by enzyme-linked immunosorbent assay (ELISA). The expressions of heme oxygenase-1 (HO-1), nuclear factor erythroid 2-related factor (Nrf2) proteins, as well as P38, extracelluar regulated protein kinase (ERK) and c-Jun N-terminal kinase (JNK) proteins as well as their phosphorylated proteins in the MAPK signal pathway of the normal control group, IL-1β induced group and 100 μmol/L phloretin group, were detected by Western blot.The purpose and methods of the study were explained to the patients and their family members.Written informed consent was obtained.The study protocol was approved by the Ethics Committee of Henan Provincial People's Hospital (No.HNEECKY-2020[07]). Results:For cultured OFs, the mesenchymal origin was confirmed by positive expression of vimentin and fibroblasts were identified by negative expression of desmin, S-100 and cytokeratin-18.CCK-8 showed that there was no significant difference in absorbance value after 24- and 48-hour treatment between 25 μmol/L, 50 μmol/L, 75 μmol/L and 100 μmol/L phloretin groups and control group (all at P>0.05). The ROS levels of 50 μmol/L and 100 μmol/L phloretin groups were 21.95±1.71 and 10.01±1.03, respectively, which were significantly lower than 39.27±4.01 of IL-1β induced group (both at P<0.01). ELISA showed that IL-6 concentrations in 25 μmol/L, 50 μmol/L, 75 μmol/L and 100 μmol/L phloretin groups were (4 544.25±572.98), (1 000.25±133.96), (724.25±98.63), (519.50±118.02)pg/ml, respectively, which were all significantly lower than (7 581.75±565.93)pg/ml in IL-1β induced group (all at P<0.01). IL-8 concentrations in 50 μmol/L, 75 μmol/L and 100 μmol/L phloretin groups were (3 679.50±676.76), (2 143.75±616.20), (1 174.75±284.18)pg/ml, respectively, which were all significantly lower than (8 411.00±939.67)pg/ml in IL-1β induced group (all at P<0.01). The concentrations of MCP-1 in 50 μmol/L, 75 μmol/L and 100 μmol/L phloretin groups were (3 783.25±610.24), (1 565.75±457.89), (745.75±227.01)pg/ml, respectively, which were all significantly lower than (5 533.00±602.87)pg/ml in IL-1β induced group (all at P<0.01). The relative expression levels of HO-1 and Nrf2 were significantly higher and the relative expression levels of p-P38, p-ERK, and p-JNK were significantly lower in 100 μmol/L phloretin group than IL-1β induced group (all at P<0.01). Conclusions:Phloretin reduces the oxidative stress level of IL-1β induced OFs from GO patients and inhibits the production of pro-inflammatory cytokines.The mechanism is related to the activation of Nrf2/HO-1 and the inhibition of the MAPK signal pathway.
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Objective:To investigate the protective effect of a modified orbital decompression on postoperative eye position in thyroid-associated ophthalmopathy (TAO).Methods:A cohort study was performed.One hundred and thirty-six eyes of 96 TAO patients who received orbital decompression in Henan Eye Hospital from July 2008 to July 2018 were enrolled.The patients were divided into two groups according to different operation methods.A depressed bone window was made in the region of orbital apex in the modified orbital decompression group with 100 eyes of 70 patients.A depressed bone window was made in the middle and anterior region of orbit in the traditional orbital decompression group with 36 eyes of 26 patients.The best corrected visual acuity, palpebral fissure, eyeball exophthalmos, strabismus, eyeball position、CT image and postoperative complications were compared.This study was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[07]), and written informed consent was obtained from each subject before surgery.Results:Strabismus was improved in 14 eyes of 10 patients, unchanged in 75 eyes of 52 patients and slightly aggravated in 11 eyes of 8 patients after operation in the modified orbital decompression group.In the traditional orbital decompression group, strabismus was slightly aggravated in 6 eyes of 4 patients, seriously aggravated in 30 eyes of 22 patients after surgery. In the modified orbital decompression group, the eyeball displacement was unchanged in 91 eyes of 64 patients, slightly aggravated in 9 eyes of 6 patients after surgery in the traditional orbital decompression group, the eyeball displacement was slightly aggravated in 15 eyes of 10 patients, seriously aggravated in 21 eyes of 16 patients after surgery.Significant differences were found in the number of eyes with different degree of strabismus and eyeball displacement between the two groups ( Z=-9.634, -10.278, both at P<0.01). The postoperative eyeball exophthalmos values were (14.36±2.03)mm and (14.36±1.03)mm in the modified orbital decompression group and the traditional orbital decompression group, respectively, which were significantly lower than preoperative (20.47±1.92)mm and (20.28±2.03)mm (both at P<0.05). CT imaging showed that the bone window was clear in orbital apex and the compression of optic nerve was relieved postoperatively in the modified orbital decompression group, and the bone window was in anterior part of the orbit and the orbital apex was still crowded in the traditional orbital decompression group.No severe complication was seen during the fellow-up duration in the two groups. Conclusions:Compared with traditional orbital decompression, the modified orbital decompression surgery can reduce the risks of strabismus and eyeball displacement, showing an obvious protective effect on eye position.
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Objective@#To discuss the radical treatment of lymphatic vascular malformation combined intracystic hemorrhage in Children.@*Methods@#66 cases with lymphatic vascular malformation combined intracystic hemorrhage were retrospectively analyzed. The longest diameter of all the lesions was nearly 4 cm.All the 66 patients received surgical treatment. Arc-shaped incision was made to separate and expose the eyes from the hair trace. The lesions were separated from the frontal and temporal parts to the eyes along the dermal fat layer, and deep separation revealed orbicularis oculi muscle and levator upper eyelid muscle.@*Results@#All the 66 cases were completely resected, and the patients were followed up for 0.5-3.0 years after the surgery. The postoperative appearance was satisfactory in 58 cases. The wound scar was healed in 8 cases, and the patients had satisfactory postoperative appearance after elective scar resection and cosmetic repair. Postoperative complications included long-term exudation of incision lymph in 6 cases. Among them, 4 cases were complicated with incision dehiscence and 2 cases were infected.@*Conclusions@#The method of complete resection of tumor as early as possible can radical cure the ocular lymphangioma with intracapsular hemorrhage, which prevent the disease from deteriorating, and meeting the aesthetic requirements of satisfactory appearance.
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Objective@#To explore the treatment of the ocular arteriovenous malformation using urea injection combined with surgical procedures and evaluate clinical effects.@*Methods@#42 cases withocular arteriovenous malformation combined with fistula were retrospectively analyzed between January 2011 and December 2016. Individual treatments were formulated according to leision areas and severity. 3 cases with diffuse malformations were excluded from the study, because no surgical procedures were performed. 39 cases underwent local injection with 40% urea before resection. The urea was injected locally into vein malformation area by means ofmulti-point injection on a basis of 30 seconds, 3-6 ml for each treatment, once a day.The injection was performed for successive 7-10 days.The therapeutic effects and cosmetic result were recorded.@*Results@#23 cases occurred intheright ocular area and 16 cases in left.21 cases were removed radically in single operation.No recurrenceoccurredin any case with follow-ups of 3 months to 1.5 years.Cosmetic result with ocularbilateral symmetrywere satisfactory.@*Conclusions@#Combined treatment with urea injection and surgical procedure could effectively treat ocular arteriovenous malformation with arteriovenousfistula.
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Objective@#To detect the expression level of Galectin-3 in the ocular Venous Malformation (VM) tissue, and explore its associations with the occurrence and development of ocular VM.@*Methods@#12 fresh ocular VM tissue samples and 12 simplex great saphenous vein varices tissue samples were collected. The mRNA and protein expression levels of Galectin-3 gene were detected by RT-PCR and Western Blot.@*Results@#The relative mRNA and protein levels of Galectin-3 in VM and control group were 5.26×10-3±8.78×10-4, 4.89×10-4±5.37×10-5 and 0.861±0.394, 0.223±0.206, respectively; Galectin-3 expressions in both mRNA and protein levels in ocular VM tissue were obviously higher than those in control group (P<0.05), and an increasing trend was accompanied with aggravating pathological changes in both degree and range of ocular VM.@*Conclusions@#Galectin-3 is highly expressed in ocular VM tissue in both mRNA and protein levels, which may be closely related to ocular VM development and prognosis, and can be used to determine the degree of local invasion of ocular VM. The pathogenesis of ocular VM may be related to Galectin-3, which can be further investigated through gene chip techniques.
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ObjectiveToinvestigatethecorrelationbetweentheetiologicsubtypeandoutcomein patients w ith non-disabling ischemic cerebrovascular events (NICE). Methods The consecutive patients w ith NICE admitted to hospital within 7 days after onset were enroled prospectively and folowed for 90 days. Etiologic subtypes w ere classified according to the Chinese Ischemic Stroke Subclassification (CISS). Good outcome w as defined as modified Rankin Scale score 0-2. Multivariate logistic regression analysis w as used to identify the independent risk factors for stroke recurrence and poor outcomes. Results A total of 162 patients with NICE were enroled. According to CISS, 76 (46.9%) were classified into large artery atherosclerosis (LAA), 54 (33.3%) into penetrating artery disease (PAD), 15 (9.3%) into cardiogenic stroke (CS), 11 (6.8%) into undetermined etiology (UE), and 6 (3.7%) into other etiology (OE). A total of 30 patients (18.5%) had recurrent stroke w ithin 90 days and 42 (25.9%) had poor outcomes. The proportions of patients w ith diabetes (46.7%vs.20.5%;χ2 =8.885, P=0.003), previous stroke or transient ischemic attack (46.7%vs.25.0%;χ2 =5.572, P=0.018), CS (20.0%vs.6.8%;Fisher exact test:P=0.036) in the stroke recurrence group w ere significantly higher than those in the non-stroke recurrence group, and the proportion of PAD patients in the stroke recurrence group w as significantly low er than that in the non -stroke recurrence group ( 16.7%vs.37.1%; χ2 =4.602, P=0.032 ). Multivariate logistic regression analysis show ed that diabetes (odds ratio [OR] 2.137, 95%confidence interval [CI] 1.359-4.187;P=0.004) and CS (OR 5.236, 95%CI 2.326-10.256; P<0.001) w ere the independent risk factors for recurrent stroke of NICE. The proportions of patients w ith hypertension ( 83.3%vs.61.7%; χ2 =6.635, P=0.010 ), diabetes (40.5%vs.20.0%;χ2 =6.900, P=0.009), atrial fibrilation (35.7%vs.14.2%;χ2 =9.113, P=0.003) and CS ( 19.0%vs.5.8%; Fisher exact test: P= 0.017 ) in the poor outcome group w ere significantly higher than those in the good outcome group, and the proportion of PAD patients ( 16.7%vs. 39.2%;χ2 =7.088, P=0.008) in the poor outcome group w as significantly low er than that in the good outcome group. Multivariate logistic regression analysis show ed that diabetes ( OR 2.257, 95%CI 1.209-3.687; P=0.010), atrial fibrilation (OR 3.137, 95%CI 1.359-6.107, P=0.002), and CS (OR 6.123, 95%CI 2.026-12.256, P<0.001) w ere the independent risk factors for poor outcomes in patient w ith NICE. Conclusions The etiologic subtype is associated w ith the poor outcomes and recurrent stroke, and can provide reference for recurrence and clinical outcome assessment in patients w ith NICE.
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Background Orbital blow-out fracture often results in the abnormalities of appearance and function of eye.Because of the special and complex anatomical structure of orbital cavity,it is difficult to design and manufacture the corresponding orbital implants.The computer-aided designing and manufacturing (CADM) technology provides a new approach to orbital implants.However,the clinical value of this method is still under evaluation.Objective This study was to investigate the application and the therapeutic effect of CADM for orbital blow-out fracture.Methods The clinical data of 74 eyes of 74 patients who received surgery for orbital blow-out fracture from July 2006 to July 2012 in Henan Eye Institute,Henan Eye Hospital were retrospectively analyzed.Fiftyeight patients underwent CADM implanted surgery and 16 patients received non-CADM surgery in the same period with matched age,gender and lateral eyes in both groups.The individualized 3D orbital implants were designed and manufactured by the technology of CADM and then were implanted in the bone defects in the CADM group,while the traditional hydroxyapatite artificial bone or high density porous polyethylene material (Medpor) was utilized in the non-CADM group with a fellow-up duration for 22 to 69 months.The best corrected visual acuity (BCVA),eyeball exophthalmos,ocular position,eye movement,diplopia and postoperative complications were evaluated.Results The preoperative BCVA were 0.71±0.37 and 0.69±0.41,and the postoperative BCVA were 0.74±0.38 and 0.72±0.41 in the CADM group and the non-CADM group,respectively,showing an insignificant intergroup difference (Fgroup =0.043,P=0.837),but a significant variation was found over time (Ftime =13.576,P ＜ 0.01).The BCVA was significantly improved after surgery compared with before surgery in both groups (both at P＜0.05).No significantdifferences were found in the number of eyes with curative and improved diplopia and eye movement disorders between the two groups during the fellow-up duration (Z =-0.298,P =0.766;Z =-0.548,P =0.584).The preoperative eyeball exophthalmos values were (3.93±0.99)mm and (3.88±0.97)mm and the postoperative ones were (0.91 ±0.67)mmand (1.84±0.80) mm in the CADM group and the non-CADM group,respectively,without significant differencebetween the two groups (Fgroup =3.558,P =0.063).However,the eyeball exophthalmos values after operation wereremarkably lower than those before operation in both groups (both at P＜0.05).CT imaging displayed implants fitting well with fracture defect and attached to bone tissue accurately in all of the eyes in the CADM group,but in the nonCADM group,the bulge of implants damaging extraocular muscles or optical nerve was found in 2 eyes.No postoperative complication was seen throughout the fellow-up duration in the CADM group.Conclusions CADM technology for orbital blow-out fracture can reconstruct a 3D bony orbit and effectively repair ocular position and appearance,and furthermore restore eye movement and visual functions.The therapeutic outcome of CADM technology for orbital blow-out fracture is superior to conventional implants.
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Objective To detect the effect of plumbagin on proliferation,apoptosis and invasion ofglioma cell lines,and investigate the underlying mechanism.Methods Glioma cell lines SWO-38 and U251 were routinely cultured in vitro,and treated with various concentrations of plumbagin (0-50 μmol/L) for 48 h; cell viability changes were detected by MTT assay,and median inhibitory concentration (IC50) was calculated; after 0,2.5,5 and 10 μmol/L plumbagin treatment for 48 h,cell apoptosis was detected by annexin V/propidium iodide double-labeled flow cytometry; scratch test was used to observe the cell invasion and migration; Western blotting was used to assess the SOX2 protein expression; MiR200b,miR200c,miR-203 and miR-21 expression changes were examined by real-time quantitative PCR.Results Plumbagin dose-dependently inhibited the proliferation of the glioma cells;the IC50 values ofplumbagin in SWO-38 and U251 cells were 6.8 and 7.4 μmol/L,respectively.After 0,2.5,5 and 10 μmol/L plumbagin treatment for 48 h,cell apoptosis ratio was gradually increased,and MiR200b,miR200c,miR-203 expressions gradually increased,with significant differences (P＜0.05).Cell invasion and migration in these two cell lines were decreased and the SOX2 protein expression was decreased.Conclusion Plumbagin inhibits cell growth,induces apoptosis,and decrease cell invasion and migration,which might be related to the increase ofmiR200b,miR200c and miR-203 expressions and the decrease of SOX2 protein expression.
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Objective To analyze the relation between SOX2 and miR-200b and their influences in clinical pathology and prognosis of gliomas patients.Methods One hundred and twenty-three human glioma specimens,collected in our hospital from January 2001 to December 2005 and conformed by pathology,were chosen in our study; other 23 healthy brain tissues collected during intracranial decompression were used as controls.Real-time quantitative PCR (qRT-PCR) was employed to detect the miR200b expression; immunohistochemistry was used to detect the SOX2 expression.Relations between SOX2 and miR-200b in different grades of gliomas were analyzed; the correlations of clinical parameters with SOX2 and miR-200b expressions were analyzed; Cox proportional hazards regression model was used to analyze the influences of SOX2 and miR-200b expressions in survival times of the patients,and the survival curves of patients with different SOX2 and miR-200b expressions were compared.Results The higher the pathology grade,the lower the miR-200b expression; gliomas of grade Ⅲ and Ⅳ had SOX2 positive expression enjoyed significantly lower miR-200b expression than those had SOX2 negative expression (P＜0.05).The SOX2 and miR-200b expressions in gliomas of different pathology grades were significantly different (P＜0.05).Cox proportional hazards regression model indicated that miR-200b and SOX2 were the independent risk factors for prognosis of gliomas.In patients of grade Ⅲ and grade Ⅳ gliomas,significantly higher 5 years survival rate in patients with high miR200b expression was noted as compared with that with low miR200b expression (P＜0.05),and significantly higher 5 years survival rate in patients with negative SOX2 expression was noted as compared with those with positive SOX2 expression (P＜0.05).Conclusion The miR-200b and SOX2 expressions show difference only in poor differentiated tissues of grade Ⅲ and Ⅳ gliomas; the two have influence in the survival time.