Mechanical protective effect of lens anterior capsule disc on corneal endothelial cells during femtosecond laser-assisted cataract surgery in a rabbit model.

PURPOSE: To evaluate the effects of a novel technique using an isolated lens anterior capsule disc (LACD) to protect corneal endothelial cells in rabbit eyes during femtosecond laser-assisted cataract surgery. METHODS: Experimental study. 40 rabbits were divided into endothelium-protected (experimental) and control groups, with 20 rabbits in each group. In the experimental group, after femtosecond laser capsulotomy, the isolated capsule disc was lifted to the corneal endothelium by an ophthalmic viscosurgical device. The endothelium was damaged for 1 min with an ultrasonic probe. The control group underwent the same surgery, except that the disc was removed immediately after capsulorhexis. Corneal endothelioscopy was performed preoperatively and on postoperative days (PODs) 3 and 7 to observe endothelial cell counts (ECC) and endothelial cell loss rate. Central corneal thickness (CCT) was measured before and at PODs 1, 3 and 7. RESULTS: There were 3.59%±1.88% (p < 0.001) and 2.92%±2.14% (p < 0.001) loss of ECC in experimental group at POD3 and POD7, respectively, while those in the control group were 11.62%±7.43% and 10.34%±5.77%, respectively. On POD 1, the difference in central corneal thickness was significant(P = 0.019) between the two groups. At POD 3 and POD 7, CCT was not significantly different (P = 0.597;0.913) between the two groups. CONCLUSIONS: The isolated LACD technique significantly reduced damage to the endothelium caused by ultrasonic energy and protects corneal endothelial cells during phacoemulsification.

Influence of Red Blood Cell Distribution Width on All-Cause Death in Critical Diabetic Patients with Acute Kidney Injury.

Objective: To explore the relationship between red blood cell distribution width (RDW) and all-cause death in critical diabetic patients with acute kidney injury (AKI). Methods: The clinical data of critical diabetic patients with AKI in MIMIC-III database were analyzed retrospectively. According to the survival status of 28-day after AKI and levels of RDW, patients were divided into survival and death groups, high RDW (RDW > 15.3%) and low RDW groups (RDW ≤ 15.3%). Kaplan-Meier curves were used to compare the survival rates of diabetic patients with AKI in different RDW and AKI stages, and Cox regression analysis was used to evaluate the risk factors of 28-day all-cause death in critical diabetic patients with AKI. Results: A total of 5200 patients with critical diabetic patients with AKI were included in this study with the male to female ratio of 1.53:1. The mean follow-up time was 24.97 ± 7.14 days, and the 28-day all-cause mortality was 17.9% (931/5200). Age, RDW, blood urea nitrogen, serum creatinine, lactic acid, proportion of AKI stage, sepsis and respiratory failure in the death group were higher than those in the survival group, while mean arterial pressure (MAP) and red blood cell count were lower than those in the survival group. Kaplan-Meier analysis showed that the 28-day survival rate of the high RDW group was significantly lower than that of the low RDW group (log-rank χ 2 = 9.970, P = 0.002). Multivariate Cox regression analysis showed that advanced age (HR = 1.042, 95% CI = 1.021-1.063), decreased MAP (HR = 0.984, 95% CI = 0.969-0.998), stage 3 AKI (HR = 3.318, 95% CI = 1.598-6.890) and increased RDW (HR = 1.255, 95% CI = 1.123-1.403) were independent risk factors of 28-day all-cause death in critical diabetic patients with AKI (P < 0.05). Conclusion: High level of RDW is an important risk factor of all-cause death in critical diabetic patients with AKI, and it may be used as a valuable index to classify the mortality.

Predictors of Femtosecond Laser-Assisted Arcuate Keratotomy Efficacy for Astigmatism Correction in Cataract Surgery.

PURPOSE: To evaluate the predictors related to the efficacy of epithelium- and Bowman membrane-penetrating femtosecond laser-assisted arcuate keratotomy (FSAK) in the treatment of preoperative astigmatism in patients with cataracts and to clarify the predictive role of the incision-to-limbus distance. METHODS: This retrospective study included patients who underwent femtosecond laser-assisted cataract surgery combined with FSAK using the LenSX platform (Alcon Laboratories, Inc) at Beijing Aier-Intech Eye Hospital from March 2017 to December 2021. The Lenstar LS900 (Haag-Streit, Inc) was used to measure the horizontal corneal diameter, and ImageJ software (National Institutes of Health) was used to measure the vertical corneal diameter and incision-to-limbus distance. Finally, the measured values were converted. Changes in corneal astigmatism before and 3 months after surgery were analyzed using Alpins vector analysis. Correlation analysis and regression analysis were used to evaluate the factors associated with surgically induced astigmatism (SIA) in preoperative ocular biometric parameters. RESULTS: The study included 94 eyes of 94 patients. The mean target induced astigmatism was 1.36 ± 0.44 diopters (D), SIA was 0.82 ± 0.43 D, and mean difference vector was 0.70 ± 0.40 D. Pearson correlation analysis and univariate regression analysis showed that preoperative corneal astigmatism, arcuate keratotomy arc length, incision-to-limbus distance, and astigmatism type were significant predictors of SIA. Multiple variable regression analysis included parameters such as age, arcuate keratotomy arc length, and incision-to-limbus distance and established a multiple regression model of SIA (all P < .01). CONCLUSIONS: The incision-to-limbus distance was a significant independent predictor of SIA, and inclusion of this parameter may further improve the accuracy of the nomogram. [J Refract Surg. 2022;38(8):480-486.].

Effect of platelet-rich fibrin extract on the proliferation of gingival fibroblasts / 口腔疾病防治

Objective@#To study the effects of platelet-rich fibrin extract (PRFe) and platelet-derived growth factor (PDGF) released from PRFe on the proliferation of human gingival fibroblasts (HGFs) and to provide an experimental basis for its application in promoting gingival soft tissue increment.@*Methods@#Platelet-rich fibrin (PRF) was transformed into PRFe by tissue culture. The three-dimensional structure of PRF was observed by electron microscopy, and the content of PDGF in PRF was quantitatively determined by ELISA. The ratios of PRFe examined were 2.5% PRFe, 5% PRFe, 7.5% PRFe, 10% PRFe, 12.5% PRFe and 15% PRFe. Gingival fibrosis was detected by the CCK-8 method. After determining the optimal concentration of PRFe, flow cytometry was used to detect the effect of PRFe on the proliferation cycle of human gingival fibroblasts, and the effect of PDGF on the proliferative activity of gingival fibroblasts was observed by neutralizing the release of PDGF.@*Results @# PRF is a three-dimensional reticular structure that contains a large number of growth factors. PDGF release peaked on the 7th day. The proliferative activity of HGFs cultured with different concentrations of PRFe was concentration-dependent, but the effect was optimal at 5% PRFe (P < 0.05). There were no significant differences in the effect of subsequent concentration increases on the proliferation of HGFs (P > 0.05). The flow cytometry results showed that 5% PRFe could significantly stimulate the S-phase division and proliferation of gingival fibroblasts, while the PDGF neutralization test showed that the proliferation of gingival fibroblasts was significantly inhibited by the neutralization of PDGF.@*Conclusion@#Overall 5% PRFe had the best effect on promoting gingival fibroblast proliferation in vitro. PDGF released from PRF plays an important role in promoting the proliferation of gingival fibroblasts.

High glucose/lysophosphatidylcholine levels stimulate extracellular matrix deposition in diabetic nephropathy via platelet­activating factor receptor.

Platelet-activating factor (PAF), protein kinase C (PKC)ßI, transforming growth factor (TGF)­ß1 and aberrant extracellular matrix (ECM) deposition have been associated with diabetic nephropathy (DN). However, the mechanistic basis underlying this association remains to be elucidated. The present study investigated the association among the aforementioned factors in a DN model consisting of human mesangial cells (HMCs) exposed to high glucose (HG) and lysophosphatidylcholine (LPC) treatments. HMCs were divided into the following treatment groups: Control; PAF; PAF+PKCßI inhibitor LY333531; HG + LPC; PAF + HG + LPC; and PAF + HG + LPC + LY333531. Cells were cultured for 24 h, and PKCßI and TGF­ß1 expression was determined using the reverse transcription­quantitative polymerase chain reaction and western blotting. The expression levels of the ECM­associated molecules collagen IV and fibronectin in the supernatant were detected using ELISA analysis. Subcellular localization of PKCßI was assessed using immunocytochemistry. PKCßI and TGF­ß1 expression was increased in the PAF + HG + LPC group compared with the other groups (P<0.05); however, this effect was abolished in the presence of LY333531 (P<0.05). Supernatant fibronectin and collagen IV levels were increased in the PAF + HG + LPC group compared with the others (P<0.05); this was reversed by treatment with LY333531 (P<0.05). In cells treated with PAF, HG and LPC, PKCßI was translocated from the cytosol to the nucleus, an effect which was blocked when PKCßI expression was inhibited (P<0.05). The findings of the present study demonstrated that PAF stimulated ECM deposition in HMCs via activation of the PKC­TGF­ß1 axis in a DN model.

Benefits and harm of niacin and its analog for renal dialysis patients: a systematic review and meta-analysis.

PURPOSE: Clinical trials have shown that niacin and its analog, niacinamide, significantly reduce serum phosphate in patients undergoing dialysis. This review aimed to assess the benefits and harm of niacin and niacinamide in renal dialysis patients. METHODS: PubMed, EMBASE, and Cochrane Library were searched, without language limitation, randomized controlled trials (RCTs). Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, version 5.2, was used for meta-analysis. RESULTS: Five RCTs with a sample size of 230 patients were included. The meta-analysis showed that niacin and niacinamide significantly decreased serum phosphorus levels [weight mean difference (WMD) -0.88; 95 % confidence interval (CI) -1.19 to -0.57] as well as the calcium × phosphorus product (Ca × P) (WMD -9.15; 95 % CI -13.23 to -5.08), and increased high-density lipoprotein (HDL) levels (WMD 9.30; 95 % CI 5.86-12.74) in renal dialysis patients. Niacin significantly increased the risk of flushing [relative risk (RR) 33; 95 % CI 4.71-232.12] in these patients, while the risk of thrombocytopenia was significantly increased in the niacinamide group (RR 2.82; 95 % CI 1.14-6.94). However, sensitivity analysis showed that our finding regarding thrombocytopenia should be regarded with a low degree of certainty. CONCLUSION: Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients. However, niacin can cause flushing and niacinamide probably cause thrombocytopenia. Further larger sample size and well-designed RCTs are needed.

Xuebijing for paraquat poisoning.

BACKGROUND: At present, there is a lack of effective treatments for paraquat poisoning. Xuebijing injection is a complex traditional Chinese prescription consisting of Flos Carthami, Radix Paeoniae Rubra, Rhizoma Chuanxiong, Radix Salviae Miltiorrhizae and Radix Angelicae Sinensis. Although clinical experience suggests that Xuebijing injection might have potential in the management of paraquat poisoning, there is no conclusion on the effectiveness of this treatment. OBJECTIVES: To assess the effects of Xuebijing injection in patients with paraquat poisoning. SEARCH METHODS: We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EBSCO), ISI Web of Science: Science Citation Index Expanded, ISI Web of Science: Conference Proceedings Citation Index-Science, Chinese bio-medical literature and retrieval system (CBM), China National Knowledge Infrastructure Database (CNKI), and the Traditional Chinese Medicine Database. The search was run on the 29th May 2013. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing Xuebijing injection combined with conventional care against conventional care alone. DATA COLLECTION AND ANALYSIS: Two or three authors independently selected studies, assessed study quality and extracted data. We calculated the mortality risk ratio (RR) and 95% confidence interval (CI). Data on all-cause mortality at the end of follow-up were summarised in a meta-analysis. MAIN RESULTS: We identified two trials including 84 people. Although there were fewer deaths in people treated with Xuebijing injection, meta-analysis showed that it did not provide a statistically significant benefit in reducing all-cause mortality in people with paraquat poisoning as compared to control (RR 0.71; 95% CI 0.48 to 1.04; P = 0.08). AUTHORS' CONCLUSIONS: Based on the findings of two small RCTs, Xuebijing injection did not have a statistically significant benefit on reducing all-cause mortality in people with paraquat poisoning. However, both included studies involved small numbers of participants and were considered to be of poor methodological quality. The results are imprecise and easily compatible with the play of chance. Xuebijing injection may be effective for people with paraquat poisoning; however, this needs to be proven by further high-quality evidence.

Enalapril versus losartan for adults with chronic kidney disease: a systematic review and meta-analysis.

AIM: Both enalapril and losartan are effective and widely used in patients with chronic kidney disease (CKD). This review aimed to evaluate the benefits of enalapril and losartan in adults with CKD. METHODS: PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, without language limitations, for randomized controlled trials (RCT), in which enalapril and losartan were compared in adults with CKD. Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, ver. 5.2, was used for meta-analysis. RESULTS: Of 318 citations retrieved, 17 RCT (14 parallel-group and three cross-over) met our inclusion criteria. The pooled analysis for parallel RCT showed that the effects of enalapril and losartan on blood pressure, renal function and serum uric acid (UA) were similar. Meta-analysis indicated that patients taking enalapril had a higher risk of dry cough (risk ratio, 2.88; 95% CI, 1.11-7.48; P=0.03). Sensitivity analysis showed good robustness of these findings. CONCLUSION: Enalapril has similar effects to losartan on systemic blood pressure, renal function and serum UA in patients with CKD, but carries a higher risk of dry cough. Larger trials are required to evaluate the effects of these medications on clinical outcomes.

Mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis: a meta-analysis.

AIM: The options for long-term maintenance therapy in lupus nephritis (LN) remain controversial. This meta-analysis of randomized controlled trials (RCTs) assessed the prognosis and safety of mycophenolate mofetil (MMF) versus azathioprine (AZA) used as maintenance therapy for lupus nephritis. METHODS: The data of Cochrane Library, PubMed, EMBASE were retrieved to search the studies about the RCT studies that compared MMF with AZA used as maintenance therapy for lupus nephritis. We extracted the data reflecting prognosis, which included mortality, end-stage renal failure (ESRF), renal relapse, doubling serum creatinine, and adverse effects, then further analyzed the combined results of data and calculated the relative risk (RR). RESULTS: Four RCT studies including 328 patients were enrolled into our meta-analysis. There was no difference between the patients receiving either MMF or AZA for maintenance therapy in preventing relapse, progression to end-stage renal failure, death and doubling of serum creatinine. MMF is not superior to AZA in terms of the risks of infection and gastrointestinal upset, but fewer patients receiving MMF developed leukopenia (RR 0.12; 95% confidence interval (CI), 0.04-0.39; P = 0.0004) and amenorrhoea (RR 0.17; 95% CI, 0.04-0.72; P = 0.02) than those receiving AZA. CONCLUSION: The current limited evidence suggests that MMF offers similar prognosis as AZA for maintenance therapy, while MMF appears safer than AZA in the treatment of lupus nephritis.

A meta-analysis of randomized controlled trials comparing tacrolimus with intravenous cyclophosphamide in the induction treatment for lupus nephritis.

Lupus nephritis (LN) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). As a standard treatment regimen for remission induction of proliferative LN, intravenous cyclophosphamide (IVCYC) and corticosteroids has been widely accepted. However, cyclophosphamide (CYC) is associated with significant adverse effects. Tacrolimus, a T-cell-specific calcineurin inhibitor, shares similar immunosuppressive actions with cyclosporine. We performed a meta-analysis of randomized controlled trials (RCTs) to compare efficacy and safety between tacrolimus (oral administration and/or IV injection) and IVCYC in the induction treatment for LN. We identified 5 trials, including 225 patients. Meta-analysis showed that tacrolimus could significantly increase complete remission (RR 1.61, 95% CI, 1.17 to 2.23; P = 0.004), response rate (RR 1.25, 95% CI, 1.09 to 1.44; P = 0.001), serum albumin level (SMD 1.11, 95% CI, 0.17 to 2.06; P = 0.02) and anti-dsDNA negative conversion rate (RR 1.34, 95% CI, 1.01 to 1.78; P = 0.04), and decrease urine protein (SMD -0.52, 95% CI, -0.83 to -0.22; P = 0.0008), systemic lupus erythematosus disease activity index (SLE-DAI) (SMD -0.59, 95% CI, -1.00 to -0.19; P = 0.004) compared with that of IVCYC. The rates of gastrointestinal symptoms and irregular menstruation (or amenorrhea) were significantly lower in tacrolimus group than IVCYC group (RR 0.46, 95% CI, 0.22 to 0.93; P = 0.03 and RR 0.14, 95% CI, 0.04 to 0.50; P = 0.003). In conclusion, tacrolimus was found to be more effective and safer than IVCYC as an induction therapy for Chinese LN patients.

Effect of statins on chronic inflammation and nutrition status in renal dialysis patients: a systematic review and meta-analysis.

AIM: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may have an adjunctive effect on chronic inflammation and nutrition status in renal dialysis patients. Therefore, we performed a systematic review of randomized controlled trials to assess the effect of statins on chronic inflammation and nutrition status in dialysis patients. METHODS: The randomized controlled trials (RCTs) of statins versus placebo or no treatment for renal dialysis patients were searched from PubMed, EMbase and Cochran Central Register of Controlled Trials. We screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using the Cochrane Collaboration's Revman 5.1 software. RESULTS: We identified nine trials including 3098 patients. Meta-analysis showed statins can significantly decrease the serum C-reactive protein (CRP) (SMD, -0.54; 95% confidence interval (CI), -1.04 to -0.05; P = 0.03) and high sensitivity CRP (hs-CRP) level (SMD, -0.72; 95% CI, -1.14 to -0.31; P = 0.0007) of dialysis patients compared with that of the control group. However, statins did not differ significantly from the control group in increasing the serum Alb level (SMD, -0.13; 95% CI, -0.42 to 0.15; P = 0.37). CONCLUSIONS: Statins can improve the chronic inflammation status reflected by the decreasing of serum CRP and hs-CRP levels, whereas there is no conclusive evidence that it can improve the nutrition status. However, this result needs to be further confirmed in more high-quality randomized clinical trials.

Differentiation of mesenchymal stem cell in the microenviroment of retinitis pigmentosa.

UNLABELLED: CORRESPONDENCE TO: Fang-Tian Dong. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. d_fangtian@sina.com AIM: To access the differentiation of rat mesenchymal stem cell (MSC) in the microenvironment of retinal degeneration induced by the administration of sodium iodate. METHODS: In-vitro cultured Lewis rat MSC were injected into the sub-retinal space of NaIO(3) induced retinal degeneration rat eyes (30g/L NaIO(3) 100mg/kg). To observe the trace and differentiation of MSC by immuno-fluorescent method successively in 5 weeks after the surgery. RESULTS: The majority of the transplanted cells stay in retinal pigment epithelium layer and cones & rods layer. From the 2(nd) week after transplantation, the engrafted MSC express PCK and rhodopsin under fluorescent microscope. CONCLUSION: MSC can survive mainly in the outer layer of retina in the microenvironment of retinal degeneration and differentiate forward the RPE cell and photoreceptor.

[Differentiation of rat mesenchymal stem cells in the microenvironment of choroidal neovascularization].

OBJECTIVE: To assay the differentiation of rat mesenchymal stem cells (MSCs) in the microenvironment of choroidal neovascularization (CNV). METHOD: Cultured BN rat MSCs were injected into the subretinal space in 25 Argon laser-induced CNV rat. The differentiation of MSCs was traced by immunofluorescent labeling successively in 5 weeks after the surgery. RESULTS: MSCs distributed on the surface of CNV in the 1st week after injection. From the 2nd week, CD31 positive MSCs were found in CNV until 5 weeks after cell injection, while rhodopsin positive MSCs in the photoreceptor layer were revealed until the 5th week after the injection. CONCLUSION: Injected MSCs in the microenvironment of CNV can differentiate into endothelium and photoreceptor.

[Prevalence and risk factors of retinopathy of prematurity].

OBJECTIVE: To investigate the prevalence and the risk factors of retinopathy of prematurity (ROP). METHODS: Totally 172 premature infants who were less than 37 weeks postconceptional age, or more than 37 weeks but weighing < 2 500 g at birth, and born at PUMC hospital from May 1, 2003 to November 30, 2004, were enrolled in this study. Their fundus were routinely checked. Diagnosis and staging of ROP were performed according to the international guidelines. Another 20 mature infants were selected as the control group. RESULTS: Twelve infants quitted the treatment or died. The remaining 160 infants completed the follow up. The prevalence of ROP in the premature group was 19.4%, while no ROP was found in the control group. The prevalence of ROP in subgroup with body weight < or = 2 000 g (28.4%) was significantly higher than in subgroup with body weight > 2 000 g (8.3%, chi2 = 10.217, P = 0.001) at birth. The prevalence of ROP in subgroup with postconceptional age < or = 32 weeks (42.5%) was significantly higher than in subgroup with postconceptional age > 32 weeks (11.7%, chi2 = 18.258, P = 0.000). The postconceptional age (OR = 0.959, P = 0.036) and body weight (OR = 0.999, P = 0.026) were the most important risk factors of ROP. Furthermore, blood transfusion ( OR = 0.076, P = 0.029) and Apgar score ( OR = 23.62, P = 0.012) were inversely correlated with ROP. Correlation was not found between ROP prevalence and oxygen inhalation mode, surface active substance, administration of dopamine and dexamethasone, and mother conditions. CONCLUSIONS: The prevalence of ROP is higher in premature infants than in mature infants. Shorter postconceptional age and lower body weight may result in higher ROP incidence. Routine screening of fundus in premature infants may be helpful for the early detection of ROP.

[Recent advances in retinopathy of prematurity].

Retinopathy of prematurity (ROP) is a vasoproliferative retinopathy. Worldwide, ROP is a major cause of blindness in children. This chapter describes its risk factors, etiology, diagnosis, treatment and recent advances.