Corneal lymphangiogenesis in dry eye disease is regulated by substance P/neurokinin-1 receptor system through controlling expression of vascular endothelial growth factor receptor 3

PurposeTo evaluate the role of substance P (SP)/neurokinin-1 receptor (NK1R) system in the regulation of pathologic corneal lymphangiogenesis in dry eye disease (DED).MethodsImmunocytochemistry, angiogenesis assay, and Western blot analysis of human dermal lymphatic endothelial cells (HDLECs) were conducted to assess the involvement of SP/NK1R system in lymphangiogenesis. DED was induced in wild-type C57BL/6 J mice using controlled-environment chamber without scopolamine. Immunohistochemistry, corneal fluorescein staining, and phenol red thread test were used to evaluate the effect of SP signaling blockade in the corneal lymphangiogenesis. The expression of lymphangiogenic factors in the corneal and conjunctival tissues of DED mouse model was quantified by real-time polymerase chain reaction.ResultsNK1R expression and pro-lymphangiogenic property of SP/NK1R system in HDLECs were confirmed by Western blot analysis and angiogenesis assay. Blockade of SP signaling with L733,060, an antagonist of NK1R, or NK1R-targeted siRNA significantly inhibited lymphangiogenesis and expression of vascular endothelial growth factor (VEGF) receptor 3 stimulated by SP in HDLECs. NK1R antagonist also suppressed pathological corneal lymphangiogenesis and ameliorated the clinical signs of dry eye in vivo. Furthermore, NK1R antagonist effectively suppressed the lymphangiogenic factors, including VEGF-C, VEGF-D, and VEGF receptor 3 in the corneal and conjunctival tissues of DED.ConclusionsSP/NK1R system promotes lymphangiogenesis in vitro and NK1R antagonism suppresses pathologic corneal lymphangiogenesis in DED in vivo.     

Ciliogenesis and autophagy are coordinately regulated by EphA2 in the cornea to maintain proper epithelial architecture

PurposeTo understand the relationship between ciliogenesis and autophagy in the corneal epithelium.MethodssiRNAs for EphA2 or PLD1 were used to inhibit protein expression in vitro. Morpholino-anti-EphA2 was used to knockdown EphA2 in Xenopus skin. An EphA2 knockout mouse was used to conduct loss of function studies. Autophagic vacuoles were visualized by contrast light microscopy. Autophagy flux, was measured by LC3 turnover and p62 protein levels. Immunostaining and confocal microscopy were conducted to visualize cilia in cultured cells and in vivo.ResultsLoss of EphA2 (i) increased corneal epithelial thickness by elevating proliferative potential in wing cells, (ii) reduced the number of ciliated cells, (iii) increased large hollow vacuoles, that could be rescued by BafA1; (iv) inhibited autophagy flux and (v) increased GFP-LC3 puncta in the mouse corneal epithelium. This indicated a role for EphA2 in stratified epithelial assembly via regulation of proliferation as well as a positive role in both ciliogenesis and end-stage autophagy. Inhibition of PLD1, an EphA2 interacting protein that is a critical regulator of end-stage autophagy, reversed the accumulation of vacuoles, and the reduction in the number of ciliated cells due to EphA2 depletion, suggesting EphA2 regulation of both end-stage autophagy and ciliogenesis via PLD1. PLD1 mediated rescue of ciliogenesis by EphA2 depletion was blocked by BafA1, placing autophagy between EphA2 signaling and regulation of ciliogenesis.ConclusionOur findings demonstrate a novel role for EphA2 in regulating both autophagy and ciliogenesis, processes that are essential for proper corneal epithelial homeostasis.     

角膜后弹力膜内皮移植术研究进展

角膜后弹力膜内皮移植术由于具有相对较低的移植排斥率以及较好的视力预后等优势,目前已成为部分发达国家治疗角膜内皮失代偿的主流手术方式,但限于手术难度较高,学习曲线较长,中国人前房偏浅,加之国内角膜内皮病变往往合并有其他较复杂的眼部疾病,目前国内尚未普遍开展这一手术。本文就角膜后弹力膜内皮移植术的手术适应证、供体植片制备(供体选择、制备技巧、植片的可视化)、关键手术技术(植片的植入、展开、固定)、术后并发症(植片脱位、高眼压、排斥反应、角膜内皮细胞密度下降以及失代偿等)以及视力预后等研究进展进行综述。     

纤维蛋白粘合剂与人角膜成纤维细胞的生物相容性

目的探讨纤维蛋白粘合剂(FS)与全飞秒激光小切口透镜取出术(SMILE)来源的人角膜成纤维细胞(HCFs)的生物相容性。方法人角膜组织取自2018年3—4月于广西医科大学第一附属医院行SMILE患者12例24眼术中取出的角膜基质透镜,体外分离培养HCFs,观察HCFs在FS表面的生长状态。将HCFs分为2倍浸提液组和正常对照组,分别与2倍浸提液和完全培养基共培养,采用吖啶橙(AO)/溴化乙锭(EB)双染色法观察并比较各组细胞凋亡情况。将HCFs分为3个组,2倍浸提液组和正常对照组细胞每孔分别加入2倍浸提液和完全培养基各100μl,空白对照组无细胞,每孔加入100μl完全培养基,采用四甲基偶氮唑蓝(MTT)法检测并比较3个组HCFs的细胞增生能力,并进行细胞毒性分级。将HCFs分为1倍浸提液组、2倍浸提液组和正常对照组,分别用1倍浸提液、2倍浸提液和完全培养基培养,采用Annexin V-FITC/PI流式细胞术检测并比较3个组细胞凋亡率。结果HCFs在FS表面生长良好,形态正常。MTT法检测结果显示,2倍浸提液组与正常对照组的HCFs具有相似的增生趋势,2倍浸提液组HCFs的0~72 h毒性评级为0~1级。AO/EB染色结果显示,2倍浸提液组和正常对照组的HCFs状态均正常,仅可见极少量早期凋亡细胞。流式细胞术检测结果显示,正常对照组、1倍浸提液组和2倍浸提液组的细胞凋亡率分别为(4.96±1.09)%、(3.66±1.35)%和(2.88±0.66)%,差异无统计学意义(F=2.89,P=0.13)。结论FS无体外细胞毒性,与HCFs有良好的生物相容性。     

超声诊断睾丸网扩张与附睾头部精液囊肿体积的相关研究

目的:探讨超声诊断睾丸网扩张与患侧附睾头部精液囊肿体积大小的相关性。方法:整理分析新疆自治区人民医院超声科2005～2012年应用彩色多普勒超声诊断睾丸网扩张,并经手术或细针穿刺确诊合并睾丸网扩张附睾头部精液囊肿36例为病例组,不合并睾丸网扩张附睾头部精液囊肿病例44例作为对照组;比较两组族别、年龄、精液囊肿体积、患侧睾丸向心动脉阻力指数(RI)。结果:病例组与对照组对比:维吾尔族与汉族没有明显差异(P>0.05);平均年龄差异不显著(P>0.05);病例组附睾头部精液囊肿体积为(2.081±1.147)cm3,对照组为(1.009±0.848)cm3,两组比较有显著性差异(P<0.01);病例组睾丸向心动脉阻力指数RI为0.644±0.099,对照组为0.608±0.116,两组比较差异不显著(P>0.05)。结论:附睾头部精液囊肿体积大小对于睾丸网扩张的形成有重要影响。     

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

Abstract

Objective: This economic evaluation aims to provide a preliminary assessment of the cost-effectiveness of radiofrequency ablation (RFA) compared with argon plasma coagulation (APC) when used to treat APC-refractory gastric antral vascular ectasia (GAVE) in symptomatic patients.

Methods: A Markov model was constructed to undertake a cost-utility analysis for adults with persistent symptoms secondary to GAVE refractory to first line endoscopic therapy. The economic evaluation was conducted from a UK NHS and personal social services (PSS) perspective, with a 20-year time horizon, comparing RFA with APC. Patients transfer between health states defined by haemoglobin level. The clinical effectiveness data were sourced from expert opinion, resource use and costs were reflective of the UK NHS and benefits were quantified using Quality Adjusted Life Years (QALYs) with utility weights taken from the literature. The primary output was the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per QALY gained.

Results: Over a lifetime time horizon, the base case ICER was £4840 per QALY gained with an 82.2% chance that RFA was cost-effective at a threshold of £20,000 per QALY gained. The model estimated that implementing RFA would result in reductions in the need for intravenous iron, endoscopic intervention and requirement for blood transfusions by 27.1%, 32.3% and 36.5% respectively. Compared to APC, RFA was associated with an estimated 36.7% fewer procedures.

Conclusions: RFA treatment is likely to be cost-effective for patients with ongoing symptoms following failure of first line therapy with APC and could lead to substantive reductions in health care resource.     

Mycobacterium fortuitum keratitis

We report a case of mycobacterial keratitis characterized by apparently spontaneous onset, delayed diagnosis, and eventually necessitating evisceration inspite of systemic antibiotics and repeated corneal grafts.