577 nm激光光凝联合玻璃体内注射康柏西普治疗糖尿病性黄斑水肿的效果观察

目的　探讨577 nm激光光凝联合玻璃体内注射康柏西普治疗糖尿病性黄斑水肿的效果。方法　选取2016年1月至2017年3月在我院治疗的糖尿病性黄斑水肿患者81例81眼，根据患者最终选取的治疗方案分为观察组43例43眼和对照组38例38眼，观察组给予577 nm激光光凝联合玻璃体内注射康柏西普治疗，对照组仅给予577 nm激光光凝，观察两组治疗前后最佳矫正视力（best corrected visual acuity，BCVA）和黄斑中心凹厚度（central fovea of macula thickness，CMT），分析观察组BCVA和CMT变化值与初始因素的相关性。结果　随治疗时间延长，观察组和对照组BCVA、CMT相应改善（均为P＜0.05）；观察组治疗后1个月、3个月和6个月BCVA分别为0.37±0.09、0.44±0.10和0.52±0.13，均明显高于对照组（均为P＜0.05）；观察组治疗后1个月、3个月和6个月CMT分别为（351.03±41.43）μm、（270.32±40.03）μm和（220.01±32.91）μm，均明显低于对照组（均为P＜0.05）；BCVA变化值与糖尿病性黄斑水肿病程、治疗前BCVA呈负相关（r=-0.422、-0.410，均为P＜0.05）；CMT变化值与糖尿病性黄斑水肿病程、治疗前CMT呈负相关（r=-0.430、-0.415，均为P＜0.05）。结论　577 nm激光光凝联合玻璃体内注射康柏西普治疗糖尿病性黄斑水肿效果较好，其效果与患者基线BCVA、糖尿病性黄斑水肿病程有一定相关性。     

Antithrombotic Management After Transcatheter Aortic Valve Replacement: A Survey of Canadian Physicians

Optimal postprocedural antithrombotic regimen is uncertain after transcatheter aortic valve replacement (TAVR). We developed an online questionnaire on post-TAVR antithrombotic management. After research ethics board approval, we distributed the survey to TAVR implanters across Canada. A total of 24 TAVR implanters from 17 centres responded to the survey for a response rate of 75%. Dual antiplatelet therapy for variable durations was the preferred initial treatment for patients in sinus rhythm after isolated TAVR, TAVR with a recent stent (≤ 1 month), and valve-in-valve procedures (71%, 96%, and 65%, respectively). Most respondents continued patients on acetylsalicylic acid indefinitely after these procedures (100%, 92%, 90%, respectively). In patients with atrial fibrillation, the CHA₂DS₂-VAS_C score was the preferred stroke risk score for 57% of respondents, the CHADS₂ score was the preferred stroke risk score for 22% of respondents, and the CHADS65 score was the preferred stroke risk score for 17% of respondents. To determine the risk of bleeding, the HASBLED score was most often used (52%), but 48% of respondents indicated that they did not use a bleeding risk score. In the presence of atrial fibrillation, antithrombotic therapy choice varied widely. Our survey shows that dual antiplatelet therapy is the most common discharge regimen after TAVR in current practice. However, the choice and duration of antithrombotic regimen vary in patients requiring anticoagulation.     

miR-577通过介导Notch信号通路抑制肺癌细胞的增殖、侵袭和耐药性

目的研究miR-577通过介导Notch信号通路抑制肺癌细胞的增殖、侵袭和耐药性。方法RT-PCR检测肺癌组织和细胞以及配对的正常组织和细胞中miR-577的表达量;CCK-8测定miR-577对肺癌细胞A549增殖的影响;荧光素酶报告实验验证miR-577和Notch是否结合;Western blot检测A549细胞中Notch、DSL以及耐药蛋白P-gp和MRP1的蛋白表达水平。结果RT-PCR结果显示,miR-577在肺癌组织和细胞中的表达量显著低于正常组织和细胞中的表达量;过表达miR-577能够显著抑制肺癌细胞A549的增殖和侵袭,并降低细胞的耐药性;荧光素酶报告实验结果表明miR-577能够靶向结合Notch的启动子序列;Western blot结果显示miR-577能够抑制Notch和DSL的蛋白表达水平;进一步的机制探究结果表明miR-577可通过下调Notch和DSL的蛋白表达抑制A549细胞增殖、侵袭以及耐药性。结论miR-577能够抑制肺癌细胞A549增殖、侵袭以及耐药性的产生,其作用机制是通过介导Notch信号通路来实现的。     

577nm阈值下微脉冲激光与传统激光治疗DME疗效的系统评价

目的：系统评价577nm阈值下微脉冲激光与传统激光治疗糖尿病性黄斑水肿(DME)疗效差异性。

方法：计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、CBM、 CNKI、CQVIP、CECDB数据库内的相关前瞻性或回顾性临床对照试验,检索时限均为从建库起截止2019-08。由两位研究者独立筛选文献、提取资料、评价文献质量,采用RevMan5.3/Stata 14.0软件对纳入研究进行meta分析。

结果：纳入7项研究,其中随机对照试验(RCT)6 项,回顾性临床对照研究(CCT)1项,共401例患者545眼。Meta分析结果显示：577nm阈值下微脉冲激光组BCVA的测量值高于传统激光组 \〖95%CI(0.02～0.08),P=0.002\〗,577nm阈值下微脉冲激光组的黄斑中心视网膜厚度测量值较传统激光组明显减少[95% CI(-26.96～-10.88),P<0.00001],577nm阈值下微脉冲激光组黄斑10°范围内视网膜平均光敏感度水平的测量值较传统激光组明显提升[95% CI(1.56～2.39),P<0.00001]。

结论：577nm阈值下微脉冲激光能更好地改善DME患者的视功能,且具有较高的治疗安全性,对于患者的治疗具有较好的研究价值。     

Alpha-actinin-3 deficiency does not significantly alter oxidative enzyme activity in fast human muscle fibres

Aim: In Western European populations, about 18% of all individuals have a complete deficiency of the alpha‐actinin‐3 protein owing to homozygosity for a stop codon mutation (R577X) in the ACTN3 gene. Actn3^?/? knock‐out mice show increased activity of multiple enzymes in the aerobic metabolic pathway in fast muscle fibres. Whether this observation is also present in human XX genotype carriers compared to RR carriers has not been studied in a fibre‐type‐specific approach in humans. The purpose of this study was therefore to compare fibre‐type‐specific oxidative enzyme activity in humans with a different ACTN3 R577X genotype. Methods: Vastus lateralis muscle biopsy samples of 17 XX and 16 RR subjects were used to measure markers of oxidative capacity [cytochrome c oxidase (CYTOX) and succinate dehydrogenase (SDH)] in a fibre‐type‐specific assay using enzyme histochemistry. Results: Cytochrome c oxidase staining showed no significant genotype group differences in type I or type II muscle fibres. Also, we found no significant differences in SDH staining of fast fibres comparing XX and RR carriers. Conclusion: In conclusion, the increase in oxidative enzyme activity of fast muscle fibres, as reported in an Actn3^?/? knock‐out mouse, was not observed in our human samples. Known differences in metabolic characteristics of muscle fibres in rodents compared to humans may in part explain this discrepancy in findings.     

雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿

目的：观察雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿(DME)的临床疗效。

方法：选取2016-06/2019-09就诊于广西壮族自治区人民医院确诊为重度DME的患者52例52眼,随机分为观察组(26例26眼,予雷珠单抗联合577nm微脉冲激光治疗)和对照组(26例26眼,仅予雷珠单抗治疗)。两组患者均予“3+PRN”方案行玻璃体腔注射雷珠单抗治疗。治疗(首次玻璃体腔注射)后随访9mo,观察黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)情况及玻璃体腔注射雷珠单抗次数。

结果：与治疗前相比,两组患者治疗后各时间点CMT、BCVA均明显改善(均P<0.001),但两组间均无差异(P>0.05)。随访期间,观察组玻璃体腔雷珠单抗注射次数明显少于对照组(5.88±1.24次 vs 7.12±1.24次,P=0.001)。

结论：雷珠单抗联合577nm微脉冲激光和单用雷珠单抗均能有效降低重度DME患者黄斑水肿程度,改善视力,但联合治疗可减少雷珠单抗的注射次数。