Detection of variability in apo(a) gene transcription regulatory sequences using the DGGE method

BACKGROUND: Retinal artery occlusion (RAO) and retinal vein occlusion (RVO) are common causes of severe visual loss and several atherothrombotic risk factors such as hyperlipidemia, diabetes mellitus and arterial hypertension have been associated with these ophthalmic lesions. METHODS: In this retrospective study we investigated 66 patients with RAO, 87 patients with RVO and 405 age- and gender-matched control subjects. Lipoproteins were separated using an ultracentrifugation-precipitation method (beta-quantification) and the levels of lipids and apolipoproteins in VLDL, LDL and HDL particles were measured. RESULTS: After adjusting for the type of occlusion and lipid-lowering medication, patients with RVO and RAO versus controls had significantly higher levels of LDL-cholesterol (3.82+/-1.06, 3.59+/-0.90 and 3.07+/-0.83 mmol/L), LDL-triglycerides (0.39+/-0.14, 0.40+/-0.12 and 0.35+/-0.14 mmol/L) and apolipoprotein B (1.06+/-0.27, 1.05+/-0.26 and 0.84+/-0.21 g/L) in the LDL fraction, respectively. In RAO, LDL-triglycerides were independently associated with retinal vascular occlusion. Interestingly, apolipoprotein AI was elevated in both patient groups compared to controls. The most striking differences were found in lipoprotein(a) where both RVO and RAO patients had significantly higher levels than the control subjects (median values: 320, 290 and 130 mg/L, respectively). CONCLUSION: These findings suggest that disorders in lipoprotein metabolism may contribute to the etiology of retinal vascular occlusions.     

血脂水平与视网膜静脉阻塞关系的临床观察

目的研究视网膜静脉阻塞（RV0）患者血脂水平的变化,以探讨血脂升高是否是RV0的独立危险因素,为治疗和预防该病提供客观依据。方法采用病例对照研究,收集40例确诊为RVO且未接受过药物治疗的患者作为病例组（其中视网膜中央静脉阻塞（CRVO）患者28人,视网膜分支静脉阻塞（BRV0）患者12人）,同期健康体检且既往无眼底血管性疾病病史者40例作为对照组,两组年龄、性别无统计学差异。检测血浆总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）含量后作统计学比较。结果RV0病例组的血浆TC,TG和LDL-C水平较对照组显著升高（5．61±1．02,2．09±0．91,3．28±0．51mmol／Lvs4．26±0．91,1．26±0．9,2．68±0．48mmol／L,t=2．432,2．126,3．27,P均〈O．05）,而HDL-C水平则显著低于对照组（1．08±0．46mmol／LVS1．76±0．62mmol／L,t=-2．33,P〈O．05）i病例组中CRV0及BRV0患者的血脂四项指标比较差异无统计学意义（P均〉0．05）。结论高脂血症为RVO的独立危险因素,降血脂药物应在治疗中被考虑使用。     

Retinal vein thrombosis: pathogenesis and management

Summary. Retinal vein occlusion (RVO) is the most common retinal vascular disease after diabetic retinopathy. Owing to its multifactorial nature, however, management of this condition remains a challenge. Of the two main types of RVO, branch retinal vein occlusion (BRVO) is more prevalent than central retinal vein occlusion (CRVO). Most patients develop the disease at an elderly age, and more than half of them have associated systemic disorders (e.g. hypertension, hyperlipidemia and/or diabetes mellitus). There is no evidence to suggest routine testing for heritable thrombophilias in patients with RVO. The main cause of the visual impairment is macular edema, while neovascularization of the retina and optic disc are the most serious complications leading to vitreous hemorrhage, retinal detachment and neovascular glaucoma. Macular grid laser photocoagulation is an effective treatment for macular edema in patients with BRVO and a visual acuity of 20/40 or less. Other treatment options for reducing the edema are intravitreal steroids, anti‐VEGF drugs and vitrectomy. The recently introduced intravitreal application of steroids and anti‐VEGF drugs may prove to be a better approach for improving visual acuity. Finally, scatter panretinal laserphotocoagulation can effectively treat neovascularization and its secondary complications.     

116例视网膜静脉阻塞患者临床和荧光素眼底血管造影的观察和分析

目的 :分析视网膜静脉阻塞 (retinalveinocclusion ,RVO)病例的有关资料 ,以提高对该病的检查和诊断水平。方法 :对经荧光素眼底血管造影 (fundusfluoresceinangiography ,FFA)确诊的 116例患者的 12 4只眼的临床和FFA资料进行分析。结果 :CR VO(centralretinalveinocclusion)者 2 7只眼 ;半侧RVO有 8只眼。BRVO(branchretinalveinocclusion) 89只眼 ,共有 93支血管受累 ,其中颞上支占 6 4 % ,为最易受累之血管分支 ;多支血管受累的患者占单纯BRVO的 13.4 1%。另外 ,双眼RVO共 8例 ,占患者总数的 7%。有 5 6只眼存在视网膜毛细血管无灌注区 ,占总眼数的 4 5 .16 % ;有新生血管形成 18只眼 ,占总眼数的 14 .5 2 %。CRVO患者的平均年龄为 6 1.0 8岁 ,BRVO患者的平均年龄为 6 7.0 6岁 ,两者有显著差异 (t=2 .4 5 ,P <0 .0 5 )。结论 :RVO的类型和年龄有一定关系 ;诊断时要考虑双眼RVO及多支BRVO的可能性 ;联合包括直接检眼镜、前置镜和FFA等检查方法能帮助RVO的诊断和指导治疗     

Increased plasma asymmetric dimethylarginine (ADMA) levels in retinal venous occlusive disease.

BACKGROUND: We investigated the levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), as well as homocysteine and cysteine thiols, in a cohort of subjects affected by retinal vein occlusion (RVO) disease. METHODS: Capillary electrophoresis analysis was performed in both RVO subjects (n=54) and in a control group (n=32). RESULTS: No differences were found between controls and patients; however, after categorisation for RVO type, central RVO (CRVO) patients showed higher levels of ADMA (0.710+/-0.139 micromol/L) than controls (0.635+/-0.117 micromol/L) and branch RVO patients (0.642+/-0.096 micromol/L). Moreover, cysteine plasma levels were also significantly higher in CRVO patients than in controls (265.8+/-46.9 vs. 226.7+/-51.9 micromol/L, p<0.01), while homocysteine plasma concentration was more or less identical in all groups. CONCLUSIONS: We hypothesise that the elevated levels of cysteine in CRVO patients may post-translationally inhibit dimethylarginine dimethylaminohydrolase enzyme activity, as already described for homocysteine, thus contributing to the accumulation of ADMA in this patient group.     

视网膜静脉阻塞患者血清同型半胱氨酸水平检测的临床意义

目的 讨论视网膜静脉阻塞(retinal vein occlusion,RVO)患者血浆同型半胱氨酸(homocysteine,Hcy)水平的变化,以研究血浆Hcy升高是否是RVO的危险因素,为治疗和预防该病提供客观依据。方法 采用病例对照研究,收集65例经过统一眼科检查标准确诊RVO且经过系统疾病排除标准筛选的患者作为病例组,其中视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)患者46例,视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)患者19例; 同期健康体检且既往无眼底血管性疾病病史者65例作为对照组,两组年龄、性别无差异。检测血浆Hcy含量后作统计学比较。结果 RVO病例组的血浆Hcy均值较对照组显著升高(t=6.192,P<0.05)。病例组中CRVO及BRVO患者的血浆Hcy比较差异无统计学意义(t=1.536,P<0.05)。结论 血浆Hcy为RVO的危险因素,降低Hcy的药物可以用于RVO的预防和治疗中。     

Initial color Doppler findings in retinal vein occlusion

PURPOSE: We assessed early hemodynamic characteristics of various types of retinal vein occlusion using color Doppler imaging and spectral analysis. METHODS: We measured the maximum systolic and diastolic blood flow velocities and the resistance index (RI) in the central retinal artery and the maximum and minimum blood flow velocities in the central retinal vein of affected eyes and contralateral unaffected eyes in 102 adults (63 men and 39 women; mean age, 61 +/- 14.6 years) who presented with retinal vein occlusion. Sixty-three control subjects (27 men and 36 women; mean age, 50 +/- 22.1 years) were also investigated. RESULTS: No significant differences in hemodynamic characteristics were found between the control subjects' eyes and the patients' unaffected eyes. In the 18 cases of ischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p = 0.005) and venous flow velocity (p < 0.04) were lower and the mean RI was higher (p = 0. 0002) in the affected eyes than in the unaffected contralateral eyes. In the 51 cases of nonischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p < 0.0001) and venous flow velocity (p < 0.0001) also were lower and the mean RI (p < 0.0001) was higher in the affected eyes than in the unaffected contralateral eyes. These variables were different in the ischemic versus nonischemic types of central retinal vein occlusion. In the 33 cases of branch retinal vein occlusion, no significant differences were observed in arterial or venous blood flow velocities in the affected versus unaffected eyes. The mean RI in the affected eyes was significantly higher (p = 0.009) in patients with central versus branch retinal vein occlusion. CONCLUSIONS: These results suggest that previous arterial disorders were not involved in the pathogenesis of central retinal vein occlusion in these patients. The findings also support the value of Doppler imaging and spectral analysis in the diagnosis and evaluation of retinal vein occlusion and confirm the involvement of arterial flow in venous occlusion.     

Ocular complications associated with diabetes mellitus

Diabetes is a progressive disease that may adversely affect healthy functioning of the body. The eyes are often indicators of systemic disease and are particularly vulnerable to the pathophysiological changes that occur as a result of diabetes. This article provides an overview of five main ocular complications associated with diabetes, cataract, diabetic retinopathy, central retinal vein occlusion, central retinal artery occlusion and neovascular glaucoma. The assessment and treatment of such complications and the role of the nurse in the care and management of patients are discussed.     

The evaluation of serum leptin level and other hormonal parameters in children with severe malnutrition

OBJECTIVES: Protein-energy malnutrition (PEM) is a clinical problem caused by inadequate intake of one or more nutritional elements, and remains as one of the most important health problems in developing countries. The aim of this study is to determine the relationship among leptin concentrations, body weight and concentrations of some serum hormones, e.g., basal GH, IGF-1, basal cortisol and IGF-BP3, in severe malnourished children, and to determine the effects of leptin in malnourished children. DESIGN AND METHODS: The study group consisted of 36 children diagnosed with PEM. Thirty healthy children were enrolled as the control group. After an overnight fast and before initiation of feedings, fasting venous blood samples were obtained from a forearm vein with needle technique for routine tests, and leptin, IGF-1, IGF-BP3, basal GH and cortisol levels were measured. Tests were carried out in the laboratories of the Department of Biochemistry by commercial kits. RESULTS: Serum leptin levels of infants with marasmus and kwashiorkor were significantly lower than that of the controls (2.09 +/- 0.93 and 2.27 +/- 1.01, 6.82 +/- 2.28 ng/ml, respectively, P < 0.001). However, there was no significant difference between serum leptin levels in children with marasmus and those with kwashiorkor (P > 0.05). Serum IGF-1 and IGF-BP3 levels were significantly lower in malnourished children (P < 0.001, both). Also, basal GH and cortisol levels were significantly higher in malnourished children (P < 0.001, both). There was a positive correlation among serum leptin levels and IGF-1 and IGF-BP3 levels and also a negative correlation among serum leptin levels and basal GH and cortisol levels in children diagnosed with marasmus or kwashiorkor and the control group. CONCLUSIONS: The decrease of energy intake and adipose tissue and serum IGF-1 levels in children with PEM may result in decrease of leptin secretion. Decrease in serum leptin levels may initiate food intake by increasing appetite and stimulating the secretion of cortisol and GH that might increase energy expenditure through an autocrine mechanism. Moreover, serum leptin level may be an important signal to reflect the metabolism of children with PEM.     

兔眼视网膜静脉阻塞模型的建立

目的；探讨建立兔眼视网膜静脉阻塞模型的方法。方法：用氩激光光凝封闭兔视网膜颞侧静脉，行眼底照像及荧光造影均证实静脉阻塞模型形成。形成后2h，1d，3周，4周处死家兔，摘除眼球，行光镜和电镜观察。结果：FFA显示击射处血管完全阻塞。光镜和电镜下显示缺血、水肿、血栓形成等典型的病理学改变。结论：用氩激光光凝兔眼视网膜静脉可导致视网膜静脉血管变细，血流中断，血栓形成。该方法可为临床研究视网膜静脉阻塞提供可靠的动物模型。     

Alteration in serum leptin correlates with alterations in serum N-telopeptide of collagen type I and serum osteocalcin during the progression of osteoporosis in ovariectomized rats.

The role of leptin during the progression of osteoporosis was investigated in ovariectomized rats by correlation of serum leptin levels with N-telopeptide of collagen type I (NTx) and osteocalcin levels before ovariectomy and 20, 40 and 60 days after the operation. Furthermore, peripheral quantitative computed tomography was used to confirm the development of severe osteoporosis in rats on day 60. The levels of NTx and osteocalcin were significantly increased on day 20 [61.9+/-5.4 nM BCE (bone collagen equivalents) and 215.6+/-53.3 ng/mL, respectively] in comparison to those before ovariectomy (41.3+/-1.7 nM BCE and 60.4+/-10.9 ng/mL). Accordingly, leptin was significantly elevated on day 20 (3033+/-661 vs. 606+/-346 pg/mL before ovariectomy). Bone markers and leptin levels remained constant up to day 40, while a slight, but not statistically significant, decrease was noted for osteocalcin and leptin on day 60. Although leptin and bone markers did not correlate before ovariectomy (r=0.09 for NTx and r=-0.05 for osteocalcin), strong correlation was observed at all time points after ovariectomy. The data obtained suggest that the alterations in serum leptin levels during the progression of osteoporosis in ovariectomized rats follow the alterations in bone markers.     

非外伤性玻璃体积血的病因分析

【目的】分析非外伤性玻璃体积血的病因。【方法】对2008年1月至2011年11月期间住院的96例（100只眼）出现玻璃体积血的非外伤患者的出血原因及治疗情况进行回顾性分析。【结果】本组非外伤性玻璃体积血患者的出血原因为视网膜静脉阻塞（RVO）54只眼（占54％）,增生性糖尿病视网膜病变（PDR）18只眼（占18％）,年龄相关性黄斑变（EAMD）10只眼（占10％）,视网膜大动脉瘤破裂6只眼（占6％）,视网膜裂孔或脱离6只眼（占6％）。【结论】RV0、PDR、EAMD是非外伤性玻璃体积血的主要原因。     

子宫腺肌病患者血清及腹腔液瘦素水平的比较分析

目的探讨瘦素在子宫腺肌病患者血清和腹腔液中的变化及其在内异症发病中的作用。方法采用ELISA方法测定40例子宫腺肌病患者和30例非子宫腺肌病患者(对照组)血清和腹腔液中瘦素的含量,并根据伴有痛经与否进行统计学分析。结果子宫腺肌病患者血清瘦素水平与对照组比较,无显著性差异,但其腹腔液中瘦素水平明显高于对照组(P<0.01)。伴有痛经及不伴痛经子宫肌腺症患者腹腔液瘦素水平均明显高于对照组,但子宫腺肌病2组之间无明显差异。结论子宫腺肌病患者腹腔液中瘦素水平明显升高,说明瘦素可能在子宫腺肌病的发生发展中发挥重要作用,但与伴有痛经与否无明显关系。     

Clinical efficacy of haemorheological treatment using plasma exchange, selective adsorption and membrane differential filtration in maculopathy, retinal vein occlusion and uveal effusion syndrome

The aim of the study was to test the clinical efficacy of haemorheological treatment with extracorporeal techniques in ocular diseases. We treated patients suffering from maculopathies of different origin: age-related (AMD, n = 17), uveitis-associated (n = 14) and myopia-associated maculopathy (n = 5). We also treated patients with uveal effusion syndrome (n = 3) and central retinal vein occlusion (n = 4) resistant to haemodilution or steroid therapy. The treatment consisted of plasma exchange, selective adsorption with a tryptophan-polyvinylalcohol adsorber and membrane differential filtration. Maculopathy patients underwent two treatments while the other patients received between 1 and 7 treatments. Pulsatile ocular blood flow was measured in 10 patients before and after therapy. The main parameter for evaluating clinical outcome was the change in visual acuity. Severe side-effects did not occur. The rheological parameters including plasma viscosity, whole blood viscosity and erythrocyte aggregation were statistically significantly lowered. Of 36 patients suffering from maculopathy, 25 showed an improvement of at least 1 line of visual acuity after therapy, 7/17 patients in AMD, 6/14 in uveitis and 0/5 in myopia improved 3 lines or more. All patients suffering from retinal vein occlusion improved at least 1 line and two showed an improvement of 3 lines or more. In uveal effusion syndrome, an improvement of 3 lines or more was reached in all patients. Plasma exchange, selective adsorption and membrane differential filtration are effective rheological treatment approaches to improving visual acuity in patients suffering from maculopathy except myopia-associated maculopathy. Efficacy in patients suffering from central retinal vein occlusion and uveal effusion syndrome was proven, even when the patients were resistant to previous haemodilution or steroid therapy. We conclude that a rheological approach should be considered before invasive methods such as laser coagulation, radiation therapy or surgery are applied.     

A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders

Micropulse laser treatment is an alternative to the conventional continuous-wave laser for the treatment of retinal or macular diseases. In contrast to the conventional laser, the therapeutic effect of the subthreshold micropulse laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required. Micropulse treatment is applied in indications such as central serous chorioretinopathy (CSC), diabetic macular edema (DME), or macular edema due to retinal vein occlusion (RVO). This review outlines and discusses the published literature of subthreshold micropulse laser treatment for CSC, DME, and macular edema after RVO.     

Diagnostic value of leptin in tuberculous pleural effusions

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.     

曲安奈德对实验性视网膜静脉阻塞血管内皮生长因子表达的影响

目的:研究曲安奈德(TA)对视网膜静脉阻塞(RVO)大鼠视网膜组织中血管内皮生长因子(VEGF)表达的影响.方法:SD大鼠48只,随机分成3组:空白组(平衡盐液),对照组(模型+平衡盐液),实验组(模型+TA),观察对照组和实验组模型眼底情况.每组分别于玻璃体腔注射平衡盐液或TA后第3、第5、第7、第14天随机处死4只大鼠,分别用免疫荧光组织化学和酶联免疫吸附试验(ELISA)测定VEGF的表达.结果:在RVO的2组模型眼中,实验组眼底病变改善显著,与对照组差异有统计学意义.免疫组织化学图像定量分析和ELISA测定显示在模型眼中VEGF的表达显著增加,与空白组比较差异有统计学意义;实验组VEGF表达在各个时间点上均显著低于对照组.结论:TA明显改善RVO模型眼底病变的作用可能是通过TA下调了视网膜组织中VEGF的表达.     

玻璃体内注射康柏西普治疗视网膜分支静脉阻塞继发黄斑水肿的临床研究

【目的】初步评价玻璃体腔内注射康柏西普治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)的疗效及安全性。【方法】对2014年8月至2015年2月就诊于本院眼科已确诊为 BRVO 继发 ME 的患者21例(21眼)的临床资料进行回顾性分析,对患眼均给予玻璃体腔内注射康柏西普,观察术前和术后1 d、1周、1个月、3个月时患者的最佳矫正视力,光学相干断层扫描测定黄斑中心区视网膜厚度的变化。【结果】在21眼中有19眼视力提高,2眼视力不变。治疗前的 LogMRA 视力为0.55±0.74,治疗后1周、1个月、3个月时分别为：0.57±0.70、0.61±0.63、0.62±0.58,其与治疗前相比差异均具有显著性(P <0.05)。黄斑中心凹平均厚度治疗前为(404.25±62.76)μm,治疗后1周、1个月、3个月时分别为(354.25±64.12)μm、(221.75±37.30)μm、(195.30±24.70)μm,治疗后明显改善,与治疗前相比差异具有显著性(P <0.05)。未发现与药物相关的眼部并发症及全身的不良反应。【结论】玻璃体内注射康柏西普治疗 BRVO 继发 ME 患者中短期内可提高视力、减轻 ME,但长期疗效仍需进一步观察。     

氩激光对视网膜静脉阻塞患者视功能康复的效果

目的 探讨氩激光对视网膜静脉阻塞的治疗效果。方法 对422例（428眼）视网膜静脉阻塞患者行氩激光治疗,其中缺血型386眼（90．2％）,非缺血型42眼（9．8％）,黄斑囊样水肿129眼（30．14％）。 结果 207眼（48．4％）视力提高,138眼（32．2％）视力无变化,黄斑囊样水肿消失率为84．45％（82／97）。结论 视网膜静脉阻塞采用氩激光治疗可控制新生血管的生成,减轻黄斑囊样水肿,保护视功能。     

Intravitreal steroid and anti-vascular endothelial growth agents for the management of retinal vein occlusion: evidence from randomized trials

Introduction: Retinal vein occlusion (RVO) is a common retinal vascular disorder, affecting visual acuity and quality of life. Macular edema (ME) and retinal ischemia are the main causes for visual impairment in RVO. Although several modalities have been evaluated for the treatment of ME secondary to RVO in clinical trials, various questions need to be clarified when translating clinical trials into real-world practice.

Areas covered: Intravitreal steroids and anti-VEGF agents are now widely used for the treatment of ME due to RVO. Herein, evidence from randomized controlled trials regarding the use of steroids and anti-VEGF agents in ME related to RVO are presented. In addition, an approach regarding the optimal treatment regimen, the most suitable time for initiating treatment and monitoring patients, as well as the potential role of ischemia in the response to treatment and the impact of treatment on the natural course of the disease was made.

Expert opinion: A comprehensive presentation of randomized clinical trials evaluating intravitreal steroids and anti-VEGF treatment for RVO indicates that both are effective and safe. However, the comparative effectiveness of the various anti-VEGF agents, the most suitable dosing regimen and the effect of these agents on retinal ischemia remains unclear.