Apelin及其受体和一氧化氮合酶在氧诱导的新生小鼠增生性视网膜病变中表达上调

 目的：通过观察apelin及其受体APJ和一氧化氮合酶（NOS）在氧诱导的新生小鼠增生性视网膜病变中的表达,探讨apelin/APJ和一氧化氮(NO)是否参与了早产儿视网膜病变新生血管的发生。方法：36只7日龄C57BL/6J新生小鼠随机均分为高氧组和对照组。高氧组暴露在75%±2%的氧浓度下5 d后,在正常空气环境下饲养5 d;对照组小鼠在正常氧环境下饲养10 d。两组均在17日龄处死,取左眼眼球做石蜡切片,HE染色计数突破内界膜的血管内皮细胞核数,以判断造模是否成功。实时荧光定量PCR检测右眼视网膜组织apelin和APJ mRNA的表达,免疫荧光组织化学法检测视网膜apelin、APJ、eNOS和iNOS蛋白的表达。结果：高氧组视网膜平均每个切面突破内界膜的血管内皮细胞核数(35.13±10.13)明显高于对照组(0.30±0.21,P<0.01）,说明造模成功。高氧组apelin和APJ mRNA水平显著高于对照组,分别为对照组的32.2倍和17.6倍（均P<0.01）。组织免疫荧光结果显示高氧组apelin和APJ蛋白表达明显强于对照组,并且主要强表达于新生血管周围;高氧组eNOS和iNOS蛋白表达明显强于对照组,但主要强表达于新生血管下方视网膜组织,在突破内界膜的血管内皮细胞核周围未见表达明显增强。结论：Apelin/APJ及NOS可能与氧诱导的新生小鼠增生性视网膜病变新生血管的发生有关。     

冷凝治疗12例早产儿视网膜病的围手术期护理

目的探讨早产儿视网膜病变(ROP)围术期的护理作用。方法对12例ROP围术期患儿冷凝治疗前后行整体护理。结果通过围手术期护理能有效控制或延缓玻璃体视网膜病变的进展,稳定视力。结论巩膜外冷凝术是阻止阈值ROP发展至晚期视网膜脱离的良好方法,而其围手术期护理是手术成功的关键。     

早产儿视网膜病发病情况及高危因素的探讨

目的 探讨早产儿视网病（retinopathy of prematurity，ROP）的发病率、高危因素及防治措施。方法对194例早产儿生后72h内及生后4w开始定期检查眼底，发现ROP者密切随访至生后1年。结果72h内早期眼底检查眼底异常包括视乳头水肿、视网膜水肿、视网膜血管改变及出血等。生4w后检出ROP患儿12例（6．2％），高危因素分别为低出生体重，小孕周、长期或高浓度吸氧。结论建议出生体重小于2000g和／或孕周小于35w的早产儿，在生后第3w或胎龄达34w时常规行首次眼底检查，以早期发现ROP并给予及时治疗。     

外周血单个核细胞中乙型肝炎病毒核酸与细胞因子含量变化

目的：探讨慢性乙型肝炎患者外周血单个核细胞中乙型肝炎病毒核酸与血清细胞因子变化关系。方法：采用荧光实时PCR技术定量检测76例慢性乙型肝炎患者和15例健康者外周血单个核细胞中HBVDNA含量，用ELISA法定量检测血浆细胞因子(IFN-γ、TNF—α、IL-4、IL-6、TGF-β1、sIL-2R)水平。结果：①慢性乙型病毒性肝炎中细胞因子(IFN-γ、TNF-α、IL-4、IL-6、TGF-β1、sIL-2R)水平明显高于健康对照组；②单个核细胞HBVDNA阳性组IFN-γ、TNF-α含量明显低于阴性组，而sIL-2R含量则高于阴性组但无统计学差异，IL-4、IL-6、TGF-β1含量无差异；③随着PBMCs中HBVDNA含量升高，TNF—α含量逐渐降低，IL-4和sIL-2R含量逐渐升高，而IFN-γ，IL-6、TGF-β1含量无显著性变化。结论：外周血单个核细胞HBVDNA持续存在及含量变化与细胞因子相对异常有关，进而导致肝细胞损伤。     

2型糖尿病视网膜病变患者血清炎症因子和脂联素水平的变化

目的: 观察2型糖尿病合并视网膜病变(DR)患者血清炎症因子和脂联素的变化。方法: 110例糖尿病患者分为3组:糖尿病无视网膜病变组(DM)35例、糖尿病伴非增殖期视网膜病变组(NPDR)45例和糖尿病伴增殖期视网膜病变组(PDR)30例,并与40名正常人对照(NC组)。观察患者的体检指标,并检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、餐后2 h血糖(2hPG),总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂联素、血清细胞间黏附分子-1(ICAM-1)、肿瘤坏死因子-α(TNF-α)和高敏C-反应蛋白(hs-CRP)。计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)。结果: DM组、NPDR组和PDR组患者的收缩压、体重指数、腰臀比、血清TG、LDL-C、FPG、2hPG、 HbA1c、ICAM-1、TNF-α、hs-CRP水平和HOMA-IR均高于NC组(P<0.05),而NPDR组和PDR组的收缩压、血清ICAM-1、TNF-α、hs-CRP水平和HOMA-IR均高于DM组(P<0.05)。DM组、NPDR组及PDR组的患者血清脂联素水平均低于NC组(P<0.05),而NPDR组及PDR组的患者血清脂联素水平低于DM组患者(P<0.05)。血清脂联素水平与ICAM-1、TNF-α、hs-CRP和HOMA-IR之间呈负相关(r值分别为-0.735、-0.781、-0.768、-0.752,均P<0.01),HOMA-IR与ICAM-1、TNF-α和hs-CRP之间呈正相关(r值分别为0.857、0.906、0.888,均P<0.01)。结论: 炎症因子和脂联素参与了DR的发生和发展,而脂联素可能通过拮抗炎症反应减轻胰岛素抵抗,对DR有一定的改善作用。     

The association of platelet counts with development and treatment for retinopathy of prematurity – is thrombocytopenia a risk factor?

IntroductionThrombocytes may regulate the activity of vascular endothelial growth factor (VEGF), limiting neovascularization in retinopathy of prematurity (ROP). The aim of this study was to examine the role of platelet counts, thrombocytopenia, and infections in the pathogenesis of ROP.Material and methodsThe study included 163 preterm infants diagnosed with ROP, comparing 76 patients who required treatment with 87 patients in whom ROP resolved spontaneously (control group). Further analysis concerned 52 patients in whom a first line treatment was sufficient to stop ROP progression, and 24 patients who required re-treatment.ResultsA statistically significant difference was found in the occurrence of thrombocytopenia (p = 0.015), platelet counts before the diagnosis of ROP (p = 0.008), and the presence of late-onset infection (p = 0.007). The ROC curve analysis showed that the value of platelets above 232 × 10⁹/l may stimulate spontaneous resolution of ROP. A significant difference between patients once treated and patients that required re-treatment was found in platelet count before the diagnosis of ROP (p = 0.017), platelet count before the first intervention (p = 0.013), and the number of transfusions (p = 0.042).ConclusionsThe results of the study confirm the association between ROP development and its severity with thrombocytopenia. While there were no differences in the occurrence of thrombocytopenia right after the birth, its episode before the diagnosis of ROP seems to be significant for ROP development. The deficiency of platelets prior to a treatment intervention may be associated with necessity of re-treatment.     

Prenatal counseling for extreme prematurity at the limit of viability: A scoping review

ObjectivesTo explore, based on the existing body of literature, main characteristics of prenatal counseling for parents at risk for extreme preterm birth.MethodsA scoping review was conducted searching Embase, Medline, Web of Science, Cochrane, CINAHL, and Google Scholar.Results46 articles were included. 27 of them were published between 2017 and 2021. More than half of them were conducted in the United States of America. Many different study designs were represented. The following characteristics were identified: personalization, parent-physician relationships, shared decision-making, physician bias, emotions, anxiety, psychosocial factors, parental values, religion, spirituality, hope, quality of life, and uncertainty.ConclusionsParental values are mentioned in 37 of the included articles. Besides this, uncertainty, shared decision-making, and emotions are most frequently mentioned in the literature. However, reflecting on the interrelation between all characteristics leads us to conclude that personalization is the most notable trend in prenatal counseling practices. More and more, it is valued to adjust the counseling to the parent(s).Practice implicationsThis scoping review emphasizes again the complexity of prenatal counseling at the limit of viability. It offers an exploration of how it is currently approached, and reflects on how future research can contribute to optimizing it.     

Serum concentrations of cytokines in patients with active tuberculosis (TB) and after treatment

During TB cytokines play a role in host defence. To determine the cytokine pattern during various disease stages of TB, serum levels of IL-12, interferon-gamma (IFN-γ), IL-4, IL-6 and IL-10 were measured in 81 patients with active TB, 15 patients during therapy and 26 patients after anti-tuberculous therapy as well as in 16 persons who had been in close contact with smear-positive TB and in 17 healthy controls. IFN-γ was elevated during active TB when compared with healthy controls, declining during and after treatment. IL-12 (p40 and p70) serum levels were not significantly higher in patients with active TB compared with any of the other groups. IL-4 levels were low in all groups. IL-6 and IL-10 serum levels were elevated in patients with active TB and during treatment. In patients with active TB serum levels of IFN-γ and IL-6 were higher in patients with fever, anorexia and malaise. IL-12 levels were higher in patients with a positive smear. Cytokine levels did not correlate with localization of TB (pulmonary versus extrapulmonary), or skin test positivity. Cytokines directing a Th1 response (IL-12) or a Th2 response (IL-4) were not elevated in sera of this large group of patients with pulmonary and extrapulmonary TB. In patients with active TB, cytokines that were elevated in serum were IFN-γ, IL-6 and IL-10.     

α—干扰素治疗慢性病毒性肝炎前后细胞因子的变化

目的：观察α－干扰素治疗慢性病毒性肝炎前后免疫细胞因子的变化,探讨α－干扰素与细胞因子之间的关系,为干扰素治疗选择合适的适应症。方法：用双抗体夹心ELISA法对82例慢性病毒性肝炎患者α－干扰素治疗前后IL－2、γ-IFN、IL-10进行了检测,同时观察了T细胞亚群的变化。结果：82例乙丙肝患者,用α－干扰素治疗后,治疗有效40 例,有效率48．78％,随访1-2年,10．98％复发。干扰素治疗前：慢性病毒性肝炎患者CD4^ /CD8^ 比值、血清IL－2、γ－INF水平降低,而IL-10水平明显升高。治疗有效组IL－10显著低于治疗无效组。治疗后：有效组CD4^ /CD8^ 比值、血清IL－2、γ－INF水平治疗前显著升高,IL－10明显下降（P＜0．05）,而治疗无效组,治疗后仅IL－2较治疗前增高,CD4^ /CD8^ 比值、血清IL－10、γ－INF较治疗前无明显变化。结论：用干扰素治疗慢性病毒性肝炎可以明显提高CD4^ /CD8^ 比值,使T细胞活化,促进Th1因子的产生,抑制Th2细胞因子。干扰素治疗无效组治疗前IL－10水平显著高于治疗有效组,可能是部分慢性病毒性肝炎干扰素疗效差的原因之一。T细胞亚群、Th1/Th2细胞因子的检测可用于干扰素抗病毒治疗适应症的选择和疗效监测。     

Invasive thymoma with paraneoplastic retinopathy

A 60-year-old man was admitted for progressive visual loss in both eyes. He was diagnosed with retinopathy and chest computed tomography revealed an invasive thymoma. In western blot analysis, serum autoantibodies against recoverin, photoreceptor-specific calcium-binding protein, and heat shock cognate protein 70 which were identified as the cause of cancer-associated retinopathy (CAR). Immunofluorescence staining showed that thymoma cells also expressed recoverin. These observations strongly suggested that similar pathogenesis of CAR was involved in the presented case.     

高氧诱导早产新生鼠视网膜病变的实验研究

目的探讨高浓度氧对新生鼠视网膜的影响及其机制。方法将新生鼠放入含氧80%的氧箱中连续饲养14d,再置于空气中饲养5d,以一直在空气中饲养的同龄鼠为对照组。分别检测14d、19d龄鼠血管灌注及密度计数检测鼠视网膜血管主干直径及周边血管覆盖率:HE染色观察并计数突破视网膜内界膜的内皮细胞核数目,检测鼠视网膜新生血管。结果持续高浓度氧使幼鼠视网膜血管收缩、分支闭塞,视网膜血管主干直径、周边血管覆盖率明显降低(P<0.01);相对低氧使视网膜血管扩张、增生,两组比较差别有显著性意义(P<0.01)。结论高浓度氧能短时间内有效诱导W istar新生鼠视网膜新生血管的生长,成功构建(retinopathy of prem aturity,ROP)动物模型,可进行定量研究,是研究ROP发病机制及治疗对策较合适的模型。     

支气管哮喘的细胞因子治疗进展

哮喘是一种慢性气道炎症性疾病,它的发生和发展与多种细胞因子密切相关.目前哮喘还没有有效的预防和治愈方法,细胞因子抑制剂已经作为潜在的治疗手段而被广泛研究.其中IL-4、IL-5、TNF-α抑制剂的临床研究已经取得了突破性的进展.IL-13和IL-9的临床试验正在研究中.对哮喘动物模型的大量研究发现了胸腺基质淋巴细胞生成素(TSLP),IL-17等新的相关细胞因子,这为哮喘细胞因子治疗提供了新的思路.而多种细胞因子抑制剂的联合使用也为治愈哮喘提供了可能.同时,哮喘个体化医疗的研究为逆转哮喘提供了有力保障.     

Review: Accounting for prematurity in developmental assessment and the use of age-adjusted scores

OBJECTIVE: This review summarizes the literature to date concerning age adjustment in developmental assessment and illustrates relevant issues for clinicians and researchers in this area. METHODS: Pubmed, Medline, Premedline, and PsycInfo databases were used to search the following terms: assessment, prematurity, age adjustment, and adjusted age. Additional sources were obtained through the references listed in the primary articles. RESULTS: Differences in clinical opinions persist with regard to whether, what type, and how long age adjustments are to be made for premature infants. Research is inconclusive regarding the most appropriate method for accounting for prematurity. CONCLUSIONS: Previous data may no longer describe the current population of premature infants. Current research is needed to inform developmental assessment practices for this population. Meanwhile, clinicians should remain aware of the issues regarding whether and how to adjust for prematurity. The authors recommend a multifaceted approach to clinical decision making and provide suggestions for future research.     

Urinary 6-sulfatoxymelatonin level in diabetic retinopathy patients with type 2 diabetes

Melatonin is a powerful antioxidant. Decreased melatonin excretion has been reported to be associated with several oxidative stress-related diseases. The urinary metabolite of melatonin, 6-sulfatoxymelatonin (aMT6s), has proved to be a very reliable index of melatonin production. The present study aims to evaluate the level of urinary aMT6s in patients with type 2 diabetes mellitus and diabetic retinopathy. Urine samples were collected from 10 patients with diabetes and no diabetic retinopathy (NDR), 19 patients with nonproliferative diabetic retinopathy (NPDR), 38 patients with proliferative diabetic retinopathy (PDR), and 16 subjects without diabetes mellitus, who served as controls. The level of aMT6s in specimens was assayed by a commercial aMT6s ELISA kit, creatinine levels were also measured for each sample to get urinary aMT6s/creatinine ratio. Creatinine-adjusted urinary aMT6s values were compared among four groups. The urinary aMT6s (mean ± SD) levels were 9.95 ± 2.42, 9.90 ± 2.28, 8.40 ± 1.84 and 5.58 ± 1.33 ng/mg creatinine in the controls and in patients with NDR, NPDR, or PDR, respectively. The urinary aMT6s level of the PDR group was significantly lower than that of the control, NDR and DR groups. No significant difference was found among the control, NDR and DR groups. After adjustment for various factors (age, smoking, cancer, and coronary heart disease) that may influence the aMT6s level, the odds-ratio of urinary aMT6s comparing PDR patients to controls was 0.246 (95% confidence interval = 0.108-0.558, P = 0.001). Therefore, the urinary aMT6s level is significantly decreased in diabetic patients with PDR but not in diabetic patients without PDR, which indicates that decreased urinary aMT6s level may be associated with the pathogenesis of PDR.     

细胞因子在神经-内分泌-免疫网络中的调节机制

免疫和神经内分泌系统之间的联系是双向的。它们有着共同的化学语言,有典型的激素和免疫调节剂中介的配体和受体。肾上腺糖皮质激素(GC)对调节内分泌起着非常重要的作用,是免疫活动的主要调节物;在证实神经-内分泌-免疫之间存在调节反馈机制后,研究发现细胞因子是联系免疫-神经-内分泌系统的关键。除了IL-1,还有许多细胞因子如IL-6、TNF等都能影响下丘脑-垂体-肾上腺轴(HPA轴)的活性。研究显示,细胞因子对HPA轴的影响不仅发生在感染、外伤和肿瘤等疾病中,而且在心理和生理应急时也出现。已有研究证明外源性和内源性细胞因子均能激活HPA轴。维护机体自我平衡,单个细胞因子的努力是绝对不够的,应该系统研究多种细胞因子对HPA轴活性作用的机制。     

糖尿病视网膜病变相关基因多态性的研究进展

糖尿病视网膜病变是目前国际上最主要的致盲性眼病之一,患病率日渐升高.其发生和发展与血糖水平、糖尿病病程、环境及遗传等多种因素有关.近些年来,随着基因多态性与糖尿病视网膜病变关系的研究不断深入和进展,已经筛选出了可能与之相关的数十 种基因,其中几种基因多态性已经被证实为糖尿病视网膜病变发生的独立危险因素.现将与糖尿病视网膜病变密切相关的基因多态性研究进展作一综述.     

玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变52眼分析

目的评价玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）的临床效果。方法回顾性分析了2005年7月至2009年12月在我院行玻璃体切除联合白内障手术的PDR患者48例（52眼）,术后随访7个月以上,统计分析手术方式、术前、术后最终矫正视力、手术并发症等临床资料。结果硅油填充率随着糖尿病眼底病变发展而增加,VI期硅油填充率分别与IV期、V期相比差异显著,P〈0.01;随访期间,71.15%（37/52）术后视力提高,随着糖尿病眼底病变发展,术后视力提高率下降,IV、V、VI期术后视力提高率分别是100%、92.31%和62.16%,但各组间无显著差异,P〉0.05,其中视力0.1以上的眼数由术前的5眼（11.36%）增加到术后的33眼（75%）,术后视力显著好于术前,P〈0.01;一次性视网膜复位成功率100%。1眼术后玻璃体再次出血,7眼发生后发性白内障,硅油填充组6眼术后早期发生高眼压,4眼在术后不同时期发生硅油乳化。结论玻璃体切除联合白内障手术治疗PDR是安全有效的,有利于早期恢复患者视力,避免再次白内障手术。     

胱抑素C及Chemerin在糖尿病视网膜病变患者血清中表达的临床意义

目的 分析胱抑素C及趋化素(Chemerin)在糖尿病视网膜病变患者血清中表达的临床意义.方法 选取80例临床确诊的糖尿病视网膜病变患者作为研究对象,其中39例增殖性糖尿病视网膜病变(proliferative diabeticretinopathy, PDR),41例无增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR),以及选取同期的45例单纯糖尿病作为对照组,40例健康体检者作为正常对照组;对比4组研究对象的一般资料、临床和生化指标,包括性别、年龄、体重指数(BMI)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HONA-IR)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hsCRP)等,以及血清胱抑素C及Chemerin水平,并进行Pearson相关性分析.结果 对照组血清胱抑素C及Chemerin水平均显著高于正常对照组,PDR组、NPDR组均显著高于对照组,PDR组均显著高于NPDR组,且血清胱抑素C及Chemerin水平均随着糖尿病视网膜病变程度加大而升高,4组间的血清胱抑素C及Chemerin水平差异均具有统计学意义(均P＜0.05);Pearson相关性分析显示:血清胱抑素C水平与收缩压、HbA1c、HONA-IR、FPG、TG、TC、LDL-C呈正相关(均P＜0.05),而血清Chemenn水平与糖尿病病程、BMI、HONA-IR、尿白蛋白量、hsCRP呈正相关(均P＜0.05);血清胱抑素C与Chemerin水平也呈正相关(P＜0.05).结论 血清高水平的胱抑素C及Chemerin共同参与了糖尿病视网膜病变的发生、发展过程,可能与糖代谢障碍有关.