胚胎及出生后大鼠视网膜细胞促红细胞生成素的表达

背景：促红细胞生成素是低氧诱导因子1的下游靶基因,受低氧诱导因子1的调节。 目的：观察大鼠视网膜胚胎期及出生后早期发育过程中促红细胞生成素的时空表达与视网膜发育的关系。 方法：取胚胎12,16,20 d鼠胚及成年Wistar大鼠各5只,处死后摘除眼球,分离视网膜,用免疫组织化学方法、半定量反转录聚合酶联反应检测视网膜促红细胞生成素蛋白及促红细胞生成素 mRNA的表达。 结果与结论：胚胎期大鼠视网膜神经上皮及色素上皮细胞的胞浆及胞核内均有促红细胞生成素阳性表达,表达趋势随胎龄增长而逐渐减弱;成年鼠视网膜促红细胞生成素阳性表达最弱。说明大鼠视网膜胚胎发育过程中促红细胞生成素的表达存在时空上的变化,这种变化可能与大鼠视网膜胚胎期的发育密切相关。     

继发性红细胞增多症患者血清促红细胞生成素水平的变化

目的 检测继发性红细胞增多症患者血清促红细胞生成素（EPO）的水平,探讨其改变的临床意义.方法 选择32例继发性红细胞增多症患者、15例真性红细胞增多症患者和30例健康者,采用夹心酶联免疫法测定其血清EPO.结果 继发性红细胞增多症患者EPO水平（中位数41.50mIU/mL）明显高于真性红细胞增多症患者（中位数9.60mIU/mL）和健康对照组（中位数15.30mIU/mL）,差异有统计学意义（U值分别为68.5和106.5,P值均＜0.01）;根据受试者操作特性曲线（ROC曲线）分析,曲线下面积为0.839,EPO检测继发性红细胞增多症的临界值为22.43 mIU/mL时,其敏感度为71.88％、特异性为82.22％;在继发性红细胞增多症患者中,血清EPO水平与RBC呈显著正相关（r=0.825,P＜0.01）,与Hb呈正相关（r=0.772,P＜0.01）.结论 EPO水平增高可能与继发性红细胞增多症的发生发展相关;EPO是直接反映继发性红细胞增多症的一项敏感、特异的指标,可作为继发性红细胞增多症诊断的辅助指标.     

促红细胞生成素改善实验性变态反应性脑脊髓炎症状观察

目的:观察促红细胞生成素(EPO)对实验性变态反应性脑脊髓炎(EAE)的神经保护作用。方法:制备EAE小鼠模型,对EPO干预组和EAE对照组小鼠进行临床症状及病理组织学评估;提取制备外周及中枢浸润淋巴细胞,应用流式细胞仪观察CD4+T亚群、炎性细胞因子水平以及细胞死亡情况;应用LDH测定评估不同浓度EPO对外周淋巴细胞死亡的影响。结果:EPO可改善EAE小鼠临床症状和病灶局部淋巴细胞浸润(P0.05);EPO干预组小鼠中枢浸润细胞以及外周淋巴细胞CD4+T细胞比例下降,IL-17和IFN-γ等炎性因子水平降低(P0.05),而细胞死亡比例以及IL-10、CD4+CD25+调节性T细胞水平与EAE对照组无显著差异(P0.05);1~1 000 U/ml浓度范围内EPO对外周单核淋巴细胞LDH的释放无显著影响(P0.05)。结论:EPO可以通过减少病灶炎性细胞浸润以及抑制IL-17和(或)IFN-γ水平等途径,对EAE具有神经保护作用。     

促红细胞生成素的神经保护作用

EPO主要的生理功能是调节红细胞生成，而研究发现EPO系统在神经系统的广泛分布，提示其可能对中枢神经系统具有重要作用。EPO还对缺血缺氧神经系统具有保护作用并具有临床应用前景。EPO发挥神经保护作用主要通过活化特异性受体、激活下游的多种信号转导通路及通过多种可能的作用机制发挥缺氧神经保护作用。     

促红细胞生成素的神经保护作用

促红细胞生成素 (EPO)是一个调节血细胞生成的细胞因子 ,近来发现EPO在大脑中广泛存在 ,具有神经保护作用 ,其保护机制为抗神经细胞凋亡、抗氧化、抗炎症和维持脑血管结构和功能正常。EPO神经保护作用具有时间、剂量依赖性。     

妊娠期糖尿病患者脐血促红细胞生成素含量及其与胎儿缺氧的相关性研究

目的通过测定妊娠期糖尿病(GDM)患者与正常妊娠孕妇脐血促红细胞生成素(EPO)的浓度和脐血血气分析,探讨GDM患者的脐血EPO水平与其胎儿慢性缺氧的相关性,以期为临床找到一种反映GDM所致的胎儿慢性缺氧及预测后遗症的理想指标。方法应用酶联免疫吸附试验测定法(ELISA)对30例GDM患者(实验组)及30例正常妊娠孕妇(对照组)的剖宫产儿的脐静脉血清EPO进行定量检测,同时进行脐静脉血气分析。应用独立样本t检验,所有的实测值均采用x±s表示。由于脐血EPO与血气分析之间可能存在一定关系,故行单因素相关分析,并行相关系数的显著性检验,所有分析均在SPSS 11.5软件包上完成。结果①实验组的脐静脉血EPO浓度,比对照组相应的EPO浓度明显升高,P<0.01;②脐血EPO值与脐血PCO2呈正相关,P<0.01;与BE值呈负相关,P<0.01;与pH值、PO2无相关性,P>0.05。结论 GDM患者脐血EPO水平明显升高,与胎儿宫内慢性缺氧程度有密切关系。预测胎儿慢性缺氧,检测脐血或羊水中EPO的价值可能优于脐血血气分析。     

促红细胞生成素防治早产儿贫血的疗效观察

目的观察重组人类促红细胞生成素(rhEPO)防治早产儿贫血的疗效.方法将45例早产儿随机分为治疗组30例、对照组15例.治疗组给予rhEPO 400IU/kg,每周2次,皮下注射,用药4w;对照组未用rhEPO;两组患儿均给每天口服铁,按元素铁6mg/(kg·d)计算,口服维生素E25mg/d,维生素C 0.2g/d.结果①两组在生后Hb、RBC、HCT均有下降,治疗组下降程度较轻,治疗结束后两组差异均有非常显著性意义(P＜0.01);②治疗后治疗组Ret较对照组显著升高,两组差异有非常显著性意义(P＜0,01);③血清铁蛋白水平(SF)在用药期间治疗组明显低于对照组,治疗结束后,治疗组血清SF上升,两组比较无显著性差异(P＞0.05);④治疗组贫血发生率(15.3%)较对照组(40%)明显减少,两组差异有显著性意义(P＜0.05);⑤治疗组体重增长指标高于对照组,两组差异有显著性意义(P＜0.05).结论rhEPO能有效防治早产儿贫血,且用药安全,无明显副作用.     

肿瘤患者体内促红细胞生成素浓度测定

目的了解肿瘤患者其内源性促红细胞生成素(erythropoietin,E PO)的变化.方法　我们采用酶联免疫法(ELISA)测定了46例次肿瘤患者血浆EPO水平,同时测定16例正常人为对照.结果肿瘤患者血浆EPO水平为48.96±67.29mU/ml,正常人血浆EPO水平为8.44±4.62mU/ml(±s ),(p<0.01).患者EPO水平与红细胞(RBC)、血红蛋白(Hb)、红细胞比积(Hct)、平均红细胞容积(MCV)均呈负相关,r值分别为-0 .464、-0.506、-0.555、-0.105.结论肿瘤患者EPO水平比正常人显著升高,但由于其含量相对不足是导致肿瘤性贫血的一个因素.     

促红细胞生成素与妊娠

促红细胞生成素 (erythropoietin ,EPO)是由肾脏产生的一种可以调节红细胞生成的激素。受缺氧、贫血刺激而变化 ,血清EPO浓度在妊娠期较非妊娠妇女高 ,妊娠合并贫血时 ,EPO的分泌水平更高 ,且与血红蛋白 (Hb)、红细胞比容 (Hct)呈负相关 ,与红细胞生成呈正相关。同时妊娠合并缺铁性贫血 (IDA)时 ,EPO与血清铁蛋白 (SF)及血清转缺铁蛋白受体 (sTfR)存在一定的关系。通过对EPO与妊娠合并缺铁性贫血关系的研究进展 ,为临床使用重组人促红细胞生成素 (rhuEPO)治疗妊娠合并缺铁性贫血 (IDA)提供了理论基础。     

瘦素在增殖性糖尿病视网膜病变中作用的研究

目的探讨瘦素及其受体在增殖性糖尿病视网膜病变（PDR）形成发展中的作用。方法应用免疫组织化学技术检测增值性糖尿病视网膜病变（PDR）患者视网膜前膜及正常视网膜瘦素效应受体-长型受体的表达,并采用酶联免疫吸附技术测定PDR患者玻璃体液及正常人玻璃体液瘦素浓度。将结果进行统计学比较分析。结果PDR患者视网膜前膜组织有瘦素受体的表达,Ⅴ期,Ⅵ期表达的阳性率之间无显著性差异;正常视网膜组织未见表达。PDR患者玻璃体液瘦素浓度比正常人显著性升高;Ⅴ期,Ⅵ期PDR患者玻璃体液瘦素浓度无显著性差异。结论瘦素及其受体参与了DR的发病,并促进DR从非增殖期向增殖期进展。     

Clinical and predictive significance of Plasma Fibrinogen Concentrations combined Monocyte-lymphocyte ratio in patients with Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the most common causes of blindness and visual impairment. Therefore, early prediction of its occurrence and progression is important. This study aimed to assess the clinical and predictive significance of plasma fibrinogen concentrations combined monocyte-lymphocyte ratio (FC-MLR) in patients with DR. A total of 307 patients with type 2 diabetes (T2D) were enrolled. Plasma fibrinogen concentrations and peripheral white blood cells were measured, and MLR was calculated, and the associations of FC-MLR with DR and severity of disease were assessed. Regression analysis and receiver operating characteristic (ROC) curves were performed to evaluate the risk factors and predictive power of FC-MLR for DR and severity of disease, respectively. DR patients showed higher fibrinogen concentrations and a higher MLR than did T2D patients without complications (P<0.01); Moreover, DR patients in proliferative stage also showed higher fibrinogen concentrations and a higher MLR than did those in non-proliferative stage (P<0.01). FC-MLR was closely associated with occurrence and severity of DR (P<0.01), and was an independent risk factor for them (OR=6.123, 95%CI: 3.122-17.102; and 7.932, 95%CI: 4.315-16.671, respectively; P<0.001). The predictive sensitivity and specificity for DR and severity of disease were 0.86 and 0.68, and 0.85 and 0.73, respectively. The study suggests that FC-MLR may be used as a predictor for the risk and progression of diabetic retinopathy.     

Cord Blood Cellular Proliferative Response as a Predictive Factor for Atopic Dermatitis at 12 Months

Since the risk of developing allergic disease increases in individuals exposed to allergens previously, even during the neonatal period, the immunologic status of a fetus may be important in the subsequent development of allergy. We evaluated the fetal factors to predict atopic dermatitis (AD) at 12 months in 412 infants of a COhort for Childhood Origin of Asthma and Allergic Diseases (COCOA) in the general Korean population. Cord blood mononuclear cells (CBMCs) were stimulated with ovalbumin and phytohemagglutinin and cellular proliferative response and concentrations of interleukin-13 and interferon-γ, were measured. The risk of developing AD was greater in boys than girls (OR 1.97, 95% CI 1.26-3.09), infants delivered by cesarean section than vaginally (OR 1.93, 95% CI 1.14-3.26) and infants with than without parental history of AD (OR 2.34, 95% CI 1.29-4.24). The CBMC proliferative response to phytohemagglutinin stimulation was higher in infants with than without AD (P = 0.048), but no difference was observed in ovalbumin-stimulated cells (P = 0.771). Risk factors for the development of AD at 12 months include male gender, delivery by cesarean section and parental history of AD. Increased CBMC proliferative response to phytohemagglutinin stimulation may predict the development of AD at 12 months.     

糖尿病痛性神经病变危险因素的研究

糖尿病痛性神经病变（PDN）是一种临床常见以疼痛为主要特征的周围神经病变,患者可出现剧烈的肢体疼痛、伴睡眠障碍及抑郁,同时易发生足部溃疡,甚至导致截肢,严重影响患者的生活质量。目前PDN发病机制尚未明确,探究PDN的危险因素对于疾病早期预防具有重要意义。本文通过对PDN的危险因素研究现状进行综述,旨在为临床防治PDN及探索发病机制提供依据。     

Rapid Grading of Fundus Photographs for Diabetic Retinopathy Using Crowdsourcing

Background

Screening for diabetic retinopathy is both effective and cost-effective, but rates of screening compliance remain suboptimal. As screening improves, new methods to deal with screening data may help reduce the human resource needs. Crowdsourcing has been used in many contexts to harness distributed human intelligence for the completion of small tasks including image categorization.

Objective

Our goal was to develop and validate a novel method for fundus photograph grading.

Methods

An interface for fundus photo classification was developed for the Amazon Mechanical Turk crowdsourcing platform. We posted 19 expert-graded images for grading by Turkers, with 10 repetitions per photo for an initial proof-of-concept (Phase I). Turkers were paid US $0.10 per image. In Phase II, one prototypical image from each of the four grading categories received 500 unique Turker interpretations. Fifty draws of 1-50 Turkers were then used to estimate the variance in accuracy derived from randomly drawn samples of increasing crowd size to determine the minimum number of Turkers needed to produce valid results. In Phase III, the interface was modified to attempt to improve Turker grading.

Results

Across 230 grading instances in the normal versus abnormal arm of Phase I, 187 images (81.3%) were correctly classified by Turkers. Average time to grade each image was 25 seconds, including time to review training images. With the addition of grading categories, time to grade each image increased and percentage of images graded correctly decreased. In Phase II, area under the curve (AUC) of the receiver-operator characteristic (ROC) indicated that sensitivity and specificity were maximized after 7 graders for ratings of normal versus abnormal (AUC=0.98) but was significantly reduced (AUC=0.63) when Turkers were asked to specify the level of severity. With improvements to the interface in Phase III, correctly classified images by the mean Turker grade in four-category grading increased to a maximum of 52.6% (10/19 images) from 26.3% (5/19 images). Throughout all trials, 100% sensitivity for normal versus abnormal was maintained.

Conclusions

With minimal training, the Amazon Mechanical Turk workforce can rapidly and correctly categorize fundus photos of diabetic patients as normal or abnormal, though further refinement of the methodology is needed to improve Turker ratings of the degree of retinopathy. Images were interpreted for a total cost of US $1.10 per eye. Crowdsourcing may offer a novel and inexpensive means to reduce the skilled grader burden and increase screening for diabetic retinopathy.     

增生型糖尿病性视网膜病变前后段联合手术的疗效观察

目的 探析增生型糖尿病性视网膜病变前后段联合手术的临床疗效。方法 选取2015年10月~2017年4月在我院进行治疗的增生型糖尿病性视网膜病变患者90例,随机分为参照组和治疗组,每组45例。参照组给予单纯玻璃体切除术治疗,治疗组应用后三联手术治疗,对比两组患者治疗前后视力情况和并发症发生率。结果 经术前检测,两组患者视力情况相比,差异无统计学意义（P＞0.05）;经治疗后,治疗组患者术后视力恢复情况优于参照组,差异有统计学意义（P＜0.05）。治疗组患者的并发症发生率为20.00%,低于参照组的42.22%,差异具有统计学意义（P＜0.05）。结论 增生型糖尿病性视网膜病变患者行后三联手术（玻璃体切除术+超声乳化人工晶体植入术联合）治疗,术后并发症少,对促进视力的恢复具有一定的临床优势和可行性,推广应用价值较高。     

黛力新对糖尿病视网膜病变伴抑郁患者的疗效观察

目的:观察黛力新配合常规治疗对糖尿病视网膜病变(DR)伴抑郁患者抑郁评分(HAMD)、血清内脏脂肪素(Visfatin)、空腹血糖(FBG)、甘油三酯(TG)、平均血糖波动幅度(MAGE)的影响。方法:选取DR伴抑郁患者36例,随机分为对照组及黛力新组(n均=18)。对照组采用DR常规治疗,黛力新组在DR常规治疗基础上加用黛力新片,于每天早晨和中午各口服1片(0.5mg/片)。疗程均为4周。观察两组患者治疗前后临床表现,并进行HAMD评分,ELISA检测血清Visfatin,电化学法测定全血FBG,酶法测定血清TG,MiniMed动态血糖监测系统测定MAGE,并行统计学比较分析。结果:治疗前,两组患者存在明显抑郁现象,各检查指标无明显差异(P>0.05);治疗后,黛力新组临床表现改善明显,HAMD评分、Visfatin、TG、FBG、MAGE水平均下降,与对照组比较,差异有统计学意义(P<0.05)。结论:黛力新不仅能降低FBG、TG,减少MAGE,还能降低血清Visfatin水平,改善DR伴抑郁患者的抑郁状态。     

检测DM2患者血清CRP、fBS和血浆Fb、HbA1c水平对预测视网膜病变的临床价值

目的：检测2型糖尿病（DM2）及视网膜病变（DR）患者血清CRP、血浆纤维蛋白原（Fb）和糖化血红蛋白（HbA1c）水平及其相互关系,探讨对预测DR风险的临床价值。方法：141例DM2患者分为单纯糖尿病（DM2）组（80例）、合并DR组（61例）和正常对照组60例;同时检测其血清CRP、空腹血糖（fBS）和血浆Fb、HbA1c水平,对三组指标进行相关性分析。结果：DM2合并DR组CRP、Fb水平明显高于对正常照组和DM2组,而与fBS、HbA1c水平比较则无统计学意义;CRP与Fb水平变化呈明显正相关（r=0.78,P〈0.01）,与fBS和HbA1c水平变化呈正相关关系不明显（r=0.02、r=0.06,P〉0.05）。结论：DM2患者血清CRP、血浆Fb水平变化与DR有密切关系,因而检测这两种指标有助于预测DM2患者发生DR的风险。     

三种不同肾功能检测指标与DR关系的探讨

目的：探讨尿白蛋白、尿白蛋白/尿肌酐、肾小球滤过率三种不同肾功能指标与2型糖尿病视网膜病变（DR）之间的关系。方法：124例DM2分为不伴视网膜病变（A组）51例,视网膜病变单纯型（B组）50例和视网膜病变增殖型（C组）23例,各组均行尿素氮、肌酐及24 h尿白蛋白（UAlb）、尿白蛋白/尿肌酐（ACR）、肾动态显像（GFR-ECT）及其相关指标检测并对结果进行分析。结果：C组与A、B组比较,UAlb、ACR明显增加,GFR明显下降（P〈0.05）。相关分析显示,UAlb、ACR及肾小球滤过率（GFR）是糖尿病视网膜病变发病的独立危险因素。结论：DR程度是随尿白蛋白、尿白蛋白/尿肌酐增加和肾小球滤过率减低而加重的;同时研究显示,GFR对早期诊断糖尿病肾病（DN）有较高的临床价值。