2型糖尿病患者黄斑区硬性渗出与血脂异常的关系

目的探讨有重度非增生性糖尿病视网膜病变的2型糖尿病患者黄斑区硬性渗出的程度与各项血脂指标异常之间的关系。方法对90例（90眼）诊断为重度非增生性糖尿病视网膜病变的2型糖尿病患者,用中央50。数字彩色眼底照片分析硬性渗出的范围并依据视网膜硬性渗出的程度进行分组：黄斑区未见明显硬性渗出者为A组;黄斑区有硬性渗出且硬性渗出面积〈1／2视盘面积者为B组;黄斑区有硬性渗出且硬性渗出面积≥1／2视盘面积者为C组,各30例。记录各组患者的年龄、性别、病程、胰岛素治疗情况及血压、血Cr水平并进行血脂分析（TC、LDL—C、HDL—C、TG）。结果A、B、C组患者血清Cr分别为（88±31）、（103±24）、（106±42）mmol／L,TC分别为（4．9±2．6）、（5．34-1．2）、（5．9±1．3）mmol／L．LDL—C分别为（2．9±0．9）、（3．1±1．1）、（3．5±1．0）mmol／L,TG分别为（1．7±0．5）、（2．0±0．7）、（2．1±0．7）mmol／L,组间比较差异均有统计学意义（P〈0．05或P〈0．01）。A、B、C组患者血HDL．C差异无统计学意义[分别为（1．16±0．19）、（1．14±0．22）、（1．17±0．24）mmol／L,P〉0．05]。结论2型糖尿病患者黄斑水肿的硬性渗出程度与患者血清TC、LDL、TG水平相关。     

增殖期糖尿病性视网膜病变应用不同激光光凝术治疗的疗效观察

目的 对比分析不同激光光凝术治疗增殖期糖尿病性视网膜病变的疗效。方法 增殖期糖尿病性视网膜病变患者156例(251眼)作为研究对象,根据手术方法不同分为两组,各78例。对照组行全视网膜激光光凝术,观察组行象限视网膜激光光凝术,观察黄斑中心凹厚度和视野缺损变化,随访3个月观察视力水平。结果 观察组视力提高率38.46%显著高于对照组15.38%,视力下降率8.97%显著低于对照组24.36%,差异具有统计学意义(P<0.05)。观察组治疗后黄斑中心凹厚度和视野缺损分别为(218.61±31.27)μm、(2.53±1.42)db,均显著低于对照组,差异具有统计学意义(P<0.05)。结论 采用象限视网膜激光光凝术治疗增殖期糖尿病性视网膜病变,可减少对黄斑区功能损伤,提高视力水平。     

光相干断层成像在特发性黄斑前膜患者视功能评估中的应用

目的 探讨特发性黄斑前膜（IMEM）患者光相干断层成像（OCT）显示视网膜结构变形程度及黄斑区视网膜厚度（RT）与患者视功能损害的相关性。方法 回顾性分析经OCT检查确诊IMEM共56例66眼,进行最佳矫正视力（BCVA）,眼底及OCT检查,依据视网膜内部结构变异严重程度分为轻、中、重组,并测量RT。结果 轻、中、重组患眼平均RT分别为（311.95±51.78）、（447.13±41.95）和（560.00±58.23）μm,依次增高,差异有统计学意义（均P＜0.05）;轻、中、重组患眼平均BCVA分别为0.78±0.16、0.38±0.12和0.27±0.14,依次降低,差异有统计学意义（P＜0.05）;轻组患眼RT与BCVA之间无相关性（r=-0.352,P=0.128）,中、重组内患眼RT与BCVA之间呈负相关（r分别为-0.768和-0.482,P＜0.05）。结论 黄斑区视网膜结构变异程度及视网膜厚度可以反映视功能损害的程度, RT值达到400um可以作为手术干预的客观标准。     

视网膜激光光凝术治疗眼底病的临床效果分析

目的 分析眼底病患者采用视网膜激光光凝术治疗的临床效果。方法 78例眼底病患者,随机分为观察组及对照组,各39例。观察组采用视网膜激光光凝术治疗,对照组采用常规保守治疗。比较两组临床疗效、治疗前后黄斑区视网膜厚度及中心凹容积、不良事件发生情况、治疗后视力水平。结果 观察组治疗总有效率92.3%高于对照组的74.3%,差异有统计学意义(P<0.05)。治疗后,观察组黄斑区视网膜厚度(311.84±13.25)μm、中心凹容积(8.99±0.24)mm3均大于对照组的(286.29±8.47)μm、(8.56±0.17)mm3,差异有统计学意义(P<0.05)。观察组不良事件发生率5.1%低于对照组的25.6%,差异有统计学意义(P<0.05)。治疗后,观察组视力水平优于对照组,差异有统计学意义(P<0.05)。结论 眼底病采用视网膜激光光凝术治疗可显著提高治疗效果,不良事件发生率更低,术后黄斑区视网膜等改善更明显,可提高患者视力,值得临床广泛应用。     

眼底激光联合雷珠单抗治疗糖尿病视网膜病变的效果观察

目的研究眼底激光联合雷珠单抗治疗糖尿病视网膜病变的临床效果。方法 60例糖尿病视网膜病变患者,按随机数字表法分为对照组和观察组,各30例。对照组患者接受眼底激光治疗,观察组患者接受眼底激光联合雷珠单抗治疗。比较两组患者治疗后6个月视力改善情况、症状改善情况、治疗前后黄斑区视网膜厚度变化情况。结果观察组治疗后6个月视力变化情况优于对照组,差异有统计学意义(P<0.05)。观察组眼底出血吸收用时(2.41±0.26)周、渗出吸收时间(10.15±0.59)周、视网膜水肿吸收时间(4.75±0.34)周均明显短于对照组的(2.98±0.31)、(11.21±0.68)、(5.64±0.45)周,差异有统计学意义(P<0.05)。治疗前,两组黄斑区视网膜厚度比较差异无统计学意义(P>0.05);治疗后,两组黄斑区视网膜厚度均优于治疗前,且观察组黄斑区视网膜厚度(241.38±20.19)μm优于对照组的(312.45±30.15)μm,差异有统计学意义(P<0.05)。结论眼底激光联合雷珠单抗治疗糖尿病视网膜病变能够更明显缓解症状,提高视力,减低视网膜厚度,能够加快患者恢复,值得推广。     

玻璃体注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞的疗效

目的：观察玻璃体注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞的安全性和有效性，为临床治疗提供参考。方法53例（63眼）视网膜分支静脉阻塞患者随机分为2组，观察组27例（32眼）应用玻璃体注射雷珠单抗联合黄斑区格栅样光凝治疗，对照组26例（31眼）应用黄斑区格栅样光凝治疗。术后随访6个月，记录临床疗效、视力情况、不良反应等。结果随访至术后6个月，观察组视力为（1．15±0．07），黄斑中心凹厚度为（314．2±112．4）μm，对照组视力为（0．86±0．06），黄斑中心凹厚度为（426．4±108．6）μm，差异均有统计学意义（ P＜0．05）；观察组术后6个月的临床总有效率为87．5％，对照组为64．5％，差异有统计学意义（ P ＜0．05）；2组患者不良反应发生率差异无统计学意义（ P ＞0．05）。结论玻璃体注射雷珠单抗联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞的临床疗效明显优于单纯黄斑区格栅样光凝治疗，且安全性较高。     

门诊儿童青少年屈光不正调查分析

目的了解儿童各年龄段异常屈光不正和视力分布概况。方法通过对2002年12月以来在我院就诊的屈光不正患者968例1936眼,对不同年龄段屈光不正的矫正视力、球镜度数、柱镜度数、柱镜轴向做统计学分析。结果 5-14岁不同年龄段矫正视力分别为0.65±0.23、0.73±0.29、0.75±0.25、0.82±0.21、0.89±0.23、0.91±0.24、0.96±0.20、1.01±0.19、1.01±0.19、0.99±0.22,方差分析差异有统计学意义（F=49.31、P=0.00）。结论 5-14岁屈光不正随着年龄增长矫正视力逐步上升,球镜呈近视化发展,散光眼百分比呈下降趋势,平均散光度数稳定在-1.00DC。     

乙胺丁醇致视神经损害临床分析

目的 探讨乙胺丁醇中毒性视神经病变的影响因素.方法 选取2012年1月至2013年12月北京老年医院眼科就诊患者56例,对其服用乙胺丁醇致视神经病变的各种影响因素进行回顾性分析.结果 将年龄作为控制变量,结果显示日剂量与患者服药至视功能损害时间呈负相关[日剂量分别为0.75、1.00、1.25 g,服药至视功能损害时间分别为（179±53）、（148±47）、（114±19）d,r=-0.283,P＜0.05].不同日剂量组患者就诊时视力差异有统计学意义[日剂量分别为0.75、1.00、1.25 g,就诊时视力分别为（0.61±0.25）、（0.39±0.18）、（0.27 ±0.13）,F=5.762,P＜0.01].同样,控制年龄变量,等级相关分析结果显示日剂量与视野损害发生率呈正相关（r =0.871,P＜0.01）,与色觉损害发生率也呈正相关（r=0.842,P＜0.01）.将年龄与服药剂量作为控制变量,探讨糖尿病患者的视功能损害情况.56例患者中17例合并糖尿病,39例未合并糖尿病.合并糖尿病与未合并糖尿病患者就诊时视力差异无统计学意义[就诊时视力分别为（0.56±0.24）、（0.35±0.18）,F=2.442,P＞0.05].与视野及色觉的等级相关分析结果显示,是否患糖尿病与视野损害发生率呈正相关（r =0.327,P＜0.05）,与色觉损害发生率也呈正相关（r=0.605,P＜0.01）.结论 乙胺丁醇日剂量高和合并糖尿病是乙胺丁醇致视神经损害的危险因素.     

预见性护理在糖尿病视网膜病变中的应用效果

目的 探讨预见性护理在糖尿病视网膜病变中的应用效果,旨在早期控制糖化血红蛋白,减少相关并发症的发生,防止糖尿病视网膜病变患者失明。方法 选择3年间（2018年1月至2020年1月）在本院诊治的60例糖尿病视网膜病变患者,按抽签的方式,将其均分为两组（对照组和观察组,各30例）,分别予以常规护理和预见性护理。比较并分析两组患者护理前后视力情况、心理状态（SAS、SDS评分）、生存质量评分及护理后患者对护理满意度评价情况。结果 护理前,两组视力水平、心理状况、生存质量评分均较低,且组间对比差异无统计学意义（P> 0.05）;护理后,观察组患者视力值（0.52±0.12）、生存质量评分（56.28±5.75）分明显高于对照组的（0.45±0.12）、（63.59±5.98）分,且SAS评分（30.25±7.11）分、SDS评分（31.79±8.56）分均明显低于对照组的（43.76±9.14）分、（42.56±7.58）分,差异有统计学意义（P <0.05）;观察组患者对护理满意度93.33%明显高于对照组的80.00%,差异有统计学意义（P <0.05）。结论 在糖尿病视...     

视网膜分支动脉阻塞患眼黄斑区拱环完整度及毛细血管密度测量结果观察

目的研究视网膜分支动脉阻塞(BRAO)患眼的光学相干断层扫描血管成像(OCTA)中黄斑区视网膜毛细血管密度及拱环完整度的变化。方法36例确诊为BRAO患者,均行最佳矫正视力(BCVA)、眼底彩色照相及OCTA检查。观察患者OCTA测量结果;比较患眼浅层、深层视网膜黄斑区拱环存留度;比较患眼与对侧健康眼浅层、深层视网膜黄斑区毛细血管密度;比较就诊与6个月随访LogMAR BCVA;观察预后视力;比较患眼浅层及深层视网膜黄斑区毛细血管密度下降程度及黄斑区拱环缺损度。结果36例(36只患眼)患者均诊断为视网膜颞侧分支动脉阻塞,26例(72.2%)为颞上分支阻塞,10例(27.8%)为颞下分支阻塞。12例(33.3%)患者眼底检查发现动脉栓子。6个月随访LogMAR BCVA低于就诊LogMAR BCVA,差异具有统计学意义(P<0.05)。19例(52.8%)患者视力提高,11例(30.6%)未见明显变化,6例(16.7%)视力下降。患眼浅层视网膜黄斑区拱环存留度(199.97±12.36)°高于深层视网膜黄斑区拱环的(119.08±10.12)°,差异具有统计学意义(P<0.05)。患眼浅层、深层视网膜黄斑区毛细血管密度分别为(47.18±3.65)%、(51.76±5.32)%,均低于对侧健康眼的(53.06±4.21)%、(59.25±4.23)%,差异有统计学意义(P<0.05)。患眼深层视网膜黄斑区毛细血管密度下降程度(7.49±2.45)%、黄斑区拱环缺损度(240.92±23.22)°均高于浅层视网膜的(5.88±2.25)%、(160.03±12.05)°,差异均具有统计学意义(P<0.05)。结论BRAO是眼科急诊疾病,正确诊断和及时治疗对疾病预后具有重要意义。OCTA为无创性检查,在疾病初期不仅可以准确显示视网膜动脉受阻部位及范围以明确诊断,对黄斑视网膜拱环破坏情况及视网膜毛细血管受损程度的客观、定量测量,亦能够评估视力预后。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.