抗血管内皮生长因子在老年性黄斑变性中的应用

老年性黄斑变性又称为年龄相关性黄斑变性(AMD),是一种迟发型、进展性疾病。其患病率随年龄增长而增高,是当前老年人致盲的重要疾病之一。主要表现为黄斑区非感染性损伤,其中脉络膜新生血管(CNV)占AMD晚期病例的2/3。由于该病的病因尚     

TTT治疗老年性黄斑变性脉络膜新生血管

目的 :探讨ＴＴＴ治疗老年黄斑变性 (ＡＭＤ)患者脉络膜新生血管 (ＣＮＶ)的临床疗效。方法 :分别对经血管造影证实存在有经典性ＣＮＶ或隐匿性ＣＮＶ的 2 1例 2 4眼ＡＭＤ患者进行一次或多次ＴＴＴ治疗 ,定期随访视力、眼底及血管造影等 ,平均随访 3 7± 2 3个月 (1～ 7个月 )。结果 :ＴＴＴ各光斑平均功率密度为 1 8 2 7± 2 32Ｗ ｃｍ2 。经治疗后 ,1 0眼 (41 7% )患者自觉症状减轻或消失 ;视力稳定或提高者 2 1眼 (87 5 % ) ,下降者 (≥ 1行 ) 3眼 (1 2 5 % ) ;3例 3眼于ＴＴＴ过程中视网膜出血增加 ,2例 2眼随访过程中出现其他部位…     

吲哚花青绿在PDT治疗大鼠肝癌中对肝细胞保护作用的研究

本文将吲哚花青绿(ICG)用于大鼠移植性肝癌的PDT治疗,通过组织病理学检查及图象分析仪测量肝组织光敏损伤量,发现PDT治疗前给予ICG的实验组光敏坏死量较不给ICG的对照组有明显减少,存活的肿瘤面积无明显差异。说明ICG在PDT治疗中对正常肝细胞有一定的选择性保护作用,而不影响对肿瘤细胞的杀伤作用。观察到ICG对照射表层和靠近中心部的正常肝细胞保护作用不明显;对氩离子激光照射组的保护作用不及对630nm染料激光照射组明显。认为ICG的保护作用受其所在正常肝细胞内含量的限制和光能量分布的影响。     

光动力学疗法治疗老年性黄斑变性合并黄斑下脉络膜新生血管的疗效观察

背景与目的老年性黄斑变性(age-relatedmaculardegeneralion,AMD)是引起北美50岁以上人口视力丧失的主要原因,它明显降低了这些人的生活质量。在未来的25年50岁以上人口将是目前的两倍。预防和治疗老年性黄斑变性是我们急需研究的课题。老年性黄斑变性引起视力丧失是脉络膜新生血管形成的结果。过去使用光凝治疗脉络膜新生血管,但光凝会损害正常组织。黄斑下的脉络膜新生血管不能使用光凝治疗。最近光动力学疗法(photodynamictherapy,PDT)应用于黄斑下脉络膜新生血管的治疗,本研究目的是评价利用维替泊芬光动力学治疗老年性黄斑变性合并黄斑下脉络膜新生血管的疗效。     

吲哚菁绿在乳腺癌前哨淋巴结活检中的应用观察

目的 探讨吲哚菁绿(ICG)单独应用于乳腺癌前哨淋巴结(SLN)活检的临床应用前景.方法 选择2014年7-12月接受手术的72例女性乳腺癌患者,年龄33～67岁,中位年龄50岁,随机分为实验组(n=35)和对照组(n=37),分别以ICG和亚甲蓝作为示踪剂实施SLN活检.手术切除标本送快速冰冻病理检测,证实存在SLN转移者,行腋窝淋巴结清扫,SLN阴性者不行腋窝淋巴结清扫.结果 ICG法检出率为94.3％,成功检出SLN 111个,平均每例检出3.2个SLN,准确率94.3％,灵敏度100％,假阴性率0％;亚甲蓝法检出率为91.9％,成功检出SLN 78个,平均每例检出2.1个SLN,准确率89.2％,灵敏度92.9％,假阴性率为7.7％.两组平均检出个数和假阴性率差异有统计学意义(P＜0.05),检出率、准确率、灵敏度差异无统计学意义(P＞0.05).结论 采用ICG法进行SLN活检成功率高,假阴性率低,临床效果优于亚甲蓝法,有望单独应用于乳腺癌SLN活检.     

前列腺素在药物性血管造影中的应用

药物性血管造影系指采用血管活性药物改变拟选动脉的血液动力学状态后再行血管造影的一种改良造影技术。其目的主要是增强病变影像,提高造影效果。它不仅可用于传统的形态学观察,也逐渐应用于病理生理学的研究。目前这项技术已被广泛接受,并被视为临床放射学的新趋势之一。近年来,各国学者通过大量的动物比较实验研究和临床实践发现:在药物性血管造影中,前列腺素(Prostaglandin,PG是迄今最为理想的血管扩张剂。目前医学界对PG的研究非常活跃,国际学坛誉之为“新一代药物”、“有力的医学武器”而寄予厚望。本文就     

光动力疗法治疗黄斑变性脉络膜新生血管的护理

年龄相关性黄斑变性为黄斑区脉络膜新生血管（ehoroidal neovascularization，CNV）增生引起视网膜下出血、渗出、水肿、纤维瘢痕而致中心视力不可逆的严重损害、甚至失明。光动力疗法（photodynamin therapy，PDT）是临床上治疗CNV的一种安全有效的新方法。我科于2006年12月-2007年5月使用PDT治疗6例年龄相关性黄斑变性CNV效果满意，无护理并发症。现将护理体会报告如下。     

激光眼底血管造影的规范流程、注意事项与不良反应的处理

目的:眼底血管造影,包括眼底荧光血管造影(FFA)和吲哚青绿血管造影(ICGA),已成为当前眼底疾病诊断常用的主要检查方法,对于眼底疾病的诊断、鉴别诊断和预后判断具有重要意义,规范的操作,高度重视注意事项,有预见性的防范和正确处理不良反应具有重要意义。     

螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用—兼与MR血管造影比较

目的探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值,并对两者作比较.材料和方法28例患者同时行SCTA、MRA、DSA,以DSA作为金标准,对SCTA与MRA作比较.结果(1)23例行SCTA及时间飞跃法(TOF)MRA者,SCTA诊断脑动脉瘤的准确性高于TOFMRA,但差异无显著统计学意义(p＞0.05).(2)SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(p＜0.01),TOFMRA测量值常偏小.(3)SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7%.(4)动态增强(DCE)MRA的图像清晰度及价值与SCTA相似.结论SCTA对体积小、破裂出血的脑动脉瘤的检出率以及对动脉瘤测量的精确性高于TOFMRA,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度,MRA是脑动脉瘤电解可脱弹簧圈(GDC)栓塞术后随访的较好方法,DCEMRA的实用价值与SCTA相似.     

Photo-toxic effects of 809-nm diode laser and indocyanine green on MDA-MB231 breast cancer cells

Photodynamic therapy (PDT), due to its positive outcomes in clinical applications, easiness of practice and few side effects, is a good candidate for an efficient treatment of cancer. Indocyanine green (ICG), a water-soluble, anionic tricarbocyanine and non-toxic molecule is a promising photosensitive agent for PDT applications on tumor cells. ICG exhibits strong maximum absorption at around 805 nm which will be an advantage for its use in PDT; light at that wavelength can be used to treat deeper tumors. In this study the inhibitory growth effects of ICG-PDT on MDA-MB231 human breast cancer cells were investigated in a time course experiment. Cells were irradiated with a continuous wave diode laser (λ = 809 nm, 60 mW, 24 J cm⁻²). Cell viability was measured by MTT assay 0, 3, 6, 9, 12, 24 and 48 h after light irradiation. The results showed that ICG-PDT application exerted its photo-oxidative effect on MDA-MB231 breast cancer cells immediately. Relative cell viability was determined throughout the 48 h time course, and a consistent decrease was observed after ICG-PDT applications. In conclusion, ICG when used in combination with near-infrared light showed a very fast (within 3 h) and persistent (up to 48 h) photo-toxic effect on MDA-MB231 human breast cancer cells.     

The effect of indocyanine green loaded on a novel nano-graphene oxide for high performance of photodynamic therapy against Enterococcus faecalis

BackgroundRecently developed photodynamic therapy (PDT) has gained attention for achieving effective root canal disinfection. Using an optimized nontoxic photosensitizer (PS), such as indocyanine green (ICG), is an imperative part of this technique. Therefore, the objective of the current study was to improve ICG photodynamic properties through incorporation of ICG into nano-graphene oxide (NGO) in order to produce NGO-ICG as a new PS and also to assess the antimicrobial effects of NGO-ICG against Enterococcus faecalis after photodynamic therapy.Materials and methodsNGO-ICG was synthesized based on oxidation of graphite flakes and direct loading of ICG onto NGO. NGO-ICG formation was confirmed using the Fourier Transform Infrared Spectroscopy (FT-IR), Scanning Electron Microscopy (SEM), and UV–vis spectrometry. The antimicrobial and anti-biofilm potential of NGO-ICG-PDT against E. faecalis was assessed via colony forming unit and crystal violet assays, respectively.ResultsFT-IR, SEM and UV–vis spectrometry confirmed successful synthesis of NGO-ICG containing 200 μg/mL of ICG. NGO-ICG-PDT at an energy density of 31.2 J/cm² showed a significant reduction (2.81 log) in the count of E. faecalis (P < 0.05). NGO-ICG-PDT significantly reduced the biofilm formation ability of E. faecalis up to 99.4% (P < 0.05). The overall antimicrobial and anti-biofilm potential of NGO-ICG-PDT was higher than PDT based on ICG (1000 μg/mL) (47% and 21%, respectively).ConclusionBecause NGO-ICG-PDT showed a significant reduction in the number and biofilm formation ability of E. faecalis at low ICG concentrations (200 μg/mL), it could be a new approach to adjuvant treatment of endodontic infections.     

和血明目片联合雷珠单抗治疗湿性年龄相关性黄斑变性的临床效果

 目的 观察和血明目片联合抗血管内皮生长因子(vascular endothelial growth factor, VEGF)药物雷珠单抗治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration, wAMD)的临床效果。方法 选择2016-06至2018-06收治的96例(96只眼)wAMD患者,按照随机数字表法分为治疗组和对照组,每组48例(48只眼)。治疗组给予雷珠单抗球内注射联合和血明目片口服治疗,对照组仅给予雷珠单抗球内注射治疗。两组均连续治疗3个月,治疗结束后随访3个月,观察最佳矫正视力(best corrected visual acuity,BCVA)、黄斑区视网膜中央厚度(central retinal thickness,CRT)、黄斑出血面积、渗出面积及累积损伤面积等情况,随访结束后黄斑水肿复发情况,并进行统计学评价。结果 (1)BCVA:治疗3个月后,两组均比治疗前升高(t=8.320,t=4.689,P＜0.01),且治疗组高于对照组(t=2.509,P＜0.01);随访3个月后,两组均比治疗前高,差异有统计学意义(t=7.909,t=3.808,P＜0.01),且治疗组高于对照组(t=3.164,P＜0.01)。(2)CRT:治疗3个月后,两组均低于治疗前(t=16.864,t=14.175,P＜0.01),但两组间差异无统计学意义(t=1.402);随访3个月后,两组均低于治疗前,差异有统计学意义(t=14.478,P＜0.01),且治疗组低于对照组(t=2.687,P＜0.05)。(3)治疗后3个月,两组眼底出血、渗出及总的累积损伤面积均较治疗前明显缩小(P均＜0.05),且治疗组眼底出血面积(t=2.893,P＜0.05)和累积损伤面积缩小幅度(t=2.164,P＜0.05)较对照组更明显,均有统计学意义。(4)两组复发率比较,差异有统计学意义(χ²=4.937,P＜0.05)。结论 抗VEGF球内注射联合和血明目片治疗wAMD的临床疗效肯定,联合治疗在控制黄斑出血及水肿复发方面有优势。     

Proton beam therapy for age-related macular degeneration: development of a standard plan

Age-related macular degeneration is the leading cause of blindness in developing countries. Irradiating the exudative form, in which a choroidal neovascular membrane develops in the subfoveal area, is presently a treatment under investigation. In 1995, Massachusetts General Hospital, collaborating with Massachusetts Eye and Ear Infirmary, initiated a protocol to treat SCNV membranes using the proton beam at the Harvard Cyclotron Laboratory and the EYEPLAN program with a light-field setup. EYEPLAN requires the axial eye length, membrane dimensions, and manipulation of the eye to include a 4.0-mm radial margin around the membrane so that the aperture margin (50% isodose line on the posterior retina) abuts the inferior aspect of the limbus. Review of 100 individually prepared plans showed that 95% of the fabricated apertures were circular (aspect ratio < 1.095) with diameters 9.5 to 15.0 mm. This information was used to develop an automated standard plan. Thirty-nine plans were developed for axial lengths ranging from 21.0 to 25.0 mm and membrane sizes from 1.5 to 6.75 mm in the usual way as the reviewed ones. Circular targets were outlined centered on the fovea. Distal and proximal 90% ranges (modulation) to the target, and doses to macula, optic disc, lens, ciliary body, retina, and globe were calculated. An automated standard plan requiring the same input data, but avoiding the need for individual plans, was developed. The program outputs the aperture diameter, fixation angle for the light-field setup, range and modulation, and calculates dose to the macula and optic nerve and percentage of retina receiving ≥ 50% and ≥ 90% of the prescribed dose. Individual plans require approximately 1.5 hours; the standard plan, 5 minutes. The standard plan could have treated 86% of the reviewed plans. The automated plan provides accurate and efficient treatment parameters for the majority of patients.     

The in vitro effect of antimicrobial photodynamic therapy with indocyanine green on Enterococcus faecalis: Influence of a washing vs non-washing procedure

IntroductionThe purpose of this study was to evaluate the in vitro effect of washing and non-washing of indocyanine green (ICG) as photosensitizer (PS) on bacterial count, biofilm formation, development and degradation of Enterococcus faecalis.MethodsThe anti-bacterial, anti-biofilm formation, anti-biofilm development and biofilm degradation of anti-microbial photodynamic therapy (aPDT) against E. faecalis was determined at concentrations of 3 to 2000 μg/mL of ICG, subject to 18 J/cm² dose of diode laser (808 nm) in washing and non-washing producers. Bacterial viability measurements and biofilm assays were evaluated by broth microdilution method and crystal violet assays, respectively.ResultsICG-mediated aPDT, using 25 to 2000 μg/mL and 50 to 2000 μg/mL showed significant reduction in E. faecalis growth when compared to the control in non-washing and washing producers, respectively (P < 0.05). Also, ICG-mediated aPDT showed a significantly inhibitory effect on biofilm formation of E. faecalis in concentration of 6 to 2000 μg/mL and 100 to 2000 μg/mL in non-washing and washing groups (P < 0.05). The biofilm development was inhibited by concentrations of 12 to 2000 μg/mL and 100 to 2000 μg/mL in non-washing and washing groups. The biofilm degradation increased from concentrations of 12 to 2000 μg/mL and 250 to 2000 μg/mL in non-washing and washing groups, respectively.ConclusionThis study shows that the application of ICG should be accompanied by laser irradiation without being washed out to achieve better result for bacterial count reduction and anti-biofilm effects.     

Evaluation of antimicrobial photodynamic therapy with indocyanine green and curcumin on human gingival fibroblast cells: An in vitro photocytotoxicity investigation

Recent investigations have suggested that antimicrobial photodynamic therapy (aPDT) can be an alternative treatment for the management of periodontal infections. However, currently there is very limited data regarding the photocytotoxicity of this method on human gingival fibroblast (HuGu) cells.AimThe in vitro optimal concentrations of indocyanine green (ICG) and curcumin as photosensitizers (PSs) and the irradiation time of diode laser emission were evaluated by assessing the photocytotoxicity of the treatment on HuGu cells.Materials and methodMonolayers of HuGu cells were incubated with various final concentrations of ICG (500, 750, 1000, 1250, 1500, 1750, and 2000 μg/ml) and curcumin (3, 4, 5, 10, and 20 mM). Three exposure times of the diode laser (30 s, 60 s, and 2 × 30 s irradiation with an interval of 1 min between each) and one of exposure time of 5 min for LED were tested; cell viability was determined using neutral red assay. Chlorhexidine (CHX) as a gold standard antimicrobial agent for periodontal disease was considered as a control group.ResultsICG and curcumin significantly reduced HuGu cell viability at concentrations below 1000 μg/ml and 10 mM, respectively (P < 0.01). Cytotoxicity was higher when the cells were treated for 2 × 30 s irradiation with an interval of 1 min and then again exposed to the laser for 30 s (2% and 0.1%). CHX demonstrated no significant reduction in HuGu cell survival.ConclusionPhotocytotoxicity is influenced by PS concentration, exposure time of PS, and time of irradiation. High doses of ICG and curcumin with lowest exposure time of light source and without cytotoxic effects may be an effective strategy for aPDT as an alternative treatment for periodontal disease.     

小胶质细胞在老年黄斑变性形成过程中的作用

目的 观察小胶质细胞在激光诱导小鼠脉络膜新生血管（CNV）发生过程中的表达特点及意义.方法 雄性CX3CR1＋/GFP杂合性转基因小鼠32只,取每只小鼠一只眼作为实验组,予532nm激光光凝,激光功率50兆瓦,曝光时间100ms,光斑直径100μm,每眼光凝4点,另一只眼作为对照组,在光凝后分别于7d、14d、21d、28d按随机数字法选取8只小鼠处死,摘出眼球,制作病理标本,用荧光免疫组化染色方法检测CD11b、Iba1的表达,并用激光共聚焦显微镜进行观察.结果 光斑处实验组较对照组小胶质细胞增生明显（P〈0.05）,并且14d组及21d组小胶质细胞较7d组增生明显,在细胞数量、细胞面积、平均光密度值等方面的差异均具有统计学意义（P〈0.05）,28d组小胶质细胞增生程度下降,与7d组接近.结论 小胶质细胞在激光诱导CNV模型中激活,随着损伤时间推移先升高,后降低,在CNV的形成过程中发挥重要作用.