ICL植入术后黄斑区节细胞-内丛状层及视网膜厚度的变化

目的：应用OCT观察ICL植入术后黄斑区节细胞-内丛状层及中央区视网膜厚度的改变,明确ICL植入术对于眼后节的影响。

方法：前瞻性研究。最终纳入行ICL植入术患者26例41眼,平均年龄28.19±6.48岁。所有受试者均行眼轴长度(AL)、裸眼视力(UCVA)、综合验光、最佳矫正视力(BCVA)、眼压(IOP)及OCT检查。观察术前及术后的中央区视网膜厚度(CRT)和节细胞-内丛状层厚度(GCT),以及UCVA、BCVA和IOP的变化。

结果： ICL植入术后UCVA和BCVA较术前均有提高(P<0.05),而眼压无变化。术前,术后1wk,1、3mo CRT分别为273.20±25.48、274.07±27.64、277.85±25.49、275.99±24.68μm,而GCT分别为85.31±5.19、88.95±6.87、87.73±4.23、87.45±4.59μm(均P<0.05),其中CRT在术后1mo较术前有增加(P<0.01),GCT在术后1wk,1、3mo均比术前有增加(P<0.05)。GCT在术后1wk的变化与AL呈正相关(r_s=0.529, P=0.001)。

结论：ICL植入术具有良好的有效性及一定的安全性,但术后也会发生一定的黄斑区改变,需给予一定的重视。     

益精补阳还五汤辅治开角型青光眼对其眼压及预后的影响

目的：研究益精补阳还五汤辅治开角型青光眼患者对其眼压控制及预后影响效果。

方法：选取我院2015-07/2017-07收治的开角型青光眼患者93例186眼。按照随机数字表法将所有患者分为两组。观察组47例94眼,给予马来酸噻吗洛尔滴眼液结合益精补阳还五汤辅助治疗; 对照组46例92眼,仅使用马来酸噻吗洛尔滴眼液治疗。观察比较两组患者治疗后临床疗效,治疗前后视力、眼压、视网膜中央动脉血流测定值、平均缺损范围、视野平均光敏度以及图像诱发视觉电位情况。

结果：观察组治疗后总有效率明显高于对照组(85.1% vs 63.0%)(P<0.01)。治疗后,观察组眼压明显低于对照组(P<0.01)。观察组治疗后视网膜中央动脉血流RI测定值明显低于对照组(P<0.01),PSA、EDV测定值明显高于对照组(P=0.011、<0.01)。观察组治疗后视野平均光敏度明显高于对照组(P=0.001),平均缺损范围明显少于对照组(P=0.011)。

结论：使用益精补阳还五汤辅治开角型青光眼临床疗效显著,可有效控制患者眼压水平,扩大视野范围,促进血流循环,改善预后。     

带状疱疹病毒性角膜炎合并青光眼及面神经麻痹一例

患者,男,70 岁,因“左眼疼痛伴视力下降1 周”,于2016年5月15日来我院就诊。患者2016年5月8日在无明显诱因下出现左眼疼痛,左侧头部疼痛,伴视力下降,于昆明某医院就诊,诊断为“左眼青光眼？”,2016年5月13日前出现左侧额部及眼睑周围皮肤带状疱疹。后患者于2016 年5 月15 日为求进一步诊治来我院,门诊以“左眼带状疱疹性角膜炎,左侧颜面部带状疱疹”收住入院。既往史：否认眼部疾病及眼部外伤史;患2 型糖尿病7 年,使用门冬30R胰岛素皮下注射,平日血糖控制情况好;无高血压及心脏病病史;无家族遗传性疾病史;否认食物、药物过敏史;否认外伤史及手术史等。眼科检查：右眼视力0.6,左眼视力0.4,右眼结膜无充血,角膜透明,角膜后沉着物（Keratic precipitates,KP）（ -）,前房中深,前房闪辉（-）,瞳孔圆,直径约3 mm,光反射灵敏,晶状体轻度混浊,眼底见视盘色正界清,后极部视网膜平伏,动脉细,未见明显出血及渗出,黄斑区（-）;左眼眼睑肿胀,睁眼困难,左侧额部及眼睑皮肤即三叉神经第1 支分布区域的皮肤可见数十个水泡,已破溃结痂,未越过颜面中线,结膜充血、水肿,角膜鼻上方可见一大小约2 mm×3 mm浸润灶,角膜基质层水肿,内皮细胞层皱褶,KP（-）,前方中深,房水混浊,瞳孔圆,直径约3 mm,光反射可,晶状体轻度混浊,眼底窥不清。右眼眼压（IOP）12 mmHg（1mmHg=0.133 kPa）,左眼IOP 45 mmHg。球结膜充血水肿,鼻上方角膜可见浸润灶,KP（+）,前房闪辉（+）,见图1。角膜荧光染色结果见图2。辅助检查：头颅CT未见异常;胸片、心电图、血常规、生化、大小便、免疫检查未见明显异常。超声生物显微镜（UBM）示：左眼前房浅,房角窄。光学相干断层成像（OCT）示：右眼角膜厚度587 μm,左眼角膜厚度613 μm。黄斑区OCT示：双眼黄斑区结构基本正常。     

超声乳化联合IOL植入术围手术期瞳孔直径和反应的变化

探究晶状体超声乳化联合人工晶状体（IOL）植入术围手术期瞳孔直径、反应的变化。方法：前瞻性临床研究。收集于2016年1-9月上海交通大学医学院附属第九人民医院眼科行超声乳化联合IOL植入术的连续白内障和高度近视透明晶状体置换患者。采用动态瞳孔测量仪（Metro-vision MONCV3）测量术前、术后1周、术后1个月在4种光照度下（0、1、10和100 cd/m2 ）的瞳孔直径,并检测瞳孔反应（如瞳孔初始直径、收缩幅度、收缩潜伏期、收缩持续时间、收缩速度、扩张潜伏期、扩张持续时间和扩张速度等）。采用重复测量方差分析、Pearson相关分析及Spearman相关分析对数据进行分析。结果：共纳入患者53例（53眼）。在4种光照度下,术前瞳孔直径随年龄增加而下降（r0=-0.467,P0<0.001;r1=-0.383,P1=0.005;r10=-0.374,P10=0.006;r100=-0.312,P100=0.023）。 4种光照强度下瞳孔直径手术前后总体差异有统计学意义（F0=206.9,P0<0.001;F1=106.8,P1<0.001; F10=41.7,P10<0.001;F100=36.7,P100<0.001）,与术前相比,4种光照强度下瞳孔直径术后1周、1个月均下降（均P<0.001）。手术前后瞳孔反应的初始直径、收缩幅度、收缩和扩张速度总体差异有统计学意义（F初始直径=99.5,P初始直径<0.001;F收缩幅度=36.2,P收缩幅度<0.001;F收缩速度=51.9,P收缩速度<0.001;F扩张速度=23.8,P扩张速度<0.001）,与术前相比,术后1周、1个月初始直径、收缩幅度、收缩和扩张速度均下降（均P<0.001）。结论：超声乳化联合IOL植入术后1个月内可引起瞳孔缩小,瞳孔反应的收缩、扩张速度变慢,为IOL设计中确定有效光学区范围提供依据。     

A Survey on Intelligent Screening for Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the leading causes of vision loss and can be effectively avoided by screening, early diagnosis and treatment. In order to increase the universality and efficiency of DR screening, many efforts have been invested in developing intelligent screening, and there have been great advances. In this paper, we survey DR screening from four perspectives: 1) public color fundus image datasets of DR; 2) DR classification and related lesion-extraction approaches; 3) existing computer-aided systems for DR screening; and 4) existing issues, challenges, and research trends. Our goal is to provide insights for future research directions on DR intelligent screening.     

中药汤剂治疗奥氮平药物副反应的临床经验

目的:分析总结中药汤剂治疗奥氮平药物副反应的临床经验。方法:调查服用奥氮平1月以上的精神病患者,统计服用药物后较常出现的中医证候及舌脉象,类推奥氮平的中医“药毒”特性;将60例受试者随机分为2组,其中奥氮平合并服用中药汤剂的为治疗组,中药汤剂根据辨证论治选用温胆汤、玉女煎、补中益气汤、补脾胃泻阴火升阳汤加减治疗,对照组服用奥氮平合并安慰剂,观察治疗前、治疗1月、2月后中医证候评分及糖脂代谢指标的前后变化及组间差异,对疗效进行评估。结果:服用奥氮平1月前后比较,受试者便秘、纳多、肥胖、口干、脉数、精神疲倦、苔厚腻、肢体乏力、舌红、舌淡、脉滑、舌边齿痕、舌胖大、苔白的中医证候评分较前显著升高,具有统计学差异(P<0.05或P<0.01)。中医辨证分型为痰湿内阻证、胃热伤津证、脾气亏虚证和兼有脾虚、痰湿、胃热证。运用传统中医分析中药药性及功效的方法,类推奥氮平的“药毒”性热,入脾胃经,具有胃热伤津、伤脾生湿的作用。经过2月中药汤剂治疗后,试验组中医证候总分较前显著降低,差异具有统计学意义(P<0.01);试验组与对照组比较治疗后中医证候总分差异有显著性(P<0.01)。治疗后试验组与对照组的空腹血糖、餐后2h血糖、血清胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、体重、腰围、腰臀比及BMI值差异有显著性(P<0.05)。结论:临床上依据奥氮平“药毒”特性来辨证论治,运用中药汤剂治疗可以显著减少奥氮平所致的药物副反应。     

Immortalized mouse fetal liver stromal cells support growth and maintenance of human embryonic stem cells

Human embryonic stem cells (hESCs) are usually maintained in an undifferentiated state by co-culture with feeder cells. The feeder cells are important for the growth of hESCs. A novel spontaneously immortalizated mouse fetal liver stromal cell line, named KM3, was isolated from a?13.5?day mouse fetal liver. In this study, we examined whether KM3 cells could be used as feeders to support the growth of hESCs. hESCs cultured on KM3 cells showed a similar proliferation rate and characteristics to mouse embryonic fibroblasts?(MEFs) after prolonged culture, including morphology, unlimited and undifferentiated proliferative ability, maintenance of normal karyotypes, formation of embryoid bodies in?vitro and typically immature teratomas in?vivo. Our results indicate that the immortalized KM3 cell line has the potential to support the growth and maintenance of hESCs. The cell line may be used for the large-scale expansion of hESCs in a low-cost and less labor-intensive manner.     

New alternatively spliced variant of prostate-specific membrane antigen PSM-E suppresses the proliferation, migration and invasiveness of prostate cancer cells

PSM-E is a newly discovered alternatively spliced variant of prostate-specific membrane antigen (PSMA). In the current study, its role on the proliferation, invasiveness and migration in prostate cancer cell lines was analyzed. PSM-E and PSMA (as a comparison) eukaryotic expression vectors pcDNA3.0/PSM-E and pcDNA3.0/PSMA were constructed, validated by RT-PCR and Western blotting, and PSMA/PSM-E overexpression PC-3 cell models were built. Gene interference was used to block PSMA and the expression of its splice variants in LNCap cells. Three shRNA fragments were synthesized against PSMA, cloned into the vector pSilencer?2.1-U6-neo, their interference effect was evaluated by RT-PCR and Western blotting, and pSilencer?2.1-U6-neo?shRNA3 (named p?shRNA3) was chosen in further analyses. Growth curves were drawn to observe the proliferation change, which showed that PSM-E had the potential to suppress proliferation (P<0.05), but no significant change was observed in PSMA/PC-3 cells and in PSMA/PSM-E interfering LNCap cells (P>0.05). Cross-river test showed that the migration speeds of PSM-E/PC-3 and PSMA/PC-3 were both significantly slower than the vector negative control, and faster in p-shRNA3 interfering LNCap cells compared with its vector negative control (P<0.05), and no significant difference existed between PSM-E/PC-3 and PSMA/PC-3 (P>0.05). Transwell assay showed that the invasive cells of both PSMA/PC-3 and PSM-E/PC-3 were fewer compared to the vector negative control (P<0.05), and the invasive suppression effect of PSM-E was weaker than PSMA (P<0.05), and accordingly, invasiveness of interfering LNCaP cells was enhanced compared with the vector negative control (P<0.05). These results showed that PSM-E could suppress proliferation, migration and invasiveness of prostate cancer cells. Its suppression effect on cell proliferation is stronger compared to PSMA and the suppression effect on invasiveness is weaker than that of PSMA.