星点设计-效应面优化法优化三七总皂苷鼻腔用粉雾剂

目的:确定三七总皂苷鼻腔用粉雾剂的较优处方.方法:以人参皂苷Rb1 1 h、12 h和人参皂苷Rg1 1 h、12 h的累积释放度、制剂的生物粘附强度及蟾蜍上腭黏膜纤毛毒性为指标,采用星点设计-效应面优化法,确定较优处方.结果:当三七总皂苷、微晶纤维素和中等粘度羟丙基纤维素的比例分别为31%、60%和9%时,Rb1 1 h、12 h和Rg1 1 h、12 h的累积释放度分别为6.82%、53.25%和83.47%、95.09%,生物粘附强度为78 min,蟾蜍上腭黏膜纤毛持续运动时间为为生理盐水组的94.84%,几乎没有纤毛毒性.结论:应用星点设计-效应面优化法能够快速方便地得到三七总皂苷鼻腔用粉雾剂的较优处方.     

睫状体平坦部滤过术对难治性青光眼的临床研究

目的 探索难治性青光眼有效的治疗方法。方法 利用自主设计的经睫状体平坦部巩膜下外滤过术对在我院就诊的难治性青光眼共11只眼（10例）施行了手术治疗。其中新生血管性青光眼9只眼（8例），青光眼滤过术后眼压未能控制者2只眼（2例）。结果 全部手术顺利完成，术中切口无明显出血。术后前房加深8只眼，不变3只眼。术后前房炎症反应轻微，1只眼前房少量渗血，4只眼少量玻璃体溢出切口，无玻璃s体出血。术后1周全部术者眼压在3～12mmHg，在3。8个月观察内眼压6～18mmHg者8只眼，3只眼术后1月眼压26～31rnmHg，经再次手术行纤维瘢痕切除术后眼压正常。有1例经超声探查有小的局部脉络膜脱离，1周后恢复正常。结论 该手术用于治疗难治性青光眼是一种安全、有效、方便的手术方法，较少出现青光眼术后早期并发症。     

睫状神经营养因子抗体对眼外肌注射肉毒毒素后神经末梢萌芽的影响

目的 观察多克隆睫状神经营养因子(CNTF)抗体对肉毒毒素(BTX)注射眼外肌后引起的神经末梢萌芽的抑制作用及对肌肉的影响.设计 实验性研究.研究对象 20只新西兰大白兔.方法随机取10只兔,左上直肌作为空白对照(1组),右上直肌直视下注射A型肉毒毒素(BTXA)2.5U(3组),14天后全麻下取出双上直肌标本;另外10只兔左上直肌注射生理盐水对照(2组),右上直肌注射BTXA 2.5 U后第4天,将50 μl CNTF抗体一次性注射到右眼上直肌(4组),14天后取出双上直肌标本.标本行电镜观察、乙酰胆碱酯酶染色及Bielschowsky神经末梢银染法显示神经末稍萌芽,使用Leica显微镜成像系统计数及测量.主要指标 眼外肌有萌芽终板数、平均萌芽总长度及电镜超微结构变化.结果 眼外肌有萌芽终板数和平均萌芽总长度,1组分别为5.75%和10.53 μm;2组为6.11%和11.16μm;3组为84.04%和170.71 μm;4组为54.77%和68.12 μm;差异均有统计学意义(P均=0.000).电镜超微结构观察显示:3组肌肉明显萎缩,肌纤维和神经结构无明显改变;而再注射CNTF抗体4组,可见部分肌丝断裂融解,变性的肌细胞坏死崩解成细胞碎片,引起部分肌肉不可逆性破坏,而神经髓鞘及运动终板结构无明显改变.结论 多克隆CNTF抗体可以抑制BTX诱发的神经萌芽,引起局部肌肉不可逆性破坏,从而可能延长肌麻痹恢复的时间,提示多克隆CNTF抗体可能延长BTX的肌麻痹作用.     

不同手术方法治疗外伤性睫状体脱离的对比观察

目的比较两种不同的手术方法治疗外伤性睫状体脱离的疗效。方法27例（27只眼）有明确的眼外伤病史,通过超声生物显微镜确诊为睫状体脱离患者,其中15只眼采用传统的睫状体脱离巩膜睫状体间断缝合术,12只眼采用睫状体巩膜连续缝合术。结果术后随访3～12个月,两组术后矫正视力0．6以上分别为60％、75％,0．3～0．5为20％、16．7％,0．1～0．2为20％、8．3％,眼压、前房、眼底均恢复正常。结论巩膜、睫状体连续缝合术较传统的间断缝合术具有术后眼压回升恢复快、并发症少、视力预后好优点。     

虹膜光凝联合小梁切除术治疗新生血管性青光眼

目的 评价虹膜激光光凝联合复合式小梁切除术治疗新生血管性青光眼临床疗效.方法 46例(46眼)药物难以控制的新生血管性青光眼随机分为2组(各23眼).A组行虹膜氪激光光凝联合复式小梁切除术,B组行睫状体冷凝术.术后观察眼压、眼前段反应及并发症等.结果 经过6～12个月随访,A组治疗成功16眼,显效4眼,成功率69.57%,总有效率95.65%,术中、术后无严重前房积血;B组治疗成功7眼,显效5眼,成功率30.43%,总有效率69.56%,2眼需要再次手术,2眼眼球萎缩.结论 虹膜氪激光联合复合式小梁切除术,避免了新生血管性青光眼滤过术中前房积血等问题,能有效降低眼压,控制病情进展,较睫状体冷凝术治疗成功率高,临床安全性好.     

3H-noradrenaline release from mouse iris–ciliary body: role of presynaptic muscarinic heteroreceptors

Sympathetic neurotransmitter release and its modulation by presynaptic muscarinic heteroreceptors were studied in mouse iris–ciliary bodies. Tissue preparations were preincubated with ³H-noradrenaline and then superfused and stimulated electrically. Firstly, experimental conditions were defined, allowing study of presynaptic sympathetic inhibition in mouse iris–ciliary body. If tissue was stimulated four times with 36 pulses/3 Hz, tritium overflow peaks were reliably and reproducibly measured. As expected, these stimulation conditions led to marked ₂-autoinhibition as indicated by the release-enhancing effect of the ₂-antagonists phentolamine and rauwolscine. To ensure autoinhibition-free ³H-noradrenaline release, which is optimal for studying presynaptic sympathetic inhibition, ₂-receptors were blocked in all subsequent experiments. Under these conditions, evoked tritium overflow was almost completely abolished in the presence of the sodium channel blocker tetrodotoxin, indicating a neuronal origin of ³H-noradrenaline release. Secondly, muscarinic inhibition of ³H-noradrenaline release was characterized using the conditions described above (36 pulses/3 Hz; phentolamine 1 M and rauwolscine 1 M throughout). The muscarinic receptor agonist oxotremorine M decreased evoked tritium overflow in a concentration-dependent manner with an IC₅₀ of 0.33 M and maximal inhibition of 51%. The concentration–response curve of oxotremorine M was shifted to the right by the muscarinic antagonists ipratropium and methoctramine, whereas pirenzepine was ineffective. The observed rank order of antagonist potencies, ipratropium > methoctramine > pirenzepine, which is typical for the M₂ subtype, indicates that presynaptic muscarinic receptors on sympathetic axons of mouse iris–ciliary bodies are predominantly M₂. Finally, inhibition of ³H-noradrenaline release by endogenously secreted acetylcholine was investigated. Longer pulse trains, 120 pulses/3 Hz and 600 pulses/5 Hz, were used and the cholinesterase inhibitor physostigmine was added to the superfusion medium to increase synaptic levels of endogenous acetylcholine. Under these conditions, ipratropium approximately doubled the evoked overflow of tritium, indicating that endogenously released acetylcholine can activate presynaptic muscarinic heteroreceptors. In conclusion, the present experiments establish measurement of the electrically induced release of ³H-noradrenaline from mouse iris–ciliary bodies. As in other species, noradrenaline release in this preparation was subject to presynaptic muscarinic inhibition. Our results also indicate that the presynaptic muscarinic receptors on sympathetic axons in mouse iris–ciliary body are predominantly M₂. Moreover, these receptors can be activated by both exogenous agonists and endogenously released acetylcholine and, hence, may operate physiologically in the interplay between the parasympathetic and sympathetic nervous system.     

张伟辨治原发性纤毛运动障碍经验

原发性纤毛运动障碍是由纤毛结构缺陷引起的多发性异常遗传病,属于临床罕见、疑难疾病。张伟老师认为本病因先天禀赋不足,肺肾亏虚,气运失司,布津不利,津聚为痰,痰凝化热导致,临床治疗以清热化痰、健脾养阴固本为法,获得良好疗效。介绍张老师临床治疗本病的经验及临床典型病案,以期对本病的辨治有所启示。     

PGF_(2α)类抗青光眼药Unoprostone对培养猴睫状肌细胞MMP-2表达的影响

目的：研究ＰＧＦ２α类抗青光眼药物Ｕｎｏｐｒｏｓｔｏｎｅ对培养猴睫状肌细胞及小梁网细胞中ＭＭＰ－２表达的影响。方法：猴睫状肌及小梁网细胞融合成单层以后,暴露于不同浓度的Ｕｎｏｐｒｏｓｔｏｎｅ代谢物Ｍ１、Ｍ２或ＰＧＦ２α中,采用Ｚｙｍｏｇｒａｐｈｙ技术比较其中ＭＭＰ－２活性。结果：Ｚｙｍｏｇｒａｐｈｙ技术对睫状肌细胞培养液中ＭＭＰ－２的定量分析表明：１０－８ｍｏｌ／Ｌ,１０－７ｍｏｌ／Ｌ,１０－６ｍｏｌ／Ｌ的Ｕｎｏｐｒｏｓｔｏｎｅ代谢物Ｍ１及Ｍ２增强了ＭＭＰ－２活性表达,并且成剂量增强关系。１０－７ｍｏｌ／Ｌ,１０－６ｍｏｌ／Ｌ的Ｍ１及Ｍ２对小梁网细胞中ＭＭＰ－２表达无明显影响。结论：在通过ＭＭＰ降解细胞外基质这方面作用机理上,Ｕｎｏｐｒｏｓｔｏｎｅ可能作用于猴葡萄膜—巩膜房水流出路而对传统通路无明显影响。     

视锥视杆细胞营养不良患者脉络膜和视网膜血流的异常变化

目的　观察视锥视杆细胞营养不良（cone-rod dystrophy,CRD）患者的眼动脉、视网膜中央动脉和睫状后动脉血流参数的变化特征。方法　选择临床诊断为CRD的患者［CRD组50例（100眼）］和正常人［对照组90名（180眼）］,应用彩色多普勒血流成像技术（color doppler flow imaging,CDI）检测其眼动脉、视网膜中央动脉和睫状后动脉的收缩期峰速（peak systolic velocity,PSV）、舒张末期流速（end diastolic velocity,EDV）、时间平均最大流速（time-averaged maximum velocity,TAMV）、脉动指数（pulsatility index,PI）和阻力指数（resistance index,RI）。将CRD组与对照组的各项参数进行比较。结果　CRD组患者的眼动脉TAMV为（14.29±3.88）cm·s^-1,与对照组（12.44±3.64）cm·s^-1相比明显上升,差异有统计学意义（P<0.05）;PI为1.75±0.42,与对照组（2.02±0.71）相比明显下降,差异有统计学意义（P<0.05）。CRD组患者的视网膜中央动脉PSV、EDV、TAMV、PI、RI分别为（4.60±1.29）cm·s^-1、（1.61±0.41）cm·s^-1、（2.59±0.67）cm·s^-1、1.11±0.31、0.63±0.10,与对照组［（10.82±2.97）cm·s^-1、（3.28±1.11）cm·s^-1、（5.50±2.06）cm·s^-1、1.48±0.49、0.71±0.08］相比均显著降低,差异均有统计学意义（均为P<0.05）。CRD患者的睫状后动脉PSV、EDV、TAMV、PI、RI分别为（7.36±2.18）cm·s^-1、（2.28±0.82）cm·s^-1、（3.99±1.22）cm·s^-1、1.28±0.37、0.68±0.09,与对照组［（11.61±3.41）cm·s^-1、（3.34±1.25）cm·s^-1、（5.83±1.91）cm·s^-1、1.49±0.43、0.70±0.09］相比均明显降低,差异均有统计学意义（均为P<0.05）。结论　CRD患者眼动脉、视网膜中央动脉及睫状后动脉血流参数的异常改变提示眼部血液供应与CRD的病理过程可能存在关联性,具体机制值得进一步探讨。     

Ahmed青光眼引流阀睫状沟植入治疗人工晶状体眼青光眼

目的：评价Ahmed青光眼引流阀睫状沟植入术治疗人工晶状体眼青光眼的疗效。方法：采用回顾性病例系列研究。收集2020-02/2022-02柳州市红十字会医院收治的人工晶状体眼青光眼患者18例18眼的临床资料,所有患者均行Ahmed青光眼引流阀睫状沟植入术。观察术前,术后1、3、6、12mo的视力、眼压、角膜内皮细胞密度、角膜内皮细胞丢失率及并发症发生情况。结果：术前平均眼压为43.41±5.33mmHg,术后1、3、6、12mo的平均眼压分别为12.11±3.26、13.82±4.12、13.54±3.83、15.80±4.35mmHg,术后各随访点平均眼压较术前明显下降(F=203.40,P&#x003C;0.01)。术后各时间点角膜内皮细胞密度较术前降低(F=6.18,P&#x003C;0.01),但术后1、3、6、12mo各时间点角膜内皮细胞密度及丢失率均无差异(P&#x003E;0.05),总手术成功率为83%。结论：青光眼引流阀睫状沟植入术治疗人工晶状体眼青光眼安全有效,对角膜内皮细胞损伤小,术后角膜内皮细胞不随时间的变化减少。