New frontiers of retinal therapeutic intervention: a critical analysis of novel approaches

A recent wave of pharmacologic and technologic innovations has revolutionized our management of retinal diseases. Many of these advancements have demonstrated efficacy and can increase the quality of life while potentially reducing complications and decreasing the burden of care for patients. Some advances, such as longer-acting anti-vascular endothelial growth factor agents, port delivery systems, gene therapy, and retinal prosthetics have been approved by the US Food and Drug Administration, and are available for clinical use. Countless other therapeutics are in various stages of development, promising a bright future for further improvements in the management of the retinal disease. Herein, we have highlighted several important novel therapies and therapeutic approaches and examine the opportunities and limitations offered by these innovations at the new frontier.

KEY MESSAGES

• Numerous pharmacologic and technologic advancements have been emerging, providing a higher treatment efficacy while decreasing the burden and associated side effects.
• Anti-vascular endothelial growth factor (anti-VEGF) and its longer-acting agents have dramatically improved visual outcomes and have become a mainstay treatment in various retinal diseases.
• Gene therapy and retinal prosthesis implantation in the treatment of congenital retinal dystrophy can accomplish the partial restoration of vision and improved daily function in patients with blindness, an unprecedented success in the field of retina.

     

A pilot investigation of e‐cigarette use and smoking behaviour among patients with chronic airway disease or respiratory symptoms

BackgroundThis pilot study aimed to investigate the current status of e‐cigarettes (ECs) use patterns among patients with chronic airway disease or chronic respiratory symptoms and the effects of ECs use on respiratory and mental health.MethodsA cross‐sectional survey was conducted at the outpatient clinic of eight teaching hospitals in South Korea between November 2019 and December 2019. All adult ECs users (19 years and above) who visited the outpatient clinic as a patient with chronic airway disease or chronic respiratory symptoms were eligible to participate in this study.ResultsA total of 51 subjects responded to the survey. Most of the participants were male (92.2%) and the mean age was 41.8 years. Dominant airway diseases were asthma and chronic obstructive pulmonary disease. Most of the subjects had a history of cigarette smoking, and 19 subjects were dual users of current cigarettes and ECs. Most of the subjects started ECs use due to health‐related reasons. When comparing exclusive ECs users and dual users, St. George''s respiratory questionnaire (SGRQ) scores, the proportion of cases with moderate to severe depressive symptoms, and average Fagerstrom test for nicotine dependence scores for ECs were higher in dual users than exclusive ECs users (mean 4.64 vs. 2.38, p = 0.006), respectively.ConclusionMost of the subjects started ECs use due to health concerns, but dual users have more respiratory symptoms and higher nicotine dependence in this pilot study. One hypothesis that comes from these results is that greater nicotine dependence may influence behaviours, habits, and views about ECs. These preliminary observations need confirmation in a large cohort.     

初产妇足月妊娠胎膜早破胎头高浮对分娩方式的影响及处理方法

目的 探讨初产妇足月妊娠胎膜早破胎头高浮对分娩方式的影响及处理方法.方法 选取2011年1月～2013年1月在我院住院分娩与治疗的214例初产足月妊娠胎膜早破胎头高浮且无其他任何相关性疾病的患者作为研究组,再选取同期214例初产足月妊娠胎膜早破胎头入盆且无其他任何相关性疾病的患者作为对照组,记录两组患者的分娩方式、潜伏期及活跃期,对产后新生儿进行Apgar评分和体质检测,对数据进行分析.结果 两组患者在潜伏期低于8小时、8～16小时之间及活跃期低于4小时的人数比较,差异均有统计学意义（均P＜0.05）;两组患者阴道正常顺产和剖宫助产的人数对比,差异均具有统计学意义（均P＜0.05）;两组胎儿宫内窘迫例数、新生儿Apgar评分＜7分例数以及新生儿平均体重比较,差异均具有统计学意义（均P＜0.05）.结论 胎膜早破后胎头高浮极易引起难产且严重危害围产儿体质,产科医护人员需要重视胎膜早破胎头高浮孕妇的临床观察,加强孕妇的孕期保健,产前严密观察孕妇头盆关系,严格试产.     

The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes?

Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06–0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26–0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01–0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59–15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95–0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.     

阴道分娩产后尿潴留危险因素分析

目的研究阴道分娩产后尿潴留的发生率和危险因素。方法纳入463例患者分为产后尿潴留组和无产后尿潴留组,记录相关数据并在两组间进行统计学比较。结果两组患者在年龄、孕周、孕产次、分娩镇痛、催产素催产、会阴切开、产道损伤和新生儿体重无统计学差异,产后尿潴留组相对有较长的第一和第二产程时间、更多的手术助产,并有统计学差异。结论对有危险因素的患者应提高警惕,及时发现和处理产后尿潴留,避免长期影响。     

先兆早产孕妇联合应用抗生素的延续时间观察

目的：分析和探讨先兆早产孕妇联合应用抗生素的延续时间观察。方法将具有先兆早产症状的患者采用随机数字表法分为观察组（n=200）和对照组（n=60）。对观察组实行单一抗生素和联合抗生素进行治疗,对照组实行普通保胎,不进行抗生素治疗。观察2组出生体质量、Apger评分、早产儿听力评分、视力评分、早产儿行为评定等各项指标。结果使用单一抗生素组和联合抗生素组以及48 h以内相比较,差异有统计学意义（P<0.05）。观察组出生体质量评分为（6.58±1.35）分,对照组（5.12±0.56）分;观察组Apger评分（8.95±2.33）,对照组（6.45±1.45）;观察组早产儿听力评分（40.76±1.96）,对照组（33.45±1.29）;观察组视力评分（5.12±0.23）,对照组（4.79±0.92）;观察组早产儿行为评定（96.45±2.45）,而对照组（87.94±3.26）。2组比较差异有统计学意义（均P<0.05）。观察组中>48 h和<48 h的患者相比,早产延长时间明显增加,差异有统计学意义（P<0.05）。结论使用联合抗生素治疗并且延长治疗时间,对于延长先兆早产孕妇具有极大意义,值得临床推广。     

Hospital Boarder Babies and Their Families

Data were abstracted from the medical and social work charts of 20 newborns who were classified as boarder babies nd their mothers (n = 18) to identify biopsychosocial factors associated with boarding. The findings show that the mothers whose newborns remained in the hospital as boarders were usually drug users, had other children in out-of-home placement, and over half are periodically homeless. Most of these mothers also lacked informal social support. The major health problems of infants were prematurity and associated infections. The total number of infant boarding days was 195 for a total of $117,000 in unreimbursed costs to the hospital. Practice and program implications and directions for future research are discussed.     

Gene delivery to dendritic cells by orally administered recombinant Saccharomyces cerevisiae in mice

DNA vaccination has caught the attention of many for triggering humoral as well as cellular immune responses. And delivering DNA into the antigen presenting cells (APCs) in order to induce efficient immunoresponse has become the backbone of this field. It has been confirmed that Saccharomyces cerevisiae, though non-pathogenic, is being engulfed by the dendritic cells and macrophages and delivers not only proteins, but also DNA materials (already confirmed in vitro). In this research, S. cerevisiae is used to deliver green fluorescent protein (GFP) reporter gene controlled under cytomegalovirus (CMV) promoter in living organism (mice). The recombinant yeast, transfected with the plasmid containing the GFP gene, was heat killed and orally administered to mice. After 60 h of yeast administration, mice were sacrificed and intestine was separated, washed and frozen in liquid nitrogen. Tissues were cut at the size of 10 μm using Cryostat machine, and GFP expression was successfully detected under a fluorescence microscope. After 45 days Western blot was able to detect GFP antibody in the blood of mice. These results imply that S. cerevisiae, being non-pathogenic, cheap, and easy to culture could be a good candidate to deliver DNA materials to the immune cells for vaccination.