黄连-吴茱萸配伍中盐酸小檗碱在大鼠体内的药动学研究

目的 比较黄连-吴茱萸提取液中盐酸小檗碱在腹泻、急性胃溃疡动物模型与正常大鼠体内的药动学差异,探讨病理状态对盐酸小檗碱在体内过程的影响.方法 ig番泻叶制备腹泻模型,ig乙醇制备急性胃溃疡模型.ig 10 g·kg-1黄连-吴茱萸(1∶1)提取液给正常大鼠和腹泻大鼠模型,ig6 g·kg-1黄连-吴茱萸(6∶1)提取液给正常大鼠和急性胃溃疡大鼠模型.采用HPLC法分别测定盐酸小檗碱的药动学参数,色谱柱为Diamonsil C18(150 mm×4.6 mm,5μm),流动相为乙腈-甲醇-0.05 mol· L-磷酸二氢钾溶液(23∶12∶65),流速1.0 mL·min-1,检测波长345 nm,柱温30℃.结果 胃溃疡模型组和正常组药动学参数比较,Tmax延后,AUC0-t、AUC0-∞增大,MRT0-T延长;腹泻模型组与其正常组药动学参数相比较,t1/2延长,MRT0-∞延长.黄连-吴茱萸(1∶1)组较黄连-吴茱萸(6∶1)组达峰时间明显滞后,AUC0-t 、AUC0-∞增大.结论 黄连-吴茱萸(6∶1)提取液在胃溃疡模型大鼠中吸收速度减慢,但吸收量多,体内滞留时间稍延长.黄连-吴茱萸(1∶1)提取液在腹泻模型大鼠中消除稍慢,MRT0-∞延长.随吴茱萸的增加,盐酸小檗碱的max和AUC增加.     

浅析国医大师唐由之运用制首乌及黄精经验

首批“国医大师”唐由之教授致力于眼科临床及科研近70年,为推动我国的中医眼科事业发展做出了重大贡献。在临床处方用药过程中,善用制首乌、黄精,他认为,制首乌、黄精二者合用可收滋补肝肾,填精益血之效,同时,亦有阴中求阳之功。     

Intraoperative floppy iris syndrome in Indian population: A prospective study on incidence,risk factors,and impact on operative performance

Purpose:

The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance.

Materials and Methods:

Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS.

Results:

Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases.

Conclusion:

The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.     

Corneal endothelial cell changes after cataract surgery in patients on systemic sympathetic α‐1a antagonist medication (tamsulosin)

Purpose: The purpose of this study was to assess the incidence of intraoperative floppy iris syndrome (IFIS) and the morphology of the corneal endothelium after cataract extraction in Caucasian male patients exposed to the α‐1_a adrenergic receptor antagonist tamsulosin. Methods: In a clinical prospective study, 23 male patients (23 eyes) treated with tamsulosin due to benign prostatic hyperplasia and 25 male patients (25 eyes) with no tamsulosin treatment had cataract surgery. The divide‐and‐conquer technique was used with the Infinity OZil^® machine. A combination of Healon and Healon5 was used in all patients, but the use of additional Vision Blue, iris retractors or intracameral phenylephrine in the tamsulosin group was at the discretion of the surgeon. The endothelial cell density, variation in endothelial cell size (CV), percentage of hexagonal cells and central corneal thickness (CCT) were recorded at baseline and at 3 months postoperatively. Results: In the tamsulosin‐treated group, 19 of 23 eyes (83%) developed IFIS, compared with no IFIS in the control group. Compared with the control group, the tamsulosin group showed significantly less dilatation at the start of the operation, significant miosis during surgery and significantly greater corneal endothelial cell loss 3 months postoperatively (12% versus 3%; p < 0.001). Conclusion: Intraoperative floppy iris syndrome during cataract surgery is significantly associated with tamsulosin‐treated male patients. Patients on tamsulosin showed less preoperative dilatation, significant miosis during surgery, and had significantly greater postoperative endothelial cell loss compared with nontreated patients despite recommended precautions.     

Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists

Purpose: To compare 2% sub‐Tenon and 1% intra‐cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods: From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α‐adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub‐Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra‐cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra‐operative pupillary constriction and iris prolapse. Results: Intra‐operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub‐Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra‐cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra‐cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub‐Tenon lidocaine group and 4.02 ± 1.06 mm in the intra‐cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub‐Tenon lidocaine group and in 10 cases in the intra‐cameral lidocaine group (p = 0.00). Twenty‐five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra‐cameral lidocaine group and 16.6% (2 of 12 patients) in the sub‐Tenon lidocaine group (p = 0.00). Conclusion: Sub‐Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α‐adrenergic inhibitors as compared with intra‐cameral lidocaine.     

Combined argon laser peripheral iridoplasty and Nd: YAG laser shock wave therapy for recurrent XEN gel stent obstruction due to iris incarceration: A case report

Introduction:Despite its proven effectiveness and safety profile, the XEN Gel Stent (Allergan Inc., CA, USA) has a small lumen and is therefore likely to become occluded by fibrin, a blood clot, or even the iris. However, few studies have investigated XEN-iris occlusion and how to manage this condition. We describe the first case report of recurrent XEN gel stent obstruction by iris incarceration, which was resolved following a combined treatment with argon laser peripheral iridoplasty (ALPI) and low-energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment.Patient information:A 74-year-old Korean male underwent uncomplicated XEN gel stent implantation and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb during the first postoperative week. On postoperative day 10, the XEN lumen was occluded by the iris and demonstrated an IOP spike of 33 mmHg. Despite the use of pilocarpine, the iris incarceration persisted. Therefore, surgery to reposition the XEN stent was attempted using a gonio-prism and intraocular forceps. After the first revision surgery, the IOP and stent position were stable for 2 weeks. However, recurrent partial obstruction of the stent by the iris, pigment dispersion into the intraluminal space, and an elevated IOP of 24 mmHg were observed later.Diagnosis:Recurrent XEN gel stent occlusion by the iris and intraluminal pigment dispersion.Interventions:Combined ALPI and low energy Nd: YAG laser shock wave therapy.Outcomes:IOP dropped from 24 mmHg to 10 mmHg immediately and continued to be well-controlled until 3 months later (range: 8–12 mmHg).Conclusions:To the best of our knowledge, this is the first case report of the efficacy of combined laser treatment for relieving recurrent XEN implant occlusion by the iris. This combination laser treatment might be a relatively safe rescue treatment to restore the patency of a XEN gel stent occluded by the iris, even in cases with recurrent XEN stent obstruction after surgical repositioning.     

基于网络药理学及生物信息学研究骨碎补-淫羊藿治疗骨质疏松的作用机制

目的基于网络药理学和生物信息学探讨"骨碎补-淫羊藿"治疗骨质疏松的分子机制,为骨质疏松治疗提供新的靶点。方法通过TCMSP数据库筛选"骨碎补-淫羊藿"的活性成分,联合Uni Prot数据库预测其调控靶点,并根据GEO数据库预测治疗骨质疏松的靶点。借助R语言获取治疗骨质疏松的有效靶点,并构建"药物-成分-靶点-通路"网络。利用Cytoscape软件构建蛋白互作网络,并对关键活性成分与关键靶点之间进行分子对接验证,利用DAVID数据库对交集基因进行GO和KEGG分析。结果得到活性成分39个,治疗靶点17个。蛋白互作网络中的核心靶点主要有ESR1、PRKDC、HSPA8、EP300和HSP90AA1。DAVID富集分析主要涵盖异源代谢、固醇代谢及破骨细胞分化调控等生物学过程,涉及MAPK、NF-κB、PI3KAKT及HIF-1等信号通路。结论通过网络药理学和生物信息学对"骨碎补-淫羊藿"治疗骨质疏松的分析不仅能识别目前已知的相关生物学过程和信号通路,还可为进一步研究"骨碎补-淫羊藿"治疗骨质疏松的药效物质基础及作用靶点提供参考。     

Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis

Bilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber and atonic pupilla. We report herein a 50-year-old female who presented with bilateral ocular pain, severe photophobia and red eyes. One month ago, a fly hit her eye, and she instantly complained of a discomfort and sensation of a foreign body in both eyes. She used a fumigation therapy, a traditional method for the treatment of ophthalmomyiasis. During follow-up examinations, intraocular pressures increased over 40?mmHg bilaterally despite maximal medical therapy, which necessitated trabeculectomy surgery with mitomycin. This is a typical BAIT case with no antecedent fluoroquinolone use or viral disease, but a fumigation therapy. There might be a possible relationship between BAIT and traditional fumigation therapy or this association might be coincidental, both of which need further evaluation.     

Short stature,mental retardation,eye anomalies,and cleft lip/palate

The syndrome: We describe 3 Brazilian brothers presenting a cluster of signs strongly suggesting a “new” MCA/MR syndrome. The main clinical signs include short stature, microbrachycephaly, mental retardation, palpebral ptosis, coloboma of iris and retina, nystagmus, strabismus, and cleft lip/palate. This is either an autosomal or X-linked recessive trait.     

Neuropeptide Y (NPY): a vasoconstrictor in the eye,brain and other tissues in the rabbit

The effect of neuropeptide Y (NPY) on uveal vascular resistance was studied in rabbits by direct determination of uveal blood flow from a cannulated vortex vein. Regional blood flows, in the eye, the brain and several other tissues, were measured, with radioactive microspheres, during neuropeptide Y-infusion in rabbits with and without α-adrenoceptor blockade. Intravenous infusion of increasing doses of neuropeptide Y caused a dose-dependent increase in the total uveal vascular resistance. Maximal effect, a 70% increase, was achieved with 120 pmol kg^-1 min^-1. In the microsphere experiments, this dose rate was given i.v. over 10 minutes and blood flow determinations were made before and at 2 and 10 minutes after the start of the infusion. After 2 minutes of neuropeptide Y, there were marked blood flow reductions in the spleen, kidneys, adrenal glands, gastro-intestinal tract, choroid plexus and pineal and pituitary gland. The effect in the eye was small at 2 minutes, but at 10 minutes local blood flows in the choroid and the ciliary body were decreased by 50% and the iridal blood flow by 30%. Retinal blood flow was not affected by neuropeptide Y. At 10 minutes there were also significant blood flow reductions in the brain, tongue, masseter muscle and several glandular tissues. The effects of neuropeptide Y on local blood flow in rabbits that had been subjected to α-adrenoceptor blockade were very similar to the effects in the animals without α-adrenoceptor blockade. The results show that, in the rabbit, neuropeptide Y has marked effects on local blood flows in several tissues, including the eye, and suggest that neuropeptide Y may significantly contribute to the uveal vasoconstriction during sympathetic nerve stimulation.