420～750 nm超连续谱光源和532 nm激光致兔视网膜损伤修复

超连续谱(SC)光源是一种宽光谱、高亮度、眼睛危害大的新光源,有关它致视网膜损伤研究却未见报道。为了观察SC光源致视网膜损伤特点和修复过程,试验将波长420～750 nm的SC光源与532 nm激光进行比较,采用两者平行光入射,在0. 1 s照射时间,3 mm角膜光斑直径条件下,用略高于视网膜损伤阈值的功率照射青紫蓝灰兔视网膜;通过检眼镜和HE染色观察视网膜照后4 h,1、3、7、14 d损伤修复过程。SC光源和532 nm激光致视网膜的损伤在检眼镜下为灰色小圆斑。照后4 h出现视网膜外核层固缩深染,感光细胞外节与视网膜色素上皮层(RPE)粘连;随后RPE层色素增生、损伤的外核层细胞丢失,损伤进行性加重; 3 d后色素细胞开始向外核层和内核层迁移,胶质细胞填充损伤区域。由此可见,波长420～750 nm的SC光源主要损伤视网膜外核层和RPE层,后期色素颗粒和胶质细胞填充损伤区域。其视网膜损伤特点和修复过程与532 nm激光类似。     

高功率微波辐照对视细胞脂质结构的影响

目的:研究高功率微波( HPM)照射后视网膜感光细胞中膜脂质的分子结构改变,探讨HPM的损伤机制.方法:通过显微FT-IR技术观察HPM照射前后大鼠视网膜冰冻切片中感光细胞外节的膜脂质分子特征吸收峰的位移与吸收值差异,分析脂质分子结构的改变情况.结果:HPM照后外节发生了膜脂质分子特征吸收峰的位移,并出现=C-H基团和...     

脉冲1.338μm激光角膜损伤效应研究

目的:实验研究脉冲1.338μm激光的角膜损伤效应,确定其损伤阈值,并与10.6μm激光角膜损伤特点进行比较。方法:采用输出波长1.338μm、脉冲宽度5 ms的Nd:YAG激光为照射光源,角膜光斑直径1.7 mm,以不同剂量的激光照射新西兰白兔角膜,于照后1 h观察角膜损伤情况,统计损伤发生率,采用加权概率单位法计算损伤发生率为50%时所对应的激光剂量,即损伤阈值ED50。在1.5倍阈值剂量下比较该激光与10.6μm激光角膜损伤的特点。实验中注意观察晶状体和眼底是否有损伤。结果:脉冲1.338μm激光角膜损伤阈值为27.0 J/cm2(95%置信区间25.8～28.1 J/cm2)。阈值水平下,角膜损伤斑肉眼观察呈淡淡的灰白色,裂隙灯下可见一与角膜同厚的灰白色反光带,晶状体或视网膜正常;1.5倍阈值剂量下,角膜损伤斑为清晰的瓷白色,裂隙灯下可见一与角膜同厚的白色反光带,同时观察到晶状体前表面白色反光点,但视网膜无变化。与之相比,10.6μm激光角膜损伤在裂隙灯下仅观察到一很窄的亮白反光条,位于角膜表层。结论:脉冲1.338μm激光在光斑直径1.7 mm,脉冲宽度5 ms条件下的角膜损伤阈值为27.0 J/cm2。角膜损伤特点是,损伤斑呈灰白色或瓷白色,累及角膜全层,而10.6μm激光损伤仅累及角膜浅层。     

大鼠脑皮层血管栓塞和再生过程的实时动态记录方法

本研究旨在建立观察脑皮层血管堵塞、脑缺血损伤区血管再生、重构的动态变化过程的方法。创建能够在体连续观测大鼠皮层血管缺血后变化的动物光窗模型,并用光化学栓塞法建立大鼠皮层局部脑缺血模型,通过光相干层析成像术(optical coherence tomography, OCT)实时记录血管堵塞的形成过程以及周围小血管的损伤、再生情况。结果显示,激光照射30 min可以形成完全堵塞大鼠皮层血管的栓塞;缺血后24～48 h内,脑损伤程度最大,损伤区域内血管数量达到最少,随后堵塞的主血管开始疏通,缺血区域内周围小血管开始再生;激光照射后皮层浅层/深层的小血管显著消失,在照射后第10天,皮层浅层出现大量新生血管,而深层血管仍未恢复。以上结果表明,本研究建立的方法可以进行不间断地长期观测,为深入定量研究脑缺血恢复期间栓塞血管及周边毛细血管的动态奠定了基础,为损伤区血管重构网络调控模式研究提供帮助,为脑缺血性疾病的治疗提供理论指导和新研究方法。     

脉冲1 064 nm激光视网膜损伤动物模型的建立

目的:建立脉冲1 064 nm Nd:YAG激光致视网膜出血性损伤及非出血性损伤动物模型,为治疗药物评价提供技术基础.方法:应用自由振荡脉冲及调Q脉冲1 064 nm激光照射青紫蓝灰兔视网膜,通过在光路中加人透镜获得直径200μm眼底光斑,加入衰减片改变角膜入射激光能量.照射即刻对损伤应用检眼镜进行实时观察,并用眼底相...     

脉冲Nd:YAG激光对单层KB细胞损伤效应的研究

目的：观察脉冲Nd：YAG激光照射体外单层培养KB细胞后的形态改变及损伤后HSP70,c-Fos的表达情况,初步探讨较强脉冲激光对细胞的损伤效应及损伤修复机制。方法：建立单层培养细胞的脉冲Nd：YAG激光损伤模型,每个脉冲能量密度为160J／cm^2～186J／cm^2或220J／cm^2～257J／cm^2,分别于照后即刻、2h和6h,用台盼蓝染色、TUNEL检测分析该激光对KB细胞的损伤特点,免疫组化法检测HSP70,c-Fos的表达水平。结果：当照射剂量为220J／ecm^2～257J／cm^2时,照后即刻,光斑中央细胞形态严重破坏,直接坏死;周围细胞形态未发生明显改变。2h后周围细胞TUNEL。着色也增强,呈强阳性。照后6h光斑中央及周围细胞着色均减弱。TUNEL着色区直径随时间先扩大后缩小。当照射剂量为160J／cm^2～186J／cm^2时,细胞内HSP70、c-Fos表达随时问先显著增强,而后减弱至正常。结论：脉冲Nd：YAG激光在所选剂量下,可以引起单层KB细胞的损伤,包括即刻坏死、延迟性死亡及可逆性损伤。HSP70、c-Fos的高表达说明它们在保护受损细胞、修复激光所致损伤中发挥重要作用。     

角膜上皮细胞代谢的研究进展

角膜上皮层位于角膜表面,外邻泪膜,内与角膜前弹力层相连。角膜上皮细胞代谢所需营养及氧分主要通过泪膜、房水和角膜缘毛细血管运送。正常的角膜上皮细胞代谢是维持角膜上皮细胞正常增殖与分化状态的关键。角膜上皮细胞代谢异常可导致上皮损伤或变性,是多种角膜疾病的病理基础。本文就近年来关于角膜上皮细胞代谢相关的组织结构、营养来源、细胞增殖分化以及相关疾病的研究进展进行综述。     

用红外光谱法研究60CO-γ射线辐照对三斑海马粉主要成分的影响

为了考察辐照剂量对名贵中药成分的影响,本研究用红外光谱法对经剂量为0、1. 5、3、4. 5、6、9、12、15、18、19. 5和21 kGy辐照的三斑海马粉进行了研究。蛋白质是三斑海马粉的主要成分,其含量高达70%以上。结果表明,经1. 5、3、4. 5和6 kGy剂量辐照,样品的红外光谱中代表蛋白质与脂类吸收带的峰形与峰位几乎没有变化,而高于9 kGy的剂量辐照后,样品的红外光谱代表蛋白质与脂类吸收带的峰形与峰位变化较大。由此可说明,辐照剂量不超过9 kGy,辐照对样品的蛋白质二级结构影响较小;剂量高于9 kGy辐照后,辐照对样品的蛋白质二级结构影响较大。此研究结果可为核辐照企业对三斑海马粉辐照剂量的设置提供参考。     

He—Ne激光穴位照射对兔子宫和卵巢细胞超微结构的作用效应

本文报道了用Ｈｅ—Ｎｅ激光照射新西兰白兔的穴位。照射外生殖器后,兔子宫和卵巢细胞超微结构在形态及数量上发生改变。线粒体数目增多,嵴长且密;高尔基复合体及内质网扩张,同时还观察到较大功率照射实验组内部分细胞膜性结构受损现象。结果表明：适当功率激光照射后,可反映出氧化代谢率高,能量代谢功能活跃。     

准分子激光表层无痕术治疗近视患者的临床疗效分析

目的:研究准分子激光表层无痕术治疗近视患者的临床疗效。方法:选择2014年6月~2015年11月在我院进行准分子激光表层无痕术治疗的近视患者110例(198眼),根据眼屈光度数分为低(-1.00~-3.00 D)、中(-3~-6 D)、高(≥-6 D)度近视组。应用准分子激光对上皮层、前弹力层和前部基质层采取屈光性的切削,使眼球的表面稍微变平,角膜曲率进而改变。于术后复查眼部症状、上皮愈合情况、裸眼视力、矫正视力和屈光度。结果:仅少数患者于术后有不同程度的异物感,182眼(91.92%)角膜上皮在3天内愈合;术后所有患者的眼部均出现了不同程度的疼痛,但随着时间的增长逐渐好转,术后6 d疼痛感消失;与术前裸眼视力相比,三组在术后1天、1周、2周、1月和3月视力均明显升高,差异有统计学意义(P0.05);高度近视组在术后各时期的视力均明显低于低度近视组(P0.05);随着术后时间的延长,三组术后不同时间残余屈光度≤±1.00 D的百分比均有不同程度的升高,差异无统计学意义(P0.05);高度近视组在术后不同时间残余屈光度≤±1.00 D的百分比均明显低于低度近视组(P0.05);所有患者均无严重并发症发生,在随访期间无一例发生高眼压。结论:准分子激光表层无痕术能做到角膜无创口,有较高的预测性、安全性及有效性,且术后并发症少,有较好的应用前景。     

Architectural and biochemical expressions of mustard gas keratopathy: preclinical indicators and pathogenic mechanisms

A subset of victims of ocular sulfur mustard (SM) exposure develops an irreversible, idiotypic keratitis with associated secondary pathologies, collectively referred to as mustard gas keratopathy (MGK). MGK involves a progressive corneal degeneration resulting in chronic ocular discomfort and impaired vision for which clinical interventions have typically had poor outcomes. Using a rabbit corneal vapor exposure model, we previously demonstrated a clinical progression with acute and chronic sequelae similar to that observed in human casualties. However, a better understanding of the temporal changes that occur during the biphasic SM injury is crucial to mechanistic understanding and therapeutic development. Here we evaluate the histopathologic, biochemical and ultrastructural expressions of pathogenesis of the chronic SM injury over eight weeks. We confirm that MGK onset exhibits a biphasic trajectory involving corneal surface regeneration over the first two weeks, followed by the rapid development and progressive degeneration of corneal structure. Preclinical markers of corneal dysfunction were identified, including destabilization of the basal corneal epithelium, basement membrane zone abnormalities and stromal deformation. Clinical sequelae of MGK appeared abruptly three weeks after exposure, and included profound anterior edema, recurring corneal erosions, basement membrane disorganization, basal cell necrosis and stromal degeneration. Unlike resolved corneas, MGK corneas exhibited frustrated corneal wound repair, with significantly elevated histopathology scores. Increased lacrimation, disruption of the basement membrane and accumulation of pro-inflammatory mediators in the aqueous humor provide several mechanisms for corneal degeneration. These data suggest that the chronic injury is fundamentally distinct from the acute lesion, involving injury mechanisms that operate on different time scales and in different corneal tissues. Corneal edema appears to be the principal pathology of MGK, in part resulting from persistent necrosis of the basal corneal epithelium and deterioration of the basement membrane. The findings also provide a potential explanation as to why administration of anti-inflammatories transiently delays, but does not prevent, the development of MGK sequelae.     

Proteomic analysis of the soluble fraction from human corneal fibroblasts with reference to ocular transparency

The transparent corneal stroma contains a population of corneal fibroblasts termed keratocytes, which are interspersed between the collagen lamellae. Under normal conditions, the keratocytes are quiescent and transparent. However, after corneal injury the keratocytes become activated and transform into backscattering wound-healing fibroblasts resulting in corneal opacification. At present, the most popular hypothesis suggests that particular abundant water-soluble proteins called enzyme-crystallins are involved in maintaining corneal cellular transparency. Specifically, corneal haze development is thought to be related to low levels of cytoplasmic enzyme-crystallins in reflective corneal fibroblasts. To further investigate this hypothesis, we have used a proteomic approach to identify the most abundant water-soluble proteins in serum-cultured human corneal fibroblasts that represent an in vitro model of the reflective wound-healing keratocyte phenotype. Densitometry of one-dimensional gels revealed that no single protein isoform exceeded 5% of the total water-soluble protein fraction, which is the qualifying property of a corneal enzyme-crystallin according to the current definition. This result indicates that wound-healing corneal fibroblasts do not contain enzyme-crystallins. A total of 254 protein identifications from two-dimensional gels were performed representing 118 distinct proteins. Proteins protecting against oxidative stress and protein misfolding were prominent, suggesting that these processes may participate in the generation of cytoplasmic light-scattering from corneal fibroblasts.     

超声乳化白内障手术后患者角膜内皮细胞损伤的研究

目的:探讨超声乳化白内障手术患者角膜内皮细胞的损伤情况。方法:收集我院确诊为白内障的患者121例,随机分配为微切口组与常规切口组。常规切口组采用3.0 mm切口超声乳化白内障手术方案,微切口组采用1.8 mm小切口超声乳化白内障手术。手术前、手术后1日、7日、1个月、3个月监测患者角膜内皮细胞密度、六角形细胞比例、角膜内皮细胞变异系数及中央角膜厚度。结果:与治疗前相比,两组患者手术后1日、7日、1个月、3个月的角膜内皮细胞密度、六角形细胞比例及角膜内皮细胞变异系数均较治疗前显著降低(P0.05);手术后1日、7日时,两组患者的中央角膜厚度均较手术前明显变薄,有统计学差异(P0.05);手术后1个月、3个月,两组患者的中央角膜厚度均呈降低趋势,最终与手术前相似。微切口组患者不同时点六角形细胞比例与同期常规切口组比较均显著升高,角膜内皮细胞变异系数与同期常规切口组比较均明显降低有统计学差异(P0.05)。两组患者手术前后不同时间点角膜内皮细胞密度、中央角膜厚度组间比较均无统计学差异(P0.05)。结论:超声乳化白内障手术后患者角膜内皮细胞损伤与手术切口有相关性,缩小手术面积的小切口手术使术后修复增快,安全有效,适宜临床推广。     

角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用

摘要 目的：探讨角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用价值。方法：回顾性研究2020年6月到2021年6月选择在本院诊治的单眼感染性角膜炎疾病患者62例,所有患者都给予角膜激光共聚焦显微镜检查,记录影像学特征并判断诊断价值（以病原学诊断为金标准）。结果：真菌性角膜炎在角膜激光共焦显微镜下的病变区纵横交错的高反射的真菌菌丝或高反光细长颗粒状的孢子,细菌性角膜炎的病变处会聚集活化的树突状细胞及大量的炎症细胞,病毒性角膜炎的基底膜下神经纤维密度、神经主干的分支数减少,棘阿米巴性角膜炎的包囊表现为圆形高反光厚壁结构。角膜激光共聚焦显微镜判断为病毒性角膜炎17例,诊断病毒性角膜炎的敏感性与特异性为94.4 %和100.0 %;角膜激光共聚焦显微镜判断为棘阿米巴性角膜炎4例,诊断棘阿米巴性角膜炎的敏感性与特异性为94.4 %和100.0 %;角膜激光共聚焦显微镜判断为细菌性角膜炎21例,诊断细菌性角膜炎的敏感性与特异性为95.5 %和97.5 %;角膜激光共聚焦显微镜判断为真菌性角膜炎20例,诊断真菌性角膜炎的敏感性与特异性为94.4 %和93.2 %。ROC曲线分析显示角膜激光共聚焦显微镜诊断细菌性角膜炎、真菌性角膜炎、病毒性角膜炎、棘阿米巴性角膜炎的曲线下面积分别为0.525、0.579、0.777、0.731。结论：角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用能较好的区分细菌性角膜炎、真菌性角膜炎、病毒性角膜炎、棘阿米巴性角膜炎,具有良好的诊断敏感性与特异性。     

垂体腺苷酸环化酶激活肽衍生多肽RHMP的重组制备及促角膜损伤修复的初步研究

利用基因工程技术高效制备具有促进角膜损伤修复功能的垂体腺苷酸环化酶激活肽(PACAP)衍生多肽RHMP,并在体外研究其生物学效应,为角膜疾病的治疗提供了新思路。采用基因重组技术表达重组肽RHMP,经Chitin-Beads柱纯化、HPLC及SDS-PAGE、质谱鉴定后,研究其对小鼠角膜损伤修复的影响。实验结果表明:利用基因重组技术制备的PACAP衍生多肽RHMP的分子量为3.4kDa,纯度为96%;将重组肽作用于创伤后的小鼠角膜,12h、24h、36h、48h后角膜修复率分别为(49.58±1.74)%、(93.66±3.39)%、(99.6±0.43)%、(99.8±0.14)%,而对照组修复率分别为(9.76±1.58)%、(29.02±1.63)%、(55.10±1.49)%、(78.59±2.52)%,P<0.001,差异具有统计学意义,重组肽RHMP可显著促进小鼠角膜损伤修复。因此,利用以上确立的表达、纯化策略,可实现新型基因重组PACAP衍生多肽RHMP的高效制备,重组多肽RHMP可快速有效地促进损伤角膜的修复,从而有望成为一种新型角膜损伤治疗药物;同时,建立的小鼠角膜上皮损伤模型可用于相关药物的生物学效应研究。     

He-Ne激光和增强UV-B辐射对小麦幼苗类囊体捕光色素的影响

采用5mW.mm-2He-Ne激光辐照、10.08kJ.m-2d-1UV-B辐射及二者组合对冬小麦幼苗进行处理。通过测定叶绿体捕光色素含量和色素蛋白组成的变化,进一步探讨He-Ne激光对增强UV-B辐射后小麦幼苗类囊体捕光色素损伤的修复效应。循环处理小麦幼苗4d,利用90%乙醇和80%丙酮分别提取各处理组小麦幼苗叶片中的叶绿素,通过纸层析和分光光度法检测捕光色素含量的变化,并探讨不同处理对叶绿素与蛋白质结合牢固性的影响。利用柱层析法测定色素蛋白的主要成分。研究表明:与对照组相比,增强UV-B辐照后小麦幼苗捕光色素总含量降低了17.76%,叶绿素和蛋白质结合牢固度显著降低,色素蛋白的组成也发生变化,D1和D2蛋白质条带消失;而一定剂量He-Ne激光辐照可使增强UV-B辐射后的叶绿体色素含量增加约10.64%,但仍低于ck组约8.12%,叶绿素和蛋白质结合牢固度也显著高于B组,色素蛋白的组成与对照组相似。因此,低剂量的He-Ne激光辐照对增强UV-B辐射后小麦幼苗类囊体捕光色素的损伤具有促进修复效应。     

Determination of the secondary structure of proteins from the amide I band of the laser Raman spectrum

The amide I band in the laser Raman spectrum of proteins has been resolved into six components, each representing residues in a different type of secondary structure. These structure types are ordered or bihydrogen-bonded helix (believed to be located in the center of helical segments), disordered or monohydrogen-bonded helix (believed to be located at the ends of helical segments), antiparallel beta sheet, parallel beta sheet, reverse turn, and undefined. The Raman spectrum representing 100% of each type of residue conformation has been computed from the solvent-subtracted Raman spectra of ten proteins with known secondary structure, plus poly-l-lysine using a least-squares solution of the overdetermined system of equations. Linear combinations of these reference spectra were then fitted to the experimental amide I spectra of these and other proteins to estimate the fractions of residues in these conformations. Statistical tests suggest that the discrimination between bihydrogen-bonded helix and monohydrogen-bonded helix is significant as is the discrimination between parallel and antiparallel β-sheet. However, the discrimination between random structure and turns has not yet been accomplished by these studies. The absolute difference between X-ray and Raman estimates of structure for 17 protein samples is generally less than 6%. We conclude that detailed and reasonably accurate estimates of secondary structure can be derived from the amide I spectra of proteins.     

Recovery of Corneal Endothelial Cells from Periphery after Injury

Background

Wound healing of the endothelium occurs through cell enlargement and migration. However, the peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium in endothelial injury.

Aim

To investigate the recovery process of corneal endothelial cells (CECs) from corneal endothelial injury.

Methods

Three patients with unilateral chemical eye injuries, and 15 rabbit eyes with corneal endothelial chemical injuries were studied. Slit lamp examination, specular microscopy, and ultrasound pachymetry were performed immediately after chemical injury and 1, 3, 6, and 9 months later. The anterior chambers of eyes from New Zealand white rabbits were injected with 0.1 mL of 0.05 N NaOH for 10 min (NaOH group). Corneal edema was evaluated at day 1, 7, and 14. Vital staining was performed using alizarin red and trypan blue.

Results

Specular microscopy did not reveal any corneal endothelial cells immediately after injury. Corneal edema subsided from the periphery to the center, CEC density increased, and central corneal thickness decreased over time. In the animal study, corneal edema was greater in the NaOH group compared to the control at both day 1 and day 7. At day 1, no CECs were detected at the center and periphery of the corneas in the NaOH group. Two weeks after injury, small, hexagonal CECs were detected in peripheral cornea, while CECs in mid-periphery were large and non-hexagonal.

Conclusions

CECs migrated from the periphery to the center of the cornea after endothelial injury. The peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium.     

Effects of photobiomodulation combined with MSCs transplantation on the repair of spinal cord injury in rat

Stem cell transplantation has shown promising regenerative effects against neural injury, and photobiomodulation (PBM) can aid tissue recovery. This study aims to evaluate the therapeutic effect of human umbilical cord mesenchymal stem cells (hUCMSCs) and laser alone or combined on spinal cord injury (SCI). The animals were divided into SCI, hUCMSCs, laser treatment (LASER) and combination treatment (hUCMSCs + LASER) groups. Cell‐enriched grafts of hUCMSCs (1 × 10⁶ cells/ml) were injected at the site of antecedent trauma in SCI model rats. A 2 cm² damaged area was irradiated with 630 nm laser at 100 mW/cm² power for 20 min. Locomotion was evaluated using Basso–Beattie–Bresnahan (BBB) scores, and neurofilament repair were monitored by histological staining and diffusion tensor imaging (DTI). First, after SCI, the motor function of each group was restored with different degrees, the combination treatment significantly increased the BBB scores compared to either monotherapy. In addition, Nissl bodies were more numerous, and the nerve fibers were longer and thicker in the combination treatment group. Consistent with this, the in situ expression of NF‐200 and glial fibrillary acidic protein in the damaged area was the highest in the combination treatment group. Finally, DTI showed that the combination therapy optimally improved neurofilament structure and arrangement. These results may show that the combination of PBM and hUCMSCs transplantation is a feasible strategy for reducing secondary damage and promoting functional recovery following SCI.     

激光、血卟啉对小鼠S-180V肿瘤细胞膜通透性的作用及其影响因素

通过Na_2~(51)CrO_4在肿瘤细胞膜内外的分布比值的测定,观察了激光血卟啉衍生物(简称HPD)对小鼠S-180V肿瘤细胞膜通透性的作用及其影响因素:(1)通过紫外吸收光谱的测定对肿瘤细胞摄取HPD的动态过程作了观察。选择了实验所需的合适HPD浓度和作用时间,并观察到细胞悬液中血清蛋白能阻抑细胞对HPD的摄取。(2)在氦氖激光照射后即可观察到含有HPD的肿瘤细胞膜外~(51)Cr/膜内~(51)Cr的比值明显增加,而单照激光或单加HPD两组的~(51)Cr比值与正常对照组相比无明显变化。(3)上述的~(51)Cr比值变化随着照后保温时间的延长而逐渐加大。与此同时细胞形态也发生相应的变化,细胞死亡率也逐渐增加。说明除了原初的光敏反应外,还有继发的细胞损伤。(4)细胞悬液中血清蛋白的存在虽然对激光血卟啉对肿瘤细胞的杀伤作用有所减弱,但在这样条件下的光敏反应比较接近临床上治疗肿瘤的实际情况。