间接眼底镜下外路手术治疗孔源性视网膜脱离对患者视力与黄斑水肿的影响

摘要 目的：探讨间接眼底镜下外路手术治疗孔源性视网膜脱离对患者视力与黄斑水肿的影响。方法：选择2018年8月到2021年9月在本院诊治的孔源性视网膜脱离患者84例作为研究对象,根据1:1随机数字表法把患者分为眼底镜组与对照组各42例,对照组采用巩膜扣带术治疗,眼底镜组给予间接眼底镜下外路手术治疗,测定患者视力与黄斑水肿情况。结果：两组术后3个月的最佳矫正视力好于术前1 d,眼底镜组好于对照组（P<0.05）。眼底镜组术后3个月的总有效率为97.6 %,高于对照组的76.2 %（P<0.05）。眼底镜组术后3个月的眼内出血、视网膜坏死、眼内炎、高眼压等并发症发生率为4.8 %,低于对照组的23.8 %（P<0.05）。两组术后3个月的视网膜下液高度低于术前1 d,眼底镜组低于对照组（P<0.05）。眼底镜组术后3个月的自理等生活质量评分较对照组高（P<0.05）。结论：间接眼底镜下外路手术治疗孔源性视网膜脱离能改善黄斑水肿提高,促进恢复患者的视力,提高总体治疗效果,减少并发症,有利于患者视网膜下液高度降低,从而提高生活质量。     

糖尿病性视网膜病变早期mfERG的研究

目的:探讨糖尿病患者糖尿病性视网膜病变早期多焦视网膜电图(multifocal electroretinogram,mfERG)的特点。方法:应用德国ROLAND公司RETIscan系统对24例40眼糖尿病患者,同时对27例40眼正常对照眼记录mfERG。按机器的默认值一阶反应进行记录。整个记录过程中可以分为12个时段,每个时段记录为时间47秒。结果:mERG测得的糖尿病患者组1～5环所在位置的P1波的振幅密度随离心度的增加而降低,P1波和N1波幅值降低和潜伏时延迟。各象限的P1、N1波振幅密度、波幅值降低,潜伏时延迟。结论:糖尿病性视网膜病变受累的区域多发生在黄斑部,功能上的改变早于形态学的变化;病变的早期功能改变最先出现于视网膜的后极偏颞上方;糖尿病患者在未出现眼底改变时各个象限视网膜的外层已经严重受累。     

糖尿病性视网膜病变术后CRT、SFCT、mALB、MBG、HbA1c水平的变化及相关性

本研究通过观察糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度,脉络膜厚度,尿微量白蛋白、血糖、糖化血红蛋白的水平,试图了解其差异及相关性。我们选取2016年1月至2017年12月于我院就诊的糖尿病性视网膜病变患者200例,根据其有无视网膜病变、有无肾病、术后有无黄斑水肿分为合并组和未合并组,同时选取100例正常成年人作为对照。观察糖尿病患者和对照组、未合并和合并并发症糖尿病患者的黄斑中心凹视网膜厚度(central retinal thickness, CRT),凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),尿微量白蛋白(microAlbunminuria, mALB)、平均血糖(mean blood glucose, MBG)和糖化血红蛋白(glycated haemoglobin, HbA1c)水平,进一步分析了糖尿病黄斑水肿患者的尿微量白蛋白水平与黄斑中心凹视网膜厚度、脉络膜厚度、血糖、糖化血红蛋白的相关性。研究结果表明,糖尿病组患者的CRT水平较对照组低,SFCT、mALB、MBG和HbA1c水平高于对照组;合并视网膜病变、合并肾病和合并黄斑水肿组患者的CRT水平较未合并组低,SFCT、mALB、MBG和HbA1c水平均高于未合并组;黄斑水肿患者的m ALB水平与CRT水平负相关,与SFCT、MBG和HbA1c水平正相关。本研究得出结论:糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度(CRT)较薄,脉络膜厚度(SFCT)变厚,且与尿微量白蛋白密切相关。     

Postoperative Vision-Related Quality of Life in Macula-Off Rhegmatogenous Retinal Detachment Patients and Its Relation to Visual Function

Objective

To determine the vision-related quality of life (VR-QOL) after surgery for macula-off rhegmatogenous retinal detachment (RRD) in relation to visual acuity, contrast acuity, and color vision.

Methods

In a prospective observational study, we included 55 patients with a macula-off RRD. Best corrected visual acuity (BCVA), color vision (saturated and desaturated color confusion indices (CCI)) and contrast acuity were measured at 12 months postoperatively in both the RRD eye and the fellow control eye, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was filled out.

Results

Operated and fellow control eyes differed significantly in mean LogMAR BCVA (P<0.0001), median Log contrast acuity (P<0.0001), saturated CCI (P = 0.009), and desaturated CCI (P = 0.016). Significant correlations were observed between the NEI VFQ-25 overall composite score and postoperative LogMAR BCVA (R = −0.551, P<0.0001), contrast acuity (R = 0.472, P<0.0001), saturated CCI (R = −0.315, P = 0.023), and desaturated CCI (R = −0.283, P = 0.044).

Conclusions

A lower VR-QOL was highly correlated to a worse postoperative BCVA and contrast acuity and to a lesser extent to color vision disturbances.     

Rhegmatogenous Retinal Detachment Surgery in Elderly People over 70 Years Old: Visual Acuity,Quality of Life,and Cost-Utility Values

Background and Purpose

To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness.

Methods

Elderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People''s Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70–79 and age over 80 years. Sensitivity analyses were performed to test stability of the results.

Results

98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70–79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years.

Conclusions

RRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization’s recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients.     

局灶性脑缺血大鼠皮层神经元超微结构及线粒体呼吸功能变化的研究

目的:研究局灶性脑缺血大鼠脑细胞超微结构及脑组织线粒体呼吸链功能的变化。方法:采用改良Zea Longa方法复制大鼠大脑中动脉缺血(MCAO)模型,透射电镜观察缺血后脑组织神经元超微结构的改变;检测呼吸链R3、R4、RCR、OPR等评价呼吸功能的指标。结果:局灶性脑缺血大鼠脑组织神经元细胞结构严重破坏;与对照组相比,脑缺血时大鼠脑线粒体ST3、RCR和OPR降低,ST4升高。结论:脑缺血急性期线粒体结构破坏,功能受损严重,随着时间延长均有所恢复;保护线粒体呼吸链可能对脑缺血损伤有保护作用。     

Postoperative Metamorphopsia in Macula-Off Rhegmatogenous Retinal Detachment: Associations with Visual Function,Vision Related Quality of Life,and Optical Coherence Tomography Findings

Purpose

To evaluate postoperative metamorphopsia in macula-off rhegmatogenous retinal detachment (RRD) and its association with visual function, vision related quality of life, and optical coherence tomography (OCT) findings.

Methods

45 patients with primary macula-off RRD were included. At 12 months postoperatively, data on metamorphopsia using sine amsler charts (SAC), best corrected visual acuity (BCVA), letter contrast sensitivity, color vision (saturated and desaturated color confusion indexes), critical print size, reading acuity, the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), and OCT, were obtained.

Results

Metamorphopsia was present in 39 patients (88.6%), with most of them (n = 35, 77.8%) showing only mild metamorphopsia (SAC score = 1). Patients with metamorphopsia had significantly worse postoperative BCVA (p = 0.02), critical print size (p<0.0005), and reading acuity (p = 0.001) compared to patients without metamorphopsia. Other visual function outcomes and NEI-VFQ-25 overall composite score were all also somewhat lower in patients with metamorphopsia, but this did not reach statistical significance. No association with OCT findings was present.

Conclusion

The prevalence of postoperative metamorphopsia in macula-off RRD patients is high, however, the degree of metamorphopsia is relatively low. When metamorphopsia is present, visual functions seem to be compromised, while vision related quality of life is only mildly affected.     

Experimental Models for Study of Retinal Pigment Epithelial Physiology and Pathophysiology

We have developed a cell culture procedure that can produce large quantities of confluent monolayers of primary human fetal retinal pigment epithelium (hfRPE) cultures with morphological, physiological and genetic characteristics of native human RPE. These hfRPE cell cultures exhibit heavy pigmentation, and electron microscopy show extensive apical membrane microvilli. The junctional complexes were identified with immunofluorescence labeling of various tight junction proteins. Epithelial polarity and function of these easily reproducible primary cultures closely resemble previously studied mammalian models of native RPE, including human. These results were extended by the development of therapeutic interventions in several animal models of human eye disease. We have focused on strategies for the removal of abnormal fluid accumulation in the retina or subretinal space. The extracellular subretinal space separates the photoreceptor outer segments and the apical membrane of the RPE and is critical for maintenance of retinal attachments and a whole host of RPE/retina interactions.     

玻璃体腔联合注射赖氨酸－纤溶酶原和瑞替普酶诱导兔眼玻璃体后脱离的有效性

目的:探讨兔眼玻璃体腔联合注射赖氨酸-纤溶酶原和瑞替普酶诱导玻璃体后脱离(PVD)的有效性。方法:选取30只健康的新西兰白兔,以白兔右眼作为实验眼,左眼作为对照眼。随机分为A、B、C三组(每组10只),三组实验眼分别联合应用1万U瑞替普酶+125μg赖氨酸—纤溶酶原、2万U瑞替普酶+125μg赖氨酸—纤溶酶原、3万U瑞替普酶+125μg赖氨酸—纤溶酶原进行玻璃体腔内注射,对照眼均注射平衡盐溶液。应用视网膜电图、扫描电镜及光镜观察、比较各组诱导PVD的效果。结果:三组实验眼均形成不同程度PVD。A组实验眼注药前与注药后24 h、注药后2周的最大混合反应a波振幅、b波振幅比较均无明显差异(P0.05);B组实验眼注药后24 h的a波振幅、b波振幅均有轻度下降,2周后均恢复正常,注药前后的a波振幅、b波振幅比较均无明显差异(P0.05)。C组实验眼注药后24 h的a波振幅、b波振幅均明显低于注药前和对照眼,注药后2周的b波振幅均明显低于注药前和对照眼(P0.05)。光学组织切片观察显示:A组实验眼及所有对照眼、B组实验眼、C组实验眼的视网膜组织细胞形态正常,结构清晰,但B组神经节内核层、细胞层细胞略有减少,C组神经节内核层及细胞层细胞明显减少。结论:玻璃体腔内联合注射赖氨酸-纤溶酶原和瑞替普酶能有效诱导PVD,1万U瑞替普酶+125μg赖氨酸-纤溶酶原可诱导实现完全性PVD,不会对视功能、视网膜结构造成损害。     

Ultrastructure of scales in a teleost (Carassius auratus L.) after use of rapid freeze-fixation and freeze-substitution

Summary New data on the ultrastructural features of the elasmoid scales ofCarassius auratus have been obtained by use of rapid freezing with subsequent freeze-substitution in anhydrous solvents. These are compared with the results obtained using conventional aqueous fixatives.The external layer of the scales is composed of randomly oriented collagen fibres. In the first stages of mineralization, mineral deposits are located in the interfibrillary substance where dense granules appear to be active sites of mineralization. Spheritic mineralization occurs in this layer.The fibrillary plate is composed of two kinds of collagen fibres. Most of them are organized in lamellae forming the plywood-like structure. They are thicker than the so-called TC fibres, which are oriented from the basal part towards the superficial layer. These TC fibres are involved in the first stages of mineral deposition in the fibrillary plate where inotropic mineralization occurs.The mineral phase is almost always located in the interfibrillary matrix in both layers of the elasmoid scale. In this respect, teleost scales differ from those described so far in other lower vertebrates.

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Resumé Des précisions concernant les aspects ultrastructuraux des dépôts minéraux dans les écailles deCarassius auratus ont été obtenues grâce à l'utilisation de la congélation ultra-rapide suivie d'une cryosubstitution en milieu anhydre. Ces données sont comparées à celles fournies par les méthodes usuelles utilisant des fixateurs aqueux.La couche externe des écailles comprend des fibres collagènes disposées sans ordre apparent. Les dépôts minéraux se produisent surtout dans la substance interfibrillaire où des granules denses semblent représenter des sites actifs au cours de la minéralisation apparentée au type sphéritique.La plaque basale comporte deux catégories de fibres collagènes. Les unes, les plus nombreuses, de plus fort diamètre, sont organisées en lamelles formant une structure en contre-plaqué; les autres appelées fibres TC, orientées de la base de l'écaille vers la zone superficielle, jouent un rôle important dans les premières phases de la minéralisation de type inotropique dans cette partie de l'écaille.Dans les deux couches de l'écaille, la phase minérale est surtout trouvée dans la substance interfibrillaire. De ce fait, les écailles élasmoides des Téleostéens peuvent être distinguées des autres écailles dermiques connues de Vertébrés inférieurs.

     

大葱卵器及受精后助细胞的超微结构

章丘大葱（Ａllium fistulosum L.cv.Zhangqiu)的卵器由１个卵细胞及２个助细胞组成,观察到不少卵器没有卵细胞,只有２个助细胞。卵细胞的核及大部分细胞质位于细胞的合点端,１个大液泡占据了细胞其他部位。卵细胞含有很多的核糖体及多聚核糖体、嵴明显的线粒体、粗面内质网、高尔基体具小泡,卵细胞似是一个活跃的细胞。细胞外被细胞壁,其合点端及侧方与助细胞共同壁不连续,助细胞有一较大的核,位于细胞膨大的部位,众多的小液泡遍布细胞中。核糖体及聚合核糖体、线粒体,粗面内质网及风心圆环状粗面内质丰富,高尔基体及小泡常见,反映了其活跃的代谢作用。助细胞合点端及侧方与卵细胞、中央细胞的共同壁不连续,与卵细胞共同壁含胞间连丝,壁不连续处,有不状多层膜结构伸入卵细胞质,显示助细胞可能对卵细胞提供营养,伟粉后,一个助细胞退化,宿存助细胞至随胚胚期尚存在,它经历了一个缓慢的退化过程,出现质壁分离,细胞质变稀,液泡扩大,细胞器逐渐减少,在椭形胚期,宿存助细胞核内的染色质及核仁消失,有细胞质侵入核内,因宿存助细胞壁变厚,细胞质出现现脂滴,宿存助细胞可能仍有合成功能,宿存助细胞壁出现若干无壁部位,细胞内的营养物质可能通过无壁部位向胚乳转运,供游离核胚乳及胚乳细胞化初期的发育。     

血液磁极化疗法对糖尿病兔胰岛功能的影响

目的观察血液磁极化疗法(简称血磁治疗)对糖尿病(DM)的治疗效果和对胰岛功能的影响。方法制备了四氧嘧啶DM兔模型20只,随机分为两组,即DM模型血磁治疗组及DM模型未治疗组,同时设立正常对照组10只,分别测定治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素(INS)及C-肽(C-P),并于观察期结束后处死动物取胰腺组织常规石蜡包埋切片,行HE及Mallory三色法特殊染色观察3组胰岛形态学变化。结果血磁治疗显著降低DM兔的FPG(P<0.001)。DM治疗组INS及C-P水平较治疗前明显升高(P<0.01),与未治疗组相比差异显著(P<0.05)。胰岛病理改变可见治疗组β细胞数量明显多于DM未治疗组,提示血磁疗法具有促进胰岛修复,改善胰岛功能的作用。结论血磁疗法能够促进DM时受损胰岛组织的修复,改善胰岛β细胞分泌功能,降血糖作用明显。