In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and quali...In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.展开更多
Objective:To explore the value of cyclosporin eye drops in treating dry eye after cataract surgery.Methods:A total of 150 patients with dry eye after cataract surgery were randomly divided into group A(n=50),group B(n...Objective:To explore the value of cyclosporin eye drops in treating dry eye after cataract surgery.Methods:A total of 150 patients with dry eye after cataract surgery were randomly divided into group A(n=50),group B(n=50),and group C(n=50).Artificial tears combined with cyclosporin eye drops were used in group A,artificial tears were used in group B,and no dry eye medication was used in group C.The clinical efficacy,ocular surface function and tear inflammatory factor level before and after surgery were compared between the groups.Results:The total effective rate of group A was 96.00%,which was significantly higher than that of group B and group C(p<.05);three months after surgery,the levels of cornealfluorescein staining score(FL score),tear meniscus height(TMH)and tear inflammatory factors[interleukin 6(IL-6),interleukin 8(IL-8),tumor necrosis factorα(TNF-α)]in group A were lower than those in group B,and those indicators in group B were lower than those in group C,and the difference between the two groups was statistically significant(p<.05);three months after surgery,Schirmer test(SIT)and break-up time(BUT)in group A were higher than those in group B,and those indicators in group B were higher than those in group C,and the difference between the two groups was statistically significant(p<.05).Conclusions:The effect of cyclosporin eye drops in treating dry eye after cataract surgery is satisfactory,significantly improving the ocular surface function and reducing the level of tear inflammatory factors,which is worthy of promotion.展开更多
We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha （IFN-α） treatment in eight hepatitis C virus （HCV）- infected patients. These events include three case...We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha （IFN-α） treatment in eight hepatitis C virus （HCV）- infected patients. These events include three cases of Vogt-Koyanagi-Harada like （VKH） disease （an association of panuveitis, retinal detachment, ear and meningeal detachment and skin and hair changes）, two cases of central retinal vein occlusion, one case of central retinal artery occlusion, one case of severe hypertensive retinopathy and one case of bilateral ischemic optic neuropathy with severe visual impairment. Rare as they are, such severe ophthalmological complications require a close follow-up of HCV-infected patients under IFN-α breabnent with ophthalmological monitoring if any ocular manifestation occurs.展开更多
AIM: To analyze whether wet-lab training(WLT) or surgical-simulator training(SST) is better for ophthalmology residents to master the chopping technique.METHODS: Sixty ophthalmology residents(in their second year) and...AIM: To analyze whether wet-lab training(WLT) or surgical-simulator training(SST) is better for ophthalmology residents to master the chopping technique.METHODS: Sixty ophthalmology residents(in their second year) and three cataract surgeons participated in the study. The residents were randomly separated into two groups, WLT group and SST group. The residents in WLT group were asked to perform 10 trials of chopping using pig eyes and scored by the surgeons, and then they performed and scored using simulator for one time. The residents in SST group underwent 10 trials of chopping using simulator, and the simulator scored each trail. Then, this group were asked to perform the chopping using pig eyes and scored by the surgeons. At last, we investigated the residents’ satisfaction about the training.RESULTS: The demographic characteristics had no significant differences between the two groups. Recorded by the simulator, the residents in SST group got significantly higher overall score(83.90±1.31) than WLT group(78.73±1.92, P=0.03). And the residents in SST group got less corner area injured, and they spend less time than WLT group(P<0.05). Moreover, the residents in WLT group used more ultrasonic energy value than SST group(P=0.03). However, scored by the surgeons, the residents in two groups got nearly the same overall score. The residents in WLT group performed better on the frequencies of posterior capsule torn and incisional stress(P=0.03, 0.008, respectively). In the survey, the residents in two groups held the same opinion that the training was helpful and they strongly recommended this training. And all of them enjoyed the training, and enjoyed being randomized in their own group. However, with respect to the realistic character, the residents thought that WLT was better than SST(P<0.001).CONCLUSION: Both of the Eyesi surgical-stimulator and the wet-lab improve the residents’ chopping ability and each has its own advantages. The combination of the two training ways could be considered to be a part of the training curriculum for new residents.展开更多
BACKGROUND Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients.By focusing on what students should be able to perform one day as clinicians,we can bridge the gap between me...BACKGROUND Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients.By focusing on what students should be able to perform one day as clinicians,we can bridge the gap between mere theoretical knowledge and its practical application.Gender aspects in clinical medicine also have to be considered when speaking of personalized medicine and learning curricula.AIM To determine sets of intellectual,personal,social,and emotional abilities that comprise core qualifications in medicine for performing well in anamnesis-taking,in order to identify training needs.METHODS An analysis of training clinicians’conceptions with respect to optimal medical history taking was performed.The chosen study design also aimed to assess gender effects.Structured interviews with supervising clinicians were carried out in a descriptive study at the Medical University of Vienna.Results were analyzed by conducting a qualitative computer-assisted content analysis of the interviews.Inductive category formation was applied.The main questions posed to the supervisors dealt with(1)Observed competencies of students in medical history taking;and(2)The supervisor’s own conceptions of"ideal medical history taking".RESULTS A total of 33 training clinicians(n=33),engaged in supervising medical students according to the MedUni Vienna’s curriculum standards,agreed to be enrolled in the study and met inclusion criteria.The qualitative content analysis revealed the following themes relevant to taking an anamnesis:(1)Knowledge;(2)Soft skills(relationship-building abilities,trust,and attitude);(3)Methodical skills(structuring,precision,and completeness of information gathering);and(4)Environmental/contextual factors(language barrier,time pressure,interruptions).Overall,health care professionals consider empathy and attitude as critical features concerning the quality of medical history taking.When looking at physicians’theoretical conceptions,more general practitioners and psychiatrists mentioned attitude and empathy in the context of"ideal medical history taking",with a higher percentage of females.With respect to observations of students’history taking,a positive impact from attitude and empathy was mainly described by male health care professionals,whereas no predominance of specialty was found.Representatives of general medicine and internal medicine,when observing medical students,more often emphasized a negative impact on history taking when students lacked attitude or showed non-empathetic behavior;no gender-specific difference was detected for this finding.CONCLUSION The analysis reveals that for clinicians engaged in medical student education,only a combination of skills,including adequate knowledge and methodical implementations,is supposed to guarantee acceptable performance.This study’s findings support the importance of concepts like relationship building,attitude,and empathy.However,there may be contextual factors in play as well,and transference of theoretical concepts into the clinical setting might prove challenging.展开更多
AIM:To investigate the side effects of the commonly used laser treatment along with testing the neuroprotective effect of bFGF on a potential retinal impairment.METHODS:To do this,30 chinchilla pigmented adult male ra...AIM:To investigate the side effects of the commonly used laser treatment along with testing the neuroprotective effect of bFGF on a potential retinal impairment.METHODS:To do this,30 chinchilla pigmented adult male rabbits were divided into the control and experimental groups.The control and experimental groups underwent both laser application and bFGF treatment.The retinal tissue impairment and its renewal rate were tested under the light and electron microscopical levels.RESULTS:The focal laser application on rabbit eyes caused morphological alterations both in the application region and in the neighbouring areas.In the damaged areas,the outer nuclear layer of the neural retina was almost disappeared,retina pigment epithelium was interrupted,the retina pigment epithelium migrated intraretinally,and the damaged region along with neighbouring areas seemed to be not separated.bFGF application just after the laser photocoagulation,revealed better results in application areas.CONCLUSION:It could be suggested that the bFGF application following laser photocoagulation might have protective,repairing and wound healing effects on the retina.展开更多
BACKGROUND Esophageal cancer(ESCA)is a heterogeneous cancer with variable outcomes that are challenging to predict.MicroRNA(miR)-1269a is a newly discovered noncoding RNA that shows promising prognostic prediction in ...BACKGROUND Esophageal cancer(ESCA)is a heterogeneous cancer with variable outcomes that are challenging to predict.MicroRNA(miR)-1269a is a newly discovered noncoding RNA that shows promising prognostic prediction in other cancers,but its clinical value in ESCA remains unclear.AIM To explore the relationship between miR-1269a and its clinical value and to develop a nomogram to succinctly display this relationship.METHODS We analyzed the expression of miR-1269a in 125 ESCA tissue samples with complete clinical data and 52 normal tissue samples.We determined the prognostic value of miR-1269a for overall survival(OS)and cancer-specific survival(CSS)and evaluated the association between miR-1269a and clinical variables including tumor location,histologic grade,metastatic stage,and American Joint Committee on Cancer(AJCC)stage using multivariate Cox analysis.Additionally,we developed a nomogram for OS and CSS based on miR-1269a expression using age and AJCC stage and assessed its prognostic performance.Using Gene Ontology and Kyoto Encyclopedia of Gene and Genomes analyses,we predicted the target genes of miR-1269a and analyzed their potential function in caner development.RESULTS The expression of miR-1269a was significantly higher in ESCA patients than healthy controls.Patients with high expression of miR-1269a showed poor prognosis in OS and CSS,suffered increased rates of low differentiation and metastasis,and exhibited tumor stage T3+T4,positive lymph stage,and AJCC stage III+IV.The area under the receiver operating characteristic curve of miR-1269a was 0.716 for OS and 0.764 for CSS.Multivariate Cox analysis revealed that AJCC stage and miR-1269a were independent factors for OS and CSS.Combing with age,we constructed a nomogram for prognostic prediction.Additionally,our nomogram showed excellent predictive performance for OS and CSS after 3 years and 5 years and was easy to use.Ultimately,the functional analysis suggested that miR-1269a was mostly involved in the PI3K-AKT signaling pathway.CONCLUSION miR-1269a can be used as a potential indicator for the prognosis of ESCA patients.We developed an easy-to-use nomogram with excellent ESCA prognostic prediction for clinical use.展开更多
AIMTo evaluate the effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.
· AIM: To evaluate and compare the efficacy and stability of intrastromal corneal ring segment(ICRs)implantation with cross-linking(CXL) using different sequence and timing.· METHODS: In this single retrospe...· AIM: To evaluate and compare the efficacy and stability of intrastromal corneal ring segment(ICRs)implantation with cross-linking(CXL) using different sequence and timing.· METHODS: In this single retrospective study, 86 keratoconic eyes subjected the ICRs implantation. We analyzed only 41 eyes that had complete follow-ups.They were divided into three groups: ICRs implantation was applied only(group normal), ICRs first followed by CXL immediately(group CXL-S), CXL first followed by ICRs long after(group CXL-B). The visual acuity,refractive results, keratometry were compared preoperatively and 1y postoperatively. Their differences among the three groups were also analyzed.·RESULTS: Group normal comprised 25 eyes, group CXL-S 8 eyes, and group CXL-B 8 eyes. There were improvements in the mean uncorrected distance visual acuity(UDVA) and the mean corrected distance visual acuity(CDVA) compared preoperatively and 1y postoperatively [UDVA: 0.31(P =0.030) logarithmic minimum angle of resolution(log MAR) group normal, 0.4(P =0.020) group CXL-S, 0.45(P =0.001) group CXL-B;CDVA : 0. 21 log MAR( P = 0. 013) group normal, 0. 30(P =0.036) group CXL-S; 0.26(P =0.000) group CXL-B].The refractive and topographic outcomes also showed improvements. In terms of comparisons among the three groups, all the P values were above 0.05, showing no significant difference. But only group CXL-B had improvement in UDVA and CDVA for all the patients.·CONCLUSION: With safety and good visual outcomes,ICRs implantation is a viable alternative for keratoconus.No significant difference was found among these three groups.展开更多
BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different typ...BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.展开更多
Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patie...Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patients with first attack of active ocular toxoplasmosis. Age,gender,clinical presentation and ophthalmic examination finding were recorded.The diagnosis was based on typical finding in ophthalmic examination.Systemic antimicrobials and corticosteroids were given to all patients.The treatment outcome and side-effects of drugs were observed.Results:Thirteen(52%) patients were male and 12(48%) were female.The mean±SD age at presentation was(26.8±11.1) years.Eye involvement was unilateral in 92% of patients and bilateral only in 8%.Lesions were located at the peripheral retina in 48%,at the macula retina in 28%,and at the macula and peripheral retina in 24%of the patients.The most common presenting symptom was blurred vision(96%),followed by eye pain(28%).All patients received antimicrobials treatment.Systemic corticosteroids were used in 48%of the patients. Clinical response were observed in 44%2 weeks before and in 56%2 weeks after.Vision was improved with treatment except in two cases.No recurrences occurred during one year follow up.Conclusions:Our study shows that active ocular toxoplasmosis has no gender predilection and affects young individuals.Unilateral involvement is more common in our study.Response to treatment is good in patients and no recurrences occur during one year follow-up.It may have implications in favor of treatment of active ocular toxoplasmosis.展开更多
Background: In pseudoexfoliative syndrome (PEX), extraocular accumulation is associated with cardiovascular morbidity and mortality. The aim of this study was to investigate the effect of exercise test on corrected QT...Background: In pseudoexfoliative syndrome (PEX), extraocular accumulation is associated with cardiovascular morbidity and mortality. The aim of this study was to investigate the effect of exercise test on corrected QT dispersion (QTcd) and QTcd recovery in PEX. Patients and Methods: A total of 37 patients diagnosed as PEX were included in the study. The control group consisted of 38 patients. The Electrocardiographies (ECG) were taken. The patients were subjected to an exercise test. Results: In the study group, baseline, peak and third minute recovery QTcd values were 41.35 ± 7.27 ms, 65.19 ± 7.83 ms, and 53.61 ± 6.45 ms, respectively. In the control group, baseline, peak and third minute recovery QTcd values were 29.92 ± 4.23 ms, 38.31 ± 4.22 ms and 28.76 ± 3.09 ms, respectively. There was statistically significant?difference between the baseline and peak QTcd values of the study group and?the control group (t = 8.34224/p 0.00001, t = 18.55079/p 0.00001, respectively). In addition, while there was a statistically significant?difference between the baseline QTcd and the third minute recovery QTcd in the study group, there was no statistically significant difference between the baseline QTcd value and the third minute recovery QTcd value in the control group as heart rate recovery (t = 8.388558/p 0.00001, t = 1.967315/p = 0.056668, respectively).?Conclusion: All of them were found to have a higher risk in terms of malignant ventricular arrhythmia in the study group, both at rest and with effort, in a statistically significant way compared to the control group.展开更多
Background:Sight-threatening diabetic macular edema(DME)is caused by increased microvascular permeability.While few direct vascular targeting strategies are available,VEGF pathway inhibition has shown to be effective ...Background:Sight-threatening diabetic macular edema(DME)is caused by increased microvascular permeability.While few direct vascular targeting strategies are available,VEGF pathway inhibition has shown to be effective in reducing retinal vascular leakage but is associated with non-negligible side effects.Thus,more options are needed.Vascular specific Activin-like kinase receptor type I(ALK1)pathway and its circulating ligand Bone morphogenetic protein-9(BMP9)is known for its potent quiescent and stabilizing effect on the vasculature.However,little is known about this pathway in the context of microvascular permeability associated with diabetes.We hypothesize that BMP9/ALK1 pathway is inhibited in diabetic(DB)retinas leading to vascular destabilization and leakage and that its activation could re-establish proper vascular endothelial barrier functions(EBF).Methods:The effect of hyperglycemia(i.e.,HG>10 mM of D-glucose)on Alk1 signaling was evaluated in vitro by subjecting endothelial cells(EC)to increasing concentrations of D-glucose(5,11,25 mM)and in vivo using DB mice(Streptozotocin-induced diabetes).The contribution of Alk1 signaling on EBF was evaluated using Evans Blue permeation in inducible endothelial specific Alk1 KO mice.To evaluate the potential protective effects of BMP9/Alk1 signaling on EBF,BMP9 overexpression was achieved using adenoviral delivery in DB mice.Statistical-One-Way ANOVA or Student’s t-test was used.Results:Endothelial tissue from DB mice showed a significant inhibition of BMP9/ALK1-canonical Smad1,5,8 quiescence signaling(DB n=5;CTL n=4;P<0.01),which was associated with reduced expression of target genes(JAG1,Id1,3,Hey1,2&HES).Moreover,we showed that retinal hyperpermeability associated with diabetes was exacerbated in Alk1 heterozygote mice(n=4-9/group;P<0.0001).Finally,we demonstrated that activation of Alk1 signaling in ECs prevented vascular permeability induced by HG,both in vitro(n=3;P=0.009)and in vivo(n=4-9/group;P<0.0001).Conclusions:Consistent with our hypothesis,vascular stability and quiescence induced by BMP9-ALK1 signaling is inhibited in the DB/HG endothelium which could be an important factor in vascular leakage leading to DME.Our results show that activation of this pathway could offer a therapeutically interesting future option to slow down the onset of DME.展开更多
Behcet’s disease (BD) is a large vessel vasculitis with a wide range of clinical manifestations. Some of these manifestation may be life threatening and rapid suppression of the inflammation with effective immunosupp...Behcet’s disease (BD) is a large vessel vasculitis with a wide range of clinical manifestations. Some of these manifestation may be life threatening and rapid suppression of the inflammation with effective immunosuppressive agent is crucial. There are traditional drugs with different response rates and all have efficacy on different manifestations of the disease. The most frightening manifestations of the disease are ocular, neurologic, intestinal and vascular types of involvement. Besides benign and easily treated manifestations there are also refractory cases with complicated involvement. The novel biologic agents have been used for these resistant patients and favorable response rates have been reported. In this review, we have shared our experience with biologic agents in BD and also reviewed the literature for the efficacy and safety for these novel agents for refractory patients.展开更多
AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated wit...AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.展开更多
·AIM: To investigate the retinal nerve fiber layer(RNFL)thickness changes in patients with obstructive sleep apnea syndrome(OSAS) for one year follow-up. To discuss the possibility of detecting tendency of glauco...·AIM: To investigate the retinal nerve fiber layer(RNFL)thickness changes in patients with obstructive sleep apnea syndrome(OSAS) for one year follow-up. To discuss the possibility of detecting tendency of glaucoma in this population by using spectral domain optical coherence tomography(3D-OCT-2000 Spectral domain).·METHODS: After polysomnographic study, all subjects(64 OSAS patients and 40 controls) underwent detailed ophthalmological examination. After these examinations,patients with glaucoma and patients who had ophthalmological and/or systemic disease were excluded from the study.Totally, 20 patients in OSAS group and five patients in controls were excluded from the study in the first examination and follow-up period. The RNFL thickness was assessed with OCT. Forty-four OSAS patients and 35 control subjects were followed up for12 mo. RNFL thickness change and OSAS patients were evaluated for severity of disease by Apnea-Hypopnea Index(AHI).·RESULTS: Forty-four OSAS patients and 35 controls were enrolled in the study. Statistically significance was found between OSAS patients and controls at the 12 thmo.Average RNFL thickness was found to be significantly lower in last measurements in OSAS patients when compared with first measurements and control subjects(P 【0.001, 0.002, respectively). There was a statistically significant correlation among AHI, and RNFL thickness(P 【0.05).·CONCLUSION: The results suggest that the patients with OSAS were related with a proportional decrease in the RNFL thickness. These patients should be followed up regularly for glaucomatous changes. Detecting more RNFL thinning in severe OSAS was important.展开更多
Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointes...Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms： atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d＇orange finding in the fundus; thinning of the retinal nerve fiber in OCT （optic coherence tomography）; bilateral and reticular papillary lesions with yellowish- color in the neck region （plucked chicken appearance）; presence of bleeding loci in fundus, and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticum diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticum cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling.展开更多
Background:Understanding the neurophysiological mechanisms of Amblyopia,a neurodevelopmental disorder of the visual cortex,will bring us closer to full recovery.Past findings have been contradictory.Results have shown...Background:Understanding the neurophysiological mechanisms of Amblyopia,a neurodevelopmental disorder of the visual cortex,will bring us closer to full recovery.Past findings have been contradictory.Results have shown that despite having severe acuity impairment,amblyopes can nonetheless perceive sharp edges.In this study,we explore the representation of blur through a series of image blur-discrimination and matching tasks,to understand more about the amblyopes’visual system.Methods:Monocular image blur-discrimination thresholds were measured in a spatial two-alternative forced-choice procedure whereby subjects had to decide which image was the blurriest.Subjects also had to interocularly match pictures that were identical to those used for the image blur discrimination task.Ten amblyopes,as well as a group of ten controls were under study.Results:Data on amblyopes and controls will be presented for both experiments.According to previous research that was done on blur-edge discrimination and matching,we predict that subjects’performance will follow a dipper function,that is,all observers will be better at discriminating between both images when a small amount of blur is applied rather than when the image is either sharp or very blurry.We also predict that amblyopes’blur discrimination will be noisier,but that they will paradoxically be able to match the sharpness of the images presented in the matching task.Conclusions:This would confirm our hypothesis about amblyopes’visual system,that they can represent blur levels defined by spatial frequencies that are beyond their resolution limit,and would also raise interesting questions about the visual system in general regarding the different perceptions driven by images versus edges.展开更多
Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herp...Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herpes zoster is a reactivation of the virus. It often occurs in immunocompromised situations such as AIDS. Several localizations can be observed in herpes zoster. Disseminated lesions are rarely described. Authors report a case of ophthalmic and generalized (or disseminated) herpes zoster in an immunocompetent child. No history of previous varicella and no particular medical background or family tare was found. However, maternal varicella when pregnant of our patient was reported. The patient had good nutritional status and no cause of immunosuppression. Immediate evolution was favorable for our patient, but the possibility of long-term complications of herpes zoster ophthalmicus should make consider the advisability of vaccination against varicella-zoster virus in children.展开更多
Background:The maintenance of a quiescent retinal vascular endothelial barrier is paramount for tissue supply and homeostasis to ensure visual function.Chronic hyperglycemia in diabetes causes structural and functiona...Background:The maintenance of a quiescent retinal vascular endothelial barrier is paramount for tissue supply and homeostasis to ensure visual function.Chronic hyperglycemia in diabetes causes structural and functional alterations of the endothelium that are accelerated by the production of several mediators such as VEGF.The disturbance of interendothelial junction stability leading to retinal hyperpermeability is one of the changes leading to diabetic macular edema(DME)that can occur at any stage of diabetic retinopathy.Advances in our understanding of the pathophysiological mechanisms of DME have enabled effective new therapies such as anti-VEGF’s,which are however associated with non-negligible side effects.The discovery of endothelium-specific protective targets that could restore retinal endothelial quiescence could provide a therapeutic alternative.Signaling mediated by BMP9 circulating protein via its endothelium-specific receptor ALK1,is known for its role in the maintenance of vascular quiescence.However,its ability to protect the endothelium and prevent vascular permeability has not been tested in the context of diabetes.Methods:We investigated BMP9/ALK1 signalling pathway in the hyperglycemic endothelium and its effect on retinal permeability in a type 1 diabetes mouse model.Hyperglycemic endothelial cells and tissue were extracted to evaluate BMP9/ALK1 signaling.BMP9 overexpression was achieved using adenoviral vectors.Retinal permeability was measured using miles assay.Results:We found that BMP9/ALK1 signaling was inhibited in hyperglycemic endothelial cells and blood vessels of diabetic(DB)mice,and that this loss of function was directly associated with retinal hyperpermeability.Molecularly,inhibition of this pathway triggers the activation of the VEGFR2/SRC pathway reducing interendothelial adhesion junctions.Conversely,the activation of ALK1 by sustained BMP9 overexpression in DB mice enabled the restoration of physiological permeability by regulating the levels and localization of interendothelial junctions,in part by limiting the action of VEGF signalling.We also observed that BMP9 overexpression demonstrated a regulating effect of blood glucose levels in DB mice.Our results showed that BMP9 significantly ameliorates glucose control over a 4-week span in DB mice and that this regulation was mediated primarily via the ALK3 receptor inhibiting gluconeogenic gene expression and hepatic glucose production and hence hyperglycemia.Conclusions:Together,our data show that BMP9 acts on several levels to safeguard endothelial integrity preventing retinal hyperpermeability in DB mice.The effects are mediated by its endocrine effect by directly stabilizing the endothelial barrier through Alk1 and its hypoglycemic paracrine/autocrine action in the liver through Alk3.Thus,BMP9 could be used in the development of future therapeutic alternatives against several vascular diseases involving edematous complications.展开更多
文摘In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.
文摘Objective:To explore the value of cyclosporin eye drops in treating dry eye after cataract surgery.Methods:A total of 150 patients with dry eye after cataract surgery were randomly divided into group A(n=50),group B(n=50),and group C(n=50).Artificial tears combined with cyclosporin eye drops were used in group A,artificial tears were used in group B,and no dry eye medication was used in group C.The clinical efficacy,ocular surface function and tear inflammatory factor level before and after surgery were compared between the groups.Results:The total effective rate of group A was 96.00%,which was significantly higher than that of group B and group C(p<.05);three months after surgery,the levels of cornealfluorescein staining score(FL score),tear meniscus height(TMH)and tear inflammatory factors[interleukin 6(IL-6),interleukin 8(IL-8),tumor necrosis factorα(TNF-α)]in group A were lower than those in group B,and those indicators in group B were lower than those in group C,and the difference between the two groups was statistically significant(p<.05);three months after surgery,Schirmer test(SIT)and break-up time(BUT)in group A were higher than those in group B,and those indicators in group B were higher than those in group C,and the difference between the two groups was statistically significant(p<.05).Conclusions:The effect of cyclosporin eye drops in treating dry eye after cataract surgery is satisfactory,significantly improving the ocular surface function and reducing the level of tear inflammatory factors,which is worthy of promotion.
文摘We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha （IFN-α） treatment in eight hepatitis C virus （HCV）- infected patients. These events include three cases of Vogt-Koyanagi-Harada like （VKH） disease （an association of panuveitis, retinal detachment, ear and meningeal detachment and skin and hair changes）, two cases of central retinal vein occlusion, one case of central retinal artery occlusion, one case of severe hypertensive retinopathy and one case of bilateral ischemic optic neuropathy with severe visual impairment. Rare as they are, such severe ophthalmological complications require a close follow-up of HCV-infected patients under IFN-α breabnent with ophthalmological monitoring if any ocular manifestation occurs.
基金Supported by Natural Science Foundation Grant from Jiangxi Science and Technology Department (No.20192BAB205049)Young Talent Scholar Grant (No.2016KJXX-12)from Shaanxi Science and Technology Department, Teaching Reform Grant (No.JC2020-0309,No.JG20190330)。
文摘AIM: To analyze whether wet-lab training(WLT) or surgical-simulator training(SST) is better for ophthalmology residents to master the chopping technique.METHODS: Sixty ophthalmology residents(in their second year) and three cataract surgeons participated in the study. The residents were randomly separated into two groups, WLT group and SST group. The residents in WLT group were asked to perform 10 trials of chopping using pig eyes and scored by the surgeons, and then they performed and scored using simulator for one time. The residents in SST group underwent 10 trials of chopping using simulator, and the simulator scored each trail. Then, this group were asked to perform the chopping using pig eyes and scored by the surgeons. At last, we investigated the residents’ satisfaction about the training.RESULTS: The demographic characteristics had no significant differences between the two groups. Recorded by the simulator, the residents in SST group got significantly higher overall score(83.90±1.31) than WLT group(78.73±1.92, P=0.03). And the residents in SST group got less corner area injured, and they spend less time than WLT group(P<0.05). Moreover, the residents in WLT group used more ultrasonic energy value than SST group(P=0.03). However, scored by the surgeons, the residents in two groups got nearly the same overall score. The residents in WLT group performed better on the frequencies of posterior capsule torn and incisional stress(P=0.03, 0.008, respectively). In the survey, the residents in two groups held the same opinion that the training was helpful and they strongly recommended this training. And all of them enjoyed the training, and enjoyed being randomized in their own group. However, with respect to the realistic character, the residents thought that WLT was better than SST(P<0.001).CONCLUSION: Both of the Eyesi surgical-stimulator and the wet-lab improve the residents’ chopping ability and each has its own advantages. The combination of the two training ways could be considered to be a part of the training curriculum for new residents.
文摘BACKGROUND Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients.By focusing on what students should be able to perform one day as clinicians,we can bridge the gap between mere theoretical knowledge and its practical application.Gender aspects in clinical medicine also have to be considered when speaking of personalized medicine and learning curricula.AIM To determine sets of intellectual,personal,social,and emotional abilities that comprise core qualifications in medicine for performing well in anamnesis-taking,in order to identify training needs.METHODS An analysis of training clinicians’conceptions with respect to optimal medical history taking was performed.The chosen study design also aimed to assess gender effects.Structured interviews with supervising clinicians were carried out in a descriptive study at the Medical University of Vienna.Results were analyzed by conducting a qualitative computer-assisted content analysis of the interviews.Inductive category formation was applied.The main questions posed to the supervisors dealt with(1)Observed competencies of students in medical history taking;and(2)The supervisor’s own conceptions of"ideal medical history taking".RESULTS A total of 33 training clinicians(n=33),engaged in supervising medical students according to the MedUni Vienna’s curriculum standards,agreed to be enrolled in the study and met inclusion criteria.The qualitative content analysis revealed the following themes relevant to taking an anamnesis:(1)Knowledge;(2)Soft skills(relationship-building abilities,trust,and attitude);(3)Methodical skills(structuring,precision,and completeness of information gathering);and(4)Environmental/contextual factors(language barrier,time pressure,interruptions).Overall,health care professionals consider empathy and attitude as critical features concerning the quality of medical history taking.When looking at physicians’theoretical conceptions,more general practitioners and psychiatrists mentioned attitude and empathy in the context of"ideal medical history taking",with a higher percentage of females.With respect to observations of students’history taking,a positive impact from attitude and empathy was mainly described by male health care professionals,whereas no predominance of specialty was found.Representatives of general medicine and internal medicine,when observing medical students,more often emphasized a negative impact on history taking when students lacked attitude or showed non-empathetic behavior;no gender-specific difference was detected for this finding.CONCLUSION The analysis reveals that for clinicians engaged in medical student education,only a combination of skills,including adequate knowledge and methodical implementations,is supposed to guarantee acceptable performance.This study’s findings support the importance of concepts like relationship building,attitude,and empathy.However,there may be contextual factors in play as well,and transference of theoretical concepts into the clinical setting might prove challenging.
基金Cumhuriyet University Scientific Research Project Foundation
文摘AIM:To investigate the side effects of the commonly used laser treatment along with testing the neuroprotective effect of bFGF on a potential retinal impairment.METHODS:To do this,30 chinchilla pigmented adult male rabbits were divided into the control and experimental groups.The control and experimental groups underwent both laser application and bFGF treatment.The retinal tissue impairment and its renewal rate were tested under the light and electron microscopical levels.RESULTS:The focal laser application on rabbit eyes caused morphological alterations both in the application region and in the neighbouring areas.In the damaged areas,the outer nuclear layer of the neural retina was almost disappeared,retina pigment epithelium was interrupted,the retina pigment epithelium migrated intraretinally,and the damaged region along with neighbouring areas seemed to be not separated.bFGF application just after the laser photocoagulation,revealed better results in application areas.CONCLUSION:It could be suggested that the bFGF application following laser photocoagulation might have protective,repairing and wound healing effects on the retina.
基金Supported by The National Natural Science Foundation of China,No.81570866the Outstanding Doctor Foundation of China Medical University,No.M0554.
文摘BACKGROUND Esophageal cancer(ESCA)is a heterogeneous cancer with variable outcomes that are challenging to predict.MicroRNA(miR)-1269a is a newly discovered noncoding RNA that shows promising prognostic prediction in other cancers,but its clinical value in ESCA remains unclear.AIM To explore the relationship between miR-1269a and its clinical value and to develop a nomogram to succinctly display this relationship.METHODS We analyzed the expression of miR-1269a in 125 ESCA tissue samples with complete clinical data and 52 normal tissue samples.We determined the prognostic value of miR-1269a for overall survival(OS)and cancer-specific survival(CSS)and evaluated the association between miR-1269a and clinical variables including tumor location,histologic grade,metastatic stage,and American Joint Committee on Cancer(AJCC)stage using multivariate Cox analysis.Additionally,we developed a nomogram for OS and CSS based on miR-1269a expression using age and AJCC stage and assessed its prognostic performance.Using Gene Ontology and Kyoto Encyclopedia of Gene and Genomes analyses,we predicted the target genes of miR-1269a and analyzed their potential function in caner development.RESULTS The expression of miR-1269a was significantly higher in ESCA patients than healthy controls.Patients with high expression of miR-1269a showed poor prognosis in OS and CSS,suffered increased rates of low differentiation and metastasis,and exhibited tumor stage T3+T4,positive lymph stage,and AJCC stage III+IV.The area under the receiver operating characteristic curve of miR-1269a was 0.716 for OS and 0.764 for CSS.Multivariate Cox analysis revealed that AJCC stage and miR-1269a were independent factors for OS and CSS.Combing with age,we constructed a nomogram for prognostic prediction.Additionally,our nomogram showed excellent predictive performance for OS and CSS after 3 years and 5 years and was easy to use.Ultimately,the functional analysis suggested that miR-1269a was mostly involved in the PI3K-AKT signaling pathway.CONCLUSION miR-1269a can be used as a potential indicator for the prognosis of ESCA patients.We developed an easy-to-use nomogram with excellent ESCA prognostic prediction for clinical use.
文摘AIMTo evaluate the effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.
文摘· AIM: To evaluate and compare the efficacy and stability of intrastromal corneal ring segment(ICRs)implantation with cross-linking(CXL) using different sequence and timing.· METHODS: In this single retrospective study, 86 keratoconic eyes subjected the ICRs implantation. We analyzed only 41 eyes that had complete follow-ups.They were divided into three groups: ICRs implantation was applied only(group normal), ICRs first followed by CXL immediately(group CXL-S), CXL first followed by ICRs long after(group CXL-B). The visual acuity,refractive results, keratometry were compared preoperatively and 1y postoperatively. Their differences among the three groups were also analyzed.·RESULTS: Group normal comprised 25 eyes, group CXL-S 8 eyes, and group CXL-B 8 eyes. There were improvements in the mean uncorrected distance visual acuity(UDVA) and the mean corrected distance visual acuity(CDVA) compared preoperatively and 1y postoperatively [UDVA: 0.31(P =0.030) logarithmic minimum angle of resolution(log MAR) group normal, 0.4(P =0.020) group CXL-S, 0.45(P =0.001) group CXL-B;CDVA : 0. 21 log MAR( P = 0. 013) group normal, 0. 30(P =0.036) group CXL-S; 0.26(P =0.000) group CXL-B].The refractive and topographic outcomes also showed improvements. In terms of comparisons among the three groups, all the P values were above 0.05, showing no significant difference. But only group CXL-B had improvement in UDVA and CDVA for all the patients.·CONCLUSION: With safety and good visual outcomes,ICRs implantation is a viable alternative for keratoconus.No significant difference was found among these three groups.
文摘BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.
文摘Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patients with first attack of active ocular toxoplasmosis. Age,gender,clinical presentation and ophthalmic examination finding were recorded.The diagnosis was based on typical finding in ophthalmic examination.Systemic antimicrobials and corticosteroids were given to all patients.The treatment outcome and side-effects of drugs were observed.Results:Thirteen(52%) patients were male and 12(48%) were female.The mean±SD age at presentation was(26.8±11.1) years.Eye involvement was unilateral in 92% of patients and bilateral only in 8%.Lesions were located at the peripheral retina in 48%,at the macula retina in 28%,and at the macula and peripheral retina in 24%of the patients.The most common presenting symptom was blurred vision(96%),followed by eye pain(28%).All patients received antimicrobials treatment.Systemic corticosteroids were used in 48%of the patients. Clinical response were observed in 44%2 weeks before and in 56%2 weeks after.Vision was improved with treatment except in two cases.No recurrences occurred during one year follow up.Conclusions:Our study shows that active ocular toxoplasmosis has no gender predilection and affects young individuals.Unilateral involvement is more common in our study.Response to treatment is good in patients and no recurrences occur during one year follow-up.It may have implications in favor of treatment of active ocular toxoplasmosis.
文摘Background: In pseudoexfoliative syndrome (PEX), extraocular accumulation is associated with cardiovascular morbidity and mortality. The aim of this study was to investigate the effect of exercise test on corrected QT dispersion (QTcd) and QTcd recovery in PEX. Patients and Methods: A total of 37 patients diagnosed as PEX were included in the study. The control group consisted of 38 patients. The Electrocardiographies (ECG) were taken. The patients were subjected to an exercise test. Results: In the study group, baseline, peak and third minute recovery QTcd values were 41.35 ± 7.27 ms, 65.19 ± 7.83 ms, and 53.61 ± 6.45 ms, respectively. In the control group, baseline, peak and third minute recovery QTcd values were 29.92 ± 4.23 ms, 38.31 ± 4.22 ms and 28.76 ± 3.09 ms, respectively. There was statistically significant?difference between the baseline and peak QTcd values of the study group and?the control group (t = 8.34224/p 0.00001, t = 18.55079/p 0.00001, respectively). In addition, while there was a statistically significant?difference between the baseline QTcd and the third minute recovery QTcd in the study group, there was no statistically significant difference between the baseline QTcd value and the third minute recovery QTcd value in the control group as heart rate recovery (t = 8.388558/p 0.00001, t = 1.967315/p = 0.056668, respectively).?Conclusion: All of them were found to have a higher risk in terms of malignant ventricular arrhythmia in the study group, both at rest and with effort, in a statistically significant way compared to the control group.
文摘Background:Sight-threatening diabetic macular edema(DME)is caused by increased microvascular permeability.While few direct vascular targeting strategies are available,VEGF pathway inhibition has shown to be effective in reducing retinal vascular leakage but is associated with non-negligible side effects.Thus,more options are needed.Vascular specific Activin-like kinase receptor type I(ALK1)pathway and its circulating ligand Bone morphogenetic protein-9(BMP9)is known for its potent quiescent and stabilizing effect on the vasculature.However,little is known about this pathway in the context of microvascular permeability associated with diabetes.We hypothesize that BMP9/ALK1 pathway is inhibited in diabetic(DB)retinas leading to vascular destabilization and leakage and that its activation could re-establish proper vascular endothelial barrier functions(EBF).Methods:The effect of hyperglycemia(i.e.,HG>10 mM of D-glucose)on Alk1 signaling was evaluated in vitro by subjecting endothelial cells(EC)to increasing concentrations of D-glucose(5,11,25 mM)and in vivo using DB mice(Streptozotocin-induced diabetes).The contribution of Alk1 signaling on EBF was evaluated using Evans Blue permeation in inducible endothelial specific Alk1 KO mice.To evaluate the potential protective effects of BMP9/Alk1 signaling on EBF,BMP9 overexpression was achieved using adenoviral delivery in DB mice.Statistical-One-Way ANOVA or Student’s t-test was used.Results:Endothelial tissue from DB mice showed a significant inhibition of BMP9/ALK1-canonical Smad1,5,8 quiescence signaling(DB n=5;CTL n=4;P<0.01),which was associated with reduced expression of target genes(JAG1,Id1,3,Hey1,2&HES).Moreover,we showed that retinal hyperpermeability associated with diabetes was exacerbated in Alk1 heterozygote mice(n=4-9/group;P<0.0001).Finally,we demonstrated that activation of Alk1 signaling in ECs prevented vascular permeability induced by HG,both in vitro(n=3;P=0.009)and in vivo(n=4-9/group;P<0.0001).Conclusions:Consistent with our hypothesis,vascular stability and quiescence induced by BMP9-ALK1 signaling is inhibited in the DB/HG endothelium which could be an important factor in vascular leakage leading to DME.Our results show that activation of this pathway could offer a therapeutically interesting future option to slow down the onset of DME.
文摘Behcet’s disease (BD) is a large vessel vasculitis with a wide range of clinical manifestations. Some of these manifestation may be life threatening and rapid suppression of the inflammation with effective immunosuppressive agent is crucial. There are traditional drugs with different response rates and all have efficacy on different manifestations of the disease. The most frightening manifestations of the disease are ocular, neurologic, intestinal and vascular types of involvement. Besides benign and easily treated manifestations there are also refractory cases with complicated involvement. The novel biologic agents have been used for these resistant patients and favorable response rates have been reported. In this review, we have shared our experience with biologic agents in BD and also reviewed the literature for the efficacy and safety for these novel agents for refractory patients.
文摘AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.
文摘·AIM: To investigate the retinal nerve fiber layer(RNFL)thickness changes in patients with obstructive sleep apnea syndrome(OSAS) for one year follow-up. To discuss the possibility of detecting tendency of glaucoma in this population by using spectral domain optical coherence tomography(3D-OCT-2000 Spectral domain).·METHODS: After polysomnographic study, all subjects(64 OSAS patients and 40 controls) underwent detailed ophthalmological examination. After these examinations,patients with glaucoma and patients who had ophthalmological and/or systemic disease were excluded from the study.Totally, 20 patients in OSAS group and five patients in controls were excluded from the study in the first examination and follow-up period. The RNFL thickness was assessed with OCT. Forty-four OSAS patients and 35 control subjects were followed up for12 mo. RNFL thickness change and OSAS patients were evaluated for severity of disease by Apnea-Hypopnea Index(AHI).·RESULTS: Forty-four OSAS patients and 35 controls were enrolled in the study. Statistically significance was found between OSAS patients and controls at the 12 thmo.Average RNFL thickness was found to be significantly lower in last measurements in OSAS patients when compared with first measurements and control subjects(P 【0.001, 0.002, respectively). There was a statistically significant correlation among AHI, and RNFL thickness(P 【0.05).·CONCLUSION: The results suggest that the patients with OSAS were related with a proportional decrease in the RNFL thickness. These patients should be followed up regularly for glaucomatous changes. Detecting more RNFL thinning in severe OSAS was important.
文摘Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms： atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d＇orange finding in the fundus; thinning of the retinal nerve fiber in OCT （optic coherence tomography）; bilateral and reticular papillary lesions with yellowish- color in the neck region （plucked chicken appearance）; presence of bleeding loci in fundus, and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticum diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticum cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling.
文摘Background:Understanding the neurophysiological mechanisms of Amblyopia,a neurodevelopmental disorder of the visual cortex,will bring us closer to full recovery.Past findings have been contradictory.Results have shown that despite having severe acuity impairment,amblyopes can nonetheless perceive sharp edges.In this study,we explore the representation of blur through a series of image blur-discrimination and matching tasks,to understand more about the amblyopes’visual system.Methods:Monocular image blur-discrimination thresholds were measured in a spatial two-alternative forced-choice procedure whereby subjects had to decide which image was the blurriest.Subjects also had to interocularly match pictures that were identical to those used for the image blur discrimination task.Ten amblyopes,as well as a group of ten controls were under study.Results:Data on amblyopes and controls will be presented for both experiments.According to previous research that was done on blur-edge discrimination and matching,we predict that subjects’performance will follow a dipper function,that is,all observers will be better at discriminating between both images when a small amount of blur is applied rather than when the image is either sharp or very blurry.We also predict that amblyopes’blur discrimination will be noisier,but that they will paradoxically be able to match the sharpness of the images presented in the matching task.Conclusions:This would confirm our hypothesis about amblyopes’visual system,that they can represent blur levels defined by spatial frequencies that are beyond their resolution limit,and would also raise interesting questions about the visual system in general regarding the different perceptions driven by images versus edges.
文摘Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herpes zoster is a reactivation of the virus. It often occurs in immunocompromised situations such as AIDS. Several localizations can be observed in herpes zoster. Disseminated lesions are rarely described. Authors report a case of ophthalmic and generalized (or disseminated) herpes zoster in an immunocompetent child. No history of previous varicella and no particular medical background or family tare was found. However, maternal varicella when pregnant of our patient was reported. The patient had good nutritional status and no cause of immunosuppression. Immediate evolution was favorable for our patient, but the possibility of long-term complications of herpes zoster ophthalmicus should make consider the advisability of vaccination against varicella-zoster virus in children.
文摘Background:The maintenance of a quiescent retinal vascular endothelial barrier is paramount for tissue supply and homeostasis to ensure visual function.Chronic hyperglycemia in diabetes causes structural and functional alterations of the endothelium that are accelerated by the production of several mediators such as VEGF.The disturbance of interendothelial junction stability leading to retinal hyperpermeability is one of the changes leading to diabetic macular edema(DME)that can occur at any stage of diabetic retinopathy.Advances in our understanding of the pathophysiological mechanisms of DME have enabled effective new therapies such as anti-VEGF’s,which are however associated with non-negligible side effects.The discovery of endothelium-specific protective targets that could restore retinal endothelial quiescence could provide a therapeutic alternative.Signaling mediated by BMP9 circulating protein via its endothelium-specific receptor ALK1,is known for its role in the maintenance of vascular quiescence.However,its ability to protect the endothelium and prevent vascular permeability has not been tested in the context of diabetes.Methods:We investigated BMP9/ALK1 signalling pathway in the hyperglycemic endothelium and its effect on retinal permeability in a type 1 diabetes mouse model.Hyperglycemic endothelial cells and tissue were extracted to evaluate BMP9/ALK1 signaling.BMP9 overexpression was achieved using adenoviral vectors.Retinal permeability was measured using miles assay.Results:We found that BMP9/ALK1 signaling was inhibited in hyperglycemic endothelial cells and blood vessels of diabetic(DB)mice,and that this loss of function was directly associated with retinal hyperpermeability.Molecularly,inhibition of this pathway triggers the activation of the VEGFR2/SRC pathway reducing interendothelial adhesion junctions.Conversely,the activation of ALK1 by sustained BMP9 overexpression in DB mice enabled the restoration of physiological permeability by regulating the levels and localization of interendothelial junctions,in part by limiting the action of VEGF signalling.We also observed that BMP9 overexpression demonstrated a regulating effect of blood glucose levels in DB mice.Our results showed that BMP9 significantly ameliorates glucose control over a 4-week span in DB mice and that this regulation was mediated primarily via the ALK3 receptor inhibiting gluconeogenic gene expression and hepatic glucose production and hence hyperglycemia.Conclusions:Together,our data show that BMP9 acts on several levels to safeguard endothelial integrity preventing retinal hyperpermeability in DB mice.The effects are mediated by its endocrine effect by directly stabilizing the endothelial barrier through Alk1 and its hypoglycemic paracrine/autocrine action in the liver through Alk3.Thus,BMP9 could be used in the development of future therapeutic alternatives against several vascular diseases involving edematous complications.
