ObjectiveTo investigate the effects and mechanisms of G protein-coupled receptor 91 (GPR91) on blood-retinal barrier (BRB) in diabetic rats. MethodsA lentiviral vector of shRNA targeting rat GPR91 and scrambled shRNA were constructed. Healthy male Sprague-Dawley (SD) rats were selected in this study. The 60 rats were randomized into 4 groups and treated as follows:(1) control group (Group A, n=15), the rats received injections of an equal volume of 0.1% citrate buffer; (2) streptozocin (STZ) group (Group B, n=15), the rats received injections of STZ; (3) LV.shScrambled group (Group C, n=15), diabetic rats received an intravitreal injection of 1 μl 1×108 TU/ml scrambled shRNA lentiviral particles at 2 weeks after the induction of diabetes; (4) LV.shGPR91 group (Group D, n=15), diabetic rats received an intravitreal injection of 1 μl 1×108 TU/ml pGCSIL-GFP-shGPR91 lentiviral particles. At 12 weeks after intravitreal injection, immunohistochemistry and Western blot were used to assess the expression of GPR91, p-extracellular signal-regulated kinase(ERK)1/2, t-ERK1/2, p-Jun N-terminal kinase (JNK), t-JNK, p-p38 mitogen-activated protein kinase (MAPK) and t-p38 MAPK. Haematoxylin and eosin (HE) staining and Evans blue dye were used to assess the structure and function of the retinal vessel. Immunohistochemistry enzyme-linked immunosorbent assay (ELISA) was used to test the protein level of VEGF. ResultsImmunohistochemistry staining showed that GPR91 was predominantly localized to the cell bodies of the ganglion cell layer. Western blot showed that GPR91 expression in Group D decreased significantly compared with Group C (F=39.31, P < 0.01). HE staining showed that the retina tissue in Group B and C developed telangiectatic vessels in the inner layer of retina, while the telangiectatic vessels attenuated in Group D. It was also demonstrated in Evans blue dye that the microvascular leakage in Group D decreased by (33.8±4.11)% compared with Group C and there was significant difference (F=30.35, P < 0.05). The results of ELISA showed the VEGF secretion of Group B and C increased compared with Group A and the VEGF expression in Group D was significantly down regulated after silencing GPR91 gene (F=253.15, P < 0.05).The results of Western blot indicated that compared with Group A, the expressions of p-ERK1/2, p-JNK and p-p38 MAPK were significantly upregulated (q=6.38, 2.94, 3.45;P < 0.05). Meanwhile, the activation of ERK1/2 was inhibited by GPR91 shRNA and the difference was statistically significant (F=22.50, P < 0.05). ConclusionsThe intravitreal injection of GPR91 shRNA attenuated the leakage of BRB in diabetic rats. GPR91 regulated the VEGF release and the leakage of BRB possibly through the ERK1/2 signaling pathway.
Objective To review the clinical operation methods of abdominal incisional hernia. Methods Classification, operation method and fellow-up of 78 patients with abdominal incisional hernia were retrospectively analyzed. Results The average time of fellow-up was 26 months. Nineteen cases were repaired with simple suture with 3 cases (15.8%) recurrence, 57 cases were repaired with man-made material with 2 case （3.4%） recurrence. Conclusions Individual operation method should be chosen according to body condition, classification of the size of abdominal loss and abdominal hypertension. It is an effective method to repair the hernia of abdominal incision with man-made material.
目的 探讨比较色努式脊柱侧弯矫形器佩戴时间及功能锻炼对矫正治疗效果的影响。 方法 将2004年7月－20011年7月收治的126例脊柱侧弯患者，按自愿选择分为试验组和对照组，试验组佩戴色努式脊柱侧弯矫形器18～20 h，功能锻炼＞90 min；对照组佩戴侧弯矫形器23 h，功能锻炼30～60 min。对比两组患者治疗前后的Cobb角、顶椎偏离中线距离（AVT）、顶椎旋转度(AVR)、躯干位移（TS）、脊柱柔韧性及肺功能指标的改善。 结果 经X线检查测定，治疗后两组患者的Cobb角、AVT、AVR、TS均低于治疗前（P＜0.01），且试验组明显低于对照组（P＜0.01）。肺功能指标：试验组治疗后肺活量（VC)、第1秒钟用力呼气容积（FEV1）、用力肺活量（FVC）、肺总量（TLC），等均高于治疗前，残气量（RV）低于治疗前（P＜0.01），对照组治疗后VC、FEV1、FVC、TLC均低于治疗前，RV高于治疗前（P＜0.01），且试验组优于对照组（P＜0.01）。功能位Cobb角：两组患者的功能位主弯Cobb角、代偿弯Cobb角均低于治疗前（P＜0.01），且试验组明显低于对照组（P＜0.01）。 结论 色努式脊柱侧弯矫形器每天佩戴18～20 h，并结合适当的体操疗法，呼吸、肌力训练及麦肯基力学疗法，可使肺功能、腰背部肌力、脊柱柔韧性、身体的协调性、以及平衡能力得到改善，从而达到脊柱侧弯治疗的较好效果。
ObjectiveTo observe the center retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) in eyes with central retinal artery occlusion (CRAO) before and after treatment.MethodsA total of 34 patients (34 eyes) diagnosed with CRAO by fundus fluorescence angiography (FFA) were retrospectively analyzed. There were 18 males (18 eyes) and 16 females (16 eyes). The average age was (61.42±14.09) years. The mean onset time was (2.64±3.73) days. The mean hospitalization time was (11.92±4.95) days. The mean axial length (AL) was (23.53±2.04) mm. The best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus color photography, fundus fluorescein angiography, spectral domain optical coherence tomography (OCT) and AL measurement were performed. BCVA was converted to the logarithm of the minimum angle of resolution (logMAR). According to FFA, visual loss and the results of OCT, patients were divided into 3 groups: incomplete CRAO (15 eyes) , subtotal CRAO (8 eyes), total CRAO (11 eyes). SFCT and CRT in affected and the fellow eye were measured by OCT for enhanced deep imaging. Follow up lasted for 1 month after treatment, with an average follow-up of (34.71±6.82) days. The changes of SFCT, CRT, and BCVA before and after treatment were observed. The correlation between BCVA after treatment and pretreatment CRT was also analyzed.ResultsAfter 1 month of follow-up, the logMAR BCVA in incomplete group, subtotal group and total group were significantly higher than before treatment (t=3.74, 3.61, 3.26; P=0.004, 0.009, 0.017). Before treatment, the average CRT of the contralateral eyes in the total, subtotal and incomplete group were (215.00±19.85), (224.00±22.79), (214.00±8.21) μm, and the mean SFCT were (264.54±121.71), (266.50±58.17), (261.86±90.95) μm. The average CRT of the affected eyes were (353.18±60.26), (280.14±11.08), (266.63±19.65) μm, and the average SFCT were (233.72±111.35), (237.75±53.30), (259.86±98.14) mm. Compared with the fellow eyes, the average CRT in the 3 groups were thickened, and the difference were statistically significant (t=8.274, 3.694, 11.577; P＜0.001, 0.008, ＜0.001); the average SFCT in the total group was decreased, the difference was statistically significant (t=−2.138, P=0.048). The mean CRT among the 3 groups of eyes was statistically significant (F=12.02, P＜0.001). There was no significant difference in the average SFCT (F=0.178, P=0.838). After 1 month follow-up, the mean CRT in the total, subtotal and incomplete group were (231.18±49.28), (219.16±21.34), (217.86±24.98) μm, and the average SFCT were (239.81±109.57), (241.86±42.81), (260.57±91.67) μm. Compared with before treatment, the average CRT in the three groups of eyes were decreased, the difference were statistically significant (t=13.032, 3.711, 4.970; P＜0.001, 0.008, 0.003); the difference in mean SFCT were not statistically significant (t=−0.785, −0.202, −0.078; P=0.466, 0.845, 0.940). Correlation analysis showed that BCVA after treatment was positively correlated with pretreatment CRT (odds ratio=0.578, P=0.002).ConclusionCRAO resulted in CRT in the preliminary stage and became thinner after receiving treatments. There exists a positive correlation between visual outcome and CRT before receiving treatments.
ObjectiveTo compare the imaging characteristics and detection of various types of lesions in diabetic retinopathy (DR) with colorful laser scanning fundus imaging (MSLI) and traditional color fundus photography (CFP).MethodsProspective case series observational study. A total of 38 eyes of 38 patients with DR diagnosed by clinical examination were included in the study. Among them, 21 were male and 17 were female; the mean age was 62.6±11.2 years; the average duration of diabetes was 14.3±7.5 years. All the patients were performed CFP, MSLI, frequency domain optical coherence tomography (SD-OCT), fluorescein angiography (FFA) examination. Using the Helielberg Spectralis HRA+OCT MSLI inspection, one scan simultaneously obtained 488 nm blue reflection (BR), 515 nm green light reflection (GR), 820 nm infrared light reflection (IR), and multicolor image (MC). The detection of traditional CFP and MC on microaneurysm (MA), hard exudation (HEX), cotton plaque (CWS), intraretinal hemorrhage (IRH), intraretinal microvascular abnormality (IRMA), venous bead (VB), venous ring (VL), macular edema (DME), macular anterior membrane (MEM) and laser photocoagulation (LB) were comparatively observed. The results of FFA examination were used as the diagnostic criteria for lesions. SD-OCT was used to determine the location and depth of lesions and the diagnostic reference for DME and MEM.ResultsThe numbers of eyes with MA (χ2=10.460), DME (χ2=4.006), MEM (χ2=4.444) was significantly higher in MC than that of traditional CFP. But the number of eyes with IRH (χ2=0.103), CWS (χ2=1.515), HEX (χ2=0.227), IRMA (χ2=0.051), VB (χ2=0.001), VL (χ2=0.149), VH (χ2=0.693) and LB (χ2=0.720) were not statistically significant between two methods (P>0.05). The imaging quality of MSLI mode is obviously better than that of traditional CFP. Among them, GR imaging shows the best structural changes of superficial retina in MA, CWS, HEX, MEM, etc. IR imaging shows clear depth in deep retina such as LB. DME was green on MC and the weak low-reflection dark area was visible on the IR image, which were consistent with the DME range indicated by the SD-OCT examination.ConclusionsCompared with the traditional CFP, the MSLI can clearly show the DR lesion. The number of checkouts is high on MA, DME and MEM by MC image.