Abstract:

Abstract:

Abstract:

Abstract:diabetic retinopathy; optical coherence tomography; multispectral imaging; anti-vascular endothelial growth factor

Abstract:Objective To investigate the efficacy and feasibility of dacryocystorhinostomy in treatment of chronic dacryocystitis in the elderly patients. Methods A total of 38 patients (38 eyes) with chronic dacryocystitis receiving dacryocystorhinostomy in our department from June 2012 to July 2014 were enrolled in this retrospective analysis. The patients were divided into 2 groups according to their age, that is, the senile group (mean age of 63 years) and the non-senile group (mean age of 44 years) with 19 cases (19 eyes) in each group. All the cases were followed up for 3?18 months, and the clinical outcomes were compared between the 2 groups. Results In the senile group, 15 cases were cured (78.9%), 3 improved (15.8%) and 1 case invalid (5.3%), and the effective rate was 94.7%. While for the non-senile group, 14 cases were cured (73.7%), 3 improved (15.8%) and 2 cases invalid (10.5%), and the effective rate was 89.5%. There was no significant difference in clinical efficacy between the 2 groups (P＞0.05). No serious complication occurred in either group. Conclusion Given sufficient safety assessment before operation, dacryocystorhinostomy is a feasible and effective surgery for chronic dacryocystitis in senile patients.

Abstract:Objective To evaluate the therapeutic effect of panretinal photocoagulation (PRP) in the treatment of ischemic central retinal vein occlusion (CRVO) at different stages. Methods From June 2011 to April 2014, all the patients with ischemic CRVO diagnosed in our department by visual function, slit-lamp biomicroscopy, funduscopy under dilated pupil and fluorescein angiography were recruited in this study. Before PRP, the cohort was divided into 2 groups according to the existence of iris neovascularization (INV), that is, group A (34 eyes without INV) and group B (7 eyes with INV). All patients received standard PRP treatment in a period of 2 to 3 weeks, and the additional laser treatments were given during the follow-up period based on the results of fundus fluorescein angiography (FFA) or clinical manifestations. They were followed up for 6 months to 3 years [(19.3±8.5) months]. The incidence of severe complications and the times of laser treatment were observed and compared between the 2 groups. Results There was no statistical difference in the term of age of onset between the 2 groups (P＞0.05). When PRP finished, the times of laser treatment and the total number of laser spots needed were significantly greater in group B than those in group A (P＜0.05). The incidence of neovascular glaucoma (NVG) was obviously higher in group B (P＜0.05), but there was no statistical difference in vitreous hemorrhage (VH) between the 2 groups (P＞0.05). No significant difference was found in the visual acuity before and after treatment in both groups (P＞0.05). Conclusion For ischemic CRVO, the incidence of severe complications is relatively low, and the times of laser treatment and the total number of laser spots are also less when PRP is performed before the occurrence of INV.

Abstract:Objective To determine the clinical efficacy of lacrimal endoscope in the obstruction of lacrimal canaliculi. Methods Totally 24 aged patients (mean age 65 years, 24 eyes) with lacrimal canaliculi obstruction in our department from March 2014 were subjected in this study. After the lacrimal endoscope was inserted into the lacrimal canaliculi to explore the blockage, the block organization was removed with the help of 980 laser to make the lacrimal duct unobstructed. Then a silicone tube was placed and fixed in the lacrimal canaliculi. Results The cohort was followed up for 3 months after the silicone tube intubation with lacrimal endoscopy. There were 18 cases succeeded with unobstructed lacrimal duct, and the other 6 cases failed. Conclusion Lacrimal duct endoscopy is helpful to directly find the blockage, and 980 laser makes minimal damage and restores the physiological structure of lacrimal canaliculi with mild postoperative impairment. Combined with silicone tube intubation, this treatment is ideal in treatment of the obstruction of lacrimal canaliculi.

Abstract:Objective To explore the clinical features of astigmatism in senile cataract patients before operation, and investigate the associated factors, such as age, eye axis, and central corneal thickness. Methods A total of 498 patients diagnosed as senile cataract in our department from October 2013 to October 2014 were recruited in this study. Before operation, their corneal astigmatism was observed, and the correlation of cataract with other factors such as age, eye axis, and central corneal thickness were analyzed. Results The cohort of patients had a mean age of (72.19±9.98) years and a mean corneal astigmatism value of (1.13±0.84)D. There were 152 eyes (30.52%) having the rule astigmatism, 249 eyes (50.00%) the inverse astigmatism, and 97 eyes (19.48%) oblique astigmatism. The age was positively correlated with the changes in ocular axial length. Conclusion In the patients with age-related cataract, the prevalence of preoperative corneal astigmatism is quite high, mainly from mild to moderate astigmatism. With the increasing in age, the proportion of inverse astigmatism is increased gradually, with a tendency of shorter axial length and increased astigmatism, especially in the patients over 80 years old. Young patients with cataract commonly have myopia.

Abstract:Objective To investigate the distribution of the elderly ocular surface tumors in the eyelid and conjunctiva, determine the characteristics of age distribution, and summarize the clinical features of the elderly ocular surface tumors. Methods A retrospective analysis was carried out on 46 cases of the elderly ocular surface tumors hospitalized in our department from December 2013 to September 2014 based on the clinical and pathological data. Results In 46 cases of the elderly ocular surface tumors, there were 25 males (54.35%) and 21 females (45.65%), with a non-significant ratio of male to female. There were 9 cases (19.57%) with malignant tumors or tumors having malignant tendency, and 37 cases of benign tumors (80.43%). Among the 39 cases of eyelid tumors (84.78%), 7 cases were malignant (17.95%) and 32 cases benign (82.05%). Seven cases had conjunctival tumors (15.22%), including 2 cases with malignant tendency or malignant tumors (28.57%) and 5 cases with benign tumors (71.43%). For the distribution of age, there were 26 cases (56.52%) at an age of 55 to 64, 14 cases (30.43%) at 65 to 74, 5 cases (10.87%) at 75 to 84, and only 1 case (2.17%) older than 85 years old. Conclusion The elderly ocular surface tumors are more commonly located in the eyelid, with malignant rate accounting for about 20%. So routine pathological examination should be required.

Abstract:

Abstract:With the population aging, the prevalence of diabetes mellitus is increasing progressively in China. Diabetic retinopathy (DR) is its common complication with high incidence and has become a leading cause of blindness. Currently, DR has no specific treatment, so early detection and diagnosis are of great important significances. Direct and indirect ophthalmoscopy, fundus photography, optical coherence tomography and fundus fluorescence angiography are commonly used in DR diagnosis, and play important roles in its treatment and follow-up. Retinal health assessment, as a novel diagnostic and screening method, clearly presents the details in the various layers of retina through multiple spectrum information, and provides a new diagnostic approach of ocular fundus diseases.

Abstract:With population ageing and improvement of life quality, ocular neovascular disease, mainly manifesting as age-related macular degeneration and diabetic retinopathy, gradually becomes a major factor affecting the quality of life in the patients. Neovascularization is its main pathological manifestation. What’s more, the disease is characterized by its complicated causes, various mechanisms, and poor prognosis. In recent years, there are a variety of drugs and treatment methods emerged and improved, such as laser therapy, anti-VEGF drugs, and surgical treatment, which have provided more and better therapies to treat such diseases. This article reviewed the advances in the treatment of the ocular neovascular diseases.

Abstract:There are about 93 million patients with diabetic retinopathy (DR) all over the world. Among them, 17 million are proliferative DR, 21 million have diabetic macular edema (DME), and 28 million have a threat of vision loss. With aging, DME has become a main cause of vision loss in the patients suffering from diabetes mellitus. Though its pathogenesis is not clear yet, evidence shows that break-down of the inner and outer blood-retinal barrier might be involved in the incidence and development of DME. At present, the treating methods of DME include retinal laser photocoagulation, application of glucocorticoids, intravitreous injection of anti-vascular endothelial growth factor (VEGF), administration of inhibitor of protein kinase C, vitrectomy, etc. However, each method has its advantages and disadvantages. The combined treatment has a bright future for its fewer repetitions, higher efficacy and great safety. In this paper, we reviewed current research status and future development trends of DME treatment for the elderly.

Abstract:Objective To determine the effects of short-term continuous positive airway pressure (CPAP) therapy on obstructive sleep apnea hypopnea syndrome (OSAHS) in the senile and non-senile patients with coexisting hypertension. Methods A total of 100 inpatients suffering from OSAHS determined by polysomnography and hypertension admitted in our center from November 2012 to May 2013 were subjected in this study. They were divided into 2 groups according to their age over or under 60 years old, senile (n＝12) and non-senile groups (n＝88). Besides pre-existing antihypertensive medication, they were all given nocturnal CPAP therapy for 7 consecutive days (＞6h/night). Their daily blood pressure, pre- and post-treatment blood pressure, decrease of the pressure and ratio of those achieving target blood pressure goal were measured and calculated, and the results were compared before and after treatment, and between the 2 groups for the efficiency of CPAP therapy. Results (1) In the 7th day after treatment, the morning systolic blood pressure [mSBP, (135.0±13.2) vs (140.6±15.0)mmHg, P＜0.05, 1mmHg＝0.133kPa], morning diastolic blood pressure [mDBP, (86.3±9.3) vs (93.3±11.5)mmHg, P＜0.05], and morning mean blood pressure [(102.6±9.8) vs (109.1±11.7)mmHg, P＜0.05] were significantly reduced when compared with the values before treatment in non-senile group, and the decrease of morning mean blood pressure at day 7 was greater than at day 1 after CPAP treatment [(9.2±11.7) vs (5.0±10.7)mmHg, P＜0.05]. Whereas, no such difference was seen in the senile group (P＞0.05). (2) The ratios of achieving target mSBP (80.7% vs 45.5%, P＜0.05) and mDBP (80.7% vs 29.5%, P＜0.05) were obviously higher in the non-senile group at day 7 than before the treatment. But there was no significant difference in the senile group (P＞0.05). Conclusion Short-term CPAP therapy has better efficiency in non-senile than senile patients in the treatment of OSAHS with coexisting hypertension.

Abstract:Objective To investigate the correlation of single nucleotide polymorphism (SNP) of C-reactive protein(CRP) with hypertension induced by obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods A total of 300 male patients diagnosed as severe OSAHS by polysomnography in our department from January 2006 to December 2012 were enrolled in this study. One hundred and forty-five of them were identified having hypertension. Another 100 healthy males randomly sampled served as normal controls. SNPs of the promoter region of CRP rs3091244 and rs1205 were detected in those OSAHS patients with or without hypertension, and health individuals. Statistical analysis was performed to evaluate the correlation between SNP of CRP and OSAHS with or without hypertension. Results The frequency of CT genotype in CRP rs3091244 was significantly higher in the OSAHS patients with hypertension than those without (17% vs 7%), so was the frequency of T allele in rs3091244 (9% vs 3%). The frequency of CC genotype in CRP rs1205 was also higher in the OSAHS patients with hypertension than those without (25% vs 11%). Conclusion CRP SNP is correlated with hypertension in the OSAHS patients. The CT genotype of CRP rs3091244 and the CC genotype of rs1205 may cause chronic inflammation and promote the occurrence of hypertension through enhancing serum CRP level.

Abstract:Objective To investigate the correlation of lower extremities peripheral arterial disease (PAD) and heart rate variability (HRV) in the elderly patients (over 60 years) with type 2 diabetes mellitus (T2DM). Methods A total of 128 T2DM patients admitted to our hospital from June 2012 to July 2014 were included in this study. All subjects were divided into 2 groups according to having PAD or not [ankle brachial index (ABI)＜0.9 defined as PAD]. Their body mass index (BMI), blood pressure, serum lipids, peripheral neuropathy, urinary albumin excretion rate (UAER), ABI and HRV were measured and analyzed. Results In the 128 T2DM patients, there were 90 patients having no PDA and 38 having. Those with PAD had older age, longer diabetes duration, higher UAER, higher incidence of hypertension, and higher levels of HbA1c and triglycerides (TG) than the patients without PAD (P＜0.05). And they had lower HRV indices, including those in time domain, such as, the standard deviation of the R-R intervals (SDNN), mean of the standard deviation of the R-R intervals calculated in 5-min segments (SDNN-index) and the standard deviation of the averages of R-R intervals (SDANN), and those infrequency domain, high-frequency activity and low-frequency activity, for example. After adjustment for age, diabetes duration, UAER, levels of HbA1c and TG, and incidence of hypertension, HRV indices were negatively correlated with the severity of PAD. Conclusion In the cohort of the elderly T2DM patients, those with PAD have lower HRV indices than those without, suggesting a dysfunction of cardiovascular autonomic regulation.

Abstract:Objective To investigate the pathological features of primary bile reflux gastritis (BRG) in the elderly. Methods Clinical data of 77 elderly patients with primary BRG diagnosed by endoscopy (observation group) and another 78 elderly patients suffering from chronic gastritis by Helicobacter pylori (Hp) infection but not with bile reflux (control group) admitted in our hospital from January 2013 to August 2014 were collected and retrospectively analyzed. The pathological changes in the gastric mucosa tissue were observed and compared between the 2 groups. Results The Hp infection rate was 19.5% in the primary BRG patients. The rates of mild, moderate and severe gastritis were 32.5% vs 11.5%, 58.4% vs 34.6% and 9.1% vs 53.8% in the observation group and the control groups respectively. Neutrophils infiltrating classification (no, mild, moderate and severe) were 83.1% vs 41.0%, 11.7% vs 20.5%, 5.2% vs 32.1% and 0.0% vs 6.4% respectively for the 2 groups. The detection rates of lymphoid follicles, intestinal metaplasia and gastric mucosal atrophy were 4.3% vs 26.9%, 5.2% vs 17.9% and 6.5% vs 25.6%, respectively between them. What’s more, between the Hp-positive and Hp-negative patients from the observation group, the ratios of mild, moderate and severe inflammation were 13.3% vs 37.1%, 53.3% vs 59.7% and 33.3% vs 3.2% respectively, the ratios of no, mild, moderate and severe infiltration of neutrophils were 53.3% vs 41.0%, 20.0% vs 9.7%, 20.0% vs 0.0% and 6.7% vs 0.0%, respectively, and the rates of lymphoid follicles, intestinal metaplasia and gastric grand atrophy were 53.3% vs 4.8%, 0.0% vs 6.5% and 0.0% vs 8.1%, respectively. Conclusion Primary bile reflux results in chronic inflammation in gastric mucosa, intestinal metaplasia, and gland atrophy in the elderly patients. But the incidence of BRG is lower than that of chronic gastritis due to Hp infection. Neutrophils infiltration and lymph follicles formation are mainly associated with Hp infection. However, for the patients with primary BRG, Hp infection does not increase the risks of mucosal atrophy and intestinal metaplasia.

Abstract:Objective To compare the distribution of bacterial strains and sensitivity to antimicrobial agents in cultured sputum from the senile dementia patients with community-acquired pneumonia (CAP) and with hospital acquired pneumonia (HAP) in order to provide a reference for clinical diagnosis and treatment. Methods A total of 132 senile dementia patients with pneumonia admitted in our hospital from July 2012 to December 2013 were enrolled in this study. Fifty-three of them suffered from CAP and the rest 79 from HAP. After their sputa were collected, the specimens were immediately inspected and cultured for microbial strains detection. The distribution of the obtained bacterial strains and sensitivity to antimicrobial agents were analyzed. The differences in pathogens, treatment and prognosis were compared between the 2 groups. Results The percentage of the patients suffering from CAP was 40.2% while that of those from HAP was 59.8%. The top 3 strains were Streptococcus pneumoniae (SPN), Staphylococcus aureus (SAU) and Haemophilus influenzae (HIN) for the dementia patients with CAP, and SAU, Pseudomonas aeruginosa (PAE) and Klebsiella pneumoniae (KPN) for those with HAP. In terms of antibiotic sensitivity, the most effective antibiotics against PAE were amikacin and aztreonam, those against KPN were piperacillin/tazobactam and imipenem, and those against SAU and SPN were vancomycin and linezolide. The condition was severer in the patients with HAP than those with CAP, and the incidences of complications and mortality were also higher in the former than the latter. Conclusion The patients of CAP group have no typical clinical manifestations, and most of them are hospitalized due to senile dementia’s symptoms, while those of HAP group are manifested with fever, attack of body function or consciousness. We should strengthen the clinical observation, improve the inspection rate of microbial cultures, and adjust the antimicrobials according to the results of susceptibility test to offer appropriate antibacterial treatment.

Abstract:Objective To investigate whether human umbilical cord mesenchymal stem cells (UC-MSC) and the cells with overexpression of hepatocyte nuclear factor 4α (HNF4α) can promote liver regeneration after subtotal hepatectomy in mice. Methods After human UC-MSC were isolated, cultured and identified, the cells were transfected with lentiviral vector LV-HNF4α. Then the cell supernatant was collected and cultured with L02 cells, and the L02 cell viability was detected by cell counting kit-8 (CCK8) assay. In the in vivo study, a total of 18 mice were randomly divided into 3 groups (n=6 for each group): normal saline (NS) group, MSC group and MSC-HNF4α group, and received an injection of NS, MSC and MSC-HNF4α (5×106/ml), respectively via tail vein in 2 h before the establishment of subtotal hepatectomy model (70%). In 48 h later, the expression of Ki67 in the liver tissues was detected by immunohistochemical assay, and the results were compared among 3 groups. Results UC-MSC was successfully isolated from human umbilical cord, and the UC-MSC with stable overexpression of HNF4α were established. In vitro study indicated that the L02 cells showed stronger proliferative ability when cocultured with MSC and MSC-HNF4α than cultured alone (P＜0.01), and those cocultured with MSC-HNF4α stronger than the cells with MSC (P＜0.05). In vivo study showed similar findings: the expression of Ki67 was stronger in the mice treated with MSC or MSC-HNF4α than those with NS (P＜0.01), and also overexpression of HNF4α resulted in more significant expression of Ki67 (P＜0.05). Conclusion Both MSC and MSC-HNF4α secret some cytokines to promote liver regeneration.

Abstract:Objective To establish a rat model of type 2 diabetes mellitus (T2DM) following by gastric bypass (GBP) surgery, and then determine the effect of GBP on the expression of glycometabolism-related factors in the liver. Methods Twelve 6-week-old SD rats were randomly divided into normal chow diet group (NCD, n＝4) and high-fat diet group (HFD, n＝8). In 4 weeks after high-fat diet, the rats of the latter group were injected with streptozocin (STZ) intraperitoneally to induce T2DM model. Body mass and blood glucose were measured, oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were carried out in the NCD and HFD groups, and the results were compared between them. In 2 weeks later, 4 rats of the HFD group underwent GBP surgery and named as HFD-GBP group. After another 2 weeks, body mass and blood glucose were measured again. The expression of farnesoid X receptor (FXR), phosphoenolpyruvate carboxykinase (PEPCK), glucose-6-phosphatase (G6Pase), glucose transporter 2 (GLUT-2) and fibroblast growth factor-21 (FGF-21) at mRNA and protein levels in the liver of the 3 groups of rats were detected by RT-PCR and Western blotting respectively. Results Compared with the HFD group, the HFD-GBP group had significantly decreased body mass and improved blood glucose (P＜0.05), obviously up-regulated FXR and GLUT2 at mRNA level (P＜0.05), and increased mRNA expression of PEPCK, G6Pase and FGF-21. The protein expression levels of FXR and PEPCK were significantly elevated in HFD and HFD-GBP groups than in the NCD group (P＜0.05). Conclusion GBP surgery effectively improves glucose metabolism in T2DM rats. FXR, PEPCK and GLUT2 may participate in the blood glucose regulation after the surgery.

Abstract:Vitamin D plays a vital role in the regulation of calcium and phosphate metabolism, and exerts essential effects on bone health. However, the wide-spread physiological roles of vitamin D and its metabolites are far beyond these well described effects in skeletal biology. Many physiological processes are directly or indirectly regulated by vitamin D. In recent years, more and more emphasis has been given to the roles of vitamin D in the other aspects besides bone metabolism and calcium homeostasis. Chronic obstructive pulmonary disease (COPD) is a progressive functional disorder in the respiratory system with high prevalence in the older population. Evidence shows there is a correlation between the severity of COPD and vitamin D deficiency. This article aims to update the knowledge about the association of vitamin D with COPD, as well as to assess the potential role of vitamin D supplements in treatment of the disease.