●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:T...●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.展开更多
BACKGROUND Central sensitization plays a pivotal role in the maintenance of chronic pain induced by chronic pancreatitis(CP).We hypothesized that the nucleus tractus solitarius(NTS),a primary central site that integra...BACKGROUND Central sensitization plays a pivotal role in the maintenance of chronic pain induced by chronic pancreatitis(CP).We hypothesized that the nucleus tractus solitarius(NTS),a primary central site that integrates pancreatic afferents apart from the thoracic spinal dorsal horn,plays a key role in the pathogenesis of visceral hypersensitivity in a rat model of CP.AIM To investigate the role of the NTS in the visceral hypersensitivity induced by chronic pancreatitis.METHODS CP was induced by the intraductal injection of trinitrobenzene sulfonic acid(TNBS)in rats.Pancreatic hyperalgesia was assessed by referred somatic pain via von Frey filament assay.Neural activation of the NTS was indicated by immunohistochemical staining for Fos.Basic synaptic transmission within the NTS was assessed by electrophysiological recordings.Expression of vesicular glutamate transporters(VGluTs),N-methyl-D-aspartate receptor subtype 2B(NR2B),andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor subtype 1(GluR1)was analyzed by immunoblotting.Membrane insertion of NR2B and GluR1 was evaluated by electron microscopy.The regulatory role of the NTS in visceral hypersensitivity was detected via pharmacological approach and chemogenetics in CP rats.RESULTS TNBS treatment significantly increased the number of Fos-expressing neurons within the caudal NTS.The excitatory synaptic transmission was substantially potentiated within the caudal NTS in CP rats(frequency:5.87±1.12 Hz in CP rats vs 2.55±0.44 Hz in sham rats,P<0.01;amplitude:19.60±1.39 pA in CP rats vs 14.71±1.07 pA in sham rats;P<0.01).CP rats showed upregulated expression of VGluT2,and increased phosphorylation and postsynaptic trafficking of NR2B and GluR1 within the caudal NTS.Blocking excitatory synaptic transmission via the AMPAR antagonist CNQX and the NMDAR antagonist AP-5 microinjection reversed visceral hypersensitivity in CP rats(abdominal withdraw threshold:7.00±1.02 g in CNQX group,8.00±0.81 g in AP-5 group and 1.10±0.27 g in saline group,P<0.001).Inhibiting the excitability of NTS neurons via chemogenetics also significantly attenuated pancreatic hyperalgesia(abdominal withdraw threshold:13.67±2.55 g in Gi group,2.00±1.37 g in Gq group,and 2.36±0.67 g in mCherry group,P<0.01).CONCLUSION Our findings suggest that enhanced excitatory transmission within the caudal NTS contributes to pancreatic pain and emphasize the NTS as a pivotal hub for the processing of pancreatic afferents,which provide novel insights into the central sensitization of painful CP.展开更多
AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related ...AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis.RESULTS:Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes:interleukin(IL)-10, IL-12, IL-15, IL-21, IL-6, chemokine(C-C motif) ligand 20, and tumor necrosis factor alpha(TNF-α). IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12(P=0.036), IL-15(P=0.001), IL-6(P=0.012), and IL-27(only detectable in APAC eyes). Age was positively correlated with IL-12(P=0.022) and IL-6(P=0.037), and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15(P=0.037), IL-27(P=0.040), and TNF-α(P=0.042).CONCLUSION:Several proinflammatory cytokines including IL-12,IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.展开更多
文摘●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.
基金Supported by National Natural Science Foundation of China,No.81620108008Major Research and Development Project of Hainan Province,No.2018153 to Yun-Qing LiTraining Program for Scientific Research Scholars of Fujian Provincial Health and Family Planning Commission,No.2018-ZQN-74 to Ying-Biao Chen
文摘BACKGROUND Central sensitization plays a pivotal role in the maintenance of chronic pain induced by chronic pancreatitis(CP).We hypothesized that the nucleus tractus solitarius(NTS),a primary central site that integrates pancreatic afferents apart from the thoracic spinal dorsal horn,plays a key role in the pathogenesis of visceral hypersensitivity in a rat model of CP.AIM To investigate the role of the NTS in the visceral hypersensitivity induced by chronic pancreatitis.METHODS CP was induced by the intraductal injection of trinitrobenzene sulfonic acid(TNBS)in rats.Pancreatic hyperalgesia was assessed by referred somatic pain via von Frey filament assay.Neural activation of the NTS was indicated by immunohistochemical staining for Fos.Basic synaptic transmission within the NTS was assessed by electrophysiological recordings.Expression of vesicular glutamate transporters(VGluTs),N-methyl-D-aspartate receptor subtype 2B(NR2B),andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor subtype 1(GluR1)was analyzed by immunoblotting.Membrane insertion of NR2B and GluR1 was evaluated by electron microscopy.The regulatory role of the NTS in visceral hypersensitivity was detected via pharmacological approach and chemogenetics in CP rats.RESULTS TNBS treatment significantly increased the number of Fos-expressing neurons within the caudal NTS.The excitatory synaptic transmission was substantially potentiated within the caudal NTS in CP rats(frequency:5.87±1.12 Hz in CP rats vs 2.55±0.44 Hz in sham rats,P<0.01;amplitude:19.60±1.39 pA in CP rats vs 14.71±1.07 pA in sham rats;P<0.01).CP rats showed upregulated expression of VGluT2,and increased phosphorylation and postsynaptic trafficking of NR2B and GluR1 within the caudal NTS.Blocking excitatory synaptic transmission via the AMPAR antagonist CNQX and the NMDAR antagonist AP-5 microinjection reversed visceral hypersensitivity in CP rats(abdominal withdraw threshold:7.00±1.02 g in CNQX group,8.00±0.81 g in AP-5 group and 1.10±0.27 g in saline group,P<0.001).Inhibiting the excitability of NTS neurons via chemogenetics also significantly attenuated pancreatic hyperalgesia(abdominal withdraw threshold:13.67±2.55 g in Gi group,2.00±1.37 g in Gq group,and 2.36±0.67 g in mCherry group,P<0.01).CONCLUSION Our findings suggest that enhanced excitatory transmission within the caudal NTS contributes to pancreatic pain and emphasize the NTS as a pivotal hub for the processing of pancreatic afferents,which provide novel insights into the central sensitization of painful CP.
基金Supported by the National Natural Science Foundation of China(No.81670847No.81600728)
文摘AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis.RESULTS:Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes:interleukin(IL)-10, IL-12, IL-15, IL-21, IL-6, chemokine(C-C motif) ligand 20, and tumor necrosis factor alpha(TNF-α). IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12(P=0.036), IL-15(P=0.001), IL-6(P=0.012), and IL-27(only detectable in APAC eyes). Age was positively correlated with IL-12(P=0.022) and IL-6(P=0.037), and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15(P=0.037), IL-27(P=0.040), and TNF-α(P=0.042).CONCLUSION:Several proinflammatory cytokines including IL-12,IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.
