Analysis of risk and protective factors associated with retinal nerve fiber layer defect in a Chinese adult population

AIM:To investigate the risk and protective factors associated with the retinal nerve fiber layer defect(RNFLD)in a Chinese adult population.METHODS:This study was a cross-sectional populationbased investigation including employees and retirees of a coal mining company in Kailuan City,Hebei Province.All the study participants underwent a comprehensive systemic and ophthalmic examination.RNFLD was diagnosed on fundus photographs.Binary logistic regression was used to investigate the risk and protective factors associated with the RNFLD.RESULTS:The community-based study included 14440 participants.There were 10473 participants in our study,including 7120 males(68.0%)and 3353 females(32.0%).The age range was 45-108y,averaging 59.56±8.66y.Totally 568 participants had RNFLD and the prevalence rate was 5.42%.A higher prevalence of RNFLD was associated with older age[P<0.001,odds ratio(OR):1.032;95%confidence interval(CI):1.018-1.046],longer axial length(P=0.010,OR:1.190;95%CI:1.042-1.359),hypertension(P=0.007,OR:0.639;95%CI:0.460-0.887),and diabetes mellitus(P=0.019,OR:0.684;95%CI:0.499-0.939).The protective factors of RNFLD were visual acuity(P=0.038,OR:0.617;95%CI:0.391-0.975),and central anterior chamber depth(P=0.046,OR:0.595;95%CI:0.358-0.990).CONCLUSION:In our cross-sectional community-based study,with an age range of 45-108y,RNFLD is associated with older age,longer axial length,hypertension,and diabetes mellitus.The protective factors of RNFLD are visual acuity and central anterior chamber depth.These can help to predict and evaluate RNFLD related diseases and identify high-risk populations early.

泪小管断裂吻合术59例临床分析

目的:探讨显微镜下泪小管断裂吻合联合环形管置入术的手术效果。方法:回顾性分析2018-06/12期间于我院就诊的下泪小管断裂患者59例59眼,在显微镜下找到泪小管断端,置入环形管作为支撑物,术后3mo拔管后随访3mo,观察手术疗效及并发症情况。结果:所有患者均在显微镜下顺利找到泪小管鼻侧断端并成功置环形管,术后第6mo复诊,治愈46例46眼,好转5例5眼,无效8例8眼,总有效率86%(51/59),术后未见严重的相关并发症及眼睑畸形。结论:显微镜下泪小管断裂吻合术是治疗泪小管断裂的有效手术方式。

Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma

AIM:To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty(UCP)for the treatment of refractory glaucoma in Chinese patients.METHODS:In this 6-month retrospective study,37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure(IOP)of≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements.A complete ophthalmic examination was performed before and at 1 d,1,3,6 mo after UCP.Therapeutic success was defined as IOP reduction from baseline≥20%and IOP≥5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit.In addition to mean IOP at each followup visit,medications used and complications were also detected and compared to baseline.RESULTS:After UCP procedure,the mean IOP was significantly reduced(P<0.01)from the preoperative 44.1±11.9 mm Hgto postoperative 26.7±11.8 mm Hg at 3 mo,and 30.4±14.5 mm Hg at 6 mo.The overall mean IOP reductions achieved at 3 and 6 mo were 39%and 31%compared to baseline IOP.Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48%at 3 mo and 42%at 6 mo.Ocular pain in most of patients were alleviated.No serious intraoperative or postoperative complications occurred.CONCLUSION:High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.

Inflammation-associated ectopic mineralization

Ectopic mineralization refers to the deposition of mineralized complexes in the extracellular matrix of soft tissues.Calcific aortic valve disease,vascular calcification,gallstones,kidney stones,and abnormal mineralization in arthritis are common examples of ectopic mineralization.They are debilitating diseases and exhibit excess mortality,disability,and morbidity,which impose on patients with limited social or financial resources.Recent recognition that inflammation plays an important role in ectopic mineralization has attracted the attention of scientists from different research fields.In the present review,we summarize the origin of inflammation in ectopic mineralization and different channels whereby inflammation drives the initiation and progression of ectopic mineralization.The current knowledge of inflammatory milieu in pathological mineralization is reviewed,including how immune cells,pro-inflammatory mediators,and osteogenic signaling pathways induce the osteogenic transition of connective tissue cells,providing nucleating sites and assembly of aberrant minerals.Advances in the understanding of the underlying mechanisms involved in inflammatory-mediated ectopic mineralization enable novel strategies to be developed that may lead to the resolution of these enervating conditions.

Silicified collagen scaffold induces semaphorin 3A secretion by sensory nerves to improve in-situ bone regeneration

Sensory nerves promote osteogenesis through the release of neuropeptides.However,the potential application and mechanism in which sensory nerves promote healing of bone defects in the presence of biomaterials remain elusive.The present study identified that new bone formation was more abundantly produced after implantation of silicified collagen scaffolds into defects created in the distal femur of rats.The wound sites were accompanied by extensive nerve innervation and angiogenesis.Sensory nerve dysfunction by capsaicin injection resulted in significant inhibition of silicon-induced osteogenesis in the aforementioned rodent model.Application of extracellular silicon in vitro induced axon outgrowth and increased expression of semaphorin 3 A(Sema3A)and semaphorin 4D(Sema4D)in the dorsal root ganglion(DRG),as detected by the upregulation of signaling molecules.Culture medium derived from silicon-stimulated DRG cells promoted proliferation and differentiation of bone marrow mesenchymal stem cells and endothelial progenitor cells.These effects were inhibited by the use of Sema3A neutralizing antibodies but not by Sema4D neutralizing antibodies.Knockdown of Sema3A in DRG blocked silicon-induced osteogenesis and angiogenesis almost completely in a femoral defect rat model,whereas overexpression of Sema3A promoted the silicon-induced phenomena.Activation of“mechanistic target of rapamycin”(mTOR)pathway and increase of Sema3A production were identified in the DRG of rats that were implanted with silicified collagen scaffolds.These findings support the role of silicon in inducing Sema3A production by sensory nerves,which,in turn,stimulates osteogenesis and angiogenesis.Taken together,silicon has therapeutic potential in orthopedic rehabilitation.

Engineered extracellular vesicles:Regulating the crosstalk between the skeleton and immune system

Osteoimmunology has gained momentum in recent years,focusing on the crosstalk between the skeleton and the immune system.Extracellular vesicles(EVs)are nanoscale vesicles that are potential candidates for cell-free tissue regeneration strategies.They may be used for repairing damaged tissues and regulating the body’s immune system and bone-related metabolic activities.Because of the ability of EVs to deliver bioactive signals and mediate intercellular communication,they can decipher the complex mechanisms of interaction within the“osteoimmune system”at the molecular level.To address the lack of targeting ability caused by vesicle heterogeneity in the clinical applications of EVs,these nanoscopical entities may be modified by bioengineering techniques to optimize the interaction between bone repair and immunomodulation for improving treatment efficacy,specificity and safety.In the present review,the endogenous properties that make EVs natural delivery agents are outlined.Properties that may be improved by bioengineering are highlighted.The therapeutic applications of EVs in the rehabilitation of bone defects are discussed.The opportunities and challenges that need to be addressed for translating this field of research into clinical practice are brought into perspectives.