Intravitreal injection of anti-VEGF drugs for the treatment of retinopathy of prematurity (ROP) is a hot topic of research, and it can be used to treat the ROP (Ⅰzone). The current anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept and conbercept, etc. However, in recent years, several studies have confirmed that anti-VEGF drugs have an increased recurrence rate and a longer recurrence time than conventional laser photocoagulation therapy. The follow-up period should be extended and repeated injections may be required. Due to the lack of large-scale prospective clinical studies, the recurrence rate, time window of recurrence, risk factors and treatment methods of various anti-VEGF drugs for ROP are still unclear. Anti-VEGF drugs in the treatment of ROP needs to accumulate more evidence-based medical evidence.
In this research a strain of isolated Pseudomonas alcaligenes which causes degradation of dexamethasone was acclimated further and its proteins of every position in the bacterium were separated by the osmotic shock method. The separated intracellular proteins which had the highest enzyme activity were extracted by the salting out with ammonium sulfate and were purified with the cation exchange chromatography and gel chromatography. The purified proteins which was active to cause degradation of dexamethasone had been detected were cut with enzyme and were analyzed with mass spectrometry. The results showed that the degradation rate to dexamethasone by acclimated Pseudomonas alcaligenes were increased from 23.63% to 52.84%. The degrading enzymes were located mainly in the intracellular of the bacteria and its molecular weight was about 41 kD. The specific activity of the purified degrading enzymes were achieved to 1.02 U·mg-1. Its 5-peptide amino acid sequences were consistent with some sequences of the isovaleryl-CoA dehydrogenase. The protein enzyme may be a new kind degrading enzyme of steroidal compounds. Our experimental results provided new strategies for cleanup of dexamethasone in water environment with microbial bioremediation technique.
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
ObjectiveTo observe and analyze the clinical features and prognosis of proliferative diabetic retinopathy (PDR) with chronic myeloid leukemia.MethodsA retrospective case series study. From May 2011 to December 2020, 5 patients (10 eyes) were included in this study in Eye-ENT Hospital of Fudan University. Basic information about the patient's age, gender, diabetes history and CML history were collected. The endocrine and hematological indexes of all patients were evaluated. All the patients were undertaken visual acuity, intraocular pressure, slit lamp and fundus examination and other examinations to observe the eye conditions. Ophthalmic treatments included panretinal laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor, vitrectomy. During the follow up period from 5 months to 6 years, prognosis was observed at each office visit. During the follow up period, patients' vision, intraocular pressure, anterior segment and retinal status were observed.ResultsThere were 4 males and a female in 5 patients. The ages were from 27 to 49 years, with the mean age of 39 years. All patients were bilateral. All patients suffered type 2 diabetes for 3 months to 13 years. Four of them were diagnosed as chronic myeloid leukemia before visiting to ophthalmologists, while the other visited to ophthalmology first due to poor vision. The initial visual acuity ranged from light perception to 0.4 and 6 eyes were less than 0.1. In addition to the typical manifestations of diabetic retinopathy, such as venous tortuous dilation, exudation, microaneurysm and neovascularization, patients also presented with Roth spot as leukemic fundus manifestations. All eyes developed to PDR stage. Abnormal thickening of the neovascular membranes may occur in the lower part of the retina, with secondary traction retinal detachment. All the eyes were treated with pan retinal photocoagulation and 9 eyes underwent pars plana vitrectomy. After treatment, retina of 8 eyes kept flat. The best corrected visual acuity ranged from no light perception to 1.0, and only 4 eyes reached more than 0.2. Unfortunately, one eye lost vision because of secondary neovascular glaucoma.ConclusionsPDR patients with CMLof fundus not only have venous tortuous dilation, exudation, microaneurysm and neovascularization, also present with Roth spot as leukemic fundus manifestations. Diabetic retinopathy combined with CML could progress rapidly, and its aggravating complications such as hyperplastic membrane, vitreous hemorrhage and traction retinal detachment may result in poor visual prognosis. Early screening and treatment can help improve the prognosis of patients.
ObjectiveTo investigate the efficacy and safety of traditional laser photocoagulation, laser combined with intravitreal injection of anti-vascular endothelial factor (anti-VEGF) drugs and intravitreal injection of anti-VEGF drugs alone in Coats disease. MethodsThe patients diagnosed as Coats disease stage 2B-3A2 in Department of Ophthalmology, Eye and ENT Hospital of Shanghai Medical College of Fudan University from December 2016 to November 2019 were included in this study. Patients were divided into three groups, including laser group, combined group and drug group, according to the different treatment. In the laser group, the initial treatment was traditional laser photocoagulation alone. In the drug group, the anti-VEGF drug was injected into vitreous once a month for three months. The initial treatment of the eyes in the combined group was laser combined with intravitreal injection of anti-VEGF drugs, or laser treatment within 1 week after anti-VEGF drug treatment. The follow-up time was more than 6 months, and best-corrected visual acuity (BCVA), ultra-wide-angle fundus photography, and fluorescein fundus angiography were performed during follow-up. The treatment efficiency, subretinal fluid (SRF), macular edema, BCVA and complications were compared among the three groups. ResultsAmong 60 patients (60 eyes), there were 55 males (55 eyes) and 5 females (5 eyes), with the mean age of 17.1±2.0 years. Among 60 eyes, there were 26 eyes in 2B stage, 23 eyes in 3A1 stage, and 11 eyes in 3A2 stage. Twenty patients (20 eyes) was in the laser group, combined group and drug group, respectively. After the initial treatment of all eyes in the drug group, the abnormal blood vessels did not regress significantly; the absorption and increase of SRF were 4 (20.0%, 4/20) and 5 (25.0%, 5/20) eyes, respectively. Supplementary laser therapy was given to 16 eyes, and vitrectomy (PPV) was given to 4 eyes. Among the 16 eyes treated by laser, 10 eyes were effective (50.0%, 10/20); vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract occurred in 1, 1, and 2 eyes during the treatment, respectively, and PPV was given again in all eyes. Recurrent and persistent macular edema occurred in 4 and 1 eyes, respectively. Among the eyes in the combined group, treatment were effective in 11 eyes (55.0%, 11/20); 5, 2, and 2 eyes had SRF, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again; the edema was repeated and persisted in 1 eye, respectively. Among the affected eyes in the laser group, 15 eyes (75.0%, 15/20) were treated effectively; 2, 2, and 1 eyes developed a large number of vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again. ConclusionsAnti-VEGF drugs alone are ineffective in the treatment of Coats disease, and ablation of other abnormal blood vessels is needed. In the treatment of Coats disease, anti-VEGF drugs can not only promote the absorption of SRF, but also may lead to its increase, and the application should be cautious.
ObjectiveTo investigate macular microvascular abnormalities in eyes with subfoveal fibrotic nodules secondary to Coats' disease. MethodsA cross-sectional study. From January 1, 2018 to July 30, 2021, 45 eyes of 45 patients diagnosed with Coats' disease with or without subfoveal fibrotic nodules in Eye and ENT Hospital, Shanghai Medical College of Fudan University were included in this study. There were 40 eyes in 40 males and 5 eyes in 5 females. All were under 21 years old. According to the presence or absence of subfoveal fiber nodules, the patients were divided into fibrotic group (26 cases, 26 eyes) and non-fibrotic group (19 cases, 19 eyes). Optical coherence tomography angiography was used to scan 3 mm×3 mm or 6 mm×6 mm macular area of both eyes. The software of the device automatically processed the images. The presence of FAZ edge anastomotic vascular arch ring breakage and abnormal microvascular branch (AMB) in the foveal avascular zone (FAZ) were observed. ResultsIn 26 eyes of fibrosis group, AMB originating from the parafoveal retinal capillary network was observed, which grew into and destroyed the integrity of the vascular arch ring at the edge of FAZ. AMB was crisscrossing and winding, and its curvature expands. B-scan images showed the blood flow signal in the subfoveal fiber nodule, and the blood flow signal traversed between the inner retina and the fiber nodule in 23 eyes (88.46%, 23/26). In the non-fibrosis group, all the vascular abnormalities were characterized by capillary dilation and defect, and no breakage of FAZ anastomotic vascular arch ring or AMB was observed. ConclusionsIn Coats' disease with subfoveal fiber nodules, staggered and dilated AMBs emerge from the parafoveal vascular network, grow into and destroy the integrity of the vascular arch ring at the edge of FAZ, and grow down longitudinally into the fiber nodules.