Objective To analyze the causes of missed diagnosis of sleep apnea hypopnea syndrome ( SAHS) . Methods 42 missed diagnosed cases with SAHS from May 2009 to May 2011 were retrospectively analyzed and related literatures were reviewed. Results The SAHS patients often visited the doctors for complications of SAHS such as hypertension, diabetes mellitus, metabolic syndrome, etc. Clinical misdiagnosis rate was very high. Lack of specific symptoms during the day, complicated morbidities, and insufficient knowledge of SAHS led to the high misdiagnosis rate and the poor treatment effect of patients with SAHS. Conclusion Strengthening the educational propaganda of SAHS, detail medical history collection, and polysomnography monitoring ( PSG) as early as possible can help diagnose SAHS more accurately and reduce missed diagnosis.
Objective To observe the effect of intravitreal injection of mouse nerve growth factor (NGF) on interphotoreceptor retinoid-binding protein (IRBP) in the vitreous of diabetic rats at early stages. Methods Ninety-six male Sprague Dawley (SD) rats were divided into control group (group A, 24 rats) and experimental group (72 rats). The rats in experimental group were induced with streptozotocin injection for diabetic retinopathy model, and then randomly divided into positive control group (group B), normal saline group (group C) and NGF group (group D), 24 rats in each group. The rats in the group A and B were not intervened. The rats were received intravitreal injection with 4mu;l normal saline (group C) or 4 mu;l (0.5 mu;g/mu;l) NGF (group D). At 2, 4, 6 and 8 weeks after injection, IRBP levels were detected by enzymelinked immunosorbent assay (ELISA); hematoxylin-eosin (HE) staining and light microscope were used to observe the morphological changes of the retina; transmission electron microscope was used to observe the retinal ultrastructure.Results At 2 weeks after injection, there was no significant difference in IRBP expression between group A,B,C and D (F=2.833，P=0.052). At 4, 6, 8 weeks after injection, the differences of IRBP expression between group A, B, C and D were significant (F=22.252, 108.459, 105.726; P=0.000). At different time points after injection, there was no significant difference in IRBP expression of group A (F=1.462, P=0.241), but there were significant differences in IRBP expression of group B, C and D (F=150.98, 63.519, 64.604; P=0.000). Light microscope found that the retinal structure was clear in group A and in group B, C, D at 2, 4 weeks after injection; the retinal thickness were thinner in group B, C, D at 8 weeks after injection. Transmission electron microscope displayed that the structure of rod outer segments was clear in group A and in group B, C, D at 2 weeks after injection; partly unclear structure of rod outer segments and slightly enlarged gap were observed in group B, C, D at 4, 8 weeks after injection. Conclusion Intravitreal injection with NGF can stabilize the IRBP expression in the vitreous of diabetic rats at early stages effectively.
Objective To determine the trend in the causes of admission among diabetic patients in West China Hospital from 1996 to 2005. Methods The medical records of diabetic inpatients from January 1996 to December 2005 were retrieved, and half of them were randomly selected. A questionnaire was completed and SPSS13.0 software was used for statistical analyses. Results The most common causes of admission for diabetic patients were diabetic chronic complications (20.2%), infection (19.5%), hyperglycemic symptoms (11.7%), malignant tumor (8.9%) and diabetic acute complications (5.8%). The constituent ratios of diabetic macrovascular disease and malignant tumor as the admission causes tended to increase, while the constituent ratios of diabetic microvascular disease, hyperglycemic symptoms and diabetic acute complications tended to decrease. Infection remained as one of the main causes of admission among diabetic patients. Conclusion The main cause of admission to West China Hospital for diabetic patients from 1996 to 2005 was diabetic chronic complications.
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
Objective To determine the clinical efficacy of probucol in patients with diabetic macular edema (DME) and elevated serum lipids after focal/grid laser photocoagulation. Methods A prospective randomized controlled study included 48 type 2 diabetic patients with DME and dyslipidemia which were randomly divided into three groups. For patients with bilateral disease only the more severe eye was included. All patients were subjected to strict metabolic and blood pressure control during enrollment. All cases received macular laser photocoagulation. Besides, sixteen patients in group A were treated with probucol, 16 members in group B with atorvastatin and 16 members in group C were not treated with any lipid-lowering therapy for about three months. The outcome measurements were status of macular edema and hard exudates, visual acuity, foveal thickness, serum lipids and urine 8-hydroxydeoxyguanosine (8-OHdG) during the three months. Results The study included 20 men and 28 women with noninsulin dependent diabetes mellitus who could achieve good metabolic and blood pressure control within three months of inclusion in the study. Thirteen of 16 patients in group A, twelve of 16 patients in group B and five of 16 patients in group C showed reduction in hard exudates. Regression of macular edema was seen in twelve patients in group A, 11 in group B and eight in group C (χ2=2.368,P＞0.05). The difference of foveal thickness in group A, B and C was statistically significant (t=4.929, 4.669; P=0.000). Nine patients in group A, eight in group B and six in group C showed improving of visual acuity (χ2=1.169,P＞0.05). Three months after treatment, triglycerides (TG) (t=7.954, 6.832; P＜0.05), total cholesterol (TC) (t=6.643, 5.368; P＜0.05) and low-density lipoprotein cholesterol (LDLC) (t=3.279, 3.835; P＜0.05) decreased in group A and group B but not in group C, and high-density lipoprotein cholesterol showed no significant difference in the three groups. 8-OHdG decreased gradually during the first and third month in group A and group B but not in group C. In the first month post treatment, 8-OHdG showed no difference between group A and group B. In the third month, the 8-OHdG was lower in group A than group B, and the difference was statistically significant (t=2.947,P＜0.05). ConclusionsIn type 2 diabetes patients with DME and dyslipidemia, oral probucol can reduce the severity of hard exudates and macular edema, improve the visual acuity, and inhibit the levels of TG, TC, LDLC and 5-OHdG. The effect of probucol was similar to atorvastatin. Probucol could be an adjunct treatment of those patients.
Objective To observe the effect of diabetic retinopathy on endothelial progenitor cells (EPCs) from peripheral blood. Methods Sixty male Wistar rats were divided into control group and diabetes group. The rats in diabetes group were induced with streptozotocin (STZ) injection for diabetic retinopathy model. Flow cytometry was used to identify and count the number of EPCs from peripheral blood at 1 week, 1, 3 and 6 months after injection. All eyeballs were examined by hematoxylin and eosin (HE) staining, periodic acidSchiff's (PAS) staining of trypsin-digested retinal vessels flat preparation and transmission electron microscope. EPCs count, and the relationship between DR morphological changes and EPCs count were compared and analyzed. Results The quantity of EPCs from peripheral blood at 1 week, 1, 3 and 6 months after STZ injection were 25plusmn;7, 28plusmn;8, 39plusmn;7, 43plusmn;7 cells per 200 000 monocytes respectively, which decreased compared with the control group 45plusmn;4 cells per 200 000 monocytes (F=8.933，Plt;0.01). The quantity of EPCs was gradually increased at 1 week, 1, 3 and 6 months after STZ injection, accompanied with responsive pathological changes of retinal structure and vessels. The thickness of retina at 1 week and 1 month after injection were reduced slightly. The number of retinal ganglion cells reduced, with the time passing by. Endothelial cells were edema, mitochondrial was swollen, capillary basement membrane was thicken, lumen was significant stenosis, lumen occlusion and retinal artery aneurysm were observed at 6 months after STZ injection. Conclusion The number of EPCs increases gradually throughout the development of DR.
Diabetic retinopathy (DR) is one of the most common and serious complication of diabetes mellitus, which is the main cause of vision loss in adults. Biological clock genes produce circadian rhythms and control its operation, while the disorder of the expression causes the occurrence and development of a series of diseases. It has been demonstrated that biological clock genes might take effects in the development and progression of DR. On the one hand, circadian rhythm disorder-related behavior disrupts the circadian oscillation of clock genes, and the change in its expression level is prone to unbalanced regulation of glucose metabolism, ultimately increasing the risk of type 2 diabetes mellitus and DR pathogenesis. On the other hand, DR patients exhibit symptoms of circadian rhythm disorders, and it has been suggested that the clock genes may control the development and progression of DR by affecting a variety of retinal pathophysiological processes. Therefore, maintaining normal circadian rhythm can be used as a disease prevention strategy, and studying the molecular mechanism of clock genes in DR can provide new ideas for more comprehensive elaboration of the pathogenesis of DR and search for new therapeutic targets.
Objective To verify the effect of Evans blue dye on determining the retina blood vessel leakage． Methods Male Sprague-Dawley rats were used in this study． The VEGF induced retinal blood vessel leakage was checked with Evans blue dye． Then the bloodretina barrier breakdown of 1 week diabetic animals was quantified with Evans blue．The dye was extracted from retina by formamide and the extraction was checked with spect rophotometer． Evans blue leakage was normalized against wet or dry retina weight． Results The retinal Evans blue content of eyes treated with VEGF was remarkably higher than that of the controls (n=17 ,Plt;0．0001)． And the eyes of 1 week diabetic duration animals had more Evans blue dye than that of the normal controls (Plt;0．05)． Conclusion Evans blue dye is a sensitive tracer in quantitatively diagnosing the blood retina barrier breakdown． (Chin J Ocul Fundus Dis, 2001,17:221-223)
Objective To evaluate the change of blood sugar in diabetic patients after vitrectomy and analyze the relative reasons. Methods Nineteen diabetes II patients (20 eyes) who underwent vitrectomies received the tests of blood sugar preoperatively, and 1～2 hours, 1, 3, and 5 days postoperatively. Analysis of variance, apaired Studentrsquo;s t-test, and correlation analysis were used to analyze the change of postoperative blood sugar and correlation between postoperative blood sugar change and its relative factors. Results Postoperative blood sugar increased significantly compared with the preoperative one (Plt;0.05),reached the peak 1～2 hours postoperatively, and reached almost the preoperative level 5 days postoperatively (Pgt;0.05). There was a positive correlation between blood sugar increase and operation time, preoperative blood sugar level, and diabetic duration (Plt;0.05). Postoperative blood sugar was relative to potentiated anesthesia. Conclusion There is a regularity that blood sugar increases just postoperatively and reaches the preoperative level 5 days postoperatively. The relative factors to blood sugar change include preoperative blood sugar level, diabetic duration, operation time, and potentiated anesthesia. (Chin J Ocul Fundus Dis,2000,16:157-159)
Objective To observe the retinal toxicity of repeated intravitreal injection with bevacizumab (Avastin) in diabetic rats. Methods Forty male Sprague Dawley (SD) rats were randomly divided into normal group (Group A, 10 rats) and diabetes mellitus group (30 rats). The rats in diabetes mellitus group were induced with streptozotocin injection for diabetic retinopathy model. And then randomly divided into diabetic retinopathy (DR) group (Group B,10 rats), the rats were not intervened; the left eyes of the other 20 rats were intravitreal injected with bevacizumab 3 mu;l (25 mg/ml) for 3 times as experimental group (Group C) ; the right eyes of the 20 rats were not intervened as experimental control group (Group D). 20 days after last intravitreal injection, retinal function was measured by Flicker Electroretinogram (F-ERG);retinal vascular pattern was determined by fluorescence microscopy of ethidium bromide (EB) stained retinal flat mounts; retinal morphological changes were determined by light microscope on hematoxylin-eosin (HE) stained sections;Thy-1 and VEGF expression was measured by immunohistochemistry staining. Results F-ERG showed that, the differences of a-and b-waves, the b-wave amplitude and the Ops-wave amplitude in the implicit time between group A, B, C and D were significant (F=33.165, 36.162,19.955, 23.243; P＝0.000); the differences of a-wave amplitude between group A,B,C and D was not significant (F=0.097,P＝0.961). Retinal blood vessel pattern was normal in Group A; retinal vascular vessels were tortuous and irregularly expanded in Group B; retinal vascular vessels of Group C were regular and thinner than Group A; microaneurysm were showed in Group D. Light microscope displayed that the layers of the rat retina of Group A were regular, the retinal architectures of Group B were irregular, the retinal layers were regular in Group C, the retinal layers were irregular in Group D. Immunohistochemistry staining discovered that Thy-1 and VEGF were mainly expressed in ganglion cell layer（GCL）. Conclusion Repeated intravitreal injection of bevacizumab is toxic to retina of diabetes mellitus rats.