The association between carotid disease, arterial stiffness and diabetic retinopathy in type 2 diabetes: the Fremantle Diabetes Study Phase II.

AIM: To determine whether macrovascular disease assessed by carotid ultrasonography and arterial stiffness by pulse wave velocity are independently associated with diabetic retinopathy in type 2 diabetes. METHODS: A random subgroup of surviving participants with type 2 diabetes from the Fremantle Diabetes Study Phase II were invited to take part in this sub-study in 2018-2019. In addition to standardized questionnaires, a physical examination and fasting biochemical tests, each underwent dilated colour fundus photography, carotid arterial ultrasonography with measurement of the intima-media thickness (IMT) and quantification of the degree of stenosis, and pulse wave analysis calculation of the carotid-femoral pulse wave velocity (cfPWV). The cross-sectional association between arterial disease parameters and diabetic retinopathy was assessed using generalized estimating equation models which enabled both eyes to be included in the analysis. RESULTS: Some 270 participants [mean ± sd age 72 ± 9 years, 153 (57%) men and median (IQR) diabetes duration 15 (11-22) years] were included in analysis. Of 524 assessable eyes, 82 (16%) had diabetic retinopathy. In multivariable analysis, significant independent associates of diabetic retinopathy were age at diabetes diagnosis (inversely), HbA1c , insulin treatment and urinary albumin to creatinine ratio (all P ≤ 0.022), as well as cfPWV [odds ratio (OR) 1.13, 95% confidence interval (CI) 1.03, 1.23 per 1 m/s increase; P = 0.008] and common carotid artery (CCA) IMT ≥1 mm (OR 2.95, 95% CI 1.21, 7.23; P = 0.018). CONCLUSIONS: The association between diabetic retinopathy and CCA IMT suggests that carotid disease may share cardiovascular risk factors with diabetic retinopathy. The association between diabetic retinopathy and cfPWV may reflect the consequences of altered intravascular haemodynamics.

Genetically elevated levels of circulating triglycerides and brachial-ankle pulse wave velocity in a Chinese population.

Elevated levels of circulating triglycerides and increased arterial stiffness are associated with cardiovascular disease. Numerous studies have reported an association between levels of circulating triglycerides and arterial stiffness. We used Mendelian randomization to test whether this association is causal. We investigated the association between circulating triglyceride levels, the apolipoprotein A-V (ApoA5) -1131T>C single nucleotide polymorphism and brachial-ankle pulse wave velocity (baPWV) by examining data from 4421 subjects aged 18-74 years who were recruited from the Chinese population. baPWV was significantly associated with the levels of circulating triglycerides after adjusting for age, sex, body mass index (BMI), systolic blood pressure, heart rate, waist-to-hip ratio, antihypertensive treatment and diabetes mellitus status. The -1131C allele was associated with a 5% (95% confidence interval 3-8%) increase in circulating triglycerides (adjusted for age, sex, BMI, waist-to-hip ratio, diabetes mellitus and antihypertensive treatment). Instrumental variable analysis showed that genetically elevated levels of circulating triglycerides were not associated with increased baPWV. These results do not support the hypothesis that levels of circulating triglycerides have a causal role in the development of arterial stiffness.

Fabp3 inhibits proliferation and promotes apoptosis of embryonic myocardial cells.

Fatty acid binding protein 3 (FABP3) is a member of a family of binding proteins. The protein is mainly expressed in cardiac and skeletal muscle cells, and it has been linked to fatty acid metabolism, trafficking, and signaling. Using suppression subtractive hybridization, we previously found that FABP3 is highly regulated in ventricular septal defect (VSD) patients and may play a significant role in the development of human VSD. We therefore aimed to identify the biological characteristics of the FABP3 gene in embryonic myocardial cells. On the basis of RT-PCR and western blotting analyses, we demonstrated that the expression levels of FABP3 mRNA and protein were up-regulated initially and then gradually decreased with P19 cell differentiation. MTT assays and cell cycle analysis showed that FABP3 inhibits P19 cell proliferation, and data from annexin V-FITC assays revealed that FABP3 can promote apoptosis of P19 cells. Further data from quantitative real-time RT-PCR revealed lower expression levels of cardiac muscle-specific molecular markers (cTnT, alpha-MHC, GATA4, and MEF2c) in FABP3-overexpressing cell lines than in the control cells during differentiation. Our results demonstrate that FABP3 may be involved in the differentiation of cardiac myocytes.

Visual acuity measurement and ocular co-morbidity in diabetic retinopathy screening.

AIMS: To evaluate the relationship between best corrected visual acuity (BCVA), age, type of diabetes, sight-threatening diabetic retinopathy (STDR) and ocular co-morbidity. METHODS: 1549 randomly selected people with diabetes mellitus (DM) from a countywide digital photographic screening programme had standardised logarithm of minimum angle of resolution (logMAR) BCVA measurement, followed by slit-lamp biomicroscopy examination by an experienced ophthalmologist. RESULTS: Subnormal vision (logMAR > or =0.3, Snellen < or =6/12) and blindness (logMAR >1.3, Snellen <3/60) in the better-seeing eye were found in 9.0% and 0.45%. The sensitivity, specificity and positive and negative predictive values of using subnormal vision to screen for STDR in an individual eye were 33.4%, 85.9%, 18.6% and 93.0%, respectively. Important contributory causes of moderate visual loss (logMAR 0.50 to 0.98, Snellen 6/18 or worse but better than 6/60) and of Acuity Blindness (logMAR > or =1.0, Snellen 6/60 or worse) in an individual eye were lenticular opacity (including capsular opacification) 49%, macular degeneration (including myopic degeneration) 29%, diabetic maculopathy 15%, other media causes (including corneal opacity) 13% and amblyopia 10%. CONCLUSION: The majority of visual loss in a population with diabetes is due to causes other than diabetic retinopathy. BCVA alone is not a reliable criterion in predicting STDR.

A new tannin-related compound from the rhizome of Polygonum bistorta L.

A new tannin-related compound named bistortaside A (1) and a known compound have been isolated from the rhizome of Polygonum bistorta L. A new compound was elucidated as 3-methyl-gallic acid 4-O-beta-d-(6'-O-3''-methyl-galloyl)-glucopyranoside and a known compound was quercetin-3'-O-beta-d-glucopyranoside (2) on the basis of spectroscopic analysis.

Slipknot for scleral fixation of intraocular lenses.

We describe a simple, quick technique to construct a slipknot that can be snared around the haptic of an intraocular lens (IOL) during transscleral fixation of a posterior chamber IOL or repositioning of a dislocated IOL. An in vitro experiment showed that the time required for the slipknot method was significantly less than that for the traditional triple-knot method. An additional advantage is that the slipknot technique can be performed by a single surgeon using standard ophthalmic instrumentation. In addition, the slipknot is as secure as a triple knot.

Impression cytology study of conjunctival epithelial phenotypes on the healing ocular surface after pterygium excision.

PURPOSE: To compare the process of conjunctival epithelial regeneration after three types of pterygium excision procedures. METHODS: Thirty-eight patients (45 eyes) with primary pterygium were randomly assigned to a bare-sclera procedure (group 1, 15 eyes of 12 patients), bare-sclera with intraoperative mitomycin C (MMC 0.02% for 30 seconds; group 2, 15 eyes of 14 patients), or pterygium excision with conjunctival autografting (group 3, 15 eyes of 12 patients). Controls were healthy fellow eyes and seven eyes of age- and sex-matched subjects. Impression cytology was performed preoperatively, at 1 and 2 weeks, and at 1, 3, 6, and 12 months after surgery. The nucleus-to-cytoplasm (N/C) ratio of nongoblet epithelial cells and goblet cell density (GCD) in the pterygial area were calculated and compared over time across treatment groups. RESULTS: Pterygium excision wounds healed in a similar four-stage process in all groups, but at different rates and with different final results. The N/C ratio was highest at about 1 month postoperatively in groups 1 and 2 and at 2 weeks in group 3, before gradually returning to control levels. Preoperatively, the GCD in treated eyes was almost twice that in control eyes (p = 0.001) but fell to zero immediately postoperatively. Goblet cells first appeared (with the most rapidly increased density) in group 3, followed by group 1. At 12 months, the mean GCD in groups 1 and 3 were not significantly different from those in controls, whereas the mean GCD in group 2 was still less than that of control (p = 0.02). CONCLUSIONS: Healing of conjunctiva is delayed by MMC and is promoted by autografting. Even 1 year after surgery, the ocular surface remains abnormal with respect to epithelial phenotypes in eyes treated by any of the three techniques.

Low-dose intraoperative mitomycin C as chemoadjuvant for pterygium surgery.

PURPOSE: To evaluate the efficacy and safety of low-dose intraoperative mitomycin C (MMC) during bare sclera procedure and to compare the rates of pterygium recurrence between recurrent pterygium patients treated with adjuvant MMC and those reconstructed with a conjunctival autograft. METHODS: We studied the recurrence of pterygium, 12-month pterygium-free survival rates, final appearance, and postoperative complications in 96 eyes of 92 patients who received either intraoperative 0.02% MMC for 30 seconds or conjunctival autografting after pterygium excision. Patients were divided into three groups: group 1 included 38 eyes with primary pterygium undergone intraoperative MMC; group 2, 26 eyes with recurrent pterygium treated with intraoperative MMC; and group 3, 32 eyes with recurrent pterygium treated with pterygium excision and conjunctival autografting. RESULTS: Pterygium recurred in 3 (7.9%) of 38 eyes in group 1, 5 (19.2%) of 26 eyes in group 2, and 2 (6.3%) of 32 eyes in group 3. Despite the higher recurrence rate in group 2 compared with that of group 3, the difference between the two was not statistically significant (p = 0.22). The cumulative probabilities of success were 91.6+/-4.6%, 80.8+/-7.7%, and 92.3+/-5.4% at 12 months for groups 1, 2, and 3, respectively. Final appearance of the pterygium excision area was satisfactory in nearly two-thirds of the MMC-treated patients, 71.1% and 65.4% for groups I and 2, compared to 75.1% of patients who had undergone conjunctival autografting. No patients experienced severe complications during a mean postoperative follow-up of 27.3+/-4.1 months, 29.9+/-3.9 months, and 40.9+/-19.1 months for groups 1, 2, and 3, respectively. CONCLUSIONS: A single intraoperative application of 0.02% MMC for 30 seconds after pterygium excision is associated with minimal complication and effectively reduces the recurrence rates after excision of primary or recurrent pterygium. In comparison with conjunctival autografting, low-dose application of MMC after bare sclera procedure is less efficacious in preventing recurrence of pterygium, but simpler and produces a similar proportion of patients with satisfactory final appearance.

[Separation of echinacoside by reversed-phase preparative high performance liquid chromatography].

Echinacoside, one kind of phenylethanoid glycosides (PhGs), was isolated from the stems of Cistanche tubulosa (Schenk) R. Wight with a series of steps, including solvent extraction, D101 polymer adsorption column separation, Sephadex LH-20 separation, C18 column reversed-phase preparative high performance liquid chromatographic (RP-prep-HPLC) preparation and polyamide thin-layer chromatographic detection. The purity of the product was over 98%. The chemical structure of echinacoside was identified by 1H NMR and 13C NMR. To find out the optimum condition of mobile phase of RP-prep-HPLC, several systems were used in this work. Finally acetonitrile-1% HCOOH water (18:82, V/V) system was found to be the best. On the other hand D101 polymer adsorption column and Sephadex LH-20 were also effective for PhGs separation.

[Metabolic regulation of phenylethanoid glycosides from Herba cistanches in dogs' gastrointestine].

AIM: To study the metabolic process of phenylethanoid glycosides (PhGs) in the gastrointestine of beagle dogs that were administered intragastrially process, and develop some new methods of biopharmacology on the effective position of traditional Chinese medicine. METHODS: High-performance liquid chromatography was used to purify constituents from faeces and analyze relative contents of the three main compounds in the gastrointestinal tract at different times and in the faeces of dogs. Every sample was collected, extracted with methanol and analyzed with integration. RESULTS: Four compounds, based on reference substances, were identified as echinacoside, acteoside, isoacteoside, and 2'-acetylacteoside from extraction of faces of dogs. Quantitative "with HPLC" analysis reveals that variation of ratios of the three main compounds is not distinct when moving in the gastrointestinal tract 7 h, that is quite different from those in faeces, in which the content of echinacoside fell from 48.0% to 16.0%, and acteoside increased from 11.0% to 34.7%. CONCLUSION: PhGs are mainly metabolized in large intestine. Among them, a portion of echinacoside is transformed into aceteoside.

Repositioning a subluxated sutured intraocular lens in a vitrectomized eye.

A simple, effective technique for repositioning a subluxated intraocular lens (IOL) in a vitrectomized eye is reported. A 49-year-old man who had previous pars plana vitrectomy and transscleral suture fixation of a posterior chamber (PC) IOL had lens subluxation caused by slippage of the haptic from a fixation suture. The IOL was dangling in the liquefied vitreous, preventing direct visualization of the displaced haptic. The displaced haptic was directly grasped from the opposite side with an intraocular forceps through a limbal wound and resutured to the sclera. Because only the end-grip intraocular forceps was required, this technique provides anterior segment surgeons an alternative technique of repositioning scleral-fixated PC IOLs.

Traumatic wound dehiscence after penetrating keratoplasty: clinical features and outcome in 21 cases.

PURPOSE: To describe the characteristics, causes, treatment, and outcome, particularly the fate of the intraocular implant and visual acuity, of traumatic wound dehiscence occurring in patients who had penetrating keratoplasty (PK). METHODS: Between 1989 and 1997, 21 corneal transplant patients sustained traumatic wound dehiscence and were treated at our hospital. Graft dehiscence was managed with primary wound closure in all patients, except in some who required some combination of anterior vitrectomy, intraocular lens removal and reimplantation, and corneal regrafting. RESULTS: The incidence of traumatic wound dehiscence among patients on whom we performed PK over a period of 9 years was 2.53%. This complication occurred, on average, 3.4 years (2 months to 13 years) after PK. Most patients (76%) were men, and the average age at dehiscence was 59 years (range, 15-82 years). All corneal ruptures occurred at the graft-host junction, which had neither particular site preference nor quadrant specificity. Of the 16 eyes that were pseudophakic, nine (56.3%) had either loss of implants or dislocation of intraocular lens so severe that lens removal was imperative. In the end, only five (23.8%) of the 21 grafts retained clarity. Of the remaining 16 eyes, seven were regrafted, of which five (71.4%) grafts remained clear. Of the nine grafts that became opaque, six eyes (28.6%) atrophied. At the last follow-up, only six eyes (28.6%) had visual acuity of 20/200 or better, and six eyes had no perception of light. Final visual acuity was found to correlate inversely with the severity and extent of wound separation. CONCLUSION: Traumatic wound dehiscence is not rare after PK. The elderly corneal transplant patient may be more prone to such an injury. Corneal rupture at the graft-host junction in all of our cases means the persistence of wound weakness after PK. Although graft survival and visual outcome are generally poor after the injury, the restoration of a satisfactory visual result is possible after regrafting, insofar as the involved eye is free of intractable glaucoma or posterior segment damage.

A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery.

OBJECTIVE: To evaluate the level of patient discomfort during phacoemulsification and implantation of a foldable intraocular lens (IOL) while under topical lidocaine, alone or in combination with intracameral lidocaine. DESIGN: A prospective, randomized, controlled trial. PARTICIPANTS: Between January and July 1997, a total of 162 patients (162 eyes) scheduled for cataract surgery were randomly assigned to either the placebo group (topical anesthesia with intracameral balanced salt solution [group 1, n = 81]) or the interventional group (combined topical-intracameral anesthesia [group 2, n = 81]). INTERVENTIONS: All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable silicone IOL. All patients received a minimum total of five doses (two drops per dose) of 2% topical lidocaine hydrochloride. Three doses were administered before surgery into the superior and inferior cul-de-sac at 10 minutes, 5 minutes, and immediately before the initial corneal incision. One dose was administered before the commencement of phacoemulsification and another dose before implantation of the IOL. In addition, all patients received an intracameral injection immediately after entrance into the anterior chamber. Patients in group 1 received a 0.5-ml injection of balanced salt solution, and those in group 2 received a 0.5-ml injection of 1% lidocaine. MAIN OUTCOME MEASURE: A 10-point visual analogue scale was used immediately after the surgery to assess each patient's overall severity of pain intraoperatively. RESULTS: Ninety percent of patients in group 1 and 95% in group 2 assigned a score of 0 or 1 to the level of intraoperative discomfort. The mean pain score +/- 1 standard deviation for group 1 was 0.63 +/- 0.68 and for group 2 was 0.37 +/- 0.58. The difference between the pain scores for the two groups was statistically significant (P = 0.0053). A small but significant proportion (15%) of patients in group 1 expressed distress when the ciliary body was stretched or the iris was manipulated with instruments. CONCLUSION: Although topical lidocaine alone provides adequate anesthesia for phacoemulsification and implantation of a foldable IOL, combined topical and intracameral administration of lidocaine can further minimize intraoperative discomfort.

Morphological and fluorophotometric analysis of the corneal endothelium after radial keratotomy.

PURPOSE: To evaluate the morphometric and fluorophotometric characteristics of corneal endothelium after an eight-incision radial keratotomy (RK). METHODS: A total of 43 eyes of 26 patients underwent RK and 44 eyes of 23 patients were used as age-matched controls. All patients underwent specular microscopic and fluorophotometric examinations. Endothelial cell density [(ECD), cells/mm2], mean cell area [(MCA), microm2], coefficient of variation (CV) for cell area, and percentage (%) of hexagonal cells were measured by specular microscopy. Cornea-to-anterior chamber transfer coefficient (kc.ca, 10(-3) min(-1)) and corneal endothelial permeability (10(-4) cm/min) were measured by fluorophotometry. RESULTS: Morphometric and fluorophotometric characteristics were similar in both the RK and control groups. Among patients in the RK group, the size of optical zone and the depth of corneal incision did not affect postoperative endothelial morphology or permeability. Those who presented for postoperative examination later than 3 months compared with those presented within 3 months of RK had lower CV for cell area; 0.28 +/- 0.04, 0.23 +/- 0.04, and 0.23 +/- 0.03, a higher percentage of hexagonal cells; 64.7 +/- 8.0, 71.7 +/- 7.8, and 72.2 +/- 6.5, and lower permeability; 5.7 +/- 1.9. 4.5 +/- 0.9, and 5.2 +/- 1.1, at <3 months, between 3 and 6 months, and >6 months after RK, respectively (all p < 0.05). In the eight cases of anisometropia, the operated eyes had a lower ECD; 3,079 +/- 429, and 3,217 +/- 495, a higher MCA; 330.6 +/- 48.1 and 317.6 +/- 50.5, and a higher endothelial permeability; 6.3 +/- 1.5 and 4.7 +/- 1.3 in the operated and unoperated eyes, respectively, at 3.4 months after RK (p < 0.05). CONCLUSION: RK induced a minimal acute and nonprogressive endothelial loss. The transient increase in permeability within 3 months may be due to a reversible endothelial dysfunction induced by RK.

Successful treatment of recurrent corneal intraepithelial neoplasia with topical mitomycin C.

PURPOSE: To evaluate the clinical efficacy of topical mitomycin C (MMC) 0.04% in the treatment of recurrent corneal intraepithelial neoplasia. METHODS: A 71-year-old man presented with a limbal tumor that had extended onto the inferior temporal quadrant of the left cornea. Superficial lamellar sclerokeratectomy was performed to remove the tumor, which was histopathologically demonstrated to be a corneal intraepithelial neoplasia. Fifteen months after the surgical excision, the tumor recurred at the previous keratectomy site. The patient was treated topically with 0.04% MMC four times daily for 2 weeks, during which time he only had a mild degree of conjunctival hyperemia and ocular pain. RESULTS: The tumor resolved completely after 2 weeks of treatment and did not recur during the 10-month follow-up. CONCLUSION: Topical MMC may be an effective alternative treatment for recurrent corneal intraepithelial neoplasia and deserves further evaluation.

[Identification and determination of marker substances in niuhuang jiedu pian by three dimensional HPLC].

The Chinese traditional patent medicine Niuhuang Jiedu Pian was analyzed by three dimensional HPLC. The results show that some of the Chinese herbal drugs contained in Niuhuang Jiedu Pian can be identified and the content of the marker substances can be determined. According to the results of determination, the content of baicalin, sennoside A and glycyrrhizin in Niuhuang Jiedu Pian was 4.21, 0.59 and 1.03 (mg/tablet), respectively. The RSD was 1.6, 2.8 and 1.4%, respectively.

[The identification and determination of marker substances in xiaoyao wan by three dimensional HPLC].

A Chinese traditional patent medicine Xiaoyao Wan was analysed by three dimensional HPLC. The result shows that the Chinese traditional medicines involved in Xiaoyao Wan were identified excellently and the content of marker substances can be determined accurately. According to the results of determination, the content of saikosaponin b1, b2, glycyrrhizin, paeoniflorin and atractylenolide III in Xiaoyao Wan was 0.43, 0.53, 5.22, 3.95 and 0.16 (mg/g), respectively; The RSD was 1.2, 0.8, 0.4, 0.3 and 1.0 (%) respectively.