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Objective:To investigate the changes, distribution and influencing factors of ocular dominance after small incision lenticule extraction (SMILE).Methods:A retrospective observational case series study was conducted.One hundred and twelve patients (224 eyes) with an average age of 25.1±5.4 years who underwent SMILE surgery at Tianjin Eye Hospital from November 2017 to February 2018 were enrolled.There were 42 male and 70 female patients.The dominant eye was determined using the hole-in-the-card test before and after the surgery.Subjective and objective refraction and uncorrected visual acuity examination were performed before operation, and 1 day, 1 week, 1 month and 3 months after operation.The subjects were divided into switch group and non-switch group based on whether the dominant eye changed after surgery.Binary logistic regression was used to analyze the main influencing factors of dominant eye switches.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.201905). Written informed consent was obtained from each patient before any medical examination.Results:There were 18 patients (16.1%) in the switch group including 7 males (38.9%) and 11 females (61.1%), and 94 patients (83.9%) in the non-switch group including 35 males (37.2%) and 59 females (62.8%). No statistically significant difference was found in sex between the two groups ( χ2=0.02, P=0.89). At 1 month and 3 months after the surgery, there was a statistically significant difference in the cylindrical power between the dominant and non-dominant eye ( t=2.31, 1.95; both at P<0.05). Binary logistic regression equation showed that spherical equivalent[odds ratio ( OR)=0.47, 95%confidence interval ( CI): 0.35-0.66]and refractive error difference ( OR=3.04, 95% CI: 2.12-4.36) were significantly related to the eye dominance switches. Conclusions:There were 16.1% of patients having eye dominance switches after SMILE.The dominant eye transfomation is associated with higher spherical equivalent and anisometropia difference before surgery.
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Objective:To investigate the influence of angle Kappa on total high-order aberration (HOA) before and after small incision lenticule extraction (SMILE).Methods:An observational case series study was conducted.Right eyes of 98 patients with myopia and myopic astigmatism who underwent SMILE surgery at Tianjin Eye Hospital from April 2015 to May 2016 were selected.Uncorrected visual acuity (UCVA), spherical diopter and cylindrical diopter under cycloplegic condition were examined before the surgery and at l and 3 months postoperatively.The chord distance of angle Kappa was measured by Pentacam topography.Wavefront aberrations were measured by WaveScan aberrometer.Pre- and postoperative UCVA, refractive status and each HOA were analyzed.The relationship between angle Kappa and each HOA was analyzed by Pearson correlation.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital (No.TJYYLL-2017-17). Written informed consent was obtained from each subject.Results:The preoperative, postoperative 1-month and postoperative 3-month UCVA (LogMAR) were 0.06±0.23, -0.03±0.07 and -0.05±0.07, respectively, showing a statistically significant difference ( F=779.330, P<0.001). There were statistically significant differences in spherical diopter, cylinder diopter and spherical equivalent (SE) between before and after operation ( F=1 107.811, 127.786, 1 191.266; all at P<0.001), and the postoperative spherical diopter, cylinder diopter and SE were significantly lower than those before surgery (all at P<0.001). At 6-mm pupil diameter, significant differences were found between postoperative total HOA, spherical aberration, coma, the third-order aberration (S3), fourth-order aberration (S4), fifth-order aberration (S5) and sixth-order aberration (S6) and the preoperative values ( F=75.915, 78.231, 66.186, 64.521, 97.161, 36.623, 28.852; all at P<0.001). The postoperative 1- and 3-month total HOA, spherical aberration, coma, S3, S4, S5 and S6 were significantly increased in comparison with those before surgery (all at P<0.05). There was a positive correlation between angle Kappa and total HOA, coma and S3 at 1 and 3 months after surgery (total HOA: r=0.357, 0.363; both at P<0.001.coma: r=0.310, 0.341; both at P<0.01.S3∶ r=0.343, 0.371; both at P<0.01). Significant differences were found in preoperative, postoperative 1-month and 3-month total HOA, coma and S3 between groups with different angle Kappa ( Fgroup=3.363, 4.277, 4.029; all at P<0.05). The postoperative total HOA, coma and S3 of the larger angle Kappa group were greater than those of the smaller angle Kappa group, with statistically significant differences between them (all at P<0.05). Conclusions:A larger angle Kappa may induce HOAs in SMILE surgery.
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Drug-associated reward memories are conducive to intense craving and often trigger relapse. Simvastatin has been shown to regulate lipids that are involved in memory formation but its influence on other cognitive processes is elusive. Here, we used a mass spectrometry-based lipidomic method to evaluate the impact of simvastatin on the mouse brain in a cocaine-induced reinstatement paradigm. We found that simvastatin blocked the reinstatement of cocaine-induced conditioned place preference (CPP) without affecting CPP acquisition. Specifically, only simvastatin administered during extinction prevented cocaine-primed reinstatement. Global lipidome analysis showed that the nucleus accumbens was the region with the greatest degree of change caused by simvastatin. The metabolism of fatty-acids, phospholipids, and triacylglycerol was profoundly affected. Simvastatin reversed most of the effects on phospholipids induced by cocaine. The correlation matrix showed that cocaine and simvastatin significantly reshaped the lipid metabolic pathways in specific brain regions. Furthermore, simvastatin almost reversed all changes in the fatty acyl profile and unsaturation caused by cocaine. In summary, pre-extinction treatment with simvastatin facilitates cocaine extinction and prevents cocaine relapse with brain lipidome remodeling.
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Drug-associated reward memories are conducive to intense craving and often trigger relapse. Simvastatin has been shown to regulate lipids that are involved in memory formation but its influence on other cognitive processes is elusive. Here, we used a mass spectrometry-based lipidomic method to evaluate the impact of simvastatin on the mouse brain in a cocaine-induced reinstatement paradigm. We found that simvastatin blocked the reinstatement of cocaine-induced conditioned place preference (CPP) without affecting CPP acquisition. Specifically, only simvastatin administered during extinction prevented cocaine-primed reinstatement. Global lipidome analysis showed that the nucleus accumbens was the region with the greatest degree of change caused by simvastatin. The metabolism of fatty-acids, phospholipids, and triacylglycerol was profoundly affected. Simvastatin reversed most of the effects on phospholipids induced by cocaine. The correlation matrix showed that cocaine and simvastatin significantly reshaped the lipid metabolic pathways in specific brain regions. Furthermore, simvastatin almost reversed all changes in the fatty acyl profile and unsaturation caused by cocaine. In summary, pre-extinction treatment with simvastatin facilitates cocaine extinction and prevents cocaine relapse with brain lipidome remodeling.
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Animals , Male , Mice , Brain , Cocaine , Conditioning, Operant , Extinction, Psychological , Lipidomics , Simvastatin/therapeutic useABSTRACT
Objective To analyze the alkaloids in the different parts of Aconitum wulingense by HPLC-ESI-Trap-MS. Methods The Agilent XDB-C18(250 mm×4.6 mm, 5 μm) column with gradient elution of 0.1% solvent (A)-acetonitrile(B), at a flow rate of 1 ml/min was used. The column temperature was set at 30 ℃. The MS analysis was based on positive ions mode. Results In the roots, a total of 61 diterpenoid alkaloids were discovered, among which 46 were identified. In the stems, 38 alkaloids have been found, among which 33 alkaloids were identified and 27 were the same with the roots. In the leaves, 18 alkaloids have been detected and 8 were the same with the roots. Conclusions The method is accurate, reliable and efficient, and is suitable for rapid identification of ingredients in Aconitum wulingense, which provides a reference for the development and utilization of Aconitum wulingense and clarify its efficacy and material basis.
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Objective To isolate and identify 3 flavonoids (taxifolin, orobol and quercetin) from Cudrania tricuspidata, and develop a method for determining 3 flavonoid constituents in Cudrania tricuspidata. Methods Three flavonoids was isolated from ethanol extract of Cudrania tricuspidata by chromatography, and its structure was identified by nuclear magnetic resonance. The analysis was conducted on an Aglient C18 column (4.6 mm ×250 mm, 5 μm) eluted with 1％ acetic acid and methanol as mobile phases in gradient mode. The flow rate was 1 ml/min and the detection wavelength was set at 310 nm. The column temperature was 25 ℃. Results Taxifolin, orobol and quercetin were isolated from ethanol extract of Cudrania tricuspidata by chromatography. The content of taxifolin, orobol and quercetin were 0.850 mg/g, 0.518 mg/g, 0.103 mg/g. Conclusion The method can be used for the quality control of Cudrania tricuspidata as a reference.
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Objective To discuss the impact of improved pipe-washing on blockage of PICC for infusion of polyene phosphatidylcholine injection (PPI). Methods A total of 15 patients treated with infusion of PPI from April 2014 to March 2015 were chosen as the control group by convenience sampling method, while another 18 patients treated with PPI from April 2015 to March 2016 were selected as the experimental group. In the control group the pipes were washed with 0.9%10 mL sodium chloride injection before PPI infusion, while in the experimental group improved pipe washing method was applied. We compared the two groups in terms of the maximum number of transfusion drops and rate of unplanned extubation caused by pipe blockage. Results The maximum number of transfusion drops for pipe biockage test in the experimental group was significantly greater than that in the control group (P<0.01). The incidence of pipe blockage was smaller than that in the control group (P<0.01). Conclusion Improved pipe washing method caneffectively reduce rate of tube blockage.
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Objective To discuss the impact of improved pipe-washing on blockage of PICC for infusion of polyene phosphatidylcholine injection (PPI). Methods A total of 15 patients treated with infusion of PPI from April 2014 to March 2015 were chosen as the control group by convenience sampling method, while another 18 patients treated with PPI from April 2015 to March 2016 were selected as the experimental group. In the control group the pipes were washed with 0.9%10 mL sodium chloride injection before PPI infusion, while in the experimental group improved pipe washing method was applied. We compared the two groups in terms of the maximum number of transfusion drops and rate of unplanned extubation caused by pipe blockage. Results The maximum number of transfusion drops for pipe biockage test in the experimental group was significantly greater than that in the control group (P<0.01). The incidence of pipe blockage was smaller than that in the control group (P<0.01). Conclusion Improved pipe washing method caneffectively reduce rate of tube blockage.
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Background The relationship between corneal central thickness (CCT) and corneal biomechanical property does not reflect the effective amount of ablated tissue because CCT measures only the change in a single point.Corneal volume (CV) is a representative parameter of corneal morphology,and it can fully reflect corneal thickness and tissue distribution.Objective This study was to investigate the correlation between volumetric corneal changes and corneal biomechanical properties after small incision lenticule extraction (SMILE).Methods A prospective series cases-observational study was carried out.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital,and written informed consent was obtained from each patient prior to entering the cohort.Sixty-seven right eyes of 67 myopia or myopic astigmatism patients who received SMILE in Tianjin Eye Hospital from June 2014 to July 2015 were included in this study.Before and 3 months after surgery,the CV at 3,3-5,5-7 and 7-10 mm (CV3,CV3-5,CV5-7,CV7-10) was measured by Pentacam anterior segment analysis system,and corneal hysteresis (CH) and corneal resistance factor (CRF) were obtained by ocular response analyzer (ORA).The changes of CV (ACV),CH (ACH) and CRF (ACRF) were calculated,and the correlations between ACV and ACH or ACRF were analyzed.Results CV3,CV3-5 and CV5-7 values after SMILE were significantly lower than those before SMILE (t =36.24,20.38,16.17,all at P＜ 0.001).The CH values before and after SMILE were (10.06± 1.11) mmHg and (8.10± 1.05) mmHg (1 mmHg =0.133 kPa),and the CRF values before and after SMILE were (10.40 ± 1.38) mmHg and (6.91 ± 1.19) mmHg,respectively,showing significant reduces after SMILE than before SMILE (t =16.71,27.41,both at P＜0.001).Positive correlations were seen between the CV values at different corneal areas and CH value or CRF value.Moderate positive correlations were found between CV3 and CH or CRF (r =0.571,0.569;both at P＜0.001) before surgery,and 3 months after surgery,a weak positive correlation was seen between ACV3 and ACH (r =0.394,P ＜ 0.001) or a moderate positive correlation between ACV3 and ACRF (r=0.501,P＜0.001).Conclusions The CV value is gradually increased from the central cornea to periphery cornea.The CV change is associated with CH and CRF changes after SMILE,and CV3 probably is a useful parameter for the evaluation of corneal biomechanics after refractive surgery.
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Background The current evaluation of corneal optical quality after small incision lenticule extraction (SMILE) is based on the single factor,such as scattering,diffraction or aberration,and all of them are not comprehensive and objective methods.Modulation transfer function (MTF) and Strehl ratio (ST) are novel parameters of corneal optical quality,which can be used to assess the optical quality comprehensively.Objective This study was to evaluate the change of MTF and SR under the photopic and scotopic environment (3 mm and 6 mm pupil size,respectively) after SMILE procedure.Methods The study protocol was approved by Ethic Committee of Tianjin Eye Hospital,and written informed consent was obtained from each patient before any medical procedure.A series cases-observational study with self-control design was carried out.Sixty-three eyes of 32 myopia or myopic astigmatism patients who underwent SMILE surgery in Tianjin Eye Hospital were included from December 2013 to March 2014.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA) (LogMAR),the effective index (postoperative UCVA/preoperative BCVA) and refractive diopter were examined,and the MTF,SR and root mean square (RMS) on the anterior corneal surface were measured under the 3 mm and 6 mm pupil size at different spatial frequencies (10,20,30,40,50 and 60 c/d) by Sirius anterior analyzer before surgery and 1 week,1 month and 3 months after surgery,respectively.Results UCVA was ≥0.8 in 59,62 and 63 eyes in 1 week,1 month and 3 months after SMILE,with the percentage of 93.65％,98.41％ and 100％,and the effective index was 1.104± 0.128,1.126±0.145 and 1.158±0.208,respectively.The refractive diopter was normal in the eyes at postoperative 3 months.The MTFs of various spatial frequencies on the vertical and horizontal meridian under the 3 mm pupil size after SMILE were significantly higher than those before SMILE,while under the 6 mm pupil size,the MTFs were higher only on vertical meridian and 10,20,30 and 40 e/d,and there were not significant differences on the horizontal meridian (all at P＜0.05).The SRs under the 3 mm and 6 mm pupil size showed increasing softly after surgery in comparison with before surgery,and the SRs were higher under the 3 mm pupil size than those under the 6 mm pupil size at various time points (all at P＜0.05).There were not significant differences in RMS among different time points under both 3 mm pupil size and 6 mm pupil size (3 mm pupil size:F =1.348,P =0.184;6 mm pupil size:F=1.990,P=0.137).Conclusions SMILE provides a great improvement in corneal optical quality for myopia or myopic astigmatism patients,which is more distinct in photopic condition than that in scotopic condition.
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Background Small incision lenticule extraction (SMILE) is increasingly applied in the correction of myopia and astigmatism.However,the early clinical outcomes of SMILE for different refractive myopia and astigmatism is seldom reported.Objective This study was to investigate the safety,efficacy,predictability and early stability after SMILE in low,moderate and high myopia.Methods A series of cases-observational study was carried out.A total of 195 eyes of 108 myopic patients were enrolled in Tianjin Eye Hospital from May to December 2012 under the informed consent.The patients were divided into the low (≤-3.00 D),moderate (＞-3.00 to-6.00 D) and high myopia (＞-6.00 D) groups according to different diopters,with 57 eyes,76 eyes and 62 eyes,respectively.SMILE was performed on all the eyes.The uncorrected visual acuity (UCVA)(LogMAR),best corrected visual acuity (BCVA) (LogMAR),equivalent sphere (SE),intraocular pressure,anterior segment and corneal topography were examined before operation and 1 day,1 week,1 month and 3 months after operation to evaluate the effective index (postoperative UCVA/preoperative BCVA),safety index (postoperative BCVA/preoperative BCVA),predictability and early stability of SMILE.The linear regression analysis was used to analyze the relationships between the attempted refraction and the achieved refraction postoperative 3 months in three groups.Results The percentage of UCVA (LogMAR)＜0.1 was 100％,97.1％ and 92.8％ in the low,moderate and high myopia group,respectively in 3 months after SMILE.The postoperative BCVA of all the operated eyes reached preoperative one.The residual SE was (-0.07±0.16),(-0.05 ±0.20) and (-0.08±0.27)D in the low,moderate and high myopia group,respectively in 3 months after SMILE.The percentage of residual SE±0.5 D was 100％,98.7％ and 93.6％ in the low,moderate and high group,and that of SE±1.0 D was 100％ in all of the groups.The postoperative corrected SE was gradually increased with the raise of predicted SE in the low,moderate and high myopia groups (r=0.942,0.959,0.957,all at P＜0.001).Conclusions SMILE is safe,effective,predictable and stable for the correction of low,moderate and high myopia.The corneal wound healing was slightly slower in the low myopia group than that in the moderate and high group.A slight regression of myopic power appears in high myopia eyes 3 months after SMILE.
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Background The visual quality and corneal biomechanical change are two major sides for evaluating the outcomes of cornea refractive surgery.It was determined that small incision lenticule extraction (SMILE) can improve the visual outcomes,but its long-term effects on corneal biomechanical are not known clearly.Objective This study was to investigate the change of corneal biomechanics and influence factors following SMILE.Methods A serial cases-observional study was performed.One hundred eyes of 58 patients with a mean spherical diopter (-5.00 ± 1.55) D and cylindrical diopter (-0.98 ± 0.87) D were included in Tianjin Eye Hospital from August 2011 to July 2013 under the informed consent.Corneal biomechanical parameters,including corneal resistance factor (CRF) and cornea hysteresis (CH) were measured using the ocular response analyzer (ORA) in preoperation and postoperative 1,3,6 and 12 months,respectively.The patients were grouped based on different lenticule thickness ratio (LTR),preoperative CRF values and residual stromal thickness (RST) separately,and the correlations of LTR,preoperative CRF and RST with ΔCRF and ΔCH were assessed.In addition,the associations between ΔCRF or ΔCH and related preoperation parameters were evaluated.Results The CRF and CH values at postoperative 1 month were (7.12 ± 1.20) mmHg and (7.90 ± 0.97) mmHg,which were significantly lower than preoperative (10.17±1.46) mmHg and (10.00±1.16) mmHg,respectively (t=15.552,P=0.000;t =13.411,P=0.000).The CRF values at postoperative 3,6 and 12 months were (7.06±0.90),(6.98 ± 1.11) and (6.87 ± 1.07) mmHg,and those of CH were (8.12 ±0.84),(8.12 ±0.97) and (8.14 ±0.86) mmHg,and no significant differences were found in CRF and CH between the adjacent time points (CRF:P =0.848,0.992,0.270;CH:P =0.370,0.791,0.777).Positive correlations were seen between the ΔCRF or ΔCH and LT/preoperative central corneal thickness (CCT) (LTR),preoperative CRF or preoperative CH values,respectively (LTR:r =0.468,P =0.000;r =0.299,P =0.004;preoperative CRF:r =0.696,P =0.000;r =0.590,P =0.000;preoperative CH:r =0.576,P =0.000;r =0.690,P =0.000).ΔCRF and ΔCH were negatively correlated with preoperative spherical equivalent diopter (r =-0.496,P =0.000;r =-0.292,P =0.010),the sum of preoperative spherical diopter and cylindrical diopter (r =-0.484,P =0.000;r =-0.293,P =0.005) or RST/preoperative CCT (r =-0.362,P =0.000;r =-0.243,P =0.019) and were positively correlated with lenticule (r =0.495,P =0.000;r =0.325,P =0.002).No significant association was found between ΔCRF or ΔCH and age,preoperative CCT and preoperative mean keratometry (all at P＞0.05).Conclusions Corneal biomechanical strength is decreased at the early stage after SMILE.However,biomechanical strength gradually enhances 1 month after surgery and tends to stability.The large RST/preoperative CCT can improve postoperative CRF and CH.The another main factor affecting the corneal biomechanics after SMILE is corrected-diopter.
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Background Small incision lenticule extraction (SMILE) is lack of eye-tracking system and there is controversy in the treatment of astigmatism.It is very important to understand its correction effctiveness for myopic astigmatism.Objective This study was to evaluate the clinical outcomes in the correction of myopic astigmatism between SMILE and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK).Methods In this retrospective study,95 eyes of 51 patients and 69 eyes of 40 patients with myopic astigmatism underwent the SMILE surgery and FS-LASIK surgery respectively in Tianjin Eye Hospital from December 2013 to July 2014 under the informed consent.No significant differences were found in spherical power,astigmatic power and spherical equivalent (SE) between the SMILE group and FS-LASIK group before surgery (all at P＞0.05).The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest refraction,slit-lamp microscopy,intraocular pressure and corneal topography were measured before surgery and 1 day,1 week,1 month,3 months after surgery.Vector analysis was used to calculate the components of astigmatism before and after surgery.Correction index (CI),index of success (IOS),angle of error (AofE) and flattening index (FI) were used to evaluate the correction effectiveness of astigmatism.Safety index and efficacy index were used to evaluate the recovery status of visual acuity.The corrected effectiveness was compared between the two groups,and the correlations of kappa angle with measured parameter were assessed by Spearman rank correlation analysis.Results The mean spherical power,astigmatic power and SE were (0.003±0.106),(-0.063 ± 0.126) and (-0.029 ± 0.101) D in the SMILE group,which were significantly lower than (0.112 ± 0.212),(-0.091 ± 0.142) and (0.067 ± 0.198)D in the FS-LASIK group (Z =-4.328,-3.197,both at P＜0.05).Vector analysis showed the postoperative with-the-rule astigmatism in the SMILE group and oblique astigmatism in the FS-LASIK group respectively,and the CI and F1 in the SMILE group were significantly lower than those in the FS-LASIK group (Z =-3.051,-3.126,both at P ＜ 0.05).The insignificant reduce in IOS and AofE were seen in the SMILE group compared with the FS-LASIK group (Z=-1.557,P=0.119;Z =-1.923,P =0.054).In addition,the safety index and efficacy index were not significantly different between the two groups (both at P ＞ 0.05).Negative correlations were found between safety index or efficacy index and preoperative kappa angle in the SMILE group (r =-0.258,-0.257,both at P＜0.05).Conclusions Both SMILE and FS-LASIK surgeries are effective and safe in correcting myopic astigmatism with good postoperative visual acuity.SMILE surgery shows less axis rotation and higher accuracy than FS-LASIK because of small incision and flapless procedure.The correction of cylinder can adjust based on experience of surgeon.