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ABSTRACT Purpose: To compare the outcomes of intravitreal dexamethasone implant used as either an adjuvant or a switching therapy for diabetic macular edema in patients with poor anatomic response after three consecutive monthly injections of ranibizumab. Methods: This retrospective study included patients with diabetic macular edema who received three consecutive doses of ranibizumab as initial therapy and demonstrated poor response. A single dose of intravitreal de xamethasone implant was administered to these patients. The patients were divided into two groups according to the treatment modalities: the adjuvant therapy group, consisting of patients who continued treatment with ranibizumab injection after receiving intravitreal dexamethasone implant, and the switch therapy group, consisting of patients who were switched from ranibizumab treatment to intravitreal dexamethasone implant as needed. The main outcome measurements were best corrected visual acuity and central retinal thickness at baseline and at 3, 6, 9, and 12 months of follow-up. Results: In this study that included 64 eyes of 64 patients, the best corrected visual acuity and central retinal thickness values did not significantly differ between the groups at baseline and at 6 months of follow-up (p>0.05). However, at 12 months, the best corrected visual acuity values in the adjuvant and switch therapy groups were 0.46 and 0.35 LogMAR, respectively (p=0.012), and the central retinal thickness values were 344.8 and 270.9, respectively (p=0.007). Conclusions: In a real-world setting, it seems more reasonable to use intravitreal dexamethasone implant as a switch therapy rather than an adjuvant therapy for diabetic macula edema refractory to ranibizumab despite three consecutive monthly injections of ranibizumab. Patients switched to intravitreal dexamethasone implant were found to have better anatomic and visual outcomes at 12 months than those who continued ranibizumab therapy despite their less-than-optimal responses.
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La hidroxicloroquina es un medicamento derivado de la Cloroquina ampliamente utilizado para el tratamiento de enfermedades inmunológicas, de creciente indicación debido a su eficacia en estas patologías. Paralelamente, se ha descrito dentro de sus reacciones adversas, la toxicidad retinal, específicamente macular, que se presenta ante la administración crónica del fármaco, habitualmente mayor a 5 años. La maculopatía por hidroxicloroquina es asintomática en etapas tempranas, observándose signos clínicos inespecíficos al examen de fondo de ojo. En etapas avanzadas aparece dificultad en la lectura, escotomas en el campo visual y finalmente, la pérdida de la visión central. El diagnóstico precoz se realiza mediante tomografía de coherencia óptica (SD-OCT), campo visual computarizado, autofluorescencia del fondo de ojos (FAF) y el electrorretinograma multifocal (mfERG). No existe tratamiento para esta enfermedad, la única herramienta para prevenir la pérdida de visión es la suspensión del medicamento y sólo es efectiva en los primeros estadios clínicos. Por este motivo, se han desarrollado guías clínicas orientadas a la evaluación periódica preventiva y la indicación de suspensión del tratamiento ante el hallazgo de ciertos criterios diagnósticos. El presente artículo está orientado a presentar una actualización de las recomendaciones de Screening de maculopatía para los pacientes en tratamiento crónico con Hidroxicloroquina, debido a que su difusión a los médicos tratantes, no exclusivamente reumatólogos, es esencial para la derivación oportuna al oftalmólogo y la prevención de la pérdida visual
Hydroxychloroquine is a Chloroquine derived drug widely used for the treatment of immunological diseases, with increasing indication due to its effectiveness in these pathologies. At the same time, retinal toxicity has been described among its adverse reactions which occurs with chronic administration of the drug, usually greater than 5 years. Hydroxychloroquine Maculopathy is asymptomatic in early stages, with non-specific clinical signs observed during fundus examination. In advanced stages, the patient reports difficulties to read, the visual field shows scotomas and finally central vision is lost. Early diagnosis is made using optical coherence tomography (SD-OCT), computed visual field, fundus autofluorescence (FAF) and multifocal electroretinogram (mfERG). There is no treatment for this disease, the only measure to prevent vision loss is the suspension of the medication and it is only effective in the early clinical stages. For this reason, clinical guidelines have been developed focusing on periodic preventive evaluation and the indication of suspension of treatment when certain diagnostic criteria are found. This article is aimed at presenting an update of the Maculopathy Screening recommendations for patients undergoing chronic treatment with Hydroxychloroquine, because its dissemination to treating physicians, not exclusively rheumatologists, is essential for timely referral to the ophthalmologist and prevention of visual loss.
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In this article, we highlight the importance of the ophthalmologist in the diagnosis of hypertensive emergencies. It is crucial to know how to make the correct diagnosis and correctly refer the patient. We report a case of a 23-year-old female patient with a history of undocumented nephropathy since the age of 10 years that was admitted for a sudden decrease in visual acuity and persistent headaches that did not respond to pain medication. Diagnosis is often difficult and delayed, the role of the ophthalmologist remains crucial, as our case illustrates. It underlines the urgent need to reduce blood pressure, and highlights the importance of regular follow-up and compliance with treatment to prevent serious complications.
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Background: Type 2 diabetes mellitus (T2DM) is endocrine disorder showing increasing prevalence worldwide. Chronic hyperglycemia of diabetes affects various organs of our body and causes dysfunction and failure of them. Diabetic retinopathy is a grave complication of diabetes mellitus. Diabetes causes neurodegeneration in retina well before the frank retinopathy. Early detection of these changes by visual evoked potentials (VEPs) may prevent the development of this complication in future, so it can be used as a screening test. Aims and Objectives: The study aimed to compare the VEP changes with the duration of T2DM. Materials and Methods: An analytical case–control study was done after obtaining Ethical Committee permission. VEPs were recorded with RMS EMG EP MK II machine. The duration of the diabetes was used to divide patients into two groups: Group I - 30 patients with disease duration <15 years; and Group II - 30 patients with T2DM with disease duration >15 years. Analysis and processing of the data was done by using statistical software SPSS23.0 using t-test. The significance level was taken as P < 0.05. Results: The comparative analysis between groups showed significant prolongation in latencies of P100 wave and N 145 wave in group II and reduced N75 - P100 amplitude in group II, though it was not statistically significant. Conclusion: It is concluded that the visual pathway is affected by diabetes and VEP changes are correlated with its duration. Therefore, VEPs can be used as a prognostic marker.
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BACKGROUND Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness among individuals with diabetes mellitus. Early detection and timely intervention are crucial for preventing irreversible vision loss. However, traditional methods of DR screening are labor-intensive and reliant on the availability of skilled personnel, posing challenges in resource-constrained settings. Objective This study aims to evaluate the effectiveness of artificial intelligence (AI) in detecting the severity of DR compared to conventional ophthalmological assessments. METHODS A hospital-based observational study was conducted at the ophthalmology outpatient department of Tertiary care hospital, India over a six-month period. A total of 300 diabetic patients were included, and fundus photographs were obtained using a fundus camera. The images were then analyzed using an AI model trained on a diabetic retinopathy dataset. The severity of DR was graded according to established criteria, and the accuracy of the AI model was compared to that of ophthalmologist grading. RESULTS The AI model demonstrated an accuracy rate of 95.25% in grading the severity of DR. Comparison between AI and ophthalmologist grading showed close sensitivity and specificity rates across different DR grades, with the AI model slightly outperforming in certain categories. CONCLUSIONS Artificial intelligence shows promise as an effective and efficient tool for the screening and diagnosis of diabetic retinopathy. Its integration into healthcare systems could enhance early detection and treatment of DR, particularly in underserved regions with limited access to ophthalmological services. Further research and validation are warranted to optimize the use of AI in diabetic eye care and ensure its equitable distribution and ethical use.
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Pregnancy-induced hypertension (PIH) is a syndrome of hypertension with or without proteinuria and oedema. PIH complicates 6 � 10% of pregnancies, major cause of new born, foetal, maternal morbidity, and mortality. The Incidence of Preeclampsia in nulliparous is more common than in multiparous women. Headache, visual disturbances and right upper quadrant pain are indicative of imminent eclampsia. Diagnosis is by clinical examination and various diagnostic modalities like regular BP measurement, weight check-up, fundus examination, and other laboratory investigations. They are at greater risk of abruptio placenta, early diagnosis is needed to reduce complications and improve foetal outcome.
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Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.
Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.
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Introduction: Diabetes is a leading cause for the cardiovascular diseases, stroke, blindness, amputations and end stage renal disease in the world. Increasing evidences in both the experimental and clinical studies suggest that oxidative stress plays a major role in the pathogenesis of diabetes mellitus. Elevated circulating levels of soluble adhesion molecules as markers of endothelial dysfunction have been related to insulin resistance and its associated metabolic abnormalities. 1- To ?nd the relationship between Apo-B and type 2 diabetes mellitus withoutAims And Objective retinopathy 2-To ?nd a relationship between HbA1C and type 2 diabetes mellitus without retinopathy. 3-To study the correlation between Apo-B and HbA1C in type 2 diabetes mellitus without retinopathy. 45 patients of newly diagnosed type 2 diabetics withoutMaterials And Methods: retinopathy of age between 20 to 65 years were selected. For control, 20 age and sex matched healthy non-diabetic & Normotensive individuals were selected as the controls, whose blood samples were drawn with their consent for comparison with the blood samples of the cases. WeResults: have found statistically non signi?cant positive correlation between HbA1C % and level of Apo 揃� The study also showedConclusion: statistically signi?cant difference in HbA1c (p<0.001) when compared between diabetics without retinopathy and normal healthy controls. Further levels of HDL-C were signi?cantly lower in patients of diabetes without retinopathy(p<0.001).
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Introduction: Diabetic retinopathy is a common microvascular complication seen in diabetic patients. The global prev alence is estimated to be 22.27 %. (1). Objective: This study aimed to assess the prevalence of diabetic retinopath y in type 2 diabetic patients visiting our institute – Karnataka Institute of Endocrinology and Research. Furthermore, we evaluated the severity of diabetic retinopath y and factors associated with diabetic retinopathy like gender and age group . Methods: A total of 5,363 diabetic patients attending the vitreoretinal OPD at our Institute from November 1st, 2022 to October 31st, 2023 were included in our study. Data was collected using a questionnaire and a detailed dilated examination was done by an ophthalmologist (vitreoretina specialist). Result: A total of 5,363 diabetic patients were included in the study. The prevalence of diabetic retinopathy y== was 30.84 % (95% CL: 29.66-32.12). Among5,363 patients, 3705 patients had no diabetic retinopath y (69.15%),812 had mild NPDR (15.14%), 438 had moderate NPDR (8.16%), 152 had severe NPDR (2.83%) and 252 patients had PDR (4.69 %). The prevalence of diabetic retinopath y was higher in males (34.82%) compared to females (25.01%). The odds ratio was 1.60. The prev alence of diabetic retinopath y was higher in the age group abo ve 45 years. Conclusion: The prevalence of diabetic retinopathy in our study was 30.84%, higher than global figures. Screening of all diabetic patients regularly and good glycemic control should be an integral part of diabetic care management to reduce the burden of diabetic retinopathy
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This article discusses the importance of diabetic retinopathy, an eye disease associated with diabetes, which is a systemic disease. The research question addresses the impact of diabetes on the retina of the eye through infection and clinical features. This approach is designed to improve the relationship between early diagnosis and treatment of disease, including laser surgery, corticosteroid injections, and vitrectomy. This article focuses on chronic diabetic retinopathy and eye examination recommendations in the United States and the United Kingdom. To prevent and manage diabetic retinopathy, it is recommended that diabetic patients have regular eye examinations. The results of this study include the importance of good glycaemic control, injections, photocoagulation, and vitrectomy as treatment options. Intravitreal long-acting steroids may also temporarily improve visual acuity by reducing macular oedema. However, long-term use of the drug may cause side effects and may lead to cataracts, steroid glaucoma, and endophthalmitis. It may cause reasons. A recent study of the disease in India shows that the incidence of high blood sugar and its effects on the eye is mainly diabetic retinopathy, including cataracts, neovascular glaucoma and even retinal detachment, which are very dangerous for eye health. Therefore, it is important to inform patients about this disease and perform timely screening because patients need to be informed carefully.
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Objective: the present study aimed to evaluate the prevalence of diabetic nephropathy and diabetic retinopathy, in addition to the associations that can be established between these microvascular complications of diabetes mellitus. Methods: this was a retrospective study, a systematic review without metaanalysis. The authors used the Pubmed and SciELO databases to search the terms "diabetic nephropathy", "diabetic retinopathy" and "type 2 diabetes", including publications dated 2011 to 2021. Results/Discussion: the results presented were a synthesis of patients with both pathologies and their correlations, in addition to associated laboratory changes and agreement between the stages or severity of both conditions. Conclusions: DN and DR are pathologies that are directly interconnected and cause repercussions for patients.
Objetivo: o presente estudo teve como objetivo avaliar a prevalência de nefropatia diabética e retinopatia diabética, além das associações que podem ser estabelecidas entre essas complicações microvasculares do diabetes mellitus. Métodos: estudo retrospectivo, revisão sistemática sem metanálise, os autores utilizaram as bases de dados Pubmed e SciELO para busca dos termos "nefropatia diabética", "retinopatia diabética" e "diabetes tipo 2", incluindo publicações datadas de 2011 a 2021. Resultados/Discussão: os resultados apresentados foram uma síntese dos pacientes com ambas as patologias e suas correlações, além de alterações laboratoriais associadas e concordância entre os estágios ou gravidade de ambas as condições. Conclusões: ND e RD são patologias que estão diretamente interligadas e causam repercussões aos pacientes.
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Diabetes Mellitus , Diabetic Retinopathy , Renal Insufficiency, ChronicABSTRACT
Objective:We applied a hypoxia-induced model of human fetal retinal microvascular endothelial cell (RMEC) to study the effect of carbonic anhydrase 9 (CA9) on cell proliferation.Methods:The eyeballs of spontaneously aborted fetuses in Guangdong Women and Children's Hospital were obtained, and the retinas were isolated. RMEC was obtained by trypsin and collagenase two-step enzyme digestion, and endothelial cells were identified by CD34. The fetal RMEC and the purchased adult RMEC were cultured in normoxic and hypoxic incubators (1%O 2+5%CO 2+94%N 2), and the expression of CA9 was detected by qPCR and Western blot. After knocking down the CA9 by small interference RNA technique, the cell proliferation was detected by CCK-8 method, and the cell viability was detected by CCK-8 after adding CA9 inhibitor U-104. Results:The primary RMEC was extracted successfully. Immunofluorescence staining showed the percentage of CD34 positive cells in the third-generation cells was nearly 100%. The expression of CA9 mRNA in immature fetus and adult RMEC under hypoxia culture was higher than that under normoxic culture (fetal 1% O 2 group vs. fetal 21% O 2 group: 67.80±10.31 vs. 1.00±0.04, P<0.001; adult 1% O 2 group vs. adult 21% O 2 group: 1.72±0.22 vs. 1.00±0.02, P=0.014). Western blot analysis showed significantly increased expression of CA9 in the fetal RMEC exposed to hypoxia, which aligned with the expression of CA9 mRNA. When fetal RMEC was transfected with siCA9 20 nM, the knockdown rate of CA9 was 95% ( P<0.001). CCK-8 assay showed significantly lower proliferation of fetal RMEC cells in siCA9 group compared to siNC group (0.57±0.05 vs. 0.90±0.03, P<0.001), which was reflected by the OD value. With the addition of 100 μM CA9 inhibitor U-104, the viability of fetal RMEC in the treated groupwas significantly lower than that in the untreated group (99.16%±3.82% vs. 119.10% ±1.72%, P=0.002). Conclusions:The expression of CA9 differed between adult and preterm fetus in our hypoxia-induced RMEC model. Inhibiting CA9 can inhibit the proliferation of retinal microvascular endothelial cells of preterm fetus.
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Diabetic retinopathy(DR)is considered to be a chronic medium-and low-grade inflammatory disease(mi-croinflammation).Inflammation runs through the entire process of DR,manifesting as an increase in ocular and systemic inflammation biomarkers.In the eyes of DR patients,there is an increase in pro-inflammatory mediators,such as interleu-kin(IL)-1 β,IL-6 and tumor necrosis factor-α,as well as activated and increased number of inflammatory cells,such as ac-tivated microglia,Müller cells in the retina,and infiltration of mononuclear macrophage.In addition,immunocytes are also involved in the pathogenesis of DR,such as the involvement of circulating T cells in leukostasis.These indicate that chronic inflammation is an inducing factor of DR,with multiple inflammation-related factors participating and influencing each other,leading to the destruction of the blood-retinal barrier and neuronal injury and exacerbating the development of DR.There-fore,personalized anti-inflammatory therapy is of great significance in the treatment of DR.
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Diabetic retinopathy(DR)is a common complication of diabetes.Sodium-glucose cotransporter 2(SGLT-2)inhibitors are widely used in diabetic patients as hypoglycemic drugs and also play a role in the prevention and treatment of DR.At present,there has been no systematic study on the clinical treatment of DR by SGLT-2 inhibitors.This paper re-views the research progress of SGLT-2 inhibitors in the treatment of DR,in order to provide more ideas for the clinical treatment of DR.
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Objective To investigate the influencing mechanism of micro ribonucleic acid(miR)-375 targeting phos-phatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)pathway on high glucose-induced proliferation and angiogenesis in human retinal endothelial cells(hRECs).Methods The hRECs were cultured in vitro,and transfection and dual lucifer-ase assay were performed on them.These hRECs were divided into the control group,high glucose group,high glucose+miR-375 group,and high glucose+miR-375+LM22B-10 group.The Cell Counting Kit-8 was used to detect the cell prolifera-tion ability,the angiogenesis assay was used to detect the vascular formation ability,real-time quantitative PCR was used to detect the miR-375 and PI3K mRNA expressions in hRECs,and Western blot was used to detect the PI3K and p-AKT/AKT protein expressions in hRECs.Results At 48 h and 72 h after the cultivation,compared with the control group,the pro-liferation viability,PI3K and p-AKT/AKT protein expressions,vascular formation ability,and PI3K mRNA expression in hRECs significantly increased,and the miR-375 expression in hRECs significantly decreased in the high glucose group,high glucose+miR-375 group and high glucose+miR-375+LM22B-10 group(all P<0.05).Compared with the high glucose group,the proliferation viability,PI3K mRNA and protein expressions,p-AKT/AKT protein expression and vascular forma-tion ability in hRECs were significantly reduced,and miR-375 expression significantly increased in the high glucose+miR-375 group(all P<0.05).Compared with the high glucose+miR-375 group,the proliferation viability,vascular formation a-bility and p-AKT/AKT protein expression in hRECs significantly increased in the high glucose+miR-375+LM22B-10 group(all P<0.05);there was no significant difference in the miR-375 and PI3K mRNA(all P>0.05).After transfected with miR-375 mimic and wt-PI3K-pGL4,the relative luciferase activity in hRECs significantly decreased compared with transfec-tion with miR-375 NC and mut-PI3K-pGL4(all P<0.05).Conclusion The targeted inhibition of the PI3K/AKT pathway by miR-375 can suppress the high glucose-induced proliferation and angiogenesis of hRECs,alleviating DR.
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Objective To investigate the effect of evodiamine(EVO)on retinal injury in diabetic rats by regulating the cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA)signaling pathway.Methods Totally 96 Sprague-Dawley rats(192 eyes)were divided into the negative control(NC)group,Model group,low-dose EVO(EVO-L)group,medium-dose EVO(EVO-M)group,high-dose EVO(EVO-H)group,calcium dobesilate(CD)group,SQ22536 group and EVO-H+SQ22536 group,with 12 rats in each group.Rats in the NC group were intraperitoneally injected with physiological saline instead of streptozotocin,and diabetic retinopathy models were established in all other groups.After successful mod-eling,the drug was administered once a day for 4 weeks.The blood glucose level of rats in each group was measured by blood glucose meter;HE staining was applied to detect the pathological changes of the retina of rats;TUNEL staining was adopted to detect the apoptosis of ganglion cells in the retina of rats;the levels of superoxide dismutase(SOD),malondial-dehyde(MDA),tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and cAMP in the retina of rats were detected;West-em blot was used to detect the protein expressions of Bcl-2 associated X protein(Bax),P53 and phosphorylated protein ki-nase A(p-PKA)in the retina of rats.Results Compared with the NC group,the pathological injury of the retina in the Model group was more serious;the blood glucose,apoptosis rate of retinal ganglion cells,MDA,TNF-α,IL-6,Bax and P53 protein expressions increased,and the SOD,cAMP and p-PKA/PKA protein expression decreased,with statistically significant differences(all P<0.05).Compared with the Model group,the pathological injury of the retina was relieved,the blood glucose,apoptosis rate of retinal ganglion cells,MDA,TNF-α,IL-6,Bax and P53 protein expressions decreased,and the SOD,cAMP and p-PKA/PKA protein expression increased in the EVO-L group,EVO-M group,EVO-H group and CD group,with statistically significant differences(all P<0.05).Compared with the Model group,the retinal tissue of the SQ22536 group was severely damaged,the blood glucose,apoptosis rate of retinal ganglion cells,MDA,TNF-α,IL-6,Bax and P53 protein expressions increased,and the SOD,cAMP,p-PKA/PKA protein expression decreased,with statistically significant differences(all P<0.05).Compared with the EVO-H group,the EVO-H+SQ22536 group showed more serious pathological injury of retinal tissue,increased blood glucose,apoptosis rate of retinal ganglion cells,MDA,TNF-α,IL-6,Bax and P53 protein expressions,and decreased SOD,cAMP and p-PKA/PKA protein expression,and the differences were statistically significant(all P<0.05).Conclusion EVO may alleviate retinal injury in diabetic rats by activating the cAMP/PKA signaling pathway.
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Objective To evaluate the relationship between diabetic nephropathy(DN)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM)based on imaging and clinical testing data.Methods Totally 600 T2DM patients who visited the First People's Hospital of Ziyang from March 2021 to December 2022 were included.The fundus photography and fundus fluorescein angiography were performed on all these patients and their age,gender,T2DM duration,cardiovascular diseases,cerebrovascular disease,hypertension,smoking history,drinking history,body mass in-dex,systolic blood pressure,diastolic blood pressure and other clinical data were collected.The levels of fasting blood glu-cose(FPG),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipo-protein cholesterol(LDL-C),glycosylated hemoglobin(HbA1c),24 h urinary albumin(UAlb),urinary albumin to creati-nine ratio(ACR),serum creatinine(Scr)and blood urea nitrogen(BUN)were measured.Logistic regression was used to analyze the risk factors associated with DR.DR staging was performed according to fundus images,and the convolutional neural network(CNN)algorithm was used as an image analysis method to explore the correlation between DR and DN based on emission computed tomography(ECT)and clinical testing data.Results The average lesion area rates of DR and DN detected by the CNN in the non-DR,mild-non-proliferative DR(NPDR),moderate-NPDR,severe-NPDR and pro-liferative DR(PDR)groups were higher than those obtained by the traditional algorithm(TCM).As DR worsened,the Scr,BUN,24 h UAlb and ACR gradually increased.Besides,the incidence of DN in the non-DR,mild-NPDR,moderate-NPDR,severe-NPDR and PDR groups was 1.67%,8.83%,16.16%,22.16%and 30.83%,respectively.Logistic regression analysis showed that the duration of T2DM,smoking history,HbA1c,TC,TG,HDL-C,LDL-C,24 h UAlb,Scr,BUN,ACR and glomerular filtration rate(GFR)were independent risk factors for DR.Renal dynamic ECT analysis demonstrated that with the aggravation of DR,renal blood flow perfusion gradually decreased,resulting in diminished renal filtration.Conclusion The application of CCN in the early stage DR and DN image analysis of T2DM patients will improve the diag-nosis accuracy of DR and DN lesion area.The DN is worsening as the aggravation of DR.
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Objective To investigate the impact of the interaction of fasting blood glucose(FBG)and serum uric acid(SUA)on diabetic retinopathy(DR).Methods A total of 306 diabetes mellitus(DM)patients diagnosed and re-ceived comprehensive ophthalmic examination in the First Affiliated Hospital of Gannan Medical University from January 2019 to January 2021 were selected.According to the presence or absence of DR,these patients were divided into the DR group(178 patients)and the non-DR(NDR)group(128 patients).The general clinical data of patients in the two groups were compared.The least absolute shrinkage and selection operator(LASSO)regression method and multivariate Logistic regression analysis were used to screen the independent influencing factors of DR in DM patients,and the odds ratio of risk factors was calculated.The sensitivity analysis of the results was performed using the E-value method.The interaction of FBG and SUA on DR in DM patients was analyzed by an additive interaction model.The Nomogram model to predict DR in DM patients was constructed and verified internally.The receiver operating characteristic curve(ROC)was used to evalu-ate the effects of FBG,SUA and both FBG and SUA on DR in DM patients.Results Compared with the NDR group,the course of DM in the DR group was significantly longer,the proportion of patients with history of oral medication was signif-icantly lower,the proportion of patients with history of insulin therapy was significantly higher,and the levels of total cho-lesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,blood urea nitrogen,serum creatinine,SUA and FBG were significantly higher(all P<0.05).The history of insulin therapy,course of DM≥9.66 years,TG≥2.07 mmol·L-1,SUA ≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 were the risk factors for DR in DM pa-tients,while the history of oral medication was the protective factor for DR in DM patients.The Nomogram model based on the above independent risk factors was accurate in predicting the occurrence of DR in DM patients.SUA and FBG had inter-active effects on DR in DM patients.The value of SUA-FBG interaction in the diagnosis of DR was greater than that of both alone.Conclusion SUA≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 are the risk factors for DR in DM patients.The value of interaction of FBG and SUA in the diagnosis of DM accompanied by DR is greater than that of both alone.
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Objective To explore the mechanism of micro ribonucleic acid(miR)-3197 in diabetic retinopathy(DR)on the basis of the nuclear factor κB(NF-κB)signaling pathway.Methods A total of 47 DR patients admitted to Heng-shui People's Hospital from January 2021 to December 2021 were selected as the DR group,and 47 healthy individuals in the same period were collected as the control group.Their information in gender,age,fasting blood glucose(FBG),fast-ing insulin(FINS),triglycerides(TG),total cholesterol(TC)and miR-3197 were compared.The correlation between miR-3197 in DR patients and laboratory data was analyzed,and the receiver operating characteristic(ROC)curve of miR-3197 for DR diagnosis was drawn.The human retinal microvascular endothelial cells(hRMECs)were cultured in vitro and treated with 5.5 mmol·L-1 glucose[low glucose(NG)group]and 30 mmol·L-1 glucose[high glucose(HG)group],respectively.After transfecting with anti-miR-NC and anti-miR-3197,the cells were treated with 30 mmol·L-1 glucose(HG+anti-miR-NC group and HG+anti-miR-3197 group).Real-time fluorescence quantitative PCR was used to detect the relative expression level of miR-3197,flow cytometry was used to detect the apoptosis rate of hRMECs,enzyme-linked im-munosorbent assay was used for detecting tumor necrosis factor-a(TNF-a)and interleukin-6(IL-6),and Western blot was adopted to detect the expressions of aspartic protease 3 containing cysteine(cleaved caspase-3)protein,Bax protein and NF-κB signaling pathway-related proteins[phospho-NF-KB p65(p-p65),p65,phospho-NF-KB inhibited protein(p-IκBα),and NF-κB inhibited protein(IκBα)].Results The levels of FBG,FINS,TC and TG in the DR group were higher than those in the control group,and the differences were statistically significant(all P<0.001).The relative expression level of miR-3197 in the peripheral blood of patients in the DR group(2.76±0.67)was higher than that of the control group(1.03±0.34),and the difference was statistically significant(P<0.05).The miR-3197 level of patients in the DR group was positively correlated with FBG,FINS,TC and TG levels(r=0.672,0.587,0.511 and 0.423;all P<0.05).The ROC curve graph showed that the area under the curve was 0.919,with sensitivity and specificity of 85.11%and 89.36%,respectively.Compared with the NG group,the HG group showed a significant increase in cell apoptosis rate and the pro-tein expressions of cleaved caspase-3,Bax,TNF-a,IL-6,p-IκBa and p-p65(all P<0.05);compared with the HG+anti-miR-NC group,the HG+anti-miR-3197 group showed a significant decrease in cell apoptosis rate and the protein expres-sions of cleaved caspase-3,Bax,TNF-a,IL-6,p-IκBa and p-p65(allP<0.05).Conclusion The miR-3197 is highly ex-pressed in the peripheral blood of DR patients and high glucose-induced hRMECs.Down-regulation of miR-3197 can allevi-ate high glucose-induced hRMEC apoptosis and inflammatory injury,and its mechanism of action may be related to the inhi-bition of the NF-κB signaling pathway.
ABSTRACT
Objective To investigate the expression of circular ribonucleic acid carnitine palmitoyltrans-ferase 1A(circRNA CPT1A)in patients with diabetic retinopathy(DR)and its mechanism of action on neuropathy.Methods To-tally 80 patients(102 eyes)with type 2 diabetes admitted to our hospital from January 2019 to January 2022 were selected,including 22 patients(28 eyes)with no DR(NDR group),38 patients(48 eyes)with non-proliferative DR(NPDR group),and 20 patients(26 eyes)with proliferative DR(PDR group).Optical coherence tomography angiography was used to measure the thickness of the peripapillary retinal nerve fiber layer(pRNFL)and macular ganglion cell complex(GCC),the level of phosphatase and tensin homolog(PTEN)in peripheral blood was detected by Western blot,and the circRNA CPT1A level in peripheral blood was detected by fluorescence quantitative polymerase chain reaction.The levels of circRNA CPT1A and PTEN in peripheral blood,as well as the thickness of pRNFL and GCC,were compared among three groups,and Pearson correlation analysis was used to investigate the correlation between circRNA CPT1A and PTEN,pRNFL and GCC thickness.Results The circRNA CPT1A in the peripheral blood of the PDR group was higher than that in the NDR group and NPDR group;the PTEN in the peripheral blood of the PDR group was lower than that in the NDR group and NP-DR group(all P<0.05).There was no statistically significant difference in the expression of circRNA CPT1A and PTEN be-tween NDPR group and NDR group(all P>0.05).The Pearson correlation analysis showed that the expression level of cir-cRNA CPT1A in peripheral blood was negatively correlated with PTEN(P<0.05).With the increase in disease severity,the thickness of pRNFL and GCC showed a decreasing trend;the thickness of pRNFL and GCC in the whole,upper and lower parts of eyes in the NDR group were higher than those in the NPDR group(all P<0.05),while those in the NPDR group were higher than the PDR group(all P<0.05).Pearson correlation analysis showed that the expression level of cir-cRNA CPT1A in peripheral blood was negatively correlated with the thickness of pRNFL and GCC in the whole,upper and lower parts of the observed eyes(all P<0.05).Conclusion With the increase in the severity of DR,circRNA CPT1A in the peripheral blood of DR patients shows an increasing trend and is negatively correlated with peripheral blood PTEN lev-el,as well as macular pRNFL and GCC thickness.The mechanism of action may be that circRNA CPT1A negatively regu-lates the expression of PTEN and thus participates in the occurrence and development of DR.