RESUMEN
The expanding range of diagnostic instrumental methods allows an in-depth study of the morphological and functional state of the eyelids, which is the basis for determining the strategy for the treatment of chronic blepharitis and subsequent timely supplementation and altering of its algorithm. PURPOSE: To substantiate the repeated courses of invasive treatment of chronic blepharitis based on morphological and functional studies. MATERIAL AND METHODS: The study included 45 patients (90 eyes) with chronic mixed blepharitis. Instrumental research methods - laser Doppler flowmetry, laser scanning confocal microscopy (LSCM), tiascopy, and optical coherence tomography - were used to assess the morphological and functional state of the eyelids during meibomian gland probing (MGP) and eyelid massage course. The therapy effectiveness was evaluated after 1 week, 1, 3 and 6 months. RESULTS: Using a complex of diagnostic methods for assessing the morphological and functional state of the eyelids, surgical invasive treatment for mixed chronic blepharitis was proved to have a significant positive clinical effect compared with the eyelid massage traditionally used in polyclinic practice. After 6 months from the start of treatment, in the absence of changes in the clinical picture in both groups, functional changes in the control group were recorded that were expressed as a decrease in the values of the Norn test, confirmed by the data of tiascopy, and the number of functioning meibomian glands. The indicators of lacrimal meniscus depth in both groups corresponded to the values of the monitoring stage after 3 months. According to LSCM, the control group had higher inflammatory activity: the heterogeneity of the interstitium and the walls of the acini of the meibomian glands increased, the acinar area decreased in comparison with the main group. Deterioration of the blood flow microcirculation in both groups was manifested as a decrease in neurogenic rhythms. Additionally, a 3.05% decrease in myogenic rhythms was recorded in the main group. The study of the microcirculation of lymph flow showed a decrease in neurogenic rhythms in the main group by 4.79%. CONCLUSION: The analysis of the morphological and functional state of the eyelids after MGP has shown that its results persisted for 6 months, and repeated probing was justified, while the interval before repeated course of eyelid massage averaged 1.5 months.
Asunto(s)
Blefaritis , Blefaritis/diagnóstico , Blefaritis/terapia , Enfermedad Crónica , Humanos , Glándulas Tarsales , Microcirculación , Microscopía ConfocalRESUMEN
A complex of measures for lid hygiene in ocular surface disease is developed. These measures together with tear substitution and antibacterial treatment were revealed to result in elimination of blepharoconjunctivitis and dry eye signs, recovery of tear film and long-time remission, that significantly improved patient's life quality. When using this complex of measures meibomian glands are not damaged and their anatomy and functions are completely preserved. Lid hygiene affects all glands, there is no pain and no local anesthesia needed, normal tear film is formed
Asunto(s)
Blefaritis , Conjuntivitis , Síndromes de Ojo Seco , Ácido Hialurónico/uso terapéutico , Soluciones Oftálmicas/uso terapéutico , Irrigación Terapéutica/métodos , Adulto , Blefaritis/complicaciones , Blefaritis/fisiopatología , Conjuntivitis/complicaciones , Conjuntivitis/fisiopatología , Síndromes de Ojo Seco/complicaciones , Síndromes de Ojo Seco/tratamiento farmacológico , Síndromes de Ojo Seco/fisiopatología , Síndromes de Ojo Seco/psicología , Párpados/efectos de los fármacos , Párpados/fisiopatología , Femenino , Humanos , Higiene/normas , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Educación del Paciente como Asunto/métodos , Lágrimas/metabolismo , Resultado del TratamientoRESUMEN
Haemoglobins have the ability to discriminate between oxygen and other diatomic molecules. To further understanding of this process the X-ray crystal structures of carbonmonoxy and nitrosyl-leghaemoglobin have been determined at 1.8 A resolution. The ligand geometry is discussed in detail and the controversial issue of bent versus linear carbon monoxide binding is addressed. The bond angle of 160 degrees for CO-leghaemoglobin is in conflict with recent spectroscopy results on myoglobin but is consistent with angles obtained for myoglobin X-ray crystal structures. In contrast to the numerous carbon monoxide studies, very little stereochemical information is available for the nitric oxide adduct of haemoglobin. This is provided by the X-ray structure of NO-leghaemoglobin, which conforms to expected geometry with an Fe-NO angle of 147 degrees and a lengthened iron-proximal histidine bond. Thus crystallographic evidence is given for the predicted weakening of this bond on the binding of nitric oxide.
Asunto(s)
Monóxido de Carbono/metabolismo , Leghemoglobina/metabolismo , Óxido Nítrico/metabolismo , Sitios de Unión , Monóxido de Carbono/química , Cristalografía por Rayos X , Electroquímica , Fabaceae/metabolismo , Hemo/química , Cinética , Leghemoglobina/química , Ligandos , Modelos Moleculares , Estructura Molecular , Óxido Nítrico/química , Plantas Medicinales , Unión Proteica , Estructura Secundaria de ProteínaRESUMEN
The leghaemoglobins have oxygen affinities 11 to 24 times higher than that of sperm whale myoglobin, due mainly to higher rates of association. To find out why, we have determined the structures of deoxy- and oxy-leghaemoglobin II of the lupin at 1.7 A resolution. Results confirm the general features found in previous X-ray analyses of this protein. The unique feature that has now emerged is the rotational freedom of the proximal histidine. In deoxy-leghaemoglobin the imidazole oscillates between two alternative orientations, eclipsing either the lines N1-N3 or N2-N4 of the porphyrin; in oxy-leghaemoglobin it is fixed in a staggered orientation. The iron atom moves from a position 0.30 A from the plane of the pyrrole nitrogen atoms in deoxy- to a position in the plane in oxy-leghaemoglobin while the Fe-