Ultra-wide-field fluorescein angiography (UWFA) can obtain very wide retinal images (up to 200°), and is a very helpful tool to detect peripheral retinal lesions which cannot be found by other imaging methods. Analyzing the characteristics of the UWFA images may improve our understanding, treatment outcomes and management strategies of ocular fundus diseases. However this technology is still in its premature stage, there is still a lot of work to be done to improve its clinical application and study the characteristics and clinical meanings of these peripheral retinal lesions.

Objective To develop an informatized continuous education system for theater nurse based on PDCA theory.Methods The system was gifted with the functions of learning planning, learning execution, learning checking, data management and system management based on PDCA theory, informatized technology and other learning systems.Results The system behaved well in overall flow and configuration, man-machine interaction and application, which facilitated the nurses to learn with fragmented time.Conclusion The nursing continuous education is enhanced greatly with the system.

Objective To investigate the association between intima-media thickness (IMT) and free fatty acids (FFA) in hypertensive patients with metabolic syndrome (MS). Methods IMT, FFA and body mass index (BMI) were measured in 69 hypertensive patients with metabolic syndrome (MS group) ,57 hypertensive patients without metabolic syndrome ( Non-MS group) ,and 50 healthy controls ( NC group). Results In the MS group,The BMI, serum levels of triglyceride (TG), fasting blood glucose (FPG) and FFA were ( 26.0 ± 2.1 ) kg/m2, (24.0 ±0.81 ) mmol/L and (5.64 ± 0.82) mmol/L respectively, which were significantly higher than those in the Non-MS group ( (24.9 ± 2.3 ) kg/m2, ( 1.93 ± 0. 55 ) mmol/L and ( 5.10 ± 1.08 ) mmol/L respectively ) and the NC group ( (23.6 ± 1.6), ( 1.49 ± 0.36) mmol/L and (4.70 ± 0.90) mmol/L respectively) ( F = 20.06, 30.96 and 15.17,P ＜0.05 or 0.01 ). FFA in the MS group ((562.11 ± 55.12)μmol/L) were significantly higher than that in the Non-MS group (402.65 ± 49.53 ) μmol/L) and the NC group ( ( 356.23 ± 45.93 ) μmol/L) ( F = 277.28, P ＜0. 01 ). IMT in the MS group, Non-MS group and NC group were (1. 10 ± 0. 13 )mm, (0. 82 ± 0. 12 )mm and (0.70 ± 0.11 ) mm, respectively, with significantly difference ( P ＜ 0. 01 ). In addition, the incidence of thickening was 28.99% (20/69), 17.54% ( 10/57 ) and 2.00% ( 1/50 ), respectively, with significantly difference ( P ＜0.01 ). Conclusions Serum level of FFA is associated with IMT in hypertensive patients with metabolic syndrome.

Objective To evaluate the applicability and reliability of optical coherence tomography (OCT) technical in detecting the thickness changes of ganglion cell complex (GCC) and outer retinal layers (ORL) in Alzheimer's disease.Method 28 AD patients and 30 healthy control subjects were recruited.SD-OCT was used to measure the macular ganglion cell complex thickness and outer retinal thickness.Cognitive function was evaluated by Mini-Mental State examination (MMSE).Intra-ocular tension and axis length were measured at the same time.Results OCT data shows statistic difference of ganglion cell complex thickness between AD group and control group,while there is no significant difference of outer retinal layers thickness between the two groups.Significant correlations between GCC thickness and MMSE scores were observed.There was no significant correlation between the MMSE scores and the ocular tension.Conclusions Retinal thickness reduction of AD patients can be detected by OTC,and could be related with disease progression.OCT can be used to screen the early stage AD patient.

Objective To compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR).Methods This is a prospective randomized study.Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients,39 eyes) and 25G+ vitrectomy group (27 patients,36 eyes).Visual acuity,intraocular pressures,ophthalmoscopy,B-scan ultrasound was examined before surgery.The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively.Intraoperative complications,operation time,postoperative visual acuity,intraocular pressure,postoperative complications and postoperative ocular conditions were analyzed.Results The mean surgical times were (53.35± 7.42)minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively,and the difference was significant (t=4.37,P＜0.05).Iatrogenic injuries occurred in 11 eyes (28.21％) and 5 (13.89％) eyes in 23G and 25G + group respectively,and the difference was significant (x2 =4.93,P＜0.05).The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (x2=16.81,18.29; P＜0.05).At last follow-up,there was 25 eyes and 24 eyes with visual acuity ≥ 0.05 in 23G and 25G+ groups respectively,and the difference was not significant (x2 =0.13,P＞0.05).Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively,and the difference was significant (x2 =5.67,P＜0.05).Conclusion 25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.

Diabetic retinopathy (DR) is a common ocular complication in patients with diabetes, and diabetic macular edema (DME) is the main cause of vision loss in patients with DR, so the early diagnosis and treatment of DME is of an important clinical significance.Optical coherence tomography (OCT) can provide high-quality imaging of retina and choroid.It has been widely used in clinical practice and can be used for long-term follow-up of the diagnosis and treatment of DME.Recent studies have found various characteristic changes in retina and choroidal layer of DME on OCT, including vitreomacular interface abnormalities, disorganization of retinal inner layers, inner segment-outer segment (IS-OS) continuity destruction, external limiting membrane continuity destruction, outer retinal tubulations, hyperreflective foci, intraretinal cystic fluid, subfoveal neuroretinal detachment, low optical reflectivity, subfoveal choroidal thickness change, and choroidal vascularity index change, etc.These changes are related to the prognosis of DME, so they can be used as biomarkers of DME.This paper reviews the research progress in this field.

Background Human retinal pigment epithelial(RPE) cells play a critical role in the pathogenesis of proliferative vitreoretinopathy(PVR) and other related ocular diseases.Research demonstrated that epidermal growth factor(EGF) stimulates activation of RPE cells and therefore causes PVR,and integrin α_5 mediates the adhesion of cells and EGF.Objective This study aims to investigate the role of mitogen-activated protein kinase(MAPK) in regulation of EGF on integrin α_5 expression in human RPE cells.MethodsHuman RPE cells strain(CRL2302) was cultured in DMEM/F12 with 10% calf serum and passaged in 0.25% trypsin.Cultured cells were divided into DMEM/F12control group,20μmol/L PD98059 +10 ng/mL EGF＋DMEM/F12(PD98059) group and 10 ng/mL EGF＋DMEM/F12(EGF) group.The expression of integrin α_5 protein in CRL2302 cells was detected by RT-PCR and calculated as α_5 mRNA/β-actin mRNA,and the expression of integrin α_5 mRNA in CRL2302 cells was detected evaluated by flow cytometry.The MAPK phosphorylation level in each group of human RPE cells was tested by Western blot.ResultsThe expression value of integrin α_5 mRNA was 0.93±0.06 in the control group,1.06±0.07 in PD98059 group and 1.97±0.09 in EGF group,showing a significant difference among the three groups(F=458.896,P<0.01).The fluorescence intensity of integrin α5 protein in CRL2302 cells after 24 hours was 1.94±0.22,4.56±0.25,2.39± 0.14 in three groups respectively with a significant difference(F=21.05,P<0.05).After 30 minutes of culture,Western blot result showed that the strongest phosphorylation levels of ERK1/2 activation in EGF group and the weakest phosphorylation levels of ERK1/2 activation in the control group;While that in PD98059 group was significantly stronger than control group and weaker than EGF group(F=143.14,P<0.01).ConclusionEGF stimulates activation of ERK1/2 pathway in human RPE cells and the expressions of integrin α_5 mRNA and protein in human RPE cells in vitro.

Objective To observe the effect of epidermal growth factor (EGF) on integrin α5 expression and its influence on human retinal pigment epithelium (RPE) cells. Methods Human RPE cells were treated in vitro with 0.1, 1.0, 10.0, 20.0 and 100.0 ng/ml of EGF, the mRNA and protein of integrin α5 was measured by reverse transcription polymerase chain reaction(RT-PCR)and flow cytometry. Human RPE cells were cultured under 4 conditions including DMEM/F12, DMEM/F12 + 10 ng/ml EGF, DMEM/F12 + 10 ng/ml EGF+ rabbit anti-human integrin α5 antibody (1: 100), DMEM/F12 + 10 ng/ml EGF+ rabbit anti-human vimentin antibody (1: 100), and their proliferation and migration were measured by methyl-thiazole tetrazolium(MTT)and Boyden chamber. Results The integrin α5 mRNA level of human RPE cells was not changed after 12 hours of EGF stimulation (F=0.618, P = 0. 687), however it was induced in a dose-dependent manner after 24 and 48 hours of EGF stimulation (F=465. 303, 212. 340; P= 0. 000, 0. 000). The protein level of integrinα5 was higher in 10 ng/ml EGF stimulation compared with the control group and 0. 1 ng/ml group (P<0. 01). MTT and Boyden chamber showed that the integrin α5 expression increased the proliferation and migration of human RPE cells. Conclusion EGF can induce integrin α5 expression, thus increase the proliferation and migration of human RPE cells.

Objective To observe the influence of down-regulation of HtrA1 expression by small interfering RNA on light-injured human retinal pigment epithelium (RPE) cells.Methods Cultured human RPE cells(8th-12th generations)were exposed to the blue light at the intensity of (2000 ± 500) Lux for 6 hours to establish the light injured model.Light injured cells were divided into HtrA1 siRNA group,negative control group and blank control group.HtrA1 siRNA group and negative control group were transfected with HtrA1 siRNA and control siRNA respectively.The proliferation of cells was assayed by CCK-8 method.Transwell test was used to detect the invasion ability of these three groups.Flow cytometry was used to detect the cell cycle and apoptosis.The expression of HtrA1 and vascular endothelial growth factor (VEGF)-A was detected by real time-polymerase chain reaction and Western blot respectively.Results The mRNA and protein level of HtrA1 in the light injured cells increased significantly compared to that in normal RPE cells (t=17.62,15.09;P＜0.05).Compared with negative control group and blank control group,the knockdown of HtrA1 in HtrA1 siRNA group was associated with reduced cellular proliferation (t=6.37,4.52),migration (t =9.56,12.13),apoptosis (t =23.37,29.08) and decreased mRNA (t=17.36,11.32,7.29,4.05) and protein levels (t=12.02,15.28,4.98,6.24) of HtrA1 and VEGF-A.Cells of HtrA1 siRNA group mainly remained in G0/G1 phase,the difference was statistically significant (t=6.24,4.93;P ＜0.05).Conclusion Knockdown of HtrA1 gene may reduce the proliferation,migration capability and apoptosis of light-injured RPE cells,and decrease the expression of VEGF-A.

The ATP2C1 gene mutation in one case of familial benign chronic pemphigus was investigated. One patient was diagnosed as familial benign chronic pemphigus by pathology, ultrastructral examination and clinical features. Genomic DNA was extracted from blood samples. Mutation of ATP2C1 gene was detected by polymerase chain reaction (PCR) and DNA sequencing. The results showed that deletion mutation was detected in ATP2C1 gene in this patient, which was 2374delTTTG. No mutation was found in the family members and normal individuals. It was concluded that the 2374delTTTG mutation in ATP2C1 gene was the specific mutation for the clinical phenotype for this patient and was a de novo mutation.
Calcium-Transporting ATPases/*genetics ; DNA Mutational Analysis ; Pemphigus, Benign Familial/*genetics ; Sequence Deletion