Objective To study the responsiveness change of neutrophils when experiencing the second insult after the initial temperature activation in cardiopulmonary bypass (CPB) by using an in vitro model. Methods The neutrophils were isolated from blood which was drawn from each of 60 health volunteers. The samples were divided into 5 groups including normothermia, tepid temperature, moderate hypothermia, deep hypothermia, and rewarming hyperthermia by random digital table with 12 in each group according to the change of temperature during CPB. An in vitro model for studying neutrophil responsiveness was established by using a polymerase chain reaction thermocycler. Five time points were set for each group, including T0: starting CPB, T1: starting rewarming, T2: 0.5 h after rewarming, T3: 1 h after rewarming, and T4: 1.5 h after rewarming. Platelet activating factor (PAF) was added into each group at T2, T3, and T4, and then the value of membranebound elastase (MBE) activity was measured as responsiveness of neutrophils. Analysis of covariance was applied by using SPSS 13.0 for statistic analysis. If the [CM(159mm]covariance had significant difference between main effects, Bonferroni method would be applied for pairwise comparison. Results The main effect difference of neutrophil responsiveness among different groups was statistically different (F=4.372,P=0.002). MBE value had no statistical difference between the normothermia and tepid temperature groups (81.9±4.5 ng/10.6 cells vs. 76.5±3.6 ng/106 cells, P=0.134). while the MBE values in these two groups were higher than those in the other three groups (P=0.001). MBE value in the rewarming hyperthermia group was higher than that in the deep hypothermia group (61.2±2.7 ng/106 cells vs. 50.9±3.7 ng/106 cells, P=0.005). There was no statistical difference between the moderate hypothermia group (56.4±3.2 ng/106 cells) and the rewarming hyperthermia group (P=0.167), so was it between the moderate hypothermia group and the deep hypothermia group (P=0.107). The main effects of neutrophil responsiveness at different time points was statistically different (F=3.566, P=0.03) when PAF was added. MBE value at T4 was higher thanthat at T2 (70.9±2.5 ng/106 cells vs. 59.9±2.3 ng/106 cells, P=0.027). There was no statistical difference among T3 (65.5±1.8 ng/106 cells), T2 (P=0.168), and T4 (P=0.292) in MBE value. Conclusion Normothermia， tepid temperature， and rewarming hyperthermia during CPB can enhance neutrophil responsiveness and MBE release when neutrophils suffer the second insult. There is a time window for neutrophils to be easily activated during rewarming period.
Idiopathic macular membrane (iERM) is a fibrocellular membrane that forms on the inner surface of the retina. In its early stages, symptoms of iERM are usually not apparent. However, advanced iERM can cause different degrees of visual impairment and effect the quality of life of patients. Current studies suggest that iERM may be associated with posterior vitreous detachment (PVD), age, sex, race and/or ethnicity, poor lifestyle, refractive error, diabetes, hypercholesterolemia, and cardiovascular disease. The most well-established risk factors for iERM are age and PVD. The pathogenesis of iERM is extremely complex. Various cell types, such as Müller cells, Hyalocytes and myofibroblasts, nerve growth factor, interleukin-6, transforming growth factor β, vascular endothelial growth factor and other cytokines and growth factors, as well as a variety of genes and proteins are directly or indirectly involved in the formation of iERM, however, their exact role remains a mystery. In the future, further studies at the molecular level and gene level are needed to provide greater help for the clinical diagnosis and treatment of iERM.
Objective To analyze the correlation between foveal avascular zone (FAZ) size and foveal morphology in patients with idiopathic macular epiretinal membrane (IMEM) using OCT angiography (OCTA). Methods A retrospective case series study contained of 54 eyes of 54 patients affected with IMEM (IEM group) and 50 eyes of 50 normal persons as the control group. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The FAZ areas were evaluated with OCTA in both the superficial and deep capillary plexus layers by using 3 mm×3 mm images of the macular. The central macular thickness (CMT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), subfoveal choroidal thickness (SFCT), and the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography. The differences of FAZ areas between the two groups were analyzed. The correlative analysis was performed to investigate the relationship between areas and foveal morphology. Results Compared with control group, the FAZ area in superficial and deep capillary plexus in the IMEM group were significantly smaller (t=−29.095, −28.743; P＜0.001, ＜0.001); the mean CMT, IRT, ORT and SFCT were significantly thickening in the IMEM group (Z=−8.784, −8.524, −7.709, −7.535; P＜0.001, ＜0.001, ＜0.001, ＜0.001). In the IMEM group, the FAZ area in superficial capillary plexus correlated inversely with the CMT, IRT, and the integrity of EZ (r=−0.464, −0.536, −0.293; P＜0.001, ＜0.001, 0.039), no significant correlation of superficial plexus FAZ areas with ORT and SFCT (r=−0.218, −0.165; P=0.172, 0.157). The FAZ area in deep capillary plexus correlated inversely with the CMT, IRT, and the integrity of EZ (r=−0.306, −0.694, −0.468; P=0.037, ＜0.001, ＜0.001), no significant correlation with ORT and SFCT (r=−0.242, −0.227; P=0.079, 0.094). Conclusions The FAZ areas is significantly decreased in IMEM eyes compared with normal eyes. Both superficial and deep FAZ area are correlated with the CMT, IRT, and the integrity of EZ.
OBJECTIVE The human epidermal cells were bred on a kind of bio-membrane, the bio-brane, in engineering a kind of new epidermal substitute, the bio-membrane bred cell graft. METHODS Fresh and frozen grafts of biomembrane bred epidermal cells were transplanted into the full-thickness wounds of nude mice and those received simple Bio-brane were served as control. The wounds of the two groups were observed daily and biopsy was taken on the 3, 5, 7, 10, 21 and 35 days respectively. RESULTS Epidermal cells could be cultured in vitro on the bio-membrane reaching the sub-saturated state of 60 to 70 percents. The bio-membrane after being grafted the epidermal cells continued to proliferate and differentiate to form a layer of new epidermis. There was no difference between the fresh and the frozen bio-membranes. CONCLUSION Bio-membrane bred with epidermal cells could be a kind of ideal epidermal substitute.
ObjectiveTo observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia.MethodsA retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm2 and 0.202±0.03 mm2, respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia.ResultsAt 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm2 and 0.240±0.019 mm2, respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased (F=8.484, 14.346; P＜0.001,＜0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline (F=5.044, 17.763, 13.545; P=0.001,＜0.001,＜0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score (r=－0.816, P＜0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score (r=－0.422, －0.882; P=0.005,＜0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score (r=－0.791,－0.716; P＜0.001,＜0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score (r=－0.343, －0.330, －0.732, －0.694; P=0.026, 0.033,＜0.001,＜0.001).ConclusionsPPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA.
Membrane guided tissue regeneration is new biological concept. The basic theory of this concept includes the belief that during the healing process of wound, the different cells will show different speed of cell migration and regeneration in the wound. If an appropriate membrane being placed to form a mechanical barrier, so that only the needed cells can grow into that area and prevent others from going in, thus resulting in the creation of a guided area where the needed cells can undergo proliferation and differentiation under protection in completing an ideal tissue regeneration and repair. In this article, the experimental researches on the application of membrane guided tissue regeneration in the repair of tubular bone defects, skull defects and faciomaxillary defects were reviewed from literatures, and the degradable and non-degradable materials were introduced, particularly. The pros and cons of this method and the materials were evaluated. It is believed that this technique will push forward the progress in bone biology and reconstructive surgery.
Objective To investigate the effect of repairing bone defect with tissue engineered bone seeded with the autologous red bone marrow (ARBM) and wrapped by the pedicled fascial flap and provide experimental foundation for cl inicalappl ication. Methods Thirty-two New Zealand white rabbits (male and/or female) aged 4-5 months old and weighing2.0-2.5 kg were used to make the experimental model of bilateral 2 cm defect of the long bone and the periosteum in the radius. The tissue engineered bone was prepared by seeding the ARBM obtained from the rabbits on the osteoinductive absorbing material containing BMP. The left side of the experimental model underwent the implantation of autologous tissue engineered bone serving as the control group (group A). While the right side was designed as the experimental group (group B), one 5 cm × 3 cm fascial flap pedicled on the nameless blood vessel along with its capillary network adjacent to the bone defect was prepared using microsurgical technology, and the autologous tissue engineered bone wrapped by the fascial flap was used to fill the bone defect. At 4, 8, 12, and 16 weeks after operation, X-ray exam, absorbance (A) value test, gross morphology and histology observation, morphology quantitative analysis of bone in the reparative area, vascular image analysis on the boundary area were conducted. Results X-ray films, gross morphology observation, and histology observation: group B was superior to group A in terms of the growth of blood vessel into the implant, the quantity and the speed of the bone trabecula and the cartilage tissue formation, the development of mature bone structure, the remolding of shaft structure, the reopen of marrow cavity, and the absorbance and degradation of the implant. A value: there was significant difference between two groups 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those three time points in groups A and B (P lt; 0.05). For the ratio of neonatal trabecula area to the total reparative area, there were significant differences between two groups 4, 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those four time points in group B (P lt; 0.05).For the vascular regenerative area in per unit area of the junctional zone, group B was superior to group A 4, 8, 12, and 16 weeks after operation (P lt; 0.05). Conclusion Tissue engineered bone, seeded with the ARBM and wrapped by the pedicled fascial flap, has a sound reparative effect on bone defect due to its dual role of constructing vascularization and inducing membrane guided tissue regeneration.
ObjectiveTo investigate expressions and biological function of membrane type matrix metallopro-teinase-1 (MT1-MMP) and matrix metalloproteinase-2 (MMP-2) in papillary thyroid carcinoma. MethodsThe expre-ssions of MT1-MMP and MMP-2 in 164 cases of papillary thyroid carcinoma and paracancerous tissues were detected by immunohistochemistry.The association between the expressions of MT1-MMP and MMP-2 and clinicopathological characteristics of papillary thyroid carcinoma was analyzed. ResultsIn paracancerous tissues, the positive expression rate of MT1-MMP was 11.0% (18/164), and the positive expression rate of MMP-2 was 14.0% (23/164).In papillary thyroid carcinoma tissues, the positive expression rates of MT1-MMP and MMP-2 was 61.6% (101/164) and 67.7% (111/164), respectively.The expressions of MT1-MMP and MMP-2 in carcinoma tissues and para carcinoma tissues were statistically significant differences (P < 0.05).The expressions of MT1-MMP and MMP-2 in papillary thyroid carcinoma tissues correlated with the lymph node metastasis (P < 0.05).In addition, the expression of MMP-2 in papillary thyroid carcinoma tissues correlated with capsule invasion (P < 0.05).The positive correlation was found between the expressions of MT1-MMP and MMP-2 in papillary thyroid carcinoma tissues (r=0.256, P < 0.05). ConclusionsMT1-MMP and MMP-2 may be involved the thyroid capsule invasion and lymph node metastasis of papillary thyroid carcinoma.MT1-MMP and MMP-2 may be involved in the progression of papillary thyroid carcinoma.
ObjectiveTo observe the incidence and risk factors of microcystic macular edema (MME) in patients with idiopathic macular epiretinal membrane (IMEM) preoperatively and postoperatively. MethodsA retrospective case series study. From January 2017 to May 2021, 72 eyes of 72 patients with IMEM in Eye Hospital of Wenzhou Medical University at Hangzhou were included. There were 18 male and 54 female. Average age was 64.8±7.8 years. Eyes were all monocular. All patients received the examination of best corrected visual acuity (BCVA) by standard logarithmic visual acuity chart, which was represented logarithmic of minimum angle of resolution (logMAR). Optical coherence tomography was used to measure central macular thickness (CMT). MME was defined as small, vertically bounded cystic space located outside the fovea in the inner layer of the retina. According to the presence or absence of MME before surgery, the affected eyes were divided into two groups: non-MME group (35 eyes) and MME group (37 eyes). The difference of logMAR BCVA and CMT was statistically significant between Group A and B (t=3.117, 2.589; P=0.003, 0.012). All patients with IMEM were treated with 23G three-channels pars plana vitrectomy (PPV) with epiretinal membrane and inner limiting membrane (ILM) peeling. The two groups were further divided into four groups according to whether there was MME in the postoperative follow-up time. The group A1 was without MME before and after surgery, group A2 was without MME before surgery and with MME after surgery. The MME group was subdivided into the group with MME before surgery and without MME after surgery (group B1) and the group with MME before and after surgery (group B2). The mean follow-up time was 8.8±7.7 months. The same equipment and methods were used to exam the patients during the follow-up. Paired t test was used to compare the changes of MME, BCVA and CMT before and after surgery. The differences of CMT and BCVA among groups before and after surgery were compared by independent sample t test and one-way ANOVA. Logistic regression was used to analyze the influencing factors of MME before and after surgery, and multiple linear regression was used to analyze the influencing factors of postoperative BCVA. ResultsThere were 35 eyes in the non-MME group, 18 eyes (51.43%, 18/35) in the A1 group and 17 eyes (48.57%, 17/35) in the A2 group, respectively. There were 37 eyes in MME group, 6 eyes (16.22%, 6/37) in group B1 and 31 eyes (83.78%, 31/37) in group B2, respectively. At last follow-up, the logMAR BCVA was 0.10±0.12, 0.25±0.17, 0.09±0.11, 0.30±0.26 in group A1, A2, B1, and B2, respectively. Compared with the logMAR BCVA before surgery, the differences were statistically significant (t=3.779, 4.253, 7.869, 6.668; P＜0.01). There was significant difference in logMAR BCVA among the four groups (F=4.460, P＜0.01). There was a significant difference in logMAR BCVA between group A1 and group A2 (t=－2.930, P=0.006). There was no significant difference between group B1 and group B2 (t=－1.921, P=0.063). The CMT of group A1, A2, B1 and B2 were 371.83±73.24, 431.24±83.13, 407.00±28.07 and 425.19±70.97 μm, respectively. Compared with those before operation, the differences were statistically significant (t=5.197, 2.465, 3.055, 6.078; P＜0.05). There was no significant difference in CMT among the four groups (F=2.597, P=0.059). Logistic regression analysis showed that pre-operation MME was correlated with pre-operation IMEM stage (β=1.494, P=0.004). New MME after surgery was correlated with age (β=0.153, P=0.013). Multiple linear regression analysis showed that postoperative visual acuity was significantly correlated with CMT before surgery and MME after surgery (β=0.001, 0.134; P=0.015, 0.019). ConclusionsPPV combined with epiretinal membrane and ILM peeling surgery for IMEM can improve visual acuity and decrease CMT. MME regress or regenerate after surgery. Age is an independent predictor of the risk of newly formed MME after surgery.
ObjectiveTo evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling. MethodsA total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana three-port vitrectomy (23G PPV). The macular ERM alone was removed in 20 eyes (non-ILM peeling group). Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group). All patients underwent removal of ERM with assistance of triamcinolone acetonide. For patients who underwent ILM peeling, indocyanine green dye was used to stain the ILM. ILM was peeled off up to the marginal of macular vessels arch. The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively. There were no significant differences in gender, age, OD/OS, preoperative best-corrected visual acuity (BCVA), preoperative central macular thickness (CMT), preoperative total macular volume (TMV) and follow-up time between the two groups (P > 0.05). Intraoperative or postoperative complication was recorded during the follow-up period. At the final visit, the differences in BCVA, CMT and TMV between the two groups were analyzed, so did the correlations between BCVA and CMT or TMV in each group at the same time. ResultsThere was no recurrence of an ERM or severe complications, such as retinal detachment and endophthalmitis in either group. The mean BCVA of ILM peeling group and non-ILM peeling group was 0.53±0.27 and 0.54±0.26 respectively at the final visit. Postoperative BCVA improved significantly in both groups with significant difference (t=5.035, 4.964; P < 0.05). The was no difference of postoperative BCVA between two groups (t=0.176, P > 0.05). The mean CMT was (343.55±48.74) μm and (311.70±42.48) μm, and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3. CMT (t=9.508, 8.549) and TMV (t=11.098、15.372) revealed a significant decrease in both groups with significant difference (P < 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203, P < 0.05). No difference was found between the two groups in terms of TMV (t=0.755, P > 0.05). Furthermore, no correlation was observed between postoperative BCVA and CMT (r=0.244, 0.266; P > 0.05) or TMV (r=-0.096, 0.157; P > 0.05). Conclusions23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM. ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling, combined with much thicker postoperative CMT.