11月 | Vesber 最佳RIO论文推荐

方法：对5例已进行折叠式人工玻璃体球囊外加压术治疗的单纯性RRD患者，术后疗效采用B超和眼底照相检查他们视网膜复位情况。根据术后感染、眼痛、复视、眼压升高等术后严重并发症来评估此疗法的安全性。术后观察时间至少为12周。

Results：The simple RRD of all fifive patients was successfully reattached before being evaluating by B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in two patients who were macularly affected. One patient had temporary diplopia and eye movement limitation after surgery. No other complications were recorded.

结果：术后经B超及眼底照相检查，5例单纯RRD患者均成功复位。2例黄斑病变患者视力提高。1例患者术后出现暂时性复视和眼球运动受限。无其他并发症发生。

Conclusions：This pilot study determined that foldable capsular vitreous body scleral buckling can be effificacious and safe for simple RRD. The results indicate that this surgery may be a novel alternative to the current extraocular procedures for simple RRD.

结论：本研究初步确定折叠式人工玻璃体球囊外加压术可安全有效的治疗单纯性RRD。结果表明此手术可能是治疗单纯性RRD一个新的方法。

此研究最大的亮点是折叠式人工玻璃体球囊外加压术是新型的治疗方法，已经小样本案例证明其安全有效，对于孔源性视网膜脱离治疗提供了一种新的治疗方式和思路，为该疾病的治愈提供了新的可能方式。

但研究仍有局限性，该研究属于小样本，研究数量少、缺乏对照。因此，还需要针对以上几点进行大样本的对照研究进一步确认其有效性和安全性。

 Methods：CSC14 human embryonic stem cells were differentiated into primordial eye structures called retinal organoids. Retinal organoids were analyzed by quantitative PCR and immunofluorescence and compared with human fetal retina. Retinal organoid sheets (30–70 day of differentiation) were transplanted into immunodeficient RCS rats, aged 44 to 56 days. The development of transplant organoids in vivo in relation to the host was examined by optical coherence tomography. Visual function was assessed by optokinetic testing, electroretinogram, and superior colliculus electrophysiologic recording. Cryostat sections were analyzed for various retinal, synaptic, and donor markers.

方法：人胚胎干细胞CSC14分化为称为视网膜器质的原始眼结构。用定量PCR和免疫荧光分析视网膜器质，并与人胎儿视网膜进行比较。将视网膜类器官组织（分化30～70天）移植到年龄44～56天的免疫缺陷的RCS大鼠中。用光学相干断层扫描术观察移植器官在体内的发育情况。视功能通过视动测试、视网膜电图和上丘电生理记录进行评估。冷冻切片分析各种视网膜、突触和供者标记物。

Results：Retinal organoids showed similar gene expression to human fetal retina transplanted rats demonstrated significant improvement in visual function compared with RCS nonsurgery and sham surgery controls by ERGs at 2 months after surgery (but not later), optokinetic testing (up to 6 months after surgery) and electrophysiologic superior colliculus recordings (6–8 months after surgery). The transplanted organoids survived more than 7 months; developed photoreceptors with inner and outer segments, and other retinal cells; and were well-integrated within the host.

结果：移植视网膜类器官与人胎儿视网膜的基因表达相似。在移植大鼠术后2个月（但不能更晚），与视网膜色素上皮功能障碍非手术组和假手术对照组相比，视动测试（术后6个月）和上丘电生理记录（术后6-8个月）显示，移植大鼠的视觉功能有显著改善。移植的类器官存活7个月以上，发育有内、外层的感光细胞和其他视网膜细胞，并在宿主内融合良好。

 Conclusions：This study, to our knowledge, is the first to show that transplanted photoreceptors survive and function even with host’s dysfunctional RPE. Our findings suggest that transplantation of organoid sheets from stem cells may be a promising approach/therapeutic for blinding diseases.

结论：据我们所知，这项研究是第一次证明移植的感光细胞即使在宿主视网膜色素上皮功能失调下也能存活和发挥功能。我们的研究结果表明，移植干细胞分化的器官可能是一种很有前途的治疗治盲性疾病的方法。

文章的创新之处在于首次报道证明了干细胞分化的细胞在移植宿主体内可以正常发育和生长，并且能有效发挥作用。未来科技对与盲人患者复明提供新的希望。对于目前的眼科治疗，我们要尽可能保护患者残留的眼球结构和组织。

文章的不足之处为仅为动物试验，未来是否应用到临床上一样有效仍有待观察，需进行更多的研究观察。

Design：Retrospective, longitudinal cohort study.

设计：回顾性纵向队列研究。

 Participants：Participants in the 2007 through 2016 Medical Expenditure Panel Survey (MEPS) 18 years of age or older. The MEPS is a nationally representative survey of the noninstitutionalized, civilian United States population.

参与者：入选2007年至2016年接受医疗支出情况调查（MEPS）的满18岁的参与者。MEPS是一项具有全国代表性的非机构化美国平民人口调查。

 Methods：We estimated trends in national and per capita annual ophthalmic prescription expenditures by pooling data into 2-year cycles and using weighted linear regressions. We also identifified characteristics associated with greater total or OOP expenditures with multivariate weighted linear regression. Costs were adjusted to 2016 United States dollars using the gross domestic product price index.

方法：我们通过将数据汇总为2年为一个周期，并使用加权线性回归来估计全国和人均眼科处方年支出的趋势。我们还用多元加权线性回归确定了升高的数据与总支出或自费支出相关的特征。成本根据2016年国内生产总值美元价格指数进行了调整。

Main Outcome Measures：Trends in total and OOP annual expenditures for ophthalmic medications from 2007 through 2016 as well as factors associated with greater expenditures.

主要观察指标：2007年至2016年眼科药物总支出和自费支出年度趋势以及与支出增加相关的因素。

 Results：From 2007 through 2016, 9989 MEPS participants (4.2%) reported ophthalmic medication prescription use. Annual ophthalmic medication use increased from 10.0 to 12.2 million individuals from 2007 and 2008 through 2015 and 2016. In this same period, national expenditures for ophthalmic medications increased from $3.39 billion to $6.08 billion and OOP expenditures decreased from $1.34 to $1.18 billion. Per capita expenditure increased from $338.72 to $499.42 (P < 0.001), and per capita OOP expenditure decreased from $133.48 to $96.67 (P < 0.001) from 2007 and 2008 through 2015 and 2016, respectively. From 2015 through 2016, dry eye (29.5%) and glaucoma (42.7%) medications accounted for 72.2% of all ophthalmic medication expenditures. Patients who were older than 65 years (P < 0.001), uninsured (P < 0.001), and visually impaired (P < 0.001) were signifificantly more likely to have greater OOP spending on ophthalmic medications.

结果：从2007年到2016年，9989名医疗支出情况调查参与者（4.2%）报告使用了眼科药物处方。从2007/2008到2015/2016年，每年眼科用药人数从1000万增加到1220万。同期，全国眼科药品总支出从33.9亿美元增加到60.8亿美元，自费总支出从13.4亿美元减少到11.8亿美元。从2007/2008到2015/2016年，人均支出从338.72美元增加到499.42美元（P<0.001），人均自费支出从133.48美元下降到96.67美元（P<0.001）。2015 – 2016年，干眼(29.5%)和青光眼(42.7%)药物支出占眼科药物支出的72.2%。年龄大于65岁(P < 0.001)、无保险(P < 0.001)和视力受损(P < 0.001)的患者在眼科药物上自费支出明显增高。

 Conclusions：Total ophthalmic medication expenditure in the United States increased signifificantly over the last decade, whereas OOP expenses decreased. Increases in coverage, copayment assistance, and use of expensive brand drugs may be contributing to these trends. Policy makers and physicians should be aware that rising overall drug expenditures ultimately may increase indirect costs to the patient and offset a decline in OOP prescription drug spending.

结论：在过去的十年里，美国眼科药物的总支出显著增加，而患者自费支出却下降了。医疗覆盖范围的扩大、国家支付援助和昂贵品牌的药物使用可能促进这种趋势的发展。执政者和医生应该要意识到药物总支出的增加最终可能会间接增加患者的成本，并造成处方药自费支出的下降。

这项研究最大的优点是含大量的参与者参与调查，通过研究结果反应一些列社会问题，作者希望政府及医生能重视造成老年人、无保险者和视力受损者继续面临着自费支出的大幅度上升的原因，并采取措施缓解这一矛盾。

研究存在几项局限性。首先，由于MEPS的数据主要是参与者报告的，所以处方药使用和支出数据可能不准确或不完整。虽然大多数患者都有药房数据来验证处方信息但是大多数社会人口群体中，经常发生医疗保健使用的漏报现象。其次我们无法解释非处方药，这很可能会降低眼科总费用。最后，我们无法确定自费付款的来源，包括它们是否来自共同支付、共同保险付款或免赔额。