12月 | Vesber 最佳RIO论文推荐

卫视博每月从三大权威杂志：Retina、Investigative Ophthalmology & Visual Science、Ophthalmology中各推荐一篇眼科论文。

— — 最佳“RIO”论文推荐

No.1     Retina · 推荐

EPIRETINAL  FIBROSIS  REMOVAL  IN  AN ARGUS II–IMPLANTED EYE  HistologicalCharacteristics  and  Functional  Results.( Retina. 2020;40(12)_2403-2409）

ARGUS II植入眼的视网膜前纤维化切除术组织学特征和功能结果

Purpose

1)To investigate morphologic and histochemical characteristics of an epiretinal fifibrosis removed in an Argus II–implanted eye; 2) to evaluate the Argus II function before and after the fifibrosis removal, and 3) to compare morphologic and functional data.1)研究Argus II植入眼视网膜前纤维变性的形态学和组织学特征；2）评估Argus II变性前后的功能；3）比较形态学和功能数据。

Methods

Fibrosis, which developed between the Argus II prosthesis and the retina two years after implant, was surgically removed. Its morphologic and histochemical characteristics were evaluated both in light and transmission electron microscopy, with special stains and immunohistochemistry. The Argus II function was evaluated during the follow-up before surgical removal and 1 month later.Argus II植入体植入两年后，手术切除植入体和视网膜之间形成的纤维化组织。用光镜、透射电镜、特殊染色和免疫组化方法观察其形态和组织化学特征。术前及术后1个月随访观察ArgusⅡ功能。

Results

Fibrosis was successfully removed. It was composed of a fifibrotic tissue with spindle cells arranged in nodular aggregates with a symmetric distribution, mixed with an inflflammatory infifiltrate. Extra- and intracellular, irregular, small iron particles were found and confifirmed ultrastructural characterization with degenerative cellular changes. The repositioned Argus II restored, and its function was partially nearly to normal values 1 month after surgery.术后纤维化被成功清除。该增殖由纤维组织和对称分布、排列成结节状聚集体上午梭形细胞混合。细胞外和细胞内发现了不规则的小铁颗粒，证实了细胞变性的超微结构特征。术后1个月，复位的ArgusⅡ功能恢复，部分功能接近正常。

Conclusion

Fibrosis can develop between the Argus II and the retina with increasing reduced function. Morphologic characteristics of the removed fifibrosis suggested a pathogenesis based on an inflflammatory process involved in a foreign body reaction with progressing connective tissue deposition leading to sclerosis. Adequate clinical follow-up is critical to successful removal of the fifibrosis with reactivation of the Argus II function.ArgusⅡ和视网膜之间可发生纤维化，功能逐渐减弱。切除的纤维组织的形态学特征提示了一种发病机制，这种发病机制是由于异物反应引起的炎症过程，结缔组织沉积进一步导致硬化。充分的临床随访是成功切除纤维组织并恢复ArgusⅡ功能的关键。

推荐理由：本文研究ArgusⅡ植入体植入后视网膜前膜纤维化，手术切除纤维化后ArgusⅡ植入体功能改善，该纤维化提示一种异物反应引起的炎症变化，提示术后的及时随访控制炎症发展对患者的预后至关重要 。

文章的创新之处在于就新产品的临床问题进行了处理措施，并就该措施做了研究分析与组织学分析，提出了患者术后炎症反应对植入物假体的干预，提示术后随访和控制术后炎症问题的重要性。但该文章随访期短，对于远期的稳定性依旧有待商榷，未来可延长随访期至54周观察，了解远期效果，收集更多临床经验以用于临床学习。

 

No.2  Investigative Ophthalmology & Visual Science · 推荐

Mitochondria as a Platform for Dictating the Cell Fate of Cultured Human Corneal Endothelial Cells (Invest Ophthalmol Vis Sci. 2020;61(15)_10.）

线粒体是决定培养人角膜内皮细胞命运平台

Purpose

Aiming to clarify the role of mitochondria in cell fate decision of cultured human corneal endothelial cell (cHCEC) subpopulations.探讨线粒体在培养人角膜内皮细胞（cHCEC）亚群细胞中的作用。

Methods

The mitochondrial respiratory ability were examined with Mito stress and Mito fuel flex test assays using an extracellular flux analyzer (XFe24; Agilent Technologies; Santa Clara, CA) for human corneal endothelium tissues, mature cHCECs and a variety of cell state transitioned cHCECs. Tricarboxylic acid cycle and acetyl-coenzyme A–related enzymes was analyzed by proteomics for cell lysates using liquid chromatography– tandem mass spectrometry for cHCEC subpopulations.用细胞外流量分析仪（XFe24；Agilent Technologies；Santa Clara，CA）对人角膜内皮组织、成熟的人角膜内皮细胞和各种细胞转分化的人角膜内皮细胞进行线粒体呼吸能力检测（有丝分裂应激试验）。使用液相色谱串联质谱分析人角膜内皮细胞亚群细胞裂解物（三羧酸循环和乙酰辅酶A相关酶）的蛋白质组学。

Results

The maximum oxygen consumption rate was found to become stable depending on the maturation of cHCECs. In the Mito stress tests, culture supplements, epidermal growth factor, SB203580, and SB431543 significantly repressed oxygen consumption rate, whereas a Rho-associated protein kinase inhibitor Y-27632 increased. Tricarboxylic acid cycle and mitochondria acetyl-coenzyme A–related enzymes were selectively upregulated in mature cHCECs, but not in cell state transitioned cHCECs. The maximum oxygen consumption rate was found to be higher in healthy human corneal endothelium tissues than those with deeply reduced cell density. An upregulated tricarboxylic acid cycle was linked with metabolic rewiring converting cHCECs to acquire the mitochondria-dependent oxidative phenotype.随着人角膜内皮细胞的成熟，最大耗氧率趋于稳定。在有丝分裂应激试验中，培养补充剂、表皮生长因子、SB203580（阻止细胞衰老）和SB431543（阻止转化生长因子-β对培养物的负面影响）显著抑制氧消耗率，而Rho相关蛋白激酶抑制剂Y-27632（促进细胞分化）则增加氧消耗率。三羧酸循环和线粒体乙酰辅酶A相关酶在成熟的人角膜内皮细胞中选择性上调，而在细胞状态转换的人角膜内皮细胞中不上调。健康人角膜内皮组织的最大耗氧率高于细胞密度明显降低的组织。上调的三羧酸循环与获得线粒体依赖的氧化表型的人角膜内皮细胞的代谢重组相联系。

Conclusion

Mitochondrial metabolic intermediates and energy metabolism are tightly linked to the endothelial cell fate and function. These findings will help us to standardize a protocol for endothelial cell injection.线粒体代谢中间产物和能量代谢与内皮细胞的命运和功能密切相关。这些发现将有助于我们规范内皮细胞注射方案。

推荐理由：本文通过测量分析线粒体呼吸在不同组织细胞中的能力，及对比分析各种干预因子影响对比及代谢相关酶的含量。得出线粒体代谢中间产物和能量代谢与内皮细胞的命运和功能密切相关。

创新之处在于人角膜内皮细胞的不可再生性质成为不可治愈疾病之一，细胞治疗作为再生医学的一个新的前沿领域，正逐步被更新，成为许多不可治愈疾病的一种新的替代治疗方法。发现线粒体代谢中间产物和能量代谢与内皮细胞的命运和功能的关系，有助于新技术的突破。本文的不足之处在于仅研究了代谢物和能量与细胞活性的相关性，但没有具体培养方案，未来可针对培养方案做进一步的对照设计。

No.3   Ophthalmology · 推荐

Responsiveness of Vision-Specific and General Quality of Life Metrics to Ocular and Systemic Events in Patients with Uveitis.(Ophthalmology. 2020;127(14)_1710-1718.）

葡萄膜炎患者视觉和生活质量指标对眼部和全身事件的反应性

Purpose

To evaluate the responsiveness of quality of life (QoL) metrics to ocular and systemic events in patients with noninfectious uveitis.评价非感染性葡萄膜炎患者生活质量（QoL）指标对眼部和全身事件的反应性。

Design

Cohort study using randomized controlled trial data.采用随机对照试验数据的队列研究。

Participants

Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study.入选多中心葡萄膜炎类固醇治疗（MUST）试验和随访研究中登记的表现或近期表现有中间型、后发性或全葡萄膜炎的患者。

Methods

Data on the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), EuroQol Questionnaire (EQ-5D), and Short Form Survey Instrument (SF-36) were evaluated semiannually during the first 3 years after randomization. The impact of ocular (e.g., changes in visual acuity [VA], activity status, cataract surgery) and systemic events (e.g., infections requiring treatment) on the 6-month changes in QoL was assessed for each metric using generalized estimating equations.在随机分组后的前3年，每半年对25项国家眼科研究所视觉功能问卷（NEI-VFQ-25）、EuroQol问卷（EQ-5D）和简式问卷（SF-36）的数据进行评估。使用广义估计方程，评估眼部（如视力[VA]变化、活动状态、白内障手术）和全身事件（如需要治疗的感染）对6个月生活质量变化的影响。

Main Outcome Measures

The primary outcomes were the 6-month changes in vision-related (NEI-VFQ-25) and general health-related (EQ-5D index, SF-36 physical component summary [PCS]) QoL.主要结果是6个月视力相关（NEI-VFQ-25）和一般健康相关（EQ-5D指数，SF-36身体成分总结[PCS]）对生活质量的变化影响。

Results

Changes in VA (adjusted change [aΔ]: 2.70 units per 5 letter change, P < 0.001), implant placement in at least 1 eye (aΔ: 5.50, P < 0.001), cataract surgery (aΔ: 3.01, P = 0.017), and quieting of all eyes active at the beginning of the interval (aΔ: 2.20, P < 0.010) were associated with improvements in the NEI-VFQ-25. Reductions in VA (aΔ: −0.014 per 5 letter decline, P = 0.003), infections requiring a prescription (aΔ: −0.024, P = 0.021), and incident uveitis activity in at least 1 eye (aΔ: −0.023, P = 0.031) were associated with declines in the EQ-5D index. Hospitalization (aΔ: −2.24, P = 0.019), infections requiring a prescription (aΔ: −1.00, P = 0.024), and vitreous hemorrhage in at least 1 eye (aΔ: −1.92, P = 0.021) were associated with declines in the SF-36 PCS. Declines in VA, initiation in IOP medication, and age were associated with changes in SF-36 PCS; however, the magnitude of the change was less than a single point.视力变化（调整后的变化[aΔ]：每5个字母变化2.70个单位，P<0.001）、至少1只眼植入物（aΔ：5.50，P<0.001）、白内障手术（aΔ：3.01，P=0.017）和间隔期开始时所有活动眼的安静（aΔ：2.20，P<0.010）与视力相关问卷指数的改善有关。视力减少（aΔ：−0.014/5个字母下降，P=0.003）、需要处理的感染（aΔ：−0.024，P=0.021）和至少一只眼睛的葡萄膜炎活动（aΔ：−0.023，P=0.031）与EuroQol问卷指数下降相关。住院治疗（aΔ：−2.24，P=0.019）、需要处理的感染（aΔ：−1.00，P=0.024）和至少1只眼的玻璃体出血（aΔ：−1.92，P=0.021）与简式问卷、身体成分总结调查指数的下降有关。视力的下降、IOP药物治疗的开始和年龄与简式问卷、身体成分总结调查指数的变化有关；然而，变化幅度小于一个点。

Conclusion

The NEI-VFQ-25 was more sensitive to ocular changes than the general QoL metrics but less sensitive to acute systemic events. When performing QoL or cost-effectiveness analyses, it is important to consider the expected outcomes (e.g., ocular vs. systemic) to ensure that the selected measurement is sensitive enough to detect clinically important changes in disease status or effects of treatment.视觉功能问卷对眼部变化的敏感性高于一般生活质量指标，但对急性全身事件的敏感性较低。在进行生活质量或成本-效果分析时，重要的是要考虑预期结果（例如，眼部与全身），以确保所选测量足够敏感，能够检测疾病状态或治疗效果的临床重要变化。

 

推荐理由：本研究视觉调查和生活质量指标问卷调查对眼部和全身事件的敏感性和反应性。得出视觉功能问卷对眼部变化的敏感性高于一般生活质量指标，但对急性全身事件的敏感性较低，暗示针对检测疾病，要检测与该病相关且敏感性高的指标，这样更具有指示意义。文章创新点是通过大数据的分析对比与调查问卷，通过统计分析证明同样相关的指标，敏感性高和敏感性第对于结果的差异是有区别的，所以选择最敏感性的指标最直接。

文章的不足之处在于问卷调查的主观判断影响因素较大，未来可在设计方面针对可直接测量的指标进行进一步研究。

三篇论文原文已放在百度网盘中，链接：https://pan.baidu.com/s/1W0v2dqmgh2Bi9KUbsUZyww
提取码：tl5g