目的：利用生物信息学方法分析与葡萄膜恶性黑色素瘤转移相关的非编码RNA，以及它们作为竞争性内源RNA的作用机制。方法：从癌症基因组图谱(The Cancer Genome Atlas，TCGA)数据库下载80例葡萄膜恶性黑色素瘤患者的RNA测序数据和临床资料，采用edgeR算法分析转移与非转移患者组织中差异表达(differentially expressed，DE)的长链非编码RNA(lncRNA)、微小RNA(miR)和mRNA，并构建lncRNA-miR-mRNA的竞争性内源RNA(competing endogenous RNA，ceRNA)调控网络，基因富集分析和通路分析研究网络中mRNA的生物学功能。Kaplan-Meier生存曲线分析ceRNA网络中核心RNA与生存率的关系。结果：从发生远处转移的葡萄膜恶性黑色素瘤样本中，共鉴定出346个上调的mRNA，118个下调的miR和45个上调的lncRNA。其中67个mRNA，7个miR和30个lncRNA相互组合形成616个ceRNA单元，并形成了一个具有181条边线ceRNA网络。基因富集分析表明：网络中的mRNA富集在肿瘤生成和转移相关的几个基因本体(Gene Ontology)和信号通路。拓扑分析确定了6个核心lncRNA(LINC00861、LINC02421、BHLHE40-AS1、LINC01252、LINC00513和LINC02389)和3个核心mRNA(UNC5D、BCL11B和MTDH)。 所有核心lncRNA、核心mRNA的表达水平和5个miR(miR-221、miR-222、miR-506、miR-507、miR-876)的表达水平均与总体生存率显着相关(均P<0.05)。结论：本研究揭示了几种lncRNA及其相关的ceRNA网络在葡萄膜恶性黑色素瘤转移中的作用，为进一步研究葡萄膜恶性黑色素瘤的发生和/或转移提供了新的方向。
Objective: To elucidate the expression of long non-coding RNAs (lncRNAs) and their roles as competing endogenous RNAs (ceRNAs) in uveal melanoma (UM) metastasis. Methods: RNA sequencing data and clinical information of 80 patients with UM were obtained from The Cancer Genome Atlas (TCGA) database. Differentially expressed (DE) mRNAs, microRNAs (miR), and lncRNAs between metastatic and non-metastatic individuals with UM were screened using the edgeR algorithm. Gene enrichment analysis was conducted for the DE mRNAs. LncRNA-miR-mRNA regulatory triples and a ceRNA network were constructed. Betweenness centrality was used to screen hub genes and lncRNAs for subnetwork analysis. Kaplan-Meier survival analysis was conducted to explore correlations between the expression of hub RNAs and overall survival in the TCGA UM cohort. Results: A total of 346 upregulated mRNAs, 118 downregulated miRs, and 45 upregulated lncRNAs were identified in samples with systemic metastasis. Among them, 67 mRNAs, 7 miRs, and 30 lncRNAs mapped to 616 ceRNA triples, thus forming an interconnected ceRNA network with 181 edges. Gene enrichment analysis revealed that mRNAs in the network were enriched in multiple gene ontology terms and pathways associated with carcinogenesis and metastasis. Topological analysis identified 6 hub lncRNAs (LINC00861, LINC02421, BHLHE40-AS1, LINC01252, LINC00513, and LINC02389) and 3 hub mRNAs (UNC5D, BCL11B, and MTDH). The expression levels of all hub genes and 5 DEmiRs (miR-221, miR-222, miR-506, miR-507, miR-876) were significantly associated with the overall survival probability. Conclusion: This bioinformatic study revealed the functions of several lncRNAs and their associated ceRNA network in UM metastasis. It provides a novel in silicon evidence for future experimental study on the pathogenesis of systemic metastasis in uveal melanoma, especially from the perspective of non-coding RNA.
目的：探讨赋能教育模式在干眼患者健康教育中的应用价值。方法：选取2017年6月至12月期间首诊于南方医科大学珠江医院眼科的干眼患者，按照完全随机分配法分为试验组(n=73)及对照组(n=73)，试验组采用赋能教育模式，对照组采用传统健康教育方式。经治疗1周、1个月、2个月及6个月后，分别随访并记录每组患者的眼表疾病指数(ocular surface disease index，OSDI)、泪膜破裂时间值(tear film break up time，BUT)，同时记录患者家庭护理(清洁睑缘、热敷、睑板腺按摩)频率以及复诊频率。结果：赋能教育组家庭护理频率及复诊频率均优于传统教育组(P<0.05)。治疗前两组OSDI和BUT差异均无统计学意义(P>0.05)，但试验组OSDI随时间的推移呈下降趋势，BUT值呈上升趋势；而对照组OSDI以及BUT值的变化均不明显。结论：运用赋能教育模式有助于提高干眼患者治疗的依从性，提高患者的家庭护理频率和复诊频率，显著改善患者的眼表情况，进而提高长期治疗效果。
Objective: To evaluate the application value of empowerment education mode in health education for patients with dry eye syndrome. Methods: Patients with dry eye syndrome were recruited from Department of Ophthalmology, Zhujiang Hospital, Southern Medical University from June 2017 to December 2017. All patients were randomly divided into the experimental group (n=73), educated with empowerment education mode, and control group (n=73), treated with traditional health education. Patients were followed up after 1 week, 1 month,2 months and 6 months, respectively. Data were collected in each follow-up visit including ocular surface disease index (OSDI), tear film break up time (BUT), the frequency of home care (cleaning eyelid margin, hot compress,palpebral gland massage) and re-visit frequency. Results: The OSDI and BUT were similar between two groups before corresponding treatment (P>0.05). After the treatment, patients in the experimental group showed a downtrend in the OSDI and uptrend in the BUT. No significant changes were found in the control group during the follow-up. The frequency of family nursing and re-visit in the experimental group was statistically higher than that in the control group. Conclusion: The application of empowering education mode can improve the compliance of dry eye patients, improve the frequency of home care and follow-up visit, and mitigate the ocular surface of patients, thereby enhancing the long-term efficacy.
本文报告1例2 8岁男性青年患者，行飞秒制瓣准分子激光原位角膜磨镶术(laser-assisted situ keratomileusis，LASIK)术 后1个月视力进行性下降，小瞳下行电脑验光矫正视力，右眼为0.3(-0.25×86°)，左眼为0.2(-0.50×91°)。眼前节及眼底检查未见器质性病变，视觉电生理检查未见异常。视光专科检查示负相对调节/正相对调节(negative correlatione regulation/positive ccorrelation regulation，NRA/PRA)：+2.00 D/?10.00 D(行PRA时稍作停顿后又可看清)，Flipper拍检查：右眼(oculus dexter，OD) 10 cpm(+)，左眼(oculus sinister，OS) 22 cpm(+)，双眼(binocular，OU)12 cpm(+)，正镜片逐渐通过困难。隐斜检查：2△BO@D，13△BI@N。调节性集合与调节的比值(accommodation convergence/accommodation，AC/A)=1。患者PRA显著增高，Flipper检查正片通过困难，看近时外隐斜大于看远，提示可能存在“集合不足，调节超前”。给予托比卡胺滴眼液滴眼3次后验光：OD +1.00/-0.50×80°=1.0，OS +0.75/-0.25×65°=1.0，进一步证实了“调节痉挛”的诊断。给予托比卡胺滴眼液滴双眼，睡前1次，结合调节放松训练。4周后，裸眼视力及屈光度稳定在正常范围。临床上对于视力下降原因不明、排除眼部器质性疾病的患者，经过仔细询问病史、睫状肌麻痹检影和视功能检查“调节痉挛”不难诊断。除传统的睫状肌麻痹剂和近附加镜外，治疗方案建议加用视功能训练可使视力恢复并稳定。
A 28-year-old man was referred to our hospital because of blurred vision in both eyes after LASIK flap made by femtosecond laser surgery for 1 month. The best corrected visual acuity based on computerized optometry was 0.3 (-0.25×86°) in the right eye and 0.2 (-0.50×91°) in the left eye. Routine examinations were conducted to exclude eye diseases. Visual electrophysiological examination showed no abnormalities. Optometry specialty examination: negative relative accommodation (NRA) and positive relative accommodation (PRA) were +2.00 D/?10.00 D (when doing PRA, the patient could see clear slowly after a pause). Flipper examination showed: OD 10 cpm(+), OS 22 cpm(+), OU 12 cpm(+). Phoria-measurement showed 2 prism degree BO@D and 13 prism degree BI@N. AC/A=1. The patient’s high PRA, flipper examination results and convergence insufficiency at near distance indicated the possibility of “convergence insufficiency and accommodative spasm”. Cycloplegic refraction was planned to assess the real diopter. After instillation of cycloplegic drops, the UCVA improved to 1.0 and the refractive error to -0.25×93 in the right eye, in the left eye to 1.0 and the refractive error to -0.25×75. the BCVA was 1.0 (+1.00/-0.50×80°) in the right eye and 1.0 (+0.75/-0.25×65°) in the left eye. A diagnosis of accommodative spasm was made. The patient was counseled and continued cycloplegic drops one time daily before bedtime, participated in vision training for 4 weeks. This patient was a rare occurrence of accommodative spasm after FSLASIK surgery. Young patients with poor gain in UCVA can be subjected to a corrective procedure accidentally. Relaxation exercises and cycloplegic drops may cure accommodative spasm. For patients with unexplained causes of vision loss and excluded organic diseases of the eye, it is not difficult to diagnose “accommodative spasm” by careful medical history inquiry, ciliary muscle paralysis optometry and visual function examination. In addition to traditional ciliary palsy agent and reading glasses, it is suggested that visual function training can restore and stabilize the treatment effect.
本文报告1例28岁男性青年患者，行飞秒制瓣准分子激光原位角膜磨镶术(laser-assisted situ keratomileusis，LASIK)术后1个月视力进行性下降，小瞳下行电脑验光矫正视力，右眼为0.3(-0.25×86°)，左眼为0.2(-0.50×91°)。眼前节及眼底检查未见器质性病变，视觉电生理检查未见异常。视光专科检查示负相对调节/正相对调节(negative correlatione regulation/positive ccorrelation regulation，NRA/PRA)：+2.00 D/-10.00 D(行PRA时稍作停顿后又可看清)，Flipper拍检查：右眼(oculus dexter，OD) 10 cpm(+)，左眼(oculus sinister，OS) 22 cpm(+)，双眼(binocular，OU) 12 cpm(+)，正镜片逐渐通过困难。隐斜检查：2△BO@D，13△BI@N。调节性集合与调节的比值(accommodation convergence/accommodation，AC/A)=1。患者PRA显著增高，Flipper检查正片通过困难，看近时外隐斜大于看远，提示可能存在“集合不足，调节超前”。给予托比卡胺滴眼液滴眼3次后验光：OD +1.00/-0.50×80°=1.0，OS +0.75/-0.25×65°=1.0，进一步证实了“调节痉挛”的诊断。给予托比卡胺滴眼液滴双眼，睡前1次，结合调节放松训练。4周后，裸眼视力及屈光度稳定在正常范围。临床上对于视力下降原因不明、排除眼部器质性疾病的患者，经过仔细询问病史、睫状肌麻痹检影和视功能检查“调节痉挛”不难诊断。除传统的睫状肌麻痹剂和近附加镜外，治疗方案建议加用视功能训练可使视力恢复并稳定。
A 28-year-old man was referred to our hospital because of blurred vision in both eyes after LASIK flap made by femtosecond laser surgery for 1 month. The best corrected visual acuity based on computerized optometry was 0.3 (-0.25×86°) in the right eye and 0.2 (-0.50×91°) in the left eye. Routine examinations were conducted to exclude eye diseases. Visual electrophysiological examination showed no abnormalities. Optometry specialty examination: negative relative accommodation (NRA) and positive relative accommodation (PRA) were +2.00 D/?10.00 D (when doing PRA, the patient could see clear slowly after a pause). Flipper examination showed: OD 10 cpm(+), OS 22 cpm(+), OU 12 cpm(+). Phoria-measurement showed 2 prism degree BO@D and 13 prism degree BI@N. AC/A=1. The patient’s high PRA, flipper examination results and convergence insufficiency at near distance indicated the possibility of “convergence insufficiency and accommodative spasm”. Cycloplegic refraction was planned to assess the real diopter. After instillation of cycloplegic drops, the UCVA improved to 1.0 and the refractive error to -0.25×93 in the right eye, in the left eye to 1.0 and the refractive error to -0.25×75. the BCVA was 1.0 (+1.00/-0.50×80°) in the right eye and 1.0 (+0.75/-0.25×65°) in the left eye. A diagnosis of accommodative spasm was made. The patient was counseled and continued cycloplegic drops one time daily before bedtime, participated in vision training for 4 weeks. This patient was a rare occurrence of accommodative spasm after FSLASIK surgery. Young patients with poor gain in UCVA can be subjected to a corrective procedure accidentally. Relaxation exercises and cycloplegic drops may cure accommodative spasm. For patients with unexplained causes of vision loss and excluded organic diseases of the eye, it is not difficult to diagnose “accommodative spasm” by careful medical history inquiry, ciliary muscle paralysis optometry and visual function examination. In addition to traditional ciliary palsy agent and reading glasses, it is suggested that visual function training can restore and stabilize the treatment effect.
目的：探讨赋能教育模式在干眼患者健康教育中的应用价值。方法：选取2017年6月至12月期间首诊于南方医科大学珠江医院眼科的干眼患者，按照完全随机分配法分为试验组(n=73)及对照组(n=73)，试验组采用赋能教育模式，对照组采用传统健康教育方式。经治疗1周、1个月、2个月及6个月后，分别随访并记录每组患者的眼表疾病指数(ocular surface disease index，OSDI)、泪膜破裂时间值(tear film break up time，BUT)，同时记录患者家庭护理(清洁睑缘、热敷、睑板腺按摩)频率以及复诊频率。结果：赋能教育组家庭护理频率及复诊频率均优于传统教育组(P<0.05)。治疗前两组OSDI和BUT差异均无统计学意义(P>0.05)，但试验组OSDI随时间的推移呈下降趋势，BUT值呈上升趋势；而对照组OSDI以及BUT值的变化均不明显。结论：运用赋能教育模式有助于提高干眼患者治疗的依从性，提高患者的家庭护理频率和复诊频率，显著改善患者的眼表情况，进而提高长期治疗效果。
Objective: To evaluate the application value of empowerment education mode in health education for patients with dry eye syndrome. Methods: Patients with dry eye syndrome were recruited from Department of Ophthalmology, Zhujiang Hospital, Southern Medical University from June 2017 to December 2017. All patients were randomly divided into the experimental group (n=73), educated with empowerment education mode, and control group (n=73), treated with traditional health education. Patients were followed up after 1 week, 1 month, 2 months and 6 months, respectively. Data were collected in each follow-up visit including ocular surface disease index (OSDI), tear film break up time (BUT), the frequency of home care (cleaning eyelid margin, hot compress, palpebral gland massage) and re-visit frequency. Results: The OSDI and BUT were similar between two groups before corresponding treatment (P>0.05). After the treatment, patients in the experimental group showed a downtrend in the OSDI and uptrend in the BUT. No significant changes were found in the control group during the follow-up. The frequency of family nursing and re-visit in the experimental group was statistically higher than that in the control group. Conclusion: The application of empowering education mode can improve the compliance of dry eye patients, improve the frequency of home care and follow-up visit, and mitigate the ocular surface of patients, thereby enhancing the long-term efficacy.
