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Albalawi FE, Alsharif I, Moawadh MS, Alkhoshaiban A, Falah Alshehri F, Albalawi AE, Althobaiti NA, Alharbi ZM, Almohaimeed HM. Immunomodulatory effects of Kaempferol on microglial and Macrophage cells during the progression of diabetic retinopathy. Int Immunopharmacol 2024; 133:112021. [PMID: 38626549 DOI: 10.1016/j.intimp.2024.112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Diabetic retinopathy (DR) stands as a prevalent secondary complication of diabetes, notably Type 1 Diabetes Mellitus (T1D), characterized by immune system involvement potentially impacting the retinal immune response mediated by microglia. Early stages of DR witness blood-retinal barrier permeabilization, facilitating peripheral immune cell interaction with the retinal immune system. Kaempferol (Kae), known for its potent anti-inflammatory activity, presents a promising avenue in DR treatment by targeting the immune mechanisms underlying its onset and progression. Our investigation delves into the molecular intricacies of innate immune cell interaction during DR progression and the attenuation of inflammatory processes pivotal to its pathology. METHODS Employing in vitro studies, we exposed HAPI microglial and J774.A1 macrophage cells to pro-inflammatory stimuli in the presence or absence of Kae. Ex vivo and in vivo experiments utilized BB rats, a T1D animal model. Retinal explants from BB rats were cultured with Kae, while intraperitoneal Kae injections were administered to BB rats for 15 days. Quantitative PCR, Western blotting, immunofluorescence, and Spectral Domain - Optical Coherence Tomography (SD-OCT) facilitated survival assessment, cellular signaling analysis, and inflammatory marker determination. RESULTS Results demonstrate Kae significantly mitigates inflammatory processes across in vitro, ex vivo, and in vivo DR models, primarily targeting immune cell responses. Kae administration notably inhibits proinflammatory responses during DR progression while promoting an anti-inflammatory milieu, chiefly through microglia-mediated synthesis of Arginase-1 and Hemeoxygenase-1(HO-1). In vivo, Kae administration effectively preserves retinal integrity amid DR progression. CONCLUSIONS Our findings elucidate the interplay between retinal and systemic immune cells in DR progression, underscoring a differential treatment response predominantly orchestrated by microglia's anti-inflammatory action. Kae treatment induces a phenotypic and functional shift in immune cells, delaying DR progression, thereby spotlighting microglial cells as a promising therapeutic target in DR management.
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Affiliation(s)
- Fahad Eid Albalawi
- Regional laboratory, blood bank and poisons centre, Sakaka 72346, Saudi Arabia; Medical College, Fahad Bin Sultan University, Tabuk 47721, Saudi Arabia.
| | - Ifat Alsharif
- Department of Biology, Jamoum University College, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
| | - Mamdoh S Moawadh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | | | - Faez Falah Alshehri
- Department of Medical Laboratories, College of Applied Medical Sciences, Ad Dawadimi-17464, Shaqra University, Saudi Arabia
| | - Aishah E Albalawi
- Faculty of science, Department of Biology, University of Tabuk, Tabuk 47913, Saudi Arabia
| | - Norah A Althobaiti
- Biology Department, College of Science and Humanities, Al Quwaiiyah, Shaqra University, Al Quwaiiyah 19257, Saudi Arabia
| | - Zeyad M Alharbi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hailah M Almohaimeed
- Department of Basic Science, College of Medicine, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia
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Piñas García P, Ruíz Romero MV, Luque Romero LG, Gómez Jiménez CA, Castillón Torre L, Hernández Martínez FJ. [Evaluation of the management and follow-up of diabetic patients in the prevention of diabetic retinopathy]. Rev Esp Salud Publica 2024; 98:e202404030. [PMID: 38597266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE Diabetes mellitus is a chronic disease with high morbidity and mortality, affecting 537 million adults worldwide. Spain is the second European country in prevalence, with 14.8% in the population aged twenty/seventy-nine years; with 11.6 cases per 1,000 people/year. Diabetic retinopathy (DR) is the fifth cause of vision loss worldwide and the seventh cause of blindness/visual impairment among members of the National Organization of the Blind in Spain (ONCE). Early detection of DR prevents blindness in diabetics and is conditioned by glycosylated hemoglobin. The aim of this paper was to analyze the management of diabetic patients in Aljarafe region (Seville) and identify opportunities for improvement in the coordination of their follow-up between the Primary Care physician and the ophthalmologist. METHODS A retrospective observational study (2016-2019) was carried out, with patients registered in the diabetic census of the twenty-eight municipalities of Aljarafe. The primary care and hospital health history, and telemedicine program were consulted. About statistical analysis, for qualitative variables, totals and percentages were calculated; for quantitative variables, mean and standard deviation (if normally distributed) and median and quartiles (if non-normally distributed). RESULTS There were 17,175 diabetics registered in Aljarafe (5.7% of the population); 14,440 patients (84.1%) had some determination of hemoglobin during the period, 9,228 (63.9%) had all of them in the appropriate range. Fundoscopic control was performed on 12,040 diabetics (70.1%), and of those who did not, 346 (10.6%) had all of them out of range. There were 1,878 (10.9%) patients without fundoscopic or metabolic control, 1,019 (54.3%) were women, 1,219 (64.9%) were under sixty-five years of age, 1,019 (54.3%) had severe comorbidity. CONCLUSIONS Most patients have adequate screening, and more than half have determinations within range. However, a significant percentage with no glycated hemoglobin within range lack fundoscopic control, and another smaller group lack fundoscopic or metabolic control, with inter-municipal variability. We propose to improve communication channels between levels.
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Affiliation(s)
| | - María Victoria Ruíz Romero
- Unidad de Calidad e Investigación. Hospital San Juan de Dios Aljarafe (HSJDA). Bormujos (Sevilla). España
| | | | | | - Luis Castillón Torre
- Servicio de Oftalmología. Jefe de servicio. Hospital San Juan de Dios Aljarafe (HSJDA). Bormujos (Sevilla). España
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Vujosevic S, Alovisi C, Piccoli G, Brambilla M, Torti E, Marenzi E, Leporati F, Luzi L, Nucci P. Severity of Disorganization of Retinal Layers and Visual Function Impairment in Diabetic Retinopathy. Ophthalmol Retina 2024:S2468-6530(24)00179-9. [PMID: 38604502 DOI: 10.1016/j.oret.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To evaluate best corrected visual acuity (BCVA), retina sensitivity (RS) and fixation impairment by microperimetry (MP) due to the presence and severity of disorganization of inner and outer retinal layers (DRIL/DROL) and ischemia in OCT/OCT-Angiography(OCT-A) in diabetic retinopathy (DR). DESIGN Retrospective case-control study. SUBJECTS Seventy-six eyes (65 patients) with DR were analyzed. Major exclusion criteria were: center-involving diabetic macular edema (DME), significant media opacity, nondiabetic macular pathology, active proliferative DR. Patients with DRIL and DROL within central 3 mm were enrolled as cases. Patients with DR and no retina disorganization were considered as controls. METHODS A detailed grading of microperimetry and OCT/OCT-A images using Image J software, and specific Image Manipulation Program was applied to co-localize the presence of retina disorganization and RS. BCVA and RS were correlated with the disorganization of retina layers' characteristics and grading (Grade 1-DRIL; Grade 2-DROL; Grade 3-DROL plus, with involvement of the ellipsoid zone). The same procedure of co-localization was applied to the vascular layers on OCT-A using Matlab. MAIN OUTCOME Correlation between BCVA and microperimetry parameters with disorganization of retina layers grading and OCT-A parameters. RESULTS BCVA, mean RS within 1mm and central 3mm (overall RS-oRS), perfusion density, vessel density and geometric perfusion deficit in intermediate and deep capillary plexuses were lower in cases versus controls (p<.001). Mean RS within 1mm (21.4dB±2.4 vs 13.8dB±5.4, p=.002), oRS (22.0dB±2.1 vs 14.4dB ±4.6, p<.001), and BCVA (76.1±7.4 vs 61.2±20.4 ETDRS letters; p=.02), had a significant decrease from grade 1 to grade 3 retina disorganization.Choriocapillaris flow-voids (CC-FV) increased from grade 1 to grade 3 (DROL plus) (p=.004). oRS and CC-FV were identified as significant predictors of retina disorganization grade with an adjusted coefficient of determination, R2=0.45. Cases had more dense scotomas(p=.03) than controls with a positive correlation between the worsening of fixation stability and the severity of DRIL/DROL(p=.04). CONCLUSION MP and BCVA documented a reduction in visual function in patients with DR and disorganization of retina layers at different grades, with greater functional impairment when outer retina layers and photoreceptors are involved. The severity of retina disorganization and the presence of ischemia could serve as a potential biomarker of functional impairment.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | | | | | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Emanuele Torti
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Elisa Marenzi
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Francesco Leporati
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Moustafa M, Khalil A, Darwish NHE, Zhang DQ, Tawfik A, Al-Shabrawey M. 12-HETE activates Müller glial cells: The potential role of GPR31 and miR-29. Prostaglandins Other Lipid Mediat 2024; 171:106805. [PMID: 38141777 PMCID: PMC10939904 DOI: 10.1016/j.prostaglandins.2023.106805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/28/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
Diabetic retinopathy (DR) is a neurovascular complication of diabetes, driven by an intricate network of cellular and molecular mechanisms. This study sought to explore the mechanisms by investigating the role of 12-hydroxyeicosatetraenoic acid (12-HETE), its receptor GPR31, and microRNA (miR-29) in the context of DR, specifically focusing on their impact on Müller glial cells. We found that 12-HETE activates Müller cells (MCs), elevates glutamate production, and induces inflammatory and oxidative responses, all of which are instrumental in DR progression. The expression of GPR31, the receptor for 12-HETE, was prominently found in the retina, especially in MCs and retinal ganglion cells, and was upregulated in diabetes. Interestingly, miR29 showed potential as a protective agent, mitigating the harmful effects of 12-HETE by attenuating inflammation and oxidative stress, and restoring the expression of pigment epithelium-derived factor (PEDF). Our results underline the central role of 12-HETE in DR progression through activation of a neurovascular toxic pathway in MCs and illuminate the protective capabilities of miR-29, highlighting both as promising therapeutic targets for the management of DR.
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Affiliation(s)
- Mohamed Moustafa
- Eye Research Center, Oakland University William Beaumont School of Medicine (OUWB-SOM), Rochester, MI, USA; Eye Research Institute, Oakland University, Rochester, MI, USA; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA
| | - Abraham Khalil
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Noureldien H E Darwish
- Eye Research Center, Oakland University William Beaumont School of Medicine (OUWB-SOM), Rochester, MI, USA; Eye Research Institute, Oakland University, Rochester, MI, USA; Department of Clinical Pathology, Mansoura College of Medicine, Mansoura University-Egypt
| | - Dao-Qi Zhang
- Eye Research Center, Oakland University William Beaumont School of Medicine (OUWB-SOM), Rochester, MI, USA; Eye Research Institute, Oakland University, Rochester, MI, USA; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA
| | - Amany Tawfik
- Eye Research Center, Oakland University William Beaumont School of Medicine (OUWB-SOM), Rochester, MI, USA; Eye Research Institute, Oakland University, Rochester, MI, USA; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA
| | - Mohamed Al-Shabrawey
- Eye Research Center, Oakland University William Beaumont School of Medicine (OUWB-SOM), Rochester, MI, USA; Eye Research Institute, Oakland University, Rochester, MI, USA; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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Nouri H, Abtahi SH, Mazloumi M, Samadikhadem S, Fernando Arevalo J, Ahmadieh H. Optical coherence tomography angiography in diabetic retinopathy: A major review. Surv Ophthalmol 2024:S0039-6257(24)00021-3. [PMID: 38521424 DOI: 10.1016/j.survophthal.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
Diabetic retinopathy (DR) is characterized by retinal vasculopathy and is a leading cause of visual impairment. Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature. We briefly describe its functional principles and advantages over fluorescein angiography and perform a comprehensive review on its clinical applications in the screening or management of people with prediabetes, diabetes without clinical retinopathy (NDR), nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME). OCTA reveals early microvascular alterations in prediabetic and NDR eyes, which may coexist with sub-clinical neuroretinal dysfunction. Its applications in NPDR include measuring ischemia, detecting retinal neovascularization, and timing of early treatment through predicting the risk of retinopathy worsening or development of DME. In PDR, OCTA helps characterize the flow within neovascular complexes and evaluate their progression or regression in response to treatment. In eyes with DME, OCTA perfusion parameters may be of predictive value regarding the visual and anatomical gains associated with treatment. We further discussed the limitations of OCTA and the benefits of its incorporation into an updated DR severity scale.
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Affiliation(s)
- Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Mazloumi
- Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sanam Samadikhadem
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tai F, Nanji K, Garg A, Zeraatkar D, Phillips M, Steel DH, Garg SJ, Kaiser PK, Guymer RH, Wykoff CC, Sivaprasad S, Chaudhary V. Subthreshold Compared with Threshold Macular Photocoagulation for Diabetic Macular Edema: A Systematic Review and Meta-Analysis. Ophthalmol Retina 2024; 8:223-233. [PMID: 37805099 DOI: 10.1016/j.oret.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
TOPIC To compare the efficacy and safety of subthreshold macular laser to conventional focal laser photocoagulation for the treatment of vision loss secondary to diabetic macular edema (DME). CLINICAL RELEVANCE Macular laser remains an important and cost effective treatment option for vision loss secondary to DME. Although anti-VEGF therapy is often first-line, macular laser is of utility in low-resource or remote settings, for patients at risk of loss to follow-up, and for DME not meeting country-specific reimbursement criteria for anti-VEGF therapy. Subthreshold laser is a modality that does not produce clinical or histologic evidence of thermal damage, thereby potentially limiting the common complications of conventional laser. METHODS Ovid MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs) from inception to September 28, 2022. Meta-analyses were performed using random-effects modeling. Data were collected at 12 and 24 months for best-corrected visual acuity (BCVA), central retinal thickness, diabetic retinopathy severity scale, rate of adverse events, rate of enrolled patients not completing treatment, rate of patients receiving retreatment, and quality-of-life measures. The risk of bias and certainty of evidence were assessed using Cochrane's Risk-of-Bias version 2 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) frameworks, respectively. Subgroup analysis was performed between subthreshold laser modalities and evaluated with Instrument to assess the Credibility of Effect Modification Analyses tool. RESULTS Fourteen RCTs comprising 514 eyes receiving conventional laser and 574 eyes receiving subthreshold laser were included. Subthreshold laser likely results in no difference to BCVA (moderate GRADE certainty) compared with conventional laser. Conventional laser demonstrated a small, statistically significant improvement in central retinal thickness (low GRADE certainty); however, the magnitude of this improvement is unlikely to be clinically important. There may not be a difference in the rate of adverse events (low GRADE certainty) at 12 months when comparing subthreshold laser to conventional laser for DME. CONCLUSION Randomized controlled trial literature to date suggests subthreshold laser to be as effective as conventional laser in the treatment of DME. Increased follow-up duration is needed to observe any long-term safety benefit from reduced retinal damage. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Felicia Tai
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Keean Nanji
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anubhav Garg
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David H Steel
- Department of Eye and Visual Sciences, Sunderland Eye Infirmary, Sunderland, United Kingdom; Department of Eye and Visual Sciences, Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Sunir J Garg
- Department of Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Peter K Kaiser
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn H Guymer
- Department of Ophthalmology, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Department of Surgery (Ophthalmology), the University of Melbourne, Melbourne, Australia
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Varun Chaudhary
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Pradhan G, Kulkarni YA. Diabetes and its Complications: Role of Luteolin, A Wonder Chemical from the Natural Source. Curr Diabetes Rev 2024; 20:CDR-EPUB-138879. [PMID: 38425118 DOI: 10.2174/0115733998285798240217084632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
Flavonoids have been reported to be vital in treating various chronic disorders. Luteolin (3',4',5,7-tetrahydroxyflavone) is a flavonoid present in a variety of plant sources such as celery, green pepper, olive oil, peppermint, thyme, rosemary, oregano, etc. It has been reported to have various pharmacological activities such as antioxidant, anti-inflammatory, anticancer, antidiabetic, anti-Alzheimer, antimicrobial, etc. Many scientific studies have been carried out on luteolin for its possible effects on diabetes and its associated complications. The present review focuses on the role of luteolin in diabetes mellitus and the associated complications. The antidiabetic impact of luteolin is linked with the increased expression of PPARγ and GLUT. Various in vitro and in vivo studies have been performed to explore the effects of luteolin on diabetic complications, and it has shown a significant impact in the management of the same.
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Affiliation(s)
- Gandhar Pradhan
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS), V.L. Mehta Road, Vile Parle (W), Mumbai 400 056, India
| | - Yogesh A Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS), V.L. Mehta Road, Vile Parle (W), Mumbai 400 056, India
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Lv Y, Zhai C, Sun G, He Y. Chitosan as a promising materials for the construction of nanocarriers for diabetic retinopathy: an updated review. J Biol Eng 2024; 18:18. [PMID: 38388386 PMCID: PMC10885467 DOI: 10.1186/s13036-024-00414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Diabetic retinopathy (DR) is a condition that causes swelling of the blood vessels of the retina and leaks blood and fluids. It is the most severe form of diabetic eye disease. It causes vision loss in its advanced stage. Diabetic retinopathy is responsible for causing 26% of blindness. Very insufficient therapies are accessible for the treatment of DR. As compared to the conventional therapies, there should be enhanced research on the controlled release, shorter duration, and cost-effective therapy of diabetic retinopathy. The expansion of advanced nanocarriers-based drug delivery systems has been now employed to exploit as well as regulate the transport of many therapeutic agents to target sites via the increase in penetration or the extension of the duration of contact employing production by enclosing as well as distributing tiny molecules in nanostructured formulation. Various polymers have been utilized for the manufacturing of these nanostructured formulations. Chitosan possesses incredible biological and chemical properties, that have led to its extensive use in pharmaceutical and biomedical applications. Chitosan has been used in many studies because of its enhanced mucoadhesiveness and non-toxicity. Multiple studies have used chitosan as the best candidate for manufacturing nanocarriers and treating diabetic retinopathy. Numerous nanocarriers have been formulated by using chitosan such as nanostructured lipid carriers, solid lipid nanoparticles, liposomes, and dendrimers for treating diabetic retinopathy. This current review elaborates on the recent advancements of chitosan as a promising approach for the manufacturing of nanocarriers that can be used for treating diabetic retinopathy.
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Affiliation(s)
- Yan Lv
- Department of Ophthalmology, Jilin Province FAW General Hospital, Changchun, 130011, China
| | - Chenglei Zhai
- Department of Orthopaedics, Jilin Province FAW General Hospital, Changchun, 130011, China
| | - Gang Sun
- Department of General Surgery, Jilin Province FAW General Hospital, Changchun, 130011, China.
| | - Yangfang He
- Department of Endocrinology, the Second Hospital of Jilin University, Changchun, 130000, China
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Aggarwal A, Jain S, Jindal H. Computational Model for the Detection of Diabetic Retinopathy in 2-D Color Fundus Retina Scan. Curr Med Imaging 2024; 20:CMIR-EPUB-138375. [PMID: 38333976 DOI: 10.2174/0115734056248183231010111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Diabetic Retinopathy (DR) is a growing problem in Asian countries. DR accounts for 5% to 7% of all blindness in the entire area. In India, the record of DR-affected patients will reach around 79.4 million by 2030. AIMS The main objective of the investigation is to utilize 2-D colored fundus retina scans to determine if an individual possesses DR or not. In this regard, Engineering-based techniques such as deep learning and neural networks play a methodical role in fighting against this fatal disease. METHODS In this research work, a Computational Model for detecting DR using Convolutional Neural Network (DRCNN) is proposed. This method contrasts the fundus retina scans of the DR-afflicted eye with the usual human eyes. Using CNN and layers like Conv2D, Pooling, Dense, Flatten, and Dropout, the model aids in comprehending the scan's curve and color-based features. For training and error reduction, the Visual Geometry Group (VGG-16) model and Adaptive Moment Estimation Optimizer are utilized. RESULTS The variations in a dataset like 50%, 60%, 70%, 80%, and 90% images are reserved for the training phase, and the rest images are reserved for the testing phase. In the proposed model, the VGG-16 model comprises 138M parameters. The accuracy is achieved maximum rate of 90% when the training dataset is reserved at 80%. The model was validated using other datasets. CONCLUSION The suggested contribution to research determines conclusively whether the provided OCT scan utilizes an effective method for detecting DRaffected individuals within just a few moments.
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Affiliation(s)
- Akshit Aggarwal
- Research Labs, Department of CSE, Indian Institute of Technology, Guwahati, India
| | - Shruti Jain
- Department of ECE, Jaypee University of Information Technology, Solan, Himachal Pradesh, India
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Tomkins-Netzer O, Niederer R, Lightman S. The role of statins in diabetic retinopathy. Trends Cardiovasc Med 2024; 34:128-135. [PMID: 36464210 DOI: 10.1016/j.tcm.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Diabetes mellitus is a growing global public health issue estimated to affect around 600 million people by 2040 [1]. It occurs in populations throughout the world, is increasing in both the developing world and high-income countries and also affects young, working-age people. Ocular involvement in diabetes occurs early in the disease and is present in over a third of diabetes mellitus Type 2 patients at the time of diagnosis. Blindness due to diabetic retinopathy (DR) remains a leading cause of adult-onset blindness, [1] which results from disruption of retinal vasculature, ischemia and its consequences and exudation causing macular edema. The prevalence of diabetic retinopathy is increasing at a greater rate than other causes of blindness including cataract, refractive errors, age-related macular degeneration and glaucoma. Compared to cataract and refractive error, management of diabetic retinopathy requires vast medical resources, including trained medical practitioners able to perform ocular injections and ophthalmologists for laser treatments and retinal surgery. This creates a significant burden on medical services as care for these patients lasts decades.
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Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rachael Niederer
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Susan Lightman
- UCL Institute of Ophthalmology, London, UK; UHI Centre for Health Sciences. Department of Optometry, Inverness, UK.
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Boyle J, Vignarajan J, Saha S. Automated Diabetic Retinopathy Diagnosis for Improved Clinical Decision Support. Stud Health Technol Inform 2024; 310:1490-1491. [PMID: 38269711 DOI: 10.3233/shti231259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
We report on the prediction performance of artificial intelligence components embedded into a telehealth platform underlying a newly established eye screening service connecting metropolitan-based ophthalmologists to patients in remote indigenous communities in Northern Territory and Queensland. Two AI-based components embedded into the telehealth platform were evaluated on retinal images collected from 328 unique patients: an image quality alert system and a diabetic retinopathy detection system. Compared to ophthalmologists, at an individual image level, the image quality detection algorithm was correct 72% of the time, and 85% accurate at a patient level. The retinopathy detection algorithm was correct 85% accurate at an individual image level, and 87% accurate at a patient level. This evaluation provides assurances for future service models using AI to complement and support decisions of eye health assessment teams.
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Affiliation(s)
| | | | - Sajib Saha
- CSIRO, Australian E-Health Research Centre
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Dahiya R, Walia A, Kaur J, Kumar P, Verma I, Rani N. Diabetic Retinopathy - Pathophysiology to Treatment: A Review. Curr Diabetes Rev 2024; 20:CDR-EPUB-137631. [PMID: 38315658 DOI: 10.2174/0115733998259940231105200251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 02/07/2024]
Abstract
Diabetic retinopathy (DR) is a microvascular disease affecting the eyes of diabetic patients, and is the most prevalent complication of diabetes mellitus. Vision improvement is not possible in the majority of DR patients. Several studies have indicated that microvascular changes, inflammation, oxidative stress, and retinal neurodegeneration are involved in the pathogenesis of DR. Therefore, there is an urgent need for the development of new and effective treatment for DR. Understanding the molecular mechanisms involved in the pathogenesis of disease will pave a way for better treatment and management of DR. This article has emphasized the molecular pathogenesis and treatment of DR.
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Affiliation(s)
- Randhir Dahiya
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
- Department of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Aditya Walia
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Jasleen Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Praveen Kumar
- SunPharma, Hill Top Area, Vill. Bhatolikalan, P.O. Barotiwala, Distt.Solan, Himachal Pradesh, 174103, India
| | - Inderjeet Verma
- MM College of Pharmacy, Maharishi Markandeshwar (deemed to be) University, Mullana, Ambala, Haryana, India
| | - Nidhi Rani
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Zhang LC, Li N, Xu M, Chen JL, He H, Liu J, Wang TH, Zuo ZF. Salidroside protects RGC from pyroptosis in diabetes-induced retinopathy associated with NLRP3, NFEZL2 and NGKB1, revealed by network pharmacology analysis and experimental validation. Eur J Med Res 2024; 29:60. [PMID: 38243268 PMCID: PMC10799395 DOI: 10.1186/s40001-023-01578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To investigate the effect of salidroside (SAL) in protecting retinal ganglion cell (RGC) from pyroptosis and explore associated molecular network mechanism in diabetic retinapathy (DR) rats. METHODS HE, Nissl and immunofluorescence staining were used to observe the retinal morphological change, and the related target genes for salidroside, DR and pyroptosis were downloaded from GeneCard database. Then Venny, PPI, GO, KEGG analysis and molecular docking were used to reveal molecular network mechanism of SAL in inhibiting the pyroptosis of RGC. Lastly, all hub genes were confirmed by using qPCR. RESULTS HE and Nissl staining showed that SAL could improve the pathological structure known as pyroptosis in diabetic retina, and the fluorescence detection of pyroptosis marker in DM group was the strongest, while they decreased in the SAL group(P < 0.05)). Network pharmacological analysis showed 6 intersecting genes were obtained by venny analysis. GO and KEGG analysis showed 9 biological process, 3 molecular function and 3 signaling pathways were involved. Importantly, molecular docking showed that NFE2L2, NFKB1, NLRP3, PARK2 and SIRT1 could combine with salidroside, and qPCR validates the convincible change of CASP3, NFE2L2, NFKB1, NLRP3, PARK2 and SIRT1. CONCLUSION Salidroside can significantly improve diabetes-inducedRGC pyrotosis in retina, in which, the underlying mechanism is associated with the NLRP3, NFEZL2 and NGKB1 regulation.
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Affiliation(s)
- Lan-Chun Zhang
- Department of Laboratory Animal Science, Institute of Neuroscience, Kunming Medical University, Kunming, 650500, China
| | - Na Li
- Department of Laboratory Animal Science, Institute of Neuroscience, Kunming Medical University, Kunming, 650500, China
- Liaoning Key Laboratory of Diabetic Cognitive and Perceptive Dysfunction, Jinzhou Medical University, Jinzhou, China
| | - Min Xu
- Liaoning Key Laboratory of Diabetic Cognitive and Perceptive Dysfunction, Jinzhou Medical University, Jinzhou, China
- Department of Anatomy, College of Basic Medicine, Jinzhou Medical University, Jinzhou, 121000, China
| | - Ji-Lin Chen
- Department of Laboratory Animal Science, Institute of Neuroscience, Kunming Medical University, Kunming, 650500, China
| | - Hua He
- Department of Pharmacology, Haiyuan College of Kunming Medical University, Kunming, 650106, Yunnan, China
| | - Jia Liu
- Department of Pharmacology, Haiyuan College of Kunming Medical University, Kunming, 650106, Yunnan, China
| | - Ting-Hua Wang
- Department of Laboratory Animal Science, Institute of Neuroscience, Kunming Medical University, Kunming, 650500, China.
- Liaoning Key Laboratory of Diabetic Cognitive and Perceptive Dysfunction, Jinzhou Medical University, Jinzhou, China.
- Department of Anatomy, College of Basic Medicine, Jinzhou Medical University, Jinzhou, 121000, China.
| | - Zhong-Fu Zuo
- Liaoning Key Laboratory of Diabetic Cognitive and Perceptive Dysfunction, Jinzhou Medical University, Jinzhou, China.
- Department of Anatomy, College of Basic Medicine, Jinzhou Medical University, Jinzhou, 121000, China.
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Song SH. Young-onset type 2 diabetes and retinopathy: evidence of an adverse phenotype. BMJ Open Diabetes Res Care 2024; 12:e003899. [PMID: 38167607 PMCID: PMC10773418 DOI: 10.1136/bmjdrc-2023-003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Soon H Song
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Tibballs K, Jenum AK, Kirkebøen L, Berg TJ, Claudi T, Cooper JG, Nøkleby K, Sandberg S, Straand J, Buhl ES. High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice. BMJ Open Diabetes Res Care 2024; 12:e003624. [PMID: 38167605 PMCID: PMC10773319 DOI: 10.1136/bmjdrc-2023-003624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. RESEARCH DESIGN AND METHODS We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. RESULTS Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. CONCLUSIONS Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD.
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Affiliation(s)
- Katrina Tibballs
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | | | - John Graham Cooper
- Norwegian Organization for Quality Improvement of Laboratory Examinations, Bergen, Norway
| | - Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations, Bergen, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit, Oslo, Norway
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Mohamed Z, Al-Natour M, Al Rahbi H. Prevalence of Diabetic Retinopathy Among Individuals with Diabetes in Gulf Cooperation Council countries: A Systematic Review and
Meta-analysis. Oman Med J 2024; 39:e585. [PMID: 38651051 PMCID: PMC11033453 DOI: 10.5001/omj.2024.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/28/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives To determine the proportion of diabetic retinopathy (DR) among individuals with diabetes mellitus in the Gulf Cooperation Council (GCC) countries. Methods This study was executed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Online databases including Scopus, Web of Sciences, PubMed, Index Medicus for the eastern Mediterranean region, Medline, and ProQuest, were utilized to retrieve studies on the prevalence of DR in GCC countries that were conducted from 2003 to 2019. Results Twenty articles were included in the meta-analysis, involving 61 855 patients. The prevalence of DR was 20.5% (95% CI: 20.212-20.850). The highest prevalence rate was observed in Saudi Arabia (69.8%; 95% CI: 64.989-74.216) and the lowest in the UAE (6.0%; 95% CI: 2.780-11.084). There was a significant heterogeneity between the reviewed studies (p < 0.001). Conclusions The prevalence of DR was high in the GCC countries. Our findings provide crucial information for the public healthcare systems in these countries to actively educate the public and screen at-risk populations for undiagnosed cases of diabetes, detect early stages of retinopathy, and provide required care to minimize the number of untreated cases.
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Affiliation(s)
| | - Malek Al-Natour
- College of Health Sciences, University of Buraimi, Al Buraimi, Oman
| | - Hilal Al Rahbi
- College of Health Sciences, University of Buraimi, Al Buraimi, Oman
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Chen L, Qi E, Liu X, Cui L, Fan X, Wei T, Hu Y. The lack of homology domain and leucine rich repeat protein phosphatase 2 ameliorates visual impairment in rats with diabetic retinopathy through regulation of the AKT-GSK-3β-Nrf2 signal cascade. Toxicol Appl Pharmacol 2024; 482:116766. [PMID: 37995808 DOI: 10.1016/j.taap.2023.116766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Pleckstrin homology domain and leucine rich repeat protein phosphatase 2 (PHLPP2) is an emerging player in diverse disorders. Our previous findings have documented that reducing PHLPP2 levels in cultured retinal ganglion cells protects against cellular damage caused by high glucose, indicating a possible link between PHLPP2 and diabetic retinopathy (DR). The present work was dedicated to the investigation of PHLPP2 in DR through in vivo experiments with rat models induced by intraperitoneal injection of streptozotocin. Compared to normal rats, the retinas of rats with DR exhibited a notable increase in the level of PHLPP2. The reduction of PHLPP2 levels in the retina was achieved by the intravitreal administration of adeno-associated viruses expressing specific shRNA targeting PHLPP2. Decreasing the expression of PHLPP2 ameliorated visual function impairment and improved the pathological changes of retina in DR rats. Moreover, decreasing the expression of PHLPP2 repressed the apoptosis, oxidative stress and proinflammatory response in the retinas of rats with DR. Reduction of PHLPP2 levels led to an increase in the levels of phosphorylated AKT and glycogen synthase kinase-3β (GSK-3β). Decreasing the expression of PHLPP2 resulted in increased activation of nuclear factor erythroid 2-related factor 2 (Nrf2), which was reversed by suppressing AKT. Notably, the protective effect of reducing PHLPP2 on DR was eliminated when Nrf2 was restrained. These observations show that the down-regulation of PHLPP2 has protective effects on DR by preserving the structure and function of the retina by regulating the AKT-GSK-3β-Nrf2 signal cascade. Therefore, targeting PHLPP2 may hold promise in the treatment of DR.
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Affiliation(s)
- Li Chen
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - En Qi
- Department of Ophthalmology, Qinghai Provincial People's Hospital, Xining 810007, Qinghai, China
| | - Xuan Liu
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
| | - Lijun Cui
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xiaojuan Fan
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Ting Wei
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Yaguang Hu
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
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Çelik Kavaklılar B, Aybı Özdemir Ö, Yıldırım T, Dikmetaş Ö, Toprak H, Hekimsoy V, İşler AO, Yılmaz R, Kadayıfçılar S, Erdem Y, Erbas T, Ünlütürk U. Evaluation of Microvascular Complications in Kidney Recipients with Post-Transplant Diabetes Mellitus. J Clin Endocrinol Metab 2023:dgad738. [PMID: 38101939 DOI: 10.1210/clinem/dgad738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/17/2023]
Abstract
CONTEXT Limited data on microvascular complications in patients with post-transplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. OBJECTIVES To evaluate diabetic microvascular complications in patients with long-standing PTDM. METHODS This study included patients with at least a five-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM). Diabetic peripheral neuropathy (PN) was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy (CAN) tests were performed using the heart rate variability. Nephropathy (DN) screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy (DR) was evaluated by fundus examination and photography, and optical coherence tomography. RESULTS This study included 41 patients with PTDM and 45 patients in the NDM group. The median follow-up was 107.5 months in the PTDM group. PN was significantly higher in the PTDM group than in the NDM group (p = 0.02). In the PTDM patients with PN, the corneal nerve fiber density examined by CCM was significantly lower than in the PTDM patients without neuropathy (p = 0.001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (p = 0.001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (p = 0.001). Retinopathy was observed in 19.5% of patients in the PTDM group, while none were in NDM patients (p < 0.001). Renal functions were similar between the study groups. CONCLUSIONS CAN and DR can affect patients with PTDM at a high rate. DR was found to be a threat to the vision of PTDM patients. Diabetic PN can be detected early in PTDM patients by CCM.
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Affiliation(s)
- Başak Çelik Kavaklılar
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Özge Aybı Özdemir
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Özlem Dikmetaş
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hilal Toprak
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vedat Hekimsoy
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alperen Onur İşler
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Rahmi Yılmaz
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sibel Kadayıfçılar
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yunus Erdem
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Uğur Ünlütürk
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
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Kalam MA, Al Asif CA, Hasan MM, Arif-Ur-Rahman M, Nag DK, Sen PK, Haque Akhanda MA, Davis TP, Talukder A. Understanding the behavioral determinants that predict barriers and enablers of screening and treatment behaviors for diabetic retinopathy among Bangladeshi women: findings from a barrier analysis. BMC Public Health 2023; 23:1667. [PMID: 37648981 PMCID: PMC10466885 DOI: 10.1186/s12889-023-16106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND AND AIM While early detection and timely treatments can prevent diabetic retinopathy (DR) related blindness, barriers to receiving these DR services may cause permanent sight loss. Despite having similar prevalence to diabetes and DR, women are less likely than men to perform these behaviors due to multi-faced barriers in screening and receiving follow-up treatments for DR. This study, therefore, aimed at identifying the barriers to - and enablers of - screening and follow-up treatments behaviors for DR among women aged more than 40 years with diabetes from the behavioral perspectives in Bangladesh. METHODS This Barrier Analysis study interviewed 360 women (180 "Doers" and 180 "Non-doers") to explore twelve behavioral determinants of four DR behaviors including screening, injection of anti-vascular endothelial growth factor (anti-VEGF medication), laser therapy and vitro-retinal surgery. The data analysis was performed to calculate estimated relative risk to identify the degree of association between the determinants and behaviors, and to find statistically significant differences (at p < 0.05) in the responses between the Doers and Non-doers. RESULTS Access to healthcare facilities was the major barrier impeding women from performing DR behaviors. Difficulty in locating DR service centers, the need to travel long distances, the inability to travel alone and during illness, challenges of paying for transportation and managing workload significantly affected women's ability to perform the behaviors. Other determinants included women's perceived self-efficacy, perceived negative consequences (e.g. fear and discomfort associated with injections or laser treatment), and cues for action. Significant perceived enablers included low cost of DR treatments, supportive attitudes by healthcare providers, government policy, and perceived social norms. CONCLUSION The study found a host of determinants related to the barriers to and enablers of DR screening and treatment behaviors. These determinants included perceived self-efficacy (and agency), positive and negative consequences, perceived access, perceived social norms, culture, and perceived risk. Further investments are required to enhance the availability of DR services within primary and secondary health institutions along with health behavior promotion to dispel misconceptions and fears related to DR treatments.
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Affiliation(s)
- Md Abul Kalam
- Global Health and Development Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh.
| | - Chowdhury Abdullah Al Asif
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
- Save the Children International, Bangladesh Country Office, Dhaka, Bangladesh
| | - Md Mehedi Hasan
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh.
| | - Md Arif-Ur-Rahman
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Dipak Kumar Nag
- National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh
| | - Pallab Kumar Sen
- Shaheed Ziaur Rahman Medical College (SZMC), Silimpur, Bogura, 5800, Bangladesh
| | - Md Aminul Haque Akhanda
- Mymensingh Medical College and Hospital, Chorpara Mymensingh, 2200, Bangladesh
- Community Based Medical College Bangladesh (CBMCB), Winnerpar, Mymensingh, 2200, Bangladesh
| | - Thomas P Davis
- Global Alliance for Vaccine and Immunization, Geneva, Switzerland
| | - Aminuzzaman Talukder
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
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Chun JW, Kim HS. The Present and Future of Artificial Intelligence-Based Medical Image in Diabetes Mellitus: Focus on Analytical Methods and Limitations of Clinical Use. J Korean Med Sci 2023; 38:e253. [PMID: 37550811 PMCID: PMC10412032 DOI: 10.3346/jkms.2023.38.e253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023] Open
Abstract
Artificial intelligence (AI)-based diagnostic technology using medical images can be used to increase examination accessibility and support clinical decision-making for screening and diagnosis. To determine a machine learning algorithm for diabetes complications, a literature review of studies using medical image-based AI technology was conducted using the National Library of Medicine PubMed, and the Excerpta Medica databases. Lists of studies using diabetes diagnostic images and AI as keywords were combined. In total, 227 appropriate studies were selected. Diabetic retinopathy studies using the AI model were the most frequent (85.0%, 193/227 cases), followed by diabetic foot (7.9%, 18/227 cases) and diabetic neuropathy (2.7%, 6/227 cases). The studies used open datasets (42.3%, 96/227 cases) or directly constructed data from fundoscopy or optical coherence tomography (57.7%, 131/227 cases). Major limitations in AI-based detection of diabetes complications using medical images were the lack of datasets (36.1%, 82/227 cases) and severity misclassification (26.4%, 60/227 cases). Although it remains difficult to use and fully trust AI-based imaging analysis technology clinically, it reduces clinicians' time and labor, and the expectations from its decision-support roles are high. Various data collection and synthesis data technology developments according to the disease severity are required to solve data imbalance.
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Affiliation(s)
- Ji-Won Chun
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Weerasinghe LS, Dunn HP, Fung AT, Maberly G, Cheung NW, Weerasinghe DP, Liew G, Do H, Hng TM, Pryke A, Marks SI, Nguyen H, Jayaballa R, Gurung S, Ford B, Bishay RH, Girgis CM, Meyerowitz-Katz G, Keay L, White AJ. Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services. BMJ Open Diabetes Res Care 2023; 11:e003376. [PMID: 37532459 PMCID: PMC10401227 DOI: 10.1136/bmjdrc-2023-003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility of point-of-care screening for high-risk populations in tertiary care settings. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (n=273). DR was assessed using portable, two-field, non-mydriatic fundus photography and combined electroretinogram/ pupillometry (ERG). With mydriatic photographs used as the reference standard, sensitivity and specificity of the devices were determined. Prevalence of DR and vision-threatening diabetic retinopathy (VTDR) were reported, with multivariate logistic regression used to identify predictors of DR. RESULTS Among 273 patients, 39.6% had any DR, while 15.8% had VTDR, of whom 59.3% and 62.8% were previously undiagnosed, respectively. Non-mydriatic photography demonstrated 20.2% sensitivity and 99.5% specificity for any DR, with a 56.7% screening failure rate. Meanwhile, mydriatic photography produced high-quality images with a 7.6% failure rate. ERG demonstrated 72.5% sensitivity and 70.1% specificity, with a 15.0% failure rate. The RETeval ERG was noted to have an optimal DR cut-off score at 22. Multivariate logistic regression identified an eGFR of ≤29 mL/min/1.73 m2, HbA1c of ≥7.0%, pupil size of <4 mm diameter, diabetes duration of 5-24 years and RETeval score of ≥22 as strong predictors of DR. CONCLUSION There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection.
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Affiliation(s)
- Lakni Shahanika Weerasinghe
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hamish Paul Dunn
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glen Maberly
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ngai Wah Cheung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Daminda P Weerasinghe
- Department of Mathematics and Statistics, Macquarie University, Sydney, New South Wales, Australia
| | - Gerald Liew
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Helen Do
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tien-Ming Hng
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Alison Pryke
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Samuel I Marks
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Helen Nguyen
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajini Jayaballa
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Seema Gurung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Belinda Ford
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Ramy H Bishay
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | | | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Andrew J White
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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22
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Jacoba CMP, Doan D, Salongcay RP, Aquino LAC, Silva JPY, Salva CMG, Zhang D, Alog GP, Zhang K, Locaylocay KLRB, Saunar AV, Ashraf M, Sun JK, Peto T, Aiello LP, Silva PS. Performance of Automated Machine Learning for Diabetic Retinopathy Image Classification from Multi-field Handheld Retinal Images. Ophthalmol Retina 2023; 7:703-712. [PMID: 36924893 DOI: 10.1016/j.oret.2023.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE To create and validate code-free automated deep learning models (AutoML) for diabetic retinopathy (DR) classification from handheld retinal images. DESIGN Prospective development and validation of AutoML models for DR image classification. PARTICIPANTS A total of 17 829 deidentified retinal images from 3566 eyes with diabetes, acquired using handheld retinal cameras in a community-based DR screening program. METHODS AutoML models were generated based on previously acquired 5-field (macula-centered, disc-centered, superior, inferior, and temporal macula) handheld retinal images. Each individual image was labeled using the International DR and diabetic macular edema (DME) Classification Scale by 4 certified graders at a centralized reading center under oversight by a senior retina specialist. Images for model development were split 8-1-1 for training, optimization, and testing to detect referable DR ([refDR], defined as moderate nonproliferative DR or worse or any level of DME). Internal validation was performed using a published image set from the same patient population (N = 450 images from 225 eyes). External validation was performed using a publicly available retinal imaging data set from the Asia Pacific Tele-Ophthalmology Society (N = 3662 images). MAIN OUTCOME MEASURES Area under the precision-recall curve (AUPRC), sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), accuracy, and F1 scores. RESULTS Referable DR was present in 17.3%, 39.1%, and 48.0% of the training set, internal validation, and external validation sets, respectively. The model's AUPRC was 0.995 with a precision and recall of 97% using a score threshold of 0.5. Internal validation showed that SN, SP, PPV, NPV, accuracy, and F1 scores were 0.96 (95% confidence interval [CI], 0.884-0.99), 0.98 (95% CI, 0.937-0.995), 0.96 (95% CI, 0.884-0.99), 0.98 (95% CI, 0.937-0.995), 0.97, and 0.96, respectively. External validation showed that SN, SP, PPV, NPV, accuracy, and F1 scores were 0.94 (95% CI, 0.929-0.951), 0.97 (95% CI, 0.957-0.974), 0.96 (95% CI, 0.952-0.971), 0.95 (95% CI, 0.935-0.956), 0.97, and 0.96, respectively. CONCLUSIONS This study demonstrates the accuracy and feasibility of code-free AutoML models for identifying refDR developed using handheld retinal imaging in a community-based screening program. Potentially, the use of AutoML may increase access to machine learning models that may be adapted for specific programs that are guided by the clinical need to rapidly address disparities in health care delivery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Duy Doan
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Recivall P Salongcay
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines; Centre for Public Health, Queen's University Belfast, United Kingdom; Eyes and Vision Institute, the Medical City, Pasig City, Philippines
| | - Lizzie Anne C Aquino
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
| | - Joseph Paolo Y Silva
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
| | | | - Dean Zhang
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Glenn P Alog
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines; Eyes and Vision Institute, the Medical City, Pasig City, Philippines
| | - Kexin Zhang
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Kaye Lani Rea B Locaylocay
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines; Eyes and Vision Institute, the Medical City, Pasig City, Philippines
| | - Aileen V Saunar
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines; Eyes and Vision Institute, the Medical City, Pasig City, Philippines
| | - Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, United Kingdom
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Philippine Eye Research Institute, University of the Philippines, Manila, Philippines; Eyes and Vision Institute, the Medical City, Pasig City, Philippines.
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Tsuboi K, Mazloumi M, Guo Y, Wang J, Flaxel CJ, Bailey ST, Huang D, Jia Y, Hwang TS. Utility of En Face OCT for the Detection of Clinically Unsuspected Retinal Neovascularization in Patients with Diabetic Retinopathy. Ophthalmol Retina 2023; 7:683-691. [PMID: 36918122 PMCID: PMC10440281 DOI: 10.1016/j.oret.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE To assess the value of en face OCT for detecting clinically unsuspected retinal neovascularization (RNV) in patients with nonproliferative diabetic retinopathy (NPDR). DESIGN A retrospective, cross-sectional study. PARTICIPANTS Treatment-naïve patients clinically graded as NPDR in an ongoing prospective observational OCT angiography (OCTA) study at a tertiary care center. METHODS Each patient underwent imaging of 1 eye with a spectral-domain OCTA, generating a 17 × 17-mm widefield image by montaging four 9 × 9-mm scans. Two independent graders examined a combination of en face OCT, en face OCTA with a custom vitreoretinal interface slab, and cross-sectional OCTA to determine the presence of RNV. We measured the area of RNV flow within RNV lesions on en face OCTA. MAIN OUTCOME MEASURES Detection rate of clinically occult RNV with OCT and OCTA. RESULTS Of 63 enrolled eyes, 27 (43%) were clinically graded as severe NPDR, 16 (25%) as moderate NPDR, and 20 (32%) as mild NPDR. Using the combination of en face OCT, en face OCTA, and cross-sectional OCTA, the graders detected 42 RNV lesions in 12 (19%) eyes, of which 8 (67%) were graded as severe NPDR, 2 (17%) as moderate NPDR, and 2 (17%) as mild NPDR. The sensitivity of en face OCT alone for detecting eyes with RNV was similar to that of en face OCTA alone (100% vs. 92%; P = 0.32), whereas the specificity of en face OCT alone was significantly lower than that of en face OCTA alone (32% vs. 73%; P < 0.001). For detecting individual RNV lesions, the en face OCT was 100% sensitive, compared with 67% sensitivity for the en face OCTA (P < 0.001). The area of RNV lesions that manual grading with en face OCTA alone missed was significantly smaller than that of manually detectable RNV (Mean [standard deviation] RNV flow area, 0.015 [0.020] mm2 vs. 0.16 [0.36] mm2; P < 0.001). CONCLUSION The combination of en face OCT and OCTA can detect clinically occult RNV with high sensitivity. For screening these small lesions, en face OCT may be a useful imaging modality. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kotaro Tsuboi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Mehdi Mazloumi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Yukun Guo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Jie Wang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Christina J Flaxel
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Steven T Bailey
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - David Huang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Yali Jia
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Thomas S Hwang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
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Taghvaei-Bijandi E, Abedian F, Ahmadzadeh Amiri A, Jafari N, Abediankenari S. The Upregulation of HLA-G1 and miRNA-34a in Lens Epithelial Cells of Diabetic Retinopathy Patients. Iran J Immunol 2023; 20:202-210. [PMID: 37209045 DOI: 10.22034/iji.2023.97403.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Background Retinopathy of diabetes is a chronic diabetes mellitus complication affecting retinal vessels, and some ocular complications' molecular mechanisms remain obscure. Objective To evaluate the expression of HLA-G1, HLA-G5, miRNA-181a, and miRNA-34a in the lens epithelial cells of patients with retinopathy of diabetes. Methods In a case-control study, 30 diabetic patients with retinopathy, 30 diabetic patients without retinopathy, and 30 cataract patients without diabetes mellitus as the control group were enrolled after a full description with details about the study methods and objectives. The expression of HLA G1, HLA G5, miRNA-181a, and miRNA-34a in lens epithelial cells was assessed by quantitative RT PCR. Moreover, the levels of HLA-G protein in aqueous humor were evaluated by the ELISA method. Results HLA-G1 expression was significantly upregulated in the retinopathy group (P=0.003). The aqueous humor of diabetic retinopathy patients contained significantly higher levels of HLA-G protein compared with the non-diabetic patients (P=0.001). miRNA-181a was significantly downregulated in the diabetic retinopathy group compared with the patients without diabetes (P=0.001). In addition, miRNA-34a was upregulated in the retinopathy group (P=0.009). Conclusion Taken together, the present results showed that HLA-G1 and miRNA-34a can be valuable markers for diabetic retinopathy. Our data offers new perspectives for improving the control of inflammation in the lens epithelial cells by considering HLA-G and miRNA.
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Affiliation(s)
| | - Fatemeh Abedian
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Narjes Jafari
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeid Abediankenari
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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25
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Cortez-Trejo B, Paz-Sosa MDP, Montiel-Jarquín ÁJ, Vargas-Huerta M, García-Galicia A, Bertado-Ramírez NR. [Pain after panretinal photocoagulation: 50-millisecond pulse versus conventional pulse]. Rev Med Inst Mex Seguro Soc 2023; 61:295-299. [PMID: 37216469 PMCID: PMC10437225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/27/2022] [Indexed: 05/24/2023]
Abstract
Background Diabetic retinopathy is a progressive disfunction of blood vessels of the retina secondary to chronic hyperglycemia. There are several treatments, out of which panretinal photocoagulation (PRP) stands out. Objective To compare the level of pain in patients undergoing PRP with different impulse. Material and methods Comparative, cross-sectional study that compared the level of pain in patients undergoing PRP with a 50-millisecond pulse (group A) versus conventional 200 milliseconds pulse (group B). Mann-Whitney U test was used. Results There were 26 patients, 12 (46.16%) female and 14 (53.84%) males. The median age was 58.73 ± 7.31 (40-75) years. 40 eyes were studied, 18 (45%) right and 22 (55%) left. The mean level of glycated hemoglobin was 8.15 ± 1.08 (6.5-12) %. The mean laser power was 297 ± 53.61 (200-380) and 214.5 ± 41.73 (170-320) milliwatts; the mean fluence was 18.85 ± 5.28 (12-28) J/cm2 and 65.9 ± 12.87 (52-98) J/cm2; the mean level of pain was 3.1 ± 1.33 (1-5) and 7.5 ± 1.23 (6-10) points for group A and B, respectively, and there was statistically significant difference (p ˂ 0.001) in the level of pain. There were no complications in any group. Conclusion The application of retinal 50-millisecond pulse PRP causes less pain and side effects than 200-millisecond pulse PRP.
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Affiliation(s)
- Brenda Cortez-Trejo
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Servicio de Oftalmología. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María del Pilar Paz-Sosa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Servicio de Oftalmología. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Álvaro José Montiel-Jarquín
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Margarita Vargas-Huerta
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Departamento de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Arturo García-Galicia
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Nancy Rosalía Bertado-Ramírez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
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26
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada. BMC Health Serv Res 2023; 23:302. [PMID: 36991464 PMCID: PMC10054218 DOI: 10.1186/s12913-023-09329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries. METHODS Following an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers. RESULTS We carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels. CONCLUSION Working with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research On Sustainable Health, VITAM, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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Kaur G, Harris NR. Endothelial Glycocalyx in Retina, Hyperglycemia, and Diabetic Retinopathy. Am J Physiol Cell Physiol 2023; 324:C1061-C1077. [PMID: 36939202 PMCID: PMC10125029 DOI: 10.1152/ajpcell.00188.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The endothelial glycocalyx (EG) is a mesh-like network present on the apical surface of the endothelium. Membrane-bound proteoglycans, the major backbone molecules of the endothelial glycocalyx, consist of glycosaminoglycans attached to core proteins. In addition to maintaining the integrity of the endothelial barrier, the endothelial glycocalyx regulates inflammation and perfusion, and acts as a mechanosensor. The loss of the EG can cause endothelial dysfunction and drive the progression of vascular diseases including diabetic retinopathy. Therefore, the endothelial glycocalyx presents a novel therapeutic target for treatment of vascular complications. In this review article, we provide an overview of the structure and function of the endothelial glycocalyx in the retina. Our partuclar focus is on hyperglycemia-induced perturbations in the glycocalyx structure in the retina, potential underlying mechanisms, and clinical trials studying protective treatments against degradation of the EG.
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Affiliation(s)
- Gaganpreet Kaur
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, United States
| | - Norman R Harris
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, United States
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Lee JS, Lee YB, Kim TW, Park KH. Visual prognosis and surgical timing of Ahmed glaucoma valve implantation for neovascular glaucoma secondary to diabetic vitrectomy. BMC Ophthalmol 2023; 23:107. [PMID: 36932350 PMCID: PMC10022148 DOI: 10.1186/s12886-023-02846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Evaluate the visual outcomes of Ahmed glaucoma valve implantation (AGVI) in patients with neovascular glaucoma (NVG) who underwent diabetic vitrectomy and suggest appropriate AGVI timing. METHODS Medical records of patients who underwent AGVI due to NVG after diabetic vitrectomy were reviewed. Successful intraocular pressure (IOP) control was defined as an IOP between 6 and 21 mmHg. Visual outcome was compared before NVG diagnosis and after AGVI, and the "favorable" visual outcome was defined as a postoperative deterioration in BCVA of less than 0.3 logMAR units compared to those before the development of NVG. Various factors including surgical timing were evaluated to identify the risk factors associated with unfavorable visual outcome. RESULTS A total of 35 eyes were enrolled and divided into group 1(medically uncontrolled NVG group, IOP more than 30mmHg, 16 eyes) and group 2(NVG group responded well to the initial non-surgical treatment but eventually required AGVI, 19 eyes). Despite the favorable rate of normalization of post-AGVI IOP (85.7%), 43.8% in Group 1 and 26.3% in Group 2 showed unfavorable visual outcomes. In group 1, delayed surgical timing more than 1 week from the NVG diagnosis showed a significant association with unfavorable visual outcomes (P = 0.041). In group 2, poor patient compliance (follow up loss, refuse surgery) was the main factor of unfavorable visual outcomes. CONCLUSION When NVG occurs in patients with proliferative diabetic retinopathy after vitrectomy, physicians should be cautious not to delay the surgical intervention, especially in patients with IOP of 30 or more despite non-surgical treatment. Early AGVI within six days might be necessary to preserve useful vision in these patients.
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Affiliation(s)
- Jong Suk Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Bok Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, South Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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Pan T, Gao J, Cai X, Zhang H, Lu J, Lei T. The average 30-minute post-prandial C-peptide predicted diabetic retinopathy progress: a retro-prospective study. BMC Endocr Disord 2023; 23:63. [PMID: 36922809 PMCID: PMC10018901 DOI: 10.1186/s12902-023-01300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The conclusion between Connecting peptide (C-peptide) and diabetic chronic complication was controversial. The purpose of this study is to explore the possible association between average C-peptide with diabetic retinopathy (DR) progression in Chinese patients with type 2 diabetes. METHODS This is a retro-prospective study. 622 patients with type 2 diabetes were included. DR was evaluated using non-mydriatic fundus photography and DR progression was defined as any deterioration of either eye. Fasting and postprandial c-peptide levels were assayed at baseline and follow-up period. Differences between continuous variables were compared using the Mann-Whitney U test; and categorical variables were analyzed by the chi-square test. Correlation between parameters and 30-minute postprandial C-peptide were determined by Spearman correlation test. The relationship between C-peptide and DR progression was evaluated by multivariable binary logistic regression. Two-tailed P-values < 0.05 were regarded as statistically significant. RESULTS DR was present in 162 (26.0%) patients at baseline, and 26.4% of patients were found progression of DR at follow-up. Patients with progression of DR had lower average levels of 30-minute postprandial C-peptide (2.01 ng/ml vs. 2.6 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (3.17 ng/ml vs. 3.92 ng/ml, p < 0.029), as well as average increment of 30-minute (0.41 ng/ml vs. 0.64 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (1.48 ng/ml vs. 1.93 ng/ml, p < 0.017), than those without DR aggravation. Multivariate logistic regression analysis determined that 30-minute postprandial C-peptide and its increment were related to reduced odds ratios for DR progression (odds ratios [OR] = 0.83 and 0.74, respectively). CONCLUSION Our results suggest that the Average 30-minute post-prandial C-peptide and increment were negatively correlated with DR progression, which further demonstrates the importance to preserve β-cell residual function in the prevention for DR progression. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ting Pan
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Jie Gao
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Xinghua Cai
- Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Anhui, China
| | - Huihui Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Jun Lu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China.
| | - Tao Lei
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China.
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Sidhu RK, Sachdeva J, Katoch D. Segmentation of retinal blood vessels by a novel hybrid technique- Principal Component Analysis (PCA) and Contrast Limited Adaptive Histogram Equalization (CLAHE). Microvasc Res 2023; 148:104477. [PMID: 36746364 DOI: 10.1016/j.mvr.2023.104477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Diabetic Retinopathy is a persistent disease of eyes that may lead to permanent loss of sight. In this paper, methodology is proposed to segment region of interest (ROI) i.e. new blood vessels in fundus images of retina of Diabetic Retinopathy (DR). The database of 50 fundus retinal images of healthy subjects and DR patients is fetched from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The experimental set up consists of three set of experiments for the disease. For DR, in the first stage of automated blood vessel segmentation, gray-scale image is produced from the colored image using Principal Component Analysis (PCA) in the preprocessing step. The contrast enhancement by the Contrast Limited Adaptive Histogram Equalization (CLAHE) highlights the retinal blood vessels in the gray-scale image i.e. it unsheathed newly formed retinal blood vessels whereas PCA preserved their texture and color discrimination in DR images. The expert ophthalmologist(s) scrutiny on both internet repository and real time data acted as the gold standard for further analysis and formation of the proposed method. Further, ophthalmologists ascertained the forming of new blood vessels only on the disc region and divulging them, which were impossible with the naked eye. These operations help in extracting retinal blood vessels present on the disc and non-disc region of the image. The comparison of the results are done with the state of art methods like watershed transform. It is observed from the results that the new blood vessels are better segmented by the proposed methodology and are marked by the experienced ophthalmologist for validation. Further, for quantitative analysis, the features are extracted from new blood vessels as they are crucial for scientific interpretation. The results of the features lie in permissible limits such as no. of segments vary from 2 to 5 and length of segments varies from 49 to 164 pixels. Similarly, other features such as gray level of new blood vessels lie in 0.296-0.935 normalized range, coefficient with variations in gray level in the range of 0.658-10.10 and distance from vessel origin lie in the range of 56-82 pixels respectively. Both quantitative and qualitative results show that the methodologies proposed boosted the ophthalmic and clinical diagnosis. The developed method further handled the false detection of vessels near the optic disk boundary, under-segmentation of thin vessels, detection of pathological anomalies such as exudates, micro-aneurysms and cotton wool spots. From the numerical analysis, ophthalmologist extracted the information of number of vessels formed, length of the new vessels, observation that the new vessels appearing are less homogenous than the normal vessels. Also about the new vessels, whether they lie on the centre of disc region or towards its edges. These parameters lie as per the findings of the ophthalmologists on retinal images and automated detection helped in monitoring and comprehensive patient assessment. The experimental results show case that the proposed method has higher sensitivity, specificity and accuracy as compared to state of art methods i.e. 0.9023, 0.9610 and 0.9921, respectively. Similar results are obtained on retinal fundus images of PGIMER Chandigarh with sensitivity-0.9234, specificity-0.9955 and accuracy-0.9682.
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Affiliation(s)
- R K Sidhu
- Department of Electronics and Communication Engineering, Chandigarh University, Mohali, India.
| | - Jainy Sachdeva
- Department of Electrical and Instrumentation Engineering, Thapar Institute of Engineering & Technology, Patiala, India.
| | - D Katoch
- Department of Ophthalmology, Advanced Eye Centre, PGIMER, Chandigarh, India.
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Vishwakarma S, Kaur I. Molecular Mediators and Regulators of Retinal Angiogenesis. Semin Ophthalmol 2023; 38:124-133. [PMID: 36536520 DOI: 10.1080/08820538.2022.2152706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Retinal neovascularization is the major cause of vision loss that affects both adults and young children including premature babies. It has been a major pathology in several retinal diseases like age-related macular degeneration (AMD), diabetic retinopathy (DR) and retinopathy of prematurity (ROP). Current treatment modalities such as anti-VEGF therapy, laser are not suitable for every patient and response to these therapies is highly variable. Thus, there is a need to investigate newer therapeutic targets for DR, ROP and AMD, based on a clear understanding of disease pathology and regulatory mechanisms involved. METHOD Appropriate articles published till February 2021 were extracted from PUBMED using keywords like ocular angiogenesis, DR, ROP, AMD, miRNA, mRNA, and cirMiRNA and containvaluable information regarding the involvement of miRNA in causing neovascularization. After compiling the list of miRNA regulating mRNA expression in angiogenesis and neovascularaization, their interactions were studied using online available tool MIENTURNET (http://userver.bio.uniroma1.it/apps/mienturnet/). The pathways involved in these processes were also predicted using the same tool. RESULTS Most of the studies have explored potential targets like HIF1-α, PDGF, TGFβ, FGF, etc., for their involvement in pathological angiogenesis in different retinal diseases. The regulatory role of microRNA (miRNA) has also been explored in various retinal ocular pathologies. This review highlights regulatory mechanism of cellular and circulatory miRNAs and their interactions with the genes involved in retinal neovascularization. The role of long noncoding RNA (ncRNA) in the regulation of genes involved in different pathways is also noteworthy and discussed in this review. CONCLUSION This review highlights the potential regulatory mechanism/pathways involved in retinal neovascularization and its implications in retinal diseases and for identifying new drug targets.
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Affiliation(s)
- Sushma Vishwakarma
- Prof Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India.,Manipal Academy of Higher Education, Manipal, India
| | - Inderjeet Kaur
- Prof Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Fickweiler W, Mitzner M, Jacoba CMP, Sun JK. Circulatory Biomarkers and Diabetic Retinopathy in Racial and Ethnic Populations. Semin Ophthalmol 2023:1-11. [PMID: 36710371 DOI: 10.1080/08820538.2023.2168488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Clinical staging systems for diagnosis and treatment of diabetic retinopathy (DR) must closely relate to endpoints that are both relevant for patients and feasible for physicians to implement. Current DR staging systems for clinical eye care and research provide detailed phenotypic characterization to predict patient outcomes in diabetes but have limitations. Biochemical biomarkers provide a rich pool of potential candidates for new DR staging systems that can be readily measured in accessible fluids. Circulating biomarkers that are specific to the retina and relate to angiogenesis and inflammation have been suggested as relevant for DR. Although there is a lack of multi-ethnic studies evaluating circulatory biomarkers in DR, variability in circulatory biomarkers have been reported in people from different ethnic and racial backgrounds. Therefore, there is a need for future studies to evaluate individual or combinations of biomarkers in diverse populations with DR from different ethnic and racial backgrounds.
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Affiliation(s)
- Ward Fickweiler
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Margalit Mitzner
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
| | - Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jennifer K Sun
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Li Y, Chai JL, Shi X, Feng Y, Li JJ, Zhou LN, Cao C, Li KR. Gαi1/3 mediate Netrin-1-CD146-activated signaling and angiogenesis. Theranostics 2023; 13:2319-2336. [PMID: 37153740 PMCID: PMC10157725 DOI: 10.7150/thno.80749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/08/2023] [Indexed: 05/10/2023] Open
Abstract
Netrin-1 binds to the high-affinity receptor CD146 to activate downstream signaling and angiogenesis. Here, we examine the role and underlying mechanisms of G protein subunit alpha i1 (Gαi1) and Gαi3 in Netrin-1-induced signaling and pro-angiogenic activity. In mouse embryonic fibroblasts (MEFs) and endothelial cells, Netrin-1-induced Akt-mTOR (mammalian target of rapamycin) and Erk activation was largely inhibited by silencing or knockout of Gαi1/3, whereas signaling was augmented following Gαi1/3 overexpression. Netrin-1 induced Gαi1/3 association with CD146, required for CD146 internalization, Gab1 (Grb2 associated binding protein 1) recruitment and downstream Akt-mTOR and Erk activation. Netrin-1-induced signaling was inhibited by CD146 silencing, Gab1 knockout, or Gαi1/3 dominant negative mutants. Netrin-1-induced human umbilical vein endothelial cell (HUVEC) proliferation, migration and tube formation were inhibited by Gαi1/3 short hairpin RNA (shRNA), but were potentiated by ectopic Gαi1/3 overexpression. In vivo, intravitreous injection of Netrin-1 shRNA adeno-associated virus (AAV) significantly inhibited Akt-mTOR and Erk activation in murine retinal tissues and reduced retinal angiogenesis. Endothelial knockdown of Gαi1/3 significantly inhibited Netrin1-induced signaling and retinal angiogenesis in mice. Netrin-1 mRNA and protein expression were significantly elevated in retinal tissues of diabetic retinopathy (DR) mice. Importantly, silence of Netrin-1, by intravitreous Netrin-1 shRNA AAV injection, inhibited Akt-Erk activation, pathological retinal angiogenesis and retinal ganglion cells degeneration in DR mice. Lastly, Netrin-1 and CD146 expression is significantly increased in the proliferative retinal tissues of human proliferative diabetic retinopathy patients. Together, Netrin-1 induces CD146-Gαi1/3-Gab1 complex formation to mediate downstream Akt-mTOR and Erk activation, important for angiogenesis in vitro and in vivo.
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Affiliation(s)
- Ya Li
- Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University and North District, The Municipal Hospital of Suzhou, Gusu School, Nanjing Medical University, Suzhou, China
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-long Chai
- Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University and North District, The Municipal Hospital of Suzhou, Gusu School, Nanjing Medical University, Suzhou, China
| | - Xin Shi
- Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University and North District, The Municipal Hospital of Suzhou, Gusu School, Nanjing Medical University, Suzhou, China
| | - Yu Feng
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jia-jun Li
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
| | - Li-na Zhou
- Department of Radiotherapy and Oncology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, China
| | - Cong Cao
- Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University and North District, The Municipal Hospital of Suzhou, Gusu School, Nanjing Medical University, Suzhou, China
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
- ✉ Corresponding authors: Prof. Cong Cao, Clinical Research Center of Neurological Disease of the Second Affiliated Hospital of Soochow University.199Ren-ai Road, Suzhou, Jiangsu 215123, China. E-mail: . Prof. Ke-ran Li, The Affiliated Eye Hospital, Nanjing Medical University,138 Hanzhong Rd, Nanjing, Jiangsu, 210029, China. E-mail:
| | - Ke-ran Li
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
- ✉ Corresponding authors: Prof. Cong Cao, Clinical Research Center of Neurological Disease of the Second Affiliated Hospital of Soochow University.199Ren-ai Road, Suzhou, Jiangsu 215123, China. E-mail: . Prof. Ke-ran Li, The Affiliated Eye Hospital, Nanjing Medical University,138 Hanzhong Rd, Nanjing, Jiangsu, 210029, China. E-mail:
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Gitay MN, Sohail A, Arzoo Y, Shakir MA. Changes in serum lipids with the onset and progression of Diabetic Retinopathy in Type-II Diabetes Mellitus. Pak J Med Sci 2023; 39:188-191. [PMID: 36694747 PMCID: PMC9842978 DOI: 10.12669/pjms.39.1.6265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/28/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the role of serum lipids in the onset and progression of Diabetic Retinopathy (DR) in Type-II diabetes (T2DM) individuals. Methods This cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology (NIDE), Dow University of Health Sciences (DUHS) from March to May 2019. After signing the informed consent, healthy controls (n=30), T2DM patients (diabetic n=30), proliferative (PDR n=30) and non-proliferative (NPDR n= 30) of age 18 to 65 years were selected by convenient sampling. Background information was gathered through interviews and the fundoscopy was done. Fasting five ml venous blood samples were collected and analysed for triglycerides (TGs), cholesterol, HDL, LDL, VLDL and the HbA1c using commercially available assays. The SPSS, version 24.0, was used for data analysis. Results The HbA1c level was high in the diabetes, NPDR and PDR groups than control (p<0.05). The serum TGs and cholesterol were raised while the HDL was low in the diabetes group than in control (p<0.05). The cholesterol and LDL were high in the diabetes group compared to NPDR and PDR groups (p<0.05). The cholesterol and VLDL showed a positive moderately strong correlation with HbA1c in the PDR group (p<0.05). Conclusion The serum lipid levels vary with the HbA1c levels and greater degree of derangement is observed with increasing mean HbA1C independent of diabetic retinopathy. For this reason, strict control of HbA1c and serum lipid level by lifestyle and/or pharmacologic intervention is recommended in diabetes with or without retinopathy.
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Affiliation(s)
- Mehnaz Nuruddin Gitay
- Dr. Mehnaz Nuruddin Gitay, Ph.D. Assistant Professor, Department of Biochemistry, Dow University of Health Science, Karachi, Pakistan
| | - Arisha Sohail
- Dr. Arisha Sohail, M.B.B.S, Ph.D. Lecturer, Department of Biochemistry, Dow University of Health Science, Karachi, Pakistan
| | - Yasmeen Arzoo
- Yasmeen Arzoo, Institute of Basic Medical Sciences, Dow University of Health Science, Karachi, Pakistan
| | - Muhammad Ali Shakir
- Muhammad Ali Shakir, M.B.B.S, M.Phil. Professor and Head of Department of Biochemistry, Karachi Medical and Dental College, Karachi, Pakistan
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Lock LJ, Channa R, Brennan MB, Cao Y, Liu Y. Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening. BMJ Open Diabetes Res Care 2022; 10:10/6/e003174. [PMID: 36517109 PMCID: PMC9756146 DOI: 10.1136/bmjdrc-2022-003174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Rural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our goal was to determine the role of level of disadvantage in explaining the effect of health systems on rural and urban disparities in diabetic eye screening. RESEARCH DESIGN AND METHODS This is a retrospective cohort study using an all-payer, state-wide claims database covering over 75% of Wisconsin residents. We included adults with diabetes (18-75 years old) who had claims billed throughout the baseline (2012-2013) and measurement (2013-2014) years. We performed multivariable regressions to assess factors associated with receipt of diabetic eye screening. The primary exposure was the primary care clinic's combined level of rurality and disadvantage. We adjusted for the health system as well as patient-level variables related to demographics and comorbidities. Health system was defined as an associated group of physicians and/or clinics. RESULTS A total of 118 707 adults with diabetes from 698 primary care clinics in 143 health systems met the inclusion criteria. Patients from urban underserved clinics were less likely to receive screening than those from rural underserved clinics before adjusting for health system in the model. After adjusting for health system fixed effects, however, the directionality of the relationship between clinic rurality and screening reversed: patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics. Similar findings were observed for both Medicare and non-Medicare subgroups. CONCLUSIONS The effect of health system on receipt of diabetic eye screening in rural versus urban areas is most pronounced in underserved areas. Health systems, particularly those providing care to urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions to support patients in overcoming barriers from social determinants of health.
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Affiliation(s)
- Loren J Lock
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meghan B Brennan
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ying Cao
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Das D, Biswas SK, Bandyopadhyay S. Detection of Diabetic Retinopathy using Convolutional Neural Networks for Feature Extraction and Classification (DRFEC). Multimed Tools Appl 2022; 82:1-59. [PMID: 36467440 PMCID: PMC9708148 DOI: 10.1007/s11042-022-14165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/14/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
Diabetic Retinopathy (DR) is caused as a result of Diabetes Mellitus which causes development of various retinal abrasions in the human retina. These lesions cause hindrance in vision and in severe cases, DR can lead to blindness. DR is observed amongst 80% of patients who have been diagnosed from prolonged diabetes for a period of 10-15 years. The manual process of periodic DR diagnosis and detection for necessary treatment, is time consuming and unreliable due to unavailability of resources and expert opinion. Therefore, computerized diagnostic systems which use Deep Learning (DL) Convolutional Neural Network (CNN) architectures, are proposed to learn DR patterns from fundus images and identify the severity of the disease. This paper proposes a comprehensive model using 26 state-of-the-art DL networks to assess and evaluate their performance, and which contribute for deep feature extraction and image classification of DR fundus images. In the proposed model, ResNet50 has shown highest overfitting in comparison to Inception V3, which has shown lowest overfitting when trained using the Kaggle's EyePACS fundus image dataset. EfficientNetB4 is the most optimal, efficient and reliable DL algorithm in detection of DR, followed by InceptionResNetV2, NasNetLarge and DenseNet169. EfficientNetB4 has achieved a training accuracy of 99.37% and the highest validation accuracy of 79.11%. DenseNet201 has achieved the highest training accuracy of 99.58% and a validation accuracy of 76.80% which is less than the top-4 best performing models.
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Affiliation(s)
- Dolly Das
- Department of Computer Science and Engineering, National Institute of Technology Silchar, Cachar, Silchar, Assam 788010 India
| | - Saroj Kumar Biswas
- Department of Computer Science and Engineering, National Institute of Technology Silchar, Cachar, Silchar, Assam 788010 India
| | - Sivaji Bandyopadhyay
- Department of Computer Science and Engineering, National Institute of Technology Silchar, Cachar, Silchar, Assam 788010 India
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Amin R, Shariff MA, Purwanita P, Saleh MI. Efficacy of Sambiloto Extracts, Andrographis paniculate, (Burm. F) in Inhibiting Diabetic Retinopathy Progression: An in Vivo Study. Rep Biochem Mol Biol 2022; 11:457-464. [PMID: 36718307 PMCID: PMC9883034 DOI: 10.52547/rbmb.11.3.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of diabetes mellitus complication and occurred in retinal microvascular. This study was aimed to investigate the efficacy of Sambiloto, Andrographis paniculate (A. paniculata) extract on glycemic profile, antioxidant and inflammatory cytokine parameters in diabetic rats, and phytochemical analysis of A. paniculata. METHODS A. paniculata extract (APE) was carried out by maceration with ethanol. Diabetes mellitus in Wistar male rats was induced with streptozotocin. Retinal vessel diameters were estimated using a method by Vucetic. Inflammatory cytokine and antioxidant parameters were evaluated in retinal tissue. The alkaloid and flavonoid contents in extract were analyzed using thin layer chromatography method. RESULTS Funduscopic examination presented some changes in the diameter of the blood vessels. The vessel diameter in the diabetic retinopathy group with APE in concentration of 100 and 200 mg/kg BW groups was significantly lower than in the DR group (p<0.05). The administration of APE in dosages of 100 and 200 mg/kg BW showed reduced glutathione, SOD, and catalase levels compared to the DR group (p<0.05). CONCLUSION A. paniculata extract doses of 100 and 200 mg/kg BW improved diabetic retinopathy in rats through hypoglycemic effects, antioxidant effects, and anti-inflammatory mechanisms.
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Affiliation(s)
- Ramzi Amin
- Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya/Dr Moh Hoesin General Hospital, Palembang, Indonesia.
| | - Muhammad Apriliandy Shariff
- Specialized Residency Training, Faculty of Medicine, Universitas Sriwijaya/Dr Moh Hoesin General Hospital, Palembang, Indonesia.
| | - Petty Purwanita
- Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya/Dr Moh Hoesin General Hospital, Palembang, Indonesia.
| | - Mgs Irsan Saleh
- Department of Pharmacology, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia.
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Amin R, Indiarsih TB, Sari PM, Purwanita P. Anti-RAGE (Receptor Advanced Glycation End products) Antibody Improves Diabetic Retinopathy in Rats via Hypoglycemic and Anti-inflammatory Mechanism. Rep Biochem Mol Biol 2022; 11:394-9. [PMID: 36718309 DOI: 10.52547/rbmb.11.3.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 01/18/2023]
Abstract
Background Receptor advanced glycation end products (RAGE) activation plays an essential role in diabetic retinopathy (DR) progression. This study was aimed to explore the role of anti-RAGE antibodies (RAGE antagonists) in inhibiting DR progression through their hypoglycemic and anti-inflammatory mechanism in diabetic retinopathy induced rats. Methods A total of 30 male Wistar rats were randomly divided into five group. The group was consisted of normal control group, DR group without treatment, DR group with anti-RAGE 1 ηg/kg BW, 10 ηg/kg BW, and 100 ηg/kg BW. To assess the diabetic retinopathy, fundus photographs were taken every week using a camera with 16x magnification placed in front of the rat's eyes. Blood glucose was checked by the glucose oxidase-peroxidase method. Retinal TNF-α levels and VEGF were examined using an enzyme-linked immunosorbent assay (ELISA) kit. Results The finding of this study showed that anti-RAGE treatment at dose of 10 and 100 ηg/kg BW, HbA1c levels were significantly higher (p< 0.05) compared to the normal control group but significantly lower (p< 0.05) than in the diabetes group. The mean blood vessel diameter in the DR+anti-RAGE 10 and 100 ηg/kg BW groups was significantly lower than in the diabetic retinopathy group (p< 0.05). The administration of anti-RAGE 10 and 100 ηg/kg BW showed the ability to significantly reduce VEGF levels compared to the DR group (p< 0.05). Discussion This study revealed at doses of 10 and 100 ηg/kg BW, anti-RAGE antibodies improved diabetic retinopathy in Wistar rats through hypoglycemic effects and anti-inflammatory mechanisms.
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Yousif Hussin Alimam H, Abdelateif Hussein W, Ibrahim S, Abdelgani S, Alharthi N, Bashier Eltayeb L, Abdelgadir Elmahdi S, Abobakr Abdrabo A. Blood Glucose, HbA1c Level, and its Correlation with VEGF-A (+405G/C) Polymorphism as Biomarker Predicts the Risk of Retinopathy and Nephropathy in Type 2 Diabetic Patients. Rep Biochem Mol Biol 2022; 11:421-9. [PMID: 36718295 DOI: 10.52547/rbmb.11.3.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/24/2022] [Indexed: 01/17/2023]
Abstract
Background Diabetes-related vascular complications linked to increase in the expression of VEGF and its receptors. It helps to accelerate tissue damage inflicted by hyperglycemia, which is potential risk for diabetic complications. The study aimed to assess VEGF genetic polymorphism and its correlation with glucose and HbA1C level among Sudanese patients with diabetic retinopathy and nephropathy. Methods A case-control study was conducted among a total of 252 subjects and divided into four groups of 63 subjects each. Glucose and HBA1c were measured then the VEGF gene was amplified using polymerase chain reaction. The data were analyzed using SPSS. Results The HBA1c, and blood glucose levels had significantly (P value≤0.00001) highest mean in the DR group, DN group followed by DM. There is a non-significant correlation between VEGF Genotypes and HbA1c, and blood glucose levels (P value≤0.102, 0.173) Patients with GC genotypes will be 74.6%, and 54% higher at risk to develop DR, and DN respectively and 40 % lower at risk to develop DM than those without GC genotype. While patients with CC genotypes will be 22.2% higher at risk of developing DM and 9.5%, 12.2% higher at risk of developing DR and DN respectively. Discussion The VEGF +405G/C gene polymorphism is linked to diabetic retinopathy, and diabetic nephropathy in type 2 Sudanese diabetics, and the presence of the GC genotypes and G allele is a significant predictor for retinopathy. There is no significant relation between HbA1C serum levels, blood glucose, and the VEGF +405G/C gene polymorphism.
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Santos C, Aguiar M, Welfer D, Belloni B. A New Approach for Detecting Fundus Lesions Using Image Processing and Deep Neural Network Architecture Based on YOLO Model. Sensors (Basel) 2022; 22:s22176441. [PMID: 36080898 PMCID: PMC9460625 DOI: 10.3390/s22176441] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 05/27/2023]
Abstract
Diabetic Retinopathy is one of the main causes of vision loss, and in its initial stages, it presents with fundus lesions, such as microaneurysms, hard exudates, hemorrhages, and soft exudates. Computational models capable of detecting these lesions can help in the early diagnosis of the disease and prevent the manifestation of more severe forms of lesions, helping in screening and defining the best form of treatment. However, the detection of these lesions through computerized systems is a challenge due to numerous factors, such as the characteristics of size and shape of the lesions, noise and the contrast of images available in the public datasets of Diabetic Retinopathy, the number of labeled examples of these lesions available in the datasets and the difficulty of deep learning algorithms in detecting very small objects in digital images. Thus, to overcome these problems, this work proposes a new approach based on image processing techniques, data augmentation, transfer learning, and deep neural networks to assist in the medical diagnosis of fundus lesions. The proposed approach was trained, adjusted, and tested using the public DDR and IDRiD Diabetic Retinopathy datasets and implemented in the PyTorch framework based on the YOLOv5 model. The proposed approach reached in the DDR dataset an mAP of 0.2630 for the IoU limit of 0.5 and F1-score of 0.3485 in the validation stage, and an mAP of 0.1540 for the IoU limit of 0.5 and F1-score of 0.2521, in the test stage. The results obtained in the experiments demonstrate that the proposed approach presented superior results to works with the same purpose found in the literature.
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Affiliation(s)
- Carlos Santos
- Computer Center, Federal Institute of Education, Science and Technology Farroupilha, Alegrete 97555-000, Brazil
- Postgraduate Program in Computing (PPGC), Federal University of Pelotas, Pelotas 96010-610, Brazil
| | - Marilton Aguiar
- Postgraduate Program in Computing (PPGC), Federal University of Pelotas, Pelotas 96010-610, Brazil
| | - Daniel Welfer
- Postgraduate Program in Computer Science (PPGCC), Departament of Applied Computing (DCOM), Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Bruno Belloni
- Federal Institute of Education, Science and Technology Sul-Rio-Grandense, Passo Fundo 99064-440, Brazil
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Gong Q, Zhang R, Wei F, Fang J, Zhang J, Sun J, Sun Q, Wang H. SGLT2 inhibitor-empagliflozin treatment ameliorates diabetic retinopathy manifestations and exerts protective effects associated with augmenting branched chain amino acids catabolism and transportation in db/db mice. Biomed Pharmacother 2022; 152:113222. [PMID: 35671581 DOI: 10.1016/j.biopha.2022.113222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Empagliflozin (EMPA) is the first sodium-glucose co-transporter 2 inhibitor to significantly reduce cardiovascular and kidney complications in type 2 diabetes mellitus. Given this, we speculate that EMPA may have the potential to intervene in diabetic retinopathy (DR), which is another diabetes-specific microvascular complication. Db/db mice were treated with EMPA for different periods to observe the retinas and related mechanisms. EMPA effectively balanced body weight and blood glucose levels, mitigated ocular edema and microaneurysm in db/db mice. EMPA significantly inhibited oxidative stress, apoptosis and recovered tight junction in diabetic retinas. MS/MS analyses showed that EMPA suppressed aberrant branched-chain amino acid (BCAAs) accumulation in db/db retinas, which led to the inhibition of the mammalian target of rapamycin activation, downregulation of inflammation, and angiogenic factors, including TNF-ɑ, IL-6, VCAM-1, and VEGF induced by diabetes. Furthermore, branched-chain α-keto acids (BCKAs), which are catabolites of BCAAs, were increased in diabetic retinas and decreased with EMPA application. Moreover, branched-chain ketoacid dehydrogenase kinase (BCKDK) was enhanced, BCKDHA and BCKDHB were decreased in diabetic retinas. This could be reversed by EMPA treatment, thus promoting BCAAs catabolism to decrease BCAAs and BCKAs accumulation in diabetic retinas. The high levels of BCAAs in the plasma and enhanced L-type amino acid transporter 1 (LAT1) were responsible for the high levels of BCAAs in diabetic retinas, which could be inhibited by EMPA. Overall, EMPA could ameliorate DR manifestations. The normalization of BCAAs catabolism and intake may play a role in this process. This study supports EMPA as a protective drug against DR.
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Affiliation(s)
- Qiaoyun Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Rulin Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Fang Wei
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Junwei Fang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jingfa Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jun Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Qian Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Haiyan Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
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Aquino-Brítez D, Gómez JA, Noguera JLV, García-Torres M, Román JCM, Gardel-Sotomayor PE, Benitez VEC, Matto IC, Pinto-Roa DP, Facon J, Grillo SA. Automatic Diagnosis of Diabetic Retinopathy from Fundus Images Using Neuro-Evolutionary Algorithms. Stud Health Technol Inform 2022; 290:689-693. [PMID: 35673105 DOI: 10.3233/shti220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Due to the presence of high glucose levels, diabetes mellitus (DM) is a widespread disease that can damage blood vessels in the retina and lead to loss of the visual system. To combat this disease, called Diabetic Retinopathy (DR), retinography, using images of the fundus of the retina, is the most used method for the diagnosis of Diabetic Retinopathy. The Deep Learning (DL) area achieved high performance for the classification of retinal images and even achieved almost the same human performance in diagnostic tasks. However, the performance of DL architectures is highly dependent on the optimal configuration of the hyperparameters. In this article, we propose the use of Neuroevolutionary Algorithms to optimize the hyperparameters corresponding to the DL model for the diagnosis of DR. The results obtained prove that the proposed method outperforms the results obtained by the classical approach.
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Affiliation(s)
| | - Jordan Ayala Gómez
- Department of Computer Engineer, Universidad Americana, Asunción, Paraguay
| | | | - Miguel García-Torres
- Department of Computer Engineer, Universidad Americana, Asunción, Paraguay
- Division of Computer Science, Universidad Pablo de Olavide, Seville, Spain
| | - Julio César Mello Román
- Department of Computer Engineer, Universidad Americana, Asunción, Paraguay
- Facultad de Ciencias Exactas y Tecnológicas, Universidad Nacional de Concepción, Concepción, Paraguay
| | - Pedro E Gardel-Sotomayor
- Department of Computer Engineer, Universidad Americana, Asunción, Paraguay
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Campus Alto Paraná, Paraguay
| | - Veronica Elisa Castillo Benitez
- Department of Ophthalmology, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Ingrid Castro Matto
- Department of Ophthalmology, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Diego P Pinto-Roa
- Department of Computer Engineer, Universidad Americana, Asunción, Paraguay
- Facultad Politécnica, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jaques Facon
- Department of Computer and Electronics, Universidade Federal do Espírito Santo, São Mateus, Brazil
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Mohan NJ, Murugan R, Goel T, Roy P. Fast and Robust Exudate Detection in Retinal Fundus Images Using Extreme Learning Machine Autoencoders and Modified KAZE Features. J Digit Imaging 2022; 35:496-513. [PMID: 35141807 PMCID: PMC9156631 DOI: 10.1007/s10278-022-00587-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy(DR) is a health condition that affects the retinal blood vessels(BV) and arises in over half of people living with diabetes. Exudates(EX) are significant indications of DR. Early detection and treatment can prevent vision loss in many cases. EX detection is a challenging problem for ophthalmologists due to its different sizes and elevations as retinal fundus images frequently have irregular illumination and are poorly contrasting. Manual detection of EX is a time-consuming process to diagnose a mass number of diabetic patients. In the domain of signal processing, both SIFT (scale-invariant feature transform) and SURF (speed-up robust feature) methods are predominant in scale-invariant location retrieval and have shown a range of advantages. But, when extended to medical images with corresponding weak contrast between reference features and neighboring areas, these methods cannot differentiate significant features. Considering these, in this paper, a novel method is proposed based on modified KAZE features, which is an emerging technique to extract feature points and extreme learning machine autoencoders(ELMAE) for robust and fast localization of the EX in fundus images. The main stages of the proposed method are pre-processing, OD localization, dimensionality reduction using ELMAE, and EX localization. The proposed method is evaluated based on the freely accessible retinal database DIARETDB0, DIARETDB1, e-Ophtha, MESSIDOR, and local retinal database collected from Silchar Medical College and Hospital(SMCH). The sensitivity, specificity, and accuracy obtained by the proposed method are 96.5%, 96.4%, and 97%, respectively, with the processing time of 3.19 seconds per image. The results of this study are satisfactory with state-of-the-art methods. The results indicate that the approach taken can detect EX with less processing time and accurately from the fundus images.
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Affiliation(s)
- N Jagan Mohan
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute of Technology Silchar, Silchar, 788010 Assam India
| | - R Murugan
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute of Technology Silchar, Silchar, 788010 Assam India
| | - Tripti Goel
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute of Technology Silchar, Silchar, 788010 Assam India
| | - Parthapratim Roy
- Department of Ophthalmology, Silchar Medical College and Hospital, Silchar, 788014 Assam India
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Luo Q, Leley SP, Bello E, Dhami H, Mathew D, Bhatwadekar AD. Dapagliflozin protects neural and vascular dysfunction of the retina in diabetes. BMJ Open Diabetes Res Care 2022; 10:e002801. [PMID: 35577387 PMCID: PMC9114950 DOI: 10.1136/bmjdrc-2022-002801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Dapagliflozin, a sodium-glucose transporter inhibitor, effectively reduces blood glucose and is indicated for individuals with kidney diseases and cardiovascular disorders. In this study, we further expand the therapeutic benefit of dapagliflozin in the neural and vascular retina, with the potential to effectively manage diabetic retinopathy (DR), the most common complication of diabetes. RESEARCH DESIGN AND METHODS Db/db mice, an animal model of type 2 diabetes, were treated with dapagliflozin orally, and the electroretinogram (ERG) response and acellular capillary numbers were assessed. Messenger RNA levels of inflammatory cytokines were studied using real-time quantitative (q)PCR. We assessed endothelial cell migration in a scratch wound assay and retinal glucose uptake using human retinal endothelial cells. RESULTS The dapagliflozin treatment improved the ERG b-wave amplitude and decreased acellular capillary numbers. The scratch wound assay demonstrated a reduction in wound closure after dapagliflozin treatment. Retinal glucose uptake reduced after dapagliflozin treatment compared with the respective controls. CONCLUSIONS Our studies suggest that dapagliflozin treatment effectively corrects neural and vascular dysfunction of the retina in diabetes. This effect is mediated by a decrease in inflammation and improved glycemic control. In addition, dapagliflozin exhibits decreased wound healing and glucose uptake, which could benefit the retina. Thus, dapagliflozin could be helpful in the management of DR, with multimodal therapeutic effects.
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Affiliation(s)
- Qianyi Luo
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana, USA
| | - Sameer P Leley
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Erika Bello
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana, USA
| | - Hurshdeep Dhami
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana, USA
| | - Deepa Mathew
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana, USA
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Wijaya AR, Surudarma IW, Wihandani DM, Putra IWAS. Polymorphisms of vascular endothelial growth factor-2578C/A rs699947 are risk factors for diabetic retinopathy in type-2 diabetes mellitus patients in Bali, Indonesia. Biomedicine (Taipei) 2021; 11:11-7. [PMID: 35223399 DOI: 10.37796/2211-8039.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Diabetic retinopathy (DR) is one of the complications in diabetes mellitus (DM) which caused by microvascular-damage in the retina due to long termmetabolic changes in diabetes. To date, there has been much research targeted on the determinant of genetic identification in DR patients. In DR, Vascular Endothelial Growth Factor (VEGF) gene is accountable for breaking down the blood-retinal barrier and implicated in the role of neovascularization. It is thought that the polymorphism of VEGF -2578C/A (rs699947) contributed to the development of diabetic retinopathy in type 2 DM. Aim To determine whether the polymorphisms of VEGF-2578C/A are the risk factors for DR in type 2 DM patients in Bali, Indonesia. Methods This study is a case-control model comparing 33 cases DR patients in type-2 diabetes mellitus and 35 cases of non-DR as controls in Balinese ethnic. Polymorphisms of VEGF-2578C/A were examined by PCR analysis and DNA sequencing on rs699947 to identify any variation in A/C/T allele distribution. Chi-square test was used to analyze the data and determine the relation of polymorphism and DR. Results This research showed the genetic variation existence in VEGF-2578C/A polymorphism significantly (p = 0,000) with C allele was higher in the DR group, in contrast, A and T allele were greater in the non-DR group compared to DR group. The result showed that C allele in VEGF-2578 contributed as a risk factor (OR = 13.05; 95% CI = 2.69–63.18; p = 0.001) for DR in type-2 DM (T2DM) patients in Bali, Indonesia. Conclusion Polymorphism of VEGF-2578C/A (rs699947) allele distribution can be concluded as a risk factor of DR within T2DM patients in Bali, Indonesia. This study may also be used to expand the knowledge in managing DR patients at an earlier stage to avoid further complications.
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Ling M, Zhou J, Pang XQ, Liang J, Qin YF, Huang S, Liang GY, Li YF, Zeng ZS. White Matter Microstructural Abnormalities of the Visual Pathway in Type 2 Diabetes Mellitus: A Generalized Q-sampling Imaging Study. Acad Radiol 2022; 29 Suppl 3:S166-S174. [PMID: 34930656 DOI: 10.1016/j.acra.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Neurodegeneration is an early event in the pathogenesis of diabetic retinopathy (DR). We assessed the white matter microstructural integrity of the visual pathway in diabetes patients vs. healthy subjects, and investigated the advantages of generalized Q-sampling imaging (GQI) in the assessment of the visual pathway. MATERIALS AND METHODS T1-weighted, T2-weighted fluid-attenuated inversion recovery, and simultaneous multislice- diffusion sequences were acquired from 21 DR patients, 29 diabetes patients without DR (NDR group), and 28 age- and gender-matched healthy controls. Diffusion source images were reconstructed to GQI. Region of interest (ROI)-based analysis was utilized to evaluate microstructural alterations in the visual pathway. Multivariate linear regression analysis (forward stepwise method) was performed to investigate associations between clinical data and mean GQI parameters. RESULTS ROI-based analyses indicated that the GQI parameters generalized fractional anisotropy, quantitative anisotropy (QA), and normalized QA (NQA) were significantly lower in the NDR group than in the healthy controls, and even lower in the DR group than in the NDR group. Disease duration was significantly and negatively correlated with mean generalized fractional anisotropy and mean NQA. CONCLUSION GQI could sensitively and non-invasively evaluate the visual pathway in diabetes patients. The nerve fibers of the visual pathway were damaged before the onset of retinopathy, and this damage was aggravated after retinopathy onset, as a consequence of long exposure to hyperglycemia.
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Tang K, Qin W, Wei R, Jiang Y, Fan L, Wang Z, Tan N. Ginsenoside Rd ameliorates high glucose-induced retinal endothelial injury through AMPK-STRT1 interdependence. Pharmacol Res 2022; 179:106123. [PMID: 35150861 DOI: 10.1016/j.phrs.2022.106123] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
Diabetic retinopathy (DR) manifests as a complicated and blinding complication in diabetes mellitus. First-line treatments for advanced DR have shown ocular side-effects in some patients. Ginsenoside Rd (Rd), an active ingredient isolated from Panax notoginseng and P. ginseng, has demonstrated diverse and powerful activities on neuroprotection, anticancer and anti-inflammation, but its vascular protective effects have rarely been reported. Herein, this study aims to investigate the protective effects of Rd on retinal endothelial injury with emphasis on AMPK/SIRT1 interaction. The results indicated that Rd promoted AMPK activation and SIRT1 expression. Besides, Rd strengthened the interaction between AMPK and SIRT1 by increasing NAD+/NADH levels and LKB1 deacetylation in endothelial cells. Moreover, Rd reversed high glucose-induced activation of NOX2, oxidative stress, mitochondrial dysfunction, and endothelial apoptosis in an AMPK/SIRT1-interdependent manner. Hyperglycemia induced loss of endothelial cells and other retinal damage, which was restored by Rd via activating AMPK and SIRT1 in vivo. The enhancement of AMPK/SIRT1 interaction by Rd beneficially modulated oxidative stress and apoptosis, and ameliorated diabetes-driven vascular damage. These data also supported the evidence for Rd clinical development of pharmacological interventions and provided a novel potential vascular protective drug for early DR.
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Affiliation(s)
- Kai Tang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Weiwei Qin
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Rongyun Wei
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Yeying Jiang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Lingling Fan
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Zhen Wang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China.
| | - Ninghua Tan
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China.
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Pei X, Yao X, Yang Y, Zhang H, Xia M, Huang R, Wang Y, Li Z. Efficacy of artificial intelligence-based screening for diabetic retinopathy in type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2022; 184:109190. [PMID: 35031348 DOI: 10.1016/j.diabres.2022.109190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/14/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022]
Abstract
AIM To explore the efficacy of artificial intelligence (AI)-based screening for diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients. METHODS Data were obtained from 549 T2DM patients who visited the Fundus Disease Center at Henan Provincial People's Hospital from 2018/10-2020/09. DR identification and grading were conducted by two retina specialists, EyeWisdom®DSS and EyeWisdom®MCS, with ophthalmologist grading as reference standard, efficacy of EyeWisdom was evaluated according to sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Ophthalmologists detected 324 DR cases. Among them, there were 43 of mild non-proliferative DR (NPDR), 79 of moderate NPDR, 61 of severe NPDR, and 141 of proliferative DR (PDR). EyeWisdom®DSS detected 337 DR and EyeWisdom®MCS detected 264 DR. Sensitivity and specificity of EyeWisdom®DSS were 91.0%(95 %CI: 87.3%-93.8%) and 81.3% (95 %CI: 75.5%-86.1%), while EyeWisdom®MCS correctly identified 76.2%(95 %CI: 71.1%-80.7%) of patients with DR and 92.4%(95 %CI: 87.9%-95.4%) of patients without DR. EyeWisdom®DSS showed 76.5%(95 %CI: 69.6%-82.3%) sensitivity and 78.4%(95 %CI: 73.7%-82.5%) specificity for detecting NPDR and 64.5%(95 %CI: 56.0%-72.3%) sensitivity and 93.1%(95 %CI: 90.1%-95.3%) specificity for diagnosing PDR. CONCLUSION EyeWisdom®DSS is effective in screening for DR, and the accuracy of EyeWisdom®MCS was higher for identifying patients without DR. It is valuable to carry out AI-based DR screening in poorer regions.
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Affiliation(s)
- Xiaoting Pei
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Xi Yao
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Yingrui Yang
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Hongmei Zhang
- Nursing Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Mengting Xia
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Ranran Huang
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Yuming Wang
- Departments of Science and Technology Administration, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhijie Li
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China.
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Chandrasekaran PR, Madanagopalan VG. Role of Curcumin in Retinal Diseases-A review. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35015114 DOI: 10.1007/s00417-021-05542-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To review the role of curcumin in retinal diseases, COVID era, modification of the molecule to improve bioavailability and its future scope. METHODS PubMed and MEDLINE searches were pertaining to curcumin, properties of curcumin, curcumin in retinal diseases, curcumin in diabetic retinopathy, curcumin in age-related macular degeneration, curcumin in retinal and choroidal diseases, curcumin in retinitis pigmentosa, curcumin in retinal ischemia reperfusion injury, curcumin in proliferative vitreoretinopathy and curcumin in current COVID era. RESULTS In experimental models, curcumin showed its pleiotropic effects in retinal diseases like diabetic retinopathy by increasing anti-oxidant enzymes, upregulating HO-1, nrf2 and reducing or inhibiting inflammatory mediators, growth factors and by inhibiting proliferation and migration of retinal endothelial cells in a dose-dependent manner in HRPC, HREC and ARPE-19 cells. In age-related macular degeneration, curcumin acts by reducing ROS and inhibiting apoptosis inducing proteins and cellular inflammatory genes and upregulating HO-1, thioredoxin and NQO1. In retinitis pigmentosa, curcumin has been shown to delay structural defects of P23H gene in P23H-rhodopsin transgenic rats. In proliferative vitreoretinopathy, curcumin inhibited the action of EGF in a dose- and time-dependent manner. In retinal ischemia reperfusion injury, curcumin downregulates IL-17, IL-23, NFKB, STAT-3, MCP-1 and JNK. In retinoblastoma, curcumin inhibits proliferation, migration and apoptosis of RBY79 and SO-RB50. Curcumin has already proven its efficacy in inhibiting viral replication, coagulation and cytokine storm in COVID era. CONCLUSION Curcumin is an easily available spice used traditionally in Indian cooking. The benefits of curcumin are manifold, and large randomized controlled trials are required to study its effects not only in treating retinal diseases in humans but in their prevention too.
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Wang N, Zhang C, Xu Y, Tan HY, Chen H, Feng Y. Berberine improves insulin-induced diabetic retinopathy through exclusively suppressing Akt/mTOR-mediated HIF-1α/VEGF activation in retina endothelial cells. Int J Biol Sci 2021; 17:4316-4326. [PMID: 34803500 PMCID: PMC8579442 DOI: 10.7150/ijbs.62868] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/12/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Insulin therapy is the major treatment of glycaemic control in type I diabetes mellitus (DM) and advanced type II DM patients who fail to respond to oral hypoglycemic agents. Nonetheless, insulin therapy is deemed unsuccessful in controlling the incidence of diabetic retinopathy (DR) and is likely a risk factor. Berberine, an isoquinoline alkaloid, has caught great attention towards its anti-diabetic mechanisms. This study aims to investigate the effect of berberine in decelerating DR progression in insulin-treated DM. Methods: To better understand the therapeutic potential of berberine in the presence of insulin, we elaborated the action of mechanism whether berberine inhibited retinal expression of HIF-1α and VEGF through regulating AKT/mTOR pathway. Suppression of insulin-induced neovasculature of retina endothelial cells by berberine was also studied. Lastly, the in vivo efficacy and safety of berberine as adjuvant therapy for the treatment of DR were systemically investigated in experimental type I and type II DM mice with insulin treatment. Results: Among various types of retinal cells, the activity of HIF-1α and VEGF in retinal endothelial cells could be particularly and exclusively stimulated by insulin intervention, which could be inhibited by berberine treatment in a dose- and time-dependent manner. Berberine suppressed Akt/mTOR activity in these cells, and restoration of Akt/mTOR signalling attenuated berberine's inhibition on HIF-1α and VEGF expression. Berberine suppressed the progression of DR in experimental type I and type II diabetic mice receiving insulin therapy. Conclusion: Berberine improves insulin-induced diabetic retinopathy in type I and II diabetes through inhibiting insulin-induced activation of retinal endotheliocytes via Akt/mTOR/ HIF-1α/VEGF pathway.
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Affiliation(s)
- Ning Wang
- School of Chinese Medicine, The University of Hong Kong
| | - Cheng Zhang
- School of Chinese Medicine, The University of Hong Kong
| | - Yu Xu
- School of Chinese Medicine, The University of Hong Kong
| | - Hor-Yue Tan
- Centre for Chinese Herbal Medicine Drug Development, School of Chinese Medicine, Hong Kong Baptist University
| | - Haiyong Chen
- School of Chinese Medicine, The University of Hong Kong
| | - Yibin Feng
- School of Chinese Medicine, The University of Hong Kong
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