• 文章类型: Journal Article
    原发性干燥病(pSD)是一种自身免疫性疾病,其特征是外分泌腺的淋巴样浸润导致粘膜表面干燥,并产生自身抗体。pSD的病理生理学仍然难以捉摸,目前还没有有效的治疗方法。为了更好地理解pSD异质性的生物学基础,我们的目的是确定共识基因模块(CMs),总结了pSD患者全血样本的高维转录组数据。我们对四个数据集进行了无监督的基因分类,并确定了13个CMs。我们通过使用基因集富集分析和分选的血细胞亚群的转录组学图谱,将这些CMs中的每一个注释和解释为对应于细胞类型丰度或生物学功能。通过流式细胞术与独立测量的细胞类型丰度的相关性证实了这些注释。我们使用这些CM来调和先前提出的pSD患者分层。重要的是,在一项临床试验中,我们发现,在治疗开始前,代表淋巴细胞和红细胞的模块的表达与羟氯喹和来氟米特联合治疗的应答相关.这些共识模块将有助于鉴定和翻译用于治疗pSD的基于血液的预测性生物标志物。
    Primary Sjögren disease (pSD) is an autoimmune disease characterized by lymphoid infiltration of exocrine glands leading to dryness of the mucosal surfaces and by the production of autoantibodies. The pathophysiology of pSD remains elusive and no treatment with demonstrated efficacy is available yet. To better understand the biology underlying pSD heterogeneity, we aimed at identifying Consensus gene Modules (CMs) that summarize the high-dimensional transcriptomic data of whole blood samples in pSD patients. We performed unsupervised gene classification on four data sets and identified thirteen CMs. We annotated and interpreted each of these CMs as corresponding to cell type abundances or biological functions by using gene set enrichment analyses and transcriptomic profiles of sorted blood cell subsets. Correlation with independently measured cell type abundances by flow cytometry confirmed these annotations. We used these CMs to reconcile previously proposed patient stratifications of pSD. Importantly, we showed that the expression of modules representing lymphocytes and erythrocytes before treatment initiation is associated with response to hydroxychloroquine and leflunomide combination therapy in a clinical trial. These consensus modules will help the identification and translation of blood-based predictive biomarkers for the treatment of pSD.
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  • 文章类型: Journal Article
    根据韩国干眼症指南制定委员会的文献综述,制定了新的韩国干眼症诊断和管理指南。韩国角膜疾病研究组以前的干眼症指南,对韩国干眼症协会(KDES)成员的调查,和KDES共识会议。干眼症的新定义也由KDES正式成员提出。KDES常规成员的新定义如下:“干眼症是一种以泪膜异常和眼部症状为特征的眼表疾病。”眼部症状和不稳定泪膜(泪液破裂时间<7s)的组合被认为是诊断干眼的重要组成部分。Schirmer试验和眼表染色被认为是辅助诊断标准。治疗指南包括根据房水缺乏占主导地位的简化逐步方法,蒸发占主导地位,和改变泪液分布亚型。新的韩国指南可以作为一个简单的,有效,在临床实践中诊断和管理干眼症的工具。
    New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: \"Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms.\" The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.
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  • 文章类型: English Abstract
    The number of contact lens wearers in China is increasing rapidly. Long-term contact lens wearing may induce or exacerbate tear film instability, and consequently affect the visual quality, ocular surface safety, and compliance of the wearers. To promote the safety and effectiveness of contact lens fitting, and to improve the visual quality and satisfaction of contact lens wearers, the Society of Contact Lens Safety Monitoring & Vision Health of Chinese Health Association has targeted to develop an expert consensus on the diagnosis and treatment of contact lens-associated dry eye. By referring to relevant literature and summarizing clinical experience, the clinical experts in corneal disease, pediatric ophthalmology and optometry have made repeated discussions to form this consensus, including the definition, pathological mechanisms, influencing factors, evaluation, prevention and treatment of contact lens-associated dry eye, for the reference of optometrists and ophthalmologists.
    我国接触镜配戴者数量日益增加。长期配戴各种类型的接触镜可能引起或加重泪膜稳态失衡,从而影响接触镜配戴者的视觉质量、眼表安全及依从性。中国健康管理协会接触镜安全监控与视觉健康专业委员会在参考国内外相关文献和总结临床实践经验的基础上,组织国内角膜病、小儿眼科及视光专业的专家,经过反复讨论、函审及修改,针对接触镜相关性干眼的定义、病理机制、影响因素、评估、预防与治疗等,形成共识性意见,以供眼视光医师在工作中参考使用,共同提高临床接触镜验配工作的安全性和有效性,进一步提升接触镜配戴者的视觉质量和满意度。.
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  • 文章类型: English Abstract
    Sjögren\'s syndrome (SjS) is one of the most prevalent rheumatic diseases. Off-label drug use is very common in the clinical practice of the treatment of SjS. In order to establish evidence-based justifications and systematically evaluate the off-label drug use in SjS treatment, the Committee of Chinese Primary Health Care Foundation for Rheumatologists and Immunologists referred to published guidelines, consensus statements, and case series, and reevaluated the outcomes of the randomized controlled trials about the marketed immunosuppressive drugs treating SjS. The single-item breakdown of the Sjögren\'s tool for assessing response (STAR) which was proposed in 2022 was employed as the outcome. The committee established the corresponding clinical questions based on the population, intervention, comparison, and outcome (PICO) principle, and then carried out evidence retrieval, and synthesized meta-analysis using the grading of recommendations, assessment, development, and evaluation (GRADE) methodology. Finally, 21 recommendations addressing twelve clinical questions were formed which included two strong recommendations, fourteen weak recommendations, and five consensus-based recommendations. The overarching objective of the guideline is to provide clinicians with a rational basis for medication selection and to offer guidance to pharmacy departments for management purposes.
    干燥综合征(SjS)是最常见的风湿免疫病之一,临床实践中普遍存在超说明书用药现象。为此,中国初级卫生保健基金会风湿免疫学专业委员会组织专家通过循证查证及系统评价超药品说明书用药治疗SjS的依据,除参考已公开发布的指南、共识、诊疗规范等外,还对已上市的免疫抑制药物治疗SjS的随机对照试验进行再评估,采用2022年提出的评价SjS治疗应答新工具(STAR)的单项分解条目作为结局,设计相应的临床问题,依据人群、干预、对照和结局(PICO)原则完成证据检索、荟萃分析及推荐意见分级的评估、制订及评价(GRADE)分级与推荐,最终形成针对12个临床问题的21条推荐意见,包括2条强推荐、14条弱推荐和5条基于共识的推荐,旨在为临床医师提供合理用药依据并为药学部门管理提供参考。.
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  • 文章类型: English Abstract
    Meibomian gland dysfunction (MGD) is a common ocular surface disease. In recent years, the meibomian gland-related examination and treatment technologies have evolved rapidly. In order to further optimize the diagnostic process of MGD in China and improve the treatment efficiency of MGD, the Chinese Branch of the Asian Dry Eye Society has organized relevant experts to discuss the clinical characteristics of MGD in China and the progress of research at home and abroad. Based on the expert consensus formed in 2017, the updated consensus opinions have been developed for clinical physicians to refer to in the diagnosis and management of MGD.
    睑板腺功能障碍(MGD)是临床常见的眼表疾病。近年来睑板腺相关检查和治疗技术发展迅速,为了进一步优化我国MGD的诊断流程,提高MGD的治疗效果,亚洲干眼协会中国分会等相关学术组织的专家,根据我国MGD的临床特点,结合近年国内外研究进展和临床实践经验,基于《我国睑板腺功能障碍诊断与治疗专家共识(2017年)》,针对MGD的检查方法、诊断标准和治疗方法进行讨论,形成新的共识性意见,以供临床医师在工作中参考。.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    目的:本研究旨在开发基于共识的核心结果集(COS),用于评估口干干预措施的临床试验。
    方法:通过2篇系统文献综述和对口干患者的访谈,我们确定了口干评估的相关结局域.Delphi调查已提交给参加在孟菲斯举行的美国口腔医学学会年会的医疗保健提供者,田纳西州,美国,2022年5月(n=104)和科克大学牙科学校和医院的10名口干患者,爱尔兰共和国。随后在第二个共识过程中讨论了未达成共识的结果领域,该过程由来自世界口腔医学VIII口干工作组的11名口腔医学专家组成的虚拟特殊利益集团领导。
    结果:在2步共识过程之后,对12个口干结果域达成共识(即,唾液腺流,唾液分泌不足的迹象,粘膜湿度/湿度,口干症的严重程度,口干症的持续时间,口干症的总体影响,对身体功能的影响,唾液分泌不足对一般健康的影响,对社会活动的影响,生活质量,口干的经济影响,患者满意度)纳入最终COS。
    结论:我们提出了一种基于共识的COS来评估临床试验中的口干干预措施。该COS包括所有评估口干治疗的临床试验应评估的最小但强制性的一组领域。
    This study aimed to develop a consensus-based core outcome set (COS) to be used in clinical trials assessing dry mouth interventions.
    Through 2 systematic literature reviews and interviews with dry mouth patients, we identified relevant outcome domains for dry mouth assessment. A Delphi survey was presented to health care providers attending the American Academy of Oral Medicine annual meeting in Memphis, Tennessee, USA, on May 2022 (n = 104) and 10 dry mouth patients at Cork University Dental School and Hospital, Republic of Ireland. The outcome domains for which no consensus was reached were subsequently discussed in a second consensus process led by a virtual Special Interest Group of 11 oral medicine experts from the World Workshop on Oral Medicine VIII dry mouth working group.
    After the 2-step consensus process, a consensus was reached for 12 dry mouth outcome domains (i.e., salivary gland flow, signs of hyposalivation, mucosal moisture/wetness, the severity of xerostomia, duration of xerostomia, the overall impact of xerostomia, impact on physical functioning, impact of hyposalivation on general health, impact on social activities, quality of life, the economic impact of dry mouth, patient satisfaction) to be included in the final COS.
    We propose a consensus-based COS to assess dry mouth interventions in clinical trials. This COS includes the minimum but mandatory set of domains that all clinical trials evaluating dry mouth treatments should assess.
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  • 文章类型: Practice Guideline
    干眼症(DED)眼的角膜穿孔难以管理,由于几个因素的相互作用,如不稳定的泪膜,表面炎症,以及影响伤口愈合过程的潜在全身性疾病,以及最终的结果。需要仔细的术前检查以确定潜在的病理,以及眼表和附件的状态,排除微生物性角膜炎,除了评估穿孔本身外,还下令进行适当的系统性检查。有几种手术选择,其中包括组织粘合剂,多层羊膜移植(AMT),榫补片移植(TPG),角膜补片移植(CPG),穿透性角膜移植术(PK)。程序的选择取决于大小,location,和穿孔的配置。在穿孔较小的眼睛中,组织粘合剂是有效的治疗方式,而AMT,TPG,和CPG是中等尺寸穿孔的可行选择。AMT和TPG在绷带接触镜片的放置可能是挑战的情况下也是优选的。大穿孔需要PK,额外的程序,如tarsorrhy,以保护眼睛免受相关的上皮愈合问题。在视觉潜能差的眼睛中考虑结膜瓣。考虑到在这些情况下延迟上皮化和再穿孔的机会,急性疾病的管理与改善泪液体积的措施结合进行。局部和全身免疫抑制的给药,当指示时,有助于改善结果。这篇综述旨在帮助临床医生在DED环境中建立同步的多方面治疗方法,以成功管理角膜穿孔。
    Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.
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  • 文章类型: Practice Guideline
    白内障手术是世界上最常见的眼科手术之一。发现干眼症(DED)在大多数白内障患者中共存,因为这两种疾病的年龄组重叠。术前评估DED对改善预后很重要。影响泪膜的预先存在的DED可能会影响生物特征。此外,对于DED患者,术中需要特别考虑,以减少并发症并改善术后结局.已知干眼症(DED)在顺利的白内障手术后发生,或者预先存在的DED也可能在白内障手术后恶化。在这些情况下,尽管视觉效果很好,由于令人痛苦的DED症状,患者不满意是常见的。这篇综述旨在总结术前,术中,以及在共存DED的情况下进行白内障手术时的术后注意事项。
    Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.
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  • 文章类型: Practice Guideline
    自体血清滴眼液提供润滑并促进上皮愈合。它们已成功用于治疗眼表疾病,如干眼病,几十年来持续的上皮缺损和神经营养性角膜病变。制备自体血清滴眼液的方法有很大差异,最终浓度和使用持续时间存在于已发表的文献中。在这次审查中,简化的准备建议,运输,描述了自体血清的储存和使用。总结了在房水缺乏的干眼症中使用这种方式的证据,以及基于专业知识的基本原理。
    Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.
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