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The relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus： the Desheng Diabetic Eye Study

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International Journal of Ophthalmology(English edition) 2018年第3期11卷 493-500页

作者： Yun-Yun Li xiu-Fen Yang Hong Gu Torkel Snellingen xi-pu liu Ning-pu liu Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing 100730 China Department of Ophthalmology Friendship Hospital Capital Medical University Beijing 100050 China Department of Ophthalmology Lihuili Hospital Ningbo 315040 Zhejiang Province China Sekwa Institute of Medicine Beijing 100035 China

AIM： To investigate the relationship between insulin resistance （IR）/β-cell dysfunction and diabetic retinopathy （DR） in Chinese patients with type 2 diabetes mellitus （T2DM）, and to explore further whether there were differences in the relationship among diabetic patients with higher and lower body mass index （BMI）. METHODS： Cross-sectional study. A total of 1466 subjects with T2DM were recruited in a local Desheng Community of urban Beijing from November 2009 to June 2012 for the cohort of Beijing Desheng Diabetic Eye Study. Standardized evaluation was carried out for each participant, including questionnaire, ocular and anthropometric examinations, and laboratory tests. Seven fields 30° color fundus photographs were used for DR grading according to the Early Treatment Diabetic Retinopathy Study protocols. Homeostatis Model Assessment （HOMA） method was employed for IR and β-cell function assessment. RESULTS： After excluding those participants who were treated with insulin （n=352） or had missing data of fasting insulin （n=96）, and further excluding those with poor quality of retinal photographs （n=10）, a total of 1008 subjects were included for the final analysis, 406 （40.3%） were men and 602 （59.7%） were women, age ranging fiom 34 to 86 （64.87±8.28）y. Any DR （levels 14 and above） was present in 278 （27.6%） subjects. After adjusting for possible covariates, the presence of any DR did not correlate with HOMA IR [odds ratio （OR） 1.51, 95% confidence interval （Cl） 0.87-2.61, P=0.14] or HOMA β-cell （OR 0.71, 95%CI 0.40-1.26, P=0.25）. After stratification by BMI, the presence of any DR was associated positively with HOMA IR （OR 2.46, 95%CI： 1.18-5.12, P=0.016）, and negatively with HOMA β-cell （OR 0.40, 95%CI： 0.19-0.87, P=0.021） in the group of patients with higher BMI （225 kg/m2）. In the group of patients with lower BMI （〈25 kg/m2）, the presence of any DR was not associated with HOMA IR （OR 1.00, 95%C1： 0.43-2.33, P=I.00） or HOMA β-cell （OR 1.41, 95%CI： 0.60-3.32, P=

关键词： type 2 diabetes mellitus diabetic retinopathy insulin resistance β-cell function body mass index

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The Beijing Desheng Diabetic Eye Study:rationale,design,methodology and baseline data

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International Journal of Ophthalmology(English edition) 2018年第1期11卷 108-116页

作者： Yun-Yun Li xiu-Fen Yang Hong Gu xi-pu liu Torkel Snellingen Ning-pu liu Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing Ophthalmology and VisualSciences Key LaboratoryBeijing 100730China Department of Ophthalmology Friendship HospitalCapitalMedical UniversityBeijing 100050China Department of Ophthalmology Ningbo Medical TreatmentCenter Lihuili HospitalNingbo 315040Zhejiang ProvinceChina Sekwa Institute of Medicine Beijing 100035China

AIM： To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study（BDDES）, and to determine the prevalence of diabetic retinopathy（DR） and possible risk factors in patients with type 2 diabetes mellitus（T2DM） in an urban community of Beijing, ***： Community-based prospective cohort study of persons diagnosed with T2DM aged 30 y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic ***： A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy（NPDR）, moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male（P=0.031）, lower income level（P=0.011）, lower education background（P=0.022）, longer duration of diabetes（P=0.001）, younger age at diabetic onset（P=0.001）, higher systolic blood pressure（P=0.007）, higher glycosylated hemoglobin A1 c levels（P=0.001）, high albuminuria（P=0.03）, and use of insulin（P〈0.001）. For vision-threatening DR, four factors were significant： younger age at diabetic onset（P〈0.001）,higher systolic blood pressure（P=0.042）, high albuminuria（P〈0.001）, and use of insulin（P〈0.001）. CONCLUSION： The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

关键词： type 2 diabetes mellitus diabetic retinopathy risk factors cohort study

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Visual impairment with possible macular changes after a high dose of sildenafil in a healthy young woman

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International Journal of Ophthalmology(English edition) 2018年第2期11卷 340-342页

作者： Yun-Yun Li Ya-Jie Yu xi-pu liu Ning-pu liu Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing 100730China Sekwa Institute of Medicine Beijing 100035China

Dear Editor,Sildenafil citrate（Viagra;Pfizer Pharmaceuticals,New York,NY,USA）,a selective inhibitor of phosphodiesterase type 5（PDE-5）,is widely used for erectile *** clinical recommended dosage is 25 to 100 mg pe... 详细信息

关键词： Visual impairment with possible macular changes after a high dose of sildenafil in a healthy young woman PDE Figure

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Association of candidate gene polymorphisms with diabetic retinopathy in Chinese patients with type 2 diabetes

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International Journal of Ophthalmology(English edition) 2020年第2期13卷 301-308页

作者： Wen-Ying Fan Hong Gu xiu-Fen Yang Chong-Yang She xi-pu liu Ning-pu liu Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing Ophthalmology and Visual Sciences Key LaboratoryBeijing 100730China Department of Ophthalmology Lihuili HospitalNingbo 315010Zhejiang ProvinceChina Department of Ophthalmology Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Ophthalmology Beijing Chao-Yang HospitalCapital Medical UniversityBeijing 100020China Sekwa Eye Hospital Sekwa Institute of MedicineBeijing 100035China

●AIM:To investigate the association between a set of six candidate genes and the risk of diabetic retinopathy(DR)in an urban community cohort of Chinese patients with type 2 diabetes mellitus(T2 DM).●METHODS:A population-based cross-sectional *** diabetic subjects were recruited from an urban community in Beijing and categorized into groups of proliferative diabetic retinopathy(PDR),non-proliferative diabetic retinopathy(NPDR),or diabetic without any retinopathy(DWR)based on the fundus photography and duration of *** candidate genes,including advanced glycation end product specific receptor(AGER),aldose reductase(AKR1 B1),inducible nitric oxide synthase(i NOS),pigment epithelium derived factor(PEDF),tumor necrosis factor-alpha(TNF-α),and paraoxonase 1(PON1),were chosen based on Meta-analysis of genetic association studies for DR and biochemical pathways implicated in DR *** allele and genotype distribution of 21 functional singlenucleotide polymorphisms(SNPs)in those 6 candidate genes were investigated using MassARRAY genotyping system.●RESULTS:Among 1461 diabetic patients recruited from community,569 were selected in following genotyping analysis,including 97 patients with PDR,217 with NPDR,and 255 with *** the promoter variant rs1051993 in AGER gene,the distribution of allele and genotype in PDR group differed from that in DWR group(allele:P=0.011;genotype:P=0.01).Compared with DWR,patients with PDR had lower frequencies of heterozygous genotype GT(9.8%for DWR,1%for PDR,OR:0.10,95%CI:0.01-0.72)and minor allele T(4.9%for DWR,0.5%for PDR,OR:0.10,95%CI:0.01-0.75).In multivariate model,the distribution of genotype for rs1051993 in PDR group was significantly different from that in DWR group(GT vs GG:OR:0.07,95%CI:0.01-0.61,P<0.001).No association with DR was observed in other genotyped SNPs.●CONCLUSION:The data suggest a significant association of the promoter variant rs1051993 in AGER gene with PDR in Chinese cohort with T2DM.

关键词： polymorphisms diabetic retinopathy AGER AKR1B1 iNOS PEDF TNF-α PON1

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C-reactive protein and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus

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International Journal of Ophthalmology(English edition) 2016年第1期9卷 111-118页

作者： xiu-Fen Yang Yu Deng Hong Gu Apiradee Lim Torkel Snellingen xi-pu liu Ning-Li Wang Amitha Domalpally Ronald Danis Ning-pu liu Department of Ophthalmology the Friendship HospitalCapital Medical University Beijing 100050 China Beijing Tongren Eye Center Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren HospitalCapital Medical University Beijing 100730 China Department of Mathematics and Computer Science Faculty of Science and Technology Prince of Songkla UniversityPattani Campus Muang Pattani 9400 Thailand Sekwa Research Institute Beijing 100088 China Fundus Photograph Reading Center Department of Ophthalmology and Visual Sciences University of Wisconsin Madison 53705 Wisconsin USA

AIM：To investigate the relationship between Creactive protein（CRP）and diabetic retinopathy（DR）in a cohort of Chinese patients with type 2 diabetes mellitus（T2DM）.·METHODS：Community-based observational cohort *** were 1131 participants recruited from November 2009 to September 2011 in Desheng community in urban *** diagnosed T2DM were recruited and underwent a standardized evaluation consisting of a questionnaire,ocular and anthropometric examinations and laboratory *** presence and severity of DR were assessed by seven fields 30°color fundus *** were then classified into groups with no DR,any DR,or vision-threatening *** was analyzed from serum of study subjects.·RESULTS：A total of 1007 patients with T2DM were included for analysis,including 408（40.5%）men and 599（59.5%）*** median CRP level was 1.5 mg/L for women and 1.1 mg/L for men（=0.004,OR 0.37,95%CI0.18-0.74）.After adjusting for possible covariates,higher levels of CRP were associated with lower prevalence of any DR（=0.02,OR 0.55,95%CI 0.35-0.89）,but not associated with vision-threatening DR（=0.62,OR 0.78,95%CI 0.28-2.14）.After stratification by sex,the inverse association between CRP and DR was found to be statistically significant in men（=0.006,OR 0.35,95%CI0.16-0.73）,but not in women（=0.58,OR 0.88,95%CI0.29-1.16）.·CONCLUSION：The data drawn from a Chinese population with T2DM suggest that increasing CRP levels may be inversely associated with development of DR.

关键词： type 2 diabetes mellitus C-reactive protein diabetic retinopathy inflammation

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Use of Cataract Surgery in Urban Beijing: a Post Screening Follow-up of the Elderly with Visual Impairment due to Age-related Cataract

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Chinese Medical Sciences Journal 2015年第1期30卷 1-6页

作者： Xue-tao Ren Torkel Snellingen Hong Gu Sawitri Assanangkornchai Yan-hong Zou Virasakdi Chongsuvivatwong Apiradee Lim Wei Jia xi-pu liu Ning-pu liu Sekwa Eye Hospital Epidemiology Unit Faculty of Science and Technology Prince of Songkla University Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Key Laboratory of Beijing Ophthalmology and Visual Sciences Department of Ophthalmology First Hospital of Tsinghua University Department of Mathematics and Computer Science Faculty of Science and Technology Prince of Songkla University

Objective To understand the perception for the use of cataract surgical services in a population acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. Results At the follow-up examination 116 of the 158 patients were available and 36 （31.0%） had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery （OR=2.64, 95% CI： 1.08-6.63, P=0.02）. There were no significant differences in vision function （P=0.11） or quality of life scores （P=0.16） between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need （50.0%）, feeling of being ＂too old＂（19.2%）, and worry about the quality of surgery （9.6%）. Cost was seeking surgery. cited by 1 （1.9%） subject as the main reason for not

关键词： cataract surgery utilization urban Beijing

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Measurement of macular pigment optical density among healthy Chinese people and patients with early-stage age-related macular degeneration

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International Journal of Ophthalmology(English edition) 2015年第6期8卷 1190-1195页

作者： Xue-Tao Ren Hong Gu Xu Han Jun-Yan Zhang Xue Li xiu-Fen Yang Jun Xu Torkel Snellingen xi-pu liu Ning-Li Wang Ning-pu liu Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical University Beijing Ophthalmology and Visual Sciences Key Laboratory Sekwa Eye Hospital Department of Ophthalmology the First Hospital of Tsinghua University

AIMTo measure the macular pigment optical density (MPOD) in healthy Chinese people and patients with early age-related macular degeneration (AMD).METHODSCross-sectional population based study. Demographic and lifestyle characteristics were ascertained by questionnaire. A food frequency questionnaire was completed for all participants. Participants underwent general physical and ophthalmic examinations and MPOD was measured by heterochromatic flicker photometry. Foveal architecture was measured by optical coherence *** of 225 participants (122 healthy and 103 early AMD) was 0.48±0.18. Patients with early AMD (0.52±0.19) tended to have higher MPOD levels than healthy people (0.47±0.17), but the difference was not statistically significant (P=0.06). Participants with carrot or corn oil intake every week tended to have higher levels of MPOD (P=0.002 and 0.008 respectively) while those with corn intake had relatively lower level of MPOD (P=0.01). MPOD increased with the center foveal thickness (P=0.01).CONCLUSIONOur findings show that there is no statistically significant association between MPOD and early AMD in the studied population. MPOD is related to center foveal thickness and diets would influence MPOD levels.

关键词： age-related macular degeneration diets foveal architecture macular pigment optical density

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Predictors for attending annual eye screening for diabetic retinopathy amongst patients with diabetes in an urban community of Beijing

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International Journal of Ophthalmology(English edition) 2017年第7期10卷 1144-1149页

作者： Yan-Hong Zou Qian Li Shan-Shan Cui Wei Jia Ning Zhang Kai Ma Torkel Snellingen xi-pu liu Beijing Huaxin Hospital the First Hospital of Tsinghua University Tsinghua University Medical Center Sekwa Eye Hospital Sekwa Institute of Medicine Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical University

AIM： To gain a better understanding of possible factors that may influence the decision of diabetes persons to participate in annual eye screening in an urban community setting of ***： A structured interview including questions on attendance of eye screening, knowledge and awareness of diabetic retinopathy was conducted. The presence and degree of retinopathy were assessed using two field nonmydriatic retinal photography. RESULTS： Totally 720 diabetes persons were recruited and 519 were enrolled in this cross-sectional study. In this urban setting of Beijing, among diabetes patients of average of 10 y duration, 77% confirmed having undergone at least one eye examination and 61% reported having at least one eye examination with dilated pupil. As for the last 12 mo, the number decreased to 210（47%） and 131（30%） separately. Most of the participants（95%） were aware that diabetes could affect their vision and that regular eye examination was necessary. Very few of them（12%） however were aware that the early stages of diabetic retinopathy presented without symptoms of vision loss. Having attended patient education on diabetes was effective in building awareness about diabetic eye disease and was a significant positive predictor for attending eye screening [education in a year, Adj. OR=0.47（0.29-0.74）, P〈0.001, education years ago, Adj. OR=0.56（0.33-0.96）, P=0.036]. The duration of disease also increasedthe likelihood of having undergone eye screening（Adj. OR=0.96, P〈0.05）. CONCLUSION： Being exposed to education about the complications of diabetes increases the probability of attending diabetic eye screening. An appropriate patient knowledge building strategy should be made available to patients from the time of diagnosis.

关键词： diabetic retinopathy annual screening education community

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Gonioscopy and Ultrasound Biomicroscopy in the Detection of Angle Closure in Patients with Shallow Anterior Chamber

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Chinese Medical Sciences Journal 2014年第4期29卷 204-207页

作者： Shan-shan Cui Yan-hong Zou Qian Li Li-na Li Ning Zhang xi-pu liu Department of Ophthalmology First Hospital of Tsinghua University Medical Center Tsinghua University Department of Ophthalmology Sekwa Eye Hospital

Objective To assess the agreement between gonioscopy and ultrasound biomicroscopy(UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. Methods An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. Results 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor(κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber(P=0.005) or plateau iris configuration tended to produce different results(P=0.075) in the 2 methods. Conclusion Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

关键词： gonioscopy ultrasound biomicroscopy angle closure glaucoma

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Comparison between Ophthalmologists and Community Health Workers in Screening of Shallow Anterior Chamber with Oblique Flashlight Test

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Chinese Medical Sciences Journal 2010年第1期25卷 50-52页

作者： Yusoh Nuriyah Xue-tao Ren Li Jiang xi-pu liu Yan-hong Zou Department of Ophthalmology Sekwa Eye Hospital Beijing 100088 China Department of Ophthalmology First Hospital of Tsinghua University Beijing 100016 China

Objective To study the agreement between ophthalmologists and community health workers in detecting shallow anterior chamber with oblique flashlight test. Methods Totally 425 subjects were given an eye examination in a community health center. The anterior chamber depth of each subject was examined by one ophthalmologist and two trained community health workers (one nurse and one non-professional health worker) using oblique flashlight test. Inter-observer agreement was determined using the weighted kappa statistic. Results Among the enrolled subjects,148 (35%) were male and 277 (65%) were female. Good agreement was noted in all the three observers. The comparison between the ophthalmologist and the nurse showed a kappa statistic of 0.42 for both eyes (P<0.001). The kappa statistic was 0.54 and 0.52 for right and left eyes respectively between the ophthalmologist and the non-professional health worker (P<0.001). As for agreement between the nurse and the non-professional health worker,the kappa statistic was 0.49 and 0.38 for right and left eyes,respectively (P<0.001). Conclusion The oblique flashlight test may be used as an applicable tool by trained community health workers for screening of shallow anterior chamber and play a role in blindness prevention in community.

关键词： glaucoma shallow anterior chamber oblique flashlight test

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