紅外線治療眼底疾病的可能性1

美國眼科醫學會AAO在2020年8月分享了一篇討論未來可能利用紅外線用來改善一些眼睛疾病的文章，但我們要強調，目前，此項技術只用在細胞實驗、動物實驗以及少數人體臨床實驗，尚未被任何衛生醫療主管單位核准一般性的治療使用，千萬『不要』用在他人與自己身上。
粒線體的工作示意圖出自參考6。
眼部照射紅光圖出自以下網站
https://www.ophthalmologytimes.com/view/photobiomodulation-shows-the-power-of-light
眼後部血管網圖來自以下網站的Figure1
https://www.semanticscholar.org/paper/Functional-Hyperemia-and-Mechanisms-of-Coupling-in-Newman/91a9816bb538f9d30fd0604e2f27ae1f9bf0bc69

紅外線治療、低劑量雷射治療low level laser therapy，或是光生物調節Photobiomodulation (PBM)，美國眼科醫學會引用的4篇論文所討論的紅光或近紅外線波長為625nm~1000nm(nanometers，奈米)，所以這次只會就文章中的資料討論，不會討論到波長更長的紅外線。

其實紅光的運用歷史悠久，1903諾貝爾生理學或醫學獎的得主芬森N. R. Finsen使用紅光治療普通狼瘡，可以說是為紅光的醫療利用開啟新局。有趣的是，真正可實用的研究是在1960年代出現的，研究者想要用雷射在實驗鼠身上誘發皮膚癌，但卻發現使用的694奈米波長的雷射反而使實驗鼠身上被剃掉的毛快速生長，因為實驗設計有「不照射雷射」的對照組，正好比較兩者之間的差異。
此後，紅光/近紅外線成為一個在醫學領域備受矚目的研究主題。目前在傷口癒合或疼痛控制或是神經性損傷上都有動物或人體上的成效，細項這邊就不多談了。(參考2)

可以從參考2的回顧中了解，紅光/近紅外光對眼睛細胞層面的作用，主要發生在粒線體中如細胞色素C氧化酶Cytochrome C oxidase、一氧化氮NO的變化，使細胞內的代謝速率增加(文獻3，5的內容也是在論述關於如何改善粒線體功能降低老化的發炎反應與增加ATP的供應)。另外也會抑制穆勒氏細胞Müller’s cells產生會影響感光細胞代謝的自由基。以上由細胞或動物實驗-老鼠來驗證。

從AAO網站文章中引用的研究，我們可以瞭解到一件事，研究中專注於視網膜上的代謝情況，如上一段所述，為什麼呢？

因為視網膜或更明確地說，感光細胞的代謝需求，是眼睛一張開始看東西就不會停止而且非常大量，直到閉起眼睛才會下降。在黑暗中看東西也是會運作的。但感光細胞的代謝，需要視網膜色素上皮層RPE來協助。所以，RPE的活力才會這麼受到重視，否則感光細胞不是餓死就是被自己製造的代謝廢棄物淹死(誇飾法)。(補充：視網膜各層，除了RPE，剩下的都不會再生。RPE是凋亡後，有新的RPE細胞補上。另外，粒線體就是所謂的細胞的發電廠，活著的細胞內通常都會有粒線體，感光細胞自己也有。參考6)

因此，回顧中眼科的紅光/近紅外光(以下稱FR/NIR)主要研究的適用症就是與RPE相關的眼底疾病，例如：年齡/老年相關性黃斑部病變(Age-related Macular Degeneration, AMD)、糖尿病視網膜病變(Diabetic Retinopathy, DR)、早產兒視網膜變性(Retinopathy of prematurity, ROP)、視網膜色素變性/色素性視網膜炎(Retinitis Pigmentosa, RP)、還有視網膜的甲醛毒性問題(Methanol toxicity in the retina)，這些都與RPE是否健康有活力來維持感光細胞正常代謝有關。當然可能還有其他未提及的視網膜病症或是眼部其他病症。

另外，參考2中也提及，年齡相關性黃斑部病變、糖尿病視網膜病變、弱視Amblyopia (包含屈光不正Ametropia或斜視Strabismus造成的)、視網膜色素變性Retinitis Pigmantosa已經有臨床研究。根據論文分享的內容，在多數的結果中，都是呈現改善的傾向。但除了，糖尿病視網膜病變的研究有說明是「閉眼」情況下照射治療，其他研究並沒有提及照射光線時是閉眼或張眼。(再次提醒，雖然已經有臨床實驗，但這樣的治療是還沒有被任何主管單位批准為常態性治療使用，目前甚至沒有標準的照射時間、照射劑量、甚至光線波長。請勿在他人或自己身上執行照射。)

AAO文章中還有一個研究因為題目比較特別，我們下個星期再來分享喔！

──────────────
參考文獻
1. Reena Mukamal, 《Does Red Light Protect Aging Eyes?》
https://www.aao.org/eye-health/news/red-light-protect-aging-eyes-rlt-pbm-near-infrared

2. Ivayla I. Geneva, 《Photobiomodulation for the treatment of retinal diseases: a review》, Int J Ophthalmol, Vol. 9, No. 1 Jan. 18, 2016.

3. Chrishne Sivapathasuntharam, Sobha Sivaprasad , Christopher Hogg , Glen Jeffery ,《Aging retinal function is improved by near infrared light (670 nm) that is associated with corrected mitochondrial decline》, Neurobiology of Aging 52 (2017) 66-70.

4. Claudia Núñez-Álvarez , Carlota Suárez-Barrio , Susana Del Olmo Aguado , Neville N Osborne, 《Blue light negatively affects the survival of ARPE19 cells through an action on their mitochondria and blunted by red light, Acta Ophthalmol》. 2019 Feb;97(1):e103-e115.
https://pubmed.ncbi.nlm.nih.gov/30198155/

5. Harpreet Shinhmar, Manjot Grewal, Sobha Sivaprasad, Chris Hogg, Victor Chong, Magella Neveu, and Glen Jeffery, 《Optically Improved Mitochondrial Function Redeems Aged Human Visual Decline》, J Gerontol A Biol Sci Med Sci, 2020, Vol. 75, No. 9.

6. Eells J. T.. 《Mitochondrial Dysfunction in the Aging Retina》. 2019 May. Biology, 8(2), 31. https://doi.org/10.3390/biology8020031

兒子喜歡躺著看電視。
我跟他說看電視要坐好，不然會斜視。
他似懂非懂的坐直，不過我一離開視線，沒兩下又躺回去。
反反覆覆，好像在玩一二三木頭人。

My son would like to lie down watching TV.
I told him to sit while watching TV; otherwise, he’d get strabismus.
He’d seemed to get the idea and sit up. But once I didn’t watch him, he’d lie down again.
So on and so forth. It’s like playing “1, 2,3, freeze!”

#坐姿 #木頭人 #單親爸爸週記 #藍聖傑BLUE #你看電視我做家事 #坐沒坐相

多謝呢位醫生既分享
祝願周同學大步擸過😭😭😭😭
同時強烈譴責港警每次出動都不斷攻擊市民頭部！！直接造成嚴重傷害！！！
解散警隊！刻不容緩🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿
#願榮光稱香港
#一齊集氣
#香港人不能麻木

[腦疝]

喺講腦疝之前，希望大家為周同學祈禱打氣，希望佢可以大步檻過。呢篇比較深，但希望大家可以睇哂佢。之前講過嘅腦硬膜外出血 (epidural haematoma)，以及腦硬膜下出血 (subdural haematoma)、蛛網膜下出血 (subarachnoid haematoma)，致死嘅原因都可以係腦疝。

疝，指器官受外力影響、而被迫入偏離本身位置嘅空間。腦疝，就係大腦或者小腦因為顱內壓上升，而被迫出本來嘅位置。

如圖，大腦同小腦由唔同嘅結構分開，形成唔同區域：大腦鐮 (falx cerebri) 分開左右兩邊大腦半球，小腦幕 (tentorium cerebelli) 將大腦半球與該邊嘅小腦半球分開。當顱內壓急速上升時，大腦小腦就會由原來嘅區域，被外力「啫」去另一區域，形成腦疝，從而壓住其他結構。

腦疝可分為四類：
一．大腦鐮下腦疝 (subfalcine herniation)。呢種腦疝嘅臨床病徵較輕微。通常嘅後續係大腦前動脈 (anterior cerebral artery) 比腦疝壓住，形成缺血性中風。
二．中央腦疝 (central herniation)。腦幹被外力向下壓，引起徵狀。最常見係第六腦神經 (外展神經, abducens nerve) 麻痺，引致斜視同埋複視。
三．顳葉鈎回腦疝 (uncal herniation)、亦稱小腦幕切蹟疝 (tentorial herniation)。指大腦顳葉 (temporal lobe, 旁邊靠近顳骨的部分) 中嘅鈎回 (uncus) 結構受壓而被擠出小腦幕。病徵有三：瞳孔擴大、郁唔到隻眼 (第三腦神經 (動眼神經, oculomotor nerve) 受壓麻痺)；半身不遂 (大腦腳 (cerebral peduncle) 受壓，其中嘅下行運動神經亦受牽連)；昏迷 (中腦網狀系統 (midbrain reticular formation) 結構受損)。大腦後動脈 (posterior cerebral artery) 亦有機會受壓，形成缺血性中風。
四．小腦扁桃體疝 (tonsillar herniation)。當壓力夠大，小腦可由枕骨大孔 (foramen magnum) 外疝。咁就嚴重啦，因為腦幹會因此受壓，其中控制呼吸同心跳嘅中心會受損，導致呼吸停頓、心跳停頓、血壓不穩，繼而死亡。

任何頭部創傷都可能引起顱內出血，繼而使顱內壓上升，最後腦疝。腦疝係可以致命嘅。所以希望大家為周同學打氣之餘，唔好忘記暴政曾經無數次向人民嘅頭顱攻擊，嘗試奪去我哋嘅性命。但係筆者亦都喺到呼籲：大家唔好絕望、唔好麻木，因為咁樣無異於自己用手向嘅頭顱使出致命一擊。要「毋忘初衷」呀，我哋繼續行落去啦。

***

[Brain herniation]

Before all, please pray for Mr. Chow - may he be safe and sound. The content of this post is a bit advanced, but I hope you can take some time and go through the whole passage. Conditions like epidural haematoma, subdural haematoma and subarachnoid haematoma can all lead to brain herniation, a serious and possibly fatal condition.

Herniation is the phenomenon where an organ is pushed to another location due to external pressure and forces. Brain herniation occurs when intracranial pressure (ICP) increases, and the brain parenchyma shifts its location.

As in the figure, we can see that the cerebrum and cerebellum are situated in different compartments, separated by different structures. The falx cerebri separates the bilateral cerebral hemispheres, and the tentorium cerebelli separates the cerebral hemisphere from the ipsilateral cerebellar hemisphere. When ICP increases, these structures will herniate into different spaces, compressing other structures.

Brain herniations can be categorised into 4 types:
1. Subfalcine herniation. Clinically this type of herniation has less symptoms. The major sequelae would be compression to the anterior cerebral artery, leading to ischaemic infarcts.
2. Central herniation. Downward compression to the brainstem leads to symptoms like strabismus and diplopia due to abducens nerve palsy.
3. Uncal / tentorial herniation. The uncus in the temporal lobe of the cerebrum are compressed and herniates through the tentorium cerebelli. Clinically there is a triad of symptoms: pupil dilation and progressive loss of eye movements (due to oculomotor nerve palsy), hemiparesis (compression to cerebral peduncle, damaging the descending motor neurons inside) and coma (damage to midbrain reticular formation). The posterior cerebral artery may also be compressed and cause ischaemic infarcts.
4. Tonsillar herniation. When ICP increases drastically, the cerebellum can herniate through the foramen magnum out of the skull. This is an extremely severe condition, in which the brainstem will be compressed, compromising its respiratory and cardiovascular control centres. This results in respiratory and cardiac arrest, fluctuation in blood pressure, and ultimately death.

Any trauma to the head can lead to intracranial haemorrhages, and that can lead to increased ICP and brain herniation, which may be fatal. We should not only pray for Mr. Chow who is suffering so much, but also remember how this government had aimed and shot at the heads of the people, trying to kill us. But it is unwise for us to be overwhelmed with hopelessness and numbness - that is even worse than a physical hit to your head! Never forget why we started - and let us walk further from here.

Figure adapted from Blumenfield H. Neuroanatomy through clinical cases, 2nd edition. Sinauer Associates, Inc. 2010.

Phá lấu A Chảy là quán phá lấu của một gia đình người Quảng Đông ở quận 11. Ở đây có bán phá lấu, phá lấu mì gói và khổ qua cà ớt.

Quán Phá lấu A Chảy bán từ 10 giờ sáng đến tối khuya. Địa chỉ: A03, Chung cư Bình Thới, đường Dương Đình Nghệ, quận 11.


fanpage facebook: https://www.facebook.com/saigondauyeu87/

Các anh chị, các bạn biết nơi nào có quán ăn ngon, đông khách muốn giới thiệu đến nhiều người hoặc muốn quảng cáo quán ăn vui lòng comment bên dưới hoặc gọi số 0789570389.

Nội dung được bảo hộ bản quyền, vui lòng không reup đăng youtube, facebook hoặc các nguồn khác. Cám ơn các bạn đã ủng hộ Sài Gòn Dấu Yêu.

Mời mọi người xem clip.

Fanpage facebook: https://www.facebook.com/saigondauyeu87/

A Chay strabismus is the strabismus shop of a Cantonese family in District 11. It sells strabismus, rice noodles and bitter melon.

A Chay Cave Shop sells from 10 am till late at night. Address: A03, Binh Thoi Apartment, Duong Dinh Nghe Street, District 11.

If you know where there is a delicious restaurant, crowded to recommend to many people or want to advertise the restaurant, please comment below or call 0789570389.

Content is copyright protected, please do not reup post youtube, facebook or other sources. Thank you for supporting Saigon Beloved.

Invite everyone to see the clip.

I often review Vietnamese street food. I live in Ho Chi Minh city. If you have passion and interest in watching and enjoying street food, please visit my channel. I post food clips at 6 PM o'clock every day. Thank you very much.

孫娘・りりか、斜視の手術で入院してました、無事終わり経過も
良好なので、翌日午後退院出来ました、眼は当分真っ赤ですね。
激しい運動も出来ないので春休みはまったり過ごしますね。
入院、手術で帰らないので、シェパード犬マック君、玄関で一睡
もしないで、クンクン寂しい鳴き・・あまりに悲しいのか、
お腹もゆるくなって・・それは大変・・外ばかり行きたがり、
夜中大変でした、お迎えも行きたがりなんとも、家から出るのも
後追い、吼えるので苦労しましたが、無事帰宅でシェパードマック君も安心しましたね。
メンバーシップ入会は下記リンク先
https://www.youtube.com/channel/UCDlsDrIuyeBtAVaPUXBeLKA/join
■今週人気の動画
○AkitaInu女医に恋する秋田犬・逢いたかったですveterinary hospital
https://youtu.be/ozy3U0dTLmA
○宿題より遊ぼう♪クネクネダンス、シェパード犬、マック君
https://youtu.be/8ElHEF-NTUY
○休日のシェパード犬と孫達、何処でもゴロゴロ甘えます
https://youtu.be/4lK9HS-C1cE
○GermanShepherdシェパード犬・学校に迎に来たよ♪ I came to the school
https://youtu.be/yVxW8RVPzfQ
○お帰り！甘えるシェーパード犬と孫娘の日常風景
https://youtu.be/kpc_p7V6GmI

grandchild and #GermanShepherd#シェパード犬#秋田犬
∴‥∵‥∴‥∵‥∴‥∴‥∵‥∴‥
REXウィーン警察シェパード犬刑事に刺激されてるかも？
ｋ-9にも憧れてシェパード犬と暮らしてます
2years old #Akita Inu #JAPANESEAKITA 秋田犬
name"Sosuke
2years old German Shepherd Dog
name"Mac
画像掲示板
http://www.husky.tv/imgbbs/index.cgi
https://www.facebook.com/cookie.akiya
https://twitter.com/huskytv777
撮影はiPhone 8 Plus
効果音
甘茶の音楽工房
ヒの字
DOVA-SYNDROME http://goo.gl/K1Epr8
∴‥∵‥∴‥∵‥∴‥∴‥∵‥∴‥
何時もご視聴ありがとうございます
ファンレター・プレゼントは下記が宛先になります
住所が新しくなりました
■新住所
〒105-0004
東京都港区新橋四丁目1番1号 新虎通りCORE
株式会社クリーク・アンド・リバー社
オンライン・クリエイター・ディビジョン
dfarmチャンネル　ファンレター・プレゼント係
OCサポート：03-4550-0003(直通)
∴‥∵‥∴‥∵‥∴‥∴‥∵‥∴‥