Top PDF Laser photocoagulation for proliferative diabetic retinopathy.

Laser photocoagulation for proliferative diabetic retinopathy.

Laser photocoagulation for proliferative diabetic retinopathy.

Main results We identified a large number of trials of laser photocoagulation of diabetic retinopathy (n = 83) but only five of these studies were eligible for inclusion in the review, i.e. they compared laser photocoagulation with currently available lasers to no (or deferred) treatment. Three studies were conducted in the USA, one study in the UK and one study in Japan. A total of 4786 people (9503 eyes) were included in these studies. The majority of participants in four of these trials were people with proliferative diabetic retinopathy; one trial recruited mainly people with non-proliferative retinopathy. Four of the studies evaluated panretinal photocoagulation with argon laser and one study investigated selective photocoagulation of non-perfusion areas. Three studies compared laser treatment to no treatment and two studies compared laser treatment to deferred laser treatment. All studies were at risk of performance bias because the treatment and control were different and no study attempted to produce a sham treatment. Three studies were considered to be at risk of attrition bias.
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A case of proliferative diabetic retinopathy in which scintillating particles appeared in the intravitreal cavity after laser photocoagulation

A case of proliferative diabetic retinopathy in which scintillating particles appeared in the intravitreal cavity after laser photocoagulation

Crystallin was initially reported as a constituent protein of the lens, with later reports indicating its expression not only in the lens but also in the ciliary body, the neural retina, and retinal pigment epithe- lium [1, 2]. It has previously been reported that the retinas of diabetes patients have higher-than-normal expressions of αA-crystallin, and that its production is induced by glycated proteins, i.e., the accumulation of advanced glycation end-products (AGE) in the eye [3]. Here, we report a case of proliferative diabetic retinopathy (PDR) in which a scintillating substance that appeared to be crystallin developed in the intra- vitreal cavity after laser photocoagulation.
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A randomised controlled trial on effects of contact and non-contact laser

photocoagulation therapy on ocular surface in patients with proliferative diabetic retinopathy

A randomised controlled trial on effects of contact and non-contact laser photocoagulation therapy on ocular surface in patients with proliferative diabetic retinopathy

Kaedah Kajian Kajian ini merupakan kajian terkawal secara rawak yang dijalankan di Hospital Universiti Sains Malaysia bermula dari Jun 2013 hingga Mei 2015. Pesakit yang menghidapi proliferatif diabetik retinopati telah dipilih dan dibahagikan secara rawak kepada 2 kumpulan (kumpulan laser kontak dan kumpulan laser tanpa kontak) dengan menggunakan kaedah pensampelan rawak sampul surat. Perubahan permukaan okular dinilai melalui ujian Schirmer, masa pemecahan filem air mata (TBUT) dan skor OSDI sebelum dan 3 bulan selepas rawatan laser. Analisis data dilaksanakan dengan menggunakan SPSS versi 22.0.
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Anti-vascular endothelial growth factor for proliferative diabetic retinopathy.

Anti-vascular endothelial growth factor for proliferative diabetic retinopathy.

Gender: 55 men and 21 women Inclusion criteria: aged ≥ 18 years, very severe non-PDR to high-risk PDR, Snellen BCVA of ≥ 3 Exclusion criteria: blood pressure > 180 mmHg (systolic) and > 110 mmHg (diastolic), glycated haemoglobin levels > 9.5%, chronic renal failure, major surgery within 1 month, or previous systemic steroids or anti-VEGF treatment. Ocular conditions other than diabetic retinopathy (e.g. retinal vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, etc.). History of treatment for diabetic macular oedema, PRP or focal/grid laser photocoagulation, or previous intraocular surgery, or uncontrolled glaucoma in the last 3 months
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Different lasers and techniques for proliferative diabetic retinopathy.

Different lasers and techniques for proliferative diabetic retinopathy.

treatment by undertaking further laser in untreated areas. Following the guidelines published by the DRS and ETDRS, ar- gon laser photocoagulation has been the gold standard for the treatment of PDR. Level 1 evidence from the DRS recommended multisession scatter PRP laser (800 to 1600 spots in one or two sittings, and follow-up treatment applied as needed at 4-month intervals) extending to or beyond the vortex vein ampullae (mid- peripheral retina) (DRS Research Group 1981). Practitioners still widely follow this guideline as a frame of reference. In general, ophthalmologists administer laser covering 360° of the midpe- ripheral retina, with adequate spacing between laser burns (~ 1 burn apart) to avoid compromising peripheral vision. In clinical practice, the power of the laser selected is set for each individual patient to achieve an adequate burn in the retina and is depen- dent on variables such as media clarity, fundus pigmentation, and method of delivery. Avoiding very intense white spots is advised to reduce possible complications such as haemorrhage and breaks through Bruch’s membrane which could lead to choroidal neovas- cularisation.
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Pan retinal photocoagulation and other forms of laser treatment and drug therapies for non proliferative diabetic retinopathy : systematic review and economic evaluation

Pan retinal photocoagulation and other forms of laser treatment and drug therapies for non proliferative diabetic retinopathy : systematic review and economic evaluation

in 22 patients with PDR and CSMO. Patients were followed up for 12 months. One group of patients received PRP and macular laser, whereas the second group received PRP, macular laser and IVTA. All patients received bilateral full scatter laser (each eye sequentially on the same day) in three sessions – weeks 1, 2 and 3 – consisting of 400 – 500 500-µm-size spots performed per session. In addition, all patients received macular (focal/grid) laser photocoagulation in each eye at the time of the initiation of the first PRP session. At the end of the third PRP session, one eye per patient was randomly assigned to receive IVTA (IVTA group) and the fellow eye of the same patient to receive no additional treatment (control group). IVTA treatment was a single intravitreal injection of 4 mg/0.1 ml of triamcinolone (Kenalog 40) 60 minutes after the third PRP session. During follow-up visits, if patients still presented with CSMO and treatable lesions on FA, then additional macular (grid and/or focal) laser treatments were given. In patients with focal leaks of greater than 500 µm from the centre of the macula, treatment was given.
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Different lasers and techniques for proliferative diabetic retinopathy

Different lasers and techniques for proliferative diabetic retinopathy

Description of the intervention Laser photocoagulation reduces the oxygen demand of the outer layers of the retina and helps divert adequate oxygen and nutri- ents to the inner retinal layers, favourably altering the haemody- namics ( Stefánsson 2001 ). Laser photocoagulation may also act by reducing the expression of vasoactive factors such as vascular endothelial growth factor (VEGF) and protein kinase C (PKC) in the retina ( Ghosh 2005 ). Indeed, different landmark studies have supported the efficacy of laser pan-retinal photocoagulation (PRP) in preventing vision loss. The Diabetic Retinopathy Study (DRS) demonstrated that laser photocoagulation of the retina reduced se- vere visual loss (defined as visual acuity of 5/200 or less on two con- secutive visits at least four months apart) ( DRS Research Group 1978 ), and the Early Treatment Diabetic Retinopathy Study (ET- DRS) addressed the question of the appropriate time for per- forming laser photocoagulation, showing that PRP was beneficial only in cases where proliferative changes were present or immi- nent ( ETDRS Research Group 1985 ). It also showed that focal or grid photocoagulation was beneficial in reducing visual loss due to macular oedema ( ETDRS Research Group 1985 ). Laser PRP is more beneficial when performed at an advanced stage of the disease, when proliferative changes have appeared and are threat- ening vision. This treatment is associated with its own morbidity, so as the disease progresses to the PDR stage the risk-benefit ratio is altered in favour of PRP. The visual loss due to PRP is much less debilitating at this stage compared with the high risk of severe
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A case of pseudoxanthoma elasticum with proliferative diabetic retinopathy

A case of pseudoxanthoma elasticum with proliferative diabetic retinopathy

Patients with angioid streaks that do not extend to the macula can be followed-up, but treatment is necessary if CNV develops. If the CNV does not involve the macula, local laser photocoagulation can be performed, but the presence of subfoveal CNV requires anti-VEGF therapy and vitreous surgery to remove the neovascularization. Nevertheless, treatment outcomes generally remain poor. Systemic diseases other than PXE that are also associated with angioid streaks include Ehlers-Danlos syndrome, Paget’s disease of bone, and sickle cell disease [7].

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Original Article Correlation between serum VEGF and glycosylated hemoglobin levels with the efficacy and prognosis of laser photocoagulation in patients with diabetic retinopathy

Original Article Correlation between serum VEGF and glycosylated hemoglobin levels with the efficacy and prognosis of laser photocoagulation in patients with diabetic retinopathy

can be produced by various retinal cells such as astrocytes, pericytes, and retinal pigment epithelial cells, and high levels of VEGF have been found in active intraocular neovascular- ization diseases such as proliferative diabetic retinopathy (PDR) [9]. Additionally, VEGF could induce microvascular hyperpermeability and induce breakdown of blood-retinal barrier in humans, especially those with NPDR [10]. Glycosylated hemoglobin (HbA1c) can predict diabetes as well as cardiovascular disease and their mortality, as an indicator of chronic blood glucose concentration [11]. Zehetner et al. re- ports that poor glycemic control positively cor- relates with up-regulated VEGF levels in DR patients and the normalization of HbA1c can be an effective way to prevent retinopathy [12]. Sugimoto et al. have been mentioned that pho- tocoagulation treatment in DR might result in decreased VEGF secretion [13], and laser treat- ment is recommended for diabetic patients in the highest quartile of HbA1c variability [14]. Nevertheless, the association between VEGF and HbA1c with the efficacy and prognosis of laser photocoagulation in patients with DR requires further exploration. Therefore, this study aims to explore whether they are correla- tive by comparing the changes of VEGF and HbA1c levels in DR patients before and after laser photocoagulation.
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Focal Laser Photocoagulation in Non-Center Involved Diabetic Macular Edema

Focal Laser Photocoagulation in Non-Center Involved Diabetic Macular Edema

the potential risks and benefits of the procedure was obtained from the patients in the treatment group. Patients older than 18 years, with non-proliferative diabetic retinopathy secondary to type II diabetes mellitus were included in this study. The eligibility criteria were as follows: (1) best corrected visual acuity (BCVA) score ≥19 letters (20/400 or better), (2) metabolic control of hyperglycemia being demonstrated by the level of glycosylated hemoglobin (HbA1c) ≤8.0%, (3) previously untreated DME characterized by a central subfield thickness (CST) ≤250 microns and ≥300 microns in at least one of the four inner subfields on the fast macular map scan, (3) well-defined focal areas of leakage from microaneurysms located between 500 and 3000 microns from the center of the macula revealed by fluorescein angiography (FA) and increased fluorescein leakage from microaneurysms positively correlated with increased retinal thickness on OCT without evidence of macular ischemia.
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The Long-term Effects of Laser Photocoagulation Treatment in Patients with Diabetic Retinopathy

The Long-term Effects of Laser Photocoagulation Treatment in Patients with Diabetic Retinopathy

Discussion Visual Acuity Results More than half of the patients originally enrolled in the ETDRS clinic at Johns Hopkins were deceased at the time of the long-term follow-up examination, and those patients with the worst visual acuity at the ETDRS closeout visit were the least likely to survive. Most of the patients who survived maintained fairly good visual acuity at the time of the long-term follow-up examination; 42% of patients in this study retained visual acuity of 20/20 or better, and 84% retained visual acuity of 20/40 or better in at least one eye. These data suggest that those patients who receive photo- coagulation and who survive long-term are more likely to have maintained good visual acuity during the early phases of treatment. They are also likely to maintain fairly good visual acuity with long-term follow-up. Although they con- tinue to have diabetes, for most, the retinopathy seems to eventually become quiescent. This is due, at least in part, to the beneficial effects of laser photocoagulation and vitrec- tomy seen at 5 years. 8 The short-term evaluation of these therapeutic strategies has demonstrated highly beneficial effects in reducing the risk of severe vision loss by more than 90% in 5 years. Only 4% of eyes and 1% of patients with proliferative diabetic retinopathy in the ETDRS had severe vision loss at 5 years. This is remarkably lower than the greater than 50% 5-year blindness rate seen in patients before the availability of photocoagulation and also esti- mated from untreated eyes of the patients enrolled in the DRS (Fig 1). 3
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Effect of retinal laser photocoagulation on contrast sensitivity and visual acuity in patients of diabetic retinopathy

Effect of retinal laser photocoagulation on contrast sensitivity and visual acuity in patients of diabetic retinopathy

Patients undergoing argon laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) developed temporary losses in high spatial frequency CS during the closely spaced PRP treatments. Since Snellen’s visual acuity remained stable at the pre-laser level, these results indicate the need for more sensitive measures of visual resolution to monitor foveal integrity in patients undergoing PRP. 7 Hellstedt et al. 8 suggested that contrast sensitivity is a sensitive indicator of changes in diabetic retinopathy and macular edema, especially at low- to mid- range spatial frequencies. Isolated losses of CS exist in certain diseases, and in many others, loss of contrast sensitivity is more prominent and disturbing to the patient than the loss of visual acuity .9
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Retinal Laser Photocoagulation

Retinal Laser Photocoagulation

Since its discovery in the 1940s, retinal photocoagulation has evolved immensely. Although the first photocoagulators utilised incandescent light, it was the invention of laser that instigated the widespread use of photocoagulation for treatment of retinal diseases. Laser permits choice of electromagnetic wavelength in addition to temporal delivery methods such as continuous and micropulse modes. These variables are crucial for accurate targeting of retinal tissue and prevention of detrimental side effects such as central blind spots. Laser photocoagulation is the mainstay of treatment for proliferative diabetic retinopathy amongst many other retinal conditions. Considering the escalating prevalence of diabetes mellitus, it is important for physicians to grasp the basic principles and be aware of new developments in retinal laser therapy.
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Effect of panretinal photocoagulation on macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema

Effect of panretinal photocoagulation on macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema

Examination included assessment of visual acuity using a Snellen chart, anterior segment examination by slit-lamp biomicroscopy, intraocular pressure measurement with applanation tonometry, and fundus examination by slit- lamp biomicroscopy and indirect ophthalmoscopy. Vision was recorded using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR) for data analysis. Fundus photography was done for documenta- tion and follow-up whenever necessary. Fundus fluorescein angiography and OCT were carried out for all patients before PRP. Fluorescein angiography was done to rule out macular ischemia and to confirm early PDR. Patients with macular ischemia were excluded from the study at baseline because this could have had a bearing on the visual outcome and be a confounding variable during analysis. OCT was done before and one week, one month, and 3 months after PRP. Line scan and fast macular scans were done to study the macula on the Stratus OCT (Carl Zeiss Meditec, Dublin, CA, USA), and a 5-line raster scan and cube 512 × 200 scan was done on the Cirrus OCT (Carl Zeiss Meditec, Dublin, CA, USA). The line scan/5-line raster protocol were used to study the morphological features of macular edema, ie, spongy edema/ spongy retinal thickening, epiretinal membrane, vitreomacu- lar traction, subretinal fluid, and cystoid macular edema. Spongy edema/retinal thickening was defined as increased retinal thickness with reduced intraretinal reflectivity and expanded areas of lower reflectivity on OCT. Fast macular protocol/cube data were used to study central foveal thick- ness. PRP was done with standard parameters using green laser in 3–4 sittings, with a one-week interval between each sitting. After completion of PRP, patients were followed up at one week, one month, and 3 months. At each visit, visual acuity was assessed by Snellen chart, and a qualitative and quantitative study of the macula was done with OCT and clinical examination. Comparison of visual acuity and macular changes with regard to morphological and macular thickness was made at each post treatment visit. The Chi- square test, paired t-test, and Pearson’s correlation were used in the statistical analysis, which was performed using the Statistical Package for the Social Sciences version 19.0 (SPSS Inc, Chicago, IL).
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Characterisation of the vitreous proteome in proliferative diabetic retinopathy

Characterisation of the vitreous proteome in proliferative diabetic retinopathy

Results: Vitreous humour from type 2 diabetic patients with PDR (n = 10) and from normal human eyes donated for corneal transplant (n = 10) were studied. The comparative proteomic analysis was performed using two- dimensional fluorescence difference gel electrophoresis (2-D DIGE). Differentially produced proteins (abundance ratio > 2 or < -2, p < 0.01) were identified by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and MALDI-TOF tandem mass spectrometry. A total of 1242 protein spots were detected on the 2-D master gel of the samples, and 57 spots that exhibited statistically significant variations were successfully identified. The spots corresponded to peptide fragments of 29 proteins, including 8 proteins that increased and 21 proteins that decreased in PDR. Excluding the serum proteins from minor vitreous haemorrhage, 19 proteins were found to be differentially produced in PDR patients compared with normal subjects; 6 of these proteins have never been reported to be differentially expressed in PDR vitreous: N(G),N(G)-dimethylarginine dimethylaminohydrolase 1 (DDAH 1), tubulin alpha-1B chain, gamma-enolase, cytosolic acyl coenzyme A thioester hydrolase, malate dehydrogenase and phosphatidylethanolamine-binding protein 1 (PEBP 1). The differential production of pigment epithelium-derived factor (PEDF) and clusterin was confirmed by Western blot analysis. Conclusions: These data provide an in-depth analysis of the human vitreous proteome and reveal protein alterations that are possibly involved in the pathogenesis of PDR. Further investigation of these special proteins may provide potential new targets for the treatment or the prevention of PDR.
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Laser treatment in diabetic retinopathy

Laser treatment in diabetic retinopathy

Panretinal Laser Treatment for Proliferative Diabetic Retinopathy The DRS enrolled 1,742 patients, 876 of whom were randomized to the argon group and 875 to the xenon group [6] . Argon photocoagulation involved the place- ment of 800–1,600 burns with 500  m diameter or 500– 1,000 burns with 1,000  m diameter, both at 0.1 s of du- ration. The areas treated included the retina to or beyond the vortex veins in 1 or 2 sessions, also covering neovas- cularization of the optic disc (NVD), which is no longer typically performed today. The primary endpoint of the study was a visual acuity of ! 5/200 on 2 consecutive vis- its 4 months apart. After 3 years argon laser coagulation could decrease the rate of severe visual loss to 13.3%, and xenon coagulation to 18.5%, while untreated eyes had 26.4%. Thus at least a 50% reduction in the rate of severe visual loss could be demonstrated for panretinal laser treatment, which was maintained during a 5-year fol- low-up period [7] . The harmful effects of photocoagula- tion were more pronounced for xenon coagulation than for argon laser coagulation and included a reduction of visual acuity due to treatment and loss of peripheral vi- sual field. For laser treatment a decrease by 6 1 lines oc- curred in 10% and a mild constriction of visual fields in 5% [7] . Macular edema, which may be exacerbated by panretinal photocoagulation and will be discussed in detail later, was not evaluated in the DRS. Finally the so- called high-risk characteristics, for which the benefits of peripheral coagulation outweigh the risks, were defined as [7, 8] :
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Influence of probucol-assisted retinal photocoagulation 
						therapy on the visual performance
						and serum biochemical indexes in patients with early 
						proliferative diabetic retinopathy

Influence of probucol-assisted retinal photocoagulation therapy on the visual performance and serum biochemical indexes in patients with early proliferative diabetic retinopathy

study, the inflammation and oxidative stress state were compared between the two groups before and after treatment, and it was found that compared with those before treatment, serum inflammatory mediators ICAM-1, IL-2, IL-23 and TNF-α as well as oxidation index MDA contents of both groups decreased while anti-oxidation index TAC contents increased after treatment, meaning that both therapies help to alleviate inflammation and oxidative stress state; further compared with those of control group, the change in serum contents of above indexes of probucol group was bigger after treatment, confirming that probucol-assisted retinal photocoagulation can more effectively inhibit the inflammation and oxidative stress status in patients with early proliferative DR, this perfectly matches with its pharmacological properties, and it is functioning pathway for the drug to achieve treatment effect.
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Social deprivation as a risk factor for late presentation of proliferative diabetic retinopathy

Social deprivation as a risk factor for late presentation of proliferative diabetic retinopathy

All patients referred by the Diabetic Screening Service to the University Hospitals Birmingham National Health System Foundation Trust Eye Service are identified and key data recorded by a Diabetic Eye Screening Failsafe Coordinator. These data include: date of referral, grade of retinopathy by screener, grade of retinopathy by consultant, date of hospital appointment offered, actual date of hospital appointment, numbers of cancellations or non-attendances prior to this appointment, whether referral for laser was required, date of laser offered, actual date of laser treatment, numbers of cancellations or non-attendances prior to this laser treat- ment. From the period 1 June 2010 to 31 May 2013 as part of a service evaluation we identified all consecutive patients referred with R3 retinopathy that had been confirmed by an ophthalmologist according to national screening criteria. 8,9,12
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Effect of glycated opticin on angiogenesis: mechanism & relevance to

proliferative diabetic retinopathy

Effect of glycated opticin on angiogenesis: mechanism & relevance to proliferative diabetic retinopathy

Bruker Autoflex MALDI-TOF-MS (Bruker Daltonik, Germany). All samples were supplied in PBS buffer at 2.5mg/ml concentration but PBS buffer should be removed from the samples because of the damaging effect of this buffer on the MALDI ionisation process. Therefore, there are two methods to clean up the samples including drop-dialysis using 0.025 μm VSWP membrane and C18 Zip Tip that both are from (Millipore corp. USA). However, in this test just one of the clean-up methods was successfully utilised, which was the ZipTip method. For MALDI analysis, 1 uL of sample was loaded onto the sample plate with 0.5uL of sinapinic acid matrix (saturated sinapinic acid in 50% Acetonitrile/50% 0.1% TFA) and allowed to co-crystallize on the sample target. The mass spectrometer is equipped with a nitrogen laser (337 nm, 3ns pulse width). All measurements were performed in positive ion linear mode using delayed ion extraction. The delay time was adjusted according to the mass of the protein. The ion acceleration voltage was set to 20 kV. In all MS/MS experiments, helium was used as the collision gas.
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Osteoprotegerin is a new regulator of inflammation and angiogenesis in proliferative diabetic retinopathy

Osteoprotegerin is a new regulator of inflammation and angiogenesis in proliferative diabetic retinopathy

in phosphate-buffered saline for 1 hour), and incubated overnight with primary antibody against OPG (1:500 dilution; clone ab73400; Abcam). Colocalization studies were per- formed using anti-glial fibrillary acidic protein (GFAP) (1:1000 dilution; clone ab10062; Abcam), anti-Iba1 (1:200 dilution; clone ab5076; Abcam), and anti-collagen IV (1:50 dilution; clone ab6311; Abcam). After sections were washed, they were incubated with Alexa Fluor 488 or 594 secondary antibodies (Molecular Probes, Invitrogen, Madid, Spain) at room temper- ature for 1 hour. Slides were cover-slipped with mounting medium containing 4 0 ,6-diamidino-2-phenylindole (DAPI) for visualization of cell nuclei (Vector Laboratories, Palex, Sant Cugat del Vall´ es, Spain). Images were acquired with a confocal laser scanning microscope (model FV1000; Olympus).
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