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Assessment of liver reserve function (LRF) is essential for predicting the prognosis of patients with chronic liver disease (CLD) and determines the extent of liver resection in patients with hepatocellular carcinoma.To establish noninvasive models for LRF assessment based on liver stiffness measurement (LSM) and to evaluate their clinical performance.A total of 360 patients with compensated CLD were retrospectively analyzed as the training cohort. The new predictive models were established through logistic regression analysis and were validated internally in a prospective cohort (132 patients).Our study defined indocyanine green retention rate at 15 min (ICGR15) ≥ 10% as mildly impaired LRF and ICGR15 ≥ 20% as severely impaired LRF. We constructed predictive models of LRF, named the mLPaM and sLPaM, which involved only LSM, prothrombin time international normalized ratio to albumin ratio (PTAR), age and model for end-stage liver disease (MELD). The area under the curve of the mLPaM model (0.855, 0.872, respectively) and sLPaM model (0.869, 0.876, respectively) were higher than that of the methods for MELD, albumin-bilirubin grade and PTAR in the two cohorts, and their sensitivity and negative predictive value were the highest among these methods in the training cohort. In addition, the new models showed good sensitivity and accuracy for the diagnosis of LRF impairment in the validation cohort.The new models had a good predictive performance for LRF and could replace the indocyanine green (ICG) clearance test, especially in patients who are unable to undergo ICG testing.

The performances of routine tests such as FIB-4 and APRI in detecting cirrhosis and significant fibrosis in chronic hepatitis B (CHB) have been shown to be discrepant between studies. Novel tests such as red cell distribution width-platelet ratio (RPR), γ-glutamyl transpeptidase to platelet ratio (GPR) and easy liver fibrosis test (eLIFT) are introduced recently. To evaluate the aminotransferase influence on the performance of these routine tests, a total of 1005 CHB patients who underwent liver biopsies and routine tests were retrospectively analysed. The diagnostic cut-offs referring to likelihood ratio were determined for excluding or including cirrhosis diagnosis and also for ruling in significant fibrosis diagnosis. The performances of RPR, FIB-4, eLIFT and APRI in detecting cirrhosis seemed improved at higher ALT levels, while GPR was conversely impaired. The likelihood ratio was ∝ for APRI cut-off 2 diagnosing cirrhosis in ALT < 2 upper limit of normal (ULN), 14.6 for APRI cut-off 1.5 determining significant fibrosis in ALT ≤ 5ULN and 20.6 for FIB-4 cut-off 3.2 diagnosing ≥ F3 in the total cohort, respectively. The optimal cut-offs for cirrhosis diagnosis were increased with higher ALTs by tests which included aminotransferase, but not for RPR. The proportions of patients classified as having cirrhosis or no cirrhosis stratified by ALT level cut-offs were superior. Stepwise applying RPR, GPR and eLIFT would determine 60% of patients as having cirrhosis or no cirrhosis with an accuracy of 93.0%. In conclusion, the performance of aminotransferase comprising tests in detecting cirrhosis in CHB were influenced by ALT levels. Thus, ALT stratified cut-offs may be a preferred alternative. In resource-limited settings, stepwise applying routine tests could be recommended as a preferred measurement for cirrhosis detection.

During the COVID-19 lockdown, atmospheric PM

To evaluate the efficiency of ultrasonic spleen thickness (UST), routine variables and (expanded) Baveno VI criteria for high-risk gastroesophageal varices (HRGOV) detection in cirrhotic patients.In total, 305 cirrhotic patients were retrospectively enrolled in the deriving cohort and 328 cirrhotic patients with hepatitis B sustained viral response were prospectively enrolled in the validation cohort. HRGOV was defined as medium and severe gastroesophageal varices (GOV), mild GOV with red signs or Child-Pugh C. The cut-offs for HRGOV were determined by likelihood ratio indicating strong evidences. Algorithms of Spleen thickness-Age-Liver stiffness measurement (LSM, by FibroscanThe area under receiver operating characteristics curve of SALA, SPA, UST, platelet, and LSM were 0.849, 0.835, 0.808, 0.746, and 0.655 in the deriving cohort, and improved to 0.901, 0.904, 0.858, 0.876, and 0.811 in the validation cohort, respectively. While SALA, SPA, UST, platelet, Baveno VI criteria (BVI), and expanded BVI spared 46.6%, 38.0%, 29.2%, 21.0%, 12.1%, and 23.6% esophagogastroduodenoscopy in the deriving cohort, these numbers were improved to 68.1%, 66.8%, 27.1%, 37.8%, 36.0%, and 61.0% in the validating cohort, respectively; however, the negative likelihood ratio of expanded BVI was up to 0.16. SPA spared less esophagogastroduodenoscopy than SALA, which can be supplemented by stepwise applying UST and SPA. Sequentially combining UST and SALA, BVI and SALA exempted additional 10-5% endoscopies.SPA, without LSM, improves HRGOV detection comparing with BVI. UST based algorithms combination can achieve the best efficiency especially in sustained virus response hepatitis B.

OBJECTIVE: To study the application of ponderal index (PI), body mass index (BMI), mid-arm circumference/head circumference (MAC/HC), and Clinical Assessment of Nutritional Status (CANS) score in assessing the nutritional status of neonates at birth, and to find a simple and reliable scheme for the assessment of fetal nutritional status. METHODS: PI, BMI, MAC/HC, and CANS were used to assess the nutritional status of full-term infants and preterm infants shortly after birth. The assessment results of these methods were analyzed. RESULTS: Among the 678 full-term infants, 61, 102, 47, and 131 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. Among the 140 preterm infants, 30, 87, 9, and 112 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. The combination of BMI and CANS had a detection rate of 99.3% in full-term infants and 100% in preterm infants. Compared with the single method, the combination significantly improved the detection rate of malnutrition (P < 0.05), while there was no significant difference between the combination of BMI+CANS and the combination of PI+BMI+CANS (P > 0.05). CONCLUSIONS: The combination of BMI+CANS can reduce the rate of missed diagnosis of fetal malnutrition. It is therefore a simple and reliable method for the assessment of fetal malnutrition.

We read with interest the recent article by Cai et al 1 describing the development of 5-hydroxymethylcytosine (5hmC)-based wd-scores that have better accuracy in diagnosing early hepatocellular carcinoma (HCC) than does α-fetoprotein (AFP). Although several gene signatures have been published but not used in practice of early HCC diagnosis,2 this study showed the potential application of the 5hmC-based wd scores. However, several concerns remain that need to be clarified. First, the wd-scores’ cut-off for early diagnosis of HCC, derived by the maximal Youden index and characterised by a sensitivity of 82.7% and a specificity of 76.4%, is suboptimal; this would result in missed diagnosis of early HCC in 17.3% of patients, and the corresponding …

Statement of problem The introduction of polymer-infiltrated ceramic network (PICN) materials may provide more options for dentists in restoring short clinical crowns and extensively damaged posterior teeth, but clinical data for their performance are lacking. Purpose The purpose of this clinical study was to compare the 3-year performance and survival rates of PICN material with those of conservative ceramic onlay restorations for endodontically treated posterior teeth using the CEREC AC chair-side system. Material and methods A total of 101 onlay restorations of endodontically treated posterior teeth using the CEREC AC chair-side system were provided in 93 participants. The 101 teeth were divided into 2 groups: Vita Enamic group and Vitablocs Mark II group. Using the modified US Public Health Service quality evaluation system, 2 calibrated evaluators examined the performance of the onlay restorations over 3 years. The Kaplan-Meier method was adopted to analyze the survival rate of restorations (α=.05). The log rank test was used to compare the survival rates of the 2 groups. The Fisher exact test was performed to detect differences in the success rates for extensively damaged teeth and short clinical crown restorations between the 2 groups. The Silness and Loe gingival index was also recorded. Results The restoration survival rates in the 2 groups were 97.0% (Vita Enamic) and 90.7% (Vitablocs Mark II) (P>.05). Five failures were recorded (4.95%). These failures were caused by restoration debonding (60%), ceramic fractures (20%), and tooth fractures (20%). There were no significant differences between the success rates of restoring extensively damaged teeth and short clinical crowns between the 2 groups (P>.05). The periodontal condition of 25% of participants was improved 3 years after the onlay restorations. Conclusions Onlay restorations of endodontically treated posterior teeth with Vita Enamic using the CEREC AC chair-side system are clinically promising prosthodontic alternatives, with a survival rate of 97.0% after 3 years. More research is needed to verify the results of this study.

Objective Prior studies have reported that blood pressure (BP) has a significant influence on retinal vascular caliber both in adults and children aged 6 years and older. This study aimed to examine the association between BP and retinal vascular caliber in Singapore Chinese preschoolers 4 to 5 years of age. Design Population-based, cross-sectional study. Participants A total of 385 eligible and healthy Singapore Chinese children 4 to 5 years of age who were recruited in The Strabismus, Amblyopia and Refractive Error Study in Singaporean Chinese Preschoolers from May 2006 through October 2008 underwent BP measurements and retinal photography. Methods According to standard protocols, BP was measured with an automatic Omron sphygmomanometer (Omron HEM 705 LP, Omron Healthcare, Inc., Bannockburn, IL) and a retinal photograph was obtained with a Canon 45° digital retinal camera (Model CR6-NM45, Canon, Inc., Tokyo, Japan) after pupil dilation. Anthropometric and optical biometric measurements such as height, weight, and axial length were obtained also. Information regarding sociodemographic status and child birth information was supplied by parents in either English or Chinese questionnaires. Main Outcome Measures The computer imaging program was used to measure the caliber of all retinal arterioles and venules located in zone B. The central retinal arteriolar equivalent and central retinal venular equivalent were estimated by using a revised Knudtson-Parr-Hubbard formula. Results The mean retinal arteriolar and venular calibers were 156.19 μm and 220.01 μm in boys and 161.97 μm and 224.22 μm in girls. Higher systolic BP was associated with narrower retinal arterioles. After adjusting for age, gender, father's education, body mass index, birth weight, axial length, and caliber of the fellow retinal vessel, each 10-mmHg increase in systolic BP was associated with 2.00 μm (95% confidence interval, 0.39–3.61; P = 0.02) of retinal arteriolar narrowing and 2.51 μm (95% confidence interval, 0.35–4.68; P = 0.02) of retinal venular widening. However, neither diastolic BP nor mean arterial BP was associated with retinal arteriolar or venular caliber. Conclusions In very young children 4 to 5 years of age, higher systolic BP was associated with narrower retinal arterioles and wider retinal venules. This suggests that elevated BP may affect the retinal microvasculature from early childhood. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Found in neurons and neuroblastoma cells, Fas-induced apoptosis and accompanied activation of NF-κB signaling were thought to be associated with neurodegenerative diseases. However, the detailed functions of NF-κB activation in Fas killing and the effect of NF-κB activation on its downstream events remain unclear. Here, we demonstrated that agonistic Fas antibody induces cell death in a dose-dependent way and NF-κB signaling is activated as well, in neuroblastoma cells SH-EP1. Unexpectedly, NF-κB activation was shown to be pro-apoptotic, as suggested by the reduction of Fas-induced cell death with either a dominant negative form of IκBα (DN-IκBα) or an IκB kinase-specific inhibitor. To our interest, when analyzing downstream events of NF-κB signaling, we found that DN-IκBα only suppressed the expression of caspase-4, but not other caspases. Vice versa, enhancement of NF-κB activity by p65 (RelA) overexpression increased the expression of caspase-4 at both mRNA and protein levels. More directly, results from dual luciferase reporter assay demonstrated the regulation of caspase-4 promoter activity by NF-κB. When caspase-4 activity was blocked by its dominant negative (DN) form, Fas-induced cell death was substantially reduced. Consistently, the cleavage of PARP and caspase-3 induced by Fas was also reduced. In contrast, the cleavage of caspase-8 remained unaffected in caspase-4 DN cells, although caspase-8 inhibitor could rescue Fas-induced cell death. Collectively, these data suggest that caspase-4 activity is required for Fas-induced cell apoptosis and caspase-4 may act upstream of PARP and caspase-3 and downstream of caspase-8. Overall, we demonstrate that NF-κB can mediate Fas-induced apoptosis through caspase-4 protease, indicating that caspase-4 is a new mediator of NF-κB pro-apoptotic pathway in neuroblastoma cells.

Based on high sequence homology, there are six members in the caspase-1 subfamily: caspases 1, 4, 5, and 13 in humans and caspases 1, 11, and 12 in mice. Only caspase-1 is known to activate interleukin-1beta and interleukin-18, and caspase-11 activates pro-caspase-1 in vivo. Almost nothing is known about caspases 4, 5, and 13. Here we report a sensitive and specific polymerase chain reaction system to analyze closely related genes. We employed this system to analyze the gene expression and regulation of human caspases 1, 4, 5, and 13, demonstrating that they have different expression patterns in normal tissues and cell lines. Interferon-gamma strongly induced CASP1 and CASP5 but not CASP4 or CASP13 gene expression in HT-29 colon carcinoma cells. In contrast to the mRNA, interferon-gamma up-regulated caspase-1 but not caspase-5 protein. In the monocytic cell line THP-1, CASP1 mRNA and caspase-1 protein are expressed constitutively, and their levels were not increased by lipopolysaccharide, whereas both CASP5 mRNA and caspase-5 protein were induced by lipopolysaccharide. Caspase-1 subfamily members displayed different in vitro activities toward pro-caspases 1 and 3 and pro-interleukin-1beta. Our results demonstrate that caspase-1 and caspase-5 levels are modulated by interferon-gamma and lipopolysaccharide, respectively, and suggest that caspase-1 subfamily members are differentially regulated and may have distinct functions.

Purpose: An association between birth order and reduced unaided vision (a surrogate for myopia) has been observed previously. We examined the association between birth order and myopia directly in four subject groups. Methods: Subject groups were participants in (1) the Avon Longitudinal Study of Parents and Children (ALSPAC; UK; age 15 years; N = 4401), (2) the Singapore Cohort Study of Risk Factors for Myopia (SCORM; Singapore; age 13 years; N = 1959), (3) the Raine Eye Health Study (REHS; Australia; age 20 years; N = 1344), and (4) Israeli Defense Force Pre-recruitment Candidates (IDFC; Israel; age 16–22 years; N = 888,277). The main outcome was odds ratios (OR) for myopia in first-born versus non-first-born individuals after adjusting for potential risk factors. Results: The prevalence of myopia was numerically higher in first-born versus non-first-born individuals in all study groups, but the strength of evidence varied widely. Adjusted ORs (95% confidence intervals, CIs) were: ALSPAC, 1.31 (1.05–1.64); SCORM, 1.25 (0.89–1.77); REHS, 1.18 (0.90–1.55); and IDFC, 1.04 (1.03–1.06). In the large IDFC sample, the effect size was greater (a) for the first-born versus fourth- or higher-born comparison than for the first-born versus second/third-born comparison (p

To determine the risk factors for strabismus and amblyopia in young Singapore Chinese children.A total of 3009 children were recruited for the population-based cross-sectional Strabismus, Amblyopia and Refractive Error in Singaporean Preschoolers Study (STARS). Strabismus was defined as any tropia identified on cover test. Visual acuity was measured in children aged 30-72 months with a logMAR chart where possible and the Sheridan-Gardiner test if not. Amblyopia was defined based on visual acuity and refractive error or presence of strabismus or past/present visual axis obstruction. Parents completed questionnaires on family, prenatal and birth histories.Our study showed that 24 children aged 6-72 months (1.2%) had strabismus (20 with exotropia), and 20 children aged 30-72 months (0.8%) were amblyopic. After multivariate analysis, strabismus was associated with astigmatism ≥1.00 diopter (D; p = 0.03), amblyopia (p = 0.003), a sibling with strabismus (p 0.001), and families with lower parental education (p = 0.04). In addition to strabismus, amblyopia was associated with anisometropia ≥1.00 D (p 0.001) and astigmatism ≥1.00 D (p 0.001). No association was noted between either strabismus or amblyopia and prematurity, maternal age or smoking.This study highlights the importance of family history in strabismus, and the close associations between refractive error and strabismus with amblyopia. These factors play a more important role in young Singapore Chinese children.

c-Myc is an important mediator of apoptosis in cytokine- or serum-deprived cells and sensitizes various cell types to tumor necrosis factor alpha (TNF) cytotoxicity. However, downstream mediators of c-Myc-dependent apoptosis are largely unknown. In this study, we investigated whether one or more cyclins which, like c-Myc, are important regulators of the cell cycle are involved in TNF-induced apoptosis downstream of c-Myc. Cyclin D3 and c-Myc levels in HeLa and fibrosarcoma cells correlated with sensitivity of these cells to TNF-induced apoptosis, as both proteins were highly expressed in TNF-sensitive HeLa D98 cells and HT-1080 fibrosarcoma cells but not in their TNF-resistant counterparts, HeLa H21 and SS-HT-1080 cells, respectively. All other cyclins tested were equally expressed in all tumor cell lines. Reduction in the expression of c-Myc by dexamethasone or inhibition of the transcriptional activity of c-Myc by introduction of a dominant negative form of c-Myc into TNF-sensitive HeLa D98 cells strongly suppressed the expression of cyclin D3 (but none of the other cyclins) and rendered the cells resistant to TNF-induced apoptosis. Conversely, introduction of the c-myc gene into TNF-resistant, c-Myc- and cyclin D3-deficient HeLa H21 cells resulted in enhanced cyclin D3 expression and TNF killing. When cyclin D3 expression in HeLa cells was altered by sense or antisense cyclin D3 cDNA, there was a concomitant alteration in their susceptibility to TNF-induced apoptosis without any change in c-Myc levels. Overall, our results show that cyclin D3 sensitizes tumor cells to TNF-induced apoptosis and indicate that the expression of c-Myc and expression of cyclin D3 in HeLa and in HT-1080 fibrosarcoma cells are closely linked.

The respiratory burst is dependent on a source of glucose. We wished to investigate the effect of glucose on the superoxide production of circulating neutrophils. Superoxide production of neutrophils was significantly enhanced by glucose concentration of from 1 to 50 mmole/liter in the medium. The neutrophils from asthmatics in both the acute and remission phases showed greater production of superoxide than those of controls. When the neutrophils were made to undergo the respiratory burst, initially in the absence of glucose, and thereafter in the presence of 5 and 20 mmole/liter glucose, the rate of superoxide formation with higher glucose medium was decreased in the control cells but significantly increased in the cells of the acute asthmatics in remission. It is concluded that glucose as an energy source is potentially critical in determining the rate of the respiratory burst and that the neutrophils from asthmatic subjects in some way have an enhanced uptake or metabolism of this substrate. Glycemic status may then have some role in determining the amount of superoxide production, and therefore airway inflammation, in asthma.

PURPOSE. We aimed to determine the relationship between puberty and growth spurts with peak spherical equivalent (SE) or axial length (AL) velocity in Singapore schoolchildren. METHODS. In the Singapore Cohort Study of the Risk Factors for Myopia of 1779 schoolchildren, the longitudinal refractive and pubertal status of 892 boys and 887 girls from ages 6 to 14 years were assessed. The study sample included 1329 Chinese, 316 Malays, 114 Indians, and 20 children of other races. Information regarding puberty parameters, age of peak height velocity, age of menarche, and break of voice (BOV) was obtained. Peak velocity was defined as the greatest change in measurements over a period of 1 year. Tanner stage 1 for pubic hair or breast development, in boys and girls, respectively, at age 12 was categorized as ‘‘later puberty,’’ whereas stages 2 to 5 corresponded to ‘‘earlier puberty.’’ Refractive error was determined by cycloplegic autorefraction using the Canon RK-F5, and AL was measured using the A-scan biometry machine. RESULTS. The children were examined annually, and the mean number of visits was 5.7 6 1.3. Age of peak height velocity occurred earlier in girls than in boys (11.0 6 1.2 vs. 12.0 6 1.7 years, P < 0.001). Girls with earlier peak height velocity experienced peak AL velocity and peak SE velocity approximately half a year earlier than those with later puberty (mean age of 10.3 6 1.6 vs. 10.8 6 1.7 years, P < 0.001; and 10.0 6 1.5 vs. 10.6 6 1.25 years, P < 0.001, respectively). Similarly, boys who had earlier peak height velocity also achieved peak AL and peak SE velocity earlier than those who experienced later peak height velocity (mean age of 10.4 6 1.6 vs. 11.1 6 1.8 years, P < 0.001; and 10.1 6 1.5 vs. 10.6 6 1.7 years, P ¼ 0.01). Both girls and boys who had early peak height velocity had earlier age of onset of myopia than those with later peak height velocity (9.7 6 1.4 vs. 10.1 6 1.5 years for girls, P ¼ 0.04; and 9.9 6 1.5 vs. 10.4 6 1.6 years for boys, P ¼ 0.03). Myopia progression, in terms of AL velocity, also occurred earlier in boys and girls with earlier peak height velocity (10.2 6 1.5 vs. 11.0 6 1.9 for boys, P < 0.001; and 10.2 6 1.5 vs. 10.7 6 1.7 for girls, P ¼ 0.004, respectively). The associations were not significant when Tanner staging, age of menarche, or BOV was used to determine stage of puberty. CONCLUSIONS. Boys and girls with earlier peak height velocity experienced earlier peak SE and AL velocity, and age of myopia onset. Thus, variations in the onset and peak progression of myopia may be associated with height spurts. (Invest Ophthalmol Vis Sci. 2012;53:7961–7966) DOI:10.1167/ iovs.12-10402

To examine the pattern of myopia-related macular and optic disc changes in Singapore adults with high myopia (spherical equivalent ≤-6.00 diopters).Asian adults with high myopia from 3 population-based surveys.Adults 40 years and older (n = 359) with high myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated.The most common myopia-related macular finding in adults with high myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P.001). Ethnicity comparisons demonstrated the highest proportion of staphyloma (P = .04) among Malays, the highest proportion of peripapillary atrophy (P = .01) and disc tilt (P.001) among Chinese, and the largest cup-to-disc ratio (P .001) among Indians.Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic myopia appears to be dependent on the duration of disease and, thus, age of the individual.

As sciatica and low back pain are among the most common medical complaints, many studies have duplicated these conditions in animals. Chronic compression of the dorsal root ganglion (CCD) is one of these models. The surgery is simple: after exposing the L4/L5 intervertebral foramina, stainless steel rods are implanted unilaterally, one rod for each vertebra, to chronically compress the lumbar dorsal root ganglion (DRG). Then, CCD can be used to simulate the clinical conditions caused by stenosis, such as a laterally herniated disc or foraminal stenosis. As the intraforaminal implantation of a rod results in neuronal somal hyperexcitability and spontaneous action potentials associated with hyperalgesia, spontaneous pain, and mechanical allodynia, CCD provides an animal model that mimics radicular pain in humans. This review concerns the mechanisms of neuronal hyperexcitability, focusing on various patterns of spontaneous discharge including one possible pain signal for mechanical allodynia — evoked bursting. Also, new data regarding its significant property of maintaining peripheral input are also discussed. Investigations using this animal model will enhance our understanding of the neural mechanisms for low back pain and sciatica. Furthermore, the peripheral location of the DRG facilitates its use as a locus for controlling pain with minimal central effects, in the hope of ultimately uncovering analgesics that block neuropathic pain without influencing physiological pain.

PURPOSE. To describe the distribution and determinants of ocular biometric parameters in adult Singapore Indians. METHODS. A population-based, cross-sectional study was conducted on 3400 Indians aged 40 to 83 years residing in Singapore. Ocular components including axial length (AL), anterior chamber depth (ACD), and corneal radius (CR) were measured by partial coherence interferometry. Refraction was recorded in spherical equivalent (SE). RESULTS. After 502 individuals with previous cataract surgery were excluded, ocular biometric data on 2785 adults were analyzed. The mean AL, ACD, and CR were 23.45 ± 1.10, 3.15 ± 0.36, and 7.61 ± 0.26 mm, respectively. The mean AL/CR ratio was 3.08 ± 0.13. The mean AL was 23.53, 23.49, 23.35, and 23.25 mm in 40- to 49-, 50- to 59-, 60- to 69-, and 700 to 83-year age groups, respectively (P < 0.001). Men had significantly longer ALs than women (23.68 mm versus 23.23 mm, P < 0.001). In multivariate linear regression models, AL was found to be longer in adults who were taller (P < 0.001), better educated (University, P < 0.001), and more apt to spend time reading (P < 0.001). Increasing CR was associated with increasing height (P = 0.008). AL was the strongest determinant for refraction in all age groups, whereas lens nuclear opacity was a predictor in adults aged 60 to 83 years. CONCLUSIONS. The AL in Indians living in Singapore was similar to that of Malays in Singapore, but longer than that of Indians living in India. Time spent reading, height, and educational level were the strongest determinants of AL. AL was the strongest predictor of SE in all age groups.

To examine the association between body fatness indices and retinal vascular calibre in Singapore Chinese children.We recruited 136 Singapore Chinese children aged 6-16 years from the STARS (The Strabismus, Amblyopia and Refractive Error Study in Singaporean Chinese Preschoolers) Family study in 2008-2010. Anthropometric measurements including weight, height and triceps skinfold (TSF) and right eye retinal photographs were performed. TSF was measured with Holtain-Tanner calliper on the back of the arm and midway between the point of the acromoion and olecranon process while the arm was hanging relaxed. TSF and BMI threshold (cut-off points for overweight and obesity) were defined as 85th and above of age- and gender-specific TSF and BMI standard charts which were based on American representative survey data.The mean retinal arteriolar and venular calibres were 155.78 ? 15.02 ?m and 219.66 ? 21.88 ?m, respectively in the STARS Family study. Each standard deviation (SD) increase in TSF (4.49 mm) and BMI (3.52 kg/m(2)) was associated with a 2.94 ?m (p = 0.012) and a 3.40 ?m (p = 0.005) widening in retinal venular calibre, respectively. Compared with children with TSF and BMI below threshold, children with TSF and BMI above threshold had a 10.21 ?m (p = 0.001) and a 9.33 ?m (p = 0.021) increase in retinal venular calibre, respectively.Greater TSF and BMI are associated with wider retinal venular calibre in healthy children aged 6 years and above. These findings suggest a possible effect of abnormal body fatness indices on early retinal vascular changes that reflect microvasculature in children.

PURPOSE. Peripheral hyperopia was hypothesized to stimulate axial elongation. This study describes peripheral refraction and its associations with central refractive error in young Singapore Chinese children.METHODS. Two hundred fifty children aged 40 months or older recruited from the Strabismus, Amblyopia, and Refractive Error in Young Singapore Children study were included in this analysis. Peripheral refraction was measured after pupil dilation using an infrared autorefractor. A total of five measurements were captured: central visual axis and 15 and 30 eccentricities in the nasal and temporal visual fields.RESULTS. The mean age of the participants recruited was 83 +/- 36 months. There were 37 children with high and moderate myopia ( 1.0 D; 18.8%). Compared with the central axis, children with high and moderate myopia had relative hyperopia at all peripheral eccentricities (P < 0.001), whereas children with low myopia had relative hyperopia only at the temporal and nasal 30 degrees (P < 0.001), but not at the nasal and temporal 15 degrees. Children with emmetropia and hyperopia had peripheral relative myopia at all eccentricities (P < 0.001). A significant correlation between the nasal and temporal refractive error at 30 degrees was noted (Spearson's correlation coefficient = 0.85, P < 0.001).CONCLUSIONS. Young myopic Singapore Chinese children had relative hyperopia in the periphery. This study substantiates previous studies in older children and in Caucasian subjects. (Invest Ophthalmol Vis Sci. 2011; 52:1181-1190) DOI:10.1167/iovs.10-5601

PURPOSE To evaluate the influence of refractive error and axial length (AL) on retinal vascular network geometry measurements in an adult Asian population. METHODS This was a population-based, cross-sectional study on 2882 persons with diabetes in the Singapore Malay Eye Study. Spherical equivalent refraction was assessed using an autokeratorefractometer and subjective refraction. AL retinal vascular caliber, tortuosity, and branching characteristics were quantified from retinal fundus photographs using a semiautomated computer-assisted program according to a standardized protocol. RESULTS In multivariate analyses adjusting for age, sex, education, smoking, blood pressure, diabetes status, and antihypertensive medication use, longer AL and more myopic refraction were associated with narrower retinal arterioles and venules (P ≤ 0.001 for all) and less tortuous (straighter) arterioles (P < 0.001 for both). Longer AL and more myopic refraction were also associated with increased branching coefficients in both arterioles (P < 0.001 for both) and venules (P = 0.02 and P < 0.001, respectively). Longer AL and more myopic refraction were associated with more acute branching angles in arterioles (P < 0.001 for both) but not venules. CONCLUSIONS Myopic refractive errors and longer AL are associated with narrower retinal arterioles and venules, less tortuous arterioles, and increased branching coefficients in both arterioles and venules. These findings provide insights into ocular blood flow in myopia and also suggest that future studies evaluating these retinal parameters should account for the influence of AL and refractive error.

PURPOSE To examine changes in lens power during refractive development in Singapore Chinese children. METHODS Children aged six to nine years from three Singapore schools were invited to participate in the Singapore Cohort study Of the Risk factors for Myopia (SCORM) study. Cycloplegic refractions and biometry were measured annually in the schools over a five year period from 1999. Children were classified into five refractive error groups: persistent hyperopia, emmetropizing hyperopia, persistent emmetropia, newly developed myopia, or persistent myopia. Crystalline lens power was calculated using Bennett's formula. The rate of change per year across the refractive groups was adjusted for age and sex using General Linear Models. RESULTS There were 1747 children with at least three sets of measurements for lens power calculations. The mean age at baseline was 7.94 ± 0.84 years and the mean spherical equivalent refraction was -0.41 ± 1.71 diopters (D). Lower lens power and lower lens thickness were associated with persistent myopia. As expected, the newly developed myopes and the persistent myopes showed the largest changes in axial length (AL). Changes in lens power and thickness at follow-up were similar in all refractive groups, except for the newly developed myopes, who showed significantly greater decreases in lens power (0.36 vs. 0.29 D/year; P < 0.001) and lens thickness (0.015 vs. 0.0003 mm/year; P < 0.001) than the persistently emmetropic group. CONCLUSIONS Newly developed myopes showed a significantly greater decrease in lens power than other refractive groups, which may be linked to rapid changes in AL and refraction that occur around the onset of myopia.

Purpose. To determine variations in eye volume, surface area, and shape with refractive error in young children using a three-dimensional magnetic resonance imaging (MRI) model. Methods. A subset of Singaporean Chinese boys enrolled in the population-based Strabismus, Amblyopia, and Refractive Error in Singapore (STARS) study underwent MRI using a 3-Tesla whole body scanner with a 32-channel head coil. Eye volume and surface area were measured. Eye shape was assessed qualitatively from the three-dimensional models and quantitatively by measurement of the longitudinal axial length (LAL), horizontal width, and vertical height along the cardinal axes. Results. One hundred thirty-four eyes of 67 subjects (mean age, 77.9 ± 3.9 months) were analyzed. The mean spherical equivalent (SE) refraction was 0.65 ± 0.92 D (range, -2.31 to 4.13 D). More myopic SE was associated with larger surface area (-20.59 [-37.09 to -4.10] mm 2 /D; P = 0.01) but not volume. In age-height adjusted models, more myopic SE was associated with longer LAL (-1.94 [-2.47 to -1.41] mm/D; P < 0.001) and greater width (-1.12 [-1.26 to -0.99] mm/D; P < 0.001) but not height (0.64 [-2.55 to 3.82] mm/D; P = 0.70). In nonmyopic subjects, less hyperopic SE was associated with longer AL (-0.40 [-0.71 to -0.10] mm/D; P = 0.01), width (-0.59 [-0.84 to -0.34] mm/D; P < 0.001), and height (-0.40 [-0.64 to -0.17] mm/D; P = 0.001). In three-dimensional models, myopic eyes conformed to an axial elongation model with a prolate profile in the axial plane, whereas nonmyopic eyes showed global expansion. Conclusions. Eye surface area increases with myopia in young children. Eye shape is different in myopia, even in its early stages. Axial globe enlargement occurs in myopic eyes leading to a prolate shape, whereas nonmyopic eyes enlarge globally in length, width, and height. © 2011 The Association for Research in Vision and Ophthalmology, Inc.

PURPOSE. Relative peripheral hyperopia has been associated with central myopia. This study was conducted to determine whether baseline relative peripheral hyperopia is associated with an increased risk of developing myopia or myopia progression in young Singapore Chinese children. METHODS. One hundred eighty-seven children who participated in the Peripheral Refraction in Preschool Children (PREP) Study at baseline underwent a follow-up examination. Autorefraction was performed at five eccentricities with an infrared autorefractor after cycloplegia: central axis and 15° and 30° eccentricities in the nasal and temporal visual fields. The primary outcomes were development of myopia among children who were nonmyopic at baseline, and myopia progression in those who were myopic at baseline. RESULTS. The mean age of the children at baseline was 7.2 ± 3.0 years, and the mean duration of follow-up was 1.26 years. At baseline, 96 children were myopic (mean central spherical equivalent [SE] -2.75 ± 1.72 D) and 91 were nonmyopic (mean central SE 0.76 ± 0.81 D). Baseline relative peripheral hyperopia was not associated with a greater likelihood of becoming myopic or myopia progression. At follow-up, children who remained nonmyopic (n = 24) retained relative peripheral myopia at all eccentricities, whereas those who became myopic (n = 67) developed relative peripheral hyperopia at the nasal (+0.44 ± 0.72 D) and temporal 30° (+0.13 ± 0.74 D). The mean change in central SE was -1.51 ± 0.63 D/y for children who developed myopia, -0.82 ± 0.76 D/y for children who were myopic at baseline, and -1.05 ± 0.80 D/y for all children. CONCLUSIONS. Baseline peripheral refraction did not predict the subsequent onset of myopia or influence the progression of myopia.

To determine the prevalence and risk factors for refractive errors in middle-aged to elderly Singaporeans of Indian ethnicity.A population-based, cross-sectional study of Indians aged over 40 years of age residing in Southwestern Singapore was conducted. An age-stratified (10-year age group) random sampling procedure was performed to select participants. Refraction was determined by autorefraction followed by subjective refraction. Myopia was defined as spherical equivalent (SE)-0.50 diopters (D), high myopia as SE-5.00 D, astigmatism as cylinder-0.50 D, hyperopia as SE0.50 D, and anisometropia as SE difference1.00 D. Prevalence was adjusted to the 2000 Singapore census.Of the 4497 persons eligible to participate, 3400 (75.6%) were examined. Complete data were available for 2805 adults with right eye refractive error and no prior cataract surgery. The age-adjusted prevalence was 28.0% (95% confidence interval [CI], 25.8-30.2) for myopia and 4.1% (95% CI, 3.3-5.0) for high myopia. There was a U-shaped relationship between myopia and increasing age. The age-adjusted prevalence was 54.9% (95% CI, 52.0-57.9) for astigmatism, 35.9% (95% CI, 33.7-38.3) for hyperopia, and 9.8% (95% CI, 8.6-11.1) for anisometropia. In a multiple logistic regression model, adults who were female, younger, taller, spent more time reading and writing per day, or had astigmatism were more likely to be myopic. Adults who were older or had myopia or diabetes mellitus had higher risk of astigmatism.In Singapore, the prevalence of myopia in Indian adults is similar to those in Malays, but lower than those in Chinese. Risk factors for myopia are similar across the three ethnic groups in Singapore.