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Abstract Background The study was designed to investigate microvascular and morphological changes in retinal vein occlusion (RVO) using multimodal imaging after intravitreal ranibizumab (IVR) with or without triamcinolone acetonide (IVTA) injections. Methods This was a retrospective and observational study. Fifty patients (52 eyes) diagnosed with RVO were enrolled. Best corrected visual acuity (BCVA), ophthalmoscopy, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SDOCT), and optical coherence tomography angiography (OCTA) were employed sequentially both before treatment and at the last visit after treatment. Results The mean logMAR VAs in BRVO eyes decreased significantly after treatment (P = 0.029). OCTA showed there was a significant difference in foveal avascular zone (FAZ) in BRVO eyes (P = 0.024), superificial foveal vessel density in both CRVO (P = 0.0004) and BRVO eyes (P = 0.02155). OCT showed the foveal thickness had significant differences after treatment in both CRVO (P

Abstract Background The aim of this study was to evaluate the effectiveness of team-, case-, lecture-, and evidence-based learning (TCLEBL) methods in cultivating students’ clinical and research abilities, as compared to traditional lecture-based learning (LBL) approaches. Methods Forty-one medical postgraduates were divided into two groups, a TCLEBL group and an LBL group. Teaching effectiveness was evaluated through student- and teacher-feedback questionnaires, scores from theoretical examinations and written literature reviews, and student learning burdens. Results Compared to the LBL approach, both teachers and students were more satisfied with the TCLEBL model (p

Abstract Background To describe the risk factors and clinical characteristics of macular epiretinal membrane (MEM) disease in patients up to the age of 40 years and to evaluate the therapeutic effect of IVTA on MEM. Methods Clinical records were reviewed and the etiology of each case and the age distribution data were collected in this retrospective, cohort study. The clinical characteristics of MEM and the factors affecting VA were analyzed. Additionally, we contrasted the effects of MEM peeling with and without intravitreal triamcinolone acetonide on visual acuity (VA) and central foveal thickness (CFT). Results In young patients, the incidence of partial posterior vitreous detachment (P-PVD) was considerably higher in IMEM than SMEM (P = 0.007). Furthermore, patients with stage 3 MEM had lower BCVA values than patients with stage 4 MEM (P

Abstract Background Intravitreal injection of anti-vascular endothelial growth factor (VEGF) has become first line therapy for diabetic macular edema. This study evaluated the efficacy and safety of intravitreal injection of Ranibizumab (IVR) as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy (PDR) patients with vitreous hemorrhage. Methods This pilot randomized controlled trial included 48 eyes with vitreous hemorrhage resulting from active PDR. Eyes were treated with IVR 1 or 3 days before vitrectomy or a sham subconjunctival injection 3 days before surgery. The occurrence of new tractional retinal detachment (TRD), total operation time, and intraoperative findings were compared. The concentrations of VEGF and connective tissue growth factor (CTGF) in aqueous humor and plasma collected at the time of IVR and vitrectomy were determined by ELISA. Results None of the patients who received IVR experienced new TRD. Ranibizumab injection improved intraoperative outcomes. The mean concentrations of VEGF in aqueous humor were significantly lower after than before IVR in patients who received IVR 1 and 3 days before surgery (P

PurposeWe sought to reveal the expression profiles of transfer RNA-derived small RNAs (tsRNAs) and microRNAs (miRNAs) in the vitreous humor of patients with proliferative diabetic retinopathy (PDR).MethodsVitreous humor samples were obtained from PDR patients and a control group for this study. Sequencing of small RNAs was conducted to assess the expression profiles of tsRNAs and miRNAs in both groups, which was followed by validation using reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). Bioinformatics analyses were conducted to predict the target genes and their potential biological functions and signaling pathways.ResultsA total of 37 tsRNAs and 70 miRNAs with significant differences were screened out from the vitreous humor samples of PDR patients compared to controls. Following validation by RT-qPCR, the target genes of the validated tsRNAs and miRNAs were predicted, and Gene Ontology analysis indicated that the target genes of the tsRNAs were most enriched in the cellular macromolecule metabolic process, cytoplasm, and ion-binding, while those of the miRNAs were most abundant in the regulation of major metabolic process, cytoplasm, and protein-binding. In addition, Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that the target genes of said tsRNAs and miRNAs were most enriched in the adenosine monophosphate-activated protein kinase signaling pathway and Th17 cell differentiation, respectively.ConclusionsThe present study identified altered tsRNAs and miRNAs in vitreous humor samples of PDR patients, which may play important roles in the pathogenesis of PDR and could be considered potential therapeutic targets in the treatment of PDR.

Abstract Dust can be regarded as environmental medium that indicates the level and spatial distribution of polycyclic aromatic hydrocarbons (PAHs) coming from different pollution sources. In this study, samples including road dust, roof dust, and bare soil near an iron and steel enterprise (ISE) in Laiwu city of North China were collected. To assess the environment impact, atmosphere particulates and one flue dust from a coking plant were simultaneously sampled. Sixteen USEPA PAHs were detected quantitatively by Gas Chromatography Mass Spectrometry (GC–MS). A laser particle size analyzer was used to obtain the grain size of the dust particle samples. The results showed that PAH concentrations displayed great variability in the dust samples. The ∑16PAHs concentration was found to be between 0.460 and 46.970 μg/g (avg ± sd 10.892 ± 1.185 μg/g) in road dust, between 0.670 and 17.140 μg/g (avg ± sd 6.751 ± 0.692 μg/g) in roof dust, and 13.990 ± 1.203 μg/g in bare soil. In the environment atmosphere sites, the ∑16 PAHs value in PM2.5 constituted a very large proportion of PM10, indicating that PAHs in finer particle sizes should be given greater emphasis. The ∑16PAHs concentration was relatively high in the area close to the ISE because of the great impact of the ISE industrial activities. PAH concentration curves were similar, and the most abundant individual PAHs in the atmosphere sites were BbF, BkF, and Flu, and BbF, BkF, and Chry in dusts. Toxicity analysis revealed that PAHs with four rings, including carcinogenic PAHs, were the dominant pollutants in the studied area. The toxic equivalency value (TEQBaP), the carcinogenic health risk assessment value recommended by the US EPA, was calculated for seven carcinogenic PAHs, revealing that they account for more than 93.0% of the total TEQBap of the 16 PAHs and indicating the major toxic equivalent concentration contributor. Incremental lifetime cancer risk (ILCR) estimation results showed that PAHs tended to bring about great health risks through skin contact, followed by ingestion and inhalation. By comparison, road dust exhibited greater carcinogenic risks than roof dust, and bare soil may undergo heavier pollution. Therefore, the results of this study would be helpful in the effort to understand the PAHs pollution from the steel industry, which will provide some guidance for the probabilistic assessment of local health risks.

Abstract Background This study aimed to investigate the benefits and challenges of the flipped classroom combined with team-, case-, lecture- and evidence-based learning (FC-TCLEBL) for ophthalmology teaching for eight-year program students. Methods FC-TCLEBL and the traditional lecture-based classroom (LBC) were compared based on student and teacher feedback questionnaires, student learning burden, and scores on standardized tests as well as their effects on the abilities of clinical thinking, scientific research, active-learning, practical application, humanistic care and communication with patients. Results Both the students and teachers were more satisfied with the FC-TCLEBL model. More students in the FC-TCLEBL group agreed that the course helped them to develop skills in creative thinking, problem solving, and teamwork. Students in the FC-TCLEBL group spent significantly more time preparing for class than those in the LBC group, but the time spent on review was significantly lower in the FC-TCLEBL group. The students from the FC-TCLEBL group performed better in a post-test on diabetic retinopathy (DR) as compared to the LBC group. Conclusions FC-TCLEBL teaching model is effective and suitable for ophthalmology teaching.

Diabetic retinopathy (DR) is a major cause of blindness worldwide and may be non-proliferative (NPDR) or proliferative (PDR). To investigate the metabolomic and lipidomic characteristics of plasma in DR patients, plasma samples were collected from patients with type 2 diabetes mellitus (DR group) with PDR (n = 27), NPDR (n = 18), or no retinopathy (controls, n = 21). Levels of 54 and 41 metabolites were significantly altered in the plasma of DR patients under positive and negative ion modes, respectively. By subgroup analysis, 74 and 29 significantly changed plasma metabolites were detected in PDR patients compared with NPDR patients under positive and negative ion modes, respectively. KEGG analysis indicated that pathways such as biosynthesis of amino acids and neuroactive ligand-receptor interaction were among the most enriched pathways in altered metabolites in the DR group and PDR subgroup. Moreover, a total of 26 and 41 lipids were significantly changed in the DR group and the PDR subgroup, respectively. The panel using the 29-item index could discriminate effectively between diabetic patients with and without retinopathy, and the panel of 22 items showed effective discrimination between PDR and NPDR. These results provide a basis for further research into the therapeutic targets associated with these metabolite and lipid alterations.

PurposeChoroidal neovascularization (CNV) is the defining feature of neovascular age-related macular degeneration (nAMD). Gut microbiota might be deeply involved in the pathogenesis of nAMD. This study aimed to reveal the roles of the gut microbiome and fecal metabolome in a mouse model of laser-induced CNV.MethodsThe feces of C57BL/6J mice with or without laser-induced CNV were collected. Multi-omics analyses, including 16S rRNA gene sequencing and untargeted metabolomics, were conducted to analyze the changes in the gut microbial composition and the fecal metabolomic profiles in CNV mice.ResultsThe gut microbiota was significantly altered in CNV mice. The abundance of Candidatus_Saccharimonas was significantly upregulated in the feces of CNV mice, while 16 genera, including Prevotellaceae_NK3B31_group, Candidatus_Soleaferrea, and Truepera, were significantly more abundant in the controls than in the CNV group. Fecal metabolomics identified 73 altered metabolites (including 52 strongly significantly altered metabolites) in CNV mice compared to control mice. Correlation analysis indicated significant correlations between the altered fecal metabolites and gut microbiota genera, such as Lachnospiraceae_UCG-001 and Candidatus_Saccharimonas. Moreover, KEGG analysis revealed six pathways associated with these altered metabolites, such as the ABC transporter, primary bile acid biosynthesis and steroid hormone biosynthesis pathways.ConclusionThe study identified an altered fecal microbiome and metabolome in a CNV mouse model. The altered microbes, metabolites and the involved pathways might be associated with the pathogenesis of nAMD.

The AC/DC hybrid distribution network is one of the trends in distribution network development, which poses great challenges to the traditional distribution transformer. In this paper, a new topology suitable for AC/DC hybrid distribution network is put forward according to the demands of power grid, with advantages of accepting DG and DC loads, while clearing DC fault by blocking the clamping double sub-module (CDSM) of input stage. Then, this paper shows the typical structure of AC/DC distribution network that is hand in hand. Based on the new topology, this paper designs the control and modulation strategies of each stage, where the outer loop controller of input stage is emphasized for its two-control mode. At last, the rationality of new topology and the validity of control strategies are verified by the steady and dynamic state simulation. At the same time, the simulation results highlight the role of PET in energy regulation. Keywords: AC/DC hybrid distribution network, Power electronic transformer (PET), Clamping double sub-module (CDSM), Energy router

AIM: To explore the clinical feature and genetic etiology of a Chinese Knobloch syndrome family. METHODS: Ocular examinations and magnetic resonance imagings (MRIs) were performed on the family. Whole exome sequencing was conducted on the two patients. Sanger sequencing was utilized to validate the presence of variation in the family as well as in 100 normal controls. Real-time quantitative polymerase chain reaction (PCR) was used to detect the expression level of COL18A1 in peripheral blood lymphocytes of the patients and normal carriers. RESULTS: The affected subjects presented with vision loss, exotropia, cataracts, retinal detachment, and other complications. A homozygous c.4759_4760delCT (p.Leu1587ValfsX72) mutation (rs398122391) in COL18A1 was identified in the two patients, cosegregating with the phenotypes, and did not be detected in 100 normal controls. This mutation caused significant decreased expression of COL18A1 mRNA in the patients. CONCLUSION: The findings strongly indicate that this mutation is the disease-causing mutation. Moreover, this is the first Knobloch syndrome pedigree reported in the Chinese population.

Download ash and emission dust samples were collected from sintering, coking, ironmaking and steelmaking processes of iron and steel enterprises in Laiwu. Sixteen kinds of polycyclic aromatic hydrocarbons (PAHs) in the United States Environmental Protection Agency (USEPA) priority controlled lists were quantitatively analyzed using Gas Chromatography-Mass Spectrometer (GC-MS). Laser particle size analyzer was used to obtain the distribution pattern of download ash. It was found that the diameter distribution pattern from four production processes was quite different. The proportion of fine particulate (0−2.5 μm) was the highest (72.62%) in the steelmaking refining process, and was 28.962% in the ironmaking process. Moreover, the particle size in download ash from steelmaking refining is all less than 10 μm and that from the ironmaking process was 52.92%. The medium-sized particles (10−100 μm) were dominant in sinter and coking download ashes. The total PAHs (∑16PAHs) mass concentration ranged from 0.49 ± 0.06 to 69.63 ± 5.57 μg·g−1 in download ash samples, and varied from 2.815 ± 0.253 to 19.429 ± 2.545 μg·m−3 in emission dust samples. The ∑16PAHs values were both largest in download ash and dust emission from the coking process (69.63 ± 5.57 μg·g−1 and 19.429 ± 2.545 μg·m−3, respectively). The most abundant individual PAHs were benzo[b]fluoranthene, benzo[k]fluoranthene, phenanthrene, benzo[a]anthracene in ash samples, and benzo[a]anthracene, benzo[k]fluoranthene, benzo[b]fluoranthene and indeno[1,2,3-cd]pyrene in emission dust samples. Dominant compounds were high-molecular weight (four- to six-ring) PAHs in both ash and dust samples. The concentration order of individual compounds in PM10 and PM2.5 in ambient air around the steel plant was completely consistent with each other, and the concentration of ∑16PAHs was the highest in the steel plant and lowest in Daqin village because of upwind of the steel plant. The concentrations of benzo[b]fluoranthene and fluoranthene in ambient air were comparatively high, and were in accordance with the higher concentration of the two monomers in the download ash samples, which suggested that the effect of the emission flue gas from the steel plant on ambient air was necessary to concern.

AIM: To evaluate the incidence and risk factors of hypotony in patients with blunt ocular trauma. METHODS: The medical records of 145 patients with blunt ocular trauma were reviewed. Hypotony was defined as an average intraocular pressure (IOP) of 5mmHg or less for three times.RESULTS: Among these 145 patients, hypotony was noted in 10 (6.9%) patients. The rate of hypotony in patients with ciliochoroidal detachment was 66.7% (2 out of 3 eyes), and 5.6% (8 out of 142 eyes) in patients without ciliochoroidal detachment，the difference was statistically significant（P=0.003）. The rate of hypotony in patients with traumatic retinal detachment was 18.5% (5 out of 27 eyes), and 4.2% (5 out of 118 eyes) in patients without traumatic retinal detachment, the difference was statistically significant (P=0.026). The rate of hypotony in the patients with anterior proliferative vitreoretinopathy was 42.9% (3 out of 7 eyes) and 5.1% (7 out of 138 eyes) in the patients without anterior proliferative vitreoretinopathy, the difference was statistically significant（P=0.002）.CONCLUSION: Ocular hypotension is a complication of blunt ocular trauma. The risk factors include ciliochoroidal detachment, traumatic retinal detachment, and anterior proliferative vitreoretinopathy.

We conducted a meta-analysis of published retrospective studies and compared the effectiveness of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IERM). The results revealed that patients in the IERM+ILM peeling group had better BCVA after surgery within 12 months than those in IERM peeling group. But patients in the IERM peeling group showed better BCVA in the 18th month. More retrospective studies or randomized controlled trials are required to investigate and compare the long-term effect of IERM removal with and without ILM peeling.

Background: The prognostic value and immune significance of T-cell proliferation regulators (TCRs) in hepatocellular carcinoma (HCC) have not been previously reported. This study aimed to develop a new prognostic model based on TCRs in patients with HCC. Method: This study used The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) and International Cancer Genome Consortium-Liver Cancer-Riken, Japan (ICGC-LIRI-JP) datasets along with TCRs. Differentially expressed TCRs (DE-TCRs) were identified by intersecting TCRs and differentially expressed genes between HCC and non-cancerous samples. Prognostic genes were determined using Cox regression analysis and were used to construct a risk model for HCC. Kaplan-Meier survival analysis was performed to assess the difference in survival between high-risk and low-risk groups. Receiver operating characteristic curve was used to assess the validity of risk model, as well as for testing in the ICGC-LIRI-JP dataset. Additionally, independent prognostic factors were identified using multivariate Cox regression analysis and proportional hazards assumption, and they were used to construct a nomogram model. TCGA-LIHC dataset was subjected to tumor microenvironment analysis, drug sensitivity analysis, gene set variation analysis, and immune correlation analysis. The prognostic genes were analyzed using consensus clustering analysis, mutation analysis, copy number variation analysis, gene set enrichment analysis, and molecular prediction analysis. Results: Among the 18 DE-TCRs, six genes (DCLRE1B, RAN, HOMER1, ADA, CDK1, and IL1RN) could predict the prognosis of HCC. A risk model that can accurately predict HCC prognosis was established based on these genes. An efficient nomogram model was also developed using clinical traits and risk scores. Immune-related analyses revealed that 39 immune checkpoints exhibited differential expression between the high-risk and low-risk groups. The rate of immunotherapy response was low in patients belonging to the high-risk group. Patients with HCC were further divided into cluster 1 and cluster 2 based on prognostic genes. Mutation analysis revealed that HOMER1 and CDK1 harbored missense mutations. DCLRE1B exhibited an increased copy number, whereas RAN exhibited a decreased copy number. The prognostic genes were significantly enriched in tryptophan metabolism pathways. Conclusions: This bioinformatics analysis identified six TCR genes associated with HCC prognosis that can serve as diagnostic markers and therapeutic targets for HCC. [ABSTRACT FROM AUTHOR]