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Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P Mycoplasma infection might be a predisposing factor for patients with keratitis.

Purpose The purpose of this study was to evaluate the efficacy of a novel double-docking technique, incorporating the use of femtosecond laser arcuate keratotomy (FSAK) in correcting low-degree astigmatism and Malyugin ring, in a patient with intraoperative floppy iris syndrome (IFIS). Methods A case report of a 72-year-old man with grade 4 cataract, low-degree astigmatism (

Background Neurotrophic keratopathy (NK) is a potentially sight-threatening condition caused by impairment in the trigeminal corneal innervations with decrease or loss of corneal sensitivity. This prospective study aimed to evaluate the outcomes of surgical neurotization of the cornea using ipsilateral supratrochlear nerve transfer in patients with herpes-induced NK. Methods An ophthalmologist and a plastic surgeon performed an interdisciplinary corneal neurotization in 13 eyes of 13 patients after preoperative exclusion of forehead sensation impairment. A 3-cm supra-eyebrow incision allowed for microsurgical supratrochlear nerve dissection, and a subconjunctival tunneling was performed for the nerve transfer. Neurotrophic keratopathy was assessed preoperatively and every 3 months postoperatively using slit-lamp microscopy, the corneal sensitivity test, specular microscopy, and in vivo confocal microscopy. Results The surgeries had no major complications. The average disease duration from cornea denervation to surgery was 15.2 years. The mean follow-up duration was 18.5 ± 6 months. The symptoms exhibited subjectively improved visual acuity, and objectively improved visual analog scale and NK grading. The subepithelial corneal nerve plexus was found at 9 months postoperatively. The corneal thickness decreased and the corneal endothelial count increased postoperatively. Conclusions This is the largest series of corneal neurotization using direct ipsilateral supratrochlear nerve transfer. It is a minimally invasive method to restore corneal sensitivity and treat NK successfully within 1 year without a sural nerve graft. A long-term follow-up is needed for further assessment.

Obesity contributes to multiple systemic disorders, however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged ≥18 years) with a diagnostic code of obesity or morbid obesity registered in the Longitudinal Health Insurance Database (LHID) 2000 and LHID2005 from 1 January 2001 to 31 December 2010 were included. All adults were traced until the diagnosis of OAG, the occurrence of death, or 31 December 2013. Risk of OAG was significantly higher in obese adults than in non-obese adults after multivariable adjustment (adjusted hazard ratio (aHR): 1.43 (95% confidence interval (CI) 1.11–1.84)/aHR: 1.54 (95% CI 1.23–1.94) in the LHID2000/LHID2005). Both databases demonstrated that young obese adults (aged ≤40 years) had a remarkably increased risk of OAG compared with young non-obese adults (aHR 3.08 (95% CI 1.82–5.21)/aHR 3.81 (95% CI 2.26–6.42) in the LHID2000/LHID2005). This two-database matched-cohort study suggests that obese adults have an increased risk of OAG. In young adults, in particular, obesity could be a potential risk factor of OAG.

Treatment of grating stimulation has been used in amblyopia for decades, but high dropout rate and inconvenience for daily practice occur in previous studies. We developed a home-based portable system with rotating grating stimulation on a tablet. Thirty anisometropic amblyopic children were randomly allocated into the control or Grating group. They drew contour of the picture under patch of a better eye for 6 months. Best-corrected visual acuity (BCVA), grating acuity (GA), and contrast sensitivity (CS) were assessed at the baseline, 1st, 2nd, 3rd, and 6th months of training. All participants completed the 6-month training. Patched eyes of both groups exhibited no difference. Trained eyes of the control group had significantly slight improvement in BCVA and GA. In particular, the Grating group exhibited significantly higher BCVA, GA, and CS compared with those of the control group at the 3rd and 6th months of training. Moreover, percentage of the Grating group with great improvement (BCVA ≥ 0.3 or CS ≥ 0.3) was significantly larger than those of the control group at the 3rd or 6th months of training. The portable grating stimulation system demonstrates its trainability by no dropout and effectiveness by significant improvements in all assessments through a well experimental design.Trial Registration: ClinicalTrials.gov NCT04213066, registered 30/12/2019, https://clinicaltrials.gov/ct2/show/NCT04213066.

Purpose We sought to analyze the incidence and risk of noninfectious uveitis (NIU) among postdelivery women with a history of pre-eclampsia/eclampsia (PEE). Design Population-based retrospective matched cohort study. Methods All participant data were retrieved from the Longitudinal Health Insurance Database 2005. Two thousand seventy-three postdelivery women ≥20 years of age were diagnosed with PEE between January 1, 1997 and December 31, 2012 and were included in the study. We traced the occurrence of NIU during 5 years of follow-up. The primary outcome measure was the occurrence of NIU with the use of anti-inflammatory drugs and adjudication by an ophthalmologist. Results NIU occurred in 14 of 2073 (0.7%) postdelivery women with PEE. The incidence rate of NIU was 1.5 and 0.5 per 1000 person-years among postdelivery women with and without PEE, respectively (incidence rate ratio 2.96 [95% confidence interval 1.48–5.90]; P = .002). Postdelivery women with PEE demonstrated a significant increase in the cumulative incidence of NIU compared with those without PEE (P = .001). The risk of the occurrence of NIU was significantly higher in the PEE group than in the non-PEE group (adjusted hazard ratio 2.96 [95% CI 1.48–5.92]; P = .002) after adjusting for age, income, urbanization, and comorbidities. Conclusions This is the first study to substantiate an association between PEE and NIU. Our results suggest that PEE could be a potential risk factor for the occurrence of NIU among postdelivery women.

Background/purpose: Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan. Methods: We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed. Results: Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy. Conclusion: Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality. Keywords: ICU, Hospital-wide computerized antimicrobial approval system, Hospital-associated infections, On-the-spot education

This study was to investigate the anti-angiogenic effect of hexahydrocurcumin (HHC) to evaluate gene (p-basic fibroblast growth factor (bFGF)-SAINT-18 & p-vascular endothelial growth factor (VEGF)-SAINT-18 complex)-induced corneal neovascularization (CorNV) in rats. CorNV was induced in 24 eyes of 24 rats. Four groups (Group A: 0 μg, B: 0.01 μg, C: 0.1 μg, and D: 1 μg) of HHC were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus at temporal side. The 1 μg of p-bFGF-SAINT-18 & p-VEGF-SAINT-18 complex were prepared and implanted into the rat corneal stroma 1.5 mm from the limbus at the same side. Inhibition of CorNV was observed and quantified from day 1 to day 60. bFGF and VEGF protein expression were analyzed by biomicroscopic examination, western blot analysis, and immunohistochemistry. Subconjunctival injection by 1 μg HHC successfully inhibited gene-induced CorNV in rats. bFGF and VEGF protein expression were reduced after 6 days. Meanwhile, the reduction of HLA-DR expression was detected. Our study showed that the HHC might provide an important anti-angiogenesis factor to inhibit CorNV development at the corneal experimental angiogenesis model.

We aim to assess the feasibility of topography-guided laser in situ keratomileusis (TOPOLINK) for correcting pre-existing and surgical-induced astigmatism. A retrospective, single center cohort study was conducted. Patients with pre-existing irregular myopic astigmatism were recruited into the primary group and those with irregular myopic astigmatism following laser in situ keratomileusis (LASIK) were recruited into the enhancement group. The changes in uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), maximum astigmatism, spherical equivalent (SE) and patient satisfaction were recorded. The Chi-square test, Mann&ndash, Whitney U test and Generalized Linear Mixed Model were utilized for the analysis in the current study. A total of 18 eyes were studied in the primary group and 14 eyes were examined in the enhancement group. One year postoperatively, the UCVA, BCVA, maximum astigmatism and SE improved significantly in both the primary and the enhancement groups (all p &lt, 0.05). The UCVA (p = 0.046) and SE (p = 0.003) were worse in the primary group preoperatively but became similar in both groups postoperatively, while the BCVA and maximum astigmatism remained identical between groups throughout the study period (all p &lt, 0.05). In addition, the rate of high and moderate satisfaction reached 90.0% in the primary and the enhancement groups, without significant differences (p = 0.871). In conclusion, the TOPOLINK showed high predictability and will contribute to similar outcomes between primary and postoperative irregular myopic astigmatism concerning visual acuity, refractive status and subject satisfaction.

To prevent scoliosis development at early stage of growth in elementary school students, we assessed how body posture-namely the school bag carrying method and head position-can affect the morphology of the spinal column...

Introduction: We aimed to determine the prevalence and severity of myopia in suburban schoolchildren. The refractive error, best corrected visual acuity (BCVA) and other ocular indices of 6069 schoolchildren (aged 6 to 15 years) from elementary and junior high schools in Chiayi County, Taiwan were examined in 2013-2015. Materials and Methods: Spherical equivalent (SE) was stratified into 4 categories: emmetropia, mild myopia, moderate myopia, and high myopia for underlying analysis. Chi-squared (χ2) tests were used to determine significant associations between myopia and BCVA and age levels. To compare statistical significance among different age levels, P values of Bonferroni tests were calculated. Receiver operating characteristic (ROC) curves and correlation coefficient were calculated to assess the correlation between myopia and each ocular index. Results: The youngest subject diagnosed with myopia was a 7-year-old. Myopia had significant associations with both BCVA and age levels (95% confidence intervals [CI] = 2.553, 2.713 and -0.284, -0.248, respectively), under P

BACKGROUND/PURPOSE: Postoperative infection is the most disastrous complication of penetrating keratoplasty (PK). Corneoscleral rim culture provided information regarding subsequent infections. Our aims were to identify the incidence of microbial contamination in donor corneas and to report the recovery of bacteria with two culture methods, i.e., conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (Fastidious Antibiotic Neutralization [FAN]). MATERIALS AND METHODS: A total of 118 patients underwent PK. Corneoscleral rim cultures were performed using aerobic/anaerobic culture cotton swabs (Transystem™, COPAN, Italia) with subsequent convention media and blood culture media (FAN bottle, BD BACTEC™, USA). The results of the different methods were reported and analyzed. RESULTS: Microorganisms were recovered from 24 in total 118 cases (20.3%, n = 118), 14 from blood culture media (FAN) (11.8%, n = 118), 9 from conventional culture media after aerobic/anaerobic cotton swabs (7.63%, n = 118), and 2 from fungus culture (1.69%, n = 118). The most commonly identified pathogen was coagulase-negative Staphylococcus (CoNS) (n = 13, 54.2%), and more isolates of CoNS and staphylococcus aureus were recovered from blood culture media (FAN) than those from conventional culture media after aerobic/anaerobic cotton swabs (13 vs. 4, P = 0.05). Conversely, more nonfermentative Gram-negative bacilli were recovered from conventional culture media after aerobic/anaerobic cotton swabs. None of the 24 cases with positive corneoscleral rim cultures reported ocular infection for the recipients in at least 6 months’ follow-up. CONCLUSION: The conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (FAN) did not yield identical isolates of bacteria. The blood culture media (FAN) could further yield Gram-positive bacteria in addition to those recovered from convention media. It seemed adding gentamicin and streptomycin could achieve bacteriostatic effect instead of the bactericidal effect. The administration of postoperative antibiotic in the recipient was suggested.

Purpose: The prevalence of myopia in school-age children and rural area in Taiwan has increased dramatically. The aim of this study was to explore the associated factors of myopia in rural ado-lescents. Methods: A cross sectional design with a rural junior high student was invited to partici-pate in this study. The relationship between refraction error (RE), spectacle fitting condition, and ocular alignment was determined by stereoacuity. The RE was determined using autorefractor. The ocular alignment was evaluated by cover-uncover test. Stereoacuity was measured by Titmus test. The examination about spectacle fitting included the lens power, lens transparency, pupil distance, frame size, and distortion of the frame. Multiple linear regression was used to determine the effect of the spectacle suitability and ocular alignment on the RE and stereoacuity. Results: The prevalence of myopia was 78% in a total of 338 adolescents, and the incidence of high myopia (≤-6 Diopter, D) accounted for 10.2%. Participant worn poor-fitting spectacles were found with more myopia (-3.95D vs -3.42D, p = 0.02). The exophoria or exotropia significantly increased RE (p < 0.01). The eye position was significantly associated with decreased steroacuity function (p = 0.03). Head position demonstrated to have a significant relationship with stereoacuity (p = 0.03). Conclusions: Good-fitting spectacles provided a good visual function and were associated with less RE condition. Exotrope showed a significant correlation with myopia and stereoacuity. The health care providers should be aware of the ocular alignment in myopic suffers.

Bevacizumab, a 149-kDa protein, is a recombinant humanized monoclonal antibody to VEGF. PEDF, a 50-kDa glycoprotein, has demonstrated anti-vasopermeability properties. In this study, we demonstrated that the combination of bevacizumab and plasmid pigment epithelium-derived factor-synthetic amphiphile INTeraction-18 (p-PEDF-SAINT-18) has a favorable antiangiogenic effect on corneal NV. Four groups (Group A: 0 μg + 0 μg, B: 0.1 μg + 0.1 μg, C: 1 μg + 1 μg, and D: 10 μg + 10 μg) of bevacizumab + p-PEDF-SAINT-18 were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus on the temporal side. Then, 1 μg of p-bFGF-SAINT-18 was prepared and implanted into the rat corneal stroma 1.5 mm from the limbus on the same side. The inhibition of NV was observed and quantified from days 1 to 60. Biomicroscopic examination, western blot analysis and immunohistochemistry were used to analyze the 18-kDa bFGF, 50-kDa PEDF and VEGF protein expression. No inhibition activity for normal limbal vessels was noted. Subconjunctival injection with the combination of bevacizumab and p-PEDF-SAINT-18 successfully inhibited corneal NV. The bFGF and PEDF genes were successfully expressed as shown by western blot analysis, and a mild immune response to HLA-DR was shown by immunohistochemistry. We concluded that the combination of bevacizumab and p-PEDF-SAINT-18 may have more potent and prolonged antiangiogenic effects, making it possible to reduce the frequency of subconjunctival.Bevacizumab, a 149-kDa protein, is a recombinant humanized monoclonalantibody to VEGF. PEDF, a 50-kDa glycoprotein, has demonstrated anti-vasopermeabilityproperties. In this study, we demonstrated that the combination of bevacizumaband plasmid pigment epithelium-derived factor-synthetic amphiphile INTeraction-18(p-PEDF-SAINT-18) has a favorable antiangiogenic effect on corneal NV. Four groups(Group A: 0 μg + 0 μg, B: 0.1 μg + 0.1 μg, C: 1 μg + 1 μg, and D: 10 μg + 10 μg) ofbevacizumab + p-PEDF-SAINT-18 were prepared and implanted into the ratsubconjunctival substantia propria 1.5 mm from the limbus on the temporal side. Then, 1 μgof p-bFGF-SAINT-18 was prepared and implanted into the rat corneal stroma 1.5 mm fromthe limbus on the same side. The inhibition of NV was observed and quantified from days1 to 60. Biomicroscopic examination, western blot analysis and immunohistochemistry wereused to analyze the 18-kDa bFGF, 50-kDa PEDF and VEGF protein expression. Noinhibition activity for normal limbal vessels was noted. Subconjunctival injection with thecombination of bevacizumab and p-PEDF-SAINT-18 successfully inhibited corneal NV.The bFGF and PEDF genes were successfully expressed as shown by western blot analysis,and a mild immune response to HLA-DR was shown by immunohistochemistry. Weconcluded that the combination of bevacizumab and p-PEDF-SAINT-18 may have morepotent and prolonged antiangiogenic effects, making it possible to reduce the frequency ofsubconjunctival bevacizumab administration combined with a relatively safe profile andlow toxicity.

Background: Foot self-care capability is an important factor in diabetic foot ulceration, especially in disadvantaged rural areas. Aim: To explore the causes of foot ulceration and practice foot self-care behaviors before and after diabetic foot ulceration. Method: A descriptive, retrospective design was conducted in a rural hospital in southern Taiwan. Results: A total of 49 participants with diabetic foot ulcers participated in this study. More than half were male (63.3%), still working in farming or fishing (61.2%). All participants were suffering from peripheral neuropathy (100%) and 71.5% showed claudication. Nearly two thirds reported not having received diabetic foot care education and 82% not having received regular vasculopathy assessment before the wound appeared. The common reasons for foot ulcers were unnoticed trauma, neglect of foot self-care. Conclusions: Most diabetic foot ulcers are preventable, since they result from a high prevalence of peripheral neuropathy, inadequate provision of vasculopathy assessment and inappropriate management of foot self-care. Community health nurses can focus care toward screen regularly for early diabetic foot problems.

A case of Stevens–Johnson syndrome in a healthy 58-year-old woman who underwent cataract surgery under topical anesthesia is reported. General skin erosions developed 2 hours after surgery. The patient's family doctor diagnosed that she was allergic to seafood. One month later, she underwent phacoemulsification surgery in the other eye. After surgery, she developed Stevens–Johnson syndrome with general skin lesions, erythema nodosa, genital mucosa erosion, oral ulcers, gastritis, and conjunctiva edema. The symptoms subsided 2 weeks later after immunotherapy. Although nonpreserved anesthesia (2% lidocaine) has seldom been reported to cause allergic reactions via the intravenous or the intramuscular route, it is possible that an intracameral injection of 0.2% lidocaine during cataract surgery can induce Stevens–Johnson syndrome. Careful evaluation of the patient's history and proper treatment were recommended to prevent additional complications.

Plantar fasciopathy (PF) is the most common cause of heel pain. Extracorporeal shockwave therapy (ESWT) improves the gait pattern in patients with PF. However, the effects of ESWT on the biomechanics of the ankle in these patients remains unclear. Sixteen participants were included in the present study. Of the 16 participants, 8 patients with PF were assigned to receive extracorporeal shockwave therapy, and 8 healthy participants served as an external control group. ESWT was applied to the PF group for 1500 pulses at an energy flux of 0.26 mJ/mm2 every 3 weeks for 3 sessions. The biomechanics of the ankle joints were then assessed using an isokinetic dynamometer, and a health-related quality of life questionnaire was administered at baseline and at the final follow-up session 12 weeks after the initial treatment. Passive stiffness was calculated and compared between the foot affected with PF, the opposite foot, and both feet of those in the healthy control group. The Kruskal-Wallis 1-way analysis of variance with repeated measures was performed, and statistical significance was considered present at the 5% (p ≤ .05) level. Ankle dorsiflexion in the affected limb increased from 14° ± 3° to 17° ± 2° after ESWT (p

The use of a recombinant adeno-associated viral (rAAV) vector carrying endostatin gene as an anti-angiogenesis strategy to treat corneal neovascularization in a mouse model was evaluated. Subconjunctival injection of recombinant endostatin-AAV was used to examine the inhibition of corneal neovascularization induced by silver nitrate cauterization in mice. The results showed that gene expression in corneal tissue was observed as early as 4 days after gene transfer and stably lasted for over 8 months with minimal immune reaction. Subconjunctival injection of a high-titer rAAV-endostatin successfully inhibited neovascularization. Immunohistchemistry staining of CD 31 and endostatin showed that the treatment significantly inhibits angiogenesis in cornea. We concluded that the rAAV was capable of directly delivering genes to the ocular surface epithelium by way of subconjunctival injection and was able to deliver sustained, high levels of gene expression in vivo to inhibit angiogenesis.

Ricinus communis agglutinin (RCA1) is one of the most important applied lectins that has been widely used as a tool to study cell surfaces and to purify glycans. Although the carbohydrate specificity of RCA1 has been described, the information obtained was mainly focused on inhibition of simple Galbeta1-related oligosaccharides and simple clusters. Here, all possible recognition factors of RCA1 of glycan binding were examined by enzyme-linked lectinosorbent (ELLSA) and inhibition assays, using known mammalian Gal/GalNAc carbohydrate structural units and natural polyvalent glycans. Among the glycoproteins (gps) tested and expressed as 50% nanogram inhibition, the high-density polyvalent Galbeta1-4GlcNAc (II) glycotopes occurring in natural gps, such as Pneumococcus type 14 capsular polysaccharide which is composed of repeating poly II residues, resulted in 9.0 x 10(4), 1.5 x 10(5), 2.3 x 10(4) and 2.1 x 10(4)-fold higher affinities to RCA1 than the monomeric Gal, linear I/II and Tri-antennary-II (Tri-II). Of the ligands tested and expressed as nanomoles of 50% inhibition, Tri-II was the best, being about 2, 4, 25.6 and 33.3 times better inhibitor than Di-II, II, I (Galbeta1-3GlcNAc) and Gal, respectively. From the results of this study, it is concluded that: (a) Galbeta1-4GlcNAc and other Galbeta1-related oligosaccharides are essential for lectin binding and their polyvalent form in macromolecules should be the most important recognition factor for RCA1; (b) the combining site of RCA1 may be a groove type, recognizing Galbeta1-4GlcNAc (II) as the major binding site; (c) its combining size may be large enough to accommodate a tetrasaccharide of beta-anomeric Gal at the non-reducing end and most complementary to human blood group I Ma active trisaccharide (Galbeta1-4GlcNAcbeta1-6Gal) and lacto-N-neotetraose (Galbeta1-4GlcNAcbeta1-3Galbeta1-4Glc); (d) RCA1 has a preference for the beta-anomer of Gal oligosaccharides with a Galbeta1-4 linkage > Galbeta1-6 > or = Galbeta1-3; (e) configuration of carbon-2, -3 -4 and -6 in Gal are essential for binding; (f) hydrophobic interaction in the vicinity of the binding site useful for sugar accommodation increases affinity. These results should be helpful for understanding the functional role of RCA1 and for characterizing glycotopes of mammalian complex carbohydrates.

Purpose: Gene delivery at high efficiency is crucial for cornea endothelial cell gene therapy. This study investigated the efficiency of gene transfer by recombinant adeno-associated virus (rAAV) in an organ culture system.Methods: Human cornea tissue was exposed to rAAV delivering green fluorescent protein (ss-rAAV2-CMV-GFP) for one hour and then cultured at 31ˆC for 2 weeks in a medium supplemented with growth factors. Endothelial cells expressing GFP gene were then identified.Results: High-efficiency gene transfer was found in over 90% of endothelial cells. Gene expression could be detected within 24 hours and remained stable up to 2 weeks in the organ culture system.Conclusions: The high-delivery efficiency and rapid induction of gene expression indicate that rAAV is a promising vector for cornea endothelial cell gene therapy for ocular diseases. Organ culture at 31ˆC using culture medium supplemented with growth factors significantly facilitates gene transfer into human corneal endothelium.

Purpose To report a patient who was diagnosed with combined adult inclusion conjunctivitis (AIC) and mucosa-associated lymphoid tissue (MALT) lymphoma. Methods This is a case report. Results An 18-year-old male patient presented with chronic conjunctivitis and giant follicles. Evaluation by chlamydial antigen assay was positive. Conjunctival biopsy for the immunohistochemical stain and polymerase chain reaction of the left eye showed MALT lymphoma. Conclusions MALT lymphoma can masquerade as other ocular surface diseases. Chlamydial infection causes chronic inflammation of the conjunctiva. Both of these diseases should be considered as a differential diagnosis of refractory follicular conjunctivitis. It is worthy of further study to determine whether chronic inflammation resulting from chlamydial infection increases the risk of MALT lymphoma or it is coincidental.

Background: Pediatric headache is a multifactorial disease and may lead to substantial levels of disability. However, the ophthalmological factors in pediatric headache remained unclear. This study aimed to investigate the contribution of ophthalmological factors in pediatric headache in Taiwan. Design: Retrospective, population based, cross-sectional study. Participants: 2727 children, between age of 7 to15, in Yu-Lin and Chia-Yi counties, Taiwan, during the health promotion examination were included during 2012~2014. Methods: General health examinations, including body weight, body height, visual acuity, and skeletal development, were recorded. Headache was assessed by questionnaire. The ocular alignment was measured by cover-and-uncover test. Ocular height, and head position were measured utilizing photographs of children in front of the modified Amsler grid. Main outcome measures: The risk factors for pediatric headache were analyzed using univariate and multivariate comparisons. Results: The prevalence of headache increased from 5.2% at the age of 7-9 group to 9.3% at the age of 10-12 group, and became 17.9% at the age of 13-15 group. Girls have a higher prevalence rate than boys (1.4:1). Headache was not associated with body height, body weight, or sleep duration. Head-roll and asymmetric ocular height were the significant predictors for the headache (p

Background: Anisometropia was a challenge for ophthalmologists to treat unilateral refraction condition. Failure of build-up the same clear image from two eyes together was the major cause for quitting spectacle wearing, which usually led to amblyopia in the eye with more myope. Case presentation: The two patients with anisometropia were found that the two eyeballs position were asymmetric by photography (RTV, Carl Ziess Meditec, Co). Binocular visual acuity was analyzed by using polarized lens in the both eyes for stereo-acuity in far vision (Polatest, Carl Zeiss, Germany) by following the guidelines from the Internationale Vereinigung for Binokulare Vollkorrektion (IVBV). Binocular vision was corrected by the stereoacuity in the far vision, and prism measurement was done by subjective opinion from the patient. Conclusion: Asymmetric eyeball position and size are the risk of anisometropia progression. Under the guidelines from MKH (Measuring and correcting Methodology after H.J-. Haase) for correction of associated phoria, the vision was corrected not only in the spherical and cylinder amount but also in binocular full-correction. Prism improved in binocular vision function in the far vision. By using the prismatic progressive additional lenses, the unilateral myopia progression was well controlled after followed for 4 years.

Background: To report an unusual case of multifocal choroidopathy with uveitis and cytomegalovirus (CMV) retinitis in a patient with acquired immunodeficiency syndrome (AIDS) after initially presenting with pulmonary tuberculosis (Mycobacterium kansasii). Case: Slit-lamp biomicroscopy and indirect ophthalmoscopic examination were done. Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. Computer tomography scan, magnetic resonance imaging and biopsy of the brain were also carried out. Observations: Multiple yellowish-white, round, slightly elevated subretinal pigment epithelium lesions were noted in areas devoid of the atrophic retina of previous CMV infection. Anterior uveitis and vitritis were also noted. Vitreous, retina, and brain biopsy did not offer any clue for diagnosis. The visual acuity improved later, along with recovered immunity under the anti-tuberculosis medications and the cocktail therapy for AIDS. Conclusions: Combined CMV retinitis and atypical tuberculosis chorioretinitis, although rare, can develop in the patients with AIDS. Systemic dissemination of atypical tuberculosis infection should be responsible for the choroidopathy in this patient.

Background and Purpose — Severe perinatal asphyxia is an important cause of brain injury in the newborn infant. We examined early events after hypoxic ischemia (HI) in the 7-day-old mouse brain by MRI and related them to long-term functional effects and histopathology in the same animals at 4 to 5 weeks of age. Methods — HI was induced in 7-day-old CD1 mice by exposure to 8% oxygen for 30 minutes after occlusion of the left common carotid artery. The resulting unilateral focal lesion was evaluated in vivo by MRI (T2 maps and apparent diffusion coefficient maps) at 3, 6, and 24 hours and 5 days after hypoxia. Locomotion and sensorimotor function were analyzed after 3 weeks. Four weeks after HI, the mice were killed, and cresyl violet–stained brain sections were examined morphologically. Results — A decrease in apparent diffusion coefficient values in cortex on the affected side was found at 3 hours after HI. T2 values were significantly increased after 6 hours and remained so for 5 days. Maximal size of the lesion was attained at 3 to 6 hours after HI and declined thereafter. Animals with MRI-detected lesions had decreased forward locomotion, performed worse than controls in the beam-walking test, and showed a unilateral hypotrophy in the cresyl violet–stained brain sections 4 weeks later. Conclusions — The temporal progression of the damage after HI in 7-day-old mice differs from that of the adult brain as judged by MRI. The early lesions detected by MRI were related to functional impairments for these mice in near-adult life.

Juveniles normally have their own preference in hair style as part of their appearance, especially the bang styles. However, they may not be aware that the bangs will cause unintended consequences of deteriorating vision, unbalanced collarbone, and even worse scoliosis and other diseases. In order to investigate and intervene in this health concern at an earlier stage we conducted extensive vision examinations on students in many elementary schools. During the eye examinations, not only the visions were examined but also questionnaires were issued to students to understand how their daily habits related to the body posture. To discover the causality from vision to scoliosis, information gain and fuzzy model are proposed to find critical factors among candidates such as bang styles, weight, height, BMI, waistline, sleeping hours per day, and the way of carrying schoolbag. Then, data mining techniques are used to extract the causal associations among different factors. Based on the chosen factors and association rules, an intelligent model is proposed to discover the knowledge of students vulnerable to scoliosis from the side effects induced by their bang styles. Analytical results from over 3,500 elementary school students are given to verify the effectiveness of the proposed model. Comparisons between before and after adjustment on subjects' visions are also presented to illustrate the continuing research on this work.

Background Health-promoting lifestyle choices of adolescents are closely related to current and subsequent health status. However, parsimonious yet reliable and valid screening tools are scarce. The original 40-item adolescent health promotion (AHP) scale was developed by our research team and has been applied to measure adolescent health-promoting behaviors worldwide. The aim of our study was to examine the psychometric properties of a newly developed short-form version of the AHP (AHP-SF) including tests of its reliability and validity. Methods The study was conducted in nine middle and high schools in southern Taiwan. Participants were 814 adolescents randomly divided into two subgroups with equal size and homogeneity of baseline characteristics. The first subsample (calibration sample) was used to modify and shorten the factorial model while the second subsample (validation sample) was utilized to validate the result obtained from the first one. The psychometric testing of the AHP-SF included internal reliability of McDonald’s omega and Cronbach's alpha, convergent validity, discriminant validity, and construct validity with confirmatory factor analysis (CFA). Results The results of the CFA supported a six-factor model and 21 items were retained in the AHP-SF with acceptable model fit. For the discriminant validity test, results indicated that adolescents with lower AHP-SF scores were more likely to be overweight or obese, skip breakfast, and spend more time watching TV and playing computer games. The AHP-SF also showed excellent internal consistency with a McDonald’s omega of 0.904 (Cronbach’s alpha 0.905) in the calibration group. Conclusion The current findings suggest that the AHP-SF is a valid and reliable instrument for the evaluation of adolescent health-promoting behaviors. Primary health care providers and clinicians can use the AHP-SF to assess these behaviors and evaluate the outcome of health promotion programs in the adolescent population. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1106) contains supplementary material, which is available to authorized users.

Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked.A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed.Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses.Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.

Objectives A community-based health promotion program (CBHP) might be beneficial for the elderly, but evidence is limited. We therefore examined the effect of a CBHP on change of lifestyle, physiological indicators and depression score among seniors in 2 rural areas. Methods A prospective quasi-experimental design involved a total of 520 senior participants living in 6 rural villages, who were clustered and conveniently assigned to 2 intervention groups. Senior nursing students were the interveners for group 1 and community peer supporters for group 2. The primary outcome measure was the change in health-related behavior measured on the geriatric health promotion scale (GHPS). The secondary outcome comprised changes in the short form of the Chinese geriatric depression scale (CGDS-15), fasting blood sugar, total cholesterol, waist circumference and blood pressure. Paired-t test and analysis of covariance were used for statistical inspection. Results Most of the participants were retired farmers or fishermen >75years of age who had little education. The total scores and all subscales of GHPS, along with some physiological indicators, improved significantly between pretest and post-test in both groups. After adjustment for confounders, intervention in group 1 was more effective than that in group 2 regarding self-protection behaviors. Systolic and diastolic blood pressure was significantly lower in group 2. Conclusions CBHP programs are valuable for improving healthy lifestyle, fasting blood sugar, blood pressure and depression score among seniors. The low cost and effectiveness of incorporating multidisciplinary resources to help rural elders to maintain a healthy status and a healthier lifestyle.

Bevacizumab, a recombinant humanized monoclonal antibody, binds vascular endothelial growth factor (VEGF) and inhibits its interaction with receptors found on endothelial cells. Bevacizumab has been increasingly used as an off-label treatment for exudative age-related macular degeneration (AMD). Whether or not bevacizumab is capable of arresting the growth of human retinal pigment epithelial cells remains to be clarified. In this study, flow cytometry was used to evaluate whether bevacizumab markedly induced the G1/S phase arrest. The G1/S phase cycle-related protein analysis demonstrated that the expression of cyclin-dependent kinase (CDK)2, 4 and 6 and of cyclin D and E, as well as the phosphorylation of retinoblastoma tumor suppressor protein (ppRB) production were found to be markedly reduced by bevacizumab. By contrast, the protein levels of p53, p16, p21 and p27 were increased in bevacizumab-treated ARPE-19 cells (a human retinal pigment epithelial cell line). These events of G1/S arrest induced by bevacizumab in ARPE-19 cells suggest that a preventive effect of bevacizumab exists in AMD.

Medial collateral ligament (MCL) healing proceeds in a temporally ordered fashion after injury. Despite the critical roles of fibroblasts during ligament repair, the phenotypic features of these healing fibroblasts have not been well characterized. Here, we show that healing MCL fibroblasts obtained from rabbits at 3-week postinjury exhibited higher rates of senescent phenotypes and produced higher levels of TGF-β1, collagens, α-SMA, and matrix metalloproteinases (MMPs), than the corresponding fibroblasts from sham-operated MCLs. Mechanical stretch further enhanced the cellular senescence and the expression of TGF-β1, collagens, α-SMA, and MMPs in both sham and healing MCL fibroblasts. In addition to MCL fibroblasts at 3-week postinjury, the increased cellular senescence was also detected in healing MCL fibroblasts obtained at 4- and 6-week postinjury. Most importantly, the association between the cellular senescence and ligament healing was confirmed in tissue sections by the senescence-associated β-galactosidase (SA-β-gal) staining. Using a recombinant TGF-β1 and a neutralizing antibody, we found that those phenotypic changes, such as cellular senescence and the expression of collagens and MMPs, in MCL fibroblasts under mechanical loading conditions were regulated through TGF-β1. Taken together, our results propose that cellular senescence and turnover of extracellular matrixes regulated by TGF-β1 in MCL fibroblasts are critical for ligament healing.

Pigment epithelial-derived factor (PEDF) displays its antiangiogenicity by mechanisms partly involving suppression of the cellular FADD-like IL-1β-converting enzyme (FLICE)/caspase-8-inhibitory protein (c-FLIP) expression in endothelial cells. c-Jun NH(2)-terminal kinases (JNKs) regulate c-FLIP expression in endothelial cells. The effect of PEDF on other cells remains unclear.c-FLIP expression was assessed by semi-quantitative reverse transcriptase (RT)-PCR and immunoblotting. Pharmacological inhibitors were used to examine the involvement of PEDF signaling.PEDF can also down-regulate c-FLIP expression in hepatoma cell line SK-Hep-1. PEDF induced p38 kinase phosphorylation in SK-Hep-1 cells. The effect of PEDF on c-FLIP expression was attenuated by p38 kinase inhibitor, but not JNK inhibitor. In addition, PEDF pretreatment significantly increased the sensitivity of SK-Hep-1 cells to procaspase-8 cleavage and apoptosis induced by ciglitazone.PEDF-induced p38 signaling causes c-FLIP down-regulation in SK-Hep-1. We postulate PEDF has a novel effect on apoptotic inducible activity in hepatoma cells.

Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness. The timing of rapidly expanded mass was strongly related to the treatment outcome.Thirteen patients who presented with severe visual defect after pituitary apoplexy were enrolled retrospectively. Six patients without severe underlying diseases were considered non-complicated and were treated early. Another seven patients who received delayed treatment after medical problems were stabilized and/or conservative management failed were considered to be complicated. The visual acuity of each individual eye was evaluated and organized into six grades based on visual acuity. Twelve patients received transsphenoidal surgery and one craniotomy was performed for tumor removal.The delay of surgical treatment was 3.5 days and 8.7 days in the two groups, respectively. Overall, 19 out of 26 eyes (73%) improved after surgery; 100% in non-complicated group and 50% in complicated group. The average grade of visual improvement was 2.66 vs. 0.71 by each individual eye, and the difference was statistically significant (P0.000). The ratio of regained useful vision was significant in non-complicated patients (P0.000). The incidence of requirement long-term hormone replacement was high in the complicated group (2/6 vs. 6/7). The resection rate was total in 8 patients, subtotal in 3, partial in 1, with one loss of image follow-up.Early decompression significantly improved visual outcomes and the need for hormone replacement was minimal. We postulated old age, underlying malignant diseases, and coagulation disorders played the predisposing factors of poor outcome in these cases.

Behavioral recovery takes place even after permanent damage to the entire brain region normally controlling sensorimotor hind limb function in the rat. In our study, 2 weeks after full behavioral recovery from an experimental unilateral permanent brain damage, the topographic representation of the previous paretic hindlimb was investigated by fMRI. The analysis showed that during electrical stimulation of the previously paretic hindlimb, two normally inactive brain regions were now being activated. One region was the non-damaged contralateral sensori-motor cortex and the other region was located lateral to the lesion. These results suggest that behavioral recovery can be explained by functional reorganization and neuromodulation of the brain.

Purpose: Gene delivery at high efficiency is crucial for cornea endothelial cell gene therapy. In this study, we investigated the efficiency of gene transfer by recombinant adeno-associated virus (rAAV) in an organ culture system.

Corneal neovascularization (NV) is usually associated with inflammatory or infectious disorders of the ocular surface and often accompanied by stromal edema, lipid deposits, keratitis, or scarring. All of which frequently results in vision impairment or blindness. Pathological angiogenesis is also thought to predispose to the reflection of corneal allografts by facilitating the exposure of antigens in the donor cornea to the immune system. Many medical and surgical treatments, including angiostatic steroid, nonsteroidal anti-inflammatory agent, argon laser photocoagulation, photodynamic therapy, and limbal stem cell transplantation have been effective in animal or human models in inhibition of corneal neovascularization. However, anti-angiogenic therapy needed to be further investigated for effective treatment against actively growing and established corneal neovascularization.