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Yu-Kai Li,1,* Song Wu,2,* Yu-Shan Wu,3,* Wei-Hu Zhang,4,* Yan Wang,5,* Yue-Hua Li,1,* Qiang Kang,1,* Song-Quan Huang,1,* Kai Zheng,1 Gai-Ming Jiang,1 Qing-Bo Wang,1 Yu-Bo Liang,1 Jin Li,1 Yawhan Lakang,1 Chen Yang,1 Jing Li,1 Jia-Ping Wang,4 Xiang Kui,5 Yang Ke1,6,7 1Department of Hepato-Biliary-Pancreatic, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 2Preventive Medicine Division, School of Life Science, Anhui University of Chinese Medicine, Hefei, AH, 230012, People’s Republic of China; 3The Second Clinical Medical College, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 4Department of Radiology, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 5Department of Pathology, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 6Department of Surgical Education and Research, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 7Yunnan Yunke Bio-Technology Institution, Kunming, YN, 650201, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Kui, Department of Pathology, the Second Affiliated Hospital, Kunming Medical University, No. 374 Kunrui Road, Wuhua District, Kunming, YN, 650101, People’s Republic of China, Tel +8613708729335, Email kuixiang@foxmail.com Yang Ke, Department of Hepato-Biliary-Pancreatic, the Second Affiliated Hospital, Kunming Medical University, No. 374 Kunrui Road, Wuhua District, Kunming, YN, 650101, People’s Republic of China, Tel +8615808875159, Email keyang1218@126.comBackground: The dominant artery blood supply is a characteristic of hepatocellular carcinoma (HCC). However, it is not known whether the blood supply can predict the post-hepatectomy prognosis of patients with HCC. This retrospective study investigated the prognostic value of the portal venous and arterial blood supply estimated on triphasic liver CT (as a portal venous coefficient, PVC, and hepatic arterial coefficient, HAC, respectively) in patients with HCC following hepatectomy.Methods: HCC patients who were tested by triphasic liver CT 2 weeks before hepatectomy and received R0 hepatectomy at the Second Affiliated Hospital, Kunming Medical University between January 1, 2016 and December 31, 2020, were retrospectively screened. Their PVC and HAC, and other variables were analyzed for the prediction of overall survival (OS) and recurrence-free survival (RFS) using the least absolute shrinkage and selection operator and Cox proportional hazard regression models.Results: Four hundred and nineteen patients (53.2 ± 10.6 years of age and 370 men) were evaluated. A shorter OS was independently associated with higher blood albumin and total bilirubin grade [hazard ratio (HR) 2.020, 95% confidence interval (CI) 1.534– 2.660], higher Barcelona Clinic Liver Cancer (BCLC) stage (HR 1.514, 95% CI 1.290– 1.777), PVC ≤ 0.386 (HR 1.628, 95% CI 1.149– 2.305), and HAC > 0.029 (HR 1.969, 95% CI 1.380– 2.809). A shorter RFS was independently associated with male (HR 1.652, 95% CI 1.005– 2.716), higher serum α-fetoprotein ≥ 400 ng/mL (HR 1.672, 95% CI 1.236– 2.263), higher BCLC stage (HR 1.516, 95% CI 1.300– 1.768), tumor PVC ≤ 0.386 (HR 1.641, 95% CI 1.198– 2.249), and tumor HAC > 0.029 (HR 1.455, 95% CI 1.060– 1.997).Conclusion: Tumor PVC or HAC before hepatectomy is valuable for independently predicting postoperative survival of HCC patients. Keywords: blood supply, computed tomography, hepatectomy, hepatocellular carcinoma, recurrence, survival

Yuan Bo Liang,1,2 Balamurali Vasudevan,3 Zhong Lin,1,2 Hong Jia Zhou,1,2 Kenneth J Ciuffreda4 1Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, People’s Republic of China; 3College of Optometry, Mid Western University, Glendale, AZ, USA; 4Department of Biological and Vision Sciences, SUNY College of Optometry, New York, NY, USACorrespondence: Zhong LinPhDEye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, Zhejiang 325027, People’s Republic of ChinaTel +86-577-88824116Email linzhong_@126.comPurpose: To investigate the impact of eye exercises of acupoints on myopic progression among Chinese urban students.Methods: The Beijing Myopia Progression Study (BMPS) was a three-year cohort study, with 386 students (aged 6– 17 years) enrolled at baseline. These students were invited to be reexamined in the years 2011, 2012, and 2013. The student’s cycloplegic refraction at each visit and the parental non-cycloplegic refraction at baseline were performed. Students were also required to complete the eye exercise of acupoints questionnaire and the convergence insufficiency symptom survey (CISS).Results: At the final follow-up, 226 students (57.2%) with complete refraction and eye exercises questionnaire data were enrolled in the present study. In the multivariate analysis, only students who performed the eye exercises twice or more per day had less myopic refractive change (β=0.32, p=0.04), as compared to those who performed the eye exercises less than twice per day. No significant association was found between the CISS score and the refractive change for items in the eye exercises questionnaire.Conclusion: In this study cohort, the Chinese eye exercises of acupoints had a modest effect on reducing myopic progression among Chinese urban students aged 6 to 17 years. The precise mechanism remains unclear, especially in the absence of a control group.Keywords: eye exercises, acupoints, myopia, progression, myopia risk factors, convergence insufficiency symptom survey

Background: The incidence of hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) is steadily increasing in China, becoming the second leading cause of AP. Clinical complications and outcomes associated with HTG-AP are generally more severe than those seen in AP caused by other etiologies. HTG-AP is closely linked to metabolic dysfunction and frequently coexists with metabolic syndrome or its components. However, the impact of metabolic syndrome components on HTG-AP clinical outcomes remains unclear., Aim: To investigate the impact of metabolic syndrome component burden on clinical outcomes in HTG-AP., Methods: In this retrospective study of 255 patients diagnosed with HTG-AP at the First Affiliated Hospital of Guangxi Medical University, we collected data on patient demographics, clinical scores, complications, and clinical outcomes. Subsequently, we analyzed the influence of the presence and number of individual metabolic syndrome components, including obesity, hyperglycemia, hypertension, and low high-density lipoprotein cholesterol (HDL-C), on the aforementioned parameters in HTG-AP patients., Results: This study found that metabolic syndrome components were associated with an increased risk of various complications in HTG-AP, with low HDL-C being the most significant risk factor for clinical outcomes. The risk of complications increased with the number of metabolic syndrome components. Adjusted for age and sex, patients with high-component metabolic syndrome had significantly higher risks of renal failure [odds ratio (OR) = 3.02, 95%CI: 1.12-8.11)], SAP (OR = 5.05, 95%CI: 2.04-12.49), and intensive care unit admission (OR = 6.41, 95%CI: 2.42-16.97) compared to those without metabolic syndrome., Conclusion: The coexistence of multiple metabolic syndrome components can synergistically worsen the clinical course of HTG-AP, making it crucial to monitor these components for effective disease management., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Purpose: To explore whether tumor-associated lymphatic vessel density (LVD) could be a biomarker for the prognosis of patients with esophageal cancer after radical resection., Methods: A systematic literature search was performed through PubMed, EMBASE, Wanfang Data, and Cochrane Library from the inception of databases until March 19, 2024. The selected studies investigated overall survival (OS) and/or recurrence-free survival (RFS) of patients with esophageal cancer with different levels of LVD after radical resection. The OS and RFS data were pooled as hazard ratios (HR) and 95% confidential interval (CI). Furthermore, the standardized mean differences (SMDs) and 95% CI were aggregated to evaluate the correlation between LVD and clinicopathological features., Results: A total of 10 retrospective studies of 1,201 patients were finally included for the meta-analysis. Patients with esophageal cancer with a high level of LVD exhibited worse OS (HR 1.65, 95% CI 1.18 to 2.31) and RFS (HR 1.57, 95% CI 1.09 to 2.26) than those with a low level of LVD. Subgroup analysis of different pathological subtypes revealed that patients with esophageal adenocarcinoma with a high level of LVD had significantly worse RFS (HR 2.84, 95% CI 1.61 to 5.02) than those with a low level of LVD; while patients with esophageal squamous cell carcinoma with a high level of LVD had similar OS (HR 1.52, 95% CI 0.93 to 2.47) and RFS (HR 1.03, 95% CI 0.72 to 1.48) to those with a low level of LVD. Furthermore, tumors with lymph node metastasis had significantly higher levels of LVD than those without lymph node metastasis (SMD = 1.11, 95% CI 0.54 to 1.67). Tumors at the stages III-IV had significantly higher levels of LVD than those at the stages I-II (SMD = 1.62, 95% CI 0.90 to 2.34)., Conclusion: A high level of LVD in tumor was associated with worse survival of patients with esophageal cancer after radical resection, especially in patients with esophageal adenocarcinoma. Tumor-associated LVD is a new parameter that should be measured in postoperative pathology for predicting the prognosis of patients with esophageal cancer., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42024553766., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Wang, Liang, Chen, Luo, Li, Chen, Lu and Ke.)

Rheumatoid arthritis (RA) is a worldwide public health problem. Interventions to delay or prevent the onset of RA have attracted much attention in recent years, and researchers are now exploring various prevention strategies. At present, there is still no unified consensus for RA prevention, but targeting therapeutic windows and implementing interventions for at-risk individuals are extremely important. Due to the limited number of clinical trials on pharmacologic interventions, further studies are needed to explore and establish optimal intervention regimens and effective measures to prevent progression to RA. In this review, we introduce the RA disease process and risk factors, and present research on the use of both Western and Chinese medicine from clinical perspectives regarding RA prevention. Furthermore, we describe several complete and ongoing clinical studies on the use of Chinese herbal formulae for the prevention of RA., (© 2024. The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.)

Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive retinal ganglion cell (RGC) degeneration and vision loss. Since irreversible neurodegeneration occurs before diagnosable, early diagnosis and effective neuroprotection are critical for glaucoma management. Small extracellular vesicles (sEVs) are demonstrated to be potential novel biomarkers and therapeutics for a variety of diseases. In this study, it is found that intravitreal injection of circulating plasma-derived sEVs (PDEV) from glaucoma patients ameliorated retinal degeneration in chronic ocular hypertension (COH) mice. Moreover, it is found that PDEV-miR-29s are significantly upregulated in glaucoma patients and are associated with visual field defects in progressed glaucoma. Subsequently, in vivo and in vitro experiments are conducted to investigate the possible function of miR-29s in RGC pathophysiology. It is showed that the overexpression of miR-29b-3p effectively prevents RGC degeneration in COH mice and promotes the neuronal differentiation of human induced pluripotent stem cells (hiPSCs). Interestingly, engineered sEVs with sufficient miR-29b-3p delivery exhibit more effective RGC protection and neuronal differentiation efficiency. Thus, elevated PDEV-miR-29s may imply systemic regulation to prevent RGC degeneration in glaucoma patients. This study provides new insights into PDEV-based glaucoma diagnosis and therapeutic strategies for neurodegenerative diseases., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Aim: To report a one-year clinical outcomes of low-dose laser cycloplasty (LCP) among malignant glaucoma patients., Methods: In this prospective, multicenter, non-comparative clinical study, participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China. Patients were followed up at 1wk, 1, 3, 6, and 12mo. Intraocular pressure (IOP), number of glaucoma medications, anterior chamber depth (ACD), and complications were recorded. Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy. Recurrence was defined by the presence of a shallow or flat anterior chamber after initial recovery from treatment., Results: A total of 34 eyes received LCP. Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg ( P <0.001) with 2.9±1.6 medications ( P =0.046) at 1d, and 17.4±6.7 mm Hg ( P <0.001) with 1.3±1.7 medications ( P <0.001) at 12mo. The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo, respectively. A total of 32 (94.1%) eyes achieved initial anatomical success. During follow-up, 2 (5.9%) eyes failed and 8 (23.5%) eyes relapsed, yielding a 12-month anatomical success rate of 64.3%. Complications including anterior synechia (8.82%), choroidal/ciliary detachment (5.88%) and hypopyon (2.94%) were observed within 1wk., Conclusion: LCP is simple, safe, and effective in reforming the anterior chamber in malignant glaucoma., Competing Interests: Conflicts of Interest: Lin HS, None; Xu XP, None; Zheng XL, None; Wang JB, None; Fan SJ, None; Wu ZH, None; Cheng SM, None; Zhao LJ, None; Cai QH, None; Zhang SD, None; Liu SS, None; Lyu AG, None; Zhang Y, None; Chen H, None; Jiang DN, None; Li WL, None; Congdon N, None; Tham CC, None; He MG, None; Liang YB, None., (International Journal of Ophthalmology Press.)

Objective: To investigate the clinical characteristics and treatment outcomes of glaucoma secondary to congenital ectropion uveae (CEU) using penetrating Schlemm's canaloplasty. Methods: This was a retrospective case series study. Medical records of patients diagnosed with glaucoma secondary to CEU and undergoing penetrating Schlemm's canaloplasty at the Eye Hospital of Wenzhou Medical University between August 2020 and December 2021 were collected. Clinical characteristics including the extent and location of iris ectropion, type of glaucoma, were analyzed. Follow-up visits were conducted at 1, 3, 6 months, and 1 year postoperatively. Visual acuity, intraocular pressure (IOP), anterior segment and fundus condition, filtering bleb morphology, use of IOP-lowering medications, ultrasound biomicroscopy results, and other indicators were analyzed to summarize surgical outcomes. Results: Six cases (6 eyes) of glaucoma secondary to CEU were included, all unilateral, with 3 left eyes and 3 right eyes; median age was 10.0 (5.3, 28.8) years; including 3 males and 3 females. Preoperative IOP was (31.7±10.0) mmHg (1 mmHg=0.133 kPa), and the preoperative number of IOP-lowering medications used was 2.0 (2.0, 3.2). The extent of iris ectropion in the 6 cases ranged from 270 ° to 360 °, with peripheral anterior synechiae corresponding to the location of iris ectropion, and angle closure with the degree of synechiae extending beyond Schwalbe's line. No surgical complications occurred in any of the 6 cases postoperatively. At 1 month postoperatively, the IOP was (16.4±3.2) mmHg, with a median of 0.0 (0.0, 1.5) medications used. At 3 months postoperatively, the IOP was (14.8±6.0) mmHg, with a median of 0.0 (0.0, 2.2) medications used. At 6 months postoperatively, the IOP was (18.1±6.1) mmHg, with a median of 0.0 (0.0, 0.5) medications used. Among them, 5 patients had a follow-up period of 1 year postoperatively, all achieving controlled IOP without the use of IOP-lowering medications, with an average IOP of (15.5±3.1) mmHg. No obvious filtering bleb formation was observed at the surgical site in all patients. Conclusions: Glaucoma secondary to CEU manifests primarily as closed-angle glaucoma, with a correspondence between the closure range of anterior iris adhesions in the angle and the extent of iris ectropion. Penetrating Schlemm's canaloplasty demonstrates favorable and stable efficacy for its treatment.

Objective: By conducting a retrospective analysis of the clinical data of 14 patients diagnosed with invasive fungal rhinosinusitis (IFRS) confirmed by metagenomics next generation sequencing (mNGS) technology, we aim to explore the rapid diagnosis value of mNGS in IFRS. Methods: The clinical data of 14 IFRS patients admitted to TianJin First Central Hospital were retrospectively analyzed from February 2021 to October 2023. The study cohort comprised 8 males and 6 females, with ages ranging from 14 to 77 years. All patients were diagnosed as IFRS by performing mNGS sequencing technology of nasal sinus lesion biopsy specimens. Clinical data such as laboratory examination, imaging examination, histopathological examination results, treatment plan and prognosis were summarized and analyzed. Results: All 14 patients were diagnosed as IFRS, with mNGS detecting pathogens such as Rhizopus (7 cases), Aspergillus (5 cases), Trichoderma (1 case), and Scedosporium apiospermum (1 case). Follow-up evaluations were conducted for a period ranging from 2 months to 2 years post-treatment. At the end of follow-up, 11 out of 14 IFRS patients achieved a complete cure with no signs of recurrence, while the symptoms of the remaining 3 patients significantly improved with comprehensive treatment. Conclusion: mNGS emerges as a highly effective diagnostic tool for IFRS, providing valuable microbiological evidence for clinical diagnosis and demonstrating promising clinical utility.

Purpose: To explore the associations between central anterior chamber depth (CACD) and other anterior segment biometric parameters and to determine the possible determinants of CACD in short, normal, and long eyes., Methods: The biometric data of pre-operation patients aged 50-80 years with coexisting cataract and primary angle-closure disease or senile cataract were reviewed. Axial length (AL), CACD, lens thickness (LT), central corneal thickness (CCT), and white-to-white distance (WTW) were measured by Lenstar optical biometry (Lenstar 900). The data of 100 normal eyes (AL = 22 to 26 mm), 100 short eyes (AL ≤ 22 mm), and 100 long eyes (AL ≥ 26 mm) were consecutively collected for subsequent analyses., Results: The mean age of the subjects was 66.60 ± 7.85 years, with 25.7% of the sample being men. Both CACD and WTW were found to be smallest in short eyes and were smaller in normal eyes than in long eyes (F = 126.524, P < 0.001; F = 28.458, P < 0.001). The mean LT was significantly thicker in short eyes than in normal and long eyes (4.66 mm versus 4.49 mm versus 4.40 mm; F = 18.099, P < 0.001). No significant differences were observed in CCT between the three AL groups (F = 2.135, P = 0.120). Stepwise regression analysis highlighted AL, LT, and WTW as three independent factors associated with CACD in the normal AL group. In the short AL group and long AL group, LT and WTW were independent factors associated with CACD., Conclusions: CACD increases as AL elongates and reaches a peak when AL exceeds 26 mm. Furthermore, CACD showed inverse correlation with LT and positive correlation with WTW. A relatively small WTW results in an anteriorly positioned lens, and thus, a decrease in CACD., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Aim: To describe the outcome of using low-dose laser cycloplasty (LCP) in chronic angle-closure glaucoma (CACG)., Methods: A retrospective case series. Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed. The main outcomes included intraocular pressure (IOP), the number of glaucoma medication, anterior segment parameters and surgery-related complications., Results: A total of 7 eyes of 7 CACG patients (age 38.9±11.0y) underwent LCP with a mean follow-up of 27.1±13.7mo (range 16-48mo). Following LCP, mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg ( P =0.027) with 0.4±1.1 glaucoma medications ( P =0.001) at final follow-up. The anterior chamber depth (ACD), angle opening distance 500 and trabecular-iris angle increased from 1.65±0.33 mm, 0.05 mm (range 0-0.30 mm) and 5.1° (range, 0-31.97°) at baseline to 1.98±0.43 mm ( P =0.073), 0.53 mm (range 0.42-0.91 mm, P =0.015), 45.9° (range, 40.2°-59.4°, ( P =0.015) in the long-term follow-up, respectively. The deepening of ACD and reopening of anterior chamber angle (ACA) was observed in 6 eyes (85.7%)., Conclusion: LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications. In addition, LCP can bring a significant deepening in ACD and reopening of ACA., (International Journal of Ophthalmology Press.)

Significance: This study reported the relationship between intraocular pressure (IOP) and myopia progression, which helps to understand more comprehensively whether IOP can be an important reference factor to intervene in the progression of myopia., Purpose: This study aimed to investigate the association between IOP and myopia progression as well as axial length elongation in rural Chinese children., Methods: A total of 598 (598 of 878 [68.1%]) children (6 to 17 years) from the baseline Handan Offspring Myopia Study who completed a 3.5-year follow-up vision examination were included. Ocular examinations at both visits included cycloplegic autorefraction, IOP, and axial length measurements., Results: Children with myopia had the highest baseline IOP of the three refractive groups (14.13 ± 1.31, 13.78 ± 1.71, and 13.59 ± 1.64 mmHg in myopes, emmetropes, and hyperopes, respectively, P = .002). However, IOPs showed no significant difference between eyes with or without newly developed myopia (13.63 ± 1.68 vs. 13.89 ± 1.68, P = .16), with or without faster myopia progression (13.75 ± 1.61 vs. 13.86 ± 1.63, P = .46), or with axial length elongation (13.80 ± 1.61 vs. 13.76 ± 1.64, P = .80). The multivariate regression analysis demonstrated that neither baseline refractive error ( β = -0.082, P = .13) nor baseline axial length ( β = -0.156, P = .08) was associated with baseline IOP., Conclusions: Myopic eyes have slightly higher IOP compared with emmetropic and hyperopic eyes, although it was not clinically significant. However, IOP was not found to be associated with either myopia progression or axial length elongation in this cohort sample of rural Chinese children., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2023 American Academy of Optometry.)

Aims The aim of this study was to investigate the anti-tumor efficacy of brucine on intrahepatic cholangiocarcinoma (ICC). Methods ICC QBC939 cells were treated with brucine, cell viability, cell cycle and apoptosis were analyzed using CCK-8 and flow cytometry. The expression of COX-2 and apoptosis related proteins Casp3, Bax and Bcl-2 were detected by Western blot analysis. QBC939 cells were subcutaneously transplanted into nude mice and the mice were injected with brucine intraperitoneally. The expression of Ki67, COX-2 and apoptosis related proteins were detected by immunohistochemical staining and Western blot analysis. Results Brucine significantly inhibited the proliferation and cell cycle progression while promoted the apoptosis of QBC939 cells. The expression of the apoptotic proteins Casp3 and Bax was upregulated, while the expression of Bcl-2 and COX-2 was downregulated in QBC939 cells with brucine treatment. Moreover, the overexpression of COX-2 could antagonize the effects of brucine on QBC939 cells. In vivo , brucine inhibited subcutaneous tumor formation in nude mice, and the expression of Ki67, COX-2 and Bcl-2 decreased while the expression of Casp3 and Bax increased in tumor tissues from nude mice with brucine treatment. Conclusions Brucine can significantly inhibit the progression of cholangiocarcinoma in vitro and in vivo , and the mechanism may be related to the inhibition of COX-2 expression., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Purpose: To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Northeastern Chinese population with Type 2 diabetes., Methods: A total of 1,322 subjects from the Fushun Diabetic Retinopathy Cohort Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were recorded. MOPP was calculated by the following formula: MOPP = 2/3 [DBP + 1/3 (SBP - DBP)] - IOP, and CSFP was estimated according to the following formula: CSFP = 0.44 × body mass index + 0.16 × DBP - 0.18 × age - 1.91. New development, progression, and regression of DR were graded based on fundus photographs at baseline and during follow-up examinations with a mean interval of 21.2 months using the modified Early Treatment Diabetic Retinopathy Study criteria., Results: Increasing MOPP was associated with the incidence of DR in the multivariate model (per 1-mmHg increase: relative risk, 1.06; 95% confidence interval, 1.02-1.10; P = 0.007) and showed a borderline negative association with DR regression (per 1-mmHg increase: relative risk, 0.98; 95% confidence interval, 0.97-1.00; P = 0.053). However, MOPP was not associated with progression of DR. Cerebrospinal fluid pressure was not associated with new development, progression, or regression of DR., Conclusion: The MOPP, but not the CSFP, was found to influence the development, but not the progression of DR in this Northeastern Chinese cohort.

Aim: To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University., Methods: A review of the medical records of inpatients who had been diagnosed with glaucoma and received anti-glaucoma surgery between January 1, 2015 and December 31, 2021 was conducted. The glaucoma diagnosis in this study included primary open angle glaucoma, primary angle-closure glaucoma, secondary glaucoma, and paediatric glaucoma. The types of surgeries were categorised as internal filtration, external filtration, and cyclodestruction surgery based on the pathway of aqueous humor outflow. The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed., Results: The number of patients hospitalised for glaucoma surgery increased yearly, from 752 in 2015 to 1373 in 2021, at the Eye Hospital of Wenzhou Medical University. Regarding the patients diagnosed with primary open angle glaucoma, internal filtration surgery increased from 27.40% of the sample to 54.40% of the sample, while external filtration surgery decreased from 71.50% to 44.20% between 2015 and 2021. For paediatric glaucoma, internal filtration surgery increased from 37.50% in 2015 to 88.20% in 2021. Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma, the proportion of internal filtration surgery also showed an increase from 18.20% in 2015 to 40.90% in 2021. Meanwhile, internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00% in 2015, and showed a small increase by 2021., Conclusion: As surgical technology and surgical experience continue to elevate and improve, the range of glaucoma surgeries are correspondingly evolving. This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021., (International Journal of Ophthalmology Press.)

Purpose: To describe the prevalence and risk factors for refractive errors in a northeastern Chinese population with type 2 diabetes., Methods: Subjects (age ≥30 years) from a community-based study, the Fushun Diabetic Retinopathy Cohort Study, were enrolled. All subjects underwent comprehensive ocular examinations, including autorefraction. Myopia, high myopia, and hyperopia were defined as a spherical equivalent (SE) of the right eye <-0.5 diopter (D), <-5.0D, and >0.5D, respectively. Astigmatism was defined as cylinder <-0.5D in a minus cylinder prescription. Anisometropia was defined as a difference of SE >1.0D between two eyes., Results: A total of 1929 participants (790 males, 41.0%) were enrolled. The age and gender standardized prevalence of myopia, high myopia, hyperopia, astigmatism, and anisometropia were 43.1% (95% confidence interval [CI]: 40.9%-45.3%), 8.5% (95% CI: 7.3%-9.8%), 21.5% (95% CI: 19.7%-23.4%), 61.0% (95% CI: 58.9%-63.2%), and 17.2% (95% CI: 15.5%-18.9%), respectively. Advancing age was associated with a higher frequency of hyperopia, astigmatism, and anisometropia, as opposed to a lower frequency of myopia. Female (adjusted odds ratio [aOR], 1.27; 95% CI, 1.02-1.57) participants, higher intraocular pressure (aOR, 1.03; 95% CI, 1.00-1.07), and lenticular opacity (aOR, 1.53; 95% CI, 1.20-1.94) were also found to be associated with myopia. Long duration of diabetes (>15 years) was found to be a significant factor for astigmatism (aOR, 1.62; 95% CI, 1.15-2.27) and anisometropia (aOR, 1.87; 95% CI, 1.29-2.71)., Conclusion: Nearly two-thirds of participants with type 2 diabetes had a refractive error. Age is a common factor with different types of refractive errors.

Objective: To report the incidence and time distribution of early transient intraocular pressure (IOP) elevation after penetrating canaloplasty. Methods: Retrospective case series study. Data of patients treated by penetrating canaloplasty for glaucoma in the Eye Hospital of Wenzhou Medical University from June 2015 to March 2020 were collected. Early transient IOP elevation was defined as an increase of IOP to over 21 mmHg on the first week to the third month after surgery followed by a decrease to 21 mmHg or less within 3 months. Main outcome measures included IOP, quantity of medication use, the occurrence time and duration of IOP elevation. Generalized estimating equations were used for statistical analysis, and measurement data with non-normal distribution was represented as M ( Q 1 , Q 3 ). Results: A total of 277 patients (315 eyes) achieved 360-degree catheterization of the canal successfully, and 299 eyes (94.9%) completed the postoperative 6-month follow-up. Thirty-four eyes (10.8%) had persistently high IOP, so the surgical treatment failed in them. Consequently, 234 patients (265 eyes) were enrolled in the analyses, including 161 males (184 eyes) and 73 females (81 eyes). The median age was 42 (26, 54) years, the mean preoperative IOP was (37.7 ± 11.1) mmHg, and the mean number of drugs used was 3 (2, 4). The incidence of early transient IOP elevation was 43.0% (114/265) in all enrolled eyes, 42.7% (35/82) in eyes with primary open angle glaucoma, 37.8% (17/45) in eyes with primary angle closure glaucoma, 27.7% (13/47) in eyes with congenital glaucoma and 53.8% (49/91) in eyes with secondary glaucoma. The IOP began to increase on the first to fourth week in 91.2% (104/114) of eyes with early transient IOP elevation and reached the peak [21.3 mmHg to 54.8 mmHg; mean, (32.4±8.2) mmHg] in 88.6% (101/114) on the first to fifth week after surgery. The IOP elevation lasted for no more than 4 weeks in 69.3% (79/114) of eyes. Conclusions: Over 40.0% of patients with penetrating canaloplasty may experience postoperative transient IOP elevation. The incidence is relatively high in secondary glaucoma but low in congenital glaucoma. Most of the elevations and peak IOP occur within 1-4 weeks after surgery.

Purpose: To assess the distribution and factors related to intraocular pressure (IOP) in a Chinese children population in Northern China., Methods: 1,238 offspring aged 6 to 18 years, residing in six villages, were recruited for this current study, the Handan Offspring Myopia Study. Participants underwent an interviewer-administered questionnaire and a complete ocular examination, including standardized measurement of IOP with Perkins applanation tonometry., Results: 1,648 eyes of 828 children were included in the analysis. The mean IOP was 13.9 ± 1.6 mmHg. The mean IOP for the study population increased from 13.0 ± 1.5 mmHg for those 6 to 7 years of age to 14.2 ± 1.4 mmHg for those 15 years of age or older ( P < .001). The mean central corneal thickness (CCT) was 548.7 ± 32.1 μm, and had no difference among different age groups and gender. In univariate regression analysis, age (0.12 mmHg per 1 year old), height (0.09 mmHg per 5 cm), weight (0.02 mmHg per kg), body mass index (0.07 mmHg per 1 m/kg2), systolic blood pressure (0.06 mmHg per 5 mmHg), CCT (0.06 mmHg per 5 μm), and SE (-0.11 mmHg per 1 D) were correlated with IOP. In multivariate regression analysis, higher IOP was only associated with older ages ( p = .002) and thicker CCT ( p = .001)., Conclusion: The mean IOP in healthy rural Chinese children aged 6-18 years is about 14 mmHg, which is lower than in adults in the same locality. The mean IOP is slightly increasing with age during childhood, which is opposite to the result among adults. Age and CCT are the major independent factors associated with IOP.

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P <0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.

Aim: To report the outcomes of penetrating canaloplasty for corticosteroid-induced glaucoma in a case series., Methods: Penetrating canaloplasty is a bleb-independent filtering surgery unifying canaloplasty and trabeculectomy. In this study, the surgery was performed to restore the natural outflow through surgically expanded Schlemm's canal and generated trabeculum ostium. A total of 10 eyes of 8 patients were treated with penetrating canaloplasty for corticosteroid-induced glaucoma. Intraocular pressure (IOP) and the number of glaucoma medications at postoperative 3, 6, 12, 18, 24, 36, and 48mo were documented as primary endpoint. Complications after the surgery were recorded as secondary endpoint., Results: Penetrating canaloplasty was accomplished successfully for all 10 eyes, with a mean follow-up of 20.4±13.0mo (range 6-48mo). The mean preoperative IOP and number of anti-glaucoma medications were 45.1±6.5 mm Hg and 3.3±0.5 respectively. The mean post-operative IOP at 3, 6, 12, 18, 24, 36, and 48mo were 15.8±6.0, 14.7±3.3, 15.3±2.0, 15.6±2.6, 17.5±1.8, 16.5±4.9, and 14.0 mm Hg. The number of anti-glaucoma medications at these time points were all 0. This surgery failed to control the IOP in 1 eye at 1mo after surgery. Hyphaema occurred in 3 eyes on the first day after surgery. Postoperative transient IOP increasing was encountered with in two eyes from 1wk to 1mo after surgery. Choroidal detachment developed in one eye but responded well to conservative treatment., Conclusion: Penetrating canaloplasty is effective for corticosteroid-induced glaucoma without serious complications, making it a viable or preferred alternative option., (International Journal of Ophthalmology Press.)

Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R 2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.

Purpose: To examine the association between near work, screen time including TV and outdoor time with myopia in children from the Sunflower Myopia Asian Eye Epidemiology Consortium (AEEC)., Methods: We analysed AEEC cross-sectional data (12 241 children) on risk factors (near work, screen time including TV and outdoor time) and myopia of six population-based studies (China, Hong Kong and Singapore). Cycloplegic refraction and axial length (AL) measurements were included. Risk factors were determined using questionnaires. Data were pooled from each study, and multivariable regression analysis was performed to evaluate the associations between risks factors and myopia, spherical equivalent (SE) and AL., Results: Among the included children, 52.1% were boys, 98.1% were Chinese and 69.7% lived in urban areas. Mean±standard deviation (SD) for age was 8.8 ± 2.9 years, for SE was -0.14 ± 1.8 D and for AL was 23.3 ± 1.1 mm. Myopia prevalence was 30.6%. In multivariate analysis, more reading and writing (OR = 1.17; 95% CI, 1.11-1.24), more total near work (OR = 1.05; 95% CI, 1.02-1.09) and less outdoor time (OR = 0.82, 95% CI, 0.75-0.88) were associated with myopia (p's < 0.05). These factors were similarly associated with SE and AL (p's < 0.05), except for total near work and AL (p = 0.15). Screen time including TV was not significantly associated with myopia (p = 0.49), SE (p = 0.49) or AL (p = 0.83)., Conclusion: In this study, increased reading and writing and decreased outdoor time were associated with myopia. Screen time may be a surrogate factor of near work or outdoor time, but further research is needed to assess its role as an independent risk factor for myopia., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objective: This study aimed to assess the knowledge, attitude, and practice (KAP) of diabetic subjects with diabetic retinopathy (DR) and those without DR (NDR) in an urban community in Northeast China, as well as their risk factors in subjects with DR and NDR., Methods: A community-based survey involving 1,662 subjects was conducted in Fushun, China, between July 2012 and May 2013. The subjects included diabetics with DR ( n = 783) and those NDR ( n = 879), and questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. A Chi-square test and multiple logistic analyses were performed to analyze the data., Results: Among the DR group, 21.88% had a good knowledge of DR, 94.15% had a positive attitude, and 68.07% followed good practice, whereas 20.98% of the NDR group had a good knowledge of DR, 94.18% had a positive attitude, and 66.92% followed good practice. There was no significant difference in the KAP of the two groups of subjects. In the NDR group, a good level of knowledge was associated with a high-level of education (OR = 0.1, 0.2; p < 0.05), a good attitude was associated with retirement (OR = 0.2; p < 0.05), and good practice was associated with being female, having a high-level of education, and the type of treatment (OR = 0.5, 0.4, 2.3, 3.1; p < 0.05). In the DR group, good practice was associated with older age and retirement (OR = 0.6, 0.4; p < 0.05)., Conclusions: There was no significant difference between the DR and NDR subjects in the overall levels of KAP, but both groups showed a poor level of knowledge. Age, gender, education, occupation, and type of treatment were the main factors associated with the KAP scores, more risk factors in the NDR group than in the DR group. There is an urgent need for coordinated educational campaigns with a prioritized focus on the northeast region of China, especially NDR group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Qi, Zhai, Wang, Liang, Li, Wen, Zang, Feng, Zang and Xie.)

Antibiotic resistance genes (ARGs) are receiving increasing concerns due to the antibiotic resistance crisis. Nevertheless, little is known about the spatial behavior and sources of extracellular ARGs (eARGs) in the chlorinated drinking water distribution systems (DWDSs). Here, tap water was continuously collected to reveal the occurrence of both eARGs and intracellular ARGs (iARGs) along a chlorinated DWDS. Afterward, the correlation between eARGs, eDNA-releasing communities, and communities of planktonic bacteria was further analyzed. The eARG concentration decreased significantly, whereas the proportion of vanA and bla NDM-1 increased. Further, the diversity of the eDNA-releasing community increased markedly with increasing distance from the drinking water treatment plant (DWTP). Moreover, the dominant eDNA-releasing bacteria shifted from Acinetobacter, Pseudomonas, and Methylobacterium-Methylorubrum in finished water from the DWTP to Bacteroides, Faecalibacterium, Staphylococcus, and Parabacteroides in the DWDS. In terms of eARG source, thirty genera were significantly correlated with seven types of eARGs that resulted from the lysis of dead planktonic bacteria and detached biofilms. Conversely, the iARGs concentration increased, whereas the biodiversity of the planktonic bacteria community decreased in the sampling points along the DWDSs. Our findings provide critical insights into the spatial behavior and sources of eARGs, highlighting the health risks associated with ARGs in DWDSs., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Aim: To estimate the prevalence of diabetic macular edema (DME) and clinically significant macular edema (CSME), and to assess their risk factors in a population with type 2 diabetic mellitus (T2DM) located in northeast China., Methods: Patients were included from the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based study conducted in northeast China. The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of fundus photographs. The age-standardized prevalence of DME and CSME was estimated. The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis., Results: A total of 292 (15.4%) and 166 (8.8%) patients were diagnosed as DME and CSME, yielding the age and sex standardized prevalence of 13.5% (95%CI: 11.9%-15.0%), and 7.1% (95%CI: 5.9%-8.3%), respectively. Female patients had a higher prevalence of DME compared to their male counterparts (15.7% vs 10.4%, P =0.03). Multivariable Logistic regression analysis showed that younger age, insulin use, proteinuria, longer duration of diabetes, and higher glycosylated hemoglobin A1c, were associated with the prevalence of DME and CSME. Patients with higher fasting plasma glucose, systolic blood pressure, and blood urea nitrogen were also found to be associated with DME., Conclusion: Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort, those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection., (International Journal of Ophthalmology Press.)

Aim: To investigate fluctuation of intraocular pressure (IOP) and seasonal variation of 24-hour IOP during one year in healthy participants., Methods: Totally 13 young healthy volunteers participated in this study. IOP was measured with Canon TX-20 at about 8:00-9:00 a.m . from Monday to Friday every week for a whole year. They also underwent 24-hour IOP examination every three months. Blood pressure, heart rate, temperature, humidity, atmosphere pressure, sunshine duration and other environment parameters were recorded., Results: The yearly fluctuation curve showed IOP in the summer months were lower than other seasons. In the multivariable generalized estimating equation analysis, IOP had a negative correlation with both temperature and sunshine duration ( P <0.05). There also was a seasonal effect on 24-hour IOP. However, all intraclass correlation coefficients values of minimum, maximum and average of the 24-hour IOP and each individual IOP were less than 0.30., Conclusion: IOP is trend to be higher in cold days than warm days. IOP have negative association with both environmental temperature and duration of sunshine. On a season-to-season basis, 24-hour IOP is not highly reproducible in healthy volunteers., (International Journal of Ophthalmology Press.)

Objective: To investigate the clinical features in patients with iridocorneal endothelial (ICE) syndrome. Methods: A retrospective case series study. Data of clinical manifestations of patients with ICE syndrome including clinical subtypes, presenting visual acuity, clinical features and secondary glaucoma were collected from January 2014 to May 2020 in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University. The Wald's Chi-square test of generalized estimating equations was performed to analyze the differences in three clinical subtypes. Results: A total of 127 eyes of 114 subjects (64 females and 50 males) were included. Mean±SD age at presentation was (49±13) years. There were 53 patients (46.5%) with Chandler's syndrome (CS), 36 patients (31.6%) with progressive iris atrophy (PIA), 24 patients (21.0%) with Cogan-Reese syndrome (CRS) and one patient (0.9%) with an undetermined subtype. And 101 patients (88.6%) had uniocular ICE syndrome. Approximately 81.7% (49/60), 56.1% (23/41) and 41.7% (10/24) of eyes presented visual acuity <0.3 in patients with CS, PIA and CRS, respectively. Corneal edema was most common in CS (52.5%, 32/61), followed by PIA (29.3%, 12/41) and CRS (20.8%, 5/24). Corectopia was found in 95.8% (23/24) of eyes with CRS, 95.1% (39/41) of eyes with PIA and 78.7% (48/61) of eyes with CS. Polycoria was observed in 29.3% (12/41) of eyes with PIA, 3.3% (2/61) of eyes with CS and 8.3% (2/24) of eyes with CRS. Ectropion uvea was most common in CRS (54.2%, 13/24), followed by 16.4% (10/61) in CS and 12.2% (5/41) in PIA. Glaucoma was found in 94 eyes (74.0%, 94/127). Among them, 60.7% (37/61) of CS, 80.5% (33/41) of PIA and 95.8% (23/24) of CRS had secondary glaucoma. The difference of presenting visual acuity, corneal edema, corectopia, polycoria, ectropion uveae and secondary glaucoma in three clinical subtypes all had statistical significance (Wald χ 2 =13.87, 10.77, 965.78, 11.45, 15.00, 222.04; all P <0.05). And 86.2% of eyes (81/94) had glaucoma surgeries and 41 eyes (43.6%, 41/94) had the intraocular pressure well controlled with various interventions. Conclusions: ICE syndrome is mostly uniocular and more common in middle-aged patients. CS is the most common clinical subtype with poor presenting visual acuity. About 3/4 of eyes have secondary glaucoma, and the majority of them require surgical interventions, but prognoses are discouraging.

Purpose: The aim of this study was to compare the prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME), as well as their risk factors in patients with early-onset diabetes (EOD, ≤40 years) and late-onset diabetes (LOD, >40 years)., Methods: Patients were recruited from a community-based study, Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), conducted between July 2012 and May 2013 in China. The presence and severity of DR and DME were determined by a modified Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of six-field fundus photographs., Results: A total of 1,932 patients (796 male, 41.2%) with gradable fundus photography were included. The prevalence of any DR and DME was 67.0% (95% confidence interval [CI]: 60.3-73.7%) and 39.3% (95% CI: 32.1-46.5%) in the EOD patients, respectively, which were both significantly higher than that in the LOD patients (DR: 41.9%, 39.6-44.2%, p < 0.001; DME: 14.4%, 12.7-16.1%, p < 0.001). Insulin use was associated with both the presence of DR and DME in both EOD and LOD patients. Besides insulin use, a high level of income (odds ratio [OR], 95% CI: 0.05, 0.01-0.51) was negatively associated with DR, and higher high-density lipoprotein (OR, 95% CI: 4.14, 1.44-11.91) was associated with DME among EOD patients., Conclusion: In this sample of patients with type 2 diabetes, both prevalence of DR and DME were apparently higher in patients who developed diabetes ≤40 years of age than those who developed it later., (The Author(s). Published by S. Karger AG, Basel.)

Purpose: To investigate the association between metabolic syndrome (MetS) and diabetic retinopathy (DR), as well as the association between MetS and retinal vessel caliber, among Chinese patients with type 2 diabetes mellitus in north-eastern China., Study Design: Cross-sectional study., Patients and Methods: The patients were recruited from a community-based study, the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). The presence of DR was determined using a modified version of the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were identified by use of Integrative Vessel Analysis software. The presence of MetS was defined according to the Joint Interim Statement proposed in 2009., Results: The prevalence of DR was significantly higher among female patients with MetS than among those without it (47.2% vs 30.9%, P = 0.002), and it increased as the number of MetS components increased (P = 0.003). Furthermore, the presence of MetS (odds ratio 2.43, 95% CI 1.39-4.26) as well as higher numbers of MetS components were significantly associated with DR in female patients, after adjustment for potential risk factors. Patients with MetS (multivariate β coefficient, 95% CI - 6.9, - 10.0, to - 3.8) or a higher number of Mets components tended to have significantly smaller CRAE., Conclusion: In this study cohort, female patients with MetS had a higher prevalence of DR. Patients tended to have thinner central retinal arterioles as the number of MetS components increased., (© 2021. Japanese Ophthalmological Society.)

Background: The incidence of cerebral hemorrhage has rapidly increased over time, and vascular dysfunction has a significant influence on the pathogenesis and outcome of these patients. This is also the case for vasospasm in cerebral hemorrhage, but there is no method to assess this. We conducted this study to find molecular biomarkers of vasospasm in cerebral hemorrhage patients., Methods: Raw data of GSE37924 was downloaded from the Gene Expression Omnibus (GEO) database, including 66 samples with cerebral vasospasm and 62 samples without cerebral vasospasm. Differentially expressed genes (DEGs) between samples with cerebral vasospasm and those without cerebral vasospasm were analyzed using the limma package in R software. To determine the functions of DEGs, we conducted functional enrichment analysis of DEGs through the clusterProfiler package in R. The protein-protein interaction (PPI) network of DEGs was constructed through STRING (https://string-db.org/) and generated via Cytoscape software. To understand the correlation between DEGs and immune-related genes, immune-related cerebral vasospasm genes were obtained via intersecting immune-related genes and cerebral vasospasm DEGs. We also compared the infiltration of 28 immune cells between cases with cerebral vasospasm and those without cerebral vasospasm. Finally, we constructed a model to perform the validation experiments., Results: Of the DEGs, there were 24 upregulated and 21 downregulated genes in the vasospasm samples compared to the no-vasospasm samples. Functional enrichment analysis showed that these genes play key roles in several biological processes and signaling pathways such as the bone morphogenetic protein (BMP) signaling pathway, cellular response to BMP stimulus, natural killer cell chemotaxis, negative regulation of transmembrane receptor protein serine/threonine kinase signaling pathway, MHC protein complex binding, and receptor ligand activity, among others. CCL4, HLA-DQA1, IGF2, NTS, and so on were the significant immune-related genes. Furthermore, the immune cell infiltration results showed that there were differences between patients with vasospasm and those without vasospasm. Finally, we found that CCL4 had significantly higher expression in patients with vasospasm than those without vasospasm., Conclusions: CCL4 is an important regulator of vascular dysfunction in cerebral hemorrhage.

Background: We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury (MIRI) in patients with acute ST-elevation myocardial infarction (STEMI) using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism., Methods: The mononuclear cells were separated by ficoll centrifugation, and plasma total antioxidant capacity (T-AOC) was determined by the ferric reducing ability of plasma (FRAP) assay. The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, gene ontology (GO) enrichment analysis was performed on DAVID website to analyze the potential mechanism further., Results: The total numbers of white blood cells (WBC) and neutrophils (N) in the peripheral blood of STEMI patients (the AMI group) were significantly higher than those in the control group (WBC: 11.67±4.85 ×10 9 /L vs. 6.41±0.72 ×10 9 /L, P <0.05; N: 9.27±4.75 ×10 9 /L vs. 3.89±0.81 ×10 9 /L, P <0.05), and WBCs were significantly associated with creatine kinase-myocardial band (CK-MB) on the first day ( Y =8.945+0.018 X , P <0.05). In addition, the T-AOC was significantly lower in the AMI group comparing to the control group (12.80±1.79 U/mL vs. 20.48±2.55 U/mL, P <0.05). According to the gene analysis, eight up-regulated differentially expressed genes (DEGs) included GADD45A , PRDX2 , HSPD1 , DNAJB1 , DNAJB2 , RAD50 , TNFSF6 , and TRADD . Four down-regulated DEGs contained CCNG1 , CAT , CYP1A1 , and ATM . TNFSF6 and CYP1A1 were detected by polymerase chain reaction (PCR) to verify the expression at different time points, and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression. GO and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response (UPR) and apoptosis., Conclusions: WBCs, especially neutrophils, were the critical cells that mediating reperfusion injury. MIRI was regulated by various genes, including oxidative metabolic stress, heat shock, DNA damage and repair, and apoptosis-related genes. The underlying pathway may be associated with UPR and apoptosis, which may be the novel therapeutic target., Competing Interests: Conflicts of interests: The authors declare that they have no conflicts of interests., (Copyright: © World Journal of Emergency Medicine.)

Aim: To investigate the association of peripheral anterior synechiae (PAS) with intraocular pressure (IOP) and glaucomatous optic neuropathy (GON) in primary angle closure (PAC) and primary angle-closure glaucoma (PACG)., Methods: Totally 355 eyes (238 PAC and 117 PACG) of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial. All patients had undergone a comprehensive ophthalmic examination. The extent of PAS in clock hours as determined on gonioscopy was documented. The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation (GEE) models., Results: The frequency of GON increased with the extent of PAS and a higher IOP. PAS were more extensive (8 vs 1 clock hour, P <0.001) and IOP higher (28.01 vs 18.00 mm Hg, P <0.001) in PACG compared to PAC. The prevalence of GON among the PAS quartiles were 10.2% (PAS<0.5 clock hours), 16.9% (PAS≥0.5 and PAS<3 clock hours), 29.6% (PAS≥3 and PAS<7 clock hours), and 74.4% (PAS≥7 clock hours), respectively. After adjusting for IOP, age, gender, spherical equivalent, average Shaffer score and number of medications, the odds ratio (OR) for GON was 4.4 (95%CI: 1.5-13.0; P =0.007) with PAS≥3 clock hours and 13.8 (95%CI: 4.3-43.6; P <0.001) with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours. The frequency of GON increased linearly with the extent of PAS. Extent of PAS was also associated with higher IOP. Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg (OR=18.0, 95%CI: 7.5-43.4; P <0.001)., Conclusion: The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP, suggesting other factors related to PAS formation may be involved in the development of GON in PACG., (International Journal of Ophthalmology Press.)

Objective: To describe the distribution and characteristics of peripheral anterior synechiae (PAS) in patients with primary angle-closure glaucoma (PACG). Methods: Retrospective case study. A total of 285 PACG patients (406 eyes) diagnosed in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University from January 2017 to August 2019 were included. They were 102 males and 183 females, with a median age of 67 years old (range, 21 to 95 years old). The PAS range was detected by gonioscopy examination, and the frequency distribution of PAS at 12 clock points was counted by clockwise. The PAS distribution at the middle point of PAS with continuous distribution and ≤6 clock points was assessed. Results: In all cases, PAS of the right eye was concentrated at 11:00 to 4:00 regions [range, 62.0% (129/208) to 78.8% (164/208)]. PAS of the left eye was concentrated at 7:00 to 1:00 regions [range, 50.0% (99/198) to 75.8% (150/198)]. When the PAS range of the atrial angle was ≤6 clock regions, it was mainly at 12:00 to 3:00 [range, 58.3% (74/127) to 67.7% (86/127)] in the right eye and at 10:00 to 12:00 [range, 54.8% (68/124) to 66.1% (82/124)] in the left eye. Among 121 cases (242 eyes) with both eyes involved, the PAS region was at 11:00 to 5:00 [range, 52.1% (63/121) to 79.3% (96/121)] in the right eye and at 8:00 to 1:00 [range, 50.4% (61/121) to 76.9% (93/121)] in the left eye. When the PAS range of the atrial angle was ≤6 clock regions, it was mainly at 12:00 to 4:00 [range, 53.2% (41/77) to 71.4% (55/77)] in the right eye and at 10:00 to 12:00 [range, 50.6% (39/77) to 64.9% (50/77)] in the left eye. In all cases, there were 171 cases of right eyes and 175 cases of left eyes with continuous angle PAS. The central PAS clock position of the right eye was mainly at 11:00 to 3:00 [range, 15.2% (26/171) to 24.0% (41/171)], and that of the left eye was mainly at 8:00 to 12:00 [range, 15.4% (27/175) to 20.6% (36/175)]. Among cases with both eyes involved, there were 98 cases of right eyes and 104 cases of left eyes with continuous angle PAS. The clock distribution of the middle position of the right eye angle PAS was concentrated at 11:00 to 3:00 [range, 17.3% (17/98) to 26.5% (26/98)], and that of the left eye was concentrated at 8:00 to 12:00 [range, 13.5% (14/104) to 20.2% (21/104)]. Conclusions: The PAS of PACG patients is mainly located in the upper and nasal sides, and the closer to the temporal side, the smaller the PAS frequency, showing a gradual downward trend. The PAS distribution of binocular angles is of obvious mirror symmetry. (Chin J Ophthalmol, 2021, 57: 666-671) .

Aim: To report the progression rate (PR) to primary angle closure (PAC) following laser peripheral iridotomy (LPI) in PAC suspects (PACS)., Methods: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. Totally 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12mo post LPI., Results: Eighty of 134 patients (59.7%) could be followed up at one year. The mean intraocular pressure (IOP) in treated eyes was 15.9±2.6 mm Hg at baseline, 15.4±3.0 mm Hg on day 7; 16.5±2.9 mm Hg at one month, and 15.5±2.9 mm Hg at 12mo; the IOP in untreated eyes was similar ( P =0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The PR to PAC in untreated eyes was 3.75% and one developed acute angle-closure glaucoma (AACG); the PR to PAC in treated eyes was 2.5% and none had developed peripheral anterior synechia (PAS) or AACG., Conclusion: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees., (International Journal of Ophthalmology Press.)

Materials combining proton conductivity and magnetism have attracted great attention in recent years due to their intriguing application in sensors and fuel cells. Herein a two-dimensional metal-organic framework, [Cu(atz) 2 (H 2 O) 2 ]⋅H 2 O (1) (Hatz=5-aminotetrazole), has been obtained in a green synthesis method. The single-crystal structure revealed that the atz - ligands as linkers coordinate with copper ions to sql networks, between which water molecules are immobilized through hydrogen bonds. The resulting complex 1 exhibits a high proton conductivity of 1.11×10 -4 and 6.19×10 -4  S cm -1 at room temperature and 333 K, respectively, under 98% RH with an activation energy of 0.56 eV. Upon dehydration, the proton conductivity of 1&#95;dg drops by an order of magnitude. Furthermore, the magnetic behavior changes from long-range ferrimagnetic ordering of 1 to canted antiferromagnetic behaviour of 1&#95;dg., (© 2021 Wiley-VCH GmbH.)

In order to study the effects of chlorine dioxide (ClO 2 ) disinfection on the super antibiotic resistance genes (SARGs), the final effluents before and after chlorine dioxide were sampled throughout one year in a wastewater treatment plant (WWTP). The bacteria and extracellular nucleic acid were collected using microporous membrane filtration and nucleic acid adsorption particles, respectively. A total of 9 SARGs was detected through a quantitative real-time polymerase chain reaction (qPCR). The results revealed that both intracellular and extracellular NDM-1 , MCR-1 , and MEC-A could be positively detected in the samples. Overall, ClO 2 disinfection enhanced the relative abundance of the iSARGs ( P <0.05), exhibiting a seasonal pattern, and increasing in the spring, summer, and autumn. In spring, it improved the most, up to twice the abundance. No SARGs were detected positive in the winter, either intracellularly or extracellularly. There was no significant variation in the concentrations of eSARGs before and after ClO 2 disinfection. Therefore, ClO 2 disinfection cannot effectively remove iSARGs and eSARGs in the final effluent from the WWTP.

Objective: To evaluate the quality of life of patients with primary open-angle glaucoma (POAG) and its related factors in Wenzhou. Methods: Cross-sectional analysis. A total of 339 POAG patients diagnosed in the Wenzhou glaucoma progression study conducted in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University from March 2014 to October 2019 were included. Quality of life of POAG patients was assessed by EQ-5D including the visual analogue scale (VAS). The effects of gender, age, visual field loss (VFL), family history of glaucoma, hypertension, diabetes, migraine, sleep quality, and amateur exercise on the quality of life were analyzed. The utility value (UV) and VAS score were expressed as the median ( P 25 , P 75 ), and Mann-Whitney U was used for the comparison between two groups. Kruskal-Wallis H was performed to compare the differences among multiple groups. Results: A total of 339 POAG patients were included in the study; 164 were males (48.4%), and 175 were females (51.6%). The mean age was (63±10) years. Thirty-four patients (10.0%) had received medication (including one with combined surgical treatment), while the remaining 305 patients (90.0%) had received no anti-glaucoma treatment. Among the patients, 10.5% (32/305) had no VFL, 68.9% (210/305) had mild VFL, 17.0% (52/305) had moderate VFL, and 3.6% (11/305) had severe VFL. In all patients, the median of UV was 1.000 (1.000, 1.000), the mean of UV was 0.964, and the median of VAS score was 80 (75, 90), the mean of VAS score was 81.58. Anxiety or depression and pain or discomfort occurred in 45.7% (43/94) and 34.1% (32/94), respectively, of POAG patients with decreased UVs, as well as mobility constraints in 13.8 % (13/94) and usual activity constraints in 6.4% (6/94). The median of UV of the eye with a better visual field in the group without VFL or with mild or moderate VFL was 1.000 (1.000, 1.000), and in the group with severe VFL was 1.000 (0.862, 1.000), but there was no significant difference in the UV and the VAS score of the eye with a better visual field among groups with different degrees of VFL (both P >0.05). There was statistically significant difference in the UV among groups with different sleep qualities ( H =17.465; P <0.01). Using pairwise comparison, the median of UV of the very good sleep group was 1.000 (1.000, 1.000), significantly different to the slightly poor sleep group 1.000 (0.866, 1.000) ( z =3.613; P <0.05). The median of UV in patients with migraine was 1.000 (0.875, 1.000), without migraine 1.000 (1.000, 1.000), and in patients with hypertension was 1.000 (0.875, 1.000), without hypertension 1.000 (1.000, 1.000), and in patients with diabetes was 1.000 (0.875, 1.000), without diabetes was 1.000 (1.000, 1.000), the difference was statistically significant ( Z =-2.189, -3.864, -2.417; all P <0.05). The UV was not related to age, gender, family history of glaucoma, amateur exercise, alcohol and tobacco, and history of anti-glaucoma medication (all P >0.05). Conclusions: VFL is related to the UV of POAG patients in Wenzhou. Quality of life in mild POAG patients is good but decrease in advanced POAG patients. Sleep quality, systemic complications and physical or psychological discomfort impact on quality of life in POAG patients. (Chin J Ophthalmol, 2021, 57: 207-214) .

Objectives: This study aimed to assess the association between the corneal biomechanical parameters and visual field (VF) loss in patients with asymmetric primary open-angle glaucoma (POAG)., Methods: A total of 89 POAG patients (50 males, 56.2%) with asymmetric VF loss, aged 65.2 ± 13.3 years, were enrolled in this study. Asymmetric VF loss was defined as an interocular difference of the global index mean deviation (MD) >2 dB. Intraocular pressure (IOP), central corneal thickness (CCT), and corneal biomechanical parameters such as maximum amplitude at the apex of highest concavity (def ampl HC) were measured. The worse eye was defined as the eye with a smaller MD., Results: The worse eyes had lower MD (-11.9 ± 6.7 dB vs. -5.3 ± 5.0 dB; p < 0.001) and higher IOP (14.6 ± 3.3 vs.13.9 ± 2.6 mm Hg, p = 0.04) than the better eyes. There was no significant difference between the 2 groups for CCT. The interocular difference of MD (IDMD) was negatively correlated with the interocular difference of IOP (r = -0.22, p = 0.04), while positively correlated with the interocular difference of def ampl HC (r = 0.27, p = 0.01). In patients with moderate asymmetric VF loss (IDMD ≥6 dB), def ampl HC of the worse eyes group (1.07 ± 0.12 mm) was significantly lower than the better eyes group (1.10 ± 0.11 mm, p = 0.02)., Conclusion: Asymmetric POAG was associated with asymmetry in IOP and corneal biomechanical parameters but not in CCT. Lower deflection amplitude and higher IOP were found in eyes with more severe VF damage in POAG patients., (© 2020 S. Karger AG, Basel.)

Purpose: To investigate the natural change of nearwork-induced transient myopia (NITM), and its association with the progression of refractive error., Methods: Students of the Beijing Myopia Progression Study were examined at baseline and follow-up examinations, which included cycloplegic autorefraction. Initial NITM and its decay were assessed objectively immediately after binocularly-viewing and performing a sustained 5-minute near task (20 cm)., Results: There were 223 students with both NITM and cycloplegic refractive data enrolled. There were 142 myopic (63.7%), 32 emmetropic (14.4%), and 49 hyperopic (22.0%) students according to their baseline cycloplegic refraction. The annual refractive change was -0.45 (-0.73, -0.21) D. From the baseline to the one-year and two-year follow-up periods, the initial NITM (median) increased significantly in the myopic students (0.16, 0.21, and 0.20D, p = 0.01, respectively). The overall proportion of NITM decay types shifted significantly from none being induced at baseline (non-induced: 17.0%, complete decay 57.4%, incomplete decay 25.6%) to incomplete decay at the 2-year follow-up (non-induced: 6.7%, complete decay 65.0%, incomplete decay 28.3%, p = 0.01). For the hyperopic students, after adjusting for risk factors, for every 1 diopter increase in the initial NITM at baseline, there was approximately a -1.48 diopter more relative myopic refractive progression (p = 0.01). No significant association was found between refractive change and the NITM parameters for either the myopic or emmetropic students after adjusting for the same confounders. However, this relation was significant in the hyperopes (p = 0.01)., Conclusion: NITM was only found to be significantly associated with the progression of a myopic refractive shift among the hyperopes., (Copyright © 2020. Published by Elsevier España, S.L.U.)

Objective: To analyze and summarize the prevalence of diabetic retinopathy (DR) in China, and provide scientific evidence for its prevention and intervention. Methods: Literature search of PubMed, Web of Science, Embase, Wanfangdata, Vip and CNKI between 1990 and 2020 was performed to retrieve epidemiological studies of DR in China. The total prevalence of DR was analyzed by performing a meta-analysis, and the prevalences of DR in different regions and age groups were also evaluated by subgroup analyses. Results: A total of 40 studies were enrolled. The total sample size of the general population was 282 620, and the total number of diabetic patients was 47 022. The prevalence of DR in the general population and diabetic patients was 1.7% (95 %CI : 1.4%-2.0%) and 22.4% (95% CI: 18.8%-26.1%), respectively. The highest prevalence of DR was found in patients aged 50-59 years (22.1%). Among the diabetic population, the prevalence of DR was high in North (27.7%) and Northeast China (23.7%), but the East China had the largest estimated number of DR patients (4 971 000). Moreover, the prevalence of DR in rural areas (34.0%) was higher than that in urban areas (18.7%). Conclusions: The prevalence of DR is high in Chinese diabetic population, and there are differences among regions and age subgroups. The results of the current meta-analysis emphasize the necessity of DR screening for diabetic population, especially in rural areas.

Purpose: To evaluate the prevalence and causes of visual impairment in a group of community people with type 2 diabetes mellitus (T2DM) in Northeast China., Methods: Population-based cross-sectional survey. Patients diagnosed with T2DM residing in 15 communities in Fushun, Northeast China, were enrolled between July 2012 and May 2013. All participants underwent an extensive and standardized eye examination (visual acuity testing, slit-lamp, and fundus examination). Low vision was defined as presenting VA of better-seeing eye <20/60 and ≥20/400, and blindness was defined as VA <20/400, according to the World Health Organization (WHO) definitions. The primary causes of blindness and low vision were assessed by senior ophthalmologists., Results: Visual acuity measurements were available for 1998 (89.8%) of 2224 subjects in the study. The prevalence of bilateral blindness and low vision defined was 0.90% and 10.81%. Uncorrected refractive error was the first leading cause of low vision (75.0%) and blindness (38.9%). After correcting the refractive error, the first leading cause of low vision was cataract (44.4%), followed by diabetic retinopathy (29.6%) and myopic maculopathy (18.5%), while the first leading cause of blindness was proliferative DR (45.4%), followed by cataract (36.4%) and myopic maculopathy (18.2%)., Conclusions: This study suggested a high prevalence of low vision and blindness in this study cohort. Uncorrected refractive error and cataract remain the leading cause of visual impairment, but the major challenge is the early diagnosis and intervention of diabetic retinopathy to reduce diabetes-related blindness., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright © 2020 Liang Wen et al.)