Factors affecting choroidal circulation parameters in 4-14-year-old Chinese children measured by SS-OCT/OCTA.

PURPOSE: To measure the choroidal circulatory parameters Han Chinese children aged 4-14 years from Southwest China, and to explore the relationships between these parameters and age, axial length (AL), and choroidal thickness (ChT). METHODS: 284 eyes from 142 subjects were included in this cross-sectional study. All participants underwent cycloplegic refraction and IOLMaster500 examination. Swept-source optical coherence tomography (SS-OCT) was used to measure submacular choroidal thickness, choroidal vascular volume (CVV), choroidal stromal volume (CSV), choroidal vascularity index (CVI), and CVV/CSV ratio. RESULTS: In this population, the mean CVV was 2.92 ± 0.55 mm3, CSV was 4.69 ± 0.68 mm3, CVI was 38.22 ± 2.46 %, and CVV/CSV ratio was 62.11 ± 6.44 %. Multivariable regression analyses showed that both CVV and CSV were negatively correlated with AL (both P < 0.001) and positively correlated with ChT (both P < 0.001), while age showed no significant correlation with them (both P > 0.05). However, the correlations between CVI and age were not uniform rectilinear. Among participants aged ≤8 years, CVI showed no correlation with age (P > 0.05), while among those aged >8 years, it was positively correlated with age (P < 0.01). CVV/CSV ratio was positively correlated with ChT and age (both P < 0.01). CONCLUSION: After the age of 8, age was positively correlated with CVI. ChT was well correlated with CVI. Longer AL and thinner ChT were associated with reduced CVV and CSV, with CVV decreasing more rapidly than CSV.

Wide-field swept-source optical coherence tomography angiography (SS-OCTA) in the assessment of retinal vessel density and thickness in 4-to 16-year-old myopic children.

PURPOSE: To analyze the characteristics of macular retinal vessel density and thickness in children with myopia. METHODS: A cross-sectional study was conducted. A total of 228 children aged 4-16 years who visited the Ineye Hospital of Chengdu University of Traditional Chinese Medicine from September 2022 to November 2023 were included. Those with -0.5D < spherical equivalent (SE) < +2.0D were included in the non-myopia group (150 eyes), those with -3.0D < SE ≤ -0.5D were included in the low myopia group (246 eyes), and those with SE ≤ -3.0D were included in the moderate-to-high myopia group (60 eyes). All subjects underwent cycloplegic refraction, IOLmaster500, and Wide-field SS-OCTA (to exclude some peripheral retinal degeneration). Multiple linear regression analysis was used to analyze the correlation between macular ETDRS subfield of full retinal thickness (FRT), outer, inner retinal thickness (ORT, IRT), retinal vessel density (VD), deep and superficial retinal vessel density (DVD, SVD), and SE, axial length (AL). RESULTS: There were statistically significant differences (P < 0.05) in FRT in the central fovea (1 mm diameter)and perifovea (Diameter 3 to 6 mm) among the non-myopia group, low myopia group, and moderate-to-high myopia group. The three groups also showed statistically significant differences (P < 0.05) in VD in the central fovea and parafovea with a diameter of 1 to 3 mm (except the lower part). In multiple linear regression analysis adjusted for gender and age, SE and AL were found to be correlated with FRT in all ETDRS regions (except the central fovea) (P < 0.01), and SE and AL were correlated with IRT in the central fovea and perifovea, respectively (ß range -2.302 to 1.652; P < 0.05). SE and AL were also correlated with ORT in the parafovea and perifovea, respectively (ß range -4.371 to -2.344; P < 0.05). AL was negatively correlated with VD in the central fovea and parafovea (except the inferior region) (P < 0.05), as well as with DVD in all ETDRS regions (ß range -1.314 to -1.031; P < 0.05). AL was only negatively correlated with SVD in the parafoveal nasal region (ß = -0.633, P < 0.05). Additionally, the correlation between AL and DVD, ORT was higher than that with SVD, IRT. CONCLUSION: The more severe the myopia, the longer the AL, the thinner the FRT in the perifovea, and the lower the VD in both the fovea and parafovea in children. In addition, DVD and ORT were more significantly correlated with AL, suggesting that they may be more closely related to the growth of AL.

Large-scale study in Chengdu, China: The prevalence of myopia full-correction decreased with increasing myopia in adolescents.

Myopia is an increasingly serious health issue among children and adolescents worldwide. This study investigated the situation related to myopia among students in Chengdu, a city in western China, and analyzed the prevalence of myopia spectacle wear and myopia full-correction and their influencing factors to understand the current status of myopia prevention. This school-based cross-sectional study investigated 1582 schools in seven districts of Chengdu City, China, enrolling a total of 417,337 students aged 6-18 years (elementary, middle, and high school) from 2020 to 2022. Examination items included uncorrected visual acuity (UCVA), slit lamp examination and non-cycloplegic autorefraction. Myopia was defined as non-cycloplegic SE ≤ -0.50 D + UCVA> 0 log MAR (age ≥6). The prevalence of myopia spectacle wear is defined as the number of people wearing glasses for myopia/the number of people with myopia (%) within the study population, and myopia full-correction is defined as normal vision after wearing glasses for myopia (≤0 log MAR for 6 years and above). With the support of the government, this programme is conducted 1-2 times a year. Statistical analyses are conducted to determine the association between myopia and various parameters. The average age of the entire survey population was 10.96 ± 3.5 years, and the overall prevalence of myopia was 48.7%, myopia spectacle wear was 65.7%, and myopia full-correction was 50.5%. With increasing age and educational levels, the prevalence of moderate to high myopia, the prevalence of myopia spectacle wear, and the prevalence of myopia full-correction all rise. The prevalence of mild myopia full-correction (46.5%) was higher than that for moderate myopia (47.1%) and even higher than that for high myopia (39.6%). The correct utilization rate of myopic spectacles was 33.17%, increasing with age and education levels, with the highest correct utilization rate of 40.7% among those with moderate myopia. The prevalence of myopia among children and adolescents in Chengdu is relatively low, and the prevalence of myopia spectacle wear and myopia full-correction need to be improved, and it was found that with the increase of myopia, the prevalence of myopia full-correction among adolescents decreased instead.

Refraction and ocular biometric parameters in 3-to 6-year-old preschool children : a large-scale population-based study in Chengdu, China.

PURPOSE: To understand the ocular biometric parameters characteristics and refractive errors in 3-to 6-year-old preschool children in Chengdu, China, and to investigate the prevalence of refractive errors. METHOD: A school-based cross-sectional study was conducted in Chengdu from 2020 to2022 with a total of 666 kindergartens. All children were measured by non-cycloplegic autorefraction and uncorrected visual acuity (UCVA) and ocular biometric parameters. Finally, univariate linear regression models were used to analyze the relationship between ocular biometric parameters and refraction. RESULTS: A total of 108,578 preschool children aged 3-6 underwent examinations, revealing a myopia prevalence of 6.1%. The mean axial length (AL), keratometry (K), corneal radius (CR), axial length/corneal radius (AL/CR) Ratio, central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), and vitreous chamber depth (VCD) were 22.35 ± 0.69 mm, 43.35 ± 1.58 D, 7.80 ± 0.28 mm, 2.87 ± 0.08, 533.31 ± 32.51 µm, 2.70 ± 0.28 mm, 3.91 ± 0.27 mm, and 15.20 ± 0.68 mm, respectively. With increasing age, AL, CR, AL/CR ratio, CCT, ACD, LT, and VCD also increased. Regardless of age, males consistently exhibited longer AL, flatter corneal curvature, shallower ACD, thicker CCT, thinner LT, and longer VCD compared to females. AL, K, CR, LT, and VCD all showed significant linear relationships with SE (all P < 0.001) in univariate linear regression analysis after adjusting for gender and age. CONCLUSION: The prevalence of myopia among preschool children aged 3-6 in Chengdu is relatively low. Ocular biometric parameters affecting refractive errors include AL, K, CR, LT, and VCD. The preschool period serves as a critical phase for myopia prevention and control.

Puerarin Attenuates Iron Overload-Induced Ferroptosis in Retina through a Nrf2-Mediated Mechanism.

SCOPE: Age-related increases in retinal iron are involved in the development of retinal degeneration. The recently discovered iron-dependent mechanism of cell death known as ferroptosis has been linked to a wide range of pathologies. However, its role in iron overload-induced retinal degeneration is still uncertain. Puerarin has been associated with retinal protection. The purpose of this research is to determine how puerarin prevents retinal ferroptosis under iron overload conditions. METHODS AND RESULTS: Models of iron overload in Kunming mice, 661W cell, and ARPE-19 cell are established. Increased iron deposition significantly worsens retinal pathology, decreases cell viability, and induces ferroptotic changes. Puerarin mitigates iron overload-induced ferroptosis by decreasing excessive iron through the regulation of iron handling proteins and lowering lipid peroxidation through the inhibition of cyclooxygenase 2 expression and activation of the nuclear factor-E2-related factor 2 (Nrf2) signaling pathway and downstream ferroptosis-related proteins (solute carrier family 7 member 11, glutathione peroxidase 4 and heme oxygenase-1). The protective effect of puerarin on ferroptosis is diminished by the Nrf2-specific inhibitor ML385. CONCLUSION: These findings suggest targeting ferroptosis may be a novel strategy for the management of retinal degeneration. Puerarin may exert some of its ocular benefits by attenuating ferroptosis.

Correlation between refractive errors and ocular biometric parameters in children and adolescents: a systematic review and meta-analysis.

BACKGROUND: Refractive errors are one of the most common ocular conditions among children and adolescents, with myopia showing an increasing prevalence and early onset in this population. Recent studies have identified a correlation between refractive errors and ocular biometric parameters. METHODS: A systematic search was conducted in electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Medline from January 1, 2012, to May 1, 2023. Various ocular biometric parameters were summarized under different refractive states, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal curvature (CC), Corneal curvature radius (CR),axial length-to-corneal radius ratio (AL/CR ratio), choroidal thickness (ChT), retinal thickness (RT), retinal nerve fiber layer thickness (RNFL), and retinal blood density (VD). The differences in these parameters among different refractive states were analyzed using Stata software with fixed or random-effects models, taking into account the assessed heterogeneity level. RESULTS: This meta-analysis included a total of 69 studies involving 128,178 eyes, including 48,795 emmetropic eyes, 60,691 myopic eyes, 13,983 hyperopic eyes, 2,040 low myopic eyes, 1,201 moderate myopic eyes, and 1,468 high myopic eyes. The results of our study demonstrated that, compared to the control group (emmetropic group), the myopic group and low, moderate, and high myopic groups showed significant increases in AL, AL/CR ratio, and ACD, while the hyperopic group exhibited significant decreases. Compared to the control group, the myopic group had a significantly increase for CC, while CR, CCT, perifoveal RT, subfoveal ChT, foveal ChT, parafoveal ChT, perifoveal (except nasal) ChT, and pRNFL (except temporal) significantly decreased. Compared to the control group, the hyperopic group had a significantly increase for subfoveal ChT, foveal ChT, parafoveal ChT, perifoveal ChT, and nasal pRNFL. Compared to the control group, the low and moderate myopic groups had a significantly decreases for the CCT, parafoveal RT (except nasal), perifoveal RT (except nasal), and pRNFL (except superior and temporal). Compared to the control group, the high myopic group had a significantly increase for CR, while LT, perifoveal ChT (except nasal), parafoveal RT, perifoveal RT, and pRNFL (except temporal) had significant decreased. CONCLUSION: The changes of ocular biometric parameters in children and adolescents are closely related to refractive errors. Ocular biometric parameters devices, as effective non-invasive techniques, provide objective biological markers for monitoring refractive errors such as myopia.

Next-generation nanomaterials: advancing ocular anti-inflammatory drug therapy.

Ophthalmic inflammatory diseases, including conjunctivitis, keratitis, uveitis, scleritis, and related conditions, pose considerable challenges to effective management and treatment. This review article investigates the potential of advanced nanomaterials in revolutionizing ocular anti-inflammatory drug interventions. By conducting an exhaustive analysis of recent advancements and assessing the potential benefits and limitations, this review aims to identify promising avenues for future research and clinical applications. The review commences with a detailed exploration of various nanomaterial categories, such as liposomes, dendrimers, nanoparticles (NPs), and hydrogels, emphasizing their unique properties and capabilities for accurate drug delivery. Subsequently, we explore the etiology and pathophysiology of ophthalmic inflammatory disorders, highlighting the urgent necessity for innovative therapeutic strategies and examining recent preclinical and clinical investigations employing nanomaterial-based drug delivery systems. We discuss the advantages of these cutting-edge systems, such as biocompatibility, bioavailability, controlled release, and targeted delivery, alongside potential challenges, which encompass immunogenicity, toxicity, and regulatory hurdles. Furthermore, we emphasize the significance of interdisciplinary collaborations among material scientists, pharmacologists, and clinicians in expediting the translation of these breakthroughs from laboratory environments to clinical practice. In summary, this review accentuates the remarkable potential of advanced nanomaterials in redefining ocular anti-inflammatory drug therapy. We fervently support continued research and development in this rapidly evolving field to overcome existing barriers and improve patient outcomes for ophthalmic inflammatory disorders.

Global trends and performances in diabetic retinopathy studies: A bibliometric analysis.

Objective: The objective of this study is to conduct a comprehensive bibliometric analysis to identify and evaluate global trends in diabetic retinopathy (DR) research and visualize the focus and frontiers of this field. Methods: Diabetic retinopathy-related publications from the establishment of the Web of Science (WOS) through 1 November 2022 were retrieved for qualitative and quantitative analyses. This study analyzed annual publication counts, prolific countries, institutions, journals, and the top 10 most cited literature. The findings were presented through descriptive statistics. VOSviewer 1.6.17 was used to exhibit keywords with high frequency and national cooperation networks, while CiteSpace 5.5.R2 displayed the timeline and burst keywords for each term. Results: A total of 10,709 references were analyzed, and the number of publications continuously increased over the investigated period. America had the highest h-index and citation frequency, contributing to the most influence. China was the most prolific country, producing 3,168 articles. The University of London had the highest productivity. The top three productive journals were from America, and Investigative Ophthalmology Visual Science had the highest number of publications. The article from Gulshan et al. (2016; co-citation counts, 2,897) served as the representative and symbolic reference. The main research topics in this area were incidence, pathogenesis, treatment, and artificial intelligence (AI). Deep learning, models, biomarkers, and optical coherence tomography angiography (OCTA) of DR were frontier hotspots. Conclusion: Bibliometric analysis in this study provided valuable insights into global trends in DR research frontiers. Four key study directions and three research frontiers were extracted from the extensive DR-related literature. As the incidence of DR continues to increase, DR prevention and treatment have become a pressing public health concern and a significant area of research interest. In addition, the development of AI technologies and telemedicine has emerged as promising research frontiers for balancing the number of doctors and patients.

Analysis and modeling of myopia-related factors based on questionnaire survey.

With the rapid development of science and technology, the trend of low age myopia is becoming increasingly significant. The latest national survey done by the Chinese government found that more than 80% of Chinese teenagers suffer from myopia. Adolescent myopia is closely related to living environment, heredity, and living habits. Quantifying the relationship between myopia and living environment, heredity, and living habits is conductive to the prevention and intervention of adolescent myopia. In this study, we investigated the relationships between four main factors (environment, habits, parental vision, and demographic) and myopia status by analyzing the questionnaire data. Data were collected from Chengdu, China in 2021, including 2808 myopia samples and 5693 non-myopia samples, with a total of 22 features. Then, these 22 features were inputted into three machine learning algorithms to discriminate the two classes of samples. Results show that the computational model could produce an AUC of 0.768. To pick out the most important features which play important roles in classification, we used incremental feature selection strategy to screen the 22 features. As a result, we found that the 4 most influential features with XGBoost could achieve a competitive AUC of 0.764. To further investigate the risk and protective factors affecting adolescent myopia, we used OR values derived from MLE-LR to analyze the relationship between 22 features and adolescent myopia. Results showed that the age variable was the most significant risk factor for myopia, followed by the myopia status of parents. The most protective factor for eyesight is the measure taken by the children, followed by the distance between books and eyes when reading. These discoveries can guide the prevention and control of myopia in children and adolescents.

Evaluation of individualized treatment of nonproliferative diabetic retinopathy: a multicenter, randomized, parallel-controlled study.

OBJECTIVE: To evaluate the differences in the efficacy of stationary treatment and individualized treatment for patients with nonproliferative diabetic retinopathy (NPDR). METHODS: This study was a randomized, controlled, multicenter clinical trial. Participants with NPDR were randomized into the stationary treatment group or the individualized treatment group. The stationary treatment group was given the basic treatment and Qiming granules, and the individualized treatment group was given the basic treatment, Qiming granules, and individualized Chinese herbal medicines over a 12-week period. The individualized therapeutic formula was also changed over time to adjust to the changes in the clinical presentation of the patient. We conducted observations of fundus retinal exudation and hemorrhage, visual acuity, Traditional Chinese Medicine symptom scores and other indicators. RESULTS: A total of 140 participants with NPDR were randomized into the stationary treatment group or the individualized treatment group, and 132 participants completed this study. Following the 12-week treatment, significant improvements in both primary and secondary outcomes were observed in the stationary and individualized treatment groups. No remarkable difference in the primary outcomes between the two groups was observed. However, there was a significant difference in the Traditional Chinese Medicine symptom scores (18 ± 7 vs 15 ± 6; P < 0.05). There were no severe adverse effects. CONCLUSION: Compared with stationary treatment, individualized treatment is more effective at relieving the Traditional Chinese Medicine symptoms and improving vision and fundus lesions at 12 weeks post treatment.

Efficacy and Safety of Different Add Power Soft Contact Lenses on Myopia Progression in Children: A Systematic Review and Meta-Analysis.

BACKGROUND: In children, myopia has become a widespread and serious global public health problem. Soft multifocal contact lenses (SMCLs) have been widely studied to control myopia progression in children. However, their efficacy in myopia control in children and its adverse effects and which added power SMCLs are more effective and safer remains to be explored. OBJECTIVES: Evaluate the efficacy and safety of various add power SMCLs to slow myopia progression in children. METHOD: Eligible randomized controlled trials were retrieved from PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. The present meta-analysis analyzed the mean differences (MD) in myopic progression, axial length, and odds ratios for adverse effects and dropout rates between SMCLs with different added powers and control groups. Changes in visual performance were also systematically evaluated. RESULTS: Seven independent studies involving 805 children were included in the present meta-analysis. At 1-year, the weighted MD (WMD) in myopia progression between SMCL and control groups was -0.22 diopters (D) (95% confidence interval [CI]: -0.56 to 0.12 D) for low add power SMCLs, 0.09 D (95% CI: 0-0.19 D) for medium add power SMCLs, and 0.2 D (95% CI: 0.13, 0.27 D) for high add power SMCLs. At 2-years, the WMD for medium add power was 0.12 D (95% CI: -0.03 to 0.27 D), and for high add power was 0.25 D (95% CI: 0.14-0.35 D). No differences were detected for adverse effects (p = 0.2) and acceptability (p = 0.74) between different added powers. Additionally, differences in visual performance changes, produced by different added powers, were not detected. CONCLUSIONS: The present meta-analysis showed that high add power SMCLs are more effective and stable to control myopia progression. Besides, the adverse effects and acceptability were not related to the added power.

Using Network Pharmacology and Molecular Docking to Explore the Mechanism of Qiju Dihuang Pill against Dry Eye Disease.

Background: Dry eye disease (DED) is a multifactorial disease of the ocular surface, which affects the quality of life and work efficiency of affected patients. The traditional Chinese medicine formula Qiju Dihuang Pill (QJDHP) has a good therapeutic effect on DED. However, the pharmacological mechanism is not clear. Objective: To explore the mechanism of QJDHP in the treatment of DED based on network pharmacology. Method: The active components in QJDHP were screened in Traditional Chinese Medicine Systems Pharmacology (TCMSP), and putative molecular targets of QJDHP were identified using the SwissTargetPrediction database. DED-related targets were screened by GeneCards and OMIM. We established protein-protein interaction (PPI) and core targets and corresponding active compound network by Cytoscape to identify the core targets and main compounds of QJDHP against DED. DAVID database was utilized for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Molecular docking was used to evaluate the binding activity between key active compounds and core targets. Results: The results of network pharmacology showed that 253 targets of QJDHP were related to DED. PPI network analysis showed the 18 core targets. The binding affinity of docking results ranged from -5.7 to -9.3 kcal/mol, indicating a good docking effect. The results of GO enrichment analysis showed that the mechanism of QJDHP in the treatment of DED mainly involved biological processes such as apoptosis, oxidative stress, response to estrogen, angiogenesis, and the regulation of transcription factors. KEGG analysis showed that QJDHP may be regulated by the TNF signaling pathway, Toll-like receptor signaling pathway, MAPK signaling pathway, and estrogen signaling pathway in the treatment of DED. Conclusion: In this study, we demonstrated the multicomponent, multitarget, and multichannel action mechanism of QJDHP in the treatment of DED and provided a foundation for further drug development research.

Ameliorative effects and mechanisms of salvianic acid A on retinal iron overload in vivo and in vitro.

Excessive iron can be accumulated in the retina and lead to retinal iron overload. Salvianic acid A (SAA) has a variety of pharmacologic effects, but there is only a limited understanding of its benefits for retinal iron overload. The aim of this study was to examine the protective effects and latent mechanisms of SAA on retinal iron overload. SAA reduced iron in the serum and retina, attenuated pathophysiological changes, and reduced retinal iron deposition in the retinas of iron-overloaded mice. It also reduced intracellular iron in ARPE-19 cells by regulating iron-handling proteins and chelating with iron. It also significantly inhibited cellular oxidative and inflammatory damage by increasing the nuclear translocation of nuclear erythroid 2-related factor 2 (Nrf2) while decreasing nuclear factor-kappa B (NF-κB), protecting the ARPE-19 cells from apoptosis by suppressing the Bax/Bcl-2 ratio, cytochrome c release, caspase activation, and poly ADP-ribose polymerase cleavage. The ability of SAA to inhibit apoptosis, increase nuclear Nrf2 expression, and decrease nuclear NF-κB expression was further confirmed in the retinas of iron-overloaded mice. This study demonstrates that SAA shows significant protective effects against retinal iron overload; its mechanisms might be associated with iron chelation; regulation of iron-handling proteins; and inhibition of oxidative stress, inflammation and apoptosis.

Retinal oxygen saturation and vessel diameter in patients with chronic kidney disease.

PURPOSE: To investigate changes in retinal oximetry and the diameter of retinal vasculature in patients with chronic kidney disease (CKD) and relationships between retinal vasculature and the estimated glomerular filtration rate (eGFR), provide a scientific basis for the early detection and diagnosis of CKD. METHODS: Eighty-three patients with CKD and 103 healthy individuals were included after providing informed consent. All participants were examined using a noninvasive technology (Oxymap Inc., Reykjavik, Iceland) for measuring the arterial (SaO2 ) and venous (SvO2 ) oxygen saturation and the arteriovenous difference in oxygen saturation (Sa-vO2 ). The corresponding retinal vessel diameters of these arterioles (D-A) and venules (D-V) were measured. The eGFR of patients with CKD was calculated from the serum creatinine concentration. RESULTS: In general, patients with CKD had higher mean SaO2 values than healthy individuals (100.15 ± 4.68% versus 97.14 ± 4.22%; p < 0.001, mean ± SD). The mean SaO2 in the superior temporal, superior nasal and inferior nasal quadrants significantly increased. There was no significant difference measured in the SvO2 when patients with CKD (63.66 ± 5.29%) and healthy individuals (62.70 ± 5.27%) were compared. The mean Sa-vO2 of the CKD group (36.49 ± 4.98%) was increased compared with normal subjects (34.44 ± 4.76%) (p = 0.005). The retinal arteriole diameter was narrower in patients with CKD than in normal individuals (117.53 ± 14.88 µm versus 126.87 ± 14.98 µm; p < 0.001, mean ± SD), and the arteriovenous ratio was smaller than in normal individuals (0.71 ± 0.09 versus 0.77 ± 0.09; p < 0.001, mean ± SD). Pearson's two-tailed correlation showed a significant correlation between the SaO2 and eGFR (R = -0.363, p = 0.001), and narrower retinal arterial calibre was significantly associated with a lower eGFR (R = 0.415, p < 0.001). CONCLUSION: Based on our results, there were alterations in retinal oxygen saturation and vascular diameter in patients with CKD. Further studies are needed to determine whether such changes play a role in the development of CKD.

Astragaloside IV protects against retinal iron overload toxicity through iron regulation and the inhibition of MAPKs and NF-κB activation.

Iron overload toxicity has been implicated in retinal pigment epithelial cell injury in age-related macular degeneration. This study investigates the effects of astragaloside IV (AS-IV), a potential retinal protective agent, on the toxicity process of retinal iron overload in vivo and in vitro. AS-IV partially restored the retinal expression of rhodopsin and retinal pigment epithelium-specific 65 kDa protein, suppressed oxidative stress and inflammatory markers, and alleviated iron deposition and retinal pathological changes in vivo. Also, AS-IV inhibited the phosphorylation of p38 and ERK mitogen-activated protein kinases (MAPKs), as well as the nuclear translocation of nuclear factor-kappa B (NF-κB). Furthermore, AS-IV prevented cell death by decreasing the ratio of Bax/Bcl-2, caspase-3, and cleaved caspase-3 expression in vitro. Although there are no chelation effects between AS-IV and iron, AS-IV can reduce intracellular iron by regulating iron-handling proteins in ARPE-19 cells (Cav1.2, divalent metal transporter-1, transferrin receptor 1, and heavy-chain ferritin). In conclusion, the results show that AS-IV has significant protective effects against retinal iron overload toxicity and suggest that iron regulation and the inhibition of MAPKs and NF-κB activation might be mechanisms underlying the effects of AS-IV.

International traditional Chinese medicine guideline for diagnostic and treatment principles of diabetes.

Diabetes mellitus (DM) was one of the most severe public health problems that affected nearly 463 million adults around the world. In addition to insulin and oral hypoglycemic agents, traditional Chinese medicine (TCM) was an effective alternative therapy for diabetes and its complications, and it had been widely used in the Pan-Pacific region, especially in Southeast Asia, however, TCM lacked specialized standards of care for DM in the past, which limited the TCM clinical efficacy of diabetes. Since March 2017, the Endocrinology Committee of World Federation of Chinese Medicine Societies (WFCMS) had invited experts in diabetes, TCM, and international standard setting to work with TCM endocrinologists from the Guideline Development Committee to review the TCM clinical research evidence related to the prevention and treatment of diabetes over the previous 14 years. Over an 8-months careful revision, the international TCM guideline was finally developed under the guidance of review experts, physicians and surveyed patients, to provide standardized diagnosis and treatment advice of diabetes for global TCM doctors. This guideline clarified the TCM classification, staging, and syndromes of diabetes, gave the instructions that how to identified different stages and syndromes clearly, and accordingly recommended different TCM therapies based on the level of evidence. It's worth noting that when the guideline was being made, fewer high-quality clinical research evidence could be found, and very few researches were so outdated that need to be updated. More high-quality research evidence would be included in the updated version of guideline to continuously improve the overall level of global TCM in preventing and treating diabetes, and long-term clinical researches were advocated.

The effectiveness and safety of acupuncture for patients with myopia: A protocol for a systematic review and meta-analysis.

BACKGROUND: Myopia is a common visual disorder which has become a public health problem worldwide. Myopia and high myopia are substantial risk factors for severe visual impairment and other serious eye diseases. Acupuncture used to prevent and control myopia is a common practice in China, but it is controversial in other countries. This study aims to evaluate the efficacy and safety of acupuncture in delaying the progression of myopia in children and adolescents through systematic evaluation. METHODS AND ANALYSIS: The following electronic databases will be searched from inception to November 2019 regardless of publication status and language: Medline, EMBASE, Web of Science, the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Chinese Scientific Journal Database (VIP), Wanfang Database, Chinese Biomedical Literature Database (CBLD), Chinese Science and Technology Periodical Database (CSTPD). RCT registration websites, including http://www.ClinicalTrials.gov and http://www.chictr.org.cn, will also be searched. Review Manager V.5.3 will be used to analysis the statistic. Two reviewers (ZY and XW) will independently select studies, extract and code the data, assess risk of bias of the included studies, evaluate the quality of evidence for outcomes. RESULTS: This study will provide a rational synthesis of current evidences for acupuncture to delay the progression for myopia in children and adolescents. CONCLUSION: The conclusion of this study will provide evidence for evaluating the efficacy and safety of acupuncture to delay the progression for myopia in children and adolescents.

Puerarin protects against iron overload-induced retinal injury through regulation of iron-handling proteins.

Excess iron content can build up in the retina and lead to iron-mediated retinal injury. An important isoflavone C-glucoside, puerarin, has been reported to be involved in retinal protection. In this experiment, we studied the effects and potential mechanisms of puerarin on retinal injury in vivo and in vitro. We found that puerarin reduced serum and retinal iron content, attenuated the pathophysiological changes and retinal iron deposition, and partially prevented the decrease of rhodopsin and retinal pigment epithelium-specific 65 kDa protein expression in retinas of iron-overload mice. Puerarin rescued the abnormal expression of iron-handling proteins in the mouse retina and suppressed the oxidative stress induced by iron overload, as evident from the enhanced activity of superoxide dismutase, catalase, and glutathione peroxidase and decreased content of malondialdehyde. Moreover, puerarin inhibited the phosphorylation of p38 and ERK mitogen-activated protein kinases (MAPKs) and signal transducer and activator of transcription 3 (STAT3), thereby protecting the retinal cells from apoptosis by suppressing cytochrome c release, caspase activation, and poly (ADP-ribose) polymerase cleavage in vivo. Also, the ability of puerarin to regulate iron-handling proteins, decrease intracellular Fe2+, and inhibit cell apoptosis was further confirmed in ARPE-19 cells. The experimental data verify the protective role of puerarin in the treatment of retinal injury caused by iron overload; its possible mechanisms might be associated with regulation of iron-handling proteins, enhancement of the antioxidant capacity, and the inhibition of MAPK and STAT3 activation and the apoptotic pathways under iron overload conditions.