Sufficiency of the BOT-2 short form to screen motor competency in preschool children with strabismus.

BACKGROUND: Strabismus is one of the most common visual disorders in children, with a reported prevalence of 2.48% in preschoolers. Additionally, up to 89.9% of preschool children with strabismus do not have normal stereopsis. Whether this lack of normal stereopsis affects the motor competency of preschool children with strabismus is unknown. The Bruininks-Oseretsky Test of Motor Proficiency Second Edition short form (BOT-2 SF) can be a useful tool for screening; however, its sufficiency as a diagnostic tool for children with various disorders is controversial. OBJECTIVE: The aims of this study were thus to examine motor competency in preschool children with strabismus by using the BOT-2 and to evaluate the usefulness of the BOT-2 SF to identify those at risk for motor competency issues. METHODS: Forty preschool children (aged 5-7 years) with strabismus were recruited, all of whom had abnormal stereopsis. The BOT-2 complete form (CF) was administered to all children. The BOT-2 CF was administered to all children. The scores of the BOT-2 SF were extracted from the relevant items of the BOT-2 CF for further analysis. RESULTS: The prevalence of children with strabismus who had below average performance in the composites of "Fine Manual Control", "Manual Coordination","Body Coordination", and "Strength and Agility" were 15%, 70%, 32.5%, and 5%, respectively, on the BOT-2 CF. Compared with these results, the sensitivity of the BOT-2 SF was 33.33% (95% CI = 7.49%-70.07%) and the specificity was 100% (95% CI = 88.78%-100%). CONCLUSION: Preschool children with strabismus had a high prevalence of impaired motor competency, especially in fine motor competency. The BOT-2 SF was not as sensitive in identifying motor difficulties in preschool children with strabismus. Therefore, the BOT-2 CF is recommended for evaluating motor proficiency in preschool children with strabismus.

SLC13A4 Might Serve as a Prognostic Biomarker and be Correlated with Immune Infiltration into Head and Neck Squamous Cell Carcinoma.

SLC13A4 is a sodium sulfate co-transporter, which is expressed in brains, placentas, thymes and other tissues, plays an essential role in maintaining the metabolic balance of sulfate in vivo. The TCGA database shows that it is differentially expressed in a variety of tumors, but its prognostic value in tumors has not been clarified. TCGA, Oncomine and Timer databases were used to analyze SLC13A4 mRNA expression in cancer tissues and normal tissues, and its correlation with clinical prognosis in head and neck tumor. The CIBERSORT database was used to analyze the correlation between SLC13A4 expression and the infiltration of immune cells. SLC13A4 enrichment analysis was carried out by GSEA. SLC13A4 mRNA levels were significantly lower in head and neck tumors than in paracancer tissues. SLC13A4 expression in Head and neck squamous cell carcinoma (HNSCC) was closely related to tumor pathological grade and clinical stage. Decreased SLC13A4 expression was associated with poor overall survival (OS), progression free survival (PFS), disease specific survival (DSS) and recurrence free survival (RFS) in HNSCC patients. The expression of SLC13A4 was negatively correlated with Monocytes, M1 macrophages, M2 macrophages, resting CD4+ memory T cells, resting NK cells and activated NK cells, but positively correlated with neutrophils, plasma cells, T follicular helper cells, gamma delta T cells, regulatory T cells and naive B cells. In addition, the genes in SLC13A4 low-expression group were mainly concentrated in immunity-related activities, viral diseases, typical tumor pathways and metabolism. The SLC13A4 high expression group was mainly enriched in metabolic pathways. These suggest that SLC13A4 may be a potential prognostic biomarker in HNSC and correlated with immune infiltrates.

Potential effects of SARS-CoV-2 on the gastrointestinal tract and liver.

COVID-19 is a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early reported symptoms include fever, cough, and respiratory symptoms. There were few reports of digestive symptoms. However, with COVID-19 spreading worldwide, symptoms such as vomiting, diarrhoea, and abdominal pain have gained increasing attention. Research has found that angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 receptor, is strongly expressed in the gastrointestinal tract and liver. Whether theoretically or clinically, many studies have suggested a close connection between COVID-19 and the digestive system. In this review, we summarize the digestive symptoms reported in existing research, discuss the impact of SARS-CoV-2 on the gastrointestinal tract and liver, and determine the possible mechanisms and aetiology, such as cytokine storm. In-depth exploration of the relationship between COVID-19 and the digestive system is urgently needed.

Correlation between higher-order aberrations and visual acuity recovery (CoHORT) after spectacles treatment for pediatric refractive amblyopia: A pilot study using iDesign measurement.

PURPOSE: To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children. METHODS: This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined. RESULTS: We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049). CONCLUSIONS: trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia.

[Pharmacokinetics of eight constituents in rat plasma after oral administration of Modified Xiaochaihu Granules for gastric ulcer based on UPLC-MS/MS].

An ultra-performance liquid chromatography-tandem mass spectrometric method (UPLC-MS/MS) was developed in this study to simultaneously determine the contents of eight effective constituents in rat plasma, including baicalin, wogonoside, baicalein, liquiritin, glycyrrhizic acid, berberine hydrochloride, saikosaponin a and saikosaponin d in plasma of gastric ulcer rats, and investigate the pharmacokinetics of Modified Xiaochaihu Granules. Chromatographic separation was conducted on Zorbax SB-C18 column (2.1 mm×100 mm, 1.8 µm) with acetonitrile -0.1% formic acid aqueous solution as the mobile phase for gradient elution, at a flow rate of 0.4 mL·min⁻¹ and column temperature of 40 °C. Detection was performed in the multiple reaction monitoring (MRM) mode with ESI ion source. All calibration curves showed good linearity (r>0.996) over a wide concentration range for all constituents. RSDs of intra-day and inter-day precision were all within 15% and the extraction recoveries of all the constituents were in the range of 81.92% to 104.8%. The time to peak (tmax) of these eight constituents was (2.69±2.02), (5.17±2.04), (0.25±0), (0.83±0.26), (0.92±0.20), (0.92±0.20), (0.58±0.20), and (0.083±0) h, respectively; the half-life (t1/2) of them was (7.85±0.34), (10.16±2.21), (6.79±0.21), (8.32±0.48), (11.05±1.78), (11.56±3.46), (15.30±1.84), and (5.54±1.91) h, respectively; the peak concentration (Cmax) of them was (55.02±1.67), (213.66±4.62), (62.61±0.69), (68.43±1.42), (62.22±0.39), (30.17±1.89), (61.79±4.81), and (38.02±1.75) µg·L⁻¹, respectively. This established method is simple and accurate with good repeatability and strong specificity, which could provide modern experimental basis for modified Xiaochaihu granules in clinical treatment of gastric ulcer.

Macular Thickness, Foveal Volume, and Choroidal Thickness in Amblyopic Eyes and Their Relationships to the Treatment Outcome.

PURPOSE: To assess the correlations between the retinal/choroidal structure and the treatment outcomes of amblyopic children. METHODS: This study enrolled eyes with amblyopia resulting from strabismus, anisometropia, or ametropia. All patients underwent detailed eye examinations, including spectral domain optical coherence tomography (SD-OCT) scan. All of the subjects received amblyopic treatment and were divided into 2 groups after 6 months of follow-up: the recovered amblyopic group with a best-corrected visual acuity (BCVA) ≥0.8 and the persistent amblyopic group with a BCVA <0.8 on the Landolt C chart. RESULTS: Forty-four amblyopic children were included, of which 26 were in the recovered amblyopic group after 6 months of follow-up. The patients with strabismic anisometropic amblyopia and severe amblyopia (initial VA ≤ 0.3) were significantly predisposed to developing persistent amblyopia (P=0.049 and P < 0.001, respectively). After correcting with Littmann's formula, the thickness and volume of the parafoveal and perifoveal retinal regions in the persistent amblyopia group did not show significant differences with the recovered amblyopia group. CONCLUSIONS: The initial severity of amblyopia and the type of amblyopia were the risk factors related to the poor outcome of amblyopic treatment. The foveal thickness, foveal volume, and choroidal thickness were not associated with the treatment outcome.

[Studies on serum pharmacochemistry of effective parts of modified Xiaochaihu Tang for treatment of gastric ulcer].

To conduct the studies on serum pharmacochemistry of effective parts of modified Xiaochaihu Tang for treatment of gastric ulcer by using chromatography-mass spectrometry. Absolute ethyl alcohol induced-gastric ulcer model of mouse was used in this study to investigate the pharmacology of modified Xiaochaihu Tang and its effective parts. Both groups could significantly decrease the absolute ethyl alcohol induced-ulcer. Gasphase-mass spectrometry (GC-MS) was used to detect chemical compositions of volatile fractions and the drug components after gastric administration. A total of 63 compounds were identified in extracts, accounting for more than 93% of the all volatile oil, including 23.51% α-curcumene, 11.96% zingiberene, 9.56% curzerene, 6.54% ß-sesquinene, 4.77% camphene, and 6 prototype components were also detected in serum for gastric ulcer model. In liquid chromatography-mass spectrometry (LC-MS), a total of 17 compounds were identified in extracts, 6 prototype components and 2 metabolites (3,5-O-feruloylquinic acid and palmatine) were obtained in serum. In a conclusion, this study provides an important scientific basis for identifying the active ingredients in modified Xiaochaihu Tang, and also helps to reveal the pharmacological effect of modified Xiaochaihu Tang for treatment of gastric ulcer.

Factors affecting surgical outcome of intermittent exotropia.

PURPOSE: The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia. DESIGNS: This was a retrospective interventional study. METHODS: Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome. RESULTS: We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94-1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80-11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84-28.58). CONCLUSION: In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.

Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial.

PURPOSE: To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities. DESIGN: Multi-area, cluster-randomized intervention controlled trial. PARTICIPANTS: A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group. METHODS: Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires. MAIN OUTCOME MEASURES: Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures. RESULTS: The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28-0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02-0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002-0.32; P = 0.048). CONCLUSIONS: The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered.

Management of diplopia with visual-field defects.

PURPOSE: The management of diplopia can be challenging in patients with a concurrent visual-field (VF) defect. We conducted a retrospective chart review to analyze and compare treatment outcomes for different types of VF defects. METHODS: A retrospective chart review. RESULTS: Seven patients with diplopia and VF defects were identified during the study. Four had bitemporal hemianopia, one had homonymous hemianopia, and two had a constricted central VF. A favorable or satisfactory outcome was achieved in all but two patients with bitemporal hemianopia. CONCLUSIONS: The hemifield-slide diplopia may develop in patients with bitemporal hemianopia or heteronymous altitudinal visual defects. Sensory abnormalities usually persist, even after elimination of ocular misalignment.

Managing Hypoplasia of the Inferior Rectus Muscle by Inferior Oblique Anterior Transposition in Children.

Congenital hypoplasia or aplasia of the inferior rectus muscle is an uncommon condition. The authors present two pediatric patients with hypoplasia of the inferior rectus muscle treated by inferior oblique anterior transposition. The long-term follow-up outcomes of eye position and stereopsis acuity development were favorable. [J Pediatr Ophthalmol Strabismus. 2017;54:e50-e53.].

Relationship of lifestyle and body stature growth with the development of myopia and axial length elongation in Taiwanese elementary school children.

CONTEXT: The development of myopia and growth of the eye, occur at a time when body stature is increasing. AIMS: To investigate the relationship of lifestyle and body growth with axial elongation and myopia development among schoolchildren aged 7 to 9 years. SETTINGS AND DESIGN: Prospective study. MATERIALS AND METHODS: Children in elementary schools without serious eye disorders were invited to participate. We measured cycloplegic refraction, corneal curvature, intraocular pressure, axial length, body height, and weight. Questionnaires about the children's daily lifestyles, family members' myopia and parents' socio-demographic status were completed. The children were followed up every 6 months in a 3-year period. STATISTICAL ANALYSIS USED: Bivariate correlations, simple and multiple regression. RESULTS: Eighty-eight children participated in this study. Forty-eight were myopic at the beginning of the study, and their myopia correlated with longer axial length and parental myopia (P = 0.015, 0.012). Sixty-five children (74%) completed the study, and the rates of change per year were -0.43 ± 0.58 (mean + standard deviation) diopters in spherical equivalence, 0.32 ± 0.25 mm in axial length (AL), 5.73 ± 2.71 cm in body height, and 3.84 ± 2.23 kg in weight. The axial length change was positively correlated with the height change (P < 0.001). The myopia shift was correlated to axial length change (P = 0.000) but not correlated to height change. Using multiple regression test, near work was the only significant risk factor for myopia progression (P = 0.022). CONCLUSIONS: Our study showed that body height increment was correlated to axial length elongation but not to myopia shift in children aged 7-9 years. Genetic factors such as parental myopia and body height had a possible influence on myopia development, and the environment factor as near work intensity was related to myopia progression.

Necrotizing scleritis after strabismus surgery in thyroid eye disease.

Surgically induced necrotizing scleritis, which can lead to potentially devastating consequences, is a rare sequela to many types of ocular surgeries. We describe a 58-year-old woman who developed necrotizing scleritis following strabismus surgery for thyroid ophthalmopathy. Tectonic corneal patch grafting resulted in a favorable outcome.

MUC5AC in juvenile conjunctival nevus.

PURPOSE: To evaluate the possible role of cysts with mucins and inflammatory cells in rapid-growing juvenile conjunctival nevus. METHODS: This was a case-control study at a university-based referral clinic. Seventeen conjunctival melanocytic lesions surgically excised from patients aged <20 years between 2001 and 2009 were examined by hematoxylin-eosin, periodic acid-Schiff, MUC5AC, and Alcian blue staining. The clinical signs of the affected patients and the histological findings were characterized. RESULTS: Eleven patients (3 girls and 8 boys; mean age 13.72 ± 3.60 years) underwent excision of a conjunctival nevus that had grown rapidly within a recent 6-month period. We found a significantly higher number of prominent cysts with mucins in the rapid-growing specimens than in the stable-growing control specimens (n = 6; 33.7 ± 19.9 vs. 0.9 ± 0.9%, P = 0.0005). However, the numbers of inflammatory cells were not statistically significantly different (42.17 ± 15.46 vs. 45.55 ± 16.31, P = 0.683). CONCLUSIONS: The period of rapid growth of juvenile conjunctival nevus is not a malignant clinical sign. Although it might correlate with enlarged cysts lined by goblet cells associated with mucin secretions, the number of inflammatory cells remains relatively stable over time.

Prognostic indicators of open globe injuries in children.

PURPOSE: To determine the prognostic indicators of visual outcome in children with open globe injuries. BASIC PROCEDURES: The charts of 62 patients, 16 years of age or younger, who had been treated for open globe injuries were reviewed. MAIN FINDINGS: The types of injury included penetrating (30 eyes), rupture (20 eyes), intraocular foreign body (10 eyes), and perforation (2 eyes). Sharp objects, such as knives or scissors, were the most common causes of open globe injuries. A visual acuity (VA) of at least 20/40 was achieved in 80.8% (21/26) of eyes with a corneal injury only, in 45.5% (5/11) of eyes with additional lens damage, and in 17.4% (4/23) of eyes with extensive anterior and posterior injuries. CONCLUSIONS: Unfavorable outcomes were related to the location of injury, the extent of injury, the initial presentation of hyphema, vitreous hemorrhage, retina detachment, cornea wound across the pupil, and the development of endophthalmitis.

Primary intraocular lens implantation for unilateral idiopathic cataract in children.

BACKGROUND: To examine the efficacy of intraocular lens implantation on visual rehabilitation and ocular growth in children with unilateral idiopathic cataracts. METHODS: Preoperative characteristics, visual outcome and postoperative refraction change were analyzed through a retrospective study of the charts of children who underwent cataract removal and primary intraocular lens implantation for unilateral idiopathic cataracts between 1994 and 2003. RESULTS: Thirty-one children were included in this study. Preoperatively, 83% of the eyes with cataracts had best corrected visual acuity (BCVA) of less than 20/200. Posterior subcapsular opacity was the most common type of cataract. The average age at surgery was 66.8 months (range 14-115 months) and the mean follow-up was 43.4 months (range 12-117 months). At the final visit, there was no significant difference in refractive development between the pseudophakic eyes and the fellow eyes of the subjects. Sixty percent of the pseudophakic eyes had a BCVA of 20/200 or better and 37% had a BCVA of 20/60 or better. Preoperative visual acuity was the only significant factor related to visual outcome. CONCLUSION: Primary intraocular lens implantation in children with unilateral idiopathic cataracts is an effective treatment for visual rehabilitation. The refractive development of the pseudophakic eyes was not significantly different from the fellow eyes.

Pediatric ocular trauma in Taiwan.

BACKGROUND: Ocular trauma is a significant problem in pediatric patients. The aim of this investigation was to evaluate the demographic, etiologic and prophylactic factors of pediatric ocular trauma in a tertiary center in northern Taiwan. METHODS: A retrospective review of medical charts of patients aged 15 years or younger who visited the emergency department of Chang Gung Memorial Hospital, Taoyuan for ocular trauma between July 2003 and June 2004 was undertaken. RESULTS: Of the 228 children in this study, ocular trauma occurred more frequently in boys than in girls (151:77 patients, p < 0.0001). Twenty-one patients (9.2%) presented with bilateral trauma. The most common ocular injury was closed globe injury (178 patients, 78.1%). The next most common ocular injuries were burns (35 patients, 15.4%), open globe injuries (8 patients, 3.5%) and orbital injuries (7 patients, 3.1%). Falling was the most common cause of ocular trauma in these children, followed by trauma caused by a fist or other part of the body. Sharp objects such as knives or scissors were the most common cause of open globe injuries. Visual impairment (visual acuity less than 20/50) occurred in three open globe injury patients. CONCLUSIONS: Ocular trauma in children is associated with visual loss. Many of the cases were preventable. Public education, general awareness and aggressive primary management may be indicated to optimize visual outcome.

Dose-response relationship between ingested arsenic and cataracts among residents in Southwestern Taiwan.

This association study was carried out to examine the effect of long-term exposure to ingested arsenic on various types of cataract. A total of 349 residents living in arseniasis-hyperendemic villages of southwestern Taiwan were recruited. Cumulative arsenic exposure was derived from the history of consuming artesian well water and the arsenic level in well water. The Lens Opacities System III was used to classify different types of cataract. The cataract surgery prevalence was 10% for the age group of 50 or more years. Cortical opacity was most common (35%), while nuclear and posterior subcapsular opacities were observed in 24% and 22% of subjects, respectively. Diabetes mellitus was a significant risk factor for all types of cataract. Occupational sunlight exposure was associated with cortical and posterior subcapsular opacities in a dose-response relationship. The cumulative exposure to arsenic from artesian well water and the duration of consuming artesian well water were associated with an increased risk of all types of lens opacity. But statistically significant dose-response relations with the cumulative arsenic exposure and the duration of consuming artesian well water were observed only for posterior subcapsular opacity (P=0.014 and P=0.023, respectively) after adjustment for age, sex, diabetes status, and occupational sunlight exposure. It was concluded that there was an increasing prevalence of posterior subcapsular opacity with the increase in exposure to ingested arsenic.

Functional visual disturbance due to hysteria.

A 23-year-old male complained of loss of peripheral visual field and everything having purple shadows in the afternoon. This had lasted for 3 years but he had paid little attention to the symptoms. Investigations, including visual acuity, intra-ocular pressure, pupil reflex, and anterior and posterior segment of the eyes, were normal. He denied ocular pain, history of head injury, epilepsy or related family history. The Goldmann perimeter and tangent screen examinations showed a bilateral constricted tubular visual field defect within the central 10 degrees and steep margins. Tracing his past social history, he had been in jail for 3 months. He also complained his work was hard and caused him tension. The visual symptoms were a functional disturbance, not an organic disorder. We diagnosed him with hysterical functional visual disturbance. Hysteria, or conversion disorder, has long been a puzzling and fascinating problem in psychology and ophthalmology. The mechanism and reasons for hysteria are still not clear. The tangent screen is useful in diagnosis. The constricted tubular, spiral or star-shaped visual fields with steep slopes are specific findings in hysteria. We suggest that ophthalmologists should treat patients with psychogenic symptoms, using suggestion, patience and reassurance.