Immunotherapy for the treatment of advanced nasopharyngeal carcinoma: a promising new era.

PURPOSE: Nasopharyngeal carcinoma (NPC) is ranked the top otorhinolaryngology malignant tumors in the world. However, the general prognosis of recurrent and metastatic (R/M) nasopharyngeal carcinomas (NPCs) remains poor, and current surgery and chemoradiotherapy do not generate satisfactory outcomes. METHODS: As a new therapeutic choice, immunotherapy, especially with regard to the development of checkpoint inhibitors including PD-1 and CTLA-4 inhibitors have made considerable progress in recent years. As Epstein-Barr virus (EBV) infection is associated with increased risk of NPC, EBV-related immunotherapy may lead to a breakthrough in advanced NPCs. RESULTS: In this review, we summarized the clinical characters of NPC, and several past and ongoing clinical trials of checkpoint inhibitors and EBV-CTLs (CTLs: cytotoxic T lymphocytes) in R/M NPC immunotherapy. CONCLUSION: We conclude that although the evaluated effects of new immunotherapy drugs have brought us hope on NPC treatment, further phase II-III trials with larger samples are still required to improve the proportion and scheme of drug collocation for better clinical outcomes and less drug-related safety.

Evaluation of the Anterior Chamber Angle Structures in Perinatal Infants Using a Wide-Field Digital Fundus Camera.

OBJECTIVE: This study aimed to evaluate the ability of a digital fundus camera to observe the development of the anterior chamber angle (ACA) in premature infants. METHODS: Forty-eight eyes of preterm infants (n=48) were examined by a digital fundus camera to observe the development of the ACA. ACA grading was performed based on the visualization of the anterior chamber structures according to the Scheie Angle Depth Evaluating System. RESULTS: ACA images from all 48 infants were successfully acquired using RetCam3. The corrected gestational age ranged from 30 weeks to 49 weeks, which covered the period from 2 months preterm to >2 months post-term. As the corrected gestational age increased, the corrected gestational age grading was significantly decreased. The mean corrected gestational ages of the infants corresponding to the ACA classification from grade IV to grade 0 were 32.75±1.89, 37.20±1.30, 39.75±2.38, 40.56±2.24, and 44.23±2.14 weeks, respectively, which were all significantly different (P<0.05). The regression analysis showed a linear correlation between the grading of the ACA and the corrected gestational age (R2=0.724, P=0.0001). CONCLUSION: The ACA of a full-term newborn can be fully detected and evaluated by a digital fundus camera. For premature infants, part of the ACA is not visible physiologically; however, it should not be misdiagnosed as angle closure or a narrow angle.

Hierarchical dynamic convolutional neural network for laryngeal disease classification.

Laryngeal disease classification is a relatively hard task in medical image processing resulting from its complex structures and varying viewpoints in data collection. Some existing methods try to tackle this task via the convolutional neural network, but they more or less ignore the intrinsic difficulty differences among different input samples and suffer from high training complexity. In order to better resolve these problems, an end-to-end Hierarchical Dynamic Convolutional Network (HDCNet) is proposed, which can dynamically process the input samples based on their difficulty. For the easy-classified samples, the HDCNet processes them with a smaller resolution and a relatively small network, while the difficult samples are passed to a large network with a larger resolution for more accurate classification results. Furthermore, a Feature Reuse Module (FRM) is designed to transfer the features learned by the small network to the corresponding block in the deep network to enhance the overall performance of some rather complicated samples. To validate the effectiveness of the proposed HDCNet, comprehensive experiments are conducted on the public available laryngeal disease classification dataset and HDCNet provides superior performances compared with other current state-of-the-art methods.

Appropriate dose of intravitreal ranibizumab for ROP: a retrospective study.

OBJECTIVE: To compare the recurrence rate of retinopathy of prematurity (ROP) after treatment with 0.3 mg vs. 0.25 mg ranibizumab. SUBJECTS: All patients with ROP who underwent intravitreal injection of ranibizumab in Hainan General Hospital between January 2014 and May 2020 were included in this retrospective study. METHODS: Eighty-two cases (146 eyes) who received intravitreal injection of 0.25 mg ranibizumab were included in the conventional-dose group, and 59 cases (108 eyes) who received intravitreal injection of 0.3 mg ranibizumab were included in the high-dose group. The two groups were further divided into the 25-28-week, 29-31-week, 32-34-week, and 35-36-week GA subgroups. The differences between the conventional-dose group and the high-dose group in gestational age (GA), birth weight (BW), age at initial injection (weeks), incidence of systemic diseases, the recurrence rate of ROP, and age at retinal vascularization completed (weeks) were analyzed. RESULTS: GA, BW, age at initial injection, and the incidence of systemic diseases were not significantly different between the conventional-dose group and the high-dose group (p > 0.05). The recurrence rates of ROP were significantly lower in the 25-28-week, 29-31-week, and 32-34-week subgroups of the high-dose group than in the same subgroups of the conventional-dose group (p < 0.05). Within the conventional-dose group, the recurrence rate of ROP was significantly lower in the 32-34-week and 35-36-week subgroups than in the 25-28-week and 29-31-week subgroups (p < 0.05). Within the high-dose group, the recurrence rate of ROP was not significantly different between the four subgroups (p > 0.05). Retinal vascularization was completed at a later age in the 32-34-week subgroup of the high-dose group than in the 32-34-week subgroup of the conventional-dose group (p < 0.05) but was not significantly different between the two groups at any other GA range (p > 0.05). No severe ocular or systemic complications occurred in any patient. CONCLUSION: Treatment with 0.3 mg ranibizumab can reduce the recurrence rate of ROP without prolonging retinal vascularization or causing serious systemic complications. Therefore, this dose may be an appropriate therapeutic dose for ROP.

Doyne honeycomb retinal dystrophy/malattia leventinese induced by EFEMP1 mutation in a Chinese family.

BACKGROUND: Doyne honeycomb retinal dystrophy (DHRD)/malattia leventinese (ML) is a rare allelic condition with massive drusen in the posterior fundus caused by EFEMP1 gene mutation. Patients showed decreased vision when the lesion affected the macular area. At present, the treatment efficiency is not satisfactory. CASE PRESENTATION: In this study, we presented a family with DHRD/ML disease and analyzed the pathological and genetic information. A 28-year-old female patient presented to our department due to impaired visual acuity for 10 years especially in the right eye with deterioration for 5 months. Gene sequencing was performed by MyGenostics (Peking, China). Gene sequencing results revealed heterozygous mutations in EFEMP1 gene, which were consistent with the DHRD/ ML. Single heterozygous mutation (c.1033C > T) was observed in each of the three blood samples. This missense mutation triggered p.R345W. CONCLUSIONS: DHRD/ML is a rare disease associated with EFEMP1 gene mutation. Up to now, we are not sure whether these lesions are associated with the onset of DHRD/ML. In future, we hope to find out the exact relationship between them.

Periocular triamcinolone acetonide injection for treating polypoidal choroidal vasculopathy concurrent with hemorrhagic retinal detachment.

To investigate the clinical efficiency of periocular triamcinolone acetonide (TA) injection for treating polypoidal choroidal vasculopathy (PCV) concurrent with hemorrhagic retinal detachment (HRD).Twenty-two cases confirmed with PCV concurrent with HRD characterized by massive subretinal hemorrhage and exudation presented to our department from January 2015 to May 2017 were included in this study. The initial vision varied from counting finger to 0.2. All cases were randomly divided into TA group (n = 12), which received periocular TA injection per month, and anti-VEGF group (n = 10), which were treated by anti-VEGF intravitreous injection per month. The patients were followed up for 6 months, in which fundus examination and visual acuity along with optical coherence tomography (OCT) were carried out.The treatment effect is divided into the following categories. Cure was defined as the elimination of subretinal hemorrhage and exudation accompanied by retinal edema and choroidal neovascularization (CNV) extinction and rise of visual acuity. Improvement was characterized by alleviation of subretinal hemorrhage and exudation accompanied by retinal edema and CNV reduction and rise of visual acuity. Ineffective means remained subretinal hemorrhage and exudation in fundus and no improvement of visual acuity, and polypoid lesions in OCT images. Among the 12 cases in TA group, 1 case was treated by periocular injection of TA twice, and 11 cases were treated by 3 times injection. After that, 3 cases (25%) were cured, 8 cases (66.7%) got improvement, and only 1 case (8.3%) showed no response. Although among 10 cases in the anti-VEGF group, 3 cases were treated by anti-VEGF intravitreous injection twice. Seven cases were treated by 3 times injection. After that, 4 cases (40%) got improvement, and the other 6 case (60%) showed no response. All patients showed no recurrence in the 6-month follow-up. No complications were noticed under periocular injection or intravitreous injection.Periocular TA injection is effective for treating PCV concurrent with HRD.

An epidemiological investigation of age-related macular degeneration in aged population in China: the Hainan study.

PURPOSE: The aim of this study was to investigate the prevalence of age-related macular degeneration (AMD) and the risk factors in the residents aged ≥50 years in Hainan Province. METHODS: Random sampling was carried out in four separated cities in Hainan Province in 2015. All the subjects accomplished the standard questionnaire and ocular examinations. The diagnosis of AMD was performed based on the criteria proposed by Beckman Initiative for Macular Research Classification Committee. RESULTS: Three hundred and fifty-seven subjects (15.6%) were diagnosed with AMD, including 267 (11.7%) of early AMD, 64 (2.80%) of intermediate AMD and 24 (1.1%) of late AMD, respectively. The factors associated with the prevalence of AMD included age, educational level, smoking, outdoor activities and diet. The prevalence of AMD increased with age, lower educational level, smoking or less outdoor activities. The prevalence of AMD in those with a diet of meat or eggs was higher compared with a diet of vegetables or fish. The prevalence of early, intermediate and late AMD in the aged population in Hainan Province was 11.7, 2.8 and 1.1%, respectively. CONCLUSIONS: Age and smoking were the risk factors for AMD, while the educational level and outdoor activities were the protective factors. Early AMD mostly occurred in those aged 50-59 years and 60-69 years, while intermediate and late AMD occurred in 70-79 years and older than 80 years.