Using three-dimensional modelling of the anterior sclera to investigate the scleral profile in myopic eyes.

PURPOSE: This study used three-dimensional (3D) modelling to investigate scleral profiles in myopic eyes and compare them with emmetropic eyes. METHODS: In this prospective observational study, the eyes of 151 participants were analysed using the corneoscleral profile module (CSP) of the Pentacam HR. Non-rotationally symmetrical ellipsoids were fitted to the anterior scleral sagittal height. Three radii were analysed, namely the nasal-temporal (Rx), superior-inferior (Ry) and anterior-posterior (Rz) orientations. Additionally, the area index (AI) and aspherical parameters (Qxy, Qxz and Qyz) of the anterior sclera-fitted ellipsoid (ASFE) were quantified. RESULTS: The findings showed an increase in Rx (-0.349 mm/D), Ry (-0.373 mm/D), Rz (-1.232 mm/D) and AI (-36.165 mm2 /D) with increasing myopia. From emmetropia to high myopia, the vertical and horizontal planes of the anterior sclera became increasingly prolate (emmetropia, Qxz: 0.02, Qyz: 0.01; low myopia, Qxz: -0.28, Qyz: -0.28; high myopia, Qxz: -0.41, Qyz: -0.43). There were no significant differences in the coronal plane across the three groups (H = 2.65, p = 0.27). The anterior scleral shape of high myopes in the horizontal and vertical planes was more prolate than that of emmetropes and low myopes (Qxz, high myopes vs. low myopes: p = 0.03, high myopes vs. emmetropes: p < 0.001; Qyz, high myopes vs. low myopes: p = 0.04, high myopes vs. emmetropes: p < 0.001). CONCLUSIONS: As the degree of myopia increased, non-uniform anterior scleral enlargement was observed. These findings provide a better understanding of the anterior segment with varying degrees of myopia.

Repeatability and Reproducibility of Corneoscleral Topography Measured With Scheimpflug Imaging in Keratoconus and Control Eyes.

OBJECTIVES: To determine and compare the repeatability and reproducibility of anterior scleral parameters measured by the corneoscleral profile (CSP) module of Pentacam in keratoconus (KC) and control eyes. METHODS: This is a prospective observational study. Thirty KC participants (30 eyes) and 24 control participants (24 eyes) were examined three times using the CSP. Sagittal height mean (SHM), sagittal height astigmatism (SHA), and mean bulbar slope (BSM) were measured in 12 mm and 16 mm chord lengths. The repeatability and reproducibility of these measurements were also assessed. Coefficients of variation (CoV), intraclass correlation coefficient (ICC), coefficient of repeatability (CoR1), and coefficient of reproducibility (CoR2) were adopted to assess the reliability. RESULTS: In the KC and control groups, SHM showed high repeatability and reproducibility (coefficients of variation [CoVs]≤0.96%, intraclass correlation coefficient [ICCs]≥0.97), and SHM of control eyes showed higher repeatability and reproducibility than that of KC eyes at 12 mm chord length (KC group, CoRs ranged from 35.56 µm to 43.52 µm, control group, ranged from 23.50 µm to 30.31 µm) and 16 mm chord length (KC group, CoRs ranged from 79.54 µm to 81.58 µm, control group, ranged from 48.25 µm to 66.10 µm). Mean bulbar slope also showed high repeatability and reproducibility (CoVs≤3.65%, CoRs≤2.64). Furthermore, the SHA of control eyes showed higher repeatability and reproducibility when compared with KC eyes (control group: CoVs≤29.95%, KC group: CoVs≥32.67%). CONCLUSIONS: Keratoconus and control eyes demonstrated high repeatability and reproducibility when using CSP measurements, which may prove helpful in fitting contact lenses.

COPII genes SEC31A/B are essential for gametogenesis and interchangeable in pollen development in Arabidopsis.

In eukaryotes, coat protein complex II (COPII) vesicles mediate anterograde traffic from the endoplasmic reticulum to the Golgi apparatus. Compared to yeasts, plants have multiple COPII coat proteins; however, the functional diversity among them is less well understood. SEC31A and SEC31B are outer coat proteins found in COPII vesicles in Arabidopsis. In this study, we explored the function of SEC31A and compared it with that of SEC31B from various perspectives. SEC31A was widely expressed, but at a significantly lower level than SEC31B. SEC31A-mCherry and SEC31B-GFP exhibited a high co-localization rate in pollen, but a lower rate in growing pollen tubes. The sec31a single mutant exhibited normal growth. SEC31A expression driven by the SEC31B promoter rescued the pollen abortion and infertility observed in sec31b. A sec31asec31b double mutant was unavailable due to lethality of the sec31asec31b gametophyte. Transmission electron microscopy revealed that one quarter of male gametogenesis was arrested at the uninuclear microspore stage, while confocal laser scanning microscopy showed that 1/4 female gametophyte development was suspended at the functional megaspore stage in sec31a-1/+sec31b-3/+ plants. Our study highlights the essential role of SEC31A/B in gametogenesis and their interchangeable functions in pollen development.

Application of prechop technique in phacoemulsification for cataract patients with highly liquefied vitreous: a retrospective study.

BACKGROUND: Phacoemulsification using phaco-chop technique has many challenging features in cataract patients with highly liquefied vitreous. This study aimed to compare the intraoperative parameters and safety between prechop technique and traditional phaco-chop in phacoemulsification for these patients. METHODS: A total of 54 eyes of 54 patients with high myopia-related or post-vitrectomy cataract that underwent phacoemulsification combined with intraocular lens implantation were included in this retrospective study. Of them, 25 eyes that received manual prechop were included in the prechop group, and 29 eyes with best match of age, axial length and nuclear opalescence (NO) that received standardized phaco-chop were included as the control group. The intraoperative complications and surgery parameters were compared between groups. RESULTS: No surgical complications were observed in the prechop group, while 2 eyes with posterior capsular rupture and 1 eye with a broken ciliary zonule (10.3%) were found in the control group. There was no significant difference in phaco time, average energy, and cumulative dissipated energy (CDE) between groups (all P > 0.05), but for hard nuclear cataracts with NO grading ≥ 5, prechop group required less phaco time (P = 0.008) and CDE (P = 0.029). There were significant correlations between phaco time vs. NO (r = 0.762 vs. 0.581, both P < 0.005) and CDE vs. NO (r = 0.717 vs. 0.668, both P < 0.001) in the prechop group and control group, respectively. CONCLUSIONS: The prechop technique which seemed to have less intraoperative complications, reduced phaco time and CDE compared to standardized phaco-chop might be a good alternative for cataract patients with highly liquefied or vitrectomized vitreous, especially those with hard nuclear cataracts.

Association between the posterior ocular contour pattern and progression of myopia in children: A prospective study based on OCT imaging.

PURPOSE: This study aims to reveal the relationship between the posterior ocular contour and the subsequent progression of myopia in children. METHODS: Children aged 8-12 years with myopia received baseline measurements and were instructed to wear their glasses every day and return for a follow-up visit after one year. Axial length and other ocular parameters were measured using a noncontact biometer. The contour of the posterior eye was calculated and analysed based on images from spectral domain optical coherence tomography (SD-OCT). Univariate and multivariate linear regression models were created to analyse the relationship between the contour of the posterior eye and the progression of myopia. RESULTS: Baseline posterior ocular contour measurements correlated with baseline axial length and spherical equivalent refraction (SER) (all p < 0.05). Eyes that were more myopic tended to have a more prolate posterior ocular contour. Although the baseline contour of the retinal pigment epithelium (RPE) and chorioscleral interface (CSI) showed no significant relationship with the progression of myopia (all p > 0.05), interestingly, when the baseline contour of the RPE was more prolate than that of the CSI, the axial length increased during the following year (R2  = 0.62; p < 0.01). The multivariate model, when adjusted for other variables, further validated the independent role of this variable. CONCLUSIONS: The difference between the RPE and CSI contours correlated with the subsequent progression of myopia in children. This finding can help inform clinicians regarding the management of children at the onset of myopia and potentially provide an avenue for experimental research on the mechanism of myopia development.

[Mechanism of Bruch's Membrane in the Occurrence and Development of Myopia].

Myopia is a process of ocular wall remodeling along with axial elongation after emmetropia decompensation, but the causal relationship among the changes taking place in ocular fundus structures during this process is not clear. The choroid, which lies between the retina and the sclera, plays an important role in the transmission of information related to myopia. The role of choroid in myopia is a hot research topic at present. Findings from animal experiments showed that form deprivation-induced changes in choroidal thickness may be related to the vascular perfusion, but the triggering mechanism of choroidal perfusion changes during the process of myopia still needs to to be further explored. Bruch's membrane is an elastic membrane located in the front of the choroid with good contractile properties. In the process of myopia, regional changes of the synthesis or biomechanics of Bruch's membrane may have formed the earliest structural basis of changes in choroidal thickness and blood flow. Taking choroidal thickness as a starting point, this paper focuses on the role and mechanism of Bruch's membrane in the occurrence and development of myopia, which may further deepen our understanding of the mechanism of changes in choroidal thickness, and provide a theoretical basis for the development of new therapeutic targets for myopia.

Advanced integrated nanochannel membrane with oppositely-charged bacterial cellulose and functionalized polymer for efficient salinity gradient energy generation.

Reverse electrodialysis (RED) systems employing charged nanochannels have gained prominence for harvesting salinity gradient energy. Nevertheless, fabricating nanochannel membranes with optimal ion selectivity and high energy conversion efficiency remains a significant challenge. In this study, we develop oppositely charged bacterial cellulose (BC)/polymer composite nano-channel membranes with precisely designed nanochannel architectures by integrating chemical modification with composite material technology. Initially, BC undergoes chemical modifications, including 2,2,6,6-Tetramethylpiperidine 1-oxy radical (TEMPO) oxidation and quaternisation. Subsequently, a polymer network is integrated into the modified BC network through a polymer synthesis technique. This approach successfully yields negatively charged BC/poly(sodium p-styrene sulfonate) (NBC/PSS) composite double-networked nanochannel membranes and positively charged BC/poly(dopamine) (PBC/PDA) composite double-networked nanochannel membranes. Notably, these membranes exhibit significantly enhanced ionic conductivities, with values of 0.0008 and 0.0014 S cm-1 for the NBC/PSS and PBC/PDA composites, respectively, while also demonstrating superior ion selectivity with cation transfer numbers of 0.9 and 0.1 respectively. Furthermore, a series connection of 30 BCE/charged polymer-based RED devices successfully powers an electronic calculator. This work offers novel insights into the design of BC-based RED devices by integrating chemical modification and polymeric composite strategies for efficient salinity gradient energy generation.

Construction of metal-organic framework/cellulose nanofibers-based hybrid membranes and their ion transport property for efficient osmotic energy conversion.

The development of advanced nanofluidic membranes with better ion selectivity, efficient energy conversion and high output power density remains challenging. Herein, we prepared nanofluidic hybrid membranes based on TEMPO oxidized cellulose nanofibers (T-CNF) and manganese-based metal organic framework (MOF) using a simple in situ synthesis method. Incorporated T-CNF endows the MOF/T-CNF hybrid membrane with a high cation selectivity up to 0.93. Nanoporous MOF in three-dimensional interconnected nanochannels provides massive ion transport pathways. High transmembrane ion flux and low ion permeation energy barrier are correlated with a superior energy conversion efficiency (36 %) in MOF/T-CNF hybrid membrane. When operating under 50-fold salinity gradient by mixing simulated seawater and river water, the MOF/T-CNF hybrid membrane achieves a maximum power density value of 1.87 W m-2. About 5-fold increase in output power density was achieved compared to pure T-CNF membrane. The integration of natural nanofibers with high charge density and nanoporous MOF materials is demonstrated an effective and novel strategy for the enhancement of output power density of nanofluidic membranes, showing the great potential of MOF/T-CNF hybrid membranes as efficient nanofluidic osmotic energy generators.

Long-term effect of orthokeratology on choroidal thickness and choroidal contour in myopic children.

PURPOSE: To investigate the long-term effect of orthokeratology (ortho-k) on the choroidal thickness and choroidal contour in myopic children. METHODS: Subjects were from a conducted 2-year randomised clinical trial. Children (n=80) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00D were randomly assigned to the control group (n=40) and ortho-k group (n=40). Optical coherence tomography images were collected at the baseline, 1-month, 6-month, 12-month, 18-month and 24-month visits, then the choroidal thickness and choroid contour were calculated. Axial length (AL) and other ocular biometrics were also measured. RESULTS: During 2 years, in the control group, the choroidal thickness became thinning and the choroidal contour became prolate with time at all visits (all p<0.001). Ortho-k can improve the choroidal thickness (all p<0.001) and maintain the choroidal contour at all visits (all p<0.05). In the ortho-k group, the choroidal contour was less changed in the temporal than nasal (p=0.008), and the choroidal thickness was more thickening in the temporal 3 mm (p<0.001). Two-year change in choroidal thickness was significantly associated with the 2-year AL change in the control group (r=-0.52, p<0.001), however, this trend was broken by ortho-k (r=-0.05, p=0.342). After being adjusted by other variables in the multivariable regression model, the effect of ortho-k on choroidal thickness was stable. CONCLUSIONS: In the current 2-year prospective study, ortho-k can improve the choroidal thickness and maintain the choroidal contour, but this effect diminished in a long term. Further study with larger sample size and longer follow-up is warranted to refine this issue.

Up-regulated serum lactate dehydrogenase could become a poor prognostic marker in patients with bladder cancer by an evidence-based analysis of 2,182 patients.

Background: A growing number of studies have considered serum lactate dehydrogenase (LDH) as an indicator of bladder cancer (BC) prognosis. However, a meta-analysis of the serum LDH's influence on BC prognosis is still missing. Methods: PubMed, EMBASE, Web of Science and Cochrane Library were exhaustively searched for studies comparing oncological outcomes between high-LDH and low-LDH patients. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3) for overall survival (OS) in patients with BC. Results: Six studies involving 2,182 patients were selected according to predefined eligibility criteria. The results showed that serum LDH level was significantly associated with OS (HR = 1.86, 95%CI = 1.54-2.25, p<0.0001) in BC. Sensitivity analysis showed the stability of the results. Subgroup analysis revealed that the levels of serum LDH had a significant impact on the OS of BC patients among different groups including publication time, research country, sample size, tumor stage, LDH cut-off value, therapy and follow-up time (all HR>1 and p<0.05), revealing that the ability of serum LDH is not affected by other factors. Conclusion: Our findings indicated that a high level of serum LDH was associated with inferior OS in patients with BC. However, caution must be taken before recommendations are given because this interpretation is based upon very few clinical studies and a small sample.

Accommodation and vergence function in children using atropine combined with orthokeratology.

PURPOSE: This study aimed to evaluate binocular vision in terms of vergence and accommodative measurements in children treated with 0.01% atropine combined with orthokeratology (OK). METHODS: This was a prospective and randomized controlled clinical trial involving participants aged 8 to 12 years, with a spherical equivalent (SE) ranging from - 1.00 to - 6.00D. Participants were randomly divided into four groups: 1) a combination group using 0.01% atropine solution and OK lens; 2) an OK group using placebo solution and OK lens; 3) an atropine group using 0.01% atropine solution and wearing spectacles; and 4) a control group using placebo solution and wearing spectacles. Binocular vision was determined at baseline and at 3-month visits, with evaluations including horizontal phoria, fusional vergence, the accommodative convergence/accommodation (AC/A) ratio, accommodative lag, and accommodative amplitude (AA). The Wilcoxon signed-rank test was used to compare the changes in binocular vision in each group, and the Kruskal-Wallis test was used for comparisons of four groups. RESULTS: Sixty-two participants completed the study. There was no significant difference in baseline refraction, accommodation or vergence measurements among the groups (all P > 0.05). Three months later, the accommodative lag significantly decreased in the OK group (P = 0.002) but remained unchanged in the other three groups (all P > 0.05). In addition, binocular accommodative facilities and positive relative accommodations increased in the combination and OK groups (both P < 0.05) but remained unchanged in the atropine and control groups (both P > 0.05). Only the participants with esophoria in the OK group had a significant decrease in esophoria (P = 0.008). Moreover, the changes in fusional vergence and AC/A did not significantly differ between the four groups (all P > 0.05). CONCLUSION: Accommodative measurements changed similarly in the groups treated with OK. Changes in vergence measurements after treatment with 0.01% atropine were not significant.

Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial.

PURPOSE: To investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy. METHODS: An age-stratified randomised controlled trial. Children (n=164) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects. RESULTS: All interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8-10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10-12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children. CONCLUSIONS: Atropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8-12. Younger children might benefit more from ortho-k. TRIAL REGISTRATION NUMBER: ChiCTR1800015541.

Changes in Stress-Strain Index in School-Aged Children: A 3-Year Longitudinal Study.

Purpose: To determine three-year change of the corneal biomechanical parameter stress-strain index (SSI) in schoolchildren aged 7- 9 years and their correlation with refractive error and axial length (AL). Methods: This is a prospective cohort study. Data of the AL, refractive error, and corneal biomechanical parameter SSI were collected at baseline and a 3-year follow-up for 217 schoolchildren. SSI, AL, and refractive error were measured via corneal visualization Scheimpflug technology (Corvis ST), IOLMaster biometry, and cycloplegic refraction. Three years of changes in SSI and its association with refractive error and AL were analyzed. Participants were divided into persistent nonmyopia (PNM), newly developed myopia (NDM), and persistent myopia (PM). The three-year difference in SSI among the three groups was analyzed. Results: After three years of follow-up, the corneal biomechanical parameter SSI decreased in all participants (P < 0.01). There was a negative correlation between the change in SSI and the change in AL (r = -0.205, P=0.002) and a positive correlation between the change in refractive error (r = 0.183, P=0.007). After three years of follow-up, there was a decrease in the SSI for the NDM, PM, and PNM participants, with a median change of -0.05 for PNM and -0.13 and -0.09 for the NDM and PM, respectively. There was a significant decrease in corneal biomechanical properties for NDM patients compared with PNM patients (P < 0.01). Conclusion: In 7- to 9-year-old schoolchildren, SSI decreased after three years of the longitudinal study, and the change in SSI was correlated with the change in AL and refractive error. There was a rapid decrease in corneal biomechanical properties among newly developed myopic patients.

Defects and asymmetries in the visual pathway of non-human primates with natural strabismus and amblyopia.

Strabismus and amblyopia are common ophthalmologic developmental diseases caused by abnormal visual experiences. However, the underlying pathogenesis and visual defects are still not fully understood. Most studies have used experimental interference to establish disease-associated animal models, while ignoring the natural pathophysiological mechanisms. This study was designed to investigate whether natural strabismus and amblyopia are associated with abnormal neurological defects. We screened one natural strabismic monkey ( Macaca fascicularis) and one natural amblyopic monkey from hundreds of monkeys, and retrospectively analyzed one human strabismus case. Neuroimaging, behavioral, neurophysiological, neurostructural, and genovariation features were systematically evaluated using magnetic resonance imaging (MRI), behavioral tasks, flash visual evoked potentials (FVEP), electroretinogram (ERG), optical coherence tomography (OCT), and whole-genome sequencing (WGS), respectively. Results showed that the strabismic patient and natural strabismic and amblyopic monkeys exhibited similar abnormal asymmetries in brain structure, i.e., ipsilateral impaired right hemisphere. Visual behavior, visual function, retinal structure, and fundus of the monkeys were impaired. Aberrant asymmetry in binocular visual function and structure between the strabismic and amblyopic monkeys was closely related, with greater impairment of the left visual pathway. Several similar known mutant genes for strabismus and amblyopia were also identified. In conclusion, natural strabismus and amblyopia are accompanied by abnormal asymmetries of the visual system, especially visual neurophysiological and neurostructural defects. Our results suggest that future therapeutic and mechanistic studies should consider defects and asymmetries throughout the entire visual system.

Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography.

This research aimed to explore the curative effect of short-term insulin pump in the treatment of type 2 diabetes mellitus (T2DM) patients with lower extremity arterial disease (LEAD) based on ultrasonography. 422 patients (220 males and 202 females) with T2DM in the hospital were selected, and they were randomly divided into control group (n = 211, oral hypoglycemic drugs or diet control, appropriate exercise to lower blood glucose) and experimental group (n = 211, insulin pump was used to reduce blood glucose). After 2 weeks, the therapeutic effect was evaluated by ultrasonography. The results showed that after two weeks of treatment, the difference in lumen intima between the two groups was statistically significant (P < 0.05). The intima-media thickness (IMT) values of the experimental group were 0.83 ± 0.03 mm, 0.62 ± 0.03 mm, and 0.41 ± 0.04 mm, respectively, which were significantly different from those of the control group (1.62 ± 0.54 mm, 1.23 ± 0.14 mm, and 0.78 ± 0.11 mm) (P < 0.05). There was obvious difference in low-density lipoprotein cholesterol (LDL-C) level between the experimental group (2.22 ± 0.46 mmol/L) and the control group (3.21 ± 0.62 mmol/L) (P < 0.05). The LEAD score of the experimental group was 5.51 ± 1.11, which was significantly different from that of the control group (7.08 ± 2.73) (P < 0.05). There was clear difference in LEAD score between the two groups under different course of disease (CD) (P < 0.05). Studies indicated that short-term application of insulin pump therapy could effectively improve the pathological changes of lower limbs in patients with T2DM, which had clinical application value.

The efficacy and safety of mirabegron in treating ureteral stent-related symptoms: A systematic review and meta-analysis.

OBJECTIVES: This meta-analysis aimed to assess the efficacy and safety of mirabegron in treating ureteral stent-related symptoms. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched to identify randomized controlled trials (RCT) of mirabegron in treating ureteral stent-related symptoms. We conducted a systematic review and meta-analysis based on the eligible RCT. RESULTS: Five RCT including 546 patients and comparing mirabegron with placebo or blank control were involved in the present research. Regarding efficacy, mirabegron was superior to controls in urinary symptom score (P = .0006) and general health score (P < .0001) of the Ureteral Stent Symptom Questionnaire, total International Prostate Symptom Score (P < .00001), quality of life (P < .0001), analgesic use (P = .008), and readmission or visit to hospital due to discomfort (P = .001). Safety assessments including adverse events (P = .40) suggested that mirabegron was well tolerated. CONCLUSIONS: The present meta-analysis shows that mirabegron is an effective and safe treatment for relieving ureteral stent-related symptoms with a low occurrence of adverse events.

Systematic review and meta-analysis of randomized controlled trials of perioperative outcomes and prognosis of transurethral en-bloc resection vs. conventional transurethral resection for non-muscle-invasive bladder cancer.

OBJECTIVES: This article aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of perioperative outcomes and prognosis of transurethral en-bloc resection versus conventional transurethral resection for non-muscle-invasive bladder cancer (NMIBC). METHODS: We searched MEDLINE, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) to find eligible RCTs. The studies were classified by version 2 of the Cochrane risk-of-bias tool for randomized trials. Review Manager 5.4.0 was used to evaluate the data. The certainty of the evidence was assessed using the Guideline Development Tool by GRADEpro GDT. RESULTS: Seven RCTs with 1142 patients was included in the present study. The results indicated that bladder perforation (OR = 0.17; 95% CI 0.05 to 0.67; P = 0.01), obturator nerve reflex (OR = 0.03; 95% CI 0.01 to 0.13; P < 0.00001), residual tumor (OR = 0.24; 95% CI 0.08 to 0.77; P = 0.02) and repeat transurethral resection of bladder tumor (re-TURBT) (OR = 0.54; 95% CI 0.34 to 0.85; P = 0.008) were significantly reduced in the en-bloc resection group than the conventional resection group. However, there were no significant differences in hemoglobin deficit (p = 0.31), urethral stricture (p = 0.47), and detrusor muscle presence (P = 0.16) between both groups. Besides, resection time (p = 0.25), operative time (p = 0.20), catheter dwell time (p = 0.24), and length of hospital stay (p = 0.16) were similar in the two groups. Meanwhile, en-bloc resection yielded no advantage for the 3-month (P = 0.11), 6-month (P = 0.05), 1-year (P = 0.61), 2-year (P = 0.53), and 3-year (P = 0.26) tumor recurrence rates. CONCLUSIONS: Our meta-analysis shows that transurethral en-bloc resection is associated with comparable outcomes to conventional transurethral resection for recurrence-free survival in NMIBC patients. En-bloc resection is more feasible and safer than conventional resection for NMIBC, with fewer intraoperative complications, less residual tumor, and less re-TURBT.

Pigment Epithelium-Derived Factor-Loaded PEGylated Nanoparticles as a New Antiangiogenic Therapy for Neovascularization.

Background: Pathological neovascularization, which involves a disruption in the balance between angiogenic and antiangiogenic factors under pathological conditions, is the basis of many intraocular diseases. Pigment epithelium-derived factor (PEDF) is a potent natural, endogenous inhibitor of neovascularization because of its antiangiogenic and neuroprotective benefits. However, its application is restricted by its instability and short half-life. The present study is aimed at investigating the cytotoxicity and antiangiogenic effects of PEDF-loaded PEGylated nanoparticles (NP-PEG-PEDF) on high glucose-stimulated human umbilical vein endothelial cells (HUVECs). Methods: In this study, NP-PEG-PEDF were fabricated using the multiple emulsion method for the first time. HUVECs were cultured in a high concentration of glucose (30 mmol/L D-glucose), simulating diabetic conditions. The antiangiogenic effects of vascular endothelial growth factor (VEGF), pure PEDF, and NP-PEG-PEDF on proliferation, migration, and tube formation were evaluated. VEGF secretion in high glucose-stimulated HUVECs was further tested in vitro. Results: NP-PEG-PEDF exhibited low cytotoxicity in HUVECs. Our results indicated that in vitro, NP-PEG-PEDF attenuated diabetes-induced HUVEC proliferation, migration, and tube formation and suppressed VEGF secretion. The apoptosis of diabetes-induced HUVECs occurred in a dose-dependent manner, which showed a statistically significant difference compared with the PEDF treatment group. Conclusion: Our study is the first to demonstrate that NP-PEG-PEDF exert antiangiogenic effects on high glucose-stimulated HUVECs and have the potential to alleviate microvascular dysfunction. These data suggest that the NP-PEG-PEDF delivery system may offer an innovative therapeutic strategy for preventing neovascularization of the fundus.

Variability of Accommodative Microfluctuations in Myopic and Emmetropic Juveniles during Sustained near Work.

Near work has been considered to be a potential risk factor for the onset of myopia, but with inadequate evidence. Chinese adolescents use digital devices for near work, such as study and entertainment purposes, especially during the COVID-19 pandemic. In this study, we investigated the influence of prolonged periods of near work on accommodative response, accommodative microfluctuations (AMFs), and pupil diameter between juvenile subjects of myopia and emmetropia. Sixty juveniles (30 myopes and 30 emmetropes) were recruited for the study. Participants were instructed to play a video game on a tablet PC at a distance of 33.3 cm for 40 min. Accommodative response and pupil diameter were measured with an open-field infrared refractometer in High-speed mode. Parameters of the subjects were measured once every 10 min, and analyzed by one-way repeated measure ANOVA for variation tendency. There were no significant differences between emmetropia and myopia groups with respect to age and sex (p > 0.05). The low-frequency component (LFC) of myopia gradually increased with time, reached a peak at 30 min, and then declined (p = 0.043). The high-frequency component (HFC) of myopia also reached a peak at 30 min (p = 0.036). Nevertheless, there was no significant difference in the LFC (p = 0.171) or HFC (p = 0.278) of the emmetropia group at each time point. There was no significant difference in the mean and standard deviation of the accommodative response and pupil diameter both in emmetropic and myopic juveniles. Compared with juvenile emmetropes, myopes exhibit an unstable tendency in their accommodation system for prolonged near work at a certain time point. Accommodative microfluctuations may be a sensitive, objective indicator of fatigue under sustained near work in juvenile myopes.

Decreased Preoperative Serum AGR as a Diagnostic Marker of Poor Prognosis after Radical Surgery of Upper Urinary Tract and Bladder Cancers from a Pooled Analysis of 9,002 Patients.

A growing number of studies have regarded the preoperative serum albumin-to-globulin ratio (AGR) as a prognostic indicator of urothelial carcinoma (UC) following radical surgery. However, a pooled analysis of AGR's effect on UC prognosis was still insufficient. Up to January 2022, a systematic search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. Stata SE software was applied in this study. The reviewers collected the hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS). A total of 9,002 patients from 12 retrospective studies were included in this analysis. The results showed that preoperative serum AGR was significantly associated with the OS (HR = 1.85, 95%CI = 1.43 to 2.39), CSS (HR = 2.38, 95%CI = 1.69 to 3.34), RFS (HR = 1.64, 95%CI = 1.29 to 2.08), PFS (HR = 2.16, 95%CI = 1.43 to 3.27), and MFS (HR = 3.00, 95%CI = 1.63 to 5.53) of patients with UC following radical surgery. Sensitivity analysis indicated the stability of the results. Subgroup analysis revealed that preoperative low AGR was seen as a risk factor for OS (HR = 1.90, 95%CI = 1.34 to 2.69), CSS (HR = 2.13, 95%CI = 1.40 to 3.26), and RFS (HR = 1.60, 95%CI = 1.24 to 2.07) in upper tract urothelial carcinoma (UTUC), but it was only a risk factor for CSS (HR = 2.95, 95%CI = 1.14 to 7.60) in bladder cancer (BC). Besides, preoperative AGR cut - value ≤ 1.4 could not be deemed as a stable prognostic indicator for RFS (HR = 2.07, 95%CI = 0.71 to 6.04) in UC. However, the predictive ability of AGR cut - value > 1.4 was stable. All in all, preoperative low AGR was considered as a risk factor for UC. AGR level can be regarded as a prognostic indicator for OS, CSS, and RFS in UTUC but only for CSS in BC. AGR greater than 1.4 can be a great cut-off value for predicting the prognosis of UC patients with radical operation.