[The 505th case: refractory ascites and monoclonal immunoglobulin].

A 52-year-old woman was admitted with a primary complaint of abdominal distension and increased abdominal circumference for more than half a year. There was no evidence of infection or solid tumor on abdominocentesis or laparoscopic surgery. Concurrently, smoldering multiple myeloma was diagnosed. Due to refractory ascites and portal hypertension, a transjugular intrahepatic portosystemic shunt was performed, but the efficacy was not satisfactory. As the anemia progressed, she was finally diagnosed with active multiple myeloma after monoclonal plasma cells were detected in the ascites by flow cytometry. Treated with a triplet regimen that included bortezomib, cyclophosphamide, and dexamethasone (BCD), she achieved a very good partial response and ascites regressed.

[Research advances in myopic children with dry eye].

Myopia is a global public health issue, particularly prevalent in China, with a rising trend in recent years. The increased use of computers, smartphones, and video display terminals has led to frequent dry eye symptoms, such as blinking, among myopic students. Studies have revealed a higher incidence of dry eye in myopic children compared to emmetropic children, significantly impacting their learning and quality of life. However, ophthalmologists have traditionally focused more on the prevention and control of myopia, often neglecting ocular surface health awareness in children. It is essential to understand the potential impact of myopia on dry eyes in children and whether there is a difference in dry eye prevalence. This article reviews the current state of research on childhood myopia-related dry eye, encompassing epidemiology, pathogenesis, and risk factors, aiming to provide clinical reference for intervention, prevention, and precise treatment of dry eyes in myopic children.

[Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma].

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ2-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.

[Investigation and analysis of airborne allergenic pollen in 4 districts and 5 counties of Hohhot City].

Objective: To investigate the species, concentration and seasonal trends of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. Methods: The Department of allergy, Beijing Shijitan Hospital Affiliated to Capital Medical University conducted a cross-sectional study about monitoring the airborne allergenic pollen from August 1, 2021 to July 31, 2022 by the gravitational method in 4 districts and 5 counties of Hohhot City, which include Yuquan District, Xincheng District, Huimin District, Saihan District, Tuoketuo County, Helingeer County, Tumotezuoqi County, Wuchuan County and Qingshuihe County. Daily pollens were counted and identified by optical microscopy, and the data were analyzed. Results: The airborne allergenic pollen was collected every month all year round in 4 districts and 5 counties of Hohhot city. Through the whole year of the total quantity of pollens ranged from 24 850 to 50 154 grains per 1 000 mm2 and two peaks of pollen concentration in air were observed,which happened in spring (from March to May) and in summer and autumn (from July to September). In spring, the main pollens were tree pollens, which principally distributed in Populus pollen (18.29%), Ulmus pollen (8.36%), Pinus pollen (6.20%), Cupressaceae pollen (5.23%), Betulaceae pollen (2.73%), Salix pollen (1.80%) and Quercus pollen (1.16%). In summer and autumn, the main pollens were weed pollens, which mainly included Artemisia pollen (42.73%), Chenopodiaceae pollen or Amaranthaceae pollen (7.46%), Poaceae pollen (2.26%), Humulus pollen or Cannabis pollen (0.60%). Conclusion: There were two peaks of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. In the spring peak of pollen, the main airborne pollens were tree pollens. In the summer and autumn peak of pollen, the main airborne pollens were weed pollens. The Artemisia pollen was the most major airborne pollen in this area.

[Considering the influence of age-related factors on the strategy and satisfaction of refractive surgery].

With the rapid development of materials, equipment and technology related to refractive surgery, the number of people who choose refractive surgery to take off glasses keeps increasing. People at different ages have different needs for refractive surgery with varying effects. How to improve the long-term postoperative satisfaction of patients at different ages should be the focus of refractive surgeons. Age-related factors are not only among the key considerations in the preoperative design of refractive surgery, but also the focus of preoperative communication and education and postoperative follow-up. By analyzing and discussing the influence of age-related factors on the strategy of refractive surgery, this article emphasizes that it is important to pay attention to age-related factors and strengthen perioperative education in ametropic patients, so as to obtain long-term ideal postoperative visual quality and improve patient satisfaction throughout the life cycle.

MicroRNA-1274a serves as a prognostic biomarker in patients with osteosarcoma and is involved in tumor progression via targeting ADAM9.

Osteosarcoma (OS) is the most frequent primary malignancy in bone, and commonly occurs in children and adolescents. The aim of this study was to assess the aberrant expression of miR-1274a in OS patients, and to evaluate the role of miR-1274a as a prognostic biomarker and tumor suppressor in OS progression. miR-1274a expression was estimated using quantitative real-time polymerase chain reaction. The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic value of miR-1274a in OS. Gain- and loss-of-function in vitro experiments were used to explore the functional role of miR-1274a in OS progression. A target gene of miR-1274a was analyzed using a dual-luciferase reporter assay. miR-1274a expression was decreased in OS tissues and associated with distant metastasis and clinical stages in OS patients. Low miR-1274a could predict poor overall survival and disease-free survival in OS. The overexpression of miR-1274a could inhibit OS cell proliferation, migration and invasion. Additionally, ADAM9 was demonstrated to serve as a direct target of miR-1274a in OS cells. In conclusion, reduced miR-1274a predicts poor prognosis and serves as a potential tumor suppressor in OS. ADAM9 is a target of miR-1274a, which may mediate the functional role of miR-1274a in OS progression.

[Strengthening the safety of phakic intraocular lens implantation for myopia and astigmatism].

With the improvement of intraocular lens materials and function design, phakic intraocular lens implantation has been widely carried out for myopia and astigmatism and achieved satisfactory clinical results at home and abroad. The range of corrected myopia diopters has gradually changed from previous super-high and high myopia to low myopia. With the expansion of the scope of indications and applications, it is necessary to strengthen the standardization of phakic intraocular lens implantation for myopia and astigmatism, and it is particularly important to further improve its safety and quality control. This article discusses how to rationally select indications, increase the accuracy of the design, and effectively prevent surgical complications, providing a reference for further improvement of clinical safety and quality control. (Chin J Ophthalmol, 2021, 57: 86-89).

[Thought of corneal collagen cross-linking combined with excimer laser ablation for irregular corneas in keratoconus].

The concept of diagnosis and treatment of keratoconus is constantly updated. Today, we are not only concerned with how to delay the progress of the disease, but also with the preservation of useful vision for patients as well as improvement of visual quality. With the precise and individualized application of excimer laser and femtosecond laser technology in ophthalmology, corneal cross-linking combined with excimer laser ablation for the irregular cornea has become a new strategy for keratoconus. However, questions have been raised and caused ophthalmologists' thinking. Are patients with keratoconus who have progressively thinned corneas suitable for excimer laser ablation? Which is better when the combined strategy is applied, simultaneous or sequential surgery? Based on the research data from home and abroad, we comprehensively sort out various treatment methods for the focus issues. It is hoped that this article can provide guidance for the rational selection of an optimal clinical solution to keratoconus. (Chin J Ophthalmol, 2021, 57:251-253).

[Regulation of bFGF and TGF-ß2 in human scleral fibroblasts by the lumican gene mutation associated with myopia].

Objective: To investigate the regulation of basic fibroblast growth factor (bFGF) and transforming growth factor (TGF)-ß2 in human scleral fibroblasts (HSFs) by the adenovirus-mediated Lumican gene mutation, and to illustrate the effect of this mutation on myopia. Methods: Experimental study. The HSFs were isolated and cultured from human scleral tissues. The 3rd to 5th generation HSFs were transduced with Lumican mutant (c.596T>C) adenovirus, Lumican wild-type adenovirus, and defective adenovirus as the mutant group, wild group, and negative control group, respectively. Untransduced HSFs were defined as control group. The operation was conducted three times in each group. The expression levels of Lumican, bFGF and TGF-ß2 were detected by qPCR. Statistical analysis of gene expression differences between groups was performed by fold changes. The differences were analyzed by one way ANOVA combined with LSD-t test. Results: The expressions of Lumican in the mutant group and the wild group were 103.146-fold and 398.646-fold increased compared to the control group with significant difference (t=-16.641, -21.729; P<0.05). There was no statistical difference between the negative control group and the control group (t=1.689, P>0.05). The expressions of bFGF and TGF-ß2 in the mutant group were 2.812-fold and 2.346-fold increased compared to the control group with significant difference, and higher than the other groups (t=-3.921, -4.851; P<0.05). There was no significant difference among the wild group, negative control group and control group (P>0.05). Conclusions: The Lumican mutation (c.596T>C) increased the expressions of bFGF and TGF-ß2 in HSFs. It indicates that the Lumican mutation (c.596T>C) may change the metabolism of extracellular matrix in the sclera by regulating bFGF and TGF-ß2 to participate in scleral remodeling during the process of myopia. (Chin J Ophthalmol, 2021, 57:277-283).

[Anterior segment OCT-assisted PTK combined with PRK in the treatment of myopia associated with cornea macula: a case report].

Nowadays, myopia morbidity keeps increasing in China. As the improvements of technique and safety in corneal refractive surgeries, an increasing number of patients with refractive error tend to choose these treatments. The 26-year-old woman with myopia in this case, whose UCVA was 0.1 in OD and 0.2 in OS, had corneal macula in the nasal side of the left eye owing to a corneal trauma occurred more than 10 years ago. After sufficient preoperative examinations, FS-LASIK was performed on the right eye and PTK combined with PRK was performed on the left eye. The UCVA was 1.2 in both eyes 3 months postoperatively, and the corneal macula was mostly cleared in the left eye. It is demonstrated that PTK combined with PRK is an effective and safe way to correct the diopter as well as remove the lesions for the lowly or moderately myopic patients accompanied with superficial corneal opacity. (Chin J Ophthalmol, 2021, 57: 614-617).

[Enhancing the management and control of perioperative infection in small incision lenticule extraction].

Small incision lenticule extraction (SMILE) has been widely used in the treatment of myopia and astigmatism due to its small incision (2 mm), without open corneal flap, rapid recovery of the ocular surface function and good comfort. However, it is the microincision and the potential cavity under the corneal cap that provide a suitable environment for microbial nourishment. In this article, the characteristics of SMILE and the particularity of postoperative infection are stated, and the key points of risk management and control during the period of operation as well as the principles of identification and treatment of infection after SMILE surgery are put forward, so as to enhance the perioperative preparation in SMILE and make sure of the safety and high quality for myopic eyes. (Chin J Ophthalmol, 2020, 56: 86-88).

[New progress in the reuse of human corneal stromal lenticules from SMILE].

With the extensive development of small incision lenticule extraction (SMILE), a large number of human corneal stromal lenticules were extracted integrally during the operation, which led some experts to study the reuse of the lenticules. In experimental research, the lenticules were used to culture fibroblasts, construct corneal scaffolds and describe the biomechanical behaviors of cornea by cytobiology, immunology and biomechanics. In clinical study, the lenticules had been successfully reimplanted into autologous or allogenic cornea of human subjects for correcting hyperopia and presbyopic, patching corneal perforation and treating defective keratopathy and so on. (Chin J Ophthalmol, 2020, 56:144-148).

[Assessment of corneal biomechanical changes after small incision lenticule extraction with Pentacam and Corvis ST].

Objective: To investigate the application value of Pentacam combined with Corvis ST in evaluation of the changes of corneal biomechanics after femtosecond laser small incision lenticule extraction (SMILE) in Chinese myopia with an irregular cornea. Methods: The clinical records for 104 eyes of 57 patients who received SMILE in the Refractive Center of Beijing Tongren Hospital during January 2018 and May 2018 were collected. According to the keratoconus severity index (KSI), they were divided into two groups: regular corneal group (KSI<15%) and irregular corneal group (KSI: 15% to 25%). In both groups, the anterior corneal surface radius curvature was>7.25 mm (K<46.50 diopters), the posterior corneal surface radius curvature was>5.90 mm, the thinnest pachymetry was>490 µm, and best corrected visual acuity was ≥1.0. The vision, refraction, and corneal biomechanics before and after SMILE were assessed. The Topographic and Biomechanics Index (TBI) was analyzed by Pentacam combined with Corvis ST. Results: Before SMILE, the Corvis Biomechanical Index (CBI), TBI, and Belin/Ambrósio Deviation Normalized Index (BADD) of the irregular corneal group were significantly higher (t=-2.17, -6.78, -4.37, P<0.05) than the regular corneal group, while the stiffness parameter (SPA1) was significantly lower (t=2.58, P=0.011) compared to the regular corneal group (P<0.05). In the irregular group, the TBI was (0.28±0.2); the maximum value was 0.03, and the minimum value was 0.43. The CBI was (0.09±0.21); the maximum value was 0.00, and the minimum value was 0.54. The BADD was (1.33±0.47); the maximum value was 0.42, and the minimum value was 2.26. In the regular group, the TBI was (0.05±0.08); the maximum value was 0.00, and the minimum value was 0.20. The CBI was (0.01±0.03); the maximum value was 0.00, and the minimum value was 0.17. The BADD was (0.92±0.46); the maximum value was 0.00, and the minimum value was 1.64. There was no significant difference between two groups in age (t=0.20, P=0.508), central corneal thickness (t=1.64, P=0.104), biomechanical corrected IOP (t=0.73, P=0.468), max inverse radius (t=-0.24, P=0.815), spherical equivalent (t=-0.97, P=0.335), and best corrected visual acuity (t=0.21, P=0.833). After SMILE, the deformation amplitude in the irregular group was significantly higher at 1 month and 3 months (t=-3.13, -3.09, P<0.05). The irregular group had a significantly higher deformation amplitude ratio at 1 week, 1 month, and 1 year (t=-2.72, -3.39, -2.51, P<0.05). The SPA1 in the irregular group was significantly lower than the regular group at 1 week, 1 month, and 3 months (t=2.11, 2.73, 3.70, P=0.335, 0.010,<0.001). The changes of deformation amplitude (t=0.50, -1.10, -0.73, 2.12, P>0.05), max inverse radius (t=-1.52, -1.41, 0.01, -0.79, P>0.05), and SPA1(t=0.89, 0.90, 1.12, 0.90, P>0.05) after SMILE were similar between the irregular and regular groups, except that at 1 month after SIMILE, the deformation amplitude ratio changed more significantly in the irregular group (t=-3.01, P=0.003). Conclusions: The changes of corneal biomechanics in the groups of regular cornea and irregular cornea were stable with no significant difference during 1 year of post-SMILE. The diagnosis based on the corneal topography and corneal biomechanics is of certain significance for the screening of early keratoconus before keratorefractive surgery. (Chin J Ophthalmol, 2020, 56:103-109).

[Expert consensus on the diagnosis and treatment of cryptococcal meningitis].

Cryptococcal meningitis is a common and refractory central nervous system infection, with high rates of mortality and disability. The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion. Based on the current situation of cryptococcal meningitis in China, the management of cryptococcal meningitis includes 6 aspects: introduction, microorganism identification, clinical manifestations and diagnosis, principles of antifungal therapy, treatment of refractory and recurrent meningitis, treatment of intracranial hypertension. There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis. This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines. The importance of early diagnosis, combined long-term antifungal therapy, control of intracranial hypertension are emphasized.

[Carefully performing the phakic intraocular lens implantation for moderate and low myopia].

The refractive surgery is improved and updated with time. In recent years, the phakic intraocular lens has been continuously modified and innovated in materials and design. With advantages such as less high-order aberrations, reversible lens and good visual quality, it has led to a new trend of refractive surgery, which attract an increasing number of high myopic persons received phakic intraocular lens implantation instead of corneal refractive surgery, particularly to further expand the applying for moderate and low myopia. This article focuses on the rational selection of moderate and low myopia to receive laser correction vision or phakic lens, and elaborates the different characteristics with advantages and disadvantages of corneal refractive surgery and phakic intraocular lens implantation, which suggest to perform the phakic intraocular lens implantation for moderate and low myopia cautiously and standardize surgical indications strictly. It is necessary to continuously strengthen the standardization and safety of laser corneal refractive surgery and phakic intraocular lens implantation in order to improve the visual quality and satisfaction further for myopic patients in clinic. (Chin J Ophthalmol, 2018, 54: 726-728).

[Research advances in corneal and scleral collagen cross-linking with ultraviolet A and riboflavin].

In recent years, the use of collagen cross-linking with ultraviolet A and riboflavin is being developed universally due to its significance in the improvement of the mechanical strength of collagen fibers in clinical and basic research. It has been used in treating some corneal diseases including keratoconus, keratectasia and keratohelcosis. Thus, it might become a new treatment to prevent progressive myopia by strengthening scleral tissue. This article focuses on the effectiveness and safety of ultraviolet A-riboflavin cross-linking, and discusses the application prospect, focal points and problems related to cross-linking therapy. (Chin J Ophthalmol, 2018, 54:948-953).

[Advantages and disadvantages of femtosecond laser assisted LASIK and SMILE].

With the development of excimer laser and femtosecond laser equipment, application of diversified and customized surgical decision in modern corneal refractive surgery has been an inevitable trend. However, how to make a personalized decision with an accurate surgical design to achieve better visual quality becomes the main focus in clinical applications. Small-incision lenticule extraction (SMILE) and femtosecond assisted laser in situ keratomileusis (FS-LASIK) have been commonly acknowledged as the mainstream of corneal refractive surgery for ametropia correction nowadays. Both methods have been verified by clinical practice for many years. This article compares and elaborates the different characteristics with advantages and disadvantages of the two methods so as to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2018, 54: 7-10).

[Differential expression of small leucine-rich proteoglycans gene in Lumican transgenic mouse cornea].

Objective: To investigate the differential expression of small leucine-rich proteoglycans at mRNA level in Lumican transgenic mouse cornea with Real-time Quantitative PCR Detecting System. Methods: Experimental research. Ten Lumican transgenic mice (5 male and 5 female) were chosen as experimental group and 10 wild mice (5 male and 5 female) were chosen as control group. All the mice were killed and enucleated both eyes at eight weeks of age. Gene expression levels of Lumican, Decorin, Biglycan, Keratocan, Fibromodulin in the excised corneas were analyzed by real-time quantitative polymerase chain reaction (RT-Q-PCR) using Real-time Quantitative PCR Detecting System. Differential expression within each group were analysed by fold changes and independent t-test. Results: There were statistic different expression level of Lumican, Decorin, Biglycan and Keratocan mRNA between experimental and control group. The expression level of Lumican RNA was found to be 1.497-fold increased relative to the control (t=4.34, P<0.05) , while Decorin, Biglycan, Keratocan were 0.648-fold (t=-9.98, P<0.05) , 0.522-fold (t=-7.74,P<0.05), 0.323-fold (t=-95.94, P<0.05)decreased in transgenic mice. Fibromodulin mRNA up regulated 1.193-fold in transgenic mice without statistic difference (t=1.66, P>0.05). Conclusions: Lumican gene mutation(cDNA 569T>C) results in abnormal SLRP expression in transgenic mouse cornea at mRNA level, which may indicate that this mutation changes the structure of Lumican and impairs the function of regulating SLRP expression. Also, Lumican gene mutation leads to amio acid exchanging(L199P), which may hinder Lumican from binding to collagens and result in abnormal expression of SLRP at mRNA level. (Chin J Ophthalmol, 2018, 54:911-917).

[The value of brachial artery peak velocity variation during the Valsalva maneuver to predict fluid responsiveness].

Objective: To evaluate whether brachial artery peak velocity variation(ΔVp) during a Valsalva maneuver(VM) could predict fluid responsiveness in spontaneously breathing patients. Methods: Ninety-six patients required radial artery catheter for elective surgery of Ningbo Yinzhou People's Hospital from December 2014 to June 2016 were enrolled. The brachial artery Doppler signal was recorded to measure the ΔVp while the VM was performed.Then doing the volume expansion (VE) , the cardiac output variation (ΔCO) before and after VE were measured.Pearson correlational analyses were conducted between ΔVp and ΔCO. Also the sensitivity and specificity of ΔVp were determined in predicting fluid responsiveness by the receiver operating characteristic (ROC) curve. Results: Patients were classified as group responders (n=24) and group non-responders (n=72). Responder was defined as cardiac output increased≥15% after VE.The ΔVp correlated well with ΔCO (r=0.792, P<0.01). The area under ROC curve was 0.903, with the ΔVp cut-off of 33%, the sensitivity of 87% and the specificity of 82%(P<0.01). Conclusion: Brachial artery peak velocity variation during a valsalva maneuver is a feasible method for predicting fluid responsiveness in spontaneously breathing patients.

[Evaluation of CT-guided iodine-125 seeds brachytherapy for intracranial malignant tumors under control of target and dose].

Objective: To assess the efficacy and safety of CT-guided iodine-125 seeds in the treatment of intracranial malignancies under control of target and dose. Methods: From November 2003 to May 2016, with the clinical data of 412 operations on 310 patients in 12 hospitals in the past 14 years, this study analyzed the method of CT guided iodine-125 particles brachytherapy in the treatment of intracranial malignant tumors and evaluated the efficacy and complications. Stratification analysis of intracranial malignant tumors was performed. Results: Overall survival (OS) of patients with single brain metastases, low-grade glioma, high-grade gliomas, recurrence after surgery, recurrence after radiotherapy and others were 19, 67, 41, 26, 23, 46 months respectively.And the progression free time (PFS) of patients with single brain metastases, low-grade glioma, high-grade gliomas, recurrence after surgery, recurrence after radiotherapy and others were 19, 42, 6, 9, 11, 12 months respectively.Various complications were observed with a relatively low incidence of 10.4%.Three cases deceased at an interval of 7-45 days after treatment. Conclusions: For patients with intracranial malignancies, iodine-125 seeds brachytherapy could achieve a satisfactory treatment efficacy with tolerated complications.Iodine-125 seeds brachytherapy may act as a first-line regimen.