Synthesis of Tetrasubstituted Enamines Using Secondary Amines and In Situ-Generated Allenes from Nitrocyclopropanes.

A novel reaction of cyclic and acyclic secondary amines with in situ-generated allene intermediate species from nitro-substituted donor-acceptor cyclopropanes is reported. In the presence of a simple inorganic base, NaOH, tetrasubstituted enamine derivatives can be obtained in moderate to excellent yields. The reaction is operationally easy, features mild reaction conditions and simple inorganic bases, and is free of transition metals.

Enantioselective Synthesis in Continuous Flow: Polymer-Supported Isothiourea-Catalyzed Enantioselective Michael Addition-Cyclization with α-Azol-2-ylacetophenones.

A packed reactor bed incorporating a polymer-supported isothiourea HyperBTM catalyst derivative has been used to promote the enantioselective synthesis of a range of heterocyclic products derived from α-azol-2-ylacetophenones and -acetamides combined with alkyl, aryl, and heterocyclic α,ß-unsaturated homoanhydrides in continuous flow via an α,ß-unsaturated acyl-ammonium intermediate. The products are generated in good to excellent yields and generally in excellent enantiopurity (up to 97:3 er). Scale-up is demonstrated on a 15 mmol scale, giving the heterocyclic product in 68% overall yield with 98:2 er after recrystallization.

Efficacy and Safety of Biosimilar QL1207 vs. the Reference Aflibercept for Patients with Neovascular Age-Related Macular Degeneration: A Randomized Phase 3 Trial.

INTRODUCTION: This trial aimed to compare the efficacy and safety between biosimilar QL1207 and the reference aflibercept for the treatment of neovascular age-related macular degeneration (nAMD). METHODS: This randomized, double-blind, phase 3 trial was conducted at 35 centers in China. Patients aged ≥ 50 years old with untreated subfoveal choroidal neovascularization secondary to nAMD and best-corrected visual acuity (BCVA) letter score of 73-34 were eligible. Patients were randomly assigned to receive intravitreous injections of QL1207 or aflibercept 2 mg (0.05 ml) in the study eye every 4 weeks for the first 3 months, followed by 2 mg every 8 weeks until week 48, stratified by baseline BCVA ≥ or < 45 letters. The primary endpoint was BCVA change from baseline at week 12. The equivalence margin was ± 5 letters. The safety, immunogenicity, pharmacokinetics (PK), and plasma vascular endothelial growth factor (VEGF) concentration were also evaluated. RESULTS: A total of 366 patients were enrolled (QL1207 group, n = 185; aflibercept group, n = 181) from Aug 2019 to Jan 2022 with comparable baseline characteristics. The least-squares mean difference in BCVA changes was - 1.1 letters (95% confidence interval - 3.0 to 0.7; P = 0.2275) between the two groups, within the equivalence margin. The incidences of treatment-emergent adverse events (TEAE; QL1207: 71.4% [132/185] vs. aflibercept: 71.8% [130/181]) and serious TEAE (QL1207: 14.1% [26] vs. aflibercept: 12.7% [23]) appeared comparable between treatment groups, and no new safety signal was found. Anti-drug antibody, PK profiles, and VEGF concentration were similar between the two groups. CONCLUSIONS: QL1207 has equivalent efficacy to aflibercept for nAMD with similar safety profiles. It could be used as an alternative anti-VEGF agent for clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05345236 (retrospectively registered on April 25, 2022); National Medical Products Administration of China: CTR20190937 (May 20, 2019).

Clinical Manifestations of Supra-Large Range Nonperfusion Area in Diabetic Retinopathy.

Objective: We describe the clinical manifestations of supra-large range nonperfusion area (SLRNPA) in diabetic retinopathy (DR). Methods: This was a retrospective case-control study. A total of 260 eyes of 236 patients with DR who underwent pars plana vitrectomy in the Department of Ophthalmology of Qingdao Municipal Hospital from February 2016 to June 2019 were enrolled. Fundus fluorescein angiography was performed after surgery to determine whether SLRNPA or non-SLRNPA in DR was present. All demographic and clinical data were carefully collected. Results: Forty-one eyes of 22 patients were diagnosed with SLRNPA in DR (15.77% of all eyes). Compared to non-SLRNPA, SLRNPA patients were more likely to be male and younger with earlier DR onset, a smoking history, other comorbidities, and a higher HbA1c level. SLRNPA in DR eyes exhibited more neovascular glaucoma (NVG) and diabetic keratopathy (DK) than did other eyes. Such eyes were more likely to require anti-VEGF therapy before surgery or a silicone oil or a gas tamponade during surgery and to suffer from persistent corneal epithelial erosion and NVG recurrence after surgery. Conclusions: SLRNPA in DR is a severe status of DR. Treatment for DR patients with SLRNPA is difficult, and the prognosis is poor, so clinicians must thus pay more attention to SLRNPA in DR.

Intraocular myofibroblastoma tumour of the ciliary body: a case report and literature review.

BACKGROUND: Inflammatory Myofibroblastoma Tumors (IMTs) are extremely tumour rare in the intraocular. CASE PRESENTATION: A ciliary body tumor was found under slit lamp biomicroscopy in a 55-year-old male first diagnosed with cataract. Then this patient underwent trans-sclera resection via partial lamellar sclerouvectomy and par plans vitrectomy to remove the mass. Hematoxylin and eosin (HE) staining and immunohistochemistry findings showed that the characteristics of the tumor were consistent with IMT. CONCLUSIONS: We reported a rare case of intraocular IMT, which is confirmed by H&E staining, and IHC positive staining for Vimentin, Desmin and ALK, while negative staining for SMA, S-100, ki-67, CK, CD68, and calponin.

Acute exudative paraneoplastic polymorphous vitelliform maculopathy in a patient with thymoma, myasthenia gravis, and polymyositis.

IMPORTANCE: This is the first reported case of acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM) in a patient with thymoma, accompanied by myasthenia gravis (MG) and polymyositis. OBJECTIVE: To examine the pathogenesis of ocular disease in a patient with yolk-like fundus lesions and thymoma, MG, and polymyositis throughout the body based on clinical manifestations, diagnosis, differential diagnosis, and genetic testing to determine the appropriate treatment course. DESIGN, SETTING, AND PARTICIPANTS: We describe a 63-year-old woman who presented to our tertiary medical center with a 3-month history of reduced visual acuity in both eyes. Concurrent fundoscopy revealed a 2.0 × 1.7-mm, unifocal, yellow, round vitelliform lesion in the macular region, surrounded by multifocal, shallow, yellow-white pockets of subretinal fluid. The patient's medical history included thymoma with thymectomy treatment, combined with pericardiectomy and postoperative radiotherapy (20 years prior), followed by a diagnosis of MG with suspect thymic association (15 years prior). Three years prior, the patient had been diagnosed with polymyositis related to paraneoplastic syndrome; 1 year prior, she had been examined for pleural thickening due to suspected metastatic tumor. RESULTS: On her most recent follow-up visit at 3 months after initial diagnosis, the patient was stable with no clinically significant progression in ocular or systemic conditions.

A case report: pseudoxanthoma elasticum diagnosed based on ocular angioid streaks and the curative effect of Conbercept treatment.

BACKGROUND: This article is a case report of pseudoxanthoma elasticum (PXE) which was diagnosed based on significant angioid streaks (AS) with choroidal neovascularization (CNV) and regain normal visual function by intravitreal injection with Conbercept. CASE PRESENTATION: A 51-year-old woman was referred to the Ophthalmology Department of Qingdao Municipal Hospital (Qingdao, China) on September 14, 2020 for metamorphopsia and loss of vision in the left eye in the preceding three days. Past history: high myopia for more than 30 years, best corrected visual acuity (BCVA) of both eyes was 1.0 (5 m Standard Logarithm Visual Acuity chart in decimal notations), hypertension for six years, and cerebral infarction two years ago, no history of ocular trauma or surgeries or similar patients in family was documented. We used methods for observation, including fundus examination, optical coherence tomography (OCT), fluorescein angiography combined with indocyanine green angiography (FFA + ICGA). Due to her symptoms and manifestations, along with the appearance of her neck skin, which resembled 'chicken skin', we speculated that she should be further examined at the Department of Dermatology by tissue paraffin section and molecular pathology analyses, and the diagnosis of PXE was then confirmed. After intravitreal injection with Conbercept (10 mg/ml, 0.2 ml, Chengdu Kanghong Biotechnologies Co., Ltd.; Chengdu, Sichuan, China) she regained her BCVA. CONCLUSIONS: This patient regained her best corrected visual acuity through intravitreal injection with Conbercept. To the best of our knowledge, no publications are available on cases in which a vision loss and the normal visual function can be reverted by intravitreal injection with Conbercept. Although PXE is a disease with low incidence and thus no effective cure established, targeted symptomatic treatment can effectively retard the disease progression and improve visual function, such as intravitreal injection with Conbercept.

Bilateral Diffuse Uveal Melanocytic Proliferation Secondary to Rectal Adenocarcinoma: A Case Report and Literature Review.

Background: Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic intraocular syndrome that causes progressive visual loss in patients, and is associated with an underlying malignancy. Recently, the incidence of BDUMP has increased with the prolonged life expectancy of oncology patients. Case Presentation: We report a case of a 68-year-old man with significant visual loss in both eyes. The patient presented with a diffusely thickened choroid and ciliary body, extremely shallow anterior chamber, increased intraocular pressure, and cataract formation, accompanied by exudative retinal detachment in both eyes. He underwent a pars plana vitrectomy and choroidal biopsy, which revealed benign proliferation of melanocytes. A small amount of subretinal fluid persisted, and uveal thickness persisted in the early postoperative period. During the 1-year follow-up assessment, he underwent rectal tumor resection, and was pathologically diagnosed with rectal adenocarcinoma. Six months after the rectal tumor resection, the subretinal fluid was completely absorbed and the retina had reattached. The thickness of both the ciliary body and choroid had significantly decreased. Conclusion: This case report describes a rare paraneoplastic intraocular syndrome, BDUMP, which was associated with rectal adenocarcinoma. Treatment for the primary malignancy gradually improved the visual symptoms and signs.

Enantioselective Syntheses of C2-Symmetric Pyrazolones and Diones via One-Pot Organo-/Iodine Sequential Catalysis.

The catalytic diastereo- and enantioselective syntheses of C2-symmetric axially chiral 1,4-dicarbonyl derivatives with 2,3-quaternary stereocenters were achieved by utilizing an organo-/iodine binary catalytic strategy. The reactions proceeded well under mild conditions without metals or strong bases.

In situ generation of highly reactive allenes from nitrocyclopropanes: controllable synthesis of enynes and enesters.

A new and efficient strategy for ring-opening reactions of nitrocyclopropanes is developed for the first time for the divergent synthesis of enynes and enesters via in situ generated highly reactive electron-deficient intermediate allenes. Controllable approaches resulted in enynes and enesters with up to 89% and 90% yields, respectively. The reaction features easy operation, involves green solvents and simple inorganic bases, and is transition-metal free.

Involvement of microRNA-34a in Age-Related Susceptibility to Oxidative Stress in ARPE-19 Cells by Targeting the Silent Mating Type Information Regulation 2 Homolog 1/p66shc Pathway: Implications for Age-Related Macular Degeneration.

The aging retinal pigment epithelium and oxidative stress, mediated by reactive oxygen species (ROS) accumulation, have been implicated in the mechanisms of age-related macular degeneration (AMD). The expression level of the adapter protein p66shc, a key protein that regulates cellular oxidative stress, is relatively low under normal conditions because of the effects of silent mating type information regulation 2 homolog 1 (SIRT1) on the binding of fully deacetylated histone H3' to the p66shc promoter region, thus inhibiting p66shc transcription and expression. The equilibrium between SIRT1 and p66shc is disrupted in the presence of various stresses, including AMD. As a major target gene, SIRT1 is regulated by microRNA-34a (miR-34a), and overexpression of miR-34a results in significant inhibition of post-transcriptional expression of SIRT1. Furthermore, our recent studies demonstrated that miR-34a is significantly upregulated, accompanied by reduced tolerance to oxidative stress in hydrogen peroxide-induced prematurely senescent ARPE-19 cells. Moreover, the expression of SIRT1 is decreased, whereas that of p66shc is increased in these cells. Accordingly, miR-34a may play a key role in age-related susceptibility to oxidative stress in ARPE-19 cells by targeting the SIRT1/p66shc pathway, leading to AMD. In this review article, we discuss the functions of miR-34a in modulating the SIRT1/p66shc pathway in age-related conditions, including AMD.

Merging catalyst-free synthesis and iodine catalysis: one-pot synthesis of dihydrofuropyrimidines and spirodihydrofuropyrimidine pyrazolones.

A new and efficient one-pot strategy combining catalyst-free synthesis and iodine catalysis has been developed for the synthesis of dihydrofuropyrimidines and spirodihydrofuropyrimidine pyrazolones. This approach affords products in moderate to high yields (up to 96%) with excellent diastereoselectivities (up to >25 : 1 dr). The reaction is simple to carry out and is metal-free.

Combining Organocatalysis and Iodine Catalysis: One-Pot Sequential Catalytic Synthesis of Chiral Spirodihydrobenzofuran Pyrazolones and Spirodihydrobenzofuran Oxindoles.

A new and efficient catalytic strategy that combines asymmetric organocatalysis and iodine catalysis was first developed for the one-pot Michael/iodization/SN2 nucleophilic substitution sequential catalytic synthesis of spirodihydrobenzofuran pyrazolones and spirodihydrobenzofuran oxindoles. The approach results in products with moderate to high yields (up to 93%), high to excellent enantioselectivities (up to 99% ee), and excellent diastereoselectivities (up to >99:1 dr). The reaction features simple operation and is metal-free and base-free.

Identification of rare paired box 3 variant in strabismus by whole exome sequencing.

AIM: To identify the potentially pathogenic gene variants that contributes to the etiology of strabismus. METHODS: A Chinese pedigree with strabismus was collected and the exomes of two affected individuals were sequenced using the next-generation sequencing technology. The resulting variants from exome sequencing were filtered by subsequent bioinformatics methods and the candidate mutation was verified as heterozygous in the affected proposita and her mother by sanger sequencing. RESULTS: Whole exome sequencing and filtering identified a nonsynonymous mutation c.434G-T transition in paired box 3 (PAX3) in the two affected individuals, which were predicted to be deleterious by more than 4 bioinformatics programs. This altered amino acid residue was located in the conserved PAX domain of PAX3. This gene encodes a member of the PAX family of transcription factors, which play critical roles during fetal development. Mutations in PAX3 were associated with Waardenburg syndrome with strabismus. CONCLUSION: Our results report that the c.434G-T mutation (p.R145L) in PAX3 may contribute to strabismus, expanding our understanding of the causally relevant genes for this disorder.

Pigment dispersion syndrome and pigmentary glaucoma after secondary sulcus transscleral fixation of single-piece foldable posterior chamber intraocular lenses in Chinese aphakic patients.

PURPOSE: To describe secondary pigment dispersion syndrome (PDS) and pigmentary glaucoma after secondary sulcus transscleral fixation of 1-piece hydrophobic acrylic foldable posterior chamber intraocular lenses (PC IOLs) in aphakic patients in a Chinese population. SETTING: Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China. DESIGN: Retrospective case series. METHODS: This chart review included eyes that had secondary sulcus transscleral fixation of a 1-piece hydrophobic acrylic foldable PC IOL (Tecnis ZCB00) between March 2011 and March 2014. The patients' demographic data, clinical data, postoperative complications, intervals between initial surgery and the onset of PDS, pigmentary glaucoma occurrences, and findings on slitlamp biomicroscopy, gonioscopy, and ultrasound biomicroscopy (UBM) were recorded. RESULTS: The study comprised 23 consecutive eyes of 21 patients. Seventeen eyes of 16 patients were diagnosed with PDS, and 7 eyes of 6 patients were diagnosed with pigmentary glaucoma. The slitlamp examination and UBM showed that the location between the IOL optic and the posterior surface of the iris was very close. Slitlamp examination of the anterior chamber angle using a gonioscope showed dense pigment deposition on the IOL surfaces. A reverse pupillary block was found in 10 eyes of 9 patients. Other postoperative complications included intraocular hemorrhage, pupillary capture of the IOL optic, IOL tilt, IOL decentration, IOL dislocation, and suture erosion. CONCLUSION: The 1-piece hydrophobic acrylic foldable PC IOL was not suitable for sulcus transscleral fixation because of a high incidence of PDS and pigmentary glaucoma after surgery in a Chinese population.

Corneal infection in Shandong peninsula of China: a 10-year retrospective study on 578 cases.

AIM: To determine the epidemiological characteristics, clinical signs, laboratory findings, and outcomes in patients with corneal infection in Shandong peninsula of China. METHODS: The medical records of 578 inpatients (578 eyes) with corneal infection were reviewed retrospectively for demographic characteristics, risk factors, seasonal variation, clinical signs, laboratory findings, and treatment strategy. Patient history, ocular examination findings using slit-lamp biomicroscopy, laboratory findings resulted from microbiological cultures, and treatment. RESULTS: Fungal keratitis constituted 58.48% of cases of infectious keratitis among the inpatients, followed by herpes simplex keratitis (20.76%), bacterial keratitis (19.03%) and acanthamoeba keratitis (1.73%). The most common risk factor was corneal trauma (71.80%). The direct microscopic examination (338 cases) using potassium hydroxide (KOH) wet mounts was positive in 296 cases (87.57%). Among the 298 fungal culture-positive cases, Fusarium species were the most common isolates (70.47%). A total of 517 cases (89.45%) received surgical intervention, including 255 (44.12%) cases of penetrating keratoplasty, 74 (12.80%) cases of lamellar keratoplasty which has become increasingly popular, and 77 cases (13.32%) of evisceration or enucleation. CONCLUSION: At present, infectious keratitis is a primary corneal disease causing blindness in China. With Fusarium species being the most commonly identified pathogens, fungal keratitis is the leading cause of severe infectious corneal ulcers in Shandong peninsula of China.

Subretinal heterotopic respiratory epithelium: a case report and literature review.

A 51-year-old female underwent vitrectomy surgery to remove a group of spherical subretinal tumors beneath the detached retina. Hematoxylin and eosin staining and immunohistochemical findings showed that the characteristics of the tumor were consistent with a subretinal heterotopic respiratory epithelium. This is the first report of a respiratory epithelial heterotopia located in the subretinal space.

Combination of Bevacizumab and NGF Reduces the Risk of Diabetic Retinopathy.

Accumulated evidences support diabetic retinopathy is caused by functional and structural alterations in both the microvascular and neuroglial compartments. Here, we explored any beneficial effects of combination of Bevacizumab and NGF to prevent diabetic retinopathy. STZ-induced diabetic rats were randomly grouped into three groups: sham, Bevacizumab and combination group (Bevacizumab + NGF). End of the treatment, vascular abnormality was evaluated by FITC-dextran. Inflammation and angiogenesis factors were also investigated by real-time PCR and western blot. Our results showed both Bevacizumab and the combination could dramatically reduce abnormal vascular permeability and limit the inflammatory and angiogenesis in 6-week diabetic rats. However, the combination indicated better preventive effects in 12-week diabetic rats compared with Bevacizumab alone. Our findings suggest that the combination of Bevacizumab with NGF may be a new method for the preventive intervention of diabetic retinopathy.

Epidemiological characteristics and risk factors of diabetic retinopathy in type 2 diabetes mellitus in Shandong Peninsula of China.

AIM: To determine the epidemiological characteristics and estimate the risk factors of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shandong Peninsula of China. METHODS: The cases of T2DM admitted to Affiliated Hospital of Medical College of Qingdao University, Shandong Province, China, from January 2006 to December 2010 were retrospectively reviewed. The epidemiological characteristics of DR were estimated. The cases were divided into two groups according to degrees of retinopathy: non-DR group and DR group. Logistic regression analysis was used to study the related risk factors of DR. RESULTS: The prevalence of DR in patients with T2DM was 25.08% (834/3326). There was significant difference between the average age for men (59.08±15.43 years) and for women (62.92±18.19 years, P=0.0021). The majority of DR occurred in women (female: male ratio=1.76:1, P<0.0001). The incidence rate of DR in urban (489/834) was higher than that in rural area (345/834, P<0.0001). In 834 DR patients, the mean duration of T2DM was 8.90±4.15 years (range: 0-16 years); 440 people (52.76%) had received varying degrees of health education about prevention and primary care of DM; and 473 people (56.71%) suffered from other DM complications confirmed at the same time. In addition, the incidence rate of monocular (551/3326) and binocular retinopathy (283/3326) were statistically different (P<0.0001). Factors associated (P<0.05) with the presence of DR included old age, lower health educational level, intraocular surgery history, longer duration of T2DM, accompanying with other DM complications, no standard treatment procedure, lower body mass index (BMI) and higher fasting plasma glucose (FPG), glycated hemoglobin A(1)C (HbA(1)C), urine albumin (UA), total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C). The risk factors (P<0.05) independently associated with the presence of DR were: longer duration of T2DM, lower health educational level, higher FPG, higher UA, lower BMI and higher TC. CONCLUSION: DR is highly prevalent in the patients with T2DM in Shandong Peninsula of China. Besides blood glucose, many factors are associated with the present and development of DR.

Effect of ginsenoside-Rg3 on the expression of VEGF and TNF-α in retina with diabetic rats.

AIM: To investigate the effect of ginsenoside-Rg3 on the expression of vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) in retina with diabetic rats and its roles in preventing neovascularization in diabetes. METHODS: Sixty male Wistar rats were divided into 3 groups randomly: negative control group, diabetic control group and ginsenoside-Rg3 treatment group (5mg/kg, 0.2mg/mL) followed by establishing diabetic model. The expression of VEGF and TNF-α were measured after 8 weeks. RESULTS: There were significant differences among negative control group, diabetic control group and ginsenoside-Rg3 treatment group in the expression of VEGF and TNF-α (F=129.363, 211.992; all the P<0.01). VEGF and TNF-α expression were significantly higher in diabetic control group and ginsenoside-Rg3 treatment group than that in negative control group (P<0.01), with a significant reduction in ginsenoside-Rg3 treatment group than that in diabetic control group (P<0.01). CONCLUSION: Ginsenoside-Rg3 can down-regulate the expression of VEGF and TNF-α in retina, which may interfere in the development of diabetic retinopathy.