Magnetic resonance Index of Activity (MaRIA) is reliable in assessing response to treatment in patients with Crohn's disease (CD).

AIM: To assess the accuracy of Magnetic Resonance Index of Activity (MaRIA) in evaluating therapeutic efficacy in Crohn's disease (CD) patients with different activity levels using ileocolonoscopy as the reference standard. MATERIALS AND METHODS: Forty-eight patients underwent magnetic resonance enterography (MRE) and ileocolonoscopy at baseline, week 26, and week 52, along with the Simple Endoscopic Score for Crohn's Disease (SES-CD) and MaRIA scores. According to the SES-CD score at baseline, all patients were subdivided into mild, moderate, and severe activity subgroups. The identification of endoscopic mucosal healing (MH) was explored primarily. Moreover, the Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and interleukin-6 (IL-6) levels were collected and analysed. RESULTS: MaRIA correlated significantly with SES-CD and CRP at baseline, week 26, and week 52. The discrepancies in MaRIA and SES-CD were statistically significant before and after treatment. MaRIA = 24.43 and ΔMaRIA = 12.77 as the cut-off points were found to have high diagnostic accuracy for predicting MH. MaRIA (p<0.001), SES-CD (p<0.001), CRP (p<0.05), ESR (p<0.05), and CDAI score (p<0.05) in patients with MH were considerably decreased compared to those in patients without MH. CONCLUSIONS: MRE has good application value in evaluating the therapeutic response of CD patients treated with biological agents. MaRIA is a reliable indicator in the follow-up of CD patients, which is strongly correlated with SES-CD, and it has high accuracy in predicting endoscopic MH.

[Mechanisms and clinical management of small bowel obstruction caused by kinking of the jejunojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass].

Currently, obesity and its complications have become increasingly serious health issues. Bariatric surgery is an effective method of treating obesity and related metabolic complications. Among them, Roux-en-Y gastric bypass (RYGB) is still considered the "gold standard" procedure for bariatric surgery. Small bowel obstruction is one of the possible complications after RYGB, and in addition to the formation of intra-abdominal hernias, kinking of the jejunojejunal anastomosis is an important cause of small bowel obstruction. The early clinical symptoms of kinking of the jejunojejunal anastomosis often lack clarity in the early stages. Therefore, early diagnosis, prevention, and effective treatment of kinking of the jejunojejunal anastomosis are challenging but crucial. The occurrence of kinking of the jejunojejunal anastomosis may be related to surgical techniques and the surgeon's experience. The use of anti-obstruction stitch, mesenteric division, and bidirectional jejunojejunal anastomosis may be beneficial in preventing kinking of the jejunojejunal anastomosis. If kinking of the jejunojejunal anastomosis occurs, timely abdominal CT scans and endoscopic examinations should be performed. Gastric and intestinal decompression should be initiated immediately, and exploratory surgery should be prepared.

[Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma].

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

[Study on the Protective effect and mechanism of Nicotinamide Riboside on lung injury in paraquat intoxicated mice].

Objective: To investigate the protective effect and mechanism of Nicotinamide Riboside (NR) on lung injury caused by Paraquat intoxicated mice. Methods: Eighty clean male BALB/C mice were selected and averagely divided forty mice into 4 groups with 10 mice in each group, PQ group was given 25% PQ solution (60 mg/kg) by one-time gavage. PQ+NR group were intraperitoneally injected with NR solution (300 mg/kg) 1 hour before given the same amount of PQ solution (60 mg/kg) by one-time gavage, The Control group were given the same amount of saline by one-time gavage, The same amount of NR was intraperitoneally injected before NR group were given saline by one-time gavage. Observed and recorded general condition of PQ intoxicated mice. Observed and recorded the death of mice every half an hour and counted the mortality and drew survival curve of each group after 72 hours exposure. another forty mice were averagely divided and treated by the same way. After 24 hours of modelling, mice were anaesthetized and killed. Then blood was extracted after eyeball was removed. The changes of TNF-a、IL-6 and MPO in serum of mice were detected by ELISA.Two lung tissues were removed from the chest and used to measure the D/W ratio of the lung. The pathological changes of lung were observed and scored under light microscope.The levels of SOD, MDA and Caspase-3 in lung tissues were determined by chemical colorimetry. The expression of Sirt1 and Nrf2 in lung tissues was detected by Western-blot. Results: Compared with the Control group and the NR group, the mice in the PQ group had a poor general condition, such as depression, crouching, skin disorder and reduced activity, food, urine and feces. The symptoms in the PQ+NR group were reduced compared with the PQ group. The survival rate at 72 hours after exposure: 80% in the PQ+NR group and 40% higher than that in the PQ group (P=0.029) . Compared with Control group and NR group, the D/W ratio (0.09±0.07) , lung pathology score under light microscope (11.80±0.37) , TNF-a (39.89±1.48) pg/ml、IL-6 (77.29±2.38) pg/ml、MPO (0.31±0.01) µg/ml、SOD (6.62±0.30) U/mgprot、MDA level (1.21±0.14) mmol/mgprot, Caspase-3 activity (356.00± 27.16) %, Sirt1 and Nrf2 protein expression (1.02±0.14、0.82±0.06) were significantly decreased in PQ group (P=0.004、0.023) ; Compared with PQ group, PQ+NR group significantly increased the D/W ratio (0.10±0.10) , decreased the pulmonary pathology score under light microscope (7.400.51) , decreased TNF-a (33.00± 0.65) pg/ml、IL-6 (52.23±4.23) pg/ml、MPO leve (0.23±0.01) µg/mll, increased SOD leve (9.28±0.45) U/mgprotl, decreased MDA level (0.78±0.02) mmol/mgprot, decreased Caspase-3 activity (222.80±7.59) %, and increased the protein expressions of Sirt1 and Nrf2 (1.62±0.16、1.06±0.04) (P=0.048、0.035) . Conclusion: NR can prolong the survival time of PQ poisoned mice; NR intervention can effectively inhibit the inflammatory response, peroxidation injury and apoptosis of PQ poisoned mice; NR intervention can upregulate the expression of Sirt1 and Nrf2 protein and effectively reduce the lung injury of PQ poisoning.

The bad relationship, osteo-decay and diabetes type 2 searching for a link: a literature review.

The diabetes and osteoporotic metabolic diseases are characterized by a wide prevalence of the population worldwide and correlated to alteration of the bone tissues. Several cofactors could influence the clinical course and the biochemistry of the pathologies such as human microbiome, nutrition characteristics, gut microbiota activity and interactions with vitamin K and D across IGF/GH and TP53 signaling pathways and the glucose/energy as mechanism for bone tissue health. Moreover, also the calories and sugar consumption seem to be correlated to an increased inflammatory state with several consequences for hematopoiesis and host tissues response. The aim of the present literature review was to highlight the role of osteoporotic diseases and diabetes type 2 link for the bone metabolism. The literature cases showed that a correlation between bone-gut-kidney-heart-CNS-Immunity crosstalk seems to be linked with bone metabolism and health regulation. Moreover, also the aging process could represent a valuable co-factor for the sustaining of the metabolic disorders upon a multi-systemic level.

[Clinical observation and analysis on the effect of orthokeratology in myopic anisometropic children].

Objective: To evaluate the clinical effects of orthokeratology lens on children with myopic anisometropia. Methods: Retrospective case series study. The data of 226 myopic anisometropia children, (10.83±1.56)years old, including 95 males and 131 females, fitted with orthokeratology(OK) lens in Beijing Tongren Hospital from June 2017 to June 2019 were collected. According to the lens wearing condition and baseline anisometropia, they were divided into four groups: group A1 with an average age of (10.68±1.66) years (bilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 50 males and 61 females), group A2 with an average age of (11.24±1.38) years (bilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 10 males and 23 females), group B1 with an average age of (10.79±1.51) years (unilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 17 males and 21 females) and group B2 with an average age of (10.97±1.60) years (unilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 18 males and 26 females). After wearing OK lens for one year, the changes of axial length(AL) and AL difference were observed and statistically analyzed. Results: (1) AL changes: after wearing OK-lens for one year, AL of each eye increased. In group A1, the AL of the more myopic eyes and the less myopic eyes increased by (0.20±0.21) mm and (0.24±0.22) mm respectively, and the difference was statistically significant (t=-3.208, P=0.002); in group A2, the AL growth of the more myopic eyes and the less myopic eyes were (0.04±0.11) mm and (0.17±0.14) mm, and the difference was statistically significant (t=-5.545, P<0.001). In group B1, the AL elongation of the more myopic eyes and the less myopic eyes were (0.14±0.21) mm and (0.39±0.23) mm, and in group B2, the AL growth of the more myopic eyes and the less myopic eyes were (0.11±0.14) mm and (0.54±0.24) mm, with statistically significant differences(t=-6.533, -11.643; all P<0.001). There was a linear correlation between AL elongation and age of the more myopic eyes and the less myopic eyes in group A1(corrected R2=0.208, 0.237) and group A2 (corrected R2=0.169, 0.360). There was no linear correlation of the more myopic eyes and the less myopic eyes between AL change and age or baseline myopia in group B1 (F=0.514, 1.205;P=0.602, 0.312) and group B2 (F=0.841, 0.056; P=0.439, 0.946). (2)Change of AL difference: after wearing OK lens for one year, the changes of AL difference in groupA1, A2, B1 and B2 were (-0.04±0.14) mm,(-0.13±0.13) mm,(-0.26±0.24) mm and (-0.43±0.25) mm, and the decrease of AL difference in moderate and high anisometropia groups were greater than that in low anisometropia groups (t =-3.211, -3.180; P=0.002, 0.002).There was a linear correlation between the reduction of AL difference and baseline anisometropia in group A1, A2 and B2 (corrected R2=0.099, 0.149, 0.230), and there was no linear relationship between the decrease of AL difference and the baseline anisometropia in group B1 (F=0.014, P=0.908). Conclusions: Orthokeratology could effectively control the progression of myopia and to treat anisometropia. The effect of myopia control was better in the older binocular OK lens wearers, and for the patients with greater baseline anisometropia, the treatment effect of anisometropia was better.

[Correlation of inflammatory cells and corneal nerve damage in fungal keratitis on in vivo confocal microscopy].

Objective: To investigate the relationship between inflammatory cell infiltration and nerve damage in patients with fungal keratitis at different degrees of severity. Methods: Retrospective study. A total of 44 consecutive patients (44 eyes) with fungal keratitis in Beijing Tongren Hospital Affiliated to Capital Medical University from January 2017 to December 2019 were selected as the patient group, including 30 males and 14 females, with an age of (58.3±11.5) years old. Twenty healthy people (20 eyes) were included as control group. Slit-lamp microscopy was performed to observe the corneal ulcer. According to the diameter of corneal ulcer, patients were divided into mild, moderate and severe groups. With in vivo confocal microscopic ,the images were obtained from the epithelial layer to the endothelial layer in the central cornea and superior, inferior, nasal and temporal peripheral cornea. Parameters of the maximum density of fungal hyphae, the maximum depth of hyphal infiltration, the density, area and length of dendritic cells (DCs), the nerve density, and the number and curvature of nerve trunks were collected. The Kruskal-Wallis test, Wilcoxon test, and Spearman correlation analysis were used for analyses. Results: On confocal microscopy, many uniform, highly reflective, segment-like structures in parallel or staggered rows were detected in the cornea, with a certain degree of physiological curvature and branching. Quantitative analysis of hyphal density found that the median rating of hyphal density was 2.6 (2.0, 3.0), mainly with medium to large amounts of hyphae. Most hyphae were 100-150 µm in depth (18 cases, 40.9%), and the maximum depth of hyphae in 95.5% (42 cases) of patients was within 300 µm. The hyphal invasion depth in the mild group was 89.4 (50.5, 106.8) µm, in the moderate group was 133 (122, 203) µm, and in the severe group was 135 (74, 151) µm. As the severity of the disease increased, the depth of hyphal invasion increased (F=4.248, P=0.001). Compared with the control group, the DC density [166 (81.3, 212.5) vs. 24.0 (20.8, 32.3) cells/µm2], area [441.3 (291.9, 529.5) vs. 63.7 (47.7, 70.3) µm2] and length [68.3 (39.4, 91.0) vs. 9.2 (7.0, 11.3) µm] increased in patients (W=493.5, 500.0, 500.0; P<0.01). The nerve density [5 398.3 (3 202.7, 6 828.3) vs. 19 171.8 (17 558.8, 21 550.4) µm/mm2; t=-14.448, P<0.01] and the length [692.7 (402.0, 925.1) vs.2 138.4 (1 940.4, 2 597.2) µm; t=-11.930, P<0.01] and number [2.9 (2.0,3.0) vs. 6.0 (5.5,7.0); t=-8.282, P<0.01] of nerve trunks in patients decreased. There were strong negative correlations between the nerve density, the number of nerve trunks, and the DC density (r=-0.555, -0.466; P<0.01). Conclusions: The depth of fungal hypha invasion in patients with fungal keratitis is mainly concentrated in the epithelial layer and superficial stroma layer. The density of mature dendritic cells in the lesion area was negatively correlated with the density and number of subbasal nerves. The density of subbasal nerves decreased as the increase of the severity of the lesion. (Chin J Ophthalmol, 2021, 57: 580-588).

[Prevalence and risk factors of common blinding ocular diseases among people aged 30 years and above in rural area of Handan].

Objective: To explore the prevalence and risk factors of common blinding ocular diseases in the population aged 30 years and above in rural areas of Handan City from 2006 to 2012. Methods: A cohort study with 6 830 subjects from rural areas of Handan City, Hebei Province was designed and conducted. The follow-up duration was 6 years, and the prevalence and incidence of common blinding diseases were evaluated. Logistic regression was used to explore the influencing factors of common blinding ocular diseases. Results: In 2006, 6 830 people participated in the baseline survey. There were 3 163 (46.31%) males and 3 667 (53.69%) females. The average age was (52.3±12.2) years (range, 30 to 97 years). There were 3 435 subjects who had common chronic systematic diseases, with a prevalence of 50.29%. In addition, 1 250 people suffered from common blinding ocular diseases, and the prevalence was 18.30%. There were 4 118 subjects without common blinding ocular diseases at baseline who participated in the six-year follow-up, during the 6-year follow-up, 247 participants developed common blinding ocular diseases. 9% (171/1 899) of patients with chronic systematic diseases developed common blinding ocular diseases, while only 3.42% (76/2 219) of normal subjects developed common blinding ocular diseases, with a statistically significant difference (χ(2)=56.504, P<0.001). The incidence of common blinding ocular diseases was age-dependent. Multivariate regression analysis showed that age (OR=1.045, 95%CI: 1.028-1.062, P<0.001), intraoccular pressure (IOP) (OR=1.064, 95% CI: 1.014-1.116, P=0.011) and baseline chronic diseases (OR=1.749, 95% CI: 1.288-2.375, P<0.001) were risk factors for common blinding ocular diseases. Moreover, the contribution of age, IOP and chronic systematic diseases to the model was 0.436, 0.084 and 0.511, respectively. Conclusions: The prevalence of common blinding ocular diseases among people over 30 years old in Handan is relatively high. From 2006 to 2012, about 1.5% patients of chronic systematic diseases developed common blinding ocular diseases each year. Moreover, chronic systematic diseases increase the risk of blinding ocular diseases sharply, and the effect is stronger than age and intraocular pressure.

[In vivo confocal microscopic characteristics of limbal stem cell deficiency].

Objective: To investigate the cellular changes and quantitative analysis of basal cell density (BCD) and corneal epithelial thickness (CET) in limbal stem cell deficiency (LSCD) by in vivo confocal microscopy (IVCM). Methods: Prospective case-control study. A total of 35 eyes of 23 patients diagnosed with LSCD and 25 eyes from normal subjects were included in this study. Based on slit-lamp presentation and the global consensus on classification, the LSCD patients were classified into LSCD Ⅰ, LSCD Ⅱ and LSCD Ⅲ. Confocal images of the central cornea, and the superior, inferior, nasal and temporal limbus were inspected by IVCM. Morphologic characteristics of LSCD were summarized. The BCD and CET in all locations were measured. ANVOA or Kruskal-Wallis test was used for analysis when appropriate. A receiver operating characteristic was used to detect the diagnosis efficiency of BCD and CET. Results: The characteristics in the corneal epithelium of LSCD on IVCM included nested corneal epithelial cells, goblet cells with hyper-reflective spots, irregular basal cells and decreasing subbasal nerve density. The mean BCD of the LSCD group was (8 976±1 096) cells/mm2 in the central cornea. Compared to the control group, the BCD in the central cornea, superior, inferior, nasal and temporal limbus decreased by 30.2%, 26.0%, 28.7%, 29.3% and 30.2%, respectively (all P<0.007). The CET in the central cornea was (47.3±8.1) µm. The CET in the central cornea, superior, inferior, nasal and temporal limbus decreased by 27.9%, 23.7%, 20.6%, 26.9% and 23.1%, respectively, compared to the control group (all P<0.007). There was a decline of BCD and CET in more serious LSCD. Additionally, the decline of BCD and CET was shown in the unaffected region. The receiver operating characteristic showed the diagnosis efficiency of BCD in the corneal center and limbus (0.931 and 0.916) was superior to CET (0.853 and 0.817). Conclusions: There was a series of characteristic cellular changes in LSCD on IVCM. Both BCD and CET decreased significantly in LSCD. The BCD had higher diagnostic efficiency for LSCD.(Chin J Ophthalmol, 2020, 56:447-455).

[The influence of different corneal diameters on Belin/Ambrósio enhanced ectasia display of Pentacam corneal topography].

Objective: To investigate the effect of corneal diameter on Belin/Ambrósio enhanced ectasia display (BAD). Methods: Retrospective case series study. The subjects were 6 744 myopic patients, including 3 341 males and 3 403 females, who had undergone corneal refractive surgery or had completed preoperative examination but had not undergone corneal refractive surgery at the Army Medical Center and Chongqing Vision Institute in Chongqing from June 2017 to June 2019. Age was (23.74±5.73) years old. No patients had keratoconus. One eye of each patient was randomly included, and the patients were divided into groups according to the corneal diameter measured by Pentacam. Group A included 630 patients (630 eyes) with corneal diameter ≤ 11.1 mm. In group B, there were 4 063 patients (4 063 eyes) with corneal diameter of 11.2 to 11.8 mm. In group C, there were 2 051 patients (2 051 eyes) with corneal diameter ≥11.9 mm. Preoperative BAD parameters of deviation of front elevation difference map (Df), deviation of back elevation difference map (Db), deviation of average pachymetric progression index (Dp), deviation of minimum thickness (Dt), deviation of Ambrósio's relational thickness maximum (Da) and overall deviation value (Do) were measured by Pentacam. One-way analysis of variance was used for preoperative BAD parameters comparison between groups. The distribution of normal, suspicious and pathological results of Df, Db, Dp, Dt, Da and Do in each group was tested by chi-square test. Results: In groups A, B and C, Df was 0.73±1.14, 0.48±1.02, and 0.11±0.91, Db was 1.09±1.07, 0.23±0.83, and-0.34±0.62, Dp was 1.57±0.91, 1.14±0.86, and 0.68±0.75, Dt was -0.11±0.84, -0.2±0.82, and 0.03±0.78, Da was 0.78±0.61, 0.64±0.64, and 0.48±0.64, and Do was 1.65±0.64, 1.24±0.60, and 0.86±0.55, respectively. The BAD parameters of Df (F=129.549), Db (F=829.491), Dp (F=344.373), Dt (F=7.249), Da (F=68.637) and Do (F=524.877) were all significantly different between groups (P<0.01). The proportion of suspicious and pathological BAD parameters [Df (χ²=161.8), Db (χ²=611.75), Dp (χ²=478.84), Da (χ²=44.636), and Do (χ²=553.11)] suggested the distribution in each group was significantly different (P<0.01). Conclusions: Corneal diameter had a significant influence on BAD. Compared with eyes with large corneas, the false positive rate of BAD was higher in eyes with small corneas.(Chin J Ophthalmol, 2020, 56: 761-767).

[Study on the protective effect and mechanism of somatostatin on renal injury in paraquat intoxicated mice].

Objective: To investigate the protective effect of somatostatin (SS) on acute kidney injury (AKI) of paraquat (PQ) poisoned mice and its mechanism. Methods: From December 2017 to April 2018, a total of 48 SPF male BALB/C mice were selected and randomly divided into 4 groups, with 12 mice in each group: Control group, SS group (20 mg/kg SS was injected 1 hour before and 3 hours after gavage with normal saline) , PQ group (2% PQ 60 mg/kg by gavage) and PQ+SS group (Intragastric administration was performed with 2% PQ solution of 60 mg/kg, and 20 mg/kg SS was administered 1 h before and 3 h after intragastric administration) , 12 mice in each group were observed for the general situation and behavioral effects. After 24 hours of modeling, mice were sacrificed.Then blood was extracted after eyeball was removed, and both kidneys were removed by laparotomy. Serum IL-6, TNF-α and MPO levels were determined by ELISA. The characteristic pathological changes of toxic renal tubular injury were observed under light microscope and scored accordingly. The changes of NF-κB expression were detected by Western-Blot, SOD, Caspase-3 and malondialdehyde (MDA) were detected by chemical colorimetry. Results: Mice in Control group and SS group showed normal general conditions and behaviors; Mice in PQ group were significantly worse than those in Control group, showing decreased feeding and activity, dry fur, hair shedding and listless spirit; The above symptoms in the mice of PQ+SS group were alleviated compared with the PQ group. Under the light microscope, the renal tissue structure of PQ group was obviously disordered and severely damaged, and the nephropathy score was (6.14±0.72) . The performance of PQ+SS group under light microscope was improved compared with PQ group, and nephropathy score (4.36±0.42) decreased (P<0.05) . Compared with the Control group, serum TNF-α (39.89±3.32) pg/ml, IL-6 (77.29±4.77) pg/ml, renal NF-κB (2.29±0.097) , MPO (0.31±0.017) µg/ml, MDA (0.91±0.03) mmol/mg prot, and Caspase-3 (376.51±8.24) % levels were significantly increased in the PQ group, while the level of renal SOD (2.36±0.73) U/mg prot was significantly decreased (P<0.05) . Compared with the PQ group, serum TNF-α (33.82±1.57) pg/ml, IL-6 (58.49±5.89) pg/ml, renal NF-κB (0.84±0.05) , MPO (0.22±0.01) µg/ml, MDA (0.72±0.05) mmol/mg prot, Caspase-3 (327.32±21.93) % decreased significantly, and renal SOD (4.90±0.81) U/mg prot increased significantly in the PQ+SS group (P<0.05) . Conclusion: PQ poisoning can lead to AKI in mice, while SS can reduce AKI caused by PQ poisoning, improve the general survival state of PQ poisoned mice, and play a certain protective role in kidney injury caused by PQ poisoning, which may be achieved by inhibiting oxidative stress response, inflammatory response and apoptosis caused by poisoning.

Receptor interacting protein kinase 3 promotes cisplatin-induced necroptosis in apoptosis-resistant HepG2/DDP cells.

Hepatocellular carcinoma is the most common primary malignancy of the liver. The chemotherapeutic drug cisplatin is widely used for advanced liver cancer. However, the development of cisplatin resistance in cancer cells, which is related to the decreased cellular susceptibility to apoptosis, results in a major limitation of cisplatin-based chemotherapy. Recently, triggering necroptosis has been proposed to be a novel therapeutic strategy to eradicate apoptosis-resistant cancer cells. In this study, we provided evidence that cisplatin could induce cell death in HepG2 cells, but not in the apoptosis-resistant HepG2/DDP cells. Ectopic expression of RIP3 promoted cisplatin-induced HepG2/DDP cells death, HMGB1 and LDH release. Moreover, we demonstrated that this type of cell death was necroptosis and depended on RIP1-RIP3-MLKL signaling pathway because inhibition of MLKL activity by necrosulfonamide (NSA) or knockdown of RIP1 significantly attenuated cisplatin-induced cell death in HepG2/DDP-RIP3 cells. Finally, we found that ectopic expression of RIP3 sensitized HepG2/DDP cancer cells to cisplatin treatment in vivo. The findings offer new insights into the molecular mechanisms underlying cisplatin-induced necroptosis in liver cancer cells and suggest that combination of cisplatin with other drugs which can restore RIP3 expression in cancer cells maybe a better choice for therapy of apoptosis-resistant cancer.

[Spontaneous focal lamina cribrosa defect in glaucoma and its relationship with nonprogressive glaucomatous neuropathy].

Objective: To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG). Methods: Case-control study. The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University. Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed. Intraocular pressure, mean defects of visual field, central corneal thickness and axis length were recorded in the follow-up duration. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated by χ(2) or Fisher's test, mixed-effect model analysis and multivariate Logistical regression analysis. Results: A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47±14) years, the group consisted of 17 males and 15 females. Fourty-five eyes showed nonprogressive VFD. LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (χ(2)=6.896, P=0.009). Eyes with nonprogressive VFD showed longer axis length[(26.82±1.34) mm vs. (25.79±1.44) mm; t=6.589, P=0.013] and wider LC defects diameter[211 (165-326) µm vs. 114 (106-156) µm; Z=4.797, P=0.042]. Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217, P=0.012). There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7, P=0.002). There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 µm) than that in the contralateral eyes with stable VFD (269 µm). Conclusions: LC defects are more common in eyes with nonprogressive VFD. Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG. (Chin J Ophthalmol, 2019, 55:338-346).

[Application of decision curve on evaluation of MRI predictive model for early assessing pathological complete response to neoadjuvant therapy in breast cancer].

Objective: To construct a dynamic enhanced MR based predictive model for early assessing pathological complete response (pCR) to neoadjuvant therapy in breast cancer, and to evaluate the clinical benefit of the model by using decision curve. Methods: From December 2005 to December 2007, 170 patients with breast cancer treated with neoadjuvant therapy were identified and their MR images before neoadjuvant therapy and at the end of the first cycle of neoadjuvant therapy were collected. Logistic regression model was used to detect independent factors for predicting pCR and construct the predictive model accordingly, then receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive model. Results: ΔArea(max) and Δslope(max) were independent predictive factors for pCR, OR=0.942 (95%CI: 0.918-0.967) and 0.961 (95%CI: 0.940-0.987), respectively. The area under ROC curve (AUC) for the constructed model was 0.886 (95%CI: 0.820-0.951). Decision curve showed that in the range of the threshold probability above 0.4, the predictive model presented increased net benefit as the threshold probability increased. Conclusions: The constructed predictive model for pCR is of potential clinical value, with an AUC>0.85. Meanwhile, decision curve analysis indicates the constructed predictive model has net benefit from 3 to 8 percent in the likely range of probability threshold from 80% to 90%.

[Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme: the Handan Eye Study].

Objective: To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods: In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results: Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio (OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service. Conclusions: Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579).

[Histopathology manifestation and imaging characteristics of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia].

Objective: To study the histopathology manifestation and imaging characteristics of in vivo confocal microscopy (IVCM) for diagnosis of ocular surface squamous neoplasia (OSSN) and analyze the reliability of IVCM in differential diagnosis from OSSN cases. Methods: A prospective study. Twenty-three patients (23 eyes) with OSSN were collected from September 2015 to November 2017 in Beijing Tongren Eye center. They were underwent the examinations sequentially as follows: visual examination; slit-lamp microscope examination and ocular surface photography; color fundus image; anterior segment optical coherence tomography examination; IVCM examination and histopathology examination after surgery. With histopathology diagnosis, all subjects were divided into two groups: conjunctival intraepithelial neoplasm (CIN) and squamous cell carcinoma (SCC). Compared with histopathological findings, the IVCM results (cell morphology, cytoplasm and nucleus) of OSSN were analyzed. The difference analysis between the count data of two groups was carried out by the chi square test or Fisher's exact test. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate SCC from OSSN. Results: There were 12 males and 11 females among the 23 patients aged (62±15) years. With the histopathological diagnosis, there were 15 cases (15 eyes) in the CIN group and 8 cases (8 eyes) in the SCC group. Eye redness, pain, foreign body sensation and tears were the symptoms of OSSN. There was no significant difference in clinical symptoms between the CIN and SCC groups. The size of tumors and the incidence of trophoblastic vessels in the SCC group were greater than those in the CIN group [8.5(6.5-15.5) mm vs. 5.8(4.0-8.5)mm, Z=4.702,P=0.029; 7/8 vs. 5/15, χ2=6.135, P=0.013). In histopathology, multilayered epithelia with cellular polymorphism, varied cytoplasm staining, and slightly thicker nuclei were observed in the CIN group. The corneal epithelial cells of SCC patients were markedly heterogeneous, and the intercellular bridge structure can be detected. Proliferative cells appeared with spindle shaped cells, nuclear mitotic figures and syncytial cells in the SCC group. The IVCM examination in the CIN group and SCC group showed that the cytoplasm was high and the ratio of nuclear plasma increased. There was no significant difference between the two groups in the size of epithelial cells, cytoplasm reflectivity, and nuclear cytoplasm ratio (P=0.053, 0.108, 0.067). The proportions of nuclear mitotic figures, spindle or chimeric cells, nests of whirlpool cells and the abnormal cells of the superficial stroma layer (8/8, 8/8, 8/8 and 8/8) in the SCC group was higher than those (2/15, 1/15, 4/15 and 0/15) in the CIN group, and the difference was statistically significant (P=0.001, 0.001, 0.003; P<0.001). Among these IVCM parameters, the abnormal cells of the superficial stroma layer had the highest diagnostic ability with the AUC value of 1.000, and the following AUC values were 0.933 for mitotic or double nuclei, 0.901 for spindle or chimeric cells, and 0.867 for the nests of whirlpool cells. Conclusions: The IVCM characteristics of OSSN are the dysplastic cells, hyper-reflective cytoplasm and increased nuclear plasma ratio in the corneal epithelium. Dysplastic cells appearing in the superficial stroma layer, nuclear mitotic figures and nests of vortex cells are the main IVCM parameters to support the malignant change of OSSN lesions. (Chin J Ophthalmol, 2018, 54: 652-660).

[Therapeutic efficacy of ultraviolet combined with riboflavin for the rabbit bacterial keratitis].

Objective: To study the effects of ultraviolet light combined with riboflavin treatment (corneal collagen-crosslinking, CXL) on infectious control and stromal reconstruction of bacterial keratitis. Methods: Experimental Study. A Staphylococcus aureus rabbit keratitis model was established by injecting Staphylococcus aureus broth into the shallow stromal layer of the right eye cornea of New Zealand white rabbits. Forty-four rabbits that successfully established the model were randomly divided into four groups: corneal collagen cross-linking (CXL) group, antibiotic group, CXL+ antibiotic group and untreated group, with 11 rabbits in each group. Before the treatment and at 3, 7, 14 and 28 days after treatment, slit lamp corneal examination, AS-OCT and in vivo confocal microscopy (IVCM) were performed. Clinical efficacy of different treatments were evaluated at different time points. Parameters including conjunctival hyperemia, corneal ulcer, infiltration, edema, and neovascular. Histopathological examinations of corneal lesions were performed in order to detect the infiltration, inflammatory cells and repair in corneal tissue. Normal data were compared with paired t-test and non-normal data were compared with paired rank sum test before and after treatment. Kruskal-Wallis rank sum test was used to compare 4 groups of data and the generalized estimation equation is used to compare the repeated measurement data at each time point and the comparison between the groups of the treatment groups. Results: After treatment, different time points and specimens for pathological observation, we obtained the following results:Conjunctival hyperemia: in CXL and CXL+ antibiotic groups after treatment for 3 days from treatment before 3 (2, -4) and 3 (2, -3),The reduction was 2 (1, -3) and 2 (1, -2), the difference was statistically significant (Z=-3.91, -5.50; P<0.008); 14 days, the antibiotic group changed from 3 (3, -4) to 2 (1, -2) after treatment, the difference was statistically significant (Z=-5.11, P<0.008); the untreated group had no statistical significance before and after treatment. After 14 days of treatment, the area of corneal ulcer (0.08±0.11) cm(2), (0.07±0.05) cm(2) in CXL group and CXL+ antibiotic group was significantly lower than that before treatment (0.40±0.18) cm(2), (0.49±0.24) cm(2). The difference was statistically significant. Significance (Z=-3.29, -3.64; P<0.008); after 14 days of treatment, after 14 days of treatment, neovascularization in the CXL and CXL+ antibiotic groups began to resolve, 1 (1, -2) and 1 (0, -2) at 7 days of treatment. decreased to 1 (1, -1) and 0 (0, -1), the difference was statistically significant (Z=4.57, 3.80; P<0.012 5); The degree of corneal edema was significantly reduced in the CXL group and the CXL+ antibiotic group at 14 days after treatment, which was reduced from (650±154) µm and (785±255) µm before the treatment to (432±95) µm and (455±109) µm, the difference was statistically significant (t=4.50, 4.92; P=0.00); The density of corneal stromal cells was also reduced from (446±257)/mm(2), (321±145)/mm(2) to (107±66)/mm(2), (114±94)/mm(2), the difference was statistically significant (t=4.15, 4.76; P<0.05). Histopathological observation under light microscope showed that most of the corneal ulcers healed in the CXL group and the CXL+ antibiotic group at 7 days of treatment. The epithelial cells were clearly visible and misaligned, and a small amount of neutrophils in the stromal layer. The upper epithelial layer was treated for 14 days. The cells are arranged neatly, the structure is clear, and the inflammatory cells are significantly reduced. Conclusion: Ultraviolet light combined with riboflavin corneal collagen cross-linking has a certain therapeutic effect on rabbit bacterial keratitis infection control and ulcer repair, and can be used as an auxiliary treatment for antibiotics. (Chin J Ophthalmol, 2018, 54:902-910).

[Genetic typing and susceptibility testing of strains from Staphylococcus aureus keratitis or conjunctivitis patients].

Objective: To study the relationship between genetic typing and the antibiotic susceptibility of staphylococcus aureus (SA) isolated from keratitis or conjunctivitis patients. Methods: Experimental study. Thirty-four (34) strains of Staphylococcus aureus were isolated from 34 cases of keratitis or conjunctivitis. The genomic DNA was extracted and amplified with PCR. With the method of multi locus sequences typing (MLST), gene fragments from 7 house-keeping genes were amplified and the products were sequenced. The results were submitted to the MLST website (www.pubmlst.org). In comparison with the allele of the corresponding gene, the allele spectrums of the strain were obtained with 7 housekeeping genes. At last, the MLST genotypes of the isolated strains were determined. With the START software, the evolutionary tree was established with UPGMA method. With the microdilution method, the MIC(90) of 13 antimicrobial agents was determined. The MIC(90) value of antimicrobial agents among different genotypes of Staphylococcus aureus was comparatively analyzed. Results: Ten (10) genotypes were obtained from 34 strains of Staphylococcus aureus. The dominant types were ST239, ST2592 and ST188. The clustering of genotyping was relatively concentrated, mainly in group Ⅰ (25 strains of SA, 83.3% of the total), and followed by group Ⅱ (5 strains of SA, 16.7%). The conjunctival isolates were distributed in the subgroup A of group Ⅰ. The cornea isolates were concentrated in subgroup B and group Ⅱ. With the exact probability method, the R×C chi square tests were used as statistic analysis method. The difference between the bacterial genotyping of two sources was statistically significant (P=0.011). Twenty-four strains of SA in group Ⅰ was sensitive to Vancomycin, Rifampicin and Amikacin (sensitivity ratio was 24/24, 20/24 and 20/24, respectively), and was generally resistant to other antibiotics. The values of MIC(90) of ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin to Staphylococcus aureus in subgroup A (0.16±0.07, 0.51±0.42, 0.31±0.14, 0.22±0.33) were significantly lower than the values in subgroup B(0.74±0.11, 0.84±0.45, 0.67±0.03, 0.68±0.26). The difference was statistically significant (P=0.004, 0.026, 0.034, 0.001). There was no significant difference between the MIC(90) values of the other 9 kinds of antibiotics in the subgroup A and in the subgroup B of Staphylococcus aureus (P value 0.047-0.561). Conclusion: The genotype of Staphylococcus aureus of corneal isolations and conjunctival isolations were different. The conjunctival isolates were distributed in the subgroup A of group Ⅰ and the corneal isolates were concentrated in subgroup B and group Ⅱ. There is a significant correlation between the MLST genotypes and antibiotic sensitivity. (Chin J Ophthalmol, 2018, 54:767-774).

[Retinal image quality in northern rural Chinese adult population].

Objective: To assess the retinal image quality of the normal northern rural Chinese adult population. Methods: A normal population-based, cross-sectional study. From Oct, 2012 to Jan 2013, a clustered, random sampling procedure was used to select normal population who visual acuity≤ 0(LogMAR) and 30-69 years old from 2 villages. All eligible subjects were invited to undergo a comprehensive eye examination, and the retinal image quality related index were examined with pupil 4 mm using objective optical quality analysis systemⅡ(OQAS Ⅱ, Visiometrics, Spain), including MTFcutoff, VA20, VA9, PSF50, PSF10, OSI, SR. And describe the retinal image quality of different age group, including 30-39y, 40-49y, 50-59y, 60-69y. Results: Among 1 108 participants (61.9%) that completed examinations in our center, 681 participants (1 362 eyes) were recruited. There were 146, 586, 440 and 190 eyes in each group. The spherical equivalent refraction of each group was (-0.35±0.84), (-0.19±0.50), (-0.03±0.54) and (0.20±0.71) D. The best corrected vision acuity of each group was -0.02±0.04, -0.01±0.03, -0.01±0.02 and -0.00±0.01. The MTFcutoff of each group was (37.06±9.31), (36.69±8.93), (36.52±9.05) and (32.61±10.08) c/deg. Retinal imaging parameters were significantly different(MTFcutoff: MD=4.45, SR:MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, A9:MD=0.09, OSI:MD=-0.41, P<0.001)between aged 30-39 group and aged 60-69 group. Objective scattering index (OSI) were significantly different(MD=-0.13, P=0.004)between aged 30-39 group and aged 50-59 group. Retinal imaging parameters were significantly different(MTFcutoff:MD=4.45, SR:MD=0.03, PSF50:MD=-0.45, PSF10:MD=-2.87, VA20:MD=0.13, VA9: MD=0.09, OSI: MD=-0.41, P<0.001)between aged 40-49 group and aged 60-69 group. Retinal imageing parameters were significantly different(MTFcutoff: MD=4.45, SR: MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, VA9:MD=0.09, OSI:MD=-0.41,P<0.001)between aged 50-59 group and aged 60-69 group. Conclusion: Retinal image quality was gradually worse over time in the northern rural Chinese adult population. (Chin J Ophthalmol, 2018, 54:593-598).

[The protective effect of Xuebijing on paraquat-induced HK-2 cells apoptosis and the underlying mechanisms].

Objective: To investigate the protective effect and mechanism of Xuebijing (XBJ) on paraquat (PQ) -induced apoptosis in Human kidney cell line-2 (HK-2) cells. Methods: Routinely cultured HK-2 cells, (1) Cell growth inhibition experiment after PQ and XBJ intervention: PQ was divided into 0、200、400、800、1600 and 3200 µmol/L PQ groups, and the cell survival rate was detected after intervening 24、48 and 72 h. XBJ was divided into 0、5、10、20、40 mg/ml XBJ groups, and the cell survival rate was detected after intervening 24、48 and 72 h.To determine the rational drug concentration and the duration of action of XBJ and PQ. (2) PQ-induced HK-2 cell growth inhibition experiment antagonized by XBJ: The cells were divided into normal control group, PQ group (800 µmol/L) and PQ+XBJ group (The cells were pretreated with 5、10 and 20 mg/ml XBJ for 1 h, then cultured with PQ of 800 µmol/L) , After cultured 24 h、48 h and 72 h separately, the cell survival rate was detected. (3) HK-2 cells were divided into normal control group、PQ group (800 µmol/L PQ cultured for 24 h) 、PQ+XBJ group (pretreated with 10 mg/ml XBJ for 1 h, and then 800 µmol/L PQ cultured for 24 h) and XBJ group (10 mg/ml XBJ cultured 24 h). The apoptosis of cells was detected by flow cytometry. The protein expression of Bcl-2 and BAX in each group was detected by Western blotting. The expressions of caspase-3 and caspase-9 were detected by caspase-3 and caspase-9 activity kit active. Results: (1) PQ could significantly reduced the survival rate of HK-2 cells and showed time and concentration dependence. The survival rate of HK-2 cells was about 55% after 800 µmol/L PQ contacted 24 h, XBJ under 20 mg/ml was no significant effect on the survival rate of HK-2 cells after cultured 72 h. (2) Compared with the PQ group, the survival rate of HK-2 cells of PQ+XBJ group was significantly increased (P<0.05). (3) Compared with the normal control group, the cell apoptosis rate of PQ group was significantly increased (P<0.05). Compared with the PQ group, the cell apoptosis rate of PQ+XBJ group was significantly decreased (P<0.05). (4) Compared with the normal control group, Bcl-2 protein expression in PQ group was significantly decreased and BAX protein expression in PQ group was significantly increased (P<0.05) ; compared with PQ group, Bcl-2 protein expression in PQ+XBJ group was significantly increased, BAX protein expression in PQ+XBJ group was significantly decreased (P<0.05). (5) Compared with the normal control group, the activities of caspase-3 and caspase-9 in PQ group were significantly increased (P<0.05). Compared with PQ group, the activities of caspase-3 and caspase-9 in PQ+XBJ group were decreased significantly (P<0.05) . Conclusion: XBJ (10 mg/ml) has obvious protective effect on HK-2 cell injuried by PQ (800 µmol/L) , It can improve the survival rate of cells through reducing the apoptosis of HK-2 cells which induced by PQ.