[Paying attention to neuropathic changes in high myopia].

The incidence of myopia is high in China. The proportion of high myopia is also high in the myopic population. High myopia is associated with multiple fundus changes, among which the neuropathic damage is usually ignored, and thus there has been limited clinical research on the pathogenesis, standard follow-up and effective treatment of optic neuropathy in high myopia. This article focuses on the types of high myopia-associated neuropathic changes, the quantitive imaging of neuropathic damage, and the need of relevant cohort studies and pathogenesis research, aiming to attract more attention to optic neuropathic changes in high myopia.

[Optic atrophy in a patient with axonal Charcot-Marie-Tooth disease 2A2A due to MFN2 gene mutations].

A 27-year-old male patient had progressive vision loss in both eyes, which was mainly manifested by impaired ganglion cells in the macular area, accompanied by systemic muscle atrophy in limbs. A complete mitochondrial exon gene detection was performed. The final diagnosis was bilateral optic atrophy and axonal Charcot-Marie-Tooth disease 2A2A caused by mutations of the MFN2 gene. There has been no effective treatment. Applications of nutrients to restore the mitochondrial function may alleviate the clinical symptoms.

[Update on B cell depletion therapy for demyelinating optic neuritis with disease-specific antibody].

Demyelinating optic neuritis coexisting with seropositive aquaporin-4 antibody or myelin oligodendrocyte glycoprotein antibody is different from the typical optic neuritis in immunopathological, clinical and radiological features, as well as therapeutic response. Due to the high recurrence rate and the potential risk of blindness, immunosuppressive therapy is warranted in most cases. The current review tracks and summarizes both the update and the potential controversies of B cell depletion therapy with a special focus on rituximab for demyelinating optic neuritis to optimize clinical decision-making.

[Myelin oligodendrocyte glycoprotein antibody positive optic neuritis with anti-N-methyl-D-aspartate receptor encephalitis: a case report].

A 6-year-old girl had binocular vision loss with pain for one week. The patient presented with symptoms such as non-communication, language deterioration, dysphonia, and choking when drinking and eating during the course. The serum myelin oligodendrocyte glycoprotein antibody was positive. Both the serum and cerebrospinal fluid anti-N-methyl-D-aspartate receptor antibody were also positive. The diagnoses were myelin oligodendrocyte glycoprotein antibody positive optic neuritis and anti-N-methyl-D-aspartate receptor encephalitis. High-dose intravenous glucocorticoids were given. Recurrence was not observed during the 15-month clinical follow-up.

[IgG4-related ophthalmic disease: three-case report].

The first patient complained visual loss of left eye for 1 week. The second patient complained visual loss of right eye for 2 months with conjunctival edema for more than 10 days. The third patient complained redness and swelling of both eyes for 1 year, poor appetite and fatigue for 4 months. All three patients were male with binocular involvement. Enlargement of lacrimal glands in both eyes with bulbar conjunctival edema were observed in 2 patients and binocular eyelid swelling in 1 patient, all 3 patients were associated with external orbital tissue involvement, which were diagnosed as IgG4-related ophthalmic diseases. After treatment with glucocorticoid, the symptoms of the patients were improved, and the patients were followed up for 58, 54, and 60 months, respectively. Among the 3 patients, 2 had recurrence for once, and 1 had recurrence 3 for times. (Chin J Ophthalmol, 2021, 57: 375-378).

[The development history and prospect of neuro-ophthalmology in China].

Neuro-ophthalmology is an interdisciplinary subspecialty that occupies an important position in ophthalmology. We review the development history and subspecialty construction of the neuro-ophthalmology in China, showing the achievements, providing reference for the clinical and scientific research of neuro-ophthalmology in the future, commemorating the predecessors and inspiring the contemporary neuro-ophthalmology profession to forge ahead. Congratulations on the 70th anniversary of the publication of the Chinese Journal of Ophthalmology.(Chin J Ophthalmol, 2020, 56:891-894).

[Progress in the treatment of neuromyelitis optica spectrum disorders related optic neuritis].

Neuromyelitis optica spectrum disorders (NMOSD) related optic neuritis (NMOSD-ON) is a common neuro-ophthalmic disease which often results in permanent blindness. NMOSD is characterized by high recurrence rate and poor prognosis. Therefore the two key objectives of the therapeutic approach for patients with NMOSD are treatment of the acute attacks and prevention of the relapses. With the in-depth study of the pathogenesis of NMOSD, new treatments developed for different stages of the disease are emerging. This review gives an update of latest knowledge of NMOSD-ON, emphasizing both current and future therapeutic approaches. (Chin J Ophthalmol, 2020, 56: 539-543).

[Clinical characteristics of myelin oligodendrocyte glycoprotein antibody-positive optic neuritis].

Objective: To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein(MOG) antibody-positive optic neuritis (MOG-ON). Methods: Retrospective case series study. A total of 65 patients diagnosed with MOG-ON at the Department of Ophthalmology of the Chinese People's Liberation Army General Hospital during January 2016 and October 2017 were selected. The patients underwent examinations including best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT) and magnetic resonance imaging (MRI). The patients were tested for serum levels of antibodies for aquaporin 4 and MOG with a cell-based assay. The follow-up duration ranged from 14 to 217 months. Statistical analyses of patients' clinical features, neuroimaging features and prognosis were conducted. The independent-sample t test or Mann-Whitney U test for continuous variable data and the χ(2) test or Fisher exact test for classified variable data and rates were used. Results: There were 35 children (<18 years) and 30 adults (≥18 years) patients. Thirty-seven patients were female and 28 patients were male. The mean age of onset was (23±16) years (range of 3-61 years). There were 40 unilateral patients and 25 bilateral patients at the first onset. Fifty-five patients (84.6%) suffered from eye pain at the first onset and the incidence in children was significantly lower than that in adult [74.3% (26/35) and 96.7% (29/30), P=0.016]. Abnormal autoimmune antibodies were found in 13 patients (20.0%).And 47.8% (43/90) eyes had optic disc edema. Sixty percent (39/65) were recurrent optic neuritis and 73.8% (48/65) were bilateral diseases at final visit. Orbital MRI scans showed T(2) hyperintensity of optic nerve in 98.4% patients (62/63). Head MRI scans showed demyelinating lesions of the brain in 12/19 patients. Within 2 weeks of onset, 78.9%(71/90) of the affected eyes had BCVA ≤ 0.1. The visual impairment of the children and adult was serious, and there was no significant difference (P=0.650). After treatment with corticosteroid, visual acuity improved in all affect eyes. After the initial attack, 95.6%(86/90) of the affected eyes had BCVA ≥ 0.5. The children and adult had good visual recovery, and there was no significant difference (P=0.061). At the final visit, 86.7%(98/113) of the eyes had BCVA ≥ 0.5, the children had better visual recovery than adult [logarithm of the minimum angle of resolution, 0.10±0.35 vs. 0.32±0.53, t=-2.526, P=0.013].Three children (8.6%) were diagnosed with acute disseminated encephalomyelitis. The average thickness of peripapillary retinal nerve fiber layers (pRNFL) and macular ganglion cell-inner plexiform layers (mGCIPL) were (69.90±12.49) µm and (59.58±7.91) µm at least 6 months after optic neuritis attack. There were different degrees atrophy and not statistically different in pRNFL and mGCIPL between children and adult (P=0.606, 0.223). Conclusions: The clinical characteristics of MOG-ON are diverse. The children patients are more common and have better recovery of visual acuity. Additionally, some patients have demyelinating lesions in the brain. (Chin J Ophthalmol, 2019, 55: 174-179).

[The importance of combined application of visual electrophysiology examination and OCT in optic neuropathy].

This article briefly analyzes the advantages and limitations of visual electrophysiology and OCT, and explains the complementarity of visual electrophysiology and OCT and the advantages of combined application in typical optic neuropathy, so as to provide guidance on how to combine the functional and morphological inspections in the clinical diagnosis and treatment of optic neuropathy. (Chin J Ophthalmol, 2019, 55: 161-163).

[The role of myelin oligodendrocyte glycoprotein antibodies for detection of demyelinating optic neuritis].

The incidence of neuromyelitis optica spectrum disorders (NMOSD) in the Asian population is much higher than in Europe and North America. Optic neuritis is the first sign of NMOSD for some people. Identification of aquaporin 4 antibody is a milestone in the research of NMOSD and has been included in the diagnosis standard of NMOSD, but about 20% to 30% of NMOSD patients is aquaporin 4 antibody-negative. With the cell-based assays, oligodendrocyte glycoprotein antibodies in demyelinating diseases of the central nervous system have aroused the attention of researchers. This article reviews the research history of oligodendrocyte glycoprotein antibodies in optic neuritis. (Chin J Ophthalmol, 2017, 53: 874-877).

PI3K-Akt-mTOR signal inhibition affects expression of genes related to endoplasmic reticulum stress.

PI3K-Akt-mTOR signaling pathway is associated with endoplasmic reticulum (ER) stress. However, it is not clear how this signaling pathway affects the ER stress. The present study aimed to determine whether the PI3K-Akt-mTOR signaling pathway regulates tunicamycin (TM)-induced increases in mRNA levels of genes involved in the ER stress, to help elucidate the mechanism by which this pathway affects the ER stress in primary goose hepatocytes. Primary hepatocytes were isolated from geese and cultured in vitro. After 12 h in a serum-free medium, the hepatocytes were incubated for 24 h in a medium with either no addition (control) or with supplementation of TM or TM together with PI3K-Akt-mTOR signaling pathway inhibitors (LY294002, rapamycin, NVP-BEZ235). Thereafter, the expression levels of genes involved in the ER stress (BIP, EIF2a, ATF6, and XBP1) were assessed. The results indicated that the mRNA level of BIP was up-regulated in 0.2, 2, and 20 µM TM treatment group (P < 0.05), whereas the mRNA levels of EIF2a, ATF6, and XBP1 were up-regulated in the 2 µM TM treatment group (P < 0.05). However, the TM mediated induction of mRNA levels of genes involved in the ER stress (BIP, EIF2a, ATF6, and XBP1) was down-regulated after the treatment with PI3K-Akt-mTOR pathway inhibitors (LY294002, NVP-BEZ235, and rapamycin). Therefore, our results strongly suggest that the PI3K-Akt-mTOR signaling pathway might be involved in the down-regulation of the TM-induced ER stress in primary goose hepatocytes.

[Clinical features of neurosyphilis with optic neuritis as an initial finding].

Objective: To study the characteristics of neurosyphilis with optic neuritis as an initial finding. Methods: Retrospective analysis of clinical data and laboratory testing results of 16 cases (27 eyes) with optic neuritis as an initial finding of neurosyphilis from October 2010 to March 2015 in General Hospital of People's Liberation Army was made. Results: Six-teen patients (12 males, 4 females) were collected, the median age of patients was 47 (range 33 to 65) years ,the mean age was (49.63±9.05) years. Treponema pallidum particle agglutination assay (TPPA) analysis was positive in all of the patients and rapid plasma reagin (RPR) test was positive in 14 patients (2 patients did not test). Lumbar puncture was requested and performed for all patients. Cerebrospinal fluid (CSF) TPPA analysis was positive in 16 patients and RPR test was positive in 12 patients. The CSF white blood cell counting increased in 9 (56.3%) patients and 10(62.5%)patients presented with increased CSF protein level. Both eyes were involved in 11 patients (68.8%). Relative afferent papillary defect was positive in 11 patients. Twenty-seven eyes were affected in 16 patients, and among them 7 eyes' pupil diameter were 2.5 mm or less. Incipient visual acuity was less than 0.1 in 22 eyes. The slit lamp examination showed vitreous opacity in 12 eyes and visible cells in 6 eyes among 27 eyes. Fundus examination found that 6 eyes had papillary edema and 15 eyes had pallordisc among 27eyes. Electro-retinogram (ERG) was tested in 24 eyes, and 18 eyes were abnormal. Visual evoked potential (VEP) were performed in 26 eyes (flash VEP in 22 eyes, pattern VEP in 4 eyes), and all were abnormal. Fourteen eyes were tested by 30-2 perimetry, and 6 eyes had diffuse visual field defect, 2 eyes had peripheral visual field defect, 4 eyes had quadrant defect and 2 eyes had center scotoma. Fundus fluorescence angiography was done in 16 eyes and choroidal hyper-fluorescent dots were found in posterior pole in 4 eyes. All patients were treated with antibiotic medicines, among them 10 cases in the General Hospital, and 6 cases in the other hospitals. During 15 months follow-up after discharge, visual acuity of 17 eyes recovered to 0.5 and above. Conclusion: Syphilitic optic neuritis is a condition that manifests with severe visual loss and tends to involve both eyes, Some patients have a smaller pupil diameter. Due to the particular infective routes of the disease, patients often conceal their sexual history. The manifestations of ocular syphilis are complicated and easy to misdiagnose or undiagnose. Clinical manifestations combining with the detailed history taking, serum and cerebrospinal fluid examination can guide to an accurate diagnosis and prevent from permanent vision loss. (Chin J Ophthalmol, 2016, 52: 898-904).

[Optic nerve subarachnoid space expansion in MR imaging: a etiology study].

Objective: To investigate spectrum of causes in optic nerve subarachnoid space (ONSS) expansion by using Magnetic Resonance Imaging (MRI). Methods: A retrospective study. Twenty-six patients (46 eyes) with ONSS expansion and 20 healthy adults (40 eyes) were recruited in Neuro-ophthalmology Department of Chinese PLA General Hospital from January, 2014 to December, 2015. The diameters were measured on the optic nerve (OND) and optic nerve sheath (ONSD) 2.4 mm behind the globe. ONSS was calculated by the formula of (ONSD-OND)/2. All participants were under went ophthalmologic examinations. The patients' clinical features, MRI and final diagnosis were analyzed. Qualitative data were compared between groups by using chi square test and quantitative data were compared by independent sample t test. Results: There was no statistically significant difference between ONSS group and control group with age, BMI and mean arterial blood pressure (P>0.05). Larger space was found in ONSS group with mean±standard deviation (SD) of (1.9±0.4) mm comparing to the control group with (1.2±0. 2) mm (t=2.879, P<0.01). Bilateral ONSS expansion were found in 20 patients, 15 patients (75%) with cerebral venous sinus thrombosis (CVST), 2 patients (10%) with neurosyphilis, 2 patients (10%) with peri-neuritis and 1 patient (5%) with hydrocephalus. Unilateral ONSS expansion were seen in 6 patients, 4 patients (66.7%) with compressive lesson on anterior visual pathway, 1 patient (16.7%) with fungal infection and 1 patient (16.7%) with peri-neuritis. Conclusions: The CVST patients more frequently presented bilateral ONSS expansion. Unilateral ONSS expansion may indicate compressive lesions located on the anterior visual pathway. (Chin J Ophthalmol, 2016, 52: 911-917).

[The immunological effects of phthalanilic acid on mice].

OBJECTIVE: To explore the effects of phthalanilic acid on immune system in mice from the respects of blood, tissues, cell and cytokines. And to find sensitive index of immunological effects and offer experimental data for toxicological safety evaluation. METHODS: 60 balb/c mice were randomly divided into 4 groups. The mice in control group were given soybean oil. The mice in group 2 to 4 were given phthalanilic acid at dose 30 mg/kg, 100 mg/kg and 300 mg/kg by gavage respectively for 28 days. After 24 hours of the last contamination, the histopathology of spleen and thymus, immunologic factors and cell multiplication of lymphocyte were analysed. The data were analysed by SPSS. RESULTS: After contamination for 28 days, 300 mg/kg phthalanilic acid could cause that the cell multiplication of lymphocyte were inhibited. Spleens were damaged at the dose of 100 mg/kg. The concentration of IFN-γ and IL-4[ (843.31±14.81) pg/ml and (1174.44±7.32) pg/ml] in thymus were increased significantly (P<0.05) at the dose of 30 mg/kg. CONCLUSION: Different doses of phthalanilic acid may damnify the immune system of mice at different degrees for 28 days continuous contamination. Phthalanilic acid might have immunotoxicity.

Higher normal range of fasting plasma glucose still has a higher risk for metabolic syndrome: a combined cross-sectional and longitudinal study in elderly.

INTRODUCTION: It is well known that higher fasting plasma glucose (FPG) is associated with metabolic syndrome (MetS). This relationship still exists even the FPG is within the normal range. However, most of these studies did not exclude subjects who were on medications which would affect the results of the studies. At the same time, there is no longitudinal study done to validate this correlation, especially in elderly. In this study, the relationships between normal FPG and MetS were evaluated. METHOD: We randomly selected 57,517 subjects who were ≥ 60-years old from health screening centre. In the first part of study, subjects were enrolled in the cross-sectional study to find out the optimal cut-off value of FPG with higher chances to have MetS. In the second part of current study, subjects with MetS at baseline were excluded from the same study group, and performed a median 5.3-year longitudinal study. RESULTS: There were 18,287 subjects enrolled in this study. In the first part of study, the cross-sectional study, optimal cut-off values of FPG were determined by the ROC curve and the sensitivity for these cut-off values were 56.6% in men and 60.9% in women, respectively. The result showed that lower FPG is healthier than the higher (log-rank test, p < 0.001). During the follow-up period, 5039 subjects showed hazard ratios of 2.09 for men and 1.884 for women developing future MetS. CONCLUSION: Our study is the first longitudinal design in elderly and showed that older subjects with higher FPG proved to have higher risk of Mets even the FPG is still within its normal range.

Identification of differentially expressed genes in a pistillody common wheat mutant using an annealing control primer system.

HTS-1 is a new kind of pistillody wheat. All or parts of its stamen are transformed into pistils or pistil-like structures, and it has more seed sets per floret than normal wheat under normal cultivation conditions. To investigate the expression divergence in this mutant, an annealing control primer system was used to identify differentially expressed genes (DEGs) in the young spikelets. As a result, three DEGs, including HDB2, HGF2, and HCG4, were detected, with variable expression in HTS-1 and the control. After further confirmation using real-time reverse transcription polymerase chain reaction analysis, these genes were overexpressed in HTS-1 wheat. NGF2 was identified in the double ridge to floret differentiation stages; HDB2 and HCG4 were identified in the stage of pistil and stamen-differentiating. Therefore, we inferred that the homeotic transformation of stamens into pistil-like structures occurred during the early stage of stamen development. Sequence alignment analysis revealed that HDB2 encodes a putative protein of 189 amino acids, with high homology to the DEAD-box ATP-dependent RNA helicase, and HCG4 was identical to the Chinese spring wheat cDNA clone predicted protein according to GenBank. However, NGF2 was not found to have significant similarity to any reported proteins, suggesting it is a new functional gene in wheat. The results suggest that HDB2, HCG4, and HGF2 are minor genes contributing to pistillody trait formation in HTS-1.

Molecular cloning, characterization and expression analysis of WAG-1 in the pistillody line of common wheat.

Wheat WAG-1 is a C-class MADS-box gene, which is orthologous to AGAMOUS in Arabidopsis. In this study, we report the cloning, characterization, and expression patterns of WAG-1 in the pistillody mutant HTS-1 and its sib-line CSTP. The cDNA of WAG-1 was found to be 765 bp in length, which was equal to the length of its open reading frame, encoding 254 amino acids. The location of WAG-1 revealed that it has three homologous genes from the short arm of chromosome 1A, 1B, and 1D. Their genomic sequences were determined to be 5864, 6454, and 6447 bp long, respectively, and possessed seven exons and six introns. Young spikes from HTS-1 contained higher levels of WAG-1 transcript than did those from CSTP, and the transcript levels in the young spikes (7-10 mm in length) of HTS-1 increased 3.3-fold relative to those of the CSTP line. The transcript level in the pistil and pistil-like stamens of HTS-1 was over 2-fold higher than that in the stamens of CSTP, and expression in the pistil-like stamens of HTS-1 was slightly higher than that in its pistils. These data provide a basis for future research into the function of WAG-1, and offer further insight into the molecular mechanism of the pistillody mutation in common wheat.

Visualization and body distribution of [¹³¹I]-herceptin in nude mice with BT-474 breast carcinoma.

The study aimed to investigate the bio-distribution and radio-immuno-imaging features of [(131)I]-herceptin in nude mice with BT-474 breast carcinoma. [(131)I]-Herceptin was administrated by tail intravenous injection to the nude mice with BT-474 breast carcinoma. Radiocounting was performed at 4, 12, 24, 48, and 96 h after administration. The activity ratio in the tumor tissue and non-tumor tissue (T/NT) and the radiocounting percentage per gram tissue to the injected dose (%ID/g) were calculated. The nude mice with BT-474 breast carcinoma were also visualized continuously by single photon emission computed tomography at 2, 4, 8, 12, 24, 48, and 96 h after the injection of [(131)I]-herceptin. Nude mice with MDA-MB-231 used as the control group were subjected to the same analyses. Clear tumor images were obtained after the injection of [(131)I]-herceptin in nude mice with BT-474 breast carcinoma. The images were the clearest at 24 h after the injection and remained clear even at 96 h. The T/NT ratio and %ID/g in the tumor tissues of nude mice with BT-474 were both significantly higher than those of the control group (P < 0.01). [(131)I]-Herceptin displays tumors clearly in the nude mice with BT-474 and accumulates well in the tumor tissues.

Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival.

BACKGROUND: Most patients requiring an extended right hepatectomy (ERH) have an inadequate standardized future liver remnant (sFLR) and need preoperative portal vein embolization (PVE). However, the clinical and oncological impact of PVE in such patients remains unclear. METHODS: All consecutive patients presenting at the M. D. Anderson Cancer Center with colorectal liver metastases (CLM) requiring ERH at presentation from 1995 to 2012 were studied. Surgical and oncological outcomes were compared between patients with adequate and inadequate sFLRs at presentation. RESULTS: Of the 265 patients requiring ERH, 126 (47·5 per cent) had an adequate sFLR at presentation, of whom 123 underwent a curative resection. Of the 139 patients (52·5 per cent) who had an inadequate sFLR and underwent PVE, 87 (62·6 per cent) had a curative resection. Thus, the curative resection rate was increased from 46·4 per cent (123 of 265) at baseline to 79·2 per cent (210 of 265) following PVE. Among patients who underwent ERH, major complication and 90-day mortality rates were similar in the no-PVE and PVE groups (22·0 and 4·1 per cent versus 31 and 7 per cent respectively); overall and disease-free survival rates were also similar in these two groups. Of patients with an inadequate sFLR at presentation, those who underwent ERH had a significantly better median overall survival (50·2 months) than patients who had non-curative surgery (21·3 months) or did not undergo surgery (24·7 months) (P = 0·002). CONCLUSION: PVE enabled curative resection in two-thirds of patients with CLM who had an inadequate sFLR and were unable to tolerate ERH at presentation. Patients who underwent curative resection after PVE had overall and disease-free survival rates equivalent to those of patients who did not need PVE.