In vivo transplantation of eye organoids and application of tissue engineering scaffolds / 器官移植

Eye organoid refers to a structure that possesses resembling cell types and functions to intraocular tissues, which is induced by stem cells in vitro. Transplanting it into the body for eye repair and regeneration is one of the key research directions in regenerative medicine, which also provides a novel direction and strategy for the treatment of major blinding diseases. As a carrier of biological tissue or cell growth, tissue engineering scaffold could support in vivo transplantation of eye organoids and promote their maturation. Organic combination of eye organoids and tissue engineering is a critical approach to realize in vivo integration of eye organoids and reconstruct corresponding structures and functions. In this review, the latest research status of eye organoids and in vivo transplantation were summarized, and relevant studies of tissue engineering scaffold-assisted eye organoid transplantation were highlighted, aiming to provide ideas and reference for subsequent inter-disciplinary research of eye organoids and tissue engineering.

Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol / 中西医结合学报

As one of the key components of clinical trials, blinding, if successfully implemented, can help to mitigate the risks of implementation bias and measurement bias, consequently improving the validity and reliability of the trial results. However, successful blinding in clinical trials of traditional Chinese medicine (TCM) is hard to achieve, and the evaluation of blinding success through blinding assessment lacks established guidelines. Taking into account the challenges associated with blinding in the TCM field, here we present a framework for assessing blinding. Further, this study proposes a blinding assessment protocol for TCM clinical trials, building upon the framework and the existing methods. An assessment report checklist and an approach for evaluating the assessment results are presented based on the proposed protocol. It is anticipated that these improvements to blinding assessment will generate greater awareness among researchers, facilitate the standardization of blinding, and augment the blinding effectiveness. The use of this blinding assessment may further advance the quality and precision of TCM clinical trials and improve the accuracy of the trial results. The blinding assessment protocol will undergo continued optimization and refinement, drawing upon expert consensus and experience derived from clinical trials. Please cite this article as: Wang XC, Liu XY, Shi KL, Meng QG, Yu YF, Wang SY, Wang J, Qu C, Lei C, Yu XP. Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol. J Integr Med. 2023; 21(6): 528-536.

Connexin 43: A new therapeutic target against blinding eye diseases / 国际眼科杂志(Guoji Yanke Zazhi)

The major blinding eye diseases, such as keratitis, cataract, glaucoma, diabetic retinopathy, seriously threaten human health and affect the quality of patients' life. Connexin 43(Cx43), as the most common connexin in vertebrates, is widely distributed in eye tissues and is involved in physiological processes such as embryonic development, metabolic regulation, tissue homeostasis, as well as pathological processes such as inflammation, oxidative stress, epithelial-mesenchymal transition, vascular leakage, and angiogenesis. Cx43 plays an important role in the occurrence and development of various blinding eye diseases. This article will review its role in the pathogenesis of the above-mentioned blinding eye diseases and the advances in targeting Cx43 therapy.

Sham acupuncture and placebo acupuncture in clinical trials / 中国针灸

The commonly used terms "sham acupuncture" and "placebo acupuncture" in clinical acupuncture research is compared and analyzed in this article. In terms of their respective characteristics, sham acupuncture has a wider scope, including various types of acupoints, needle insertion at non-acupoint or non-insertion at acupoints, while placebo acupuncture mainly focuses on non-insertion at acupoints. Sham acupuncture mainly emphasizes the appearance similarity to real acupuncture, while placebo acupuncture emphasizes both similarity in appearance and the absence of therapeutic effects. Properly distinguishing and applying sham acupuncture and placebo acupuncture can help standardize their usage in terminology. Considering the difficulty in setting up qualified placebo acupuncture, it is suggested that researchers use the term "sham acupuncture" to describe the acupuncture control methods used in clinical research.

PANoptosis： Molecular Mechanism of Action and Effects on Blinding Eye Diseases / 中山大学学报(医学科学版)

Previous studies focused on the unique regulatory mechanisms of different cell death pathways. However， recent studies highlight crosstalk and co-ordination between these pathways and initiate a new cell death process called PANoptosis （pyroptosis， apoptosis， necroptosis）. PANoptosis is an inflammatory programmed cell death pathway regulated by the PANoptosome complex with critical features of pyroptosis， and/or necroptosis but cannot be characterized by any of the death modes of pyroptosis， apoptosis or necroptosis alone. By activating the PANoptosis pathway， some triggers like bacterial， viral， and fungal infections can cause death of the host. This review explains the PANoptosis-related routes， regulators and their potential effects on blinding eye diseases.

The Diet, ExerCIse and CarDiovascular hEalth (DECIDE)-Diet study was taken as a case to discuss the methods of blinding and blinding assessment for feeding trials / 中华临床营养杂志

DECIDE-Diet trial was taken as a case to introduce the methods of blinding and blinding assessment for feeding trials, report the details of blinding, conduct a blinding survey and calculate Jame's BI and Bang's BI. Jame's BI was 0.683 (95% CI: 0.593~0.772). The Bang's BI for the intervention group was 0.340 (95% CI: 0.199~0.481), and for the control group was 0.086 (95% CI: -0.060~0.231). The blinding of the DECIDE)-Diet was generally successful, but the intervention group may infer their group to a certain extent. Feeding trials should report the details of blinding and consider blinding assessment.

Ocular auto-stimulation and its morbidity in stage 5 retinopathy of prematurity

Purpose: To evaluate the characteristics and morbidity due to ocular auto-stimulation (OAS) in stage 5 Retinopathy of Prematurity (ROP). Methods: Stage 5 ROP cases presenting to ROP clinic of a tertiary care centre from January 2017 to December 2017 were recruited. Eye-pressing was elicited on history from parents and categorized as infrequent (performed <50% of waking time) or frequent (?50% of time). B-scan ultrasonography was performed for configuration of retinal detachment (open or closed funnel). Keratometry was performed in eyes undergoing vitrectomy under general anaesthesia using automated hand-held keratometer. The outcome measures were the presence and characteristics of OAS, enophthalmos, corneal opacity and keratometry values. Results: Out of 93 eyes of 49 babies, 78.5% (n = 73) had OAS. Gestational age, birth weight, sex, retinal funnel configuration, and visual function did not significantly affect OAS. However, post-conceptional age was significantly greater in eyes with OAS (95% CI: 63.1 to 69.9 weeks) than those without OAS (95% CI: 52.4 to 63.4 weeks) (P = 0.018). OAS occurred frequently in 32.8% (n = 24/73) eyes, more commonly in eyes with light followability. Keratometry did not differ significantly with the presence of OAS (P = 0.88). Enophthalmos, corneal opacity, posterior synechiae were noted in 79.5% (58/73), 21.9% (16/73), and 28.8% (21/73) eyes with OAS, respectively. Enophthalmos occurred significantly in eyes with OAS (P = 0.001), while corneal opacity and posterior synechiae did not (P = 0.071 and 0.91, respectively). Conclusion: OAS and its resultant morbidity are common occurrences in stage 5 ROP. The post-conceptional age and residual visual function may govern the characteristics of OAS.

Effect of Eletroacupuncture Intervention on Insulin Resistance, Lipid Metabolic Disorder and Expression of Hepatic SREBP-1 c and Fatty Acid Synthase Proteins in Rats with Hyperlipidemia / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture(EA) of "Fenglong" (ST 40) and "Sanyinjiao" (SP 6) on lipid metabolic disorder, insulin resistance (IR) and expression of sterol regulatory element blinding protein-1 (SREBP-1) c and fatty acid synthase (FAS) proteins in the liver tissue in hyperlipidemia rats with IR, so as to reveal its mechanisms underlying improvement of IR. METHODS: Forty male SD rats were randomly divided into blank control, model, medication and EA groups (n＝8 in each group). The IR model was established by feeding the rat with high-fat diet. Rats of the medication group were treated by intragastric administration of pioglitazone (10 mL/kg). For rats of the EA group, EA (2 Hz/100 Hz，1 mA) was applied to bilateral ST 40 and SP 6, once daily for 14 days. The insulin sensitivity index (ISI) was assessed by calculating 60－120 min glucose infusion rate (GIR 60－120) with euglycemic hyperinsulinemic clamp in reference to Kraegen's and colleagues' methods. Fasting blood samples (10 mL) were collected and analyzed for fasting blood glucose (FBG) using enzyme method, serum fasting insulin(FINS) using ELISA, free fatty acid(FFA) using spectrophotometry, and total triglyceride(TG) and total cholesterol(TC) employing glycerine phosphate oxidase peroxidase (GPO-PAP) assay, low density lipoprotein(LDL), high density lipoprotein(HDL) levels using combined filiter paper activity and lipase activity methods, respectively. The IR level was assessed by calculating homeostatic model assessment of insulin resistance (HOMA-IR) using the formula (FBG×FINS)/22.5. The expression levels of SREBP-1 c and FAS proteins in the liver tissue were detected by Western blot. RESULTS: Following modeling, the GIR 60－120 and serum HDL were significantly decreased(P0.05). CONCLUSION: EA intervention is able to improve the disorder of lipid metabolism of IR rats, which may be associated with its effects in reducing the expression of SREBP-1 c and FAS proteins and in lowering the synthesis of fatty acid.

The expressions and the effects of cystatin C, retinol-binding protein and β2-microglobulin on predicting renal damage in elderly patients with hypertension / 中华老年医学杂志

Objective To investigate the expressions of serum cystatin C CysC),retinolbinding protein (RBP),serum and urinary β2-microglobulin (β2-MG) and their effects on predicting renal damage in primary hypertension in elderly patients.Methods A total of 149 patients were divided into 3 groups of hypertension grade 1 (n =50),hypertension grade 2 (n =50) and hypertension grade 3 group (n=49).92 healthy controls who took physical examination were selected as control group.The levels of serum CysC,RBP,serum and uric β2-MG,blood urea nitrogen,creatinine and other biochemical indexes were detected.The complications of hypertension were observed.The differences in renal function indexes between groups and their correlations were analyzed.Results There were 86 cases with hyperlipidemia (57.7％),71 cases with atherosclerosis (47.7％),59 cases with type 2 diabetes mellitus (39.6％),56 cases with coronary heart disease (37.6％),and 49 cases with cerebral vascular disease (32.9％) in 149 hypertensive patients.The levels of serum CysC,RBP,serum and uric β2-microglobulin were increased in hypertensive patients as compared with healthy controls (P＜0.05 or 0.01),and the extents of increments in the above indexes were positively correlated with blood pressure level [CysC:(1.2± 0.5) mg/L,(1.7±0.6) mg/L,(2.2±0.9) mg/L;RBP:(53.1±10.2) mg/L,(65.2±16.3)mg/L,(75.8±17.5) mg/L;serum β2-MG:(2.7±1.5) mg/L,(4.0±2.1) mg/L,(4.9±2.0) mg/L;uric β2-MG:(178.3±73.9) ng/L,(237.9±78.6) ng/L,(277.5±87.5) ng/L;respectively,P＜0.05or 0.01].Conclusions Elderly hypertensive patients are complicated with a variety of diseases.The levels of serum CysC,retinol-binding protein,serum and uric β2 microglobulin have significant diagnostic values on renal impairment caused by hypertension,and can be considered as sensitive factors for early renal impairment in essential hypertension.

Analysis on iron metabolism indicators in children with various genotypes of thalassemia / 国际检验医学杂志

Objective To study the value of iron metabolism indicatorsin thalassemia .Methods 218 cases of thalassemia ,57 ca‐ses of iron deficiency anemia (IDA) children and 70 healthy children(control group) were enrolled in the study ,and serum iron (SI) ,total iron binding capacity(TIBC) ,transferrin(Tf) ,serum ferritin (SF) were detected for them .Results β‐thalassemia double heterozygous(β0 ) or homozygous group :SI levels were significantly higher than the other groups(P0 .05) ,but Tf level was higher than control group(P0 .05) .Conclusion Compared with Tf ,SI and TIBC are better indicators for monitoring iron loading in children with thalassemia .The increased SI level and decreased TIBC level are two indicators for the diagnosis of β0 thalassemia in children with cellule anaemia .

Bedside nasointestinal tube insertion without visual guiding in critically ill patients / 中华临床营养杂志

Objective To evaluate the safety and effectiveness of bedside nasointestinal nutritional tube insertion with specific guiding techniques in critically ill patients.Methods Critically ill patients who could not take oral or gastric feeding were collected from September 1st, 2013 to September 10th, 2015 in Intensive Care Unit of The Second Hospital of Anhui Medical University.In these patients, bedside nasointestinal tube insertion was performed according to the relevant standard operating procedure in our department, and guiding technique was chosen based on patients' clinical characteristics.Operation time, position of tube tip and complications associated with the bedside operations were recorded for retrospective analysis.Results A total of 21 patients were collected in this study, in whom 23 bedside insertions were preformed.In 21 insertions (91.3％), the tip of the tube was successfully inserted across the transpyloric plane;and in 20 insertions (87.0％), 10 cm distal to the ligament of Treitz.The average operation time was (14.10 ± 1.80) min.The average cost was (297.01 ± 35.26) yuan.No severe complications were occurred.Conclusions The bedside nasointestinal feeding tube insertion without visual guiding is simple, safe, low-cost, and of high success rate.It may be a good choice for establishing enteral nutrition channel in order to implement early enteral nutrition in patients unable to take oral or gastric feeding.

Fatty acid binding protein in children with obesity / 国际儿科学杂志

With the improvement of living standards and dietary changes,obesity has become a serious threat to human health.In this huge group,the proportion of children is increasing.Many factors play significant roles in obesity-related research areas.Fatty acid blinding protein has become a hot topic in recent years.

Limits to clinical trials in surgical areas

Randomized clinical trials are considered to be the gold standard of evidence-based medicine nowadays. However, it is important that we point out some limitations of randomized clinical trials relating to surgical interventions. There are limitations that affect the external and internal validity of many surgical study designs. Some limitations can be bypassed, but can make it more difficult for the study to be carried out. Other limitations cannot be bypassed. When it is intended to extrapolate the result of a randomized clinical trial, the premise is that the performed or to be performed intervention will be similar wherever applied and/or for every doctor using it. However, no matter how standardized the technique may be, the results are not similar for all surgeons, which implies a significant limitation to surgical randomized clinical trials concerning external validity. When considering the various limitations presented for performing surgical trials capable of generating scientific evidence within the patterns currently proposed in the evidence level classifications of medical publications, it is necessary to rethink whether those scientific evidence levels are similarly applicable to surgical works and to nonsurgical trials. We currently live in a time of supposed ''inferiority'' of surgical scientific works under the optics of the current quality criteria for a ''suitable'' clinical trial.

A Case of Xanthoma Disseminatum Accentuating over the Eyelids

Xanthoma disseminatum (XD) is a rare, benign non-familial mucocutaneous disorder, which is a subset of non-Langerhans cell histiocytosis. It is characterized by mucocutaneous xanthomas in a disseminated form typically involving the eyelids, trunk, face, and proximal extremities and occurs in flexures and folds such as axillae and the groin. Mucosal involvement of the respiratory or gastrointestinal tracts may lead to hoarseness or intestinal obstruction from a mechanical mass effect. This paper outlines the case of a 47-year-old female with progressive yellow-to-brown confluent nodules and plaques of various sizes on her scalp, face, oral mucosa, neck, shoulder, axillary folds, and perianal area. Xanthomas accentuating over the eyelids and eyelashes led to partial obstruction of her visual field and interfered with blinking. Further, she suffered from xerophthalmia. The presentation of histopathological features including foamy histiocytes, inflammatory cells, and Touton giant cells in conjunction with her clinical findings indicated a diagnosis of XD. Evaluations for extracutaneous involvement including the central nervous system, respiratory tract, gastrointestinal tract, and bone resulted in nonspecific findings. Although she has been treated with surgical excisions, CO2 laser therapy, and oral prednisolone, new lesions are still emerging.

Optimization of design types in TCM clinical research / 中华中医药杂志

TCM clinical research covers different design types on basis of objective of the study. For exploratory research of TCM, cross-sectional study and descriptive research (e.g. case report and case analysis) is suitable. For hypothesis-testing research, RCT design is commonly adopted. RCT is most commonly used in activity or prevention therapy research, when using randomized cross-over design, the influence of sequence effects should be considered, and double-blind method is the best choice. Cohort study includes various intervention measures, as it doesn’t involve randomized allocation and blinding. Case-control study is widely applicable, but it may bring about bias. Cross-sectional study is much used in syndrome investigation of TCM clinical research. Descriptive research is available for summarization of TCM clinical experience and TCM exploratory research. Third party-central randomization system is recommended, as the randomization is not easy to be damaged. Randomization concealment should also be attached importance to. When blinding is impossible, blindness testing could reduce measurement bias, positive control should be supported high-level evidence. Placebo application could improve the level of evidence-based medicine.

A Report of Intraocular Lens Implantations in Korea

The implantation of intraocular lens(IOL) has now been routinely used in cataract surgery and its indication has more extended gradually. Improvement of surgical methods, IOL designs and dvelopment of viscoelastic substance have accelerated the implantation of IOLs. In Korea, 20 IOL Study Club also was organized in 1984. And in 1988, domestic mode IOL named UNI-PCL was finally approved from ROK government. This report is concernd to investigate the datas of IOL implantations in Korea by use of questionnaire method which was conducted by prof. Dr. Jae Ho Kim. The brief summary on 21,779 IOL cases from 1975 to May 31, 1988 is as follows. 1. Cases of Primary IOL implantation were 21,093(973%) among 21,779 cases and posterior chamber lens(PCL) implantation was done in 20,242 case(95%) among primary IOL implantation. 588 cases(2.7%) were secondary IOL implantation, among them, cases of ACL implantation were 361(61.4%). 2, PCL implantation was done in 20,269 cases(91.1%) and ACL implantation in 1,412 cases(6.4%). It shows that PCL implantation has increased in number annually. 3. J-loop type of PCL including modified J-loop type was most comonly used and the use of C-Ioop type was gradually increased. 4. Posterior capsule rupture was the most common complication in intraoperative period, However, the transient intraocular pressure rise and after cataract were the most common complications in early and late postoperative period. 5. The most common cause of blindness after IOL implantation was bullous keatopathy. 6. In this study, number of surgeons who performed IOL implantation were 120 and IOL implantation was thought to be performed more than 75 hospitals including general hospital and offices.

A Report of Intraocular Lens Implantations in Korea

The implantation of intraocular lens(IOL) has now been routinely used in cataract surgery and its indication has more extended gradually. Improvement of surgical methods, IOL designs and dvelopment of viscoelastic substance have accelerated the implantation of IOLs. In Korea, 20 IOL Study Club also was organized in 1984. And in 1988, domestic mode IOL named UNI-PCL was finally approved from ROK government. This report is concernd to investigate the datas of IOL implantations in Korea by use of questionnaire method which was conducted by prof. Dr. Jae Ho Kim. The brief summary on 21,779 IOL cases from 1975 to May 31, 1988 is as follows. 1. Cases of Primary IOL implantation were 21,093(973%) among 21,779 cases and posterior chamber lens(PCL) implantation was done in 20,242 case(95%) among primary IOL implantation. 588 cases(2.7%) were secondary IOL implantation, among them, cases of ACL implantation were 361(61.4%). 2, PCL implantation was done in 20,269 cases(91.1%) and ACL implantation in 1,412 cases(6.4%). It shows that PCL implantation has increased in number annually. 3. J-loop type of PCL including modified J-loop type was most comonly used and the use of C-Ioop type was gradually increased. 4. Posterior capsule rupture was the most common complication in intraoperative period, However, the transient intraocular pressure rise and after cataract were the most common complications in early and late postoperative period. 5. The most common cause of blindness after IOL implantation was bullous keatopathy. 6. In this study, number of surgeons who performed IOL implantation were 120 and IOL implantation was thought to be performed more than 75 hospitals including general hospital and offices.