Self-Restricted Diet in Pediatric Autism Leading to Vitamin A Deficiency and Severe Photophobia.

In developed countries, vitamin A deficiency (VAD) remains rare but is a leading cause of global blindness. We describe the case of a 10-year-old girl with autism spectrum disorder (ASD) initially presenting mild VAD symptoms, escalating to severe photophobia and reluctance to leave a darkened room due to a self-restricted diet of fast-food french fries. A timely examination revealed severe VAD and vitamin A supplementation resolved her symptoms in three weeks. This case highlights the challenge of obtaining accurate patient history in ASD, emphasizing the need for routine dietary discussions and micronutrient testing, especially at ages nine and 13 when the United States Department of Agriculture (USDA) recommends increased vitamin A intake. Early intervention can prevent micronutrient deficiencies in pediatric patients, particularly those with ASD.

Optimal acupuncture protocol improving symptoms of typical dry eye syndrome: meta-analysis and systematic review.

Previous meta-analyses have shown a superiority of acupuncture over artificial tear for treating typical dry eye syndrome (DES). However, given that the acupuncture protocols were quite diverse in the randomized controlled trials (RCTs) included in the meta-analyses, it is necessary to establish the acupuncture guidelines. Thus, the optimal acupuncture protocol involved in improvements of tear-film breakup time (BUT) or Schirmer tear test (STT) was examined by meta-analyses for RCTs in patients with typical DES. Eight databases until Jun 2018 were searched for 21 RCTs (n = 1542 eyes) comparing effectiveness of acupuncture versus artificial tear control. Indirect comparison of Bucher analysis was used to find specific acupoints (SAPs) improving BUT or STT by comparing the outcomes between subgroups of the RCTs including and excluding certain SAPs. Meta-analysis was examined for the outcomes in subgroups of the RCTs based on the number of SAPs, and network meta-analysis was for multiple pairwise comparisons across the protocols using the SAPs to yield relative effects. The Bucher analyses identified nine SAPs with positive effects on BUT or STT, and the positive relations of two SAPs involved in improvements of both BUT and STT suggested potential combinations of three ('KI3-LI4-SP6' or 'KI3-GB14-ST2') or four SAPs ('KI3-BL1-EX-HN7-SP6'). Subgroup meta-analyses showed the SAP-depending improvements of BUT or STT in the subgroups including more than three SAPs, compared with the artificial tear control. Meta-regression and network meta-analyses revealed significant correlations between the number of SAPs and the improvements of BUT and STT, and demonstrated that acupuncture using four SAPs for 21-30 days, particularly at two-three times per week, can be optimal for improving the symptoms of typical DES. These results provide useful information for guiding acupuncture in clinical trials for DES.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective.

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

Bilateral Corneal Melting in a Pediatric Patient with Severe Vitamin A Deficiency: A Case Report and Review of Literature.

Background: Keratomalacia refers to an ocular destructive dryness of the cornea that results from severe vitamin A deficiency. It is an ocular condition, usually affecting both eyes. It affects infants, children and women of reproductive age. In developing countries, vitamin A deficiency in the diet and associated keratomalacia are a major cause of childhood blindness. Purpose: To report the clinical finding of a patient with bilateral keratomalacia arising from severe vitamin A deficiency from a malnourished diet. Patients and Methods: Case report. Results: A two-year-old female with severe malnutrition presented with 3 weeks of watering and tonic blepharospasm affecting the right and left eyes. She exhibited trichomegaly, severe weight loss, abnormal hairs with complete corneal melt in the right and left eyes and inflamed iris tissue in the right eye. She was treated with high dose vitamin A, but the right eye required evisceration and tarsorrhaphy was done in the left eye. Conclusion: The visual morbidity associated with xerophthalmia secondary to vitamin A deficiency can be devastating. Diet-induced vitamin A deficiency is prevalent in developing and war-torn countries. A good history taking and review of systems are valuable in evaluating malnourished patients with corneal melt.

Impact of home food production on nutritional blindness, stunting, wasting, underweight and mortality in children: a systematic review and meta-analysis of controlled trials.

Vitamin A deficiency is highly prevalent and remains the major cause of nutritional blindness in children in low-and middle-income countries, despite supplementation programmes. Xeropthalmia (severe drying and thickening of the conjunctiva) is caused by vitamin A deficiency and leads to irreversible blindness. Vitamin A supplementation programmes effectively reduce vitamin A deficiency but many rural children are not reached. Home food production may help prevent rural children's vitamin A deficiency. We aimed to systematically review trials assessing effects of home food production (also called homestead food production and agricultural interventions) on xeropthalmia, nightblindness, stunting, wasting, underweight and mortality (primary outcomes). We searched Medline, Embase, Scopus, Cochrane CENTRAL and trials registers to February 2019. Inclusion of studies, data extraction and risk of bias were assessed independently in duplicate. Random-effects meta-analysis, sensitivity analyses, subgrouping and GRADE were used. We included 16 trials randomizing 2498 children, none reported xerophthalmia, night-blindness or mortality. Home food production may slightly reduce stunting (mean difference (MD) 0.13 (z-score), 95% CI 0.01 to 0.24), wasting (MD 0.05 (z-score), 95% CI -0.04 to 0.14) and underweight (MD 0.07 (z-score), 95% CI -0.01 to 0.15) in young children (all GRADE low-consistency evidence), and increase dietary diversity (standardized mean difference (SMD) 0.24, 95% CI 0.15 to 0.34). Home food production may usefully complement vitamin A supplementation for rural children. Large, long-duration trials with good randomization, allocation concealment and correct adjustment for clustering are needed to assess effectiveness of home food production on nutritional blindness in young children.

[Lingnan fire needling combined with 0.1% sodium hyaluronate eye drops in the treatment of xerophthalmia: a randomized controlled trial].

OBJECTIVE: To observe the effect of Lingnan fire needling combined with artificial tears in the treatment of xerophthalmia. METHODS: A total of 86 xerophthalmia patients were equally and randomly divided into treatment group and control group. The patients of both groups were received treatment with 0.1% sodium hyaluronate eye drops in their eyes 3 times a day, one drop in each eye. In addition, the patients of treatment group also treated by Lingnan fire needling on bilateral Shaoze (SI1), Neichengqi and beside lacrimal puncta once a week. The treatment was conducted for 4 consecutive weeks. Before and after 4 weeks of treatment, the clinical efficacy, visual acuity, intraocular pressure, ocular symptom score, OSDI score, fluorescence staining （FL） score, schemer I, tear menisci height, tear film break-up time (BUT) and eye redness index were recorded and evaluated. RESULTS: After the treatment, self-comparison showed that the symptom score, OSDI score, FL score and eye redness index were significantly decreased (P<0.05), and BUT was notably increased in both groups (P<0.05) in comparison with their own pre-treatment. The tear menisci height in the treatment group was higher than that before the treatment (P<0.05). Comparison between the two groups showed that the symptom score, OSDI score and eye redness index were obviously lower in the treatment group than in the control group (P<0.05), whereas the BUT and tear menisci height were evidently higher (P<0.05). The total effective rate of the treatment group was 84.88% (73/86), better than 76.74% (66/86) of the control group (P<0.05). CONCLUSION: Lingnan fire needling combined with 0.1% sodium hyaluronate eye drops is more effective than simple sodium hyaluronate eye drops for xerophthalmia patients, with significant curative effect and no adverse reactions.

Herbal Formula SS-1 Increases Tear Secretion for Sjögren's Syndrome.

Background: Sjögren's syndrome (SS) is an autoimmune inflammatory disease that primarily affects the exocrine glands, leading to glandular dysfunction. The hallmark symptoms of SS are dry eyes and mouth, compromising the quality of life of patients and decreasing their capacity to perform their daily activities. Objective: This study aims to evaluate the efficacy of the herbal formula SS-1 for its potential therapeutic benefits for patients with Sjögren's syndrome. Materials and Methods: The bioactivity profile of SS-1 was determined using four different SS-1 concentrations across 12 human primary cell systems of the BioMAP profile. After that, a randomized, double-blind, crossover, placebo-controlled trial was performed including 57 patients treated with SS-1 for 28 weeks. Results: Biologically multiplexed activity profiling in cell-based models indicated that SS-1 exerted anti-proliferative activity in B cells and promoted anti-inflammatory and immunomodulatory activity. In the clinical trial, Schirmer's test results revealed significant improvements in both eyes, with increases of 3.42 mm (95% CI, 2.44-4.41 mm) and 3.45 mm (95% CI, 2.32-4.59 mm), respectively, and a significant reduction in artificial tear use, which was -1.38 times/day, 95% CI, -1.95 to -0.81 times/day. Moreover, the increases in B-cell activating factor (BAFF) and B-cell maturation antigen (BCMA) levels were dampened by 53.20% (295.29 versus 555.02 pg/ml) and 58.33% (99.16 versus 169.99 pg/ml), respectively. Conclusion: SS-1 treatment significantly inhibited B-cell maturation antigen. No serious drug-related adverse effects were observed. Oral SS-1 administration may be a complementary treatment for Sjögren's syndrome.

Efficacy of Qiju Dihuang decoction combined with sodium hyaluronate eye drops in the treatment of xerophthalmia after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy of Qiju Dihuang decoction combined with sodium hyaluronate eye drops in the treatment of xerophthalmia after cataract surgery.<p>METHODS: A total of 120 patients with xerophthalmia after cataract surgery admitted to our hospital were selected between January 2018 and January 2020, and randomly divided into control group and observation group, with 60 cases in each group. The control group was treated with sodium hyaluronate eye drops alone, and the observation group was given Qiju Dihuang decoction combined with sodium hyaluronate eye drops, and they were treated for 1mo. The clinical efficacy, Traditional Chinese Medicine(TCM)syndromes scores, tear film break-up time(BUT), Schirmer Ⅰ test(SⅠt), corneal fluorescein staining(FL)and quality of life \〖25-item National Eye Institute Visual Function Questionnaire(NEI-VFQ-25)\〗were compared between the two groups.<p>RESULTS:After treatment, the total effective rate of treatment was 93% in observation group and was 75% in control group(<i>P</i><0.05). After 1mo of treatment, the scores of TCM syndromes(dry eyes, foreign body sensation, photophobia, blurred vision), BUT, SⅠt and FL in the two groups were improved compared with those before treatment, and the TCM syndromes scores after treatment in observation group were lower than those in control group, the BUT time was longer than that in control group, the SⅠt level was higher than that in control group while the FL score was lower than that in control group(all <i>P</i><0.05). During 3mo of follow-up, the NEI-VFQ-25 scores(general health status, mobility impairment, visual impairment)in the two groups were increased compared with those before treatment, and the scores of dimensions of NEI-VFQ-25 during 3mo of follow-up in observation group were higher than those in control group(<i>P</i><0.05).<p>CONCLUSION: Qiju Dihuang decoction combined with sodium hyaluronate eye drops has exact efficacy in treating xerophthalmia after cataract surgery, and it can effectively alleviate the symptoms of ocular discomfort, improve tear film function, and promote the quality of life of patients.

Sterile Corneal Perforation Occurring Several Years After Biliopancreatic Diversion.

BACKGROUND: To report the first two cases of sterile corneal perforation secondary to vitamin A deficiency after biliopancreatic diversion with duodenal switch (BPD/SW). METHODS: Observational case series. RESULTS: Two patients with a history of BPD/SW presented with corneal perforation associated with conjunctival xerosis and keratopathy. In both cases, serum vitamin A level dosage revealed a marked deficit, and the patients admitted poor compliance with vitamin supplementation. Oral therapy with vitamin A was started immediately, and in one case ocular surgery was performed to preserve the integrity of the globe. CONCLUSIONS: Ophthalmologists should carefully examine the ocular surface of patients undergone bariatric surgery in order to promptly recognize the signs of vitamin A deficiency and avoid serious sight-threatening complications.

Xerophthalmia: Findings from the Eye Lead to Diagnosis of a Fatal Intestinal Disease.

Vitamin A has an essential role in the maintenance of corneal and conjunctival epithelization, as well as photoreceptor transduction in the retina. A deficiency of vitamin A causes keratinization of the surface epithelium, and night blindness is often the first symptom. This report describes a case of chronic intestinal pseudo-obstruction (CIPO), a rare and potentially fatal disease, diagnosed following detection of a vitamin A deficiency in an ophthalmological examination. A 25-year-old female patient presented with a 3-month history of dryness, a burning sensation, and decreased vision, especially at night, in both eyes. She appeared cachectic and ill, and reported having lost 10 kg in the previous year. An ophthalmological examination revealed conjunctival and corneal keratinization in addition to punctate keratopathy with xerosis in both eyes, which raised the suspicion of a vitamin A deficiency. Her serum vitamin A level confirmed the diagnosis, and she was referred to the gastroenterology clinic, where she was diagnosed with CIPO and treated with parenteral multivitamin supplementation. A vitamin A deficiency should be suspected in patients with malnourishment and xerosis. Rapid diagnosis and treatment can be life-saving in cases with a severe underlying pathology.

Bilateral Keratomalacia Secondary to Diet Induced Vitamin A Deficiency in an Ethiopian Young woman: A Case Report.

BACKGROUND: Diet induced vitamin A deficiency is less commonly seen in otherwise healthy adults, due to large store of vitamin A in the body. Night blindness is the commonest manifestation of vitamin A deficiency in adults, whereas Keratomalacia is a rare manifestation. CASE REPORT: A 27 years old Ethiopian woman came to Jimma University Department of Ohthalmology with a compliant of protrusion of the globe content of both eyes within a week, after having redness and fear of light of both eyes for 2 months. She was a mother of twins and had low socioeconomic status. On general examination, she was cachectic with enlarged parotid glands. On ocular examination, she was bilaterally blind and had dry ocular surface. There was bilaterally melted cornea with prolapsed uveal tissue. After several investigations she was diagnosed as bilateral Keratomalacia (stage X3B) secondary to diet induced vitamin A deficiency. She was supplemented with vitamin A and other nutritional supplementation. Topical lubricating drops and ointments were administered. Finally, conjunctival flap was done to preserve the globe. CONCLUSION: Although it is rare, treating physicians should be aware of the occurrence of Keratomalacia in adults which is potentially blinding. Early recognition and treatment of vitamin A deficiency at the stage of night blindness is essential in reducing blindness caused by Keratomalacia.

Efficacy of pranoprofen combined with 0.3% hyaluronic acid sodium eye drops in the treatment of dry eye after cataract surgery / 中国基层医药

Objective@#To study the effect of pranoprofen combined with 0.3% hyaluronic acid sodium eye drops on dry eye after cataract surgery.@*Methods@#From July 2016 to June 2018, 80 patients with dry eye after cataract surgery in the Traditional Chinese Medicine Hospital of Yiwu were selected study objects, and they were randomly divided into control group and observation group by double blind random assignment method, with 40 cases in each group.The control group was treated with pranoprofen eye drops alone, while the observation group was treated with pranoprofen eye drops combined with 0.3% hyaluronic acid sodium eye drops.The lacrimal gland secretion, corneal fluorescein staining (FL) and corneal rupture time (BUT) were observed before and after treatment in the two groups.The improvement of dry eye symptoms, ocular surface signs score and life satisfaction were observed in the two groups.@*Results@#There were no statistically significant differences in lacrimal gland secretion test, FL and BUT test before treatment between the two groups (all P>0.05). The lacrimal gland secretion test, BUT and FL in the control group were (6.44±0.32)mm/5 min, (1.60±0.45), (4.31±0.23)s, respectively, which in the observation group were (9.03±0.86)mm/5 min, (0.66±0.25), (5.20±0.33)s, respectively, the differences were statistically significant(t=17.79, 11.43, 13.59, all P<0.05). In the control group, significant improvement in dry eye symptoms observed in 26 cases, slightly improved in 9 cases, no improvement in 5 cases, which in the observation group were 32 cases, 8 cases, 0 case, and there was statistically significant difference between the two groups (Z=0.342, P=0.006). Ocular surface signs analysis: before treatment, the score of the control group was (3.61±1.33)points, which of the observation group was (3.65±1.27)points, the difference was not statistically significant (P=0.051); after treatment, the score of the control group was (1.97±1.21)points, which of the observation group was (1.32±0.91)points, the difference was statistically significant (t=4.673, P=0.003). Life satisfaction score: after 1, 2 and 3 weeks of treatment, the control group was (20.62±3.17)points, (22.35±2.17)points, (29.16±3.19)points respectively, and the observation group was (23.32±2.16)points, (27.41±2.51)points, (33.11±4.15)points respectively, the differences are statistically significant between the two groups(t=6.29, 8.34, 6.31, P=0.002, 0.005, 0.013).@*Conclusion@#Pranoprofen combined with hyaluronic acid sodium eye drops has significant effect in the treatment of dry eye after cataract surgery.

The clinical effects of acupuncture combined with Mingmu-Dihuang pill on dry eyes / 国际中医中药杂志

Objective To evaluate the effect and safety of acupuncture combined with Mingmu-Dihuang pill in patients with dry eyes.Methods A total of 100 patients with dry eye were enrolled in line with the inclusion criteria and divided into experimental group and control group by random figure table.The experimental group was treated with acupuncture combined with Mingmu-Dihuang pill,and the control group was treated with artificial tears.After 2 months of treatment,the Schirmer test (schirmerI,SIT),tear film break up time (BUT),fluorescent staining (FL) and clinical symptom score were observed and compared,and the clinical efficacy and safety were evaluated.Results The total effective rate of the experimental group was 89.0％ (89/100) and the control group was 67.0％ (67/100),and the difference was significant (x2=14.121,P＜0.001).After treatment,the levels of BUT (7.89 ± 1.65 s vs.5.01 ± 1.72 s,t=8.543),SIT (7.45 ± 1.68 mm vs.5.01 ± 1.72 mm,t=5.991) in the experimental group were significantly higher than those of the control group,and the difference is significant (P＜0.01).The FL score and dry eye score in the experimental group were significantly lower than those of the control group (t were 11.551,12.342,P＜0.01).Conclusions Acupuncture combined with Mingmu-Dihuang pill has better clinical effect and good safety for the treatment of dry eye patients.

Efficacy of pranoprofen combined with 0.3% hyaluronic acid sodium eye drops in the treatment of dry eye after cataract surgery / 中国基层医药

Objective To study the effect of pranoprofen combined with 0.3% hyaluronic acid sodium eye drops on dry eye after cataract surgery.Methods From July 2016 to June 2018,80 patients with dry eye after cataract surgery in the Traditional Chinese Medicine Hospital of Yiwu were selected study objects , and they were randomly divided into control group and observation group by double blind random assignment method ,with 40 cases in each group.The control group was treated with pranoprofen eye drops alone ,while the observation group was treated with pranoprofen eye drops combined with 0.3% hyaluronic acid sodium eye drops.The lacrimal gland secretion , corneal fluorescein staining ( FL) and corneal rupture time (BUT) were observed before and after treatment in the two groups.The improvement of dry eye symptoms ,ocular surface signs score and life satisfaction were observed in the two groups.Results There were no statistically significant differences in lacrimal gland secretion test ,FL and BUT test before treatment between the two groups ( all P＞0.05).The lacrimal gland secretion test ,BUT and FL in the control group were (6.44 ±0.32)mm／5 min,(1.60 ±0.45),(4.31 ±0.23)s,respectively,which in the observation group were (9.03 ±0.86)mm／5 min,(0.66 ±0.25),(5.20 ±0.33)s,respectively,the differences were statistically significant(t＝17.79,11.43,13.59,all P＜0.05).In the control group,significant improvement in dry eye symptoms observed in 26 cases,slightly improved in 9 cases,no improvement in 5 cases,which in the observation group were 32 cases,8 cases,0 case,and there was statistically significant difference between the two groups (Z＝0.342,P＝0.006).Ocular surface signs analysis :before treatment,the score of the control group was (3.61 ±1.33) points, which of the observation group was (3.65 ±1.27)points,the difference was not statistically significant (P＝0.051); after treatment,the score of the control group was (1.97 ±1.21)points,which of the observation group was (1.32 ± 0.91)points,the difference was statistically significant (t＝4.673,P＝0.003).Life satisfaction score:after 1, 2 and 3 weeks of treatment, the control group was (20.62 ±3.17) points,(22.35 ±2.17) points,(29.16 ±3.19) points respectively,and the observation group was (23.32 ±2.16) points,(27.41 ±2.51) points,(33.11 ±4.15) points respectively,the differences are statistically significant between the two groups ( t＝6.29,8.34,6.31,P＝0.002, 0.005,0.013).Conclusion Pranoprofen combined with hyaluronic acid sodium eye drops has significant effect in the treatment of dry eye after cataract surgery.

[Xerophthalmia of qi and yin deficiency treated with jinhuobu needling technique].

OBJECTIVE: To explore the differences in the clinical therapeutic effects on xerophthalmia of qi and yin deficiency between the jinhuobu needling technique (the combined reinforcing technique to induce warm sensation) and the reinforcing needing technique achieved by rotating needle. METHODS: A total of 54 patients of xerophthalmia were randomized into an observation group (28 cases) and a control group (26 cases). In both of the groups, the main acupoints included Cuanzu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20); the combined acupoints were Danzhong (CV 17), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3). In the observation group, the jinhuobu needling technique was used and in the control group, the reinforcing needing technique achieved by rotating needle was adopted. The treatment was given once every day. 10 treatments made one course and 2 courses were required. Before and after treatment, the score of eye symptoms, tear secretion and the breakup time of tear film were observed in the two groups. The clinical therapeutic effects were compared between the two groups after treatment and in 4-week follow-up after treatment separately. RESULTS: After treatment, the total effective rate was 92.9% (26/28) in the observation group and was 80.8% (21/26) in the control group, without significant difference in comparison (P>0.05). In 4-week follow-up after treatment, the total effective rate was 85.7% (24/28) in the observation group and was 61.5% (16/26) in the control group, indicating the significant difference in comparison (P<0.05). After treatment, the differences were significant in the score of eye symptoms, tear secretion and the breakup time of tear film as compared with those before treatment in the two groups (all P<0.01). After treatment, the improvements of the score of eye symptoms, tear secretion and the breakup time of tear film in the observation group were better remarkably than those in the control group, indicating the significant differences (all P<0.05). CONCLUSION: The jinhuobu needling technique achieves the significant therapeutic effects on xerophthalmia of qi and yin deficiency and the recurrence rate of the disease is low.

[Comparison effects of acupuncture at distal acupoints and local acupoints on treatment of xerophthalmia].

OBJECTIVE: To compare the clinical efficacy differences between acupuncture at distal acupoints and local acupoints on treatment of xerophthalmia. METHODS: A total of 40 patients of xerophthalmia were randomly divided into a distal group and a local group, 20 cases in each one. One patient in local group lost contact, and finally 20 cases in the distal group and 19 cases in the local group finished treatment. The patients in the distal group were treated with acupuncture at Guangming (GB 37) and Diwuhui (GB 42), while those in the local group were treated with acupuncture at Cuanzhu (BL 2), Tongziliao (GB 1) and Taiyang (EX-HN 5). Patients in both groups were treated once a day, five times per week, and totally 2-week treatment were given. The subjective symptom based on visual analogue scale (VAS), tear secretion, ocular surface disease index (OSDI) and breakup time (BUT) were evaluated before treatment, after two-week treatment (end of treatment) and two weeks after end of treatment (follow-up visit) in the two groups. RESULTS: After treatment and follow-up visit, the VAS, tear secretion, OSDI and BUT were all improved (P<0.05, P<0.01), but the differences of VAS and OSDI between the two groups were not significant (both P>0.05). At follow-up visit, the differences of tear secretion and BUT between the two groups were significant (both P<0.05). CONCLUSION: The acupuncture at distal acupoints could relieve xerophthalmia symptoms, improve quality of life, increase tear secretion and prolong BUT, which is superior to local acupoints in long term.

Comparison effects of acupuncture at distal acupoints and local acupoints on treatment of xerophthalmia / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy differences between acupuncture at distal acupoints and local acupoints on treatment of xerophthalmia.</p><p><b>METHODS</b>A total of 40 patients of xerophthalmia were randomly divided into a distal group and a local group, 20 cases in each one. One patient in local group lost contact, and finally 20 cases in the distal group and 19 cases in the local group finished treatment. The patients in the distal group were treated with acupuncture at Guangming (GB 37) and Diwuhui (GB 42), while those in the local group were treated with acupuncture at Cuanzhu (BL 2), Tongziliao (GB 1) and Taiyang (EX-HN 5). Patients in both groups were treated once a day, five times per week, and totally 2-week treatment were given. The subjective symptom based on visual analogue scale (VAS), tear secretion, ocular surface disease index (OSDI) and breakup time (BUT) were evaluated before treatment, after two-week treatment (end of treatment) and two weeks after end of treatment (follow-up visit) in the two groups.</p><p><b>RESULTS</b>After treatment and follow-up visit, the VAS, tear secretion, OSDI and BUT were all improved (<0.05,<0.01), but the differences of VAS and OSDI between the two groups were not significant (both>0.05). At follow-up visit, the differences of tear secretion and BUT between the two groups were significant (both<0.05).</p><p><b>CONCLUSION</b>The acupuncture at distal acupoints could relieve xerophthalmia symptoms, improve quality of life, increase tear secretion and prolong BUT, which is superior to local acupoints in long term.</p>

Biomarkers of Nutrition for Development (BOND)-Vitamin A Review.

The Biomarkers of Nutrition for Development (BOND) project is designed to provide evidence-informed advice to anyone with an interest in the role of nutrition in health. The BOND program provides information with regard to selection, use, and interpretation of biomarkers of nutrient exposure, status, function, and effect, which will be especially useful for readers who want to assess nutrient status. To accomplish this objective, expert panels are recruited to evaluate the literature and to draft comprehensive reports on the current state of the art with regard to specific nutrient biology and available biomarkers for assessing nutritional status at the individual and population levels. Phase I of the BOND project includes the evaluation of biomarkers for 6 nutrients: iodine, folate, zinc, iron, vitamin A, and vitamin B-12. This review of vitamin A is the current article in this series. Although the vitamin was discovered >100 y ago, vitamin A status assessment is not trivial. Serum retinol concentrations are under homeostatic control due in part to vitamin A's use in the body for growth and cellular differentiation and because of its toxic properties at high concentrations. Furthermore, serum retinol concentrations are depressed during infection and inflammation because retinol-binding protein (RBP) is a negative acute-phase reactant, which makes status assessment challenging. Thus, this review describes the clinical and functional indicators related to eye health and biochemical biomarkers of vitamin A status (i.e., serum retinol, RBP, breast-milk retinol, dose-response tests, isotope dilution methodology, and serum retinyl esters). These biomarkers are then related to liver vitamin A concentrations, which are usually considered the gold standard for vitamin A status. With regard to biomarkers, future research questions and gaps in our current understanding as well as limitations of the methods are described.

Research progress on acupuncture therapy forxerophthalmia / 国际中医中药杂志

The clinical and experimental publish literatures of the traditional acupuncture treatment for xerophthalmia were review and selected, and the acupoints and outcomes index were analyzed. The clinical studies demonstrated that acupoints around eyes, head and face were mainly coordinated with Zangfu organs and meridians; and the experimental studies showed the effect of acupuncture work through stimulation of the lacrimal gland secretion, repairing lacrimal gland structure, inhibition of apoptosis to increase the flow of tears, extending the breakup time of lacrimal film, and relieving eye related symptoms.

Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: case reports and a review of the literature.

We describe the cases of 2 autistic children with ophthalmic and systemic manifestations of vitamin A deficiency due to food faddism. Although vitamin A deficiency is common in the developing world, reports in developed societies are rare. Our patients presented over a 1-year period. The patients were 14 and 13 years old at the time of presentation and were both found to have marked features of vitamin A deficiency related to unusual dietary habits. Anterior segment signs of xerophthalmia were present in both patients. In addition, patient 1 showed evidence of a rod-predominant retinopathy, which resolved with vitamin A supplementation. Due to its rare occurrence, hypovitaminosis A must be highlighted and anticipated in this cohort.