Precise prediction of size of a foldable capsular vitreous body via computerized three-dimensional ocular reconstruction in severe retinal detachment.

BACKGROUND: This study aimed to precisely predict the size and silicone oil injection of a foldable capsular vitreous body (FCVB) via computerized three-dimensional (3D) ocular reconstruction in the treatment of severe retinal detachment in China. METHODS: The 3D software Unigraphics NX was applied to determine the volume of the inner cavity with 16-30 mm axial length, assigning the anterior and posterior chambers, the FCVB sizes, and the silicone oil injection volume, and modeling the data between the axial length and the FCVB size. In clinical practice, IOL Master was applied to accurately measure the axial length of the contralateral healthy eye to anchor the anterior-posterior and horizontal diameters of the operated eye in horizontal position CT, and compared with the model to recommend the FCVB size and silicone oil amount, and the clinical effect was validated in cases across five hospitals in China. RESULTS: For the axial length of 16-30 mm, the volume of the inner cavity is 1.2 ml-8.4 ml. FCVB size and silicone oil volume were recommended based on this volume of the inner cavity. Of 253 cases, we noted 11 cases implanted with AV-10P and 1.05 ± 0.21 ml of silicone oil, 41 with AV-12P and 1.58 ± 0.18 ml of silicone oil, 163 with AV-13.5P and 2.48 ± 0.29 ml of silicone oil, 31 with AV-15P and 3.57 ± 0.39 ml of silicone oil, and 7 with AV-17P and 5.71 ± 0.81 ml of silicone oil. There was no significant difference in postoperative visual acuity scores compared with preoperative (P = 0.097), postoperative IOP(10.29 ± 0.57mmHg)was slightly higher than preoperative IOP (9.76 ± 0.48 mmHg), but there was still no statistically significant difference between the two comparisons (P = 0.405). CONCLUSION: Three-dimensional reconstruction prediction is a good solution for eyeballs with obvious individualized changes in severe retinal detachment, and this method helps doctors standardize FCVB size selection and the silicone oil amount for patients.

Brca1 Is Regulated by the Transcription Factor Gata3, and Its Silencing Promotes Neural Differentiation in Retinal Neurons.

Previous studies have indicated that Brca1 (Breast cancer suppressor gene 1) plays an important role in neural development and degenerative diseases. However, the bioactivity and regulatory mechanism of Brca1 expression in retinal neurocytes remain unclear. In the present study, our data indicated that Brca1 maintains the state of neuronal precursor cells. Brca1 silencing induces differentiation in 661W cells. Nestin, a marker of precursor cells, was significantly decreased in parallel with Brca1 silencing in 661W cells, whereas Map2 (Microtubule associated protein 2), a marker of differentiated neurons, was significantly increased. Neurite outgrowth was increased by ~4.0-fold in Brca1-silenced cells. Moreover, DNA affinity purification assays and ChIP assays demonstrated that Gata3 (GATA binding protein 3) regulates Brca1 transcription in 661W cells. Silencing or overexpressing Gata3 could significantly regulate the expression of Brca1 and affect its promoter inducibility. Furthermore, the expression of Gata3 generally occurred in parallel with that of Brca1 in developing mouse retinas. Both Gata3 and Brca1 are expressed in the neonatal mouse retina but are developmentally silenced with age. Exogenous Gata3 significantly inhibited neural activity by decreasing synaptophysin and neurite outgrowth. Thus, this study demonstrated that Brca1 is transcriptionally regulated by Gata3. Brca1/Gata3 silencing is involved in neuronal differentiation and maturation.

Risk Factors and Prognosis of Pediatric Open Globe Injuries without Initial Light Perception.

PURPOSE: The aim of this study was to investigate the possible risk factors and prognosis of initial no light perception (NLP) in pediatric open globe injuries (POGI). PROCEDURES: This retrospective, comparative, interventional case-control study included 865 eyes of POGI patients presenting to a tertiary referral ophthalmic center from January 1, 2011 to December 31, 2015. Eyes were divided into 2 groups: the NLP group included eyes with initial NLP, and the light perception (LP) group included eyes with initial LP or vision better than LP. RESULTS: The following risk factors were significantly related to initial NLP: severe intraocular hemorrhage (OR 3.287, p = 0.015), retinal detachment (RD; OR 2.527, p = 0.007), choroidal damage (OR 2.680, p = 0.016), and endophthalmitis (OR 4.221, p < 0.001). Choroidal damage is related to remaining NLP after vitreoretinal surgery (OR 12.384, p = 0.003). At the last visit, more eyes in the NLP group suffered from silicone oil-sustained status (OR 0.266, p = 0.020) or ocular atrophy (OR 0.640, p = 0.004), and fewer eyes benefitted from final LP (OR 41.061, p < 0.001) and anatomic success (OR 4.515, p < 0.001). CONCLUSION: Severe intraocular hemorrhage, RD, choroidal damage, and endophthalmitis were possible predictors of initial NLP in POGI. Choroidal damage was the major factor related to an NLP prognosis. Traumatized eyes with initial NLP could be anatomically and functionally preserved by vitreoretinal surgery.

The Study of Dynamic Modeling and Multivariable Feedback Control for Flexible Manipulators with Friction Effect and Terminal Load.

The flexible manipulato is widely used in the aerospace industry and various other special fields. Control accuracy is affected by the flexibility, joint friction, and terminal load. Therefore, this paper establishes a robot dynamics model under the coupling effect of flexibility, friction, and terminal load, and analyzes and studies its control. First of all, taking the structure of the central rigid body, the flexible beam, and load as the research object, the dynamic model of a flexible manipulator with terminal load is established by using the hypothesis mode and the Lagrange method. Based on the balance principle of the force and moment, the friction under the influence of flexibility and load is recalculated, and the dynamic model of the manipulator is further improved. Secondly, the coupled dynamic system is decomposed and the controller is designed by the multivariable feedback controller. Finally, using MATLAB as the simulation platform, the feasibility of dynamic simulation is verified through simulation comparison. The results show that the vibration amplitude can be reduced with the increase of friction coefficient. As the load increases, the vibration can increase further. The trajectory tracking and vibration suppression of the manipulator are effective under the control method of multi-feedback moment calculation. The research is of great significance to the control of flexible robots under the influence of multiple factors.

Identification of Motor and Mental Imagery EEG in Two and Multiclass Subject-Dependent Tasks Using Successive Decomposition Index.

The development of fast and robust brain-computer interface (BCI) systems requires non-complex and efficient computational tools. The modern procedures adopted for this purpose are complex which limits their use in practical applications. In this study, for the first time, and to the best of our knowledge, a successive decomposition index (SDI)-based feature extraction approach is utilized for the classification of motor and mental imagery electroencephalography (EEG) tasks. First of all, the public datasets IVa, IVb, and V from BCI competition III were denoised using multiscale principal analysis (MSPCA), and then a SDI feature was calculated corresponding to each trial of the data. Finally, six benchmark machine learning and neural network classifiers were used to evaluate the performance of the proposed method. All the experiments were performed for motor and mental imagery datasets in binary and multiclass applications using a 10-fold cross-validation method. Furthermore, computerized automatic detection of motor and mental imagery using SDI (CADMMI-SDI) is developed to describe the proposed approach practically. The experimental results suggest that the highest classification accuracy of 97.46% (Dataset IVa), 99.52% (Dataset IVb), and 99.33% (Dataset V) was obtained using feedforward neural network classifier. Moreover, a series of experiments, namely, statistical analysis, channels variation, classifier parameters variation, processed and unprocessed data, and computational complexity, were performed and it was concluded that SDI is robust for noise, and a non-complex and efficient biomarker for the development of fast and accurate motor and mental imagery BCI systems.

The anti-inflammatory effect of minocycline on endotoxin-induced uveitis and retinal inflammation in rats.

Purpose: Uveitis is a serious inflammatory disease of the uvea, frequently leading to visual impairment and irreversible blindness. Here, we investigated the anti-inflammatory effect of minocycline on rat endotoxin-induced uveitis (EIU) and retinal inflammation. Methods: For in vivo studies, the rat EIU model was induced with intravitreal injection of lipopolysaccharide (LPS). Minocycline was administered intraperitoneally 2 h before and after the LPS injection. The severity of the ocular inflammation was evaluated with slit-lamp photography, aqueous humor cell counting, protein quantitative determination, and histological analysis. Retinal microglia were labeled with a fluorescent dye 4Di-10ASP. Microglial activity and inflammatory cytokine production were analyzed with immunofluorescence and real-time PCR. For the in vitro studies, BV-2 microglia cells were stimulated with LPS or cotreated with minocycline for 6 h. Toll-like receptor (TLR) 2/4 levels were determined with real-time PCR and western blotting. Results: The LPS-challenged eyes displayed severe inflammation in all ocular structures, including a large number of anterior chamber cells, fibrin exudation, hypopyon, and infiltrated inflammatory cells in the vitreous and retina. Immunostaining of the retinal whole-mounts also revealed numerous retinal microglia were activated promptly, and then more and more peripheral leukocytes were recruited and infiltrated in the LPS-injected retinas. Additionally, the production of tumor necrosis factor-α (TNF-α), chemokine (C-C motif) ligand 2 (CCL-2), interleukin-1 beta (IL-1ß), and IL-6 was dramatically increased. However, minocycline treatment strongly inhibited microglia activation, decreased inflammatory cytokine production, prevented peripheral inflammatory cell recruitment, and significantly attenuated ocular inflammation. Finally, we demonstrated the mechanism of the microglia inactivation effect of minocycline is via suppression of TLR4 signaling. Conclusions: This study indicates minocycline is far beyond an antibiotic. It not only attenuates rat EIU but also inhibits retinal inflammation through inactivating microglia, inhibiting inflammatory cell recruitment and inflammatory cytokine production.

Ocular surface pathogenesis associated with precocious eyelid opening and necrotic autologous tissue in mouse with disruption of Prickle 1 gene.

Ocular surface disease is one major type of eye diseases. Different etiologies trigger distinct pathological responses of the ocular surface. We previously reported that genetically engineered mice with ablation of Prickle 1 manifested precocious eyelid opening with ensuing cornea dysplasia. The current study aimed to characterize the molecular traits and the direct cause of ocular pathology associated with precocious eyelid opening in the Prickle 1 mutant mouse. Prickle 1 mutant mice exhibited a slew of ocular surface pathology including cell proliferation, cell fate transformation and inflammatory infiltration coinciding with the timing of the precocious eyelid opening. Forced eyelid opening in wild type mice did not induce cornea pathology comparable to that of the Prickle 1 mutants. Necrotic tissue debris was found associated with the lesioned cornea. RNAseq analysis of the mutant cornea revealed an expression profile shared by a range of dermatological diseases involving immune responses and cancer. Taken together, the data suggest that the necrotic eyelid debris plays an important role in ocular pathogenesis of the Prickle 1 mutant mouse, which may represent a type of non-infectious keratoconjunctivitis caused by damaged autologous tissues. Additionally, Prickle 1 mutant cornea pathogenesis may offer molecular insights into other types of epithelial pathogenesis.

Feasibility evaluation of micro-optical coherence tomography (µOCT) for rapid brain tumor type and grade discriminations: µOCT images versus pathology.

BACKGROUND: Precise identification, discrimination and assessment of central nervous system (CNS) tumors is of critical importance to brain neoplasm treatment. Due to the complexity and limited resolutions of the existing diagnostic tools, however, it is difficult to identify the tumors and their boundaries precisely in clinical practice, and thus, the conventional way of brain neoplasm treatment relies mainly on the experiences of neurosurgeons to make resection decisions in the surgery process. The purpose of this study is to explore the potential of Micro-optical coherence tomography (µOCT) as an intraoperative diagnostic imaging tool for identifying and discriminating glioma and meningioma with their microstructure imaging ex vivo, which thus may help neurosurgeons to perform precise surgery with low costs and reduced burdens. METHODS: Fresh glioma and meningioma samples were resected from patients, and then slices of such samples were excised and imaged instantly ex vivo with a lab-built µOCT, which achieves a spatial resolution of ~ 2.0 µm (µm). The acquired optical coherence tomography (OCT) images were pathologically evaluated and compared to their corresponding histology for both tumor type and tumor grade discriminations in different cases. RESULTS: By using the lab-built µOCT, both the cross-sectional and en face images of glioma and meningioma were acquired ex vivo. Based upon the morphology results, both the glioma and meningioma types as well as the glioma grades were assessed and discriminated. Comparisons between OCT imaging results and histology showed that typical tissue microstructures of glioma and meningioma could be clearly identified and confirmed the type and grade discriminations with satisfactory accuracy. CONCLUSIONS: µOCT could provide high-resolution three-dimensional (3D) imaging of the glioma and meningioma tissue microstructures rapidly ex vivo. µOCT imaging results could help discriminate both tumor types and grades, which illustrates the potential of µOCT as an intraoperative diagnostic imaging tool to help neurosurgeons perform their surgery precisely in tumor treatment process.

Positioning, Navigation, and Book Accessing/Returning in an Autonomous Library Robot using Integrated Binocular Vision and QR Code Identification Systems.

With rapid advancements in artificial intelligence and mobile robots, some of the tedious yet simple jobs in modern libraries, like book accessing and returning (BAR) operations that had been fulfilled manually before, could be undertaken by robots. Due to the limited accuracies of the existing positioning and navigation (P&N) technologies and the operational errors accumulated within the robot P&N process, however, most of the current robots are not able to fulfill such high-precision operations. To address these practical issues, we propose, for the first time (to the best of our knowledge), to combine the binocular vision and Quick Response (QR) code identification techniques together to improve the robot P&N accuracies, and then construct an autonomous library robot for high-precision BAR operations. Specifically, the binocular vision system is used for dynamic digital map construction and autonomous P&N, as well as obstacle identification and avoiding functions, while the QR code identification technique is responsible for both robot operational error elimination and robotic arm BAR operation determination. Both simulations and experiments are conducted to verify the effectiveness of the proposed technique combination, as well as the constructed robot. Results show that such a technique combination is effective and robust, and could help to significantly improve the P&N and BAR operation accuracies, while reducing the BAR operation time. The implemented autonomous robot is fully-autonomous and cost-effective, and may find applications far beyond libraries with only sophisticated technologies employed.

Modified technique for transscleral fixation of posterior chamber intraocular lenses.

BACKGROUND: Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens (PCIOL). We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of PCIOL. METHODS: The modified surgical technique is as following: at first, two 3 mm × 4 mm square scleral pockets were created from groove incisions at opposite positions. A straight needle attached to a 10-0 polypropylene suture was passed through one incision groove. Then, a 27-Gauge hollow needle passed through the opposite sclera incision bed was used to retrieve the straight fine needle via its barrel. The sutures were tied to themselves after one more bite on the scleral bed. At last, the suture ends were left long (about 4 mm) and laid flat into corresponding laminar scleral pockets. This modified technique of PCIOL was performed in 48 post-traumatic aphakic vitrectomized eyes from 48 patients (47 male, one female) with mean age of 34.8 ± 14.8 years. Main outcome measures included best corrective visual acuity (BCVA), IOL decentration, IOL tilt, and postoperative complications. RESULTS: The mean follow-up was 32.3 ± 10.8 months (3-67 months). The LogMAR BCVA remained stable, from a preoperative value of 0.46 ± 0.34 to postoperative 0.44 ± 0.34 (p = 0.69). Mild IOL tilt (5-10°) was observed in five eyes, and slight IOL decentration (0.5-1.0 mm) was seen in three cases. No case of suture exposure, suture breakage, IOL dislocation, or endophthalmitis was observed during the follow up period. CONCLUSION: The modified technique allowed stable placement of PCIOLs in post-traumatic aphakic eyes with a wide range of follow-up. Our procedure might have the potential benefit to avoid suture exposure in scleral-fixated IOL implantation.

Causative organisms of post-traumatic endophthalmitis: a 20-year retrospective study.

BACKGROUND: A wide range of organisms that enter the eye following ocular trauma can cause endophthalmitis. This study was to investigate the spectrum of pathogens and antibiotic susceptibility of bacterial isolates from a large cohort of post-traumatic endophthalmitis cases. METHODS: A retrospective study of 912 post-traumatic endophthalmitis patients treated at a tertiary eye-care center in China was performed. The associations between risk factors and the most common isolated organisms were investigated by Chi square Test. The percent susceptibilities for the first 10 years (1990-1999) and the second 10 years (2000-2009) were compared by Chi square test. p < 0.05 was considered statistically significant. RESULTS: Three-hundred-forty-seven (38.1%) cases of endophthalmitis were culture-positive, and 11 (3.2%) showed mixed infections (Gram-negative bacilli and fungi), yielding a total of 358 microbial pathogens. Culture proven organisms included 150 (41.9%) Gram-positive cocci, 104 (29.1%) Gram-negative bacilli, 44 (12.3%) Gram-positive bacilli, and 60 (16.8%) fungi. The coagulase-negative staphylococcal (CNS) species S. epidermidis (21.8%) and S. saprophyticus (12.0%) were the predominant pathogens, followed by Bacillus subtilis (8.7%), Pseudomonas aeruginosa (7.8%), and Escherichia coli (6.4%). Delayed repair over 24 h (p < 0.001) and metallic injury (p < 0.01) were significantly associated with positive culture of CNS. The most frequent fungal species were Aspergillus (26/60), followed by yeast-like fungi (18/60). P. aeruginosa was relatively sensitive to ciprofloxacin (83.3%), cefoperazone (75%), tobramycin (75%), cefuroxime (75%), and ceftazidime (75%) during the second decade. Multi-drug resistance was observed in the predominant Gram-negative bacteria. CONCLUSION: We identified a broad spectrum of microbes causing post-traumatic endophthalmitis, with Gram-positive cocci the most frequently identified causative organism, followed by Bacillus species, fungi, and mixed infections. CNS infection was statistically associated with delayed repair and metallic injury. Variation in antibiotic susceptibility was observed among isolated bacteria and between different periods. Ciprofloxacin and ceftazidime in the first and second decades of the study, respectively, showed the highest activity against bacterial post-traumatic endophthalmitis. For infections caused by P. aeruginosa, a combination therapy of ciprofloxacin, tobramycin, and one of the cephalosporins might provide optimal coverage according to data from the second decade.

Multiscale knowledge distillation with attention based fusion for robust human activity recognition.

Knowledge distillation is an effective approach for training robust multi-modal machine learning models when synchronous multimodal data are unavailable. However, traditional knowledge distillation techniques have limitations in comprehensively transferring knowledge across modalities and models. This paper proposes a multiscale knowledge distillation framework to address these limitations. Specifically, we introduce a multiscale semantic graph mapping (SGM) loss function to enable more comprehensive knowledge transfer between teacher and student networks at multiple feature scales. We also design a fusion and tuning (FT) module to fully utilize correlations within and between different data types of the same modality when training teacher networks. Furthermore, we adopt transformer-based backbones to improve feature learning compared to traditional convolutional neural networks. We apply the proposed techniques to multimodal human activity recognition and compared with the baseline method, it improved by 2.31% and 0.29% on the MMAct and UTD-MHAD datasets. Ablation studies validate the necessity of each component.

ECG classification using 1-D convolutional deep residual neural network.

An electrocardiograph (ECG) is widely used in diagnosis and prediction of cardiovascular diseases (CVDs). The traditional ECG classification methods have complex signal processing phases that leads to expensive designs. This paper provides a deep learning (DL) based system that employs the convolutional neural networks (CNNs) for classification of ECG signals present in PhysioNet MIT-BIH Arrhythmia database. The proposed system implements 1-D convolutional deep residual neural network (ResNet) model that performs feature extraction by directly using the input heartbeats. We have used synthetic minority oversampling technique (SMOTE) that process class-imbalance problem in the training dataset and effectively classifies the five heartbeat types in the test dataset. The classifier's performance is evaluated with ten-fold cross validation (CV) using accuracy, precision, sensitivity, F1-score, and kappa. We have obtained an average accuracy of 98.63%, precision of 92.86%, sensitivity of 92.41%, and specificity of 99.06%. The average F1-score and Kappa obtained were 92.63% and 95.5% respectively. The study shows that proposed ResNet performs well with deep layers compared to other 1-D CNNs.

[Preliminary Study on the Relationship between the Developmental Stage of Multiple Myeloma Disease and the Results of Bone Marrow Whole Exome Sequencing].

OBJECTIVE: To investigate the genetic results of whole exome sequencing of bone marrow from new onset multiple myeloma (MM) patients to analyze the process of genetic clonal evolution in MM patients. METHODS: Genomic DNA was extracted from bone marrow samples of 15 MM patients and the whole exomes sequencing was performed using next generation sequencing technology. Using own buccal cells as germline controls, combinated with clinical information, the mutation profile of genes from high-risk asymptomatic myeloma to symptomatic myeloma were analyzed, and genes that may be associated with the efficacy and side effects of bortezomib were screened. RESULTS: Except for two patients in whom no peripheral neuropathy was observed after a short treatment period, other patients peripheral neuropathy developed of various degrees during treatment with bortezomib containing chemotherapy, and the vast majority of patients achieved remission after receiving this bortezomib-related chemotherapy regimen. All patients had comparable levels of the inherited mutations number, but the somatic mutations was correlated with disease evolution. CONCLUSION: different gene "mutational spectra" exist in myeloma patients at different stages and are associated with progression through all stages of the disease.

Incidence of myopic shift and related factors in young Chinese adults.

CLINICAL RELEVANCE: Myopia is a leading cause of visual impairment worldwide, and myopia progression in young adulthood may worsen this public health issue. BACKGROUND: The aim was to describe the changes in myopia and various ocular biometry parameters, and to determine the incidence and related factors of myopic shift among young adults in China. METHODS: This 2-year prospective cohort study was conducted at the Zhongshan Ophthalmic Center, Sun Yet-san University, China. A total of 291 Chinese medical freshmen (314 enrolled at baseline) were followed over 2 years. The participants underwent detailed eye examinations at baseline and follow-up visits, including cycloplegic refraction, ocular biometry measurements, and swept-source optical coherence tomography. Visual fatigue was assessed with the Convergence Insufficiency Symptom Survey (CISS) using Rasch analysis. Questionnaire on eye care habits and physical activities was administered. RESULTS: A total of 291 study participants (baseline mean [SD] age, 18.7 [0.9] years; 132 [45.4%] male) were analysed. Seventy eight (26.8%) developed a myopic shift (defined as negative change in spherical equivalent worse than or equal to -0.50 D) over a 2-year period. The magnitude of subfoveal choroidal thinning was greater in participants with myopic shift, compared to those without. Axial length increased significantly by 0.12 mm in the group with myopic shift, compared to 0.02 mm in those without the myopic shift (p < 0.001) over 2 years. After multivariable adjustment, visual fatigue (using CISS) was found to be associated with the myopic shift (p = 0.02). CONCLUSIONS: Approximately one in four Chinese medical students had a clinically significant myopic shift. Choroidal thinning and axial elongation were observed in young adults with myopic shift. Greater visual fatigue score at baseline was associated with myopic shift after multivariable adjustment.

Clinical Features, Antibiotic Susceptibilities, and Outcomes of Endophthalmitis Caused by Streptococcal Infection: Children vs. Adults.

Streptococcus spp. are common causative organisms of endophthalmitis. Analysis of the clinical features, antibiotic susceptibilities, and outcomes of streptococcal endophthalmitis in children and adults may guide future management. Sixty-seven patients (67 eyes) with streptococcal endophthalmitis who were admitted to the Zhongshan Ophthalmic Center between January 2013 and December 2022 were retrospectively reviewed. The mean age was 20.7 ± 21.6 years, and 59.7% were children. Streptococcal infection accounted for 13.9% of culture-proven bacterial endophthalmitis cases; the proportion was higher in children than in adults (32.3% vs. 7.6%, p < 0.01) and increased from 8.1% in 2013-2017 to 20.1% in 2018-2022 (p < 0.01). Eye trauma was the most common etiology in both children and adults (82.5% and 66.7%, respectively). Viridans group streptococci were the most common isolates, followed by S. pneumoniae. The susceptibility rates of the streptococci to vancomycin, cefuroxime, and levofloxacin were 100%, 95.5%, and 93.0%, respectively. The overall mean best-corrected visual acuity increased from 2.74 ± 0.19 logMAR initially to 2.32 ± 0.75 logMAR at the last follow-up (p < 0.05). In conclusion, streptococcal infections have increased in cases of bacterial endophthalmitis in recent years and are more common in children. The commonly used antibiotics, vancomycin, cefuroxime, and fluoroquinolone, showed higher antibiotic susceptibility. After prompt treatment, visual outcomes improved.

Exposure to the Life of a School Child Rather Than Age Determines Myopic Shifts in Refraction in School Children.

Purpose: The prevalence of myopia increases with both age and grade for children attending school. The current study aimed to distinguish the effects of aging and grade on myopia. Methods: Grade 1 students (706 at baseline in 2009, mean age 6.56 ± 0.29 years, range 6.00 to 6.99 years old, 55.5% boys) were followed up until 2012. Cycloplegic spherical equivalent (SE) was measured annually. Results: The sample in a grade was divided into three 4-month age blocks according to their birth month. Within each grade, there were no significant differences in SE between age blocks (all P > 0.05), despite an age range of one year. More myopic SE was observed in the youngest block of grade 2 compared to the oldest block of grade 1 (difference, -0.36 ± 0.08 D; P < 0.001), although age of the two blocks only differed by four months. Similarly, more myopic SE were found in the youngest block in grade 3 than the oldest block in grade 2 (differences, -0.50 ± 0.10 D; P < 0.001) and in the youngest block in grade 4 than the oldest block in grade 3 (differences, -0.82 ± 0.14 D; P < 0.001). Conclusions: Exposure to schooling, rather than age, appears to be the major driver of refractive development, at least in the early years of schooling. Interventions during this period, involving reductions in educational pressure and increased time outdoors may have major effects on the subsequent development of myopia.

Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal.

PURPOSE: To evaluate endogenous endophthalmitis clinical features following minimally invasive removal of upper urinary tract calculi. METHODS: Medical records of twelve patients (17 eyes) with endogenous endophthalmitis secondary to minimally invasive upper urinary tract calculus removal were retrospectively reviewed. RESULTS: Diabetes mellitus was found in 7 patients (58%). 10 patients (83%) suffered from fever. The stone extraction and ocular symptom onset interval ranged from 2 to 22 days. All eyes presented as vitritis and fluffy yellow-white retinal exudates. Hypopyon was only found in 3 eyes (18%). 5 patients (42%) were misdiagnosed as uveitis which led to mismanagement. Ocular fluids were culture positive for only C. albicans in 12 eyes (71%). 10 of 12 eyes (83%) with silicon oil tamponade obtained a final BCVA≥0.05. CONCLUSIONS: C. albicans was the most common endogenous endophthalmitis pathogen after urinary calculus removal by minimally invasive surgery. Pars plana vitrectomy with silicon oil tamponade may be helpful to achieve a favorable visual outcome. Routine ophthalmologic evaluation by the uveitis or vitreoretinal specialist may be necessary within 2 weeks after the urological procedures.

[Expression and Significance of PD-1, PD-L1 and CTLA-4 in the Bone Marrow of Patients with Multiple Myeloma].

OBJECTIVE: To study the expression and significance of PD-1, PD-L1 and CTLA-4 tumor-associated antigens in multiple myeloma. METHODS: Bone marrow specimens from 122 patients with multiple myeloma were collected and divided into new-onset group (NDMM), complete remission group (CRMM) and relapsed and refractory group (RRMM) according to the disease progression stage. The proportion of CD4+ T lymphocytes, CD8+ T lymphocytes, Treg cells and plasma cells in the specimens and the expressions of PD-1, PD-L1 and CTLA-4 were detected by multi-parameter flow cytometry. RESULTS: There was no significant difference in the proportion of CD8+T and Treg cells among the three groups (P>0.05), while the proportions of CD4+T cells and PC in NDMM group were significantly higher than those in the CRMM group (P<0.05), the ratios of CD4+ to CD8+T in the NDMM and RRMM groups were significantly higher than those in the CRMM group (P<0.05). The expressions of PD-1, PD-L1 and CTLA-4 in CD8+ T cells was no significant difference among NDMM, CRMM and RRMM groups (P>0.05). While the expressions of PD-1, PD-L1 and CTLA-4 in CD4+ T cells and PC in the NDMM group were significantly lower than that in the CRMM group (P<0.05). There was significantly difference among the three groups in the expression of PD-1 in Treg cells, of which the NDMM group was significantly lower than that of the CRMM group (all P<0.05). The expressions of PD-1 and CTLA-4 in PC were significantly higher than those in CD8+ T, CD4+ T and Treg cells (P<0.05), the expression of PD-L1 in CD8+ T cells was significantly higher than that in CD4+ T and Treg cells (P<0.05). CONCLUSION: There is a correlation between the immune status of multiple myeloma and the expressions of PD-1, PD-L1 and CTLA-4 in plasma cells and lymphocyte subsets in vivo.