Do not stumble over the same "stone" twice: a case series of endogenous endophthalmitis secondary to severe systemic diseases.

BACKGROUND: Endogenous endophthalmitis (EE) is a rare but highly destructive eye emergency secondary to systemic infection. Acute endophthalmitis can lead to irreversible vision impairment or even loss of the whole eye, unless being diagnosed and treated promptly. CASE PRESENTATION: This study reports three typical EE cases of endogenous endophthalmitis secondary to different severe systemic diseases. Patients were recruited from the Department of ophthalmology at Zhongnan hospital of Wuhan University and the Department of ophthalmology at the Second Affiliated Hospital of Fujian Medical University. Patients were followed up for up to 60 days. Among these cases, the eye symptoms is the initial manifestations while secondary to original different special systemic conditions. Patients have been treated under dynamically prompt response undergoing systemic treatment and eye treatment at the same time. Best corrected visual acuity were 20/40, 20/60 and light perception during follow-up evaluation. CONCLUSIONS: Our observation suggest that prompt identification and treatment could save patients' vision from EE.

Clinical Differences between Posner-Schlossman Syndrome Patients with Intermittent Intraocular Pressure Elevation and Glaucomatous Damage.

INTRODUCTION: Although there is abundant evidence that Posner-Schlossman syndrome (PSS) can lead to secondary glaucoma, data on the clinical differences between PSS patients with secondary glaucoma and those with intermittent intraocular pressure (IOP) elevation are sparse. METHODS: This retrospective observational study included 52 patients (52 eyes) diagnosed with PSS and admitted to Zhongnan Hospital of Wuhan University between January 2019 and February 2022. Demographic characteristics and clinical features were gathered from admission records. Patients were divided into two groups: 27 cases with intermittent IOP elevation (group A) and 25 cases with secondary glaucoma (group B and C). Of the secondary glaucoma cases, 18 were further divided into the topical IOP-lowering medications group (group B) and 7 into the glaucoma surgery group (group C). Clinical characteristics of different groups were compared. RESULTS: Compared to the intermittent IOP elevation group, PSS patients with secondary glaucoma had a longer course of disease, a higher incidence of iris depigmentation, lower best corrected visual acuity, lower endothelial cell density, and higher interferon-γ (IFN-γ) concentration and cytomegalovirus (CMV) deoxyribonucleic acid (DNA) copy number in the aqueous humor (all p < 0.05). Group C presented a higher CMV DNA copy number in the aqueous humor than groups A and B (p < 0.05). Compound trabeculectomy proved effective in group C, with a functional filter bleb and well-controlled IOP without disease progression after 1 year of follow-up. CONCLUSION: Distinctive characteristics existed between PSS patients with secondary glaucoma and those with intermittent IOP elevation. Compound trabeculectomy appears to be an effective treatment option when IOP cannot be controlled through topical medications.

C-MET-dependent signal transduction mediates retinoblastoma growth by regulating PKM2 nuclear translocation.

Mesenchymal epithelial transition (C-MET) factor overexpression has been found in many types of cancer and has served as an important molecular target for therapeutic intervention. However, the role of C-MET in retinoblastoma remains largely unclear. The present study aimed to investigate the potential role and mechanism of C-MET in Y79 retinoblastoma cells. We found that C-MET was highly expressed in Y79 retinoblastoma cells, and, in addition, the levels of C-MET were positively correlated with cell proliferation and retinoblastoma growth. Inhibition of C-MET suppressed Y79 retinoblastoma cell proliferation and tumour growth. Mechanistically, we showed that HGF-induced C-MET-dependent signal transduction resulted in ERK 1/2 phosphorylation, which subsequently promoted the nuclear translocation of PKM2. Nuclear PKM2 further interacted with histone H3 and contributed to C-MET-dependent cyclin D1 and c-Myc expression and cell proliferation. These findings highlight the role of C-MET in Y79 retinoblastoma cells and reveal a C-MET-dependent signal transduction mechanism. C-MET may be a potential therapeutic target for retinoblastoma. SIGNIFICANCE OF THE STUDY: We demonstrated a new target of retinoblastoma, C-MET. C-MET-dependent signal transduction promotes Y79 retinoblastoma cell proliferation and tumour growth through ERK 1/2/PKM2/histone H3 signalling pathway. C-MET may be a potential target for retinoblastoma therapy.

Long term follow up and retrospective study on 533 gastric cancer cases.

BACKGROUND: Gastric cancer (GC) is the third leading cause of cancer death in China and the outcome of GC patients is poor. The aim of the research is to study the prognostic factors of gastric cancer patients who had curative intent or palliative resection, completed clinical database and follow-up. METHODS: This retrospective study analyzed 533 GC patients from three tertiary referral teaching hospitals from January 2004 to December 2010 who had curative intent or palliative resection, complete clinical database and follow-up information. The GC-specific overall survival (OS) status was determined by the Kaplan-Meier method, and univariate analysis was conducted to identify possible factors for survival. Multivariate analysis using the Cox proportional hazard model and a forward regression procedure was conducted to define independent prognostic factors. RESULTS: By the last follow-up, the median follow-up time of 533 GC patients was 38.6 mo (range 6.9-100.9 mo), and the median GC-specific OS was 25.3 mo (95% CI: 23.1-27.4 mo). The estimated 1-, 2-, 3- and 5-year GC-specific OS rates were 78.4%, 61.4%, 53.3% and 48.4%, respectively. Univariate analysis identified the following prognostic factors: hospital, age, gender, cancer site, surgery type, resection type, other organ resection, HIPEC, LN status, tumor invasion, distant metastases, TNM stage, postoperative SAE, systemic chemotherapy and IP chemotherapy. In multivariate analysis, seven factors were identified as independent prognostic factors for long term survival, including resection type, HIPEC, LN status, tumor invasion, distant metastases, postoperative SAE and systemic chemotherapy. CONCLUSIONS: Resection type, HIPEC, postoperative SAE and systemic chemotherapy are four independent prognostic factors that could be intervened for GC patients for improving survival.

Evaluation of the staging systems for gastric cancer.

BACKGROUND: Some staging systems for gastric cancer (GC) have been developed as alternatives to the 6th and 7th TNM staging systems, including the Hybrid, tumor-ratio-metastasis (TRM), and Kiel staging systems. This study evaluated the overall performance of these systems for GC. METHODS: A total of 540 GC patients undergoing surgical resection were staged using these five systems. Homogeneity, discrimination power, predictive accuracy, and complexity of these systems were compared. RESULTS: Multivariate analyses showed that all of 7th pT, pN, and pM classifications were independent factors for GC prognosis (P < 0.001 for all). Compared with the other four systems, 7th TNM system had improved stage groups homogeneity (7 of 8 stage groups homogeneous), enhanced discrimination power (4 of 5, 5 of 7, 4 of 7, 3 of 7, and 1 of 4 adjacent stage groups were differentiated by the 6th, 7th TNM, Hybrid, TRM, and Kiel systems, respectively), and better prediction value for GC patients' outcome (AUC = 0.801, P < 0.001). In addition, the 7th TNM system did not increase the staging complexity (9 groups and 21 subgroups). CONCLUSIONS: The 7th TNM staging system represents advancement in GC staging system for better prediction of clinical outcomes.

Risk factors associated with corneal endothelial cell density in Posner-Schlossman syndrome.

PURPOSE: To investigate the risk factors related to corneal endothelial cell density (ECD) in patients with Posner-Schlossman syndrome (PSS). PATIENTS AND METHODS: It was an observational retrospective study. We reviewed the medical records of patients with PSS who attended the ophthalmology department at Wuhan University Zhongnan Hospital from January 2019 to December 2021. 42 eyes of 42 patients with PSS were included in the study. Demographic characteristics and clinical manifestations were recorded. The clinical characteristics of PSS patients with reduced ECD were compared with PSS patients with normal ECD. Simple and multiple linear regression analyses were carried out to identify the risk factors for ECD in PSS. RESULTS: The ECD-lowered group had a longer disease duration (P = 0.000), higher rate of occurrence of corneal edema (P = 0.039), higher cytomegalovirus (CMV) deoxyribonucleic acid (DNA) copy number (P = 0.044), higher interleukin-10 (IL-10) level in the aqueous humor (P = 0.044), and thinner average retinal nerve fiber layer (RNFL) thickness (P = 0.016) than the control group. The results of multiple linear regression analysis indicated that disease duration (ß = - 0.287, P = 0.024) and level of IL-10 in the aqueous humor (ß = - 0.408, P = 0.001) were significantly negatively associated with ECD, while average RNFL thickness (ß = 0.330, P = 0.007) was significantly positively related to ECD in PSS. CONCLUSION: A longer disease duration, higher degree of glaucomatous damage and elevated level of IL-10 in the aqueous humor were associated with reduced ECD in PSS.

Efficacy and Safety of Combined Surgeries including Intraocular Direct Cyclophotocoagulation with a 532 nm Laser to Treat Advanced Neovascular Glaucoma.

PURPOSE: The purpose of this study was to assess the efficacy and safety of intraocular direct cyclophotocoagulation (IDCP) using a 532 nm laser with combination treatment in reducing intraocular pressure (IOP) for patients with advanced neovascular glaucoma (NVG) with angle closure. In addition, we sought to determine the success rate and frequency of complications and explore an optimized solution to reduce the number of topical medications and the pain of patients. METHODS: A retrospective case note review of all patients undergoing combined treatment including IVR, phaco, PPV, PRP, and IDCP from January 2017 to June 2018. RESULTS: In total, 24 consecutive patients (25 eyes) were reviewed. The mean IOP was significantly decreased from 42.2 ± 8.5 mmHg preoperatively to 15.56 ± 2.0 mmHg (P < 0.0001), and no neovascularization of the iris (NVI) reoccurred at month 18. The number of medications used was reduced from 2.72 ± 0.45 preoperatively to 0.87 ± 0.40 at month 18 (P < 0.0001). CONCLUSIONS: During 18 months of follow-up, the combined treatments were safe and had a significant IOP-lowering effect. This study provides a new method of performing IDCP with a 532 nm laser, allowing for the use of internal cyclophotocoagulation without extra equipment.

HELZ2 promotes K63-linked polyubiquitination of c-Myc to induce retinoblastoma tumorigenesis.

Retinoblastoma is a rare ocular tumor in children that originates in the retina. Several core transcriptional regulators maintain the expansion of retinoblastoma tumors, including c-Myc. Here, we demonstrated that Helicase with zinc finger domain 2 (HELZ2) promoted retinoblastoma tumorigenesis by targeting c-Myc. HELZ2-deficient inhibited retinoblastoma cell proliferation, whereas overexpression of HELZ2 promoted retinoblastoma cell proliferation. In addition, high levels of HELZ2 promoted xenograft retinoblastoma tumorigenesis and inhibited animal survival. Mechanistically, HELZ2 interacted with c-Myc and promoted its K63-linked polyubiquitination. We indicated that HELZ2 promoted the interaction between E3 ubiquitin ligase HUWE1 and c-Myc, and HELZ2-mediated K63-linked polyubiquitination and activation of c-Myc were dependent on HUWE1. Taken together, HELZ2 plays a critical role in the regulation of retinoblastoma tumorigenesis by enhancing the activity of c-Myc.

Evaluation of Autologous Blood in Pterygium Surgery With Conjunctival Autograft.

PURPOSE: Autologous blood has been used exploratively with conjunctival autograft in pterygium surgery. However, it is controversial whether autologous blood performed better than other fixation methods, including fibrin glue and sutures. This meta-analysis was conducted to evaluate the effectiveness of using autologous blood in pterygium surgery with conjunctival autograft. METHODS: The study was conducted according to the PRISMA guidelines. The MEDLINE, Cochrane library, and Embase databases were systematically searched from their establishment until April 1, 2018. Randomized controlled trials comparing autologous blood with fibrin glue/suture in pterygium surgery with conjunctival autograft were included. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Outcome measurements were recurrence, graft displacement, graft retraction, and surgical duration. Review Manager 5.3 (Cochrane Community, Cochrane Collaboration, London, UK) was used to perform the statistical analysis. When I < 50%, statistical heterogeneity was considered acceptable, and a fixed-effects model was adopted; alternatively, the random-effects model was used. RESULTS: Seven randomized controlled trials including 516 patients were finally included in the meta-analysis. Four studies with 379 patients compared autologous blood and fibrin glue. Autologous blood was inferior to fibrin glue with respect to surgical duration, graft retraction, and graft displacement. However, there was no statistical difference between the 2 groups in terms of the recurrence rate. Four studies with 152 patients compared autologous blood and traditional suturing. Autologous blood was superior to sutures in terms of surgical duration and inferior to sutures in terms of graft retraction. No difference was detected in terms of graft displacement and recurrence rate. CONCLUSIONS: In conclusion, autologous blood is an appropriate method for graft fixation in pterygium surgery. Current research suggests that autologous blood derivatives may be a promising approach after pterygium excision. However, this requires further confirmation.

Quantum dot-based multiplexed imaging in malignant ascites: a new model for malignant ascites classification.

PURPOSE: The aims of this study are to establish a new method for simultaneously detecting the interactions between cancer cells and immunocytes in malignant ascites (MA) and to propose a new model for MA classification. METHODS: A quantum dot (QD)-based multiplexed imaging technique was developed for simultaneous in situ imaging of cancer cells, lymphocytes, and macrophages. This method was first validated in gastric cancer tissues, and then was applied to MA samples from 20 patients with peritoneal carcinomatosis from gastrointestinal and gynecological origins. The staining features of MA and the interactions between cancer cells and immunocytes in the ascites were further analyzed and correlated with clinical features. RESULTS: The QD-based multiplexed imaging technique was able to simultaneously show gastric cancer cells, infiltrating macrophages, and lymphocytes in tumor tissue, and the technique revealed the distinctive features of the cancer tumor microenvironment. When this multiplexed imaging protocol was applied to MA cytology, different features of the interactions and quantitative relations between cancer cells and immunocytes were observed. On the basis of these features, MA could be classified into immunocyte-dominant type, immunocyte-reactive type, cancer cell-dominant type, and cell deletion type; the four categories were statistically different in terms of the ratio of cancer cells to immunocytes (P<0.001). Moreover, in the MA, the ratio of cancer cells to immunocytes was higher for patients with gynecological and gastric cancers than for those with colorectal cancer. CONCLUSION: The newly developed QD-based multiplexed imaging technique was able to better reveal the interactions between cancer cells and immunocytes. This advancement allows for better MA classification and, thereby, allows for treatment decisions to be more individualized.

Lymph node ratio is a better prognosticator than lymph node status for gastric cancer: A retrospective study of 138 cases.

To study the clinical significance of lymph node ratio (LNR) in gastric cancer (GC), this study analyzed 613 patients with GC who underwent surgical resection. Of 613 patients with GC, 138 patients who had >15 lymph nodes (LNs) resected and radical resection were enrolled into the final study. All major clinicopathological data were entered into a central database. LNR was defined as the ratio of the number of metastatic LNs to the number of removed LNs. In order to determine the best cut-off points for LNR, the log-rank test and X-tile were used. LNR was then substituted for lymph node status (pN) in the 7th American Joint Committee on Cancer tumor-node-metastases (TNM) staging system and this was defined as the tumor-node ratio-metastases (TRM) staging system. Pearson's correlation coefficient (r) was used to study the correlations among the number of removed LNs, pN and LNR. The Kaplan-Meier survival curve was used to study the survival status, and the log-rank test and Cox proportional hazards model were used to identify the independent factors for survival. Receiver operating characteristic curve analysis was used to determine the predictive value of the parameters. By the time of last follow-up (median follow-up period, 38.3 months; range, 9.9-97.7 months), the median overall survival (OS) was 23.9 months [95% confidence interval (CI), 18.8-29.0 months]. The 1-, 2-, 3- and 5-year survival rates were 76.8, 57.2, 50.0 and 46.4%, respectively. The cut-off points were 0, 0.5 and 0.8 (R0, LNR=0; R1, LNR ≤0.5; R2, 0.5> LNR ≤0.8; and R3, LNR >0.8). Univariate and multivariate analyses revealed that both LNR and pN were independent prognostic factors for GC. LNR could better differentiate OS in patients than LN. In addition, the TRM staging system was better at predicting the clinical outcomes than the TNM staging system, and LNR was better than pN. In conclusion, LNR was a better prognosticator than pN for GC.

Cellulose nanowhiskers: preparation, characterization and cytotoxicity evaluation.

OBJECTIVE: To characterize the structure and to evaluate the cytotoxicity of cellulose nanowhiskers (CNW) prepared from cotton linters. METHODS: A series of CNW dispersions was prepared by hydrolyzing cotton linters with sulfuric acid. The structure of CNW was characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR) and X-ray diffraction (XRD). The cytotoxicity of CNW dispersions to L929 cells was preliminarily investigated by cell culture and MTT assay. RESULTS: SEM and TEM observation showed that the original cotton litters have been successfully acid-hydrolyzed into cellulose nanowhiskers having needle- or short rod-like structure with an average length of 250 nm and diameter of 10 nm. XRD patterns suggested that degree of crystalline in the CNW was much higher than that in the cotton linters as a result that the acid-hydrolysis process has removed the amorphous domains in the cotton linters. The results from MTT assay and cell morphology observation indicated that CNW with concentration from 0.01% to 0.2% had low toxicity to L929 cells, while cytotoxicity showed an increase tendency with an increase in the concentration of CNW. CONCLUSIONS: Cellulose nanowhiskers dispersion could be prepared from cotton linters by acid-hydrolysis process. CNW showed potential applications as nanobiomaterials due to its low cytotoxicity.