MicroRNA-376b is involved in the pathogenesis of thyroid-associated ophthalmopathy by regulating HAS2.

PURPOSE: The aim of this study was to investigate the microRNA (miRNA) expression profile in peripheral blood mononuclear cells (PBMC) of thyroid-associated ophthalmopathy (TAO) patients and to explore the molecular mechanisms of MicroRNA-376b (miR-376b) in the pathogenesis of TAO. METHODS: PBMCs from TAO patients and healthy controls were analyzed by miRNA microarray to screen for the significantly differentially expressed miRNAs. The miR-376b expression in PBMCs were confirmed by quantitative real-time polymerase chain reaction (qRT-PCR). The downstream target of miR-376b was screened by online bioinformatics, and detected by qRT-PCR and Western blotting. RESULTS: Compared with normal controls, 26 miRNAs were significantly different in PBMCs of TAO patients (14 miRNAs were down-regulated and 12 miRNAs were up-regulated). Among them, miR-376b expression was significantly decreased in PBMCs from TAO patients compared to healthy controls. Spearman correlation analysis revealed that miR-376b expression in PBMCs was significantly negatively correlated with free triiodothyronine (FT3), and positively correlated with thyroid-stimulating hormone (TSH). MiR-376b expression was obviously reduced in 6T-CEM cells after triiodothyronine (T3) stimulation compared to controls. MiR-376b mimics significantly decreased hyaluronan synthase 2 (HAS2) protein expression and the mRNA expression of intercellular cell adhesion molecule-1 (ICAM1) and tumor necrosis factor-α (TNF-α) in 6T-CEM cells, whereas miR-376b inhibitors markedly elevated HAS2 protein expression and gene expression of ICAM1 and TNF-α. CONCLUSIONS: MiR-376b expression in PBMCs was significantly decreased in PBMCs from TAO patients compared with the healthy controls. MiR-376b, regulated by T3, could modulate the expression of HAS2 and inflammatory factors. We speculate that miR-376b may be involved in the pathogenesis of TAO patients by regulating the expression of HAS2 and inflammatory factors.

Analysis of Antibodies Induced after SARS-CoV-2 Vaccination Using Antigen Coded Bead Array Luminex Technology.

Objectives. Since the outbreak of SARS-CoV-2 in late 2019, nearly 12.2 billion doses of the COVID-19 vaccine have been administered worldwide; however, the humoral immune responses induced by different types of vaccines are yet to be fully validated. Methods. We analyzed antibody levels in 100 serum samples after vaccination with different types of COVID-19 vaccines and their reactivity against the RBD antigen of Delta and Omicron variants using a bead-based microarray. Results. Elevated levels of anti-wild-type (WT)-RBD IgG and anti-WT-NP IgG were detected in participants who received two doses of the inactivated vaccines (CoronaVac or BBIBP-CorV) and three doses of the recombinant spike protein vaccine (ZF2001), indicating that antibody responses to SARS-CoV-2 were generated regardless of the vaccine administered. We found highly correlated levels of serum anti-RBD IgG and anti-NP IgG (r = 0.432, p < 0.001). We observed that the antibodies produced in vivo after COVID-19 vaccination still reacted with variants of SARS-CoV-2 (p < 0.0001). Conclusions. Our results show that high levels of specific antibodies can be produced after completion of COVID-19 vaccination (two doses of the inactivated vaccines or three doses of ZF2001), with some degree of cross-reactivity to the RBD antigen of Delta and Omicron variants, and provide an accessible and practical experimental method for post-vaccination antibody detection.

Association between HLA-B*27:04 and genetic susceptibility to ankylosing spondylitis in Hunan Province. / 湖南地区携带HLA-B*27꞉04ç­‰ä½åŸºå› äººç¾¤ä¸Žå¼ºç›´æ€§è„ŠæŸ±ç‚Žçš„æ˜“æ„Ÿæ€§å ·æœ‰å¼ºç›¸å ³æ€§ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Human leukocyte antigen (HLA) B27 is a susceptibility allele of ankylosing spondylitis (AS), and HLA-B27 antigen typing is an important indicator for clinical diagnosis of AS, but current typing methods such as sequence specific primer polymerase chain reaction (PCR-SSP) still possess limitation. Therefore, this study aims to analyze the correlation between B27 subtypes and susceptibility to AS in Hunan Province by applying high-resolution polymerase chain reaction-sequence-based typing (PCR-SBT). METHODS: Peripheral blood of 116 patients with suspected AS (suspected AS group) and 121 healthy volunteers (control group) admitted to the Second Xiangya Hospital from January 2020 to December 2020 were collected for HLA-B genotyping by PCR-SBT. Among the patients in the suspected AS group, 23 patients were finally diagnosed with AS (confirmed AS group), and the remaining 93 undiagnosed patients served as the non-confirmed AS group. PCR-SBT and PCR-SSP were used to detect HLA-B27 typing in 116 patients with suspected AS, and the results of the 2 methods were compared. RESULTS: The HLA-B27 allele frequency in the suspected AS group was significantly higher than that in the control group [11.63% vs 2.48%; P<0.001, odds ratio (OR)=5.18, 95% confidence interval (CI) 2.097 to 12.795]. B*27:04, B*27:05, B*27:06, and B*27:07 were detected in the suspected AS group and the control group. The frequency of the B*27:04 allele in the suspected AS group was significantly higher than that in the control group (9.48% vs 1.24%; P<0.001, OR=8.346, 95% CI 2.463 to 28.282). The positive rate of B27 in the suspected AS group and the confirmed AS group (B27+/+ and B27+/-) was significantly higher than that in the control group (χ2=16.579, P<0.001; χ2=94.582, P<0.001, respectively). Among the confirmed AS group, 21 were HLA-B27 carriers, and the B27 positive rate in the confirmed AS group was 91.3%. PCR-SBT could achieve high resolution typing of the HLA-B gene locus, with higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy than PCR-SSP. CONCLUSIONS: PCR-SBT typing analysis shows a strong correlation between HLA-B * 27:04 and AS in Hunan province. The PCR-SBT method can be used as the preferred option for the auxiliary diagnosis of clinical AS.

A Soluble NK-CAR Mediates the Specific Cytotoxicity of NK Cells toward the Target CD20+ Lymphoma Cells.

The structures of chimeric antigen receptors (CARs) currently designed for natural killer (NK) cells are mostly based on knowledge gained about CAR-T cells. Although these CAR-NK cells have shown promising effects, there are still many limitations to their application. In this study, we designed a soluble NK-CAR since the membrane protein NKG2D expressed by NK cells can directly trigger NK cell cytotoxicity by binding with the ligand MICA. This CAR is composed of three segments: the extracellular domain of MICA, an anti-CD20 single-chain variable fragment (anti-CD20 ScFv), and a human IgG Fc component. The nucleotide sequence of the soluble NK-CAR was cloned into a eukaryotic expression vector and expressed in suspension HEK293 cells, and the recombinant NK-CAR protein was then purified in a Staphylococcus aureus protein A column. The novel NK-CAR exhibited bifunctional activity, recognizing both the CD20 antigen of target cells and the NKG2D receptor of NKL cells. The NK-CAR activated the NKG2D receptor signaling pathway, causing NKL cells to express CD107a and secrete interferon-gamma. The soluble NK-CAR mediated the NKL cell killing of CD20+ Daudi cells in vitro, with a 1 µg/mL concentration inducing the maximum killing effect. Moreover, 51.7% (p < 0.01) of Daudi cells were killed at the effector-to-target ratio of 10:1. In the presence of recombinant rMICA and NKG2D-Ig proteins, this killing effect was reduced to 30% (P < 0.01) owing to competitive interference. Our results highlight the clinical application potential of this novel immunotherapy for killing target tumor cells.

Tumor-Derived Soluble MICA Obstructs the NKG2D Pathway to Restrain NK Cytotoxicity.

The natural killer group 2D (NKG2D) receptor and its ligands play important roles in immune surveillance. In this study, we observed that the average serum soluble MICA (sMICA) concentration of 174 hepatocellular carcinoma (HCC) patients was significantly higher than that in 80 healthy subjects (602.17 ± 338.15 vs. 72.26 ± 87.88 pg/ml, t = 3.107, P=0.002). The levels of serum sMICA in 44 HCC patients with initial levels above 400 pg/ml declined significantly after surgical removal of the liver cancer tissue (P<0.001). Moreover, the mean survival time of HCC patients who had sMICA above 400 pg/ml was significantly shorter than that HCC patients with lower sMICA levels (P<0.001). Using the reporter cell line (NKG2D-2B4) in which activation of the NKG2D receptor pathway results in GFP expression based on the stimulation of immobilized rMICA, we showed that the number of GFP-expressing cells decreased sharply in presence of sMICA. Upon adding sMICA, the release of cytokines IFN-γ, TNF-α, and IL-8 by NK cell line (NKL) under stimulation of immobilized rMICA was blocked. Using MICA-expressing cells as the target cells, we observed that about 80% of target cells were killed by NKL at E:T of 10:1, but in presence of sMICAhigh serum of HCC patients, the dead target cells were reduced to 30.8%. Compared in presence of sMICAlow serum from HCC patients, there were 63.7% of target cells dead (p=0.043). Thus, our data suggested that sMICA obstructs the activation of NKG2D pathway to protect tumor cells from NK cell-mediated cytotoxicity.

Effect of silicone oil on macular capillary vessel density and thickness.

The present study assessed changes in macular capillary vessel density and thickness associated with ocular silicone oil tamponade (SOT) following complex vitreoretinal surgery. A total of 23 patients who underwent pars plana vitrectomy combined with intravitreal SOT were retrospectively enrolled, and a single eye was assessed in each participant. Furthermore, 20 patients who required silicone oil removal (SOR) were included. The macular capillary vessel density and the foveal avascular zone (FAZ) area were analyzed using optical coherence tomography angiography (OCTA) and retinal thickness was assessed by OCT. The results demonstrated that the macular capillary vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the FAZ area and full retinal thickness were retained at a stable level following SOT (P>0.05), and also following SOR (P>0.05). Furthermore, the parafoveal (P=0.008), superior-hemi (P=0.007), temporal (P=0.015), superior (P=0.028) and nasal (P=0.002) inner retinal thickness decreased in the SOT group, whereas the inner retinal thickness was unaltered after SOR vs. baseline (P>0.05). In conclusion, silicone oil has no significant effect on macular capillary vessel density within a 6-month period but may compress and reduce the thickness of the inner retina.

The Impact of Primary Treatment on Post-Traumatic Endophthalmitis in Children with Open Globe Injuries: A Study in China.

Post-traumatic endophthalmitis (PTE) is considered as one of the most serious complications after open globe injuries (OGIs), especially in children. Poor prognosis of this disease can lead to a variety of socioeconomic problems. This study aimed to investigate the clinical characteristics of pediatric OGIs and the factors associated with the development of PTE in China. 131 patients under 14 years old and needed hospitalization for management of OGIs were enrolled. There were 90 males and 41 females. 44 patients were left-behind children, the majority were 3-6 years old (n = 71, 71/131, 54.2%) and living in rural area (n = 106, 106/131, 80.9%). After injury, 82 patients received primary repair within 24 h, with the remaining 49 patients receiving primary repair after 24 h. Eventually, there were 28 (28/131, 21.4%) patients presented with PTE. In those 49 patients, the frequency of PTE achieving 32.7% (16/49). Univariate analysis showed that the timing of primary repair is significantly associated with the development of PTE (p < 0.05). Moreover, left-behind children took higher risks in having delayed treatment that over 24 h after OGIs (OR = 2.466, 95% CI: 1.16-5.26). Reducing the time before primary repair is a useful strategy to prevent the development of PTE. Special supervision is needed for pre-school-aged boys living in rural areas, especially for left-behind children.

Ocular Cyclorotation and Corneal Axial Misalignment in Femtosecond Laser-Assisted Cataract Surgery.

Purpose: To explore ocular cyclorotation and the source of corneal axial misalignment during femtosecond laser-assisted cataract surgery (FLACS).Methods: Forty-five sequential patients (50 eyes) who had undergone FLACS (LenSx Laser System, Alcon Inc) were recruited. We took screenshots from videos of FLACS to analyze ocular cyclorotation and the real angle between primary incision and secondary incision (RAPS). In addition, crystalline lens tilt and theoretic angle between the primary and secondary incisions (TAPS) was also calculated.Results: The mean absolute value of ocular cyclorotation was 8.03 ± 4.48 degrees (0-19.1 degrees). The crystalline lens tilt was 3.30 ± 1.44 degrees (0.93-6.44 degrees). And the mean preoperative uncorrected visual acuity was 0.89 ± 0.50 LogMAR units. Pearson bivariate correlation analysis showed significant positive correlation between ocular cyclorotation with crystalline lens tilt (r = 0.37, p = .008), and ocular cyclorotation negatively correlated with axial length (r = -0.29, p = .038). In addition, the TAPS was 89.78 ± 1.45 degrees, and the RAPS was 85.68 ± 2.04 degrees. The angle error was 4.11 ± 1.28 degrees (p<0.001).Conclusions: Ocular cyclorotation commonly occurred during FLACS. In addition, increased axial length was associated with less ocular cyclorotation and increased crystalline lens tilt was related to more ocular cyclorotation. Importantly, machinery systemic errors during corneal astigmatism correction by arcuate incision in FLACS should be taken into consideration.

Inhibition of LPA1 Signaling Impedes Conversion of Human Tenon's Fibroblasts into Myofibroblasts Via Suppressing TGF-ß/Smad2/3 Signaling.

Purpose: Lysophosphatidic acid (LPA) is a growth factor-like phospholipid that has been recognized as a profibrotic mediator in numerous tissues, yet, whether it plays a role in subconjunctival fibrosis remains to be investigated. Therefore, this study was designed to examine the effect of LPA1-3 signaling inhibitor, Ki16425 on the conversion of human Tenon's fibroblasts (HTFs) into myofibroblasts. Methods: Primary cultured HTFs were incubated with transforming growth factor-ß1 (TGF-ß1) alone or combined with Ki16425, the cell proliferation and migration were measured by Cell Counting Kit-8 and the scratch wound assay, respectively. HTFs contractility was evaluated with 3-dimensional (3D) Collagen Contraction assay. The mRNA and protein levels of α-smooth muscle actin (α-SMA), Snail and the phosphorylation levels of Smad2/3, p38MAPK, and ERK1/2 were determined by real-time quantitative polymerase chain reaction (RT-qPCR), western blot, and immunofluorescence staining. Results: Ki16425 significantly prevent the proliferation and migration of Tenon's fibroblasts (HTFs) in a dose-dependent manner. Furthermore, Ki16425 blocked HTFs myofibroblast differentiation via downregulation of mRNA and protein expression of α-SMA. 3D collagen gel contraction assay demonstrated that Ki16425 effectively inhibits myofibroblast contraction induced by TGF-ß1. Mechanistically, we revealed that Ki16425 reduces Smad2/3 but not p38MAPK or ERK1/2 phosphorylation by TGF-ß1. By using an LPA1-specific inhibitor, AM095, we confirmed that LPA1 signaling but not LPA2 or LPA3 is involved in TGF-ß1 induced HTFs activation. Conclusions: Our results show that inhibition of LPA1 signaling presents potent antifibrotic effect in HTFs, which may serve as a promising intervention strategy for preventing subconjunctival fibrosis caused by glaucoma filtration surgery.

Human Macrophages Clear the Biovar Microtus Strain of Yersinia pestis More Efficiently Than Murine Macrophages.

Yersinia pestis is the etiological agent of the notorious plague that has claimed millions of deaths in history. Of the four known Y. pestis biovars (Antiqua, Medievalis, Orientalis, and Microtus), Microtus strains are unique for being highly virulent in mice but avirulent in humans. Here, human peripheral lymphocytes were infected with the fully virulent 141 strain or the Microtus strain 201, and their transcriptomes were determined and compared. The most notable finding was that robust responses in the pathways for cytokine-cytokine receptor interaction, chemokine signaling pathway, Toll-like receptor signaling and Jak-STAT signaling were induced at 2 h post infection (hpi) in the 201- but not the 141-infected lymphocytes, suggesting that human lymphocytes might be able to constrain infections caused by strain 201 but not 141. Consistent with the transcriptome results, much higher IFN-γ and IL-1ß were present in the supernatants from the 201-infected lymphocytes, while inflammatory inhibitory IL-10 levels were higher in the 141-infected lymphocytes. The expressions of CSTD and SLC11A1, both of which are functional components of the lysosome, increased in the 201-infected human macrophage-like U937 cells. Further assessment of the survival rate of the 201 bacilli in the U937 cells and murine macrophage RAW 264.7 cells revealed no viable bacteria in the U937 cells at 32 hpi.; however, about 5-10% of the bacteria were still alive in the RAW264.7 cells. Our results indicate that human macrophages can clear the intracellular Y. pestis 201 bacilli more efficiently than murine macrophages, probably by interfering with critical host immune responses, and this could partially account for the host-specific pathogenicity of Y. pestis Microtus strains.

MEK inhibition prevents TGF­ß1­induced myofibroblast transdifferentiation in human tenon fibroblasts.

Subconjunctival fibrosis represents the primary cause of postoperative failure of trabeculectomy, and at present there is a lack of effective intervention strategies. The present study aimed to investigate the effect of the mitogen­activated protein kinase kinase (MEK) inhibitor U0126 on human tenon fibroblast (HTF) myofibrosis transdifferentiation, and to illuminate the underlying molecular mechanisms involved. It was demonstrated that U0126 significantly inhibited the proliferation, migration and collagen contraction of HTFs stimulated with TGF­ß1. In addition, U0126 largely attenuated the TGF­ß1­induced conversion of HTFs into myofibroblasts, as indicated by a downregulation of the mRNA and protein expression of α­smooth muscle actin and zinc finger protein SNAI1, and by ameliorating the 3D­collagen contraction response. Mechanistically, U0126 suppressed the TGF­ß1­stimulated phosphorylation of mothers against decapentaplegic homolog 2/3, P38 mitogen­activated protein kinase and extracellular signal­regulated kinase 1/2, indicating that U0126 may inhibit HTF activation through the canonical and non­canonical signaling pathways of TGF­ß1. Therefore, U0126 exhibits a potent anti­fibrotic effect among HTFs, and the inhibition of MEK signaling may serve as an alternative intervention strategy for the treatment of trabeculectomy­associated fibrosis.

Prevalence and characteristics of peripheral myopic retinopathy in Guangzhou office workers.

AIM: To determine the prevalence and characteristics of peripheral myopic retinopathy among a sample of Guangzhou office workers. METHODS: A cross-sectional study of Guangzhou Chinese office works in different departments and units of the Guangzhou Power Supply Bureau, China, in 2016. Myopic retinopathy was recorded and analyzed with a scanning laser ophthalmoscope and by slit-lamp microscopy combined with a three-mirror contact lens. RESULTS: In total, 1910 eyes of 955 subjects (508 females and 447 males) aged 21-59y were included; 69.6% of these eyes were myopic. The myopia group had a younger age and worse uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) when compared with hyperopia and emmetropia groups (P<0.001). The axial length (AL) was significantly longer, the spherical equivalent (SE) was more serious, and the optic nerve crescent was significantly larger in subjects with myopia than with hyperopia and emmetropia. Subjects with myopia, and especially high myopia, had the highest frequency of myopic retinal 18 changes (49.4%, P<0.001) [white-without-pressure (43.8%, P<0.001), lattice degeneration (4.5%, P=0.044)] among the three groups. Logistic regression confirmed that any myopia (OR: 3.41, P<0.001) [mild myopia (OR: 1.93, P=0.001), moderate myopia (OR:3.64, P<0.001), and high myopia (OR:10.58, P<0.001)], a greater AL (OR: 1.55, P<0.001) and a much higher SE (OR: 0.77, P<0.001) increased the risk for peripheral retinal changes. CONCLUSION: Myopia-related retinal changes are positively associated with greater AL, higher SE, and myopia.

The Prevalence and Associations of Peripheral Retinopathy: Baseline Study of Guangzhou Office Computer Workers.

PURPOSE: To determine the prevalence of peripheral retinopathy and its associated risk factors among a sample of Guangzhou office computer workers. METHODS: A cross-sectional study of Guangzhou Chinese computer workstations and operators in different departments and units of the Guangzhou Power Supply Bureau, China, in 2016. Peripheral retinopathy was recorded and analyzed using a scanning laser ophthalmoscope (SLO; Optos, Daytona, United Kingdom) and slit-lamp microscopy combined with a three-mirror contact lens. RESULTS: The 1934 eyes of 967 subjects (513 females and 454 males) were included in this study. In total, 79.1% of the eyes were myopic in workers aged 20-29 years, 72.9% in workers aged 30-39 years, 62.2% in workers aged 40-49 years, and 43.4% in workers aged 50-59 years (p < 0.001). Most eyes had optic nerve crescents (81.3%). Various peripheral degenerations were found: 7 eyes (0.4%) had microcystoid degeneration, 40 (2.1%) had peripheral pigmentary degeneration, 87 (4.5%) had lattice degeneration, and 4 (0.2%) had snail-track degeneration. Nineteen (1.0%) eyes had paving-stone degeneration, 11 (0.6%) eyes had a retinal hole or tear, and 16 (0.8%) eyes had chorioretinal degeneration. Multivariate regression confirmed that greater axial length (OR: 1.18 (1.03, 1.35), p=0.012) and more serious spherical equivalent (OR: 0.82 (0.77, 0.88), p < 0.001) were significant risk factors for peripheral retinal changes. CONCLUSION: Peripheral retinal degenerative changes were found in a larger proportion of younger computer workers than older ones. Myopia is occurring in younger and younger people, accompanied by peripheral retinal degeneration.

Nintedanib inhibits TGF-ß-induced myofibroblast transdifferentiation in human Tenon's fibroblasts.

Purpose: This study aimed to investigate the effect of nintedanib on the conversion of human Tenon's fibroblasts (HTFs) into myofibroblasts and reveal the molecular mechanisms involved. Methods: Primary cultured HTFs were incubated with transforming growth factor ß1 (TGF-ß1) alone or combined with nintedanib, and cell proliferation and migration were measured by cell counting kit-8 (CCK8) and the scratch wound assay, respectively. HTF contractility was evaluated with a 3D collagen contraction assay. The mRNA and protein levels of α smooth muscle actin (α-SMA) and Snail and the phosphorylation levels of Smad2/3, p38 mitogen-activated protein kinase (p38MAPK), and extracellular signal-regulated kinase ½ (ERK1/2) were determined by quantitative reverse transcription polymerase chain reaction (RT-PCR), western blot, and immunofluorescence staining. Results: Nintedanib inhibited the proliferation and migration of HTFs in a dose-dependent manner. Furthermore, nintedanib prevented HTF myofibroblast differentiation via downregulation of mRNA and protein expression of α-SMA and Snail. A three-dimensional (3D) collagen gel contraction assay demonstrated that nintedanib effectively inhibits myofibroblast contraction induced by TGF-ß1. Mechanistically, we revealed that nintedanib reduces the TGF-ß1-induced phosphorylation of Smad2/3, p38MAPK, and ERK1/2, suggesting that nintedanib acts through both classic and nonclassic signaling pathways of TGF-ß1 to prevent HTF activation. Conclusions: Our study provides new evidence that nintedanib has potent antifibrotic effects in HTFs and suggests that it may be used as a potential therapeutic agent for subconjunctival fibrosis.

[Analysis of out-of-hospital emergency treatment for ventricular fibrillation between 2013 and 2016 in Shanghai].

OBJECTIVE: To investigate the epidemiological features of out-of-hospital patients with ventricular fibrillation (VF) in Shanghai and to analysis factors associated with outcomes, and to provide evidence for improving the success rate of VF. METHODS: The data of patients with VF admitted to Shanghai Medical Emergency Center from January 2013 to December 2016 were analyzed retrospectively. All the data were recorded including the clinical data, medical service time, return of spontaneous circulation (ROSC) at scene/en route, survival to hospital discharge. Factors that associated with successful resuscitation were analyzed by Logistic regression. RESULTS: From 2013 to 2016, 21 096 patients with suspected cardiac arrest were admitted to the Shanghai Medical Emergency Center. After excluding ventricular tachycardia (13 cases) and ventricular asystole (20 995 cases), 88 patients with VF were enrolled, with 62 male and 26 female; the average age was (63.22±16.15) years old. While bystander cardiopulmonary resuscitation (CPR) was performed in only 21 cases (23.86%). Fifty-seven cases occurred during the day (08:00-20:00), while 31 cases occurred in the night. And the average emergency response time was (6.47±4.13) minutes; the average on-site time was (14.76±10.88) minutes; the average transport to hospital time was (5.95±4.00) minutes. There were no significant differences in response time, on-site time and transport to hospital time each year, and there were no significant differences in emergency medical service time between day and night either. From 2013 to 2016, prehospital successful resuscitation rate was decreased by years [95.65% (22/23), 87.50% (14/16), 83.33% (20/24) vs. 80.00% (20/25), respectively, χ2 = 1.895, P = 0.595]. Survival to hospital discharge rate was increased by years [21.74% (5/23), 31.25% (5/16), 37.50% (9/24), 40.00% (10/25), respectively, χ 2 = 2.862, P = 0.413]. The success rate of prehospital resuscitation for patients with 1, 2, ≥3 defibrillation was 35.23% (31/88), 23.08% (12/52), 89.19% (33/37), respectively (χ2 = 42.811, P = 0.000). The on-site time in successful final resuscitation group was shorter than that in final resuscitation failure group (minutes: 10.85±8.83 vs. 16.79±11.36, t = 2.367, P = 0.020), the ROSC time in successful final resuscitation group was shorter than that of final resuscitation failure group (minutes: 3.24±3.17 vs. 7.43±6.64, t = 3.175, P = 0.002). It was shown by Logistic regression that long ROSC time was the risk factor for final resuscitation failure [odds ratio (OR) = 0.771, P = 0.024]. Gender, age, availability of witnesses CPR, call time, emergency response time, on-site time and transport to hospital time had no significant impact on the prehospital successful resuscitation and final successful resuscitation. In prehospital successful resuscitation group, there was significant difference in survival to hospital discharge rate among different defibrillation times group [48.39% (15/31), 58.33% (7/12) vs. 21.21% (7/33), χ2 = 7.460, P = 0.024]. CONCLUSIONS: From 2013 to 2016, there were no significant changes in the emergency response time, prehospital successful resuscitation rate and survival to hospital discharge rate of patients with VF in Shanghai. Though, repeated defibrillation could significantly increased prehospital successful resuscitation rate, multiple defibrillation indicated decline of survival to hospital discharge rate in prehospital successful resuscitation group. Additionally, long on-site time and long ROSC time indicated poor prognosis.

Rasch analysis of the hospital anxiety and depression scale among Chinese cataract patients.

PURPOSE: To analyze the validity of the Hospital Anxiety and Depression Scale (HADS) among Chinese cataract population. METHODS: A total of 275 participants with unilateral or bilateral cataract were recruited to complete the Chinese version of HADS. The patients' demographic and ophthalmic characteristics were documented. Rasch analysis was conducted to examine the model fit statistics, the thresholds ordering of the polytomous items, targeting, person separation index and reliability, local dependency, unidimentionality, differential item functioning (DIF) and construct validity of the HADS individual and summary measures. RESULTS: Rasch analysis was performed on anxiety and depression subscales as well as HADS-Total score respectively. The items of original HADS-Anxiety, HADS-Depression and HADS-Total demonstrated evidence of misfit of the Rasch model. Removing items A7 for anxiety subscale and rescoring items D14 for depression subscale significantly improved Rasch model fit. A 12-item higher order total scale with further removal of D12 was found to fit the Rasch model. The modified items had ordered response thresholds. No uniform DIF was detected, whereas notable non-uniform DIF in high-ability group was found. The revised cut-off points were given for the modified anxiety and depression subscales. CONCLUSION: The modified version of HADS with HADS-A and HADS-D as subscale and HADS-T as a higher-order measure is a reliable and valid instrument that may be useful for assessing anxiety and depression states in Chinese cataract population.

Pars Plana Vitrectomy and Evisceration Resulting in Death Due to Misdiagnosis of Retinoblastoma in Children: A Review of 3 Cases.

Retinoblastoma is a curable intraocular malignancy in children. However, in clinical practice, retinoblastoma can sometimes be misdiagnosed and mismanaged, leading to extraocular extension and even death. In this report, a series of 3 cases are related that emphasize the conditions and consequences resulting from misdiagnosis and mismanagement of retinoblastoma. The clinical features, imaging findings, histopatholigical examination, and management in 3 case reports of children with misdiagnosed retinoblastoma are presented. Two of the cases received pars plana vitrectomy after being misdiagnosed with Coats disease or ocular blunt trauma, whereas the third case received evisceration after being misdiagnosed with suppurative endophthalmitis. When the diagnosis of retinoblastoma had been confirmed after a second surgery was performed in our hospital, only 2 of the cases received adjuvant orbital radiotherapy. All 3 cases died of systemic tumor metastases. Intraocular surgical procedures should be avoided in any equivocal case until the possibility of latent retinoblastoma is eliminated.We strongly recommend that early enucleation be executed as soon as possible followed by postoperative adjuvant therapy under conditions wherein an intraocular surgery was inadvertently performed in an eye with retinoblastoma.

Concomitant Idiopathic Orbital Inflammatory Pseudotumor and Thyroid-Associated Ophthalmopathy.

PURPOSE: Coexistence of idiopathic orbital inflammatory pseudotumor (IOIP) and thyroid-associated ophthalmopathy (TAO) is extremely rare. The purpose of this article is to analyze the clinical features, image findings, and therapeutic outcomes of concomitant IOIP and TAO in China. MATERIALS AND METHODS: Detailed clinical records of 3 Chinese patients with concomitant IOIP and TAO were reviewed, including their clinical history, symptoms and signs, ultrasonography, computed tomography (CT), and steroid therapy. RESULTS: Among the 3 patients, were 2 men and 1 woman, aged 42, 49, and 48 years, respectively. The right orbit was involved in 1 patient and both orbits in 2 patients. In addition to showing the typical features of TAO, such as hyperthyroidism, upper eyelid retraction, and enlarged extraocular muscles with tendon sparing, all 3 patients showed ambiguous soft tissue masses in one or both orbits. Pathologic examination after biopsy of the mass in 1 patient confirmed the diagnosis of lymphatic IOIP. All the patients responded extremely well to steroid treatment. CONCLUSIONS: Although rare, a simultaneous coexistence of IOIP and TAO can occur. Therefore, it is important for clinicians to be aware of the potential for concomitant IOIP and TAO.

Orbital schwannoma originating from the superior oblique muscle.

PURPOSE: Orbital schwannoma in extraocular muscles is quite rare. In this study, we describe what, to the best of our knowledge, represents the first report of a schwannoma in the superior oblique muscle. METHODS: A case report relating clinical features as well as radiologic, surgical, and histologic findings is presented. RESULTS: A 27-year-old man presented with a 2-year history of progressive swelling in the left upper eyelid. A smooth mass was palpable within the superior nasal orbit. The left eye was slightly displaced inferiorly, and upward gaze was mildly impaired. There was no strabismus in the primary position. Magnetic resonance imaging revealed a well-defined mass in the left superior orbit measuring 32 × 18 × 8 mm, with a high T2 signal and low-to-moderate signal on T1. A left anterior orbitotomy was performed, and the tumor was completely resected. The mass originated from the tendon of the superior oblique muscle, and histologic diagnosis confirmed a schwannoma of Antoni type A. After this procedure, all symptoms were relieved and left superior oblique function was normal. No recurrence was evident at 6 months after surgery. CONCLUSIONS: This rare case demonstrates that orbital schwannoma may occur in association with the superior oblique muscle. With careful surgical dissection, normal function of the involved muscle can be restored.

Cholesterol granuloma of the orbit.

PURPOSE: The aim of this study was to present image findings, clinical and histopathologic features, and surgical management of orbital cholesterol granuloma (CG), a rare orbital entity. METHODS: Findings from 2 patients with orbitofrontal CG are presented along with a review of the literature on CG of the orbit. RESULTS: Both patients were 40-year-old men. The common symptoms of this condition in the present cases were proptosis and inferomedial displacement of the globe. Computed tomography scan in patient 1 revealed the presence of a cystic lesion without bone erosion in the superolateral orbital roof. Magnetic resonance imaging in patient 2 revealed a non-contrast-enhancing lesion with moderate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. For both cases, anterior orbitotomy through subbrow incision by drainage and curettage resulted in a curative outcome. No lesion recurrence was observed by 5 years after surgery in 1 case and 3 years in the other. Histopathologic evaluation revealed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of CG. CONCLUSIONS: Orbital CG is a rare expansive cystic condition and nearly always occurs in the lateral region of the superior orbital ridge within the frontal diploic space. This condition shows a marked preponderance in middle-aged males. The findings that computed tomography scan did not reveal bone erosion in patient 1, and magnetic resonance imaging examination showed moderate signal intensity, rather than high signal intensity, on T1-weighted images in patient 2 indicated that these represented unusual presentations. Surgical excision has a high success rate with a low incidence of recurrence.