Novel valley character and tunable quasi-half-valley metal state in Janus monolayer VSiGeP4.

The manipulation and regulation of valley characteristics have aroused widespread interest in emerging information fields and fundamental research. Realizing valley polarization is one crucial issue for spintronic and valleytronic applications, the concepts of a half-valley metal (HVM) and ferrovalley (FV) materials have been put forward. Then, to separate electron and hole carriers, a fresh concept of a quasi-HVM (QHVM) has been proposed, in which only one type of carrier is valley polarized for electron and hole carriers. Based on first-principles calculations, we demonstrate that the Janus monolayer VSiGeP4 has QHVM character. To well regulate the QHVM state, strain engineering is utilized to adjust the electronic and valley traits of monolayer VSiGeP4. In the discussed strain range, monolayer VSiGeP4 always favors the ferromagnetic ground state and out-of-plane magnetization, which ensures the appearance of spontaneous valley polarization. It is found that the QHVM state can be induced in different electronic correlations (U), and the strain can effectively tune the valley, magnetic, and electronic features to maintain the QHVM state under various U values. Our work opens up a new research idea in the design of multifunctional spintronic and valleytronic devices.

755-nm picosecond laser plus topical 20% azelaic acid compared to topical 20% azelaic acid alone for the treatment of melasma: a randomized, split-face and controlled trial.

PURPOSE: Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients. METHODS: A randomized, evaluator-blinded, controlled study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient's satisfaction assessments (PSA). RESULTS: Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period. CONCLUSION: The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100051294; 18 September 2021).

Impact of Telemedicine on Blood Glucose Control and Ophthalmic Screenings for Patients with Diabetes in Remote Areas During the COVID-19 Pandemic: A Real-World Study in Northern Taiwan.

Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine (p = 0.01 and p = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.

Effect of high-frequency stimulation on the complexity of low-Mg2+-induced epileptiform discharge rhythm waves in the CA3 region of rat hippocampal slices.

High-frequency stimulation (HFS) is a crucial therapeutic approach for neurodegenerative conditions, such as epilepsy. However, its underlying mechanism of inhibition remains unclear. In this study, a rat model of epileptiform discharges (EDs) was constructed by perfusing brain slices with magnesium-free artificial cerebrospinal fluid (aCSF), where after HFS was used to stimulate the CA3 area of the hippocampus. The EDs signals of each sub-region of hippocampal slices before and after HFS were recorded based on a multi-electrode Array (MEA). Secondly, the changes of approximate entropy (ApEn) complexity of rhythms in different regions of hippocampal slices before and after HFS were deeply analyzed The results showed that different rhythm characteristics of EDs signals exhibited significant differences before and after HFS. Here HFS significantly inhibited the delta rhythm of field potential and enhanced the beta rhythm. Finally, the changing rhythm of the EDs signal in the propagation path before and after HFS was analyzed, and it was found that the inhibitory target of HFS on EDs signal was in the CA3b sub-region. The rhythm would gradually decline with the propagation of EDs signal in the hippocampal neural pathway. This study shows that HFS can modulate the local field potential, thus inhibiting the pathological rhythm caused by epilepsy, which provides a novel research incentive for HFS to inhibit EDs.

Inhibition of Rho-associated protein kinase activity enhances oxidative phosphorylation to support corneal endothelial cell migration.

Corneal endothelial cell (CEC) dysfunction causes corneal edema and severe visual impairment that require transplantation to restore vision. To address the unmet need of organ shortage, descemetorhexis without endothelial keratoplasty has been specifically employed to treat early stage Fuchs endothelial corneal dystrophy, which is pathophysiologically related to oxidative stress and exhibits centrally located corneal guttae. After stripping off central Descemet's membrane, rho-associated protein kinase (ROCK) inhibitor has been found to facilitate CEC migration, an energy-demanding task, thereby achieving wound closure. However, the correlation between ROCK inhibition and the change in bioenergetic status of CECs remained to be elucidated. Through transcriptomic profiling, we found that the inhibition of ROCK activity by the selective inhibitor, ripasudil or Y27632, promoted enrichment of oxidative phosphorylation (OXPHOS) gene set in bovine CECs (BCECs). Functional analysis revealed that ripasudil, a clinically approved anti-glaucoma agent, enhanced mitochondrial respiration, increased spare respiratory capacity, and induced overexpression of electron transport chain components through upregulation of AMP-activated protein kinase (AMPK) pathway. Accelerated BCEC migration and in vitro wound healing by ripasudil were diminished by OXPHOS and AMPK inhibition, but not by glycolysis inhibition. Correspondingly, lamellipodial protrusion and actin assembly that were augmented by ripasudil became reduced with additional OXPHOS or AMPK inhibition. These results indicate that ROCK inhibition induces metabolic reprogramming toward OXPHOS to support migration of CECs.

Electronic-correlation induced sign-reversible Berry phase and quantum anomalous valley Hall effects in Janus monolayer OsClBr.

Topological phase transition can be induced by electronic correlation effects combined with spin-orbit coupling (SOC). Here, based on the first-principles calculations +U approach, the influence of electronic correlation effects and SOC on topological and electronic properties of the Janus monolayer OsClBr is investigated. With intrinsic out-of-plane (OOP) magnetic anisotropy, the Janus monolayer OsClBr exhibits a sequence of states, namely, the ferrovalley (FV) to half-valley-metal (HVM) to quantum anomalous valley Hall effect (QAVHE) to HVM to FV states with increasing U values. The QAVHE is characterized by a chiral edge state linking the conduction and valence bands with a Chern number C = 1, which is closely associated with the band inversion between dx2-y2/dxy and dz2 orbitals, and sign-reversible Berry curvature. The section with larger U values (2.31-2.35 eV) is very essential for determining the new HVM and QAVHE states, and also proves that a strong electron correlation effect exists in the interior of the Janus monolayer OsClBr. When taking into consideration a representative U value (U = 2.5 eV), a valley polarization value of 157 meV can be observed, which can be switched by reversing the magnetization direction of Os atoms. It is noteworthy that the Curie temperature (TC) strongly depends on the electronic correlation effects. Our work provides a comprehensive discussion on the electronic and topological properties of the Janus monolayer OsClBr, and demonstrates that the electronic correlation effects combined with SOC can drive the emergence of QAVHE, which will open up new opportunities for valleytronic, spintronic, and topological nanoelectronic applications.

Automated Age-Related Macular Degeneration Detector on Optical Coherence Tomography Images Using Slice-Sum Local Binary Patterns and Support Vector Machine.

Artificial intelligence has revolutionised smart medicine, resulting in enhanced medical care. This study presents an automated detector chip for age-related macular degeneration (AMD) using a support vector machine (SVM) and three-dimensional (3D) optical coherence tomography (OCT) volume. The aim is to assist ophthalmologists by reducing the time-consuming AMD medical examination. Using the property of 3D OCT volume, a modified feature vector connected method called slice-sum is proposed, reducing computational complexity while maintaining high detection accuracy. Compared to previous methods, this method significantly reduces computational complexity by at least a hundredfold. Image adjustment and noise removal steps are excluded for classification accuracy, and the feature extraction algorithm of local binary patterns is determined based on hardware consumption considerations. Through optimisation of the feature vector connection method after feature extraction, the computational complexity of SVM detection is significantly reduced, making it applicable to similar 3D datasets. Additionally, the design supports model replacement, allowing users to train and update classification models as needed. Using TSMC 40 nm CMOS technology, the proposed detector achieves a core area of 0.12 mm2 while demonstrating a classification throughput of 8.87 decisions/s at a maximum operating frequency of 454.54 MHz. The detector achieves a final testing classification accuracy of 92.31%.

New Device of Neonatal Ostomy: To Effectively Reduce the Postoperative Complications of Neonatal Ostomy.

Background need. Complications frequently occur after neonatal enterostomy. Enterostomy formation is a common outcome following emergency neonatal laparotomy. We introduce a new method for improving proximal enterostomy in newborns.Methodlogy and device description. We added a simple drainage device on the proximal enterostomy.The simple drainage device consists of several materials: a foreskin cerclage staple (Chong Qing BORN Biological Technology Co. Ltd., Sichuan, China), a condom,and 0- Mersilk Silk braided nonabsorbable suture (ETHICON 15 × 60 cm).Preliminary results. A total of 20 cases participated in the study. All surgeries were performed by a single surgeon. The cases only occurred one case of prolapse of the intestinal, one case of premature surgery due to excessive orifice flow, and one case of periostomy dermatitis, Other patients not experienced intraoperative or postoperative complications.Current status. Based on our preliminary observations, the simple drainage device is a safe and effective operation device that can reduce the risk of stoma-related complications.

[Chrysin alleviates cerebral ischemia-reperfusion injury by inhibiting ferroptosis in rats].

The purpose of this study is to investigate whether chrysin reduces cerebral ischemia-reperfusion injury(CIRI) by inhi-biting ferroptosis in rats. Male SD rats were randomly divided into a sham group, a model group, high-, medium-, and low-dose chrysin groups(200, 100, and 50 mg·kg~(-1)), and a positive drug group(Ginaton, 21.6 mg·kg~(-1)). The CIRI model was induced in rats by transient middle cerebral artery occlusion(tMCAO). The indexes were evaluated and the samples were taken 24 h after the operation. The neurological deficit score was used to detect neurological function. The 2,3,5-triphenyl tetrazolium chloride(TTC) staining was used to detect the cerebral infarction area. Hematoxylin-eosin(HE) staining and Nissl staining were used to observe the morphological structure of brain tissues. Prussian blue staining was used to observe the iron accumulation in the brain. Total iron, lipid pero-xide, and malondialdehyde in serum and brain tissues were detected by biochemical reagents. Real-time quantitative polymerase chain reaction(RT-qPCR), immunohistochemistry, and Western blot were used to detect mRNA and protein expression of solute carrier fa-mily 7 member 11(SLC7A11), transferrin receptor 1(TFR1), glutathione peroxidase 4(GPX4), acyl-CoA synthetase long chain family member 4(ACSL4), and prostaglandin-endoperoxide synthase 2(PTGS2) in brain tissues. Compared with the model group, the groups with drug intervention showed restored neurological function, decreased cerebral infarction rate, and alleviated pathological changes. The low-dose chrysin group was selected as the optimal dosing group. Compared with the model group, the chrysin groups showed reduced content of total iron, lipid peroxide, and malondialdehyde in brain tissues and serum, increased mRNA and protein expression levels of SLC7A11 and GPX4, and decreased mRNA and protein expression levels of TFR1, PTGS2, and ACSL4. Chrysin may regulate iron metabolism via regulating the related targets of ferroptosis and inhibit neuronal ferroptosis induced by CIRI.

Methylation- and homologous recombination deficiency-related mutant genes predict the prognosis of lung adenocarcinoma.

BACKGROUND: Lung adenocarcinoma (LUAD) is a lung cancer subtype with poor prognosis. We investigated the prognostic value of methylation- and homologous recombination deficiency (HRD)-associated gene signatures in LUAD. METHODS: Data on RNA sequencing, somatic mutations, and methylation were obtained from TCGA database. HRD scores were used to stratify patients with LUAD into high and low HRD groups and identify differentially mutated and expressed genes (DMEGs). Pearson correlation analysis between DMEGs and methylation yielded methylation-associated DMEGs. Cox regression analysis was used to construct a prognostic model, and the distribution of clinical features in the high- and low-risk groups was compared. RESULTS: Patients with different HRD scores showed different DNA mutation patterns. There were 272 differentially mutated genes and 6294 differentially expressed genes. Fifty-seven DMEGs were obtained; the top 10 upregulated genes were COL11A1, EXO1, ASPM, COL12A1, COL2A1, COL3A1, COL5A2, DIAPH3, CAD, and SLC25A13, while the top 10 downregulated genes were C7, ERN2, DLC1, SCN7A, SMARCA2, CARD11, LAMA2, ITIH5, FRY, and EPHB6. Forty-two DMEGs were negatively correlated with 259 methylation sites. Gene ontology and pathway enrichment analysis of the DMEGs revealed enrichment of loci involved in extracellular matrix-related remodeling and signaling. Six out of the 42 methylation-associated DMEGs were significantly associated with LUAD prognosis and included in the prognostic model. The model effectively stratified high- and low-risk patients, with the high-risk group having more patients with advanced stage disease. CONCLUSION: We developed a novel prognostic model for LUAD based on methylation and HRD. Methylation-associated DMEGs may function as biomarkers and therapeutic targets for LUAD. Further studies are needed to elucidate their roles in LUAD carcinogenesis.

Ranibizumab reimbursement and treatment patterns for neovascular age-related macular degeneration in Taiwan - Results from the 12-month, observational RENOWNED study.

BACKGROUND: The RENOWNED study investigated the treatment patterns, real-world effectiveness and safety of ranibizumab in Taiwanese patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab 0.5 mg in accordance with the first reimbursement scheme effective from 2012 to 2014. METHODS: This study was a Phase IV, 12-month, open-label, prospective, observational study conducted in Taiwan. Patients with visual impairment due to nAMD initiating treatment with ranibizumab 0.5 mg were included. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from Baseline at Month 3. RESULTS: Overall, 202 patients with nAMD were included. Mean (standard deviation [SD]) BCVA Early Treatment Diabetic Retinopathy Study letters improved from Baseline (49.6 [21.5] letters) at Month 3 (+4.9 [11.8], P < 0.0001), and at Month 12 (+3.5 [14.1], P = 0.0043). The proportion of patients with nAMD who lost ≥5 letters at Months 3 and 12 was 13.6% (n = 27) and 26.6% (n = 37), respectively. Mean (SD) central retinal thickness decreased from Baseline (320.1 [127.2] µm) with a mean reduction of 49.1 (107.3) µm at Month 3 (P < 0.0001), but was not significant at Month 12 with a mean reduction of 11.6 (115.6) µm (P = 0.2861). Mean (SD) number of ranibizumab injections over 12 months was 3.1 (1.0). A mean treatment interval of 109.5 days was observed between the third and fourth injections. After limited reimbursed ranibizumab injections, 43.8% patients received other treatments. The safety findings are consistent with previous studies. CONCLUSION: Ranibizumab 0.5 mg treatment for 12 months under real-world settings improved visual outcomes in Taiwanese patients with nAMD.

Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by relapses and autoimmunity caused by antibodies against the astrocyte water channel protein aquaporin-4. Over the past decade, there have been significant advances in the biologic knowledge of NMOSD, which resulted in the IDENTIFICATION of variable disease phenotypes, biomarkers, and complex inflammatory cascades involved in disease pathogenesis. Ongoing clinical trials are looking at new treatments targeting NMOSD relapses. This review aims to provide an update on recent studies regarding issues related to NMOSD, including the pathophysiology of the disease, the potential use of serum and cerebrospinal fluid cytokines as disease biomarkers, the clinical utilization of ocular coherence tomography, and the comparison of different animal models of NMOSD.

[Exploration of mechanism of "simultaneous treatment of brain and heart" of Naoxintong Capsules based on Toll-like receptor signaling pathway].

This study aims to explore the mechanism of "simultaneous treatment of the brain and the heart" of Naoxintong Capsules(NXT) under cerebral ischemia based on Toll-like receptor(TLR) signaling pathway.Male SD rats were randomized into sham operation group, model group, NXT group, and positive drug group.Middle cerebral artery occlusion(MCAO) model rats were used in model group, NXT group, and positive drug group, respectively.Neurological function was scored with the Bederson scale, and brain infarct rate was measured by 2,3,5-triphenyltetrazolium chloride(TTC) staining.Brain edema was detected with wet-dry weight method.Hematoxylin-eosin(HE) staining and TdT-mediated dUTP nick-end labeling(TUNEL) staining were used to observe and count apoptotic cardiocytes.In addition, serum myocardial enzymes were measured.The expression of 8 TLR signaling pathway-related proteins interferon-α(IFN-α), interferon regulatory factor-3(IRF3), interferon regulatory factor-7(IRF7), TLR2, TLR4, TLR7, TLR9, and tumor necrosis factor-α(TNF-α) in the cerebral cortex and heart of rats was detected by Western blot. Brain infarct rate, neurological function score, and brain water content in NXT group decreased significantly compared with those in the model group. At the same time, the reduction in apoptosis rate of cardiocytes and the content of serum aspartate aminotransferase(AST), alanine aminotransferase(ALT), creatine kinase(CK), and lactate dehydrogenase(LDH) were decreased in the NXT group.Systems pharmacological results and previous research showed that TLR signaling pathway played an important role in immune inflammatory response.The study of TLR signaling pathway and related proteins is helpful to elucidate the mechanism of "simultaneous treatment of the brain and the heart". Western blot results showed that NXT significantly inhibited the expression of IRF3, IRF7, TLR2, TLR7, and TNF-α in cerebral cortex and heart under cerebral ischemia.Cerebral ischemia influences cardiac functions, and TLR signaling pathway is one of the pathways for "simultaneous treatment of the brain and the heart" of NXT.

Efficient frequency conversion based on resonant four-wave mixing.

Efficient frequency conversion of photons has important applications in optical quantum technology because the frequency range suitable for photon manipulation and communication usually varies widely. Recently, an efficient frequency conversion system using a double-Λ four-wave mixing (FWM) process based on electromagnetically induced transparency (EIT) has attracted considerable attention because of its potential to achieve a nearly 100% conversion efficiency (CE). To obtain such a high CE, the spontaneous emission loss in this resonant-type FWM system must be suppressed considerably. A simple solution is to arrange the applied laser fields in a backward configuration. However, the phase mismatch due to this configuration can cause a significant decrease in CE. Here, we demonstrate that the phase mismatch can be effectively compensated by introducing the phase shift obtained by two-photon detuning. Under optimal conditions, we observe a wavelength conversion from 780 to 795 nm with a maximum CE of 91.2%±0.6% by using this backward FWM system at an optical depth of 130 in cold 87Rb atoms. The current work represents an important step toward achieving low-loss, high-fidelity quantum frequency conversion based on EIT.

A Computational and Experimental Study to Compare the Effectiveness of Bipolar Mode With Phase-Shift Angle Mode in Radiofrequency Fat Dissolution on Subcutaneous Tissue.

BACKGROUND AND OBJECTIVES: Radiofrequency (RF) energy exposure refers to a popular non-invasive method employed to generate heat in cutaneous and subcutaneous tissues. RF thermal stimulation of adipose tissue has been considered to cause adipocyte metabolism and enzymatic degradation of triglycerides into free fatty acids and glycerol. Bipolar mode (BM) has achieved extensive applications in clinical studies on RF fat dissolution, whereas BM has a less penetration depth than monopolar, result in a higher RF voltage that may be required to increase power to the deeper fat layer of the subcutaneous tissue, and improper power control may easily cause the skin layer to be thermally damaged. To tackle down the mentioned defect, a novel phase-shift angle mode (PM) was proposed in this study based on double-channel bipolar RF. By employing the finite element method (FEM) and performing the ex vivo experiment, the effectiveness of BM was compared with that of PM in RF fat dissolution on subcutaneous tissue. In addition, this study attempted to develop reasonable phase-shift angles capable of achieving fat dissolution effects, while the RF energy of which would not cause the skin layer to be thermally damaged. STUDY DESIGN/MATERIALS AND METHODS: Two electrode spacings (1 and 2 cm) were applied in BM (BM-1 cm and BM-2 cm, respectively), and six phase-shift angles (i.e., 30°, 60°, 90°, 120°, 150°, and 180°) were set in PM (i.e., PM-30°, PM-60°, PM-90°, PM-120°, PM-150°, and PM-180°). In addition, COMSOL was adopted to conduct a finite element analysis for achieving thermoelectric coupling. Ex vivo experiments were performed with a self-developed double-channel bipolar RF device, through which up to two adjustable phase-shift angle sinusoidal voltages could be generated. Such a device was isolated with a transformer and then connected to four electrodes with a 5 mm diameter contacting the ex vivo porcine abdominal tissue. RESULTS: Under the RF voltage amplitude of 30 V, and after 1800 seconds of RF heating, no thermally damaged area was formed in the tissue in BM-1 cm and BM-2 cm; in PM-30°, PM-60°, and PM-90°, thermally damaged areas were formed in the fat layer, while the skin layer was not located in the thermally damaged area. Moreover, the temperature in the thermally damaged area attributed to the mentioned three conditions may satisfy the requirement of fat dissolution temperature. CONCLUSIONS: Under the identical RF voltage and heating time, PM is easier to cause the fat layer of the subcutaneous tissue to be thermally damaged as compared with BM. Accordingly, PM may be enabled to achieve the fat dissolution effect under a relatively low RF voltage as opposed to BM, thus avoiding the possibility of thermal damage of the skin layer attributed to the use of higher RF voltage. In PM, different phase-shift angle significantly affects the electrical and thermal properties of RF energy applied on subcutaneous tissue; the phase-shift angle of RF voltage is likely to be regulated for fat dissolution effect, while the RF energy of which will not cause the skin layer to be thermally damaged.© 2021 Wiley Periodicals LLC.

Algae Oil Treatment Protects Retinal Ganglion Cells (RGCs) via ERK Signaling Pathway in Experimental Optic Nerve Ischemia.

BACKGROUND: We investigated the therapeutic effects and related mechanisms of algae oil (ALG) to protect retinal ganglion cells (RGCs) in a rat model of anterior ischemic optic neuropathy (rAION). METHODS: Rats were daily gavaged with ALG after rAION induction for seven days. The therapeutic effects of ALG on rAION were evaluated using flash visual evoked potentials (FVEPs), retrograde labeling of RGCs, TUNEL assay of the retina, and ED1 staining of optic nerves (ONs). The levels of inducible nitric oxide synthase (iNOS), IL-1ß, TNF-α, Cl-caspase-3, ciliary neurotrophic factor (CNTF), and p-ERK were analyzed by using western blots. RESULTS: Protection of visual function in FVEPs amplitude was noted, with a better preservation of the P1-N2 amplitude in the ALG-treated group (p = 0.032) than in the rAION group. The density of RGCs was 2.4-fold higher in the ALG-treated group compared to that in the rAION group (p < 0.0001). The number of ED1-positive cells in ONs was significantly reduced 4.1-fold in the ALG-treated group compared to those in the rAION group (p = 0.029). The number of apoptotic RGCs was 3.2-fold lower in number in the ALG-treated group (p = 0.001) than that in the rAION group. The ALG treatment inhibited ERK activation to reduce the levels of iNOS, IL-1ß, TNF-α, and Cl-caspase-3 and to increase the level of CNTF in the rAION model. CONCLUSION: The treatment with ALG after rAION induction inhibits ERK activation to provide both anti-inflammatory and antiapoptotic effects in rAION.

Effect of dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes of Taiwanese patients with treatment-naïve diabetic macular edema.

BACKGROUND/PURPOSE: Vitrectomy may affect intravitreal drug clearance and efficacy for treating diabetic macular edema (DME). This study aimed to evaluate functional and anatomical outcomes of intravitreal dexamethasone (DEX) implant for vitrectomized and nonvitrectomized eyes with treatment-naïve DME in Taiwanese patients. METHODS: In this retrospective single-center study, we reviewed treatment-naïve patients who received DEX implant monotherapy for center-involved DME from January 2015 to May 2017. Retreatments were provided at least 4 months apart as needed. The primary outcomes included changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at Month 6. Adverse events were recorded. RESULTS: Twenty-seven eyes in 27 patients had prior vitrectomy and 43 eyes in 41 patients without vitrectomy. Baseline data were comparable. Overall, the improvements in BCVA and CFT were significant by 1 month post-treatment and sustained throughout the study (all p < 0.05). At Month 6, BCVA improved by 16.5 and 12.1 letters, and CFT reduced by 138.0 and 121.9 µm in vitrectomized and nonvitrectomized eyes, respectively, with a mean of 1.5 DEX implant injection. No significant differences in clinical outcomes were seen between the two groups (all p > 0.05). DEX implant injection was well tolerated. About 30% of patients had post-injection intraocular pressure value > 20 mmHg, and all were manageable with topical hypotensive agents, and no serious ocular complication was observed. CONCLUSION: In this 6-month retrospective study, intravitreal DEX implant was effective in Taiwanese patients with treatment-naïve DME regardless of vitrectomy status.

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis.

AIM: Cystic biliary atresia (CBA) can be easily misdiagnosed as choledochal cyst (CC). Some patients have already progressed to severe liver fibrosis and missed the optimal surgical time, when the differential diagnosis is made. We aim to determine the differentiation between CBA and CC, and to validate the value of aspartate aminotransferase-to-platelet ratio index (APRI) in the assessment of liver fibrosis and prediction of post-operative outcome for infants with biliary cystic malformations (BCMs). METHODS: Clinical data of children (categorised into CBA and CC groups) with BCMs were analysed retrospectively. Biochemical indicators together with B-ultrasound examinations and the degree of liver fibrosis were analysed, and those with statistical difference between the two groups were selected for diagnostic receiver operating characteristic curve analysis. RESULTS: The parameter that showed the highest accuracy with a significant diagnostic performance for differentiating CBA from CC was cyst size. Liver assessment at operation was categorised into mild fibrosis and moderate-to-severe fibrosis. The APRI values were much lower in the mild fibrosis groups than in the moderate-to-severe fibrosis group (0.4 ± 0.2 vs. 1.4 ± 0.8, P < 0.001). A cut-off value of 0.96 (area under the curve 0.92, P < 0.001) showed a sensitivity of 81.3% and a specificity of 100% for moderate-to-severe fibrosis. Lower APRI value was correlated with short-term post-operative bilirubin clearance. CONCLUSION: There is still certain difficulty in the early identification of CBA and CC clinically. Liver fibrosis could occur as early as infantile period in both CBA and CC. In infants with BCMs, APRI can be used as a non-invasive method to detect liver fibrosis in early stages.

Comparison of efficacy of intravitreal ranibizumab between non-vitrectomized and vitrectomized eyes with diabetic macular edema.

PURPOSE: To compare the efficacy of intravitreal ranibizumab between non-vitrectomized and vitrectomized eyes with diabetic macular edema (DME). STUDY DESIGN: A retrospective, nonrandomized, and comparative study. METHODS: From May 2013 to March 2016, 148 eyes of 148 patients with treatment-naïve center-involving DME were reviewed in one institution. Forty-six eyes underwent prior vitrectomy at least 3 months ago, and 102 eyes did not receive any vitrectomy. Three monthly then PRN intravitreal ranibizumab treatments were performed in all the patients with monthly follow-up for 6 months. Primary outcome measures included change in central foveal thickness (CFT) and best-corrected visual acuity (BCVA) at month 6. RESULTS: The CFT significantly reduced, and the BCVA significantly improved 6 months after ranibizumab injections in either vitrectomized or non-vitrectomized groups (p < 0.05). There was no difference between vitrectomized and non-vitrectomized eyes in baseline characteristics. Significantly better final BCVA and visual gain were found in non-vitrectomized eyes than in vitrectomized eyes (p = 0.01 and 0.03, respectively). Final CFT and CFT decrease were significantly greater in non-vitrectomized group than in vitrectomized group (p = 0.02 and 0.006, respectively). Injection number of ranibizumab was 4.12 ± 0.58 in non-vitrectomized eyes, significantly less than that in vitrectomized eyes (5.05 ± 0.71) during 6-month period (p < 0.001). There were no severe systemic/ocular adverse effects in both groups. CONCLUSIONS: Intravitreal ranibizumab was helpful for either vitrectomized or non-vitrectomized eyes with DME in short-term follow-up. Anatomical and functional improvements were greater in non-vitrectomized patients than in vitrectomized cases.