Corneal Biomechanical Properties of Various Types of Glaucoma and Their Impact on Measurement of Intraocular Pressure.

INTRODUCTION: Corneal biomechanical properties could affect intraocular pressure (IOP) measurement. The aim of this study was to evaluate the differences in corneal biomechanical properties of various types of glaucoma, assess their effect on IOP measurements. METHODS: This is an observational clinical study of 486 subjects including 102 normal subjects, 104 ocular hypertension (OHT), 89 normal tension glaucoma (NTG), and 191 high tension glaucoma (HTG). Corneal biomechanical parameters were measured using an ocular response analyzer. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg), and corneal-compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used to measure central corneal thickness (CCT). IOP was measured by a Goldmann applanation tonometer (GAT) and a noncontact tonometer (NCT). Visual field (VF) and refractive status were also recorded. Results were analyzed by one-way analysis of variance, univariate and multivariate linear regression analyses, and Bland-Altman plots. RESULTS: Multiple comparison by analysis of variance showed significantly lower CH and CRF in NTG compared to HTG, OHT, and normal subjects (CH: 0.011, 0.015, and 0.033; CRF: 0.001, <0.001, and 0.042, respectively). CRF and CH associated with IOP were measured using either GAT, NCT and IOPcc-GAT, IOPcc-NCT, yet CCT was not. GAT correlated strongly with IOPg (r = 0.79; p < 0.001) and IOPcc (r = 0.77; p < 0.001), but limits of agreement between the measurements were poor. CH and CRF were both negatively correlated with VF change (p < 0.01). CONCLUSION: CH and CRF affect the measurement of IOP and were related to types of glaucoma or severity of glaucoma. Pure CCT should not be used to correct IOP values or estimate the risk of disease.

A compensation mechanism for air pollutants generated by tourism-related land-based transportation: An exergy-based case study from Macao.

This paper discusses the compensation standard for exhaust pollution and devises a compensation mechanism for Macao's tourism-related transport sector based on an integration of chemical exergy and universal exergy, using data on gasoline consumption by automobile sector retrieved from the transportation industry. The results reveal that: (1) the exergy values of air pollutant emissions increased from 1.53 × 1012 kJ in 2010 to 2.03 × 1012 kJ in 2019 (an increase of 1.33 times), and the exergy of CO, NOx, and SO2 emissions accounted for 77.5%, 20.4% and 2.1% of total exhaust emissions in Macao respectively. (2) In 2019, the monetary value of emission exergy, and the environmental costs of air pollution, were 1.7 times greater than in 2010. (3) If Light Rail Transit is compensated for, then the mean interval's values of the upper and lower limits of the compensation standard are 0.55 USD and 0.05 USD, respectively. When gasoline tax is used as a means of compensation it is necessary to raise its rate by about 8% based on the tax rate. A three-stage bargaining game model is used to provide evidence that this compensation standard is practical and acceptable.

How does tourism affect the urban heat island effect? A case study of the tourism heat footprint in Macao.

This paper uses the tourism heat footprint (THF) and a structural vector autoregressive model to investigate how tourism has affected the urban heat island effect in Macao, a typical urban tourism destination. The dynamic relationships between the THF, heat island intensity (HII), and quarterly average temperature (QAT) are investigated. The impulse response function and variance decomposition analysis are used to assess if a long-term causal relationship exists between the three indicators. The results show the following. (1) The hotel industry in Macao is the source of energy consumption and heat release. (2) A Granger causality relationship exists between the THF and QAT but not between the THF and HII. (3) The interaction effect between the growth rate of the THF and QAT is manifested as shocks with the same frequency and regular periodic fluctuations. (4) The heat island effect of this tourism destination is reflected in an increase in local temperature due to the energy consumption and heat release by tourists. Based on the results, policy implications for a sustainable tourism city are provided.

Optical Coherence Tomography Angiography of the Macula in Patients with Primary Angle-Closure Glaucoma.

BACKGROUND: The retinal microvasculature within the macula in glaucomatous eyes is not clear. OBJECTIVES: To detect macular vessel density (MVD) changes in primary angle-closure glaucoma (PACG). METHODS: Twenty-two PACG patients who had an episode of acute primary angle closure were included. Structural optical coherence tomography (OCT) scans were conducted to measure the thickness of the peripapillary retinal nerve fiber layer and macular ganglion cell complex (GCC). The MVD was measured with OCT angiography. RESULTS: A weakened macular microvascular network that had an expanded fovea avascular zone was observed in the case group. Compared with the control group, the case group had a lower MVD (p < 0.001). Single correlation analysis revealed a significant correlation of the MVD with best-corrected visual acuity (BCVA) (r = -0.65, p = 0.001), GCC (r = 0.50, p = 0.018), and the visual field mean deviation (r = -0.54, p = 0.009) in the case group. Moreover, in the mixed-effect models, the MVD was found to be positively correlated with GCC (p = 0.017) and negatively correlated with LogMar BCVA (p < 0.001). CONCLUSIONS: After an acute angle-closure attack, the macular microvascular network is attenuated, and the MVD decreases significantly.

[Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO2 Laser-assisted Sclerectomy Surgery].

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO2 laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP [(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered [(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all P<0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29% and 53.57%,85.71%,respectively.UBM images can present "dolphin head sign" after successful CLASS.The thickness of trabeculo-Descemet's window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(r=-0.278,P=0.144)and 24 months(r=0.026,P=0.895).UBM examination revealed a severe scleral lake diminution(a change > 50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.

Kinetic changes in virology, specific antibody response and imaging during the clinical course of COVID-19: a descriptive study.

BACKGROUND: To explore the kinetic changes in virology, specific antibody response and imaging during the clinical course of COVID-19. METHODS: This observational study enrolled 20 patients with COVID-19, who were hospitalized between January 20-April 6, 2020, in the two COVID-19 designated hospitals of Zhoushan, Zhejiang and Rushan, Shandong, China, The laboratory findings, imaging, serum response to viral infection, and viral RNA level in the throat and stool samples were assessed from onset to recovery phase in patients with COVID-19. RESULTS: SARS-COV-2 RNA was positive as early as day four. It remained positive until day 55 post-onset in the sputum-throat swabs and became negative in most cases (55%) within 14 days after onset. Lymphocytopenia occurred in 40% (8/20) of patients during the peak infection period and returned to normal at week five. The most severe inflammation in the lungs appeared in week 2 or 3 after onset, and this was completely absorbed between week 6 and 8 in 85.7% of patients. All patients had detectable antibodies to the receptor binding domain (RBD), and 95% of these patients had IgG to viral N proteins. The antibody titer peaked at week four. Anti-S IgM was positive in 7 of 20 patients after week three. CONCLUSIONS: All COVID-19 patients in this study were self-limiting and recovered well though it may take as long as 6-8 weeks. Our findings on the kinetic changes in imaging, serum response to viral infection and viral RNA level may help understand pathogenesis and define clinical course of COVID-19.

Intensive Continuous Positive Airway Pressure Adherence Program During Stroke Rehabilitation.

Background and Purpose- Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea may improve stroke recovery, but adherence is poor. We assessed the effectiveness of an intensive CPAP adherence program during and after inpatient stroke rehabilitation on 3-month adherence and stroke recovery. Methods- In a single-arm study, 90 stroke rehabilitation patients were enrolled into an intensive CPAP adherence program. CPAP was continued after a run-in among qualifying patients with evidence of obstructive sleep apnea. The primary outcome was CPAP adherence, defined as ≥4 hours of use on ≥70% of days, over 3 months. Results- A total of 62 patients qualified for continued CPAP and 52 of these were willing to continue CPAP after discharge from rehabilitation. At 3 months, the average daily CPAP use was 4.7 hours (SD 2.6), and 32/52 (62%) patients were adherent. Factors significantly associated with adherence included more severe stroke, aphasia, and white race. Compared with nonadherent patients, adherent patients experienced greater improvements in the cognitive component of the Functional Independence Measure ( P=0.02) and in the National Institutes of Health Stroke Scale ( P=0.03). Conclusions- This intensive CPAP adherence program initiated during stroke rehabilitation can lead to CPAP adherence in the majority of patients with evidence of obstructive sleep apnea, including those with more severe stroke and aphasia, and may promote recovery. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02809430.

Iris lens distance to predict the risk of intraocular pressure elevation after dark room provocative test.

PURPOSE: To investigate if a new ultrasound biomicroscopy (UBM) parameter, iris lens distance (ILD), and its model could predict clinically significant intraocular pressure (IOP) elevation after darkroom provocative test (DRPT). METHODS: Cases with a peripheral anterior chamber depth less than one-fourth corneal thickness were enrolled. All subjects underwent UBM examination and DRPT if possible. Anterior chamber depth (ACD) and ILD were measured in the central axis at different positions in dark (ACDD, ILDD) and bright (ACDB, ILDB). An IOP elevation over 5 mmHg and 8 mmHg was set as cutoffs for a positive DRPT result (positive-5 and positive-8). SAS 9.3 statistical software was used to manage and analyze data and calculate the linear probability model (LPM). Another 17 patients (34 eyes) were included to validate the model. RESULTS: Two hundred and ten (210) UBM images qualified for analysis. ILD was significantly less in the dark than in the bright and in patients with a positive DRPT result (p < 0.001). The LPM for positive-5 and positive-8 were P = 1.14 + (- 0.49*ILDD) + (- 0.41*ACDD) (n = 210, R2 = 0.1079, AUC = 0.715), and P = 0.87 + (- 0.44*ILDD) + (- 0.35*ACDD) (n = 210, R2 = 0.1358, AUC = 0.807), respectively. CONCLUSIONS: LPMs based on ILD could predict the risk of an IOP elevation over 5 mmHg or 8 mmHg. The LPM for positive-8 reached a good level of diagnostic accuracy.

Lifestyle and Addictive Behaviors Among Chinese Adolescents in Hong Kong, Macau, Taipei, Wuhan, and Zhuhai-a First Cross-subculture Assessment.

PURPOSE: This study aimed at assessing the differences in prevalence rates of common health behavior among adolescents in the five Chinese cities and the influential factors at the contextual and individual levels. METHOD: We compared the standardized rates of three lifestyle behaviors (sedentary, dietary, and physical activity) and three addictive behaviors (cigarette smoking, alcohol consumption, and participation in gambling) among a sample of 13,950 adolescents. The sample was randomly selected from five cities, including Hong Kong, Macau, Taipei, Zhuhai, and Wuhan. Population size, GDP per capita, and literacy at the city level as well as parental monitoring and school performance at the student's level were assessed. Multi-level mixed effect models were used to examine the interaction of individual level factors with study sites. RESULTS: The six health behaviors differed significantly across sites with the highest rates of alcohol consumption in Hong Kong (39.5 %), of cigarette smoking in Macau (9.8 %), and of gambling in Taipei (37.1 %) and Hong Kong (35.9 %). The city-level measures were associated with only a few behavioral measures. Relative to Hong Kong, parental monitoring had stronger association with the three addictive behaviors in the other sites. CONCLUSION: Findings suggest that although the study sites share similar Chinese culture, students in the five cities differed from each other with regard to levels of health behaviors. Relative to the broad socioeconomic development, differences in parental monitoring played a significant role in explaining the observed difference.

Integration of bulk RNA sequencing to reveal protein arginine methylation regulators have a good prognostic value in immunotherapy to treat lung adenocarcinoma.

Background: Given the differential expression and biological functions of protein arginine methylation (PAM) regulators in lung adenocarcinoma (LUAD), it may be of great value in the diagnosis, prognosis, and treatment of LUAD. However, the expression and function of PAM regulators in LUAD and its relationship with prognosis are unclear. Methods: 8 datasets including 1798 LUAD patients were selected. During the bioinformatic study in LUAD, we performed (i) consensus clustering to identify clusters based on 9 PAM regulators related expression profile data, (ii) to identify hub genes between the 2 clusters, (iii) principal component analysis to construct a PAM.score based on above genes, and (iv) evaluation of the effect of PAM.score on the deconstruction of tumor microenvironment and guidance of immunotherapy. Results: We identified two different clusters and a robust and clinically practicable prognostic scoring system. Meanwhile, a higher PAM.score subgroup showed poorer prognosis, and was validated by multiple cohorts. Its prognostic effect was validated by ROC (Receiver operating characteristic curve) curve and found to have a relatively good prediction efficacy. High PAM.score group exhibited lower immune score, which associated with an immunosuppressive microenvironment in LUAD. Finally, patients exhibiting a lower PAM.score presented noteworthy therapeutic benefits and clinical advantages. Conclusion: Our PAM.score model can help clinicians to select personalized therapy for LUAD patients, and PAM.score may act a part in the development of LUAD.

Prognostic significance of alveolar collapse in lung invasive adenocarcinoma and its relationship with tumor infiltrating lymphocytes.

This study aims to investigate the correlations between alveolar collapse, tumor size, and tumor infiltrating lymphocytes (TILs), while also evaluating the prognostic significance of alveolar collapse in invasive lung adenocarcinoma. 355 patients with solitary invasive lung adenocarcinoma were divided into two groups based on the maximum diameter of alveolar collapse: alveolar collapse ≤ 5 mm group and alveolar collapse > 5 mm group. Differences in clinicopathological characteristics, tumor size, TILs, and prognosis were compared between the two groups. The alveolar collapse > 5 mm group had a higher mean age, larger tumor diameter, and increased TILs levels compared to the alveolar collapse ≤ 5 mm group (P < 0.05). A moderate positive correlation was observed between alveolar collapse and tumor size (r = 0.646, P < 0.001). Lung adenocarcinoma with alveolar collapse > 5 mm demonstrated superior 5-year survival and acted as an independent prognostic indicator (HR=0.152, P = 0.004) in multivariate Cox regression analysis, alongside tumor size (HR=10.172, P = 0.034) and lymph node metastasis (HR=2.88, P = 0.017). The size of alveolar collapse is associated with TILs abundance, suggesting that the immune microenvironment may play a crucial role in alveolar collapse formation. Pathologists should take note of alveolar collapse in lung adenocarcinoma.

Comparison of Long-Term Effects Following Phacoemulsification Combined with Goniosynechialysis and Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Cataract.

INTRODUCTION: Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. METHODS: A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. RESULTS: The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. CONCLUSIONS: Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.

[Peripapillary choroidal thickness in primary open angle glaucoma and normal subjects measured by enhanced depth imaging optical coherence tomography].

OBJECTIVE: To compare peripapillary choroidal thickness (CT) between primary open angle glaucoma (POAG) and normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This research was a cross-sectional study. A 360-degree 3.4 mm diameter peripapillary circle scan was performed for retinal nerve fiber layer (RNFL) assessment by EDI-OCT in one eye of 40 POAG patients and 41 age- and sex-matched normal subjects. The observer used the manual segmentation function to delineate the posterior edge of the retinal pigment epithelium and the sclerochoroidal interface. The RNFL thickness algorithm function was used to automatically generate the CT in corresponding sectors. The intra- and inter-observer reproducibility was evaluated by intraclass correlation coefficient (ICC). Repeated measures ANOVA and LSD-t test were used to analyze differences in CT by peripapillary location. A Pearson correlation was calculated for variation in CT relative to age and RNFL. Spearman rank correlation was calculated to test the strength of the relationship between global mean RNFL and visual field mean deviation (MD) and between CT and MD. Independent-samples t-test was conducted to compare mean RNFL and CT between POAG and normal subjects. RESULTS: The intra- and interobserver ICC values ranged from 0.993 to 0.999 and 0.993 to 0.998 respectively. In both groups, the CT showed a negative correlation with age at each peripapillary location (r = -0.509 to -0.608, -0.549 to -0.668; P = 0.000 to 0.001) but no significant correlation with RNFL for any location (r = -0.186 to 0.273, -0.090 to 0.132; P = 0.092 to 0.869). The peripapillary CT was thickest superotemporally and superonasal, then nasally and temporally, and was thinnest inferotemporally and inferonasal (P = 0.000 to 0.036). Compared to normal subjects, eyes with POAG had significantly thinner RNFL at all locations (t = 6.975 to 16.087, P = 0.000), but CT measurements did not differ between groups for any location (t = -0.474 to 0.367, P = 0.637 to 0.978). In POAG patients, the global mean RNFL (rs = -0.511, P = 0.001) but not CT (rs = -0.285, P = 0.079) was found to significantly correlate with visual field MD. CONCLUSIONS: The peripapillary CT in POAG neither differ from that in normal subjects nor correlate with RNFL and visual field index, which does not support using it as a clinical parameter in glaucoma diagnosis or management.

Micropapillary Pattern in Invasive Mucinous Adenocarcinoma of the Lung: Comparison With Invasive Non-Mucinous Adenocarcinoma.

Background. The presence of a micropapillary pattern is associated with poor outcomes in lung adenocarcinoma. This study aimed to assess the clinicopathological features of micropapillary pattern in mucinous adenocarcinoma of the lung. Methods. The patients were stratified into three groups: the invasive mucinous adenocarcinoma group (60 patients), the mixed invasive mucinous adenocarcinoma group (33 patients), and the invasive non-mucinous adenocarcinoma group (237 patients). The presence of micropapillary pattern and its clinicopathological features were analyzed and compared between the three groups. Results. Compared to mixed invasive mucinous adenocarcinoma, invasive mucinous adenocarcinoma had lower frequencies of micropapillary pattern (28.3% vs 87.9%, respectively; P < .001) and lymph node metastasis (00.0% vs 15.1%, respectively; P = .005). The frequency of tumor spread through air space (STAS) in invasive mucinous adenocarcinoma (23.3%) was higher than that in invasive non-mucinous adenocarcinoma (6.3%; P < .001), while lower than that in mixed invasive mucinous adenocarcinoma (60.6%; P < .001). When the three groups were all accompanied by micropapillary pattern, there was no obvious difference in STAS between invasive mucinous adenocarcinoma with micropapillary pattern and mixed mucinous adenocarcinoma with micropapillary pattern (P > .05). No filigree pattern occurred in invasive mucinous adenocarcinoma with micropapillary pattern. Conclusions. The micropapillary pattern is frequently observed in invasive mucinous adenocarcinoma and has a better prognosis compared to mixed invasive mucinous adenocarcinoma and invasive non-mucinous adenocarcinoma. However, the malignancy of the micropapillary pattern in mixed mucinous adenocarcinoma was similar to that in invasive non-mucinous adenocarcinoma, even with the presence of mucus. These findings suggest that the development mechanisms of the micropapillary pattern in invasive mucinous adenocarcinoma and mixed mucinous adenocarcinoma may differ.

[Choroidal thickness in normal subjects measured by enhanced depth imaging optical coherence tomography].

OBJECTIVE: To evaluate the efficiency of enhanced depth imaging optical coherence tomography (EDI-OCT) on quantifying choroidal thickness (CT) in normal subjects. METHODS: This was a cross-sectional study. From June to November 2011, 129 eyes of 129 normal subjects were enrolled in this study and divided into three groups by age distribution. Group A, 43 eyes, 22 to 40 years old; group B, 42 eyes, 41 to 60 years old and group C, 44 eyes, 61 to 79 years old. They were examined with EDI-OCT for CT. The choroid was measured from the posterior edge of the retinal pigment epithelium to the choroid-scleral junction at 500 µm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. The paired t test was used to analyze differences in CT by location in the macula. One-way analysis of variance (ANOVA) was conducted to compare mean CT in different groups. Subsequently the data between two groups were analyzed by least significant difference (LSD-t). The reliability was evaluated by intraclass correlation coefficient (ICC). RESULTS: The choroid was thickest beneath the fovea (305.9 ± 78.2) µm. The mean CT decreased rapidly in the nasal direction and gradually in the temporal direction, reaching (159.0 ± 67.3) µm at 3 mm nasal to the fovea and (256.8 ± 73.6) µm at 3 mm temporal to the fovea. There was a significant difference between subfoveal CT and CT at all extrafoveal locations (t = 4.021 to 34.544, P < 0.05). There was also a significant difference of CT at all locations among three age groups (F = 34.122 to 72.239, P < 0.05). CT was significantly greater in group A than group B and C at all locations (P = 0.000, 0.000). It was also significantly greater in group B than group C (P = 0.000). The inter-examination ICC values ranged from 0.979 to 0.996. The intraobserver ICC values ranged from 0.981 to 0.997. The interobserver ICC values ranged from 0.971 to 0.995. CONCLUSIONS: Normal CT can be measured accurately by EDI-OCT. There are significant differences of CT between different age groups in normal subjects.

[Analysis of fundus fluorescein angiography, indocyanine green angiography and choroidal thickness in central serous chorioretinopathy].

OBJECTIVE: To evaluate the characteristics of choroidal thickness changes and abnormalities in choroidal circulation in cases of central serous chorioretinopathy (CSC). METHODS: This was a case control study, we measured the bilateral choroidal thickness in 21 patients with unilateral CSC and 24 eyes of 24 age- and sex-matched normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT). The choroid was measured from the posterior edge of the retinal pigment epithelium (RPE) to the choroid-scleral junction at 500 µm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Paired-samples t-test was conducted to compare mean choroidal thicknesses between symptomatic eyes and fellow eyes of patients. The datum between patients and normal subjects were analyzed by independent-samples t-test. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed and the digital images were analyzed in CSC patients. RESULTS: The 21 CSC patients had a mean age of 45.6 years, and 12 patients (57.1%) were male. The choroid in symptomatic eyes was thickest beneath the fovea (519.0 ± 102.5) µm. It was significantly thicker than that in the fellow eyes (439.3 ± 94.1) µm (t = 4.171, P < 0.05). Choroidal thickness in both groups was significantly greater than that in the eyes of age- and sex-matched normal subjects (332.0 ± 67.3) µm (t = 7.125, 4.441; P < 0.05). Choroidal thickness at each of the other 12 points showed a similar tendency (t = 2.544 to 3.819, 4.799 to 7.816, 2.487 to 5.236; P < 0.05). ICGA showed a choroidal filling delay (100%), vessels dilation (90.5%), and focal choroidal hyperfluorescence (100%) surrounding leakage from the RPE in symptomatic eyes. Pigment epithelium detachment with abnormal choroidal circulation was observed in 6 fellow eyes. In 4 symptomatic eyes and 11 fellow eyes, ICGA revealed choroidal hyperfluorescence but FFA showed normal appearance. CONCLUSIONS: CSC seems to be a bilateral eye disease with choroidal focal ischemia followed by vessels congestion and hyperpermeability. EDI OCT is a useful tool for monitoring choroidal thickness changes caused by choroidal vascular hyperpermeability.

Comparison of Long-Term Effects After Modified CO2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

INTRODUCTION: To compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study. METHODS: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively. RESULTS: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group. CONCLUSIONS: MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

Elevated IGF-1 and GH Levels Are Correlated With a Thicker Iris and Wider Anterior Chamber Angle in Treatment-Naïve Acromegaly Patients.

Purpose: To compare the difference in anterior segment biometrics derived from anterior segment optical coherence tomography (AS-OCT) between treatment-naïve acromegaly patients and normal controls and evaluate the correlations between above biometrics and insulin-like growth factor 1 (IGF-1) and growth hormone (GH) levels. Methods: Sixty eyes of 30 acromegaly patients and 60 eyes of 30 normal controls were included in this case-control study. Central corneal thickness, pupil diameter, iris thickness (IT), iris curvature (IC), anterior chamber depth (ACD), anterior chamber width, lens vault (LV), angle open distance (AOD) 500, AOD750, and trabecular iris space area (TISA) 500 and TISA750 were measured by AS-OCT. General linear regression models were constructed to evaluate the independent endocrine factors affecting iris morphology and anterior chamber angle (ACA) width. Results: The acromegaly patients had an evenly thicker iris (P < 0.001), a smaller IC (P < 0.05), a smaller LV (P = 0.040) and significantly larger AOD500, AOD750, TISA500 and TISA750 (P < 0.001). There was a positive correlation between the serum GH level and ACD in the acromegaly patients (P = 0.031). Linear regression models showed the lower LV and smaller IC were independent influencing factors of the increase in the AOD500, AOD750, and TISA750 and nasal TISA500. Serum IGF-1 was an independent factor for the increase in pupil diameter (ß = 0.002, P = 0.031) and both the average nasal (ß = 6.781*10-5, P = 0.049) and temporal (ß = 7.736*10-5, P = 0.045) IT values and for the decrease in temporal IC (ß < 0.001, P = 0.037). GH was an independent factor for the increase in temporal AOD750 (ß = 0.001, P = 0.030) and temporal TISA750 (ß = 0.002, P = 0.016). Conclusions: Patients with acromegaly have a thicker IT, smaller IC, and lower LV with a wider ACA than normal controls. Serum GH is independently correlated with the temporal ACA width, whereas serum IGF-1 is independently correlated with IT, pupil diameter, and IC.

Systematic profiling of antigen bias in humoral response against SARS-CoV-2.

We know little about the antigen bias in SARS-CoV-2 humoral response and the epitopes of spike recognized by the immune system in asymptomatic (AS) patients and symptomatic (S) patients. Here, we used a microarray to evaluate the humoral immune response in the sera collected from 33 COVID-19-recovered patients up to 1 year. We found that the levels of IgG and IgM induced by the 23 proteins differed significantly in the same patients, and were able to distinguish AS and S patients. The N- and S-specific antibodies were detected even at 12 months after onset. Five epitopes were identified to be associated with the clinical adverse events, and three peptides located in RBD. Overall, this study presents a systemic view of the SARS-CoV-2 specific IgG and IgM responses between AS and S recovered patients and provide insights to promote precise development of SARS-CoV-2 vaccines.

The method of Yiqi Yangyin Tongluo can attenuate the pyroptosis of rheumatoid arthritis chondrocytes through the ASIC1a/NLRP3 signaling pathway.

Background: Based on the ASIC1a/NLRP3 signaling pathway, we explored the specific molecular mechanism of the pyroptosis of rheumatoid arthritis (RA) chondrocytes by the method of nourishing qi, nourishing yin, and dredging collaterals to provide new ideas for the treatment of this disease. Methods: A total of 50 rats were divided into a normal group, model group, methotrexate group, Yiqi Yangyin Tongluo group, and combined group. Except for the normal control group, the other groups used Freund's complete adjuvant (FCA) to make RA rat model. The arthritis index and ankle joint swelling of rats in each group were recorded. HE staining and ELISA were used to assess the pathology of the ankle joint of each group of rats and the content of IL-1ß and IL-18 in rat serum. Furthermore, immunofluorescence and qPCR methods were used to detect the protein and mRNA expression levels of NLRP3, caspase 1, ACS, and ASIC1a in the cartilage tissue of each group of rats. Results: Compared with the normal group, the right hind foot joint of the model group was significantly swollen, the levels of IL-18 and IL-1ß in the serum of rats increased significantly, and the mRNA and protein levels of NLRP3, caspase 1, ACS, and ASIC1a in the chondrocytes also increased significantly. Compared with the model group, the degree of ankle joint swelling and IL-18 and IL-1ß content in rat serum in each medication group was significantly reduced, and the combined group showed the greatest reduction compared with the other groups. After 8 weeks of treatment, compared with the model group, the mRNA and protein levels of NLRP3, caspase 1, ACS, and ASIC1a in the chondrocytes of each medication group were down-regulated. HE staining found that there were large numbers of infiltrating inflammatory cells and pannus in the joint tissue of the model group, while only a small amount of inflammatory cell infiltration and pannus was seen in the joint tissue of the rats in each treatment group. Conclusions: The method of Yiqi Yangyin Tongluo can attenuate the pyroptosis of RA chondrocytes through the ASIC1a/NLRP3 signaling pathway.