Medication is one of the important methods in treatment of glaucoma, but misunderstandings of some problems during glaucoma medication still exist, such as how to use and evaluate the drugs and when to use the drugs etc. These are reviewed and discussed in this paper.

Background Primary angle-closure glaucoma (PACG) is the most common type of glaucoma in China.A screening to identify the possible angle closure is important in the prevention and treatment of PACG.Objective This study was to determine the characteristics and the optimal parameters measured by the scanning peripheral anterior chamber depth analyzer (SPAC) in the screening of occludable angle of a sample of adult Chinese population.Methods A cross-sectional study was performed in Handan from February to April in 2013.One hundred and eighty Chinese adults were enrolled with the age of 40 years and older and acceptable criteria during 5-year following-up duration of the Handan Eye Study.Routine eye examinations were carried out in all subjects under the informed consent,including visual acuity,optometry,anterior ocular segment examination under the slit lamp microscope,and then SPAC measurement and gonioscopy were performed in a dark room.Occludable angle was defined as posterior trabecular meshwork being invisible in ≥ 180° range under the static gonioscope.Occludable angle by SPAC was estimated using available central chamber depth (ACD) and a combined indicator,numerical grade was 5 or fewer and/or the categorical grade was S or P,separately.Receiver operating characteristic (ROC) curve was calculated to assess the performance of these parameters in detecting eyes with occludable angle for the population-based sample,and area under curve (AUC) was drown to compare the screening efficiencies between available ACD and combined indicator.Results In 180 subjects,occludable angles were found in 62 and open angles were in 118.Compared to the subjects with open angle,the subjects with occludable angle showed the older age (P＜0.001),more females (P＜0.05),lower visual acuity (P＜0.001),greater hyperopic diopter (P＜0.05),smaller ACD value (P＜0.001) and shorter axial length(P＜0.001).In eyes with occludable angle by using SPAC,the ACD showed an AUC of 0.832.Using a cutoff of 2.7 mm for ACD,the sensitivity and specificity were 85.48％ and 68.64％,and under the cutoff of 2.8 mm,the sensitivity and specificity was 90.32％ and 61.02％,respectively.For the combined parameters,the sensitivity and specificity was 62.90％ and 90.68％,respectively and the AUC was 0.768.Conclusions When gonioscopy is used as a reference,a cutoff of 2.8 mm ACD by SPAC shows the highest sensitivity for the screening of occludable angle in Chinese population.

Background Early diagnosis of primary angle-closure glaucoma (PACG) and screening or case detection of high risk population have become a major challenge in the prevention and treatment of PACG.Commonly used methods for evaluation of anterior chamber depth (ACD) and anterior chamber angle nowadays have their shortcomings.Scanning peripheral anterior chamber depth analyzer (SPAC) measures ACD and evaluates the risk of angle closure.Also,SPAC is handy,objective and noninvasive.Objective This study was to evaluate the repeatability (within-rater differences) and reproducibility (between-rater differences) of SPAC to measure anterior chamber-related parameters and agreement of SPAC to estimate occludable angle between two operators.Methods A prospective cross-sectional study was designed.Thirty subjects with shallow ACD (modified van Herick grading≤ 3 and Shaffer grading≤2) aged 35 years and older,who met the inclusion criterion were enrolled as shallow anterior chamber group and 30 age-and gender-matched normal adults (modified van Herick grading≤3 and Shaffer grading≤2)from the follow-up research of the Handan Eye Study in February 2013.After an elementary eye examination,a randomly selected eye of each subject in both groups received three consecutive SPAC measurements by each of the two examiners,respectively to obtain ACD,central corneal thickness (CCT) and corneal radius of curvature (CRC).Meanwhile,the identity of occludable angle as the numerical grade was 5 or fewer and/or the categorical grade being S or P was also obtained.The repeatability of each examiner was evaluated by the repeatability limit (RL) and the reproducibility of the two examiners was evaluated by intraclass correlation coefficient (ICC).The agreement of occludable angle estimation between two operators was evaluated using Kappa coefficient.Results The RLs percentage for ACD,CCT and CRC ranged from 0.36％ to 3.29％,and 0.90％ to 4.72％ in the normal control group and shallow anterior chamber group from operator A,and those from operator B were 0.38％ to 2.55％,and 0.51％ to 3.42％.The ICCs for ACD,CCT and C RC of SPAC were 0.966,0.859,0.989 and 0.915,0.905,0.971,respectively from operator A and operator B.The Kappa coefficients for the identity of occludable angle between two operators were 1.000 and 0.520 in the normal control group and the shallow anterior chamber group,respectively.Conclusions Measurements of the three parameters provided by SPAC in normal and shallow anterior chamber subjects show a good repeatability and reproducibility.The results of identity of occludable angle from two examiners have a good agreement for normal subjects and a moderate reproducibility for subjects with shallow ACD.

Objective To explore the mechanism of epinephrine in down-regulating intraocular pressure.Methods The third passage bovine trabecular meshwork cells were divided into control group and epinephrine treated groups in random fashion.Different dosages of epinephrine(10-4、10-5 and 10-6mol/L) were added in cultures and incubated for 14 days.AQP1 expressions was stained by immunocytochemistry method,and the cell area was measured by computer image analytical system.Results The expressions of AQP1 and cell areas in epinephrine treated groups was significantly lower than control group(P

Objective To assess the level of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the sera of patients with systemic lupus erythematosus (SLE),rheumatoid arthritis (RA),multiple sclerosis (MS)and insulin dependent diabetes mellitus (IDDM).Method The level of sFas and sFasL was determined by a sandwich enzyme linked immunosorbent assay.Anti ssDNA (single stranded DNA) was detected by indirect enzyme linked immunosorbent assay.Results The level of sFas in patients with SLE,RA,IDDM and MS was significantly higher than that in healthy individuals.It was interesting that among these autoimmune diseases,the level of sFas in the sera of patients with SLE was dramatically higher than that of the other diseases.The high level of sFasL accompanied by sFas was found in the sera of SLE and RA patients.In the sera of patients with SLE,the anti ssDNA antibody always accompanied by high concentration of sFas and,by contrast,no anti ssDNA antibody was found in all the patients in whose sera no sFas was found.In patients with IDDM,the sFasL level of the serum was significantly lower than that of the serum of healthy donors.Conclusion Serum sFas level of patients with SLE,RA,MS and IDDM is higher than that of healthy individuals.These results indicate that the sFas level can be used as a marker of disease progress and relaxing after treatment with the medicine.It is also demonstrated that there is relationship between the level of anti ssDNA antibody and sFas.The level and significance of serum sFas and sFasL in these autoimmune disease patients are under investigation.

Objective:To investigate the risk factors for synchronous multiple early gastric cancer (SMEGC).Methods:A retrospective analysis was conducted on data of 390 patients with early gastric cancer, including 353 cases of solitary early gastric cancer (SEGC group) and 37 cases of SMEGC (SMEGC group), who underwent endoscopic submucosal dissection (ESD) in Chinese PLA General Hospital from January 2017 to June 2019. The differences in clinical characteristics (gender, age, body mass index, smoking status, drinking status, family history of gastrointestinal cancer and other cancers, etc.) and pathological characteristics (size, location, morphology, differentiation degree, invasion depth, with or without Helicobacter pylori infection, intestinal metaplasia, ulcers and atrophic gastritis of lesions, etc.) between the two groups were compared by t test, Mann-Whitney U test, Chi-square test, or Fisher′s exact test. Logistic regression (forward LR) was used to screen the independent risk factors for SMEGC. Results:There were no significant differences in the general clinical characteristics between SMEGC group and SEGC group ( P>0.05). Significant statistical differences were observed in the location of lesions ( χ2=8.375, P=0.015), the proportion of atrophic gastritis [48.6% (18/37) VS 23.8% (84/353), χ2=10.710, P=0.001] and the proportion of intestinal metaplasia [81.1% (30/37) VS 43.1% (152/353), χ2=19.452, P<0.001] between the two groups, but there were no significant differences in other pathological characteristics ( P>0.05). Multivariate logistic regression analysis showed that location of lesions in the middle 1/3 of stomach (VS upper 1/3: P=0.036, OR=3.38, 95% CI: 1.08-10.53), in the lower 1/3 of stomach (VS upper 1/3: P=0.049, OR=2.59, 95% CI: 1.00-6.69), presence of intestinal metaplasia ( P=0.001, OR=4.38, 95% CI: 1.77-10.86) and atrophic gastritis ( P=0.043, OR=2.24, 95% CI: 1.04-5.07) were independent risk factors for SMEGC. Conclusion:Patients with early gastric cancer located in the middle or lower 1/3 of stomach, with intestinal metaplasia and atrophic gastritis are prone to SMEGC and should be carefully evaluated and closely followed up after ESD.

Background Evidence-based medicine (EBM) has been widely applied to solve clinical issues internationally,however,the awareness of oculists in China still is dissatisfied,and the relevant issue survey can offer the training guidance.Objective This study was to survey the status of the cognition and practice of EBM in ophthalmologists in China and analyze the problems in their EBM practice.Methods Two hundred and thirty-three ophthalmologists were enrolled in the 18th Congress of Chinese Ophthalmological Society in August,2013.A survey about EBM was performed by self-made questionnaire,including general data from the surveyors,the way and channel of understanding EBM,the attitude toward EBM,clinical practice of EBM and influencing factors.The educational background,professional qualifications,ranked distribution of hospitals which surveyors came from,size of the citys and attribute of hospitals were stratified and analyzed.SPSS 17.0 software was used for statistical analysis.Results A total of 233 questionnaires were distributed,and 233 were regained with the response rate 100％,and 214 valid questionnaires were included,with the effective rate 91.8％.50.5％ of the respondents (104/206) knew EBM in university.The proportion of those believe EBM initially as medical students was 41.8％,and 49.1％ (102/208) were aware of EBM in recent 8 years.And 47.7％ (101/211) believed that EBM should be given priority in clinic,and 7.5％ (16/211) were indifferent to EBM.Only 3.8％ (8/211) surveyors thought EBM to be little important.The proportion of the respondents choosing ‘ know’ or ‘ moderately-know’ were 69.1％ (148/214),35.0％ (75/ 213),21.5％ (46/213) and 57.4％ (121/211) respectively in EBM,Meta analysis,Cochrane as well as Preferred Practice Patterns (PPPs) with a higher receiving degree in well-educated individuals (P =0.000,0.000,0.001,0.000).EBM was well practiced in 11.7％ (25/211) oculists,with a higher using frequency in senior ophthalmologists,and 17.8％ (89/495,frequency) oculists consulted the EBM literature to resolve problems in clinic,with a significant difference in the using frequency of EBM among the different educational background subjects (x2=13.406,P=0.037).The top three barriers which affected the application of EBM in clinical practices were lack of time and the limited energy,feeling it difficult to evaluate the evidence correctly as well as the absence of cases proving the efficacy to treat based EBM.The type of EBM evidence mostly used by respondents was medical database (36.7％),and CNKI (33.5％) and PubMed (38.4％) were the mostly used Chinese and English database,respectively.Respondents who have never searched the Chinese or English database occupied up to 7.3％ and 17.2％,respectively.Conclusions The cognition degree and applying frequency are still lower in ophthalmologists in China.The training of EBM should be strengthened in medical students.The guidance measurement should be taken to encourage eye doctors to apply EBM.

Background Randomized controlled trial (RCT) can offer high quality of evidence for the medical decisions.Consolidated standards of reporting trials (CONSORT) statement,an international criteria for RCT report,is a guideline and methodology of RCT report.However,the assessment and application of RCT according to CONSORT are dissatisfactory in China.Objective This study was to evaluate the reporting quality of ophthalmic diseases related RCTs published in SCI journals from mainland China and offer a good methodology of RCT report.Methods The RCT literature were searched on PubMed database according to Ophthalmology, Eye and all of their inferior subjective terms,and the published papers were limited in mainland China and before March,2013.Included papers were evaluated independently and checked by two searchers.The methodology and results of all retrieved papers were stratifiedly analyzed by the year of CONSORT published and revised.Results Sixty eligible RCTs were assessed,and the intervention methods were primarily surgery trials (34/60).Forty-four papers presented the comparison study of two groups with the median sample size of 76.0.Only 22％ (13/60) trial reports gave the clear identification of RCT in the title.Majority of papers described trial design,eligibility criteria for participants,detail of interventions and outcome measures.Twelve pieces of articles reported how sample size was determined,and 41 pieces referred settings and locations,but only 6 pieces recorded interim analyses and stopping guidelines.After CONSORT 2010 Statement was published,the proportion of trial reports that included details of the randomization had little improvement (RR=1.06,95％ CI:0.62-1.82).Only 42％ trial reports (25/60) offered a description about blinding method.Conclusions RCT reports related to ophthalmic diseases from mainland China in SCI journals are still flawed with certain shortcomings.Following the guidance of the CONSORT statement can improve the quality of ophthalmic diseases related RCT from mainland China.

Objective To identify certain isoforms involved in the onset of retinal ischemic preconditioning (IPC), the effects of ischemic pretreatment (IP) were observed on level of conventional protein kinase C (cPKC) ?,?Ⅰ、?Ⅱand ? isoform-specific membrane translocation and protein expression in retina of rats. Methods Retinal IP was produced by intra-ocular pressure (IOP) elevation for 5 minutes in anesthetized Wistar rats. Sham operation was similar to IP except the pressure elevation. 10, 20, or 40 minutes and 1, 12, 24, 72 or 168 hours after the procedure, cPKC isoform-specific membrane translocation and protein expression were analyzed using Western-blot. Results cPKC? protein expression significantly increased from 12 h to 168 h. A peak reached at 72 h after IP. cPKC? membrane translocation enhanced during 20 min to 1 hours with a peak at 40 min. cPKC? protein expressionlevels significantly increased from 12 hours to 72 hours. A peak was found at 24 hours after IP. However, there were no significant changes in both membrane translocation of cPKC?, ?Ⅰ、?Ⅱand protein expression of cPKC?Ⅰ, ?Ⅱ in retina of rats following IP.Conclusion The enhanced cPKC? membrane translocation, the increased cPKC? and ? protein expressions might be involved in the onset and sustain of retinal IPC in rats respectively.

Aim To explore the mechanism of the immune tolerance induced by the auto-islets in the intermingled skin grafting. Methods The mixed epidermal cell and lymphocyte culture (MELC) was established, in which auto-keratinocytes were added to mimic the effect exerted by the auto-islets in vivo. Results Auto-keratinocytes could inhibit the lympho-proliferation induced by alloantigen. Conclusion The immune tolerance induced by auto-islets may be related to the function of auto-keratinocytes as antigen presenting cells.