Objective To assess the prevalence and binocular dysfunctional risk factors associated with asthenopia among adult myopes.Methods The study population included 800 adult myopes,a cross-sectional visual parameters that characterize the accommodative:accommodation amplitude (AA),accommodative facility,and accommodative response (fused crossed cylinder-FCC) and binocular function (near and distant horizontal and vertical associated phorias,near and distance negative and positive fusional vergence,near point of convergence,negative and positive relative accommodation (NRA/PRA),stimulus AC/A ratio and stereoacuity) were evaluated when these subjects wore adequate spectacle correction.Results Asthenopia was reported in 24.2％ (194/800) of myopes.The incidence of asthenopia in female (27.8％,128/460) was more than that in male (19.4％,66/340),and there was significant difference (P =0.006).In univariate analysis,the monocular AA,binocular AA,NRA and PRA were significantly associated with asthenopia (P =0.000).In multivariate analysis,low NRA (≤1.25 D),low NRA (≤1.50 D) were significant risk factors for asthenopia (P =0.000,OR =7.644 ;95％ CI 2.913-17.580;P =0.000,OR =5.303;95％ CI 2.822-16.205).Conclusion Preventive measures directed against the binocular dysfunctional risks factors associated with asthenopia may help reduce the prevalence and provide a positive impact on asthenopia.

Objective To compare the effectiveness of controlling blood loss in the treatment of complex acetabular fracture between temporary occlusion of abdominal aorta by interventional balloon (TOAAIB),temporary occlusion of common iliac artery by interventional balloon (TOCAIIB) and internal iliac artery ligation (IIAL).Methods Included for this study were 113 complex acetabular fractures which had been treated at Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University from January 2000 through January 2017.There were 68 males and 45 females,aged from 23 to 61 years (average,42.3 years).According to the Letournel classification,all of them belonged to complex fractures,including 10 T-type,24 double-column,16 posterior column & posterior wall,46 transverse & posterior wall and 15 anterior & posterior half-transverse ones.They were all treated by open reduction and internal fixation but differed in surgical hemostasis techniques:TOAAIB was used in 37cases,TOCAIIB in 31 and IIAL in 45.Fracture reduction was evaluated by Matta criteria.Intraoperative bleeding and postoperative wound drainage,fracture union and complications related to interventions were recorded.Hip function was evaluated by Modified d'Aubigne & Postal clinical grading system after fracture healing.Results The 3 groups (TOAAIB,TOCAIIB and IIAL) were comparable because there were no significant differences in gender,age,time from injury to surgery,Letournel classification or surgical approaches between the patients in the 3 groups (P ＞ 0.05).Anatomical reduction was achieved in 91.15％ of the patients (103/113) and satisfactory reduction in 8.85％ (10/113).Intraoperative hemorrhage was 1,631.5 ±675.5 mL in the HAL group,892.6 ±217.7 mL in the TOCAIIB group and 648.0 ± 170.2 mL in the TOAAIB group,showing significant differences between the 3 groups (P ＜ 0.05).One case of femoral artery thrombosis occurred in the TOAAIB group at the end of operation but was cured by symptomatic treatment of anticoagulation.There were no interventional complications in the other 2 groups.There were no significant differences between the 3 groups in postoperative wound drainage,fracture union time,hip function score or complications (P ＞ 0.05).Conclusions In controlling intraoperative bleeding in the surgery for complex acetabular fracture,TOAAIB may be the best,followed by TOCAIIB,and IIAL may be the worst.However,choice of a proper surgical hemostasis technique should also depend on the specific intraoperative condition of a specific patient.

Aging is a degenerative process that leads to dysfunction and abnormalities of tissues and cells in vivo.In the retinal neural degenerative diseases associated with aging, retinal ganglion cells (RGCs) are injured and lose their function.Through interacting ways including energy generation disorders, oxidative stress damage, mitochondrial mutation accumulation, protein misfolding and aggregation, immune inflammatory response, lack of neurotrophic factors, insufficient blood flow, increased pressure difference across lamina cribrosa and sclerosis of connective tissues, the sensitivity of RGCs to damage factor might be increased, which plays an important role in the process of optic nerve injury and degeneration.Rejuvenation of RGCs is supposed to be the key to the treatment of neurodegenerative diseases such as glaucoma, which can reduce or even reverse the damage caused by aging and promote the regeneration of RGCs, providing new targets for protecting visual function.Therefore, the research on the role of aging in RGCs injury will provide a new direction for optic nerve protection strategies.From aging and RGCs damage as well as new ideas of RGCs rejuvenation, this paper reviews the role and significance of aging in RGCs damage.

Background and objective BIM gene is a member of the BCL-2 family, is involved in cell death. The aim of this study is to explore the relationship between BIM gene polymorphism and therapeutic efficacy in the retreatment advanced non-small cell lung cancer (NSCLC) with tyrosine kinase inhibitor (EGFR-TKI). Methods In the study, there were 123 patients who were diagnosed with advanced NSCLC in Zhejiang Province Cancer Hospital bewteen January 2009 to October 2012, all of who were received gefitinib and erlotinib therapy after failure to chemotherapy. We detected the genotype of peripheral blood leukocytes of patients with BIM gene polymorphism though polymerase chain reaction (PCR). Statistical analysis was performed by SPSS version 13.0. Results On the disease control rates, BIM gene with no polymorphism type was slightly better trend than polymorphism types in disease control rate DCR (75.5% vs 57.1%, χ2=2.931, P=0.087). Univariate analysis the median PFS, women were longer than men (6.9 months vs 4.5 months, χ2 =7.077, P=0.008). Non-smokers were longer than smokers (8.0 months vs 2.5 months, χ2 =15.277, P<0.001). Adenocarcinoma were longer than others pathological type (7.0 months vs 2.0 months, χ2 =14.978, P<0.001). The median PFS in BIM gene with no polymorphism type were longer than with polymorphism type (6.0 months vs 3.5 months, χ2=7.035, P=0.008). Multi-factor analysis showed that smoking, pathological type, the BIM gene polymorphism were the independent prognostic factors for PFS. Conclusion The patients with the BIM gene no polymorphism have longer the median progression-free time than the polymorphism types in retreatment advanced non-small cell lung cancer patients with tyrosine kinase inhibitor.

Glaucoma is a disorder that leads to retinal ganglion cells (RGCs) apoptosis, visual field loss and optic nerve degeneration.The RGCs death is irreversible, which limites their ability for axon regeneration after injury.Bone marrow mesenchymal stem cells (BMSCs) have shown promise as cell-incorporation, cell-supplements and paracrine-mediated therapy for compromised neurons, which have allowed the possibility of the pluripotent BMSCs based regeneration of retinal cells and repair of neurodegenerative diseases.Intravitreal injection, subretinal injection and autologous BMSCs homing transplantation were explored as therapy for various retinal injury conditions.These BMSCs primarily have paracrine trophic effects and can also incorporate into the damaged retina directly, which have regenerative and protective effects on the reduce of RGCs apoptosis and retinal nerve fiber loss, and multiple cell signals and mechanisms are involved.This review provides an update of the current evidence of BMSCs as treatment and potential limitations, and complications for glaucomatous RGCs dysfunction.The researches including induced-differentiation, transplantation methods and the potential neuroprotective mechanism of BMSCs as therapy for glaucomatous retinal degeneration were discussed.

Visual behaviorally operant method is one of the main detections for identifying animal models of visual diseases, which is mainly through the optomotor response (OMR) and optokinetic reflex (OKR) stimulated by the virtual operating system (VOS). The automated VOS was commonly used as a powerful tool to control the contrast sensitivity and measure the spatial frequency of the monitoring device by adjusting parameters such as grating fringe width, rotation velocity and light intensity, and also to track the OKR, OMR, and the combined movement of OKR and OMR.Both the optimized measuring methods and evaluation indicators including the search coils, the corneal labeling, OMR-arena system, the OMR index, the staircase protocol tests and the improved stimuli from two-dimensional to three-dimensional helped to ensure the validity of test data.Moreover, the introduction of image recognition technology benefited in extracting the body and head contours of mice.Computer algorithms such as deep learning were also applied to analyze and process the visual behavior of diseased mice, which promoted sensitivity, shortened testing time, reduced detection errors and improved data accuracy.For all the factors mentioned, the VOS could be used as an effective research tool for glaucoma, cataract, retinopathy, hereditary eye disease, optic nerve degeneration and others.This article reviewed the value of VOS for visual behavioral assessment in mice models of visual disease from the visual detection methods and assessment indicators.

Axenfeld-Rieger syndrome is a rare autosomal dominant hereditary disease characterized by anterior segment dysgenesis, which may be accompanied by various systemic defects, including craniofacial dysmorphism, hypodontia, microdontia, and redundant periumbilical skin.Its typical ocular manifestations include posterior embryotoxon, iris hypoplasia, peripheral anterior synechiae, corectopia and polycoria with a high prevalence of glaucoma.Patients can exhibit any combination of these features.However, family members with the same genotype may present different phenotypes due to phenotypic heterogeneity.Emerging evidence suggests that PITX2 and FOXC1 genes encoding transcription factors are primarily associated with genetic variants in ARS.Intragenic mutations and gene deletions are common types of genetic variations suspected to trigger changes in gene dosages and protein function.However, the underlying molecular mechanism remains unclear.Some patients with ARS carry mutations in the COL4A1, PRDM5, and CYP1B1 genes, but the pathogenicity of these variations has yet to be confirmed by further studies.This article provided an overview of the typical clinical features, potential correlations between phenotype and genotype, as well as gene function.

Background and objective Molecular targeting therapy is the direction of individualized treatment of lung cancer, scholars has been established targeted therapy prediction models which provide more guidance for clinical individual therapy. hTis study investigated the relationship among pulmonary surfactant-associated protein D (SP-D), trans-forming growth factorα(TGF-α), matrix metalloproteinase 9 (MMP-9), tissue polypeptide speciifc antigen (TPS), and Krebs von den Lungen-6 (KL-6) and response as well as survival in the patients with recurrent non-small cell lung cancer, which Erlotinib was as second line treatment atfer failure to chemotherapy. hTis study also established a predictive prognostic model.Methods Serum levels of SP-D, TGF-α, MMP-9, TPS, and KL-6 in 114 patients before erlotinib treatment were detected by ELISA method. Combined with clinical factors, these levels were used to investigate the relationship with effcacy in erlotinib treatment and construct a predicted prognostic model by Kaplan-Meier curve and Cox proportional hazard model multivariate analysis. Results hTe objective response rate (ORR) and disease control rate (DCR) in the 114 patients, were 22.8%(26/114) and 72.8%(83/114), to Erlotinib treatment respectively. hTe median progression-free survival (PFS) and one year survival rate with Erlotinib treatment were 5.13 months and 69.3%, respectively. Patients in the SP-D>110 ng/mL group exhibited more ORR (33.3%vs 13.3%, P=0.011) and DCR (83.3%vs 63.3%, P=0.017) than those in the≤110 ng/mL group. Patients in the MMP-9≤535 ng/mL group showed more DCR (83.9%) than those in the>535 ng/mL group (62.1%) (P=0.009). Patients in the TPS<80 U/L group showed more DCR (82.4%) than those in the≥80 U/L group (55.0%) (P=0.002). hTe SP-D>110 ng/mL (5.95 months vs 3.25 months, P=0.009), MMP-9≤535 ng/mL (5.83 months vs 3.47 months, P=0.046), KL-6<500 U/mL (6.03 months vs 3.40 months, P=0.040), and TPS<80 U/L (6.15 months vs 2.42 months, P=0.014) groups showed better PFS. Multivariate analysis showed that current or ever-smoker, wild style of EGFR status, progression atfer prior chemotherapy, absence of skin rash, elevated serum LDH level, and TPS≥80 U/L were independent adverse prognostic factors for PFS. hTese six factors were used in the prognostic model. Patients were categorized into four prognosis risk groups based on the prog-nostic index from the model, namely, low risk, intermediate low risk, intermediate risk, and high risk groups. hTe median PFS of good, intermediate, poor, and very poor prognosis groups were 9.12, 6.88, 3.52, and 0.93 months (P<0.001), respectively. Conclusion hTe prognostic model based on clinical parameters with TPS will be useful in identifying patients who might be most likely to beneift from Erlotinib therapy in the patients with recurrent non-small cell lung cancer.

Objective:To identify disease-causing variation in a Chinese family with Axenfeld-Rieger syndrome (ARS) through the analysis of clinical symptoms and hereditary information.Methods:The method of pedigree investigation was adopted.A Chinese ARS family including 15 family members of 3 generations was recruited in the Second Affiliated Hospital of Harbin Medical University in 2018.There were 3 patients in the family.The family history and clinical data were collected.Ophthalmic and general examinations were carried out in all the members included.DNA and RNA were extracted from collected peripheral venous blood samples of 2-5 ml from each member.Whole exome sequencing was used to screen the variations in the proband.Suspected variations screened through searching population databases and bioinformatics analysis were verified by Sanger sequencing and real-time quantitative PCR.Conservation analysis and deleteriousness prediction of suspected variations were conducted.The pathogenecity of candidate rare variations were evaluated according to the American College of Medical Genetics and Genomics (ACMG) standards and guidelines.This study followed the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (No.KY2019-231).Written informed consent was obtained from each subject or custodian prior to entering the study cohort.Results:The 3 patients all had typical ARS clinical features in eyes, teeth and umbilicus, and carried the same heterozygous variant, c.525delC (p.Asp175Glufs *) in the PITX2 gene, which were not found in other members, indicating co-segregation.The relative expression of PITX2 mRNA was 0.672±0.063 in the patients, which was significantly lower than 1.015±0.179 in the healthy controls ( t=8.847, P<0.001).This variant was not recorded in dbSNP, 1000G, gnomeAD, ExAC, Korea1K and EVS databases, and it was labelled as deleterious by MutationTaster.The affected conservative amino acid sequences were found in 9 species.The variant was determined as pathogenic according to the ACMG standards and guidelines. Conclusions:The c.525delC (p.Asp175Glufs *) mutation of PITX2 gene is pathogenic in the pedigree.This is the first time that this mutation has been reported in Chinese family with ARS.

BACKGROUNDThe preclinical experiments and several clinical studies showed icotinib, an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in Chinese patients with advanced non-small cell lung cancer (NSCLC) who failed previous chemotherapy. We performed a retrospective study of the efficacy and safety of icotinib monotherapy in a different and more recent sample of Chinese patients.

METHODSThe clinical data of 149 patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from August 1, 2011 to July 31, 2012 were retrospectively analyzed. All patients were given icotinib treatment after the failure of previous chemotherapy. Univariate and multivariate analyses were conducted based on the Kaplan Meier method and Cox proportional hazards model.

RESULTSThe objective response rate was 33/149 and disease control rate was 105/149. No complete response occurred. Median progression free survival (PFS) with icotinib treatment was 5.03 months (95% CI: 3.51 to 6.55). Median overall survival was 12.3 months (95% CI: 10.68 to 13.92). Multivariate analysis showed that the mutation of EGFR and one regimen of prior chemotherapy were significantly associated with longer PFS. At least one drug related adverse event was observed in 65.8% (98/149) of patients, but mostly grade 1 or 2 and reversible and none grade 4 toxicity.

CONCLUSIONSIcotinib monotherapy is an effective and well tolerated regimen for Chinese patients with NSCLC after the failure of chemotherapy. It is a promising agent and further study with icotinib in properly conducted trials with larger patient samples and other ethnic groups is warranted.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Crown Ethers ; adverse effects ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Quinazolines ; adverse effects ; therapeutic use ; Retrospective Studies