AIM:To evaluate the clinical efficacy of 0.05% cyclosporine eye drops(Ⅱ)combined with sodium hyaluronate eye drops in treating patients with type 2 diabetes mellitus(T2DM)and moderate-to-severe dry eye.METHODS:A total of 120 T2DM patients(120 eyes)with moderate-to-severe dry eye, treated at the endocrinology and ophthalmology departments at the Affiliated Hospital of Xuzhou Medical University from January 2024 to September 2024, were enrolled in the study. The patients were randomly divided into two groups: combination group [0.05% cyclosporine eye drops(Ⅱ)+ sodium hyaluronate eye drops] and control group(sodium hyaluronate eye drops alone), with 60 cases(60 eyes)in each group. Assessments were conducted at baseline and at 1, 2, and 3 mo post-treatment, including the ocular surface disease index(OSDI), non-contact tear meniscus height(NITMH), first non-invasive tear breakup time(NIBUTf), meibomian gland loss score, lipid layer thickness grade, conjunctival hyperemia grade, and corneal fluorescein staining(FL)score. At 3 mo after treatment, changes in tear inflammatory factors were observed, and corneal subbasal nerve plexus(SBN)morphology/density were analyzed using in vivo confocal microscopy(IVCM).RESULTS:At 1, 2, and 3 mo post-treatment, both groups showed statistically significant increases in NITMH and NIBUTf compared to baseline(all P<0.05), with greater improvement observed in the combination group(both P<0.05). OSDI and FL scores significantly decreased from baseline(all P<0.05), with more pronounced reductions in the combination group(both P<0.05). Meibomian gland loss scores showed no significant improvement in either group(all P>0.05). At 3 mo after treatment, tear levels of interleukin 6(IL-6)and matrix metalloproteinase-9(MMP-9)significantly decreased in both groups(all P<0.001), with a greater reduction noted in the combination group(both P<0.001). The combination group displayed increased corneal nerve branch density and nerve fiber density, along with decreased nerve tortuosity and dendritic cell(DC)density compared to baseline(all P<0.001), while the control group did not show significant changes(all P>0.05).CONCLUSION: The combination of 0.05% cyclosporine eye drops(Ⅱ)and sodium hyaluronate eye drops significantly improves clinical outcomes in T2DM patients with moderate-to-severe dry eye. This treatment effectively alleviates ocular surface inflammation, restores corneal nerve morphology and density, and demonstrates a favorable safety profile.

AIM: To explore the risk factors associated with diabetic retinopathy(DR)based on ultra-widefield swept-source optical coherence tomography angiography(UWF-SS-OCTA), and to establish a clinical prediction model.METHODS:A total of 235 patients(235 eyes)with type 2 diabetes mellitus who were treated in the Affiliated Hospital of Xuzhou Medical University from July to November 2024 were selected as the research objects. According to the presence or absence of DR, they were divided into 120 cases(120 eyes)in non-DR group(NDR group)and 115 cases(115 eyes)in non-proliferative DR group(NPDR group). Data on general characteristics, laboratory tests, and OCTA results were collected for both groups. Univariate analysis was employed to identify DR-related risk factors. Logistic regression analysis was conducted to analyze these risk factors and to establish a DR prediction model. The efficacy of the model was evaluated using the receiver operating characteristic(ROC)curve, calibration curve, and decision curve analysis(DCA).RESULTS: The duration of diabetes, fasting blood glucose, blood urea nitrogen(BUN), history of hypertension, and the choroidal vascular index(CVI)were found to be statistically significant in the model(all P<0.05). Specifically, the duration of diabetes, fasting blood glucose, BUN, and history of hypertension were identified as risk factors for DR among diabetic patients, while CVI was recognized as a protective factor. The area under the curve for the model predicting the probability of DR was 0.898(0.859-0.938), with a diagnostic threshold of 0.438. The corresponding sensitivity and specificity were 87.8% and 78.3%, respectively, indicating that the model possesses high predictive value for the occurrence of DR.CONCLUSION: The duration of diabetes, fasting blood glucose, BUN, history of hypertension, and CVI are significantly correlated with DR. The established prediction model demonstrates a substantial screening capability for DR.

Objective To observe the value of high-resolution direct MRI using hydrogen peroxide for diagnosing complex or recurrent anal fistulas.Methods Data of preoperative specialized physical examination,transperineal ultrasound(TPUS),pelvic cavity low-resolution plain MRI and fistula high-resolution direct MRI of 27 patients with complex or recurrent anal fistulas confirmed by surgery were retrospectively analyzed.The receiver operating characteristic(ROC)curves were constructed,and the area under the curves(AUC)were calculated to assess the diagnostic performance of the above 4 methods for identifying internal openings,tracts of fistulas and perianal abscesses.Results Among 27 cases,totally 51 internal openings,54 fistula tracts(including 30 intersphincteric,18 transsphincteric,3 extrasphincteric and 3 suprasphincteric fistulas)and 18 perianal abscesses were found.The efficacy of high-resolution direct MRI for diagnosing internal opening of complex or recurrent anal fistula(AUC=0.880)was higher than that of specialized physical examination,TPUS and low-resolution plain MRI(AUC=0.553,0.687,0.687,all P＜0.05),and the efficacy of high-resolution direct MRI for diagnosing tract of complex or recurrent anal fistula(AUC=0.889)was higher than that of specialized physical examination and TPUS(AUC=0.556,0.694,both P＜0.05),but not significantly different with low-resolution plain MRI(AUC=0.833,P＞0.05).The efficacy of high-resolution direct MRI for diagnosing perianal abscesses of complex or recurrent anal fistula(AUC=0.971)was higher than that of specialized physical examination(AUC=0.549,P＜0.05)and comparable to TPUS and low-resolution plain MRI(AUC=0.745,0.858,both P＞0.05).Conclusion High-resolution direct MRI using hydrogen peroxide was helpful for diagnosing complex or recurrent anal fistulas.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

Background: Epimedii Folium, first recorded in the Shennong’s Classic of Materia Medica (Shen Nong Ben Cao Jing), is a traditional Chinese medicine (TCM) known for its effects of “benefiting Qi and strengthening the heart.” Icariside II (ICS II) is one of the main active components of Epimedii Folium, possessing cardiovascular protective and anti-inflammatory properties. However, the potential mechanisms of ICS II on myocardial ischemia (MI) remain unclear. Objective: The aim of the study was to investigate the effects and preliminary molecular mechanisms of ICS II in treating isoproterenolinduced MI in rats. Methods: A rat model of MI was established by subcutaneous injection of isoproterenol. Electrocardiography, echocardiography, myocardial enzymes analysis, heart weight index, triphenyltetrazolium chloride staining, histopathology, TUNEL staining, RT-qPCR, and Western blot were employed to evaluate the effects and preliminary molecular mechanisms of ICS II on MI rats. Results: Pharmacodynamic studies suggested that ICS II inhibited ST-segment elevation in electrocardiograms, improved cardiac function, reduced heart weight index and myocardial enzyme levels, decreased myocardial infarct size, alleviated cardiac histological damage, and inhibited apoptosis, thereby exerting cardioprotective effects in MI rats. Further studies revealed that ICS II may partially inhibit the expression of NLRP3/Caspase-1 axis-related targets at both protein and mRNA levels. Conclusions: Our findings indicate that ICS II exerts anti-MI effects, and its preliminary molecular mechanisms may be related to inhibiting the activation of the NLRP3/Caspase-1 axis to alleviate inflammatory responses.

AIM: To assess the stability of the tear film and the characteristics of corneal nerves in patients with Parkinson's disease(PD).METHODS: This cross-sectional observational study included 72 PD patients and 50 healthy controls. Disease severity was determined using the Hoehn-Yahr(H-Y)scale, dividing patients into mild and moderate PD groups. Dry eye symptoms were evaluated via the ocular surface disease index(OSDI)questionnaire, while tear secretion was quantified using the Schirmer I test. Ocular surface damage was assessed through staining scores, and comprehensive ocular examinations were performed utilizing the LipiView ocular surface interferometer and an ocular surface analyzer. Corneal nerve parameters were examined using corneal confocal microscopy in conjunction with automated analysis software ACCMetrics, with correlations drawn between these parameters, PD course, and severity.RESULTS: PD patients exhibited significantly elevated OSDI scores, indicative of more pronounced dry eye symptoms compared to the control group(F=70.290, P<0.01). Tear film stability was markedly compromised, with significantly shorter tear film breakup time and increased corneal fluorescein staining, both showing statistically significant differences relative to controls(all P<0.01). Tear secretion indices, including Schirmer I test results and tear meniscus height, were significantly reduced in PD patients(all P<0.01), whereas lipid secretion indices, such as lipid layer thickness and meibomian gland dropout score, did not show significant variation. Corneal nerve analysis revealed significant reductions in corneal nerve fiber density, nerve branch density, fiber length, and total branch density in PD patients compared to controls(all P<0.01). Furthermore, blink frequency was markedly prolonged(F=62.353, P<0.01). Correlation analysis demonstrated a significant relationship between alterations in tear film stability and both disease duration and H-Y scores.CONCLUSION: PD patients have obvious dry eye manifestations in the early stage of the disease, including the reduction of tear film stability and corneal nerve fiber density, and gradually aggravate with the progress of the disease. Neurodegenerative disease-related dry eye needs to be diagnosed early and actively treated.

Objective To observe the value of high-resolution direct MRI using hydrogen peroxide for diagnosing complex or recurrent anal fistulas.Methods Data of preoperative specialized physical examination,transperineal ultrasound(TPUS),pelvic cavity low-resolution plain MRI and fistula high-resolution direct MRI of 27 patients with complex or recurrent anal fistulas confirmed by surgery were retrospectively analyzed.The receiver operating characteristic(ROC)curves were constructed,and the area under the curves(AUC)were calculated to assess the diagnostic performance of the above 4 methods for identifying internal openings,tracts of fistulas and perianal abscesses.Results Among 27 cases,totally 51 internal openings,54 fistula tracts(including 30 intersphincteric,18 transsphincteric,3 extrasphincteric and 3 suprasphincteric fistulas)and 18 perianal abscesses were found.The efficacy of high-resolution direct MRI for diagnosing internal opening of complex or recurrent anal fistula(AUC=0.880)was higher than that of specialized physical examination,TPUS and low-resolution plain MRI(AUC=0.553,0.687,0.687,all P＜0.05),and the efficacy of high-resolution direct MRI for diagnosing tract of complex or recurrent anal fistula(AUC=0.889)was higher than that of specialized physical examination and TPUS(AUC=0.556,0.694,both P＜0.05),but not significantly different with low-resolution plain MRI(AUC=0.833,P＞0.05).The efficacy of high-resolution direct MRI for diagnosing perianal abscesses of complex or recurrent anal fistula(AUC=0.971)was higher than that of specialized physical examination(AUC=0.549,P＜0.05)and comparable to TPUS and low-resolution plain MRI(AUC=0.745,0.858,both P＞0.05).Conclusion High-resolution direct MRI using hydrogen peroxide was helpful for diagnosing complex or recurrent anal fistulas.

Objective To observe the clinical manifestations of 3 cases with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis antibody overlapping syndrome (MNOS), aiming to expand the understanding of the clinical spectrum of such syndromes. Methods Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies. Clinical features, neuroimaging characteristics, and outcomes were collected, and cell-based assay (CBA) technique was used for diagnosis. Results One case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In one case, the clinical and cranial magnetic resonance imaging (MRI) features of demyelinating disease recurred after anti-NMDAR encephalitis, with atypical symptoms of MNOS such as numbness and weakness in limbs, blurred vision, and diplopia. The last case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In MNOS, MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially, with epilepsy being the most common symptom. Cranial MRI findings showed that the patients presented and mainly involved supratentorial lesions, which may also involve the brainstem, but no spinal cord lesions were found. All patients showed slightly abnormal cerebrospinal fluid. Patients showed a good response to first-line immunotherapy during the acute phase of the disease, with a favorable prognosis. But most patients were prone to relapse. Conclusion In MNOS patients, anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simultaneously or sequentially. The clinical manifestations of patients are complex and diverse. Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.

This study reported a 50-year-old female patient who was diagnosed with anti-IgLON family member 5 (anti-IgLON5) antibody-related encephalopathy, presented with cognitive and sleep disorders, autonomic dysfunction and seizures, positive serum IgLON5 antibody but negative cerebrospinal fluid IgLON5 antibody, negative human leukocyte antigen (HLA) by genetic testing, and was diagnosed as anti-IgLON5 antibody-related encephalopathy. After hospital admission, the patient was given intravenous methylprednisolone combined with immunoglobulin immunotherapy, donepezil for improvement of cognition, sodium valproate and oxcarbazepine for prevention and treatment of epileptic seizures, and finally her symptoms improved significantly.