AIM:To evaluate the effectiveness of EYESI binocular indirect ophthalmoscope simulation system as a training platform for fundus examination skills of general practitioner.METHODS:Prospective randomized study. A total of 40 general practitioners who received clinical ophthalmology training at Shenzhen Eye Hospital from January 2021 to December 2024 were selected and randomly divided into two groups by random number table method, with 20 cases in the study group and 20 cases in the control group. The study group was trained by EYESI binocular indirect ophthalmoscope simulation system and the control group was trained by conventional teaching. Training effects of the two groups were analyzed.RESULTS: The general information of the two groups was comparable. Through training with the EYESI binocular indirect ophthalmoscope simulator, the study group showed significant improvements in total examination and drawing scores compared to pre-training results(all P<0.001). Additionally, examination duration, retinal light exposure time, and drawing time were all significantly shorter than those before training(all P<0.001).The study group achieved significantly higher total examination and drawing scores than the control group during the EYESI binocular indirect ophthalmoscope simulator assessment(all P<0.001). Furthermore, examination duration, retinal light exposure time, and drawing time were all significantly shorter in the study group compared to the control group(all P<0.001). Moreover, ratings for the novelty of the training method and overall satisfaction with the training were significantly higher in the study group than in the control group(all P<0.001); while the perceived psychological stress during training was significantly lower in the study group(P<0.001).CONCLUSION:The EYESI binocular indirect ophthalmoscope simulaton system effectively enhances both the proficiency in fundus examination skills and overall training satisfaction among general practitioners.

Humans ; East Asian People ; Psoriasis/drug therapy* ; Antibodies, Monoclonal, Humanized/therapeutic use* ; Treatment Outcome ; Severity of Illness Index

Objective:To summarize the clinical characteristics and treatment of cytomegalovirus(CMV)infection in pediatric kidney transplant patients.Methods:From May 2014 to July 2021, a total of 9 cases(8.65%)of 104 pediatric kidney transplant recipients were diagnosed with CMV infection in our centre.Retrospective data was collected for these 9 paediatric recipients.The clinical characteristics of the disease, treatment data and outcomes were summarized.Results:The median age of the 9 children was 10 years(0.25-15 years), 6 of whom were treated with polyclonal antibody for immunity induction.CMV IgG was negative in 4 children before renal transplantation.Only one patient received anti-CMV prophylaxis.The median time from transplant to the diagnosis of CMV infection was 22(7-15)days.Among the 9 children, 7 had fever, pneumonia and diarrhea, 2 had no typical symptoms, three patients were complicated with viral, bacterial or fungal infections.Acute rejection occurred in 3 patients at the same time as CMV infection or after CMV DNA turned negative.Nine patients were cured and discharged after ganciclovir or valganciclovir treatment.Median time of CMV DNA negative transformation was 32(17-90)days.Conclusions:Pediatric transplant recipients are at particularly elevated risk of CMV disease.Antiviral prophylaxis should be initiated early after transplantation.

Objective:To summarize the clinical characteristics and therapeutic drug selection of post-transplantation diabetes mellitus(PTDM)after kidney transplantation in children.Methods:From May 2014 to March 2021, a total of 5 cases(5.38%)of 93 paediatric kidney transplant recipients with a median follow-up period of 34 months were diagnosed with PTDM in our centre.Retrospective data analysis was performed for these 5 paediatric recipients.The characteristics of the disease, treatment data and outcomes were summarized.Among the five paediatric recipients, one was male and four patients were female, ranging the age from 12 to 17 years.All recipients received a tacrolimus-based immunosuppressive regimen with prednisone discontinued no later than 3 months after kidney transplant.Results:The onset of PTDM ranged from 1 month to 46 months(median: 17 months)after transplantation.The blood glucose of two children returned to normal gradually after tacrolimus conversion to cyclosporine, with one of them was given insulin temporarily.Three children received oral hypoglycaemic agents, including one received acarbose, one received metformin, and one received metformin combined with acarbose.After a median follow-up of 6 months, the levels of blood glucose in five children were stable, and there was no significant change in serum creatinine and urine protein.Conclusions:The treatment of PTDM in children should be individualized with considering of age, gender and immunosuppressive regimen. Switch from tacrolimus to cyclosporine is effective. Metformin or other hypoglycemic agentsis helpful when tacrolimus is maintained.

Objective To detect the expression levels of adipose-specific phospholipase A2 (AdPLA) mRNA in orbital adipose tissue of thepatients with thyroid associated ophthalmopathy and the normals.Methods Sixteen patients with TAO of m level and stationary phase underwent orbital decompression,and 29 normals underwent ocular plastic surgery in Shenzhen Eye Hospital between August,2015 and October,2016.Orbital fat samples were collected from one eyes of these patients during surgery.The age,gender,height,weight,body mass index (BMI),exophthalmos degree,orbital fat of the patients with TAO and the normals were recorded and calculated.Using real time PCR,the AdPLA mRNA were detected from these orbital fat samples.Results There was no significant difference between the patients with TAO and the normals in age,gender,and BMI (all P ＞ 0.05).TAO group had more exophthalmos degree (20.406 ± 1.369)mm than the normals (14.207 ± 1.146) mm.TAO group had more orbital fat (32.162 ± 1.923) mL than the normals (24.279 ± 1.070) mL.The average expression level of AdPLA in patients with TAO was 0.039 42 ± 0.009 85,and 0.004 42 ± 0.001 36 in the normal.There was significant difference between two groups (P ＜ 0.05).Conclusion The patients with TAO of Ⅲ level and stationary phase have more exophthalmos degree and orbital fat than the normals.AdPLA mRNA is higher expressed in orbital adipose tissue of the patients with TAO of Ⅲ level and stationary phase than the normals.The high expression of AdPLA may reduce lipolysis in the orbital adipose tissue,lead to fat accumulation in orbits,and aggravate exophthalmos of patients with TAO.

Background Posner-Schlossman syndrome (PSS) is often recurrent and is a cause of blindness.The etiology of PSS remains to be elucidated.It is reported that there is a certain association between pathogenic microorganisms and PSS in rather small samples.Objective This study was to analyze the related serum antibody levels of cytornegalovirus (CMV),herpes simplex virus (HSV),rubella virus (RV),helicobacter pylori (HP) and anti-streptolysin O (ASO) and provide a clue for the study on pathogenesis and therapy of PSS.Methods A prospective cases-controlled study was carried out in Shenzhen Eye Hospital from December,2014 to December,2016 under the approval of Ethic Committee of this hospital and informed consent of each subject prior to initial of any medical examination.Peripheral blood samples were collected from 82 PSS patients as the PSS group and 100 age-and gender-matched healthy blood donors as the normal control group.The positive rates of serum CMV IgG,CMV IgM,HSV IgG,HSV IgM,RV IgG,RV IgM,HP IgG and HP IgM in the subjects were detected by indirect ELISA,and the positive rate of serum ASO antibody was determined by immuno-scatter turbidmetry.Results The positive rates of serum CMV-IgG,CMV-IgM,HP-IgG,HP-IgM and ASO antibody were 22.0％,17.1％,22.0％,17.1％ and 17.1％ in the PSS group,which were significantly higher than 5.0％,0.0％,10.0％,2.0％ and 7.0％ in the normal control group (x2 =11.726,18.496,4.943,12.766,4.479,all at P＜0.05).The positive rates of serum HSV-IgG,HSV-IgM,RV-IgG and RV-IgM in the PSS group were not significantly different from those in the normal control group (x2 =3.305,0.986,0.898,0.503,all at P ＞ 0.05).Conclusions CMV,HP and hemolytic streptococcal infection may participate in the occurrence and development of PSS.

Background Lattice corneal dystrophy (LCD) is a progressive disease,whose clinical features are varied in different stages.It is rarely be reported that clinical findings of different stages and factors of promoting the occurrence and development on LCD in a family.Objective The aim of this study was to identify the characteristics of the pedigree and clinical features of different stages in a LCD family,and further to discuss its influence factors.Methods A cross-sectional study was performed in this study.A Chinese family with LCD was enrolled in Shenzhen Eye Hospital from 2015 to 2016.Questionnaires for disease-related history,visual acuity measurement,ocular anterior segment examination and color photography were carried out for all the members of the family.In addition,anterior segment OCT (AS-OCT),laser scanning confocal microscope and corneal endothelium microscope were used to observe the morphology of corneal stroma and changes of corneal endothelial cells.The pedigree chart was drawn by Cyrillic2.1 software and analyzed based on Mendel law.Results This family included 5 generations of 73 members.Patients with LCD were found in each generation with similar morbidity in different gender,which followed the law of autosomal dominant inheritance.Eleven patients were found in 49 members related with Ⅲ1 of this family with the prevalence rate of 22.45％ and onset age at 21-50 years old,and the course of disease was 3-34 years.All of the members had no systemic disease except for two patients (Ⅲ 1 and Ⅲ 5) with hypertension.In the early stage of LCD,some bifurcate striolae appeared in the patients' corneal stroma without symptoms for many years.In the progressive stage,there was corneal irritation symptom accompanying with vision's decrease in the eyes with LCD.The bifurcate striolae were increased,widened and interwoven into lattice lines that the boundaries gradually became fuzzy,then corneal macula was formed because of recurrent corneal infiltration,and eventually resulted in corneal leucoma.High reflection corresponding to the pathologic region was showed by laser scanning confocal microscope and AS-OCT.No significant differences were found in corneal endothelial cell density and the percentage of hexagonal cells between LCD patients and normal phenotype families (t =1.887,P=0.075;t=-0.719,P =0.481).Penetrating keratoplasty was performed in a patient with corneal opacity and serious corneal opacity occurred near the surgical incision one year after the surgery.One patient was diagnosed as LCD 2 years after laser assisted in-situ keratomileusis.One patient was a welder.Conclusions LCD is autosomal dominant inheritance in the family.The clinical manifestations of LCD in the early,progressive and late stage can be seen in the pedigree,which offers a reference for ophthahnologists.Corneal surgery and lesion may induce the onset or aggravation of LCD.

Background Activation of serum complement system is involved in the pathological process of uveitis and open angle glaucoma.Pathogenesis and pathological characteristics of Posner-Schlossman syndrome (PSS) are similar to uveitis and open angle glaucoma.However,etiology of PSS remains unelucidated.The activation complement in PSS patients' serum is rarely reported.Objective The aim of this study was to investigate the activation of serum complement in PSS patients for PSS pathogenesis.Methods A prospective case-controlled study was designed.The peripheral blood simples of 79 PSS patients were collected from Shenzhen Eye Hospital during December 2013 to December 2015,and the peripheral blood simples were obtained from 83 unrelated healthy blood donors as healthy control group.Immuno-scatter turbidmetry was adopted to detect the common activated components in complement pathway in each group including complement C3 (a vital intersection molecule in the three pathways),C4 (the vital molecule both the complement classical and lectin pathways),split products C3a,soluble membrane attack complex (sC5b-9),C 1q (complement classical pathway),L-ficolin (complement lectin pathway),complement factor Bb (complement alternative pathway),IgG,IgA and IgM.The correlation between serum C3a content and sC5b-9 content in PSS group was analyzed.The serum contents of fabric binding protein 2 (FCN2) (a marker of serum classical pathway),factor Bb (a marker of complement alternative pathway),C3a (the common activation products of three complement activation pathways),and sC5b-9 were assayed by ELISA.This research protocal was approved by Shenzhen Eye Hospital and written informed consent was obtained from each PSS patient prior to any medical examination.Results Compared with normal control group,the serum levels of C3,C4,C3a,sC5b-9,C1q,FCN2,IgG,IgA and IgM were significantly higher in PSS group (Z =-4.743,-2.913,-1.985,-2.620,-2.062,-2.500,-7.010,-6.327,-3.652,all at P ＜ 0.05).The serum complement factor Bb level was 13.87 (9.24,32.00) μg/ml in PSS group,which was significantly lower than 20.51 (12.90,33.50) μg/ml in normal control group (Z =-2.515,P =0.012).Serum C3a content was positively correlated with the serum sC5b-9 content in PSS group (rs =0.832,P＜0.001).Conclusions The serum complement system is activated in PSS patients.Complement alternative pathway,classical pathway and lectin pathway might all be involved in the activative process of complement system.

OBJECTIVETo assess the association of HLA-DPA1 and -DPB1 polymorphisms with Posner-Schlossman syndrome (PSS) in southern Chinese Han population.

METHODSA total of 100 randomly selected PSS patients of southern Chinese Han origin were served as the experimental group, while 128 unrelated healthy blood donors of the same origin were served as the control group. All samples were subjected to sequencing-based typing (SBT) for exon 2 of HLA-DPA1 and -DPB1 loci in both directions. HLA genotype was assigned using an Assign 3.5 HLA SBT software. The allele frequencies and haplotype frequencies of HLA-DPA1 and -DPB1 of the two groups were compared. x² test, P value and odds ratio (OR) value were calculated.

RESULTSSix HLA-DPA1 alleles in the experimental group and 4 HLA-DPA1 alleles in the healthy control group were identified. The allelic frequency for HLA-DPA1*02:01 in the experimental group was significantly lower than the control group (4.50% vs. 12.109%; x²=8.124, P=0.004). Sixteen HLA-DPB1 alleles were identified in both the experimental and control groups. The allelic frequencies for HLA-DPB1*14:01 and - DPB1*17:01 in the experimental group were significantly lower than those of the control group ( DPB1*14:01: 1.00% vs. 4.688%, x²=5.130, P=0.024; DPB1*17:01: 0% vs. 2.344%, x²=3.897, P=0.048). The DPA1-DPB1 haplotypes for the experimental and control groups were 23 and 25, respectively. The haplotype frequencies for both DPA1*02:01- DPB1*14:01 and DPA1*02:01- DPB1*17:01 were significantly lower than those of the control group.

CONCLUSIONDPA1*02:01- DPB1*14:01 and DPA1*02:01- DPB1*17:01 haplotypes may provide considerable protection effect against PSS in the southern Chinese Han population.

Adult ; Asian Continental Ancestry Group ; ethnology ; genetics ; Case-Control Studies ; China ; ethnology ; Female ; Glaucoma ; ethnology ; genetics ; HLA-DP alpha-Chains ; genetics ; HLA-DP beta-Chains ; genetics ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic

Objective Situational teaching was used to develop the nursing students ’ professional competence .Methods An illustrate of pneumonia in children was given to explain how to design and implement situational teaching, including setting goals, writing case, designing scenario, simulating scenario, playing roles, clinical application, and so on.Results In the situational teaching, students recognized nursing work, simulated scene , took part in practice , and their professional competence were improved .Conclusions The situational teaching helps nursing students to get more chance to practice , train their clinical thinking , and develope their nursing professional competence .It is worthy being popularized and applied .