[Therapeutic outcomes and influence factors of maximal orbital decompression in the treatment of severe dysthyroid optic neuropathy].

Objective: To evaluate the effectiveness of maximal orbital decompression in treatment for severe dysthyroid optic neuropathy (DON) of thyroid associated ophthalmopathy (TAO) and predictive factors of this therapy. Methods: The group consisted of 21 patients (30 eyes) with DON. The diagnosis was based on the following criteria: Deterioration of best corrected visual acuity (VA≤0.1), enlargement of extraocular muscles and sign of apical crowding in CT imaging, loss of colour vision. EXCLUSION CRITERIA: VA of DON>0.1 or other diseases with visual function damage. Maximal 3-wall orbital decompression was undergone. Clinical outcomes were recorded and assessed including pre- and postoperative VA, age, clinical activity score (CAS), thyroid hormonal status and duration of DON. The pre- and postoperative VA were compared by Wlicoxon signed rank analysis. The relationships between the change of VA and age(<50 years vs ≥50 years), thyroid hormonal status(hyperthyroidism vs hypothyroidism), CAS(<3 vs ≥3), duration (<3 months vs ≥3 months), pre-VA(<0.01 vs ≥0.01) were made statistically by Mann-Whitney U-test, rank correlation analysis,and Logistic regression analysis. Results: Thirty eyes of 21 patients (11 male, 10 female) were included in this study. Hyperthyroidism was recorded in 13 cases, the other 8 cases with hypothyroidism. The average age at the time of diagnosis was 52.9 years (range, 33.0-71.0 years). The median of the duration of DON was 4.5 months (range, 1.0-12.0 months). Twenty-eight eyes (28/30, 93%) showed improvement of visual acuity after surgery (Z=-4.62, P=0.000). There was positive correlation between pre- and postoperative VA(r=0.38, P<0.05 ). Patients with VA of 0.01 or better had better postoperative VA than those with poorer VA (0.10 vs 0.50, Z=-2.09, P=0.037). There was negative correlation between the duration and degree of improvement of postoperative VA (r=-0.44, P<0.05). Other factors such as age, thyroid hormonal status, CAS were not statistical factors for postoperative VA (Z=-1.83--0.97, P>0.05 ) and improvement of postoperative VA (Z=-1.80--0.82, P>0.05). Conclusions: Maximal orbital decompression is safe and effective for management of visual damage in severe DON in this small sample study. Preoperative VA and duration of DON were important predictive factors for surgical outcome. Earlier diagnosis and treatment are possibly useful for improvement of prognosis of DON but large sample data are needed.(Chin J Ophthalmol, 2017, 53:416-423).

[Multi-wall orbital decompression for disfiguring proptosis in patients with mild or moderate thyroid eye disease].

Objective: To evaluate the efficacy of orbital decompression by transconjunctival medial and inferior wall combined transpalpebral lateral wall for disfiguring proptosis with mild or moderate thyroid eye disease (TED). Methods: It is a retrospective case series study. The clinical data of 18 TED cases (28 orbits) between Dec 2013 and Dec 2015 at the Institute of Orbital Diseases of the General Hospital of the Armed Police were reviewed. All the patients underwent mulit-wall orbital decompression to relieve remarkable proptosis, widen eyelid fissure, and swollen eyelid. INCLUSION CRITERIA: 1. Hertel value was 14-23 mm or over 2-7 mm than contralateral eye; 2.Orbitalpathy has been inactive with normal thyroid function for at least 6 months; 3.Orbital pressure is normal or (+). Clinical outcomes were recorded including best-corrected visual acuity, exophthalmometry, margin-to-central distance of upper and lower lids, diplopia, and CT scans before and 3 months after surgery. Results: The mean protosis of pre-and postoperation were (19.2±2.3) mm and (14.7±1.4) mm with mean reduction was (4.6±1.7) mm (t=14.08, P<0.01). Margin-to-central distance of the upperlid of pre- and postoperation were (5.1±1.2) mm and (4.9±1.3) mm with mean reduction was (0.2±0.5) mm (t=1.73, P=0.095). Margin-to-central distance of the lowerlid of pre-and postoperation were (5.9±0.9) mm and 4.3±0.7 mm with mean reduction was (1.6±0.8) mm (t=10.09, P<0.01). The difference of bilateral exophthalmos after surgery is 0-2.5 mm (median=1 mm). None of the patients showed new-onset diplopia at primary gaze and two patient showed surrounding gaze diplopia postoperatively. Two patients with diplopia relieved after surgery (Z=743.00, P=0.458). Conclusions: Transconjunctival and transpalpebral medial, inferior, and lateral walls decompression with a hidden incision was a controllable, safe, effective technique with minimal complications in relieving not only mild, moderate proptosis, but also retraction of lowerlid, and swollen eyelids. (Chin J Ophthalmol, 2017, 53: 128-135).

[The importance for improving the cure rate of lacrimal gland benign pleomorphic adenoma].

The pleomorphic adenoma was the most common epithelial tumor of the lacrimal gland. The 2 major factors determining the prognosis of pleophormic adenoma of lacrimal gland were likelihood of recurrence and evidence of malignant transformation. Management of the recurrent pleomorphic adenoma was difficult. Moreover, the malignant transformation was danger for life. The reason for orbital recurrent involved many factors, but the main reasons may be related to correct preoperative judgment of the nature of the tumor, taking the appropriate surgical approach and operative techniques. Long-term follow-up was available for the patient. It could help doctors detect recurrence of tumor earlier and treat it timely. (Chin J Ophthalmol, 2016, 52: 241-243).

Effect of 5-fluorouracil mobilized bone marrow regenerative cells transplantation on brain injury following focal cerebral ischemia in rats.

OBJECTIVE: The aim of this study was to evaluate the effect of 5-fluorouracil mobilized bone marrow regenerative cells (BMRCs) transplantation on brain injury following focal cerebral ischemia and to explore the mechanisms. MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MACO) for 120 minutes, followed by intravenous administration of DAPI-labeled 1×10(7) 5-fluorouracil mobilized BMRCs at 24 h post MACO. Infarct volumes, neurological deficit score, angiogenesis and cytokine expression were evaluated at specific time point after cell transplantation. RESULTS: Comparable number of BMRCs and bone marrow cells (BMCs) were found in the infarcted area at Day 3 and Day 14 post MACO. Significant decreased infarcted size and neurological deficit score were found in the animals receiving BMRCs. The microvessel density was significantly increased after BMRCs transplantation. Moreover, the expression of vessel endothelial growth factor (VEGF) was increased significantly after BMRCs transplantation. CONCLUSIONS: Intravenous 5-fluorouracil mobilized BMRCs were neuroprotective following MACO and might be considered as therapeutic choice in the treatment of transient focal cerebral ischemia.

Expression Profiles of Cellular Retinol-binding Protein, Type II (CRBP II) in Erlang Mountainous Chickens.

Cellular retinol-binding protein II (CRBP II) belongs to the family of cellular retinol-binding proteins and plays a major role in absorption, transport, and metabolism of vitamin A. In addition, because vitamin A is correlated with reproductive performance, we measured CRBP II mRNA abundance in erlang mountainous chickens by real-time PCR using the relative quantification method. The expression of CRBP II showed a tissue-specific pattern and egg production rate-dependent changes. The expression was very high (p<0.05) in jejunum and liver, intermediate in kidney, ovary, and oviduct, and lowest (p<0.05) in heart, hypothalamus, and pituitary. In the hypothalamus, oviduct, ovary, and pituitary, CRBP II mRNA abundance were correlated to egg production rate, which increased from 12 wk to 32 wk, peaked at 32 wk relative to the other time points, and then decreased from 32 wk to 45 wk. In contrast, the expression of CRBP II mRNA in heart, jejunum, kidney, and liver was not different at any of the ages evaluated in this study. These data may help to understand the genetic basis of vitamin A metabolism, and suggest that CRBP II may be a candidate gene to affect egg production traits in chickens.

mRNA expression profiles of calmodulin and liver receptor homolog-1 genes in chickens.

Calmodulin (CALM), a calcium-binding protein, is expressed in the hypothalamic-pituitary-gonadal axis; it plays a pivotal role in the reproductive system by regulating gonadotropin-releasing hormone signaling. Downstream of hypothalamic-pituitary-gonadal signaling pathways, liver receptor homolog-1 (LRH-1) is involved in female gonadal hormone synthesis. In the chicken, although the two genes are known to be associated with reproductive traits, the interaction between gonadotropins and gonadal steroids remains unclear. We used quantitative real-time PCR to quantify the tissular (hypothalamus, pituitary, ovary, liver, kidney, oviduct, heart) and ontogenetic (12, 18, 32, and 45 weeks) mRNA expression profiles of CALM and LRH-1 in Erlang Mountainous chickens to determine their roles in the endocrine control of fertility, and compared these profiles with expression in Roman chickens. We found that the relative expressions of CALM and LRH-1 genes had the highest levels in the pituitary and ovary at 32 weeks. The expression level of CALM mRNA in the pituitary of Roman chickens was significantly higher than that in Erlang Mountainous chickens at 32 and 45 weeks, while the LRH-1 transcript level in the ovaries of Roman chickens was significantly lower than that of Erlang Mountainous chickens at 32 and 45 weeks. In summary, the transcript levels of CALM and LRH-1 genes are associated with chicken reproductive traits; in addition, we found that the CALM gene is the key regulator in the hypothalamic-pituitary-gonadal signaling network.

Orbital schwannomas: findings from magnetic resonance imaging in 62 cases.

PURPOSE: To evaluate the diagnostic value of magnetic resonance imaging (MRI) and illustrate the common MRI features of orbital schwannoma. METHODS: We reviewed 62 consecutive cases of pathologically proven orbital schwannoma investigated by MRI. All cases were examined using T1- and T2-weighted images. Enhanced T1-weighted images were obtained after administration of gadopentetate dimeglumine. The images were analysed and compared. RESULTS: Cone-shaped lesions were the most frequent (16, 26%), followed by dumbbell-shaped (10, 16%), oval (9, 15%) and round lesions (8, 13%). The most common site was the superior aspect of the orbit (17, 27%), followed by the medial superior (12, 19%) and the orbital apex (12, 19%). On unenhanced T1-weighted images, 53 (85%) lesions showed isointensity or small patches of hypointensity. The patterns of enhancement seen on T1-weighted images correlated with the signal characteristics of unenhanced T2-weighted images. Five patterns emerged in our series. Among these patterns, the most common sign, found in 18 (29%) cases, was peripheral (ring) enhancement on enhanced T1-weighted images, which showed peripheral isointensity with central hyperintensity on T2-weighted images. Lesions with homogeneous or heterogeneous enhancement were seen in 16 (26%) and 26 (42%) cases, respectively.ConclusionsMRI is a valuable diagnostic method for orbital schwannoma, particularly when contrast is applied. The locations and shapes of tumours can be seen distinctly. T1-weighted images are relatively nonspecific. T2-weighted and enhanced T1-weighted images provide information about the pathology of tumours. In particular, peripheral enhancement should be considered a target sign of schwannoma.Eye (2008) 22, 1034-1039; doi:10.1038/sj.eye.6702832; published online 20 April 2007.

[Magnetic resonance imaging in 80 cases of orbital tumors].

Magnetic resonance imaging (MRI) is a new medical imaging technique which has been used in evaluating ocular and orbital diseases in recent years. Owing to the high resolution of soft tissues and lesions, it is superior to ultrasound and computed tomography in the localization and characterization of an orbital tumor in diagnosis. In this paper, we analysed 80 cases of MR images of orbital tumors by which all the lesions were detected. Benign or malignant disorders were recognized in 59 cases and complete tumors with accurate localization were shown in 79 cases. The principles of MRI, signal intensity of various tumors and the indications of MRI were discussed.