Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis.

OBJECTIVE: We aimed to systematically review the impact of local estrogen use in combination with a pessary on vaginal complications in postmenopausal women with pelvic organ prolapse (POP). METHODS: We searched databases including Medline, Embase, PubMed, Clinical Trials and the Cochrane Central Register of Controlled Trials for relevant literature published in English from inception to 31 May 2021. Only randomized controlled trials (RCTs) and cohort studies were included. RESULTS: In total, five studies were included (three RCTs, one prospective study and one retrospective cohort study). The meta-analysis was performed with subgroups. Our results indicated a significantly lower incidence of bacterial vaginosis (BV) among postmenopausal women who used estrogen than among controls, with a total pooled odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.11-0.72; I2 = 38%; p = 0.008). The summary ORs of the estrogen use group were 0.98 (95% CI: 0.59-1.63; I2 = 41%; p = 0.95) for vaginal ulceration, 0.80 (95% CI: 0.42-1.54; I2 = 29%; p = 0.50) for vaginal bleeding and 0.74 (95% CI: 0.35-1.58; I2 = 35%; p = 0.44) for vaginal discharge. CONCLUSIONS: Local estrogen in combination with a pessary could decrease the BV rate among postmenopausal women with POP. However, consensus regarding the value of estrogen use for decreasing other pessary complications has not yet been reached. Additional multicenter RCTs with large sample sizes should be conducted to better understand the effect of estrogen use on reducing pessary-related complications.

[Oxymatrine improves renal fibrosis and inflammation in diabetic rats by modulating CHK1/2 phosphorylation].

OBJECTIVE: To explore the role of cell cycle checkpoint kinase 1/2 (CHK1/2) in mediating the inhibitory effect of oxymatrine (OMT) against renal inflammation and fibrosis in diabetic rats. METHODS: SD rats were randomly divided into normal control group, diabetes model group (DM) and OMT treatment group (n=6). HE and Masson staining were used to observe histopathological changes of the renal tissue, and the expressions of CHK1, CHK2, p-CHK1 and p-CHK2 were localized by immunohistochemical staining. The contents of interleukin-6 (IL-6) and IL-1ß in the renal tissue were detected using ELISA, and the expression levels of CHK1, CHK2, p-CHK1, p-CHK2, type Ⅲ collagen (Col-Ⅲ), type Ⅳ collagen (Col-Ⅳ), and fibronectin (FN) were determined using Western blotting. The changes in the expressions of CHK1, CHK2, p-CHK1, p-CHK2, Col-Ⅲ, Col-Ⅳ and FN proteins were also examined with Western blotting in NRK-52E cells in response to high glucose exposure, OMT treatment and siRNA-mediated CHK1/2 knockdown. RESULTS: In diabetic rats, OMT treatment significantly decreased the levels of blood glucose, serum creatinine and 24 h urinary protein (P < 0.05) and obviously improved inflammatory cell infiltration and fibrosis phenotype in the renal tissue (P < 0.05). CHK1 and CHK2 were mainly expressed in the cytoplasm and nuclei of renal tubule cells, and their phosphorylation levels were significantly higher in DM group than in the control group and OMT group. OMT treatment significantly decreased the protein expression levels of p-CHK1, p-CHK2, Col-Ⅲ, Col-Ⅳ and FN in the renal tissue of diabetic rats and in NRK-52E cells exposed to high glucose (P < 0.05). In NRK-52E cells, CHK1/2 knockdown resulted in significant reduction of the protein expressions of p-CHK1/2, Col-Ⅲ, Col-Ⅳ and FN (P < 0.05). CONCLUSION: The inhibitory effects of OMT against renal inflammation and fibrosis in diabetic rats are mediated probably by lowered phosphorylation levels of CHK1 and CHK2, which result in reduced release of the downstream inflammatory mediators and decreased secretion and deposition of extracellular matrix.

Orphan nuclear receptor COUP-TFII is an oncogenic gene in renal cell carcinoma.

BACKGROUND: Chicken ovalbumin upstream promoter-transcription factor II (COUP-TFII) may be an oncogenic gene in renal cell carcinoma (RCC). However, the direct association between COUP-TFII expression and patient survival has not been investigated in patients with RCC, and the molecular oncogenesis of COUP-TFII in RCC remains unclear. METHODS: The mRNA expression levels of COUP-TFII in the tumors of 283 patients with RCC were determined by RT-qPCR. The remaining 266 patients were categorized into low- and high-expression groups according to the cut off value generated by receiver operating curve (ROC) analysis. The function of COUP-TFII in RCC cells was tested by knockdown experiments in vitro. RESULTS: In the present study, it was revealed that the mRNA expression levels of COUP-TFII were significantly higher in tumors compared with those in adjacent non-cancerous tissues, and that the overexpression of COUP-TFII was strongly associated with poor patient survival. It was further demonstrated that knockdown of COUP-TFII suppressed proliferation, and induced apoptosis and cell cycle arrest in RCC cells in vitro. This also resulted in the activation of the mitochondria-mediated apoptosis pathway, impaired migration and invasion of RCC cells through epithelial-mesenchymal transition in vitro, and suppressed tumor growth in vivo. In addition, it was revealed that the induction of cell migration and invasion by COUP-TFII was mediated, at least in part, by integrin subunit ß1. CONCLUSIONS: In summary, the present study indicated that COUP-TFII is an oncogenic gene in RCC, and a potential therapeutic target for the treatment of the disease.

Factors associated with long-term pessary use in women with symptomatic pelvic organ prolapse.

Objectives: This study aimed to evaluate the continuation rate and identify the factors associated with long-term pessary use, which are essential for counseling women with symptomatic pelvic organ prolapse (POP) seeking long-term pessary treatment. Methods: This prospective observational study included 277 patients who had successful pessary fittings between April 2015 and November 2016. All patients were followed until April 2018. Data analysis was performed with independent-samples t-tests, non-parametric tests, chi-square tests, and logistic regression. Results: The median (range) follow-up time was 26 (17-36) months; 76.5% of patients continued to use pessaries at the study endpoint. Sixty-one patients discontinued pessary use, and almost all of them (55/61, 90.2%) discontinued pessary use within the first 12 months after successful pessary fitting. A total vaginal length (TVL) < 7.5 cm (odds ratio [OR], 0.181; 95% confidence interval [CI], 0.062-0.524; p = 0.002) and a lower baseline Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) score (OR, 0.974; 95% CI, 0.954-0.994; p = 0.013) were independent factors associated with pessary discontinuation. Conclusion: TVL ≥ 7.5 cm and a higher baseline POPDI-6 score were independent factors associated with long-term pessary use after successful fitting in women with symptomatic POP.

Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study.

OBJECTIVE: To evaluate the success rate of vaginal pessary fitting and identify the risk factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP). DESIGN: Prospective observational study. SETTING: The Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China. POPULATION: Women with symptomatic POP between May 2015 and December 2016 (n = 343). METHODS: A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting and continued use 2 weeks later. The independent samples t-test, non-parametric test, Chi-square test, Fisher's exact test, logistic regression and receiver operating characteristic curves were used for the data analysis. MAIN OUTCOME MEASURES: The success rate of vaginal pessary fitting and the risk factors associated with unsuccessful pessary fitting. RESULTS: 302 patients had successful pessary fitting (88.0% success rate). A higher body mass index [BMI; 24.7 ± 3.1 kg/m2 in the successful group versus 25.7 ± 3.8 kg/m2 in the unsuccessful group, odds ratio (OR) 1.174, 95% CI 1.055-1.307, P = 0.003] and a shorter TVL [8.0 (8-9) cm in the successful group versus 7.0 (6.8-8) cm in the unsuccessful group, OR 0.338, 95% CI 0.223-0.513, P < 0.001) were independent predictors of an unsuccessful pessary fitting. The receiver operating characteristic curve showed that patients with a total vaginal length (TVL) less than 7.3 cm had a higher unsuccessful pessary fitting rate (sensitivity = 0.82, specificity = 0.64). CONCLUSIONS: A higher BMI and shorter TVL were independent predictors of an unsuccessful pessary fitting. Patients with a TVL <7.3 cm are not appropriate candidates for a vaginal pessary. TWEETABLE ABSTRACT: A higher BMI and shorter TVL (<7.3 cm) were independent predictors of an unsuccessful pessary fitting.

Depressive symptoms affect outcomes of pessary use in postmenopausal women with uterine prolapse.

OBJECTIVE: This study aimed to investigate the impact of depressive symptoms on successful pessary treatment for postmenopausal women with symptomatic pelvic organ prolapse (POP). METHODS: We performed a prospective study involving postmenopausal women with POP who visited our clinic seeking pessary treatment. Demographic information and medical histories were collected. The participants completed the following questionnaires at baseline and after 3 months of successful pessary use: (1) the Pelvic Floor Impact Questionnaire-7 (PFIQ-7); (2) the Pelvic Floor Distress Inventory (PFDI-20); and (3) the Patient Health Questionnaire-9 (PHQ-9). The data were analyzed with the independent samples t-test, Mann-Whitney U-test, χ2 test, Fisher's exact test, paired t-test or Wilcoxon signed-rank test as appropriate. RESULTS: In total, 102 (92.7%) participants who completed the entire study were included in the analysis. No significant differences were found in the sociodemographic or clinical characteristics between the 'positive' and 'negative' depressive symptom groups (p > 0.05). After 3 months of successful pessary treatment, the scores of the PFIQ-7 (including the Urinary Incontinence Questionnaire-7, the Colon Rectal Anal Impact Questionnaire-7 and the Pelvic Organ Prolapse Impact Questionnaire-7 subscales) and PFDI-20 (including the Pelvic Organ Prolapse Distress Inventory-6, the Colon Rectal Anal Distress Inventory-8 and the Urinary Distress Inventory-6 (UDI-6) subscales) were significantly decreased in all participants (p < 0.05). The PHQ-9 score was also significantly decreased (p < 0.001). However, the participants with depressive symptoms reported significantly less improvement post-treatment than those without depressive symptoms in the score of the PFDI-20 subscale UDI-6, which represented the degree of distress due to the lower urinary tract symptoms (p = 0.022). CONCLUSIONS: Both the quality of life and depressive symptom scores were significantly improved after 3 months of successful pessary use. We advocate making depressive symptom screening a regular indicator for assessing the effectiveness of conservative POP treatment.

Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse.

OBJECTIVE: This study aimed to investigate the prevalence of general anxiety disorder (GAD) among postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify its associated factors. METHODS: A cross-sectional study was conducted among postmenopausal women with symptomatic POP. Sociodemographic data and medical histories were obtained. Participants completed the POP Quantification (POP-Q), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) measures. Measures of GAD were obtained using the Generalized Anxiety Disorder-7 (GAD-7). The data were analyzed using independent sample t-tests, the Mann-Whitney U-test, χ2 tests, Fisher's exact tests and logistic regression. RESULTS: Of the 177 participants interviewed, 19.2% had symptoms of GAD. There were no statistically significant differences in the sociodemographic characteristics or the POP-Q stage between women with and without GAD (p > 0.05). GAD was significantly associated with higher PFDI-20 and PFIQ-7 subscale scores (p < 0.05). After multiple logistic regression analyses, only the PFIQ-7 subscale UIQ-7 (odds ratio = 1.025, 95% confidence interval 1.007-1.043, p = 0.005) and the PFDI-20 subscale CRADI-8 (odds ratio = 1.025, 95% confidence interval 1.004-1.047, p = 0.021), which represented the impact on quality of life from lower urinary tract symptoms and the distress caused by bowel dysfunction, were risk factors that were independently associated with GAD. CONCLUSIONS: GAD is prevalent in almost one-fifth of postmenopausal women with symptomatic POP. GAD is not associated with the severity of the POP-Q stage but is associated with higher scores for lower urinary tract and bowel dysfunction caused by POP.

[Prospective cohort study on the outcomes of sacrospinous ligament fixation using conventional instruments in treating stage â ¢-â £ pelvic organ prolapse].

Objective: To evaluate the medium and long term safety and efficacy of sacrospinous ligament fixation (SSLF) performed with conventional instruments in treating stage Ⅲ-Ⅳ pelvic organ prolapse (POP). Methods: A prospective cohort analysis was conducted in the Peking Union Medical College Hospital, between May 2007 and June 2015, enrolling 55 women with stage Ⅲ-Ⅳ POP who intended to receive SSLF. Primary end points were objective success rates using pelvic organ prolapse quantitation system (POP-Q) and subjective satisfaction rates with questionnaires after surgery according to vaginal examination and related questionnaires for all patients who received SSLF eventually. Exploratory outcomes included perioperative parameters and complications. Results: Of these 55 POP patients enrolled, 52 (95%, 52/55) received SSLF using conventional surgical instruments, the other 3 cases converted to ischial spinous fascia fixation due to difficulty exposing. Medium blood loss during operation was 100 ml (20-300 ml) and operative time 60 minutes (20-165 minutes). Pelvic hematoma with diameters of 5 cm and 7 cm were observed in two patients, both recovered fully with conservative methods. All patients were able to micturate spontaneously after catheter withdrawal. One patient reported right thigh pain after operation which remained till 3-month follow-up and relieved after physiotherapy. The objective success rate was 100% (52/52) at 3 months. With a medium follow-up time of 23.7 months, the objective success rate was 98% (51/52), the recurrence rate was 2% (1/52) and the satisfactory rate was 94% (49/52). De novo urinary incontinence occurred in 6% (3/52) of patients. Conclusion: Most POP could be corrected with SSLF using conventional instruments which is a feasible, economic and effective procedure for Asian patients with medium compartment prolapse.

Ultrasonography of fetal cleft lip and palate in first-trimester.

PURPOSE OF INVESTIGATION: To explore the ultrasonographic methods towards cleft lip and palate (CLP) in first-trimester. MATERIALS AND METHODS: 3,795 fetuses were scanned for facial structures including cross section of upper alveolar process, oblique coronal section of upper lip, and postnasal triangle section when measuring nuchal translucency (NT). The abnormal cases underwent ultrasonography for clear diagnosis at 17-18 gestational weeks (GWs), while the negative cases underwent systemic ultrasonography at 20-26 GWs, and followed up until birth. RESULTS: Among the 3795 fetuses, 16 cases had CLP, with an incidence rate as 4.2%; 12 were detected in first trimester, with a detection rate of 75%, and the detection rate of bilateral CLP was 100%, four were missed, with a misdiagnosis rate of 25%, and 12 cases examined at 17-18 GWs met first-trimester diagnosis. Among the four missed cases, two were diagnosed with systemic ultrasonography, and two were diagnosed postnatally. All cases were confirmed after induction of labor or after birth. CONCLUSIONS: Ultrasonography in first-trimester could diagnose severe case of CLP.

MicroRNA-191 correlates with poor prognosis of colorectal carcinoma and plays multiple roles by targeting tissue inhibitor of metalloprotease 3.

MicroRNA-191 (miR-191) is reported to be overexpressed in colorectal carcinoma (CRC), but the role of miR-191 in CRC progress remained unclear. This study demonstrated that High miR-191 expression was associated with clinical stage, lymph node metastasis, liver metastasis and depth of tumor invasion. Kaplan-Meier analysis indicated that patients with high miR-191 expression had a poor overall survival. Moreover, multivariate analysis showed that miR-191 was an independent prognostic factor in patients with CRC. Furthermore, we found that tissue inhibitor of metalloprotease 3 (TIMP3) was a direct target of miR-191 in colorectal cancer SW620 cells. TIMP3 downregulation mediated by miR-191 activated matrix metalloproteinases (MMPs) and thus promoted invasiveness of cancer cells. Anti-miR-191 could attenuate the invasiveness, suppress proliferation and induce apoptosis by restoring TIMP3 expression. Our results suggested that miR-191 might be a potential diagnostic and therapeutic target in patients with colorectal cancer.

Assessment of lateral geniculate nucleus atrophy with 3T MR imaging and correlation with clinical stage of glaucoma.

BACKGROUND AND PURPOSE: Although previous animal studies have shown structural changes in ocular hypertension such as atrophy of the LGN, such changes have not been thoroughly studied in human glaucoma patients nor correlation made with clinical stage. Our aim was to investigate prospectively LGN atrophy in patients with POAG using 3T MR imaging and correlation with the clinical stage of disease. MATERIALS AND METHODS: Twenty-six patients with known POAG and 26 age-matched healthy volunteers were included in this institutional review board-approved study. All subjects underwent imaging on a 3T MR imaging system with a PD and GM sequence. LGN height and volume were measured by 2 blinded neuroradiologists. Measurements were compared and correlated with clinical glaucoma severity as assessed by static threshold visual field parameters. RESULTS: Average maximum LGN height in patients with glaucoma on PD images was 4.36 ± 0.61 mm (right) and 4.31 ± 0.61 mm (left), significantly less (P < 10⁻³) than respective measurements of 5.05 ± 0.41 and 4.99 ± 0.41 mm in volunteers. With the GM sequences, such respective measurements were also less (P < 10⁻³) in patients with glaucoma (4.20 ± 0.71 mm right, 4.00 ± 0.85 mm left) versus respective measurements in volunteers (4.88 ± 0.51 mm right, 4.77 ± 0.47 mm left). Average LGN volumes in the patient group were 98.0 ± 27.2 mm³ (right) and 93.7 ± 25.8 mm³ (left) with the PD sequence versus respective measurements of 85.2 ± 27.1 and 80.5 ± 23.6 mm³ with the GM sequence. All height and volume measurements were greater in volunteers (P < 10⁻³). In the patient group, both maximum height and volume of the LGN with both sequences were significantly correlated with cumulative clinical glaucoma stage (P < .05). CONCLUSIONS: MR imaging measurements of LGN height and volume are diminished in patients with glaucoma, with the extent of atrophy correlating to clinical stage, suggesting a novel imaging marker of disease severity.

Apolipoprotein-E gene variants associated with cardiovascular risk factors in antipsychotic recipients.

Interest exists in identifying the factors that specifically contribute to the increased prevalence of cardiovascular disease observed in psychiatric disease. The apolipoprotein-E (APOE) gene codes for a protein that has a key role in metabolism of cholesterol and triglycerides, with increased levels of apoE found in specific areas of post-mortem schizophrenic brains. This study investigated whether apoE variants influence the prevalence of cardiovascular risk factors (obesity, diabetes and dyslipidaemia), in patients receiving antipsychotic treatment, due to extension of the risk seen in the general population, but also due to the role of the APOE gene in mediating antipsychotic-induced side effects. Seven polymorphisms (rs741780, rs483082, rs429358, rs7412, rs10119, rs439401 and rs405509) were genotyped in 427 American Caucasian patients who were either receiving, or had been prescribed risperidone. Our results support the hypothesis that APOE gene variants influence the prevalence of diabetes and possibly overweight in psychiatric patients. Unfortunately, due to the cross sectional nature of this study, the contribution of antipsychotic treatment was not determined. These associations warrant prospective study to assess interaction between APOE gene variants and the propensity of antipsychotics to induce cardiovascular risk factors.

Grafting sulfobetaine monomer onto the segmented poly(ether-urethane) surface to improve hemocompatibility.

Polyurethanes are widely used as blood-contacting biomaterials, due to their good biocompatibility and mechanical properties. Nevertheless, their blood compatibility is still not adequate for more demanding applications. Surface modification is an effective way to improve the hemocompatibility for biomaterials. The purpose of the present study was to synthesize a novel nonthrombogenic biomaterial by modifying the surface of polyurethane. Ozonization was used to introduce active peroxide groups onto the segmented poly(ether-urethane) (SPEU) film surface and graft polymerization of N,N'-dimethyl (methacryloyloxyethyl) ammonium propanesulfonate (DMAPS), a sulfobetaine structure, onto the ozone-activated SPEU surface was conducted. The SPEU-g-PDMAPS film was characterized by ATR-FTIR, XPS, and contact angle measurements. ATR-FTIR and XPS confirmed the graft polymerization. The grafted film possessed a relatively hydrophilic surface, as revealed by contact angle measurement. The blood compatibility of the grafted films was evaluated by a platelet-rich plasma (PRP) adhesion study and scanning electron microscopy, using SPEU film as the reference. No platelet adhesion was observed for the grafted films incubated with PRP at 37 degrees C for 60 and 180 min. This new sulfobetaine structure grafted biomaterial might have potential for biomedical applications.

[Poly-static quantitative perimetry for detection of open angle glaucoma].

OBJECTIVE: To evaluate the sensitivity of poly-static quantitative perimetry for the detection of visual field defect in open angle glaucoma. METHODS: 48 patients (95 eyes) of open angle glaucoma were examined with poly-static quantitative perimetry [Friedmann visual field analyzer (FVFA)] and dynamic perimetry (tangent screen) respectively. RESULTS: 26 eyes showed small defect of visual field on tangent screen with 2/1,000 visual size, and 23 eyes (88%) showed the same defects checked with FVFA; visual field defects of early stage glaucoma were found in 26 eyes checked with FVFA, but only 16 eyes showed the same defects on tangent screen with 1/1,000 visual size; the visual field defects of glaucoma on tangent screen in 43 eyes were found larger when they were checked with FVFA. CONCLUSION: Comparing with dynamic perimetry, poly-static quantitative perimetry is more sensitive to detect visual field defect of early stage glaucoma.

[Evaluating retinal nerve fiber layer by scanning laser ophthalmoscopy].

OBJECTIVE: To evaluate the efficiency of scanning laser ophthalmoscopy (SLO) on detecting retinal nerve fiber layer defects (RNFLD). METHODS: 95 eyes with primary open angle glaucoma, 37 ocular hypertension, 83 glaucomatous suspect and 34 normal eyes were investigated by SLO to evaluate the retinal nerve fiber layer (RNFL). Recording tapes of 68 eyes were re-investigated by two investigators for estimating the intra- and inter-observer agreement. RESULTS: The intra- and inter-observer agreement of the presence and types of RNFLD was fairly good (Kappa values were 0.66 - 0.76 and 0.59 - 0.65 respectively). The sensitivity and specificity in detecting RNFLD by SLO were 80.0% and 94.1% respectively. CONCLUSION: The evaluation of RNFL by SLO is a quick, accurate and safe method. It may be clinically useful in the diagnosis of glaucoma.

[Research of polymer coating in solid phase microextraction].

The solid phase microextraction (SPME) is a new extraction technique which has been developed rapidly in 1990s. It is a fast, simple, solventless and sensitive method for analyzing environmental samples. However, the solid phase materials of SPME are relatively limited. This paper presents the research work on a new type of solid phase, polymethylvinylsiloxane (PMVS), used in SPME. The phase with 1% vinyl content could be used in light curing. The PMVS solution was coated on the surface of silica fiber and was quickly cured by UV. Two fibers with 87 microns and 44 microns thick PMVS coatings were prepared. They were compared with commercial polymer coating SPME fibers through Headspace SPME Gas Chromatograph (HS-SPME-GC). The adsorption and desorption kinetics of PMVS were studied. The HS-SPME system was optimized and the differences between HS-SPME and HS were investigated as well. The results indicated that PMVS is efficient in extracting volatile and semi-volatile organic compounds and PMVS showed the high thermostability and easy-coating properties. The detection limit of SPME using 88 microns PMVS coating was about 1-5 micrograms/L.

[Treatment of acute optic neuritis with high dose of prednisone].

OBJECTIVE: The benefit of glucocorticoid for the treatment of acute optic neuritis remains controversial. The efficacy of oral prednisone in 12 patients (14 eyes) with acute optic neuritis was reviewed. METHODS: The time of visual symptoms before treatment was 3-15 days. The visual acuities were worse than 0.1 in all patients, with positive relative afferent pupillary defect. Visual field defect and delay latency of P100 in pattern VEP were also found. The regimen of glucocorticoid therapy was oral prednisone, starting with 160 mg daily followed by reducing the dosage by 20 mg every three days until 40 mg per day was attained and then tapering the dosage at 70 mg every other day until stoppage of the drug. The treatment was 3-11 months and 9 patients were followed up more than one year. RESULTS: The visual acuities improved rapidly and stable. After 4 days, the visual acuity was 0.2 or better in 10 eyes. It was better than 0.6 in 12 eyes at 15 days. At 6 months, all had the visual acuity better than 0.7, with 85.7% equal or better than 1.0. CONCLUSIONS: The regimen of oral prednisone beginning with 160 mg followed by tapering for three months would be feasible. Pattern VEP was a sensitive and credible sign for evaluating the extent of demyelination.