Fractal analysis of retinal vasculature in normal subjects on ultra-wide field fluorescein angiography.

AIM: To evaluate the fractal feature of the retinal vasculature of normal eyes on a stereographic projected and montaged ultra-wide field (UWF) fluorescein angiography (FA). METHODS: Prospective, observational, cross-sectional study. Totally 59 eyes of 31 normal subjects were imaged using the Optos 200Tx. Images obtained at different gaze angles stereographically projected and montaged. The early-phase UWF FA frames were processed to segment the retinal vasculature and the results were exported as binary masks. The fractal dimension (FD) was calculated using the box-counting method. RESULTS: The global FD for the entire retina was 1.6±0.04, with no difference between males and females (1.59±0.04 vs 1.61±0.04, P=0.084) or between right and left eyes (1.6±0.04 vs 1.6±0.05, P=0.61). FD was non-uniformly distributed among four quadrants (P<0.001) and decreased as the distance from the fovea increased (P<0.001). A negative association was observed between FD and age (R=-0.37, P=0.006), and this relationship was observed in the posterior and mid-peripheral retina (P<0.05) but absent in far-periphery (P>0.05). CONCLUSION: Fractal geometry is non-uniformly distributed across the retina in normal eyes and decreases from the fovea to the far-periphery. Subjects with an older age tend to have a smaller FD, however, the FD in the far-periphery does not appear to be influenced by age.

Efficacy and Safety of Bushenjiangya-Optimized Granule for Left Ventricular Diastolic Dysfunction in Hypertensive Patients: A Double-Blind, Randomized, Placebo-Controlled Trial.

OBJECTIVE: The study aimed to evaluate the efficacy and safety of Bushenjiangya-optimized (BSJYO) granule on left ventricular diastolic dysfunction (LVDD) in hypertensive (HTN) patients. METHODS: 120 patients diagnosed with HTN plus LVDD were randomly assigned to the BSJYO granule group and placebo group, and all patients received basal western medicine (WM) treatment. After eight weeks of treatment, we evaluated echocardiography, traditional Chinese medicine (TCM) syndromes, 24-hour ambulatory blood pressure, liver and kidney functions, and adverse events. Major adverse cardiovascular events (MACEs) were collected at 6-month follow-up. RESULTS: Compared with pretreatment, E/Ea (Doppler-derived index of filling pressure and worsening LVDD) significantly decreased significantly after 8 weeks of treatment in the BSJYO granule plus basal WM group (10.52 ± 1.87 vs. 9.49 ± 1.49, P < 0.01), alongside reductions in significantly effective response (SER), effective response (ER), and total effective response (TER = SER + ER) in TCM symptom scores (21.59% vs. 71.70%, P < 0.01). There were no differences between treatment groups in kidney and liver function, early adverse events, or MACE. CONCLUSION: BSJYO granule plus basal WM is an effective and safe therapy for HTN patients with LVDD.

Association of candidate gene polymorphisms with diabetic retinopathy in Chinese patients with type 2 diabetes.

AIM: To investigate the association between a set of six candidate genes and the risk of diabetic retinopathy (DR) in an urban community cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: A population-based cross-sectional study. The diabetic subjects were recruited from an urban community in Beijing and categorized into groups of proliferative diabetic retinopathy (PDR), non-proliferative diabetic retinopathy (NPDR), or diabetic without any retinopathy (DWR) based on the fundus photography and duration of diabetes. Six candidate genes, including advanced glycation end product specific receptor (AGER), aldose reductase (AKR1B1), inducible nitric oxide synthase (iNOS), pigment epithelium derived factor (PEDF), tumor necrosis factor-alpha (TNF-α), and paraoxonase 1 (PON1), were chosen based on Meta-analysis of genetic association studies for DR and biochemical pathways implicated in DR progression. The allele and genotype distribution of 21 functional single-nucleotide polymorphisms (SNPs) in those 6 candidate genes were investigated using MassARRAY genotyping system. RESULTS: Among 1461 diabetic patients recruited from community, 569 were selected in following genotyping analysis, including 97 patients with PDR, 217 with NPDR, and 255 with DWR. For the promoter variant rs1051993 in AGER gene, the distribution of allele and genotype in PDR group differed from that in DWR group (allele: P=0.011; genotype: P=0.01). Compared with DWR, patients with PDR had lower frequencies of heterozygous genotype GT (9.8% for DWR, 1% for PDR, OR: 0.10, 95%CI: 0.01-0.72) and minor allele T (4.9% for DWR, 0.5% for PDR, OR: 0.10, 95%CI: 0.01-0.75). In multivariate model, the distribution of genotype for rs1051993 in PDR group was significantly different from that in DWR group (GT vs GG: OR: 0.07, 95%CI: 0.01-0.61, P<0.001). No association with DR was observed in other genotyped SNPs. CONCLUSION: The data suggest a significant association of the promoter variant rs1051993 in AGER gene with PDR in Chinese cohort with T2DM.

Meta-analysis of association between K469E polymorphism of the ICAM-1 gene and retinopathy in type 2 diabetes.

AIM: To collectively evaluate the association of intercellular adhesion molecule-1 (ICAM-1) gene K469E polymorphism (rs5498) with diabetic retinopathy (DR) in patients with type 2 diabetic mellitus (T2DM). METHODS: Overall review of available literatures relating K469E polymorphism to the risk of DR was conducted on 4 electronic databases. Meta-analysis was performed by Stata 12.0 to calculate pooled odds ratios (ORs). Potential sources of heterogeneity and bias were explored. RESULTS: Seven studies with genotype frequency data including 1120 cases with DR and 956 diabetic controls free of DR were included. Meta-analysis did not show significant association of K469E polymorphism with DR (P>0.05). A statistically significant association was detected between the K469E polymorphism and proliferative diabetic retinopathy (PDR) in Asians only in dominant model (GG+AG vs AA) with pooled OR of 0.729 (95%CI: 0.564-0.942, P=0.016, P heterogeneity=0.143), however, this association was not detected in recessive model (GA+AA vs GG; OR=1.178, 95%CI: 0.898-1.545, P=0.236, P heterogeneity=0.248) or allelic model (G vs A; OR=0.769, 95% CI: 0.576-1.026, P=0.074, P heterogeneity=0.094). No publication bias was found by Funnel plot, Begg's and Egger's test. CONCLUSION: This research found no statistically significant association between ICAM-1 gene K469E polymorphism and DR in patients with T2DM, but showed significant association of the K469E polymorphism with PDR in Asian diabetic patients only in dominant model. Further investigation would be required to consolidate the conclusion.

Pinworm infection in laboratory mice in southern China.

The present investigation examined the prevalence and intensity of pinworm infection in laboratory mice from three laboratory animal centres in China's southern Guangdong Province between August 2008 and April 2009. A total of 301 laboratory mice representing BALB/c, Kunming (KM) and C57BL/6J breeds were examined and the worms were counted and identified according to existing keys and descriptions, and their specific identity was ascertained by polymerase chain reaction (PCR) amplification of the second internal transcribed spacer (ITS-2) of ribosomal DNA. While the BALB/c and C57BL/6J mice were not found to be infected with pinworms, postmortem examination of the KM mice revealed a prevalence of 46.7%. PCR amplification of ITS-2 rDNA and subsequent sequencing confirmed that the mice were infected with Syphacia obvelata. The results of the present investigation demonstrated that the prevalence of pinworm infection in laboratory mice was high in the Guangdong province, and integrated control strategies and measures should be implemented to prevent and control pinworm infection in laboratory mice.

[Quality of vision in eyes that underwent implantation of ReSTOR apodized diffractive multifocal intraocular lens on bilateral eyes in cataract surgery].

OBJECTIVE: To compare the visual outcomes and subjective parameters in patients who underwent implantation of ReSTOR apodized diffractive multifocal intraocular lens on bilateral eyes with those in patients who had monofocal intraocular lens in cataract surgery. METHODS: Retrospective observational case series. 50 eyes of 25 patients received ReSTOR multifocal intraocular lens (multifocal group) and 56 eyes of 28 patients taken implantation of Natural monofocal intraocular lens (monofocal group) participated in the study. The distance and near visual acuity were compared, as well as contrast and glare sensitivity. Visual symptom and spectacle dependence were assessed using a standardized questionnaire. The minimal follow-up was 3 months. RESULTS: An uncorrected distance visual acuity of 0.6 or better was achieved in 94% of eyes in multifocal group and 96% in the monofocal group, respectively (chi(2) = 0.347, P > 0.05). Uncorrected near visual acuity was J(3) or better in 88% of eyes in the multifocal group and 13% in the monofocal group (chi(2) = 60.315, P < 0.01). Best distant corrected near visual acuity was Jr3 or better in 90% of eyes in the multifocal group and 11% in the monofocal group (chi(2) = 66.515, P < 0.01). No significant difference in contrast and glare sensitivity was found between the groups (P > 0.05). Glare was reported as severe in 12% of the multifocal group and 7% of the monofocal group, respectively (chi(2) = 0.365, P > 0.05). Halo was reported as severe in 8% of the multifocal group and 4% of the monofocal group, respectively (chi(2) = 0.485, P > 0.05). 96% of patients in both groups never had to wear glasses for the distant purpose (chi(2) = 0.007, P > 0.05), and 80% in multifocal group and 11% in monofocal group never had to wear glasses for the near purpose (chi(2) = 25.811, P < 0.01). CONCLUSION: The ReSTOR apodized diffractive intraocular lens provided predictably excellent uncorrected distance and near visual acuities, and obtained satisfactory quality of vision. Spectacle independence was significantly higher with this multifocal intraocular lens.

The effect of micro-incision and small-incision coaxial phaco-emulsification on corneal astigmatism.

PURPOSE: To evaluate the effect of micro-incision (2.2 mm) and small-incision (2.6 mm or 3.0 mm) coaxial phaco-emulsification on surgically induced astigmatism (SIA). METHODS: Cataract patients (n = 83, 129 eyes) were randomized into three groups: 43 eyes in the 2.2-mm incision group, 42 eyes in the 2.6-mm group and 44 eyes in the 3.0-mm group. Torsional phaco-emulsification was followed by intraocular lens implantation via the Monarch II injector with the C cartridge (Alcon Laboratories Inc., Fort Worth, TX, USA). Corneal astigmatism, SIA and uncorrected distance visual acuity were assessed 30 and 90 days after cataract surgery. RESULTS: At 30 and 90 days postoperative, SIA of the 3.0-mm group was greater than SIA of the 2.2-mm and 2.6-mm groups (P < or = 0.015), but SIA was similar between the 2.2-mm group and the 2.6-mm group. Timewise, mean SIA at 30 days was greater than SIA at 90 days in the 3.0-mm group (P = 0.04), while SIA did not change with time for the 2.2-mm and 2.6-mm groups. Postoperative uncorrected distance visual acuity tended to be better with the smaller incisions, but this trend did not reach statistical significance (P > or = 0.07). CONCLUSION: Incision size contributed to postoperative corneal astigmatism. When incision size was reduced from 3.0 mm to 2.6 mm, SIA was reduced and refractive stabilization was faster. Reduction of incision size from 2.6 mm to 2.2 mm offered no greater reduction of SIA when using the C cartridge; however, the D cartridge (designed for 2.2-mm incisions) should be evaluated.

[Risk factors and prognosis of peripheral retinal breaks complicating pars plana vitrectomy].

OBJECTIVE: To assess the risk factors and prognosis of peripheral retinal breaks complicating pars plana vitrectomy. METHODS: Retrospective observational case series. Four hundred and four consecutive vitrectomies performed on eyes without preexisting retinal breaks or retinal detachments were retrospectively reviewed. Cases with peripheral retinal breaks found during or after the vitrectomy were recorded and analyzed. RESULTS: Of the 404 vitrectomies, 32 eyes had 55 iatrogenic peripheral retinal breaks with an average incidence of 7.9%. Peripheral retinal breaks were most common in cases with branch retinal vein occlusion (BRVO) (13.3%) and less common in proliferative diabetic retinopathy (PDR) (3.7%) (chi2 =9.18, P<0.01). Of the 55 breaks, 51 (92.7%) occurred around the sclerotomy sites, and 29 (52.7%) in the quadrant corresponding to the predominant hand of the surgeon. Cases with breaks detected during surgery had a better outcome of retinal reattachment as compared with cases identified postoperatively. CONCLUSIONS: Peripheral retinal breaks complicating pars plana vitrectomy is mainly sclerotomy-related and is more common in cases with BRVO than in cases with PDR. Early detection during surgery tends to have a better outcome.