Clinical features and possible pathogenesis of multiple evanescent white dot syndrome with different retinal diseases and events:a narrative review

●Multiple evanescent white dot syndrome(MEWDS)is a rare fundus disease,characterized by acute vision loss and visual field defects.Many previous studies have explained the possible pathogenesis and clinical features of primary MEWDS.However,as the number of reported cases increases,secondary MEWDS occurs in other related retinal diseases and injuries,exhibiting some special characteristics.The associated retinal diseases include multifocal choroiditis/punctate inner choroidopathy(MFC/PIC),acute zonal occult outer retinopathy,best vitelliform macular dystrophy,pseudoxanthoma elasticum,and ocular toxoplasmosis.The related retinal injury is laser photocoagulation,surgery,and trauma.Although primary MEWDS often have a self-limiting course,secondary MEWDS may require treatment in some cases,according to the severity of concomitant diseases and complications.Notably,MEWDS secondary to MFC/PIC that is prone to forming choroidal neovascularization and focal choroidal excavation,needs positive treatment with corticosteroids.The possible underlying pathogenesis of secondary MEWDS is the exposure of choroidal antigen after the disruption of Bruch’s membrane.The MEWDS-related features in secondary MEWDS are still evanescent under most circumstances.Its prognosis and treatment depend on the severity of complications.Current studies propose that the etiology is associated with immune factors,including viral infection,inflammation in choroid and Bruch’s membrane,and antigen exposure caused by retinal and/or choroidal insults.More pathogenic studies should be conducted in the future.Accurate diagnosis for secondary MEWDS could benefit patients in aspects of management and prognosis.

Chickenpox followed streaky multifocal choroiditis with prednison treatment in a girl with asthma

Dear Editor,We report a case of streaky multifocal choroiditis(SMFC)followed by chickenpox in a girl with asthma under prednison treatment.To our knowledge,this is the first case report of an SMFC followed by chickenpox in a patient with asthma.

Hard X-ray Imager (HXI) onboard the ASO-S mission

Hard X-ray Imager(HXI)is one of the three scientific instruments onboard the Advanced Spacebased Solar Observatory(ASO-S)mission,which is proposed for the 25th solar maximum by the Chinese solar community.HXI is designed to investigate the non-thermal high-energy electrons accelerated in solar flares by providing images of solar flaring regions in the energy range from 30 keV to 200 keV.The imaging principle of HXI is based on spatially modulated Fourier synthesis and utilizes about 91 sets of bi-grid sub-collimators and corresponding LaBr3 detectors to obtain Fourier components with a spatial resolution of about 3 arcsec and a time resolution better than 0.5 s.An engineering prototype has been developed and tested to verify the feasibility of design.In this paper,we present background,instrument design and the development and test status of the prototype.

Effect of femtosecond and microkeratome flaps creation on the cornea biomechanics during laser in situ keratomileusis： one year follow-up

AIM： To compare the corneal biomechanical outcomes at one year after laser in situ keratomileusis（LASIK） with the flaps created by Ziemer and Moria M2 microkeratome with 110 head and -20 blade.METHODS： Totally 100 eyes of 50 consecutive patients were enrolled in this prospective study and divided into two groups for corneal flaps created by Ziemer Femto LDV and Moria M2 microkeratome with 110 head and -20 blade.Corneal biomechanical properties including cornea resistance factor（CRF） and cornea hysteresis（CH） were measured before and 1,3,6,12 mo after surgery by ocular response analyzer.Central cornea thickness and corneal flap thickness were measured by optical coherence tomography.RESULTS： The ablation depth（P=0.693）,residual corneal thickness（P=0.453）,and postoperative corneal curvature（P=0.264） were not significant different between Ziemer group and Moria 110-20 group after surgery.The residual stromal bed thickness,corneal flap thickness,CH and CRF at 12 mo after surgery were significant different between Ziemer group and Moria 110-20 group（P〈0.01）; Ziemer group gained better corneal biomechanical results.The CRF and CH increased gradually from 1 to12 mo after surgery in Ziemer group,increased from 1 to 6 mo but decreased from 6 to 12 mo in Moria 110-20 group.Both CRF and CH at one year after surgery increased with the increasing of residual cornea thickness; pre-LASIK CRF,CRF also increased with residual stromal bed thickness,while CH decreased with the increasing of pre-LASIK intraocular pressure and cornea flap thickness（P〈0.01）.CONCLUSION： In one year follow-up,femtosecond laser can provide better cornea flaps with stable cornea biomechanics than mechanical microkeratome.

Th lymphocyte subsets in patients with Vogt-KoyanagiHarada disease

AIM: To assess helper T(Th) lymphocyte subset balance in patients with Vogt-Koyanagi-Harada(VKH) disease. METHODS: Sixty-eight active VKH patients and seventytwo inactive VKH patients were included in this study. One hundred healthy individuals served as controls. Peripheral blood was obtained from VKH patients and healthy controls. Th lymphocyte subsets were analyzed by flow cytometry. Plasma concentration of interleukin(IL)-17, IL-10, transforming growth factor(TGF)-β, IL-23 and IL-6 was examined by enzyme-linked immunosorbent assay(ELISA). RESULTS: VKH patients with active uveitis had significantly higher percentages of both Th1 and Th17 cells and lower percentages of regulatory T(Treg) cells as compared with inactive VKH patients and healthy controls. Th1/Th2 and Th17/Treg ratios were also significantly elevated in active VKH patients. The percentages of Th1, Th17 and Treg cells and the Th1/Th2, Th17/Treg ratio did not differ between inactive VKH patients and healthy controls. There was no difference concerning the percentage of Th2 cells among all the groups. VKH patients with active uveitis showed an elevated level of peripheral Th17 related cytokines levels(TGF-β, IL-6, IL-23, and IL-17) and a decreased level of Treg related cytokines(IL-10) compared with inactive VKH patients and healthy controls. Inactive VKH patients showed no differences in peripheral Th17 related cytokines(TGF-β, IL-6, IL-23, and IL-17) and Treg related cytokines(IL-10) levels compared with healthy controls. CONCLUSION: Th1 and Th17 cells are significantly increased and Treg cells significantly decreased in active VKH compared with inactive VKH or healthy controls. Therefore, Th lymphocyte subset analysis may serve as a disease biomarker for VKH.

Strong and ductile Al−Zn−Mg−Zr alloy obtained by equal angular pressing and subsequent aging

An ultrafine-grained Al−Zn−Mg−Zr alloy with superior mechanical performance was obtained by high passes of equal angular pressing(ECAP)and subsequent aging.After 8 ECAP passes and aging,the yield strength(YS)and ultimate tensile strength(UTS)of the solid-solutioned alloy are significantly improved from(98±10)and(226±7)MPa to(405±9)and(427±9)MPa,respectively.A large elongation is also maintained((17.4±2.5)%).The microstructure features including grain refinement,morphology of precipitates,and dislocation density,were revealed with multiscale characterizations,including transmission electron microscopy,electron backscattered diffraction,and X-ray diffraction.After 8 passes of ECAP,the original coarse elongated grains are refined to a unique bimodal grain structure consisting of ultrafine equiaxed and lath-like grains.Additionally,the effects of ECAP and subsequent aging on the strengthening contribution of a variety of strengthening mechanisms,such as dislocation strengthening and precipitation strengthening,were discussed in detail.

Effect of non-isothermal aging on microstructure and properties of Al−5.87Zn−2.07Mg−2.42Cu alloys

The evolution of microstructure and properties of Al−5.87Zn−2.07Mg−2.42Cu alloys during non-isothermal aging was studied.The mechanical properties of the alloy were tested by stretching at room temperature.The results show that in the non-isothermal aging process,when the alloy is cooled to 140℃,the ultimate tensile strength of the alloy reaches a maximum value of 582 MPa and the elongation is 11.9%.The microstructure was tested through a transmission electron microscope,and the experimental results show that the GP zones andη'phases are the main strengthening precipitates.At the cooling stage,when the temperature dropped to 180℃,the GP zones were precipitated again.Besides,the experimental results show that the main strengthening phase during non-isothermal aging isη'phases.

Macular ganglion cell complex injury in different stages of anterior ischemic optic neuropathy

BACKGROUND Anterior ischemic optic neuropathy(AION)is a group of ophthalmic diseases in which the optic nerve is injured causing blindness.However,the pathogenesis,clinical manifestations,and clinical treatments of AION are yet elusive.Only a few related experimental or clinical reports are available on the disease.In this study,spectral domain optical coherence tomography(SD-OCT)was used to examine the morphology of thickness swelling and atrophic changes of macular ganglion cell complex(mGCC)in the different stages of AION that were then compared with the visual fields.Thus,the clinical value of mGCC examination was alleged to be similar to that of the visual field.AIM To explore the mGCC injury at different stages in AION and the clinical significance.METHODS Cases with AION were analyzed in a retrospective study.SD-OCT was used to analyze the correlation between mGCC and peripapillary retinal nerve fiber layer thicknesses at different stages of AION and the changes in the corresponding stages of visual fields.RESULTS A total of 21 cases(28 eyes)presented AION.The onset time of AION was defined as early stage(within 3 wk of onset),middle stage(from 3 wk to 2 mo),and late stage(disease span>2 mo).In the early stage,the mGCC thickness of SD-OCT was within the normal high limit,and the perioptic nerve fibers thickness was more than the normal.The changes in the visual field in early stage were not consistent with the swelling changes in mGCC and peri-disc nerve fibers.In addition,atrophy and thinning appeared in mGCC,and the perioptic nerve fibers were swollen.However,the thickness was lower in the middle period than that in the early stage.The change in visual field was consistent with that of mGCC in this period.In the late stage,mGCC shrank and thinned,and the thickness of the nerve fibers around the optic disc in the corresponding region shrank and thinned.CONCLUSION The changes in mGCC thickness in patients with AION showed early,middle,and late stages of development by SD-OCT.Although the early stage visual field changes of AION were not consistent with the swelling changes of mGCC,the horizontal delimitation or annular atrophy of mGCC was consistent with that in the middle and late stage of the disease.The atrophy of peripheral nerve fibers was later than that of the mGCC atrophy.

Successively bilateral cytomegalovirus retinitis in immunocompromised patient with Good's syndrome

Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an extremely rare primary immune-deficiency syndrome,which consists of simultaneous occurrence of

High temperature mechanical properties and microstructure of die forged Al-5.87Zn-2.07Mg-2.42Cu alloy

The high temperature mechanical properties(250 ℃) and microstructure of a die-forged Al-5.87 Zn-2.07 Mg-2.42 Cu alloy after T6 heat treatment were investigated. High temperature tensile tests show that as the temperature increases from room temperature to 250 ℃, the ultimate tensile strength of the alloy decreases from 638 to 304 MPa, and the elongation rises from 13.6% to 20.4%. Transmission electron microscopy(TEM) and electron backscattered diffraction(EBSD) were applied for microstructure characterization, which indicates that the increase of tensile temperature can lead to the coarsening of precipitates, drop of dislocation density, and increase of dynamic recovery. After tensile testing at 250 ℃, a sub-grain structure composed of a high fraction of small-angle grain boundary is formed.

Optic disc coloboma associated with macular retinoschisis:A case report

BACKGROUND To report an unusual case of bilateral optic disc coloboma associated with macular retinoschisis in the left eye.CASE SUMMARY A 37-year-old woman presented with complaints of blurred and distorted vision in her left eye for more than 1 year.Fundus examination demonstrated choroidal atrophy around the optic disc in both eyes,with a cup-to-disc ratio of 0.9.Serous retinal detachment in the macular area of the left eye.Left eye macular blood flow imaging optical coherence tomography(Angio-OCT)showed macular retinal serous cleavage.En-face OCT showed that the canal gully-like structure formed by the defect of the optic disc nerve fiber layer between the optic disc and macula,serous detachment area was connected with the enlarged optic disc coloboma through the canal gully-like structure,and the fluid leaked from the enlarged and thinned optic disc coloboma into the retinal layer of the macular area.Patients with optic disc abnormalities and macular degeneration must be monitored appropriately.During the follow-up period,the use of optic disc stereography and 3D-OCT,en-face,and Angio-OCT imaging can clarify the correlation between macular retinoschisis and optic disc coloboma.CONCLUSION Macular retinoschisis may be owing to the combined force of disc edge loss,enlarged optic disc coloboma,the canal gully-like structure formed by the defect of the nerve fiber layer around the optic disc,and the traction of the posterior vitreous cortex.

Effects of antiseizure medications on alternative psychosis and strategies for their application

Forced normalization(FN)is a unique phenomenon that is often seen in the treatment of epilepsy.FN is characterized by abnormal mental behavior and disordered emotions in epilepsy patients despite a significantly improved electroencephalogram and successful seizure control;the occurrence of FN seriously affects patients’quality of life.The causes of FN include antiseizure medications(ASMs),epilepsy surgery and vagus nerve stimulation,with ASMs being the most common cause.However,with the timely reduction or discontinuation of ASMs and the use of antipsychotic drugs,the overall prognosis is good.Here,we perform an extensive review of the literature pertaining to FN,including its epidemiology,possible mechanisms,clinical features,treatment and prognosis.

BiAlO_(3)-modified BiFeO_(3)-BaTiO_(3) high Curie temperature lead-free piezoelectric ceramics with enhanced performance

BiFeO_(3)-BaTiO_(3)(BF-BT)lead-free piezoelectric ceramics have high piezoelectricity and high Curie temperature(T_(C)),but the mixed-valence Fe ions and Bi^(3+)volatilization would promote the formation of Bi_(25)FeO_(40)/Bi_(2)Fe_(4)O_9 and oxygen vacancy,which greatly degrade the insulation properties required for polarization.In this study,it was found that the modification of BiAlO_(3)(BA)in BF-BT ceramics could effectively solve these problems,reducing the leakage current to 1×10^(-9)A·cm^(-2)and transiting the space charge-limited conduction to ohmic conduction.Because of the enhanced insulation properties and appropriate rhombohedral-pseudocubic phase ratio(C_R/C_(PC)),BF-BT-xBA ceramics in an optimized composition obtain enhanced piezoelectric performance:piezoelectric charge coefficient(d_(33))=196 pC·N^(-1),planar electromechanical coupling coefficient(k_(p))=31.1%,T_(C)=487℃and depolarization temperature(T_d)=250°C;unipolar strain(S_(uni))=0.17%and piezoelectric strain coefficient(d_(33)^(*))=335 pm·V^(-1)at 100℃.Especially,d_(33)exceeds 283 pC·N^(-1)at 233℃and d_(33)^(*)is 335 pm·V^(-1)at100℃,showing an excellent high-temperature piezoelectricity and high depolarization temperature.The results are attributed to the domain structure of rhombohedral-pseudocubic phase coexistence and its high-temperature switching behavior.This work provides a feasible and effective approach to improve the high temperature piezoelectric properties of BF-BT-xBA ceramics,making them more suitable for high temperature applications.

Clinical Study with Randomized Control on the Therapy of Integrated Chinese and Western Medicine in Treating Neurological Autoimmune Diseases:A Meta-Analysis

Objective: The main objective of this study is to evaluate the effects of integrated Chinese and Western medicine in the treatment of neurological autoimmune diseases. Materials and Methods: The literature was comprehensively searched to collect the randomized controlled trials about integrated Chinese and Western medicine in the treatment of neurological autoimmune diseases. Neurological autoimmune diseases mainly occur in the central nervous system(CNS) and peripheral nervous system. Therefore, multiple sclerosis(MS) was chosen as the representative in the CNS, and Guillain–Barre syndrome(GBS) was chosen as the representative in the peripheral nervous system. Extended Disability Status Scale(EDSS) score, effective rate, clinical symptom score, neurological functional sign score, recurrence frequency, and incidence rate of adverse reactions were chosen as the markers of outcome variables of MS, and the effective rate and Hughes score were also chosen as the markers of outcome variables of GBS. Results: For MS, the results showed that there was a significant difference in statistical analysis between the experimental group and the control group in EDSS score, the effective rate, and the recurrence frequency. However, through the comparison of clinical symptom score, neurological functional sign score, and incidence rate of adverse reaction of both two groups, the results showed that there was no significant difference in the statistical analysis. For GBS, through the comparison of effective rate and Hughes score of both two groups, the results showed that there was a significant difference in statistical analysis. Conclusions: The study demonstrated that compared with Western medicine, the therapy of integrated Chinese and Western medicine was more effective in treating neurological autoimmune diseases.

Reduction on OFF-responses of Electroretinogram in Monkeys with Long-term High Intraocular Pressure

Background： There are ON- and OFF-pathways in the normal vertebrate retina. Short- and long-flash electroretinogram （ERG） are suitable methods to observe the function of ON- and OFF-pathways in vivo, respectively. It is clear that high intraocular pressure （IOP） might cause dysfunction of cone-dominated photopic negative response （PhNR） in monkeys with high lOP in ON-pathway. However, whether cone-dominated OFF-responses are also affected is less known. The aim of this study was to observe photopic OFF-responses of ERG in monkeys with high lOP. Methods： Nine monkeys were involved in the experiment from January 2006 to December 2016. High IOP was induced in the right eye by laser coagulation of the mid-trabecular meshwork in five monkeys. Six years after the laser coagulation, both short- and long-flash of the photopic ERG were recorded. Stimulus light was red flashes superimposed on a blue background. Four normal monkeys were examined under the same ERG protocols as controls. Paired t-test was used to compare the difference of each ERG parameter between the lasered eye and the fellow eye. Analysis of variance （ANOVA） with Tukey adjustment was adopted to calculate the differences among the lasered eye, the fellow eye, and the eyes of normal monkeys. Results： The mean amplitude of a-wave （11.73 ± 2.05） and PhNR （8.67 ± 2.44） in lasered eyes was significantly lower than that of a-wave （21.47 ±3.15） and PhNR （22.05 ± 3.42） in fellow eyes （P = 0.03 and P 0.01, respectively） in response to short flash. The mean amplitude old-wave （ 1.60 ± 0.59） and/-wave （3.13± 0.64） was significantly reduced in the lasered eyes than that of d-wave （4.01 ± 0.56） and/-wave （8.79 ± 1.75） in the fellow eyes （P =0.02 and P = 0.02, respectively） in response to long flash. Conclusions： Reduced OFF-responses are recorded in monkeys with high IOP when dysfunction ofphotoreceptor is involved. The reduced OFF-responses to long-flash stimulus show evidence of anomalous retinal circuitry in glaucomatous retinopathy.

Therapeutics of Integrative Medicine Ameliorate Immunological Disorders of the Nervous System: A Meta-Analysis

Objective: The objective of the study is to evaluate the therapeutic efficacy of integrative medicine in the treatment of immunological disorders of the nervous system. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were adopted to conduct this study, which included randomized controlled trials with a confirmed diagnosis of multiple sclerosis(MS), myasthenia gravis(MG), and Guillain–Barre syndrome(GBS), all of which were treated with integrative medicine. The effective rate, recurrent frequency, and disease score were used as the markers of outcome variables for the meta-analysis. Results: A total of 48 randomized control trials were included. The effective rates of treatment with integrative medicine were noticeably higher than those with Western medicine alone for the three diseases. The recurrence frequency for MS and the recurrence rate for MG treated with integrative medicine were reduced more than those with Western medicine alone. The Extended Disability Status Scale, acetylcholine receptor antibody, and Hughes scores for MS, MG, and GBS, respectively, treated with integrative medicine were significantly lower than those with Western medicine alone. The risks of bias in the literature evaluation showed that the quality of the included studies was not high. Conclusions: Compared to treatment with Western medicine alone, integrative medicine might ameliorate immunological disorders of the nervous system.