IntroductionAge-related macular degeneration (AMD) is a leading cause of irreversible vision loss among the older adults, and understanding the knowledge, attitudes, and practices (KAP) of patients and their family members is essential for improving disease management and patient education. This study aimed to assess the knowledge, attitudes, and practices (KAP) of patients with age-related macular degeneration (AMD) and their family members.MethodsA cross-sectional survey was conducted between April and July 2023 at the Department of Ophthalmology, the Second Hospital of Jilin University, using a self-administered questionnaire.ResultsA total of 538 valid questionnaires were included in the analysis, comprising 325 patients (60.41%) and 213 family members (39.59%). Among all participants, 495 (92.01%) reported having undergone intraocular injection therapy, while 43 (7.99%) had not received such treatment. The mean KAP scores were 10.99 ± 1.30 for knowledge, 43.05 ± 3.48 for attitude, and 22.36 ± 3.96 for practice. Significant positive correlations were observed between knowledge and attitude, knowledge and practice, and attitude and practice. Structural equation modeling further demonstrated that knowledge had a significant direct effect on attitude, and attitude had a significant direct effect on practice, with attitude fully mediating the relationship between knowledge and practice.DiscussionOverall, patients and their family members exhibited adequate knowledge of AMD, whereas attitude and practice levels were moderate. These findings highlight the need for targeted educational interventions to enhance AMD-related knowledge, foster positive attitudes through supportive patient–family interactions, and facilitate the translation of knowledge and attitudes into appropriate health-related behaviors, with particular emphasis on timely medical consultation and adherence to treatment.

Purpose This study compared the efficacy and safety of intravitreal injection of conbercept with panretinal photocoagulation (PRP) and PRP alone in Chinese patients with proliferative diabetic retinopathy (PDR) without center-involved diabetic macular edema (CI-DME). Methods This multicenter, prospective, controlled study randomized patients with PDR without CI-DME (1:1) to receive a single conbercept intravitreal injection followed by PRP (combination group, n = 51) or PRP alone (PRP group, n = 59). Mild pre-retinal or vitreous hemorrhage was permitted but not required for enrollment. The primary outcome was the PRP completion rate at week 4. Secondary outcomes included the total number of PRP spots at week 4; best-corrected visual acuity (BCVA) and central subfield thickness (CST) changes from baseline to week 4, 12, 16, and 24; and treatment-related adverse events. Results Ninety-eight patients (89.1%) completed the study. Baseline demographics, ocular characteristics, and the presence of pre-retinal or vitreous hemorrhage were similar between the groups (all P > 0.05). The PRP completion rate at week 4 was 93.0% in the combination group, versus 76.4% in the PRP group (P = 0.03). Reasons for PRP incompletion included vitreous hemorrhage (VH) progression (4.7% vs. 18.2%, P = 0.04) and pars plana vitrectomy (PPV) because of severe VH (2.3% vs. 5.5%, P = 0.79). The combination group demonstrated a smaller number of total PRP spots than the PRP group at week 4 (1380.1 ± 137.9 vs. 1558.8 ± 264.7, P < 0.01). The combination group displayed a BCVA improvement (expressed as the logarithm of the minimum angle of resolution) of 0.06 ± 0.10 at 4 weeks, whereas the PRP group exhibited a deterioration of 0.03 ± 0.08 (P < 0.01). Similarly, for CST, the combination group displayed a reduction of 27.4 ± 27.5 μm at 4 weeks, versus an increase of 14.1 ± 27.2 μm in the PRP group (P < 0.01). However, the changes in BCVA and CST from baseline were not significantly different between the groups at 12, 16, and 24 weeks. No serious adverse effects were reported in either group. Conclusions Conbercept administered intravitreally 1 week prior to PRP helped improve the PRP completion rate and delayed VH progression. Its impact on long-term prognosis remains to be elucidated by future research. Trial Registration A prospective randomized controlled trial to compare the efficacy and safety of intravitreal injection of conbercept plus PRP versus PRP alone in Chinese patients with PDR without CI-DME (ChiCTR2200063637).

PULSAR (NCT04423718) was a global, phase 3, randomized, double-masked, non-inferiority study of adults with neovascular age-related macular degeneration (nAMD). Patients were randomized 1:1:1 to receive aflibercept 8 mg every 12 (8q12), or 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following 3 initial monthly doses. This subgroup analysis investigated the efficacy and safety of aflibercept 8 mg vs. aflibercept 2 mg in patients from China with nAMD from the PULSAR trial. This exploratory analysis evaluated the change from baseline in best-corrected visual acuity (BCVA), central retinal thickness (CRT), durability, and safety outcomes through week 48 in patients from China. All results were descriptive in nature. Least squares (LS) mean (95

This case report covers the novel use of an Nd:YAG Ultra-Q Reflex laser to treat a symptomatic vitreous cyst in a 47-year-old man. Following a single 0.3-mJ laser pulse applied to the cyst's superior pole, controlled fluid egress led to cyst collapse and inferior displacement without complications. The patient experienced immediate visual improvement, with the cyst remaining inactive in the inferior vitreous at 1-month follow-up and demonstrating no significant change in size when located in the anterior vitreous at 10 months. This laser cystotomy technique presents a safe, effective, and minimally invasive alternative to traditional management.

Retinal metastasis is an exceedingly rare manifestation of systemic cancer, accounting for less than 1% of ocular metastases. Lung adenocarcinoma is among the primary tumors that can metastasize to the retina, though such cases are seldom reported. We present a 70-year-old male with a history of lung adenocarcinoma who presented with a decline in vision in his left eye. Fundus examination revealed a large yellow-white lesion with hemorrhage in the macula and temporal retina. Multimodal imaging, including optical coherence tomography (OCT) and fluorescein angiography (FA), confirmed the diagnosis of retinal metastasis. This case underscores the importance of considering retinal metastasis in cancer patients with visual disturbances. Early diagnosis through comprehensive ophthalmic evaluation is crucial to avoid misdiagnosis.

Intracellular alkalosis and extracellular acidosis are well-established characteristics of Alzheimer's disease (AD). We present a computational analysis and modeling of transcriptomic data of AD tissues, aiming to understand their causes and consequences. Our analyses have revealed that (1) persistent mitochondrial alkalization is due to chronic inflammation coupled with elevated iron and copper metabolisms; (2) the affected cells activate multiple acid-producing metabolisms to keep the mitochondrial pH stable for survival; (3) the most significant one is the continuous import and hydrolysis of glutamine to glutamate, NH3, and H+, resulting in persistent release of glutamate, an excitatory neurotransmitter, into the extracellular space; (4) this leads to persistent hyperexcitability of the nearby neurons, resulting in their continuous firing and release of H+-rich synaptic vesicles; (5) the H+ is neutralized by bicarbonates released by the neighboring astrocytes in normal tissues, which could not keep up with the increased the release of H+ in their discharge rates of bicarbonates in AD tissues, leading to progressively increased extracellular acidosis and ultimately cell death; and (6) multiple extensively studied AD-associated phenotypes, including Aβ aggregates and tau fibers, are induced to help to alleviate the pH imbalances and beneficial to cell survival in the early phase of AD, which gradually become contributors to the AD development. Each step in this model is largely supported by published studies. Overall, we have developed a fundamentally novel and systems-level view of how AD may have evolved.

Cancer occurrence rates exhibit diverse age-related patterns, and understanding them may shed new and important light on the drivers of cancer evolution. This study systematically analyzes the age-dependent occurrence rates of 23 carcinoma types, focusing on their age-dependent distribution patterns, the determinants of peak occurrence ages, and the significant difference between the two genders. According to the SEER reports, these cancer types have two types of age-dependent occurrence rate (ADOR) distributions, with most having a unimodal distribution and a few having a bimodal distribution. Our modeling analyses have revealed that (1) the first type can be naturally and simply explained using two age-dependent parameters: the total number of stem cell divisions in an organ from birth to the current age and the availability levels of bloodborne growth factors specifically needed by the cancer (sub)type, and (2) for the second type, the first peak is due to viral infection, while the second peak can be explained as in (1) for each cancer type. Further analyses indicate that (i) the iron level in an organ makes the difference between the male and female cancer occurrence rates, and (ii) the levels of sex hormones are the key determinants in the onset age of multiple cancer types. This analysis deepens our understanding of the dynamics of cancer evolution shared by diverse cancer types and provides new insights that are useful for cancer prevention and therapeutic strategies, thereby addressing critical gaps in the current paradigm of oncological research.

AIM:To pool existing studies to assess the overall effectiveness of integrated care for older adults (ICOPE)-based interventions in improving depressive symptoms in older adults. DESIGN:A systematic review and meta-analysis. DATA SOURCES:Ten databases were systematically searched from inception to 15 July 2023 and the search was last updated on 2 September 2023. METHODS:Standardized mean difference (SMD) was calculated using random effects models. RoB 2 and GRADEpro GDT were used to assess the methodological quality and confidence in the cumulative evidence. Funnel plots, egger's test and begg's test were used to analyse publication bias. Sensitivity, subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity. RESULTS:The results of 18 studies showed ICOPE-based interventions had a significant effect on improving depressive symptoms (SMD = -.84; 95% CI, -1.20 to -.3647; p < .001; 18 RCTs, 5010 participants; very low-quality evidence). Subgroup analysis showed the intervention group was characterized by mean age (70-80 years old), intervention duration between 6 to 12 months, gender (female <50%), non-frail older adults, depressed older adults and mixed integration appeared to be more effective. Sensitivity analysis found the results to be robust. CONCLUSION:ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Healthcare professionals are expected to use ICOPE as one of the interventions for depressive symptoms in older adults, and this ICOPE could provide more comprehensive care services for older adults to reduce depressive symptoms. IMPACT:ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. ICOPE-based interventions had a significant effect on reducing depressive symptoms in the older adults. The intervention group characterized by mean age of older adults, intervention duration, gender ratio, health condition and integration types may influence the effect size. REPORTING METHOD:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

Background and Objectives Cholangiocarcinoma (CHOL) is a rare and highly aggressive cancer that originates in the bile duct; it has an average five-year survival rate of 9%, which makes it the cancer with the lowest survival rate among all 33 cancer types in the cancer genome atlas (TCGA) Program. The aim of this study is to elucidate the key determinants of the high malignancy level of CHOL through computational and cell-based experimental approaches and, particularly, to investigate how bile acids (BAs) influence CHOL's propensity to metastasize.Methods Our study analyzed the transcriptomic data from 1835 tissue samples of 7 digestive system cancer types in the TCGA database and compared them with those of 330 control tissue samples. Multiple cellular and molecular factors were considered in the study, including the level of hypoxia, level of immune cell infiltration, degree of cellular dedifferentiation, and level of sialic acid (SA) accumulation on the surface of cancer cells. Using these factors, we developed a multivariable regression model for the five-year survival rate, as reported by the Surveillance, Epidemiology, and End Results (SEER) Program reports, and analyzed how BA biology influences a few of these factors and causes CHOL to have a high malignancy level.Results CHOL exhibited the highest level of SA accumulation and B-cell infiltration among all cancer types studied. BAs inhibit the cell cycle progression through the receptor GPBAR1, thereby limiting the rate of nucleotide biosynthesis-which in turn forces the cells to increase SA biosynthesis in order to maintain the intracellular pH at a stable level-thereby driving cell migration and metastasis, as established in our previous study.Conclusions BAs are the key contributors to the lowest five-year survival rate of CHOL among the seven cancer types studied here. This finding not only reveals the molecular mechanisms underlying the high malignancy level of CHOL but also provides a new potential target for the diagnosis and treatment of CHOL.

RATIONALE:Generally, there is no lipoprotein in aqueous humor, and chyle usually exists transiently in the body. Therefore, persistent chylous aqueous humor is rare. PATIENT CONCERNS:We report a case of a 39-year-old man with persistent milky white appearance over the right eye. DIAGNOSES:The patient had a history of poorly controlled diabetes for the past 2 years and central retinal vein occlusion of the same eye for the past 2 weeks. The patient's right eye had a uniform milky appearance in the anterior chamber, transparent cornea, and no keratic precipitate in the posterior cornea. Color Doppler ultrasound of the affected eye showed no obvious inflammation in the vitreous cavity. Laboratory tests revealed severe chylemia. The patient was finally diagnosed as chylous aqueous humor. INTERVENTIONS AND OUTCOMES:After conventional hypolipidemia and hypoglycemia treatment and locally glucocorticoid treatment. The milky white changes in the anterior chamber improved considerably and finally disappeared. LESSONS:Although the impact of hyperlipidemia on the cardiovascular system and digestive system is well known, its impact on the eyes is often overlooked. We report a rare case of unilateral chylous aqueous humor caused by hyperlipidemia. Through the analysis of this special case, we recommend that ophthalmologists should pay attention to the impact of blood lipid change on eyes.

Introduction The objective of this study is to report a case of complete recovery of the retinal pigment epithelium (RPE) layer after spontaneous large serous RPE tear and explore the possible RPE repair mechanism. Case description A 63-year-old male patient developed serous detachment of the RPE in the macula of his left eye. During the follow-up period, an oval-shaped RPE tear spontaneously occurred in the macular area, and fundus autofluorescence showed that the torn area was 6.59 mm 2 . Spectral-domain optical coherence tomography (OCT) revealed that the subretinal fluid had been absorbed and that the continuity of the RPE layer was gradually restored from the periphery to the center over the course of 9 months. Moreover, visual acuity (VA) in the left eye was restored to 20/20, and there was no significant difference in macular function between the two eyes, as measured by multifocal electroretinography, at the last follow-up. In addition, the patient received no special treatment during the entire follow-up period. Conclusion The integrity of the RPE layer can be restored completely after extensive RPE tear, and recovered RPE may allow the recovery of macular function.

BACKGROUND:To report the spontaneous regression of an isolated retinal astrocytic hamartoma in a newborn. During the seven-month follow-up duration, fundus photography and fluorescein angiography examinations were performed.CASE PRESENTATION:An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant. At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina. Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage. Seven months later, the fundus examination showed no lesion in the left eye, FA revealed mild tortuous vessels without leakage.CONCLUSIONS:In the present case, we established that the isolated retinal astrocytic hamartoma in this infant has underwent spontaneous regression. This case can point out that follow -up reexaminations are advisable for a solitary yellowish-white flat mass of the fundus in a newborn.

Background:Retinal disorders cause substantial visual burden globally. Accurate estimates of the vision loss due to retinal diseases are pivotal to inform optimal eye health care planning and allocation of medical resources. The purpose of this study is to describe the proportion of visual impairment and blindness caused by major retinal diseases in China.Methods:A nationwide register-based study of vitreoretinal disease covering all 31 provinces (51 treating centres) of mainland China. A total of 28 320 adults diagnosed with retinal diseases were included. Participants underwent standardised ocular examinations, which included best-corrected visual acuity (BCVA), dilated-fundus assessments, and optical coherence tomography. Visual impairment and blindness are defined using BCVA according to the World Health Organization (WHO) (visual impairment: <20/63-≥20/400; blindness: <20/400) and the United States (visual impairment: <20/40-≥20/200; blindness: <20/200) definitions. The risk factors of vision loss were explored by logistic regression analyses.Results:Based on the WHO definitions, the proportions for unilateral visual impairment and blindness were 46% and 18%, respectively, whereas those for bilateral visual impairment and blindness were 31% and 3.3%, respectively. Diabetic retinopathy (DR) accounts for the largest proportion of patients with visual impairment (unilateral visual impairment: 32%, bilateral visual impairment: 60%) and blindness (unilateral blindness: 35%; bilateral blindness: 64%). Other retinal diseases that contributed significantly to vision loss included age-related macular degeneration, myopic maculopathy, retinal vein occlusion, and rhegmatogenous retinal detachment and other macular diseases. Women (bilateral vision loss: P = 0.011), aged patients (unilateral vision loss: 45-64 years: P < 0.001, ≥65 years: P < 0.001; bilateral vision loss: 45-64 years: P = 0.003, ≥65 years: P < 0.001 (reference: 18-44 years)) and those from Midwest China (unilateral and bilateral vision loss: both P < 0.001) were more likely to suffer from vision loss.Conclusions:Retinal disorders cause substantial visual burden among patients with retinal diseases in China. DR, the predominant retinal disease, is accountable for the most prevalent visual disabilities. Better control of diabetes and scaled-up screenings are warranted to prevent DR. Specific attention should be paid to women, aged patients, and less developed regions.

Purpose: To report the progression of a patient with retinal racemose hemangioma after five years of follow-up. Methods: Observational case report. Results: A 14-year-old girl was diagnosed with an isolated retinal racemose hemangioma with retinal arteriovenous malformation in the posterior pole of the left eye fundus. At the fifth year of follow-up, a spontaneous enlargement of the previously normal vessel was found above the original lesion. The patient’s vision remained stable and no complication was observed. Conclusions: Retinal racemose hemangioma was once considered stable and non-progressive, but progression and expansion of the lesion may also occur, so long-term follow-up is necessary.

Background Herein, we report two cases of unilateral retinal pigment epithelium dysgenesis (URPED) in Chinese patients and explore the relationship between URPED and combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). Case presentation The lesion margins in the two cases showed pathognomonic clinical features of URPED, namely, a scalloped reticular margin in hyperplastic retinal pigment epithelium and mild fibrosis. The hypoautofluorescence observed by fundus autofluorescence was inverted compared with that observed by fundus fluorescence angiography. A large amount of fibroglial proliferation and disorganization of the retina involving the whole layer, which are also found in peripapillary CHRRPE, were found in the lesions. Conclusions URPED appears to share some clinical features with CHRRPE, and the relationship between URPED and CHRRPE needs further study.

Brain metastasis of a cancer is a malignant disease with high mortality, but the cause and the molecular mechanism remain largely unknown. Using the samples of primary tumors of 22 cancer types in the TCGA database, we have performed a computational study of their transcriptomic data to investigate the drivers of brain metastases at the basic physics and chemistry level. Our main discoveries are: (i) the physical characteristics, namely electric charge, molecular weight, and the hydrophobicity of the extracellular structures of the expressed transmembrane proteins largely affect a primary cancer cell's ability to cross the blood-brain barrier; and (ii) brain metastasis may require specific functions provided by the activated enzymes in the metastasizing primary cancer cells for survival in the brain micro-environment. Both predictions are supported by published experimental studies. Based on these findings, we have built a classifier to predict if a given primary cancer may have brain metastasis, achieving the accuracy level at AUC = 0.92 on large test sets.

ABSTRACT Purpose To describe the primary tumour type, clinical features, treatment and outcome of patients with Iris metastasis. Methods Retrospectively analyzed articles published from 1934 to 2019 in the PubMed database. Results In total, 133 eyes of 125 patients with iris metastatic carcinoma were retrieved. The average age at metastasis diagnosis of the patients was 56 ± 15 years; 60 left eyes and 49 right eyes were involved. The most common primary tumors were lung carcinoma (42%) and breast carcinoma (15%). Approximately one-third of the patients were first diagnosed in the ophthalmology department before the primary tumor was detected. Twenty-two percent of iris metastases were discovered before and 33% were discovered after systemic metastasis. The most common complaints were blurred vision and pain. The clinical features included iris masses, neovascularization and keratic precipitates. 57 patients (64%, N = 90) had an elevated intraocular pressure. Local administration of radiation therapy or intraocular injections of anti-VEGF drugs relieved eye discomfort and controlled the high intraocular pressures. Conclusions Iris nodules with increased intraocular pressure and neovascularization may indicate iris metastasis. Lung cancer is the most common primary tumor.

Gastric cancer has two distinct subtypes: the diffuse (DGC) and the intestinal (IGC) subtypes. Morphologically, the former each consists of numerous scattered tiny tumors while the latter each has one or a few solid biomasses. The former tends to be more aggressive and takes place in younger patients than the latter. While these have long been documented, little is known about the underlying causes. Our hypothesis is that the level of sialic acid (SA) accumulation on the cancer cell surfaces is a key reason for the observed differences. Our transcriptomic data-based analyses provide evidence that (i) DGCs tend to deploy more SAs on cancer cell surfaces than IGCs; (ii) this gives rise to considerably stronger cell-cell electrostatic repulsion in DGCs due to the negative charge that each SA carries; and (iii) such repulsion drives stronger cell protrusion and metastasis. Similar observations as well as our transcriptomic data-based predictions hold for multiple other cancer types, namely breast, lung, prostate plus liver and thyroid cancers, each known to have diffuse-like vs. non-diffused subtypes as well as more aggressive behaviors like DGCs vs. IGCs. Hence, we speculate that the discovery presented here applies not only to gastric cancer but multiple and even potentially all cancer types having diffuse-like and non-diffused subtypes.