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We describe the baseline ophthalmic and cardiovascular risk factors across countries, race, and sex for the Quark207 treatment trial for acute nonarteritic anterior ischemic optic neuropathy (NAION). Prospective, randomized controlled clinical trial. Adults 50 to 80 years of age with acute NAION recruited from 80 sites across 8 countries. Ophthalmic features of NAION and cardiovascular risk factors. We evaluated demographics and clinical and ophthalmologic data, including best-corrected visual acuity (BCVA) and average visual field total deviation (TD), in affected eyes and cup-to-disc ratio in fellow eyes at enrollment. We report the prevalence (mean and standard devition, and median and interquartile range [IQR]) of ophthalmic features and cardiovascular risk factors, stratified by country, race, and sex. We corrected for multiple comparisons using Dunn's test with Bonferroni correction for continuous variables and chi-square testing with Holm-Bonferroni correction for categorical variables. The study enrolled 500 men and 229 women with a median age of 60 and 61 years (P = 0.027), respectively. Participants were predominantly White (n = 570) and Asian (n = 149). The study eye BCVA was 71 characters (IQR, 53–84 characters; approximately 0.4 logarithm of the minimum angle of resolution), and the TD was –16.5 dB (IQR, –22.2 to –12.6 dB) for stimulus III and –15.7 dB (IQR, –20.8 to –10.9 dB) for stimulus V. The vertical and horizontal cup-to-disc ratio was 0.1 (IQR, 0.1–0.3) for unaffected fellow eyes. The prevalence of cardiovascular risk factors varied among countries. The most notable differences were in the baseline comorbidities and ophthalmologic features, which differed between Asian and White races. Men and women differed with respect to a few clinically meaningful features. The cardiovascular risk factors in the NAION cohort varied among the 7 countries, race, and sex, but were not typically more prevalent than in the general population. Ophthalmic features, typical of NAION, generally were consistent across countries, race, and sex, except for worse BCVA and TD in China. Men have a frequency of NAION twice that of women. Having a small cup-to-disc ratio in the fellow eye was the most prevalent risk factor across all demographics. This study suggests that factors, not yet identified, may contribute to the development of NAION. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Livedoid vasculopathy (LV) is a thrombo‐occlusive vascular disease with an uncertain aetiology. In addition to cutaneous manifestations, LV patients may develop peripheral neuropathy. This study aimed to examine features of peripheral neuropathy in Chinese LV patients. We retrospectively reviewed and analysed the clinical data of 55 LV patients treated at Peking Union Medical College Hospital and conducted a literature review of peripheral neuropathy in LV patients. The incidence of peripheral neuropathy in our cohort was 12.73%. Among the seven patients with neuropathy, five were women and two were men. Median age at enrollment and disease onset in these patients was 27.29 and 22.57 years, respectively. Mean time from the appearance of cutaneous manifestations to the development of neurological symptoms was 38.67 months. Peripheral neuropathy was generally refractory to treatment, asymmetric in the distal extremities, and slowly progressive. The main symptom was numbness; hypoesthesia and neuromuscular manifestations occurred occasionally. The proportion of patients reporting seasonal worsening of symptoms was significantly higher in LV patients with peripheral neuropathy than in LV patients without neuropathy (P <.05). Peripheral neuropathy is a potential complication of LV. LV patients with peripheral neuropathy require long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the clinical epidemiological characteristics of nitrous oxide (N2O) abusers in a hospital in China, which have not been systematically reported. Methods: The characteristics of patients abusing N2O who were examined and treated at the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2020 were analyzed. Results: A total of 61 patients (average age: 21.7 ± 3.2 years; 42 male and 19 female) were enrolled; 60.7% of the patients had an education level of high school or lower, and most (59.0%) had no stable occupation. The mean exposure time was 8.5 ± 7.7 months (range: 1–36 months). Only 52.5% of the abusers reported the physician of the relevant exposure history at the first time of visiting the doctor. The main clinical type was mixed (49.2%). The most common clinical manifestation was distal limb numbness (80.3%). The most frequent outcome was peripheral neuropathy (59%) and subacute combined degeneration (36%). Serum homocysteine level was elevated in 67.5% (27/40) of the patients, while 44.4% (20/45) showed reduced vitamin B12. Note that 61% (22/36) showed abnormal signals in the posterior or lateral funiculus of the spinal cord, and 97% (31/32) of the patients showed peripheral nerve damage by electromyography. In all cases, symptoms were alleviated after halting N2O intake and receiving nutritional neurotherapy. Conclusions: N2O abuse can lead to nervous system damage, especially peripheral nerve and spinal cord damage. A full understanding of its clinical epidemiological characteristics is helpful for clinicians to make a timely and clear diagnosis. [ABSTRACT FROM AUTHOR]

The purpose is to use medical image processing technology to avoid the influence of subjective factors through the mutual penetration and development of clinical medicine and computer science. Can diagnose the degree of malignancy of ischemic optic neuropathy as quickly as possible, and can take an effective treatment plan for the patient early.Therefore, image segmentation of ischemic optic neuropathy based on fuzzy clustering theory is particularly important for the diagnosis of disease in patients. This paper analyzes the research status of medical image segmentation at home and abroad and the development trend in this aspect in China. Discussed the fuzzy C-means clustering (FCM) image segmentation algorithm in depth, studied the effects of iterative cutoff error, initial clustering center, number of clustering categories and fuzzy weighted index on the practical application of the algorithm. At the same time, the traditional algorithm is not sensitive to the spatial information of the image, making the algorithm sensitive to noise. Firstly, introduced the spatial information of the image, and introduced the algorithm based on spatial information constraint, Based on the above description and based on the neighborhood properties described by the two-dimensional histogram, studied and proposed a relatively easy to understand multidimensional distance measurement method. That is, the two-dimensional pixel value and the neighborhood pixel value viewpoint that can be updated in the two-dimensional direction, by setting a clustering objective function, a clustering measurement method includes neighborhood information. Through the above two-dimensional image segmentation algorithm based on neighborhood spatial information, proposed an image segmentation algorithm for ischemic optic neuropathy of fuzzy kernel clustering theory combined with spatial information. The experimental results show that the proposed algorithm can show excellent results in ischemic neuropathy image segmentation, and the algorithm has faster convergence speed and higher classification accuracy. Experimental results of artificial images and actual images show that the algorithm has strong noise immunity and practicability. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, there has been a sharp increase in the number of patients with neurological disorders associated with recreational use of nitrous oxide (N2O) in China. Here, we summarize the clinical characteristics of patients with neurological disorders associated with N2O abuse diagnosed in our Hospital. Further, we conducted a literature search on recent cases reported in mainland China to improve the awareness of the outbreak of neurological disorders associated with N2O abuse. Methods: We retrospectively collected data of patients diagnosed with neurological disorders associated with recreational use of N2O in Shengjing Hospital of China Medical University from January 2018 to June 2019, and performed a literature search using the "nitrous oxide" and "neurological disorder" as keywords in the Chinese literature databases of WANFANG and CNKI and the English literature databases of Pubmed and Web of Science Results: We enrolled 43 patients (average age: 21.9 ± 3.3 years). The main clinical manifestations were weakness and paresthesia in the four extremities and unsteady gait. Further, most patients showed significantly lower levels of serum vitamin B12 (169.4 ± 79.1 pg/mL) and increased homocysteine levels (78.1 ± 32.2 μmol/L). MRI of the spinal cord showed longitudinal high T2 signal lesions in the dorsal spinal cord in some patients. Moreover, electromyography showed sensory and motor nerve axonal damage combined with demyelination, which was relatively more severe in the lower limbs. There was rapid improvement of the symptoms after treatment with intramuscular injections of vitamin B12 and the overall prognosis was good. The literature search indicated that the number of published papers and related patients showed a rapid annual increase since the first Chinese case reported in 2016 Conclusion: Recreational use of N2O is an emerging public health problem in China that needs prompt action from the society and government. Early diagnosis and treatment allow a good overall prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. The aim of this study was to estimate the prevalence of HZ and PHN in China, and to examine the clinical characteristics of patients identified with PHN. Methods: This was a cross-sectional study conducted in 24 hospitals in seven cities in China. Prevalence of HZ and PHN was determined by physician (n = 100) chart review of patients (n = 36,170) aged ≥ 40 years seeking medical care over a 30- to 60-day period. The health history of patients identified with PHN was obtained and included time since diagnosis of HZ or PHN, time since onset of PHN-related pain, and the methods used for diagnosing HZ and PHN. Results: The prevalence rates of HZ and PHN were 7.7% [95% confidence interval (CI) 7.5–8.0] and 2.3% (95% CI 2.2–2.5), respectively. Of patients with HZ, 29.8% developed PHN. Rates of HZ and PHN increased with age and were highest in patients aged ≥ 70 years (10.6% and 4.1%, respectively). The majority of patients with PHN were diagnosed with HZ (80.9%) and PHN (83.8%) for < 1 year, and had experienced PHN-related pain for < 1 year (80.5%). Patient description and clinical examination were most commonly used to diagnose HZ and PHN. Conclusion: These results provide current estimates of the prevalence of HZ and PHN in the general adult population in urban China. These rates are similar to previously reported rates in China and worldwide, and highlight the global nature of HZ and PHN. Funding: Pfizer Inc. [ABSTRACT FROM AUTHOR]

Radiation-induced optic neuropathy (RION) is a severe visual complication resulting from radiotherapy of the head and neck, which mostly occurs in patients with nasopharyngeal carcinoma (NPC) in the southern part of China. The mechanism of RION is unclear. Therefore, identifying risk factors for RION is an important step towards enhancing our understanding. In the current study, we retrospectively reviewed patients with NPC who were admitted to Sun Yat-Sen Memorial Hospital for visual loss between 2006 and 2017. The study included 38 participants (68 eyes) in the corticosteroid-effective group and 35 participants (64 eyes) in the corticosteroids-ineffective group. We analyzed potential risk factors for RION and developed a prediction model for the therapeutic effect of corticosteroid effect based on a random forests method. The prediction model showed a high accuracy with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval = 0.889-0.975). Our results revealed that blood urea nitrogen (BUN) was significantly associated with RION and that RION patients with higher BUN levels responded better to corticosteroid treatment. Altogether, these results suggest that a prediction model, based on clinical factors, could be applied to estimate the therapeutic effect of corticosteroids on RION. Further investigation, however, is needed to confirm the study conclusion. [ABSTRACT FROM AUTHOR]

Background: This study assessed the extent to which diabetes mellitus (DM) and SCN10A (rs7375036) and their interaction impact on cardiovascular autonomic neuropathy (CAN) susceptibility in a Chinese Han sample.Method: We performed a study in a cross-sectional dataset that included 419 patients with DM and 1557 controls who were genotyped for the presence of the SCN10A rs7375036 polymorphisms. Genotyping was performed by iPLEX technology. The associations of rs7375036 and DM with CAN was assessed by using univariate and multivariate logistic regression controlling for confounders. The interaction between rs7375036 and DM for CAN susceptibility on an additive scale was calculated by using the relative excess risk due to interaction (RERI), the proportion attributable to interaction (AP), and the synergy index (S).Results: The univariate logistic analyses failed to show an association between the SCN10A rs7375036 polymorphisms and CAN. Interestingly, a novel interaction effect of SCN10A rs7375036 and DM on CAN was assessed (p=0.055; RERI=3.515, 95% CI 1.829 to 5.805; AP=0.632, 95% CI -0.368 to 1.632; S=4.361, 95% CI 2.071 to 9.184).Conclusions: Our findings suggest that there are interaction effects of DM and SCN10A (rs7375036) that influence the development of CAN.Trial Registration Number: NCT02461342. [ABSTRACT FROM AUTHOR]

Background: n-Hexane is a well-known neurotoxicant. Polyneuropathy due to occupational n-hexane exposure has been reported worldwide, however, our case is the first report in the Chinese herb industry.Case Presentation: A 25-year-old Asian man experienced progressive weakness and numbness in his hands and feet after working as an operator in a Chinese medicine pharmaceutical plant for the manufacture of Chinese herbal pain relief patches for 10 months. Electrophysiological studies indicated a reduction in nerve conduction velocity, prolongation of distal latencies, mildly positive sharp waves, and reduced recruitment with polyphasic potentials, particularly at distal sites. Demyelination with axonal degeneration caused by occupational n-hexane exposure was strongly suspected. Through investigation of our patient's workplace, the ambient n-hexane concentration in air was found to considerably exceed the permissible exposure limit/time-weighted average for n-hexane in Taiwan. His symptoms were gradually relieved after 4 months of cessation of exposure to n-hexane. He was then confirmed as a case of occupational n-hexane intoxication. Further effective control measures should be implemented as soon as possible to prevent exposure of workers to n-hexane.Conclusions: Despite a typical clinical presentation, his exposure at workplace was appropriately investigated. Chemical exposure in Chinese medicine pharmaceutical plants could be an emerging issue that may affect workers' health. The lack of knowledge and management of solvents could endanger the health of workers. This case has profound educational implications for occupational health and is worthy of further follow-up for improving hazards control. [ABSTRACT FROM AUTHOR]

Background: Non-arteritic anterior ischemic optic neuropathy (NA-AION) is one of the most common types of ischemic optic neuropathy. Several recent studies suggested that abnormalities of choroidal thickness might be associated with NA-AION. The main objective of this case-control study was to evaluate whether choroidal thickness is an ocular risk factor for the development of NA-AION by evaluating the peripapillary and subfoveal choroidal thicknesses in affected Chinese patients.Methods: Forty-four Chinese patients with unilateral NA-AION were recruited and compared with 60 eyes of 60 normal age and refractive-error matched control subjects. Peripapillary and subfoveal choroidal thicknesses were measured by enhanced depth imaging optical coherence tomography. Choroidal thicknesses of eyes with NA-AION and unaffected fellow eyes were compared with normal controls. Choroidal thicknesses of NA-AION eyes with or without optic disc edema were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logMAR best-corrected visual acuity (BCVA), and the mean deviation (MD) of Humphrey static perimetry in NA-AION eyes were analyzed.Results: The peripapillary choroidal thicknesses at the nasal, nasal inferior and temporal inferior segments in NA-AION eyes with optic disc edema were significantly thicker compared with that of normal subjects (P < 0.05). There was no significant difference in the choroidal thicknesses between the unaffected fellow eyes of NA-AION patients and normal eyes of healthy controls; or between the NA-AION eyes with resolved optic disc edema and normal eyes (all P > 0.05). No significant correlation between choroidal thickness and RNFL thickness, logMAR BCVA and perimetry MD was found in eyes affected by NA-AION (all P > 0.05).Conclusions: Increase in peripapillary choroid thickness in some segments was found in NA-ION eyes with optic disc edema. However, our findings do not support the hypothesis that choroidal thickness is abnormal in Chinese patients with NA-AION compared with normal subjects with similar age and refractive error status. [ABSTRACT FROM AUTHOR]

Objective: This study determined the prevalence and factors associated with peripheral neuropathy (PN) in subjects with diabetes mellitus, impaired glucose regulation (IGR), and normal glucose tolerance (NGT) in a community-based Chinese population. Research Design and Methods: A total of 2035 subjects in Shanghai were classified as having NGT, IGR, or diabetes. All subjects underwent complete foot examination. PN was assessed according to the neuropathy symptom and neuropathy disability scores. Binary logistic regression was performed to analyze the contributions of factors to PN. Results: The prevalence of PN was 8.4%, 2.8%, and 1.5% in diabetes mellitus, IGR, and NGT subjects, respectively (P<0.05 for diabetes vs. NGT, and IGR). The subjects with known diabetes had the highest frequency of PN (13.1%). Among the subjects without diabetes, those with PN were older, had a higher waist circumference and 2-h postprandial plasma glucose levels, and were more likely to be hypertensive. Among the IGR subjects, other than age, the 2-h postprandial plasma glucose level was an independent factor significantly associated with PN. Meanwhile, among the subjects with diabetes, PN was associated with fasting plasma glucose, duration of diabetes, and decreased estimated glomerular filtration rate. Conclusions: The prevalence of PN is slightly higher in individuals with IGR than that in individuals with NGT, but small fibre damage in IGR as the earliest nerve fibre deficit may be underestimated in our study. As an independent risk factor, postprandial plasma glucose level may be an important target for strategies to prevent or improve PN in IGR subjects. [ABSTRACT FROM AUTHOR]

Background: Hereditary neuropathy with liability to pressure palsy (HNPP), mainly associated with the peripheral myelin protein 22 (PMP22) gene, is generally an autosomal-dominant inherited peripheral neuropathy. The present large family including four generations provides an exciting opportunity to gain important insights into HNPP in China. Patients and Methods: A large 43-member family with ten members suspected to be affected by HNPP was studied. Neurologic examinations, electrophysiological and neuropathological studies and molecular genetic testing were used for these kindred. Results: Clinically, the proband had limb hyposthenia and atrophy, and his mother showed declined tendon reflexes in the right lower limb. Electrophysiologically, sensory and motor nerve conduction velocities were generalized reduced. Sural nerve biopsy for the proband showed focal thickesning of the myelin sheaths. Furthermore, real-time quantitative PCR demonstrated that the PMP22 gene has a higher Ct value than reference gene in all suspected patients. Conclusions: These results indicated that the family is indeed a rare and large pedigree of HNPP caused by the deletion of PMP22 gene. Given that the suspected patient in the fourth generation is absent, this family is still worthy of further follow-up study. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background and Aim: Hepatitis B surface antigen (HBsAg) clearance is the closest cure outcome in hepatitis B. The goal of this study was to investigate clinical features in chronic hepatitis B patients achieving seroconversion of HBsAg after treatment with α-interferon (IFN-α) and a nucleos(t)ide analog. Methods: This retrospective study enrolled 38 chronic hepatitis B patients treated with IFN-α plus a nucleos(t)ide analog who achieved HBsAg seroconversion during the period from June 2001 to May 2009. Clinical and laboratory data of the patients were collected before and after treatment every 3 months. All patients with HBsAg seroconversion in this study were followed up for at least 12 months post-treatment. Results: A total of 38 out of 142 patients achieved HBsAg seroconversion after treatment with IFN-α and a nucleos(t)tide analog for a prolonged period of time (medium 31 months). The median time to hepatitis B e antigen seroconversion and to HBsAg seroconversion was 19.5 months (range 3-60 months) and 25.5 months (range 9-63 months), respectively. Thirty-six patients (95%) sustained HBsAg seroconversion during the post-treatment follow up. Three different HBsAg response patterns were observed with classical model accounting for 57.9% (22/38 cases), simultaneous transition mode accounting for 23.7% (9/38 cases), and HBsAg prior transition model accounting for 18.4% (7/38 cases). Conclusions: Extended treatment with IFN-α in combination with a nucleos(t)ide analog in patients with hepatitis-B-e-antigen-positive appears to be a promising approach for achieving a high rate of HBsAg clearance-the closest outcome to cure. [ABSTRACT FROM AUTHOR]

POEMS syndrome is a rare plasma cell dyscrasia characterized by polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. This study reviewed the clinical characteristics and long-term outcome of 99 consecutive Chinese patients with newly diagnosed POEMS syndrome in a single institute. The median age of 99 patients was 45 years, and the ratio of men/women was 1.4. The median time from onset of symptoms to diagnosis was 18 months. The typical five features of peripheral neuropathy, organomegaly, endocrinopathy, M protein, and skin change remained to be essential for patients with POEMS syndrome in China. The unusual features like pulmonary hypertension (36%) and renal impairment (37%) were not uncommon in China. Eighty-three percent patients were alive after follow-up time of 25 months, and 10% patients had survived more than 60 months. Melphalan-based therapy (OR, 0.076; 95% CI, 0.02-0.285) and normal renal function (OR, 0.246; 95% CI, 0.076-0.802) were independent prognostic factors for the survival of patients with POEMS syndrome. In conclusion, POEMS syndrome in Chinese patients was a multi-systemic disease with clinical features similar to non-Chinese ones. Active therapy can effectively improve the prognosis of patients with POEMS syndrome. [ABSTRACT FROM AUTHOR]

Leber's hereditary optic neuropathy (LHON) is a maternally transmitted disease. Clinically, no efficient assay protocols have been available. In this study, we aimed to develop an oligonucleotide biochip specialized for detection of known base substitution mutations in mitochondrial DNA causing LHON and to investigate frequencies of LHON relevant variants in Anhui region of China. Thirty-two pairs of oligonucleotide probes matched with the mutations potentially linked to LHON were covalently immobilized. Cy5-lablled targets were amplified from blood DNA samples by a multiplex PCR method. Two kinds of primary mutations 11778 G > A and 14484 T > C from six confirmed LHON patients were interrogated to validate this biochip format. Further, fourteen Chinese LHON pedigrees and twenty-five unrelated healthy individuals were investigated by the LHON biochip, direct sequencing and pyrosequencing, respectively. The biochip was found to be able efficiently to discriminate homoplasmic and heteroplasmic mtDNA mutations in LHON. Biochip analysis revealed that twelve of eighteen LHON symptomatic cases from the 14 Chinese pedigree harbored the mutations either 11778G > A, 14484T > C or 3460G > A, respectively, accounting for 66.7%. The mutation 11778G > A in these patients was homoplasmic and prevalent (55.5%, 10 of 18 cases). The mutations 3460G > A and 3394T > C were found to co-exist in one LHON case. The mutation 13708G > A appeared in one LHON pedigree. Smaller amount of sampling and reaction volume, easier target preparation, fast and high-throughput were the main advantages of the biochip over direct DNA sequencing and pyrosequencing. Our findings suggested that primary mutations of 11778G > A, 14484T > C or 3460G > A are main variants of mtDNA gene leading to LHON in China. The biochip would easily be implemented in clinical diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Leber hereditary optic neuropathy (LHON) is the most common cause of sudden blindness in young adults and is caused by mtDNA mutations. At least 30 mutations have been identified but only the three common mutations (m.3460G>A, m.11778G>A, and m.14484T>C) have been extensively studied. Most other mutations, including m.3635G>A, are considered as potential candidate LHON mutations due to a lack of enough evidence. The frequency of these potential candidate mutations in populations has not been determined. In this study, we performed a comprehensive survey of m.3635G>A in 1398 unrelated probands suspected to have LHON and detected the m.3635G>A mutation in 8 cases, including 4 probands with a family history of LHON. The mutation in 7 cases was homoplasmic, but the mutation in one patient was heteroplasmic. Patients with the m.3635G>A mutation demonstrated the typical phenotype of LHON. Our results provide strong evidence that similar to m.3460G>A, m.3635G>A is a pathogenic and common LHON mutation in the Chinese population. [ABSTRACT FROM AUTHOR]

PurposeTo analyse the long-term visual acuity (VA) and intraocular pressure (IOP) outcomes in phacomorphic glaucoma.Patients and methodsA retrospective analysis of 100 consecutive, acute phacomorphic glaucoma cases from January 2000 to April 2009 was conducted at The Caritas Medical Centre in Hong Kong. All cases underwent cataract extraction after IOP control with medication and/or laser.ResultsDuring a 3.1±2.6-year follow-up, the mean visual improvement was 1.1±0.9 LogMAR units with improvements in 81.7% of cases. A shorter duration from symptoms to cataract extraction resulted in greater visual improvement (r2=0.1, P=0.001). In all, 80.5% of the cases had IOP21 mm Hg without any glaucoma treatment; 19.5% required 1.6±0.7 glaucoma eye drops; and 3.7% required additional laser iridotomy or trabeculectomy for IOP control at 1.8±2.3 years. The vertical cup-disc ratio (VCDR) of the index eye was 0.6±0.3. Gonioscopy revealed an averaged Shaffer grading of 3.0±1.0 and 99±90 degrees of peripheral anterior synechiae (PAS). The Humphrey automated perimetry mean deviation was 5.2±2.7 and the pattern standard deviation was −15.9±10.ConclusionOver 80% of phacomorphic patients had long-term visual improvements and normalization of IOP after cataract extraction. A shorter attack seemed to offer better VA. Post-operatively, most have open angles with some degree of PAS formation, and glaucomatous optic neuropathy is evident from enlarged VCDRs and visual field defects. At least 2 years of follow-up is useful to detect a 20% glaucoma progression possibly requiring additional glaucoma treatments. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine the prevalence of diabetic peripheral neuropathy (DPN) and risk factors associated with DPN in type 2 diabetic patients. Methods: 435 diabetic patients were evaluated on complete foot examination. Body mass measurements, resting blood pressure, fasting blood measures, urinary albumin-to-creatinine ratio (ACR) and the digitally stored fundus images were investigated. Results: (1) The prevalence of DPN was 61.8% among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown, 59.1% with vibration perception threshold ≥25V and 13.8% with inability to feel the monofilament. (2) DPN was significantly associated with age (β: 0.068, S.E.: 0.013, OR: 1.070, CI: 1.043–1.098, P <0.001) and HbA1c (β: 0.224, S.E.: 0.081, OR: 1.251, CI: 1.067–1.466, P =0.006) by a logistic regression analysis. (3) The percentage of diabetic retinopathy (DR) in the DPN group (26.5%) was significantly higher than that in the non-DPN group (15.2%). (4) The percentage of macroalbuminuria in the DPN group (9.0%) was significantly higher than that in the non-DPN group (1.8%). Conclusions: The prevalence of DPN observed in the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown reached up to 61.8% though the observations in our study might be representative of the diabetic patients of the Shanghai downtown. [Copyright &y& Elsevier]

Abstract: Background: We investigated the relationship between the mode and duration of iliac artery anastomosis and acute femoral neuropathy (AFN). Methods: A retrospective analysis was performed for 83 AFN cases from 6 transplantation centers in China. The incidence and nature of dysfunction of AFN were classified based upon the duration of iliac arterial anastomosis. No prisoners were used, and no organs from prisoners were used to obtain the data. Results: The incidence of AFN was 3.6% (53/1,449) in internal iliac anastomosis (group 1), 3.1% (11/346) in external iliac anastomosis (group 2) (P > .05 vs. group 1), and was 54.2% (19/35) in internal iliac ligation with external iliac anastomosis (group 3 P < .01 vs. groups 1 and 2). In group 1, the duration of the arterial anastomosis was ≤20 minutes in 1 case (1.9%), and >20 minutes in 52 cases (98.1%). In group 2, the duration of arterial anastomosis was ≤20 minutes in 1 case (9.0%) and >20 minutes in 10 cases (91%). In group 3, the duration of the arterial anastomosis was >20 minutes in all cases; 20 cases showed injury to the iliolumbar or deep iliac circumflex artery. Conclusion: The incidence of AFN was associated with the selection of iliac arteries, the duration of the arterial anastomosis, and an injury to the iliolumbar or deep iliac circumflex artery. [Copyright &y& Elsevier]

Abstract: Based on reports published so far, organophosphorus (OP) compounds do remarkable harm to human health. In 1995 there was an outbreak of organophosphorus-ester induced delayed neuropathy (OPIDN) due to tri-ortho-cresyl phosphate (TOCP) poisoning in northern suburbs of Xi’an in China. The 74 affected patients were treated and followed up after definite diagnosis. 13 years later, all the epidemiological data obtained from 61 survivors were evaluated, and 15 patients underwent clinical, laboratory, neuroimaging and electrophysiological examinations. In addition, a review of the literature about the possible mechanism of OPIDN was made. According to our investigation, of 61 survivors, 35 patients almost regained normal function of limbs and work outside; 23 patients walked with bilateral support and could perform housework; and 3 patients could not self-care. The patients undergoing examinations presented spasticity and minor lower leg muscle atrophy without sensory impairment. Laboratory investigations and brain and spinal cord magnetic resonance imaging examinations were normal. Neurophysiological investigations also showed normal electroencephalogram and visual, brainstem auditory and somatosensory evoked potentials. Motor evoked potential (MEP) obtained from the upper limbs had normal central motor conduction time (CMCT). However, the CMCT of MEP response recorded from the bilateral lower limbs was delayed, or showed even no MEP responses. Motor and sensory nerve conduction velocity and electromyography studies were normal except for two severely affected patients. TOCP showed long-term effects on the nervous system and influenced the quality of life. OP compounds should be strictly regulated to prevent similar occurrences. [Copyright &y& Elsevier]

Abstract: To determine the diagnoses in a population of patients with presumed optic neuritis (ON) in China and compare the spectrum of etiologies with those in western countries, we studied a group of 204 patients referred to a teaching hospital with a presumptive diagnosis of ON. We conducted detailed medical and family history, thorough ophthalmologic and neurological examinations, and laboratory tests including neuroimaging. Patients were diagnosed using international diagnostic criteria. One hundred and thirteen patients (55.4%) met ON criteria, among whom 83 patients (73.5%) were diagnosed with idiopathic demyelinating optic neuritis (IDON). Brain MRI white matter lesions were found in 11 of 78 (14.1%) clinically “isolated” IDON patients. Tuberculosis meningitis was found in 2 patients and syphilis in 1 patient. The cause of ON in 26 patients (23.0%) remained uncertain, but it was still likely to be IDON accompanied by secondary axonal degeneration. Leber’s hereditary optic neuropathy (LHON) was found in 38 patients (18.6%), confirmed by mitochondrial DNA point mutation screening. Seventeen patients (8.3%) had ischemic optic neuropathy. A spectrum of other entities mimicked ON. Therefore, idiopathic demyelinating ON was the most common type of optic neuropathy in our group. Despite minor differences regarding the causes and prognosis, the etiology of ON in our population is similar to that reported in Western countries. [Copyright &y& Elsevier]

Objective: To document clinical features of molecular proved Leber hereditary optic neuropathy in China. Background: LHON is well documented in western countries and some other Asian countries. In English literature very few studies addressed LHON in China. Method: Retrospective clinical chart review of molecular proved LHON patients seen in a university hospital during 2001 to 2005. Demographic, clinical features including visual acuity, visual field defects, family history, brain magnetic resonance image (MRI), cerebral spinal fluid examination and mitochondrial DNA mutation points were recorded. Results: Of 51 patients included, 40 cases (78.4%) were male. Patients' age at onset ranged 10 to 54 years with an average of 18.2 years. Only 17 (33.3%) patients reported positive family history. G11778A, T14484C and G3460A mutation accounted for 45 (88.2%), 4 (7.8%) and 2 (3.9%) cases respectively. Visual acuity worse than 0.1 was found in 65.5%, 87.5% and 75% of patients with G11778A, T14484C and G3460A patient respectively at onset, remained in 62.2%, 25% and 25% in these groups. Central scotoma was the commonest visual field defect. Brain MRI abnormality and oligo band of CSF was found in 6 (14.3%) and 5 (11.9%) patients with G11778A mutation while no other mutation patients showed similar abnormalities. Conclusion: clinical features of genetically proved LHON patients in china were documented. LHON patients in China shared similar clinical features with those reported in Western countries and other Asian countries. G11778A mutation accounted for nearly 90% LHON patients. T14484C and G3460A mutation patients showed better visual acuity recovery than 11778 mutation patients did. Some patients with G11778A mutation were associated with "MS-like" changes. [ABSTRACT FROM AUTHOR]

Objective: To document the clinical features of optic neuritis in a population of China and compare with reports of Western countries. Background: Optic neuritis is a common optic neuropathy well studied in Western countries. In English literature very few studies addressed optic neuritis in China. Method: Retrospective medical chart review of all patients admitted in a teaching hospital from 2002 to 2005 with a final diagnosis of idiopathic demyelinating optic neuritis. Results: Ninety-eight patients including 45 men and 53 women were collected, with a mean age of 25.7 years. Sixty-six cases (67.3%) were unilateral optic neuritis and 32 (32.7%) were bilateral. Eye pain was reported in 42 cases (42.9%). Visual acuity in 130 affected eyes varied from 0.8 to no light perception, with 0.1 or worse in 101(77.7%), between 0.1 and 0.4 in 15 (11.5%) and 0.5 or better in 14(10.8%). Fifty-two eyes (40%) showed disc swelling. Central scotoma was the most common (61%) localized visual field defect. Optic nerve enhancement was found in 85 of 121 eyes (70.2%) while 15 cases (15.3%) showed periventricular plaques in brain MRI. Positive oligoclonal band or elevated myelin basic protein was found in 17 (17.3%) cases. Eight (8.2%) cases met the criteria of clinical definite multiple sclerosis and 4 cases had neuromyelitis optica. Visual acuity of 35 eyes (26.9%) improved to 1.0 or better while 37 eyes (28.5%) remained 0.1 or worse at the 3-month follow-up. Conclusion: Clinical features of optic neuritis in a population of China were documented. Less ocular pain, less brain MRI abnormalities, more severe visual loss and poor visual outcome were seen compared to reports of Western countries. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between obesity, evaluated by fat mass index (FMI) with the risk of microvascular diseases in patients with type 2 diabetes mellitus (T2DM) and compare the magnitude of associations of FMI, body mass index (BMI), and waist circumference (WC) with the risk of microvascular diseases. We performed a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes study. The primary microvascular outcomes of the present study included chronic kidney disease (CKD) progression, retinopathy, and neuropathy. Cox proportional-hazards models were performed to evaluate the association of FMI with microvascular diseases. A discordant analysis was performed to compare the magnitude of associations of FMI, BMI, and WC with the risk of microvascular diseases. Our study included 10,251 T2DM participants with a median of 5 years (interquartile range, 4.2-5.7) of follow-up. A total of 6,184 participants developed CKD progression, 896 participants had retinopathy, and 3,213 participants developed neuropathy (Michigan Neuropathy Screening Instrument, >2.0). After the confounding factors were adjusted for, patients in the highest FMI quartile had a higher risk of CKD progression (HR: 1.26, 95%CI: 1.16-1.36) and neuropathy (HR: 1.93, 95% CI: 1.74-2.15), except for retinopathy (HR: 1.17, 95% CI: 0.96-1.43), than those in the lowest quartile. Discordant analyses found that FMI and WC are better in identifying individuals with obesity-related risk of neuropathy, compared with BMI; neither is better in identifying individuals with obesity-related risk of CKD progression and retinopathy. Obesity is associated with CKD progression and neuropathy in T2DM participants. Further randomized trials are needed to test whether obesity control can improve the outcomes of T2DM participants with CKD or neuropathy. FMI and WC are more useful in identifying obesity-related risk of neuropathy compared with BMI in T2DM patients., Clinical Trial Registration: http://www.clinicaltrials.gov, NCT00000620., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gao, Zhang, Long and Xing.)

Pathological variants in the nuclear malonyl-CoA-acyl carrier protein transacylase (MCAT) gene, which encodes a mitochondrial protein involved in fatty-acid biogenesis, have been reported in two siblings from China affected by insidious optic nerve degeneration in childhood, leading to blindness in the first decade of life. After analysing 51 families with negative molecular diagnostic tests, from a cohort of 200 families with hereditary optic neuropathy (HON), we identified two novel MCAT mutations in a female patient who presented with acute, sudden, bilateral, yet asymmetric, central visual loss at the age of 20. This presentation is consistent with a Leber hereditary optic neuropathy (LHON)-like phenotype, whose existence and association with NDUFS2 and DNAJC30 has only recently been described. Our findings reveal a wider phenotypic presentation of MCAT mutations, and a greater genetic heterogeneity of nuclear LHON-like phenotypes. Although MCAT pathological variants are very uncommon, this gene should be investigated in HON patients, irrespective of disease presentation. [ABSTRACT FROM AUTHOR]

SummaryAims Recently an (A–C)n dinucleotide repeat polymorphic marker in the 5′-region of the ALR2 gene encoding aldose reductase was found to be associated with diabetic retinopathy in the Chinese population in Hong Kong, and with nephropathy and neuropathy in the British Caucasian population. The present study assessed the association between the polymorphism and microvascular complications in Japanese patients with Type 2 diabetes mellitus. Methods DNA from 87 Japanese patients with Type 2 diabetes mellitus and 90 control subjects with normal glucose tolerance were typed for the polymorphic marker by polymerase chain reaction and direct sequencing. Results Six alleles, namely Z-12, Z-6, Z-4, Z-2, Z, and Z+2 were identified. There was no significant difference in allele distribution between diabetic patients and controls. The Z-2 allele frequency was significantly higher in subjects with diabetic retinopathy than those without retinopathy (0.35 vs. 0.20, P = 0.039), suggesting that aldose reductase is involved in the development of diabetic retinopathy. In contrast, the microsatellite marker was not associated with diabetic nephropathy, peripheral or autonomic neuropathy. The discrepancy may be partly attributable to the low frequency of Z+2 allele in the Japanese subjects. Conclusions The (A–C)n dinucleotide repeat polymorphism may be a useful genetic marker to screen for patients at high risk of retinopathy. [ABSTRACT FROM AUTHOR]

Purpose of Review: Diabetes can lead to development of devastating microvascular complications, such as nephropathy, retinopathy, and peripheral sensory and autonomic neuropathy. While China and the USA both face the threat of this major public health challenge, the literature is limited in describing similarities and differences in the prevalence, and risk factors for the development, of diabetic microvascular complications between these two countries., Recent Findings: The current review discusses the following: (1) the most recent evidence on prevalence of diabetic microvascular complications in China and the USA (including downtrends of diabetes retinopathy and neuropathy in the USA); (2) differences in patient risk factors of these complications; (3) challenges and current knowledge gaps (such as lacking national epidemiological data of diabetic complications in China); and (4) potential future clinical and research opportunities (including needs in diabetes evaluation and management in remote areas and standardization of methods in evaluating diabetic complications across countries). Diabetic microvascular complications remain to be health threats in both China and the USA. Further investigations are needed for comprehensive understanding and effect prevention and management of these complications.

Background: The emerging avian influenza A (H7N9) virus, a subtype of influenza viruses, was first discovered in March 2013 in China. Infected patients frequently present with pneumonia and acute respiratory disorder syndrome with high rates of intensive care unit admission and death. Neurological complications, such as Guillain-Barré syndrome(GBS), and intensive care unit-acquired weakness, including critical illness polyneuropathy and myopathy, have only rarely been reported previously.Case Presentation: In this study, we report on two Chinese patients with H7N9 severe pneumonia presenting neurological complications. These two patients had non-immune diseases prior to the onset of virus infection. A 56-year-old female patient (case 1) and a 78-year-old female patient (case 2) were admitted because of fever, cough, chest tightness and shortness of breath. These patients were confirmed to have H7N9 infection soon after admission followed by the development of acute respiratory distress syndrome and various severe bacterial and fungal infections. The case 1 patient was found to have muscle weakness in all extremities after withdrawing the mechanical ventilator, and the case 2 patient was found when withdrawing extracorporeal membrane oxygenation, both of these conditions prolonged ventilator-weaning time. Furthermore, the case 1 patient carried the H7N9 virus for a prolonged period, reaching 28 days, and both of them stayed in the hospital for more than two months. A clinical diagnosis of intensive care unit-acquired weakness could be confirmed. However, based on results from electrophysiological testing and needle electromyography of these 2 patients, it is difficult to differentiate critical illness polyneuropathy from GBS, since no lumbar puncture or muscle and nerve biopsy were conducted during hospitalization. Following a long-term comprehensive treatment, the patients' neurological condition improved gradually.Conclusions: Although there is great improvement in saving severe patients' lives from fatal respiratory and blood infections, it is necessary to pay sufficient attention and to use more methods to differentiate GBS from intensive care unit-acquired weakness. This unusual neurological complication could result in additional complications including ventilator associated pneumonia, prolonged hospital stay and then would further increase the death rate, and huge costs. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced peripheral neuropathy (CIPN) has no cure, but acupuncture may provide relief through its known neuromodulation or neuroendocrine adjustment. This review aimed to assess the efficacy of acupuncture in treating CIPN. Method: A literature review following the PRISMA Statement was performed, searching 7 databases from inception through August 2019. All studies were clinical trials of the effect of acupuncture on CIPN. The methodological quality of these trials was assessed using Cochrane criteria; meta-analysis software (RevMan 5.2) was used to analyze the data. Data Sources: The databases searched were the following: MEDLINE (Ovid), Embase, Cochrane CENTRAL, Scopus, World Health Organization International Clinical Trials Registry Platform, CNKI (China National Knowledge Infrastructure), and Wanfang Med Online. Results: We examined 386 cancer patients from 6 randomized control trials, which had high quality, based on the modified Jadad scale. Meta-analysis showed that acupuncture led to significant improvements in pain scores (-1.21, 95% confidence interval [CI] = -1.61 to -0.82, P < .00001) and nervous system symptoms based on Functional Assessment of Cancer Therapy/Neurotoxicity questionnaire scores (-2.02, 95% CI = -2.21 to -1.84, P < .00001). No significant change was noted in nerve conduction velocity (1.58, 95% CI = -2.67 to 5.83, P = .47). Conclusion: Acupuncture can effectively relieve CIPN pain and functional limitation. The limited number of subjects warrants a larger scale study.

Autosomal recessive hereditary spastic paraparesis (ARHSP) with thin corpus callosum is a neurodegenerative disorder characterized by progressive spastic paraparesis, mental subnormality and complicated by peripheral neuropathy. The hallmarks of the neuroimage are thinning of the anterior corpus callosum (TCC) and periventricular white matter changes. Linkage analysis in north American, Japanese, Mediterranean basin ARHSP-TCC families demonstrated the phenotype links to chromosome 15q13-15. Mutations of the KIAA1840 gene which is located at the linked region, were identified to be responsible for the ARHSP-TCC. The gene encodes a predicted protein of 2,443 amino acids of unknown function, which is called spatascsin. Herein, we report 6 patients from 2 families with ARHSP-TCC. All family members are ethnic Taiwanese/Chinese and each family has three affected siblings. Parents in one of the family have consanguineous marriage. Clinically, they suffered from slowly progressive spastic paraparesis with hyperreflexia and pyramidal tract signs. Mental retardation was developed since their 2nd decade of life. Brain MRI demonstrated the thinning of corpus callosum with some white matter changes. Genetic analysis demonstrated that the proband with the consanguineous parents harbored a homozygous deletion, c.4461..4462delGT. A compound heterozygous mutation (c.4461..4462del and c.6091C>T) was identified in the other family. Both the mutations are novel and introduced a truncated protein. This is the first report of spatacsin mutations in Chinese patients with ARHSP-TCC. [ABSTRACT FROM AUTHOR]

The article presents information on prognosis in the acute motor axonal form of Guillain Barré. It has become apparent that recovery from acute motor axonal neuropathy (AMAN) may actually be either rapid or slow. In the early 1990's, AMAN was characterised in northern China as a rapidly ascending tetra paresis with Wallerian-like degeneration of motor fibers at necropsy. Rapid recovery in AMAN in the current study was defined as an improvement of two or more Guillain Barré syndrome disability scale grades in the first four weeks e.g. from bed-bound to independent ambulation, which occurred in 27% of the AMAN group.