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Myasthenia Gravis (MG) is divided into ocular (OMG) and generalized (GMG) subtypes. While clinical diagnosis is well-established, understanding the underlying biochemical mechanisms and metabolic shifts during disease progression remains challenging; untargeted metabolomics offers a novel perspective to explore these systemic alterations. To characterize the serum metabolic landscape of MG patients and identify potential metabolic signatures associated with disease subtypes (OMG and GMG) via untargeted metabolomics. 91 participants (41 GMG, 22 OMG, 28 healthy controls [HC]) were enrolled. Fasting serum samples were analyzed by LC-MS/MS. Multivariate analyses (PCA, PLS-DA/OPLS-DA), differential metabolite screening (VIP > 1.0, p < 0.05), and KEGG pathway enrichment were performed. HC and MG groups showed distinct metabolic profiles. MG had 515 (175 up, 340 down) and 368 (146 up, 222 down) differential metabolites in positive/negative ion modes, respectively. Key perturbed pathways included glycerophospholipid, sphingolipid metabolism, and unsaturated fatty acid biosynthesis. Ten representative metabolites (e.g., ubiquinone, cortisol) differed significantly among groups; clustering analysis revealed distinct metabolite abundance trajectories across HC, OMG, and GMG. MG is associated with notable systemic metabolic dysregulation, particularly in lipid-related pathways. Rather than serving as immediate diagnostic tools, these integrative metabolic signatures provide a crucial biochemical framework for understanding disease pathogenesis and offer valuable clues for future hypothesis-driven research and prospective validation.
This study compared refractive outcomes and visual quality between femtosecond laser-assisted arcuate keratotomy (FSAK) and steep-axis meridian clear corneal incision (SCCI) combined with Implantable Collamer Lens (ICL) implantation for correcting moderate-to-high myopia and low astigmatism. This prospective study included 28 eyes undergoing FSAK + ICL surgery and 31 undergoing SCCI + ICL surgery. The primary outcome was total corneal higher-order aberrations (HOAs) at 3 months postoperatively. HOA components, including spherical aberration, coma, and trefoil, were also analyzed as prespecified secondary visual-quality outcomes. Secondary outcomes included UDVA, CDVA, refraction (spherical equivalent and cylinder), astigmatism vector parameters, and corneal endothelial cell density, measured preoperatively and at 1 and 3 months postoperatively. Data are presented as mean ± standard deviation unless otherwise stated. Postoperative spherical equivalent (SE), UDVA, or CDVA were comparable between groups. At 3 months, the safety index was 1.14 ± 0.12 and 1.04 ± 0.51 (P = 0.344), and the efficacy index was 1.13 ± 0.22 and 1.03 ± 0.23 (P = 0.118) for the FSAK and SCCI groups, respectively. All eyes (100%) in both groups achieved ± 1.00 D of the expected corrected SE. Residual astigmatism was − 0.48 ± 0.26 D in the FSAK group and − 0.41 ± 0.27 D in the SCCI group, (P > 0.05). Total HOAs at 3 months were lower in the FSAK group than in the SCCI group (P = 0.039), with lower spherical and trefoil aberrations in the FSAK group (P < 0.05). Corneal endothelial cell density did not change significantly in the FSAK group (P > 0.05) but decreased significantly in the SCCI group at 3 months (P < 0.01). In this short-term follow-up, FSAK and SCCI combined with ICL implantation demonstrated good safety, efficacy, and predictability for correcting moderate-to-high myopia with low astigmatism. FSAK showed better early stability, fewer higher-order aberrations (including spherical and trefoil components), and superior corneal endothelium protection compared to SCCI.
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Myopia in children has become increasingly prevalent worldwide, resulting in greater medical expenditures and a higher prevalence of retinal complications associated with high myopia, thereby significantly impairing quality of life. The use of orthokeratology and low-concentration atropine eye drops for myopia management has seen a notable rise in recent years. This study aims to evaluate the efficacy and safety of orthokeratology combined with low-concentration atropine for the treatment of myopia in children through a meta-analysis. A comprehensive search was conducted across eight electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, SinoMed, and the VIP Database. The search encompassed all relevant studies published up to April 15, 2025, including randomized controlled trials that assessed the efficacy of orthokeratology lenses in combination with low-concentration atropine for the treatment of myopia in children. Statistical analyses were conducted using Stata 16.0 software, and study quality was evaluated using the Cochrane Risk of Bias Assessment Tool. Eleven randomized controlled trials (RCTs) were included. Compared with the orthokeratology (OK) group, the atropine-orthokeratology (AOK) group demonstrated a significant reduction in axial length [WMD = -0.16, 95% CI (-0.22, -0.10), p < 0.001], along with a significant increase in choroidal thickness [WMD = 17.29, 95% CI (0.95, 33.63), p < 0.05]. Additionally, baseline diopter influenced changes in axial length, while follow-up duration was associated with changes in both axial length and choroidal thickness. Moreover, the AOK group exhibited a slight increase in spherical equivalent refraction, diopter, and pupil diameter [WMD = 0.26, 95% CI (0.11,0.42), p < 0.005], [WMD = 0.61, 95% CI (0.01,1.20), p < 0.05], [WMD = 0.05, 95% CI (0.35,0.66), p < 0.001]. Corneal thickness showed a tendency to decrease [WMD =-9.79,95% CI (-15.52, -4.06), p < 0.005]. There were no significant differences between the OK and AOK groups for uncorrected visual acuity, intraocular pressure, keratometry, lipid layer thickness, and tear film break-up time. For children with myopia, orthokeratology combined with low-concentration atropine is more effective than orthokeratology alone in slowing axial elongation and enhancing choroidal thickness. Regarding safety, the findings were consistent across both studies, with no serious adverse events reported. PROSPERO (CRD420251103504). The online version contains supplementary material available at 10.1186/s12886-026-04816-7.
Intranasal dexmedetomidine is widely used in pediatric procedural sedation; however, its dose-related effect on delayed awakening remains insufficiently characterized. This single-center retrospective cohort study included pediatric patients who received oral midazolam combined with intranasal dexmedetomidine for procedural sedation at the Sedation Center of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital between March 2022 and March 2024. The exposure was the intranasal dexmedetomidine dose (μg/kg). The primary outcome was delayed awakening, defined as a time of ≥ 90 min from the last sedative administration (including rescue/secondary sedatives when applicable) to full awakening documented by the anesthesiologist on duty using routinely recorded standardized criteria (Modified Aldrete score ≥ 9). Firth penalized multivariable logistic regression models were applied to evaluate the association between dexmedetomidine dose and delayed awakening, adjusting for age group, sex, weight, fasting duration, procedure type, and midazolam dose. Dose-response relationships and subgroup analyses restricted to baseline/procedural characteristics were also conducted. A total of 2,116 children were included, with an overall delayed awakening incidence of 2.6%. When stratified by tertiles of dexmedetomidine dose, the incidence of delayed awakening increased from 1.1% in the low-dose group to 2.9% in the medium-dose group and 4.1% in the high-dose group (P = 0.004). In multivariable analyses, each 1 μg/kg increase in intranasal dexmedetomidine dose was associated with a significantly higher risk of delayed awakening (adjusted odds ratio [OR] 3.665, 95% confidence interval [CI] 2.091-6.636; P < 0.001). Dose-response analysis demonstrated a positive linear association (no evidence of nonlinearity, P = 0.451) between dexmedetomidine dose and delayed awakening. This corresponds to an aOR of 1.91 per 0.5 μg/kg increase (and 1.99 per IQR increase); adjusted predicted probabilities were 0.96% at 2 μg/kg, 3.37% at 3 μg/kg, and 10.70% at 4 μg/kg. In pediatric procedural sedation, higher intranasal dexmedetomidine dose is associated with delayed awakening and demonstrates a positive dose-response relationship. Younger children appear to be more susceptible to this adverse outcome. Clinically, dexmedetomidine dosing should be carefully individualized-particularly in younger patients-to balance effective sedation with recovery efficiency.
To evaluate retinal microcirculation in biologic-treated ankylosing spondylitis (AS) using optical coherence tomography angiography (OCTA) and its association with disease activity. Fifty-seven AS patients (31 active, 26 inactive) under biologic therapy and 57 age- and sex-matched healthy controls were included. Right eyes underwent 10°×10° macular OCTA imaging (Heidelberg Spectralis). Vessel area density (VAD), foveal avascular zone (FAZ) metrics, and vessel density within a 300-µm-wide ring surrounding the FAZ (FD-300) were quantified for the superficial and deep vascular complexes (SVC and DVC). Structural OCT provided foveal and parafoveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL), and subfoveal choroidal thickness. Biologic therapy details and disease activity indices (Ankylosing Spondylitis Disease Activity Score-C-reactive protein [ASDAS-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI]) were obtained from records. OCTA and structural parameters were compared among active AS, inactive AS, and control groups. Parafoveal SVC VAD was reduced only in the active AS group (p = 0.007), whereas DVC total/parafoveal VAD and FD-300 values were lower in both AS groups compared with controls (all p < 0.01). Retinal thickness, RNFL, and choroidal thickness were similar across groups (all p > 0.05). For distinguishing AS patients from controls, DVC metrics showed the highest performance (AUC ≈ 0.70-0.73; 0.63 for SVC), while the combined model including age, sex, and OCTA parameters achieved an AUC of 0.77. For differentiating disease activity, DVC-FAZ alone showed limited performance (AUC = 0.67). A parsimonious multivariable model including age, sex, BASFI, and DVC FAZ area yielded an AUC of 0.88 (95% CI: 0.80-0.97). In AS patients receiving biologic therapy, retinal microcirculatory alterations were detected-particularly within the DVC-while retinal and choroidal structural measurements appeared to remain largely preserved. Further studies are warranted to confirm these findings.
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This study aimed to evaluate the safety of anterior chamber air tamponade post-phacoemulsification on the cornea compared to balanced salt solution or Ringer's lactate filling, and summarize its potential influence on the aspects like the risk of postoperative endophthalmitis and Descemet's membrane detachment (DMD). This meta-analysis was conducted using Review Manager 5.4 and included studies that evaluated post-phacoemulsification air tamponade compared with no air tamponade before October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool. This review was registered in PROSPERO (CRD420251177446) and followed PRISMA guidelines. Among seven included studies (1340 eyes), there were no significant between-group differences (mean difference [95% confidence interval]) at 1 month, with or without air tamponade, in the endothelial cell density (-103.59 [-256.86 to 49.68] cells/mm2; p = 0.19), central corneal thickness (-4.86 [-19.81 to 10.08] µm; p = 0.52), or coefficient of variation of the corneal endothelial cell size (-0.01 [-0.04 to 0.01]; p = 0.22). A minimal yet significant difference in hexagonality favored the no-air-tamponade group (-0.01 [-0.03 to -0.00]; p = 0.03). Intracameral air injection demonstrated comparable short-term corneal endothelial safety, with the potential added benefits of reduced inflammation and infection risk and of protection of the Descemet's membrane. PROSPERO, CRD420251177446. Registered 2025. Not applicable.
To investigate the correlation between the expression levels of microRNA-199a-3p (miR-199a-3p) and Fibronectin 1 (FN1) in serum and aqueous humor and the severity of Type 2 Diabetic Retinopathy (DR) in a Chinese population. The dataset GSE102485 (containing 3 normal controls and 22 DR samples) was downloaded from the Gene Expression Omnibus (GEO) database as a discovery set, and the dataset GSE60436 (containing 3 normal controls and 6 DR samples) was used as a validation set. The limma package was employed for differential expression analysis to identify differentially expressed genes (DEGs). The potential downstream target genes of miR-199a-3p were predicted using seven databases including ENCORI. A Venn diagram was used to identify the intersection between the DEGs and the predicted miR-199a-3p target genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed on the intersecting genes. A protein-protein interaction (PPI) network was constructed, and the CIBERSORT algorithm was applied for in-depth analysis of FN1 expression characteristics. Furthermore, the expression pattern of FN1 was validated in independent datasets concerning its association with miR-199a-3p and DR. Finally, real-time quantitative polymerase chain reaction (qPCR) was used to verify the relationship between the expression levels of miR-199a-3p and FN1 in clinical serum and aqueous humor samples and DR severity. Bioinformatics analysis identified a total of 458 DEGs, comprising 214 upregulated and 244 downregulated genes. A heatmap was generated for the top 50 most significantly altered genes. Venn diagram analysis revealed three overlapping genes (PHYHIPL, FN1, CALD1) between the DEGs from GSE102485 and the predicted miR-199a-3p target genes. Further analysis using the miRDB website indicated that FN1 had the strongest correlation with miR-199a-3p, suggesting both as potential important biomarkers for DR. Additionally, the relative expression level of serum miR-199a-3p was significantly negatively correlated with fasting plasma glucose (FPG) (r = -0.425, P = 0.012), glycated hemoglobin (HbA1c) (r = -0.513, P = 0.003), and duration of diabetes (r = -0.587, P < 0.001), indicating its decrease with elevated blood glucose and prolonged disease course. Conversely, serum FN1 levels showed significant positive correlations with FPG (r = 0.458, P = 0.008), HbA1c (r = 0.621, P < 0.001), and diabetes duration (r = 0.694, P < 0.001), suggesting that poor glycemic control and disease progression may promote FN1 overexpression. Both biomarkers demonstrated good diagnostic value for DR, with miR-199a-3p exhibiting the highest diagnostic efficacy. The expression levels of miR-199a-3p and FN1 in serum and aqueous humor are significantly correlated with the severity of Type 2 Diabetic Retinopathy, highlighting their potential as non-invasive diagnostic and prognostic biomarkers for DR.
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Undetected glaucoma among hospital workers poses a significant risk of preventable vision loss within the healthcare workforce, potentially impacting the delivery of care. The purpose of this study was to assess the medical and non-medical hospital workers’ knowledge, attitude and self-care practice regarding glaucoma. In a hospital-based cross-sectional study, a stratified random sample of 401 hospital workers, including 206 (51.4%) medical and 195 (48.6%) non-medical personnel, were administered a structured knowledge, attitude, and practice (KAP) questionnaire on glaucoma. Differences in glaucoma knowledge among staff cadres were compared using the Chi-square test. The predictors of KAP were analysed using multivariate logistic regression. Glaucoma was defined by respondents as blindness (26.9%), raised intraocular pressure (24.7%), and optic nerve damage (9.5%). Common risk factors identified were hypertension (87.9%), diabetes (86%) and positive family history of glaucoma (80.8%). Only 8.0% believed that early diagnosis and treatment could prevent blindness. Strikingly, 70.1% of hospital workers had never undergone an eye examination. Workers (68.6%) would rather use medications than accept surgery, adding adjunctive modalities like prayers and traditional medicines were reported by 58.9% of the workers. Medical personnel demonstrated greater knowledge of glaucoma (p < .001) and were more likely to accept surgical intervention (p = .003). Good knowledge of glaucoma, positive attitude and good self-care practice were reported by 2.5%, 10.7% and 14.4% of the workers. Secondary level educational was predictive of positive attitude (OR 3.35, 95% CI 1.60-7.03, P= .001), non-medical cadre was predictive of poor glaucoma practice (OR 0.22. 95% CI 0.10-0.48, p<.001) while a visit to the ophthalmologist was predictive of good glaucoma practice (OR 19.92, 95% CI 8.78-42.94, p<.001). All hospital personnel should be re-educated about the potential blinding effect of glaucoma. The need for timely, regular, comprehensive glaucoma evaluation and the adoption of early, appropriate management is advocated. The online version contains supplementary material available at 10.1186/s12886-026-04832-7.
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The likelihood of experiencing psychological symptoms, such as depression and anxiety, is reported to be higher among people with visual impairment. This study investigated the everyday challenges that contribute to these symptoms in young and middle-aged adults with visual impairment. An online Concept Mapping method was used, blending qualitative and quantitative elements. Participants (individuals with visual impairment and professionals) provided statements to the question: What are challenges in daily life for people with visual impairment that may cause symptoms of depression and anxiety? Participants then sorted these statements by theme, and rated them on importance on a scale from 1 to 5. A concept map was generated based on multidimensional scaling using Concept Systems Inc. Software. A total of 55 individuals with visual impairment and 27 professionals participated. They sorted 50 distinct statements into 8 different clusters. Ranked from highest to lowest in perceived importance, the clusters were: processing and acceptance (4.07), future perspective and participation (3.89), practical actions (3.77), social environment (3.75), physical consequences (3.74), recreation (3.68), emotions and feelings (3.48), and medical aspects (3.36). Across all clusters, the statements that were rated as most important were: accepting the disability (4.45), fatigue and energy balance (4.40), and equal relationships with family, friends, and colleagues (4.26). This study highlights crucial challenges faced by young and middle-aged individuals with visual impairment, emphasizing the significance of acceptance, emotional well-being, and adaptation. It is important to address these challenges through supportive counseling and rehabilitation programs to enhance their mental health.
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This research investigates miR-28-5p in type 2 diabetes mellitus (T2DM), aiming to clarify its mechanistic role and clinical significance in the pathogenesis of diabetic retinopathy (DR). The research enrolled 112 T2DM patients (including 58 non-DR (NDR) and 54 DR) and 72 healthy controls. The expression of miR-28-5p and RAP1B were assessed by quantitative reverse transcription polymerase chain reaction. Receiver operating characteristic curve was employed to determine the diagnostic value of miR-28-5p in DR. Cell proliferation and migration were determined using cell counting kit-8 assay and Transwell assay. Concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were quantified via enzyme-linked immunosorbent assay. The direct targeting of RAP1B by miR-28-5p was validated using a luciferase reporter assay. The correlation between their expression was evaluated using Pearson correlation analysis. In serum and cell samples, miR-28-5p was upregulated, while RAP1B was downregulated. In patients with DR, miR-28-5p expression was negatively correlated with that of RAP1B. miR-28-5p had good diagnostic value for distinguishing DR from NDR, with an area under the curve of 0.891, achieving a sensitivity of 77.80% and a specificity of 93.10% at a cut-off value of 2.165. In high-glucose (HG)-treated cells, inhibition of miR-28-5p enhanced cell proliferation and migration, while reducing IL-6 and TNF-α levels. RAP1B was a target gene of miR-28-5p. Suppressing miR-28-5p upregulated RAP1B in HG-treated cells. miR-28-5p contributes to DR pathology by directly targeting and downregulating RAP1B. It may serve as a potential diagnostic biomarker and promising therapeutic target for DR. Not applicable.