Escape from X-chromosome inactivation and sex differences in Alzheimer's disease

Sex differences exist in the onset and progression of Alzheimer's disease. Globally, women have a higher prevalence, while men with Alzheimer's disease experience earlier mortality and more pronounced cognitive decline than women. The cause of sex differences in Alzheimer's disease remains unclear. Accumulating evidence suggests the potential role of X-linked genetic factors in the sex difference of Alzheimer's disease (AD). During embryogenesis, a remarkable process known as X-chromosome inactivation (XCI) occurs in females, leading to one of the X chromosomes undergoing transcriptional inactivation, which balances the effects of two X chromosomes in females. Nevertheless, certain genes exceptionally escape from XCI, which provides a basis for dual expression dosage of specific genes in females. Based on recent research findings, we explore key escape genes and their potential therapeutic use associated with Alzheimer's disease. Also, we discuss their possible role in driving the sex differences in Alzheimer's disease. This will provide new perspectives for precision medicine and gender-specific treatment of AD.

Meterscale Strong Coupling between Magnons and Photons

We experimentally realize a meterscale strong coupling effect between magnons and photons at room temperature, with a coherent coupling of ∼20  m and a dissipative coupling of ∼7.6  m. To this end, we integrate a saturable gain into a microwave cavity and then couple this active cavity to a magnon mode via a long coaxial cable. The gain compensates for the cavity dissipation, but preserves the cavity radiation that mediates the indirect photon-magnon coupling. It thus enables the long-range strong photon-magnon coupling. With full access to traveling waves, we demonstrate a remote control of photon-magnon coupling by modulating the phase and amplitude of traveling waves, rather than reconfiguring subsystems themselves. Our method for realizing long-range strong coupling in cavity magnonics provides a general idea for other physical systems. Our experimental achievements may promote the construction of information networks based on cavity magnonics.

[Characteristics of Guyton's exaggerated forced duction test (FDT) and torsional FDT in congenital superior oblique palsy]

Objective: To investigate the characteristics of Guyton's exaggerated forced duction test (FDT) and torsional FDT in patients with congenital superior oblique palsy (CSOP) and their correlation with clinical features. Methods: This cross-sectional study included single-eye CSOP patients and intermittent exotropia (IXT) patients scheduled for strabismus correction surgery at Tianjin Eye Hospital from September 2021 to March 2022. Prior to surgery, measurements of fovea-disc angle (FDA) and maximum cross-sectional area of the superior oblique muscle (max-CSA) were obtained in both eyes of the patients. The Guyton's exaggerated FDT and torsional FDT were performed intraoperatively to assess the degree of superior oblique muscle relaxation. The characteristics of the two FDT tests and their correlation with vertical strabismus angle, FDA, and max-CSA were analyzed. Statistical analyses were conducted using t-test, ANOVA, Tukey's test, Mann-Whitney U test, and chi-square test. Results: A total of 42 patients (84 eyes) were included in the study, including 19 IXT patients (38 eyes) and 23 CSOP patients (46 eyes, 23 eyes with palsy and 23 eyes without palsy). There were no statistically significant differences in gender composition or age between the IXT and CSOP patients (all P>0.05). The degrees of superior oblique muscle relaxation measured by the Guyton's exaggerated FDT were (-2.52±1.20), (-0.35±0.71), and (-0.03±0.16) for the palsy eye, non-palsy eye, and IXT eyes, respectively, showing significant differences (F=88.10, P<0.001). The torsional FDT measurements yielded external rotation angles of 48.70°±9.67°, 37.39°±5.40°, and 38.95°±2.88° for the palsy eye, non-palsy eye, and IXT eyes, respectively, showing significant differences (F=16.67, P<0.001). There was no statistically significant difference in internal rotation angles (F=2.36, P=0.100). The FDA values were-12.11°±7.42° for IXT patients and-19.02°±4.95° for CSOP patients, while the max-CSA values for the palsy eye and non-palsy eye of CSOP patients were (7.59±4.69) mm² and (11.63±3.64) mm², respectively, all showing significant differences (all P<0.001). The degree of superior oblique muscle tendon relaxation assessed by the Guyton's exaggerated FDT was negatively correlated with the external rotation angle measured by the torsional FDT (r=-0.64, P=0.001). They were positively correlated with max-CSA (r=0.45, P=0.030) and negatively correlated with max-CSA (r=-0.52, P=0.011). However, there was no correlation with vertical and rotational strabismus angle (r=-0.12, P=0.579; r=0.33, P=0.126) and FDA (r=-0.02, P=0.921; r=-0.23, P=0.309). Conclusions: Guyton's exaggerated FDT and torsional FDT can both assess the degree of superior oblique muscle relaxation in patients with CSOP. Furthermore, these two tests are correlated with changes in superior oblique muscle morphology. However, FDT cannot reflect the degree of vertical and rotational strabismus in patients.

[Application of indocyanine green iris angiography in the evaluation of anterior segment blood supply in different strabismus patients]

Objective: To evaluate the perfusion features of the anterior segment in patients with different types of strabismus. Methods: A cross-sectional study. Sixteen strabismus patients (16 eyes) who received the examination of iris indocyanine green angiography (ICGA) in Tianjin Eye Hospital from November 2016 to December 2021 were enrolled and divided into two groups according to whether they had a history of extraocular muscle injury/rectus muscle surgery. All patients underwent routine ophthalmic examinations. Angiographic images were obtained by the anterior segment camera, and indicators such as arm to iris circulation time, whole iris filling time, regression onset time, and complete regression time were recorded. The independent sample t test or Mann-Whitney U test was used to compare iris perfusion aspects of the two groups, and the Pearson/Spearman correlation tests was used to analyze the correlation of arm to iris circulation time and whole iris filling time with age and course of strabismus. Results: Among the 16 patients, there were 10 males and 6 females. The mean age was (49.2±13.2) years, and the course of strabismus ranged from 2 to 31 months. There were 7 patients in the group of without extraocualr muscle injury and 9 patients in the extraocular muscle injury/surgery group. There was no significant difference in age and course of strabismus between the two groups (both P>0.05). The arm to iris circulation time [M (Q₁, Q₃)] of the group without extraocular muscle injury and the group with extraocular muscle injury/surgery were 18 (18, 21) and 22 (20, 24) s, respectively. The average whole iris filling time was (13.86±1.95) and (12.22±3.60) s, respectively. There was no statistical significance between the two groups (both P>0.05). Correlation analysis showed that arm to iris circulation time was not correlated with age and course of strabismus (r=-0.033, -0.079; both P>0.05). And the whole iris filling time was not correlated with age and course of disease (r=0.057, -0.119; both P>0.05). The matrix scatter plots showed that in the group of extraocular muscle injury/surgery, there were three patients who were older than the average (49.2 years) and above the median of arm to iris circulation time (20 s) (two cases with the vertical muscle involved), meanwhile, there were three patients (all with the vertical muscle involved) whose course of strabismus was longer than 6 months and above the median of arm to iris circulation time, which were more than those in the group of without extraocular muscle injury (1 case, respectively). Conclusions: ICGA in patients with strabismus show that a history of injury to the extraocular muscle or surgical treatment beyond 2 months had no effect on iris perfusion. Age and course have no correlation with iris reperfusion. The vertical muscle involvement has more effects on the blood supply to the anterior segment.

[Graded vertical rectus tenotomy for small angle vertical deviation]

Objective: To observe the effectiveness of the graded vertical rectus tenotomy procedure for small-angle vertical deviation. Methods: Retrospective case series study. Twelve patients, including 8 males and 4 females, with an average age of (48±8) years were treated in Tianjin Eye Hospital from January 2017 to December 2019 for diplopia in primary gaze by strabismus surgery. The disease duration was (15±7) months. MRI/CT scan of the orbits and brain was performed to exclude the orbital and craniocerebral diseases. All patients underwent ocular movement examination, with the prism and alternate cover test to detect the deviation angle in primary gaze and the double Maddox test. Based on the results, the posterior segment of the nasal/temporal superior/inferior rectus muscle was operated. The changes of vertical and cyclotorsion deviation angle and the relationship between the vertical rectus graded tenotomy and corrected vertical deviation angle were observed at 1 day after surgery and the last follow-up. The vertical deviation angle was represented by M (Q₁, Q₃). Friedman test (Bonferroni correction) and linear fitting analysis were used for statistical analysis. Results: The follow-up time of all patients was (7±3) months. The vertical deviation angle in primary gaze before surgery [7.00 (5.25, 7.75) PD] was significantly different from that at 1 day after surgery [1.00 (1.00, 2.00) PD] and the last follow-up [1.50 (1.00, 2.00) PD] (P<0.001, P=0.003). There was no significant difference in postoperative cyclotorsion in all patients. Linear fitting results showed that 50% to 90% vertical rectus tenotomy corrected 5 to 8 PD vertical deviation (R²=0.72; P<0.001). Conclusion: The graded vertical rectus tenotomy procedure can effectively improve the small-angle vertical deviation in primary gaze.

[Clinical observation of anterior tucking of the superior oblique tendon for correction of excyclotropia in adults]

Objective: To investigate the clinical effect of anterior 1/3 superior oblique tendon tucking in acquired symptomatic excyclotropia adults. Methods: Retrospective case series. Seven patients (7 eyes) with acquired symptomatic excyclotropia who underwent an anterior 1/3 superior oblique tendon tuck procedure in Tianjin Eye Hospital from January 2019 to December 2019 were included. There were 5 male patients and 2 female patients, with an average age of (49±12) years old. All the patients had a history of a closed head injury. There was torsional diplopia in primary position, and eye movement examination showed paralysis of the superior oblique muscle in the affected eye, without obvious hyperactivity of the inferior oblique muscle. The anterior 1/3 tendon of the superior oblique muscle was tucked during surgery according to the relaxation of the superior oblique tendon in the forced duction test. The paired-sample nonparametric rank sum test was used to analyze the preoperative and postoperative (at 1 day after surgery and the last follow-up) excyclotropia angle. Results: The mean tuck amount was (7.7±1.8) mm (range, 6.0 to 10.0 mm). During operation, patients complained that excyclotropia improved markedly. The excyclotropia angle with the double Maddox rod test improved significantly from preoperative 10° (8°, 15°) to 2° (0°, 3°) at 1 day (Z=-2.379; P<0.05) and 2° (2°, 5°) at the last follow-up (Z=-2.375; P<0.05). The follow-up period was (112+38) days. All patients had no complaints of excyclotropia at the last follow-up. Conclusions: The anterior 1/3 superior oblique tendon tucking can effectively improve clinical symptoms in the primary position in adults with acquired excyclotropia and diplopia. The short-term postoperative results seem to be stable, without significant regression. (Chin J Ophthalmol, 2021, 57: 685-688).

[Label-free quantitative peptidomics-based analysis on glycopeptides in deerhorn gelatin and deer-hide gelatin]

Nano-LC-MS/MS was used to analyze trypsin digested deer-horn gelatin( DCG) and deer-hide gelatin( DHG) samples.The glycopeptides in DCG and DHG were quantified by Label-free quantitative( LFQ) peptidomics,on the basis of which the glycopeptides with significant difference in DCG and DHG were determined. As a result,5 736 peptides were identified from DCG samples,including 213 galactosyl-hydroxylysine containing peptides( Gal-Hyl-peptides) and 102 glucosyl-galactosyl-hydroxylysine containing peptides( Glc-Gal-Hyl-peptides),while 6 836 peptides were identified from DHG samples,among which there were 250 Gal-Hyl-peptides and 98 Glc-Gal-Hyl-peptides. With over 3-fold peak area difference and highly significant intergroup difference( P &lt; 0. 01) as the screening criteria,444 differential peptides were determined in DCG and DHG,including 16 Gal-Hyl-peptides and 5 Glc-Gal-Hyl-peptides. Then XIC peak shapes,standard deviation of peak area,and fold change were applied for further screening and 5 glycopeptides with significant differences in DCG and DHG were confirmed,which could serve as potential biomarkers for distinguishing DCG and DHG. The present study provided ideas and strategies for the in-depth investigation on the discrimination of DCG and DHG and is of good theoretical significance and application value for the further research on chemical constituents and quality control of gelatin derived Chinese medicinals.

[Clinical analysis and surgical treatment of atypical acute acquired concomitant esotropia]

Objective: To investigate the clinical characteristics, possible etiology and surgical efficacy of acute acquired concomitant esotropia (AACE) with atypical etiology. Methods: Case-control study. Twelve patients, including 7 males and 5 females, who complained of diplopia and were diagnosed with AACE in Tianjin Eye Hospital from January to December 2019 and underwent surgical treatment were included. The duration of the disease was (8.83±3.71) months. All patients underwent routine ocular examination except amblyopia and ocular organic lesions. MRI examination of the orbits and the brain was performed in all the patients in order to screen orbital and craniocerebral diseases, and patients denied that the existence of common causes of AACE (such as occlusion of one eye, mental or psychological factors, medium to high myopia, etc. during medical examination). The characteristics of the disease, the difference of deviation angle at 33 cm and 5 m, and the changes of deviation angle and stereopsis before and after surgery were analyzed. The forced duction test was performed before operation, and the distance between the sclera margin and the midpoint of the medial rectus muscle attachment was measured and compared with the patients with intermittent exotropia (10 cases) and comitant esotropia (10 cases). Paired sample t-test and one-way analysis of variance were used for statistical analysis. Results: The mean spherical equivalent was (1.70±0.88) D in all AACE patients, and the deviation angle was (22.42±5.82) prism diopter (PD) at 33 cm and (20.00±4.86) PD at 5 m in primary gaze, which were not statistically significant (P=0.371). The force duction test showed no obvious tension or contracture of the medial rectus and no paralysis. In patients with AACE, the horizontal distance from the midpoint of the medial rectus to the limbus was (5.20±0.27) mm, versus (5.30±0.25) mm in intermittent exotropia patients and (5.30±0.31) mm in concomitant esotropia patients. All the differences were not statistically significant (P=0.618). All the patients with AACE had residual esotropia (mean, 3.42 to 6.33 PD) at 6 weeks, 3 months, and 6 months postoperatively, and their stereopsis improved more than before, with no stereopsis in 2 patients before surgery and stereopsis in all 12 patients after surgery. Conclusions: AACE patients with atypical etiology do not have high myopia and hyperopia. There is no significant difference between the distance and near angles. The occurrence of esotropia is related to decompensation of esophoria, which may result in clinical symptoms of diplopia. Conventional surgery can reduce esotropia and restore stereoscopic vision, but there is still a small amount of esophoria after surgery. There is no abnormality in the attachment point of the medial rectus muscle. (Chin J Ophthalmol, 2021, 57: 348-352).

[MRI study of rectus extraocular muscles in concomitant exotropia with small angle vertical deviation]

Objective: To observe the changes of four pulley locations of extraocular rectus muscles and rectus muscle volumes, as well as superior and inferior part ratio of horizontal rectus muscles, in concomitant exotropia with small-angle vertical deviation in primary gaze. Methods: Cross-sectional study. Data was collected from January 2018 to December 2019 in Tianjin Eye Hospital. The pulley position changes and volumes of four extraocular rectus muscles in the coronal position of patients who had concomitant exotropia without vertical deviation (group A) or with small-angle vertical deviation in primary gaze (<5 prism diopter; group B) and normal controls (group C) were observed using MRI, and the changes of the volume ratio of the superior and inferior parts of the horizontal rectus muscle were calculated. One way analysis of variance and Kruskal-Wallis test were used for statistical analysis. Results: There were 19 patients (38 eyes; 10 males, 9 females) aged (30±7) years in group A, ten patients (20 eyes; 4 males, 6 females) aged (27±6) years in group B, and 20 healthy volunteers (40 eyes) in group C. Age and gender distribution were matched among the three groups (all P>0.05). Among the three groups, the pulley locations of the four extraocular rectus muscles were not significantly different (all P>0.05). The medial rectus muscle volume in groups A [(358.6±44.9) mm³; t=6.405, P<0.01] and B [(334.7±35.6) mm³; t=6.025, P<0.01] was significantly smaller than group C [(437.5±49.3) mm³]. There was no statistically significant difference in the superior and inferior muscle volume ratio of the lateral rectus in three groups (all P>0.05), while the ratio in group B was more dispersive. Conclusions: The pulley location changes of four extraocular rectus muscles of patients with concomitant exotropia and small-angle vertical deviation in primary gaze are not significant, but the medial rectus volume in patients who had concomitant exotropia with vertical deviation or not is significantly smaller. The dispersive superior and inferior muscle volume ratio of the horizontal rectus muscles may be related to the small angle of vertical deviation in clinical examinations. (Chin J Ophthalmol, 2021, 57: 223-227).

[Analysis of hydroxylation and O-glycosylation on lysine sites in deer-hide gelatin]

Nano-LC MS/MS was used to analyze trypsin digested deer-hide gelatin(DHG) samples, hydroxylation and O-glycosylation on lysine sites of DHG were comprehensive identified by using PEAKS Studio software. The sites, sorts and amounts of hydroxylation and O-glycosylation on Type Ⅰ collagen α1 chain(COL1 A1) and α2 chain(COL1 A2) of DHG were revealed. As a result, 5 284 peptides were identified from DHG samples, which were mainly from COL1 A1 and COL1 A2. Among these peptides, there were 449 peptides with hydroxylysine, 442 with galactosyl-hydroxylysine, 449 with glucosyl-galactosyl-hydroxylysine. The major modified sites of hydroxylation and O-glycosylation in DHG were shown as follow: α1-9 N and α2-5 N in N-telopeptides, α1-87, α1-174, α1-930, α2-87, α2-174, α2-933 in triple helix domain, and α1-16 C in C-telopeptides. These hydroxylation and O-glycosylation were correlated with the formation and stability of collagen molecules and collagen fibrils. It is feasible for the collagens and peptides dissolving from deer skin collagen fibrils under high temperature and pressure decocting, high temperature and pressure also might destroy inter-molecular covalent cross-linking and help those glycol-peptides formations. The present study provided ideas and strategies for the in-depth investigation on DHG chemical constituents, and showed good theoretical significance and application value.

[Advances in research on Crouzon syndrome and related ophthalmic complications]

Crouzon syndrome is an autosomal dominant disorder characterized by acrocephaly, exophthalmos, hypertelorism, strabismus, parrot-beaked nose, and hypoplastic maxilla. It is usually caused by a pathogenic mutation in the fibroblast growth factor receptor 2 gene and premature fusion of the sutures of the cranium and the base of the skull. This article documents the ophthalmic complications in patients with Crouzon syndrome before and after the influence of craniofacial surgery with particular emphasis on the different mechanisms and treatments involved. It is important to perform timely decompressive surgery before the presence of optic atrophy and corneal defects, and make early detection and adequate management of amblyopia, ptosis and strabismus. (Chin J Ophthalmol, 2020, 56: 544-548).

[The development history of CAPOS and the diagnosis and treatment of pediatric eye diseases in China since 1949]

On the occasion of the 70(th) anniversary of the founding of Chinese Journal of Ophthalmology, we review the establishment and development of Chinese Association for Pediatric Ophthalmology and Strabismus (CAPOS) and the major advances in the diagnosis and treatment of pediatric eye diseases in China since 1949, so as to remember our predecessors and inspire young generations, and to provide important reference for the future clinical and scientific research. (Chin J Ophthalmol, 2020, 56:161-165).

[Knapp procedure and modified Knapp procedure with Foster suture for the treatment of double elevator palsy]

Objective: To investigate the efficacy of Knapp procedure and modified Knapp procedure with Foster suture in the treatment of double elevator palsy(DEP). Methods: Retrospective study. Twenty-two patients with congenital DEP were underwent Knapp procedure (n=15) and modified Knapp procedure(n=7). The clinical data were retrospectively analyzed, including the preoperative and postoperative vertical deviation in the primary position, ocular motility, and binocular vision. Results: The average vertical deviation in the primary position was (34.7±8.6) prism diopters(PD) before surgery and (6.5±6.5) PD after surgery (t=30.41, P=0.00) in the group underwent Knapp procedure. The mean preoperative and postoperative deviations of the group underwent modified procedure were respectively (38.6±14.6) PD and (5.7±9.3)PD (t=15.33, P=0.00). The mean corrected vertical deviation of the latter (32.8±5.7) PD was greater than that of the former (28.1±3.6) PD(t=-2.39, P=0.03). The mean improved upgaze in the modified group (2.6±0.5) was more obvious than that in the Knapp group (1.9±0.6) (t=2.41, P=0.02). There is no significant difference in the surgical effect on downgaze between two groups (U=43.00, P=0.54). Seven patients having binocular vision with abnormal head posture (AHP) before surgery obtained binocular single vision in the primary position and reading position after operations. AHP disappeared or reduced to less than 5°. The surgical outcomes were satisfied in 72.7% patients. But the patients with ≥40 PD preoperative vertical deviation were under-corrected and needed the further operations. Conclusions: Knapp procedure and modified Knapp procedure with Foster suture were the efficient procedures for treatment of DEP without restriction of ipsilateral inferior rectus. Both procedures can obviously correct the vertical deviation and improve upgaze without remarkable limitation of downgaze, which is good to obtain the binocular single vision in the primary and reading position. The modified procedure has more powerful effect on the corrected vertical deviation and improved upgaze. (Chin J Ophthalmol, 2017, 53: 903-907).

[A study of superior oblique muscle changes in superior oblique palsy using magnetic resonance imaging]

Objective: To observe the magnetic resonance imaging(MRI) changes of superior oblique muscle and to study the relationship between changes and clinical signs in superior oblique muscle palsy. Methods: Cross-sectional study. Data was collected from January 2014 to January 2016 in Tianjin Eye Hospital. Twenty-three(30 eyes) patients who were diagnosed with superior oblique palsy included 15 patients with congenital superior oblique palsy [9 males and 6 females aged (32±13) years (range, 12-53 years)] and 8 cases with acquired superior oblique palsy [3 males and 5 females aged (36±15) years(range, 17-62 years)]. Twenty normal volunteers [11 males and 9 females aged (35±13) years (range, 15-60 years)] were also observed. Coronal MRI was used to detect superior oblique muscle morphological changes, as well as the maximum cross-sectional area and volume changes. The relationship between the morphological changes and vertical deviation and cyclotorsion in the primary gaze was analyzed. Rank sum test, t-test and Person correlation analysis were used for statistical analysis. Results: Two morphological changes were obtained using MRI in superior oblique muscle palsy, including round (19 eyes) and oval changes (11 eyes). The maximum cross-sectional area in eyes with the palsied superior oblique muscle [round, (10.38±1.76) mm(2); oval, (11.16±2.02) mm(2)] was significantly smaller than fellow eyes [(14.16±1.88) mm(2); Z=6.208, 5.178, both P<0.001] and eyes with normal superior oblique muscle [(15.40±1.71) mm(2); Z=8.215, 6.330, both P<0.001], and the volume changes [round, (104.92±13.36) mm(3); oval, (110.43±16.11) mm(3)] were also significantly different from fellow eyes [(254.57±20.15) mm(3); Z=7.511, 5.396, both P<0.001] and eyes with normal superior oblique muscle [(258.04±16.36) mm(3); Z=10.040, 6.936, both P<0.001]. There was no significant difference in vertical deviation between round and oval superior oblique muscle palsies (P>0.05). The cyclotorsion effect of the round change in superior oblique muscle palsy was significantly less than that of the oval change (5.47°±1.05° vs. 7.36°±0.97°, t=3.083, P=0.005). The correlation of the volume changes with vertical deviation angle in the primary gaze was not significantly different (round and oval, both P<0.05), but there was a correlation between the morphological changes and cyclotorsion strabismus (r=0.631, P=0.004; r=0.801, P=0.003). Conclusions: In the patients with superior oblique palsy, MRI scans shows that the maximum cross-sectional area decreased and the volume was smaller, which indicated superior oblique muscle atrophy. Deformation of superior oblique muscle do not significantly affect the vertical deviation, but is in correlation with cyclodeviation. (Chin J Ophthalmol, 2019, 55:20-24).

[Longterm surgery outcome of Möbius syndrome]

Objective: To investigate clinical features and the long-term surgery results of Möbius syndrome patients. Methods: This investigation presents a retrospective study of Möbius syndrome in 7 children we found since 2009. All 7 patients had MRI scan, ocular alignment in primary position, the limitation of versions and ductions and forced duction under general anesthesia. Early surgery is done to the 7 esotropia children. The pre-operative and post-operative outcomes, including the ocular alignment, deviation measurements and ocular rotations, were evaluated and compared. Results: MRI showed absence of uni- or bilateral CN6 and CN7 in all 7 patients. All 7 patients underwent extra large recession of medial rectus at the first surgery, (6.17±1.47) mm/eye. Variation of ocular deviation in the primary position within 6 months postoperatively in all patients, demonstrating that strabismus surgical stabilization needs time. Three patients with esotropia deviation≥40° preoperative were under corrected and needed the secondary operations. The average deviation in the primary position was +35.00°±16.58° before surgery and +2.14°±5.67° after surgery(t=6.040, P<0.01). The abduction in affected eye is limited both pre and postoperatively and a smaller limitation of adduction after surgery. Conclusions: Möbius syndrome has been classified to congenital cranial dysinnervation disorders (CCDDs). We recommend MR recession as the first surgical choice because of the lack of abduction ability. Longterm surgical results were considered satisfactory, improving patient self-esteem and the parent satisfaction. (Chin J Ophthalmol, 2017, 53: 897-902).

[Could binocular treatment be a substitute for patching]

Amblyopia is a common eye disease with a high prevalence in clinical practice of pediatric ophthalmology and strabismus. The primary treatment strategy for amblyopia is precise correction of refractive errors and patching of the dominant eye. The application of patching has a history of more than 200 years, and now is still the most effective method for treatment of amblyopia. Similar to the principle of traditional patching, atropine penalization has been testified that it can be used as an initial treatment for amblyopia with similar therapeutic effects as patching. In the past decade, binocular treatment has been proposed as a strategy for the treatment of amblyopia. Successively, different kinds of binocular treatment methods were reported by the researchers. This article systematically reviews all these methods reported in the recent years and their therapeutic effects. Most results about the therapeutic effect of binocular treatment are from the designers of the studies themselves, but in recent 2 years the results from monocenter or multicenter randomized controlled clinical trials to compare the therapeutic effects of binocular treatment and patching were reported. We hope to help colleagues have a comprehensive and objective understanding of the research progress on binocular treatment for amblyopia and thus keep a cool head on the question of whether binocular treatment could be a substitute for patching. (Chin J Ophthalmol, 2017, 53: 885-889).

[The preliminary study of stimulus input temporal changes on the visual cortex of rats at different ages]

Objective: To observe the impact of the input temporal changes on visual cortex of rats cells and the change of the synaptic efficacy, for the study of visual developmental plasticity mechanism. Methods: Experimental research. The brain slice of ten 14d healthy Wistar rats and ten 21d healthy Wistar rats were recorded with whole cell recording technique, using single stimulation and combined stimulate model, to observe the visual cortex of rats neurons changes in synaptic activity. Change the stimulus input sequence, and observe the visual cortex of rats changes of synaptic efficacy. Using the paired t test to compare the change of excitatory postsynaptic potential (EPSC) of visual cortex. Result: The difference between single stimulation and combined stimulate about EPSC was statistically significant, which was decreased (14.3±7.4) % (n=15) in single stimulation and (53.4±17.5) % (n=20) in combined stimulation for P14 rats which were long-term depression (t_s2=3.9, t_s1+s2=2.2; P<0.05) , and was increased (27.5±11.4) % (n=16) in single stimulation and (34.6±10.3) % (n=10) in combined stimulation for P20 rats which were long-term potentiation (t_s2=2.3, t_s1+s2=3.5; P<0.05) . Rats in different development period have a specific time window for input temporal changes. Combined stimulation patterns produced by the neuron cell reaction were not just an accumulation of simple response caused by single stimulation. For P14 rats, its time window was of about ±0.5ms. However, for P20 rats, scope of time window reduced to ±0.1ms. Conclusions: Different development period of rats, change the stimulation pattern can cause the change of the visual cortex synapses reaction, and stimulate the temporal change within a specific time window to producenonlinear results. (Chin J Ophthalmol, 2016, 52: 936-940).

[Clinical observation of the graduated "hang-back" recession of superior oblique in a-pattern strabismus with superior oblique overaction]

OBJECTIVE

To investigate the effect and safety of the graduated "hang-back" recession of superior oblique (SO) in treatment of A-pattern strabismus with superior oblique overaction (SOOA).

METHODS

Retrospective study. The clinical data of 15 cases (28 eyes), who underwent graduated "hang-back" recession of SO depending on the scales of SOOA, were collected and analyzed. The principle we carried on was hang-back recession 8-10mm for SOOA+4, 6 to 8 mm for SOOA+3, 5 to 6 mm for SOOA+2 and 4 mm for SOOA+1. The pre-operative and post-operative outcomes, including the ocular alignment, ocular motility, A-pattern and objective torsion demonstrated by fundus photographs were evaluated and compared.

RESULTS

In 15 cases (28 eyes), 2 cases had unilateral hang-back recession of SO for unilateral SOOA. Thirteen cases had bilaterally symmetric or asymmetric hang-back procedure. All the patients had no A pattern after surgery. The average difference of pre- and post-operative A-patterns were (24.5±11.9) PD and (3.2±4.2) PD in 13 cases with bilateral SOOA (t=8.01, P=0.00). The bilateral SO hang-back procedure could correct A-pattern in an amount of 21.3±10.3 PD in average. The average amount of pre- and post-operative SOOA were +3.0±2.0 and +0.5±1.0 in 28 eyes (Z=-4.70, P=0.00). Only 1 case remained residual SOOA+2.0. Fundus photos were measured by SigmascanPro5.0 program and the average pre- and post-operative torsion were +5.4°±3.9°and +0.3°±5.6° (The baseline was the line across the center of optic disc. The torsional angle was measured between the line across the fovea and and the line across the center of optic.) in 28 eyes (t=5.76, P=0.00). The average corrected torsion was 5.2°±4.8°. The pre-operative SOOA was related with the pre-operative torsion (Spearman correlation coefficient=0.47, P=0.01). The surgical amounts in 28 eyes were various from 4 to 10 mm (8±12 mm in average), which were not related with the corrected torsion (Spearman correlation coefficient=0.17, P=0.39), but related with pre-operative torsion (Spearman correlation coefficient=0.44, P=0.02). The total amounts on both eyes in patients operated by bilateral SO hang-back procedure were also not related with the corrected A-pattern (Spearman correlation coefficient=0.55, P=0.05). No case had secondary SO palsy and V-pattern after surgery.

CONCLUSIONS

The graduated "hang-back" recession of SO is optional for treatment of mild to moderate SOOA and A-pattern. It corrected objectively in-torsion without risks of secondary SO palsy and V-pattern. It is a safe and effective SO weakening procedure. (Chin J Ophthalmol, 2016, 52: 579-583).

Observation of a charged charmoniumlike structure in e+ e- → π+ π- J/ψ at sqrt[s] = 4.26 GeV

We study the process ee+ e- → π+ π- J/ψ at a center-of-mass energy of 4.260 GeV using a 525  pb(-1) data sample collected with the BESIII detector operating at the Beijing Electron Positron Collider. The Born cross section is measured to be (62.9±1.9±3.7)  pb, consistent with the production of the Y(4260). We observe a structure at around 3.9  GeV/c2 in the π(±)J/ψ mass spectrum, which we refer to as the Z(c)(3900). If interpreted as a new particle, it is unusual in that it carries an electric charge and couples to charmonium. A fit to the π(±)J/ψ invariant mass spectrum, neglecting interference, results in a mass of (3899.0±3.6±4.9)  MeV/c2 and a width of (46±10±20)  MeV. Its production ratio is measured to be R = (σ(e+ e- → π(±)Z(c)(3900)(∓) → π+ π- J/ψ)/σ(e+ e- → π+ π- J/ψ)) = (21.5±3.3±7.5)%. In all measurements the first errors are statistical and the second are systematic.

Observation of two new N* resonances in the decay ψ(3686)→ppπ0

Based on 106×10(6)ψ(3686) events collected with the BESIII detector at the BEPCII facility, a partial wave analysis of ψ(3686)→ppπ0 is performed. The branching fraction of this channel has been determined to be B(ψ(3686)→ppπ0)=(1.65±0.03±0.15)×10(-4). In this decay, 7 N* intermediate resonances are observed. Among these, two new resonances, N(2300) and N(2570) are significant, one 1/2+ resonance with a mass of 2300(-30-0)(+40+109)  MeV/c2 and width of 340(-30-58)(+30+110)  MeV/c2, and one 5/2- resonance with a mass of 2570(-10-10)(+19+34)  MeV/c2 and width of 250(-24-21)(+14+69)  MeV/c2. For the remaining 5 N* intermediate resonances [N(1440), N(1520), N(1535), N(1650) and N(1720)], the analysis yields mass and width values that are consistent with those from established resonances.

Evidence for the direct two-photon transition from ψ(3686) to J/ψ

The two-photon transition ψ(3686)→γγJ/ψ is studied in a sample of 1.06×10(8) ψ(3686) decays collected by the BESIII detector. The branching fraction is measured to be (3.1±0.6(stat)(-1.0)(+0.8)(syst))×10(-4) using J/ψ→e(+)e(-) and J/ψ→μ(+)μ(-) decays, and its upper limit is estimated to be 4.5×10(-4) at the 90% confidence level. This work represents the first measurement of a two-photon transition among charmonium states. The orientation of the ψ(3686) decay plane and the J/ψ polarization in this decay are also studied. In addition, the product branching fractions of sequential E1 transitions ψ(3686)→γχ(cJ) and χ(cJ)→γJ/ψ(J=0,1,2) are reported.

First observation of the M1 transition ψ(3686)→γη(c)(2S)

Using a sample of 106×10(6) ψ(3686) events collected with the BESIII detector at the BEPCII storage ring, we have made the first measurement of the M1 transition between the radially excited charmonium S-wave spin-triplet and the radially excited S-wave spin-singlet states: ψ(3686)→γη(c)(2S). Analyses of the processes ψ(3686)→γη(c)(2S) with η(c)(2S)→K(S)(0)K(±)π(∓) and K(+)K(-)π(0) give an η(c)(2S) signal with a statistical significance of greater than 10 standard deviations under a wide range of assumptions about the signal and background properties. The data are used to obtain measurements of the η(c)(2S) mass (M(η(c)(2S))=3637.6±2.9(stat)±1.6(syst) MeV/c(2)), width (Γ(η(c)(2S))=16.9±6.4(stat)±4.8(syst) MeV), and the product branching-fraction (B(ψ(3686)→γη(c)(2S))×B(η(c)(2S)→KKπ)=(1.30±0.20(stat)±0.30(syst))×10(-5)). Combining our result with a BABAR measurement of B(η(c)(2S)→KKπ), we find the branching fraction of the M1 transition to be B(ψ(3686)→γη(c)(2S))=(6.8±1.1(stat)±4.5(syst))×10(-4).

[An investigation of the multi-channel VEP topography by full field stimulation in functional amblyopia of children]

37 children of functional amblyopia and 40 normal children were examined with the multi-channel VEP topography by full field pattern reversal stimulation. The average results of esotropia showed a "half field stimulation effect", or an asymmetric distribution, in the amblyopic eyes, and a minor "half field stimulation effect" also existed in the nonamblyopic fellow eyes. However, the "half field stimulation effect" did not appear in both the amblyopic and non-amblyopic fellow eyes in anisometropic amblyopia. The findings suggest that (1) the pathological mechanism may be different between esotropic and anisometropic amblyopia, and (2) the non-amblyopic eye in esotropic amblyopia may not actually be "normal".