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The aim was to analyze the association of subfoveal choroidal thickness (SFCT) with age, best-corrected visual acuity, refractive error, and axial length in Taiwan pediatric population. A total of 374 eyes in 187 children were enrolled in this retrospective cross-sectional comparative study, who underwent examinations of best-corrected visual acuity (BCVA), cycloplegic refraction, and axial length (AL). Subfoveal choroidal thickness was assessed utilizing spectral domain enhanced depth imaging optical coherence tomography (EDI-OCT), with measurements taken at the subfovea, defined as the distance from the retinal pigment epithelium to the chorioscleral border. The mean age was 5.6 ± 1.9 years (range 2-16 years). The cycloplegic spherical equivalent refractive error was between + 7.25 and - 15.25 diopters (D) and cycloplegic sphere power was between + 8.25 and - 11.5 diopters (D). The mean SFCT was 299.0 ± 69.80 μm. The mean axial length was 22.87 ± 1.29 mm. In univariate analysis, SFCT had significant positive correlations with spherical equivalent (SE) and sphere power (p < 0.05) and significant negative correlations with age, cylinder power, and axial length (p < 0.05). However, after adjusting in the multivariate regression analysis, spherical equivalent, sphere power and age were not independently associated with SFCT. In multivariate analysis, lower cylinder power and longer axial length have significant correlations with thinner SFCT. The relationship between best-corrected visual acuity and SFCT was not significant in both analyses. This study showed that mean subfoveal choroidal thickness was 299.0 ± 69.80 μm among Taiwanese children. The SFCT was thinner in myopic, longer axial length, and lower cylinder power eyes.

Hyperpolarized (HP) magnetic resonance imaging (MRI) is a groundbreaking imaging platform advancing from research to clinical practice, offering new possibilities for real-time, non-invasive metabolic imaging. This review explores the latest advancements, challenges, and future directions of HP MRI, emphasizing its transformative impact on both translational research and clinical applications. By employing techniques such as dissolution Dynamic Nuclear Polarization (dDNP), Parahydrogen-Induced Polarization (PHIP), Signal Amplification by Reversible Exchange (SABRE), and Spin-Exchange Optical Pumping (SEOP), HP MRI achieves enhanced nuclear spin polarization, enabling in vivo visualization of metabolic pathways with exceptional sensitivity. Current challenges, such as limited imaging windows, complex pre-scan protocols, and data processing difficulties, are addressed through innovative solutions like advanced pulse sequences, bolus tracking, and kinetic modeling. We highlight the evolution of HP MRI technology, focusing on its potential to revolutionize disease diagnosis and monitoring by revealing metabolic processes beyond the reach of conventional MRI and positron emission tomography (PET). Key advancements include the development of novel tracers like [2- C]pyruvate and [1- C]-alpha-ketoglutarate and improved data analysis techniques, broadening the scope of clinical metabolic imaging. Future prospects emphasize integrating artificial intelligence, standardizing imaging protocols, and developing new hyperpolarized agents to enhance reproducibility and expand clinical capabilities particularly in oncology, cardiology, and neurology. Ultimately, we envisioned HP MRI as a standardized modality for dynamic metabolic imaging in clinical practice.

The effectiveness of electronic word-of-mouth (eWOM) communication has attracted increasing attention from marketing practitioners, but relatively few studies focus on the dissemination of eWOM communication from a message perspective. Online video is a prominent form of marketing promotion, yet again, little is known about which factors make online video engaging or how they influence recipients’ forwarding intentions. This study adopts Lasswell’s communication model to investigate the persuasiveness of online video and uses the source, content, and channel dimensions to examine three potentially influential factors: awareness of persuasive intent, perceived humor, and multimedia effect. Awareness of persuasive intent exerts a negative influence, whereas the humor and multimedia effects have positive influences on both attitude toward a received online video and forwarding intentions. Therefore, e-marketers should reshape video clips to be humorous, use multimedia effects, and disguise their commercial intent to attract recipients’ attention and persuade them to disseminate an online video.

Hyperpolarized carbon-13 MRI has the advantage of allowing the study of glycolytic flow in vivo or in vitro dynamically in real-time. The apparent exchange rate constant of a metabolite dynamic signal reflects the metabolite changes of a disease. Downstream metabolites can have a low signal-to-noise ratio (SNR), causing apparent exchange rate constant inconsistencies. Thus, we developed a method that estimates a more accurate metabolite signal. This method utilizes a kinetic model and background noise to estimate metabolite signals. Simulations and in vitro studies with photon-irradiated and control groups were used to evaluate the procedure. Simulated and in vitro exchange rate constants estimated using our method were compared with the raw signal values. In vitro data were also compared to the Area-Under-Curve (AUC) of the cell medium in 13C Nuclear Magnetic Resonance (NMR). In the simulations and in vitro experiments, our technique minimized metabolite signal fluctuations and maintained reliable apparent exchange rate constants. In addition, the apparent exchange rate constants of the metabolites showed differences between the irradiation and control groups after using our method. Comparing the in vitro results obtained using our method and NMR, both solutions showed consistency when uncertainty was considered, demonstrating that our method can accurately measure metabolite signals and show how glycolytic flow changes. The method enhanced the signals of the metabolites and clarified the metabolic phenotyping of tumor cells, which could benefit personalized health care and patient stratification in the future.

Corneoscleral-ring-derived extracellular vesicles represent a potential therapeutic strategy for promoting in vitro corneal wound healing. In this study, we successfully isolated and characterized extracellular vesicles from human corneolimbal tissue obtained from 42 donors, with a mean age of 51.62 ± 15.56 years. Donor-related factors such as age, corneal endothelial cell density, and underlying systemic conditions did not confound extracellular vesicle size and concentration with mean peak size of 99.52 ± 13.00 nm by nanoparticle tracking analysis. Western blotting analysis revealed positive Alix, stable expression of CD9 and CD81, and variable expression of CD63. Limbal stem cell (LSC)-associated markers, i.e., ABCG2, p63, Notch-1, and Integrin α9 were positively detected in the isolated extracellular vesicles. Notably, Integrin α9 showed stable and relatively strong expression in all samples serving a specific marker of LSC-derived extracellular vesicles. Functional assays demonstrated that LSC-derived extracellular vesicles exhibited better wound healing potency compared to extracellular vesicles derived from mesenchymal stem cells (MSCs). These findings suggest that corneoscleral-ring-derived extracellular vesicles express distinct LSC markers, including Integrin α9, and hold significant potential for application in corneal wound healing and ocular surface regeneration.

Background There is a critical period for visual development, conventionally considered to be the first 6 years of life. Children aged 7 years and older are significantly less responsive to amblyopia treatment. This study investigated the efficacy of binocular vision therapy in amblyopic children aged 7–10 years. Methods This retrospective study enrolled 36 children with unilateral amblyopia who were divided into a case group (receiving vision therapy, optical correction, and part-time patching of the weaker eye) and a control group (receiving optical correction and part-time patching of the weaker eye). Visual acuity (VA) was measured at baseline, at the 3-month, 6-month, and 9-month visits, and 3 months after cessation of treatment. Results There were 19 subjects in the case group and 17 subjects in the control group. Mean VA in the case group improved from 0.39 ± 0.24 logMAR at baseline to 0.10 ± 0.23 logMAR at the endpoint of treatment ( p  < 0.001, paired t-test). Mean VA in the control group improved from 0.64 ± 0.30 logMAR at baseline to 0.52 ± 0.27 logMAR at the endpoint of treatment ( p  = 0.015, paired t-test). The improvement was significantly greater in the case group than in the control group ( p  = 0.006, two-samples independent t-test). All subjects underwent follow-up examinations within 6 to 12 months. There was no regression of VA in the case group 3 months after cessation of vision therapy. The patients in the case group who received visual therapy were with better VA improvement then patients with only optic correction and patching. Conclusions Vision therapy combined with conventional treatment (optical correction and part-time patching) is more effective than conventional treatment alone in children aged 7–10 years with unilateral refractive amblyopia. The treatment results not only in greater vision gain, but also in shorter duration of treatment.

Hyperpolarized (HP) carbon-13 ( C) MRI represents an innovative approach for noninvasive, real-time assessment of dynamic metabolic flux, with potential integration into routine clinical MRI. The use of [1- C]pyruvate as a probe and its conversion to [1- C]lactate constitute an extensively explored metabolic pathway. This review comprehensively outlines the establishment of HP C-MRI, covering multidisciplinary team collaboration, hardware prerequisites, probe preparation, hyperpolarization techniques, imaging acquisition, and data analysis. This article discusses the clinical applications of HP C-MRI across various anatomical domains, including the brain, heart, skeletal muscle, breast, liver, kidney, pancreas, and prostate. Each section highlights the specific applications and findings pertinent to these regions, emphasizing the potential versatility of HP C-MRI in diverse clinical contexts. This review serves as a comprehensive update, bridging technical aspects with clinical applications and offering insights into the ongoing advancements in HP C-MRI.

Background and purpose Radiomics offers little explainability. This study aims to develop a radiomics model (Rad-Score) using diffusion-weighted imaging (DWI) to predict high-risk patients for nodal metastasis or recurrence in endometrial cancer (EC) and corroborate with choline metabolism. Materials and methods From August 2015 to July 2018, 356 EC patients were enrolled. Rad-Score was developed using LASSO regression in a training cohort ( n  = 287) and validated in an independent test cohort ( n  = 69). MR spectroscopy (MRS) was also used in 230 patients. Nuclear MRS measured choline metabolites in 70 tissue samples. The performance was compared against European Society for Medical Oncology (ESMO) risk groups. A P  < .05 denoted statistical significance. Results Rad-Score achieved 71.1% accuracy in the training and 71.0% in the testing cohorts. Incorporating clinical parameters of age, tumor type, size, and grade, Rad-Signature reached accuracies of 73.2% in training and 75.4% in testing cohorts, closely matching the performance to the post-operatively based ESMO's 70.7% and 78.3%. Rad-Score was significantly associated with increased total choline levels on MRS ( P  = .034) and tissue levels ( P  = .019). Conclusions Development of a preoperative radiomics risk score, comparable to ESMO clinical standard and associated with altered choline metabolism, shows translational relevance for radiomics in high-risk EC patients. Trial registration This study was registered in ClinicalTrials.gov on 2015–08-01 with Identifier NCT02528864.

Background: In this study we aim to determines the effect of our vision therapy program for 7- to 10-year-old patients who exhibit bilateral amblyopia that is no longer responsive to conventional treatment. Methods: Children with bilateral amblyopia between the ages of 7 and 10 treated with vision therapy at the China Medical University Hospital between 2016 and 2019 were retrospectively reviewed. Age and visual acuity-matched bilateral amblyopes are included as a control group. The visual acuity for both groups showed no improvement for more than 3 months with part-time patching and full refraction correction. The initial and final visual acuity, stereopsis, and refractive status were analyzed. Results: Here, 15 cases were included as the treatment group and 16 cases as a control group. At the endpoint, the study group shows a significant improvement in BCVA, with a mean of 0.32 ± 0.15 logMAR (3 lines improvement) versus 0.003 ± 0.19 logMAR (nearly no improvement) for the control group (p < 0.001). The benefits of treatment are most obvious in the first 3 months after treatment (p < 0.001) and last until the end point. Stereoacuity also improves from 190.00 ± 163.34 to 85.00 ± 61.24 arc seconds, which is a 55.26% improvement. Conclusions: Vision therapy, comprising orthoptic therapy, perceptual learning and dichoptic training, is a successful program for increasing visual acuity and stereoacuity in 7- to 10-year-old children with bilateral amblyopia that is unresponsive to conventional treatment.

Background Monitoring pyruvate metabolism in the spleen is important for assessing immune activity and achieving successful radiotherapy for cervical cancer due to the significance of the abscopal effect. We aimed to explore the feasibility of utilizing hyperpolarized (HP) [1- 13 C]-pyruvate magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to evaluate pyruvate metabolism in the human spleen, with the aim of identifying potential candidates for radiotherapy in cervical cancer. Methods This prospective study recruited six female patients with cervical cancer (median age 55 years; range 39–60) evaluated using HP [1- 13 C]-pyruvate MRI/MRS at baseline and 2 weeks after radiotherapy. Proton ( 1 H) diffusion-weighted MRI was performed in parallel to estimate splenic cellularity. The primary outcome was defined as tumor response to radiotherapy. The Student t -test was used for comparing 13 C data between the groups. Results The splenic HP [1- 13 C]-lactate-to-total carbon (tC) ratio was 5.6-fold lower in the responders than in the non-responders at baseline ( p  = 0.009). The splenic [1- 13 C]-lactate-to-tC ratio revealed a 1.7-fold increase ( p  = 0.415) and the splenic [1- 13 C]-alanine-to-tC ratio revealed a 1.8-fold increase after radiotherapy ( p  = 0.482). The blood leukocyte differential count revealed an increased proportion of neutrophils two weeks following treatment, indicating enhanced immune activity ( p  = 0.013). The splenic apparent diffusion coefficient values between the groups were not significantly different. Conclusions This exploratory study revealed the feasibility of HP [1- 13 C]-pyruvate MRS of the spleen for evaluating baseline immune potential, which was associated with clinical outcomes of cervical cancer after radiotherapy. Trial registration ClinicalTrials.gov NCT04951921 , registered 7 July 2021. Relevance statement This prospective study revealed the feasibility of using HP 13 C MRI/MRS for assessing pyruvate metabolism of the spleen to evaluate the patients’ immune potential that is associated with radiotherapeutic clinical outcomes in cervical cancer. Key points • Effective radiotherapy induces abscopal effect via altering immune metabolism. • Hyperpolarized 13 C MRS evaluates patients’ immune potential non-invasively. • Pyruvate-to-lactate conversion in the spleen is elevated following radiotherapy. Graphical Abstract