Cone parameters in different vision levels from the adaptive optics imaging

To investigate the relationship between visual resolution and cone parameters in eyes with different levels of best corrected visual acuity (BCVA).Seventeen eyes of 10 volunteers with BCVA of 20/12.5 or better (group 1) and 16 eyes of 10 volunteers with BCVA of 20/16 (group 2) were investigated in the study. Images of the cone photoreceptors at 1.5^° from the fovea were obtained using an adaptive optics (AO) retinal camera. The BCVA was obtained following a subjective refraction using a standardized logMAR visual acuity chart.The mean cone density (29,570.96 ± 2489.94 cells/mm²) at 1.5° from the fovea in group 1 (BCVA ≥ 20/12.5, n = 17) was significantly greater (P < .001) than that (22,963.59 ± 2987.92 cells/mm²) in group 2 (BCVA = 20/16, n = 16). The cone spacing at 1.5^° from the fovea in group 1 was 6.45 ± 0.28 μm (mean ± SD), which was significantly smaller (P < .001) than 7.36 ± 0.50 μm (mean ± SD) in group 2. In the stepwise regression analysis, greater angular cone density (odds ratio [OR], 4.48; P = .005) and smaller angular cone spacing (OR, 0.60; P = .007) at 1.5^° from the fovea were significantly associated with the better BCVA.The greater cone density and smaller cone spacing at the parafovea were found in eyes with BCVA of 20/12.5 or better, as compared to that in eyes with BCVA of 20/16. Knowledge of cone distribution for different BCVA levels may be beneficial for different clinical conditions.     

Nonexercise Activity Thermogenesis is Significantly Lower in Type 2 Diabetic Patients With Mental Disorders Than in Those Without Mental Disorders: A Cross-sectional Study

Physical activity improves health in patients with mental disorders. Nonexercise activity thermogenesis (NEAT) represents energy expenditure due to daily physical activities other than volitional exercise. We aimed to evaluate NEAT in type 2 diabetic patients with and without accompanying mental disorders.Between September 2010 and September 2014, we studied 150 patients with type 2 diabetes, 50 of whom also had a diagnosis of mental disorder, such as schizophrenia or mood disorder. We evaluated their NEAT in structured interviews using a validated questionnaire, and investigated differences in NEAT score and metabolic parameters between patients with and without mental disorders.The NEAT score was significantly lower in patients with mental disorders than in those without (56.3 ± 9.9 vs 61.9 ± 12.1; P = 0.005). Patients with mental disorders had significantly higher triglyceride (184.5 ± 116.3 vs 146.4 ± 78.4 mg/dL; P = 0.02) and insulin levels (18.7 ± 20.1 vs 11.2 ± 8.5 μU/mL; P = 0.006), and significantly lower B-type natriuretic peptide (12.1 ± 13.3 vs 26.3 ± 24.8 pg/mL; P < 0.001) and brachial-ankle pulse wave velocity levels (1501 ± 371 vs 1699 ± 367 cm/s; P = 0.003) than patients without mental disorders. In patients with schizophrenia, specifically, NEAT showed a negative correlation with hemoglobin A1c levels (β = −0.493, P = 0.031), and a positive correlation with high-density lipoprotein cholesterol (β = 0.519, P = 0.023) and B-type natriuretic peptide levels (β = 0.583, P = 0.02).Our results suggest that NEAT may be beneficial for the management of obesity, insulin sensitivity, and lipid profiles in patients with mental disorders. Incorporating NEAT into interventions for type 2 diabetes in patients with mental disorders, especially schizophrenia, shows promise and warrants further investigation.     

Dexmedetomidine dosage in critically ill patients undergoing intraoperative wake-up test: A randomized controlled trial

Objective:The aim of this study was to find the optimum dosage of dexmedetomidine in Spinal Orthopedic Scoliosis Correction Surgery when used in combination with propofol and remifentanil in American Society of Anesthesiologists (ASA) III patients with severe scoliosis undergoing intraoperative wake-up test.Materials and methods:We selected a total of 60 ASA III ≤40 years old patients who underwent Spinal Orthopedic Scoliosis Correction Surgery (SOSCS) and randomized them into groups A, B, and C. Group A was administered 0.2 μg/(kg·h) of dexmedetomidine, group B 0.3 μg/(kg·h), and group C 0.4 μg/(kg·h). The main parameters monitored were: wake-up time; wake-up quality; adverse effects that occur while the patient is awake; postoperative awareness of intraoperative wake-up test; heart rate (HR); mean arterial pressure (MAP); and oxygen saturation (SpO₂). Values of these parameters were monitored at 7 timestamps separated by 5 minutes >30 minutes.Results:Group B had a higher MAP at 10 minutes before wake-up (P = .03) and at the moment of wake-up (P = .04) than group A. The Wake-up time of group A was 14.95 ± 7.42 minutes, group B was 14.7 ± 6.52 minutes, which was significantly shorter than that of group C 21.3 ± 10.02 minutes (P = .02). The wake-up quality was excellent. All other parameters had no significant statistical differences.Conclusion:Doses of 0.2 to 0.3 μg/(kg·h) have shorter wake-up time and fewer hemodynamic fluctuations compared to 0.4 μg/(kg·h).     

Clinical course after the onset of choroidal neovascularization in eyes with central serous chorioretinopathy

Chronic central serous chorioretinopathy (CSC) can be complicated with choroidal neovascularization (CNV); however, the timing of its occurrence and its clinical significance are not well understood. This study aimed to observe the time of choroidal neovascularization detection after CSC diagnosis and determine whether clinical features and prognosis differed in patients with chronic CSC or age-related retinal degeneration.In this retrospective study, medical records of CSC patients complicated with CNV who visited Seoul St. Mary''s hospital of Korea between October 2009 and December 2020 were reviewed. The presence of CNV was determined using fluorescein, indocyanine green, or optical coherent tomography angiography (OCTA). Based on the patients’ medical records, we observed the change of clinical pattern, best-corrected visual acuity (BCVA) and central macular thickness (CMT) at CNV detection and at 6 months, 1 year, 3 years, and 5 years following CNV detection.Thirty eyes of 30 patients (male: female ratio of 13:17) were enrolled. Mean age at diagnosis of CSC was 54.0 ± 8.5 years (mean ± standard deviation). On average, CNV was detected 1.65 ± 2.30 years after the diagnosis of CSC. The mean CMT was significantly decreased at 6 months, 1 year, and 3 years after choroidal neovascularization detection (P < .001, P < .001, P = .001 respectively). BCVA tend to improve after CNV detection, but there was no statistical significance at 6 months, 1 year, 3 years, and 5 years (all with P > .05). There were no clinical findings suggesting age-related macular degeneration such as intraretinal, subretinal hemorrhage or drusen in any of the case during follow-up. None of the subjects had severe visual acuity loss of 1.0 logarithm of the minimum angle of resolution (logMAR) (20/200 Snellen equivalent) or greater. Among the subjects, 6 patients (20%) did not require any treatment during observation, while 24 other patients required anti-vascular endothelial growth factor (anti-VEGF) or photodynamic therapy. At the last visit, 22 patients (73.3%) remained stable for more than 6 months, without subretinal fluid recurrence.Choroidal neovascularization was detected earlier than previously reported. There was no rapid deterioration of visual acuity or clinical features even after CNV detection.     

Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens

The incidence of Crohn''s disease (CD) is increasing in Chinese populations in whom intestinal tuberculosis (ITB) is prevalent.This study aimed to identify differential diagnostic microscopic and endoscopic characteristics of CD from those of ITB.Patients with CD (N = 52) and patients with ITB (N = 16) diagnosed between 2010 and 2013 were identified. Specimens obtained via endoscopy were analyzed microscopically by a pathologist. The relationship between endoscopic appearance and histopathological features was analyzed. The χ² test, Fisher''s exact probability test, and the Mann-Whitney U test were used.Granulomas were present in 81.3% of ITB cases and in 67.3% of CD cases (P = 0.36). Granulomas in ITB cases were denser than those in CD cases (mean 5.29 ± 4.30 vs. 2.46 ± 3.50 granulomas per 10 low power fields; each low power field = 3.80 mm²; P = 0.005). Granulomas in ITB cases were larger (mean widest diameter, 508 ± 314 μm; range, 100–1100 μm) than those in CD cases (mean widest diameter, 253 ± 197 μm; range, 50–800 μm). Basal plasmacytosis was more common in CD cases than in ITB cases (77.0% vs. 37.5%, P = 0.000). Endoscopy findings such as longitudinal ulcer, aphthous ulcer, and cobblestone appearance were only seen in CD cases (34.6%, 21.2%, and 23.1%, respectively). Granulomas were detected in the majority of cases with longitudinal ulcers (88.9%). Basal plasmacytosis was exclusively detected in cases with longitudinal ulcer and a cobblestone appearance.Characteristics of granulomas maybe the most important distinguishing features between CD and ITB. However, the histopathological characteristics of both diseases may overlap on endoscopic biopsy specimens. An accurate diagnosis should be made that considers clinical, endoscopic features, and pathologic findings.     

Danning tablets might improve glucose and lipid metabolism in asymptomatic T2MD patients after cholecystectomy: A cohort study

Considering the role of bile acids in glucose metabolism and the effect of farnesoid X receptor agonists on bile acids, we investigated the possible effect of Danning tablets (DNTs), a type of farnesoid X receptor agonist, on glucose and lipid metabolism in asymptomatic type 2 diabetes mellitus (T2DM) patients.A series of asymptomatic T2DM patients who underwent cholecystectomy at least 2 years prior and were regularly followed up in our hospital were included in our analysis. According to their choice, they were divided into 2 groups: the DNT group and the control group. Demographic data, body weight, food intake, effects on diabetes control, and biomedical variables were collected.After propensity score matching, a total of 64 T2DM patients (41 males and 23 females) were included in the analysis. The amount of daily food intake (kcals) and diet composition were little changed 6-months after DNT administration (P = .612). However, the average fasting glucose level of the DNT group decreased from 9.5 ± 1.4 mmol/L to 8.3 ± 1.6 mmol/L (P < .001), and the level of hemoglobin A1c decreased from 8.3 ± 1.1% to 7.6 ± 1.0% (P = .001). The total cholesterol level (P = .024) and low-density lipoprotein cholesterol level (P = .034) decreased significantly (P = .018). Moreover, the average level of total bile acids decreased from 6.05 ± 2.60 μmol/L to 5.10 ± 1.83 μmol/L in the DNT group (P = .037), and the level of glucagon-like peptide-1 significantly increased from 6.93 ± 4.94 pmol/L to 11.25 ± 5.88 pmol/L (P < .001).The results of our study show that DNT intake improved glucose and lipid metabolism and increased the level of glucagon-like peptide-1.Trial registration: registered in Chinese Clinical Trial Registry (No. ChiCTR1900027823).     

Preanesthetic nebulized ketamine vs preanesthetic oral ketamine for sedation and postoperative pain management in children for elective surgery: A retrospective analysis for effectiveness and safety

Preoperative anxiety is a major problem in children leading to a poor outcome. Preanesthetic oral ketamine is generally used in children but has less bioavailability due to the first-pass effect. Even ketamine has an unpleasant taste. Preanesthetic inhaled ketamine is also reported effective and safe in children. The objectives of the study were to compare the effectiveness and safety of preanesthetic nebulized ketamine against preanesthetic oral ketamine for sedation and postoperative pain management in children.Children received 10 mg/kg oral ketamine (children received preanesthetic oral ketamine [OK cohort], n = 142), or nebulized with 3 mg/kg ketamine (children were preanesthetic nebulized with ketamine [NK cohort], n = 115), or received apple juice (children suspectable to preoperative ketamine and received apple juice only [OA cohort], n = 126) before anesthesia for elective surgery. Data regarding preoperative hemodynamic parameters, sedation score measurements, postoperative pain management, postoperative nausea and vomiting management, and postoperative complications were collected and analyzed.Preoperative hemodynamic parameters for oral and nebulized ketamine administration were stable. Nebulized ketamine was provided higher sedation than apple juice (P = .002, q = 4.859) and oral ketamine (P = .002, q = 3.526). Children of NK cohort had required fewer fentanyl consumption until discharge than those of OA (55.45 ± 7.19 μG/ child vs 65.15 ± 15.24 μG/ child, P < .0001, q = 9.859) and OK (55.45 ± 7.19 μG/child vs 60.19 ± 8.12 μG/child, P < .0001, q = 4.953) cohorts. Children of the NK cohort had consumed higher ondansetron syrup than those of the OA cohort but fewer than those of the OK cohort until discharge. Gastrointestinal side effects were reported in the OK cohort, and nose irritation and drowsiness were reported in the NK cohort.Like preanesthetic oral ketamine, preanesthetic inhaled ketamine also has safety for children. Preanesthetic inhaled ketamine can provide effective sedation in low doses during operation than preanesthetic oral ketamine.Level of evidence: III.     

Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention: A randomized controlled trial

Background:The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI).Methods:In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed.Results:Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate.Conclusions:The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.     

Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension

To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design.Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography series were post-processed. A reference region-of-interest (ROI) was placed in the afferent splenic artery and a target ROI was positioned on the embolization territory of the spleen on digital subtraction angiography series pre- and post-embolization. The ratios of the target ROIs to the reference ROIs were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using Wilcoxon signed-rank test and Spearman''s rank correlation coefficient (r). Afterwards, the study population was divided by the median of the TTP before PSE to analyze its value for the prediction of PR following PSE.Following PSE, PLT increased significantly from 43,000 ± 21,405 platelets/μL to 128,500 ± 66,083 platelets/μL with a PR of 255 ± 243% (P = .003). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIR_pre-PSE 1.23 ± 2.42/WIR_post-PSE 0.09 ± 0.07; -64 ± 46% (p = 0.04), TTP_pre-PSE 4.41 ± 0.99/TTP_post-PSE 5.67 ± 1.52 (P = .041); +34 ± 47% and AUC_post-PSE 0.81 ± 0.85/AUC_post-PSE 0.14 ± 0.08; -71 ± 18% (P = .002). A significant correlation of a 2D-PPBF parameter with the PLT was found for TTP_pre-PSE/PLT_pre-PSE r = -0.66 (P = .01). Subgroup analysis showed a significantly increased PR for the group with TTP_pre-PSE >4.44 compared to the group with TTP_pre-PSE ≤4.44 (404 ± 267% versus 107 ± 76%; P = .04).2D-PPBF is an objective approach to analyze the perfusion reduction of embolized splenic tissue. TTP derived from 2D-PPBF has the potential to predict the extent of PR during PSE.     

Effect of Intraoperative Dexmedetomidine Infusion on Postoperative Bowel Movements in Patients Undergoing Laparoscopic Gastrectomy: A Prospective,Randomized, Placebo-Controlled Study

Sympathetic hyperactivation is one of the causes of postoperative ileus, which occurs frequently after abdominal surgery and adversely influences the patient''s prognosis. We aimed to investigate whether dexmedetomidine (DEX) could attenuate postoperative ileus in patients undergoing laparoscopic gastrectomy.Ninety-two patients were randomized to the control (n = 46) or DEX group (n = 46). DEX was administered at a loading dose of 0.5 μg/kg for 10 minutes, followed by an infusion rate of 0.4 μg/kg/h from insufflation of the pneumoperitoneum to the end of surgery. The primary goal was to compare postoperative bowel movements by evaluating the time to first flatus. The balance of the autonomic nervous system, duration of postoperative hospital stay, and pain scores were assessed.The time to first flatus was shorter in the DEX group compared with the control group (67.2 ± 16.8 hours vs 79.9 ± 15.9 hours, P < 0.001). The low-frequency/high-frequency power ratio during pneumoperitoneum increased in the control group, compared with baseline values and the DEX group. The length of postoperative hospital stay was shorter in the DEX group compared with the control group (5.4 ± 0.7 days vs 5.8 ± 1.1 days, P = 0.04). Patients in the DEX group had lower pain scores and required fewer analgesics at 1 hour postoperatively.DEX facilitated bowel movements and reduced the length of hospital stay in patients undergoing laparoscopic gastrectomy. This may be attributed to the sympatholytic and opioid-sparing effects of DEX.     

Abatacept Improves Whole-Body Insulin Sensitivity in Rheumatoid Arthritis: An Observational Study

Rheumatoid arthritis (RA) is characterized by increased insulin resistance, a well-known risk factor for diabetes and cardiovascular diseases. The aim of the present study was to evaluate the effect of abatacept on insulin sensitivity in RA patients with moderate to severe disease despite treatment with methotrexate.Fifteen RA patients were recruited for the present study. Patients were evaluated at time 0 and after 6 months of the treatment with i.v. abatacept at the dosage recommended for weight range. Evaluation included oral glucose tolerance test (OGTT) at both time points. Insulin sensitivity was estimated with insulin sensitivity index (ISI) by Matsuda, a measure of whole-body insulin sensitivity.ISI significantly increased after the treatment with abatacept from 3.7 ± 2.6 to 5.0 ± 3.2 (P = 0.003) with a mean difference of 1.23. Analysis of glucose and insulin values during OGTT revealed a reduction of both glucose (303.9 ± 73.4 mg/dL min versus 269.2 ± 69.5 mg/dL min, P = 0.009) and insulin (208.4 ± 119.7 mg/dL min versus 158.0 ± 95.3 mg/dL min, P = 0.01) area under the curves (AUCs). Accordingly also glycated hemoglobin significantly improved (5.5 ± 0.4% versus 5.3 ± 0.3%, P = 0.04). No significant differences were found for measures of β-cell function insulinogenic index (1.11 ± 1.19 versus 1.32 ± 0.82, P = 0.77) and oral disposition index (2.0 ± 5.4 versus 6.0 ± 6.0, P = 0.25).Treatment with abatacept seems to be able to improve whole-body insulin sensitivity in RA patients without affecting β-cell function.     

Associations between salivary cytokines and periodontal and microbiological parameters in orthodontic patients

Orthodontic treatment can lead to microbial-induced gingival inflammation and aseptic periodontal inflammations. The aim of this study was to investigate the relationship between salivary pro-inflammatory cytokines levels with gingival health status and oral microbe loads among patients undergoing orthodontic treatment.The present investigation was a cross-sectional study among a sample of 111 consecutive orthodontic patients (mean age 18.4 ± 4.4 years). Clinical examinations were conducted to assess the gingival health status employing the Modified Gingival Index, Gingival Bleeding Index, and Plaque Index. Salivary microbiological assessments of total aerobic and anaerobic bacteria count, streptococci count, and lactobacilli count were undertaken. Saliva immunological assessments included Interleukin-1Beta (IL-1β) and macrophage migration inhibitory factor (MIF) ELISA assays.The mean ± standard deviation of salivary IL-1β was 83.52 ± 85.62 pg/ml and MIF was 4.12 ± 0.96 ng/ml. Moderate positive correlations were found between salivary IL-1β levels and total aerobic and anaerobic bacteria count, streptococci count, and lactobacilli count (r = 0.380–0.446, P < .001), and weak positive correlations between salivary MIF levels and total salivary aerobic and anaerobic bacteria counts (r = 0.249–0.306, P < .01) were observed. A positive correlation was found between salivary IL-1β levels and Bleeding Index (r = 0.216, P < .05).The level of salivary IL-1β positively correlates with oral bacterial load among orthodontic patients; the relationship between inflammatory cytokines and oral microflora deserved further study.     

Adipokine CTRP-5 as a Potential Novel Inflammatory Biomarker in Chronic Obstructive Pulmonary Disease

Local and systemic inflammation often present in chronic obstructive pulmonary disease (COPD). Adipokines are secretory protein mediators by adipose tissue, which have been found to involve in inflammatory responses in many chronic inflammatory diseases. Therefore, we performed this preliminary clinical study to investigate the possible association between 2 adipokines, C1q/tumor necrosis factor-related protein-3 and -5 (CTRP-3 and CTRP-5), with lung function and other markers of inflammation in COPD. Serum CTRP-3 and CTRP-5 levels were measured in 73 COPD patients and 54 health controls, together with lung function and levels of adiponectin, CRP, TNF-α, and MPO in both groups. Pearson''s partial correlation was used to analyze the correlations between CTRPs and other serum markers or lung function. Serum CTRP-5 was significantly elevated in COPD patients (0.41 ± 0.35 versus 0.29 ± 0.28 μg/ml, P = 0.01) and correlated inversely with FEV1/FVC ratio in all patients (r = −0.31, P = 0.001). In COPD patients, CTRP-5 was also correlated negatively with FEV1% predicted (r = −0.464, P < 0.001) and had a positive association with CRP levels (r = 0.262, P = 0.04). However, serum CTRP-3 levels were not correlated with measures of lung function or systemic inflammation. In conclusion, circulating CTRP-5 was associated with the severity of airflow obstruction and systemic inflammation in patients with COPD, which suggests that it may be used as a potential novel inflammatory biomarker in COPD. Further studies should be performed to clarify the exact role of CTRP-5 on the pathogenesis and outcomes of COPD.     

Cross-Sectional Study of the Retinal Nerve Fiber Layer Thickness at 7 Years After an Acute Episode of Unilateral Primary Acute Angle Closure

The purpose of this article is to investigate the long-term retinal nerve fiber layer (RNFL) status and determinants of RNFL thinning after an episode of unilateral primary acute angle closure (AAC).This cross-sectional study analyzed the medical records of consecutive patients with a single episode of unilateral AAC from 1999 to 2009 in Hong Kong. The peripapillary RNFL thickness was correlated with age, gender, presenting intraocular pressure (IOP), time to laser iridotomy, time to cataract extraction, follow-up duration, as well as the last IOP, vertical cup-to-disc ratio (CDR), and vision. The fellow uninvolved eye was used as a proxy comparison of RNFL loss in the attack eye.In 40 eligible patients, the mean age was 68.3 ± 8.7 years with a male-to-female ratio of 1:7. The mean presenting IOP was 49.2 ± 14.0 mm Hg and the time from presentation to laser iridotomy was 6.7 ± 6.9 days. Forty percent of subjects received a cataract extraction at 3.2 ± 2.9 years after the attack. The last IOP, CDR, and LogMAR vision were 16.0 ± 3.8 mm Hg, 0.6 ± 0.2, and 0.6 ± 0.6 LogMAR units, respectively, at 7.9 ± 2.4 years. The RNFL thickness in the attack eye (69.2 ± 19.1 μm) was 25.2 ± 17.9% thinner than the fellow eye (93.0 ± 17.8 μm) at 7.5 ± 2.9 years post-AAC. Using univariate analysis, the last vertical CDR (odds ratio [OR] = 17.2, P = 0.049) and LogMAR visual acuity (VA) (OR = 6.6, P = 0.03) were the only significant predictors for RNFL thinning whereas none of the other covariates showed significant associations (P > 0.1).At 7.5 years following unilateral AAC, the RNFL thickness was 25% thinner than the fellow eye. CDR enlargement and poor VA were the only significant predictors for RNFL loss.     

Comparison of safety and efficiency of corneal topography-guided photorefractive keratectomy and combined with crosslinking in myopic correction: An 18-month follow-up

To compare the safety and efficiency of simple corneal topography-guided (T-CAT) photorefractive keratectomy (PRK) and T-CAT PRK combined with crosslinking (CXL) to correct myopia with borderline suspicious tomography.Eyes with suspicious tomography (not classified as forme fruste keratoconus) underwent PRK combined with CXL. The suspicious tomography showed irregular posterior corneal morphology or maximum elevation value of the central 6 mm zone of the posterior surface (MEL) >15 μm, or Belin/Ambrósio Enhanced Ectasia Index (BAD-D) was >1.6. The PRK group was generated and matched within 2 μm for MEL, 0.3 for BAD-D value, and 0.5 D for manifest refractive spherical equivalent (MRSE) compared with the PRK-CXL group.PRK-CXL exhibited a larger MRSE (0.09 ± 0.22 D vs −0.03 ± 0.24 D, P = .02) and a larger sphere (0.14 ± 0.22 D vs 0.01 ± 0.21 D, P = .002) compared with PRK alone at 18 months postoperatively. The magnitude change and relative change rate of stiffness parameter A1 in the PRK-CXL were smaller than in the PRK group (−15.72 ± 14.56 vs −19.95 ± 14.37, P = .04, for magnitude change and −0.16 ± 0.15 vs −0.20 ± 0.14, P = .02, for relative change rate). In the PRK-CXL and PRK groups, 4.8% and 6.9% of eyes suffered grade 0.5 haze at postoperative 18-month. No cases of ectasia were reported in either group.PRK in combination with prophylactic crosslinking showed comparable safety and efficacy, but higher biomechanical stability compared to PRK alone, thus, the additional CXL plays a measurable role in reducing the change in corneal biomechanical properties after PRK in suspicious eyes.     

Preliminary Study on Electrophysiological Changes After Cellular Autograft in Age-Related Macular Degeneration

Evolving atrophic macular degeneration represents at least 80% of all macular degenerations and is currently without a standardized care. Autologous fat transplantation efficacy was demonstrated by several studies, as these cells are able to produce growth factors. The aim of the work was to demonstrate possible therapeutic effect of the joined suprachoroidal graft of adipocytes, adipose-derived stem cells (ADSCs) in stromal vascular fractions (SVFs) of adipose tissue, and platelet-rich plasma (PRP).Twelve eyes in 12 dry age-related macular degeneration (AMD) patients, aged 71.25 (SD ± 6.8) between 62 and 80 years, were analyzed. A complete ocular evaluation was performed using best corrected visual acuity (BCVA), retinographic analysis, spectral-domain optical coherence tomography, microperimetry, computerized visual field, and standard electroretinogram (ERG). Each eye received a cell in graft between choroid and sclera of mature fat cells and ADSCs in SVF enriched with PRP by means of the variant second Limoli (Limoli retinal restoration technique [LRRT]). In order to test if the differences pre- and post-treatment were significant, the Wilcoxon signed-rank test has been performed.Adverse effects were not reported in the patients. After surgery with LRRT, the most significant increase in the ERG values was recorded by scotopic rod-ERG (answer coming from the rods), from 41.26 to 60.83 μV with an average increase of 47.44% highly significant (P < 0.05). Moderately significant was the one recorded by scotopic maximal ERG (answer coming from the rods and cones), from 112.22 to 129.68 μV with an average increase of 15.56% (P < 0.1).Cell-mediated therapy based on growth factors used appears interesting because it can improve the retinal functionality responses in the short term. The ERG could, therefore, be used to monitor the effect of cell-mediated regenerative therapies.     

Feasibility and safety of automated CO2 angiography in peripheral arterial interventions

Carbon dioxide (CO₂) gas is an established alternative to iodine contrast during angiography in patients with risk of postcontrast acute kidney injury and in those with history of iodine contrast allergy. Different CO₂ delivery systems during angiography are reported in literature, with automated delivery system being the latest. The aim of this study is to evaluate the safety, efficacy, and learning curve of an automated CO₂ injection system with controlled pressures in peripheral arterial interventions and also to study the patients’ tolerance to the system.From January 2018 to October 2019 peripheral arterial interventions were performed in 40 patients (median age-78 years, interquartile range: 69–84 years) using an automated CO₂ injection system with customized protocols, with conventional iodine contrast agent used only as a bailout option. The pain and tolerance during the CO₂ angiography were evaluated with a visual analog scale at the end of each procedure. The amount of CO₂, iodine contrast used, and radiation dose area product for the interventions were also systematically recorded for all procedures. These values were statistically compared in 2 groups, viz first 20 patients where a learning curve was expected vs the rest 20 patients.All procedures were successfully completed without complications. All patients tolerated the CO₂ angiography with a median total pain score of 3 (interquartile range: 3–4), with no statistical difference between the groups (P = .529). The 2 groups were statistically comparable in terms of comorbidities and the type of procedures performed (P = .807). The amount of iodine contrast agent used (24.60 ± 6.44 ml vs 32.70 ± 8.70 ml, P = .006) and the radiation dose area product associated were significantly lower in the second group (2160.74 ± 1181.52 μGym² vs 1531.62 ± 536.47 μGym², P = .043).Automated CO₂ angiography is technically feasible and safe for peripheral arterial interventions and is well tolerated by the patients. With the interventionalist becoming familiar with the technique, better diagnostic accuracy could be obtained using lower volumes of conventional iodine contrast agents and reduction of the radiation dose involved.     

Retinal Nerve Fiber Layer Thickness in Myopic,Emmetropic, and Hyperopic Children

The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) thickness in myopic, emmetropic, and hyperopic children using optical coherence tomography.Two-hundred one right eyes of subjects aged 4 to 18 years were divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<−1.0 D), emmetropes (≥−1.0 to ≤+1.0 D), and hyperopes (>+1.0 D). The RNFL was correlated with age, spherical equivalent, and axial length. The RNFL was compared between the 3 groups before and after age adjustment.The RNFL was thickest in the hyperopic group (107.2 ± 10.13 μm, n = 73), followed by the emmetropic group (102.5 ± 9.2 μm, n = 61), and then the myopic group (95.7 ± 10.3, n = 67) (all P < 0.0001). The myopic group (9.6 ± 3.9 years) was significantly older than the emmetropic (6.9 ± 2.7 years) and hyperopic (6.5 ± 1.9 years) groups (both P < 0.0001). When adjusted for age, myopes had a thinner RNFL than the other 2 groups (all P < 0.0001), but there was no RNFL thickness difference between the emmetropic and hyperopic groups (P > 0.05). A thinner RNFL was associated with an older age (r = −0.4, P < 0.0001), a more myopic spherical equivalent (r = 0.5, P < 0.0001), and a longer axial length (r = −0.4, P < 0.0001) on Pearson correlation analysis.The apparently thicker RNFL in hyperopic and emmetropic children was attributed to their younger age as compared with their myopic counterparts. When adjusted for age, only myopia was associated with a thinner RNFL, with emmetropic and hyperopic children having equal RNFL thicknesses. Advancing age, a more myopic spherical equivalent, and a longer axial length were associated with a thinner RNFL in children.     

Elevated Salivary Alpha-Amylase Level,Association Between Depression and Disease Activity,and Stress as a Predictor of Disease Flare in Systemic Lupus Erythematosus: A Prospective Case–Control Study

Psychological stress has been shown to trigger systemic lupus erythematosus (SLE). However, objective evidence of symptom aggravation due to mental stress is difficult to identify. We aimed to investigate the relationship between SLE disease activity and mental stress, and the usefulness of saliva as an assessment index for stress in patients with SLE.We prospectively assessed the salivary stress hormone and disease-related biomarkers, and questionnaire data regarding stress and depression in 100 patients with SLE and 49 sex- and age-matched normal controls (NCs).Patients with SLE had higher mean salivary α-amylase levels (5.7 ± 4.6 U/mL vs 2.7 ± 2.5 U/mL, P < 0.001), anti-chromatin antibody levels (25.3 ± 22.9 U/mL vs 15.9 ± 10.9 U/mL, P < 0.001), and Beck Depression Index (BDI) scores (11.1 ± 9.2 vs 5.3 ± 5.1, P < 0.001) than NCs. However, salivary cortisol levels and Perceived Stress Scale (PSS) scores did not differ between the groups. The BDI scores correlated with the SLE disease activity index (SLEDAI) scores (r = 0.253, P = 0.011) and erythrocyte sedimentation rates (r = 0.234, P = 0.019). SLE patients with the highest-quartile PSS scores had significantly increased SLEDAI scores compared to those with the lowest-quartile PSS scores after 4 to 5 months’ follow-up. Moreover, SLE patients with elevated SLEDAI scores had higher baseline PSS scores.Patients with SLE showed uncoupling of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis; higher salivary α-amylase and no different cortisol levels compared with NCs. Also, patients with SLE were more depressed, which correlated with disease activity. Furthermore, perceived stress was not correlated with disease activity; however, disease activity worsened several months later with elevated perceived stress levels.     

Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation: A pilot control clinical study

Background.To the best of our knowledge, no studies have evaluated the effects of inspiratory muscle training (IMT) on recovered COVID-19 patients after weaning from mechanical ventilation. Therefore, this study assessed the efficacy of IMT on recovered COVID-19 patients following mechanical ventilation.Methods.Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ± 8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group). Forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), dyspnea severity index (DSI), quality of life (QOL), and six-minute walk test (6-MWT) were assessed initially before starting the study intervention and immediately after intervention.Results.Significant interaction effects were observed in the IMT when compared to control group, FVC% (F = 5.31, P = .041, ηP² = 0.13), FEV1% (F = 4.91, P = .043, ηP² = 0.12), DSI (F = 4.56, P = .032, ηP² = 0.15), QOL (F = 6.14, P = .021, ηP² = 0.17), and 6-MWT (F = 9.34, P = .028, ηP² = 0.16). Within-group analysis showed a significant improvement in the IMT group (FVC%, P = .047, FEV1%, P = .039, DSI, P = .001, QOL, P < .001, and 6-MWT, P < .001), whereas the control group displayed nonsignificant changes (P > .05).Conclusions.A 2-week IMT improves pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit (ICU) COVID-19 patients after consecutive weaning from mechanical ventilation. IMT program should be encouraged in the COVID-19 management protocol, specifically with ICU patients.