Digitally assisted three-dimensional surgery – Beyond vitreous

Purpose:The aim of this study was to evaluate the application and safety of three-dimensional (3D) visualization system in varied anterior segment procedures and Scleral Buckle.Methods:This was a prospective observational study of 313 eyes. Patients undergoing phacoemulsification (PE) with intraocular lens (IOL), trabeculectomies, glaucoma triple procedure (GTP), scleral fixated (SF) IOL, and scleral buckle (SB) were included in the study. Cases were randomly distributed in 3D visualization system (learning and post-learning phase) and conventional microscope group. Parameters studied were complications (intraoperative and early postoperative), surgical outcomes, and surgeon’s perspective on various parameters (through a validated questionnaire) like surgical time, time lag, learning curve, ease of doing various steps and its value as an educational tool, for both groups [Questionnaires 1 and 2].Results:Complications rates were not different in two groups. Surgical outcomes (anatomical and physiological) were similar in both the groups. Mean duration of surgery in PE+IOL, Trabeculectomy, GTP in learning stage by 3D was significantly higher than Microscope, which became insignificant in postlearning stage. For, SB and SFIOL, duration between two groups were insignificantly different. There was significant learning struggle in PE+IOL, SB, and Trabeculectomy. Image resolution, depth perception, illumination and postural comfort was graded higher for 3D surgery across the stages. Time lag, poor color contrast, and field of view were appreciated during the learning stage. Educational relevance of 3D was higher, as appreciated by resident and nurses.Conclusion:3D surgery is as safe, faster, and predictable after initial learning struggle. Even in anterior segment procedure, no apparent lag was appreciated after learning curve.     

DNA-triggered innate immune responses are propagated by gap junction communication

Cells respond to infection by sensing pathogens and communicating danger signals to noninfected neighbors; however, little is known about this complex spatiotemporal process. Here we show that activation of the innate immune system by double-stranded DNA (dsDNA) triggers intercellular communication through a gap junction-dependent signaling pathway, recruiting colonies of cells to collectively secrete antiviral and inflammatory cytokines for the propagation of danger signals across the tissue at large. By using live-cell imaging of a stable IRF3-sensitive GFP reporter, we demonstrate that dsDNA sensing leads to multicellular colonies of IRF3-activated cells that express the majority of secreted cytokines, including IFNβ and TNFα. Inhibiting gap junctions decreases dsDNA-induced IRF3 activation, cytokine production, and the resulting tissue-wide antiviral state, indicating that this immune response propagation pathway lies upstream of the paracrine action of secreted cytokines and may represent a host-derived mechanism for evading viral antiinterferon strategies.     

Clinical Profile and Outcome of Aluminum Phosphide-Induced Esophageal Strictures

Aluminum phosphide (AlP) is a lethal solid fumigant pesticide which has been recently linked to esophageal stricture formation. This paper aims to study the clinical profile and response to treatment of AlP-induced esophageal strictures. Data on all patients of AlP-induced strictures seen between January 2004 and June 2008 were retrieved and analyzed for clinical parameters and response to endoscopic dilation. Each patient underwent barium swallow to define the site and length of stricture and then was dilated endoscopically. Twelve patients of AlP-induced esophageal stricture (seven males) with a mean age of 26.83?±?8.43 years were evaluated. They had consumed one to three AlP tablets, 4–156 weeks before reporting to us. They had onset of dysphagia within 2 to 8 weeks of ingestion of AlP. Of 14 strictures in 12 patients, seven were in upper third, two in middle third, and five in lower third of esophagus with a mean length of 1.96?±?0.75 cm. Nine patients responded to dilation requiring 5.56?±?2.65 dilations. Four patients were given intralesional steroids to augment the effect of dilation. Three patients failed and were operated upon. All patients remained symptom free over a follow-up of 3–30 (15.67?±?9.41)?months. AlP-induced esophageal strictures can be dilated endoscopically in a majority of patients; however, 25% of them require surgical intervention. AlP-induced esophageal strictures, thus, behave like caustic-induced strictures.     

Patient-Based Abdominal Aortic Aneurysm Rupture Risk Prediction with Fluid Structure Interaction Modeling

Elective repair of abdominal aortic aneurysm (AAA) is warranted when the risk of rupture exceeds that of surgery, and is mostly based on the AAA size as a crude rupture predictor. A methodology based on biomechanical considerations for a reliable patient-specific prediction of AAA risk of rupture is presented. Fluid–structure interaction (FSI) simulations conducted in models reconstructed from CT scans of patients who had contained ruptured AAA (rAAA) predicted the rupture location based on mapping of the stresses developing within the aneurysmal wall, additionally showing that a smaller rAAA presented a higher rupture risk. By providing refined means to estimate the risk of rupture, the methodology may have a major impact on diagnostics and treatment of AAA patients.     

Tibial cyst formation after anterior cruciate ligament reconstruction using a new bioabsorbable screw

We report a case of tibial cyst formation twelve months after anterior cruciate ligament reconstruction using hamstring graft. A composite bioabsorbable interference screw made of 'beta tricalcium phosphate and poly L-lactide' fixed the graft distally. The patient presented with acute symptoms of pain and swelling over the proximal tibia. Curettage of the cyst resulted in complete recovery within 3 months.     

A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India

Purpose:This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India.Methods:This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3–15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination.Results:Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand.Conclusion:Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed.     

No evidence of correlation between p53 codon 72 G > C gene polymorphism and cancer risk in Indian population: a meta-analysis

p53 is a tumor suppressor gene, which is activated in response to several forms of cellular stress and exerts multiple antiproliferative functions, making it the most frequent target for genetic alteration in cancer. Various studies have evaluated the association between p53 codon 72 G?>?C (rs1042522) polymorphism and risk of cancer. However, results from the published studies remained inconclusive. The aim of this study is to investigate the precise association between this variant and a risk of cancer in a large-scale meta-analysis. We searched the PubMed (MEDLINE) and Google Scholar web databases for studies regarding the association of p53 codon 72 G?>?C polymorphism and risk of cancer in the Indian population. Pooled odds ratio (OR) with 95 % confidence interval (CI) were calculated by using random effect model to assess the association. Twenty studies with 3,258 cancer cases and 4,260 healthy controls were included. Overall, no significant association was detected for C allele carrier (C vs. G: OR?=?1.135, 95 % CI?=?0.930 to 1.386, p?=?0.211) and homozygous (CC vs. GG: OR?=?1.200, 95 % CI?=?0.810 to 1.779, p?=?0.364), heterozygous (CG vs. GG: OR?=?1.204, 95 % CI?=?0.921 to 1.575, p?=?0.175), dominant (CC?+?CG vs. GG: OR?=?1.231, 95 % CI?=?0.932 to 1.625, p?=?0.144), and recessive (CC vs. GG?+?GC: OR?=?1.078, 95 % CI?=?0.792 to 1.468, p?=?0.632) genetic models, respectively. No significant publication bias was observed by using Begg’s funnel plot and Egger’s test. Present meta-analysis indicated that the p53 codon 72 G?>?C polymorphism was not associated with cancer risk. This suggests that this polymorphism may not be an independent risk factor for cancer in the Indian population.     

Hair Toe Tourniquet Syndrome in a Four-year-old Boy

Background

Hair toe tourniquet syndrome is a condition in which a hair or thread encircles a digit and results in acute digital ischemia. It usually occurs in children under the age of 1 year. Prompt recognition and surgical removal of the constricting material can save the digit from irreversible tissue necrosis and the loss of digit.

Case Report

We report the first known case of hair toe tourniquet syndrome in a 4-year-old child, who had successful diagnosis and treatment of this condition.

Conclusion

We suggest that hair toe tourniquet syndrome should be considered as a cause of acute digital swelling and discoloration in children of all ages.     

Outcome following knee arthroplasty beyond 15 years

There is a paucity of information detailing functional outcome following total knee arthroplasty for this length of follow-up. We collected data from 187 knees in 150 surviving patients, beyond 15 years from implantation. Survival of the implant was confirmed and a patient administered questionnaire including WOMAC, SF-36 and patient satisfaction was used, data was scrutinised for differences between primary and revision knee surgery. Seventy knees were revised at a mean of 10.8 years. The mean WOMAC Pain score was 72 indicating predominantly mild pain. The mean WOMAC Function scores were lower at 55 indicating moderate limitation of most activities. No significant differences were found between revised and un-revised patients. Long-term pain and satisfaction scores in this population were good illustrating the benefits of TKA in the long term even in patients who have undergone revision surgery.