Modified subretinal dye extrusion technique (MORE-DETECH): subretinal diluted trypan blue for detecting occult retinal breaks in retinal detachment after endotamponade removal

To investigate the effectiveness of a new technique for the identification of occult retinal breaks in retinal redetachment after removal of silicone oil endotamponade. The technique involves injection of subretinal dye and extrusion through the unidentified breaks. A prospective interventional case series. Main outcome measures were rate of break detection, rate of retinal attachment at 3 months after removal of endotamponade, and improvement in visual acuity after surgery. A total of 21 patients fulfilled the study criterion. The occult rhegma could be identified successfully in all except two cases (90.4 % success). In most cases the rhegma was identified at the posterior edge of the laser retinopexy scar. Complete retinal attachment could be seen in all cases at 12 weeks after removal of silicone oil. The mean visual acuity improved from logMAR 1.4, preoperatively to logMAR 0.81 (p = 0.001) postoperatively. Subretinal dye injection was useful in detecting occult retinal breaks in patients with retinal redetachment and was helpful in preventing surgical failure.     

Ambient air pollution and chronic respiratory morbidity in Delhi

The authors conducted a cross-sectional study among residents of Delhi to determine the role of ambient air pollution in chronic respiratory morbidity in Delhi. The authors selected a random, stratified sample (N = 4,171) of permanent residents who were 18+ y of age and who lived near 1 of the 9 permanent air quality monitoring stations in the city. Air-quality data for the past 10 y were obtained; data were based on the differences in total suspended particulates, and the study areas were categorized into lower- and higher-pollution zones. A standardized questionnaire was administered, clinical examination was carried out, and spirometry followed. The authors assessed chronic respiratory morbidity by (a) prevalence of chronic respiratory symptoms (i.e., chronic cough, phlegm, breathlessness, and wheezing) and airway diseases (i.e., chronic obstructive pulmonary disease/chronic bronchitis and bronchial asthma); and (b) lung function results in asymptomatic nonsmoking subjects in the two pollution zones. A multiple logistic regression identified the determinants of chronic symptoms. Smoking, male sex, increasing age, and lower socioeconomic status were strong independent risk factors for occurrence of chronic respiratory symptoms. In the comparison of nonsmoking residents of lower- and higher-pollution zones--stratified according to socioeconomic levels and sex--chronic cough, chronic phlegm, and dyspnea (but not wheezing) were significantly more common in the higher-pollution zone in only some of the strata. Furthermore, prevalence rates of bronchial asthma, chronic obstructive pulmonary disease, and chronic bronchitis among residents in the two pollution zones were not significantly different. Nonetheless, lung function of asymptomatic nonsmokers was consistently and significantly better among both male and female residents of the lower-pollution zone.     

Dome-shaped macula—Review of literature

Dome-shaped macula is a convex retinochoroidal elevation within the region of a posterior staphyloma seen commonly in high myopia on optical coherence tomography. With growing awareness of the condition facilitated by inclusion of optical coherence tomography in routine retinal practice, coupled with evolution of enhanced depth optical coherence tomography imaging, multiple studies have attempted to shed light on pathogenesis of this complex pathology, its clinical implications, and treatment of associated complications such as serous macular detachment and choroidal neovascularization with variable success. Our review aims to assimilate, scrutinize, and discuss the available literature for a comprehensive insight into dome-shaped macula.     

Combined inhibition of the PI3K/mTOR/MEK pathway induces Bim/Mcl-2-regulated apoptosis in pancreatic cancer cells

Pancreatic ductal adenocarcinoma (PDAC) progression and chemotherapy insensitivity have been associated with aberrant PI3K/mTOR/MEK signalling. However, cell death responses activated by inhibitors of these pathways can differ – contextually varying with tumour genetic background. Here, we demonstrate that combining the dual PI3K/mTOR inhibitor PF5212384 (PF384) and MEK inhibitor PD325901 (PD901) more effectively induces apoptosis compared with either agent alone, independent of KRAS mutational status in PDAC cell lines. Additionally, a non-caspase dependent decrease in cell viability upon PF384 treatment was observed, and may be attributed to autophagy and G0/G1 cell cycle arrest. Using reverse phase protein arrays, we identify key molecular events associated with the conversion of cytostatic responses (elicited by single inhibitor treatments) into a complete cell death response when PF384 and PD901 are combined. This response was also independent of KRAS mutation, occurring in both BxPC3 (KRAS wildtype) and MIA-PaCa-2 (KRAS^G12C mutated) cells. In both cell lines, Bim expression increased in response to PF384/PD901 treatment (by 60% and 48%, respectively), while siRNA-mediated silencing of Bim attenuated the apoptosis induced by combination treatment. In parallel, Mcl-1 levels decreased by 36% in BxPC3, and 30% in MIA-PaCa-2 cells. This is consistent with a functional role for Mcl-1, and siRNA-mediated silencing enhanced apoptosis in PF384/PD901-treated MIA-PaCa-2 cells, whilst Mcl-1 overexpression decreased apoptosis induction by 24%. Moreover, a novel role was identified for PDCD4 loss in driving the apoptotic response to PF384/PD901 in BxPC3 and MIA-PaCa-2 cell lines. Overall, our data indicates PF384/PD901 co-treatment activates the same apoptotic mechanism in wild-type or KRAS mutant PDAC cells.     

Double Giant Lambl’s Excrescence of aortic valve causing posterior circulation stroke

Diagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. Lambl’s Excrescences (LE)are filiform fronds that occur at sites of valvular closure due to “wear and tear” (Lambl Wien Med Wschr 6:244–247, 1856). The complex form of LE is “giant Lambl’s Excrescences” which results from the adherence of multiple adjacent excrescences that grow large. We recently had young male adult who presented with features of posterior circulation stroke (basilar) and detected to have two separate giant Lambl’s Excrescences on the aortic valve and treated successfully.     

Innovative use of single-incision internal fixation of distal clavicle fractures augmented with coracoclavicular stabilisation

Introduction

The management of displaced fractures of the distal clavicle remains controversial, particularly in younger patients where there is no consensus as to which surgical intervention is best. Each surgical method has unique surgical complications and rates of persistent pain and post-traumatic arthritis. We report an innovative surgical technique using a plate fixation augmented with minimally invasive tension slide coracoclavicular fixation using a cortical tenodesis button (8.5 mm).

Methods

A single-surgeon series, comprising of eleven cases, underwent retrospective review. A low-profile pre-contoured stainless steel plate that combines locking and non-locking options was used. Secondary fixation to the coracoid, through the plate, was achieved under fluoroscopic guidance eliminating the need for arthroscopy or exposure of the coracoid. An 8.5-mm cortical button loaded with a single FiberTape is inserted with fluoroscopic navigation, flipped under the coracoid and fixed to the plate. Patients followed a standardised rehabilitation protocol and clinical review assessing time to union, complications and Oxford Shoulder Scores.

Results

The mean age of the patients was 40 years, 82% male. The majority were day-case admissions with a mean follow-up of 18 months. Although a single patient requested plate removal due to lateral prominance, there were no revisions for implant failure and no surgical site infections or neurovascular injuries. All patients were reviewed at a minimum of 17 weeks and were progressing to union. Mean Oxford Shoulder Score was 43 (28–48, SD 6.5).

Conclusion

We consider this technique ideal for treating Neer type II distal clavicle fractures or fractures that have poor bone quality laterally, in which it can be difficult to achieve adequate screw fixation. The technique benefits from smaller tunnel diameter (3.7-mm spade-tip drill) and button length (8.5 mm). The procedure has a short learning curve and is both safe and time efficient.

Level of evidence

IV.