The TNF-derived TIP peptide activates the epithelial sodium channel and ameliorates experimental nephrotoxic serum nephritis

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Visual outcome and ocular survival in open-globe injuries

AIM: To detect the risk factors that predicts final visual acuity, retinal detachment, and ocular survival after penetrating trauma. METHODS: In a prospective case series study, 116 eyes with open-globe injuries were evaluated between 2001 and 2004. All data were filled in the questionnaire chart. Sex, age, involved eye, best-corrected visual acuity (BCVA), afferent pupillary defect (APD), location and wound length, cataract, iris prolapse, vitreous prolapse, retinal detachment (RD), intraocular foreign body (IOFB), vitrectomy procedure, and type of injury were evaluated as predisposing factors by logistic regression models for final visual acuity, RD, and ocular survival. RESULTS: Low BCVA, RD, and vitrectomy procedure were detected significant in the final visual acuity of 20/200 or less. APD and vitrectomy procedure were statistically significant in the final RD. BCVA 20/250 or less, wound length >10mm, scleral and corneoscleral lacerations, vitreous prolapse, vitreous hemorrhage, RD, and sharp injury were correlated with decreased globe survival. CONCLUSION: Low BCVA, APD, and vitrectomy procedure were effective in the visual outcome. RD and vitrectomy procedure were detected significant in the anatomic result. Establishment of predictors of visual outcome and ocular survival may assist clinicians in salvageable eyes for surgical repair.     

Q-value customized ablation (custom-Q) versus wavefront optimized ablation for primary myopia and myopic astigmatism

Comparison between treatment with wavefront optimized and custom-Q laser-assisted in situ keratomileusis (LASIK) ablations. Our study included 400 eyes of 200 patients divided into two equal groups. All patients were treated for myopia and myopic astigmatism with LASIK. The first group was treated with wavefront optimized ablation and the second group with custom-Q ablation. They were examined preoperatively and postoperatively to assess asphericity, image quality, and other classical outcome parameters. The wavefront optimized ablation group comprised 200 eyes with a mean spherical equivalent refraction (SE) of ?5.2188 diopters (D) (range: ?1.15 to ?10.50 D); the mean Q-value changed from 0.30 preoperatively to 0.06 postoperatively. The custom-Q ablation group also comprised 200 eyes with a mean SE of ?5.1575 D (range: ?1.35 to ?9.00 D); the mean Q-value changed from 0.32 preoperatively to 0.03 postoperatively. A statistically significant difference in postoperative change in Q-values (P = 0.02) and in postoperative visual acuity (P = 0.42) between the two groups was noted. There was no difference between the two groups regarding refractive correction. There was a marginally significant change in BSCVA (best spectacle-corrected visual acuity) between the two groups, and less impairment in the corneal asphericity in the custom-Q group.     

Day-of-surgery rejection of donors in living donor liver transplantation

AIM: To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT).METHODS: This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor’s serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholan-giopanc reatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS: Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, nar-cotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras,open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five donors were found to have livers with a grossly normal appearance. Four donors out of 69 (5.7%) were rejected on the day of surgery because their livers were grossly fatty and pale. In the laparoscopic era, thirty LDLT procedures were attempted between the end of May 2009 and October 2010. After the laparoscopic assessment on the day of surgery, twenty-two transplantation procedures were completed (73.4%), and eight were aborted (26.6%). Our data showed that the levels of steatosis in the rejected donors were in the acceptable range. Moreover, the results of the liver biopsies of rejected donors were comparable between the group A and group B donors. The laparoscopic assessment of donors presents many advantages relative to the assessment of donors through open exploration; in particular, the laparo-scopic assessment causes less pain, requires a shorter hospital stay and leads to far superior cosmetic results. CONCLUSION: The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.     

Refractive effect of the horizontal rectus muscle recession

Purpose To determine refractive and corneal topographic changes after horizontal rectus muscles recession. Methods In a noncomparative interventional case series, 49 eyes of 27 patients were evaluated in two groups: (1) exotropic patients (24 eyes) who underwent lateral rectus muscle(s) recession, and (2) esotropic patients (25 eyes) who underwent medial rectus muscle(s) recession. Full ophthalmic examination including cycloplegic automated refraction was carried out before, 1 and 3 months after surgery. Corneal topography was performed preoperatively and repeated at 3 months postoperatively. Results In eyes underwent medial rectus recession, there were statistically significant myopic shifts in spherical equivalent at month 1 (from + 2.09 ± 1.82 to + 1.88 ± 1.83 diopters, P = 0.03) and in astigmatic power at both month 1 (from −0.85 ± 0.67 to −1.15 ± 0.65 diopter, P = 0.04) and month 3 (from −0.85 ± 0.67 to −1.16 ± 0.65 diopter, P = 0.01). Myopic shifts were also noted following lateral rectus recession; however, there were not statistically meaningful. Significant astigmatic axis shift, which was toward with the rule astigmatism, was detected only after lateral rectus recession at both month 1 (P = 0.02) and month 3 (P = 0.02). Corneal power measured by topography was also demonstrated a statistically significant reduction (less than 0.3 diopter) after recession of either medial (P < 0.001) or lateral (P < 0.001) rectus muscle. Conclusions In spite of being statistically significant in some parts, the amounts of refractive and corneal topographic changes were not clinically remarkable. Therefore, it does not seem necessary to perform cycloplegic refraction early after horizontal rectus muscle recession; however, a precise refraction in all cases of strabismus should not be deferred later than 3 months.     

Comparison of the effect of three suturing techniques on postkeratoplasty astigmatism in keratoconus

PURPOSE: To compare the effect of 3 common suturing techniques on postkeratoplasty astigmatism and final best corrected visual acuity (BCVA) in patients with keratoconus. METHODS: In this randomized clinical trial, 103 eyes of 103 patients with advanced keratoconus, who were contact lens intolerant, or with contact lens-corrected visual acuity less than 20/80, underwent penetrating keratoplasty with 3 suturing techniques: interrupted (IR), single running (SR), and combined interrupted and running (CIR). Postkeratoplasty astigmatism and BCVA were evaluated during regular examinations 1.5, 3, 6, and 12 months postoperatively and 2 months after complete suture removal. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 4 D of corneal astigmatism in the SR and IR/CIR groups, respectively. RESULTS: Of 87 patients who completed follow-up, 26 eyes underwent PK with interrupted suturing technique (IR), 26 eyes had single running sutures (SR), and in 35 eyes, the suturing technique was combined (interrupted + running sutures; CIR). Mean age was 27.2 +/- 8.4, 28.9 +/- 8.7, and 30.3 +/- 8.7 years, and postoperative astigmatism 1.5 months after surgery was 3.77 +/- 1.68, 5.48 +/- 2.09, and 4.10 +/- 1.79 D in the 3 groups, respectively (P = 0.015). However, 2 months after complete suture removal, final postoperative astigmatism was 3.83 +/- 1.65, 3.37 +/- 1.9, and 3.88 +/- 2.79 D (P = 0.851) and BCVA (log MAR) was 0.08 +/- 0.14, 0.13 +/- 0.23, and 0.09 +/- 0.16, respectively (P = 0.53). Immunologic endothelial rejection reactions were seen in 5 eyes (19.2%) in the IR group, 3 eyes (11.72%) in the SR group, and 6 eyes (17.64%) in the CIR group (P = 0.44). There was no case of graft failure during the follow-up period. CONCLUSION: Postkeratoplasty astigmatism and BCVA are comparable with the 3 common suturing techniques (IR, SR, and CIR) in patients with keratoconus, provided that regular postoperative examinations and topography-guided suture adjustment and/or removal are performed.     

Keratectasia after LASIK but not after PRK in one patient

PURPOSE: To report a case of keratectasia in a patient who underwent LASIK in the right eye and photorefractive keratectomy (PRK) in the left eye for correction of compound myopic astigmatism. METHODS: A 30-year-old man underwent LASIK in the right eye and PRK in left eye for refraction of -1.75 -1.50 x 48 degrees and -1.00 -1.75 x 100 degrees, respectively. Preoperative corneal thickness was 447 microm in the right eye and 446 microm in the left eye. RESULTS: Postoperative corneal thickness decreased to 341 microm and 384 microm in the right and left eye, respectively. Uncorrected visual acuity in the left eye was 20/20, but the right eye developed keratectasia, which led to severe visual loss (20/400). CONCLUSIONS: Photorefractive keratectomy may be better than LASIK for ablative refractive surgery for low myopic astigmatism in eyes with low central corneal thickness.     

Hemodialysis Access Maintenance in the Medicare Population: An Analysis Over a Decade of Trends by Provider Specialty and Site of Service

Purpose

To evaluate annual national trends in hemodialysis access maintenance procedures in the Medicare population by specialty and setting.