Intermediate-term outcomes of combined phacoemulsification and Aurolab aqueous drainage implant in eyes with refractory glaucoma and coexistent cataract

International Ophthalmology - To investigate the efficacy and safety of non-valved Aurolab aqueous drainage implant (AADI) surgery combined with phacoemulsification in eyes with refractory glaucoma...     

A comparative study on endothelial cell loss in nanophthalmic eyes undergoing cataract surgery by phacoemulsification

Purpose:The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series.Methods:We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy.Results:The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD <2.5 mm had a significantly greater reduction in ECD at 3 months postcataract surgery compared to baseline (P = 0.039). Visual outcomes and IOP reduction in the study group with ACD >2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively).Conclusion:The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth <2.5 mm, the percentage cell loss was significantly higher warranting the need for extensive intraoperative care. Increasing age was found to be the only significant risk factor influencing the ECD in short eyes.     

In elective arch surgery with circulatory arrest,does the arterial cannulation site really matter? A propensity score analysis of right axillary and innominate artery cannulation

Objective

The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery.

Three-photon microscopy shows that somatic release can be a quantitatively significant component of serotonergic neurotransmission in the mammalian brain

Recent experiments on monoaminergic neurons have shown that neurotransmission can originate from somatic release. However, little is known about the quantity of monoamine available to be released through this extrasynaptic pathway or about the intracellular dynamics that mediate such release. Using three-photon microscopy, we directly imaged serotonin autofluorescence and investigated the total serotonin content, release competence, and release kinetics of somatic serotonergic vesicles in the dorsal raphe neurons of the rat. We found that the somata of primary cultured neurons contain a large number of serotonin-filled vesicles arranged in a perinuclear fashion. A similar distribution is also observed in fresh tissue slice preparations obtained from the rat dorsal raphe. We estimate that the soma of a cultured neuron on an average contains about 9 fmoles of serotonin in about 450 vesicles (or vesicle clusters) of < or =370 nm average diameter. A substantial fraction (>30%) of this serotonin is released with a time scale of several minutes by K(+)-induced depolarization or by para-chloroamphetamine treatment. The amount of releasable serotonin stored in the somatic vesicles is comparable to the total serotonin content of all the synaptic vesicles in a raphe neuron, indicating that somatic release can potentially play a major role in serotonergic neurotransmission in the mammalian brain.     

The relationship between independent and dependent life events and depression symptoms in Sri Lanka: a twin and singleton study

Social Psychiatry and Psychiatric Epidemiology - Life events have been associated with a variety of mental health conditions including depression. There is a scarcity of research in South Asia...     

Estrogen receptor (ER) β expression in oligodendrocytes is required for attenuation of clinical disease by an ERβ ligand

Treatment of experimental autoimmune encephalomyelitis (EAE) mice with the estrogen receptor (ER) β ligand diarylpropionitrile (DPN) has been shown to have neuroprotective effects via stimulation of endogenous myelination. The direct cellular mechanisms underlying the effects of this ERβ ligand on the central nervous system are uncertain because different cell types in both the peripheral immune system and central nervous system express ERs. ERβ is the target molecule of DPN because DPN treatment fails to decrease EAE clinical symptoms in global ERβ-null mice. Here we investigated the potential role of ERβ expression in cells of oligodendrocyte (OL) lineage in ERβ ligand-mediated neuroprotection. To this end, we selectively deleted ERβ in OLs using the well-characterized Cre-loxP system for conditional gene knockout (CKO) in mice. The effects of this ERβ CKO on ERβ ligand-mediated neuroprotective effects in chronic EAE mice were investigated. ERβ CKO in OLs prevented DPN-induced decrease in EAE clinical disease. DPN treatment during EAE did not attenuate demyelination, only partially improved axon conduction, and did not activate the phosphatidylinositol 3-kinase/serine-threonine-specific protein kinase/mammalian target of rapamycin signaling pathway in ERβ CKO mice. However, DPN treatment significantly increased brain-derived neurotrophic factor levels in ERβ CKO mice. These findings demonstrate that signaling through ERβ in OLs is essential for the beneficial myelination effects of the ERβ ligand DPN in chronic EAE mice. Further, these findings have important implications for neuroprotective therapies that directly target OL survival and myelination.Multiple sclerosis (MS) is an inflammatory, demyelinating neurodegenerative disease characterized by physical, and often cognitive, deficits that can progress to severe debilitation. Although current MS treatments exist in the form of immunomodulatory or immunosuppressive agents, these treatments fail to halt disease progression and are not directly neuroprotective.Building on a wealth of research supporting a role for estrogens in neuroprotection, we have demonstrated that treatment of experimental autoimmune encephalomyelitis (EAE) mice with the estrogen receptor (ER) β ligand 2,3-bis(4-Hydroxyphenyl)-propionitrile (DPN) attenuates clinical disease, neurodegeneration, and axon demyelination and improves axon conduction (1–4). Notably, these effects were observed with both prophylactic and therapeutic treatment regimens, and they occurred in the presence of peripheral cytokine production and central nervous system (CNS) inflammation. Evidence of direct neuroprotection by an ERβ ligand is welcomed, because it circumvents ERα-mediated adverse effects of synthetic estrogens [i.e., increased breast and uterine endometrial growth in females and feminizing effects in males (5)].Because ERs are present in various cell types in the peripheral immune system and CNS, including cells of oligodendrocyte (OL) lineage, it is difficult to assess which cell type(s) mediate ERβ ligand-conferred neuroprotection (6). ERβ is the target molecule of DPN: DPN treatment fails to decrease EAE clinical symptoms in global ERβ-null mice (4). Although informative, such studies do not elucidate the cell type(s) on which DPN acts. We have recently demonstrated that therapeutic treatment with DPN increases mature OL numbers, remyelination-induced callosal conduction, and phosphorylated ERβ levels in OLs, and that it activates the phosphatidylinositol 3-kinase (PI3K)/serine-threonine-specific protein kinase (Akt)/mammalian target of rapamycin (mTOR) signaling pathway, a pathway implicated in OL survival, differentiation, and axon myelination (1, 7, 8). Taken together with the pronounced, functional improvement in endogenous myelination observed in DPN-treated chronic EAE mice, a direct effect on ERβ in OLs may mediate ERβ ligand-induced myelination/remyelination improvement and neuroprotection. To test this hypothesis, ERβ was selectively deleted from OLs using the well-characterized Cre-loxP recombination system for conditional gene knockout (CKO) in mice (9–12). The Olig2,ERβ CKO mice that resulted from crossing ERβ^flox/flox and Olig2-tva-Cre mice were viable and displayed normal behavior and gross CNS anatomy; hence, the effect of ERβ CKO in OLs on ERβ ligand-induced neuroprotection in chronic EAE mice was investigated. ERβ CKO in OLs prevented DPN-induced attenuation of clinical disease and demyelination and failed to activate the PI3K/Akt/mTOR signaling pathway. However, DPN treatment in Olig2,ERβ CKO mice partially improved axon conduction and reduced axonal loss and, as in WT mice, significantly increased BDNF levels. These findings reveal a direct action of the ERβ ligand DPN on ERβ in OLs in DPN-induced myelination/remyelination effects within a chronic mouse model of MS.     

Open Repair of Acute Type A Intramural Hematoma in 3 Patients

Acute aortic syndrome encompasses classic aortic dissection and less common aortic phenomena, including intramural hematoma (IMH), a hemorrhage within the aortic media that occurs without a discrete intimal tear. We reviewed our experience with treating acute type A IMH to better understand this acute aortic syndrome. A review of our clinical database identified 1,902 proximal aortic repairs that were performed from January 2006 through December 2018; of these, 266 were for acute aortic syndrome, including 3 (1.1%) for acute type A IMH. Operative technique varied considerably. All IMH repairs involved hemiarch or total arch replacement. In all 3 patients, the IMH extended distally into the descending thoracic aorta. There were no operative deaths or major adverse events (stroke, paraplegia, paraparesis, or renal failure necessitating dialysis) that persisted to hospital discharge. Length of hospitalization ranged from 5 to 20 days. All 3 patients were alive at follow-up (range, 2–6 yr) and needed no aortic reintervention after their index or staged repairs. In our experience, repair of acute type A IMH was infrequent and could be either simple or complex. Despite our limited experience with this disease, we found that it can be repaired successfully in urgent and emergency cases. Following treatment guidelines for aortic dissection appears to be a reasonable strategy for treating IMH.     

Pulmonary artery dissection—A review of 150 cases

Pulmonary artery dissection (PAD) is considered to be a rare condition with a very high mortality. Since a comprehensive review on PAD has not yet been done, we analysed all the available reports on PAD. In this analysis and review we searched the databases; Medline, PubMed Central, Directory of Open Access Journals, Google Scholar using the search term “Pulmonary Artery Dissection” with no language restrictions. In the 150 cases of PAD reported from 1842 to June 2018, the average age at diagnosis was 44.8 years with a male to female ratio of 1.1:1. Diagnosis was made in 49.3% of the males in the third and fourth decades, and 55.4% of the females in the fifth and sixth decades. The primary underlying causes were pulmonary hypertension and heart diseases, both congenital (mainly PDA) and acquired. The commonest clinical presentations were dyspnoea and chest pain. The best investigation of diagnosis was CT scan. The pulmonary trunk was the site of dissection in 72.5%. Surgical treatment, or medical management followed by surgery, had the best success rates. The overall survival rate which was 10.9% up to the year 2000, increased to 59.3% thereafter. If PAD was diagnosed ante-mortem, 70.5% survived. Haemopericardium / cardiac tamponade was seen at autopsy in 84.2%. PAD is not as rare, nor as fatal as believed, and with a high index of suspicion and appropriate investigations, an early diagnosis of PAD can be made and successful treatment instituted.