Contralateral assessment of sub-Bowman keratomileusis (SBK) microkeratome suction duration on laser-assisted in-situ keratomileusis (LASIK) flap characteristics

PURPOSE

To describe the effect of prolonging the standard suction duration during laser-assisted in-situ keratomileusis (LASIK) and its effect on flap thickness and hinge length using sub-Bowman keratomileusis (SBK) microkeratome.

METHODS

Fifty-six eyes (28 patients) were included and divided into 2 groups; Group-A: eyes with flatter corneas (36 eyes, 18 patients) and mean keratometric readings ranging from 40.13 to 43.71 diopters (D). Group-B: eyes with steeper corneas (20 eyes, 10 patients) with mean keratometric readings ranging from 43.85 to 46.72 D. One-Use-Plus SBK microkeratome was used for flap creation. For right eyes, flap was created immediately once suction was built up. In left eyes, the surgeon waited for 10 s after suction was built up before flap creation. Flap hinge length and flap thickness were measured using surgical caliper and ultrasonic pachymetry, respectively.

RESULTS

Statistically significant differences were observed in corneal flap hinge size between right eyes versus left eyes, with a mean of 3.98 ± 0.48 vs. 3.78 ± 0.55 mm (p < 0.001). Mean flap thickness in both eyes did not prove to be statistically significantly different with either surgical technique (90.2 ± 1.68 vs. 90.07 ± 1.44 μm, p = 0.8). Sub-group analysis of Group-A vs. Group-B revealed hinge sizes that were significantly larger in steeper corneas (p < 0.01 and p < 0.05, respectively). However, flap thickness in both groups was unaffected by surgical procedure (p = 0.5).

CONCLUSIONS

Increasing suction duration increases flap hinge length and stabilizes the flap, especially in steeper corneas.

Molecular underpinnings of corneal angiogenesis: advances over the past decade

The cornea is maintained in an avascular state by maintaining an environment whereby anti-angiogenic factors take the upper hand over factors promoting angiogenesis. Many of the common pathologies affecting the cornea involve the disruption of such equilibrium and the shift towards new vessel formation, leading to corneal opacity and eventually-vision loss. Therefore it is of paramount importance that the molecular underpinnings of corneal neovascularization (CNV) be clearly understood, in order to develop better targeted treatments. This article is a review of the literature on the recent discoveries regarding pro-angiogenic factors of the cornea (such as vascular endothelial growth factors, fibroblast growth factor and matrix metalloproteinases) and anti-angiogenic factors of the cornea (such as endostatins and neostatins). Further, we review the molecular underpinnings of lymphangiogenesis, a process now known to be almost separate from (yet related to) hemangiogenesis.

Host immune cellular reactions in corneal neovascularization

Corneal neovascularization (CNV) is a global important cause of visual impairment. The immune mechanisms leading to corneal heme- and lymphangiogenesis have been extensively studied over the past years as more attempts were made to develop better prophylactic and therapeutic measures. This article aims to discuss immune cells of particular relevance to CNV, with a focus on macrophages, Th17 cells, dendritic cells and the underlying immunology of common pathologies involving neovascularization of the cornea. Hopefully, a thorough understanding of these topics would propel the efforts to halt the detrimental effects of CNV.

Molecular and clinical implementations of ovarian cancer mouse avatar models

Innovation in oncology drug development has been hindered by lack of preclinical models that reliably predict clinical activity of novel therapies in cancer patients. Increasing desire for individualize treatment of patients with cancer has led to an increase in the use of patient-derived xenografts (PDX) engrafted into immune-compromised mice for preclinical modeling. Large numbers of tumor-specific PDX models have been established and proved to be powerful tools in pre-clinical testing. A subset of PDXs, referred to as Avatars, establish tumors in an orthotopic and treatment naïve fashion that may represent the most clinical relevant model of individual human cancers. This review will discuss ovarian cancer (OC) PDX models demonstrating the opportunities and limitations of these models in cancer drug development, and describe concepts of clinical trials design in Avatar guided therapy.

Clinical correlates of common corneal neovascular diseases: a literature review

A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far.

Inducible nitric oxide synthase promoter polymorphism: a molecular susceptibility marker for vitiligo in Egyptians

BACKGROUND

Vitiligo is a depigmentary disease characterized by loss of melanocytes from the skin and mucous membranes. The pathomechanism of vitiligo is still obscure. Inducible nitric oxide synthase (iNOS) produces very large amounts of nitric oxide (NO). Promotor polymorphisms within iNOS gene have been reported to be associated with overproduction of NO, which may induce melanocyte destruction.

AIM

The current study aimed at investigating the possible association between iNOS gene polymorphism (-954 G/C and Ex 16+14 C/T) and susceptibility to non-segmental vitiligo in a cohort of Egyptians.

METHODS

The study was conducted on 200 participants: 100 patients with vitiligo and 100 aged matched healthy controls. Polymerase chain reaction using restriction fragment length polymorphism method (PCR-RFLP) was used to identify the genotypes.

RESULTS

Our results showed that iNOS -954 G/C heteromutant genotype (GC) was associated with increased risk of vitiligo (OR = 3.35, 95% CI = 1.77-6.33), and the risk increased when confined to females (OR = 7.4, 95% CI = 2.80-19.40). iNOS Ex 16 + 14 C/T heteromutant genotype (CT) conferred two folds increased risk of vitiligo (OR = 2.47, 95% CI = 1.39-4.37). Furthermore, the risk of vitiligo increased when the heteromutant genotype of iNOS -954 G/C (GC) was co-inherited with the wild genotype of iNOS Ex16+14 C/T (CC) (OR = 23.2, 95% CI = 3.04-177.21).

CONCLUSIONS

Inducible nitric oxide synthase -954 G/C and Ex 16+14 C/T might be considered as genetic susceptibility markers for non-segmental vitiligo among Egyptians.

Ligneous conjunctivitis with oral mucous membrane involvement and decreased plasminogen level

Ligneous conjunctivitis (MIM 217090) is a rare autosomal recessive hereditary disorder. We report a case with both ligneous conjunctivitis and ligneous periodontitis in association with plasminogen type I deficiency. Diagnosis was based on the clinical and histological findings and most importantly, decreased serum level of plasminogen type I.

A new enrichment model for high sensitivity detection and downstream analyses of circulating tumor cells in breast cancer patients

Abstract #4162

The detection of circulating tumor cells (CTCs) in breast cancer patients have the potential to improve prognostication and the monitoring of response to treatment. Most CTC enrichment technologies are based on binding to anti-EpCAM antibodies. The sensitivity of such assays is limited by tumors that express no or undetectable levels of EpCAM. Improvements in CTC detection coupled with the development of systems to interrogate CTCs for therapeutic target expression could lead to novel applications for patient monitoring, clinical diagnosis and treatment. In this study, we describe a sensitive and reproducible enrichment method for CTCs. We defined cells as circulating tumor cells with three criteria: Positive for cytokeratin (CK+) and DAPI (nuclear) (DAPI+) and negative staining for CD45 (CD45-). We have previously reported that this system has a higher sensitivity for circulating tumor cell detection and provides a better platform for CTC downstream analyses compare to the methods currently available in the market. Herein, we describe the use of this platform for the evaluation of breast cancer biomarkers in CTCs. Blood samples from patients with metastatic breast cancer were used for CellSearch™ assay (Veridex , LLC ) and our CTC assay (A1000 CTC enrichment and detection kit, Genetix). We performed the CTC enrichment assay using the combination of anti-CK and anti-EpCAM antibodies. CTCs were identified with brightfield and fluorescence labeled anti-CK, anti-CD45 and DAPI (nuclear stain) images. The Ariol® system (Applied Imaging Corporation) was employed for automated cell image capture and analysis of CTCs on glass slides. CTCs enriched on the glass slides were used for CTC downstream analysis. Our CTC enrichment model is designed to have the capability to enrich all the three types of CTCs including CK+ & EpCAM+, CK+ & EpCAM-/low and CK-/low & EpCAM+ cells. Compared to the enrichment methods using anti-EpCAM or anti-cytokeratin antibody alone, a higher CTC detection rate and a larger dynamic CTC detected range were obtained with our new enrichment model. Interestingly there were clear CTC number differences with enrichment methods in the higher CTC count patient samples which indicate that the different enrichment methods may enrich different types of CTCs from patient blood samples.&#x2028; Results of DNA and RNA FISH analyses on enriched CTCs indicate that the CTCs on glass slides can be used for its downstream analyses directly or indirectly. Our method may have better performance on enrichment of heterogeneous CTCs and provide a better platform for CTCs profiling for biomarker evaluations and CTC downstream analyses.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4162.

Characterization of midgut and salivary gland proteins of Hyalomma dromedarii females controlled by entomopathogenic nematodes

Biological control of hard ticks, Hyalomma dromedarii (Acari: Ixodidae) using entomopathogenic nematode of two families; Heterorhabditidae and Steinernematidae was studied. The protective effect of controlled ticks including haemolymph and haemocytes against these biological agents were also investigated. It was found that heterorhabditid strains cause a higher effect in biological control of engorged female H. dromedarii than those of stienernematid strains. It induced mortality rates ranged from 12-92% versus 4-88% for stienernematid strains. It was also found that these entomopathogenic nematodes can not reproduce within the exposed ticks. SDS-PAGE of proteins extracted from midguts and salivary glands infected with 4000 IJs tick(-1) separated 21 and 25 protein bands versus 13 and 19 protein bands from non-infected ones, respectively. It was concluded that entomopathogenic nematodes of family Heterorhabditidae proved to have a potential acaricidal effect in the control of hard ticks. Moreover, the controlled ticks released unknown proteins in their haemolymph that may promote the haemocytes to phagocyte the nematodes as a type of defense mechanism.

Vitiligo vs. hypopigmented mycosis fungoides (histopathological and immunohistochemical study, univariate analysis)

Vitiligo is a common skin disease characterized by the presence of well circumscribed, depigmented milky white macules devoid of identifiable melanocytes. On the other hand, hypopigmented mycosis fungoides (MF) is a rare variant of MF which presents clinically as persistent hypopigmented macules and patches. Both disorders show a predominance of CD8+ T cells in tissue samples and hence the differentiation between the two diseases on clinical, histopathological and even immunohistochemical grounds may offer great difficulty. The aim of this work is to identity certain histopathological clues which might help to differentiate between the two diseases. The study included 54 patients (26 vitiligo patients and 28 patients with Hypopigmented MF). Skin biopsies were taken and examined by hematoxylin and eosin and CD3, CD4 and CD8 markers were performed for ten vitiligo and nine MF patients. We have found that epidermotropism, hydropic degeneration of basal cells, partial loss of pigment, preservation of some melanocytes, presence of lymphocytes within the papillary dermis, increased density of the dermal infiltrate and wiry fibrosis of the papillary dermal collagen were detected with a significantly higher incidence in hypopigmented MF rather than vitiligo (P-values < 0.0001, < 0.00011, < 0.00011, = 0.001, = 0.008 and = 0.001 respectively). On the other hand, focal thickening of the basement membrane, complete loss of pigmentation, total absence of melanocytes, as well as absence or sparsness of lymphocytes in the dermal papillae were seen much more frequently in vitiligo. Statistical analysis of these differences was significant with P-values < 0.00011, < 0.00011, < 0.00011, = 0.008 respectively, regarding these pathological criteria. We conclude that differentiation of hypopigmented MF from vitiligo is possible by relying on the histopathological clues described in this study. This is particularly useful in areas of the world where cost benefit is crucial.

In vitro acaricidal effect of plant extract of neem seed oil (Azadirachta indica) on egg, immature, and adult stages of Hyalomma anatolicum excavatum (Ixodoidea: Ixodidae)

Effects of the plant extract of neem seed (Azadirachta indica) on eggs, immature, and adult stages of Hyalomma anatolicum excavatum was studied at concentrations of 1.6, 3.2, 6.4, and 12.8%. The extract was found to have a significant effect on the hatching rate of eggs. It significantly increased the hatching rate during the first 7 days post-treatment (DPT) giving incompletely developed and dead larvae; however, it cause hatching failure at DPT 15. Neem Azal F induced a significant increased in mortality rates of newly hatched larvae, unfed larvae, and unfed adults reaching 100% on 15th, 3rd, and 15th DPT, respectively. The mortality rates increased with the extract concentrations. Although, it had no significant effect on the moulting rates of fed nymphs, it caused malformation or deformities in 4% of adults moulted. It was concluded that the concentration of Neem Azal F which may be used for commercial control of this tick species were 1.6 and 3.2%.

Localization and migration route of Cephalopina titillator (Diptera: Oestridae) larvae in the head of infested camels (Camelus dromedarius)

The localization and migration routes of Cephalopina titillator larvae were studied in the heads of 45 naturally infested camels. Larvae were located in the pharyngeal cavity (95.6%), the labyrinth of the ethmoid bone (71.1%), the turbinates (28.9%) and the lower nasal meatus (6.7%). Out of 261 first-instar larvae, 73.7% were found in the labyrinth of the ethmoid bone and 26.3% in the turbinates, while 88.9% of second-instar larvae were observed in the pharyngeal cavity and 11.1% in the labyrinth of the ethmoid bone. Most third-instar larvae (91.9%) were found in the pharyngeal cavity, with a few larvae in the labyrinth of the ethmoid bone (6.5%) and lower nasal meatus (1.6%). The first moult occurred in the labyrinth of the ethmoid bone. The second moult was observed in both the labyrinth of ethmoid bone and the pharyngeal cavity. The migration route of these larvae in the infested head was discussed.

Pig, donkey and buffalo meat as a source of some coccidian parasites infecting dogs

Experimental infection of dogs with meat samples (oesophagus, heart and diaphragm) from each of 105 pigs, 11 donkeys and 17 Egyptian water buffaloes indicated that they contained the infective stages of some coccidian parasites of dogs. The dogs which were fed pig meat shed in their faeces Isospora ohioensis, I. canis oocysts and Sarcocystis miescheriana sporocysts after prepatent periods of 3-5, 4-7 and 9-10 days, respectively. The dogs which were fed donkey meat excreted only I. ohioensis oocysts and Sarcocystis bertrami sporocysts after prepatent periods of 3 and 11 days, respectively. However, the dogs which were fed buffalo meat shed in their faeces I. ohioensis, I. canis and Hammondia heydorni oocysts with prepatent periods of 1, 1 and 7 days, respectively.

Studies on Rhinoestrus purpureus (Diptera: Oestridae) larvae infesting donkeys (Equus asinus) in Egypt. III. Pupal duration under controlled conditions

The pupal duration of Rhinoestrus purpureus was studied under variable degrees of temperature and relative humidity (RH). It was found that pupal duration was affected by temperature but not by RH. An increase in the temperature above 22 degrees C decreased the pupal duration: 26-27 days at 22 degrees C, 16-24 days at 27 degrees C, 13-15 days at 32 degrees C. At 37 degrees C, the pupated larvae failed to pupate and died. The deformity ratio of emerged flies was 25-30% at 22-32 degrees C, but it was directly proportional to RH at a constant temperature of 32 degrees C: 26.1% at 75% RH, 16.7% at 50% RH, 6.7% at 30% RH. It was concluded that the optimum temperature and RH for obtaining normal active flies were 32 degrees C and 30%, respectively.

The bulbocavernosus reflex in urology: a prospective study of 299 patients

Bulbocavernosus reflex was evaluated clinically in 299 patients during a routine urodynamic evaluation and compared to the electromyographic demonstration of the reflex. The findings were correlated with the neurologic status of the patients. There were 127 patients who were normal neurologically, and 98 per cent of the male and 81 per cent of the female patients in this group had a normal bulbocavernosus reflex clinically. All of the male and 92 per cent of the female patients had a bulbocavernosus reflex demonstrated by electromyography. There were 73 patients with neurologic lesions involving the sacral spinal cord. All patients with a complete lesion had absent bulbocavernosus reflexes clinically and on electromyography, while 44 per cent of the patients with incomplete sacral lesions had an intact bulbocavernosus reflex clinically and 78 per cent had reflex demonstrated by electromyography. There were 99 patients with neurologic lesions of the spinal cord above the sacral outflow, and 90 per cent of this group had demonstrable bulbocavernosus reflexes clinically and 93 per cent had the reflex demonstrated by electromyography. It is concluded that the absence of a bulbocavernosus reflex in a male patient is indicative of a neurologic lesion involving the sacral spinal cord and is highly suggestive of such a lesion in a female patient. The presence of a normal bulbocavernosus reflex in either sex does not rule out the possibility of a significant lesion. The electromyographic demonstration of the bulbocavernosus reflex is more sensitive than the clinical one.

Detrusor-external sphincter dyssynergia

Detrusor-external sphincter dyssynergia is characterized by involuntary contractions of the external urethral sphincter during detrusor contractions. A review of 550 consecutive patients who underwent urodynamic evaluation revealed that this condition was found only in patients who had involuntary detrusor contractions owing to well defined neurologic lesions of the suprasacral spinal cord. All patients with supracervical neurologic lesions had synergistic voiding patterns. We conclude that bladder-external sphincter dyssynergia is a neurologic condition owing to interruption of the spinal pathways connecting the pontine mesencephalic and the sacral micturition centers. In the absence of such a neurologic lesion one should be extremely cautious in making this diagnosis.

Detrusor-external sphincter dyssynergia: a detailed electromyographic study

We reviewed 54 cases of detrusor-external sphincter dyssynergia following complete urodynamic evaluations. All patients had well defined neurologic lesions of the suprasacral spinal cord. On the basis of urodynamic findings 3 types of dyssynergia were encountered: type 1 (30 per cent) was characterized by a crescendo increase in electromyographic activity that reached a maximum at the peak of the detrusor contraction, type 2 (15 per cent) consisted of clonic sphincter contractions interspersed throughout the detrusor contraction and type 3 (55 per cent) was characterized by a sustained sphincter contraction that coincided with the detrusor contraction. There was no correlation between the clinical neurologic level and the type of dyssynergia.

Cystometric response to propantheline in detrusor hyperreflexia: therapeutic implications

We studied 42 patients with urinary incontinence who demonstrated uninhibited detrusor contractions during cystometry. Each patient underwent urodynamic evaluation before and after the parenteral administration of propantheline bromide. Of these 42 patients 33 (79 per cent) had a positive response to propantheline: total abolition of uninhibited bladder contractions or 200 per cent increase in bladder capacity. Of these 33 patients 26 were treated with the oral drug and all but 1 had complete clinical response. Urinary retention occurred in half of the patients. These patients were managed with intermittent self-catheterization in addition to oral propantheline. None of the patients who failed to respond to the parenteral medication had a favorable response to the orally administered drug.

Failure of bethanechol denervation supersensitivity as a diagnostic aid

A total of 33 patients who demonstrated detrusor areflexia during cystometry underwent the bethanechol denervation supersensitivity test. In each instance the presence or absence of a neurologic lesion was documented carefully by complete neurologic evaluation. Of the 21 patients with a neurogenic bladder there was a falsely negative rate of 24 per cent. Of the 12 patients without a neurogenic bladder the falsely positive rate was 50 per cent. It is concluded that a positive bethanechol test is not by itself indicative of neurogenic bladder nor does a negative test exclude this diagnosis.