Prevalence data for total corneal astigmatism in cataract patients

PURPOSE

To report the prevalence data for total corneal astigmatism (TCA) in cataract patients.

METHODS

The authors retrospectively collected and analyzed the preoperative biometric data of the patients who underwent cataract surgery in the Department of Ophthalmology, Peking University Third Hospital, from January 2019 to May 2023.

RESULTS

The mean age of the 10817 patients was 71 ± 10 years; the male/female ratio was 4653/6164. The mean TCA obtained by the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany), the Abulafia-Koch (AK) formula, and the Barrett toric calculator was 1.11 ± 0.81 diopter (D), 1.13 ± 0.75 D, and 1.12 ± 0.74 D respectively, which was significantly greater than the mean standard keratometric (K) astigmatism (0.99 ± 0.75 D) obtained by IOLMaster 700. Against-the-rule (ATR) astigmatism was dominant in all the TCA measurements, and its proportion increased with age. TCA measurements by different methods exhibit high variability, with a total of 1574 (8.9%) data sets from 1016 (9.4%) patients showing a difference larger than 0.5 D in at least one pair of TCA measurements.

CONCLUSION

The use of TCA rather than K astigmatism significantly influenced the choice of intraocular lenses (IOLs) as more patients would be candidates for toric IOLs. It was essential to carefully compare and select TCA obtained with multiple methods for optimal postoperative visual quality.

Protocol to examine immune subpopulations in murine conjunctiva and lacrimal gland using flow cytometry

Here, we present a protocol for the examination of immune cells in the murine conjunctiva and lacrimal gland using flow cytometry. We describe steps for dissection, preparation of high-quality single-cell suspensions, utilization of comprehensive staining panels, and optimization of flow cytometry voltage. We then detail procedures for compensation adjustments and the implementation of effective gating strategies. For complete details on the use and execution of this protocol, please refer to Ma et al.1.

Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Male Wistars and P Rats

Problematic alcohol consumption is associated with deficits in decision-making and alterations in prefrontal cortex neural activity likely contribute. We hypothesized that the differences in cognitive control would be evident between male Wistars and a model of genetic risk: alcohol-preferring P rats. Cognitive control is split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus, whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol seeking whereas P rats would show reactive control over alcohol seeking. Neural activity was recorded from the prefrontal cortex during an alcohol seeking task with two session types. On congruent sessions, the conditioned stimulus (CS+) was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, made more incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned rule. This motivated the hypothesis that neural activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times of alcohol access, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage in proactive cognitive control strategies whereas P rats are more likely to engage in reactive cognitive control strategies. Although P rats were bred to prefer alcohol, the differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.

Analysis of Clinical Characteristics and Neuropeptides in Patients with Dry Eye with and without Chronic Ocular Pain after FS-LASIK

INTRODUCTION

Chronic ocular pain, particularly prevalent in patients with dry eye disease and post-femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) surgery, presents with unclear clinical characteristics and an undefined pathogenesis. In this study, we aimed to compare clinical characteristics and tear neuropeptide concentrations in patients with dry eye disease (DED) with and without chronic ocular pain following FS-LASIK, and investigate correlations between ocular pain, clinical characteristics, and tear neuropeptide levels.

METHODS

Thirty-eight post-FS-LASIK patients with DED were assigned to two groups: those with chronic ocular pain and those without chronic ocular pain. Dry eye, ocular pain, and mental health-related parameters were evaluated using specific questionnaires and tests. The morphology of corneal nerves and dendritic cells (DCs) was evaluated by in vivo confocal microscopy. Function of corneal innervation was evaluated by corneal sensitivity. Concentrations of tear cytokines (interleukin [IL]-6, IL-23, IL-17A, and interferon-γ) and neuropeptides (α-melanocyte-stimulating hormone, neurotensin, β-endorphin, oxytocin, and substance P [SP]) were measured using the Luminex assay.

RESULTS

Most patients with chronic ocular pain experienced mild to moderate pain; the most common types included stimulated pain (provoked by wind and light), burning pain, and pressure sensation. More severe dry eye (P < 0.001), anxiety symptoms (P = 0.026), lower Schirmer I test values (P = 0.035), lower corneal nerve density (P = 0.043), and more activated DCs (P = 0.041) were observed in patients with ocular pain. Tear concentrations of SP and oxytocin were significantly higher in patients with ocular pain (P = 0.001, P = 0.021, respectively). Furthermore, significant correlations were observed among ocular pain severity, SP, and anxiety levels.

CONCLUSIONS

Patients with DED after FS-LASIK who have chronic ocular pain show more severe ocular and psychological discomfort and higher tear levels of neuropeptides. Furthermore, ocular pain severity is correlated with tear SP levels.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05600985.

Efficacy of topical 0.05% cyclosporine A and 0.1% sodium hyaluronate in post-refractive surgery chronic dry eye patients with ocular pain

BACKGROUND

The management of post-refractive surgery dry eye disease (DED) can be challenging in clinical practice, and patients usually show an incomplete response to traditional artificial tears, especially when it is complicated with ocular pain. Therefore, we aim to investigate the efficacy of combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate treatment in post-refractive surgery DED patients with ocular pain unresponsive to traditional artificial tears.

METHODS

We enrolled 30 patients with post-refractive surgery DED with ocular pain who were unresponsive to traditional artificial tears. Topical 0.05% cyclosporine A and 0.1% sodium hyaluronate were used for 3 months. They were evaluated at baseline and 1 and 3 months for dry eye and ocular pain symptoms and objective parameters, including Numerical Rating Scale (NRS), Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), tear break-up time (TBUT), Schirmer I test (SIt), corneal fluorescein staining (CFS), corneal sensitivity, and corneal nerve morphology. In addition, tear levels of inflammatory cytokines and neuropeptides were measured using the Luminex assay.

RESULTS

After 3 months of treatment, patients showed a statistically significant improvement in the ocular surface disease index (OSDI), TBUT, SIt, CFS, and corneal sensitivity (all P < 0.01) using linear mixed models. As for ocular pain parameters, the NRS and NPSI-Eye scores were significantly reduced (both P < 0.05) and positively correlated with the OSDI and CFS scores. Additionally, tear IL-1β, IL-6, and TNF-α levels were improved better than pre-treatment (P = 0.01, 0.03, 0.02, respectively).

CONCLUSION

In patients with post-refractive surgery DED with ocular pain, combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate treatment improved tear film stability, dry eye discomfort, and ocular pain, effectively controlling ocular inflammation.

TRIAL REGISTRATION

Registration number: NCT06043908.

Interpretable Detection of Diabetic Retinopathy, Retinal Vein Occlusion, Age-Related Macular Degeneration, and Other Fundus Conditions

Diabetic retinopathy (DR), retinal vein occlusion (RVO), and age-related macular degeneration (AMD) pose significant global health challenges, often resulting in vision impairment and blindness. Automatic detection of these conditions is crucial, particularly in underserved rural areas with limited access to ophthalmic services. Despite remarkable advancements in artificial intelligence, especially convolutional neural networks (CNNs), their complexity can make interpretation difficult. In this study, we curated a dataset consisting of 15,089 color fundus photographs (CFPs) obtained from 8110 patients who underwent fundus fluorescein angiography (FFA) examination. The primary objective was to construct integrated models that merge CNNs with an attention mechanism. These models were designed for a hierarchical multilabel classification task, focusing on the detection of DR, RVO, AMD, and other fundus conditions. Furthermore, our approach extended to the detailed classification of DR, RVO, and AMD according to their respective subclasses. We employed a methodology that entails the translation of diagnostic information obtained from FFA results into CFPs. Our investigation focused on evaluating the models' ability to achieve precise diagnoses solely based on CFPs. Remarkably, our models showcased improvements across diverse fundus conditions, with the ConvNeXt-base + attention model standing out for its exceptional performance. The ConvNeXt-base + attention model achieved remarkable metrics, including an area under the receiver operating characteristic curve (AUC) of 0.943, a referable F1 score of 0.870, and a Cohen's kappa of 0.778 for DR detection. For RVO, it attained an AUC of 0.960, a referable F1 score of 0.854, and a Cohen's kappa of 0.819. Furthermore, in AMD detection, the model achieved an AUC of 0.959, an F1 score of 0.727, and a Cohen's kappa of 0.686. Impressively, the model demonstrated proficiency in subclassifying RVO and AMD, showcasing commendable sensitivity and specificity. Moreover, our models enhanced interpretability by visualizing attention weights on fundus images, aiding in the identification of disease findings. These outcomes underscore the substantial impact of our models in advancing the detection of DR, RVO, and AMD, offering the potential for improved patient outcomes and positively influencing the healthcare landscape.

Transmembrane Protein CMTM6 Alleviates Ocular Inflammatory Response and Improves Corneal Epithelial Barrier Function in Experimental Dry Eye

Purpose

To investigate the impact of transmembrane protein CMTM6 on the pathogenesis of dry eye disease (DED) and elucidate its potential mechanisms.

Methods

CMTM6 expression was confirmed by database analysis, real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemistry. Tear secretion was measured using the phenol red thread test. Immune cell infiltration was assessed through flow cytometry. Barrier function was evaluated by fluorescein sodium staining, immunofluorescence staining of zonula occludens 1 (ZO-1), and electric cell-substrate impedance sensing (ECIS) assessment. For silencing CMTM6 expression, siRNA and shRNA were employed, along with lentiviral vector-mediated overexpression of CMTM6. Proinflammatory cytokine levels were analyzed by RT-PCR and cytometric bead array (CBA) analysis.

Results

CMTM6 showed high expression in healthy human and mouse corneal and conjunctival epithelium but was notably reduced in DED. Notably, this downregulation was correlated with disease severity. Cmtm6-/- dry eye (DE) mice displayed reduced tear secretion, severe corneal epithelial defects, decreased conjunctival goblet cell density, and upregulated inflammatory response. Additionally, Cmtm6-/- DE mice and CMTM6 knockdown human corneal epithelial cell-transformed (HCE-T) cells showed more severe barrier disruption and reduced expression of ZO-1. Knockdown of CMTM6 in HCE-T cells increased inflammatory responses induced by hyperosmotic stress, which was significantly mitigated by CMTM6 overexpression. Moreover, the level of phospho-p65 in hyperosmolarity-stimulated HCE-T cells increased after silencing CMTM6. Nuclear factor kappa B (NF-κB) p65 inhibition (JSH-23) reversed the excessive inflammatory responses caused by hyperosmolarity in CMTM6 knockdown HCE-T cells.

Conclusions

The reduction in CMTM6 expression on the ocular surface contributes to the pathogenesis of DED. The CMTM6-NF-κB p65 signaling pathway may serve as a promising therapeutic target for DED.

Comparison of binocular visual quality in six treatment protocols for bilateral cataract surgery with presbyopia correction: a prospective two-center single-blinded cohort study

OBJECTIVE

To compare the postoperative binocular visual quality in six treatment protocols for bilateral age-related cataract surgery with presbyopia correction for clinical decisions.

MATERIALS AND METHODS

In this prospective two-center single-blinded cohort study, participants from North or South China who underwent bilateral phacoemulsification and intraocular lens implantation were divided into six protocols: monovision, diffractive bifocal, mixed, refractive bifocal, trifocal, and micro-monovision extended range of vision (EROV). Binocular visual quality was evaluated at 3 months postoperatively, including binocular uncorrected full-range visual acuity, binocular defocus curves (depth of focus [DoF] and area under the curve [AUC]), binocular visual function (fusion function and stereopsis), binocular subjective spectacle independence rates, visual analog scale (VAS) of overall satisfaction, 25-item visual function questionnaire (VFQ-25), and binocular dysphotopsia symptoms.

RESULTS

Of the 300 enrolled patients, 272 (90.7%; 544 eyes) were analyzed. The trifocal protocol showed excellent binocular full-range visual acuity and the best performance for most DoFs and AUCs. The monovision protocol presented the worst binocular visual quality in most perspectives, especially in convergence, distance, and near stereopsis (p < 0.001). The full-range subjective spectacle independence rates were sorted from highest to lowest as follows: trifocal (84.8%), refractive bifocal (80.9%), EROV (80.0%), mixed (73.3%), diffractive bifocal (65.2%), and monovision (32.6%) protocols, with no statistically significant differences between the former five protocols (p > 0.05). The EROV protocol achieved the highest VAS and VFQ-25 scores. The incidence of postoperative binocular dysphotopsia symptoms was comparable in all protocols.

CONCLUSIONS

The trifocal protocol showed the best performance, and the monovision protocol presented the worst performance in most perspectives of binocular visual quality for presbyopia correction. The refractive bifocal, mixed, or EROV protocols can provide an approximate performance as a trifocal protocol. Ophthalmologists can customize therapies using different protocols.

Clinical Characteristics and Tear Film Biomarkers in Patients With Chronic Dry Eye Disease After Femtosecond Laser-Assisted Laser in Situ Keratomileusis

PURPOSE

To investigate clinical characteristics and tear film biomarkers of patients with chronic dry eye disease (DED) following femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).

METHODS

Patients were divided into the chronic DED after FS-LASIK (n = 36), DED without FS-LASIK (n = 39), and normal control (without FS-LASIK; n = 34) groups. Dry eye, pain, and psychological-related symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Numerical Rating Scale (NRS), Neuropathic Pain Symptom Inventory Modified for the Eye (NPSI-Eye), and Hamilton Anxiety Rating Scale (HAMA) questionnaires. Ocular surface parameters, tear cytokines, and neuropeptide concentrations were evaluated with specific tests.

RESULTS

The DED after FS-LASIK group showed higher corneal fluorescein staining scores, but lower OSDI and NPSI-Eye scores than the DED without FS-LASIK group (all P < .05). Corneal sensitivity and nerve density decreased in the DED after FS-LASIK group (all P < .01). Granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-17A, IL-23, alpha-melanocyte stimulating hormone (α-MSH), oxytocin, and substance P levels were highest in the DED after FS-LASIK group, followed by the DED without FS-LASIK and normal control groups (all P < .05). Interferon-γ and neurotensin levels were only significantly higher in the DED after FS-LASIK group (all P < .05).

CONCLUSIONS

Patients with chronic DED after FS-LASIK showed milder ocular symptoms, greater epithelial damage, and higher levels of tear inflammatory cytokines and neuropeptides than patients with DED without FS-LASIK, indicating that the nervous and immune systems may play significant roles in FS-LASIK-related chronic DED development. [J Refract Surg. 2023;39(8):556-563.].

Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Wistar and P rats

Problematic alcohol consumption is associated with deficits in decision-making, and alterations in prefrontal cortex neural activity likely contributes. We hypothesized that differences in cognitive control would be evident between male Wistar rats and a model for genetic risk for alcohol use disorder (alcohol-preferring P rats). Cognitive control can be split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol-seeking whereas P rats would show reactive control over alcohol-seeking. Neural ensembles were recorded from prefrontal cortex during an alcohol seeking task that utilized two session types. On congruent sessions the CS+ was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, exhibited an increase in incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned task-rule. This motivated the hypothesis that ensemble activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times relevant for alcohol delivery, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage proactive cognitive-control strategies whereas P rats are more likely to engage reactive cognitive control strategies. Although P rats were bred to prefer alcohol, differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.

Comparison of mucin levels at the ocular surface of visual display terminal users with and without dry eye disease

BACKGROUND

The long-term use of visual display terminals (VDT) is linked to an increased risk of dry eye disease (DED). Numerous studies have indicated that ocular mucins play a vital role in the pathogenesis of DED. Therefore, we aimed to evaluate (1) whether mRNA levels of membrane-associated mucins (MAMs), including MUC1, MUC4, MUC16, and MUC20, as well as MUC5AC are altered in conjunctival cells of VDT users with and without DED and (2) the relationship between mucin levels and subjective and objective tests of DED in VDT users.

METHODS

Seventy-nine VDT users were enrolled and divided into DED (n = 53) and control (n = 26) groups. All participants were evaluated for parameters of DED using the Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time (TBUT), corneal fluorescein staining (CFS), lissamine green (LG) staining, and tear meniscus height (TMH). Based on the conjunctival impression cytology (CIC) method, differences in MUC1, MUC4, MUC16, MUC20, and MUC5AC mRNA expression levels were observed between the DED and control groups, and between symptomatic and asymptomatic participants.

RESULTS

The DED group showed significantly decreased MUC1, MUC16, and MUC20 expressions (all P < 0.05) compared to the control group. In addition, these mucin levels were lower in subjects with frequent ocular symptoms (foreign body sensation, blurred vision and painful or sore eyes) than in asymptomatic participants (all P < 0.05). Correlation analysis revealed that MUC1, MUC16, and MUC20 levels in VDT users were positively correlated with TBUT or TMH, or both. However, no significant relationship was found between MUC4 and MUC5AC levels and the DED parameters.

CONCLUSION

VDT users with an increased frequency of ocular discomfort or a diagnosis of DED had a decreased MUC1, MUC16 and MUC20 mRNA expression in their conjunctival cells. MAMs deficiency in the conjunctival epithelium may be one of the mechanisms leading to tear film instability and DED in VDT users.

Safety and clinical activity of atezolizumab plus erlotinib in patients with non-small-cell lung cancer

BACKGROUND

Acquired resistance limits long-term epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) efficacy in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC) in whom anti-programmed death-ligand 1 (PD-L1) efficacy is also limited. We hypothesized that combining atezolizumab with erlotinib could enhance antitumor immunity and extend efficacy in these patients.

PATIENTS AND METHODS

This open-label phase Ib trial was conducted in adults aged ≥18 years who had advanced, unresectable NSCLC. Stage 1 (safety evaluation) enrolled EGFR TKI-naive patients regardless of EGFR status. Stage 2 (expansion) enrolled patients with EGFR-mutant NSCLC treated with ≤1 prior non-EGFR TKI therapy. Patients received 150 mg erlotinib orally once daily. After a 7-day erlotinib run-in, atezolizumab 1200 mg was administered intravenously every 3 weeks. The primary endpoint was the safety and tolerability of the combination in all patients; secondary endpoints included antitumor activity per RECIST 1.1 in stage 2 patients.

RESULTS

At the data cut-off on 7 May 2020, 28 patients (8 in stage 1, 20 in stage 2) were assessable for safety. No dose-limiting toxicities or grade 4 or 5 treatment-related adverse events occurred. Grade 3 treatment-related adverse events occurred in 46% of patients; the most common were increased alanine aminotransferase, diarrhea, pyrexia, and rash (each in 7% of patients). Serious adverse events occurred in 50% of patients. Pneumonitis (grade 1) was reported in a single patient (4%). The objective response rate was 75% [95% confidence interval (CI) 50.9% to 91.3%]), median response duration was 18.9 months (95% CI 9.5-40.5 months), median progression-free survival was 15.4 months (95% CI 8.4-39.0 months), and median overall survival was not estimable (NE) (95% CI 34.6-NE).

CONCLUSIONS

Atezolizumab combined with erlotinib demonstrated a tolerable safety profile and encouraging, durable clinical activity in patients with advanced EGFR mutation-positive NSCLC.

[Observational study on perioperative outcomes of pelvic exenteration]

Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.

Mapping Resident Immune Cells in the Murine Ocular Surface and Lacrimal Gland by Flow Cytometry

BACKGROUND

The ocular surface and lacrimal gland have a frontline position in mucosal immunology. However, there have been few updates to the immune cell atlas of these tissues in recent years.

PURPOSE

To map the immune cells in murine ocular surface tissues and lacrimal gland.

METHODS

Central and peripheral corneas, conjunctiva, and lacrimal gland were dissociated into single cell suspensions, followed by flow cytometry. Discrepancy of immune cells between the central and peripheral corneas was compared. In the conjunctiva and lacrimal gland, myeloid cells were clustered by tSNE and FlowSOM based on the expression of F4/80, Ly6C, Ly6G, and MHC II. ILCs, type 1 immune cells, and type 3 immune cells were analyzed.

RESULTS

The number of immune cells in peripheral corneas was about 16 folds of that in central corneas. B cells accounted for 8.74% of immune cells in murine peripheral corneas. In the conjunctiva and lacrimal gland, most myeloid cells tended out to be monocytes, macrophages, and classical dendritic cells (cDCs). ILC3 were 6.28% and 3.63% of ILCs in the conjunctiva and lacrimal gland, respectively. Th1, Tc1, and NK cells were predominant type 1 immune cells. γδ T17 cells and ILC3 outnumbered Th17 cells among type 3 T cells.

CONCLUSION

B cells resident in murine corneas were reported for the first time. Additionally, we proposed a strategy of clustering myeloid cells to better understand their heterogeneity in the conjunctiva and lacrimal gland based on tSNE and FlowSOM. Furthermore, we identified the ILC3 in the conjunctiva and lacrimal gland for the first time. Compositions of type 1 and type 3 immune cells were summarized. Our study provides a fundamental reference and novel insights for ocular surface immune homeostasis and diseases.

Porphyromonas gingivalis Evades Immune Clearance by Regulating Lysosome Efflux

Porphyromonas gingivalis, a major periodontal pathogen, invades autophagosomes of cells, including gingival epithelial cells, endothelial cells, gingival fibroblasts, macrophages, and dendritic cells, to escape antimicrobial autophagy and lysosome fusion. However, it is not known how P. gingivalis resists autophagic immunity, survives within cells, and induces inflammation. Thus, we investigated whether P. gingivalis could escape antimicrobial autophagy by promoting lysosome efflux to block autophagic maturation, leading to intracellular survival, and whether the growth of P. gingivalis within cells results in cellular oxidative stress, causing mitochondrial damage and inflammatory responses. P. gingivalis invaded human immortalized oral epithelial cells in vitro and mouse oral epithelial cells of gingival tissues in vivo. The production of reactive oxygen species (ROS) increased upon bacterial invasion, as well as mitochondrial dysfunction-related parameters with downregulated mitochondrial membrane potential and intracellular adenosine triphosphate (ATP), upregulated mitochondrial membrane permeability, intracellular Ca²⁺ influx, mitochondrial DNA expression, and extracellular ATP. Lysosome excretion was elevated, the number of intracellular lysosomes was diminished, and lysosomal-associated membrane protein 2 was downregulated. Expression of autophagy-related proteins, microtubule-associated protein light chain 3, sequestosome-1, the NLRP3 inflammasome, and interleukin-1β increased with P. gingivalis infection. P. gingivalis may survive in vivo by promoting lysosome efflux, blocking autophagosome-lysosome fusion, and destroying autophagic flux. As a result, ROS and damaged mitochondria accumulated and activated the NLRP3 inflammasome, which recruited the adaptor protein ASC and caspase 1, leading to the production of proinflammatory factor interleukin-1β and inflammation.

Characteristics of vertical drop jump to screen the anterior cruciate ligament injury

OBJECTIVE

To clarify the characteristics of vertical drop jump (VDJ) for screening athletes at high risk of ACL injury by comparing the kinematic, kinetic and electromyographic variables of different VDJ.

SUBJECTS AND METHODS

Thirty male soccer players were recruited to measure parameters of knee kinematics, kinetics, and surface electromyograph during VDJ in four kinds of movements measured (the distance between the take-off feet is 5 cm or 30 cm, and the distance between the landing feet is 5 cm or 30 cm) using the Vicon motion capture system, Kistler3-D dynamometer, and Noraxon surface electromyograph test system.

RESULTS

The peak knee abduction moment was significantly greater for landing feet distance of 30 cm compared to landing feet distance of 5 cm, regardless of whether the distance between take-off feet was 5 cm (0.58 vs. 0.44) or 30 cm (0.61 vs. 0.40); regardless of whether the distance between landing feet was 5 cm (22.78 vs. 20.45) or 30 cm (24.32 vs. 21.87), the peak vertical Ground Reaction Force was significantly increased for the take-off feet distance was 5 cm compared to take-off feet of 30 cm.

CONCLUSIONS

In the test of VDJ, athletes will adopt different landing strategies for different movement instructions, and the VDJ with the distance of 5 cm between the take-off feet and the distance of 30 cm between the landing feet may be the better maneuver to screen for risk of ACL injury.

[Development of a Ranking Tool for Scientificity, Transparency and Applicability of Clinical Practice Guidelines]

Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.

Sleep Duration and Frailty Risk among Older Adults: Evidence from a Retrospective, Population-Based Cohort Study

OBJECTIVES

Frailty and sleep duration complaints are both prevalent and often coexist among older adults. The purpose of this study was to examine the prospective association between sleep duration and frailty risk in a nationally representative cohort study.

DESIGN

Prospective cohort study, ten-year follow-up.

SETTING

Community-based setting in 23 provinces of China.

PARTICIPANTS

A total of 7623 older adults age 65 and over without frailty at baseline were included in the analysis.

MEASUREMENTS

The participants were divided into three groups according to self-reported sleep duration: short (≤6 hours per day), middle (>6 but <10 hours per day) and long (≥10 hours per day). Frailty was measured according to the accumulation of health deficits by the construction of a frailty index of 38 items with 0.25 as the cutoff. A Cox proportional hazard model, a competing risk model and a generalized estimating equation (GEE) model with multiple adjustments were performed to evaluate the association between sleep duration and frailty risk.

RESULTS

During a median follow-up period of 4.4 years (IQR 2.9-9.0), 2531 (33.2%) individuals developed frailty. Compared with participants with middle sleep duration, the risk of frailty was increased among participants with long sleep duration (HR 1.26, 95% CI 1.14-1.38) in the fully adjusted Cox proportional hazard model. However, short sleep duration was insignificantly associated with frailty risk. The competing risk model and the GEE model yielded similar results.

CONCLUSION

Long sleep duration is significantly associated with frailty incidence among older adults even after adjustment for confounding factors. This study provides reinforcing longitudinal evidence for the need to design sleep quality improvement interventions in health care programs to prevent frailty among older adults.

A non-dispersive infrared sensor for real-time detection of cyanogen chloride

Cyanogen chloride, as a systemic toxic agent, can cause death rapidly. In this paper, a non-dispersive infrared sensor was designed for the infrared absorption detection of cyanogen chloride at 800 cm−1. The roughness of the internal coating material was analyzed by experiments, and the gold-plated gas chamber was selected. The light path propagation of different cross-section gas chambers was simulated, and the circular section gas chamber was selected to increase the infrared detector signal. The effect of flow rate on voltage was studied. The standard curve between voltage and concentration was obtained under the optimal condition of 0.4 L min−1. The maximum response time was 19 s, and RSD was less than 2%. The interference experiment results showed that common gases entering the gas chamber do not cause interference. The non-dispersive infrared sensor for cyanogen chloride has good stability and detects cyanogen chloride in real-time.

[Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations]

Objective: To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods: The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results: The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions: NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

Challenges to effective breastfeeding among indigenous Ngäbe-Bugle communities in Panama

Background

Panama's overall infant mortality rate is 13.2 deaths per 1000 live births and 28.4 per 1,000 among indigenous populations such as the Ngäbe-Bugle. 93.8% of the Ngäbe population is impoverished and the cost of formula is prohibitive, resulting in poor substitutes such as cheap sugary beverages. These mothers received little education for breastfeeding and it is understandable why breastmilk ‘alternatives' are used. This study explored factors impeding effective breastfeeding in a representative community-based cohort of indigenous Ngäbe-Bugle mothers. This study used the hypothesis that preventable breastfeeding challenges are common and likely negatively impact infant health.

Methods

We conducted a closed response and open questionnaire survey of 139 selectively sampled Ngäbe women with 529 live births in 2018-2019. Mothers reported the need for support, use of milk substitutes, and breastfeeding complications such as mastitis. Systemic barriers such as poor access to healthcare professionals were also assessed. Data was analyzed with SAS and Power-BI statistical software by independent statisticians.

Results

71% of mothers stated a need for more support. 32% ceased breastfeeding and used milk substitutes. Latching difficulties (2%), pain (3%), sore, cracked, and bleeding nipples (2%), and mastitis (8%) contributed to cessation. 80% reported no formal education on infant feeding and 83% were unaware of breastmilk benefits. 12% received breastfeeding support from healthcare professionals and 2% received it from a village midwife.

Conclusions

Among the Ngabe, lack of knowledge or access to health services contribute to breastfeeding complications and challenges resulting in cessation and the use of poor milk substitutes.

Key messages

Breastfeeding initiation and continuation rates are negatively affected by poor education, poor healthcare access, and complications resulting in breastfeeding cessation and milk substitution. Supporting mothers with community-based education and improved healthcare access seems likely to positively impact these challenges to effective infant nutrition.

Optical quality in patients with dry eye before and after treatment

CLINICAL RELEVANCE

Dry eye disease could result in vision-related subjective symptoms even in patients with good best-corrected visual acuity. The standard deviation of corneal power and the surface asymmetry index could be indicators of treatment efficacy in dry eye.

BACKGROUND

Few studies have examined changes in optical quality before and after dry eye treatment. Here, we evaluated changes in optical quality in patients with dry eye before and after treatment and identified potential indicators of dry eye-treatment efficacy.

METHODS

Twenty-five right eyes of 25 untreated patients with dry eye were included. The same ocular-surface and optical-quality examinations were performed before and after two-weeks of treatment with hyaluronate in conjunction with fluorometholone eye drops. The Ocular Surface Disease Index, tear film break-up time, and corneal fluorescein staining were measured. Contrast sensitivity was used to measure resolution capability, the double-pass Optical Quality Analysis System to examine the modulation transfer function, Strehl ratio, and objective scattering index, and OPD Scan III to measure anterior corneal aberrations over 4-mm analytical zones including total corneal and high-order aberrations. The standard deviation of corneal power, surface regularity index, and surface asymmetry index were also measured. Paired sample t-tests and Spearman's correlations were used for the analyses.

RESULTS

The Ocular Surface Disease Index, tear film break-up time, and corneal fluorescein staining improved after two weeks of treatment. Contrast sensitivity in photopic, photopic with glare, scotopic, and scotopic with glare conditions all improved (p < 0.05), as did the modulation transfer function, Strehl ratio, and objective scattering index (p = 0.001, p = 0.008, and p = 0.001, respectively). Total corneal aberrations and the surface regularity index did not significantly differ before and after treatment; corneal high-order aberrations, standard deviation of corneal power, and the surface asymmetry index significantly improved after treatment (p = 0.045, p = 0.019, and p = 0.049, respectively). Changes in standard deviation of corneal power and in surface asymmetry index correlated with change in corneal fluorescein staining (p = 0.006 and p = 0.007, respectively).

CONCLUSION

Optical quality in patients with dry eye improved after treatment. The standard deviation of corneal power and surface asymmetry index could be indicators of treatment efficacy in dry eye.

[Potential suitable habitats of Haemaphysalis longicornis in China under different climatic patterns]

OBJECTIVE

To evaluate the impact of environmental and climatic factors on the distribution of suitable habitats of Haemaphysalis longicornis, and to predict the potential distribution of H. longicornis under different climate patterns in China.

METHODS

Data pertaining to the distribution of H. longicornis were retrieved from public literatures. The effects of 19 climatic factors (annual mean temperature, annual mean temperature difference between day and night, isothermality, standard deviation of seasonal variation of temperature, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest season, mean temperature of the driest season, mean temperature of the warmest season, mean temperature of the coldest season, annual mean precipitation, precipitation of the wettest month, precipitation of the driest month, coefficient of variance of precipitation, precipitation of the wettest season, precipitation of the driest season, precipitation of the warmest season and precipitation of the coldest season) and 4 environmental factors (elevation, slope, slope aspect and vegetation coverage) on the potential distribution of H. longicornis were assessed using the maximum entropy (MaxEnt) model based on the H. longicornis distribution data and climatic and environmental data, and the potential distribution of H. longicornis was predicted under the RCP 2.6 and 8.5 emissions scenarios.

RESULTS

Among the environmental and climatic factors affecting the geographical distribution of H. longicornis in China, the factors contributing more than 10% to the distribution of H. longicornis mainly included the precipitation of the driest month (26.0%), annual mean temperature (11.2%), annual mean precipitation (10.0%) and elevation (24.2%). Under the current climate pattern, the high-, medium- and low-suitable habitats of H. longicornis are 1 231 900, 1 696 200 km² and 1 854 400 km² in China, respectively. The distribution of H. longicornis increased by 336 100 km² and 367 300 km² in 2050 and 2070 under the RCP 2.6 emissions scenario, and increased by 381 000 km² and 358 000 km² in 2050 and 2070 under the RCP 8.5 emissions scenario in China, respectively.

CONCLUSIONS

Climatic and environmental factors, such as precipitation, temperature and elevation, greatly affect the distribution of H. longicornis in China, and the suitable habitats of H. longicornis may expand in China under different climate patterns in future.

[Distribution and suitable habitats of ticks in the Yangtze River Delta urban agglomeration]

OBJECTIVE

To investigate the current distribution of ticks and predict the suitable habitats of ticks in the Yangtze River Delta urban agglomeration in 2017, so as to provide insights into tick control and management of tick-borne diseases in these areas.

METHODS

All publications pertaining to tick and pathogen distribution in the Yangtze River Delta urban agglomeration were retrieved, and the geographical location of tick distribution was extracted. The effects of 19 climatic factors on the distribution of ticks were examined using the jackknife method, including the mean temperature of the wettest quarter, precipitation of the coldest quarter, mean temperature of the driest quarter, maximum temperature of the warmest month, precipitation of the driest month, minimal temperature of the coldest month, annual precipitation, mean daily temperature range, precipitation seasonality, annual temperature range, temperature seasonality, annual mean temperature, mean temperature of the warmest quarter, precipitation of the wettest quarter, isothermality, mean temperature of the coldest quarter, precipitation of the wettest month, precipitation of the driest quarter and precipitation of the warmest quarter. The distribution of ticks was analyzed in 2020 using the maximum entropy (MaxEnt) model, and the potential suitable habitats of ticks were predicted in 2070 using the MaxEnt model based on climatic data.

RESULTS

A total of 380 Chinese and English literatures were retrieved, and 148 tick distribution sites were extracted, with 135 sites included in the subsequent analysis. There were 7 genera (Haemaphysalis, Rhipicephalus, Ixodes, Dermacentor, Boophilus, Hyalomma and Amblyomma) and 27 species of ticks detected in the Yangtze River Delta urban agglomeration. The climatic factors affecting the distribution of ticks in the Yangtze River Delta urban agglomeration mainly included the mean temperature of the wettest quarter and the precipitation of the coldest quarter, with 26.1% and 23.6% contributions to tick distributions. The high-, medium- and low-suitable habitats of ticks were 20 337.08, 40 017.38 km² and 74 931.43 km² in the Yangtze River Delta urban agglomeration in 2020, respectively. The climate changes led to south expansion of the suitable habitats of ticks in the Yangtze River Delta urban agglomeration in 2070, and the total areas of suitable habitats of ticks was predicted to increase by 18 100 km². In addition, the high-, medium- and low-suitable habitats of ticks were predicted to increase to 24 317.84, 45 283.02 km² and 83 766.38 km² in the Yangtze River Delta urban agglomeration in 2070, respectively.

CONCLUSIONS

Multiple tick species are widespread in the Yangtze River Delta urban agglomeration, and the future climate changes may lead to expansion of tick distribution in these areas.

[Effects of climate changes on the distribution of Rhipicephalus microplus in China]

OBJECTIVE

To identify the environmental factors affecting the geographical distribution of Rhipicephalus microplus in China, and to examine the impact of climate changes on the distribution of R. microplus in China.

METHODS

The national and international publications pertaining to the geographical distribution of R. microplus in China were retrieved, and the geographical location was extracted. The suitable habitats of R. microplus and the dominant environmental factors affecting the distribution of suitable habitats of R. microplus were predicted in China based on the geographical data and environmental variables using the ArcGIS 10.7 software and the maximum entropy model.

RESULTS

Among the main climatic factors affecting the geographical distribution of R. microplus in China, the factors contributing more than 10% to the suitable habitats of R. microplus mainly include the annual mean precipitation (38.2%), the average temperature of the coldest quarter (28.4%) and the precipitation of the driest month (14.2%). The current suitable habitats of R. microplus were mainly found in southern China, and the high-, medium- and low-suitable areas accounted for 8.6%, 13.1% and 10.5% of the total land area of China, respectively. The suitable habitats of R. microplus were predicted to increase by 399 800 km² in China using the maximum entropy model under the RCP 4.5 emissions scenario in 2070, and the emerging suitable habitats were mainly distributed in Gansu Province, Ningxia Hui Autonomous Region, Qinghai Province, Hebei Province, Shaanxi Province, Liaoning Province, Inner Mongolia Autonomous Region, Shandong Province, Sichuan Province and Tibeten Autonomous Region. In addition, the suitable habitats of R. microplus were predicted to show an overall expansion towards northward from present to 2070.

CONCLUSIONS

Climate changes affect the distribution of suitable habitats of R. microplus in China, and annual mean precipitation may be a key factor affecting the distribution of suitable habitats of R. microplus.

[Effects of environmental factors on the distribution of suitable habitats of Ixodes ovatus in China]

OBJECTIVE

To identify the environmental factors affecting the distribution of suitable habitats of Ixodes ovatus, and to examine the effects of environmental changes on the distribution of suitable habitats of I. ovatus.

METHODS

Data pertaining to the distribution of I. ovatus in China were captured by literature review. The distribution of suitable habitats of I. ovatus in China was simulated using the maximum entropy model with the environmental variable data and the I. ovatus distribution data. In addition, the potential distribution of suitable habitats of I. ovatus was predicted based on the 2050 and 2070 environmental data.

RESULTS

The current suitable habitats of I. ovatus cover 3.11 million km², accounting for 32.28% of the total land area of China, and they are mainly concentrated in southwestern and northwestern China. Among the screened 16 environmental factors, the standard deviation of seasonal variation of temperature, average annual precipitation and altitude were predominant environmental factors affecting the distribution of suitable habitats of I. ovatus, and these three variables contributed 76.5% to the distribution of suitable habitats of I. ovatus in China. The suitable habitats of I. ovatus were predicted to showing a tendency towards expansion to northwestern and northeastern China in 2050 and 2070, and the proportion of highly suitable habitats of I. ovatus was predicted to increase.

CONCLUSIONS

Moderate climate, adequate precipitation and high altitude are favorable for the survival of I. ovatus. Future climate changes may cause expansion of suitable habitats of I. ovatus in China.

[Prediction of suitable habitats of Ixodes persulcatus in China]

OBJECTIVE

To evaluate the effects of environmental factors the distribution of Ixodes persulcatus, and to predict the future suitable habitats of I. persulcatus in China.

METHODS

The known distribution sites of I. persulcatus in China were captured from national and international published literatures. The effects of 14 environmental factors on the distribution of I. persulcatus were examined using the Jackknife test, including mean annual temperature, mean monthly temperature range, isothermality, temperature seasonality, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest quarter, mean temperature of the driest quarter, mean temperature of the wet-test quarter, mean temperature of the coldest quarter, annual mean precipitation, precipitation of the wettest month, precipitation of the driest month, precipitation seasonality, precipitation of the wettest quarter, precipitation of the driest quarter, precipitation of the warmest quarter, precipitation of the coldest quarter, elevation, slope, aspect and vegetation. The suitable habitats of I. persulcatus were predicted in China using the maximum entropy model and ArcGIS 10.7 software with the environmental factors.

RESULTS

Currently, the highly suitable habitats of I. persulcatus covered an area of 886 600 km² in China, which were predominantly located in northeastern China. The environmental factors that contributed more than 10% to the distribution of the suitable habitats of I. persulcatus in China included annual temperature variation range (39.1%), the coldest quarterly precipitation (23.2%), and the annual mean precipitation (11.9%). Based on the maximum entropy model, the suitable habitats of I. persulcatus were predicted to show a shrinking tendency towards northeastern China in 2070.

CONCLUSIONS

The suitable habitat of I. persulcatus strongly correlates with temperature and precipitation, and climate and environmental changes may lead to shrinking of the future suitable habitat of I. persulcatus in China.

Quantification of Increased Corneal Subbasal Nerve Tortuosity in Dry Eye Disease and Its Correlation With Clinical Parameters

Purpose

This study quantified corneal subbasal nerve tortuosity in dry eye disease (DED) and investigated its correlation with clinical parameters by proposing an aggregated measure of tortuosity (Tagg).

Methods

The sample consisted of 26 eyes of patients with DED and 23 eyes of healthy volunteers, which represented separately the dry eye group and the control group. Clinical evaluation of DED and in vivo confocal microscopy analysis of the central cornea were performed. Tagg incorporated six metrics of tortuosity. Corneal subbasal nerve images of subjects and a validation data set were analyzed using Tagg. Spearman's rank correlation was performed on Tagg and clinical parameters.

Results

Tagg was validated using 1501 corneal nerve images. Tagg was higher in patients with DED than in healthy volunteers (P < 0.001). Tagg was positively correlated with the ocular surface disease index (r = 0.418, P = 0.003) and negatively correlated with tear breakup time (r = -0.398, P = 0.007). There was no correlation between Tagg and visual analog scale scores, corneal fluorescein staining scores, or the Schirmer I test.

Conclusions

Tagg was validated for quantification of corneal subbasal nerve tortuosity and was higher in patients with DED than in healthy volunteers. A higher Tagg may be linked to ocular discomfort, visual function disturbance, and tear film instability.

Translational Relevance

Corneal subbasal nerve tortuosity is a potential biomarker for corneal neurobiology in DED.

Propofol improves intestinal ischemia-reperfusion injury in rats through NF-κB pathway

OBJECTIVE

The aim of this study was to investigate the effects of propofol on intestinal ischemia-reperfusion injury in rats through the nuclear factor-kappa B (NF-κB) pathway.

MATERIALS AND METHODS

A total of 24 Sprague-Dawley rats were selected and randomly divided into three groups, including sham operation group, ischemia group and propofol group. Rats in sham operation group were only treated with isolation of superior mesenteric artery, which was clipped for 1 h and reperfused for 2 h in ischemia group. Meanwhile, propofol (60 mg/kg) was injected into the femoral vein 1 h before ischemia in propofol group. TUNEL assay was performed to detect cell apoptosis of intestinal tissues. Real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to measure the expression levels of malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), caspase-3 and B-cell lymphoma-2 (Bcl-2) in rats of each group. Western blotting was utilized to detect the protein expression levels of NF-κB pathway related molecules, such as myeloid differential protein-88 (MyD88), v-rel avian reticuloendotheliosis viral oncogene homolog A (RelA) and NF-κB. Furthermore, changes in plasma cytokine levels were determined via enzyme-linked immunosorbent assay (ELISA).

RESULTS

The number of apoptotic cells in ischemia group was remarkably higher than that in sham operation group (p<0.05). However, it decreased notably in propofol group compared with ischemia group (p<0.05). In comparison with sham operation group, significantly up-regulated expression of caspase-3 and down-regulated expression of Bcl-2 were observed in the intestinal tissues of rats in ischemia group (p<0.05). Caspase-3 was lowly expressed, while Bcl-2 was highly expressed in the intestinal tissues of rats in propofol group compared with ischemia group (p<0.05). In addition, no statistically significant differences were observed in the expression level of SOD among sham operation group, ischemia group and propofol group (p>0.05). The expression levels of MDA and MPO were overtly higher in the intestinal tissues of rats in ischemia group than those in sham operation group and propofol group (p<0.05). Besides, the protein expression levels of MyD88, RelA and NF-κB in the intestinal tissues of rats in ischemia group were remarkably higher than those in sham operation group and propofol group (p<0.05). The activity of the NF-κB pathway in the intestinal tissues of rats in propofol group significantly declined compared with ischemia group (p<0.05). Moreover, compared with sham operation group, plasma levels of TNF-α, interleukin (IL)-2, IL-6 and IL-4 increased significantly in rats of ischemia group (p<0.05). However, they were markedly lower in propofol group than those in ischemia group (p<0.05).

CONCLUSIONS

Propofol protects rats from intestinal ischemia-reperfusion injury through the NF-κB pathway.

Long noncoding RNA FAM201A mediates the metastasis of lung squamous cell cancer via regulating ABCE1 expression

OBJECTIVE

Long noncoding RNA (lncRNA) family with sequence similarity 201-member A (FAM201A) is a novel lncRNA promoting the development of various cancers. However, the biological function of FAM201A on the metastasis of lung squamous cell carcinoma (LSCC) remains unknown. The aim of this study was to explore the molecular mechanism of FAM201A and its target protein in advanced LSCC.

PATIENTS AND METHODS

Quantitative Polymerase Chain Reaction (qPCR) was applied to evaluate FAM201A expression in lung cancer tissues. The impact of high FAM201A expression on the overall survival in patients with lung cancer was tested using the log-rank test. The relevance between aberrant FAM201A and clinicopathological characteristics in patients with lung cancer was analyzed using the Chi-square tests. Cell proliferation was assayed using the Cell Counting Kit-8 (CCK-8) and a transwell assay, and the mice xenograft models were applied to determine the promoting effects of FAM201A on LSCC in vitro and in vivo. The underlying regulatory mechanism was explored through RNA transfection, qPCR, and Western blotting. The correlation between ATP-binding cassette transporter E1 (ABCE1) and FAM201A expression was verified using Spearman's correlation coefficient.

RESULTS

FAM201A is aberrantly elevated in tissues from patients with non-small cell lung cancer. High levels of FAM201A expression were more likely to present in patients with squamous type, M1 stage, and inferior overall survival. Differential expression was found between non-metastatic and metastatic squamous carcinoma, but not in adenocarcinoma. FAM201A knockdown inhibits cell proliferation, migration, and invasion of LSCC cells in vitro, and represses tumor growth in vivo. Furthermore, ABCE1 in LSCC cells was downregulated by silencing FAM201A. The tissue level of ABCE1 was positively correlated with FAM201A expression in patients with LSCC.

CONCLUSIONS

FAM201A may markedly induce migration and invasion of LSCC, resulting in the M1 stage and poor survival. These findings suggest the FAM201A-ABCE1 axis as a novel therapeutic target in LSCC.

Epidemiological Investigation of OHCWs with COVID-19

During the coronavirus disease 2019 (COVID-19) pandemic, there is an important risk of infection in health care workers, including oral health care workers (OHCWs), due to the characteristics of dental practice. In this retrospective study, data pertaining to the 31 OHCWs diagnosed with COVID-19 in Wuhan, Hubei Province, were retrieved and analyzed. Questionnaires were administered to the subjects over the Internet and telephone. Clinical and epidemiological characteristics and information on the use of personal protective equipment (PPE) were collected. There were 22 females and 9 males, with a median age of 39 y. Although the severity of most cases of COVID-19 (93.5%) was mild or moderate, 1 case was severe, and another case was critical, resulting in death. Fever was the main first symptom of COVID-19, followed by fatigue and myalgia. Most of the OHCWs routinely used PPE such as medical masks, gloves, caps, and work clothes while performing clinical work. N95 or KN95 masks were rarely available because of the scarcity of PPE during the outbreak. Nineteen OHCWs reported a contact history, among whom 7 worked in a fever clinic, 5 reported contact with dental patients suspected of having COVID-19, and 7 reported contact with family members with COVID-19–related symptoms at least 1 d earlier. Our findings indicated that there were few clusters of COVID-19 in dental settings. Since the outbreak, the Hospital of Stomatology, Wuhan University, has provided emergency dental treatment, and none of their staff were infected while providing dental service, which indicates that comprehensive measures such as the use of advanced PPE and environmental disinfection can prevent cross-infection in dental practice. The analysis of the procedures followed during the emergency treatments indicated that OHCWs preferred to recommend conservative treatment to patients, suggesting that attention should be paid to the psychological impact of COVID-19 on dental practitioners.

Influence of angle kappa-customized implantation of rotationally asymmetric multifocal intraocular lens on visual quality and patient satisfaction

PURPOSE

To evaluate the visual outcomes and patient satisfaction with angle kappa-customized implantation of SBL-3 (Lenstec, Inc.; +3 D), a rotationally asymmetric multifocal intraocular lens (MIOL).

METHODS

This was a prospective randomized control study. Data from consecutive patients, who underwent bilateral implantation of SBL-3 MIOL from June 2017 to August 2018, were enrolled in the study. One eye of each patient was randomly chosen to receive a horizontal IOL placement (control group), while the other eye received angle kappa-customized placement (design group). The outcomes include uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, contrast sensitivity, quality of vision and patient satisfaction. The follow-up was 3 months.

RESULTS

The study enrolled 80 eyes of 40 patients. There was no significant difference in mean UDVA, UIVA and UNVA between the two groups. The design group showed significantly better visual acuity at -1.50 D of defocus, based on the defocus curve (p = 0.022), and less vertical coma (p = 0.002) than the control group. No significant differences in contrast sensitivity, modulation transfer function, Strehl ratio and patient satisfaction were found between the two groups.

CONCLUSION

Angle kappa-customized implantation of SBL-3 had little impact on visual outcomes and patient satisfaction, except for a moderate impact on intermediate visual acuity.

[Effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis]

Objective: To explore the effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis. Methods: From March 2014 to December 2018, 6 patients with skin and soft tissue defects in perineal region caused by necrotizing fasciitis were admitted to Department of Burns of Hanzhong Central Hospital (hereinafter referred to as our hospital). Two female patients had labia major defects and 4 male patients had scrotum defects, with age of 43-68 years. The areas of skin and soft tissue defects after debridement were 4%-8% total body surface area. The wounds in non-joint and non-functional area were repaired with free split-thickness skin grafts from medial femoral region, and the residual wounds areas in perineal region after repair were 10 cm×4 cm-22 cm×10 cm, which were repaired with pedicled anterolateral thigh flaps, with area of 12 cm×5 cm-24 cm×12 cm. The secondary wounds in the donor sites were sutured directly or repaired with free split-thickness skin grafts from medial thigh on the same or opposite side of the wounds. The bacterial culture result of wound exudate, drug sensitivity test result, and blood bacterial culture result on admission were recorded. The postoperative flap survival was observed. The length of hospital stay, debridement times, and antibiotics use time were recorded. The flap swelling condition was observed to evaluate whether flap thinning operation was necessary, the sensory recovery of the flap and hip joint activity were evaluated, and the scrotum function of male patients was evaluated by urologist in our hospital during follow-up. Results: The bacterial culture results of wound exudate in 5 patients on admission showed Escherichia coli with 4 of them having the same bacteria and the other one having methicillin-resistant Staphylococcus aureus detected in their blood samples. All the flaps survived in 6 patients after the operation, with total length of hospital stay of (22±5) d, debridement of 3-5 times, and antibiotics use time of (13±3) d. During follow-up of 3 to 6 months after the operation, the flaps were slightly bloated in 2 patients, and the flap thinning operation was performed 6 months after wound repair. The sensory function recovered to normal in 2 flaps of patients with anterolateral femoral cutaneous nerve, and the superficial sensory function in the other flaps of patients recovered in different degrees.The hip joint activity was close to normal in all the patients, and the scrotum function was normal in 4 male patients. Conclusions: The pedicled anterolateral thigh flap showed good effects in repairing skin and soft tissue defects on perineal region caused by necrotizing fasciitis, with good appearance and function after operation, and the method is simple, safe, and easy to apply.

Molecular catalysis of CO2 reduction: recent advances and perspectives in electrochemical and light-driven processes with selected Fe, Ni and Co aza macrocyclic and polypyridine complexes

Earth-abundant Fe, Ni, and Co aza macrocyclic and polypyridine complexes have been thoroughly investigated for CO2 electrochemical and visible-light-driven reduction. Since the first reports in the 1970s, an enormous body of work has been accumulated regarding the two-electron two-proton reduction of the gas, along with mechanistic and spectroscopic efforts to rationalize the reactivity and establish guidelines for structure-reactivity relationships. The ability to fine tune the ligand structure and the almost unlimited possibilities of designing new complexes have led to highly selective and efficient catalysts. Recent efforts toward developing hybrid systems upon combining molecular catalysts with conductive or semi-conductive materials have converged to high catalytic performances in water solutions, to the inclusion of these catalysts into CO2 electrolyzers and photo-electrochemical devices, and to the discovery of catalytic pathways beyond two electrons. Combined with the continuous mechanistic efforts and new developments for in situ and in operando spectroscopic studies, molecular catalysis of CO2 reduction remains a highly creative approach.

An artificial intelligence-based deep learning algorithm for the diagnosis of diabetic neuropathy using corneal confocal microscopy: a development and validation study

AIMS/HYPOTHESIS

Corneal confocal microscopy is a rapid non-invasive ophthalmic imaging technique that identifies peripheral and central neurodegenerative disease. Quantification of corneal sub-basal nerve plexus morphology, however, requires either time-consuming manual annotation or a less-sensitive automated image analysis approach. We aimed to develop and validate an artificial intelligence-based, deep learning algorithm for the quantification of nerve fibre properties relevant to the diagnosis of diabetic neuropathy and to compare it with a validated automated analysis program, ACCMetrics.

METHODS

Our deep learning algorithm, which employs a convolutional neural network with data augmentation, was developed for the automated quantification of the corneal sub-basal nerve plexus for the diagnosis of diabetic neuropathy. The algorithm was trained using a high-end graphics processor unit on 1698 corneal confocal microscopy images; for external validation, it was further tested on 2137 images. The algorithm was developed to identify total nerve fibre length, branch points, tail points, number and length of nerve segments, and fractal numbers. Sensitivity analyses were undertaken to determine the AUC for ACCMetrics and our algorithm for the diagnosis of diabetic neuropathy.

RESULTS

The intraclass correlation coefficients for our algorithm were superior to those for ACCMetrics for total corneal nerve fibre length (0.933 vs 0.825), mean length per segment (0.656 vs 0.325), number of branch points (0.891 vs 0.570), number of tail points (0.623 vs 0.257), number of nerve segments (0.878 vs 0.504) and fractals (0.927 vs 0.758). In addition, our proposed algorithm achieved an AUC of 0.83, specificity of 0.87 and sensitivity of 0.68 for the classification of participants without (n = 90) and with (n = 132) neuropathy (defined by the Toronto criteria).

CONCLUSIONS/INTERPRETATION

These results demonstrated that our deep learning algorithm provides rapid and excellent localisation performance for the quantification of corneal nerve biomarkers. This model has potential for adoption into clinical screening programmes for diabetic neuropathy.

DATA AVAILABILITY

The publicly shared cornea nerve dataset (dataset 1) is available at http://bioimlab.dei.unipd.it/Corneal%20Nerve%20Tortuosity%20Data%20Set.htm and http://bioimlab.dei.unipd.it/Corneal%20Nerve%20Data%20Set.htm.

[Clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap]

Objective: To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap. Methods: From March 2014 to March 2017, 6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit, including 5 males and 1 female, aged 27-65 years, 1 case of electric injury, 2 cases of coal burn, 3 cases of traffic injury, 2 cases involving upper limb, and 4 cases involving lower limb. After debridement, the wound area ranged from 26 cm×8 cm to 36 cm×15 cm, and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm. The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap. The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm. The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap. The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded, and the recovery of donor and recipient areas and the occurrence of complications were followed up. Results: Three patients were treated with simple vascular supercharging technique during flap transplantation, and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation. All the flaps survived well in 6 patients without vascular crisis. Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees. Except for 1 case of upper limb flap, the other flaps had no obvious swelling and needed no second thinning. There were only depressed scars in the donor sites, and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts. No short-term or long-term complications were found. Conclusions: The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation, which is worth popularizing.

Generation of a neutralizing antibody against RD114-pseudotyped viral vectors

The feline endogenous RD114 glycoprotein has proved to be an attractive envelope to pseudotype both retroviral and lentiviral vectors. As a surface protein, its detection on packaging cells as well as viral particles would be useful in different fields of its use. To address this, we generated a monoclonal antibody against RD114 by immunization of rats, termed 22F10. Once seroconversion was confirmed, purified 22F10 was cloned into murine Fc and characterized with a binding affinity of 10nM. The antibody was used to detect RD114 and its variant envelopes on different stable viral packaging cell lines (FLYRD18 and WinPac-RD). 22F10 was also shown to prevent the infections of different strains of RD-pseudotyped vectors but not related envelope glycoproteins by blocking cell surface receptor binding. We are the first to report the neutralization of viral particles by a monoclonal αRD114 antibody.

Tear Inflammatory Cytokines Analysis and Clinical Correlations in Diabetes and Nondiabetes With Dry Eye

PURPOSE

To enhance the understanding of dry eye (DE) in diabetes by evaluating the ocular surface characteristics and the levels of tear inflammatory cytokines.

DESIGN

Cross-sectional study.

METHODS

Subjects were divided into 4 groups: 32 patients in the diabetes with DE group; 24 patients in the diabetes without DE group; 28 patients in the nondiabetes with DE group; and 29 volunteers in the normal group. Ocular surface disease index (OSDI) was self-answered and ocular surface characteristics including tear film break-up time (BUT), Schirmer I test, corneal fluorescein staining (CFS), and corneal sensitivity were evaluated. Concentrations of epidermal growth factor (EGF), IL-17A, IL-1β, and tumor necrosis factor alpha (TNF-α) were measured by mutiplex bead analysis. Spearman correlations between cytokines and ocular surface parameters were calculated.

RESULTS

The level of EGF in tears significantly increased in the diabetes with DE group and positively correlated with the CFS and negatively correlated with the Schirmer I test in this group (P < .05). No differences were found in the levels of IL-17A, IL-1β, and TNF-α in the diabetes with DE and diabetes without DE groups compared to the normal group (P > .05). The nondiabetes with DE group showed increased levels of IL-17A, IL-1β, and TNF-α in tears compared to the normal group and the levels of IL-1β and TNF-α in tears positively correlated with CFS (P < .05).

CONCLUSIONS

Our study showed that levels of EGF in tears have potential to be the diagnostic biomarker of DE in diabetes. No differences of IL-17A, IL-1β, and TNF-α in tears were found between the diabetes with DE and normal group, suggesting different pathogenesis of diabetes DE vs nondiabetes DE.

[Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps]

Objective: To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods: From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly. Results: All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal. Conclusions: The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.

Prevalence and Risk Factors for Frailty among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis

OBJECTIVE

To systematically assess the prevalence of frailty, including prefrailty, stratified prevalence according to frailty criteria, gender, age, and region, and the risk factors for frailty in China.

DESIGN

We conducted a systematic literature review and meta-analysis using articles available in 8 databases including PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP).

SETTING

Cross-sectional and cohort data from Chinese community.

PARTICIPANTS

Community-dwelling adults aged 65 and older.

MEASUREMENTS

Two authors independently extracted data based upon predefined criteria. Where data were available we conducted a meta-analysis of frailty parameters using a random-effects model.

RESULTS

We screened 915 different articles, and 14 studies (81258 participants) were ultimately included in this analysis. The prevalence of frailty and prefrailty in individual studies varied from 5.9% to 17.4% and from 26.8% to 62.8%, respectively. The pooled prevalence of frailty and prefrailty were 10% (95% CI: 8% to 12%, I2 = 97.4%, P = 0.000) and 43% (95% CI: 37% to 50%, I2 = 98.0%, P = 0.000), respectively. The pooled frailty prevalence was 8% for the Fried frailty phenotype, 12% for the frail index, and 15% for the FRAIL scale. Age-stratified meta-analyses showed the pooled prevalence of frailty to be 6%, 15%, and 25% for those aged 65-74, 75-84, and ≥85 years old, respectively. The pooled prevalence of frailty was 8% for males and 11% for females. The pooled prevalence of frailty in Mainland China, Taiwan, and Hong Kong was 12%, 8%, and 14%, respectively. The pooled frailty prevalence was 10% in urban areas and 7% in rural areas. After controlling for confounding variables, increasing age (OR = 1.28, 95% CI: 1.2 to 1.36, I2 = 98.0%, P = 0.000), being female (OR = 1.29, 95% CI: 1.16 to 1.43, I2 =92.7%, P=0.000), activities of daily living (ADL) disability (OR = 1.72, 95% CI: 1.57 to 1.90, I2 = 99.7%, P = 0.000), and having three or more chronic diseases (OR = 1.97, 95% CI: 1.78 to 2.18, I2 = 97.5%, P = 0.000) were associated with frailty.

CONCLUSIONS

These findings of this review indicate an overall pooled prevalence of frailty among Chinese community-dwelling older people of 10%. Increasing age, being female, ADL disability, and having three or more chronic diseases were all risk factors for frailty. Further research will be needed to identify additional frailty risk factors in order to better treat and prevent frailty in the community.