Effects of full-thickness wedge resection on ocular surface and in vivo confocal microscopy findings in floppy eyelid syndrome patients

OBJECTIVE

To evaluate the effect of full-thickness wedge resection (FTWR) on ocular surface and in vivo confocal microscopy (IVCM) findings in patients with floppy eyelid syndrome (FES).

METHODS

The study included two groups: a surgical treatment (ST) group (26 eyes) consisting of patients who underwent FTWR surgery, and a conservative treatment (CT) group (30 eyes). Pre-treatment and post-treatment ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescein staining (CFS), IVCM findings along with the body mass index (BMI), FES grade, the presence and the treatment of obstructive sleep apnea syndrome (OSAS) were recorded and compared between the groups.

RESULTS

The groups were comparable in terms of BMI, FES grade, and OSAS data. After six months, TBUT in the ST group significantly increased to 12.92 ± 1.15, compared to 8.10 ± 1.60 in the CT group (p = 0.000). The CFS and OSDI scores were significantly lower in the ST group (0.15 ± 0.37, 18.0 ± 8.3, respectively) compared to the CT group (0.90 ± 0.61, 27.3 ± 9.3, respectively) (p = 0.000). IVCM analysis revealed a significant decrease in dendritic cell count (ST: 22.0 ± 12.4, CT: 39.5 ± 15.1, p = 0.000) and nerve tortuosity (ST: 1.38 ± 0.64, CT: 2.00 ± 0.59, p = 0.000), with a significant increase in total nerve density (ST: 4.27 ± 0.83, CT: 3.57 ± 0.90, p = 0.002) in the ST group compared to the CT group after six months.

CONCLUSION

In our retrospective cohort, FTWR surgery was shown to be an effective and reliable surgical treatment for FES, improving both ocular surface and IVCM findings. Patients with moderate to severe stages of FES not responding to conservative treatment may benefit from eyelid tightening.

Evaluation of dry eye disease and corneal epithelial mapping in patients with lower eyelid ectropion

PURPOSE

To evaluate the corneal epithelial mapping, ocular surface parameters and their relationship with each other in lower eyelid ectropion patients according to severity.

METHODS

This retrospective study included 48 lower eyelid ectropion patients and 63 healthy individuals as control group. Ocular surface and tear functions were evaluated with ocular surface staining score, tear film break-up time (BUT), non-invasive tear break-up time (NIBUT) and ocular surface disease index (OSDI). Meibography scores and corneal epithelial thickness (CET) mapping were evaluated. The lower eyelid ectropion was classified and divided into subgroups as follows: mild, moderate and severe.

RESULTS

There was no significant differences between the groups for age and gender. Compared to controls, CET was significantly thinner at inferior (p = 0.047) and inferior nasal quadrants (p = 0.023) in the ectropion patients. Lower BUT and NIBUT, higher OSDI scores and higher ocular surface staining were observed in the ectropion patients. In the subgroups determined according to the severity of ectropion, ocular surface damage was found to be significantly higher as the severity of ectropion increased (p < 0.05).

CONCLUSION

Patients with lower eyelid ectropion had worse ocular surface findings and more ocular complaints. Furthermore, the inferior and inferior nasal CETs were thinner in patients with lower ectropion.

Dexpanthenol/sodium hyaluronate eye drops for corneal epithelial healing following corneal cross-linking in patients with keratoconus

PURPOSE

To evaluate the effect of dexpanthenol 2%/sodium hyaluronate 0.15% eye drops on corneal epithelial healing and corneal microstructural changes following corneal cross-linking (CXL) in patients with keratoconus.

METHODS

The study included 42 eyes of 21 patients with keratoconus who underwent CXL on both eyes. One eye of each patient was instilled dexpanthenol 2%/sodium hyaluronate 0.15% eye drops (DP/SH group) and the fellow eye was instilled unpreserved sodium hyaluronate 0.15% eye drops (SH group). The epithelial healing process was assessed every day until complete reepithelialization was achieved. The in vivo confocal microscopy (IVCM) findings were also recorded.

RESULTS

The mean epithelial defect size 48.6 ± 6.7 mm2 for the DP/SH group and 48.2 ± 5.3 mm2 for the SH group. Complete reepithelialization was seen after 2.24 ± 0.44 days (range 2-4 days) in the DP/SH group and 3.43 ± 0.60 days (3 to 5 days) in the SH group. Posterior keratocyte density and endothelial cell density were similar in both groups. The mean subbasal nerve plexus density was significantly higher in the DP/SH group (postoperative 1 month: 1.13 ± 1.51, 3 months: 3.53 ± 2.55, 6 months: 7.07 ± 1.42) compared to the SH group (postoperative 1 month: 0.87 ± 1.43, 3 months: 2.89 ± 2.62, 6 months 6.33 ± 1.29). The DP/SH group revealed faster subbasal nerve regeneration and less edema compared to the SH group.

CONCLUSION

Dexpanthenol 2%/sodium hyaluronate 0.15% eye drops were effective and safe for corneal epithelial healing, and promoted faster corneal reepithelialization, nerve regeneration, and keratocyte repopulation with reduced corneal edema compared to sodium hyaluronate eye drops.

The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Effects of lipid-containing eye drops on the ocular surface and in vivo confocal microscopy findings in patients using systemic isotretinoin

OBJECTIVE

To evaluate the effects of lipid-containing Rohto Dry Aid eye drops and sodium hyaluronate eye drops on the ocular surface and in vivo confocal microscopy (IVCM) findings in patients using systemic isotretinoin.

METHODS

This retrospective study included 71 patients using systemic isotretinoin for acne vulgaris. Ocular surface and tear functions were evaluated with the tear break-up time (TBUT), corneal fluorescein staining (CFS), and the ocular surface disease index questionnaire (OSDI). Meibography was used for the staging of Meibomian gland dysfunction (MGD) while IVCM was used for the analysis of corneal micro-structural changes. The data of 36 patients using Rohto Dry Aid (the Rohto group) and 35 patients using sodium hyaluronate (the SH group) were recorded. Pre-treatment, first month and third month data were analyzed.

RESULTS

Longer TBUT, lower OSDI score, and less CFS were observed in the first and third months after treatment in the Rohto group (p < 0.001). There was no significant change in TBUT and CFS in the first month (p > 0.05) in the SH group (p < 0.05) but lower TBUT and more CFS were observed in the third month. There was no significant change in the OSDI score in the SH group. There was a significant decrease in dendritic cells, activated keratocytes, and nerve tortuosity with IVCM in both groups. However, no significant difference was found between the two groups.

CONCLUSION

Rohto Dry Aid, with its support of the lipid layer, is an effective and safe treatment agent that can improve both ocular surface and IVCM findings in evaporative dry eye cases with MGD.

Ocular surface and in vivo confocal microscopic findings in patients with active tyhroid eye disease treated with glucocorticoids

OBJECTIVES

To evaluate the effect of treatment with high-dose glucocorticoids (HDG) on ocular surface parameters and in vivo confocal microscopy (IVCM) findings in patients with active thyroid eye disease (TED).

METHODS

This study included 15 active TED patients treated with a cumulative HDG dose of 4.5g (500 mg and then 250 mg for 6 weeks each). Disease activity was assessed by the clinical activity score (CAS), Graves' Orbitopathy-specific Quality of Life (GO-QoL) questionnaire, ocular surface disease index (OSDI), tear break-up time(T-BUT), ocular surface staining and IVCM.

RESULTS

The mean follow-up time was 48.6 months. The treatment resulted in a significant improvement in the T-BUT, ocular surface staining values. In comparison to the baseline, a notable reduction in CAS, OSDI and an increase in GO-QoL were seen after one year. IVCM showed a significant decrease in the number of dendritic cells, activated keratocytes, the degree of tortuosity, there was also a significant increase in the number of basal epithelial cells and total nerves over one-year period. All of those changes remained stable during the follow-up period.

CONCLUSION

HDG treatment results in a sustained decrease in corneal inflammatory cells, an increase in tear film stability, and an improvement in disease symptoms and QoL scores for up to 4 years.

Evaluation of the Effect of Dermatochalasis and Upper Eyelid Blepharoplasty Surgery on Corneal Epithelial Thickness Alterations

BACKGROUND

The aim of this study was to assess the effect of different grades of dermatochalasis (DC) and upper eyelid blepharoplasty (UEB) surgery on corneal epithelial thickness (CET), objectively using anterior segment-optical coherence tomography (AS-OCT) measurements.

METHODS

90 eyes of patients with DC were divided into three groups according to the severity of the DC. Forty-one eyes of age and sex-matched patients without DC were randomly selected as the control group. The study did not include patients with more than 2 D of spherical refractive error and more than 1.5 D of astigmatism, a history of previous eyelid surgery, ocular surface disease, contact lens use, and ophthalmic eye drop use. CET measurements of all the patients were performed with an AS-OCT (RTVue-XR, Optovue Inc., USA).

RESULTS

There were statistically significant differences in the CET of the superior, superonasal, superotemporal, inferotemporal, and temporal sectors between the DC and control groups (p = 0.001, p = 0.02, p = 0.03, p = 0.02, p = 0.04, respectively). While there were no differences in CET among the sectors of the control group, there was a difference in CET among some sectors of the DC group. When the DC group was subdivided by severity, there was no difference between subgroups for CET across all sectors both preoperatively and postoperatively. In the measurements made 6 months after UEB surgery, the CET in all sectors increased statistically significantly compared to those measured in the preoperative period.

CONCLUSION

This study revealed that DC reshaped the corneal epithelium and UEB surgery restored this remodeling 6 months after surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The state of the art in beyond 5G distributed massive multiple-input multiple-output communication system solutions

Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal pro- cessing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on be- yond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.

An overlap case of Parry-Romberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity

Parry–Romberg syndrome (PRS) may overlap localized scleroderma (morphea) lesions with linear depression (en coup de sabre [ECDS]). Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

Sonographic Findings of Median Nerve and Prevalence of Carpal Tunnel Syndrome in Computer Mouse Users

The purpose of this study was to evaluate the median nerve sonographically and estimate the prevalence of carpal tunnel syndrome (CTS) in computer mouse users. Forty-nine right wrists of 49 employees who had used a computer mouse were included in the study. Thirty-three right wrists of 33 non-mouse user employees were studied as a control group. Both the mouse user and non-mouse user employees underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained proximally, in the middle and distally in the carpal tunnel. At each level, flattening ratio and the cross-sectional area of the median nerve were calculated. We found no significant difference in any parameters between mouse users and control group ( p>0.05). However, when we compared mouse users according to the presence of pain, there was a significant increase in the cross-sectional area of the median nerve proximally in the mouse users having pain ( p<0.05). Of all mouse users, eight (16.3%) were diagnosed as sensory CTS, four (8.2%) as motor CTS by EMG. We also found that four (50%) CTS patients had a proximal cross-sectional area of median nerve exceeding 10 mm2 and five (62.5%) had a distal flattening ratio over three. Prolonged use of a mouse may pose an occupational risk for employees. Sonography can serve as an initial step in symptomatic patients for diagnosis of CTS.

Potential protective effect of resveratrol on acoustic trauma: electron microscopy study

OBJECTIVE

To investigate the potential preventive effect of resveratrol in rats exposed to acoustic trauma (AT).

MATERIALS AND METHODS

In this experimental study, Wistar albino rats were divided into three groups: Group 1 (Control, n = 6), Group 2 (AT, n = 6), and Group 3 (resveratrol + AT). The rats in Group 2 were exposed to AT. The rats in Group 3 received resveratrol (300 mg/kg/day) via gavage for 7 days. On day 7, the rats were exposed to AT 10 min following resveratrol treatment. Histological sections of the cochleae were examined using light microscopy, transmission (TEM), and scanning electron microscopy (SEM).

RESULTS

The cochlear hair cells, stereocilia, and Deiters' cells of the control group appeared normal in all microscopic evaluations. In Group 2, light microscopy revealed predominantly inner hair cell loss, although the outer hair cells were affected. TEM and SEM examination showed severe loss of stereocilia and SEM revealed stereocilia arranged in an asymmetric array. The cochlear structure in Group 3 appeared well preserved under the light microscope, and although TEM and SEM revealed stereocilia loss, the hair cells and stereocilia appeared near normal compared with those of Group 2.

CONCLUSIONS

Resveratrol may have a protective effect against AT damage in the cochlea, most likely through its antioxidant activity. Our results may be useful for studies in humans exposed to AT and noise-induced hearing loss related to chronic exposure to occupational noise.

Choroidal Thickness in Patients with Graves' Ophthalmopathy

PURPOSE

The purpose of the study is to compare choroidal thickness (CT) in patients with active and inactive Graves' ophthalmopathy (GO) and that in healthy subjects by using spectral domain optical coherence tomography (SD-OCT).

METHODS

We conducted an observational, cross-sectional study of 28, 48, and 74 eyes of 14 patients with active GO (group 1), 24 patients with inactive GO (group 2), and 37 age-matched healthy subjects (group 3), respectively. Activity of GO was assessed by using initial clinical activity score (CAS). CT was measured by using SD-OCT. The differences in CT among the groups were compared, and the factors affecting subfoveal CT were analyzed.

RESULTS

The mean subfoveal CT was significantly greater in group 1 (395.84 ± 9.68 µm) than that in group 2 and group 3 (319.76 ± 7.07 µm and 314.22 ± 5.74 µm, respectively; p < 0.001) after adjusting for age, axial length, and intraocular pressure (IOP). Subfoveal CT was positively correlated with CAS (p < 0.001; r = 0.567). In multivariate analysis, thicker subfoveal CT was associated with younger age (p < 0.001; correlation coefficient B, -1.67; 95% CI, -2.57 to -0.78); disease activity (p < 0.001; correlation coefficient B, 95.28; 95% CI, 73.14-117.43); and lower IOP ((p < 0.001; correlation coefficient B, -4.09; 95% CI, -8.03 to -0.15).

CONCLUSIONS

To our knowledge, this is the first study showing that the mean subfoveal CT increases in patients with active GO. Subfoveal CT may be a useful parameter to monitor disease activity.

Comparison of Physical Activity Levels in Rheumatic Diseases

Objectives: The aim of this study was to evaluate levels of physical activity in patients with rheumatoid arthritis, osteoarthritis and fibromyalgia and to compare the results with both healthy subjects and each other.

Methods: A group of 50 rheumatoid arthritis patients, 95 osteoarthritis patients, 82 fibromyalgia patients and 110 healthy subjects were included in this study. Physical activity levels were assessed by the International Physical Activity Questionnaire (IPAQ).

Results: There were significant differences in walking and total physical activity scores in IPAQ between the rheumatoid arthritis (RA), osteoarthritis (OA), fibromyalgia (FMS) patients and the control group (p<0.05). 36.6% of the fibromyalgia group, 28.4% of the osteoarthritis group, 38% of the rheumatoid arthritis group and 22.7% of the healthy subjects were found to be inactive. 45.1% of the fibromyalgia group, 42.1% of the osteoarthritis group, 46% of the rheumatoid arthritis group and 36.4% of the healthy subjects were found to be insufficiently active.

Conclusion: As a result, when compared to healthy people, physical activity levels were significantly decreased in patients with rheumatoid arthritis, osteoarthritis, fibromyalgia. The decreases in the physical activity levels were clearer in patients with rheumatoid arthritis than in patients with osteoarthritis and fibromyalgia. Recommending regular physical activity should be integral to rheumatic disease management and walking offers a potentially accessible, inexpensive, and acceptable physical activity intervention.

Prostaglandin E2 Levels of Aqueous and Vitreous Humor in Ketorolac 0.4% and Nepafenac 0.1% Administered Healthy Rabbits

PURPOSE

To compare the lowering effects of ketorolac 0.4% and nepafenac 0.1% on aqueous and vitreous humor prostaglandin E₂ (PGE₂) levels in rabbits.

METHODS

Ketorolac and nepafenac ophthalmic solutions were administered to the right eyes of 24 healthy rabbits after randomized division into two groups. The left eyes of these rabbits were considered as controls for the two groups. On the 4th day of the experiment, the samples were taken from the aqueous and vitreous humors of the rabbits bilaterally, and PGE₂ levels were measured by an enzyme immune assay kit.

RESULTS

Ketorolac and nepafenac achieved a statistically significant decrease (p<0.001, for each) in PGE₂ levels in the aqueous (11.75 ± 6.15 and 14.75 ± 7.60 pg/mL, respectively) and the vitreous humor (6.58 ± 4.62 and 9.83 ± 4.55 pg/mL, respectively).

CONCLUSIONS

Both ketorolac and nepafenac inhibited PGE₂ levels in both the aqueous and vitreous humors of rabbits. Although PGE₂-lowering effects were similar in the aqueous humor, nepafenac seemed to be more potent than ketorolac in the vitreous humor.

Aripiprazole Induced Acute Transient Bilateral Myopia: A Case Report

BACKGROUND

Aripiprazole is an atypical antipsychotic drug. Acute transient myopia is a rare response to systemic medication. Unspecified ocular side effects of aripiprazole have rarely been reported. To the best of our knowledge, only 3 cases of aripiprazole induced myopia and diplopia have been reported in the literature. The aim of this article is to present a case of aripiprazole-induced acute transient myopia.

CASE REPORT

A 30 year-old woman underwent treatment for 5 days with aripiprazole and presented with bilateral painless blurred vision. The patient's uncorrected visual acuity was 2/10 in both eyes and her best corrected visual acuity was 10/10 in both eyes with a refractive error of -3.00 diopters using a standard Snellen chart. Adding 2 mgs of biperiden a day to her treatment regimen decreased her blurred vision symptoms. After discontinuation of aripiprazole treatment and cross-switching to Paliperidon palmitate (75 mg/month) her blurred vision completely resolved. The same side effect did not re-occur when checked on her 6-month follow up.

CONCLUSION

Ophthalmologists as well as psychiatrists must be aware of this myopic shift and should also ask these patients about medicine usage, especially aripiprazole. Ophthalmologists should consult the prescribing psychiatrist and stop the drug immediately to reverse this temporary condition.

Evaluation of dry eye findings in patients with vitiligo

Objective:

To evaluate the association of dry eye and vitiligo diseases with objective parameters and a questionnaire.

Methods:

The study was conducted in 30 vitiligo patients and 31 patients with non-complicated refractory complaints. All the patients underwent complete ophthalmologic examinations including fluorescein break-up time (FBU), corneal fluorescein staining (CFS) and Schirmer test-I. The dry eye status was evaluated by means of Ocular Surface Disease Index (OSDI).

Results:

The groups were similar regarding the age and gender distribution. The vitiligo group had higher OSDI scores (26.1±15.9 vs 14.7±5.4, t-test, p<0.001), shorter FBU (7.8±2.9 vs 9.8±2.2, Mann Whitney U test, p=0.005) and higher CFS positivity (18/30 vs 3/31, chi-square test, p<0.001) than control group. The groups were similar regarding the Meibomian Gland Dysfunction (MGD) and Schirmer test results. Fourteen (46.7%) of vitiligo patients had periocular involvement. The analysis within vitiligo patients revealed that FBU and Schirmer test were shorter in patients with periocular involvement, the OSDI scores and MGD status were similar.

Conclusion:

Our study suggest a possible association of dry eye and vitiligo diseases. The diagnostic tools for dry eye disease are in good correlation with each other. The OSDI questionnaire seems practical for both diagnostic purposes and follow-up.

Abdominal cocoon with imaging findings: Importance of radiology

Abdominal cocoon is a rare disease characterized by a thick fibrous membrane surrounding and compressing the small intestines completely or partially, which results in mechanical small bowel obstruction. The clinical findings of the disease include recurrent ileus and subileus episodes, colicky abdominal pain, weight loss, and abdominal distension. The etiology and pathogenesis of abdominal cocoon is not clearly defined. Detection of the disease is essential for accurate treatment. Imaging modalities come into prominence due to the nonspecific clinical findings of the disease.

Intraocular pressure-lowering effects of commonly used fixed combination drugs with timolol in the management of primary open angle glaucoma

AIM

To evaluate intraocular pressure (IOP)-lowering effect and ocular tolerability of brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies in the management of primary open angle glaucoma.

METHODS

Each drug was administered for two months, after which a circadian tonometric curve was recorded using a Goldmann applanation tonometer. Ocular discomfort (conjunctival hyperemia, burning or stinging, foreign body sensation, itching, ocular pain) of each eye was assessed by the subject on a standardized ocular discomfort scale.

RESULTS

Among the three study groups, there were no significant differences in the mean baseline IOP measurements, mean 2(nd) mo IOP measurements, and mean (%) change of IOPs from baseline. Among the three study groups, there were no significant differences in the mean IOP measurements obtained at circadian tonometric curves at baseline and at two months controls. In sum brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies showed similar effects on IOP levels.

CONCLUSION

Brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies showed similar lowering efficaties on IOP levels whereas there was no any difference between each other.

Nasal septal body and inferior turbinate sizes differ in subjects grouped by sex and age

OBJECTIVES

To compare the size of the nasal septal body (SB) and inferior turbinate (IT) of subjects grouped by sex and age.

METHOD

We measured SB and IT areas (in cm2) bilaterally in computed tomography (CT) sections of 150 para nasal sinuses from 72 males and 78 females.

RESULTS

The right and left SB areas were smaller in females than in males. In the s25-year-old group, the right IT (RIT) was significantly smaller in females than in males. In the 26-35 and 46-45 age groups, the right SB (RSB) was significantly smaller in females than in males.

CONCLUSION

The nasal SB may play a role in nasal physiology similar to a turbinate and help support optimal airflow. The vascular and glandular structures of the SB should be investigated in detail, and minimal invasive procedures should be performed in nasal surgery to avoid damaging essential structures.

Long-term effects of PAP on ocular surface in obstructive sleep apnea syndrome

OBJECTIVE

To assess the long-term effects of positive airway pressure (PAP) therapy on the ocular surface and eyelid in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).

DESIGN

Single-centred, prospective, and double-blinded study.

PARTICIPANTS

Fifty-one patients with OSAHS.

METHODS

Fifty-one patients with OSAHS were treated with PAP for a period of 18 months. The pre- and post-PAP values for eye examination scores (presence of floppy eyelid syndrome [FES], results of the Ocular Surface Disease Index [OSDI] questionnaire, Schirmer I test, tear film break-up time [TBUT] values, and corneal staining stages) were compared.

RESULTS

Based on the apnea-hypopnea index, 17 patients were followed with moderate and 34 patients were followed with severe OSAHS. The presence of FES before and after PAP was 56.9% and 74.5% (p < 0.01). FES stage was determined as 1.41 ± 0.98 before PAP and 0.78 ± 0.78 after PAP (p < 0.01). Pre-PAP and post-PAP OSDI results were 47.79 ± 21.04 and 42.17 ± 19.97, respectively (p < 0.01). Schirmer values before and after PAP were 7.23 ± 1.95 and 8.49 ± 1.79 mm, respectively (p < 0.01). TBUT values before and after PAP were 7.11 ± 1.82 and 8.68 ± 1.76 seconds, respectively (p < 0.01). Scores of the corneal staining stages before and after PAP were 1.05 ± 0.75 and 0.68 ± 0.54, respectively (p < 0.01).

CONCLUSIONS

OSAHS is associated with low Schirmer and TBUT values, and high scores in OSDI questionnaire, and high corneal staining stage. An appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns. We believe that long-term (at least 1 year) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP.

Volumetric evaluation of fat in the renal sinus in normal subjects using stereological method on computed tomography images and its relationship with body composition

BACKGROUND

The aim of the study was: to describe a simple, accurate and practical technique for estimating the volume of adipose tissue within the renal sinus (RS) using stereological method on computed tomography (CT) images; to establish a population database for volume of fat within the RS from 21 to 80 years of age; to investigate the effect of age, gender, body mass index (BMI) and abdominal diameters on RS fat volume in normal subjects.

MATERIALS AND METHODS

We retrospectively reviewed abdominal CT examinations of 240 patients without renal pathology between the ages of 21 and 80 years. There were 6 groups of patients, with 40 patients for each decade.

RESULTS

RS fat volumes in the left and right kidney were 5.70 ± 2.87 cm³ and 4.15 ± 2.39 cm³, respectively, in males and 3.51 ± 2.67 cm³ and 2.49 ± 2.16 cm³, respectively, in females. RS fat volume and age were positively correlated for both kidneys (left: r = 0.46; right: r = 0.44; p < 0.001, both), though it appeared to decline after age 70.

CONCLUSIONS

Quantitative data may allow clinicians to better estimate the age-related RS fat volume changes and help them in decision making.

Tear levels of tumor necrosis factor-alpha in patients with Parkinson's disease

Neuroinflammatory events mediated by the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) cause progressive neurodegeneration in dopaminergic neurons, and play an important role in the pathogenesis of Parkinson's disease (PD). The purpose of this study was to determine TNF-α levels in tear samples obtained from patients with PD and to analyze the relationship between TNF-α values and PD characteristics. Eighteen patients with PD and 17 healthy control subjects were included in the study. We examined the patient demographics, modified Hoehn and Yahr Staging Scale (mHY) stages, Unified Parkinson's disease rating scale (UPDRS) II and III scores, Mini Mental State Examination (MMSE) scores, and the predominant symptoms. We measured TNF-α using the multiplex immunobead assay in unstimulated tear samples, and determined the Schirmer's test and blink rate for each subject. Tear TNF-α values were significantly higher in patients with PD (196.9 ± 121.2 pg/ml) than in control subjects (110.7 ± 87.2 pg/ml; p=0.02). We identified no relationship between tear TNF-α levels and age, sex, age at onset, PD duration, mHY stages, UPDRS II, UPDRS III, or MMSE scores. The higher TNF-α levels observed in the tears of patients with PD suggests neuroinflammation and TNF-α plays a role in the pathogenesis of PD. Tear TNF-α levels, however, were not related to the duration or severity of PD. Tears are a suitable method for measuring TNF-α levels, and can be used as a diagnostic measure to evaluate biomarkers in PD.

Effect of hypericin on the ADAMTS-9 and ADAMTS-8 gene expression in MCF7 breast cancer cells

AIM

To investigate the effects of hypericin which is obtained from the plant Hypericum perforatum on the expression and the regulation of ADAMTS8 and ADAMTS9 genes in MCF7 breast cancer cells and on the viability of these cells.

MATERIALS AND METHODS

MCF7 cells were cultured and were separately exposed to 2, 10 and 50 µl/mL of hypericin. After 24 hours, RNA was isolated from these cells and converted to cDNA. The expression levels of ADAMTS8 and ADAMTS9 genes were evaluated using the Reverse Transcription Polymerase Chain Reaction. XTT (2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide, disodium salt) cell viability assay was used to determine cytotoxicity.

RESULTS

ADAMTS9 expression in MCF7 cells were increased 1.8 and 3.6 fold with the use of 2 and 10 µl/mL of hypericin, respectively; and decreased 0.7 fold with the use of 50 µl/mL of hypericin. There was no significant change in the ADAMTS8 expression. Rapid cell death was observed in the cancer cells when hypericin was used at a dose of ≥ 50 µl/mL.

CONCLUSIONS

The increase in ADAMTS9 expression can be a useful factor in the prevention of possible metastasis in breast cancer and for the occurrence of a tumor suppressive effect. Hypericin increases the expression of ADAMTS9, therefore, it may show its antitumoral and antiapoptotic effects by means of ADAMTS9.

Ocular surface assessment in patients with obstructive sleep apnea-hypopnea syndrome

PURPOSE

The aim of this study was to assess the correlation between ocular surface changes and disease severity in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Two hundred eighty patients with OSAHS were compared with respect to the presence of a floppy eyelid syndrome (FES), Ocular Surface Disease Index (OSDI) questionnaire, the corneal fluorescein staining stages, the Schirmer I test, and tear film break-up time (TBUT) values.

RESULTS

Based on the apnea-hypopnea index, the presence of FES was detected at the following rates: 23.1 % in non-OSAHS group (A), 41.7 % in mild group (B), 66.7 % in moderate group (C), and 74.6 % in severe group (D); severe and moderate stage of FES was found in groups C and D and mild stage of FES in group B (p < 0.01). OSDI questionnaire values were as follows: group A, 12.57 ± 17.64; group B, 22.90 ± 16.78; group C, 45.94 ± 22.03; and group D, 56.68 ± 22.85(p < 0.01). Schirmer values were as follows: group A, 10.76 ± 3.58 mm; group B, 9.83 ± 2.53 mm; group C, 7.73 ± 2.42 mm; and group D, 6.97 ± 2.15 mm (p < 0.01). The TBUT values were as follows: group A, 10.53 ± 3.64 s; group B, 9.46 ± 2.40 s; group C, 7.29 ± 2.13 s; and group D, 6.82 ± 2.20 s (p < 0.01). Corneal staining scores are as follows: 0.26 ± 0.60 in group A, 0.40 ± 0.71 in group B, 0.98 ± 0.72 in group C, and 1.14 ± 0.90 in group D, and the differences were statistically significant among the groups(p < 0.01).

DISCUSSION

OSAHS, particularly the moderate and severe forms, is associated with low Schirmer and TBUT values and high scores in OSDI questionnaire and corneal staining pattern stage. The presence of FES is observed as a practically constant finding in OSAHS. If complaints such as burning, stinging, and itching which can be commonly observed in middle-aged patients are accompanied by FES, the patient should be evaluated for sleep disorders. We speculate that appropriate treatment of OSAHS may result in better control of these symptoms.

Viscoelastic finite element analysis of the cervical intervertebral discs in conjunction with a multi-body dynamic model of the human head and neck

This article presents the effects of the frontal and rear-end impact loadings on the cervical spine components by using a multi-body dynamic model of the head and neck, and a viscoelastic finite element (FE) model of the six cervical intervertebral discs. A three-dimensional multi-body model of the human head and neck is used to simulate 15 g frontal and 8.5 g rear-end impacts. The load history at each intervertebral joint from the predictions of the multi-body model is used as dynamic loading boundary conditions for the FE model of the intervertebral discs. The results from the multi-body model simulations, such as the intervertebral disc loadings in the form of compressive, tensile, and shear forces and moments, and from the FE analysis such as the von Mises stresses in the intervertebral discs are analysed. This study shows that the proposed approach that uses dynamic loading conditions from the multi-body model as input to the FE model has the potential to investigate the kinetics and the kinematics of the cervical spine and its components together with the biomechanical response of the intervertebral discs under the complex dynamic loading history.

Energy-absorbing car seat designs for reducing whiplash

OBJECTIVES

This study presents an investigation of anti-whiplash features that can be implemented in a car seat to reduce whiplash injuries in the case of a rear impact. The main emphasis is on achieving a seat design with good energy absorption properties.

METHODS

A biofidelic 50th percentile male multi-body human model for rear impact is developed to evaluate the performance of car seat design concepts. The model is validated using the responses of 7 volunteers from the Japanese Automobile Research Institute (JARI) sled tests, which were performed at an impact speed of 8 kph with a rigid seat and without head restraint and seatbelt. A generic multi-body car seat model is also developed to implement various seatback and recliner properties, anti-whiplash devices, and head restraints. Using the same driving posture and the rigid seat in the JARI sled tests as the basic configuration, several anti-whiplash seats are designed to allow different types of motion for the seatback and seat-pan.

RESULTS

The anti-whiplash car seat design concepts limit neck internal motion successfully until the head-to-head restraint contact occurs and they exhibit low NIC(max) values (7 m(2)/s(2) on average). They are also effective in reducing neck compression forces and T1 forward accelerations. In principle, these car seat design concepts employ controlled recliner rotation and seat-pan displacement to limit the formation of S-shape. This is accomplished by using anti-whiplash devices that absorb the crash energy in such a way that an optimum protection is provided at different severities.

CONCLUSIONS

The results indicate that the energy absorbing car seat design concepts all demonstrate good whiplash-reducing performances at the IIWPG standard pulse. Especially in higher severity rear impacts, two of the car seat design concepts reduce the ramping of the occupant considerably.

Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material

AIM

To evaluate the effects of sonographic characteristics of thyroid nodules, the diameter of needle used for sampling, and sampling technique on obtaining sufficient cytological material (SCM).

MATERIALS AND METHODS

We performed sonography-guided fine-needle biopsy (FNB) in 232 solid thyroid nodules. Size-, echogenicity, vascularity, and localization of all nodules were evaluated by Doppler sonography before the biopsy. Needles of size 20, 22, and 24 G were used for biopsy. The biopsy specimen was acquired using two different methods after localisation. In first method, the needle tip was advanced into the nodule in various positions using a to-and-fro motion whilst in the nodule, along with concurrent aspiration. In the second method, the needle was advanced vigorously using a to-and-fro motion within the nodule whilst being rotated on its axis (capillary-action technique).

RESULTS

The mean nodule size was 2.1+/-1.3 cm (range 0.4-7.2 cm). SCM was acquired from 154 (66.4%) nodules by sonography-guided FNB. In 78 (33.6%) nodules, SCM could not be collected. There was no significant difference between nodules with different echogenicity and vascularity for SCM. Regarding the needle size, the lowest rate of SCM was obtained using 20 G needles (56.6%) and the highest rate of adequate material was obtained using 24 G needles (82.5%; p=0.001). The SCM rate was 76.9% with the capillary-action technique versus 49.4% with the aspiration technique (p<0.001).

CONCLUSION

Selecting finer needles (24-25 G) for sonography-guided FNB of thyroid nodules and using the capillary-action technique decreased the rate of inadequate material in cytological examination.