Exploring Co-occurring POLE Exonuclease and Non-exonuclease Domain Mutations and Their Impact on Tumor Mutagenicity

POLE driver mutations in the exonuclease domain (ExoD driver) are prevalent in several cancers, including colorectal cancer and endometrial cancer, leading to dramatically ultra-high tumor mutation burden (TMB). To understand whether POLE mutations that are not classified as drivers (POLE Variant) contribute to mutagenesis, we assessed TMB in 447 POLE-mutated colorectal cancers, endometrial cancers, and ovarian cancers classified as TMB-high ≥10 mutations/Mb (mut/Mb) or TMB-low <10 mut/Mb. TMB was significantly highest in tumors with "POLE ExoD driver plus POLE Variant" (colorectal cancer and endometrial cancer, P < 0.001; ovarian cancer, P < 0.05). TMB increased with additional POLE variants (P < 0.001), but plateaued at 2, suggesting an association between the presence of these variants and TMB. Integrated analysis of AlphaFold2 POLE models and quantitative stability estimates predicted the impact of multiple POLE variants on POLE functionality. The prevalence of immunogenic neoepitopes was notably higher in the "POLE ExoD driver plus POLE Variant" tumors. Overall, this study reveals a novel correlation between POLE variants in POLE ExoD-driven tumors, and ultra-high TMB. Currently, only select pathogenic ExoD mutations with a reliable association with ultra-high TMB inform clinical practice. Thus, these findings are hypothesis-generating, require functional validation, and could potentially inform tumor classification, treatment responses, and clinical outcomes.

SIGNIFICANCE

Somatic POLE ExoD driver mutations cause proofreading deficiency that induces high TMB. This study suggests a novel modifier role for POLE variants in POLE ExoD-driven tumors, associated with ultra-high TMB. These data, in addition to future functional studies, may inform tumor classification, therapeutic response, and patient outcomes.

Tumor mutation burden in colorectal cancers with POLE exonuclease and non-exonuclease domain variants

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Background: Driver mutations in the exonuclease domain (ExoD) of DNA polymerase epsilon ( POLE) have been associated with high tumor mutation burden (TMB). High TMB is an important marker for immunotherapy, and thus understanding the mechanisms that lead to high TMB is an area of active investigation. Many tumors with POLE ExoD driver mutations have additional POLE variants of uncertain significance (VUS). Some of these VUS lie within the ExoD, while most lie outside the ExoD. This study investigates the role of such POLE VUS on TMB and POLE functionality of ExoD-mutated tumors. Methods: Retrospective colorectal cancer (CRC) genomic profiles from Caris Life Sciences (n=1,870) were separated into groups based on the presence of POLE ExoD mutations and the TMB status. Groups were defined as: ‘TMB-high (TMB-H) POLE ExoD driver without additional POLE VUS’, ‘TMB-H POLE ExoD driver plus POLE VUS’, and ‘TMB-low (TMB-L) POLE variant(s) without ExoD driver’. An additional group with ‘TMB-H POLE variant(s) without ExoD driver’ was identified as potentially novel drivers for future study. The microsatellite instability status (MSI or MSS) was also considered. The level of TMB, the presence of polymerase proofreading-associated mutational signatures and POLE stability/functionality analyzed using AlphaFold2 models and Rosetta Molecular Modeling Suite, were evaluated. Results: POLE variants were identified in 4.9% of the CRCs studied (92/1870). In all, 52.2% (48/92) of those tumors were TMB-H, and 38.0% (35/92) of them contained POLE ExoD drivers. The highest median TMB (mTMB) was found in the ‘TMB-H POLE ExoD driver plus POLE VUS’ group, and this was significantly different from the ‘TMB-H POLE ExoD driver without additional POLE VUS’ and the ‘TMB-L POLE variant without ExoD driver’ group, even when MSI tumors were excluded (p<0.001, Mann-Whitney). These results were validated in TCGA CRC tumors and in other tumor types. Within the ‘TMB-H POLE ExoD driver plus POLE VUS’ group, the mTMB increased with the number of accumulated POLE VUS (p<0.001, Mann Whitney). The nucleotide sequence context of 77.8% of the POLE VUS matched mutational spectra associated with POLE ExoD defects, suggesting that most of the POLE VUS are secondary to the ExoD driver mutation. Finally, the majority of POLE VUS within ‘TMB-H POLE ExoD driver plus POLE VUS’ group have a predicted effect on POLE stability and/or function. Conclusions: Our results suggest that the presence of secondary POLE non-driver variants increase TMB in POLE ExoD-mutated tumors. Although still preliminary, these data could impact prognosis and response to immune checkpoint inhibitors in patients. [Table: see text]

Comparative study of visual outcome of newly designed scleral tuck lens and suture-fixated lens for rehabilitation of aphakia in various aetiologies

Purpose:

Visual rehabilitation in aphakia can be performed using several modalities. However, these modalities could be either technically difficult or expensive. Herein, we developed a scleral tuck lens to provide a simple and cost-effective solution for aphakia and compared its outcome with standard methods.

Methods:

A specially designed posterior chamber self-sustaining lens was implanted in patients with aphakia without capsular support because of different primary etiologies. The visual outcomes, as well as intraoperative and postoperative complications, were examined. The data were retrieved from electronic medical records, and visual outcome and complication rates were compared. The outcomes were also compared according to the etiology and age groups (pediatric and adults).

Results:

We found significant improvement in preoperative and postoperative visual outcome. We did not find any significant difference in visual outcome amongst suture-supported scleral fixated lens with scleral tuck lens.

Conclusion:

Satisfactory visual outcomes were noted with minimal complications; and comparable with gold standard suture fixated lens, however long-term follow-up is required.

Therapeutic implications of germline vulnerabilities in DNA repair for precision oncology

DNA repair vulnerabilities are present in a significant proportion of cancers. Specifically, germline alterations in DNA repair not only increase cancer risk but are associated with treatment response and clinical outcomes. The therapeutic landscape of cancer has rapidly evolved with the FDA approval of therapies that specifically target DNA repair vulnerabilities. The clinical success of synthetic lethality between BRCA deficiency and poly(ADP-ribose) polymerase (PARP) inhibition has been truly revolutionary. Defective mismatch repair has been validated as a predictor of response to immune checkpoint blockade associated with durable responses and long-term benefit in many cancer patients. Advances in next generation sequencing technologies and their decreasing cost have supported increased genetic profiling of tumors coupled with germline testing of cancer risk genes in patients. The clinical adoption of panel testing for germline assessment in high-risk individuals has generated a plethora of genetic data, particularly on DNA repair genes. Here, we highlight the therapeutic relevance of germline aberrations in DNA repair to identify patients eligible for precision treatments such as PARP inhibitors (PARPis), immune checkpoint blockade, chemotherapy, radiation therapy and combined treatment. We also discuss emerging mechanisms that regulate DNA repair.

Developing a multi-disciplinary program for routine acetylcholine vasoreactivity testing in the cardiac catheterization laboratory

Background/Introduction

Of the patients who are referred for invasive coronary angiography 30–50% are found to have no obstructive coronary artery disease. Current ESC Guidelines for chronic coronary syndromes have a class IIa recommendation for intracoronary provocative testing with acetylcholine in patients with ischemia and no obstructive coronary artery disease (INOCA). However, there is limited guidance for pharmacy and nursing teams for the support of provocative testing in the cardiac catheterization laboratory.

Purpose

To demonstrate feasibility and safety of acetylcholine vasoreactivity testing in the cardiac catheterization laboratory.

Methods

The inpatient pharmacy developed an adapted protocol based on available evidence and facilitated a multi-disciplinary operational workflow for the assessment of vasospastic angina. 3mL acetylcholine aliquots of 1mcg/mL, 10 mcg/mL, 25 mcg/mL, 50 mcg/mL, and 100 mcg/mL were prepared by pharmacy following sterile compounding standards. The transition from provider or nursing staff compounding to pharmacy compounding provided quality assurance following United States Pharmacopeia compounding standards for improved sterility and patient safety, especially with a complicated micro-dilution recipe. Pharmacy supported the necessary guidance with optimized clinical decision support in the form of a customized order panel embedded in the electronic health record system and compounding software as another layer of standardization and quality assurance. Syringes were made available to the interventional cardiologist in the cardiac catheterization laboratory suite immediately prior to a scheduled case. Eleven orders of acetylcholine were placed with five dilution syringes per order (total 55 compounded syringes) from the customized acetylcholine provoked coronary vasospasm procedure order panel.

Results

From January 2020 to March 2021, 11 patients underwent acetylcholine vasoreactivity testing for clinical indications. One patient developed atrial fibrillation with a rapid ventricular rate during provocative testing of the right coronary artery which required elective cardioversion the following day. Of 11 patients, 9 were outpatients and 2 were inpatients. 1 patient received intravenous atropine and ondansetron due to profound bradycardia and nausea after 100mcg acetylcholine administration. No other safety events occurred.

Conclusion(s)

Provocative testing with intracoronary acetylcholine administration is safe and feasible. For clinical assessment, sterile compounding and customized order panels facilitate routine clinical assessment for patients with suspected vasospastic angina. Nursing protocols should include cardiac monitoring, medications to reverse adverse effects, and possible outcomes of provocative testing. We provide a practical description of our workflow for pharmacists, catheterization laboratory staff, and providers for routine acetylcholine provocation for the evaluation of INOCA.

Funding Acknowledgement

Type of funding sources: None.

Effect of Idebenone, Resveratrol and Taurine on the Sperm Quality and Lipid Peroxidation of Cryopreserved Crossbred Ram Semen

BACKGROUND

Antioxidants reduce oxidative stress and improve sperm quality during cryopreservation.

OBJECTIVE

To investigate the effect of idebenone, resveratrol and taurine on the sperm quality and lipid peroxidation of cryopreserved crossbred ram semen.

METHODS

In a split study, pooled ejaculates were divided into four aliquots cryopreserved in tris extender with no antioxidant (control), with idebenone (0.01 mM), resveratrol (0.1 mM), and taurine (40 mM).

RESULT

Among all antioxidants, taurine treatment yielded significantly better sperm quality. Malondialdehyde (MDA) level in seminal plasma was significantly lower for taurine compared to the control, idebenone and resveratrol treatments. Moreover, sperm quality declined significantly in all the groups from pre-freeze to post-thaw.

CONCLUSION

The findings indicate that taurine at 40 mM significantly improves sperm quality compared to 0.01 mM idebenone and 0.1 mM resveratrol, hence it can be considered as a potent and promising antioxidant supplement in tris extender for the cryopreservation of crossbred ram semen.

A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group

Purpose:

To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group.

Methods:

This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software.

Results:

Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration.

Conclusion:

Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.

Genotyping and antibiotic resistance patterns of Campylobacter fetus subsp.venerealis from cattle farms in India

Bovine genital campylobacteriosis caused by Campylobacter fetus subsp. venerealis (Cfv) is of considerable economic importance to the cattle industry worldwide. Cfv causes syndrome of temporary infertility in female cattle, early embryonic mortality, aberrant oestrus cycles, delayed conception, abortions and poor calving rates. In the present study, a total of 200 samples obtained from vaginal swabs, cervicovaginal mucous (CVM), preputial washes and semen straws were investigated that were obtained from organized cattle farm of MLRI, Manasbal and unorganized sectors. Out of a total of 200 samples, 49 (47·57%) vaginal swabs, 1 (3·33%) preputial wash and 8 (25%) carried out CVM samples were positive for Cfv, whereas none of the semen straws were positive for Cfv. A total of eleven isolates of Cfv were recovered. PFGE (Pulse field gel electrophoresis) analysis revealed four different pulsotypes (I-IV) circulating in the screened farms. A common pulsotype circulating among farms could not be established. Insertion element (ISCfe1), a 233 bp amplicon of Cfv, was sequenced and the sequence was deposited in GenBank (accession no: MK475662).

Ethnoecological, Elemental, and Phytochemical Evaluation of Five Plant Species of Lamiaceae in Peshawar, Pakistan

The use of medicinal plants as an unconventional health treatment is gaining considerable recognition and popularity worldwide. The current study was designed to inspect five medicinally important species (such as Mentha longifolia (L.) Huds., Mentha piperita L., Mentha spicata L., Ocimum basilicum L., and Rosmarinus officinalis L.) of Lamiaceae, collected from district Peshawar, through ethnoecological, phytochemical, and elemental analyses. Biological spectra expressed that therophytes (60%) were the dominant life-form class, while nanophyll (60%) was the leading class among leaf size. The ethnobotanical profile showed that all the species were medicinal and ornamental (100%) each, while 60% were used in spices. Quantitative analysis for the macro- and microminerals confirmed the presence of 13 elements (C, N, O, Mg, K, P, S, Ca, Al, Si, Fe, Cl, and Na), which were present in varying amounts from species to species. The methanol extract of leaf samples was used for the analysis of phytochemical constituents such as saponins, flavonoids, tannins, terpenoids, phlobatannins, steroids, and anthraquinones. The medicinal potential of these plants was correlated with the presence of these phytochemicals. Due to the presence of active constituents, the plants had high potential in antifungal, antidiuretic, antioxidant, and anti-inflammatory activities.

Innovative cost-effective method to repair lacrimal cannaliculi laceration - finding proximal end and stent

Purpose: To explore a new technique to find out the proximal end of lacerated canaliculi and a new material for the stent.

Methods: Surgery was performed on 9 eyes of 9 patients using a 5/0 prolene suture needle as a modified probe. Prolene suture was inserted as a stent and left in place for two months. All the data were analyzed.

Results: The surgery was successful in all cases and the prolene were removed after two months. The mean follow-up time after the tube removal was 3.8 months (range 3–6 months). No other complications associated with the prolene sutures were noticed except for epiphora and corneal irritation in three cases. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during prolene removal.

Conclusions: The reported surgical technique is a very cost-effective option for lacrimal canalicular laceration repair.

A phytobeneficial strain Planomicrobium sp. MSSA-10 triggered oxidative stress responsive mechanisms and regulated the growth of pea plants under induced saline environment

AIMS

The study was planned to characterize Planomicrobium sp. MSSA-10 for plant-beneficial traits and to evaluate its inoculation impact on physiology of pea plants under different salinity levels.

METHODS AND RESULTS

Strain MSSA-10 was isolated from pea rhizosphere and identified by the analysis of 16S rRNA gene sequence. The strain demonstrated phosphate solubilization and auxin production up to 2 mol l-1 NaCl and exhibited 1-aminocyclopropane-1-carboxylic acid deaminase activity up to 1·5 mol l-1 salt. In an inoculation experiment under different salinity regimes, a significant increase in growth was observed associated with decreased levels of reactive oxygen species and enhanced antioxidative enzyme activities. The strain also promoted the translocation of nutrients in plants with subsequent increase in chlorophyll and protein contents as compared to noninoculated plants. It has been observed that rifampicin-resistant derivatives of MSSA-10 were able to survive for 30 days at optimum cell density with pea rhizosphere.

CONCLUSION

Growth-stimulating effect of MSSA-10 on pea plants may be attributed to its rhizosphere competence, nutrient mobilization and modulation of plant oxidative damage repair mechanisms under saline environment.

SIGNIFICANCE AND IMPACT OF THE STUDY

Planomicrobium sp. MSSA-10 might be used as potent bioinoculant to relieve pea plants from deleterious effects of salinity.

Comparative study of visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract in children

OBJECTIVE

To compare final visual outcomes of surgically treated traumatic cataract between open-globe and closed-globe injuries in children, as classified by the Birmingham Eye Trauma Terminology system.

METHODS

This is an observational cohort study with permission from Hospital Ethical Committee. We enrolled children meeting specific inclusion criteria, examined their eyes to review any co-morbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were re-examined postoperatively. We classified the cases of traumatic cataract as either open-globe (Group 1) or closed-globe (Group 2) according to the Birmingham Eye Trauma Terminology system and compared visual acuity.

RESULT

Our study cohort of 1076 eyes with traumatic cataracts included 405 eyes in Group 1 and 671 in Group 2. Postoperatively, the visual acuity was >20/60 in 223 (55.3%) and 377 (56.3%) operated eyes in Groups 1 and 2, respectively ( p < 0.001, analysis of variance). With further follow-up, >20/60 vision was significantly higher in Group 2 as compared to Group 1 (odds ratio = 1.61; 95% confidence interval = 0.85-3.02). Overall, 600 eyes (55.7%) regained final visual acuity >20/60.

CONCLUSION

Closed-globe injury has more favourable prognosis for the satisfactory (>20/60) visual recovery after effective management of traumatic cataracts in children.

Is the pelvis stable during supine total hip arthroplasty?

Intra- operative changes in pelvic position during total hip arthroplasty (THA) can affect acetabular orientation. We evaluated these changes during supine THA using a proprietary mobile application called PelvicTracker. Twenty- two patients undergoing THA using direct anterior approach were included in the study. In the sagittal plane, the pelvis was extended (anterior tilt) as compared to the start of surgery in 19/ 22 hips at the time of cup implantation (mean extension: 3.1°; range: 1°-6°). In the transverse plane, the pelvis was rolled to the opposite side of surgery in 12 hips (mean roll: 2.8°; range: 1°-5°), to the same side in 8 hips (mean roll: 3.9°, range: 1°-9°) and unchanged in 2 hips at the time of cup implantation. Predicted change in cup version of ≥5° due to changes in pelvic position was seen in 7/22 (32%) patients. Although minor, changes in pelvic position do occur during supine THA which may affect acetabular orientation.

Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts

OBJECTIVE

To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves.

RESULTS

POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014).

CONCLUSION

POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.

Iron Polymaltose Complex in the Treatment of Iron Deficiency Anemia in Pregnancy

Iron deficiency anaemia is a major public health problem in pregnancy. About 58% of pregnant women in developed countries are anaemic mainly due to iron deficiency resulting a serious negative consequences on children, mothers and eventually on the nation. This quasi-experimental multi centered study (Before after study) was done to evaluate the efficacy and tolerability of Iron Polymaltose Complex (IPC) in the treatment of iron deficiency anaemia and it was performed at the OPD of Bangladesh Medical College and two other clinics of Dhaka city from August 2011 to September 2013. A total of 80 (eighty) subjects were selected by purposive sampling as per inclusion and exclusion criteria. They were treated by Iron Polymaltose-IPC [47mg elemental iron + Folic Acid 0.5mg + Zinc 22.5mg - Once daily orally for 12 weeks]. At the beginning and after 12 weeks of intervention by Iron Polymaltose Complex (IPC) Hb%, Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Serum iron, and Serum ferritin were measured. Data were analyzed by SPSS version 13.0. Paired and unpaired 't' test was used to analyze differences within groups and between groups. Chi-square test was done to analyze primary efficacy parameters and adverse drug reactions (ADR). Most of the respondents were within the age group of 18-23 and 30-35 years (32.6% each). Significant differences were found by treatment with IPC for 12 weeks in Hb%, PCV, MCV, MCH, Serum iron, and Serum ferritin level. In iron deficiency anaemia during pregnancy IPC may be used as a safe and cost-effective therapeutic management.

Traumatic cataracts in children: Visual outcome

AIM: To review results of traumatic cataracts in children.

METHODS: Only those pediatric patients who fitted in the definite inclusion criteria were considered for study enrollment. They were further examined for any kind of co-morbidities because of trauma, operated upon for traumatic cataracts with intraocular lens implantation. Amblyopia if present was treated. All were re-examined at the culmination of six-week postoperative period. According to the Birmingham Eye Trauma Terminology System the traumatic cataract cases were divided into group 1 (open globe) and group 2 (closed globe), and then determinants of visual acuity were compared.

RESULTS: There were 544 eyes in group 1 and 127 eyes in group 2 in our study of 671 eyes with pediatric traumatic cataracts. Visual acuity at the end of 6 wk after surgery in the operated eye was > 6/60 in 450 (82.7%) and ≥ 6/12 in 215 (39.4%) eyes in the open globe group and > 20/200 in 127 (81.8%) and ≥ 6/12 in 36 (28.4%) eyes in the closed globe group (P = 0.143), and the difference between the groups was not significant in children. Overall, 402 (39.4%) eyes gained ≥ 6/60 and > 5/12 in 238 (35.4%) cases. Surgical treatment caused a significant difference in visual outcome (P = 0.000). When we compared achieved visual outcome with ocular trauma score predicted vision, no significant difference was found.

CONCLUSION: Traumatic cataracts in children may have better outcome and ocular trauma score is a useful predictive method for the ocular trauma in children.

Lens siderosis resulting from a small intralenticular metallic foreign body

We report a rare case of lens siderosis with an undetectable intraocular foreign body by imaging. An 8-year-old boy presented with diminution of vision in the left eye since 3 months. His parents gave a preceding uncertain history of a foreign body injury to his left eye 3 months ago while playing. Presenting visual acuity in the left eye was perception of hand movements. Slit-lamp examination revealed a total white cataract with brownish-pigmented spots on the anterior capsule of the lens, but no intraocular foreign body was found. There was also no evidence of an intraocular foreign body on ultrasonography. Patient underwent cataract extraction with intraocular lens implantation. During the operation, a small (2×1×1 mm in size) intralenticular foreign body of metal material was found and removed carefully with a magnet. The patient regained 20/30 vision after surgery.

Spontaneous dislocation of lens bag with acrylic lens after uneventful cataract surgery - unusual complication of cataract surgery

Introduction: Spontaneous dislocation of intraocular lens with bag is rare.

Methods: We report a case of a 56-year-old male who presented with spontaneous anterior dislocation of an in-the-bag intraocular lens 3 years after manual small incision cataract surgery. He had undergone manual small incision cataract surgery with foldable acrylic intraocular lens implantation, and 18 months after cataract surgery ND: YAG capsulotomy with uneventful post capsulotomy follow-up. 17 months after capsulotomy, the patient presented with sudden decrease of vision. On anterior segment examination, the intraocular lens with bag was dislocated into the anterior chamber.

Result: It was managed with intraocular lens explantation with bag, anterior vitrectomy and sclera fixated intraocular lens.

Conclusion: Spontaneous intraocular lens dislocation with bag is possible after 1.5 years of uneventful surgery which may be managed using different techniques.

Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy

Objective:

The objective was to provide evidence-based care for patients with traumatic cataracts, we assessed whether a posterior capsulotomy and anterior vitrectomy, as part of the primary surgical procedure, could be a positive predictor of final visual outcome.

Materials and Methods:

This is a prospective randomized control trial. Patients presenting at our hospital between January 2010 and December 2012 having ocular trauma and traumatic cataracts were enrolled, according to the inclusion criteria. We enrolled two groups: Those with and without primary posterior capsulotomy and vitrectomy. Information regarding demographic and ocular trauma were collected using the World Eye Trauma Registry form at the first visit and follow-up, and specific information was collected for both the group who underwent posterior capsulectomies and vitrectomies as a part of the primary procedure, and the control group. Data were analyzed to evaluate the predictive value of primary posterior capsulectomy and anterior vitrectomy.

Results:

We enrolled 120 cases, 60 in each group, comprising 31 females and 89 males. When all other variables were controlled for, the visual outcome (best corrected visual acuity) differed significantly (P < 0.001) between the groups.

Conclusion:

Performance of posterior capsulectomy and anterior vitrectomy as part of the primary procedure improves the final visual outcome.

Cannula dacryocystorhinostomy: a simple, innovative and cost-effective method of lacrimal surgery

To compare our innovative, cost-effective method of lacrimal surgery with other methods. A prospective cohort study. The study included 80 eyes of 80 consecutive patients who presented to our clinic between January 2009 and December 2011. The patients underwent surgery using a new technique with a specially designed cannula and were followed according to our protocol. Patency on irrigation. Of the 80 cases enrolled, the procedure was successful in 52.5 % with a mean follow-up of 247.2 days. The success rate was significantly affected by the preoperative conditions (p = 0.001) and follow-up duration (p = 0.006). This simple innovative technique was cost-effective and the results were comparable with those of other techniques.

Lithium alters the morphology of neurites regenerating from cultured adult spiral ganglion neurons

The small-molecule drug lithium (as a monovalent ion) promotes neurite regeneration and functional recovery, is easy to administer, and is approved for human use to treat bipolar disorder. Lithium exerts its neuritogenic effect mainly by inhibiting glycogen synthase kinase 3, a constitutively-active serine/threonine kinase that is regulated by neurotrophin and "wingless-related MMTV integration site" (Wnt) signaling. In spiral ganglion neurons of the cochlea, the effects of lithium and the function of glycogen synthase kinase 3 have not been investigated. We, therefore, set out to test whether lithium modulates neuritogenesis from adult spiral ganglion neurons. Primary cultures of dissociated spiral ganglion neurons from adult mice were exposed to lithium at concentrations between 0 and 12.5 mM. The resulting neurite morphology and growth-cone appearance were measured in detail by using immunofluorescence microscopy and image analysis. We found that lithium altered the morphology of regenerating neurites and their growth cones in a differential, concentration-dependent fashion. Low concentrations of 0.5-2.5 mM (around the half-maximal inhibitory concentration for glycogen synthase kinase 3 and the recommended therapeutic serum concentration for bipolar disorder) enhanced neurite sprouting and branching. A high concentration of 12.5 mM, in contrast, slowed elongation. As the lithium concentration rose from low to high, the microtubules became increasingly disarranged and the growth cones more arborized. Our results demonstrate that lithium selectively stimulates phases of neuritogenesis that are driven by microtubule reorganization. In contrast, most other drugs that have previously been tested on spiral ganglion neurons are reported to inhibit neurite outgrowth or affect only elongation. Lithium sensitivity is a necessary, but not sufficient condition for the involvement of glycogen synthase kinase 3. Our results are, therefore, consistent with, but do not prove lithium inhibiting glycogen synthase kinase 3 activity in spiral ganglion neurons. Experiments with additional drugs and molecular-genetic tools will be necessary to test whether glycogen synthase kinase 3 regulates neurite regeneration from spiral ganglion neurons, possibly by integrating neurotrophin and Wnt signals at the growth cone.

Study of two techniques for midline laparotomy fascial wound closure

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique.

Statin use after first myocardial infarction in UK men and women from 1997 to 2006: Who started and who continued treatment?

BACKGROUND AND AIMS

To examine trends in initiation and continuation of statin treatment after myocardial infarction (MI) and their determinants, during a period of increasing usage.

METHODS AND RESULTS

9367 patients aged 30-84 with a first Myocardial Infarction (MI) in 1997-2006 were identified in DIN-LINK, an anonymised, UK primary care database. We assessed statin initiation (prescription within 6 months of MI) and continued therapy (% covered by a prescription on a given day of those prescribed a statin within 6 months). The influences of co-morbidities and socio-economic deprivation (Index of Multiple Deprivation) were examined. Statin initiation increased from 37% for MIs in 1997 to 92% in 2006. Continuation at 1 year remained stable over successive cohorts at approximately 80%, settling to about 76% in patients with 5-10 years follow up. Younger age, affluence, revascularisation in 6 months after MI, and absence of congestive heart failure, predicted higher initiation and continuation; a diagnosis of hypertension or diabetes predicted higher initiation, while smoking was associated with poorer continuation. Men had higher initiation and continued therapy, but these effects were largely explained by their younger age. Type of statin initially prescribed did not influence continued usage.

CONCLUSION

Statin use after MI increased markedly between 1997 and 2006, whilst continued therapy remained high and stable. Importantly, first choice of statin had no effect on continuation. Whilst the high current levels of initiation may have reached a ceiling, increasing continuation rates among smokers, older patients and those from lower socio-economic groups, should remain a priority.

OcularTrauma Score: a useful predictor of visual outcome at six weeks in patients with traumatic cataract

OBJECTIVE

To validate the predictive value of the Ocular Trauma Score (OTS) in injury cases with traumatic cataracts.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 787 eyes.

METHODS

A total of 787 eyes of 787 subjects with traumatic cataracts were enrolled using specific inclusion criteria. The eyes were examined to review comorbidities caused by trauma. Surgery was performed for traumatic cataracts, lenses were implanted, and patients were treated for amblyopia, as applicable. The patients were reexamined 6 weeks postoperatively. On the basis of ocular trauma described according to the Birmingham Eye Trauma Terminology System, the patients were divided into 2 traumatic cataract groups: open globe injury and closed globe injury. The relationship of visual acuity (VA) with demographic and clinical variables was analyzed. The visual outcomes were predicted using the OTS, and the predictions were compared with the actual outcomes using statistical tests.

MAIN OUTCOME MEASURES

Visual acuity.

RESULTS

At 6 weeks postoperatively, 245 eyes (31%) had a VA ≥ 20/40 and 480 eyes (61.0%) had a VA >20/200. The OTS prediction was not significantly different when compared with actual visual outcome at 6 weeks postoperatively in all OTS categories.

CONCLUSIONS

The relationship of VA at 6 weeks with demographic and clinical variables was analyzed. In this study, the OTS was found as a reliable tool to predict visual outcome in cases of traumatic cataracts 6 weeks postoperatively.

Final visual outcome following re exploration of cataracts performed by trainee surgeons in India

OBJECTIVE

To investigate the outcome of secondary intraocular lens implantation, compare final visual outcome between different categories of surgeon, and evaluate care provided by teaching hospitals to patients with capsular complications.

SETTING

Teaching hospital.

DESIGN

Retrospective study. Subjects were recruited by examination of electronic medical records. All patients operated for corrective surgery following capsular complications during cataract surgery were included. All patient medical records were reviewed, and data were collected for 359 eyes.

MAIN OUTCOME MEASURES

Visual acuity and major complications. All collected data were entered into Microsoft Excel and analyzed by SPSS 17 software using cross tabulation and Chi-squared tests.

RESULTS

Surgical intervention made a significant difference to the final visual outcome (P < 0.001). The category of the trainee had a significant effect on the final visual outcome (P = 0.021).

CONCLUSION

Capsular complications during cataract surgery should be surgically treated to improve outcome.

Morphology of traumatic cataract: does it play a role in final visual outcome?

Aim To study the morphology of traumatic cataract as an important predictor for final visual outcome after treatment of traumatic cataracts. Setting Tertiary eye care centre in Dahod at the trijunction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. Methods This was a prospective observational cohort study among all patients presenting at the hospital with traumatic cataracts between January 2003 and December 2009. All information regarding demographic and ocular trauma was collected on a pretested World Eye Trauma Registry form for both the first visit and follow-up. In particular, the authors collected specific information about the morphology of traumatic cataracts; the surgical technique was determined accordingly. Data were entered and analysed with regard to the relationship between type of trauma and resulting injury, results achieved with particular surgical techniques, and the relationship between morphology and final visual outcome. Outcome measures Final visual outcome. Results Traumatic cataracts of different morphologies showed significant differences in the final visual outcome (χ(2) test, p=0.014). Conclusion The morphology of traumatic cataract plays an important role in the final visual outcome.

Antipsychotic prescribing to older people living in care homes and the community in England and Wales

OBJECTIVE

Excessive use of antipsychotic medication by older people is an international concern, but there is limited comparative information on their use in different residential settings. This paper describes and compares antipsychotic prescribing to older people in care homes and the community in England and Wales.

METHOD

Analysis of a primary care database (THIN) with 403 259 community and 10 387 care home residents aged 65-104 years in 2008-9.

RESULTS

3677 (0.9%) patients in the community and 2173 (20.9%) in care homes (20.5% in residential homes, 21.7% in nursing homes) received an antipsychotic medication prescription in the last 90 days. Most patients had received prescriptions for more than three months and 60% of prescriptions were for atypical antipsychotics. In patients without severe mental illness, 2367 (0.6%) patients in the community and 1765 (18.2%) in care homes received antipsychotic medication; such prescribing was common for patients with recorded dementia (30.2% in care home, 10.1% in the community). In care homes, younger age and living in the North of England predicted prescribing, but care home type did not. In the community, female gender, increasing age, living in a deprived area and the North predicted prescribing.

CONCLUSIONS

Despite safety concerns, antipsychotic prescribing is markedly higher in care homes than in the community, and strongly associated with dementia in both settings. In England and Wales, we estimate that 54 000 older care home patients and 50 000 community patients receive antipsychotic medication without a diagnosis of severe mental illness with important implications for health and social services.

Socio-economic determinants of casualty and NHS Direct use

BACKGROUND

There is limited evidence on the social determinants of A&E use and concerns over the equity of NHS Direct utilization.

METHODS

We analysed data from the 2004-05 British General Household Survey, which included 20,421 participants. Logistic regression was used to examine individual casualty use in the last 3 months and household NHS Direct use in the last year.

RESULTS

Casualty use was higher for individuals living in rented accommodation or without car access, lower income groups, unskilled manual workers, current smokers and for individuals with limiting illness. In contrast, NHS Direct use was lower in households with older residents, low income, no car access and where the head of household was from a manual occupational group, a minority ethnic group or born outside the UK. The odds ratio for use of NHS Direct for households in the lowest equivalized income quintile was 0.67 (0.55-0.81). Adjustment for limiting illness increased the effect of socio-economic factors on NHS Direct use.

CONCLUSIONS

Reduced access to A&E services will disproportionately affect poorer individuals, whereas increased investment in telephone services will benefit affluent populations. Current national policy may widen inequities in access to emergency care.