Treatment strategies and long-term outcomes in patients with congenital microphthalmia-anophthalmia with cyst

BACKGROUND/AIMS

Microphthalmia and anophthalmia are rare conditions, which represent ocular maldevelopment; both may be associated with orbital cysts. Current literature recommends retention to stimulate orbital growth during socket rehabilitation but does not illustrate their potential to deform the periocular tissues. This study aims to illustrate the long-term outcomes when other elements, such as forniceal and lid development, are also considered when formulating bespoke treatment plans for patients.

METHODS

Retrospective case series of 78 patients attending a single prosthetics clinic between 1988 and 2020. Clinical and surgical notes, radiological imaging, clinical photographs and patient/doctor satisfaction questionnaires were used to report patient outcomes and natural history data.

RESULTS

89 sockets of 78 patients (11 bilateral) were included; average age of presentation being 2.8 years (9 days to 29.5 years). Cysts were clinically detected (48%) or were incidental findings (52%). The mean follow-up time was 7.2 years (6 months to 28 years). Cysts in 46% of sockets underwent surgical excision while the remainder were retained. Satisfaction surveys were obtained for 75 patients, with cosmetic outcomes rated as 'excellent' or 'good' in 90% of cases by physicians and 97% of cases by patients or guardians.

CONCLUSION

The favourable long-term outcomes in this study have resulted from bespoke plans which considered periocular tissue development, regional orbital growth and orbital volume replacement. The authors contemplate cyst excision if the prosthetic fitting or retention is impeded by the cyst as this often heralds the increased risk of long-term periocular distortion.

Should we care about the ocular surface in the anophthalmic patient?

PURPOSE

To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis.

METHODS

Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls.

RESULTS

Patients had significantly higher SANDE (p < 0.001), Schirmer I test (p = 0.004), conjunctival inflammation (p < 0.001), and MGD scores (p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression (p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) (p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket.

CONCLUSIONS

Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.

Mycoremediation effect of Trichoderma harzianum strain T22 combined with ozonation in diesel-contaminated sand

This study aimed to determine the ability of the fungus Trichoderma harzianum strain T22 (Th-T22) to utilize diesel fuel as a carbon source. The potential use of Th-T22 for diesel bioremediation in an artificial soil was tested by inoculating a diesel-sand mixture with a fungal mycelial suspension of Th-T22. Given the ability of ozone to degrade compounds with low biochemical reactivity, the effect of a pre- and post-ozonation was also evaluated. The survival, growth and sporulation of Th-T22 throughout the bioremediation trial were monitored in all the treatments. In the post-ozonation treatments, the biodegradation percentages of diesel removal were 70.16% and 88.35% in Th-T22-inoculated sand treated or untreated with the antibacterial streptomycin, respectively. The results showed that ozonation alone caused good removal efficiencies (41.9%) but it was much more effective if combined with Th-T22 in a post-ozonation regime, whereas pre-ozonation negatively affected the subsequent biodegradation, likely due to its disinfectant and oxidizing effect on Th-T22. The results obtained demonstrated the significant mycoremediation ability of Th-T22 in diesel-contaminated sand and its possible use as a bioremediation agent for diesel spills in polluted sites.

CO2 and N2O from water resource recovery facilities: Evaluation of emissions from biological treatment, settling, disinfection, and receiving water body

Water resource recovery facilities (WRRFs) contribute to climate change and air pollution, as they are anthropogenic potential sources of direct and indirect emission of greenhouse gases (GHGs). Studies concerning the monitoring and accounting for GHG emissions from WRRFs are of increasing interest. In this study, the floating hood technique for gas collection was coupled with the off-gas method to monitor and apportion nitrous oxide (N₂O) and carbon dioxide (CO₂) emissions from both aerated and non-aerated tanks in a municipal water resource recovery facility, in order to investigate its carbon footprint (CFP). To our knowledge, this is the first time that the chamber technique was applied to evaluate gas fluxes from the settler, where an emission factor (EF) of 4.71 ∗ 10^-5 kg_CO2,eq kg_bCOD^-1 was found. Interesting results were found in the disinfection unit, which was the major contributor to direct N₂O emissions (with a specific emission factor of 0.008 kg_CO2,eq kg_bCOD^-1), due to the chemical interaction between hydroxylamine and the disinfectant agent (hypochlorite). The specific emission factor of the biological aerated tank was 0.00112 kg_CO2,eq kg_bCOD^-1. The average direct CO₂ emission was equal to 0.068 kg_CO2 kg_bCOD^-1 from the activated sludge tank and to 0.00017 kg_CO2 kg_bCOD^-1 from the secondary clarifier. Therefore, taking into account the contribution of both direct N₂O and CO₂ emissions, values of 0.069 kg_CO2,eq kg_bCOD^-1, 0.008 kg_CO2,eq kg_bCOD^-1 and 0.00022 kg_CO2,eq kg_bCOD^-1_, were found for the net CFP of the aerated compartment, the disinfection unit and the clarifier, respectively. The plant energy Footprint (eFP) was also evaluated, confirming that the aeration system is the major contributor to energy consumption, as well as to indirect CO₂ emission, with a specific eFP of 1.49 kWh kg_bCOD^-1.

Long-term outcomes after cosmetic customized prostheses and dermis fat graft in congenital anophthalmia: a retrospective multicentre study

PURPOSE

To evaluate long-term outcomes of progressively enlarging cosmetic customized prostheses (CCP) early after birth followed by dermis fat graft (DFG), as a strategy of socket rehabilitation in children with clinical congenital anophthalmia (CCA).

METHODS

Twenty patients with unilateral and two patients with bilateral CCA were enrolled. All patients were treated by inserting a CCP at the time of their first assessment which was then enlarged. Subsequently they underwent DFG. Differences in vertical palpebral aperture (VPA) and horizontal palpebral length (HPL), between affected and unaffected sides, were recorded at the first CCP fitting as well as before and after DFG. Satisfaction with cosmetic results, prosthetic retention, and complications rate were assessed. Magnetic resonance imaging of the orbit was performed in all patients before and after surgery.

RESULTS

A significant decrease in the difference between the normal and the anophthalmic side of both PA and HPL was found over follow-up. Both VPA and HPL differences decreased by 47.6% (10.5 mm, range 1-28 mm) and by 7.1% (5.8 mm, range 0-18 mm), respectively. Satisfaction in terms of cosmetic outcomes proved to be very positive, being "very satisfied" for families and "satisfied" for physicians. Excellent retention of prostheses was observed in all cases.

CONCLUSIONS

A rehabilitating strategy combining early CCP and further DFG proved to be a valuable approach in children with CCA, offering significant benefits in terms of socket expansion, prosthetic retention, psychological impact, and cosmetic outcomes.

Halogen atom effect on the photophysical properties of substituted aza-BODIPY derivatives

The influence of halogen atom substitution (Br and I), in different amounts and positions in an aza-BODIPY skeleton, on the photophysical properties of some aza-BODIPY derivatives has been investigated by using density functional theory and its time-dependent extension.

Curative gastric resection for the elderly patients suffering from gastric cancer

The improvement of the socio-economic conditions and the progress of medicine have extended the life span of the world's population and as a result, the number of patients with malignant neoplasms has increased. Gastric cancer is the third most common cancer (after lung and prostate) and the second leading cause of death caused by cancer (after lung bronchogenic cell carcinoma) in males; while it's the fifth cancer by frequency and the fourth cause of cancer death in females. It presents a peculiar geographical distribution with a lower incidence in Western Europe and North America, and higher incidence in the Far East, South America and Eastern Europe. Its incidence in Italy is 122 cases per 100000 inhabitants in males and 83 cases per 100000 inhabitants in females (in Italy). It occurs more frequently in old age, is quite rare in individuals under the age of 45. The aim of this work is to analyze the clinical and pathological characteristics of gastric carcinoma and the feasibility of curative surgery in patients over 75, identifying the factors affecting mortality, morbidity, survival and quality of life after surgery. These data have been compared with those of younger patients to assess the correct type of surgery.

Deep vein thrombosis of the lower limb secondary to lumbar discal hernia compression: a rarity? Review of the literature

This case report is about a 70-years-old female patient, suffering from discal hernia, with compression of the iliac vein, that led to the formation of deep vein thrombosis of the lower limbs. The angio-CT scan revealed the starting point of the L4- L5 compression where a voluminous discal hernia caused deep vein thrombosis, with the involvement the femoro-popliteal venous axis. Blood samples and PET-CT scans excluded other possible etiologic factors. This case demonstrates how a voluminous discal hernia can cause venous thrombosis.

Effects of the rearing season on carcass and meat quality of suckling Apennine light lambs

The aim of this study was to evaluate the effects of the rearing season (autumn vs winter) on the carcass and meat quality of light lambs, obtained according to the traditional farming system usual in central Italy. Eighty carcasses from 60 d+/-3 old unweaned Apennine single birth male lambs, permanently reared indoor, half in autumn (receiving milk from ewes permanently pastured) and half in winter (which dams did never acceded to pasture), were weighed, classified according to the EU classification system for light lambs, and their Longissimus lumborum meat was analysed for pH, colour, drip and cooking losses, proximate composition and fatty acids profile of intramuscular fat. Most of the carcasses fully responded to the 1st quality EU requirements and no effects of the rearing season was evident on carcass characteristics. On the contrary, L. lumborum of lambs born and reared in autumn, receiving milk from ewes permanently pastured, evidenced a lower Lightness L* (P=0.02), a higher Chroma C* (P=0.01), with a higher fat content (P=0.04) than lambs reared in winter, which dams were permanently stall-fed. Moreover the intramuscular fat of the former was characterized by a greater PUFA concentration (P=0.01), a more favourable n-6/n-3 ratio (P<0.001), and a higher CLA content (P<0.001) than the latter, as a result of the difference related to the sheep traditional feeding system.

Effects of loading methods on rabbit welfare and meat quality

The effects of different loading methods on the welfare, carcass characteristics and meat quality traits of hybrid commercial rabbits were investigated. 384 male rabbits, 82 days old, were transported from the farm to the slaughterhouse. At the farm, 192 rabbits were loaded onto the truck smoothly (S) and 192 rabbits were loaded roughly (R). The S loading method consisted of carefully placing each rabbit into the transport crates. In the R method, the loading was hurriedly and carelessly executed by the transport operator, throwing each animal into the crates fixed on the truck. Live weight before and after transport as well as slaughter data were recorded for each rabbit, and a subset of 80 carcasses were evaluated for meat quality. Blood samples from 80 rabbits were analysed for haematological and biochemical parameters. A significant neutrophilia (P<0.001), lymphocytopaenia (P<0.001) and an increase in serum aspartate aminotransferase (AST) (P<0.01), alanine aminotransferase (ALT) (P<0.001) and creatine kinase (CK) activities (P<0.001) were recorded in all rabbits after transport, independent of the loading method. A twofold increase in serum corticosterone concentration (6.23 vs. 14.88 ng/mL; P=0.001) was observed in all rabbits following transport. Results suggest that the stress parameters analysed were more influenced by transport and handling itself rather than by the different loading methods. The results showed that there was no adverse effect of loading method on carcass traits. Furthermore, the stress condition evidenced by haematological and biochemical parameters prior to slaughter did not affect meat quality.

Effects of selenium source and level of supplementation on the performance and meat quality of lambs

Objective of this study was to evaluate the performance, the quality and oxidative stability of meat, the total Se and specific selenoamino-acids content of muscle of lambs that were fed diets supplemented from different Se sources and at different levels. Forty-eight Apennine lambs 30day old (12.78±0.94kg) received, during a 63day period, a total mixed ration (TMR) which was either Se unsupplemented (Control group - background only- 0.13mg/kg Se) or supplemented with Na selenite (0.30mg/kg Se as sodium selenite) or selenium enriched yeast (0.30mg/kg and 0.45mg/kg Se as Se-yeast). Growth performance, feed to gain ratio, carcass and meat quality (pH, drip and cooking losses, colour, GSH-Px activity and chemical analysis) did not show any difference between the treatments. Meat colour and oxidative stability during 9 days of refrigerated storage were unaffected by dietary supplementation, suggesting that, at the levels of Se used in this experiment, dietary Se, even from an organic source, had limited potential for reducing lipid oxidation. Selenium supplementation raised the Se content in muscle (P<0.001) with the greatest increase when Se-yeast was fed. Although selenite increased total Se, it did not influence total or specific selenoamino-acids in this tissue. On the contrary, Se-yeast supplementation led to an increase in muscle Se-methionine content. We conclude that Se supplementation can increase significantly muscle Se levels and produce, particularly when Se-yeast is fed, a source of Se enriched meat as Se-methionine.

Contrast-enhanced colour-Doppler sonography versus pH-metry in the diagnosis of gastro-oesophageal reflux in children

PURPOSE

The aim of this study was to evaluate the accuracy of contrast-enhanced colour-Doppler ultrasound (CDUS) in the diagnosis of gastro-oesophageal reflux in children.

MATERIALS AND METHODS

One hundred and twenty children (68 boys and 52 girls aged between 1 month and two years) with a clinical suspicion of gastro-oesophageal reflux (postprandial vomiting, weight loss, failure to thrive, anaemia, night-time coughing and crying, regurgitation, etc.) were studied by contrast-enhanced CDUS and subsequently by 24-hour pH-metry. Results of the two techniques were compared using the McNemar test.

RESULTS

Gastro-oesophageal reflux was detected on CDUS in 84 patients and with 24-h pH-metry in 86. In all cases of reflux, CDUS visualised the passage of contrast material from the stomach into the abdominal and middle and distal third of the thoracic oesophagus, enabling assessment of the segment of oesophagus involved by the reflux. Compared with pH-metry, CDUS had a sensitivity of 98% (p<0.0001 with McNemar's test).

CONCLUSIONS

In consideration of the results obtained and particularly of the low level of invasiveness, contrast-enhanced CDUS could be used to monitor children undergoing medical or surgical treatment for the complications of gastro-oesophageal reflux disease.

Functional study of the transplanted kidney with power Doppler US and time/intensity curves

PURPOSE

Power Doppler ultrasound (US) with time-intensity curves was used to study renal graft function both in the absence of disease and with complications (acute tubular necrosis and chronic rejection) in an attempt to identify pathognomonic patterns. Time-intensity curves allow representation of the kidneys' wash-in and wash-out phases after intravenous administration of sonographic contrast material.

MATERIALS AND METHODS

Fifty-six asymptomatic renal transplant patients (36 men and 20 women), 19 of whom had altered creatinine clearance levels, were studied by power Doppler US with time-intensity curves followed by biopsy. Ten asymptomatic patients with normal creatinine clearance levels were used as controls.

RESULTS

Time-intensity curve analysis enabled identification of three groups of patients: group A, consisting of 27 patients showing peak enhancement between 50 and 65 s from intravenous administration of contrast material; group B, consisting of 16 patients with peak enhancement between 135 and 235 s; group C, consisting of three patients with peak enhancement between 100 and 130 s.

CONCLUSIONS

Data showed significant variations according to renal graft function (no abnormality, acute tubular necrosis or chronic rejection). Although confirmation by a larger series is required, our findings appear to indicate pathognomonic patterns in patients with chronic rejection and acute tubular necrosis.