Effectiveness of toric intraocular lens implantation for correcting irregular corneal astigmatism in cataract eyes

A retrospective cohort study was conducted to observe the correction effect of Toric intraocular lens (IOL) implantation in cataract eyes with specific types of irregular corneal astigmatism. Thirty-four eyes with either the "asymmetric bow-tie" pattern (Type I) or the "angled bow-tie" pattern (Type II) were included. Corneal topography was assessed using Pentacam HR, and changes in preoperative corneal astigmatism, visual acuity, manifest refraction, and objective visual quality were measured and compared. The average uncorrected distance visual acuity improved significantly from 0.86 ± 0.40 logMAR to 0.22 ± 0.15 logMAR (P < 0.001). Preoperative corneal astigmatism of 2.05 ± 0.90 D was corrected to a postoperative residual astigmatism of 0.78 ± 0.57 D (P < 0.001), with 32% of eyes within 0.50 D. The residual astigmatism prediction errors in Type I and Type II cases were (0.97 ± 0.68 D) and (0.66 ± 0.37 D), respectively (P = 0.100). The mean spherical equivalent prediction error in Type II cases (0.07 ± 0.36 D) was significantly smaller than that in Type I cases (- 0.29 ± 0.52 D) (P = 0.030). This study concludes that Toric IOL implantation effectively corrects specific types of irregular corneal astigmatism in cataract surgery. Eyes with the "angled bow-tie" pattern show higher accuracy in refractive predictions compared to eyes with the "asymmetric bow-tie" pattern.

The predictive accuracy of Barrett toric calculator using measured posterior corneal astigmatism derived from swept source-OCT and Scheimpflug camera

PURPOSE

To compare the performance of Barrett toric calculator incorporated with measured posterior corneal astigmatism (PCA) derived from IOL Master 700 and Pentacam HR versus predicted PCA.

METHODS

The predicted residual astigmatism using Barrett toric IOL calculator with predicted PCA, measured PCA from IOL Master 700 and measured PCA from Pentacam were calculated with the preoperative keratometry and intended IOL axis with modification. The vector analysis was performed to calculate the mean absolute prediction error (MAE), the centroid of the prediction error and the percentage of eyes with a prediction error within ±0.50 D, ±0.75 D, and ±1.00 D.

RESULTS

In 57 eyes of 57 patients with mean age of 70.42 ± 10.75 years, the MAE among the three calculation methods were 0.59 ± 0.38 D (Predicted PCA), 0.60 ± 0.38 D (Measured PCA from IOL Master 700) and 0.60 ± 0.36 D (Measured PCA from Pentacam) with no significant difference, either in the whole sample, the WTR eyes and the ATR eyes (F = 0.078, 0.306 and 0.083, p = 0.925, 0.739 and 0.920, respectively). Measured PCA obtained from IOL Master 700 resulted in one level reduction (from Tn to Tn-1) in 49.12% eyes in cylindrical model selection, while measured PCA obtained from Pentacam resulted in one level reduction of toric model selection in 18.18% eyes.

CONCLUSION

The present study suggested that the incorporation of measured PCA values derived from IOL Master 700 and Pentacam produce comparable clinical outcome with the predicted PCA mode in Barrett toric calculator.

The Combined Impact of Intense Pulsed Light Combined and 3% Diquafosol Ophthalmic Solution on Evaporative Dry Eye: A Randomized Control Study

INTRODUCTION

The primary objective of this study is to assess whether the combination of intense pulsed light (IPL) with 3% diquafosol (DQS) ophthalmic solution is more effective than intense pulsed light in alleviating signs and symptoms of dry eye disease (DED).

METHODS

This randomized study included 66 participants with evaporative dry eye (EDE) who received IPL + DQS therapy (n = 44 eyes), IPL therapy (n = 44 eyes), or sham therapy (n = 44 eyes). All participants were examined at baseline (D0), day 14 (D14), and day 28 (D28) for non-invasive break-up time (NITBUT), tear-film lipid layer (TFLL), corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expression (MGEx), and ocular surface disease index (OSDI).

RESULTS

At day 28, comparison among the IPL + DQS therapy, IPL therapy, and sham therapy found significant differences in the mean NITBUT (12.03 ± 1.27 versus 10.47 ± 3.48 versus 4.57 ± 0.46; p < 0.001), TFLL (2.09 ± 0.29 versus 2.27 ± 0.45 versus 2.89 ± 0.65; p < 0.001), CS (1.43 ± 0.82 versus 1.93 ± 1.32 versus 3.52 ± 1.00; p < 0.001), MGQ (1.55 ± 0.66 versus 1.91 ± 0.77 versus 2.66 ± 0.53; p < 0.001), MGEx (1.27 ± 0.45 versus 1.75 ± 0.44 versus 2.41 ± 0.50; p < 0.001), and OSDI score (19.36 ± 7.01 versus 24.77 ± 4.68 versus 42.61 ± 7.49; p < 0.001); significant improvements in NITBUT, TFLL, CS, MGQ, MGEx, and OSDI were found in the IPL + DQS therapy and IPL therapy, while the sham therapy had no significant improvements.

CONCLUSION

Combining 3% diquafosol ophthalmic solution with intense pulsed light was superior to IPL therapy alone in relieving the signs and symptoms of patients with severe evaporative DED.

TRIAL REGISTRATION

Clinical Trials Identifier: NCT05694026.

Comparison of two objective methods for measuring postoperative toric intraocular lens orientation under the natural pupil

PURPOSE

To evaluate and compare the accuracy of iTrace and CASIA2 in measuring the postoperative orientation of toric intraocular lens (IOL) without mydriasis.

SETTING

Tianjin Medical University Eye Hospital, Tianjin, China.

DESIGN

Prospective cohort study.

METHODS

Patients with SN6AT toric IOLs implanted after cataract surgery were enrolled. 1 month after surgery, the toric IOL orientation were measured by iTrace and CASIA2 in non-mydriatic, semi-dark conditions. Then, the toric axis was directly reviewed using the slit-lamp under full mydriasis. Axis measurement differences between each of the 2 devices and the slit-lamp, described as their relative differences (RDs), were calculated and compared. The percentage of RDs within 5 degrees, within 10 degrees and greater than 30 degrees were analyzed.

RESULTS

77 eyes of 70 patients were included. Generally, the mean toric axis measurement RDs of CASIA2 and iTrace were 9.24 ± 10.53 degrees and 13.89 ± 15.47 degrees respectively ( P = .04). For CASIA2 (72 eyes), 54.17% (39), 72.22% (52), and 4.17% (3) of eyes had RDs within 5 degrees, within 10 degrees and greater than 30 degrees, compared with 40.00% (28), 61.43% (43) and 12.86% (9) for iTrace (70 eyes). The 95% limits of agreements of CASIA2 with slit-lamp was narrower than that of iTrace with slit-lamp. The median RD of CASIA2 was significantly smaller in eyes with pupil ≥4 mm under dark condition compared with eyes with pupil <4 mm ( P = .03).

CONCLUSIONS

CASIA2 demonstrates greater precision in measuring toric IOL orientation under non-mydriatic conditions compared with iTrace. Moreover, the accuracy of CASIA2 is enhanced in cases of pupil >4 mm.

Visual Acuity-Related Outer Retinal Structural Parameters on Swept Source Optical Coherence Tomography and Angiography in XLRS Patients and Carriers

Purpose

To assess the quantitative differences in vessel density and retinal thickness of X-linked retinoschisis (XLRS) patients and RS1 mutation carriers, and the correlation with best-corrected visual acuity (BCVA) with swept source optical coherence tomography (SS-OCT) and OCT angiography (OCTA).

Methods

We analyzed the correlation between the BCVA of XLRS patients and the SS-OCT and OCTA findings including the detailed structural characteristics of XLRS patients.

Results

Besides the schitic changes in various retinal layers, the structural disturbance of outer retina was universally found. In 29 eyes included in the quantitative analysis, XLRS patients showed lower vessel density of the superficial capillary plexus, deep capillary plexus and lower thickness of the outer nuclear layer. BCVA was correlated with the thickness of the outer plexiform layer and outer nuclear layer and the thickness from the outer limiting membrane to the retinal pigment epithelium. Carriers showed higher thickness of outer plexiform layer and smaller foveal avascular zone area.

Conclusions

SS-OCT and OCTA could identify the pathological alterations of the individual retinal layers and capillaries, which could pinpoint the exact location of the damages related to visual impairment. In the carriers, the subtle alterations that can be detected with SS-OCT, despite their normal visual acuity, may be caused by the lyonization.

Translational Relevance

Swept source optical coherence tomography can be used as an efficient technique to expose the retinal damage related to visual impairment for prognosis and follow-up.

Plasmin-Induced Lens Epithelial Cells Detachment for the Reduction of Posterior Capsular Opacification

Purpose

We sought to evaluate the efficacy and safety of plasmin injection in the capsular bag during the cataract operation for the prevention of posterior capsule opacification.

Methods

Thirty-seven anterior capsular flaps taken from phacoemulsification surgery were immersed in either 1 µg/mL plasmin (plasmin group, n = 27) or phosphate-buffered saline (control group, n = 10) for 2 minutes and photographed after fixation and nuclear staining to compare the numbers of residual lens epithelial cells. In the animal experiments, the plasmin solution was injected into the capsular bag and remained for 5 minutes during hydrodissection or after lens extraction. The degree of posterior capsular opacity of the rabbits at 2 months were photographed by slit lamp biomicroscopy. In HLE-B3 cell culture, the cell detachment rate, proliferation, and apoptosis after the plasmin digestion were analyzed.

Results

The residual lens epithelial cell numbers on the capsule after plasmin treatment were 168 ± 190.7/mm2 in the 1 µg/mL plasmin group, which was significantly lower than that of the control (1012 ± 798.8/mm2; P < 0.0001). In a rabbit model, the treatment of plasmin resulted in a significantly clearer posterior capsule compared with that of the control group at 2 months postoperatively.

Conclusions

This study suggested that plasmin injection can induce effective lens epithelial cell detachment, which could be a promising adjunctive treatment to further improve the success rate in posterior capsule opacification prevention.

Translational Relevance

Plasmin injection for lens epithelial cell detachment could significantly decrease the number of residual lens epithelial cells. This approach could be a promising treatment incorporating the current treatment approach to further improve the success rate in posterior capsule opacification prevention.

The impact of posterior corneal astigmatism on the surgical planning of toric multifocal intraocular lens implantation

Purpose

To investigate the influence of posterior corneal astigmatism on the prediction accuracy of toric multifocal intraocular lens (IOL) calculation.

Methods

The keratometric astigmatism measured by Lenstar LS 900 (KCAL), keratometric astigmatism (KCAP) and total corneal astigmatism (TCA) measured by Scheimpflug camera (Pentacam HR) were documented and analyzed accordingly. Three deduction models using different parameters were compared. Model 1: KCAL ​+ ​keratometric corneal surgically induced astigmatism (KCSIA, 0.30 D @ 50°); Model 2: KCAP ​+ ​KCSIA); Model 3: TCA ​+ ​total CSIA (TCSIA, 0.23 D @ 50°). The prediction errors of each model as the difference vector between the actual and the intended residual astigmatism were compared.

Results

Seventy-six eyes implanted with toric multifocal IOLs were included in this study. The vector differences of the actual KCSIA and TCSIA were statistically significant in the total sample and against-the-rule (ATR) subgroup (both P ​< ​0.05). Model 1 deduced the smallest mean values of prediction error, while that of Model 3 were smaller than that of Model 2, both in the total sample and the ATR subgroups (all P ​< ​0.05). Meanwhile, in the total sample and ATR subgroups, the centroid vector magnitudes of Model 3 were smaller than that of Model 1 (0.31 ​± ​0.76 D and 0.39 ​± ​0.76 D).

Conclusions

The calculation of toric multifocal IOL should be individualized especially in the ATR eyes for the impact of PCA on the estimation of the preoperative corneal astigmatism and the CSIA.

Optic disc and retinal vascular features in first 6 years of Chinese children

Purpose

Retinal microvasculature plays an important role in children's fundus lesions and even in their later life. However, little was known on the features of normal retina in early life. The purpose of this study was to explore the normal retinal features in the first 6 years of life and provide information for future research.

Methods

Children, aged from birth to 6 years old and diagnosed with various unilateral ocular diseases were included. Venous phase fundus fluorescein angiography images with the optic disc at the center were collected. Based on the ResUNet convolutional neural network, optic disc and retinal vascular features in the posterior retina were computed automatically.

Results

A total of 146 normal eyes of 146 children were included. Among different age groups, no changes were shown in the optic disc diameter (y = -0.00002x + 1.362, R² = 0.025, p = 0.058). Retinal vessel density and fractal dimension are linearly and strongly correlated (r = 0.979, p < 0.001). Older children had smaller value of fractal dimension (y = -0.000026x + 1.549, R²= 0.075, p = 0.001) and narrower vascular caliber if they were less than 3 years old (y = -0.008x + 84.861, R²= 0.205, p < 0.001). No differences were in the density (y = -0.000007x + 0.134, R²= 0.023, p = 0.067) and the curvature of retinal vessels (lnC = -0.00001x - 4.657, R²= 0.001, p = 0.667).

Conclusions

Age and gender did not impact the optic disc diameter, vessel density, and vessel curvature significantly in this group of children. Trends of decreased vessel caliber in the first 3 years of life and decreased vessel complexity with age were observed. The structural characteristics provide information for future research to better understand the developmental origin of the healthy and diseased retina.

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Introduction: Incontinentia pigmenti (IP) is a rare X-linked neuroectodermal dysplasia affecting multiple organs. One of its most significant ophthalmic manifestations is retinal neovascularization due to retinal ischemia, which has been traditionally treated with laser photocoagulation or cryotherapy. The application of anti-vascular endothelial growth factor (VEGF) has been reported for the treatment of retinopathy of IP with beneficial results. However, clinicians should be aware of the possible ocular and systemic side effects of the intravitreal injection of anti-VEGF agents.

Case Report: A 4-month-old female infant with IP was treated with intravitreal injection of conbercept in both eyes. However, cotton-wool spots were noticed in the left eye 1 week after the injection. Laser photocoagulation was performed as an adjunct treatment. The cotton-wool spots were absorbed 1 month after the first intravitreal injection and have eventually disappeared.

Discussion: The cotton-wool spots, after intravitreal injection of conbercept for the treatment of IP, indicated severe retinal ischemia resulting from the neutralization of excessive VEGF, which was shown on fundus photograph and fluorescent angiography. Anti-VEGF agents could cause retinal arteriolar vasoconstriction and artery occlusion on rare occasions. The administration of anti-VEGF agents in pediatric cases with severe neovascularization and retinal ischemia should be carefully considered.

Distribution and internal correlations of corneal astigmatism in cataract patients

The aim of the study is to explore the distribution patterns and internal correlations of the morphological parameters of the cornea in patients with age-related cataract. The Pentacam HR was used to measure anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), total corneal astigmatism (TCA) and keratometric corneal astigmatism (KCA). With age, the proportion of with-the-rule (WTR) ACA decreased from 65.31% to 23.63%, while the against-the-rule (ATR) ACA increased from 26.53% to 56.20%. PCA exceeded 0.50 D in 9.14% of eyes, while 76.35% of them were ATR. The magnitude of ACA was positively correlated with PCA in the whole sample, with a more significant correlation in WTR eyes (s_r = 0.349, P < 0.001). The vector summation effect of PCA to ACA changed from compensation to augmentation with aging. In 57.53% of WTR eyes, KCA was overestimated by an average of 0.21 ± 0.17 D, while it was underestimated by 0.38 ± 0.27 D in 87.62% of ATR eyes. In conclusion, among age-related cataract patients, ACA and TCA gradually shifted from WTR to ATR with aging, while most PCA remained as ATR. Ignoring the age-related changes and real PCA might cause overestimation of WTR astigmatism and underestimation of ATR astigmatism.

Two AOS genes attributed to familial exudative vitreoretinopathy with microcephaly: Two case reports

RATIONALE

Familial exudative vitreoretinopathy (FEVR) is an inherited disorder, which is mostly reported to be associated with the mutation of genes involved in the Wnt signaling pathway related to β-catenin. To the best of our knowledge, the involvement of Adams-Oliver syndrome (AOS) genes in FEVR patients have not been reported before.

PATIENT CONCERNS

Two patients with FEVR presented with microcephaly. One of them showed slight scarring of the scalp vertex which is a typical manifestation of AOS. The whole exon sequencing confirmed the diagnosis of AOS with 2 AOS-gene mutations at DOCK6 and ARHGAP31. Further clinical examination revealed that their parents with the same mutations showed FEVR-like vascular anomalies.

DIAGNOSIS

Both patients were diagnosed with AOS through whole exon sequencing, and they presented with some FEVR-like retinopathy including retinal detachment.

INTERVENTIONS

Both patients received vitrectomy for tractional retinal detachment with proliferative vitreoretinopathy. During the follow-up, 1 patient received additional laser photocoagulation for tractional retinal detachment.

OUTCOMES

The 2 patients remained stable in the latest follow up after the treatment.

LESSONS

Microcephaly could be associated with some form of retinopathy. We proposed that mutation of DOCK6 and ARHGAP31 genes could be the possible cause of FEVR associated with microcephaly. Our study suggested that these genes may be candidate genes of FEVR.

Comparison of Five Intraocular Lens Power Formulas to Predict Postoperative Refraction Accuracy

The present study sought to investigate and compare the accuracy of two third-generation intraocular lens calculation formulas contrasted against three new-generation intraocular lens calculation formulas regarding their ability to predict postoperative refraction following cataract surgery. A retrospective case study following 172 patients (172 eyes) exhibiting age-related cataracts in their eyes who were subject to phacoemulsification between September 2017 and September 2018 at the Department of Cataracts, Tianjin Medical University Eye Hospital, was carried out. Based upon ocular axial length, the sampled patients were grouped into a short axis group (ocular axial length ≤ 22 mm; 17 cases; 17 eyes), a normal axis group (22 mm < ocular axial length ≥ 24.5 mm; 132 cases; 132 patients), and a long axis group (ocular axial length > 24.5 mm; 23 cases; 23 eyes); mean absolute prediction error (MAE) postoperative refraction in each group was determined using five formulas, and the percentage of eyes displaying postoperative myopic shift symptoms, postoperative hyperopic shift symptoms, alongside the percentage of eyes displaying postoperative refractive shift symptoms in the range of (−0.25 to 0.25 D, −0.50 to 0.50 D, −1.00 to 1.00 D), were all calculated following the procedures of the five selected formulas. The MAE of the 172 patient cases was compared within the five selected formulas, and SRK/T possessed the highest prediction accuracy, exhibiting a significant difference from the other four formulas (P < 0.05), with accuracy levels subsequently followed by the Holladay 1 and Barrett Universal II formulas-however, the two formulas lacked a significant difference between them (P > 0.05). In addition, the MAE of the normal axial group was compared and analyzed within the five formulas, with analysis revealing that the SRK/T, Holladay 1, and Barrett Universal II formulas exhibited strong prediction accuracy, with no significant difference present among these three formulas (P > 0.05), and also revealing a significantly difference between the aforementioned formulas and remaining two formulas (P < 0.05). For further analysis, the MAE of the short axis group was compared, and the SRK/T and Haigis (Holladay 1, and Barrett Universal II) demonstrated stronger prediction accuracy when compared to the Olsen formula (P < 0.05). Finally, the MAE of the long axis group was compared, and it was found that the SRK/T and Barrett Universal II formulas exhibits the best prediction accuracy, followed by the Haigis and Holladay 1 formulas, with no significant difference (P > 0.05) between the former two formulas or the latter two. The majority of patients exhibited hyperopic shift post-surgery. Of the five formulas studied, the SRK/T and Barrett Universal II formulas possessed strong accuracy capable of predicting postoperative refraction. However, more long-term observation, including large patient samples, is necessary in order to corroborate our result.

KLF6 Induces Apoptosis in Human Lens Epithelial Cells Through the ATF4-ATF3-CHOP Axis

Background

Many studies have confirmed that high myopia is related to the high prevalence of cataracts, which results from apoptosis of lens epithelial cells (LECs) due to endoplasmic reticulum stress. Krüppel-like factor 6 (KLF6) is a tumor suppressor that is involved in the regulation of cell proliferation and apoptosis.

Purpose

In this study, our purpose was to find the relationship between KLF6-induced apoptosis in LECs and ATF4 (activating transcription factor 4)-ATF3 (activating transcription factor 3)-CHOP (C/EBP homologous protein) signaling pathway.

Methods

KLF6, ATF4, ATF3, and CHOP were ectopically expressed using cDNAs subcloned into the pCDNA3.1+ vector. ATF4, ATF3, and CHOP knockdown were performed by small interfering RNA (siRNA). Expression of relative gene was tested using QT-PCR and western-blot. Then, accompanied by UVB stimulation, cell viability was measured by CCK-8 assay; The cell damage was examined by live & dead staining; The apoptotic markers Bax and Bcl-2 were detected by immunoblotting; Quantitative apoptotic levels were measured with the Apoptosis Detection Kit; The expression level of reactive oxygen-free radical (ROS) was analyzed by DCFH-DA` probe.

Results

Ectopically expressed ATF4, ATF3, and CHOP-induced apoptosis in cells, whereas ATF4, ATF3, and CHOP knockdown by small interfering RNA (siRNA) blocked KLF6-induced apoptosis. In addition, we determined that ATF4 regulates ATF3 and CHOP expression and that ATF3 silencing reduces CHOP upregulation without changing ATF4 levels; however, ATF4 and ATF3 expression was unaffected by blockade of CHOP, suggesting that KLF6 triggers endoplasmic reticulum stress in LECs by mediating the ATF4-ATF3/CHOP axis. Besides, KLF6 overexpression significantly induced LEC apoptosis under UV radiation, as demonstrated by the elevated Bax/Bcl-2 ratio.

Conclusion

The ATF4-ATF3-CHOP pathway plays an important role in KLF6-induced apoptosis in HLECs. Our results increase our understanding of the mechanisms that regulate LEC apoptosis and contribute to the development of a new preventative strategy for cataract.

Safety and efficacy of intravitreal conbercept injection after vitrectomy for the treatment of proliferative diabetic retinopathy

BACKGROUND/OBJECTIVES

The aim of this study was to evaluate the safety and efficacy of intravitreal conbercept (a recombinant fusion protein that primarily targets vascular endothelial growth factors) after vitrectomy for the management of proliferative diabetic retinopathy without tractional retinal detachment (TRD).

SUBJECTS/METHODS

Fifty patients with non-clearing vitreous haemorrhage (VH) due to proliferative diabetic retinopathy without TRD were enroled. They were randomly divided into control and treatment groups (25 eyes to each group) after they provided informed consent. The treatment group received intravitreal conbercept (10 mg/mL, 0.5 mg) immediately after surgery, while the control group did not. The best corrected visual acuity (BCVA) and the central retinal thickness were measured.

RESULTS

There were no significant between-group differences in baseline characteristics (P > 0.05), except in age (P = 0.003). Improvement in BCVA was significantly greater at 1, 4, 12, and 24 weeks post surgery in the treatment group than it was in the control group (P < 0.001). There were more cases in the control group who developed recurrent VH, but the recurrence rate of VH was not significantly different between the two groups at 12 and 24 weeks post surgery (P = 0.192 and  0.103). Central retinal thickness was lower in the treatment group than in the control group at 1 week (P = 0.012), 4 weeks (P = 0.01), 12 weeks (P = 0.001), and 24 weeks (P = 0.004) post surgery, which were statistically significant.

CONCLUSIONS

An intravitreal injection of conbercept after vitrectomy improved visual acuity and seemed to reduce the recurrence of VH resulting in prompt visual recovery in the PDR patients.

Mussel-inspired nanofibrous sheet for suture-less stomach incision surgery

We report a dopamine-based crosslinker-conjugated gelatin/polycaprolactone nanofibrous sheet. The nanosheet was then employed to treat stomach incisions without sutures during surgery.

Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations

OBJECTIVE

To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters.

METHODS

Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.

RESULTS

Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.

CONCLUSION

Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.

PRACTICE IMPLICATIONS

Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.

Recovery of nickel ions from simulated electroplating rinse water by electrodeionization process

Pure water production and recovery of Ni(2+) from dilute NiSO(4) solution via improved electrodeionization (EDI) process were investigated. It was indicated that, with the feed water containing 50 mg L(-1) Ni(2+), the dilute resistivity of the EDI could achieve 3 MOmega cm which gave a Ni(2+) rejection more than 99.8% while the Ni(2+) was concentrated as high as 1,583 mg L(-1) in the concentrate stream. The current efficiency was as high as 40% and the concentrate factor could reach 31.7. The experiment results demonstrated that, just in a single process, it was feasible to purifying and concentrating dilute nickel wastewater synchronously by the EDI technology.

GroEL-GroES solubilizes abundantly expressed xylulokinase in Escherichia coli

AIMS

The aims of the present work were to solubilize the abundantly expressed recombinant xylulokinase in Escherichia coli and to develop a reliable xylulokinase assay.

METHODS AND RESULTS

Three mutants of xylulokinase of Bacillus megaterium that were expressed at high level but formed insoluble protein in E. coli BL21(DE3)pLysS were selected for solubility study. The solubility of xylulokinase increased eight to 77-fold after introduction of molecular chaperones GroEL-GroES into the host.

CONCLUSION

This investigation reports that GroEL-GroES minimizes the formation of insoluble protein in three highly expressed recombinant xylulokinases and an improved xylulokinase assay.

SIGNIFICANCE AND IMPACT OF THE STUDY

Commercial production of bioethanol is critically dependent on the development of an efficient and low-cost process of enzymatic conversion of xylan, a major component in lignocellulose biomass, to xylulose-5-phosphate, which can then be channelled into pentose phosphate pathway and metabolized to ethanol. The improved intracellular xylulokinase activity is expected to facilitate the xylose degradation.

Control of hyperchaos

A general method for controlling chaotic systems with one or more positive Lyapunov exponents is investigated analytically and numerically. The method retains the formal features of the adaptive adjustment mechanism and can be equally applied to various types of the unstable fixed points. It is shown that the method proposed here neither asks for any prior analytical knowledge of the system, nor any internal or external controlling parameters in advance.

Stabilizing unstable discrete systems

A general method for stabilizing unstable discrete systems to a fixed point or high-period orbit is developed analytically and numerically in this paper. It is shown that the method can be equally applied to the systems with one or more positive Lyapunov exponents. Moreover, the method does not require a prior analytical knowledge of the system under investigation, nor any additional control parameters.

Smad7 mediates apoptosis induced by transforming growth factor beta in prostatic carcinoma cells

Transforming growth factor beta (TGF-beta) is an important regulator of apoptosis in some cell types, but the underlying molecular mechanisms are largely unknown. TGF-beta signals through type I and type II receptors and downstream effector proteins, termed Smads. TGF-beta induces the phosphorylation of Smad2 and Smad3 (receptor-activated Smads) which associate with Smad4 and translocate to the nucleus, where they regulate gene transcription [1]. Smad7 protein is induced by TGF-beta1 and has been classified as an inhibitory Smad. Smad7 prevents phosphorylation of receptor-activated Smads, thereby inhibiting TGF-beta-induced signaling responses [1]. Smad7 expression is increased in rat prostatic epithelial cells undergoing apoptosis as a result of castration [2]. Here we have shown that TGF-beta1 treatment or ectopic expression of Smad7 in human prostatic carcinoma cells (PC-3U) induces apoptosis. Furthermore, TGF-beta1-induced apoptosis was prevented by inhibition of Smad7 expression, by antisense mRNA in stably transfected cell lines or upon transient transfection with antisense oligonucleotides in several investigated cell lines. These findings provide evidence for a new effector function for Smad7 in TGF-beta1 signaling.

Effects of enzyme inducers and inhibitor on the pharmacokinetics of intravenous 2-(allylthio)pyrazine, a new chemoprotective agent, in rats

In order to find what types of hepatic cytochrome P450 (CYP) isozymes are involved in the metabolism of 2-(allylthio)pyrazine (2-AP) in rats, enzyme inducers, such as phenobarbital, 3-methylcholanthrene, dexamethasone, or isoniazid, and an enzyme inhibitor, such as SKF 525-A were pretreated. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with SKF 525-A (a non-specific CYP inhibitor in rats), the plasma concentrations were significantly higher, and the area under plasma concentration-time curve from time zero to time infinity (AUC) was significantly greater (1365 compared with 1034 microg min/mL) as a result of significantly slower total body clearance (Cl) (36.6 compared with 48.3 mL/min/kg) than those in control rats, indicating that 2-AP was metabolized by CYP isozymes. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with dexamethasone (an inducer of CYP3A in rats), phenobarbital (an inducer of CYP2B1/2, 2C6, 2C7, and 3A1/2 in rats), and 3-methylcholanthrene (an inducer of CYP1A1/2 and 2A1 in rats), the plasma concentrations were significantly lower, and AUC was significantly smaller (27, 41 and 60% decrease, respectively, compared with respective control rats) owing to faster Cl [37 (p>0.05), 70 (p<0.001), and 150% (p<0.001) increase, respectively, compared with respective control rats].

[Effect of Saikosaponin-d on up-regulating GR mRNA expression and inhibiting cell growth in human leukemia cells]

OBJECTIVE

To study the effect of Saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and cell growth in HL60 cells.

METHODS

Antiproliferation effects of SSd on HL60 cells were determined by 3H-thymidine incorporation. Cell cycle analysis was also performed by flow cytometry. GRmRNA was analyzed by northern blot analysis.

RESULTS

After 48 hours treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation decreased in HL60 cells and the effect was time and dose dependent. The flow cytometry analysis showed HL60 cells were arrested at G0/G1 phase. The expression of GR mRNA increased.

CONCLUSION

SSd exhibits the inhibition effects on cell growth in HL60 cells and could up-regulate the expression of GR mRNA in HL60 cells.

[The influence of nerve growth factor on inferior alveolar nerves regeneration in the silicone tubes]

OBJECTIVE

To explore the effect of exogenous nerve growth factor(NGF) in the regeneration of adult white rabbits inferior alveolar nerve within the silicone tubes.

METHODS

In 24 adults white rabbits. A bilateral 8 mm inferior alveolar nerve gaps were created, and the proximal and distal stumps were inserted into a 12 mm silicone tube. The silicone tube of the right side was filled with exogenous NGF(experimental group) and the contralateral side was filled with saline (control group). Regeneration of the nerves was assessed by histological exam and nerve electrophysiological appreciation. Total number of the regenerating myelinated nerve fibers, the conduction velocities of nerves the thickness of myelin sheaths and the cross section area of myelinated nerve fibers between the experimental and the control groups were compared.

RESULTS

The results showed that: 1. The experimental groups demonstrated more myelinated nerve fibers than that of the controls in 12 and 18 weeks. 2. At the same time following surgery, the myelin sheath thickness and the cross section area of myelinated nerves in the experimental groups were significantly greater than that in the controls. 3. In 12 and 18 weeks, the conduction velocities of regenerating nerves in the experimental groups were faster than that of the controls.

CONCLUSION

This study suggested that exogenous NGF can enhance regeneration of inferior alveolar nerve with necovery of its sensory function.

[Saikosaponin-d up-regulates GR mRNA expression and induces apoptosis in HL-60 cells]

OBJECTIVE

To research the effect of saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and induction of apoptosis in HL-60 cells.

METHODS

Antiproliferation effects of SSd on HL-60 cells were determined by 3H-thymidine incorporation. Apoptosis of the SSd-treated cells was determined by DNA fragmentation analysis and flow cytometry. GR mRNA was analyzed by Northern blot analysis.

RESULTS

After 48 h treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation was decreased in HL-60 cells and the effects were time and dose dependent. DNA ladder appeared after 60 h treatment with SSd. The flow cytometry analysis showed HL-60 cells was arrested at G0/G1 phase and apoptotic peak appeared in sub-G1 phase. The expression of GR mRNA was increased.

CONCLUSION

SSd up-regulates the expression of GR mRNA, inhibits the cell growth and induces apoptosis in HL-60 cells.

[Surgical reconstruction of laryngeal and tracheal stenosis]

OBJECTIVE

Reconstruction of laryngotracheal stenosis.

METHOD

According to the pathologic condition of the larynx and trachea, various surgical procedures were designed for the treatment of laryngotracheal stenosis. These techniques included endoscopic management, laser therapy and laryngotrachoetomy with autogenous tissue and stent.

RESULT

Among 36 patients, 32 were decannulated. The success rate was 88.8%.

CONCLUSION

In order to improve the curation effects of laryngjotrachal stenosis, the choice of surgical procedure must be individualized to the pathologic condition of larynx and trachea, as well as the experience of the surgeon. Learning previous successful experience is also very important for a good result.

[Effect of Gengnianjian on up regulated estrogen receptor mRNA to substance P and beta-endorphin in hypothalamus of aging female rats]

OBJECTIVE

To investigate the effect of Chinese herbal formula Gengnianjian on estrogen receptor (ER), ERmRNA substance P (SP) and beta-endorphin (beta-EP) in the hypothalamus of aging female rats.

METHODS

ER proteins were determined by radioligand binding assay, ER mRNA was analyzed by Northern blot analysis and the levels of beta-EP and SP were detected by immunohistochemistry.

RESULTS

In aging rats, lowered ER and ER mRNA in the hypothalamus were still up-regulated by low serum E2 level, but not in rats of after the age of 21 months; Gengnianjian significantly increased ER protein level and ER mRNA expression, decreased SP and increased the level of beta-EP in the hypothalamus in aging female rats before 21 months of age, without changing of serum E2 level. In EB group, serum E2 and beta-EP levels increased and SP level decreased but ER expression suppressed in the hypothalamus except after 21 months.

CONCLUSION

Enhance estrogen bioactivity can decrease the level of SP and increase the level of beta-EP in hypothalamus of aging female rats. Herbal formula Gengnianjian increase-EP level and decrease SP level by raising the level of ER and ER mRNA.

[Clinical experience of coronal flap approach in surgery of anterior skull base tumor]

Surgery of the anterior skull base tumor has been undertaken in 7 cases by coronal flap approach, of which 4 cases were malignant tumors and 3 cases were benign tumors. The dura became torn in 3 cases and resected in 2 cases due to tumor invasion. The dura and bony defects could be repaired with galea, pericranial flaps and fascia flaps of temporalis. The bigger bony defect was consolidated with scalp flap. Three out of 4 cases with malignant tumors were free of tumors for 6 years, 4 years and 17 months, respectively: 1 case died of tumor recurrence after 18 months. No case had postoperative complications.