Changes of binocular surface indexes after unilateral endoscopic dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of unilateral endoscopic dacryocystorhinostomy on binocular surface indexes.METHODS: Totally 45 cases with monocular primary acquired nasolacrimal duct obstruction(PANDO)who successfully underwent endoscopic dacryocystorhinostomy between 1 December 2022 and 31 July 2023 were enrolled in the study. Ocular surface indexes, including the non-invasive tear break-up time(NIBUT), Sjögren's International Collaborative Clinical Alliance ocular staining score(SICCA OSS), Korb score of lid wiper and Schirmer test scores, were collected preoperatively and at 0.5, 1 and 3 mo post-operatively. Subsequently, various indexes were compared at each time point between the operated and healthy eyes pre- and post-operatively.RESULTS: There was no significant differences between operated and healthy eyes in NIBUT, SICCA OSS, Korb scores and Schirmer test(all P>0.05). Furthermore, the Korb scores of operated eye at 0.5, 1 and 3 mo post-operatively were significantly lower than the preoperative value(P=0.034, 0.044, 0.027). Moreover, the Schirmer test score of the operated eye at 1 mo post-operatively was significantly lower than the preoperative value(P=0.0461).CONCLUSION:After a successful endoscopic dacryocystorhinostomy, tear drainage is restored, however, ocular surface damage worsens. These changes typically peak at 1 mo post-operatively before gradually improving.

Comparison of the effects of corneal and lacrimal gland denervation on the lacrimal functional unit of rats / Comparação dos efeitos da denervação da córnea e da glândula lacrimal na unidade funcional lacrimal de ratos

ABSTRACT Purpose: This study aimed to compare the changes in the lacrimal functional unit in the following two models of neurogenic dry eye syndrome: sensory denervation of the cornea versus autonomic denervation of the lacrimal gland. Methods: The neural network supports the lacrimal functional unit. It can be divided into afferent (sensory) and efferent (autonomic) pathways and is affected by severe diseases that compromise the lacrimal functional unit. Male Wistar, 8-week-old rats were divided into the following three groups: 1) control naïve (n=16 animals); 2) autonomic denervation: where rats were subjected to right lacrimal gland nerve ablation and evaluated after 1 and 2 months (1M and 2M) after the procedure (n=7 animals per subgroup, autonomic denervation 1M and autonomic denervation 2M, respectively); 3) sensory denervation induced by 0.2% benzalkonium chloride eye drops, twice a day for 7 days in the right eye (n=10 animals). The corneal sensitivity was measured using the eye wipe test with capsaicin (10 µM). The quantitative real-time PCR was performed to compare the mRNA expressions of proinflammatory cytokines, such as Il-1β, Il-6, Tnf, Mmp9, in the cornea, trigeminal ganglion, and lacrimal gland. In addition, the mRNA of the promitotic factors in the lacrimal gland, such as Bmp7, Runx1, Runx3, Fgf10, and Smad1, was compared. Results: Sensory denervation induced corneal hyperalgesia (p=0.001). Sensory denervation and autonomic denervation increased the mRNA of proinflammatory cytokines in the cornea and lacrimal gland (p<0.05), but only sensory denervation increased the mRNA levels of Il-1β and Tnf in the trigeminal ganglion (p<0.05) compared with the control naïve. Conclusions: Autonomic denervation and sensory denervation models can have common features, such as inflammation of different parts of the lacrimal functional unit. However, hyperesthesia and inflammatory markers in the trigeminal ganglion because of sensory denervation and the expression of regenerative mediators in the lacrimal gland owing to autonomic denervation are the distinguishing features of these diseases that can be explored in future studies assessing dry eye syndrome secondary to neural damage of the lacrimal functional unit.

RESUMO Objetivo: O nosso objetivo neste estudo foi comparar as alterações na unidade funcional lacrimal em dois modelos de síndrome do olho seco neurogênica: desnervação sensorial da córnea versus desnervação autonômica da glândula lacrimal. Métodos: A rede neural é um importante suporte para a unidade funcional lacrimal. Pode ser dividido em vias aferentes (sensoriais) e eferentes (autonômicas), sujeitas a doenças graves que comprometem a unidade funcional lacrimal. Ratos Wistar machos, com 8 semanas de idade, foram divididos em três grupos: 1) Controle naïve (n=16 animais); 2) Desnervação autonômica: onde os ratos foram submetidos à ablação do nervo da glândula lacrimal direita e avaliados após um e dois meses (1 M a 2 M) do procedimento (n=7 animais por subgrupo, desnervação autonômica 1M e desnervação autonômica 2M, respectivamente); 3) Desnervação sensorial induzida por colírio a 0,2% de cloreto de benzalcônio, duas vezes ao dia por 7 dias no olho direito (n=10 animais). A sensibilidade da córnea foi medida pelo teste de movimento pata-olho com capsaicina (10 µM). A PCR quantitativa em tempo real foi aplicada para comparar a expressão relativa de mRNA de citocinas pró-inflamatórias: Il1b, Il6, Tnf, Mmp9, na córnea, gânglio trigêmio e glândula lacrimal. O mRNA dos agentes pró-mitóticos Bmp7, Runx1, Runx3, Fgf10 e Smad1 foram comparados na glândula lacrimal. Resultados: A desnervação sensorial induziu hiperalgesia da córnea (p=0,001). Desnervação sensorial e desnervação autonômica aumentaram o mRNA de citocinas pró-inflamatórias no córnea e glândula lacrimal (p<0,05), mas apenas desnervação sensorial aumentou o mRNA de Il1b e Tnf no gânglio trigêmio (p<0,05) quando comparado ao controle naïve. Conclusões: Os modelos de desnervação autonômica e desnervação sensorial podem ter características comuns, como inflamação de diferentes partes da unidade funcional lacrimal. No entanto, a hiperestesia e os marcadores inflamatórios no gânglio trigêmio de desnervação sensorial e a expressão de mediadores regenerativos na glândula lacrimal na desnervação autonômica são características que distinguem essas doenças, podendo ser investigadas em estudos futuros que abordam o olho seco secundário ao dano neural da unidade funcional lacrimal.

Escala De Observación Clínica Para Valorar La Tercera Unidad Funcional De La Teoría De Luria: Eocl-1 / Scale Of Clinical Observation To Valuate The Third Functional Unit Of The Luria Theory: Eocl-1

Resumen El modelo de organización cerebral de Luria propone la interacción de tres unidades funcionales para comprender el trabajo que realiza el cerebro humano. La primera de ellas se encarga de la regulación del tono y la vigilia. La segunda de recibir, procesar y almacenar la información. La tercera, y de central interés de la investigación, se encarga de programar, ejecutar y verificar la actividad mental. Para valorar esta teoría se han desarrollado una serie de test neuropsicológicos experimentales, no obstante, no se ha propuesto una escala que, en base a los preceptos teóricos de la tercera unidad funcional, permita valorarla basada en la observación clínica de las conductas de la vida diaria del ser humano. En esta investigación se propone una escala que permita al clínico valorar las habilidades mentales asociadas con la capacidad de programar, ejecutar y verificar la forma más compleja de actividad mental; integradas en la tercera unidad funcional de Luria. Se discute la propuesta realizada, en base al beneficio que se genera el contar con una escala que permitirá valorar esta teoría, en los diferentes ambientes donde se desenvuelve el individuo mediante la acción de las habilidades cerebrales de la tercera unidad funcional.

Abstract Luria's brain organization model proposes the interaction of three functional units to understand the work performed by the human brain. The first of them is responsible for the regulation of tone and wakefulness. The second one to receive, process and store the information. The third, and of central interest of the investigation, is responsible for programming, executing and verifying mental activity. To evaluate this theory, a series of experimental neuropsychological tests have been developed, however, a scale has not been proposed that, based on the theoretical precepts on the third functional unit, allows to assess it based on the behaviors of the daily life of the human being. This research proposes a scale that will allow the clinician to assess the mental abilities associated with the ability to program, execute and verify the most complex form of mental activity; integrated in the third functional unit of Luria. The proposal is discussed, based on the benefit that is generated by having a scale that will allow to assess this theory, in the different environments where the individual develops through the action of the cerebral abilities of the third functional unit.

Apoyo social percibido y dependencia funcional en el adulto mayor con dolor / Perceived social support in the elderly with pain

Resumen En la actualidad la prevalencia de dolor en el adulto mayor constituye un problema de salud pública. Esta condición del doliente, en ocasiones tiende agravarse con el tiempo, limitan las actividades diarias del individuo y generan un impacto psicológico, social, familiar y laboral. El objetivo de este artículo es describir el nivel dependencia funcional y apoyo social percibido en el adulto mayor con dolor. Metodológicamente se concibe como una investigación transversal descriptiva con muestreo no probabilístico por conveniencia con una muestra de 200 adultos mayores de Bucaramanga. Se aplicó el instrumento de apoyo social percibido, la prueba Barthel y el cuestionario Mcguill. Como resultado se obtuvo que hay una mayor prevalencia de mujeres, casadas, en edades entre los 65 y 75 años, pertenecientes a estratos 3, con nivel de escolaridad sin finalización de básica primaria. Los participantes describen su dolor en mayor medida como brusco 58,5 %, cruel 71,5 % y molesto 61,0 %. La mayoría tiene altos niveles de apoyo social y el 86,5 % son totalmente independientes.

Abstract Currently, the prevalence of pain in the elderly constitutes a public health problem, since these disorders tend to worse over time, limiting the daily activities of the individual and generating a psychological, social, family and work impact. Objective: Describing the functional dependence level and the perceived social support in the elderly with pain. Methodology: transversal descriptive research with non-probability convenience sampling, with a sample of 200 older adults from bucaramanga. the instrument of perceived social support, the Barthel test and the McGill questionnaire were applied. The results indicate higher prevalence of 69% women, married, with ages between 65 and 75 years, belonging to social strata 3, with a level of education without the elementary school complete. that participants describe their pain as abrupt 58.5%, 71.5% cruelly, 61.0% Most have high levels of social and 86.5% is totally independent.

Dry eye - a review.

Of the myriad reasons for visits to an ophthalmologist, one of the most common maladies afflicting patients is Dry Eye Disease (DED), which can cause mild discomfort in the early stages and endstage ocular surface damage in its more severe forms. Dry eye is a problem of utmost importance, more in the developed rather than developing nations. Various aspects of the manifestation, including the tear osmolarity, ocular surface homeostasis and the role of ocular surface epithelial stem cells in maintaining the ocular surface homeostasis have been discussed. The objective tests to assess and grade dry eye have been noted. A systematic approach to the affected eye and the patient has also been outlined. The major categories of medications used along with the methods of delivery are specified in this review. A systematic approach in understanding the type and grade of Dry Eye Disease is mandatory for good clinical response. Along with clinical management the doctor should also stress on environmental changes that exaggerates dryness.

Three-dimensional functional unit analysis of hemifacial microsomia mandible-a preliminary report / 대한악안면성형재건외과학회지

BACKGROUND: The aim of this study was to present three-dimensional (3D) structural characteristics of the mandible in the hemifacial microsomia. The mandible has six distinct functional units, and its architecture is the sum of balanced growth of each functional unit and surrounding matrix. METHODS: In order to characterize the mandibular 3D architecture of hemifacial microsomia, we analyzed the mandibular functional units of four hemifacial microsomia patients using the 3D reconstructed computed tomography (CT) images. And we compared the functional unit size between affected and non-affected side. RESULTS: The length of condyle and angle showed significant differences between affected and non-affected sides. However, the length of mandibular body showed insignificant differences. The size differences between affected and non-affected side were observed at the condyle, angle, and body in descending order. CONCLUSIONS: This preliminary study suggests that the main etiopathogenic units are condyle and angle in the hemifacial microsomia mandible. Further investigation with the increased number of subjects will be helpful to establish treatment modality by etiopathogenic targeting of hemifacial microsomia.

Análisis de la unidad funcional cutánea de tórax anterior para el movimiento de abducción completa de hombro en niños sanos de 7 a 10 años de edad / Anterior thorax cutaneous functional unit analysis of complete shoulder abduction movement in healthy 7 to 10 year old children

Introduction: cutaneous functional units (CFU) are predilected skin areas that determine the skin recruitment necessary for complete range of movement. Finding out the characteristics of CFU in healthy children, would allow for better diagnostics and prevent burn scar contractures. Objective: to determine angular displacement of CFU in anterior thorax (AT), for complete shoulder abduction movement, in healthy children between 7-10 years of age. Methods and material: a descriptive study of 42 healthy children at COANIQUEM, Santiago 2011, was developed. Independent photographs were taken of each child in a neutral position and in maximal abduction range for both shoulders. AT length was measured, and a vertical line was drawn dividing the thorax into two hemibodies with ten symmetric spaces or percentage units (PU). Photographs were analyzed through double exposure with Photoshop CS3 Extended®. AT skin recruitment, elongation and angulation measures were obtained. Results: while in upper extremity abduction, 59.5 percent of the children recruited AT skin up to PU 100 in the right shoulder, and up to 66.7 percent in the left shoulder, a non significant difference. Greatest AT skin displacement was produced at line four, while PU 50 achieved greatest elongation. Greatest angle displacement was observed at PU 10, with a meaningful difference between shoulders. Conclusion: CFU of AT for complete shoulder abduction movement is wider in children than in adults. Skin tension is greater among PU’s from the central portion of the chest.

Introducción: las unidades funcionales cutáneas (UFC), son campos de piel que determinan el reclutamiento de piel necesario para permitir el movimiento recluta completo de hombro. Conocer las características de UFC en niños sanos, permitiría mejorar diagnóstico y prevenir retracciones cicatriciales en secuelados por quemaduras. Objetivo: determinar el desplazamiento angular de UFC en tórax anterior (TA), de niños sanos entre 7-10 años, para el movimiento de abducción completa de hombro. Materiales y métodos: estudio descriptivo de 42 niños/as sanos en COANIQUEM Santiago 2011. A cada niño se tomó una fotografía de TA en posición neutra y otra en rango máximo de abducción de ambos hombros en forma independiente. Se midió longitud del TA y se trazó una línea vertical dividiendo el tronco en dos hemicuerpos con 10 espacios simétricos o unidades porcentuales (UP). Las fotografías se analizaron con doble exposición mediante Photoshop CS3 Extended®; se obtuvieron medidas de reclutamiento de piel, elongación y angulación de piel de TA. Resultados: el 59,5 por ciento de los niños en abducción de extremidad superior, reclutó piel de TA hasta la UP 100 en hombro derecho y el 66,7 por ciento en hombro izquierdo, diferencia no significativa. El mayor desplazamiento de piel del TA, se produjo en línea 4; la UP 50 logró mayor elongación; el mayor ángulo de desplazamiento se produjo en UP 10, con diferencia significativa entre ambos hombros. Conclusión: la UFC de TA para el movimiento de abducción del hombro, es más ancha que en adultos. La tensión de la piel es más alta en unidades porcentuales de la parte central del pecho.

Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

PURPOSE: Based on the questionnaires for dry eyes in 2006, we have investigated the current status and new trends in the recognition and management of the dry eye. METHODS: We ask the 15 questionnaires to 197 ophthalmologists. After reorganizing the data based on each questions, we compared the result with the most current studies in Korea and other countries as well. Then, we report the current trends in the diagnosis and treatment of dry eye. RESULTS: Dry eye patients account for take up about 20-30% of total outpatients and it is currently accepted etiology that dry eye inflammation is related to the function of the immune system. Patient's symptoms and slit lamp examination are important for diagnosis. An anti-inflammatory therapy is needed for patients with moderate to severe dry eye. CONCLUSIONS: Increasingly, there are positive attitudes toward accepting that persistent dry eye is an inflammatory disease; therefore, there are increases in use of an anti-inflammatory agent for treatment.

Current Concepts and Therapeutic Management of Dry Eye

The majority of dry eye symptoms are due to a chronic inflammation of the lacrimal functional unit resulting in a loss of tear film integrity and normal function. The tear secretion is controlled by the lacrimal functional unit consisting of the ocular surface (cornea, conjunctiva, and meibomian glands), the main lacrimal gland, and the interconnecting innervation. A lack of systemic androgen support to the lacrimal gland has been shown to be a facilitating factor in the initiation of ocular inflammation. If any portion of this functional unit is compromised, lacrimal gland support to the ocular surface is impeded. In this review, the classification and treatment of dry eye syndrome will be presented according to the A Delphi approach.

El ojo, un órgano inmunológicamente privilegiado / The eye, an immunologically privileged organ

El propósito es entender las reacciones inmunológicas fundamentales que ocurren a nivel ocular, las cuales son comunes al resto del sistema inmune, pero con vías preponderantes en silenciar la respuesta inmune para conservar la unidad funcional. A partir de un extensa revisión de la literatura, se definen conceptos inmunológicos claros sobre las vis de inactivación de la respuesta inmune, que muestran la necesidad de la inmunidad innata representada principalmente en las barreras mecánicas del globo ocular, las cuales ayudan a mantener la integridad funcional de este órgano. Gracias al avance del conocimiento en inmunoquimica, y técnicas de estudios celulares, se puede entender la esencia de la inmunidad de los tejidos oculares y de la unidad funcional definida como cornea, conjuntiva, glándulas lagrimales, glándulas de meibomio y parpados unidos por un arco reflejo neural. Todo ello para entender que el sistema inmunológico que protege al ojo es un sistema primordialmente de barreras mecánicas y mediadores solubles inespecíficos (sistema inmune innato) y de mecanismos encaminados a inhibir una respuesta inflamatoria, lo que lo convierte en un órgano inmunológicamente privilegiado.

The purpose is to understand the fundamental immunologic relationships that occur at the ocular level, which are common to the rest of the immune system, but with prevailing ways in silencing the immune response in order to preserve the functional unity. As of an extensive revision of literature, clear immunologic concepts are defined regarding the inactivation ways barriers of the ocular globe, which help to maintain the organLs functional integrity. Thanks to progress in the knowledge of immuno]chemestry and cellular study techniques, the essence of the immunity of the ocular tissues can be understood, as well as that of the functional unit defined as the cornea, conjunctive, lachrymal glands, Meibomian glands and eyelids, united by a neutral reflex arch. All of which, to understand that the immunologic system that projects the eye is a system primarily of mechanical barriers and unspecified soluble mediators and mechanism directed towards inhibiting and inflammatory response, which turns it into a privileged organ.