Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26?G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25?G flat?tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.

Regulatory control of the Na-Cl co-transporter NCC and its therapeutic potential for hypertension

Hypertension is the largest risk factor for cardiovascular disease, the leading cause of mortality worldwide. As blood pressure regulation is influenced by multiple physiological systems, hypertension cannot be attributed to a single identifiable etiology. Three decades of research into Mendelian forms of hypertension implicated alterations in the renal tubular sodium handling, particularly the distal convoluted tubule (DCT)-native, thiazide-sensitive Na-Cl cotransporter (NCC). Altered functions of the NCC have shown to have profound effects on blood pressure regulation as illustrated by the over activation and inactivation of the NCC in Gordon's and Gitelman syndromes respectively. Substantial progress has uncovered multiple factors that affect the expression and activity of the NCC. In particular, NCC activity is controlled by phosphorylation/dephosphorylation, and NCC expression is facilitated by glycosylation and negatively regulated by ubiquitination. Studies have even found parvalbumin to be an unexpected regulator of the NCC. In recent years, there have been considerable advances in our understanding of NCC control mechanisms, particularly

Single Circulating Blast in the Peripheral Blood Film in Normal Individuals and Patients of Non-neoplastic Haematological Disorders and Non-hematological Neoplasms/Disorders- A Study at a Tertiary Care Centre

Introduction: The blasts in the peripheral blood is usuallyassociated with a haematological disorder. Study aimed tosee if a single blast seen in a peripheral blood film of healthyindividuals and patients of non-neoplastic haematologicaldisorders and non-hematological neoplasms/disorders didhave any clinical significance.Material and Methods: The period of study was from 2014to 2018 conducted at a tertiary care hospital. The study wasdone exclusively on Peripheral Blood Films. The films werestained with Leishman stain. An occasional blast was detectedin some healthy subjects and patients of non-neoplastichaematological disorders and non-hematological neoplasms/disorders.Result: The routine smears were analyzed with caution afterthe first case of a patient of Iron Deficiency Anemia revealeda clear-cut Blast. In the period of 4 years from 2014 to 2018,a total of 23 cases of apparently normal individuals or patientswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1% on oneseparate occasion.Conclusion: A careful morphological examination in theperipheral smears of few normal individuals and individualswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1%Blast on one separate occasion. The cells were clear cutblasts with a large size, fine nuclear chromatin, one to twonucleoli with round to slightly irregular nuclear contours anda mild amount of pale agranular cytoplasm. On thoroughinvestigations of these individuals there was no evidence ofa neoplastic haematological disorder. Therefore a single blastin a peripheral blood seen in a healthy individuals or patientswith benign haematological disorder and non-neoplasticneoplasms/disorders may not always indicate a neoplasticprocess.

Spontaneous HBsAg loss in Korean patients: relevance of viral genotypes, S gene mutations, and covalently closed circular DNA copy numbers

BACKGROUND/AIMS: Occult HBV infection can persist following HBsAg loss and be transmitted, but the virological features are not well defined. METHODS: Here we investigated 25 Korean patients who lost HBsAg during follow up, either spontaneously or subsequent to therapy. RESULTS: Whereas subtype adr (genotype C) was found in 96% of HBsAg positive patients, 75 % of patients who lost HBsAg spontaneously were seemed to be infected with the ayw subtype with sequence similar to genotype D. Mutations in the major hydrophilic region (MHR) of HBsAg were found in 7 patients who lost HBsAg spontaneously. The mutations include T123S, M125I/N, C139R, D144E, V177A, L192F, and W196L, some of which have not been reported before. Functional analysis via transfection experiments indicate that the C139R and D144E mutations drastically reduced HBsAg antigenicity, while the Y225del mutation found in one interferon-treated patient impaired HBsAg secretion. CONCLUSIONS: Lack of detectable HBsAg in patient serum could be explained by low level of ccc DNA in liver tissue, low antigenicity of the surface protein, or its secretion defect.

Usefulness of Open Ring Guider for Continuous Curvilinear Capsulorrhexis

PURPOSE: To compare the size, circularity and repeatability between the conventional manual technique and the open-ring guided continuous curvilinear capsulorrhexis (CCC) technique in cataract surgery. METHODS: The present study comprised 120 eyes divided into two equal groups. In the first group (group A), CCC was performed using a 5.3-mm open ring-shaped caliper and in the second group (group B), CCC was performed using the conventional manual technique. Photographs were taken after each surgical step (CCC, phacoemulsification, Intraocular lens insertion and corneal stromal hydration). The diameter, area and circularity of the anterior capsule were compared between the two groups. RESULTS: The anterior capsule diameter was 5.32 +/- 0.26 mm for group A (coefficient of variation 0.049) and 5.14 +/- 0.64 mm for group B (coefficient of variation 0.125); the area was 22.9 +/- 0.71 mm2 for group A (coefficient of variation 0.031) and 21.40 +/- 1.37 mm2 for group B (coefficient of variation 0.064). Circularity was 0.93 +/- 0.24 for group A (coefficient of variation 0.258) and 0.86 +/- 0.78 for group B (coefficient of variation 0.907). CONCLUSIONS: The open ring-guided CCC technique resulted in an increase of diameter and capsulorrhexis area. This method showed superior circularity and repeatability compared to conventional manual technique and can be useful in cataract surgery.

Mielodisplasia en pacientes pediátricos: evaluación de clasificaciones actuales / Myelodysplasia in pediatric patients: evaluation of current classifications

Introduction: Myelodysplastic Syndrome (MDS) in pediatrics is a rare and difficult clinical picture to diagnose. Classifications currently in use do not always help in identifying risk factors for leukemic transformation in children. Objective: To evaluate the value of current classifications by simultaneously determining a) the frequency of MDS in a pediatric population b) applying CCC classification (category, cytopenias, cytogenetic) and Passmore score (risk score), and c) correlating with progression and evolution to leukemia. Methods: Medical records of 56 children with cytopenias who were registered at the Hemato-oncology Unit, Hospital Roberto del Rio, were retrospectively reviewed from July 2000 to December 2007. Results: 13 patients met MDS diagnostic criteria (7.3 percent of the total hematological malignancies population). According to CCC classification, de novo MDS, refractory cytopenias with dysplasia and abnormal karyotype were the most frequent features. All patients with a high Passmore score progressed to leukemia. Conclusions: SMD classification in pediatrics patients remains difficult given the many differences with an adult population. CCC appears to be the most applicable for our pediatric population. High Passmore score correlated with leukemia development.

Introducción: El Síndrome mielodisplásico (SMD) en pediatría constituye una patología hemato-oncológica rara y de difícil diagnóstico. Las clasificaciones en uso, FAB (Franco Américo Británica) y OMS (Organización Mundial de la Salud), no han permitido definir factores de riesgo de transformación leucémica. Objetivo: Conocer la frecuencia del SMD en una población pediátrica, aplicar la clasificación CCC (Categoría, Citopenia, Citogenética) y el Score de Passmore (puntaje de riesgo) y relacionarlos con evolución y progresión a leucemia. Pacientes y Método: Revisión retrospectiva de 56 fichas de pacientes con citopenias atendidos en la Unidad de Hemato-oncología del Hospital Roberto del Río, entre Julio 2000 y Diciembre 2007. Resultados: Trece pacientes reunían criterios de SMD, correspondiendo al 7,3 por ciento de las neoplasias hematológicas. Al aplicar la clasificación CCC, predominaron los SMD de novo, las citopenias refractarias con displasia y el cariotipo anormal. Todos los pacientes con Score de Passmore > 2 progresaron a leucemia (4/9). Conclusiones: La clasificación del SMD en pediatría continúa siendo compleja. La clasificación CCC resultó más aplicable en la población pediátrica que las anteriores clasificaciones. El Score de Passmore mostró una alta correlación entre puntaje elevado y evolución a leucemia.

A Case of Congenital Cutaneous Candidiasis in a Premature Baby / 대한피부과학회지

Although candidal infections are common in the neonatal period, less than 100 cases of Congenital Cutaneous Candidiais (CCC) have been reported in the English literature. CCC appears to be acquired in the uterus by the ascension of organisms from an infected vagina into the uterine cavity. In this report, we describe a premature baby with CCC. At 6 months, his mother had a vaginal candidial infection which was treated. Her pregnancy terminated in preterm labor at 32 weeks. Desquamated patches that involved the trunk and extremities were noted at birth. The possibility of CCC was considered and numerous psedohyphae and spores were seen in the lesions by KOH microscopic examination. The skin lesions cleared completely after 2 weeks of topical clotrimazole cream.

The effect of posterior continuous circular capsulectomy with anterior vitrectomy in pediatric cataract on development of posterior capsular opacification

PURPOSE: To evaluate the effect of posterior continuous circular capsulectomy (pCCC) and anterior vitrectomy during cataract surgery in children on the development of posterior capsular opacification (PCO). METHODS: 52 eyes of 32 children aged from 3 months to 14 years who underwent pCCC and anterior vitrectomy at the time of cataract removal were evaluated more than 12 months. All eyes were divided into two groups, one group of children under 1 year of age and the other aged 1 year and more. The degree of PCO was evaluated prospectively in both groups. In 16 eyes of 8 children with bilateral cataracts, IOL was inserted in the bag in one eye, and in the anterior vitreous with pCCC capture in the opposite eye. The degree of PCO according to the location of IOL was compared between the two eyes. RESULTS: At 1 month postoperatively, mild PCO was developed in 9 out of 18 eyes of children under 1 year old, and in 14 out of 34 eyes of children of 1 year and over. There was a difference according to age. Severe PCO involving the visual axis was not developed in all eyes during 12 months follow up period. The degree of PCO was more in eyes of children under 1 year, but was not different between eyes with IOLs inserted in the bag and eyes with IOLs in the anterior vitreous. CONCLUSIONS: The development of PCO was much reduced with pCCC and anterior vitrectomy followed by in-the-bag implantation of IOL during cataract surgery in children.

Reduction in the Area of the Anterior Capsular Opening A fter Ac ryl Intraocular Lens Implantation: Diabetics vs Nondiabetics

We compared the rate of continuous curvilinear capsulorhexis[CCC]con traction and degree of postoperative capsular fibrosis between patients with non-proliferative diabetic retinopathy and age-matched non-diabetic patients after phacoemulsification with posterior chamber acryl foldable intraocular lens implantation.Sixty-two eyes of 42 patients of non-proliferative diabetic retinopathy and 78 eyes of 55 patients of control group who underwent cataract surgery with acryl foldable intraocular lens were enrolled in this retrospective study.During follow up examination the rate of CCC contractions were evaluated by NIDEK EAS-1000 System and we measured the area of anterior capsular opening.The diabetic patients average percentage of anterior capsular shirinkage rate was higher than non-diabetic patient's. But no statistically significant difference was found between the two groups. In conclusion, small incision cataract surgery with acryl foldable intraocular lens implantation showed good results in diabetic patients.Further studies will be needed for better clinical safety and efficacy.

Phacoemulsification in Hypermature Cataract

Phacoemulsification in hypermature cataract has not been recommended for routine procedure because of the difficult techniques and the possibility of high complication rates.48 eyes of 48 patients with hypermature cataracts were operated with phacoemulsification by one surgeon.The complications related to the status of continuous circular capsulorrhexis (CCC) were prospectively studied for three years.25 eyes (52.1%)had complete CCC and 23 eyes (47.9%)had incomplete CCC, and in 6 (12.5%)of these 23 eyes, posterior capsular rupture was occurred.Decentration of intraocular lens more than 1mm, occurred in 4 eyes (8.3%)with 3 or more radial tears. These results shows that phacoemulsification in hypermature cataract can be considered relatively safe procedure with recent techniques.CCC is also regarded as one of the most important procedures in hypermature cataract as in normal cataracts in reducing complications during and after the operation.

Postoperative Capsular Bag Distension in Cataract Surgery

We have experienced six cases of postoperative capsular bag distension following continuous curvilinear capsulorhexis(CCC) and phacoemulisification with posterior chamber intraocular lens. Successful CCC, phacoemulsification and in the bag fixation of intraocular lens(IOL) were accomplished, and the optics of the IOL were made of silicone material in 6 cases. We have observed various degree of anterior chamber shallowing, anterior displacement of IOL, bulging of posterior capsule, and myopic shift of refractive error, and these findings improved by YAG laser anterior or posterior capsulotomy. Mean refractive change was +2.6D(diopter) at post-laser 1 day.

Postoperative Changes of Continuous Curvilinear Capsulorhexis

As a growing number of surgeons are perforining cataract extraction by phacoernulsification and the continuous curvilinear capsulorhexis [CCC] has rapidly increased in popularity as the anterior capsulotomy technique, its advantages have been reported recently. But its complications induced by capsular contraction after ccc have been noted, and so we have studied the change in anterior capsular opening area and refractive error after ccc. One surgeon performed cataract extraction using ccc and phacoernulsification, and implanted posterior chamber IOL [optic size 5. 5mm, Pharmacia 812A] in the bag in 48 eyes, and we measured the area of anterior capsular opening and refractive error [spherical equivalent] at I week and 3 months after operation. The average percentage of anterior capsular shrinkage rate at 3 months was 14.8% and showed statistically significant difference [P<0.05], but. had not correlation with initial ccc size. The average refractive change at 3 months was 0. 2D hyperopic shift but did not show statistically significant difference.

The Evaluation of Capsule Contraction Syndrome

As increasing demands for CCC (Continuous Curvilinear Capsulorhexis) fincreases, the incidence of capsule contraction syndrome is also increasing in cataract surgery. We tried to classify and treat this syndrome with 44 eyes who have capsule contraction. It is known that the basic mechanism of capsule contraction is fibrotic dysplasia of anterior capsule, and we found that capsular contraction can arise with glaucoma, diabetes mellitus, uveitis, retinitis pigmentosa, psuedoexfoliation syndrome and old aged group as ordered. It can also be frequently can be found in age 50 to 60. In order to decrease the complication of capsule contraction(IOL dislocation, retinal detachment, etc.), we incised the anterial capsule with Nd:Yag laser at the time of fibrotic change. For the case of weak zonules, we made a radial incision in the 12 o'clock direction after IOL insertion.

Study on lead expelling effect of carboxymethyl chitosan calcium in lead poisoned mice / 中国海洋药物

Objective To observe the effect of carboxymethyl chitosan calcium(CCC) on the concentration of lead,calcium,and liver antioxidative capacity in lead poisoned mice.Methods mice were randomly divided into 6 groups.Three test groups were treated with CCC at three doses.The lead poisoned mice model was established by giving water containing lead acetate,and then CCC was administered to mice once a day.After 30 days,the mice were killed and the content of lead in blood,liver,brain and femur were determined by atomic absorption spectrophotometer,and antioxidative capacity in liver was measured using assay kit.Results CCC could reduce the contents of lead in blood,brain,liver and femur significantly,decrease the level of maleicdialdehyde(MDA),increase activities of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and total antioxidative capacity(T-AOC) in liver markedly. Conclusion CCC can promote the excretion of lead,increase the content of calcium in femur and antioxidative capacity in lead poisened mice.