Effect of Macrophage Migration Inhibitory Factor on Corneal Sensitivity after Laser In Situ Keratomileusis in Rabbit

PURPOSE: To investigate the effect of macrophage migration inhibitory factor (MIF) on corneal sensitivity after laser in situ keratomileusis (LASIK) surgery. METHODS: New Zealand white rabbits were used in this study. A hinged corneal flap (160-microm thick) was created with a microkeratome, and -3.0 diopter excimer laser ablation was performed. Expressions of MIF mRNA in the corneal epithelial cells and surrounding inflammatory cells were analyzed using reverse transcription polymerase chain reaction at 48 hours after LASIK. After LASIK surgery, the rabbits were topically given either 1) a balanced salt solution (BSS), 2) MIF (100 ng/mL) alone, or 3) a combination of nerve growth factor (NGF, 100 ug/mL), neurotrophine-3 (NT-3, 100 ng/mL), interleukin-6 (IL-6, 5 ng/mL), and leukemia inhibitory factor (LIF, 5 ng/mL) four times a day for three days. Preoperative and postoperative corneal sensitivity at two weeks and at 10 weeks were assessed using the Cochet-Bonnet esthesiometer. RESULTS: Expression of MIF mRNA was 2.5-fold upregulated in the corneal epithelium and 1.5-fold upregulated in the surrounding inflammatory cells as compared with the control eyes. Preoperative baseline corneal sensitivity was 40.56 +/- 2.36 mm. At two weeks after LASIK, corneal sensitivity was 9.17 +/- 5.57 mm in the BSS treated group, 21.92 +/- 2.44 mm in the MIF treated group, and 22.42 +/- 1.59 mm in the neuronal growth factors-treated group (MIF vs. BSS, p < 0.0001; neuronal growth factors vs. BSS, p < 0.0001; MIF vs. neuronal growth factors, p = 0.815). At 10 weeks after LASIK, corneal sensitivity was 15.00 +/- 9.65, 35.00 +/- 5.48, and 29.58 +/- 4.31 mm respectively (MIF vs. BSS, p = 0.0001; neuronal growth factors vs. BSS, p = 0.002; MIF vs. neuronal growth factors, p = 0.192). Treatment with MIF alone could achieve as much of an effect on recovery of corneal sensation as treatment with combination of NGF, NT-3, IL-6, and LIF. CONCLUSIONS: Topically administered MIF plays a significant role in the early recovery of corneal sensitivity after LASIK in the experimental animal model.

A prospective randomised clinical trial comparing FARES method with the Eachempati external rotation method for reduction of acute anterior dislocation of shoulder.

OBJECTIVE: To compare the safety, efficacy and reliability of FARES (fast, reliable and safe) method with the Eachempati external rotation method for reduction of anterior dislocation of shoulder. METHODS: In a single centre, prospective, randomised clinical trial, conducted in our institution from January 2010 to October 2011, 160 patients with acute anterior dislocation of shoulder (with or without an associated fracture of the greater tuberosity of the humerus) who satisfy the inclusion and exclusion criteria were enrolled in the study. Patients were randomised to receive reduction of dislocation with one of the two methods (FARES and Eachempati method) with 80 patients in each group, according to a table of random numbers. Following successful reduction, the following information was recorded: (i) intensity of pain perceived during reduction by using a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (worst pain possible), (ii) time interval between the dislocation and the first attempt of reduction, (iii) time interval between the start of the reduction manoeuvre and completion of the reduction, (iv) number of attempts taken to complete the reduction and (iv) any post-reduction complications. RESULTS: There were no significant differences between the two groups with regard to baseline characteristics. No post-reduction complications were noted in any of the patients in this study. Successful reduction of shoulder dislocation was achieved with the FARES method in 76 (95%) of 80 patients and with the Eachempati external rotation method in 73 (91.25%) of 80 patients. This difference was not statistically significant (p=0.53, Fisher's exact test). Post-reduction result analysis shows that there was a statistically significant difference between the two methods in favour of the FARES method in terms of speed of reduction, pain felt during reduction and number of attempts taken during reduction. CONCLUSIONS: FARES method, as compared with the Eachempati method, is significantly faster, less painful and less number of attempts required for reduction. As both the methods appeared to be safe and effective compared to the previous traditional techniques, we strongly recommend FARES method as the first-choice method compared to Eachempati method for reduction of acute anterior dislocation of shoulder. LEVEL OF EVIDENCE: Therapeutic Level I.

A prospective randomized, double-blind, controlled clinical trial comparing epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus.

OBJECTIVE: To compare the efficacy of up to 3 epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus. MATERIALS AND METHODS: In a randomized, double-blind controlled clinical trial, we administered up to 3 epidural injections of either 80 mg (2 mL) of methylprednisolone acetate and 1 mg (1 mL) of butorphanol diluted with 7 mL of isotonic saline or 80 mg (2 mL) of methylprednisolone acetate diluted with 8 mL of isotonic saline by a lumbar interlaminar approach under fluoroscopic guidance to 120 patients (60 patients in each group) with sciatica due to a herniated nucleus pulposus lasting for 4 weeks to 1 year. All patients had scores higher than 30 mm on visual analog scale (VAS). Information on the use of paracetamol, intensity of pain on a VAS ranging from 0 (no pain) to 100 mm (worst pain possible), Schober's test (cm), Straight Leg Raising test, neurologic examination assessing sensory deficits, motor deficits and reflex changes, and Oswestry Low Back Pain Disability Questionnaire were evaluated at 3 weeks, 6 weeks, and 3 months after the first injection. RESULTS: There were no significant differences between the 2 groups with regard to baseline characteristics, withdrawals, and complication rate. Three weeks, 6 weeks, and 3 months after the first injection, all the outcome measures in the butorphanol plus corticosteroid group were significantly different from that of the corticosteroid group. CONCLUSIONS: Epidural butorphanol plus corticosteroid injections, as compared with corticosteroid alone injections, offered marked improvement in pain, reflex, motor and sensory deficits, and functional status and reduced the need for analgesics. LEVEL OF EVIDENCE: Therapeutic Level I.

Expression of IRFs and iNOS in the Mouse Cornea with Pseudomonas Aeruginosa Keratitis

PURPOSE: To investigate the expression of IRF-1, IRF-7 and iNOS in the mice model of Pseudomonas aeruginosa keratitis. The enzymatic activity of iNOS and its expression were also investigated. METHODS: With western blot analysis, the protein expression of IRF-1, IRF-7 (at 24 hours), and iNOS (at 12 hours and 24 hours) were evaluated in the mouse model of P. aeruginosa keratitis. iNOS enzymatic activity was determined with a scintillation counter. IRF-1 and IRF-7 expression were localized with immunofluorescent labeling. The wounded control group was given the same corneal wound without bacterial inoculation, and the fellow eyes served as normal controls. RESULTS: Expression of IRF-1, IRF-7 and iNOS was highly upregulated in corneas with P. aeruginosa keratitis compared to normal or wounded corneas. iNOS enzymatic activity also was higher in infected than normal corneas. In wounded corneas, NOS2 expression and activity slightly increased at 12 hours after the infection. Intense IRF-1 immunopositivity was seen in the epithelial layer of infected corneas. Some corneal stromal cells and endothelial cells showed moderate positive labeling in infected corneas. IRF-7 showed intense labeling in the epithelial layer and endothelial cells of normal as well as infected corneas. Increased IRF-7 labeling was observed in epithelial cells in the ulcerated region of infected corneas. CONCLUSIONS: These results suggest that IRF-1, IRF-7 and iNOS may play a regulatory role in the immune responses and wound healing process in P. aeruginosa keratitis.