Visual outcome of intraocular Iris-Claw lens implantation in Indonesian children with ectopia lentis.

PURPOSE: The purpose of the study was to describe the visual outcomes of anterior chamber iris-claw intraocular lens (IOL) implantation in pediatric ectopia lentis. MATERIALS AND METHODS: A retrospective review was conducted on the medical records of children with ectopia lentis who underwent primary anterior iris-claw IOL implantation at a national referral hospital in Indonesia in the years 2013-2020. Primary outcomes include visual acuity (VA) and postoperative complications. Postoperative data were collected at 1-year follow-up. RESULTS: A total of 26 eyes of 17 patients were included, the average age at surgery was 9 (5-14) years. Uncorrected VA significantly improved (P = 0.000) from an average of 1.6 ± 0.35 logMAR preoperatively to 0.7 ± 0.33 logMAR postoperatively, best-corrected VA also significantly improved, and 77% of eyes that achieved a postoperative best-corrected VA of 0.3 logMAR. Postoperative complications were reported in three eyes, including elevated intraocular pressure, IOL de-enclavation, severe inflammation, and endophthalmitis; all cases were promptly treated and had good visual outcomes. The mean onset of complications was roughly 3 months (77 ± 129 days) after surgery. CONCLUSION: Anterior iris-claw implantation in children with ectopia lentis appear to be effective in achieving good visual outcome. With its relatively simple technique, anterior iris-claw implantation can potentially serve as a favorable option for the treatment of pediatric ectopia lentis. Long-term prospective research with larger sample sizes is needed.

Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: A protocol for a randomized double-blind, controlled Phase 2 trial in Indonesia (MetLep Trial).

Background: The clinical management of leprosy is complicated by leprosy reactions (LR) causing irreversible nerve damage and disabilities. LR often require long-term use of corticosteroids causing serious side effects. Adjunct host-directed therapy (HDT) is a potentially attractive strategy in leprosy to prevent LR and associated immunopathology, modulate immunological memory that protects against recurrence, and thereby reduce nerve damage, disability and corticosteroid-associated morbidities. Metformin, a well-tolerated, safe and cheap anti-hyperglycaemic drug, is repurposed as HDT in auto-immune and infectious diseases, like tuberculosis (TB). Metformin use in people with diabetes is associated with reduced risks of TB-infection, progression to active TB, treatment failure and TB-mortality. Given the similarities both mycobacteria share, we hypothesize that among persons with multibacillary (MB) leprosy, adjunctive metformin may prevent/mitigate LR. Methods: We will perform a double-blind controlled proof-of-concept trial in which people with newly diagnosed multibacillary leprosy will be randomized (1:1) to metformin hydrochloride 1000mg extended release once daily versus placebo for 24 weeks in addition to standard-of-care WHO MB multidrug therapy (MDT) during 48 weeks. We aim to enrol 166 participants aged between 18 and 65 years, across five clinical sites in two leprosy endemic areas in Indonesia. Primary outcomes are the proportion of participants experiencing a LR and the frequency of (serious) adverse events. Secondary outcomes are the severity and time to first LR, the cumulative corticosteroid usage, and quality of life. The total study follow-up is 48 weeks. Discussion: LR signify the most important cause of irreversible nerve damage leading to anatomical deformities and disabilities, imposing a social and financial burden on those affected. Our study aims to evaluate the efficacy, tolerability and safety of adjunct metformin added to MDT in persons with multibacillary leprosy, and explore its effects on clinical and immunological outcomes. ClinicalTrialsgov registration: NCT05243654 (17/02/2022).

A common epigenetic mechanism across different cellular origins underlies systemic immune dysregulation in an idiopathic autism mouse model.

Immune dysregulation plays a key role in the pathogenesis of autism. Changes occurring at the systemic level, from brain inflammation to disturbed innate/adaptive immune in the periphery, are frequently observed in patients with autism; however, the intrinsic mechanisms behind them remain elusive. We hypothesize a common etiology may lie in progenitors of different types underlying widespread immune dysregulation. By single-cell RNA sequencing (sc-RNA seq), we trace the developmental origins of immune dysregulation in a mouse model of idiopathic autism. It is found that both in aorta-gonad-mesonephros (AGM) and yolk sac (YS) progenitors, the dysregulation of HDAC1-mediated epigenetic machinery alters definitive hematopoiesis during embryogenesis and downregulates the expression of the AP-1 complex for microglia development. Subsequently, these changes result in the dysregulation of the immune system, leading to gut dysbiosis and hyperactive microglia in the brain. We further confirm that dysregulated immune profiles are associated with specific microbiota composition, which may serve as a biomarker to identify autism of immune-dysregulated subtypes. Our findings elucidate a shared mechanism for the origin of immune dysregulation from the brain to the gut in autism and provide new insight to dissecting the heterogeneity of autism, as well as the therapeutic potential of targeting immune-dysregulated autism subtypes.

Resolution of refractory orbital cellulitis in an immunocompetent child: A case report.

INTRODUCTION: Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications. PRESENTATION OF CASE: We report a case of a 16-month-old girl who presented to the emergency department unconscious with a four-day history of a swollen right eyelid. CT scan revealed soft tissue swelling at the superior and inferior palpebral region with bilateral maxillary sinusitis. She had a severe sepsis and received intravenous antibiotics. After her general condition improved, she underwent surgical drainage in conjunction with mini-FESS (functional endoscopic sinus surgery)-the culture of purulent material from which Staphylococcus Aureus was isolated. After a few days, she had hospital-acquired pneumonia, and an abscess in her right eyelid reformed. Immunoglobulin test and lymphocyte subset test was normal. The patient underwent re-surgical drainage and had complete resolution of refractory orbital cellulitis. DISCUSSION: Severe refractory orbital cellulitis secondary to indolent infection is oftentimes found in immunocompromised patients or in those with underlying ocular diseases; our immunocompetent patient had a seemingly mild case of sinusitis which quickly progressed to severe orbital cellulitis. Oftentimes, broad-spectrum antibiotics are sufficient to treat orbital cellulitis, however, the same cannot be said for our patient, abscess reformed despite appropriate definitive antibiotic therapy in accordance with the culture results. CONCLUSION: While the main treatment of orbital cellulitis is administration of antibiotics, in certain conditions as found in our patient, patients may not respond well to conservative treatment. Thus, close monitoring is essential, and any sign of progression warrants prompt surgical drainage.

Experimental study of concrete activation compared to MCNP simulations for safety of neutron sources.

The neutron activation of shielding materials and the generated decay gamma radiation are well-known issues in terms of occupational exposure. Though the trace elements of shielding concretes can be dominant sources of the produced activity in such cases, their concentrations are often missing from the input data of shielding-related Monte Carlo simulations. For this reason, three concrete types were studied, that were considered in the European Spallation Source (ESS) ERIC. Their composition - including the trace elements - were determined via XRF, PGAA and NAA techniques. Realistic input data were developed for these materials, containing the parent elements of all the dominant radioisotopes, and were validated against measured data of neutron irradiation experiments.

The Effect of Laser Acupuncture on Spasticity in Children with Spastic Cerebral Palsy.

BACKGROUND: Spasticity in cerebral palsy is one of the most common disabilities of children in developing countries. OBJECTIVES: The objective of this study was to determine the efficacy of laser acupuncture on spasticity in children with spastic cerebral palsy. METHODS: This clinical trial was conducted on 60 patients with spastic cerebral palsy at 2 to 10 years. The patients were categorized into two groups: the control group and treatment group. Laser acupuncture was applied on GV20, GV14, LI4, GB34, and LR3 (power 50 mW, 785 nm, 1 Joule, 40 seconds) three times a week for 12 sessions in the treatment group and placebo laser acupuncture on the same points in the control group. The spasticity was measured using the Modified Ashworth Scale before and after complete sessions. RESULTS: The results showed that there was a significant reduction in the Modified Ashworth Scale score in the treatment group compared with the control group (p = 0.003). CONCLUSIONS: This study suggest that laser acupuncture on GV20, GV14, LI4, GB34, and LR3 can reduce spasticity for children with spastic cerebral palsy.

Neutron activation and prompt gamma intensity in Ar/CO2-filled neutron detectors at the European Spallation Source.

Monte Carlo simulations using MCNP6.1 were performed to study the effect of neutron activation in Ar/CO2 neutron detector counting gas. A general MCNP model was built and validated with simple analytical calculations. Simulations and calculations agree that only the 40Ar activation can have a considerable effect. It was shown that neither the prompt gamma intensity from the 40Ar neutron capture nor the produced 41Ar activity have an impact in terms of gamma dose rate around the detector and background level.

Aqueous Photochemistry of Secondary Organic Aerosol of α-Pinene and α-Humulene Oxidized with Ozone, Hydroxyl Radical, and Nitrate Radical.

Formation of secondary organic aerosols (SOA) from biogenic volatile organic compounds (BVOC) occurs via O3- and OH-initiated reactions during the day and reactions with NO3 during the night. We explored the effect of these three oxidation conditions on the molecular composition and aqueous photochemistry of model SOA prepared from two common BVOC. A common monoterpene, α-pinene, and sesquiterpene, α-humulene, were used to form SOA in a smog chamber via BVOC + O3, BVOC + NO3, and BVOC + OH + NOx oxidation. Samples of SOA were collected on filters, water-soluble compounds from SOA were extracted in water, and the resulting aqueous solutions were photolyzed to simulate the photochemical aqueous processing of SOA. The extent of change in the molecular level composition of SOA over 4 h of photolysis (approximately equivalent to 64 h of photolysis under ambient conditions) was assessed with high-resolution electrospray ionization mass spectrometry. The analysis revealed significant differences in the molecular composition between SOA formed by the different oxidation pathways. The composition further evolved during photolysis with the most notable change corresponding to the nearly complete removal of nitrogen-containing organic compounds. Hydrolysis of SOA compounds also occurred in parallel with photolysis. The preferential loss of larger SOA compounds during photolysis and hydrolysis made the SOA compounds more volatile on average. This study suggests that aqueous processes may under certain conditions lead to a reduction in the SOA loading as opposed to an increase in SOA loading commonly assumed in the literature.

High-resolution mass spectrometry and molecular characterization of aqueous photochemistry products of common types of secondary organic aerosols.

This work presents a systematic investigation of the molecular level composition and the extent of aqueous photochemical processing in different types of secondary organic aerosol (SOA) from biogenic and anthropogenic precursors including α-pinene, ß-pinene, ß-myrcene, d-limonene, α-humulene, 1,3,5-trimethylbenzene, and guaiacol, oxidized by ozone (to simulate a remote atmosphere) or by OH in the presence of NOx (to simulate an urban atmosphere). Chamber- and flow-tube-generated SOA samples were collected, extracted in a methanol/water solution, and photolyzed for 1 h under identical irradiation conditions. In these experiments, the irradiation was equivalent to about 3-8 h of exposure to the sun in its zenith. The molecular level composition of the dissolved SOA was probed before and after photolysis with direct-infusion electrospray ionization high-resolution mass spectrometry (ESI-HR-MS). The mass spectra of unphotolyzed SOA generated by ozone oxidation of monoterpenes showed qualitatively similar features and contained largely overlapping subsets of identified compounds. The mass spectra of OH/NOx-generated SOA had more unique visual appearance and indicated a lower extent of product overlap. Furthermore, the fraction of nitrogen-containing species (organonitrates and nitroaromatics) was highly sensitive to the SOA precursor. These observations suggest that attribution of high-resolution mass spectra in field SOA samples to specific SOA precursors should be more straightforward under OH/NOx oxidation conditions compared to the ozone-driven oxidation. Comparison of the SOA constituents before and after photolysis showed the tendency to reduce the average number of atoms in the SOA compounds without a significant effect on the overall O/C and H/C ratios. SOA prepared by OH/NOx photooxidation of 1,3,5-trimethylbenzene and guaiacol were more resilient to photolysis despite being the most light-absorbing. The composition of SOA prepared by ozonolysis of monoterpenes changed more significantly as a result of the photolysis. The results indicate that aqueous photolysis of dissolved SOA compounds in cloud/fog water can occur in various types of SOA, and on atmospherically relevant time scales. However, the extent of the photolysis-driven change in molecular composition depends on the specific type of SOA.