Lack of association between cognitive impairment and systemic inflammation in asymptomatic carotid stenosis.

BACKGROUND: Asymptomatic carotid atherosclerotic stenosis (ACAS) is associated with cognitive impairment. Systemic inflammation occurs in patients with systemic atherosclerosis and is also associated with cognitive impairment. The goal of this study was to determine if cognitive impairment in patients with ACAS is the result of systemic inflammation. METHODS: A cross-sectional analysis of 104 patients (63 patients with ACAS, 41 controls) with cognitive function and inflammatory biomarker assessments was performed. Venous blood was assayed for proinflammatory biomarkers (IL-1ß, IL-6, IL-6R, IL-8, IL-17, tumor necrosis factor-α, matrix metalloproteinase [MMP]-1, MMP-2, MMP-7, MMP-9, vascular cell adhesion molecule, and high-sensitivity C-reactive protein). The patients also underwent comprehensive cognitive testing to compute five domain-specific cognitive scores per patient. We first assessed the associations between carotid stenosis and cognitive function, and between carotid stenosis and systemic inflammation in separate regression models. We then determined whether cognitive impairments persisted in patients with carotid stenosis after accounting for inflammation by adjusting for inflammatory biomarker levels in a combined model. RESULTS: Patients with ACAS and control patients differed in age, race, coronary artery disease prevalence, and education. Stenosis patients had worse cognitive scores in two domains: learning and memory (P = .05) and motor and processing speed (P = .002). Despite adjusting for inflammatory biomarker levels, patients with ACAS still demonstrated deficits in the domains of learning and memory and motor and processing speed. CONCLUSIONS: Although systemic atherosclerosis-induced inflammation is a well-recognized cause for cognitive impairment, our data suggest that it is not the primary underlying mechanism behind cognitive impairments seen in ACAS. Cognitive impairments in learning and memory and motor and processing speed seen in patients with ACAS persist after adjusting for systemic inflammation. Thus, alternative mechanisms should be explored to account for the observed functional impairments.

Thermal Processing of Chloride-Contaminated Plutonium Dioxide.

Over 80 heat treatment experiments have been made on samples of chloride-contaminated plutonium dioxide retrieved from two packages in storage at Sellafield. These packages dated from 1974 and 1980 and were produced in a batch process by conversion of plutonium oxalate in a furnace at around 550 °C. The storage package contained a poly(vinyl chloride) (PVC) bag between the screw top inner and outer metal cans. Degradation of the PVC has led to adsorption of hydrogen chloride together with other atmospheric gases onto the PuO2 surface. Analysis by caustic leaching and ion chromatography gave chloride contents of ∼2000 to >5000 ppm Cl (i.e., µgCl g-1 of the original sample). Although there are some subtle differences, in general, there is surprisingly good agreement in results from heat treatment experiments for all the samples from both cans. Mass loss on heating (LOH) plateaus at nearly 3 wt % above 700 °C, although samples that were long stored under an air atmosphere or preexposed to 95% relative humidity atmospheres, gave higher LOH up to ∼4 wt %. The majority of the mass loss is due to adsorbed water and other atmospheric gases rather than chloride. Heating volatilizes chloride only above ∼400 °C implying that simple physisorption of HCl is not the main cause of contamination. Interestingly, above 700 °C, >100% of the initial leachable chloride can be volatilized. Surface (leachable) chloride decreases quickly with heat treatment temperatures up to ∼600 °C but only slowly above this temperature. Storage in air atmosphere post-heat treatment apparently leads to a reequilibration as leachable chloride increases. The presence of a "nonleachable" form of chloride was thus inferred and subsequently confirmed in PuO2 samples (pre- and post-heat treatment) that were fully dissolved and analyzed for the total chloride inventory. Reheating samples in either air or argon at temperatures up to the first heat treatment temperature did not volatilize significant amounts of additional chloride. With regard to a thermal stabilization process, heat treatment in flowing air at 800 °C with cooling and packaging under dry argon appears optimal, particularly, if thinner powder beds can be maintained. From electron microscopy, heat treatment appeared to have the most effect on degrading the square platelet particles compared to those with the trapezoidal morphology.

Corneal imaging and densitometry measurements in keratoconus patients to monitor disease progression and treatment outcomes after contact lens or Intacs treatment.

AIM: The aim of this study was to compare the pre- and posttreatment corneal densitometry and corneal thickness value of keratoconus (KCN) patients managed via contact lenses (CLs) or by both intrastromal corneal rings and contact lenses. PATIENTS AND METHODS: This prospective study was performed at the Manchester Royal Eye Hospital, UK. Patients were recruited before treatment and followed up for 12 months. Data of corneal densitometry and corneal thickness were collected using the Oculus Pentacam at the pretreatment visit and posttreatment visit at 12 months. RESULTS: Corneal clarity significantly differs between both groups at pre treatment at zone 0-2 mm for the anterior layer (P=0.002). The same diversity is present at zone 2-6 mm for the anterior layer (P=0.003) and posterior layer (P=0.008). The corneal clarity diversity found was not statistically significant at 12 months post treatment (P>0.05). Corneal thickness was found to be statistically significantly different between pre treatment and post treatment for the CL group for central corneal thickness (CCT) and thinnest area (P=0.01 and P=0.02), respectively. DISCUSSION: This study shows that KCN management with Intacs was found to be effective in maintaining corneal clarity for a longer time than that with CL alone. On the other hand, corneal clarity reduces with disease progression in cases managed with CLs only. Analysis of Oculus Pentacam images provides an objective evaluation to monitor the corneal status after these different pathways of management.

Evaluation of corneal symmetry after UV corneal crosslinking for keratoconus.

PURPOSE: The purpose of this study was to assess UV corneal crosslinking (CXL) treatment outcomes for keratoconus by evaluating the corneal regularity in patients through follow-up using the Oculus Pentacam. PATIENTS AND METHODS: A total of 18 eyes from CXL patients with keratoconus were studied before and after CXL treatment, and six eyes from six patients who were not treated with CXL served as controls. Treated patients had Pentacam images taken before CXL treatment and regularly 3 months post treatment up to the 12th month. Controls were imaged during their first appointment and after 12 months. Symmetry and asphericity were evaluated and correlated with both best-corrected visual acuity (BCVA) and maximum K-readings. RESULTS: In the CXL-treated group, there was a significant improvement in the index of symmetrical variation (ISV) and keratoconus index (KI) at 3 months and in the index of height asymmetry (IHA) and minimum radius of curvature (Rmin) at 9 months post treatment. On the contrary, the untreated group's indices showed some significant worsening in ISV, KI, central keratoconus index (CKI), and Rmin. A novel finding in our study was a slight positive shift of anterior asphericity in the 6 mm, 7 mm, and 8 mm 3 months after treatment, which had a correlation with BCVA (R2=0.390, p=0.053) and a strong correlation with maximum K-reading (R2=0.690, p=0.005). However, the untreated group had no significant changes after 1 year. CONCLUSION: The corneal asymmetrical shape is associated with the spherical aberration alteration influenced by temporal evolution of surface ablation and increased corneal haze. However, insignificant changes in symmetry attest the stabilization effect on cornea postoperatively as compared with controls.