Repeat corneal transplantation in Southern China: Indications, surgical technique, outcomes, and risk factors for repeat keratoplasty failure.

PURPOSE: To report the indications, surgical techniques, and outcomes of repeat keratoplasty and evaluate the risk factors for graft failure in the Chinese population. METHODS: The medical records of 216 patients (243 cases) who underwent at least two keratoplasties at a leading eye hospital in southern China between 2011 and 2020 were retrospectively reviewed. Indications and surgical procedures for repeat corneal transplantation were analyzed. Kaplan-Meier survival analysis was used to determine the graft survival rate after repeat keratoplasty. A multivariable survival model was used to assess the risk factors. RESULTS: Repeated keratoplasties increased continuously from 2011 to 2020 (P = 0.002). The most common primary indication was infectious keratitis (38.7%), and the most common reason for repeat keratoplasty was graft rejection (30.04%). Regraft techniques included penetrating keratoplasty (PK) in 165 cases (67.9%), deep lamellar keratoplasty (DALK) in 52 cases (21.40%), and endothelial keratoplasty (EK) in 26 cases (10.7%). Median survival was 5.3, 6.8, and 6.4 years for PK, DALK, and EK, respectively. The 5-year survival rate was 53.5%, 66.6%, and 69.8% for PK, DALK, and EK, respectively. The median LogMAR visual acuity was 1.4 for PK, 0.75 for DALK, and 1.2 for EK at the end of the follow-up. Multivariate analysis revealed that graft rejection is a risk factor for repeat keratoplasty failure (P = 0.002). CONCLUSIONS: DALK and EK may provide better outcomes than PK in treating graft failure. Preventing and treating postoperative graft rejection may be key to improving regraft survival. These findings will aid in the management of failed corneal grafts.

Effect of guar gum, gelatin, and pectin on moisture changes in freeze-dried restructured strawberry blocks.

This study aimed to investigate the effects of edible gum addition on moisture changes in freeze-dried restructured strawberry blocks (FRSB), which involved five groups: the control, 1.2% guar gum, 1.2% gelatin, 1.2% pectin, and the composite group with 0.5% guar gum, 0.5% gelatin, and 0.45% pectin. The results indicated that the drying rates of the five groups of FRSB presented similar early acceleration and later deceleration trends. Moisture content in FRSB was linearly predicted by peak area of low field nuclear magnetic resonance with R2 higher than 0.90 for all the five groups. The FRSB samples in the gelatin and composition groups formed a denser porous structure and had a lower hygroscopicity after four days of storage. This study provides a theoretical basis for controlling the processing of FRSB.

Changes and correlation analysis of volatile flavor compounds, amino acids, and soluble sugars in durian during different drying processes.

Durian contains rich flavor components that undergo complex changes during drying. In this study, durian was subjected to integrated freeze-drying (IFD), conventional freeze-drying (CFD), and hot air drying (AD). Compared with the fresh samples, those dried by IFD, CFD, and AD lost 11, 9, and 7 original volatile compounds, respectively, and generated 7, 6, and 8 new volatile compounds, respectively, and showed a rapid and then slow decreasing trend in the total content during drying. However, the types of amino acids and soluble sugars remained unchanged during each of the drying methods. Furthermore, volatile compounds showed a significant negative correlation with the majority of amino acids and a significant positive correlation with soluble sugars. The IFD samples had the highest content of volatile compounds, amino acids, and soluble sugars. Therefore, IFD is recommended as a preferable drying method for durian.

Phytic acid cross-linked and Hofmeister effect strengthened polyvinyl alcohol hydrogels for zinc ion storage.

It is a big challenge to retain the water and thus reduce the charge impedance for solid electrolytes used in flexible and wearable zinc ion batteries. Here, we propose novel phytic acid (PA) cross-linked polyvinyl alcohol (PVA) hydrogels as high-performanced solid electrolytes strengthened by the Hofmeister effect. In this approach, freeze-thawing followed by a salting-out procedure via anions to induce the Hofmeister effect can greatly improve the tensile strain and flexibility of the hydrogels. The PA addition dramatically enhances the ionic conductivity and increases the affinity between the electrolyte and zinc plate. Consequently, the PVA/PA hydrogels exhibit remarkable electrochemical performances with stable full-cell cycling in zinc ion storage and capability in inhibiting Zn dendrite growth.

Structure-Guided Evolution Modulate Alcohol Oxidase to Improve Ethanol Oxidation Performance.

A high ethanol usage of alcohol oxidase (AOX) was required in industry. In this study, a "expand substrate pocket" strategy achieved a high activity AOX from Hansenula polymorpha (H. polymorpha) by Phe to Val residue (F/V) site-directed mutation to enlarge ethanol channel. Although H. Polymorpha AOX (HpAOX) possessed respectively 71.3% and 76.1% similarity with AOX (PpAOX) from Pichia pastoris (P. pastoris) in DNA and protein sequences, their active site structures including catalytic site and substrate channel were similar according to computer-aided analysis. After 3D structure analysis, Phe99 residue of their substrate channels was the most important residue to impact enzyme activity because of its large aromatic side chains. F99V mutation of HpAOX (HpAOXF99V) was designed and executed based on the enzyme catalytic mechanism and molecular computation in order to allow more larger size ethanol into active site. The highest enzyme activity of the fourth strains of HpAOXF99V mutant strain exhibited 12.06-folds increase than that of the host GS115 strain. Furthermore, kinetic studies indicated that the HpAOXF99V significantly promoted catalytic efficiency of ethanol than HpAOX, including Km, Vmax, kcat and kcat/Km. We also provided a new insight that the cofactor FAD irritated both active AOX octamer biosynthesis production and enzyme-catalysed ability due to help enzyme assembly and redox potential.

Changes in, and correlation analysis of, volatile compounds, key enzymes, and fatty acids in lemon juice vesicles during freeze drying and hot-air drying.

BACKGROUND: Lemon juice vesicles are distinguished by their unique and abundant volatile flavor compounds, which can undergo complex changes during drying. In this study, integrated freeze drying (IFD), conventional freeze drying (CFD), and hot-air drying (AD) were used to dry lemon juice vesicles to investigate the changes in, and correlations among volatile compounds, fatty acids, and key enzyme activity during the drying process. RESULTS: Twenty-two volatile compounds were detected during the drying processes. Compared with fresh samples, seven compounds were lost in the dried samples after IFD, seven after CFS, and six after AD, and the loss rates of the total content of volatile compounds in the dried samples were 82.73% in CFD, more than 71.22% in IFD, and more than 28.78% in AD. In total, 1.015 mg/g of seven fatty acids were detected in the fresh samples; the content loss rates of total fatty acids after drying were 67.68% in AD, more than 53.00% in CFD, and more than 36.95% in IFD, respectively. During the three drying processes, IFD retained relatively higher enzyme activity in the samples. CONCLUSION: Many positive and negative correlations (P < 0.05) were observed among the key enzyme effects, fatty acids, and volatile compounds, showing close associations. The current work provides information that is important for the selection of suitable drying techniques for lemon juice vesicles and suggests how to control their flavor during the drying process. © 2023 Society of Chemical Industry.

Edible gum addition improves the quality of freeze-dried restructured strawberry blocks.

Freeze-dried restructured strawberry blocks (FRSB) have become an increasingly popular product. In this study, the effects of six edible gums (guar gum, gelatin, xanthan gum, pectin, konjac gum, and carrageenan) on the FRSB quality were investigated. For FRSBs, compared with those in untreated samples, the 0.6 % guar gum addition increased texture profile analysis (TPA) hardness, chewiness, and puncture hardness by 29.59%, 174.86%, and 25.34%, respectively; after the 0.6% gelatin addition, the sensory evaluation sourness was reduced by 8.58%, whereas yield, TPA chewiness, and puncture hardness were increased by 3.40%, 28.62%, and 92.12%, respectively; with the 0.9% gelatin addition, the sensory evaluation sourness was reduced by 8.58%; with the 0.9% pectin addition, the yield, TPA hardness, chewiness, and puncture hardness were increased by 4.55%, 5.94%, 77.49%, and 103.62%, respectively. In summary, 0.6-0.9% pectin, gelatin, and guar gum addition are recommended to improve the main qualities of FRSBs.

Elliptical deep anterior lamellar keratoplasty in severe Acanthamoeba keratitis.

Acanthamoeba keratitis (AK) is an intractable infection of the cornea. Penetrating keratoplasty is widely used for the management of severe AK but suffers from complications like graft rejection, endophthalmitis, and glaucoma. Herein, we aimed to describe the surgical technique and the results of elliptical deep anterior lamellar keratoplasty (eDALK) for the management of severe AK. In this retrospective case series, records of consecutive patients with AK poorly responsive to medical treatment who underwent eDALK from January 2012 to May 2020 were reviewed. The largest diameter of infiltration was ≥8 mm and did not involve the endothelium. The recipient bed was made by an elliptical trephine, and big bubble or wet-peeling technique was performed. Postoperative best spectacle-corrected visual acuity, endothelial cell density, corneal topographic data, and complications were evaluated. Thirteen eyes of thirteen patients (eight men and five women, 45.54 ± 11.78 years old) were included in this study. The mean follow-up interval was 21.31 ± 19.59 months (range, 12-82 months). At the last follow-up, the mean best spectacle-corrected visual acuity was 0.35 ± 0.27 logarithm of the minimum angle of resolution. The mean refractive and topographic astigmatism were - 3.21 ± 1.77 and 3.08 ± 1.14 D, respectively. Intraoperative perforation was encountered in one case and double anterior chambers occurred in two cases. One graft developed stromal rejection and one eye developed amoebic recurrence. eDALK can serve as the first-line surgical management of severe AK poorly responsive to medical treatment.

Clinical Outcomes of the Intraocular Lens Injector and Busin Glide for Descemet Stripping Automated Endothelial Keratoplasty in Patients with Iridocorneal Endothelial Syndrome.

Purpose: To report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed in iridocorneal endothelial (ICE) syndrome patients using the intraocular lens injector (injector), in comparison with those using the Busin glide. Methods: In this retrospective, interventional comparative study, we evaluated the outcomes of DSAEK performed using the injector (n = 12) or the Busin glide (n = 12) for patients with ICE syndrome. Their graft position and postoperative complications were recorded. Their best-corrected visual acuity (BCVA) and endothelial cell loss (ECL) were monitored over a 12-month follow-up period. Results: DSAEK was conducted successfully in the 24 cases. The BCVA improved from the preoperative 0.99 ± 0.61 to 0.36 ± 0.35 at 12 months after operation (p < 0.001), with no significant difference between the two groups (the injector group and the Busin group) (p = 0.933). ECL at 1 month after DSAEK was 21.80 ± 15.01% in the injector group, which was significantly lower than 33.69 ± 9.75% of the Busin group (p = 0.031). No surgery-related complications were observed in the 24 cases intraoperatively or postoperatively except that one case suffered from postoperative graft dislocation, without statistical difference between the two groups. Conclusions: At 1 month after surgery, the use of graft injector for delivering DSAEK-based endothelial graft may cause significantly less endothelial cell damage than the pull-through technique used in the application of Busin glide. The injector allows safe endothelial graft delivery without the need of anterior chamber irrigation, which increases the ratio of successful graft attachment.

Effects of whole grain intake on glycemic traits: A systematic review and meta-analysis of randomized controlled trials.

Whole grains (WGs) may have various health benefits, including lowering blood glucose and improving insulin sensitivity. To conduct a meta-analysis of the effects of WGs compared with non-WGs on changes in fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and homeostasis model assessment of insulin resistance (HOMA-IR). A systematic literature search was performed for all published randomized controlled trials on the effects of WG intake on fasting glucose, fasting insulin, HbA1c and HOMA-IR response up to February 2021. Weighted mean differences (WMD) were calculated. Pre-specified subgroup and univariate meta-regression analyses were explored to identify the sources of heterogeneity. Sensitivity analysis and bias analysis were conducted to appraise study quality. Among 12,435 articles screened for eligibility, data were extracted from 48 articles. Meta-analysis of 4,118 participants showed that WG consumption resulted in a significant reduction in fasting glucose by -0.15 mmol/L, fasting insulin by -2.71 pmol/L, HbA1c by -0.44%, and HOMA-IR by -0.28, respectively. Compared with mixed grains, brown rice, and wheat, oats were significantly lower on marker of glycemic. Besides, multiple interventions per day consolidated effectiveness of WGs. WG consumption decreased the levels of fasting glucose, fasting insulin, HbA1c, and HOMA-IR compared with non-WG consumption.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2001429 .

Optimization of Conditions for a Freeze-Dried Restructured Strawberry Block by Adding Guar Gum, Pectin and Gelatin.

With its high moisture content and tender texture, fresh strawberry is very susceptible to mechanical damage and microbial infection. Drying is one of the most frequently employed methods to extend its shelf life, and freeze-dried restructured strawberry block (FRSB) is an emerging popular food. Here, in order to enhance the quality of FRSB, edible gums of guar gum, pectin, and gelatin were added and the combination was optimized using response surface methodology (RSM) with chewiness, hardness, and organoleptic evaluations of the dried sample as the response indicators. The results showed that the combination addition of 0.10% guar gum, 0.22% pectin, and 0.30% gelatin contributed to the highest comprehensive quality of the dried sample. Compared with the untreated sample, the optimal combination addition of the three edible gums resulted in a higher moisture content for the dried sample (increased by 0.8%), and increased the chewiness, hardness, and porosity by 82.04%, 27.09%, and 3.01%, respectively, while maintaining more original color and forming a denser porous microstructure. The findings in the current work will be useful for the application of edible gums in freeze-dried restructured fruits and vegetables.

Computational Screening of Metal-Organic Frameworks for Ammonia Capture from H2/N2/NH3 Mixtures.

The separation of ammonia from H2/N2/NH3 mixtures is an important step in ammonia decomposition for hydrogen production and ammonia synthesis from H2 and N2 based nonaqueous technologies. Metal-organic frameworks (MOFs) are considered as potential materials for capturing ammonia. In the present work, high-throughput screening of 2932 Computation-Ready Experimental MOFs (CoRE MOFs) was carried out for ammonia capture from H2/N2/NH3 mixtures by Grand Canonical Monte Carlo (GCMC) simulations. It was found that the high-performing MOFs are characterized by tube-like channels, moderate LCD (largest cavity diameter) (4-7.5 Å), and high Q st 0(NH3) (the isosteric heat of NH3 adsorption) (>45 kJ/mol). MOFs with high NH3 adsorption capacity often feature moderate surface area, while the surface area of MOFs with high NH3 selectivity is relatively lower, which limits the NH3 adsorption capacity. Q st 0 and the Henry's constant (K H ) are two energy descriptors describing the interactions between adsorbents and adsorbates. The former has a stronger correlation with the adsorption selectivity, while the latter has a stronger correlation with the adsorption capacity. By analyzing the molecular density distribution of adsorbates in high-performing MOFs, it was found that unsaturated coordinated metal sites provide the main functional binding sites for NH3. Most MOFs with high NH3 selectivity have multiple different metal nodes or other atoms except C, O, and H, such as N and P. Multiple metal nodes and nonmetallic atoms provide more functional binding sites. Finally, the adsorption behavior with various concentrations of gas mixtures was examined to verify the universality of the screening calculations, and the effect of framework flexibility on adsorption performance was explored.

Dynamic Changes in Volatile Flavor Compounds, Amino Acids, Organic Acids, and Soluble Sugars in Lemon Juice Vesicles during Freeze-Drying and Hot-Air Drying.

Lemon juice vesicles have abundant flavor components that can undergo complex changes during drying. Three drying methods, including integrated freeze-drying (IFD), conventional freeze-drying (CFD), and hot-air drying (AD), were studied to determine their effects on the dynamic changes in the flavor compounds in lemon juice vesicles. Compared with the fresh samples, the final dried samples that underwent IFD, CFD, and AD lost seven, seven, and six volatile flavor compounds and three, four, and five amino acids, respectively; the order of the loss ratios with respect to the volatile compound content was: 82.73% in CFD > 71.22% in IFD > 28.78% in AD. AD resulted in the highest total amino acid content (10.83 ± 0.20 mg/g), which was 1.39 and 5.54 mg/g higher than that of IFD and CFD, respectively; CFD resulted in the highest total organic acid content (45.94 ± 0.34 mg/g), which was 8.01 and 7.87 mg/g higher than that of IFD and AD, respectively; and AD contributed to the highest total soluble sugars (17.12 ± 0.20 mg/g), which was 1.24 and 1.49 mg/g higher than that of IFD and CFD, respectively. A correlation analysis demonstrated that most of the amino acids and the soluble sugars were closely related to the profiles of the volatile compounds in the lemon juice vesicles during drying.

Assessment of Novel Oligopeptides from Rapeseed Napin (Brassica napus) in Protecting HepG2 Cells from Insulin Resistance and Oxidative Stress.

Oligopeptides (Thr-His-Leu-Pro-Lys (THLPK), His-Pro-Leu-Lys (HPLK), Leu-Pro-Lys (LPK), His-Leu-Lys (HLK), and Leu-His-Lys (LHK)) are newly identified from rapeseed napin (Brassica napus) protein-derived hydrolysates with the capability of upregulating glucose transporter-4 (GLUT4) expression and translocation. However, whether each of them enhances GLUT4 expression and translocation and their specific mechanisms remain unclear. Here, we assess the effects of the oligopeptides against insulin resistance (IR) and oxidative stress in hepatocytes and screen out the most antidiabetic one. Specifically, compared with other oligopeptides, LPK not only remarkably elevated glucose consumption to 8.45 mmol/L protein; superoxide dismutase (SOD) activity to 319 U/mg protein; GLUT4 expression and translocation; and phosphorylated level of insulin receptor substrate-1 (IRS-1), phosphatidylinositol 3-kinase (PI3K), and protein kinase B (Akt) (P < 0.05) but also remarkably attenuated the reactive oxygen species (ROS) level to 2255, lactate dehydrogenase (LDH) activity to 20.5 U/mg protein, malondialdehyde (MDA) content to 241 nmol/mg protein, and NO content to 1302 µmol/mL protein (P < 0.05). These findings demonstrated that antidiabetic oligopeptide LPK possessed the most potential to protect HepG2 cells from IR and oxidative stress via activating IRS-1/PI3K/Akt/GLUT4 and regulating common oxidative markers in vitro.

Short-Chain Fatty Acids Ameliorate Depressive-like Behaviors of High Fructose-Fed Mice by Rescuing Hippocampal Neurogenesis Decline and Blood-Brain Barrier Damage.

Excessive fructose intake is associated with the increased risk of mental illness, such as depression, but the underlying mechanisms are poorly understood. Our previous study found that high fructose diet (FruD)-fed mice exhibited neuroinflammation, hippocampal neurogenesis decline and blood-brain barrier (BBB) damage, accompanied by the reduction of gut microbiome-derived short-chain fatty acids (SCFAs). Here, we found that chronic stress aggravated these pathological changes and promoted the development of depressive-like behaviors in FruD mice. In detail, the decreased number of newborn neurons, mature neurons and neural stem cells (NSCs) in the hippocampus of FruD mice was worsened by chronic stress. Furthermore, chronic stress exacerbated the damage of BBB integrity with the decreased expression of zonula occludens-1 (ZO-1), claudin-5 and occludin in brain vasculature, overactivated microglia and increased neuroinflammation in FruD mice. These results suggest that high fructose intake combined with chronic stress leads to cumulative negative effects that promote the development of depressive-like behaviors in mice. Of note, SCFAs could rescue hippocampal neurogenesis decline, improve BBB damage and suppress microglia activation and neuroinflammation, thereby ameliorate depressive-like behaviors of FruD mice exposed to chronic stress. These results could be used to develop dietary interventions to prevent depression.

Impact of cone base diameter on outcomes of deep anterior lamellar keratoplasty in keratoconus.

PURPOSE: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in treating keratoconus in relation to cone base diameter (CBD). METHODS: A retrospective study. Sixty-one eyes of 49 keratoconus patients who underwent DALK between 2009 and 2018 were enrolled. Preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent, and astigmatism were measured. Scheimpflug tomography (Pentacam) was used to measure the cone base area (CBA) and CBD using MATLAB software. RESULTS: The mean age of the patients was 20.8 ± 6.1 years old, and the mean follow-up time was 27.3 ± 15.2 months. Mean UCVA improved from 1.23 ± 0.48 to 0.57 ± 0.27 (LogMAR, 95% CI [0.52, 0.80]; P < 0.001), whereas mean BCVA improved from 0.98 ± 0.55 to 0.18 ± 0.13 (95% CI [0.66, 0.94]; P < 0.001). The mean spherical equivalent decreased by 4.53 ± 5.65 D (95% CI [- 6.25, - 2.82]; P < 0.001), with little change in astigmatism (95% CI [- 1.39, 0.64]; P = 0.457). The postoperative BCVA in the patients with CBD < 5.07 mm and corneal curvature ≥ 55D was significantly better than those whose CBD ≥ 5.07 mm (0.14 ± 0.09 vs 0.25 ± 0.15, P = 0.001). The follow-up time was negatively correlated with the BCVA (P = 0.004). CONCLUSIONS: In this study, outcomes of DALK in keratoconus were related to CBD and corneal curvature. Patients with large CBD (≥ 5.07 mm) where the corneal curvature ≥ 55D are more likely to have poor visual outcomes after DALK.

Magnetic Functional Materials: Synthesis, Characterization and Application: A New Open Special Issue in Materials.

Magnetic Functional Materials: Synthesis, Characterization and Application is a new open Special Issue of Materials, which aims to publish original and review papers on new scientific and applied research, and make great contributions to the finding and understanding of magnetic functional materials and related synthesis, fundamentals, characterization, and applications [...].

Polyphyllin I alleviates inflammatory injury in mice with gestational diabetes through AMPK pathway.

Our study aimed to detect the effects of polyphyllin I (PPI) on relieving gestational diabetes mellitus (GDM), and the possible mechanism. A mouse model of GDM was constructed. The effects of PPI on GDM mice were evaluated by detecting blood glucose, insulin level, glucose tolerance test, and insulin tolerance test. The inflammation response in GDM and GDM+PPI group were evaluated by enzyme-linked immunosorbent assay (ELISA). The effect of PPI on the offspring of GDM mice was analyzed. In addition, immunoblot assays were performed to investigate the effects of PPI on the AMPK pathway. We found that PPI improved diabetes-related symptoms and decreased serum inflammatory response in GDM mice. In addition, we also found that PPI reduced the tissue damage of GDM mice. We noticed that PPI alleviated inflammatory injury in GDM mice through targeting AMPK pathway. Our findings showed that PPI has the potential to be explored as the drug for GDM treatment.

Observation of the Effect of Singulair Combined With Ketotifen in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Airway Hyperresponsiveness and Its Influence on Th17/Treg.

Objective: To investigate the effect of montelukast sodium (singulair) combined with ketotifen fumarate on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with airway hyperresponsiveness (AHR) and its effect on helper T cells 17 (Th17)/regulator T cells (Treg). Methods: 168 patients with AECOPD and AHR diagnosed in our hospital from February 2018 to December 2019 were selected, and divided into the observation group (n = 84) and the control group (n = 84). Both groups were given anti infection, bronchodilator, glucocorticoid, phosphodiesterase inhibitor, cough and expectorant. The observation group was additionally treated with singulair tablets and ketotifen tablets for 14 days. The curative effect were observed after treatment. The first second forced expiratory volume (FEV1), forced vital capacity (FVC) and FEV1 as percentage of predicted value (FEV1% pred), blood oxygen pressure (PaO2) and blood carbon dioxide pressure (PaCO2), high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT), Th17 and Treg levels were measured in both groups before and after treatment. Results: Compared with the control group, the total effective rate after treatment in the observation group was increased (94.05 vs. 75.00%, P < 0.05). Compared with before treatment, the FEV1, FVC and FEV1%pred levels of the two groups of patients after treatment were increased (P < 0.05). Compared with the control group, the FEV1, FVC and FEV1%pred levels of the observation group were increased after treatment (P < 0.05). Compared with before treatment, the PaCO2, hs-CRP and PCT levels of the two groups of patients were reduced after treatment, and PaO2 levels were increased (P < 0.05). Compared with the control group, the PaCO2, hs-CRP and PCT levels in the observation group were reduced after treatment, and the PaO2 level was increased (P < 0.05). Compared with before treatment, Th17 and Th17/Treg levels of the two groups of patients were reduced after treatment, and Treg levels were increased (P < 0.05). Compared with the control group, the Th17 and Th17/Treg levels of the observation group were reduced after treatment, and the Treg levels was increased (P < 0.05). Conclusion: Singulair combined with ketotifen in the treatment of patients with AECOPD combined with AHR can significantly improve the efficacy, improve lung function, reduce inflammatory response, and improve the balance of Th17/Treg, effectively controlling the disease.

Comparison of deep anterior lamellar keratoplasty and corneal cross-linking in patients with advanced keratoconus.

PURPOSE: To compare outcomes of deep anterior lamellar keratoplasty (DALK) and corneal cross-linking (CXL) in patients with advanced keratoconus, with the primary aim of assessing CXL as a potential therapeutic alternative. STUDY DESIGN: Retrospective, multi-center, comparative study. METHODS: Patients with advanced keratoconus (maximum keratometry reading (K-max) > 58D, best spectacle-corrected visual acuity worse than 0.52logMAR), undergoing either DALK or CXL treatment at four tertiary ophthalmic centers in Wenzhou, Hangzhou, Nanjing and Wuhan were included. Visual acuity, refractive error, corneal topography and complications were evaluated at baseline and at least 2 year postoperatively. RESULTS: 75 eyes of 72 patients were included, of which 37 eyes underwent DALK and 38 eyes, CXL. A larger reduction in Kmax was observed in the DALK group (-18.18 ± 9.44 D versus -1.10 ± 2.70D, p < 0.001). Seven eyes (18%) in the CXL group showed progression of keratoconus. No disease progression was observed in the DALK group. Greater improvements in best spectacle-corrected visual acuity (logMAR) were observed in the DALK group (-0.59 ± 0.25 versus -0.24 ± 0.44, p < 0.001). CONCLUSIONS: Compared to CXL, DALK leads to larger reductions in Kmax and better improvement in visual acuity in advanced keratoconus.