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PURPOSE: To evaluate the outcomes of divided residual donor corneas obtained from endothelial keratoplasty in keratoconus with deep anterior lamellar keratoplasty (DALK). METHODS: In this retrospective, comparative, clinical study, 103 keratoconic eyes that underwent DALK were enrolled; 67 eyes received thin grafts from Descemet stripping automated endothelial keratoplasty, and 36 received thick grafts from Descemet membrane endothelial keratoplasty. Baseline and postoperative central corneal thickness (CCT), inferior corneal thickness, uncorrected distance visual acuity, corrected distance visual acuity, corneal astigmatism, mean keratometry, biomechanical properties, and complication rates were measured. RESULTS: Six months after transplantation, the group receiving thin grafts had a CCT of only 455.1 ± 43.0 µm, whereas that of the group receiving thick grafts was 546.7 ± 44.2 µm. Both CCT and inferior corneal thickness in the thin group were significantly lower than those in the thick group (measured with Pentacam at 36 months, P < 0.001) and remained throughout the 5-year follow-up period. Both procedures had comparable postoperative logarithm of the minimum angle of resolution UDVAs, logarithm of the minimum angle of resolution corrected distance visual acuity, astigmatism, and mean keratometry values (36 months; P = 0.335, 0.286, 0.680, and 0.365, respectively). Corneal biomechanical analysis revealed that the thin group had a significantly higher stiffness parameter at the first applanation than the thick group at the 2-year follow-up (P = 0.036) while other parameters were equivalent. CONCLUSIONS: The outcomes of keratoplasty with donor tissue are comparable regardless of the thickness of the graft, which suggests that transplantation with either type of the split corneal procedure for DALK in patients with keratoconus is feasible.
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With the development of autonomous driving, there has been considerable attention on 3D object detection using LiDAR. Pillar-based LiDAR point cloud detection algorithms are extensively employed in the industry due to their simple structure and high real-time performance. Nevertheless, the pillar-based detection network suffers from significant loss of 3D coordinate information during the feature degradation and extraction process. In the paper, we introduce a novel framework with high performance, termed EFNet. The EFNet uses the Enhancing Pillar Feature Module (EPFM) to provide more accurate representations of features from two directions: pillar internal space and pillar external space. Additionally, the Head Up Module (HUM) is utilized in the detection head to integrate multi-scale information and enhance the network's information perception ability. The EFNet achieves impressive results on the nuScenes datasets, namely, 53.3% NDS and 42.4% mAP. Compared to the baseline PointPillars, EFNet improves 8% NDS and 11.9% mAP. The results demonstrate that the proposed framework can effectively improve the network's accuracy while ensuring deployability.
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PURPOSE: The aim of this study was to evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) and compare it with penetrating keratoplasty (PKP) in keratoconic eyes with Descemet membrane (DM) rupture. METHODS: In this comparative retrospective case series, 33 keratoconic eyes with a history of hydrops underwent DALK and 27 received PKP. Baseline and postoperative visual acuity, corneal astigmatism, mean keratometry, endothelial cell density, and complication rates were measured. RESULTS: The median follow-up of patients who underwent DALK was 45 months (range, 4-76 months) and that of patients who underwent PKP was 84 months (range, 4-136 months). Both procedures had comparable postoperative visual acuity, astigmatism, and mean keratometry. Significantly higher endothelial cell densities were observed in DALK than in PKP at 2, 3, and 5 years postsurgery (2043 ± 767 vs. 1165 ± 683 cell/mm2, P = 0.007, n = 12 in both groups at 2 years). Intra-DALK, 15 perforations occurred (44.12%) and 1 (2.94%) was converted to PKP. Graft rejection was diagnosed in 1 (3.03%) DALK procedure versus 8 (29.63%) PKP (P = 0.008), and other long-term complication rates were equivalent. Kaplan-Meier survival analysis also revealed a higher rejection-free survival rate for the DALK group (P = 0.012). Subgroup analysis within both groups based on the severity of preoperative DM rupture revealed no significant difference in any major 2-year outcomes. CONCLUSIONS: DALK showed similar beneficial visual outcome and safety but significantly better endothelial protection over PKP in eyes with keratoconus and previous hydrops. Therefore, DALK is recommended in posthydrops cases irrespective of the DM rupture severity.
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PURPOSE: To compare the efficacy and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) with those of manual-trephination DALK (M-DALK) in treating keratoconus. DESIGN: Systematic review and meta-analysis. METHODS: Through November 2022, we comprehensively searched PubMed, EMBASE, the Cochrane Library, and 4 Chinese databases. Studies that involved comparisons between F-DALK and M-DALK groups and that reported on relevant efficacy and/or safety parameters were included. Primary outcomes were uncorrected- and corrected-distance visual acuity and intraoperative complication rates. Secondary outcomes were spherical equivalent, topographic astigmatism, refractive cylinder, mean keratometry, endothelial cell density, suture removal time, and postoperative complication rates. These data were analyzed using Cochrane Review Manager software version 5.3. RESULTS: This meta-analysis included 9 nonrandomized controlled studies involving 1713 eyes. In eyes treated with F-DALK, corrected-distance visual acuity at 1 to 6 months (weighted mean difference = -0.07 [95% confidence interval {CI} -0.10 to -0.03]; I2 = 0%; P < .001) after surgery was better and intraoperative Descemet membrane perforation occurred less often (odds ratio = 0.53 [95% CI 0.31-0.92]; I2 = 6%; P = .02) than in eyes treated with M-DALK. No clinically significant differences in other outcomes were found among the groups. CONCLUSIONS: Both F-DALK and M-DALK are safe and efficacious for patients with keratoconus. Compared with M-DALK, F-DALK can provide better early visual acuity and reduce the intraoperative perforation rate, and its likely improvements to long-term visual quality and endothelial cell preservation warrant further investigation. In addition, the 2 techniques seem to be comparable regarding refractive outcomes and other complications.
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Trasplante de Córnea , Queratocono , Humanos , Queratocono/cirugía , Trasplante de Córnea/métodos , Queratoplastia Penetrante/métodos , Trepanación , Resultado del Tratamiento , Rayos Láser , Estudios RetrospectivosRESUMEN
Fine-grained urban environment instance segmentation is a fundamental and important task in the field of environment perception for autonomous vehicles. To address this goal, a model was designed with LiDAR pointcloud data and camera image data as the subject of study, and the reliability of the model was enhanced using dual fusion at the data level and feature level. By introducing the Markov Random Field algorithm, the Support Vector Machine classification results were optimized according to the spatial contextual linkage while providing the model with the prerequisite of the differentiation of similar but foreign objects, and the object classification and instance segmentation of 3D urban environments were completed by combining the Mean Shift. The dual fusion approach in this paper is a method for the deeper fusion of data from different sources, and the model, designed more accurately, describes the categories of items in the environment with a classification accuracy of 99.3%, and segments the different individuals into groups of the same kind of objects without instance labels. Moreover, our model does not have high computational resource and time cost requirements, and is a lightweight, efficient, and accurate instance segmentation model.
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Algoritmos , Humanos , Reproducibilidad de los ResultadosRESUMEN
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in western countries and China. Fenofibrate (FNB) can activate peroxisome proliferator-activated receptor α (PPARα) to increase fatty acid oxidation and ameliorate NAFLD. However, the application of FNB is limited in clinic due to its poor water solubility and low oral bioavailability. In this study, FNB-loaded nanoparticles (FNB-NP) based on a reactive oxygen species (ROS)-responsive peroxalate ester derived from vitamin E (OVE) and an amphiphilic conjugate 1,2-distearoyl-sn-glycerol-3-phosphoethanolamine-N-[methoxy(poly(ethylene glycol))-2000] (DSPE-PEG) were developed to enhance the preventive effects of FNB against NAFLD. In in vitro studies, FNB-NP displayed a high encapsulation efficiency of 97.25 ± 0.6% and a drug loading efficiency of 29.67 ± 0.1%, with a size of 197.0 ± 0.2 nm. FNB released from FNB-NP was dramatically accelerated in the medium with high H2O2 concentrations. Moreover, FNB-NP exhibited well storage stability and plasma stability. In pharmacokinetic (PK) studies, FNB-NP, compared with FNB crude drug, significantly increased the AUC0ât and AUC0â∞ of the plasma FNB acid by 3.3- and 3.4-fold, respectively. In pharmacodynamics (PD) studies, compared with an equal dose of FNB crude drug, FNB-NP more significantly reduced hepatic lipid deposition via facilitating FNB release in the liver and further upregulating PPARα expression in NAFLD mice. Meanwhile, oxidative stress in NAFLD was significantly suppressed after FNB-NP administration, suggesting that OVE plays a synergistic effect on antioxidation. Therefore, ROS-sensitive FNB delivery formulations FNB-NP enhance the preventive effects of FNB against NAFLD and could be further studied as a promising drug for the treatment of NAFLD in clinic.
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Fenofibrato , Nanopartículas , Enfermedad del Hígado Graso no Alcohólico , Ratones , Animales , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Fenofibrato/uso terapéutico , Fenofibrato/farmacocinética , PPAR alfa/metabolismo , PPAR alfa/uso terapéutico , Especies Reactivas de Oxígeno/metabolismo , Peróxido de Hidrógeno/metabolismo , Hígado/metabolismo , Ratones Endogámicos C57BLRESUMEN
Candida albicans is a human opportunistic pathogen that causes superficial and life-threatening infections. An important reason for the failure of current antifungal drugs is related to biofilm formation, mostly associated with implanted medical devices. The present study investigated the synergistic antifungal efficacy of low-frequency and low-intensity ultrasound combined with amphotericin B (AmB)-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles (AmB-NPs) against C. albicans biofilms. AmB-NPs were prepared by a double-emulsion method and demonstrated lower toxicity than free AmB. We then established biofilms and treated them with ultrasound and AmB-NPs separately or jointly in vitro and in vivo The results demonstrated that the activity, biomass, and proteinase and phospholipase activities of biofilms were decreased significantly after the combination treatment of AmB-NPs with 42 kHz of ultrasound irradiation at an intensity of 0.30 W/cm2 for 15 min compared with the controls, with AmB alone, or with ultrasound treatment alone (P < 0.01). The morphology of the biofilms was altered remarkably after joint treatment based on confocal laser scanning microscopy (CLSM), especially in regard to reduced thickness and loosened structure. Furthermore, the same synergistic effects were found in a subcutaneous catheter biofilm rat model. The number of CFU from the catheter exhibited a significant reduction after joint treatment with AmB-NP and ultrasound for seven continuous days, and CLSM and scanning electron microscopy (SEM) images revealed that the biofilm on the catheter surface was substantially eliminated. This method may provide a new noninvasive, safe, and effective therapy for C. albicans biofilm infection.