Activation of sigma-1 receptor ameliorates sepsis-induced myocardial injury by mediating the Nrf2/HO1 signaling pathway to attenuate mitochondrial oxidative stress.

BACKGROUND: Sepsis is a condition that triggers the release of large amounts of reactive oxygen species and inflammatory factors in the body, leading to myocardial injury and cardiovascular dysfunction - an important contributor to the high mortality rate associated with sepsis. Although it has been demonstrated that the sigma-1 receptor (S1R) is essential for preventing oxidative stress, its effectiveness in treating sepsis is yet unknown. AIM: This study aimed to investigate the role and mechanisms of S1R activation in sepsis-induced myocardial injury. METHODS: A model of sepsis-induced myocardial injury was constructed by performing cecum ligation and puncture(CLP) surgery on rats. Flv or BD1047 were intraperitoneally injected into rats for one consecutive week before performing CLP, and then intraperitoneally injected into the rats again 1 h after the surgery.The effects of Flv and BD1047 were detected by HE staining, immunofluorescence staining, IHC staining, echocardiography measurements,TUNEL, oxidative stress detection, TEM, flow cytometry and western blot. We further validated the mechanism in vitro using neonatal rat cardiomyocites and H9C2 cells. RESULTS: S1R protein level was reduced in the hearts of septic rats, whereas administration of Flv, an S1R activator, ameliorated myocardial injury, mitochondrial oxidative stress, and pathological manifestations of sepsis. On the other hand, administration of the S1R inhibitor BD1047 exacerbated the mitochondrial oxidative stress, and apoptosis, as well as symptoms and pathological manifestations of sepsis. In addition, we found that up-regulation of S1R activated the Nrf2/HO1 signaling pathway and promoted nuclear translocation of Nrf2, which activated downstream proteins to generate antioxidant factors, such as HO1, in turn alleviating oxidative stress and countering myocardial damage. CONCLUSION: By scavenging ROS accumulation and reducing mitochondrial oxidative stress via the Nrf2/HO1 signaling pathway, activation of S1R improves cardiac function, mitigates death of cardiomyocytes, and attenuates sepsis-induced myocardial injury.

A tau fragment links depressive-like behaviors and cognitive declines in Alzheimer's disease mouse models through attenuating mitochondrial function.

Introduction: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease characterized by extracellular senile plaques including amyloid-ß peptides and intracellular neurofibrillary tangles consisting of abnormal Tau. Depression is one of the most common neuropsychiatric symptoms in AD, and clinical evidence demonstrates that depressive symptoms accelerate the cognitive deficit of AD patients. However, the underlying molecular mechanisms of depressive symptoms present in the process of AD remain unclear. Methods: Depressive-like behaviors and cognitive decline in hTau mice were induced by chronic restraint stress (CRS). Computational prediction and molecular experiments supported that an asparagine endopeptidase (AEP)-derived Tau fragment, Tau N368 interacts with peroxisome proliferator-activated receptor delta (PPAR-δ). Further behavioral studies investigated the role of Tau N368-PPAR-δ interaction in depressive-like behaviors and cognitive declines of AD models exposed to CRS. Results: We found that mitochondrial dysfunction was positively associated with depressive-like behaviors and cognitive deficits in hTau mice. Chronic stress increased Tau N368 and promoted the interaction of Tau N368 with PPAR-δ, repressing PPAR-δ-mediated transactivation in the hippocampus of mice. Then we predicted and identified the binding sites of PPAR-δ. Finally, inhibition of AEP, clearance of Tau N368 and pharmacological activation of PPAR-δ effectively alleviated CRS-induced depressive-like behaviors and cognitive decline in mice. Conclusion: These results demonstrate that Tau N368 in the hippocampus impairs mitochondrial function by suppressing PPAR-δ, facilitating the occurrence of depressive-like behaviors and cognitive decline. Therefore, our findings may provide new mechanistic insight in the pathophysiology of depression-like phenotype in mouse models of Alzheimer's disease.

Individualized Nursing Interventions in Patients with Comorbid Chronic Obstructive Pulmonary Disease and Chronic Heart Failure.

Objective: Individuals with chronic obstructive pulmonary disease (COPD) are more likely to develop heart failure (HF) compared with the general population, and the presence of HF may contribute to reduced quality of life (QoL), increased hospitalizations and worse survival rates in patients with COPD. Our study examined the exercise capacity, QoL, mental health, family burden and rehospitalization rate of patients with comorbid COPD and chronic heart failure (CHF) after individualized inpatient and outpatient nursing care. Methods: A total of 100 patients with comorbid COPD and CHF admitted to Affiliated Hospital of Jiangnan University January 2021 to July 2022 were enrolled in our study and then randomly assigned to one of two groups of 50 patients: patients receiving traditional nursing care and patients receiving individualized nursing care. Exercise capacity, mental health, QoL and family burden were assessed by means of the 6-minute walk test (6MWT), Zung's Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), the short-form health survey (SF-36) and the Perceived Family Burden Scale (PFBS). Results: The patients receiving individualized nursing care had notable differences regarding distance walked in the 6MWT, the scores in all domains of both the physical and mental composites, SAS and SDS scores and PFBS scores of patients at on admission (T0), at discharge (T1) and at 2 months after discharge (T2) (P < .05). The patients receiving individualized nursing care walked longer distances on the 6MWT, more scores reflecting improved QoL and reduced SAS and SDS scores at both T1 and T2 compared with patients receiving traditional nursing care (P < .05). The patients receiving individualized nursing care exhibited decreased PFBS scores at T2 compared with patients receiving traditional nursing care (P < .05). None of the patients receiving individualized nursing care were rehospitalized, but 2 patients receiving traditional nursing care were rehospitalized due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute HF, respectively. Conclusion: Our study demonstrates that individualized inpatient and outpatient nursing care can enhance exercise capacity and improve QoL and mental health in patients with comorbid COPD and CHF.

Grace-AKO: a novel and stable knockoff filter for variable selection incorporating gene network structures.

MOTIVATION: Variable selection is a common statistical approach to identifying genes associated with clinical outcomes of scientific interest. There are thousands of genes in genomic studies, while only a limited number of individual samples are available. Therefore, it is important to develop a method to identify genes associated with outcomes of interest that can control finite-sample false discovery rate (FDR) in high-dimensional data settings. RESULTS: This article proposes a novel method named Grace-AKO for graph-constrained estimation (Grace), which incorporates aggregation of multiple knockoffs (AKO) with the network-constrained penalty. Grace-AKO can control FDR in finite-sample settings and improve model stability simultaneously. Simulation studies show that Grace-AKO has better performance in finite-sample FDR control than the original Grace model. We apply Grace-AKO to the prostate cancer data in The Cancer Genome Atlas program by incorporating prostate-specific antigen (PSA) pathways in the Kyoto Encyclopedia of Genes and Genomes as the prior information. Grace-AKO finally identifies 47 candidate genes associated with PSA level, and more than 75% of the detected genes can be validated.

Generating Synthesized Ultrasound Biomicroscopy Images from Anterior Segment Optical Coherent Tomography Images by Generative Adversarial Networks for Iridociliary Assessment.

INTRODUCTION: The aim of this study was to investigate the feasibility of generating synthesized ultrasound biomicroscopy (UBM) images from swept-source anterior segment optical coherent tomography (SS-ASOCT) images using a cycle-consistent generative adversarial network framework (CycleGAN) for iridociliary assessment on a cohort presenting for primary angle-closure screening. METHODS: The CycleGAN architecture was adopted to synthesize high-resolution UBM images trained on the SS-ASOCT dataset from the department of ophthalmology, Xinhua Hospital. The performance of the CycleGAN model was further tested in two separate datasets using synthetic UBM images from two different ASOCT modalities (in-distribution and out-of-distribution). We compared the ability of glaucoma specialists to assess the image quality of real and synthetic images. UBM measurements, including anterior chamber, iridociliary parameters, were compared between real and synthetic UBM images. Intra-class correlation coefficients, coefficients of variation, and Bland-Altman plots were used to assess the level of agreement. The Fréchet Inception Distance (FID) was measured to evaluate the quality of the synthetic images. RESULTS: The whole trained dataset included anterior chamber angle images, of which 4037 were obtained by SS-ASOCT and 2206 were obtained by UBM. The image quality of real versus synthetic SS-ASOCT images was similar as assessed by two glaucoma specialists. The Bland-Altman analysis also suggested high consistency between measurements of real and synthetic UBM images. In addition, there was fair to excellent agreement between real and synthetic UBM measurements for the in-distribution dataset (ICC range 0.48-0.97) and the out-of-distribution dataset (ICC range 0.52-0.86). The FID was 21.3 and 24.1 for the synthetic UBM images from the in-distribution and out-of-distribution datasets, respectively. CONCLUSION: We developed a CycleGAN model to translate UBM images from non-contact SS-ASOCT images. The CycleGAN synthetic UBM images showed fair to excellent reproducibility when compared with real UBM images. Our results suggest that the CycleGAN technique is a promising tool to evaluate the iridociliary and anterior chamber in an alternative non-contact method.

The Value of the Antibody Detection in the Diagnosis of Ocular Toxocariasis and the Aqueous Cytokine Profile Associated With the Condition.

Introduction: To evaluate and compare the specificity of Toxocara canis-specific antibody detection in the serum and aqueous samples for the diagnosis of ocular toxocariasis (OT) and explore the cytokine profiles associated with the condition in children. Materials and Methods: This is a prospective cohort study. The inclusion criteria were the clinical presentations of OT, which included unilateral vision reduction, typical peripheral or posterior pole granuloma with variable degrees of vitritis, and exclusion of other diagnoses. The titer of antibody against the excretory-secretory antigen of Toxocara canis [T-immunoglobulin G (IgG)] was measured in serum and aqueous samples that were taken from the affected eyes. The diagnosis of OT was made upon positive detection of T-IgG either in the serum or aqueous. The rest with typical clinical presentations as described above but a positive serum or aqueous T-IgG could not be confirmed were diagnosed as suspected OT. Cytokines were measured using multiplexed cytometric bead array system. Results: Two hundred and eleven eyes of 211 patients had participated in the study. One hundred and twenty-eight eyes were diagnosed as OT. The median age of the cohort was 7.7 years with a male to female ratio of 2.5:1. Major initial symptoms were decreased vision (74%) and strabismus (22%). The percentages of eyes with peripheral granuloma, posterior granuloma, and endophthalmitis were 40, 18, and 41%, respectively. Vitritis (100%), vitreous strands (64%), retinal fibrotic bands (57%), and retinal detachment (42%) were the most common signs. T-IgG was positive in 66.7% of the aqueous and 57.2% of the serum samples. Forty-four patients were diagnosed T-IgG negative in both serum and aqueous of the affected eyes. Interleukin (IL)-6, monocyte chemoattractant protein (MCP)-1, IL-8, eosinophil chemotactic protein (Eotaxin), MCP-1ß, and vascular endothelial growth factor (VEGF) were higher in T-IgG negative eyes when compared to controls and further increased in T-IgG positive eyes. However, only T-IgG positive eyes showed increased IL-5, IL-13, and IL-10. IL-1ß, tumor necrosis factor-alpha (TNF-α), IL-12, IL-2, interferon-gamma (IFN-γ), and IL-4 were undetectable in all eyes. Conclusions: Pediatric OT is often present with severe retinal complications. Polarized intraocular Th2 response was only found in aqueous T-IgG positive eyes. Our results supported an aqueous sample-based antibody test for the more specific diagnosis of OT.

Oxycodone relieves permeability damage and apoptosis of oxygen-glucose deprivation/reoxygenation-induced brain microvascular endothelial cells through ras homolog family member A (RhoA)/ Rho-associated coiled-coil containing kinases (ROCK)/ myosin light chain 2 (MLC2) signal.

Cerebrovascular disease, an important cause of acute ischemic stroke, has attracted worldwide attention. Oxycodone has been widely used to treat various painful disorders. This study was designed to explore the mechanism of oxycodone in oxygen-glucose deprivation/reoxygenation (OGD/R)-induced brain microvascular endothelial cell model. For the reliability of the results in the following experiments, the viability was firstly detected using CCK-8. With the application of LDH, TEER and TUNEL assays, the LDH expression, permeability and apoptosis of brain microvascular endothelial cells were detected, respectively. Besides, the mRNA and protein expressions of tight junction proteins and RhoA were measured using RT-qPCR and Western blot. Moreover, RT-qPCR was employed to evaluate the expressions of inflammatory cytokines. Western blot was adopted to measure the levels of RhoA, ROCK, MLC2 and apoptosis-related proteins. The results revealed that oxycodone attenuated permeability damage, inflammatory factor release and apoptosis of OGD/R-induced brain microvascular endothelial cells in a dose-dependent manner. It was also found that oxycodone could reduce the expressions of RhoA, ROCK and MLC2 in brain microvascular endothelial cells induced by OGD/R. More importantly, oxycodone exhibited desirable effects on OGD/R-induced brain microvascular endothelial cells through RhoA/ROCK/MLC2 signal. In conclusion, oxycodone relieved permeability damage and apoptosis of OGD/R-induced brain microvascular endothelial cells through RhoA/ROCK/MLC2 signal, suggesting that oxycodone might be an effective method for the improvement of cerebral ischemia-reperfusion injury.

Repetitive Transcranial Magnetic Stimulation of the Brain Region Activated by Motor Imagery Involving a Paretic Wrist and Hand for Upper-Extremity Motor Improvement in Severe Stroke: A Preliminary Study.

Approximately two-thirds of stroke survivors experience chronic upper-limb paresis; however, treatment options are limited. Repetitive transcranial magnetic stimulation (rTMS) can enhance motor function recovery in stroke survivors, but its efficacy is controversial. We compared the efficacy of stimulating different targets in 10 chronic stroke patients with severe upper-limb motor impairment. Motor imagery-based brain-computer interface training augmented with virtual reality was used to induce neural activity in the brain region during an imagery task. Participants were then randomly assigned to two groups: an experimental group (received high-frequency rTMS delivered to the brain region activated earlier) and a comparison group (received low-frequency rTMS delivered to the contralesional primary motor cortex). Behavioural metrics and diffusion tensor imaging were compared pre- and post rTMS. After the intervention, participants in both groups improved somewhat. This preliminary study indicates that in chronic stroke patients with severe upper-limb motor impairment, inducing activation in specific brain regions during motor imagery tasks and selecting these regions as a target is feasible. Further studies are needed to explore the efficacy of this intervention.

Motor Imagery-Based Brain-Computer Interface Combined with Multimodal Feedback to Promote Upper Limb Motor Function after Stroke: A Preliminary Study.

BACKGROUND: Recently, the brain-computer interface (BCI) has seen rapid development, which may promote the recovery of motor function in chronic stroke patients. METHODS: Twelve stroke patients with severe upper limb and hand motor impairment were enrolled and randomly assigned into two groups: motor imagery (MI)-based BCI training with multimodal feedback (BCI group, n = 7) and classical motor imagery training (control group, n = 5). Motor function and electrophysiology were evaluated before and after the intervention. The Fugl-Meyer assessment-upper extremity (FMA-UE) is the primary outcome measure. Secondary outcome measures include an increase in wrist active extension or surface electromyography (the amplitude and cocontraction of extensor carpi radialis during movement), the action research arm test (ARAT), the motor status scale (MSS), and Barthel index (BI). Time-frequency analysis and power spectral analysis were used to reflect the electroencephalogram (EEG) change before and after the intervention. RESULTS: Compared with the baseline, the FMA-UE score increased significantly in the BCI group (p = 0.006). MSS scores improved significantly in both groups, while ARAT did not improve significantly. In addition, before the intervention, all patients could not actively extend their wrists or just had muscle contractions. After the intervention, four patients regained the ability to extend their paretic wrists (two in each group). The amplitude and area under the curve of extensor carpi radialis improved to some extent, but there was no statistical significance between the groups. CONCLUSION: MI-based BCI combined with sensory and visual feedback might improve severe upper limb and hand impairment in chronic stroke patients, showing the potential for application in rehabilitation medicine.

Analysis of Influencing Factors of Acute Medication Poisoning in Adults in Emergency Department of Our Hospital from 2016 to 2019 and Observation of Curative Effect of Optimizing Emergency Procedures.

Objective. This study analyzed the influencing factors of acute medication poisoning in adults in the emergency department of our hospital from January 2016 to December 2019 and observed the curative effect of optimizing emergency procedures on adult acute medication poisoning. Our results showed that, among all acute drug poisoning patients, the most common poisoning drug was sleeping pills (24.22%), followed by painkillers (20.31%) and antipsychotics (16.41%). Education level, drug category, drug source, drug dosage, unknown drug composition, and medication side effect were all influencing factors of acute drug poisoning. High school education level or below, self-purchasing medicine, medication overdose, unknown drug composition, and medication side effect were the risk factors of acute medication poisoning. In addition, after the nursing management of optimizing emergency procedures for this type of patients, the rescue time, observation time, and hospital stay of the patients had been shortened, the incidence of complications was low, the rescue success rate was high, and the clinical application effect was good.

Effects of Stress Psychological Intervention on the Cardiopulmonary Function, Negative Emotion, Self-Efficacy, and Quality of Life in Patients with Acute Respiratory Failure.

OBJECTIVE: To investigate the changes in cardiopulmonary function, negative emotion, self-efficacy, and quality of life in patients with acute respiratory failure (ARF) after stress psychological intervention. METHODS: A prospective study was conducted on 104 patients with ARF admitted to our hospital from March 2019 to March 2021. According to the random number method, the patients were divided into a control group (n = 52) and an experimental group (n = 52). Routine intervention was implemented in the control group, and stress psychological intervention was implemented in the experimental group on the basis of the control group. The cardiopulmonary function, negative emotion, self-efficacy, and quality of life in the two groups were compared. RESULTS: The left ventricular ejection fractions and fraction shortening in the experimental group were higher than those in the control group, as well as the left ventricular mass index was lower than that in the control group (P < 0.05). The first forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC in the experimental group were higher than those in the control group (P < 0.05). The Self-Rating Anxiety Scale scores and Self-Rating Depression Scale scores in the experimental group were lower than those in the control group (P < 0.05). The General Self-Efficacy Scale scores of the experimental group were higher than those of the control group (P < 0.05). The Concise Health Measurement Scale scores of the experimental group were higher than those of the control group (P < 0.05). CONCLUSION: Stress psychological intervention in patients with ARF can improve cardiopulmonary function, reduce negative emotions, improve self-efficacy, and improve quality of life.

Clinical and genetical features of probands and affected family members with familial exudative vitreoretinopathy in a large Chinese cohort.

AIMS: To explore the clinical and genetical features of families with strictly confirmed familial exudative vitreoretinopathy (FEVR) in a large Chinese cohort. METHODS: A retrospective chart review study was conducted on the FEVR families diagnosed by both angiography and targeted next-generation sequencing in six FEVR known genes (FZD4, LRP5, TSPAN12, NDP, KIF11, ZNF408) in the probands and at least one first-degree family member. Variation in expressivity and severity was evaluated in different gene groups. RESULTS: 105 FEVR families (223 FEVR affected subjects with 434 eyes) met the inclusion criteria. There were 105 probands with mean age of 3.8 years old and 118 affected family members of 32.7 years old averagely. Mutations in FZD4 were most prevalent (33.33%), followed by LRP5 (29.52%), TSPAN12 (22.86%), NDP (5.71%), KIF11 (1.9%) and ZNF408 (0.95%). 81% of the probands were classified as stage 4 or worse which most prevalently contributed to FZD4 mutations. All of the three affected family members with stage 4 or worse carried FZD4 variants. More than half (51.43%) of the probands in FZD4 group showed asymmetry. Unilateral FEVR was detected in 11 (10.5%) families consisting of six probands and six affected relatives, and FZD4 mutations accounted for 63.64% of all the cases with variant (c.1282_1285del, p. D428fs) identified in three families. CONCLUSIONS: Genotype-phenotype correlation in FEVR was complex with family dependent. Mutations in FZD4 might initiate the most diverse and asymmetric phenotypes.

Clinical and Echographic Features of Morning Glory Disc Anomaly in Children: A Retrospective Study of 249 Chinese Patients.

PURPOSE: To report the clinical and echographic features, the prevalence of retinal detachment (RD), and associated visual acuity in a cohort of pediatric patients with morning glory disc anomaly (MGDA). METHODS: This was a retrospective review of 249 pediatric patients with MGDA (271 eyes) seen at the Dept. of Ophthalmology, Xinhua Hospital. Their medical records were reviewed for demographic data and ocular and systemic findings. The maximal depth and width of the cavity were measured using standardized echographic images. The ratios of cavitary depth to axial length, cavitary depth to maximal cavitary width, and the product of cavitary depth and width were calculated and used to indicate the relative size of the excavation. The clinical and echographic findings were correlated with visual acuity and the occurrence of RD of the patient. RESULTS: The relative size of the excavation and the presence of RD were positively associated with increased risk of poor vision (p < 0.05). The presence of persistent fetal vasculature was not associated with the risk of RD and poor vision. The ratio of cavitary depth to axial length more than or equal to 0.25 conferred an increased risk of RD (OR, 2.101; 95% CI, 1.469-3.003). CONCLUSIONS: Clinical and echographic features of MGDA may be used in predicting the risk of RD. Measuring the relative size of excavation via echography may guide the follow-ups and assist in the early diagnosis of RD.

Prevalence and associations of epiretinal membrane in an elderly urban Chinese population in China: the Jiangning Eye Study.

AIMS: To describe the prevalence and associations of epiretinal membrane (ERM) in an elderly urban Chinese population in China. METHODS: A population-based cross-sectional study was conducted using a cluster random sample of residents aged 50 years or older living in the Jiangning Road Sub-district, Shanghai, China. All participants underwent a standardised interview and comprehensive eye examinations, including digital retinal photography and spectral domain optical coherence tomography (SD-OCT) examinations of both eyes between November 2012 and February 2013. ERM was identified and classified as either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) based on the fundus photography and OCT features. RESULTS: Of the 2044 subjects who participated (82.5% response rate), 2005 had fundus photographs and OCT results of sufficient quality for grading of ERM signs. ERM was present in 8.4% of participants, including 5.0% with CMR and 3.4% with PMF. After age and gender standardisation to the 2010 Chinese census population, the prevalence rate of ERM in mainland Chinese individuals of 50 years of age or older was estimated to be 7.3%. After adjusting for age and/or gender, idiopathic ERM was positively associated with age (OR, 1.06; 95% CI 1.04 to 1.08), female gender (OR 1.67, 95% CI 1.16 to 2.40), myopia (OR 2.21, 95% CI 1.51 to 3.22) and hyperlipaemia (OR 1.80, 95% CI 1.04 to 3.12). CONCLUSIONS: The prevalence of ERM in elderly urban Chinese was similar to that in Caucasians. Risk factors for idiopathic ERM were older age, female gender, myopia and hyperlipaemia.

Prevalence of age-related macular degeneration in an elderly urban chinese population in China: the Jiangning Eye Study.

PURPOSE: To describe the prevalence of AMD in an elderly urban Chinese population in China. METHODS: A population-based, cross-sectional study was conducted using a cluster random sample of residents aged 50 years or older living in the Jiangning Road Subdistrict, Jing'an District, Shanghai, China. All participants underwent a standardized interview and comprehensive eye examinations, including digital retinal photography and spectral-domain optical coherence tomography (OCT) examinations of both eyes between November 2012 and February 2013. Trained graders assessed the presence and severity of AMD lesions based on a modified version of the Wisconsin Age-Related Maculopathy Grading System. RESULTS: Of the 2044 subjects who participated (82.5% response rate), 2005 had fundus photographs and OCT results of sufficient quality for grading of AMD signs. Early and late AMD were present in 206 (10.3%) and 23 (1.1%) participants, respectively. After age standardization, the prevalence of early AMD in Chinese persons aged 50 years or older was 9.5% (95% confidence interval [CI], 8.2-10.8) and that of late AMD was 1.0% (95% CI, 0.5-1.5). CONCLUSIONS: The prevalence of early and late AMD in this urban Chinese sample was higher than that reported in the Beijing and Handan studies. Age-related macular degeneration is highly prevalent among the elderly urban Chinese population in mainland China. : Chinese Abstract.

Topical anesthesia versus regional anesthesia for cataract surgery: a meta-analysis of randomized controlled trials.

PURPOSE: To examine possible differences in the clinical outcomes of topical anesthesia (TA) and regional anesthesia including retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA) in phacoemulsification. DESIGN: Systematic review and meta-analysis. PARTICIPANTS: Patients from previously published randomized controlled trials (RCTs) of phacoemulsification under TA and RBA/PBA reporting clinical outcomes. METHODS: A comprehensive literature search was performed according to the Cochrane Collaboration method to identify RCTs that compare TA and RBA/PBA in phacoemulsification. MAIN OUTCOME MEASURES: Primary outcome parameters investigated were pain score during and after surgery, intraoperative difficulties and inadvertent ocular movement, intraoperative necessity to administer additional anesthesia, and patient preference. Secondary outcome parameters investigated were postoperative visual acuity, anesthesia-related complications, intraoperative complications, and severe local or systemic complications. RESULTS: Fifteen studies were identified and analyzed to compare TA (1084 eyes) with RBA/PBA (1121 eyes) in phacoemulsification. Data synthesis showed that intraoperative and postoperative pain perception was significantly higher in the TA group (P < 0.05). The TA group showed more frequent inadvertent ocular movement (P < 0.05) and a greater intraoperative need for supplementary anesthesia (P = 0.03). There was no statistically significant difference between the 2 groups in intraoperative difficulties as assessed by the surgeons (P > 0.05). Patients significantly preferred TA (P < 0.00001). The RBA/PBA group had more frequent anesthesia-related complications, such as chemosis, periorbital hematoma, and subconjunctival hemorrhage (P < 0.05). There was no statistically significant difference in surgery-related complications (P > 0.05). CONCLUSIONS: Compared with RBA/PBA, TA does not provide the same excellent pain relief in cataract surgery; however, it achieves similar surgical outcomes. Topical anesthesia reduces injection-related complications and alleviates patients' fear of injection. The choice of TA is not suitable for patients with a higher initial blood pressure or greater pain perception.

A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy.

AIMS: To examine possible benefits of intravitreal bevacizumab (IVB) pretreatment in vitrectomy for severe diabetic retinopathy. METHODS: A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify randomised controlled trials and comparative studies of vitrectomy with or without IVB pretreatment for severe or complicated diabetic retinopathy. Meta-analyses were performed for intraoperative (including intraoperative bleeding, endodiathermy, iatrogenic retinal tears and mean surgical time) and postoperative outcome parameters (including best-corrected visual acuity, recurrent vitreous haemorrhage, reabsorption time of blood and other complications). RESULTS: Six randomised controlled trials and one comparative study were identified and used for comparing vitrectomy alone (142 eyes, control group) with vitrectomy with IVB pretreatment (139 eyes). The intraoperative findings showed that the incidence of intraoperative bleeding and frequency of endodiathermy were statistically significantly less in the IVB pretreatment group (p<0.01) than in the vitrectomy alone group. The IVB pretreatment group took significantly less surgical time than the control group (p=0.003). Postoperative results indicated that reabsorption time of blood was significantly shorter (p=0.04), incidence of recurrent VH was almost significantly less (p=0.05), and final best-corrected visual acuity was significantly better (p=0.003) in the IVB group than in the control group. Other complications, including final retinal detachment, and reoperation, were statistically insignificant. CONCLUSION: IVB pretreatment in vitrectomy can achieve excellent clinical outcomes for severe diabetic retinopathy. It potentially facilitates surgeons' manoeuvres and reduces intra- and postoperative complications.

Practical method to calculate post-LASIK corneal power: the Actual K(a+p) method.

AIM: To evaluate the accuracy of a practical method (the Actual K(a+p) method) of corneal power measurement for post-LASIK eyes undergoing cataract surgery. METHODS: Ten eyes of 7 patients (4 male, 3 female, average age 50.10±4.01 years, with -11.01±3.55D mean refraction before LASIK), underwent post-LASIK phaco+IOL cataract surgery. We used the posterior corneal curvature as measured by the Pentacam in a method we named Actual K(a+p) to calculate the post-LASIK corneal power for IOL calculation. The refractive outcomes after cataract surgery were evaluated. The Actual K(a+p) was compared with the back- calculated corneal power (BCK), which was thought to be the benchmark of true corneal power. The corneal power estimated by other published methods, including Maloney, Shammas, Koch-Maloney, Savini, and McCulley, together with the true net power and equivalent K reading (EKR) as found by the Pentacam were also compared with the BCK. RESULTS: All eyes achieved satisfied refractive status after cataract surgery. The difference between the postoperative refraction and the target refraction was 0.04±0.40D, range from -0.63D and +0.85D. Among all the methods we studied, although the Bonferroni multiple comparison tests did not detect significant differences between any two of them, the Actual K(a+p) yielded the highest agreement with the BCK, with 80% of the eyes falling within ±0.5D and 100% within ±1.0D from the BCK values. CONCLUSION: The Actual K(a+p) method can provide encour- aging results in post-LASIK eyes undergoing cataract surgery.

[The accuracy of posterior curvature method in corneal power calculation after LASIK surgery].

OBJECTIVE: To estimate the accuracy of posterior curvature method in corneal power calculation after LASIK surgery. METHODS: Corneal power calculation in 11 eyes that underwent Intraocular Lens (IOL) implantation after LASIK surgery (10 cases of Phaco + IOL, 1 case of IOL displacement), all of which used posterior curvature method, was analyzed retrospectively. The differences between post-operative stable refraction and target refraction were calculated, the actual corneal powers were deduced, and the expected refractive errors using other corneal power evaluation methods (auto-keratometry, corneal topography, spherical equivalent method, anterior curvature method, Equivalent K Reading method provided by Pentacam) were analyzed. In addition, refraction of 23 eyes underwent LASIK surgery were done on their 6 months follow-up. The theoretical corneal powers were deduced by subtracting the change of refraction before and after LASIK surgery from the pre-operative corneal powers. The differences between calculated corneal powers using posterior curvature method and the theoretical corneal powers were analyzed, and were compared with other corneal power evaluation methods. RESULTS: The mean uncorrected post-operative visual acuity of IOL implantation eyes using posterior curvature method was 0.8 +/- 0.2, with mean absolute refractive error from target of (0.36 +/- 0.36) D (-0.63 to +0.85 D). The ratio of eyes with absolute error within 0.25 D, 0.50 D, and 1.00 D was 55%, 73%, and 91% respectively. This result was significantly lower than that of the auto-keratometry (2.50 +/- 1.08) D, corneal topography (1.90 +/- 0.88) D, and those obtained from spherical equivalent method (2.09 +/- 1.62) D (P < 0.01) or anterior curvature method (1.45 +/- 1.10) D (P < 0.05). It also showed less bias (-1.13 to 0.85 D) when compared to the Equivalent K Reading (-1.10 to 1.80 D), but the difference was not significant (P > 0.05). For the 23 post LASIK eyes, the absolute difference between the corrected corneal power using posterior curvature method and theoretical power was (0.67 +/- 0.45) D, also showed least bias compared with other methods. CONCLUSION: It is a practical and accurate way to calculate the corneal power after LASIK surgery using posterior curvature method.

Tear cytokine and ocular surface alterations following brief passive cigarette smoke exposure.

PURPOSE: To prospectively investigate the effects of acute passive cigarette smoke exposure on the ocular surface and tear film in healthy non-smokers. METHODS: Twelve right eyes of 12 subjects without any ocular diseases were examined before, 5 min, and 24h after 5 min of passive cigarette smoke exposure in a controlled smoke chamber. Tear samples were obtained before, 5 min and 24 h after smoke exposure to detect tear hexanoyl-lysine (HEL), acrolein and inflammatory cytokine concentrations. Tear evaporation rate, DR-1 tear film lipid layer interferometry, tear film break-up time (TBUT), ocular surface fluorescein staining (FS) and Rose Bengal staining (RB), Schirmer I test were performed before, 5 min, and 24h after smoke exposure. Conjunctival impression cytology (IC) and brush cytology (BC) were carried out before and 24h after smoke exposure. RESULTS: Tear evaporation rate, tear lipid spread time, tear film break-up time, and vital staining scores showed significant worsening with passive smoke exposure. Tear HEL and IL-6 concentrations increased significantly 24 h after smoke exposure. Tear acrolein level showed an insignificant increase at 5 min. IC and RT-PCR revealed a significant reduction in goblet cell density, a shift toward higher squamous metaplasia grades and a significant downregulation of MUC5AC mRNA expression at 24 h. CONCLUSION: Even brief passive exposure to cigarette smoke in healthy non-smoker subjects was associated with adverse effects on the ocular surface health as evidenced by an increase of tear inflammatory cytokines, tear lipid peroxidation products and decrease of mucosal defense resulting in tear instability and damage to the ocular surface epithelia.