Risk factors for recurrence of periprosthetic joint infection following operative management: a cohort study with average 5-year follow-up.

Background: Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision. Methods: This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision. Results: A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ2=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision. Conclusions: Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.

Local antibiotics in primary hip and knee arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Infection is a truly devastating complication of total joint arthroplasty, causing most patients to undergo a revision surgery, and to bear significant psychological and financial burden. The purpose of this study is to systematically evaluate the literature to determine the efficacy and complication profile of local antibiotic application in primary total joint arthroplasty. METHODS: All studies of primary total joint arthroplasty which assessed local antibiotics in any form other than antibiotic-impregnated cement as an intervention were included. Studies that reported at least one outcome related to infection and were available in full text in English were eligible for inclusion. Studies which included both primary and revision cases but did not report the stratified data for each type of surgery and studies on fracture populations were excluded. RESULTS: A total of 9 studies involving 3,714 cases were included. The pooled deep infection rate was 1.6% in the intervention groups and 3.5% in the control groups. Meta-analysis revealed a RR of 0.53 (95%CI: 0.35-0.79, p = 0.002) with no heterogeneity (I2 = 0%) for infection in the intervention groups. Meta-analysis revealed a non-significant reduction in superficial infection rates in the intervention groups; however, there was a significant increase in aseptic wound complications in the intervention groups. CONCLUSION: Local antibiotic application results in a moderate reduction in deep infection rates in primary total joint arthroplasty, with no significant impact on superficial infection rates. However, local antibiotic application may be associated with a moderate increase in aseptic wound complications.

Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial.

AIM: To compare the clinical outcomes of the standard corneal cross linking (CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty. METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL (3 mW/cm2 for a period of 30min) or accelerated CXL (18 mW/cm2 for a period of 5min). The main outcomes for comparison were the change in: maximum-K reading (K-max), manifest refractive spherical equivalent (SE), central corneal thickness (CCT), and the best corrected distance visual acuity (CDVA). RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group. CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.

SMILE intraoperative complications: incidence and management.

AIM: To report the intraoperative complications associated with small incision lenticule extraction (SMILE) and their management. METHODS: This was a retrospective consecutive interventional clinical study, carried out on patients with myopia and myopic astigmatism, who underwent SMILE procedure. Type of intraoperative complications and their management were recorded. RESULTS: Our study comprised 282 eyes of 141 patients who were enrolled for SMILE surgeries. The intraoperative complications included lost vacuum (18 eyes, 6.38%), treatment decentration (6 eyes, 2.12%), wound bleeding (21 eyes, 7.45%), incomplete bubble separation (black islands) (3 eyes, 1.06%), the epithelial defects (15 eyes, 5.32%). Incision tear (27 eyes, 9.57%), lenticule adherence to the cap (6 eyes, 2.12%), and cap perforation occurred in 2 eyes (0.7%). CONCLUSION: Although SMILE is a promising technique for the correction of myopia and myopic astigmatism with predictable, efficient, safe refractive and visual outcomes, complications can occur. However, most of them are related to inexperience and are included in the learning curve of the technique. More studies with a bigger number of eyes are required to efficiently evaluate the intraoperative complications and standardize their management strategies.

A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis.

PURPOSE: Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation. STUDY DESIGN: A prospective nonrandomized clinical study. METHODS: The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery. RESULTS: One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3-5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results. CONCLUSION: Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143.

Anatomical and Functional Retinal Complications of Combined Sofosbuvir and Ribavirin Therapy in Patients With Chronic Hepatitis C Virus.

BACKGROUND AND OBJECTIVE: To evaluate the anatomical and functional retinal complications of combined sofosbuvir and ribavirin therapy in patients with chronic hepatitis C virus (HCV). PATIENTS AND METHODS: Three hundred patients with chronic HCV were recruited for this prospective, observational study from the National Liver Institute of Menoufia University from November 2015 to September 2017. Ophthalmic examination and follow-up were performed in the outpatient clinic of the Ophthalmology Department at Menoufia University. All patients received the same regimen (sofosbuvir and ribavirin) for 6 months. Patients were followed up during the period of treatment (6 months) and for 6 months after treatment completion. Complete ophthalmic examination, fundus fluorescein angiography (FFA) (to detect retinal ischemia), optical coherence tomography (OCT) (to detect retinal nerve fiber layer [RNFL] thickness and central macular thickening), and electroretinogram (ERG) (to detect rod and cone functions) tests were performed before and after treatment completion. RESULTS: The mean age of the patients was 46.17 years ± 11.38 years (range: 20 years to 60 years). The study included 138 men (46%) and 162 women (54%). During follow-up, there were no signs of retinopathy or optic nerve affection. There were also no signs of retinal ischemia (by FFA), RNFL affection, macular edema (by OCT), or rod or cone affection (by ERG). CONCLUSION: Combined treatment (sofosbuvir and ribavirin) may be safe without causing anatomical or functional retinal complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:39-42.].

Sutureless Scleral Tunnel Trabeculectomy: Evaluation of Feasibility and Effectiveness versus Conventional Trabeculectomy for Management of Primary Open Angle Glaucoma.

PURPOSE: To evaluate the intraocular pressure-lowering effect of sutureless scleral tunnel trabeculectomy with Mitomycin-C (MMC) compared to the standard trabeculectomy with MMC in patients with primary open angle glaucoma (POAG). METHODS: This was a masked, randomized, controlled comparison trial involving 34 eyes of 34 patients with bilateral POAG. Patients were randomized to receive sutureless sclera flap trabeculectomy with MMC or conventional trabeculectomy with MMC. The main outcome for comparison was the IOP-lowering effect of both procedures. Complete surgical success was considered if the patient's IOP was <22 mmHg and the IOP were lowered by more than 20% with the use of maximum two anti-glaucoma medications. RESULTS: All surgeries passed uneventfully without intraoperative complications and all patients showed significantly (p<0.05) lower IOP on the first postoperative day compared to their respective preoperative IOP with non-significant (p>0.05) difference between both study groups. All patients, irrespective of operative procedure, maintained significantly (p<0.05) lower IOP compared to their respective preoperative IOP until the end of 12 months' follow-up. There were no recorded serious postoperative complications in either groups, like wound leaks or endophthalmitis. CONCLUSION: Sutureless scleral tunnel trabeculectomy exhibits potential as an alternative to conventional trabeculectomy surgery. Over 12 months of follow-up, sutureless sclera flap trabeculectomy was safe and effective with an IOP-lowering effect comparable to that achieved with the conventional technique, but with increased rate of postoperative transient hypotony.

Reconstitution of polyunsaturated fatty acid synthesis enzymes in mammalian cells to convert LA to DHA / 生物工程学报

DHA (22:6n-3) is a Ω-3 polyunsaturated fatty acid with 22 carbon atoms and 6 double bonds, which has important biological functions in human body. Human and other mammals synthesize only limited amounts of DHA, more requirements must be satisfied from food resources. However, the natural resources of DHA (Mainly deep-sea fish and other marine products) are prone to depletion. New resources development is still insufficient to satisfy the growing market demand. Previous studies have revealed that the mammals can increase the synthesis of DHA and other long-chain polyunsaturated fatty acids after transgenic procedures. In this study, mammalian cells were transfected with Δ6, Δ5 desaturase, Δ6, Δ5 elongase, Δ15 desaturase (Isolated from nematode Caenorhabditis elegans) and Δ4 desaturase (Isolated from Euglena gracilis), simultaneously. Results show that the expression or overexpression of these 6 enzymes is capable of conversion of the o-6 linoleic acid (LA, 18:2n-6) in DHA (22:6n-3). DHA content has increased from 16.74% in the control group to 25.3% in the experimental group. The strategy and related technology in our research provided important data for future production the valuable DHA (22:6n-3) by using genetically modified animals.

Overexpression of four fatty acid synthase genes elevated the efficiency of long-chain polyunsaturated fatty acids biosynthesis in mammalian cells / 生物工程学报

Three long-chain polyunsaturated fatty acids, docosahexaenoic acid (DHA, 22:6n-3), eicosapentaenoic acid (EPA, 20:5n-3) and arachidonic acid (ARA, 20:4n-6), are the most biologically active polyunsaturated fatty acids in the body. They are important in developing and maintaining the brain function, and in preventing and treating many diseases such as cardiovascular disease, inflammation and cancer. Although mammals can biosynthesize these long-chain polyunsaturated fatty acids, the efficiency is very low and dietary intake is needed to meet the requirement. In this study, a multiple-genes expression vector carrying mammalian A6/A5 fatty acid desaturases and multiple-genes expression vector carrying mammalian Δ6/Δ5 fatty acid desaturases and Δ6/Δ5 fatty acid elongases coding genes was used to transfect HEK293T cells, then the overexpression of the target genes was detected. GC-MS analysis shows that the biosynthesis efficiency and level of DHA, EPA and ARA were significantly increased in cells transfected with the multiple-genes expression vector. Particularly, DHA level in these cells was 2.5 times higher than in the control cells. This study indicates mammal possess a certain mechanism for suppression of high level of biosynthesis of long chain polyunsaturated fatty acids, and the overexpression of Δ6/Δ5 fatty acid desaturases and Δ6/Δ5 fatty acid elongases broke this suppression mechanism so that the level of DHA, EPA and ARA was significantly increased. This study also provides a basis for potential applications of this gene construct in transgenic animal to produce high level of these long-chain polyunsaturated fatty acid.

A short-term randomized clinical trial of daily versus alternate day use of travoprost 0.004% in the treatment of ocular hypertension.

PURPOSE: To compare the daily versus the alternate day use of travoprost 0.004% in lowering the intraocular pressure (IOP) in patients with ocular hypertension. METHODS: Fourteen patients with ocular hypertension in both eyes have been randomly assigned to receive travoprost 0.004% once a day in 1 eye and once every other day in the other eye. The main outcome measure was change in the mean of the IOPs measured at 9:00 AM, and 4:00 PM between baseline (before treatment) and measurement of IOPs at 1, 2, 4, 8, and 12 weeks after treatment. RESULTS: After 3 months of treatment, daily use of travoprost 0.004% significantly reduced IOP (mean±standard error of mean) by 6.1±0.5 mmHg (P<0.001) and alternate day use by 5.9±0.3 mmHg (P< 0.001) adjusted from an overall baseline of 24.3±0.5 mm Hg. The difference in the IOP-lowering effect was not statistically significant (P<0.05). CONCLUSIONS: Alternate day use of travoprost 0.004% was as safe and effective as its daily use in lowering the IOP in patients with ocular hypertension.

Incidence and natural course of symptomatic central serous chorioretinopathy in pregnant women in a maternity hospital in Kuwait.

PURPOSE: To report the incidence, clinical features and natural course of central serous chorioretinopathy (CSR) in pregnant women in Kuwait. MATERIALS AND METHODS: Patients were actively recruited from a private maternity hospital. Out of the 17,000 pregnant women who visited the antenatal care clinics (Al-Orf Hospital, Kuwait) over 3 years, 900 had visual complaints. Patients with visual complaints underwent complete ophthalmological assessment. Medical records of patients with CSR were reviewed, and a full clinical ophthalmological assessment was performed including measurement of best corrected visual acuity, intraocular pressure, slit lamp biomicroscopy, dilated indirect ophthalmoscopy and Amsler grid screening, color and red free fundus photography and retinal optical coherence tomography. All patients were evaluated throughout the course of pregnancy and for 6 months after delivery. RESULTS: Four patients had CSR among the 17,000 pregnant women reviewed over 3 years corresponding to an incidence of 0.008 % per year. Two patients (50%) had CSR with white subretinal exudates and 2 (50%) had no exudates. There was complete resolution in all patients (100%) within 3 months after delivery. CONCLUSIONS: In pregnant women, CSR can present with or without retinal exudates and completely resolves in either case. Further studies with a larger sample size are warranted to investigate the risk factors in pregnant women.

Frequency, molecular pathology and potential clinical significance of partial chromosome 3 aberrations in uveal melanoma.

The clinical significance of partial chromosome 3 alteration in uveal melanoma is still not clear. Also, the reported frequencies vary considerably in the published literature from 0 to 48%. The aims of the following study were to identify the frequency, molecular pathology and potential clinical significance of partial chromosome 3 alteration in uveal melanoma. We studied 47 uveal melanomas with an average follow-up of 36 months. Of these, 14 had confirmed metastasis. Allelic imbalance/loss of heterozygosity was studied using microsatellite markers on chromosome 3 enriched in markers located in the previously reported smallest regions of deletion overlap. Chromosomal alterations were assessed by conventional cytogenetics or comparative genomic hybridization (CGH) in a subset of patients. Utilizing genotyping, partial chromosome 3 alteration was detected in 14/47 tumors (30%). In the 23 tumors with available cytogenetic/CGH, partial chromosome 3 alteration was detected in 8/23 (38%) and was caused by both gains (4/8) and losses (4/8) of chromosome 3 with high frequency of complex chromosome 3 aberrations detected by cytogenetics. Out of the 14 tumors with confirmed metastasis, only 1 showed partial chromosome 3 alteration and the remaining showed monosomy 3. By limiting the aggressive disease marker to monosomy 3, genotyping showed 93% sensitivity and 67% specificity for detection of aggressive uveal melanoma. In conclusion, partial chromosome 3 alterations are common in uveal melanoma and mostly caused by complex cytogenetic changes leading to partial gains and/or partial losses of chromosome 3. Partial chromosome 3 alteration is not likely to be associated with highly aggressive uveal melanoma that metastasizes within the first 3 years after treatment. Microsatellite-based genotyping of chromosome 3 is highly sensitive for detection of aggressive uveal melanoma.