Posterior segment nucleotomy for dislocated sclerotic cataractous lens using chandelier endoilluminator and sharp tipped chopper

· AIM: To describe a new surgical technique for managing dislocated sclerotic cataractous lens.· METHODS: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port23 G pars plana vitrectomy and perfluorocarbon liquid(PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL,Fluid Air Exchange was done in all the cases and surgery completed uneventfully.·RESULTS: Best corrected visual acuity(BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up.·CONCLUSION: Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser.

Sclerotic marginal zone lymphoma:A case report

BACKGROUND Marginal zone lymphoma(MZL)is an indolent non-Hodgkin B cell lymphoma with various architectural pattern including perifollicular,follicular colonization,nodular,micronodular,and diffuse patterns.A sclerotic variant has not been previously reported and represents a diagnostic pitfall.CASE SUMMARY A 66-year-old male developed left upper extremity swelling.Chest computed tomography(CT)in September 2020 showed 14 cm mass in left axilla.Needle core biopsy of axillary lymph node showed sclerotic tissue with atypical B lymphoid infiltrate but was non-diagnostic.Excisional biopsy was performed for diagnosis and showed extensive fibrosis and minor component of infiltrating B cells.Flow cytometry showed a small population of CD5-,CD10-,kappa restricted B cells.Monoclonal immunoglobulin heavy chain and light chain gene rearrangement were identified.Upon being diagnosed with MZL,patient was treated with rituximab,cyclophosphamide,doxorubicin,vincristine,and prednisone and achieved complete remission by positron emission tomography/CT.CONCLUSION This is an important case report because by morphology this case could have easily been overlooked as non-specific fibrosis with chronic inflammation representing a significant diagnostic pitfall.Moreover,this constitutes a new architectural pattern.While sclerotic lymphomas have rarely been described(often misdiagnosed as retroperitoneal fibrosis),we do not know of any cases describing this architectural presentation of MZL.

Comparison of lens oxidative damage induced by vitrectomy and/or hyperoxia in rabbits

AIM： To compare of lens oxidative damage induced by vitrectomy and/or hyperoxia in rabbit.METHODS： Sixteen New Zealand rabbits （2.4-2.5 kg） were randomly divided into two groups （Group A, n=12; Group B, n=4）. In Group A, the right eyes were treated with vitrectomy and systemic hyperoxia （oxygen concentration： 80%-85%, 1 ATA, 4h/d） （Group A-right）, and the left eyes were treated with hyperoxia without vitrectomy surgery （Group A-left）. Four rabbits in group B （eight eyes） were untreated as the controls. Lens transparency was monitored with a slit lamp and recorded before and after vitrectomy. After hyperoxic treatment for 6mo, the eyeballs were removed and the lens cortices （containing the capsules） and nuclei were separated for further morphological and biochemical evaluation.RESULTS： Six months after treatments, there were no significant morphological changes in the lenses in any experimental group when observed with a slit lamp. However, the levels of water-soluble proteins and ascorbate, and the activities of catalase and Na＋-K＋-ATPase were significantly reduced, whereas the levels of malondialdehyde and transforming growth factor β2 （TGF-β2） were significantly elevated, in both the cortices and nuclei of eyes treated with vitrectomy and hyperoxia. The increase in protein-glutathione mixed disulfides and the reduction in water-soluble proteins were more obvious in the lens nuclei. The levels of ascorbate in the vitreous fluid were also reduced after vitrectomy, whereas TGF-β2 increased after vitrectomy and hyperoxia. Systemic hyperoxia exposure increased these effects. CONCLUSION： Removal of the intact vitreous gel with vitrectomy and exposing the lens to increased oxygen from the retina induce lens oxidation and aggregation. Thus, an intact vitreous gel structure may protect the lens from oxidative insult and maintain lens transparency.

An extremely rare pedunculated lipoma of the hypopharynx: A case report

BACKGROUND Hypopharyngeal lipoma is a rare disease that can lead to asphyxiation after aspiration.Sclerotic lipoma in the hypopharynx is an extremely rare histological type.Hypopharyngeal lipoma should be resected in time after diagnosis.CASE SUMMARY An 86-year-old female patient presented to our department with a long pedunculated mass protruding from her mouth.Until this time,the patient had no dyspnea,dysphagia,or throat discomfort.Physical examination showed stable vital signs and clear consciousness.The pedicel was derived from the posterior wall of the hypopharynx.The tumor was smooth,hyperemic and dark red,about 10 cm long,and 4 cm wide.In order to prevent airway obstruction,the hypopharyngeal tumor was excised in emergent operation.The pharyngeal cavity was exposed by a mouth gag during the operation.A disposable plasma knife was used to completely remove the tumor along the base of the new organism,and no active bleeding occurred.The postoperative pathological results were sclerotic lipoma.CONCLUSION Lipoma in the pharynx is relatively rare.Patients with this condition must be referred immediately to Ear-Nose-Throat specialists and complete surgical excision should be performed as soon as possible to prevent serious complications,such as airway obstruction and death.

Bone Pathology: Osteopoikilosis

Osteopoikilosis is a rare benign sclerotic bone dysplasia. The disease which usually develops asymptomatically is coincidentally diagnosed with direct radiographs. Our subject, a 52-year-old male was admitted to our policlinic two days ago due to turning of his left ankle causing pain and swelling on his left ankle. We asked for bilateral direct radiograph of left ankle. The left ankle radiograph indicates multiple, small oval/round hyperdense sclerotic regions. As a result of available clinical finding and radiological viewing, the patient was diagnosed with osteopoikilosis.

On Dinosaur Reconstruction: The Head

This paper presents the current knowledge about the reconstruction of dinosaur heads. To reconstruct the dinosaur head, several features and functions of the head must be studied, namely osteology, musculature and soft tissue of the head, cranial kinesis, craniodental biomechanical characteristics, posterior part of the cranium, skin, and others. The main steps and points resulting from the study are the following. Firstly, the osteological remains of the head are studied for reconstruction according to the correct size and form in comparison with known remains belonging to the same family in case the remains were not complete. As the dinosaurs did not have facial muscles, their skin was pressed directly to the skull. The skin covering the large openings in front of the orbits of many dinosaurs probably bulged gently outward, and similarly, the jaw muscles bulged gently from the skull openings. Also, an investigation is performed to decide if sauropods were terrestrial or aquatic animals. Then, the individual characteristics of the head are examined in detail. These concern: 1) endocranial cast and nerves, 2) nostrils position, 3) the existence and kind of cheeks and lips, 4) Teeth types and function, 5) the palate shape and skin covering, 6) hyoid apparatus and tongues, 7) the details of the ear, 8) sclerotic rings and eyes, 9) skin and color. With the knowledge gathered about the various parts of the head in mind, decisions are made about the Amargasaurus (a sauropod) head in order to reconstruct a 3D, actual size head, as a worked example. Finally, the reconstruction procedure is described in detail.

An insect sclerotization-inspired antifouling armor on biomedical devices combats thrombosis and embedding

Thrombus formation and tissue embedding significantly impair the clinical efficacy and retrievability of temporary interventional medical devices.Herein,we report an insect sclerotization-inspired antifouling armor for tailoring temporary interventional devices with durable resistance to protein adsorption and the following protein-mediated complications.By mimicking the phenol-polyamine chemistry assisted by phenol oxidases during sclerotization,we develop a facile one-step method to crosslink bovine serum albumin(BSA)with oxidized hydrocaffeic acid(HCA),resulting in a stable and universal BSA@HCA armor.Furthermore,the surface of the BSA@HCA armor,enriched with carboxyl groups,supports the secondary grafting of polyethylene glycol(PEG),further enhancing both its antifouling performance and durability.The synergy of robustly immobilized BSA and covalently grafted PEG provide potent resistance to the adhesion of proteins,platelets,and vascular cells in vitro.In ex vivo blood circulation experiment,the armored surface reduces thrombus formation by 95%.Moreover,the antifouling armor retained over 60%of its fouling resistance after 28 days of immersion in PBS.Overall,our armor engineering strategy presents a promising solution for enhancing the antifouling properties and clinical performance of temporary interventional medical devices.

Minimally invasive surgical approach for abdominoscrotal hydrocele treatment:A case report

Abdominoscrotal hydrocele(ASH)is a rare clinical finding comprising fluid collection between the layers of the tunica vaginalis,extending from the scrotum to the abdominal cavity.At present,there is no unique or recommended management for ASH,and different surgical treatments have been proposed.Despite an open surgical approach being the most common treatment,the use of laparoscopy has also previously been described.The most common intraoperative complication is devascularization of the testis due to damage to the spermatic cord,with consequent orchiectomy.We present a case of ASH treated with minimally invasive surgery,consisting of a right inguinotomy with puncture of the ASH by positioning a mono-J stent avoiding spermatic cord dissection and the risk of testis devascularization.Sclerotization of the hydrocelic sac with iodopovidone through a mono-J stent was performed with healing from ASH and preservation of testicular vascularization.Two months later,magnetic resonance imaging showed the presence of scar tissue replacing the previous ASH cavity.

Endoscopic transcanal modified canal-wall-down mastoidectomy for cholesteatoma

Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively.Drilling through a sclerotic and small mastoid cavity,keeping the canal wall intactis often difficult and increases the risk of serious injury.Consequently,a canal-wall-down mastoidectomy is often performed.The endoscopic transcanal modified canal-wall-down mastoidectomy approach al lows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.

Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture - Should bone quality determine the type of nail used？

Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA） require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.

Implications for the therapeutic role of Imatinib in systemic sclerosis: a single-arm meta-analysis

Sclerotic chronic graft-versus-host disease (ScGVHD) or systemic sclerosis (SSc) is one of the most severe manifestations of chronic graft-versus-host disease (cGVHD) since the involvement of major organs significantly affects the mortality and morbidity of SSc patients. Currently, there are no effective therapeutic approaches or standard “second-line” therapy for SSc. Imatinib, a clinical tyrosine kinase inhibitor used to treat chronic myeloid leukemia and gastrointestinal tumor, has shown potential therapeutic effects in treating ScGVHD or SSc. Due to the current limitations of clinical trials using Imatinib in the treatment of SSc, the results vary among different studies, and the applications of Imatinib in SSc is still in vagueness. Here we conducted a single-arm meta-analysis to quantitatively and systematically interpret the results of previous studies, as to evaluate the potential therapeutic effect of Imatinib in SSc. The pooled clinical response rate (CRR) showed that Imatinib had higher CRR in SSc patients with longer disease duration (CRR = 0.550) and lung involvement (CRR = 0.601) than those without (P<0.001). Therefore, it was encouraging to con duct future clinical studies regarding Imatinib therapy in SSc patients, since the global response rate of Imatinib was higher than expected in specific subgroup patients.

Melanization in living organisms: a perspective of species evolution

Eumelanin is a heteropolymer that is generally composed of hydroxylated indole residues and plays diverse protective functions in various species.Melanin is derived from the amino acid tyrosine and production of melanin is a highly complex oxidative process with a number of steps that can either proceed enzymatically or non-enzymatically.Although melanin plays important protective roles in many species,during melanization,particularly in steps that can proceed non-enzymatically,many toxic intermediates are produced,including semiquinones,dopaquinone,indole-quinones and moreover,the production of many reactive oxygen species.To mitigate the production of reactive species,a number of proteins that regulate the biochemical process of melanization have evolved in various living species,which is closely related to adaptation and physiological requirements.In this communication,we discuss differences between non-enzymatic and enzymatic processes of melanization and the enzymatic regulation of melanization in difference species with an emphasis on differences between mammals and insects.Comparison between melanization and insect sclerotization is also emphasized which raises some interesting questions about the current models of these pathways.

Molecular identification, expression and function analysis of peroxidasin in Chilo suppressalis

Peroxidasin plays a unique role in the formation and stability of extracellular matrix(ECM)in the animal kingdom;however,it was only characterized in Diptera,not in other insect orders.In this study peroxidasin(CsPxc/)was first identified and characterized from Chilo suppressalis,a lepidopteran pest.CsPxd complementary DNA with a 4080 bp open reading frame encodes a peptide of 1359 amino acids;the derived amino acid sequence of CsPxd harbors the typical structural characteristics of peroxidasin family in heme-peroxidase superfamily,including the signal peptide at N-terminal,leucine-rich repeat domain,Ig-loop motifs and peroxidase domain,signifying the extracellular location of protein and the involvement in ECM formation.Eukaryotic expression reveals CsPxd protein displays peroxidase activity on H2O2,justifying the membership of peroxidase.Phyletic analysis shows the monophyletic evolution pattern of peroxidasin in insect phyle,and moreover only one peroxidasin is present in each species of insects,suggesting its evolutionary conservation on function.Peroxidasin messenger RNA is mainly expressed in egg and the final instar larvae stage.Injection of peroxidasin double-stranded RNA into the final instar larvae impacts the cuticle sclerotization during the metamorphosis from larvae to pupa,and eventually lead to lethality of larvae and pupa.These results suggest the presence of collagen crosslink in chorion and cuticle of insects,and indicate peroxidasin plays a role in the development of chorion and cuticle;furthermore peroxidasin might be the one of potential target genes for pest control using RNA interference.

Bayer CropScience and Chinese OCRI Sign Agreements for Oilseed Research Collaboration

Bayer CropScience and the Chinese Oil Crops Research Institute (OCRI) have finalizedtwo agreements in the area of oilseed rape research.The parties have agreed to conduct ajoint research collaboration related to increasing seed oil content and resistance against thefungal disease Sclerotinia in oilseed rape.Increasing seed oil content is an important target for Bayer CropScience’s oilseed raperesearch in the context of maximizing oil yield which ultimately delivers premiums to farmersand further strengthens the competitiveness of Bayer CropScience’s leading oilseed