Incidence of endophthalmitis after phacoemulsification cataract surgery:a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Intrahepatic and intra-abdominal splenosis:A case report and review of literature

BACKGROUND Splenosis is defined as the process by which tissue from the spleen disseminates through the body and grows in an ectopic location following trauma or a splenectomy.Visceral sites of splenosis are rare.CASE SUMMARY We report a case of intrahepatic splenosis in a 57-year-old man with a history of trauma over 40 years ago who initially presented with chest pain.Findings initially mimicked malignancy but a diagnosis of intrahepatic splenosis was confirmed using computed tomography and scintigraphy with technetium-99m heat-denatured red blood cells(Tc-99 DRBC).CONCLUSION Scintigraphy with Tc-99 DRBC is a reliable technique to diagnose splenosis and should be performed before using more invasive procedures are carried out.Splenosis should be considered as a possible differential diagnosis for a hepatic nodule in any patient with a history of abdominal trauma,previous splenectomy or atypical radiological features on imaging.

Cultivated Cordyceps: A Tale of Two Treasured Mushrooms

Ophiocordyceps sinensis and Cordyceps militaris both contain many bioactive compounds that confer potential therapeutic benefits. This review discusses the possible use of cultivated C. militaris as an effective substitute for native O. sinensis in the face of ever-increasing prices of O. sinensis because of its short supply. On the one hand, cultivated C. militaris contains higher levels of cordycepin when compared with that of wild-type O. sinensis and cultivation of C. militaris has been shown to be capable of reducing the risk of heavy metal contamination. On the other hand, there is a paucity of robust in vivo studies and randomized controlled tests comparing the pharmacology and use of C. militaris and O. sinensis. For extraction of cordycepin as western-style tablets, the use of cultivated C. militaris rather than O. sinensis represents the most appropriate future approach. For many other purposes, comparative pharmacology and clinical trials are in urgent needs.

Taming the Fire of Nephrotoxic Botanicals

Criteria for diagnosing nephropathy and urothelial neoplasms induced by botanicals containing aristolochic acids(AAs) are well established. Highlights of recent research on AAs include mechanisms of AA intrarenal transport and metabolism and vigorous debate on whether AAs may also cause liver cancers. Many other botanicals may also cause renal injury, but a generalized framework for diagnosing botanical-induced kidney injury(BIKI) is lacking. Based on what we have learnt about the wide spectrum of phenotypes of BIKI attributed to AAs and a recently published standardized phenotypic framework of drug-induced kidney disease, we propose that BIKI may be categorized into six phenotypes(acute kidney injury, tubular dysfunction, glomerular disorders, nephrolithiasis, chronic kidney disease, and neoplasms) and four mechanistic types(A, predictable;B, idiosyncratic;C, chronic;and D, delayed). We call for international cooperation assembling a task force to develop, refine, and regularly appraise an online BIKI database, documenting botanical use, phenotypes, mechanisms, and levels of evidence. Once established, such a database may be linked with electronic patient records and pharmacovigilance channels to generate alerts, guide clinical decision-making, direct future research, and support evidence-based regulation of herbal medicines and education of healthcare professionals and the public. Finally, to prevent BIKI, we propose that a proactive approach integrating the triad of botanicals, users, and stakeholders will be needed.

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Background Bouveret syndrome is characterized by gallstone impaction in the upper gastrointestinal tract causing gastric outlet obstruction.In Bouveret syndrome,endoscopic gallstone removal can avert the need for surgery.However,in cases in which endoscopic therapy is unlikely to succeed,endoscopic attempts delay definitive treatment and compound patient risks.We previously developed a model that predicts endoscopic outcomes from data derived through a systematic review.This tool uses gallstone length,site of impaction,and the number of planned methods of lithotripsy to predict the likelihood of endoscopic success with an accuracy of 81.0%.This study aimed to evaluate our tool performance in an independent,non-training data set and assess endoscopic and surgical outcomes.Methods Systematic searches of the PubMed,Scopus,and Cochrane databases were performed for articles published between 16 April 2018 and 1 June 2021.The data reported after our previous study were harvested and inputted into the tool to evaluate their ability to accurately predict outcomes when compared with actual outcomes.Results Newly collated data in fields of interest showed no significant statistical differences compared with previous training data sets.Endoscopic therapy was successful in 41.9%of cases.Gallstones of ≤4 cm had a higher chance of successful endoscopic intervention(odds ratio 6.7,95%confidence interval 1.7–25.8,P<0.01).Complications of surgery were reported in 29.5%;there was one fatality reported.Post hoc evaluation of our predictive tool demonstrated an AUROC score of 0.80.Conclusions We have demonstrated in an independent data set that the tool can be used to accurately predict outcomes of endoscopic therapy.Patients in whom endoscopic therapy is most likely to fail should be offered an early surgical opinion.

Role of Rapamycin and 3-MA in oxidative damage of HLECs caused by two doses of UVB radiation

Background:This study compared the role of autophagy regulators Rapamycin and 3-MA in oxidative damage and apoptosis of human lens epithelial cells(HLECs)caused by two doses of Ultraviolet Radiation B(UVB).Methods:HLECs were irradiated with UVB,and two doses of UVB damage models were constructed.After treatment with autophagy regulators,cell damage tests such as CCK-8,LDH activity,and Ros detection were performed.Western blotting was used to detect the levels of autophagy-related proteins and apoptosis-related proteins.Quantitative real-time PCR(RT-qPCR)was used to detect the mRNA leve of secondary antioxidant enzymes.Flow cytometry was used to examine cell viability and apoptosis.Finally,the proportion of autophagy and apoptosis was observed by electron microscope.Results:Autophagy inhibitor 3-MA promoted oxidative damage and apoptosis of HLECs at low doses of UVB(5 mJ/cm2),which corresponds to 1.3 h of exposure to sunlight in human eyes.Under the high dose of UVB(50mJ/cm2),which is equivalent to 13 h of exposure to sunlight in human eyes,the autophagy inducer Rapamycin caused more extensive oxidative damage and apoptosis of HLECs.3-MA was able to reduce this damage,indicating that moderate autophagy is necessary for HLECs to cope with mild oxidative stress.For high dose UVBinduced oxidative stress,the use of 3-MA inhibiting autophagy is more beneficial to reduce cell damage and apoptosis.The mechanisms include degradation of damaged organelles,regulation of the expression of antioxidant enzymes HO-1,NQO1,GCS and regulation of apoptosis-related proteins.Conclusions:Autophagy played different roles in HLECs oxidative stress induced by two doses of UVB.It provides new ideas for reducing oxidative damage and apoptosis of HLECs to prevent or delay the progression of agerelated cataract(ARC).

The barriers to global eye care equity and the role of digital innovations

1.Introduction Ophthalmology has benefited from a myriad of digital innovations ranging from simple virtual clinics to complex deep-learning imaging analysis.1 With an increasingly ageing global population,the need for population eye health planning is paramount and should be recognised as an essential aspect of overall health.2 However,high-quality eye health services are often not universally delivered.This is especially the case in low middle-income countries(LMICs),whose populations suffer far more in blindness and visual impairment compared to wealthier countries.3 Numerous social determinants,including low education levels,poverty,physical distance,and socio-cultural situations,can all contribute towards inequitable access to eye care services.4 New modes of healthcare delivery proposed by digital innovations have the potential to reduce inequity.

乳腺癌新辅助化疗的再思考

质疑乳腺癌新辅助化疗合理性的证据逐渐增多,Jayant Vaidya和同事们认为必须对当下的治疗方案进行再思考。 乳腺癌是世界范围内女性最常见的恶性肿瘤。2014年英国有55000名女性被诊断为乳腺癌,其中11000名死于该疾病。早期乳腺癌传统上会应用手术、联合放疗以及必要时辅助系统药物治疗的综合治疗模式。