Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

AIM: To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls.·METHODS: The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sexmatched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30 min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software.·RESULTS: Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls.Pharmacologic mydriasis led to significant increments in iris thickness at 750 μm, anterior chamber depth and volume, whereas significant decrements in iris curve,cross sectional area and volume in both groups. Angle opening distance at 500 μm was increased significantly in normal controls(from 0.465±0.115 mm to 0.539±0.167 mm,P =0.009), but not in angle closure suspects(from 0.125±0.100 mm to 0.145±0.131 mm, P =0.326). Iris volume change per millimeter of pupil dilation(△IV/△PD) decreased significantly less in angle closure suspects than normal controls(-2.47 ±1.33 mm2vs-3.63±1.58 mm2, P =0.019).Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth(β =0.841, P =0.002) and △IV/△PD(β =0.028, P =0.002),followed by gender(β =0. 062, P =0.032).·CONCLUSION: Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic iris change may be as a prospective indicator of iris compressibility and angle closure glaucoma.

Autologous sclera-muscle flaps technique in evisceration with hydroxyapatite implantation

·AIM: To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications,we have developed a novel and simple technique for anophthalmic patients.·METHODS: All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed.· RESULTS: A total of twenty-eight patients were enrolled in the study. Eighteen were men(64.29%) and ten were women(35.71%). Ages ranged from 18 to 65y(mean age, 32 years old). Mean follow-up was 12.32mo(range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29 ±1.36 mm(range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04 ±1.45 mm horizontally(range, 7-14 mm) and 8.57 ±1.50 mm vertically(range, 5-12 mm).·CONCLUSION: The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant.

Neuroprotective effects of naturally sourced bioactive polysaccharides: an update

Polysaccharides are macromolecular complexes that have various biological activities.In vivo and in vitro studies have shown that polysaccharides play neuroprotective roles through multiple mechanisms;consequently,they have potential in the prevention and treatment of neurodegenerative diseases.This paper summarizes related research published during 2015-2020 and reviews advances in the understanding of the neuroprotective effects of bioactive polysaccharides.This review focuses on 15 bioactive polysaccharides from plants and fungi that have neuroprotective properties against oxidative stress,apoptosis,neuroinflammation,and excitatory amino acid toxicity mainly through the regulation of nuclear factor kappa-B,phosphatidylinositol-3-kinase/protein kinase B,mitogen-activated protein kinase,nuclear factor-E2-related factor 2/hemeoxygenase-1,c-jun N-terminal kinase,protein kinase B-mammalian target of rapamycin,and reactive oxygen species-nucleotide-binding oligomerization domain,leucine-rich repeat and pyrin domain-containing 3 signaling pathways.Natural bioactive polysaccharides have potential in the prevention and treatment of neurodegenerative diseases because of their advantageous characteristics,including multi-targeting,low toxicity,and synergistic effects.However,most of the recent related research has focused on cell and animal models.Future randomized clinical trials involving large sample sizes are needed to validate the therapeutic benefits of these neuroprotective polysaccharides in patients having neurodegenerative diseases.

Ultrasound-based artificial intelligence in gastroenterology and hepatology

Artificial intelligence (AI), especially deep learning, is gaining extensive attentionfor its excellent performance in medical image analysis. It can automatically makea quantitative assessment of complex medical images and help doctors to makemore accurate diagnoses. In recent years, AI based on ultrasound has been shownto be very helpful in diffuse liver diseases and focal liver lesions, such asanalyzing the severity of nonalcoholic fatty liver and the stage of liver fibrosis,identifying benign and malignant liver lesions, predicting the microvascularinvasion of hepatocellular carcinoma, curative transarterial chemoembolizationeffect, and prognoses after thermal ablation. Moreover, AI based on endoscopicultrasonography has been applied in some gastrointestinal diseases, such asdistinguishing gastric mesenchymal tumors, detection of pancreatic cancer andintraductal papillary mucinous neoplasms, and predicting the preoperative tumordeposits in rectal cancer. This review focused on the basic technical knowledgeabout AI and the clinical application of AI in ultrasound of liver and gastroenterologydiseases. Lastly, we discuss the challenges and future perspectives of AI.

Diurnal macular choroidal area fluctuation in normal and primary open angle glaucoma groups

AIM:To assess and compare the diurnal macular choroidal area fluctuation in normal and primary open angle glaucoma(POAG) groups using enhanced depth imaging optical coherence tomography(EDI-OCT).METHODS: Twenty-eight normal and 27 POAG eyes were enrolled in this study. EDI-OCT was used to measure the macular choroidal area every 3h from 9:00 a.m. to 21:00 p.m. RESULTS: Significant diurnal fluctuations of macular choroidal area were observed in both normal(P=0.003) and POAG groups(P<0.001). But no significant macular choroidal area difference has been found between the two groups at all the five measurement time-points(512778±166242 vs 455079±207278 μm2,P=0.195 at 9:00 a.m.; 501526±168953 vs 447846±211147 μm2,P=0.245 at 12:00a.m.; 501982±173158 vs 448024±206653 μm2,P=0.239 at 15:00 p.m.; 508912±174589 vs 457783±207081 μm2,P=0.252 at 18:00p.m.;503787±171241 vs 453230±205955 μm2,P=0.274 at 21:00 p.m.;respectively). Furthermore,neither the fluctuation manners nor the change in macular choroidal area between the two adjacent measurement time points showed significant difference between normal and POAG groups(all P>0.05). In the meantime,significant diurnal intraocular pressure fluctuations were also observed in normal and POAG groups(both P<0.001).CONCLUSION: In diurnal time,the macular choroidal area in both normal and POAG groups fluctuated significantly; moreover,neither the value of macular choroidal area,nor the fluctuation of macular choroidal area in POAG group is significantly different from that in normal group.

Does delaying ureteral stent placement lead to higher rates of preoperative acute pyelonephritis during pregnancy?

BACKGROUND Pregnancy with renal colic may cause pyelonephritis,decreased renal function,systemic infection and even shock in pregnant women,and cause premature birth and other adverse pregnancy outcomes.When surgery is necessary,the relationship between timing of the operation and the outcome of the mother and child are not known.AIM To investigate the association between time to ureteral stent placement and clinical outcomes of patients with renal colic during pregnancy.METHODS In this retrospective study,pregnant women with renal colic who underwent surgery were studied.Maternal preoperative acute pyelonephritis(PANP),pregnancy outcome,and length of hospital stay(LOS)were compared between the two groups.RESULTS 100 patients were included in the analysis,median age was 30 years.Median time to ureteral stent placement was 48 h(interquartile range,25-96 h),and 32 patients(32%)were diagnosed with PANP.PANP was closely related to hospitalization costs,re-admission to the hospital due to urinary tract infection after surgery and premature delivery.Multivariate analysis found that stone location and time from pain to admission were related to PANP.CONCLUSION Both early and delayed surgery are safe and effective for the treatment of renal colic during pregnancy.Early surgery may be superior to a delayed procedure due to shorter LOS.For pregnant patients with renal colic,delayed surgery within 48 h is not related to the clinical outcome of the mother and child.However,the time from pain to hospital admission was related to PANP.

Changes in electroencephalography and sleep architecture as potential electrical biomarkers for Alzheimer’s disease

Alzheimer’s disease(AD)is a neurodegenerative disease characterized by dementia and mental illness.The main pathological changes of AD are the accumulation of amyloidβ(Aβ)and phosphorylated tau.With the increase in the aging population,the prevalence among adults aged≥60 years will be growing from 5.4%(2015)to 6.7%(2050)in China.[1]At the present stage,the diagnosis of AD is primarily based on the long term clinical observation.Neuro-imaging and invasive cerebrospinal fluid(CSF)measurement of Aβand tau may help making a differential diagnosis,but the cost to conduct these examinations is high and they are only applicable for the middle to late stages of the disease.