EVA NEXUS-Phaco performance study

AIM:To investigate a novel phacoemulsification system“EVA NEXUS”(D.O.R.C.,Dutch Opthalmic Research Center)in comparison to the existing system“EVA”in clinical use.And to compare both phacoemulsification systems in terms of efficiency,safety and postoperative inflammatory activity.METHODS:In this study standardized cataract surgery was performed on both eyes of the study participant,using the“EVA system”(control group,n=20)on one eye and the“EVA NEXUS system”(intervention group,n=20)on the other eye.Only patients with cataract LOCS Grading 1-3 and no accompanying eye diseases were included in this study.A total of 20 patients were included in this study,with each treatment arm including 20 eyes.During surgery a 0.1 mL aqueous humor sample was collected 1min after phacoemulsification to measure the total prostaglanin E2 concentrations using an enzyme-linked immunosorbent assay.The endothelial cell count,visual and refractive outcomes,and anterior chamber flare were evaluated preoperatively,and 1d,1wk,and 3mo postoperatively.RESULTS:There were no statistically significant differences between both groups regarding intraoperative safety parameters including effective phacoemulsification time(P=0.904),balanced saline solution flow(P=0.701)and total surgery time(P=0.565).Postoperative prostaglandin E2 levels,anterior chamber flare as well as endothelial cell loss tended to be lower in the NEXUS-Group,however not being statistically significant(P=0.718;0.164;0.486).Both systems provided similar clinical outcomes,regarding best corrected visual acuity and refractive parameters,showing no statistically significant differences between both groups.CONCLUSION:Both systems show a high level of safety and efficency with similar results in terms of safety parameters including postoperative inflammatory activity and endothelial cell loss as well as visual and refractive outcomes.Although statistically not significant,the EVA NEXUS system tends to cause less postoperative inflammation with lower prostaglandin E2 levels and lower anterior chamber flare values.

Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori

BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy(UGE)to perform gastric juice analysis and real-time detection of Helicobacter pylori(H.pylori).AIM To assess the diagnostic performance of this technology and its impact on the management of H.pylori in the real-life clinical setting.METHODS Patients undergoing routine UGE were prospectively recruited.Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test(RUT).Gastric juice sampling and analysis was performed using the Endofaster,and the diagnosis of H.pylori was based on real-time ammonium measurements.Histological detection of H.pylori served as the diagnostic gold standard for comparing Endofaster-based H.pylori diagnosis with RUT-based H.pylori detection.RESULTS A total of 198 patients were prospectively enrolled in an H.pylori diagnostic study by Endofasterbased gastric juice analysis(EGJA)during the UGE.Biopsies for RUT and histological assessment were performed on 161 patients(82 men and 79 women,mean age 54.8±19.2 years).H.pylori infection was detected by histology in 47(29.2%)patients.Overall,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value(NPV)for H.pylori diagnosis by EGJA were 91.5%,93.0%,92.6%,84.3%,and 96.4%,respectively.In patients on treatment with proton pump inhibitors,diagnostic sensitivity was reduced by 27.3%,while specificity and NPV were unaffected.EGJA and RUT were comparable in diagnostic performance and highly concordant in H.pylori detection(κ-value=0.85).CONCLUSION Endofaster allows for rapid and highly accurate detection of H.pylori during gastroscopy.This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.

1972-2009年念青唐古拉山西段冰湖分布及其变化特征

冰湖是研究气候变化的重要指标之一,了解冰湖分布和变化的特征,对认识冰川与气候之间关系和冰湖溃决灾害评估有着重要意义。运用遥感资料监测念青唐古拉山西段近40a来的冰湖分布及其变化,并结合DEM研究冰湖垂直分布的变化,探讨影响冰湖分布和变化的可能因素。研究结果表明:(1)研究区冰湖数量和面积近年来都呈迅速增加趋势,冰湖增加150个,冰湖面积增加4.384km2。气温升高、冰川融水增加是冰湖增多和面积增大的主要原因;(2)冰湖垂直分布变化明显,新增冰湖个数峰值位于海拔5 500～5 700m,占新增冰湖总数的61%;新增冰湖面积峰值在海拔5 400～5 700m,占新增湖总面积的44%;冰湖面积在大部分海拔高度上均呈扩张态势;(3)海拔高于5 400m的区域,1991-2009年新增的冰湖数量远多于1972-1991年。冰湖在高海拔区分布的变化对念青唐古拉山区冰川消融以及气候垂直变化具有一定的指示作用。

世界生物精神病学会联合会(WFSBP)关于焦虑障碍、强迫症和创伤后应激障碍的药物治疗指南

这篇文章根据现有的随机、安慰剂或参照药物对照临床研究 ,向大家推荐焦虑障碍、强迫症的药物治疗。 5-HT再摄取抑制剂 (SSRI)是治疗惊恐障碍的一线药物。三环类抗抑郁药 (TCA)与SSRI疗效相当 ,但耐受性差。难治性患者 ,如没有药物依赖和耐受史 ,则可使用苯二氮 艹卓 类药物如阿普唑仑。由于单胺氧化酶抑制剂 (MAOI)苯乙肼会产生严重的不良反应 ,且会与其他药物和食物成分相互作用 ,因此只有当一线药物无效时才使用。广泛性焦虑者可用万拉法新和SSRI,也可选用丁螺环酮和丙咪嗪。SSRI可作为社交恐怖症的一线药物 ,MAOI、吗氯贝胺和苯二氮 艹卓 类药物作为二线药物。强迫症最好用SSRI或氯丙咪嗪治疗。

针对脑卒中的ICF核心分类模板

目的通过循证和专家讨论研究法建立第一版针对脑卒中的一套综合ICF核心分类模板和与之相应的简明ICF核心分类模板。方法来自于不同国家和地区的国际专家从初步研究中搜集证据,结合这些证据进行正式的决策并最终达成共识。初步研究包括Delphi研究方法、对ICF分类的系统评价以及实证数据的收集。结果来自12个不同国家的39位专家出席会议并达成共识。专家初步研究决定在ICF分类的第二、第三和第四级水平上针对脑卒中确定一套448个类目的ICF核心分类摸板,其中193项类目属于身体功能,26项属于身体结构,165项属于活动和参与,64项属于环境因素。综合性ICF核心分类模板包括在ICF分类第二级水平上的130个类目,其中41项属于"身体功能",5项属于"身体结构",51项属于"活动和参与",33项属于"环境因素"。简明型ICF核心分类模板包括在ICF分类第二级水平上的18个类目,其中6项属于身体功能,2项属于身体结构,7项属于活动参与,以及3项属于环境因素。结论专家组通过整合研究过程中的证据,以及专家们基于ICF框架和分类的观点达成正式的共识,并确定针对"脑卒中"的ICF核心分类模板,同时界定综合型ICF核心分类模板和简要型ICF核心分类模板。

Intravenous administration of glutathione protects parenchymal and non-parenchymal liver cells against reperfusion injury following rat liver transplantation

AIM:To investigate the effects of intravenous administration of the antioxidant glutathione (GSH) on reperfusion injury following liver transplantation. METHODS:Livers of male Lewis rats were transplanted after 24 h of hypothermic preservation in University of Wisconsin solution in a syngeneic setting.During a 2-h reperfusion period either saline (controls,n=8) or GSH (50 or 100 μmol/(h·kg),n=5 each) was continuously administered via the jugular vein. RESULTS:Two hours after starting reperfusion plasma ALT increased to 1 457±281 U/L (mean±SE) in controls but to only 908±187 U/L (P<0.05) in animals treated with 100 μmol GSH/(h·kg).No protection was conveyed by 50μmol GSH/(h·kg).Cytoprotection was confirmed by morphological findings on electron microscopy:GSH treatment prevented detachment of sinusoidal endothelial cells (SECs) as well as loss of microvilli and mitochondrial swelling of hepatocytes.Accordingly,postischemic bile flow increased 2-fold.Intravital fluorescence microscopy revealed a nearly complete restoration of sinusoidal blood flow and a significant reduction of leukocyte adherence to sinusoids and postsinusoidal venules.Following infusion of 50μmol and 100 μmol GSH/(h·kg),plasma GSH increased to 65±7 mol/L and 97±18 mol/L,but to only 20±3 mol/L in untreated recipients. Furthermore,plasma glutathione disulfide (GSSG) increased to 7.5±1.0 mol/L in animals treated with 100μmol/(h·kg) GSH but infusion of 50μmol GSH/(h·kg) did not raise levels of untreated controls (1.8±0.5 mol/L vs 2.2±0.2 mol/L). CONCLUSION:Plasma GSH levels above a critical level may act as a “sink” for ROS produced in the hepatic vasculature during reperfusion of liver grafts.Therefore,GSH can be considered a candidate antioxidant for the Drevention of reperfusion injury after liver transplantation,in particular since it has a low toxicity in humans.

Importance of performance status for treatment outcome in advanced pancreatic cancer

Despite progress in the treatment of advanced and metastatic pancreatic cancer （PC）, the outcome of this disease remains dismal for the majority of patients. Given the moderate efficacy of treatment, prognostic factors may help to guide treatment decisions. Several trials identified baseline performance status as an important prognostic factor for survival. Unfit patients with a Kamofsky performance status （KPS） below 70% only have a marginal benefit from chemotherapy with gemcitabine （Gem） and may often benefit more from optimal supportive care. Once, however, the decision is taken to apply chemotherapy, KPS may be used to select either mono- or combination chemotherapy. Patients with a good performance status （KPS = 90%-100%） may have a significant and clinically relevant survival benefit from combination chemotherapy. By contrast, patients with a poor performance status （KPS ≤ 80%） have no advantage from intensified therapy and should rather receive single-agent treatment.

Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection

AIM:To characterize the impact of the Pringle ma-neuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies. METHODS: Sixty one consecutive patients who un-derwent hepatic resection under in flow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers. RESULTS: Occlusion times of 33 ± 12 min (mean ± SD) and 34 ± 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 ± 210 U/I vs 550 ± 650 U/I, P < 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery in flow.CONCLUSION: IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.

Optically Digitalized Holography: A Perspective for All-Optical Machine Learning

Holography, which was invented by Dennis Gabor in 1948, offers an approach to reconstructing both the amplitude and phase information of a three-dimensional (3D) object [1]. Since its invention, the concept of holography has been widely used in various fields, such as microscopy [2], interferometry [3], ultrasonography [4], and holographic display [5]. Optical holography can be divided into two steps: recording and reconstruction. A conventional hologram is recorded onto a photosensitive film as the interference between an object beam carrying the 3D object information and a reference beam. Thereafter, the original object wavefront is reconstructed in the 3D image space by illuminating the reference beam on the recorded hologram.

Non-Maxwellian electron distributions resulting from direct laser acceleration in near-critical plasmas

The irradiation of few-nm-thick targets by a finite-contrast high-intensity short-pulse laser results in a strong pre-expansion of these targets at the arrival time of the main pulse.The targets decompress to near and lower than critical densities with plasmas extending over few micrometers,i.e.multiple wavelengths.The interaction of the main pulse with such a highly localized but inhomogeneous target leads to the generation of a short channel and further self-focusing of the laser beam.Experiments at the Glass Hybrid OPCPA Scaled Test-bed(GHOST)laser system at University of Texas,Austin using such targets measured non-Maxwellian,peaked electron distribution with large bunch charge and high electron density in the laser propagation direction.These results are reproduced in 2D PIC simulations using the EPOCH code,identifying direct laser acceleration(DLA)[1]as the responsible mechanism.This is the first time that DLA has been observed to produce peaked spectra as opposed to broad,Maxwellian spectra observed in earlier experiments[2].This high-density electrons have potential applications as injector beams for a further wakefield acceleration stage as well as for pump-probe applications.

Translational research in pancreatic ductal adenocarcinoma: current evidence and future concepts

Pancreatic ductal adenocarcinoma(PDA) is one of the major causes for cancer death worldwide. Treatment of metastatic disease remains challenging as only certain patients benefit from advances made with the intensified chemotherapy regimen folinic acid, irinotecan and oxaliplatin, the epidermal growth factor receptor inhibitor erlotinib or the recently FDA-approved nab-paclitaxel. Up to date, no established approach for prediction of treatment response or specific treatment allocation exists. Translational research was able to identify a number of potential biomarkers that might help to improve the dismal prognosis of PDA by facilitating upfront treatment allocation. This topic highlight is focused on current evidence on potential biomarkers for tumor biology, prognosis and prediction of treatment efficacy.

Occurrence of Clinostomum complanatum in Aphanius dispar(Actinoptrygii:Cyprinodontidae) collected from Mehran River,Hormuzgan Province,South of Iran

Objective:To investigate the possibility of Aphanius dispar(A.dispar) acting as intermediate host for Clinostomum complanalum(C.complanalum),from Mehran River,Hormuzgan Province of Iran.Methods:During a biological study of A.dispar in Mehran River,Hormuzgan Province,South of Iran,a total of 97 fish specimens were collected in 24 January 2006.Results: 4 specimens(4.12%) including 1 male and 3 female were found infected with C.complanalum metacercaria.These metacercaria were coiled in the epiderm on the body surface of infected fishes.The infection is known as yellow spot disease.The parasite abundance,intensity and prevalence were 0.03%,1.25%and 4.12%,respectively.The infection was higher in females than males.Conclusions:To the best of our knowledge,this is the first report on occurrence of C. complanatum metacercaria in A.dispar in Iran.

Animal models of pulmonary hypertension due to left heart disease

Pulmonary hypertension due to left heart disease(PH-LHD) is regarded as the most prevalent form of pulmonary hypertension(PH). Indeed, PH is an independent risk factor and predicts adverse prognosis for patients with left heart disease(LHD). Clinically, there are no drugs or treatments that directly address PH-LHD, and treatment of LHD alone will not also ameliorate PH. To target the underlying physiopathological alterations of PH-LHD and to develop novel therapeutic approaches for this population, animal models that simulate the pathophysiology of PH-LHD are required. There are several available models for PH-LHD that have been successfully employed in rodents or large animals by artificially provoking an elevated pressure load on the left heart, which by transduction elicits an escalated pressure in pulmonary artery. In addition, metabolic derangement combined with aortic banding or vascular endothelial growth factor receptor antagonist is also currently applied to reproduce the phenotype of PH-LHD. As of today, none of the animal models exactly recapitulates the condition of patients with PH-LHD. Nevertheless, the selection of an appropriate animal model is essential in basic and translational studies of PH-LHD. Therefore, this review will summarize the characteristics of each PH-LHD animal model and discuss the advantages and limitations of the different models.

Implication of proliferation gene biomarkers in pulmonary hypertension

Objective/Background:Proliferation is a widely recognized trigger for pulmonary hypertension(PH),a life-threatening,progressive disorder of pulmonary blood vessels.This study was aimed to identify some proliferation associated genes/targets for better comprehension of PH pathogenesis.Methods:Human pulmonary arterial smooth muscle cells(hPASMCs)were cultured in the presence or absence of human recombinant platelet derived growth factor(rhPDGF)-BB.Cells were collected for metabolomics or transcriptomics study.Gene profiling of lungs of PH rats after hypoxia exposure or of PH patients were retrieved from GEO database.Results:90 metabolites(VIP score>1,fold change>2 or<0.5 and p<.05)and 2701 unique metabolism associated genes(MAGs)were identified in rhPDGF-BB treated hPASMCs compared to control cells.In addition,1151 differentially expressed genes(313 upregulated and 838 downregulated)were identified in rhPDGF-BB treated hPASMCs compared to control cells(fold change>2 or<0.5 and p<.05).152 differentially expressed MAGs were then determined,out of which 9 hub genes(IL6,CXCL8,CCL2,CXCR4,CCND1,PLAUR,PLAU,HBEGF and F3)were defined as core proliferation associated hub genes in protein proten interaction analysis.In addition,the hub gene-based LASSO model can predict the occurrence of PH(AUC=0.88).The expression of CXCR4,as one of the hub genes,was positively correlated to immune cell infiltrates.Conclusion:Our findings revealed some key proliferation associated genes in PH,which provide the crucial information concerning complex metabolic reprogramming and inflammatory modulation in response to proliferation signals and might offer therapeutic gains for PH.

Aspirin inhibits cell viability and mTOR downstream signaling in gastroenteropancreatic and bronchopulmonary neuroendocrine tumor cells

AIM: To investigate the effect of aspirin on neuroendocrine tumor (NET) cell growth and signaling in vitro.

Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel

This is the first report describing a case where prolonged,severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically,endoscopically,and histologically followed for 21 years until her death at the age 47 due to multifocal,metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits(so-called brown bowel syndrome) and severe jejunitis were observed microscopically,and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades,multifocal nests of adenocarcinoma cells and extensive,flat,neoplastic mucosal proliferations were found only in the small bowel,along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence.

Titanium allergy or not? “Impurity” of titanium implant materials

For patients suffering from allergies to nickel, chrome and cobalt, titanium implants are the implants of choice. Nevertheless, titanium implant sensitivity has been reported in the form of “allergies” and an increasing number of patients are confused. This paper aims to use spectral analysis as a diagnostic tool for analyzing different titanium implant alloys in order to determine the percentage of the alloy components and additions that are known to cause allergies. Different materials, such as sponge titanium, TiAl6Nb7, Ti21SRx, TiAl6V4 [forged alloy], TiAl6V4 [cast alloy], TMZF, pure titanium [c. p. 1] and iodide titanium were analyzed for the presence of the elements that have been associated with allergic reactions using spectral analysis. All the implant material samples contained traceable amounts of Be, Cd, Co, up to a maximum of 0.001 percent by weight [wt.%], Cr up to 0.033 wt.%, Cu up to 0.007 wt.%, Hf up to 0.035 wt.%, Mn up to 0.007 wt.%, Ni up to 0.031 wt.%, and Pd up to 0.001 wt.%. This paper demonstrates that all the investigated implant material samples contained a low but consistent percentage of components that have been associated with allergies. For example, low nickel contents are related to the manufacturing pro- cess and are completely dissolved in the titanium grid. Therefore, they can virtually be classified as “impurities”. Under certain circumstances, these small amounts may be sufficient to trigger allergic reactions in patients suffering from the corresponding allergies, such as a nickel, palladium or chrome allergy.

Ecstasy-induced optic disc swelling and consequent visual loss

Dear Editor,We present the first reported case of unilateral optic disc swelling with subsequent persistent loss of vision triggered by ecstasy consumption in the case of a young man.Ecstasy is one of the most commonly consumed recreational drugs among young adults.Its main constituent and active substance is 3,4-methylenedioxymethamphetamine(MDMA).

Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: A case report and review of literature

BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different underlying pancreatic disorders and characterized by subcutaneous fat necrosis induced by elevated serum lipase levels.These lesions usually affect the lower extremities and may precede abdominal symptoms of pancreatic disease.Acinar cell carcinoma(ACC)of the pancreas is a rare pancreatic neoplasm,accounting for only 1%-2%of pancreatic tumors in adults.We present the case of a 72-year-old man with ACC of the pancreatic head and synchronous liver metastases.Both the primary tumor and liver metastases were resected.Serum lipase was elevated before surgery and decreased to normal postoperatively.Rising serum lipase levels at follow-up led to the diagnosis of hepatic recurrence.This disease progression was then accompanied by pancreatic panniculitis,with subcutaneous fat necrosis and acute arthritis.To the best of our knowledge,only 4 cases have been reported in the literature and each showed a similar association of serum lipase levels with pancreatic panniculitis and progression of ACC.CONCLUSION Clinical symptoms and progression of ACC may correlate with serum lipase levels,suggesting potential usefulness as a follow-up biomarker.

Transrectal High-Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Current Role

Over the past 25 years, the average life expectancy for men has increased by 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy and brachytherapy have prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL. High intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a non-invasive approach that uses precisely-delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of prostate cancer, and is under experimental investigation for therapeutic use in renal and breast malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been approximately 30,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Transurethral resection of the prostate (TURP) has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy and in salvage and palliative indications are serving to expand the role of HIFU as a highly versatile non-invasive therapy for prostate cancer.