The relationship between chronic PTSD,cortical volumetry and white matter microstructure among Australian combat veterans

Background:Posttraumatic stress disorder(PTSD)has been associated with volumetric and white matter microstructural changes among general and veteran populations.However,regions implicated have greatly varied and often conflict between studies,potentially due to confounding comorbidities within samples.This study compared grey matter volume and white matter microstructure among Australian combat veterans with and without a lifetime diagnosis of PTSD,in a homogenous sample assessed for known confounding comorbidities.Methods:Sixty-eight male trauma-exposed veterans(16 PTSD-diagnosed;mean age 69 years)completed a battery of psychometric assessments and underwent magnetic resonance and diffusion tensor imaging.Analyses included tractbased spatial statistics,voxel-wise analyses,diffusion connectome-based group-wise analysis,and volumetric analysis.Results:Significantly smaller grey matter volumes were observed in the left prefrontal cortex(P=0.026),bilateral middle frontal gyrus(P=0.021),and left anterior insula(P=0.048)in the PTSD group compared to controls.Significant negative correlations were found between PTSD symptom severity and fractional anisotropy values in the left corticospinal tract(R^(2)=0.34,P=0.024)and left inferior cerebellar peduncle(R^(2)=0.62,P=0.016).No connectome-based differences in white matter properties were observed.Conclusions:Findings from this study reinforce reports of white matter alterations,as indicated by reduced fractional anisotropy values,in relation to PTSD symptom severity,as well as patterns of reduced volume in the prefrontal cortex.These results contribute to the developing profile of neuroanatomical differences uniquely attributable to veterans who suffer from chronic PTSD.

Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors:A systematic review and meta-analysis

Purpose:This systematic review and meta-analysis aimed to evaluate the effect of wearable devices for improving physical activity and healthrelated outcomes in cancer survivors.Methods:CINAHL,Cochrane,Ebscohost,MEDLINE,Pubmed,ProQuest Health and Medical Complete,ProQuest Nursing and Allied Health Source,ScienceDirect,and SPORTDiscus databases were searched for randomized controlled trials published before September 1,2020,that evaluated interventions involving wearable devices in cancer survivors.Standardized mean differences(SMDs)were calculated to assess effects on physical activity and health-related outcomes.Subgroup analyses were conducted to assess whether the effects differed by interventions and cancer characteristics.Risk of bias was assessed using the Cochrane risk of bias tool.Results:Thirty-five trials were included(breast cancer,n=15,43%).Intervention durations ranged between 4 weeks and 1 year.Most trials(n=25,71%)involved pedometer-based physical activity interventions.Seven(20%)involved Fitbit-based interventions,and 3(9%)involved other wearable physical activity trackers(e.g.,Polar,Garmin).Compared to usual care,wearable devices had moderate-to-large effects(SMD range 0.54-0.87,p<0.001)on moderate-intensity physical activity,moderate-to-vigorous-intensity physical activity,total physical activity,and daily steps.Compared to usual care,those in the intervention had higher quality of life,aerobic fitness,physical function,and reduced fatigue(SMD range=0.18-0.66,all p<0.05).Conclusion:Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer.Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.

Comparison of encirclage and cryotherapy with argon laser in the management of traumatic cyclodialysis cleft

The study compared anatomical and functional outcome of a novel technique of encirclage and cryotherapy with the conventional argon laser in the management of traumatic cyclodialysis cleft in 19 patients(10: encirclage and 9: argon laser). The postoperative anatomical success was taken as rise in intraocular pressure(IOP) more than 6 mm Hg or the closure of cleft on gonioscopy or ultrasound biomicroscopy(UBM). Visual outcome was measured as change in logMAR visual acuity. Traumatic cataract and hypotony were present in majority. IOP>6 mm Hg was noted in 90% of encirclage group and in 77.70% of argon laser group. Two cases had non-closure of cleft. Encirclage is comparable to argon laser in terms of anatomical and functional success with possible advantage of single procedure and use in cases with failed laser.

Correlation network analysis shows divergent effects of a long-term,high-fat diet and exercise on early stage osteoarthritis phenotypes in mice

Background:Obesity increases knee osteoarthritis(OA) risk through metabolic,inflammatory,and biomechanical factors,but how these systemic and local mediators interact to drive OA pathology is not well understood.We tested the effect of voluntary running exercise after chronic diet-induced obesity on knee OA-related cartilage and bone pathology in mice.We then used a correlation-based network analysis to identify systemic and local factors associated with early-stage knee OA phenotypes among the different diet and exercise groups.Methods:Male C57 BL/6 J mice were fed a defined control(10% kcal fat) or high fat(HF)(60% kcal fat) diet from 6 to 37 weeks of age.At 25 weeks,one-half of the mice from each diet group were housed in cages with running wheels for the remainder of the study.Histology,micro computed tomography,and magnetic resonance imaging were used to evaluate changes in joint tissue structure and OA pathology.These local variables were then compared to systemic metabolic(body mass,body fat,and glucose tolerance),inflammatory(serum adipokines and inflammatory mediators),and functional(mechanical tactile sensitivity and grip strength) outcomes using a correlation-based network analysis.Diet and exercise effects were evaluated by two-way analysis of variance.Results:An HF diet increased the infrapatellar fat pad size and posterior joint osteophytes,and wheel running primarily altered the subchondral cortical and trabecular bone.Neither HF diet nor exercise altered average knee cartilage OA scores compared to control groups.However,the coefficient of variation was≥25% for many outcomes,and some mice in both diet groups developed moderate OA(>33% maximum score).This supported using correlation-based network analyses to identify systemic and local factors associated with early-stage knee OA phenotypes.In wheel-running cohorts,an HF diet reduced the network size compared to the control diet group despite similar running distances,suggesting that diet-induced obesity dampens the effects of exercise on systemic and local OA-related factors.Each of the 4 diet and activity groups showed mostly unique networks of local and systemic factors correlated with early-stage knee OA.Conclusion:Despite minimal group-level effects of chronic diet-induced obesity and voluntary wheel running on knee OA pathology under the current test durations,diet and exercise substantially altered the relationships among systemic and local variables associated with early-stage knee OA.These results suggest that distinct pre-OA phenotypes may exist prior to the development of disease.

Theoretical basis of a beneficial role for vitamin D in viral hepatitis

Abnormal bone metabolism and dysfunction of the calcium-parathyroid hormone-vitamin D axis have been reported in patients with viral hepatitis. Some studies suggested a relationship between vitamin D and viral hepatitis. Genetic studies have provided an opportunity to identify the proteins that link vitamin D to the pathology of viral hepatitis (i.e., the major histocompatibility complex class Ⅱ molecules, the vitamin D receptor, cytochrome P 450 , the renin-angiotensin system, apolipoprotein E, liver X receptor, toll-like receptor, and the proteins regulated by the Sp1 promoter gene). Vitamin D also exerts its effects on viral hepatitis via non-genomic factors, i.e., matrix metalloproteinase, endothelial vascular growth factor, prostaglandins, cyclooxygenase-2, and oxidative stress. In conclusion, vitamin D could have a beneficial role in viral hepatitis. Calcitriol is best used for viral hepatitis because it is the active form of the vitamin D 3 metabolite.

Understanding practice patterns of glaucoma sub-specialists in India

AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.

Propionyl-L-carnitine hydrochloride for treatment of mild to moderate colonic inflammatory bowel diseases

AIM:To assess clinical and endoscopic response to propionyl-L-carnitine hydrochloride(PLC) in colonic inflammatory bowel disease.METHODS:Patients suffering from mild to moderate ulcerative colitis(UC) or Crohn's disease(CD) colitis,with disease activity index(DAI) between 3 and 10 and under stable therapy with oral aminosalicylates,mercaptopurine or azathioprine,for at least 8 wk prior to baseline assessments,were considered suitable for enrollment.Fourteen patients were enrolled to assume PLC 2 g/d(two active tablets twice daily) orally.Clinical-endoscopic and histological activity were assessed by DAI and histological index(HI),respectively,following a colonoscopy performed immediately before and after 4 wk treatment.Clinical response was defined as a lowering of at least 3 points in DAI and clinical remission as a DAI score ≤ 2.Histological response was defined as an improvement of HI of at least 1 point.We used median values for the analysis.Differences pre-and post-treatment were analyzed by Wilcoxon signed rank test.RESULTS:All patients enrolled completed the study.One patient,despite medical advice,took deflazacort 5 d before follow-up colonoscopy examination.No side effects were reported by patients during the trial.After treatment,71%(SE 12%) of patients achieved clinical response,while 64%(SE 13%) obtained remission.Separating UC from CD patients,we observed a clinical response in 60%(SE 16%) and 100%,respectively.Furthermore 60%(SE 16%) of UC patients and 75%(SE 25%) of CD patients were in clinical remission after therapy.The median DAI was 7 [interquartile range(IQR):4-8] before treatment and decreased to 2(IQR:1-3)(P < 0.01) after treatment.Only patients with UC showed a significant reduction of DAI,from a median 6.5(IQR:4-9) before treatment to 2(IQR:1-3) after treatment(P < 0.01).Conversely,in CD patients,although displaying a clear reduction of DAI from 7(IQR:5.5-7.5) before therapy to 1.5(IQR:0.5-2.5) after therapy,differences observed were not significant(P = 0.06).Seventy-nine percent(SE 11%) of patients showed improvement of HI of at least 1 point,while only one CD and two UC patients showed HI stability;none showed HI worsening.Median HI decreased from 1(IQR:1-2),to 0.5(IQR:0-1) at the endoscopic control in the whole population(P < 0.01),while it changed from 1(IQR:1-2) to 0.5(IQR:0-1) in UC patients(P < 0.01) and from 1.5(IQR:1-2) to 0.5(IQR:0-1) in CD patients(P = not significant).The two sample tests of proportions showed no significant differences in clinical and histological response or in clinical remission between UC and CD patients.No side effects were reported during treatment or at 4 wk follow-up visit.CONCLUSION:PLC improves endoscopic and histological activity of mild to moderate UC.Further studies are required to evaluate PLC efficacy in colonic CD patients.

Update on small intestinal stem cells

Among somatic stem cells, those residing in the intestine represent a fascinating and poorly explored research field. Particularly, somatic stem cells reside in the small intestine at the level of the crypt base, in a constant balance between self-renewal and differentiation. Aim of the present review is to delve into the mechanisms that regulate the delicate equilibrium through which intestinal stem cells orchestrate intestinal architecture. To this aim, special focus will be addressed to identify the integrating signals from the surrounding niche, supporting a model whereby distinct cell populations facilitate homeostatic vs injury-induced regeneration.

Peritraumatic Behavior Questionnaire- Observer Rated: Validation of the objective version of a measure for combatrelated peritraumatic stress

AIM: To validate the first third-person-rated measure assessing combat-related peritraumatic stress symptoms and evaluate its psychometric properties and war-zone applicability.METHODS: The valid assessment of peritraumatic symptoms in the theater of military operations represents a significant challenge in combat-related, mental health research, which mainly relies on retrospective, subjective self-report ratings. This longitudinal observational study used data from actively deployed troops to correlate third-person observer ratings of deployment peritraumatic behaviors [Peritraumatic Behavior Questionnaire- Observer Rated(PBQ-OR)] collected on a bimonthly basis with post-deployment(1-wk follow-up) ratings of the previously validated PBQ self-rate version(PBQ-SR), and(3-mo follow-up) clinician assessed and self-report posttraumatic stress disorder(PTSD) symptoms(Clinician Administered PTSD Scale, PTSD Checklist). Cronbach's alpha(α) and correlation coefficients were calculated to assess internal reliability and concurrent validity respectively. RESULTS: Eight hundred and sixty male Marines were included in this study after signing informed consents at pre-deployment(mean age 23.2 ± 2.6 years). Although our findings were limited by an overall sparse return rate of PBQ-OR ratings, the main results indicate satisfactory psychometric properties with good internal consistency for the PBQ-OR(α = 0.88) and high convergent and concurrent validity with 1-wk post-deployment PBQSR ratings and 3-mo posttraumatic stress symptoms. Overall, later PBQ-OR report date was associated with higher correlation between PBQ-OR and postdeployment measures. Kappa analysis between PBQOR and PBQ-SR single items, showed best agreement in questions relating of mortal peril, desire for revenge, and experience of intense physical reactions. Logistic regression demonstrated satisfactory predictive validity of PBQ-OR total score with respect to PTSD caseness(OR = 1.0513; 95%CI: 1.011-1.093; P = 0.02).CONCLUSION: Since no comparable tools have been developed, PBQ-OR could be valuable as real-time screening tool for earlier detection of Service Members at risk.

Assessment of single nucleotide polymorphisms associated with steroid-induced ocular hypertension

AIM:To access the association of forty-eight single nucleotide polymorphisms(SNPs)identified from Caucasian population with steroid-induced ocular hypertension(OHT)in India population.METHODS:Fifty-four triamcinolone-acetonide(TA)and for ty-seven dexamethasone(Dex)administered subjects were enrolled in the study after a written consent.Intraocular pressure(IOP)values were recorded for a period of 6-month post steroid injections and patients were grouped as steroid-responders(SR:IOP≥21 mm Hg)and non-responders(NR:IOP≤20 mm Hg).Genomic DNA was isolated from peripheral venous blood.Forty-eight SNPs identified in TA treated Caucasian patients by genome wide association study(GWAS)were genotyped using iPLEXTM MassA RRAY among TA as well as Dex administered Indian patients.Genotyping data of 48 general subjects from a previous study were considered as reference controls for statistical analysis.Genotypic frequencies were calculated and P-value,Chi-square and odds ratio at 95%confidenceinterval of group A(steroid treated vs controls),group B(SR vs NR),group C(phenotype correlation:influence of time,severity and gender on IOP rise),were calculated.P<0.05 was considered to be statistically significant.RESULTS:OHT was observed in 50%of TA and 26%of Dex administered patients,respectively.IOP rise was mostly severe(>30 mm Hg)and immediate(<1 wk)among TA-SR patients while it was noticed to be mild(<30 mm Hg)and between 1-2 mo among Dex-SR patients.Logistic regression for risk factor correlation with OHT remained non-significant,hence these factors were not considered as confounding parameters for further analysis.rs133,rs34016742,rs274554,rs10936746,rs274547,rs804854,rs7751500,rs359498,and rs7547448 SNPs significantly varied even after Bonferroni corrections(P<0.0025;group A).rs1879370(TA)and rs6559662(Dex)were significantly(P<0.05)associated with OHT(group B).rs133(severe IOP rise),rs11047639 and rs1879370(male gender),and rs11171569(immediate IOP rise)significantly(P<0.05)influenced the phenotype correlation only among TAOHT patients.However,the significance of these SNPs in group B and phenotype analysis(group C)was lost upon Bonferroni corrections(P<0.0025).CONCLUSION:Prevalence of OHT in study population is observed to be similar to other studies both in TA and Dex treated patients.We can correlate rs34016742 involved in diabetes signaling pathway to the occurrence of ocular edematous and inflammatory conditions.Except rs133 that is involved in neuro-degeneration and myopia occurrence,none of the other SNPs identified in Caucasian population possess any correlation with OHT incidence in TA and Dex administered Indian subjects.

Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

Ophthalmic profile and systemic features of pediatric facial nerve palsy

Background: Facial nerve palsy(FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identii able cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation.Methods: This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008.Results: A total of 22 patients were included in the study. The average age at presentation was 6.08 years(range, 4 months to 16 years). Only one patient(4.54%) had bilateral FNP and 21 cases(95.45%) had unilateral FNP. Seventeen patients(77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients(22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients(36.36%). Amblyopia was seen in ten patients(45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy.Conclusions: FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.

The Status of Human Immuno-deficiency Virus （HIV） Infection among Youth Aged 15-24 Years in Malawi and Kenya

HIV （Human Immuno-deficiency Virus） prevalence in Malawi is one of the highest in the world, with 10.3% of population living with HIV. Kenya has a prevalence rate of 6% and with 1.6 million people living with HIV infection. The broad objective of the study was to assess the proportion of youth aged 15-24 years affected by HIV in Malawi and Kenya. This was a descriptive study design. Data were mainly collected from reports from government, World Bank, World Health Organization and UN agencies. Graphs, tables and charts have been used to present statistics. Data for specific age cohort were hard to find and hence, data were used for general HIV and AIDS with special attention to the youth where possible. In Kenya, HIV prevalence among young women jumps three folds from 2.8% of 15-17 year olds to 8.3% among 23-24 year olds. In Malawi, around 2,100 young people and adolescents are infected with HIV every day. In 2013, four million young people aged 15-24 were living with HIV, with 29% aged under 19 years. This age group includes school going youths, newly employed, economically productive and sexually active group. HIV prevalence in Malawi has been declining over time among persons aged 15-19 years from 16.4% in 1999 to 11.8 % in 2004 to 10.6% in 2010 and 10.3% in 2016. However, in Kenya, the trend of HIV prevalence reached its peak of 10.55% in 1995-1996 after which it declined to 6.7% in 2003 and has been stable since then.

Telehealth Combined with Differentiated ART Delivery Improves ART Pick Up during COVID 19 at a Large HIV Treatment Facility in Trinidad and Tobago

Objective: To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. Design and Methods: Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. Results: During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. Conclusion: Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.

Systems biology applications to study mechanisms of human immunodeficiency virus latency and reactivation

Eradication of human immunodeficiency virus(HIV) in infected individuals is currently not possible because of the presence of the persistent cellular reservoir of latent infection. The identification of HIV latency biomarkers and a better understanding of the molecular mechanisms contributing to regulation of HIV expression might provide essential tools to eliminate these latently infected cells. This review aims at summarizing gene expression profiling and systems biology applications to studies of HIV latency and eradication. Studies comparing gene expression in latently infected and uninfected cells identify candidate latency biomarkers and novel mechanisms of latency control. Studies that profiled gene expression changes induced by existing latency reversing agents(LRAs) highlight uniting themes driving HIV reactivation and novel mechanisms that contribute to regulation of HIV expression by different LRAs. Among the reviewed gene expression studies, the common approaches included identification of differentially expressed genes and gene functional category assessment. Integration of transcriptomic data with other biological data types is presently scarce, and the field would benefit from increased adoption of these methods in future studies. In addition, designing prospective studies that use the same methods of data acquisition and statistical analyses will facilitate a more reliableidentification of latency biomarkers using different model systems and the comparison of the effects of different LRAs on host factors with a role in HIV reactivation. The results from such studies would have the potential to significantly impact the process by which candidate drugs are selected and combined for future evaluations and advancement to clinical trials.

The Expressed Parasitism Genes in the Reniform Nematode (<i>Rotylenchulus reniformis</i>)

The reniform nematode (RN), Rotylenchulus reniformis, is an agriculturally important pest with a broad host range that results in a large economic impact in tropical, subtropical and in warm temperate zones. In an initial effort to understand the transcriptome and gene expression in RN, we present EST results that reveal numerous putative parasitism-related genes some of which play roles in plant cell wall modification. The characterized contigs included 8362 (40.6%) matches to unique proteins. Coding contigs predicted were 10,656 (51.7%) or 3079 (14.9%), that was similar to those identified in Brugia malayi and Caenorhabditis elegans as reference organisms respectively. Specific transcripts studied in more detail include putative plant parasitism genes, prominent among them were several plant cell wall modification genes. Contigs matching 14 parasitism genes found in sedentary endoparasitic nematodes included expansins, hexosaminidase, glycosyl hydrolases family, 14-3-3 protein, xylanases, glutathione peroxidase, pectate lyase, β-1,4-endoglucanase, major sperm protein, aminopeptidase, c-type lectin, chitin synthase, FMR famide-like peptide, and calreticulin. These genes function in suppression of host defenses and development of feeding sites.

Security and Audit Trail Capabilities of a Facilitated Interface Used to Populate a Database System with Text and Graphical Data Using Widely Available Software

In prior work we described techniques used to capture, store, and retrieve narrative data forms from a database using widely available off the shelf software. This concept makes use of the security and versioning features of database architecture together with those of image-supported electronic document information capture. We present herein the security and audit trail features of our construct. Unique usernames and passwords are used at the operating system level to enforce client validation and control access to the database system via an electronic signature using a Boolean logic algorithm. We used the database domain to capture original data and any changes to the data, developing an audit trail displaying identification information. Version controlled and change tracked electronic documents can be retrieved through the client side web interface to enable direct search operations, thus uncoupling the client from database query languages.

The Triple Procedure:Analysis of Structural,Functional&Refractive Outcome

To analyse the outcome of Triple procedure(Combined penetrating keratoplasty,cataract extraction and intraocular lens implantation)is a surgical technique for visually disabling corneal conditions with associated cataract.METHODS:The medical records of 120 patients who underwent triple procedure between January 2007 and December 2011 in terms of demographic data,past ophthalmic history,indications for surgery were retrospectively reviewed.Salient preoperative data included the initial visual acuity at the time of presentation,slit lamp findings of cornea(scar,haze,vascularisation,stromal folds with bullae),anterior chamber,lens details,intraocular pressure status,posterior segment examination with the help of indirect ophthalmoscope or B scan ultrasongraphy.RESULTS:A total of 120 corneal triple procedures performed were included in this study.Of 120 patients,25(20.83%)were male and 95(79.17%)were female.Mean age of these patients was 42.45+/-15.85 years(range 9 to 75 years).The mean postoperative follow up was 15.08+/-12.8 months(range,1.5 to 49 months).Failed therapeutic grafts(42.5%)-was the common indication found for surgery.Preoperatively,intraocular pressure was increased in 11(9.16%)patients.Conventional triple procedure in terms of combined penetrating keratoplasty with extracapsular cataract extraction with intraocular lens implantation(PK+ECCE+IOL)was performed in 114(95%)eyes,01(0.83%)eye underwent keratoplasty with phacoemulsification with intraocular lens implantation(PK+PE+IOL),and secondary intraocular lens implantation(PK+IOL)in 05(4.17%)eyes.CONCLUSION:Triple procedure is an effective surgical option in corneal diseases associated with cataract.It provides an optimal visual and refractive outcome especially in high risk grafts situation.

印度南部农村地区闭角型青光眼的患病率

Objective:To estimate the prevalence of primary angle-closure glaucoma,primary angle closure(PAC),and primary angleclosure suspect(PACS)and its associated risk factors in a rural population in southern India.Methods:Three thousand and nine hundred thirty-four(81.95%)of 4800 enumerated subjects aged 40 years or older underwent a complete ophthalmic examination,including compression gonioscopy.Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology classification.Results:Data were analyzed for 3924 subjects(81.75%).Primary angleclosure glaucoma was diagnosed in 34 subjects(0.87% ;95% confidence interval CI,0.58 to 1.16)(27 women,7 men).The mean intraocular pressure was 20.71± 9.24 mm Hg.One subject(2.94%)was blind.Twenty-eight subjects(0.71% ;95% CI,0.45 to 0.98)were diagnosed to have PAC(21 women,7 men).Eleven subjects(39.3%)had an intraocular pressure greater than 21 mm Hg,13 subjects(46.43%)had peripheral anterior synechiae,and 4 subjects(14.29%)had both.Two hundred forty-six subjects(6.27% ;95% CI,5.51 to 7.03)had PACS(168 women,78 men).Primary angle closure and primary angle-closure glaucoma were more common in women(age-adjusted odds ratio,3.02;95% CI,1.66 to 5.51)with an increasing prevalence with age.Increasing intraocular pressure was associated with the disease(odds ratio,1.14;95% CI,1.09 to 1.19).There was no association with hypertension and hyperopia.Axial length and anterior chamber depth were longer in the normal group than in the 3 groups with angle closure(P <.05).Women had shorter axial lengths than men(P <.001)in the angle closure groups.Conclusions:The overall prevalence of primary angle closures(PAC and primary angleclosure glaucoma)in a rural population of southern India was 1.58%.There was a female preponderance,and the disease tends to be asymptomatic.

慢性丙型肝炎患者初期治疗应答的多种细胞因子表达谱

Currently available prognostic tools are inadequate to discern the molecular basis of the heterogenic response in hepatitis C virus (HCV) infected patients treated with the current standard of therapy. The expression and biological function of immune mediators have been shown to be critical in all phases of the immune response to HCV infection and likely therefore influence host response. Herein, a biometric multiplex serum cytokine assay was utilized to characterize the immunomodulatory effects of host response in 10 HCV patients. Serum levels of 17 cytokines were compared before and after 1 month of treatment and against controls. Overall serum cytokine levels were significantly higher in patients (P < 0.05) than controls. Additionally, viral titers decreased in all patients after 1 month of therapy, as did overall serum cytokine levels in the cohort (P < 0.05). To assess relationships between changes in cytokine levels and changes in viral titer, the cohort was divided into three statistically distinct subgroups based on changes in viral titers. Specific sets of cytokines decreased in each group: decreases in CCL4, interleukin (IL)-2, CXCL8, and IL-1β.correlated with the greatest drops in viral titer, decreases in IL-5, granulocyte colony stimulating factor (G-CSF), and CCL4 correlated with moderate drops in viral titer, and only CCL2 correlated with the lowest drops in viral titer. Interestingly, decreases in CCL4 levels correlated with decreases in viral titers in all patients. CCL4 controls leukocyte influx and thus propagates inflammation. In conclusion, these data raise the possibility that characteristic changes in host response modulate the therapeutic response, demonstrating the prognostic power of serum cytokine profiling in chronic HCV.