New approaches in the diagnosis and management of diabetic retinopathy

Diabetic retinopathy(DR)presents one of the greatest challenges currently faced in ophthalmology by both patients and clinicians.Simply by virtue of the number of people impacted and the acceleration in the development of diabetes in larger populations throughout the world,the problem of diabetic complications has taken on new urgency in recent years.Because of the immediate impact on quality of life,activities of daily living,and a person’s ability to work and live independently,DR tops the list of concerns about the damage wrought by the explosive growth of diabetes.

Telemedicine diabetic retinopathy screening: rationale and practical considerations in mobile imaging with ultra-widefield photography

Several factors drive the need for increased efficiency in telemedicine screening programs directed toward diabetic retinopathy:continually increasing prevalence of diabetes worldwide,growing awareness among physicians and patients of the importance of early detection of retinal damage,and emerging technology in artificial intelligence that enables rapid identification of vision-threatening fundus features.In this context,optimizing workflows in teleretinopathy programs becomes a priority.Recent work has revealed opportunities for improvement in areas of logistics,in particular in finding the best way to get diabetic patients in front of screening cameras as conveniently as possible,as this improves compliance and,ultimately,achieves the widest reach for detection programs.The present review discusses particular aspects of mobile screening programs in which specialized retinal cameras are deployed in a van or similar type of vehicle so that they can reach patients anywhere in order to reduce barriers to access.The rationale for implementing such programs and practical considerations are presented,along with a view toward future expansion of screening and integration with artificial intelligence platforms.Lacking standardization of format and quality control among smartphone-linked approaches at present,translation of eye clinic-based photographic techniques to community-based screening offers a means of expanding the scope of impactful screening programs without the need for adoption of significantly new technology.

Interleukin-6 mediates neutrophil mobilization from bone marrow in pulmonary hypertension

Myeloid cells,such as neutrophils,are produced in the bone marrow in high quantities and are important in the pathogenesis of vascular diseases such as pulmonary hypertension(PH).Although neutrophil recruitment into sites of inflammation has been well studied,the mechanisms of neutrophil egress from the bone marrow are not well understood.Using computational flow cytometry,we observed increased neutrophils in the lungs of patients and mice with PH.Moreover,we found elevated levels of IL-6 in the blood and lungs of patients and mice with PH.We observed that transgenic mice overexpressing Il-6 in the lungs displayed elevated neutrophil egress from the bone marrow and exaggerated neutrophil recruitment to the lungs,resulting in exacerbated pulmonary vascular remodeling,and dysfunctional hemodynamics.Mechanistically,we found that IL-6-induced neutrophil egress from the bone marrow was dependent on interferon regulatory factor 4(IRF-4)-mediated CX3CR1 expression in neutrophils.Consequently,Cx3cr1 genetic deficiency in hematopoietic cells in Il-6-transgenic mice significantly reduced neutrophil egress from bone marrow and decreased neutrophil counts in the lungs,thus ameliorating pulmonary remodeling and hemodynamics.In summary,these findings define a novel mechanism of IL-6-induced neutrophil egress from the bone marrow and reveal a new therapeutic target to curtail neutrophil-mediated inflammation in pulmonary vascular disease.

Best practices in teaching endoscopy according to a Delphi survey of gastroenterology trainees

Introduction Endoscopy is a core component of gastroenterology training[1],yet there are no guidelines on how endoscopists should teach the procedure[2].Across most programs in the USA,endoscopy training follows an apprenticeship model,in which trainees develop skills through supervised,hands-on practice[3].Although some programs use assessment tools to determine proficiency in performing endoscopy procedures,most rely principally on procedural volume and subjective evaluations.As a result,endoscopic training is variable across and within institutions.