Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

PURPOSE: To evaluate posterior capsule opacification (PCO) in humans after cataract surgery with intraocular lens (IOL) implantation, by using optical coherence tomography (OCT-1). METHODS: Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 microm. Results were compared with visual acuity (VA) and PCO type. RESULTS: Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88-20.41) and 11.9 (8.58-14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 microm; range, 46.33-115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 microm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (r(o) = 0.66; P = 0.01). CONCLUSIONS: OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation

Cirrus high-definition optical coherence tomography compared with Stratus optical coherence tomography in glaucoma diagnosis

To compare the retinal nerve fiber layer (RNFL) evaluation using Cirrus optical coherence tomography (OCT) and Stratus OCT in glaucoma diagnosis. METHODS: One hundred thirty normal and 86 patients with glaucoma were included in this prospective study. The signal strengths of the OCTs were evaluated. The sensitivities and specificities of global RNFL average thickness were compared in the four quadrants and in each clock hour sector. Receiver operating characteristic (ROC) curves, areas under the ROC (AUC), and the likelihood ratio (LR) were plotted for RNFL thickness. Agreement between the OCTs was calculated by using the Bland-Altman method and kappa (kappa) coefficient. RESULTS: Twenty-three percent of all cases examined with Stratus OCT and 1.9% examined with Cirrus OCT had a signal strength below 6 (P = 0.01). In cases with signal strengths > or =6, the mean signal strength was higher with Cirrus OCT than with Stratus OCT (P = 0.01). The RNFL measurements by Cirrus were thicker than those of Stratus OCT (P < 0.05). The AUCs were 0.829 for Stratus and 0.837 for Cirrus OCT (P = 0.706) for global RNFL average. LRs were similar in both OCTs in global RNFL classification but varied in quadrants. The widths of the limits of agreement varied between 42.16 and 97.79 microm. There was almost perfect agreement (kappa = 0.82) in the average RNFL classification. CONCLUSIONS: Cirrus OCT has better scan quality than Stratus OCT, especially in glaucomatous eyes. In cases with good-quality scans, the sensitivity and specificity, and AUCs were similar. The best agreement was in the global average RNFL classification. The widths of limits of agreements exceed the limits of resolution of the OCTs

Retinal thickness study with optical coherence tomography in patients with diabetes

To quantitatively assess retinal thickness by optical coherence tomography (OCT) in normal subjects and patients with diabetes. This study was intended to determine which retinal thickness value measured with OCT best discriminates between diabetic eyes, with and without macular edema. METHODS: OCT retinal thickness was measured by a manual technique in a total of 26 healthy volunteers (44 control eyes) and 85 patients with diabetes (148 eyes) with the clinical diagnosis of no diabetic retinopathy (45 eyes), nonproliferative diabetic retinopathy without clinically significant macular edema (CSME; 54 eyes), proliferative diabetic retinopathy without CSME (21 eyes), and 28 eyes with diabetic retinopathy with CSME. Independent predictors of the presence of CSME were quantified by using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to evaluate and compare the predictor variables. The correlation of retinal thickness measurements and visual acuity was calculated. RESULTS: There were statistically significant differences in foveal thickness between control eyes and all the other eye groups (P = 0.001). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other groups. In a multivariate logistic regression model, foveal thickness was a strong and independent predictor of CSME (odds ratio [OR], 1.037; 95% confidence interval [CI] 1.02-1.05). The area under the ROC curve of this predictor variable was 0.94 (P = 0.001). For a cutoff point of 180 microm, the sensitivity was 93%, and specificity was 75%. Foveal thickness correlated with visual acuity in a log minimum angle of resolution (logMAR) scale (Spearman's rho = 0.9, P = 0.001). CONCLUSIONS: These results suggest that foveal thickening over 180 microm measured by OCT may be useful for the early detection of macular thickening and may be an indicator for a closer follow-up of the patient with diabetes

Seafood Consumption, Omega-3 Fatty Acids Intake, and Life-Time Prevalence of Depression in the PREDIMED-Plus Trial

Background: The aim of this analysis was to ascertain the type of relationship between fish and seafood consumption, omega-3 polyunsaturated fatty acids (ω-3 PUFA) intake, and depression prevalence. Methods: Cross-sectional analyses of the PREDIMED-Plus trial. Fish and seafood consumption and ω-3 PUFA intake were assessed through a validated food-frequency questionnaire. Self-reported life-time medical diagnosis of depression or use of antidepressants was considered as outcome. Depressive symptoms were collected by the Beck Depression Inventory-II. Logistic regression models were used to estimate the association between seafood products and ω-3 PUFA consumption and depression. Multiple linear regression models were fitted to assess the association between fish and long-chain (LC) ω-3 PUFA intake and depressive symptoms. Results: Out of 6587 participants, there were 1367 cases of depression. Total seafood consumption was not associated with depression. The odds ratios (ORs) (95% confidence intervals (CIs)) for the 2nd, 3rd, and 4th quintiles of consumption of fatty fish were 0.77 (0.63–0.94), 0.71 (0.58–0.87), and 0.78 (0.64–0.96), respectively, and p for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5–1 g/day) was significantly associated with a lower prevalence of depression. Conclusion: In our study, moderate fish and LC ω-3 PUFA intake, but not high intake, was associated with lower odds of depression suggesting a U-shaped relationship

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

PURPOSE: To evaluate posterior capsule opacification (PCO) in humans after cataract surgery with intraocular lens (IOL) implantation, by using optical coherence tomography (OCT-1). METHODS: Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 microm. Results were compared with visual acuity (VA) and PCO type. RESULTS: Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88-20.41) and 11.9 (8.58-14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 microm; range, 46.33-115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 microm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (r(o) = 0.66; P = 0.01). CONCLUSIONS: OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation

Capa de fibras nerviosas en ojos glaucomatosos. Estudio realizado mediante OCT y su comparación con el campo visual

To investigate the retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes using Optical Coherence Tomography (OCT). To compare the RNFL thickness with visual field damage (Humphrey field analyzer). MATERIAL AND METHODS: The mean RNFL thickness in glaucomatous eyes (n = 80) was compared with age-matched normal eyes (n = 40). Three circular scans were obtained for each eye using OCT (3.4 mm diameter). In each eye, average RNFL, 4 quadrants and 12 meridians were calculated and compared. The superior-inferior asymmetry of RNFL was studied. The average RNFL thickness was compared with mean deviation (MD) and mean standard deviation (MSD) of SITA 24-2 visual field program. RESULTS: Mean RNFL was significantly thinner in glaucomatous eyes than in normal eyes (p<0.001). The RNFL thickness was decrease in the 4 quadrants and 11 of 12 meridians studied in glaucomatous eyes (p<0.05). The superior-inferior asymmetry showed a significant difference in RNFL thickness at 30 degrees central meridian (p<0.05). Mean RNFL thickness was significantly associated with DM and DSM of visual field (p<0.001) in glaucomatous eyes. CONCLUSIONS: OCT revealed significant quantitative differences in RNFL thickness between glaucomatous and normal eyes. OCT showed a considerable measurements overlap between glaucomatous and normal eyes, which can limit the sensitivity and specificity of this instrumen

Capa de fibras nerviosas en ojos glaucomatosos. Estudio realizado mediante OCT y su comparación con el campo visual

To investigate the retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes using Optical Coherence Tomography (OCT). To compare the RNFL thickness with visual field damage (Humphrey field analyzer). MATERIAL AND METHODS: The mean RNFL thickness in glaucomatous eyes (n = 80) was compared with age-matched normal eyes (n = 40). Three circular scans were obtained for each eye using OCT (3.4 mm diameter). In each eye, average RNFL, 4 quadrants and 12 meridians were calculated and compared. The superior-inferior asymmetry of RNFL was studied. The average RNFL thickness was compared with mean deviation (MD) and mean standard deviation (MSD) of SITA 24-2 visual field program. RESULTS: Mean RNFL was significantly thinner in glaucomatous eyes than in normal eyes (p<0.001). The RNFL thickness was decrease in the 4 quadrants and 11 of 12 meridians studied in glaucomatous eyes (p<0.05). The superior-inferior asymmetry showed a significant difference in RNFL thickness at 30 degrees central meridian (p<0.05). Mean RNFL thickness was significantly associated with DM and DSM of visual field (p<0.001) in glaucomatous eyes. CONCLUSIONS: OCT revealed significant quantitative differences in RNFL thickness between glaucomatous and normal eyes. OCT showed a considerable measurements overlap between glaucomatous and normal eyes, which can limit the sensitivity and specificity of this instrumen