Observation of angiographic dye leakage in ocular surface squamous neoplasia.

PurposeThe clinical diagnosis of ocular surface squamous neoplasia is challenging, mostly requiring excisional biopsy. Human tumor angiogenesis is characterized by abnormal vessel architecture and transvascular hyperpermeability. This case report describes features of fluorescein and indocyanine green angiography in a case of conjunctival intraepithelial neoplasia.ObservationsColor photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed in a patient with suspected conjunctival intraepithelial neoplasia before excisional biopsy and histologic confirmation of clinical diagnosis. Fluorescein dye showed extensive early extravascular dye leakage within the limits of the lesion. Indocyanine green dye displayed corneal terminal vessel bulbs with early leakage after 70 seconds and showed diffuse intralesional dye leakage after 7 minutes.ConclusionsIncreased fluorescein and early indocyanine green dye leakage can be used to confirm active angiogenesis already in early stages of dysplastic ocular surface squamous neoplasia. Late leakage of indocyanine green dye may be due to chronic transvascular hyperpermeability within intrinsic tumor vessels. The leakage behaviour of intravenous dyes has the potential to serve as a diagnostic indicator of active growth in dysplastic ocular surface neoplastic lesions

Artificial Intelligence (AI) Reveals Ethnic Disparities in Cataract Detection and Treatment

Introduction: The aim of this work is to identify patients at risk of limited access to healthcare through artificial intelligence using a name-ethnicity classifier (NEC) analyzing the clinical stage of cataract at diagnosis and preoperative visual acuity. Methods: This retrospective, cross-sectional study includes patients seen in the cataract clinic of a tertiary care hospital between September 2017 and February 2020 with subsequent cataract surgery in at least one eye. We analyzed 4971 patients and 8542 eyes undergoing surgery. Results: The NEC identified 360 patients with names classified as ‘non-German’ compared to 4611 classified as ‘German’. Advanced cataract (7 vs. 5%; p = 0.025) was significantly associated with group ‘non-German’. Mean best-corrected visual acuity in group ‘non-German’ was 0.464 ± 0.406 (LogMAR), and in group ‘German’ was 0.420 ± 0.334 (p = 0.009). This difference remained significant after exclusion of patients with non-lenticular ocular comorbidities. Surgical time and intraoperative complications did not differ between the groups. Retrobulbar or general anesthesia was chosen significantly more frequently over topical anesthesia in group ‘non-German’ compared to group ‘German’ (24 vs. 18% respectively; p < 0.001). Conclusions: This study shows that artificial intelligence is able to uncover health disparities between people with German compared to non-German names using NECs. Patients with non-German names, possibly facing various social barriers to healthcare access such as language barriers, have more advanced cataracts and worse visual acuity upon presentation. Artificial intelligence may prove useful for healthcare providers to discover and counteract such inequalities and establish tailored preventive measures to decrease morbidity in vulnerable population subgroups

Intraoperative management of macroperforations of Descemet's membrane in deep anterior lamellar keratoplasty.

BackgroundTo describe a surgical approach for the completion of pre-descemetic deep anterior lamellar keratoplasty (pdDALK) in the presence of a macroperforation of Descemet's membrane (DM).MethodsUsing case notes, we recorded the details of the intra- and perioperative course of patients who underwent successful pdDALK in the presence of macroperforation. A literature search of pdDALK techniques available to the corneal surgeon in a similar scenario was undertaken.ResultsIn two very different scenarios with intra- or preoperative perforation of DM, a centripetal layered lamellar dissection was performed and allowed completion of pdDALK with a residual recipient central stromal thickness of 36 and 115 µm and good visual outcome.ConclusionDespite very different scenarios, a centripetal layered lamellar dissection offers an approach for the completion of pdDALK in the presence of a macroperforation

Public policy-making and risk profiles: Scandinavian centre-right governments after the turn of the millennium

Recent theoretical advances in the welfare state literature have outlined the differences between labour market- and life course-related schemes as centre-right parties have difficulties in enacting retrenchment on life course-related schemes because these concern every voter. In contrast, the textbook risk profile of centre-right parties’ electorates allows them to cutback on labour market-related schemes as these parties get negligible support from workers and low-income voters. Conducting a comparative case study of recent Danish and Swedish centre-right governments, this article analyses the stylized assumptions on the party level by comparing two similar centre-right governments, which differed in their voter coalitions’ risk profile. I first argue that centre-right governments are generally constrained by the popular entrenchment of the universal welfare state when it comes to life course-related welfare schemes. Second, I argue that the leeway on labour market-related schemes is contingent on the actual risk profile of the centre-right’s electorate, and thereby move beyond the stylized assumptions from recent literature. In this respect, the Danish centre-right did, in contrast to its Swedish counterpart, gain power with an unusual high support among workingclass voters which constrained its latitude on labour market-related schemes. I find that the Danish centre-right governments after 2001 acted with bound hands thanks to its high working-class backing, and refrained from outright cutbacks on both labour market- and life course-related schemes until 2010 except for labour market outsiders. In contrast, the Swedish centre-right had a much lower working-class backing and therefore engaged in some outright cutbacks of labour market-related schemes such as unemployment benefits directly after taking office 2006. The centre-right’s actual voter coalition’s risk profile is thus an important determinant for its public policies and its leeway for policy-seeking

Stress hormones or general well-being are not altered in immune-deficient mice lacking either T- and B- lymphocytes or Interferon gamma signaling if kept under specific pathogen free housing conditions

It is controversially discussed whether immune-deficient mice experience severity in the absence of infection. Because a comprehensive analysis of the well-being of immune-deficient mice under specific pathogen free conditions is missing, we used a multi-parametric test analyzing, corticosterone, weight, nest building and facial expression over a period of 9 month to determine the well-being of two immune-deficient mouse lines (recombination activating gene 2- and interferon gamma receptor-deficient mice). We do not find evidence for severity when comparing immune-deficient mice to their heterozygous immune-competent littermates. Our data challenge the assumption that immune-deficiency per se regardless of housing conditions causes severity. Based on our study we propose to use objective non-invasive parameters determined by laboratory animal science for decisions concerning severity of immune-deficient mice

Functional Staging of Corneal Neovascularization Using Fluorescein and Indocyanine Green Angiography

Court of Appeals No. 89-0340 CA Argument Priority No. 14(b) District Court No. C-86-8833 Judge: John A. Rokic

Assessment of the correlation of the tear breakup time with quality of vision and dry eye symptoms after SMILE surgery

Purpose: It is well reported that dry eye symptoms can increase after many refractive surgery procedures. This study aims to provide a clinical understanding of the correlation of fluorescein tear film breakup time (FTBUT) with quality of vision (QoV) and dry eye symptoms following small incision lenticule extraction surgery (SMILE). Methods: Patients electing to have SMILE surgery were subdivided into 2 groups: Group 1 included short preoperative FTBUTs of 3 to 6 seconds (s); Group 2 included long FTBUTs of ≥ 8 s. Uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction, FTBUT, QoV and Ocular Surface Disease Index (OSDI) questionnaires were recorded 1 and 6 months postoperatively. Results: Thirty-nine subjects were included in each group. There was no significant difference in visual outcomes between the 2 groups at both the 1- and 6-month postoperative assessments. FTBUT remained significantly lower in group 1. Oxford staining was initially higher for group 1 at 1 month (P = 0.007), but there was no significant difference at 6 months (P = 0.180). There was no significant difference in QoV or OSDI scores between the 2 groups at both postoperative visits. Conclusions: Low preoperative FTBUT (3–6 s) does not appear to negatively affect postoperative visual outcomes or results in a greater likelihood of dry eye symptoms and poor ocular surface compared to eyes with a longer preoperative FTBUT. These results suggest that a low preoperative FTBUT does not necessarily increase the likelihood of poor visual acuity, dry eyes symptoms, or poor ocular surface outcomes following SMILE surgery

Inhibition of lysyl oxidases synergizes with 5-azacytidine to restore erythropoiesis in myelodysplastic and myeloid malignancies

Limited response rates and frequent relapses during standard of care with hypomethylating agents in myelodysplastic neoplasms (MN) require urgent improvement of this treatment indication. Here, by combining 5-azacytidine (5-AZA) with the pan-lysyl oxidase inhibitor PXS-5505, we demonstrate superior restoration of erythroid differentiation in hematopoietic stem and progenitor cells (HSPCs) of MN patients in 20/31 cases (65%) versus 9/31 cases (29%) treated with 5-AZA alone. This effect requires direct contact of HSPCs with bone marrow stroma components and is dependent on integrin signaling. We further confirm these results in vivo using a bone marrow niche-dependent MN xenograft model in female NSG mice, in which we additionally demonstrate an enforced reduction of dominant clones as well as significant attenuation of disease expansion and normalization of spleen sizes. Overall, these results lay out a strong pre-clinical rationale for efficacy of combination treatment of 5-AZA with PXS-5505 especially for anemic MN