Low-Cost and Readily Available Tissue Carriers for the Boston Keratoprosthesis: A Review of Possibilities

The Boston keratoprosthesis (B-KPro), currently the most commonly used artificial cornea worldwide, can provide rapid visual rehabilitation for eyes with severe corneal opacities not suitable for standard corneal transplantation. However, the B-KPro presently needs a corneal graft as a tissue carrier. Although corneal allograft tissue is readily available in the United States and other developed countries with established eye banks, the worldwide need vastly exceeds supply. Therefore, a simple, safe, and inexpensive alternative to corneal allografts is desirable for the developing world. We are currently exploring reasonable alternative options such as corneal autografts, xenografts, noncorneal autologous tissues, and laboratory-made tissue constructs, as well as modifications to corneal allografts, such as deep-freezing, glycerol-dehydration, gamma irradiation, and cross-linking. These alternative tissue carriers for the B-KPro are discussed with special regard to safety, practicality, and cost for the developing world

Consejo de administración y desempeño financiero. Un estudio bibliométrico

Este trabajo analiza la evolución que ha tenido la investigación científica sobre los “consejos de administración” o llamados “directorios” y su relación con los “resultados financieros de las empresas”. Se propone un análisis bibliométrico con base a revistas indexadas en Web of Science (WoS) hasta el año 2019, permitiendo evidenciar la relevancia que ha tenido para las empresas y el mundo científico. Metodológicamente, se analizó inicialmente 4.468 artículos del área de negocios, filtrando la búsqueda de al menos una de las palabras clave, encontrando 3.302 publicaciones desde 1988. Se aplicaron técnicas bibliométricas apoyadas por el software VOSviewer. Entre los resultados se destaca que las publicaciones se concentran en 637 revistas, con la mayor producción entre el 2009 y 2019, equivalente al 80,8% del total. Tres revistas de alto impacto concentran la mayor cantidad de publicaciones. Europa lidera la producción científica, destacando la académica Isabel María García Sánchez y el autor más citado David Yermack. Las palabras clave más citadas son gobierno corporativo, directores y desempeño. Se observan nuevas líneas potenciales de investigación en temas de diversidad, mujeres y características propias en los CA como el estudio de caso de países emergentes y empresas familiares

Body image before and after bariatric surgery: Perceptions of young-adults women / Imagen corporal antes y después de cirugía bariátrica: Percepciones de mujeres jóvenes-adultas

Abstract Considering the high prevalence of obesity and the lack of effective response to non-surgical treatments, bariatric surgery (BS) has been established as an increasingly frequent alternative, with implications on the physical, psychological and social level, highlighting the changes related to body image (BI). The objective of this study was to describe changes in BI expressed by young women undergoing BC. Based on a qualitative methodology, in-depth interviews were conducted with 10 women between 18 and 24 years. The results were grouped in Pre-BC: body dissatisfaction as motivation, low awareness of the obesity condition, shame of the body, frustration and difficulties with dressing; and Post-BS: body satisfaction associated with self-confidence, change in peer relations, new aspects of appearance, clothing associated with identity, difficulties in adapting to a new BI, and health team as support for adaptation. It is concluded that body satisfaction is a central aspect that affects individual and social wellbeing. Post-CB begins a process of adaptation to a new body scheme, with greater body satisfaction, but with difficulties related to body perception.ResumenDada la alta prevalencia de obesidad y la pobre efectividad de los tratamientos no quirúrgicos, la cirugía bariátrica (CB) constituye una alternativa cada vez más frecuente, con implicaciones a nivel físico, psicológico y social, entre las que destacan aquellas relativas a la imagen corporal (IC). El objetivo de este estudio fue describir los cambios en la IC manifestados por mujeres jóvenes sometidas a CB. Con base a una metodología cualitativa, se llevaron a cabo entrevistas a profundidad a 10 mujeres de entre 18 y 24 años de edad. Los resultados fueron categorizados en Pre-CB: insatisfacción corporal como motivación, baja conciencia de la condición de obesidad, vergüenza por el cuerpo, frustración y dificultades con la vestimenta; y Post-CB: satisfacción corporal (SC) asociada a autoconfianza, cambio en las relaciones con pares, nuevos aspectos de la apariencia, vestimenta asociada a identidad, dificultades en la adaptación a la nueva IC y equipo de salud como apoyo para la adaptación. Se concluye que la SC es un aspecto central que incide en el bienestar individual y social. Post-CB se inicia un proceso de adaptación a un nuevo esquema corporal, con mayor SC, pero con dificultades relacionadas a la percepción corporal

Eating disorders: Reflecting on the sociocultural variables / Trastornos de la conducta alimentaria: Reflexionando en torno a las variables socioculturales

Abstract. Eating disorders (ED) are illnesses that had awakened enormous interest in social and health media in the last years. Thus now days, it is spoken of authentic epidemics, in which the diagnosis is late, existing multiple management difficulties and numerous risks in their development. This article aims to install a reflection on the importance of a socio-cultural context, since cultural beliefs and values associated to beauty and food would be linked to the subjectivity that surrounds this disease. In this sense, the characteristic symptoms of this disorder occur in a cultural reference framework that has to be analyzed.   Key words: Eating Disorders, treatment, culture.   Resumen. Los trastornos de la conducta alimentaria (TCA) son enfermedades que han despertado, en los últimos años, enorme interés en medios sociales y sanitarios. En la actualidad se habla de auténticas epidemias, donde el diagnóstico es tardío, existiendo múltiples dificultades de manejo y numerosos riesgos en su evolución. Este artículo tiene como objetivo instalar una reflexión en torno a la importancia de rescatar el contexto sociocultural, ya que las creencias y valores culturales asociados a la belleza y a la comida, estarían vinculados a la subjetividad que rodea dicha patología. En ese sentido, la sintomatología característica de este trastorno se da en un marco referencial cultural importante de ser analizado.   Palabras clave: Trastornos alimentarios, tratamiento, cultura

Desempeño financiero y tipología de profesionales en directorios de empresas brasileñas

This research purports to measure the relationship between the professional diversity of the boards of directors and the financial performance of the Brazilian stock companies with a multiple regression model. Methodologically, this is study of a quantitative character with an explanatory scope and a transversal section; it concerns the companies listed in the Ibovespa index for the years 2017 and 2018. Likewise, these firm´s performance was measured through financial indicators, such as ROA, ROE and Profit Margin. The results reveal a diversified board of directors, but this is not statistically significant compared to the financial indicators ROA, ROE and Profit Margin for both years, that have reached a 95% confidence level.  There is, however, an average of 87.4% professional diversity and 49.5% of postgraduate´s presence in the board of directors.  The Engineering, Administration, Economy and Law areas predominate as important decision-making focus.Esta investigación tiene por objetivo medir la relación entre la diversidad profesional de los directorios y el desempeño financiero de las empresas bursátiles de Brasil con un modelo de regresión múltiple. El estudio es de carácter cuantitativo con un alcance explicativo de corte transversal, considerando las compañías cotizantes en el índice Ibovespa para los años 2017 y 2018. Asimismo, los desempeños de estas firmas se midieron a través de los indicadores financieros, ROA, ROE, y Margen de Utilidad. Los resultados revelan que existen directorios diversificados, pero no son estadísticamente significativos frente a los indicadores financieros ROA, ROE y Margen de Utilidad.  Sin embargo, se observa en promedio un 87,4% de diversidad profesional y un 49,5% de presencia de postgrados dentro del directorio. Además, las áreas de Ingeniería, Administración, Economía y Leyes predominan en la toma de decisiones

Speeches in anorexia and bulimia nervosa: A qualitative study about the disorder experiencing / Discursos en anorexia y bulimia nerviosa: Un estudio cualitativo acerca del vivenciar del trastorno

Abstract Background: distinctive discursive characteristics related to the experience of an eating disorder (ED) in anorectic and bulimic patients have been observed. Material and methods: a descriptive-analytical-qualitative design based on the Grounded Theory model was used. The sample was intentional, and 15 patients were included, 7 anorectics and 8 bulimics, according DSM-IV-TR diagnostic criteria. Data were collected by a depth interview pattern and analysed by an open codification. Results: differences in perception of the following categories in anorectic versus bulimic patients were detected: sickness notion (diagnostic reception), meanings associated to foods (traumatic versus pleasant experience), body conception (thinness beauty body ideal and dissociated body from the self) and self image (body dissatisfaction related to alexithymia, lack of assertiveness, perfectionism and impulsivity). Conclusion: although ED patients often transit from one diagnostic to another, in their speeches exist some differences related to core ED parameters. Resumen Introducción: se han observado características discursivas particulares en relación a la vivencia del trastorno de la conducta alimentaria (TCA) en pacientes anorécticas y bulímicas. Material y métodos: se utilizó un diseño descriptivo-analítico cualitativo basado en el modelo de la Grounded Theory. El muestreo fue intencionado, conformándose la muestra por 15 pacientes, 7 anorécticas y 8 bulímicas, según criterios del DSM-IV-TR. Se recolectaron los datos mediante el patrón de entrevista en profundidad y para su análisis una codificación abierta. Resultados: se detectaron diferencias en la percepción de pacientes anorécticas versus bulímicas en las siguientes categorías: noción de enfermedad (recepción del diagnóstico), significados asociados a los alimentos (experiencia traumática versus placentera), concepción de la corporalidad (ideal delgado de belleza corporal y cuerpo disociado del sí mismo) y autoimagen (insatisfacción corporal relacionada con alexitimia, falta de asertividad, perfeccionismo e impulsividad). Conclusiones: si bien las pacientes con TCA transitan, a menudo, desde un diagnóstico a otro, existen en sus relatos ciertas distinciones relacionadas a los parámetros nucleares de los TCA.

Corneal Epithelial Immune Dendritic Cell Alterations in Subtypes of Dry Eye Disease: A Pilot In Vivo Confocal Microscopic Study

Citation: Kheirkhah A, Rahimi Darabad R, Cruzat A, et al. Corneal epithelial immune dendritic cell alterations in subtypes of dry eye disease: a pilot in vivo confocal microscopic study. Invest Ophthalmol Vis Sci. 2015;56:7179-7185. DOI:10.1167/ iovs.15-17433 PURPOSE. To evaluate density and morphology of corneal epithelial immune dendritic cells (DCs) in different subtypes of dry eye disease (DED) using in vivo confocal microscopy (IVCM). METHODS. This retrospective study included 59 eyes of 37 patients with DED and 40 eyes of 20 age-matched healthy controls. Based on clinical tests, eyes with DED were categorized into two subtypes: aqueous-deficient (n ¼ 35) and evaporative (n ¼ 24). For all subjects, images of laser scanning in vivo confocal microscopy (IVCM) of the central cornea were analyzed for DC density and DC morphology (DC size, number of dendrites, and DC field). These DC parameters were compared among all dry eye and control groups. RESULTS. Compared with the controls, patients with DED had significantly higher DC density, larger DC size, higher number of dendrites, and larger DC field (all P < 0.001). Comparison between aqueous-deficient and evaporative subtypes demonstrated that DC density was significantly higher in aqueous-deficient subtype (189.8 6 36.9 vs. 58.9 6 9.4 cells/mm 2 , P ¼ 0.001). However, there were no significant differences in morphologic parameters between DED subtypes. When aqueous-deficient DED with underlying systemic immune disease (Sjögren's syndrome and graft versus host disease) were compared with nonimmune conditions, the immunologic subgroup showed significantly higher DC density, DC size, and number of dendrites (all P < 0.05). CONCLUSIONS. Corneal IVCM demonstrated differential changes in DC density and morphologic DC parameters between subtypes of DED. These changes, which reflect the degree of immune activation and inflammation in DED, can be used for clinical practice and endpoints in clinical trials. Keywords: dry eye disease, in vivo confocal microscopy, inflammation, dendritic cells D ry eye disease (DED) is one of the most commonly encountered ophthalmic disorders. It is a multifactorial disease of the ocular surface and tear film, characterized by symptoms of eye irritation, tear instability, and vision impairment. 1 In addition to evaluating symptoms, a variety of clinical tests are currently being used to diagnose DED, including the Schirmer's wetting test, tear break-up time (TBUT), tear osmolarity, and vital dye staining of the ocular surface by fluorescein, Rose Bengal and Lissamine Green. However, complex clinical features of the disease make the diagnosis a challenge in many cases. 2,3 Therefore, there remains a significant need for objective tests, which can be used to accurately diagnose DED and/or monitor therapeutic response in DED and its underlying changes. Recent studies have shown that the immune changes play an important role in the pathogenesis of DED. To evaluate changes in DCs in patients with DED, corneal in vivo confocal microscopy (IVCM) has lately been used. In vivo confocal microscopy is a noninvasive imaging modality that enables studying the cornea at a cellular level

Corneal Sensation and Subbasal Nerve Alterations in Patients with Herpes Simplex Keratitis

Purpose To study and correlate corneal sensation in patients with herpes simplex keratitis (HSK) with density and morphology of subbasal corneal nerves by in vivo confocal microscopy (IVCM). Design Prospective, cross-sectional, controlled, single-center study. Participants Thirty-one eyes with the diagnosis of acute (n=7) or chronic (n=24) HSK and the contralateral clinically unaffected eyes were studied and compared to normal controls (n=15). Methods IVCM (Confoscan 4, Nidek) and corneal esthesiometry (Cochet-Bonnet) of the central cornea were performed bilaterally in all patients and controls. Patients were grouped into normal (>5.5 cm), mild (>2.5 to 5.5cm) and severe (≤2.5 cm) loss of sensation. Main Outcome Measures Changes in corneal nerve density, total nerve number, main nerve trunks, branching and tortuosity were evaluated after IVCM and correlated to corneal sensation, disease duration, and number of recurrences. Results HSK eyes, as compared to controls, demonstrated significant (p<0.001) decrease in mean nerve density (448.9±409.3 vs. 2,258.4±989.0 μm/frame), total nerve number (5.2±4.5 vs. 13.1±3.8), main nerve trunks (2.3±1.6 vs. 4.7±1.2) and nerve branches (3.2 ± 4.3 vs. 9.8±3.3). In contralateral unaffected eyes, mean nerve density (992.7±465.0 μm/frame), total nerve number (7.8±3.3), and branches (4.5±2.3) were significantly decreased as compared to controls (p<0.002). Reduced nerve density, total nerve count and main trunks in HSK eyes were significantly correlated with corneal sensation across all subgroups (p<0.001). Nerve density decreased within days of infection and was correlated to frequency of episodes in patients with HSK (p<0.02). Conclusions In vivo confocal microscopy reveals that the loss of corneal sensation in HSK correlates strongly with profound diminishment of the subbasal nerve plexus after herpes simplex virus (HSV) infection. Surprisingly, the contralateral clinically unaffected eyes also demonstrated a diminishment of the subbasal nerve plexus, as compared to normal subjects, revealing bilateral nerve alteration in an apparently unilateral disease

Unilateral Herpes Zoster Ophthalmicus Results in Bilateral Corneal Nerve Alteration

Purpose Herpes zoster ophthalmicus (HZO), thought to be a unilateral disease, results in loss of corneal sensation, leading to neurotrophic keratopathy. This study aimed to analyze bilateral corneal nerve changes in patients with HZO by in vivo confocal microscopy (IVCM) and their correlation with corneal sensation as a measure of nerve function. Design Prospective, cross-sectional, controlled, single-center study. Participants Twenty-seven eyes with the diagnosis of HZO and their contralateral clinically unaffected eyes were studied and compared with normal controls (n = 15). Methods In vivo confocal microscopy (Confoscan 4; Nidek Technologies, Gamagori, Japan) and corneal esthesiometry (Cochet-Bonnet; Luneau Ophthalmologie, Chartres, France) of the central cornea were performed bilaterally in all patients and controls. Patients were grouped into normal (>5.5 cm), mild (>2.5–5.5 cm), and severe (<2.5 cm) loss of sensation. Main Outcome Measures Changes in corneal nerve density, total nerve number, main nerve trunks, branching, and tortuosity were evaluated after IVCM and were correlated to corneal sensation, disease duration, and number of recurrences. Results Eyes with herpes zoster ophthalmicus had a significant (P<0.001) decrease in total nerve length (595.8±358.1 vs. 2258.4±989.0 μm/frame), total number of nerves (5.4±2.8 vs. 13.1±3.8), number of main nerve trunks (2.3±1.1 vs. 4.7±1.2), and number of nerve branches (3.2±2.3 vs. 8.4±3.7) as compared with controls. In the contralateral clinically unaffected eyes, total nerve length (1053.1±441.4 μm/frame), total number of nerves (8.3±2.9), and main nerve trunks (3.1±1.0) also were decreased significantly as compared with controls (P<0.01). Reduced nerve density, total nerve count, main trunks, and tortuosity was correlated significantly with corneal sensation across all subgroups (P<0.001). Conclusions Patients with unilateral HZO demonstrated a profound and significant bilateral loss of the corneal nerve plexus as compared with controls, demonstrating bilateral changes in a clinically unilateral disease. Loss of corneal sensation strongly correlated with subbasal nerve plexus alterations as shown by IVCM

Inflammation and the Nervous System: The Connection in the Cornea in Patients with Infectious Keratitis

Purpose. To study the density and morphologic characteristics of epithelial dendritic cells, as correlated to subbasal corneal nerve alterations in acute infectious keratitis (IK) by in vivo confocal microscopy (IVCM). Methods. IVCM of the central cornea was performed prospectively in 53 eyes with acute bacterial (n = 23), fungal (n = 13), and Acanthamoeba (n = 17) keratitis, and in 20 normal eyes, by using laser in vivo confocal microscopy. Density and morphology of dendritic-shaped cells (DCs) of the central cornea, corneal nerve density, nerve numbers, branching, and tortuosity were assessed and correlated. It should be noted that due to the “in vivo” nature of the study, the exact identity of these DCs cannot be specified, as they could be monocytes or tissue macrophages, but most likely dendritic cells. Results. IVCM revealed the presence of central corneal DCs in all patients and controls. The mean DC density was significantly higher in patients with bacterial (441.1 ± 320.5 cells/mm2; P < 0.0001), fungal (608.9 ± 812.5 cells/mm2; P < 0.0001), and Acanthamoeba keratitis (1000.2 ± 1090.3 cells/mm2; P < 0.0001) compared with controls (49.3 ± 39.6 cells/mm2). DCs had an increased size and dendrites in patients with IK. Corneal nerves were significantly reduced in eyes with IK compared with controls across all subgroups, including nerve density (674.2 ± 976.1 vs. 3913.9 ± 507.4 μm/frame), total nerve numbers (2.7 ± 3.9 vs. 20.2 ± 3.3), main trunks (1.5 ± 2.2 vs. 6.9 ± 1.1), and branching (1.2 ± 2.0 vs. 13.5 ± 3.1; P < 0.0001). A strong association between the diminishment of corneal nerves and the increase of DC density was observed (r = −0.44; P < 0.0005). Conclusions. IVCM reveals an increased density and morphologic changes of central epithelial DCs in infectious keratitis. There is a strong and significant correlation between the increase in DC numbers and the decreased subbasal corneal nerves, suggesting a potential interaction between the immune and nervous system in the cornea