Trends in refractive surgery at an academic center: 2007-2009

<p>Abstract</p> <p>Background</p> <p>The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients.</p> <p>Methods</p> <p>Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs.</p> <p>Results</p> <p>Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0.05). The proportions of types of procedure changed, with an increase in the proportion of PRK between 2007 and 2009 (p = 0.02). The mean age of patients did not change [42.4 ± 14.4 (standard deviation) years in 2007 vs. 39.6 ± 14.5 years in 2009; p = 0.4]. Astigmatism-correcting IOL and presbyopia-correcting IOL volumes increased 15-fold and three-fold, respectively, between 2007 and 2009.</p> <p>Conclusions</p> <p>Volume of excimer laser refractive surgery decreased by at least 30% between 2007 and 2009. No significant change in mean age or in the distribution of refractive error was seen, although the proportion of high myopes decreased between summer quarters of 2007 and 2009. PRK gained as a proportion of total cases. Premium IOL volume increased, but still comprised a very small proportion of total IOL volume.</p

Rectification of electronic heat current by a hybrid thermal diode

We report the realization of an ultra-efficient low-temperature hybrid heat current rectifier, thermal counterpart of the well-known electric diode. Our design is based on a tunnel junction between two different elements: a normal metal and a superconducting island. Electronic heat current asymmetry in the structure arises from large mismatch between the thermal properties of these two. We demonstrate experimentally temperature differences exceeding $60$ mK between the forward and reverse thermal bias configurations. Our device offers a remarkably large heat rectification ratio up to $\sim 140$ and allows its prompt implementation in true solid-state thermal nanocircuits and general-purpose electronic applications requiring energy harvesting or thermal management and isolation at the nanoscale.Comment: 8 pages, 6 color figure

Do horizontal propulsive forces influence the nonlinear structure of locomotion?

<p>Abstract</p> <p>Background</p> <p>Several investigations have suggested that changes in the nonlinear gait dynamics are related to the neural control of locomotion. However, no investigations have provided insight on how neural control of the locomotive pattern may be directly reflected in changes in the nonlinear gait dynamics. Our simulations with a passive dynamic walking model predicted that toe-off impulses that assist the forward motion of the center of mass influence the nonlinear gait dynamics. Here we tested this prediction in humans as they walked on the treadmill while the forward progression of the center of mass was assisted by a custom built mechanical horizontal actuator.</p> <p>Methods</p> <p>Nineteen participants walked for two minutes on a motorized treadmill as a horizontal actuator assisted the forward translation of the center of mass during the stance phase. All subjects walked at a self-select speed that had a medium-high velocity. The actuator provided assistive forces equal to 0, 3, 6 and 9 percent of the participant's body weight. The largest Lyapunov exponent, which measures the nonlinear structure, was calculated for the hip, knee and ankle joint time series. A repeated measures one-way analysis of variance with a t-test post hoc was used to determine significant differences in the nonlinear gait dynamics.</p> <p>Results</p> <p>The magnitude of the largest Lyapunov exponent systematically increased as the percent assistance provided by the mechanical actuator was increased.</p> <p>Conclusion</p> <p>These results support our model's prediction that control of the forward progression of the center of mass influences the nonlinear gait dynamics. The inability to control the forward progression of the center of mass during the stance phase may be the reason the nonlinear gait dynamics are altered in pathological populations. However, these conclusions need to be further explored at a range of walking speeds.</p

Evaluation of NV556, a Novel Cyclophilin Inhibitor, as a Potential Antifibrotic Compound for Liver Fibrosis

Hepatic fibrosis can result as a pathological response to nonalcoholic steatohepatitis (NASH). Cirrhosis, the late stage of fibrosis, has been linked to poor survival and an increased risk of developing hepatocellular carcinoma, with limited treatment options available. Therefore, there is an unmet need for novel effective antifibrotic compounds. Cyclophilins are peptidyl-prolyl cis-trans isomerases that facilitate protein folding and conformational changes affecting the function of the targeted proteins. Due to their activity, cyclophilins have been presented as key factors in several stages of the fibrotic process. In this study, we investigated the antifibrotic effects of NV556, a novel potent sanglifehrin-based cyclophilin inhibitor, in vitro and in vivo. NV556 potential antifibrotic effect was evaluated in two well-established animal models of NASH, STAM, and methionine-choline-deficient (MCD) mice, as well as in an in vitro 3D human liver ECM culture of LX2 cells, a human hepatic stellate cell line. We demonstrate that NV556 decreased liver fibrosis in both STAM and MCD in vivo models and decreased collagen production in TGFβ1-activated hepatic stellate cells in vitro. Taken together, these results present NV556 as a potential candidate for the treatment of liver fibrosis

Viroids: survivors from the RNA world?

[EN] Because RNA can be a carrier of genetic information and a biocatalyst, there is a consensus that it emerged before DNA and proteins, which eventually assumed these roles and relegated RNA to intermediate functions. If such a scenario¿the so-calledRNAworld¿existed,wemight hope to find its relics in our presentworld. The properties of viroids that make them candidates for being survivors of the RNA world include those expected for primitive RNA replicons: (a) small size imposed by error-prone replication, (b) high G + C content to increase replication fidelity, (c) circular structure for assuring complete replication without genomic tags, (d ) structural periodicity for modular assembly into enlarged genomes, (e) lack of protein-coding ability consistent with a ribosome-free habitat, and ( f ) replication mediated in some by ribozymes, the fingerprint of the RNA world. With the advent of DNA and proteins, those protoviroids lost some abilities and became the plant parasites we now know.R.F. has received funding by grant BFU2011-28443 from Ministerio de Economia y Competititvidad (MINECO, Spain), R.S. by grants BFU2011-25271 (MINECO) and ERC-2011-StG-281191-VIRMUT (European Research Council), and S.F.E. by grant BFU2012-30805 (MINECO). P.S. has been supported by postdoctoral contracts from Generalitat Valenciana (APOSTD/2010, program VALi+d) and MINECO (program Juan de la Cierva).Flores Pedauye, R.; Gago Zachert, SP.; Serra Alfonso, P.; Sanjuan Verdeguer, R.; Elena Fito, SF. (2014). Viroids: survivors from the RNA world?. Annual Review of Microbiology. 68:395-414. https://doi.org/10.1146/annurev-micro-091313-103416S3954146

Thiol-Based Redox Switches in Eukaryotic Proteins

Abstract For many years, oxidative thiol modifications in cytosolic proteins were largely disregarded as in vitro artifacts, and considered unlikely to play significant roles within the reducing environment of the cell. Recent developments in in vivo thiol trapping technology combined with mass spectrometric analysis have now provided convincing evidence that thiol-based redox switches are used as molecular tools in many proteins to regulate their activity in response to reactive oxygen and nitrogen species. Reversible oxidative thiol modifications have been found to modulate the function of proteins involved in many different pathways, starting from gene transcription, translation and protein folding, to metabolism, signal transduction, and ultimately apoptosis. This review will focus on three well-characterized eukaryotic proteins that use thiol-based redox switches to influence gene transcription, metabolism, and signal transduction. The transcription factor Yap1p is a good illustration of how oxidative modifications affect the function of a protein without changing its activity. We use glyeraldehyde-3-phosphate dehydrogenase to demonstrate how thiol modification of an active site cysteine re-routes metabolic pathways and converts a metabolic enzyme into a pro-apoptotic factor. Finally, we introduce the redox-sensitive protein tyrosine phosphatase PTP1B to illustrate that reversibility is one of the fundamental aspects of redox-regulation. Antioxid. Redox Signal. 11, 997-1014.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78110/1/ars.2008.2285.pd

Severe sepsis caused by Aeromonas hydrophila in a patient using tocilizumab: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Aeromonas </it>species do not commonly cause disease in humans. However, when disease is seen, it often occurs in patients with underlying immunosuppression or malignancy and has a high fatality rate.</p> <p>Case presentation</p> <p>A 72-year-old Japanese woman with rheumatoid arthritis treated with tocilizumab (which has an immunosuppressive effect) presented with severe epigastric pain. She had a fever with chills, hypotension and jaundice. She was diagnosed with acute suppurative cholangitis and treated with cefoperazone-sulbactam and an endoscopic drainage was performed. Jaundice was slightly improved, but the shock state and inflammatory reactions were prolonged as typical of septic shock. On the second day after admission, an electrocardiogram showed ST segment elevation and echocardiography showed ventricular wall dysfunction. Coronary arteries were patent in coronary angiography and she was diagnosed with stress-induced cardiomyopathy. Blood cultures showed <it>Aeromonas hydrophila</it>. A stool culture was negative for <it>A. hydrophila</it>. On day six, her white blood cell count and neutrophils were normalized and cefoperazone-sulbactam treatment was halted. Left ventricular function normalized on day twelve and a laparoscopic cholecystectomy for cholelithiasis was performed on the 16th day of hospitalization. A culture from the bile showed <it>A. hydrophila</it>. Eighteen days after surgery, tocilizumab treatment was restarted and there were no complications. Two months after restarting tocilizumab, our patient is stable without any serious events.</p> <p>Conclusion</p> <p>We present a rare case of <it>A. hydrophila </it>sepsis and acute suppurative cholangitis in an elderly patient with gallstones and rheumatoid arthritis using tocilizumab. This clinical course may suggest that preemptive treatment for cholelithiasis prior to using molecular-targeting agents might be feasible in elderly patients.</p

Intraprostatic Botulinum Toxin Type A injection in patients with benign prostatic enlargement: duration of the effect of a single treatment

<p>Abstract</p> <p>Background</p> <p>Botulinum Toxin Type-A (BoNT/A) intraprostatic injection can induce prostatic involution and improve LUTS and urinary flow in patients with Benign Prostatic Enlargement (BPE). However, the duration of these effects is unknown. The objective of this work was to determine the duration of prostate volume reduction after one single intraprostatic injection of 200U of Botulinum Toxin Type-A.</p> <p>Methods</p> <p>This is an extension of a 6 month study in which 21 frail elderly patients with refractory urinary retention and unfit for surgery were submitted to intraprostatic injection of BoNT/A-200U, by ultrasound guided transrectal approach. In spite of frail conditions, eleven patients could be followed during 18 months. Prostate volume, total serum PSA, maximal flow rate (Qmax), residual volume (PVR) and IPSS-QoL scores were determined at 1, 3, 6, 12 and 18 months post-treatment.</p> <p>Results</p> <p>Mean prostate volume at baseline, 82 ± 16 ml progressively decreased from month one coming to 49 ± 9,5 ml (p = 0,003) at month six. From this moment on, prostate volume slowly recovered, becoming identical to baseline at 18 months (73 ± 16 ml, p = 0.03). Albeit non significant, serum PSA showed a 25% decrease from baseline to month 6. The 11 patients resumed spontaneous voiding at month one. Mean Qmax was 11,3 ± 1,7 ml/sec and remained unchanged during the follow-up period. PVR ranged from 55 ± 17 to 82 ± 20 ml and IPSS score from10 to 12 points.</p> <p>Conclusion</p> <p>Intraprostatic BoNT/A injection is safe and can reduce prostate volume for a period of 18 months. During this time a marked symptomatic improvement can be maintained.</p

Mini-open anterior spine surgery for anterior lumbar diseases

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified “mini-open anterior spine surgery” (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24–52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12–L1, 18 at L1–L2, 18 at L2–L3, 22 at L3–L4 and 11 at L4–L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62–124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4–26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases