Notes

Using combination therapeutic solutions regarding male impotence: reasoning as well as present reputation.
To compare the rotational stability of two commonly used toric presbyopia-correcting (PC) IOLs and their monofocal toric counterparts SETTING Single two-surgeon private practice DESIGN Retrospective study with two cohorts (1) all eyes receiving a toric Restor (n=61) or toric Symfony (n=779) IOL September 2016-January 2019; (2) all eyes receiving an Acrysof (n=2,393) or Tecnis (n=731) monofocal toric IOL (TIOL) April 2015-January 2019. Eyes were only excluded if digital marking could not be utilized.

All patients had image-guided digital marking to verify TIOL position at the conclusion of surgery. Postoperative rotation was determined by dilated examination performed later on the day of surgery or the following morning.

The toric Restor was more likely to rotate ≤5 degrees than the toric Symfony, 91.8% v. 79.0% (p=0.01). This remained true for rotation ≤10 degrees (100% v. 89.5%, p<0.003). Mean rotation was 2.3 degrees for toric Restor compared to 4.5 for toric Symfony (p=0.01). Significantly more totioning.
To assess the efficacy, safety and predictability of the Visian Implantable Collamer Lens with a central port in patients between 45 and 55 years old.

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

Retrospective case series.

Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault and adverse events over a 1-year period were evaluated retrospectively.

87 eyes (49 patients) were evaluated. The mean postoperative UDVA and CDVA were 0.82±0.24 and 0.93±0.12, respectively. 78 eyes (about 90%) achieved a CDVA ≥20/25. No eye lost 1 or more lines, 53 eyes (60.92%) did not change, 15 eyes (17.24%) gained 1 line and 19 eyes (21.84%) gained ≥2 lines of CDVA. The efficacy and safety indexes were 0.95 and 1.08, respectively. 78 eyes (89.65%) were within ±0.50D of the desired sphere refraction and all eyes (100%) were within ±1.00D. 50 eyes (57.7%) showed a spherical equivalent within ±0.13D. Mean postoperative IOP was 13.58±1.79 mmHg and no significant rise (>18 mmHg) occurred during the follow-up. The largest proportion of eyes (35.63%) reported a reduction in IOP by 1 to 2 mmHg. Postoperative mean ECD was 2574±362 cells/mm (0.41% loss from the preoperative baseline). The mean postoperative vault was 398±187 µm, being the most prevalent range from 201 to 300 µm (22.89% of eyes). No adverse events were reported during the study.

The outcomes reported in this study support the use of this lens in older patients.
The outcomes reported in this study support the use of this lens in older patients.
To describe the distribution of angle alpha and angle kappa in a population with cataract in Shanghai.

Eye and Ear, Nose, Throat Hospital, Fudan University, Shanghai, China.

Hospital-based, cross-sectional study.

We included 15,127 eyes of 15,127 cataract patients in this study. Angle alpha, angle kappa, and other ocular biometric parameters were determined by IOLMaster 700 (Carl Zeiss Meditec AG, Germany). The distributions of angle alpha and angle kappa and their associations with systemic and ocular parameters were assessed.

The mean angle alpha and angle kappa values were 0.45 ± 0.21 mm and 0.30 ± 0.18 mm, respectively. Angle alpha and angle kappa were both predominantly located temporal to the visual axis. A greater angle alpha or angle kappa was associated with older age, lower corneal power, shorter white-to-white distance, and shallower anterior chamber depth (all P < 0.05). Angle alpha correlated positively with angle kappa. With increasing axial length (AXL), angle alpha gradually decreased in a nonlinear way and shifted to the nasal side of the visual axis, whereas angle kappa decreased in eyes with AXL < 27.5 mm but increased again in eyes with longer AXL.

Angle alpha and angle kappa, both predominantly located temporal to the visual axis, are influenced by multiple anterior segment parameters. As AXL increases, the changes in angle alpha and angle kappa are nonlinear, and their locations gradually shift from the temporal to the nasal side of the visual axis.
Angle alpha and angle kappa, both predominantly located temporal to the visual axis, are influenced by multiple anterior segment parameters. As AXL increases, the changes in angle alpha and angle kappa are nonlinear, and their locations gradually shift from the temporal to the nasal side of the visual axis.
To compare the accuracy of Barrett Universal II to other formulas (Holladay II, Hoffer Q, and SRK-T) in the prediction of post-operative refraction for pediatric intraocular lens implantation.

Academic Medical Center/Children's Hospital, San Francisco, California, USA.

Retrospective case series.

Children </=16 years of age who underwent cataract extraction and IOL implantation (2012-2019) and had a refraction at 3-16 weeks post-operatively. Prediction error (PE) was calculated as post-operative mean spherical equivalent minus the target refraction. Mean, median and standard deviation was calculated for PE and absolute PE. Performance across co-variables (axial length, age, biometry type, keratometry, etc.) was studied and a multivariable regression analysis was performed using a single prediction model for each formula.

64 eyes of 64 patients, ages 1.5 to 15.5 years, were included. Barrett had the lowest mean PE (-0.22D), SD (1.18D), median PE (-0.26D) and median APE (0.71) compared to the other reasonable and reliable option for lens power calculation in children, including those with extreme biometric measurements.
Trauma induces neutrophil migration toward injury sites, both initiating wound healing and protecting against local bacterial infection. We have previously shown that mitochondrial formyl peptides (mtFPs) released by injured tissues act as chemoattractants by ligating neutrophil (PMN) formyl peptide receptor 1 (FPR1). But this process can also internalize multiple neutrophil chemoattractant receptors and thus might limit neutrophil migration to the lung in response to bacteria. Our objective was to better understand susceptibility to pneumonia after injury and thus find ways to reverse it.

We modeled the alveolar chemotactic environment in pulmonary infections by incubating Staphylococcus aureus or Escherichia coli with peripheral blood mononuclear cells (PBMC). Survey of the chemotactic mediators in the resultant conditioned media (CM) showed multiple potent chemoattractants. Pretreating PMN with mtFPs to mimic injury potently reduced net migration towards CM and this net effect was mostly reversed by an FPR1 antagonist. Using an established mouse model of injury-dependent lung infection, we then showed simple instillation of exogenous unstimulated human neutrophils into the airway resulted in bacterial clearance from the lung.

Injury-derived mtFPs suppress global PMN localization into complex chemotactic environments like infected alveoli. Transplantation of naïve exogenous human neutrophils into the airway circumvents that pathologic process and prevents development of post-traumatic pneumonia without injury noted to the recipients.
Injury-derived mtFPs suppress global PMN localization into complex chemotactic environments like infected alveoli. Transplantation of naïve exogenous human neutrophils into the airway circumvents that pathologic process and prevents development of post-traumatic pneumonia without injury noted to the recipients.
Prednisolone (PL) is a standard component of most immunosuppressive protocols after solid organ transplantation (Tx). Adverse effects are frequent and well known. The aim of this study was to characterize the pharmacokinetics (PKs) of PL and prednisone (PN), including cortisol (CL) and cortisone (CN) profiles, after PL treatment in renal Tx recipients in the early post-Tx phase.

This single-center, prospective, observational study included stable renal Tx recipients, >18 years of age, and in the early postengraftment phase. Blood samples were obtained predose and during a 24-hour dose interval [n = 26 samples per area under the curve (AUC0-24)], within the first 8 weeks post-Tx. PL, PN, CL, and CN concentrations were measured using high-performance liquid chromatography-tandem mass spectrometry.

In renal Tx recipients (n = 28), our results indicated a relatively high PL exposure [median, range AUC0-24 = 3821 (2232-5382) mcg h/L], paralleled by strong suppression of endogenous CL profile, demonstratedure and suppression of endogenous CL implies a possible role for therapeutic drug monitoring. An abbreviated profile within the first 4 hours after PL dosing provides a good prediction of PL exposure in renal Tx recipients. The strong negative correlation between PL AUC0-24 and morning CL levels suggests a possible surrogate marker for drug exposure for further evaluation.
Chronic opioid use and polypharmacy are commonly seen in chronic pain patients presenting for spine procedures. Substance abuse and misuse have also been reported in this patient population. Negative perioperative effects have been found in patients exposed to chronic opioid, alcohol, and recreational substances. Toxicology screening testing (TST) in the perioperative period provides useful information for adequate preoperative optimization and perioperative planning.

We designed a pilot study to understand this population's preoperative habits including accuracy of self-report and TST-detected prescribed and unprescribed medications and recreational substances. We compared the results of the TST to the self-reported medications using Spearman correlations.

Inconsistencies between TST and self-report were found in 88% of patients. click here Spearman correlation was 0.509 between polypharmacy and intraoperative propofol use, suggesting that propofol requirement increased as the number of substances used increased.

TST in patients presenting for spine surgery is a useful tool to detect substances taken by patients because self-report is often inaccurate. Discrepancies decrease the opportunity for preoperative optimization and adequate perioperative preparation.
TST in patients presenting for spine surgery is a useful tool to detect substances taken by patients because self-report is often inaccurate. Discrepancies decrease the opportunity for preoperative optimization and adequate perioperative preparation.The authors present a case series of patients with composite loss of nasal skin cover and lining following road accidents. The nasal skeletal framework in all these cases was also severely communited. The reconstruction of all the these was achieved in 1 operation. The authors have utilized islanded supratrochlear artery based paramedian forehead skin and pericranial flap for reconstruction of both skin and lining defects. The nasal skeletal framework was restored with the help of cantilevered split cranial bone graft. In all but 1 patient, the reconstruction was done in the emergency setting at the time of initial admission itself. One patient had infected wound that necessitated an initial debridement and split skin grafting. In this case, the definitive reconstruction was done after a gap of 3 months.A long-term follow-up of these patients is presented.
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