Notes

Self-Report Stress Measures to Assess Anxiety in Adults Together with Slight Rational Disabilities-A Scoping Assessment.
as a new circulatory inflammatory mediator, responsible for brain alterations and anxious behavior after HS in a murine model. The ability to target UA holds the potential of an adjunctive therapeutic solution to reduce brain dysfunction related to hemorrhagic shock in human.
Lactic acidosis after cardiac surgery with cardiopulmonary bypass is common and associated with an increase in postoperative morbidity and mortality. A number of potential causes for an elevated lactate after cardiopulmonary bypass including cellular hypoxia, impaired tissue perfusion, ischemic-reperfusion injury, aerobic glycolysis, catecholamine infusions, and systemic inflammatory response after exposure to the artificial cardiopulmonary bypass circuit. Our goal was to examine the relationship between early abnormalities in microcirculatory convective blood flow and diffusive capacity and lactate kinetics during early resuscitation in the intensive care unit. We hypothesized that patients with impaired microcirculation after cardiac surgery would have a more severe postoperative hyperlactatemia, represented by the lactate time-integral of an arterial blood lactate concentration greater than 2.0 mmol/L.

We measured sublingual microcirculation using incident darkfield video microscopy in 50 subjects on Isel density and high microcirculatory heterogeneity are associated with an increased intensity and duration of lactic acidosis after cardiac surgery with cardiopulmonary bypass.
Low perfused vessel density and high microcirculatory heterogeneity are associated with an increased intensity and duration of lactic acidosis after cardiac surgery with cardiopulmonary bypass.
Aeromedical evacuation can expose traumatically injured patients to low pressure (hypobaria) and hypoxia. Here we sought to assess the impact of hypobaria on inflammation, organ injury, and mortality in a mouse model of polytrauma.

Eight to 12 week-old male C57BL/6J mice were subjected to sham or polytrauma consisting of bowel ischemia by superior mesenteric artery (SMA) occlusion, hindlimb muscle crush, and tibia fracture. Two hours after injury, animals were randomized to undergo either 6 hours of hypobaria or sea-level, room air conditions. At 8 or 24 hours after injury, transthoracic echocardiography was performed. Acute kidney injury (AKI) biomarkers were measured by qRT-PCR. Plasma cytokine and endothelial injury markers were determined by ELISA.

Eight hours after traumatic injury, mice exhibited a marked increase in plasma IL-6 (57 vs. 1216 pg/ml), AKI with increased Ngal and Kim-1, and endothelial injury as evidenced by significantly increased plasma hyaluronic acid (96 vs.199 ng/ml), thrombomodulin (23.2 vs. 58.9 ng/ml), syndecan-1 (0.99 vs. 4.34 ng/ml), and E-selectin (38.6 vs. 62.7 ng/ml). The trauma mice also developed cardiac dysfunction with decreased cardiac output and stroke volume at 8 hours post-injury. Hypobaric exposure after polytrauma led to decreased ejection fraction (81.0 vs. 74.2%, p < 0.01) and increased plasma hyaluronic acid (199 vs. 260 ng/ml, p < 0.05), thrombomodulin (58.9 vs. 75.4 ng/ml, p < 0.05), and syndecan-1 (4.34 vs. 8.33 ng/ml, p < 0.001) at 8 hours post-injury.

Hypobaria exposure appeared to worsen cardiac dysfunction and endothelial injury following polytrauma and thus may represent a physiological "second hit" following traumatic injury.
Hypobaria exposure appeared to worsen cardiac dysfunction and endothelial injury following polytrauma and thus may represent a physiological "second hit" following traumatic injury.
IL-33 and WISP1 play central roles in acute lung injury (ALI) induced by mechanical ventilation with moderate tidal volume (MTV) in the setting of sepsis. Here, we sought to determine the inter-relationship between IL-33 and WISP1 and the associated signaling pathways in this process.We used a two hit model of cecal ligation puncture (CLP) followed by MTV ventilation (4 h 10 ml/kg) in wildtype, IL-33-/- or ST2-/- mice or wildtype mice treated with intratracheal antibodies to WISP1. Macrophages (Raw 264.7 and alveolar macrophages from wildtype or ST2-/- mice) were used to identify specific signaling components.CLP + MTV resulted in ALI that was partially sensitive to genetic ablation of IL-33 or ST2 or antibody neutralization of WISP1. Genetic ablation of IL-33 or ST2 significantly prevented ALI after CLP + MTV and reduced levels of WISP1 in the circulation and BALF. rIL-33 increased WISP1 in alveolar macrophages in an ST2, PI3K/AKT and ERK dependent manner. This WISP1 upregulation and WNT β-catenin activati IL-33 or ST2 or antibody neutralization of WISP1. Genetic ablation of IL-33 or ST2 significantly prevented ALI after CLP + MTV and reduced levels of WISP1 in the circulation and BALF. Cell Cycle inhibitor rIL-33 increased WISP1 in alveolar macrophages in an ST2, PI3K/AKT and ERK dependent manner. This WISP1 upregulation and WNT β-catenin activation were sensitive to inhibition of the β-catenin/TCF/CBP/P300 nuclear pathway.We show that IL-33 drives WISP1 upregulation and ALI during MTV in CLP sepsis. The identification of this relationship and the associated signaling pathways reveals a number of possible therapeutic targets to prevent ALI in ventilated sepsis patients.
To investigate the types of intraretinal cysts (IRCs) that are associated with epiretinal membranes (ERMs) and to evaluate the effects of each type of IRC on postoperative outcomes.

Retrospective, cross-sectional study design. Patients who underwent preoperative fluorescent angiography and ERM surgery from February 2014 to May 2019 were included. IRCs were subdivided into cystoid macular edema (CME) with angiographic leakage and microcystic macular edema (MME) without angiographic leakage.

A total of 100 eyes from 100 patients was enrolled. IRCs were present in 54 (54.0%) eyes before surgery, of which 27 (27.0%) eyes showed MME, 18 (18.0%) eyes showed CME, and 9 (9.0%) eyes showed CME and MME. After surgery, the number of eyes with CME decreased significantly (p<0.001), while the number of eyes with MME did not (p=0.302). Absence of preoperative MME, poorer initial visual acuity, increased central foveal thickness, and intact ellipsoidal zone were associated with favorable visual recovery (p=0.035, 0.033, 0.018, and 0.035, respectively).

MME associated with ERM was a poor prognostic factor for ERM surgery. link2 The persistent existence of MME after surgery affirms related chronic structural changes. Further studies should investigate whether earlier surgical intervention (possibly before the development of MME) benefits visual outcomes.
MME associated with ERM was a poor prognostic factor for ERM surgery. The persistent existence of MME after surgery affirms related chronic structural changes. Further studies should investigate whether earlier surgical intervention (possibly before the development of MME) benefits visual outcomes.
To investigate the repeatability of choroidal vascularity index (CVI) measurements in centered and decentered (regarding pupil entry position of the beam) directional subfoveal optical coherence tomography (OCT) scans with (CVI1) and without (CVI2) brightness adjustment.

Thirty-two eyes of 32 healthy volunteers were included in this prospective study. First, the fovea was evaluated by a single horizontal enhanced depth imaging OCT scan in a centered direction. Then, the same subfoveal horizontal line was scanned in a decentered direction. link3 The agreement between CVIs obtained from these centered and decentered directional OCT scans was investigated using Bland-Altman analysis and intra-class correlation coefficient (ICC).

ICC between centered and decentered CVI1 was 0.71 (95% CI 0.48 - 0.85, P value <0.001). ICC between centered and decentered CVI2 was 0.73 (95% CI 0.5- 0.86, P value < 0.001). The mean difference between centered and decentered directional measurements for CVI1 and CVI2 were 0.5 and 0.8, respectively.

There is moderate agreement between CVIs obtained from centered and decentered directional single OCT scans of the same subfoveal area. Studies investigating choroidal vascularity should be standardized by using the same OCT beam direction in all scans.
There is moderate agreement between CVIs obtained from centered and decentered directional single OCT scans of the same subfoveal area. Studies investigating choroidal vascularity should be standardized by using the same OCT beam direction in all scans.
To report surgical observations formulated during the first 120 cases of subretinal gene therapy in patients with inherited retinal degenerations (IRDs).

A two-surgeon team compiled surgical observations and formulated surgical pearls based on the consecutive cases of subretinal viral vector injection in patients enrolled in clinical trials focusing on choroideremia, achromatopsia, and RPGR-associated retinitis pigmentosa, as well as patients with RPE65-associated Leber congenital amaurosis receiving FDA-approved voretigene neparvovec-rzyl therapy.

120 subretinal surgeries were performed by a two-surgeon team. Key anatomical features pertinent to surgical management were noted and are described in this manuscript. Surgical decision making for successful subretinal administration of viral vectors and management of potential surgical challenges were formulated.

Lessons learned during subretinal gene therapy cases may be helpful to other surgeons entering clinical trials or performing post-approval gene therapy administration. Surgical pearls outlined in this manuscript may also be helpful for other targeted subretinal therapies such as cellular transplantation or retinal prosthesis implantation.
Lessons learned during subretinal gene therapy cases may be helpful to other surgeons entering clinical trials or performing post-approval gene therapy administration. Surgical pearls outlined in this manuscript may also be helpful for other targeted subretinal therapies such as cellular transplantation or retinal prosthesis implantation.
To clarify whether internal limiting membrane (ILM) peeling provides better outcomes for patients with idiopathic epiretinal membrane (ERM).

Randomized controlled trials (RCTs) comparing ERM removal with and without ILM peeling were searched in Embase, PubMed, Web of Science, Cochrane Library and CNKI before 15 April 2020. The pooled mean difference (MD) for best corrected visual acuity (BCVA), central macular thickness (CMT), and odds ratio (OR) for recurrence were calculated.

8 RCTs involving 422 eyes were included. No significant difference in BCVA (final follow-up MD 0.03 logarithm of the minimum angle of resolution [1.5 Early Treatment Diabetic Retinopathy Study letters]; 95% CI -0.04 to 0.09 [-4.5 to 2 Early Treatment Diabetic Retinopathy Study letters]; P=0.40) or recurrence rate (OR, 0.21; 95% CI 0.04 to 1.05; P=0.06) between the groups was observed. However, patients with ILM peeling presented thicker CMT at 3 months (MD, 16.36; 95% CI 1.26 to 31.46; P=0.03), 6 months (MD, 22.64; 95% CI 10.29 to 34.98; P=0.0003) and the final follow-up (MD, 25.87; 95% CI 13.96 to 37.79; P<0.0001).

ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker CMT, indicating inessential for idiopathic ERM.
ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker CMT, indicating inessential for idiopathic ERM.
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