Segment Disorders Research Articles

Efficacy of a new customized navigation template for placement of transpedicular screws for unilateral access in children with congenital spinal deformity and thoracic malformation

BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine. AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies. MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results. RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment. CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.

Accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders in a rural-based hospital: A descriptive study

Background: In India, there is an unequal distribution of eye health care, and tele-ophthalmology promises to be a potential tool to provide accessible, affordable, and good-quality health care to the population residing in the rural and remote areas of our country. Aims: The aim of the study was to study the accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders at a rural-based hospital. Setting and Design: A hospital-based descriptive study was conducted for 18 months. The study was carried out in the outpatient department (OPD) of ophthalmology at a rural health training center (RHTC), attached to a tertiary care hospital. Materials and Methods: Inclusion-A routine examination was carried out in the ophthalmology OPD at the RHTC. The off-site assessment was done based on the smartphone camera (iPhone Xs Max) images and videos captured on-site, which were remotely shared with two independent blinded observers to make the diagnosis which was compared with the clinical (on-site) diagnosis. Statistical Analysis: The agreement between the expert’s finding and the clinical examination finding was determined using Light’s Kappa coefficient. Accuracy of the photographic method was carried out in terms of sensitivity and specificity, considering clinical findings as the gold standard. Results and Conclusion: The diagnostic accuracy of smartphone imaging was the highest for the diagnosis of cataracts, followed by anterior segment conditions. The clinical diagnosis and smartphone imaging agreement were almost perfect for anterior segment disorders, while it was moderate for glaucoma and other disc pathologies.

AYURVEDIC MANAGEMENT OF PRE-MACULAR HAEMORRHAGE: A CASE STUDY

Pre-macular haemorrhage (PMH) is a condition characterized by bleeding between hyaloid and retina leading to visual impairment. Ayurveda offers extensive treatment protocols for managing such posterior segmental disorders. This case study presents the successful Ayurvedic management of PMH in a 54-year-old female patient who is a known hypertensive. The patient presented with a sudden onset of blurred vision in the right eye and black patches in the vision. After a thorough Ayurvedic assessment, a treatment plan including Netra kriyakalpas and panchakarma procedures was adopted along with oral medications. For one month, the patient experienced significant improvement in visual acuity, and the resolution of the haemorrhage was confirmed by ophthalmological examination and imaging studies. This case highlights the potential of Ayurveda as an effective approach to managing pre-macular haemorrhage.

Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies

BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.

The Value of Magnetic Resonance Enterography Activity Indices in Evaluation of Crohn’s Disease Clinical Activity

Abstract Background Crohn’s disease is a chronic inflammatory segmental bowel disorder characterized by attacks of remission and exacerbation that can significantly affect the patients’ quality of life. Hence monitoring the disease activity is crucial to achieve longer symptom free intervals which may result either from active inflammation and its complications as deep ulceration, fistulae formation and abscesses or sequelae from longstanding inflammatory process as fibrotic scarring and strictures. Aim of the Work to compare the performance of the currently available scoring systems Maria, Clermont, CDMI and MEGS to the clinical disease activity index and endoscopic indices Patients and Methods the study was conducted at the Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. Over a period of 9 months. Convenience sample of proven cases of Crohn’s disease based on clinical suspicion, biomarkers, endoscopy and histopathological specimens who were referred for MRE enterography at our institution. Results We studied the relevance of 18 different single MR parameters and 5 indices in conjunction with clinical and endoscopic based scores. Our aim was to identify if any of the MR parameters can be used solely or in combination with others (indices) as predictors of disease activity. In our study, we identified that the presence of ulcers reflected the clinical rather than the endoscopic severity. Other individual MR parameters couldn’t predict either the clinical or endoscopic severity. The MaRIA score showed significant correlation with the clinical but not endoscopic score. The simplified MaRIA score reflected both the endoscopic and clinical severity scores regarding their absolute values and severity grade. Neither Diffusion- MaRIA/Clermont nor the CDMI scores could predict the degree of clinical and endoscopic disease severity. MEGS score was the most reliable score in determining the endoscopic activity despite being a consuming score with relative subjectivity in comparison to the forementioned scores. Conclusion MR indices provide an adjunct tool for evaluation of disease activity and identifying the severe disease evidenced by MaRIA, simplified MaRIA and MEGS scores. However, the use of a single MR parameter doesn’t provide a true reflection of the ongoing disease process, even the presence of ulcers and haustral loss may be associated with chronic disease.

Segmental Spinal Aplasia: Anatomical Variations and Treatment Insights.

Retrospective Cohort Study. The study aimed to analyze anatomical variants of segmental spinal aplasia (SSA) and investigate factors influencing surgical treatment outcomes, with a specific focus on the incidence of complications. The study focused on patients with SSA treated at a single medical center, with over two years of follow-up. Neurological function changes were evaluated using the modified Japanese Orthopedic Scale (mJOA). Functional independence was measured using the Functional Independence Measure (FIM/WeeFIM) scale, and complications, well-being, and reoperation instances were documented. Statistical analyses used ANOVA and Kruskal-Wallis test. The predominant localization of SSA in 36 own cases occurs near or at the level of the thoracolumbar junction, often accompanied by significant spinal cord narrowing and a low position of the conus medullaris. Additionally, it frequently presents with aplasia of the lower ribs. Cervicothoracic SSA was more commonly associated with segmentation disorders (P = .04). The most common early complications were wound problems (17%) and neurological deterioration (17%); the most common late complications were: non-fusion (34%); 38% of patients required one or more revision surgery. The type, age of surgery, level of surgery, and initial neurological deficient did not significantly influence the incidence of complications or neurological and functional outcomes. SSA, a range of anomalies appearing early in childhood, progresses gradually. Surgery involves vertebrectomy followed by interbody fusion and screw fixation, guided by neurophysiological monitoring. Surgery is recommended for worsening neurological symptoms, but conservative options like bracing can be considered, due to a high risk of complications.

Increased hippocampal epigenetic age in the Ts65Dn mouse model of Down Syndrome.

Down syndrome (DS) is a segmental progeroid genetic disorder associated with multi-systemic precocious aging phenotypes, which are particularly evident in the immune and nervous systems. Accordingly, people with DS show an increased biological age as measured by epigenetic clocks. The Ts65Dn trisomic mouse, which harbors extra-numerary copies of chromosome 21 (Hsa21)-syntenic regions, was shown to recapitulate several progeroid features of DS, but no biomarkers of age have been applied to it so far. In this pilot study, we used a mouse-specific epigenetic clock to measure the epigenetic age of hippocampi from Ts65Dn and euploid mice at 20 weeks. Ts65Dn mice showed an increased epigenetic age in comparison with controls, and the observed changes in DNA methylation partially recapitulated those observed in hippocampi from people with DS. Collectively, our results support the use of the Ts65Dn model to decipher the molecular mechanisms underlying the progeroid DS phenotypes.

Interscapular Pain after Anterior Cervical Discectomy and Fusion: Does Zygapophyseal Joints over Distraction Play a Role?

Introduction: Anterior cervical discectomy and fusion (ACDF) for cervical disc herniation (CDH) is commonly performed. Specific post-operative complications include dysphagia, dysphonia, cervicalgia, adjacent segment disorder, cage subsidence, and infections. However, interscapular pain is commonly reported by these patients after surgery, although its mechanisms have not been clarified yet. Methods: This retrospective series of 31 patients undergoing ACDF for CDH at a single Academic Hospital. Baseline and post-operative clinical, radiological, and surgical data were analyzed. The linear regression analysis was conducted to identify any factor independently influencing the incidence rate of post-operative interscapular pain. Results: The mean age was 57.6 ± 10.8 years, and the M:F ratio was 2.1. Pre-operative mean VAS-arm was 7.15 ± 0.81 among the 20 patients reporting brachialgia, and mean VAS-neck was 4.36 ± 1.43 among those 9 patients reporting cervicalgia. At 1 month, interscapular pain was still reported by 8 out of the 17 patients who experienced it post-operatively, and it was recovered in all patients after 2 months. The regression analysis showed that interscapular pain was not directly associated with age (p = 0.74), gender (p = 0.46), smoking status (p = 0.44), diabetes (0.42), pre-operative brachialgia (p = 0.21) or cervicalgia (p = 0.48), symptoms duration (p = 0.13), baseline VAS-arm (p = 0.11), VAS-neck (p = 0.93), or mJOA (p = 0.63) scores, or disc height modification (p = 0.90). However, the post-operative increase in the mean zygapophyseal joint rim distance was identified as an independent factor in determining interscapular pain (p = 0.02). Conclusions: Our study revealed that the onset of interscapular pain following ACDF may be determined by over distraction of the zygapophyseal joint rim. Then, proper sizing of prosthetic implants could reduce this painful complication.

Impact of Telemedicine on Blood Glucose Control and Ophthalmic Screenings for Patients with Diabetes in Remote Areas During the COVID-19 Pandemic: A Real-World Study in Northern Taiwan.

Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine (p = 0.01 and p = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.

Modernizing the evaluation of infantile nystagmus: the role of handheld optical coherence tomography

BackgroundInfantile nystagmus syndrome can be associated with an afferent problem (anterior or posterior segment) or constitute an isolated idiopathic disorder. With a normal ophthalmic examination, current guidelines recommend electroretinography (ERG) rather than magnetic resonance (MRI) for preliminary workup. Given the limited use of optical coherence tomography (OCT) in preverbal children, the purpose of this study was to evaluate the role of handheld OCT (HH-OCT) in the initial diagnostic evaluation of infantile nystagmus. MethodsIn this cross-sectional case series, the medical records of all children with infantile nystagmus and HH-OCT imaging at the Duke Eye Center from August 2016 to July 2021 were retrospectively reviewed. Children with anterior segment disorders or obvious retina/optic nerve structural pathology, bilateral ophthalmoplegia, or Down syndrome were excluded. Two masked pediatric ophthalmologists graded HH-OCT images for optic nerve head and macular abnormalities. A neuro-ophthalmologist reviewed clinical findings of each patient’s presenting visit and recommended appropriate testing (MRI vs ERG), initially without, and again with HH-OCT image review. ResultsA total of 39 cases were included, with mean presenting age of 1.3 years. Final diagnoses included retinal or foveal abnormalities (7), optic nerve pathology (13), idiopathic (10), or unknown (9). HH-OCT findings included optic nerve hypoplasia (1), optic nerve elevation (3), persistence of the inner layers at the fovea (9), thin ganglion cell layer (8), ellipsoid zone abnormality (3), and thin choroid (1). HH-OCT findings altered initial clinical-only management in 16 cases (41%), including avoiding MRI (5) and ERG (10) testing. ConclusionsOur results suggest that HH-OCT has the potential to augment and streamline the evaluation of infantile nystagmus.

Association of spinal cord abnormalities with vertebral anomalies: an embryological perspective.

To analyze the relationship between spinal cord and vertebral abnormalities from the point of view of embryology. We analyzed the clinical and radiological data of 260 children with different types of spinal cord malformations in combination with vertebral abnormalities. Among 260 individuals, approximately 109 presented with open neural tube defects (ONTDs), 83 with split cord malformations (SCMs), and 83 with different types of spinal lipomas. Pathological spina bifida emerged as the most frequent vertebral anomaly, affecting 232 patients, with a higher prevalence in ONTD. Vertebral segmentation disorders, including unsegmented bars, butterfly vertebrae, and hemivertebrae, were present in 124 cases, with a higher prevalence in SCM. The third most common spinal anomaly group consisted of various forms of sacral agenesis (58 cases), notably associated with blunt conus medullaris, spinal lipomas, and sacral myelomeningocele. Segmental aplasia of the spinal cord had a typical association with segmental spinal absence (N = 17). The association between SCM and neuroenteric cyst/canal and vertebral segmentation disorders is strong. High ONTDs often coincide with pathological spina bifida posterior. Type 1 spinal lipomas and focal spinal nondisjunction also correlate with pathologic spina bifida. Segmental spinal absence or dysgenesis involves localized spinal and spinal cord aplasia, sometimes with secondary filar lipoma.

Method of Selecting Surgical Treatment for Children with Congenital Deformity of the Spine and Thorax

Introduction. Spinal anomalies are considered to be the most severe pathology of the axial skeleton. Intrauterine formation of deformity with its subsequent progression during growth is the reason for the need for surgical intervention. The prevalence of patients with congenital scoliosis in the total structure of spinal deformities is up to 2%. In terms of the malignancy of the course of the disease, children with unsegmented rod and rib synostosis represent one of the most unfavorable groups of patients. Aim. To perform a comparative analysis of the results of surgical treatment of children with congenital scoliosis with unilateral lateral vertebral segmentation disorder and rib synostosis using different techniques. Methods. The work is a monocenter cohort study of “case-control” type (III level of evidence). The design of the work is a monocenter cohort retro and prospective study. The results of surgical treatment of patients between 2010 and 2020 were analyzed. The study included 45 patients aged 3 to 7 years with the diagnosis of congenital scoliosis with unilateral lateral segmentation disorder of vertebral bodies and rib synostosis. The patients were divided into 2 groups depending on the surgical treatment method applied. In the first group (n = 24), patients underwent thoracoplasty with implantation of an individual rib/rib/vertebral distractor; in the second group (n = 21), patients underwent spinal surgery in the scope of vertebrotomy at the apex of the curvature and correction of the deformity with a multifocal spinal system. The data of medical records, as well as MSCT, radiographs, and pulse oscillometry were included in the analysis of the results. Results. Me (median) of scoliosis before treatment in group 1 patients 58.5, IQR = 19.75; after treatment — Me = 40.0, IQR = 20.0. Me of kyphosis before surgery 22, IQR = 4.5; after surgery Me = 26.0, IQR = 4.0. In the second group, Me of scoliosis before treatment 58.0, IQR = 3.0; after treatment, Me = 20.0, IQR = 6.0. Me of kyphosis before surgery 22, IQR = 2.0; after surgery Me 28.0, IQR = 4.0. When comparing MSCT data, group 1 patients showed an increase in lung tissue volume by 21% of the initial lung volume, in group 2 the increase amounted to 27%. The analysis of external respiratory function indices demonstrates improvement of reactive component indices by 21.1%, frequency dependence of resistive component by 46.4%, resistive component by 50% in group 1 patients, in group 2 there is an improvement of reactive component indices by 21.1%, resistive component by 50.9% and frequency dependence of reactive component by 46.7%. Conclusion. Corrective intervention on the spine at an early age makes it possible to achieve effective correction of the deformity; similar changes are observed both in lung volume and functional state of the respiratory system due to the mediated correction of the thorax shape.

Dynamics of Right Ventricle Pressure During Stress Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction

Shortness of breath during physical exertion is a non-specific symptom that can hide such potentially dangerous diseases as structural or functional bronchopulmonary, coronary heart disease, structural cardiac disease, but the frequent cause is left ventricle diastolic dysfunction due to its significant hypertrophy. Pathogenetic mechanisms leading to this symptom require detailed study for the possibility of a comprehensive approach in the treatment of such patients with the aim of maximally improving their prognosis and quality of life. Objective — evaluate changes in right ventricle systolic pressure during stress echocardiography in patients with LV myocardial hypertrophy and clinical manifestations of heart failure, search for other mechanisms leading to clinical symptoms. Materials and methods. The study included 49 patients with shortness of breath during physical exertion, who underwent further diagnostic examination after exclusion of coronary stenotic lesions by invasive coronary and ventricular angiography. Patients were excluded from bronchopulmonary pathology using spirometry and chest radiography, structural heart pathology using echocardiography, microvascular angina using echocardiography with intravenous dipyridamole infusion, and the change in systolic pressure in the right ventricle was investigated using echocardiography during a physical exercise test. Results and discussion. There were no cases of infiltrative lung changes, signs of emphysema, or other manifestations of significant pathology according to X-ray data. Spirometry also showed the absence of significant functional abnormalities. Echocardiography revealed significant hypertrophy of LV myocar­dium (thickness of IVS — on average (14.1 ± 0.5) mm, posterior wall thickness — on average (13.5 ± 0.3) mm) with the presence of LV diastolic dysfunction and echocardiographic signs of increased end-diastolic pressure in the LV, which was confirmed invasively during coronary and ventricular angiography. In 9 (18.4 %) cases, heart wall thickening was due to hypertrophic cardiomyopathy according to cardiac MRI, these patients had LV outflow tract obstruction and mild pulmonary hypertension at rest. Conducting strain imaging showed the presence of signs of myocardial ischemia (segmental contractility disorder) with varying degrees of severity (from 1 to 5 segments), which spread to the IVS, the apex of the heart and, less often, to the anterior wall of the LV. All patients experienced an increase in pulmonary artery systolic pressure during exercise, on average, from (37.4 ± 2.1) to (47.1 ± 1.6) mm Hg. Conclusions. The pathogenic mechanism underlying shortness of breath in patients with LV myocardial hypertrophy involves transient pulmonary hypertension occurring during exercise due to left ventricular diastolic dysfunction. Another contributing factor is the development of myocardial ischemia during physical exertion, which, in the absence of coronary stenosis and microvascular angina, is attributed to inadequate supply of coronary blood flow volume velocity relative to the significant left ventricular hypertrophy.

Topical Tacrolimus in Anterior Segment Disorders in Ophthalmology: A Review.

The purpose of this study is to emphasize topical tacrolimus's role in treating anterior segment diseases in ophthalmology. The present study analyzed research papers and publications from international databases, including Pubmed, MedLine, Google Scholar, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Scopus to highlight the significance and advantages of topical application of tacrolimus and its efficacy in treating allergic eye disorders, immune-mediated diseases, and other ocular surface disorders. Tacrolimus and cyclosporine are the two most commonly used topical immunosuppressants in ophthalmology. Tacrolimus is a selective calcineurin inhibitor administered for the prevention and treatment of allograft rejection in solid organ transplant recipients and has a similar mechanism of action to cyclosporine. Management of immune-mediated inflammatory anterior segment requires intense immunosuppression and studies have shown that tacrolimus is ten to hundred times more effective than cyclosporine. Abbreviations: IL-2 = interleukin-2, FDA = Food and Drug Administration Agency, GvHD = graft versus host disease, (Ig)E = immunoglobulin E, SAC = seasonal conjunctivitis, PAC = perennial allergic conjunctivitis, VKC = vernal keratoconjunctivitis, AKC = allergic keratoconjunctivitis, GPC = giant papillary conjunctivitis, PKC = phyctenular keratoconjunctivitis, DED = dry eye disease, TBUT = tear break up time.

Triamcinolone-loaded self nano-emulsifying drug delivery systems for ocular use: An alternative to invasive ocular surgeries and injections

Inflammation of the posterior segment of the eye is a severe condition and hard to cure as delivery of drugs to the inflammation site is inefficient. Currently, the primary treatment approach is ocular surgery or invasive ocular injections. Herein, we designed and developed a topically self nano-emulsifying drug delivery system (SNEDDs) to deliver triamcinolone acetonide (TCA) to the posterior segment of the eye. A screening based on TCA solubility was conducted on each excipient followed by preparation of various formulations using different ratios of the selected excipients. Vesicles of optimized SNEDDs had less than 100 nm size and spherical morphology. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay showed self-emulsified vesicles have relatively high safety on retinal pigment epithelium (RPE) cell line. Furthermore, efficient cellular uptake of coumarin 6-loaded SNEDDs in RPE using confocal laser scanning microscopy (CLSM) was confirmed.In addition, an in-vivo study using hematoxylin and eosin (H&E) staining revealed that 14 days of topical treatment of albino rabbit eyes with TCA-loaded SNEDDs was safe and no sign of tissue destruction and inflammation was detected in different parts of the eye sections including cornea, sclera, retina, and optic nerve. Also, the CLSM images from topically treated eyes with coumarin 6 (a hydrophobic, fluorescent drug model) loaded SNEDDs, showed that the optimized SNEDDs could properly penetrate toward the posterior segments of the eye especially the retina, posterior parts of the choroid, and sclera. Considering the outstanding results obtained by ocular tissue penetration and low toxicity, prepared SNEDDs, have the potential to be used as a topical administration for treating posterior segment disorders of the eye through an utterly non-invasive route and TCA-loaded SNEDDs could be an alternative for TCA intravitreal and intra conjunctival injections.

Evaluation of Roxithromycin as a Treatment Option for Small Abdominal Aortic Aneurysms: An Integrated Study of Meta-analysis and Network Pharmacology.

Abdominal aortic aneurysm (AAA) is a segmental, progressive, and fatal vascular disorder, and the current strategy for small AAAs is close observation alone.The purpose of this study is to summarize the available evidence to assess the effects of antibiotics on small abdominal aortic aneurysms (AAA). We searched PubMed, EMBASE, Web of Science, and Scopus from inception to September 29, 2023, and included randomized controlled trials (RCTs) that evaluated the effects of antibiotics on small AAAs in humans. We first performed a meta-analysis to assess the effects of antibiotics on small AAAs. Afterward, network pharmacology analysis was applied to investigate the optimal drug generated from the meta-analysis results. We searched Pharmmapper and GeneCards to obtain the common potential targets of the selected drug and AAA-related targets. The protein-protein interaction network and functional enrichment analysis were performed by the STRING database, Cytoscape 3.7.2 software, and R, respectively. Docking studies were carried out for validation. We incorporated data from six RCTs involving a total of 997 patients. The results of this meta-analysis revealed that roxithromycin exhibited a modest yet statistically significant protective effect in terms of slowing down the AAA expansion rate. Furthermore, our subsequent bioinformatics analysis pinpointed MMP-2, MMP-9, ALB, MMP-3, and CCL-5 as potential therapeutic targets that could be explored for the treatment of AAA using roxithromycin. In conclusion, the study indicates roxithromycin is a promising drug for treating small AAAs and supports its underlying clinical use in small AAAs.

Анализ функций миокарда по данным Стресс-эхокардиографии при безболевой ишемии миокарда

The purpose — to analyze the results of stress-EchoCG in patients with and without silent myocardial ischemia (SMI). Material and methods. Results of stress-EchoCG of 202 patients during exercise test (ET) on treadmill according to Bruce protocol were analyzed. Results. Patients with SMI were 2.5 times more likely to achieve submaximal heart rate (p = 0.015) compared with the control group (CG). With the same exercise load, the maximum heart rate was higher in SMI group (p = 0.04). Maximum depression of ST segment was greater in SMI than in CG (p = 0.04). Dynamic of ST segment during ET was found in 75.6% subjects in SMI group and in 36.6% subjects in CG (p = 0.0001). Decrease in myocardial contractility during ET was 80.5% in SMI and 34.1% in CG (p = 0.0001). Combination of ST segment depression and contractility decrease was 56% in SMI and 9.2% in CG (p = 0.0001). In SMI, contractility decrease was found in 84.2% of segments. Conclusions. Decrease in contractility is higher in SMI than in CG. Positive ET with ST segment depression is more common in SMI. Depression of ST segment on positive ET was deeper in SMI than in CG. Negative test happens more often at SMI. Duration of ET in SMI was shorter due to rapid achievement of submaximal heart rate or ST segment depression. In SMI, ischemic manifestations occurred earlier and were more severe than in CG. Combination of segmental contractility disorders and ST segment depression in ET is a feature of myocardium in SMI.

May a post‐radiation ocular surface disorder compromise penetrating keratoplasty surgery? A case report

Aims/Purpose: Ocular surface disorder after ocular radiation therapy, even commonly reported, remains overlooked. Any delay in diagnosis may lead to vision threatening complications. The presented case highlights the clinical outcome of a severe post‐radiation ocular surface disorder, the importance of intense therapy and the limitations of further surgical interventions.Methods: Case report.Results: A 34‐year‐old woman was referred with complains of painful and reddish right eye since years. Her medical history revealed an iris melanoma excision at the age of 29 years. Due to recurrence, a proton beam treatment has been performed thereafter. Consequently, the patient developed post‐radiation retinopathy with macula edema, secondary glaucoma, cataract, as well as a severe ocular surface disorder with corneal decompensation and band keratopathy. Several surgical treatments have been attempted among which: phacoemulsification with IOL implantation, trabeculectomy with mitomycin C. Due to refractory glaucoma a Baerveldt glaucoma drainage was necessitated, thereafter. Despite these various therapeutic approaches, there was no improvement of the ocular surface problem. With increasing deterioration of the corneal situation, a penetrating keratoplasty, has been discussed.Conclusions: The continuous worsening of clinical symptomatology of the proton beam radiotherapy ocular surface disorder can be the result of a post‐radiation syndrome. An ischaemic retinopathy and anterior segment disorder lead to engorgement of posterior and anterior segment tissues. Gradual expansion of ischemia, vasculitis and inflammatory mediators compresses the retinal tissue leading to recurrent macular oedema; as well as to secondary glaucoma and corneal decompensation. Due to the worsening of the clinical presentation of ocular surface disorder a penetrated keratoplastic surgery has been discussed. It remains however still questionable whether such patients would make profit from penetrated keratoplastic surgery, as the resulting corneal stromal lymphangiogenesis and hemangiogenesis, in the presence of post‐radiation keratopathy, are essential conditions for allograft rejection.

Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement.

This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.

Role of artificial intelligence in anterior segment disorders

Role of artificial intelligence in anterior segment disorders