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Cancer is a significant challenge for effective treatment due to its complex mechanism, different progressing stages, and lack of adequate procedures for screening and identification. Pancreatic cancer is typically identified in its advanced progression phase with a low survival of ~5 years. Among cancers, pancreatic cancer is also considered a high mortality-causing casualty over other accidental or disease-based mortality, and it is ranked seventh among all mortality-associated cancers globally. Henceforth, developing diagnostic procedures for its early detection, understanding pancreatic cancer-linked mechanisms, and various therapeutic strategies are crucial. This review describes the recent development in pancreatic cancer progression, mechanisms, and therapeutic approaches, including molecular techniques and biomedicines for effectively treating cancer. [ABSTRACT FROM AUTHOR]

Background: Hyalinizing trabecular tumors (HTT) are rare follicular cell-derived tumors of the thyroid gland that are infrequently reported in otolaryngology literature. We present here an interesting case of HTT which provides the basis for review of this entity's clinical characteristics, criteria useful in making the diagnosis, and any currently available therapeutic modalities. Case presentation: A 70-year-old Caucasian female underwent a CT scan of her chest and was incidentally found to have a nodule within the right thyroid lobe. Gross examination of the excised thyroid lobe revealed a circumscribed and encapsulated lesion (tan / gritty in texture), confined to the gland. Histologic sections of the lesion revealed a circumscribed neoplasm with a trabecular and organoid architecture associated with abundant dystrophic calcification. Neoplastic cells showed a spindled morphology with clumped chromatin and ample eosinophilic cytoplasm. Conclusions: Histologically, HTT is a follicular cell-derived tumor composed of neoplastic cells arranged in a trabecular pattern with hyalinization and calcification of extracellular material. Distinguishing features of HTT include minimal cytologic atypia with a low nuclear: cytoplasmic ratio, cellular aggregates around hyalinized material, and nuclei with clumped chromatin and occasional grooves and/or pseudoinclusions. Though debated in the literature, the general consensus is that this tumor is a benign entity. It is our hope that additional clinical research will elicit awareness of these rare tumors. [ABSTRACT FROM AUTHOR]

Serious infections such as endocarditis due to extremely drug-resistance gram-negative bacteria are an increasing challenge. Here, we present successful adjunctive use of cefiderocol for a patient with persistently bacteremic healthcare-associated native aortic valve endocarditis due to an extended-spectrum beta-lactamase–positive Pseudomonas aeruginosa susceptible in vitro only to colistin, following failure of conventional therapeutic options. [ABSTRACT FROM AUTHOR]

Background Despite the increasing prevalence of type 2 diabetes mellitus ( T2DM) in Asia, clinical trials for glucose-lowering therapies are often dominated by Caucasian and/or Western populations. The present Phase III randomized placebo-controlled double-blind, 24-week study evaluated the efficacy and safety of the dipeptidyl peptidase-4 inhibitor linagliptin added to metformin in Asian T2DM patients. Methods In all, 306 patients ( n = 265 Chinese; n = 24 Malaysian; n = 17 Filipino), aged 18-80 years with HbA1c between ≥7.0 and ≤10.0% and on metformin therapy were randomized (2:1) to either linagliptin 5 mg daily or placebo added to metformin. Antidiabetes drugs other than metformin were washed out prior to randomization. The primary endpoint was change in mean HbA1c from baseline after 24 weeks. Results Baseline characteristics were well-matched between the groups (overall mean [± SD] HbA1c 8.0 ± 0.8%). Adjusted mean (± SE) HbA1c decreased in the linagliptin and placebo groups by −0.66 ± 0.05 and −0.14 ± 0.07%, respectively (placebo-corrected difference −0.52 ± 0.09%; 95% confidence interval [ CI] −0.70, −0.34; P < 0.0001). In patients with baseline HbA1c ≥8.5%, the placebo-corrected decrease in HbA1c was −0.89 ± 0.17% ( P < 0.0001). Adverse events occurred in similar proportions in the linagliptin and placebo patients (27.3% and 28.0%, respectively) and few were considered drug-related (2.4% and 0.0%, respectively). Hypoglycemia occurred in 1.0% of patients in both groups. Linagliptin therapy was weight neutral. Conclusions Linagliptin 5 mg was efficacious and well tolerated over 24 weeks in Asian patients with T2DM inadequately controlled by metformin. [ABSTRACT FROM AUTHOR]

Objective: To compare pathological characteristics, treatment patterns, and survival in patients with ductal adenocarcinoma (DC) compared to those with acinar adenocarcinoma (AC).Materials and Methods: Using the National Cancer Database, we identified patients diagnosed with clinically localized (cN0, cM0) pure DC (n = 1328) and AC (n = 751,635) between 1998 and 2011. High-risk AC was defined as Gleason 8-10. Demographic, treatment, pathological, and survival characteristics of patients were compared.Results: Compared to patients with Gleason 8-10 AC, those with DC presented with lower mean prostate-specific antigen (10.3 vs 16.2 ng/mL, P <.001), had similar rates (11.7% vs 11.5%, P = .8) of clinical extra-capsular extension (stage ≥ cT3), and were more likely to undergo prostatectomy (54% vs 36%, P <.001). Compared to patients with Gleason 8-10 AC undergoing prostatectomy, those with DC had more favorable pathology: stage ≥ T3 (39% vs 52%, P <.001), fewer positive lymph nodes (4% vs 11%, P <.001), and fewer positive margins (25% vs 33%, P <.001). On Kaplan-Meier analysis, patients with DC had similar 5-year survival (75.0%, 95% confidence interval [CI] [71.7-78.9]) compared to those with Gleason 8-10 AC (77.1%, 95% CI [76.6%-77.6%], P = .2). On Cox multivariable analysis, patients with Gleason 8-10 AC had a similar risk of death compared to those with DC (hazards ratio = 0.92, 95% CI [0.69-1.23], P = 6).Conclusion: In this large contemporary population-based series, patients with DC of the prostate presented with lower prostate-specific antigen, had more favorable pathological features, and similar overall survival compared to men with Gleason 8-10 AC. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the efficacy and safety of empagliflozin/linagliptin in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS Subjects not receiving antidiabetes therapy for ≥12 weeks were randomized to empagliflozin 25 mg/linagliptin 5 mg (n = 137), empagliflozin 10 mg/linagliptin 5 mg (n = 136), empagliflozin 25 mg (n = 135), empagliflozin 10 mg (n = 134), or linagliptin 5 mg (n = 135) for 52 weeks. The primary end point was change from baseline in HbA1c at week 24. RESULTS Mean HbA1c at baseline was 7.99-8.05% (64 mmol/mol). At week 24, adjusted mean (SE) changes from baseline in HbA1c with empagliflozin 25 mg/linagliptin 5 mg, empagliflozin 10 mg/linagliptin 5 mg, empagliflozin 25 mg, empagliflozin 10 mg, and linagliptin 5 mg were -1.08 (0.06)% (-11.8 [0.7] mmol/mol), -1.24 (0.06)% (-13.6 [0.7] mmol/mol), -0.95 (0.06)% (-10.4 [0.7] mmol/mol), -0.83 (0.06)% (-9.1 [0.7] mmol/mol), and -0.67 (0.06)% (-7.3 [0.7] mmol/mol), respectively. Reductions in HbA1c were significantly greater for empagliflozin 25 mg/linagliptin 5 mg compared with linagliptin 5 mg (P < 0.001) but not com pared with empagliflozin 25 mg and were significantly greater for empagliflozin 10 mg/linagliptin 5 mg compared with the individual components (P < 0.001 for both). At week 24, 55.4%, 62.3%, 41.5%, 38.8%, and 32.3% of subjects with R baseline HbA1c ≥7% (≥53 mmol/mol) reached HbA1c <7% with empagliflozin 25 mg/linagliptin 5 mg, empagliflozin 10 mg/linagliptin 5 mg, empagliflozin 25 mg, empagliflozin 10 mg, and linagliptin 5 mg, respectively. Efficacy was maintained at week 52. The proportion of subjects with adverse events (AEs) over 52 weeks was similar across groups (68.9-81.5%), with no confirmed hypoglycemic AEs. CONCLUSIONS Reductions from baseline in HbA1c with empagliflozin/linagliptin were significantly different versus linagliptin and empagliflozin 10 mg but not versus empagliflozin 25 mg. Empagliflozin/linagliptin was well tolerated. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the efficacy and safety of combinations of empagliflozin/linagliptin as second-line therapy in subjects with type 2 diabetes inadequately controlled on metformin. RESEARCH DESIGN AND METHODS Subjects were randomized to a combination of empagliflozin 25 mg/linagliptin 5 mg (n = 137), empagliflozin 10 mg/linagliptin 5 mg (n = 136), empagliflozin 25 mg (n = 141), empagliflozin 10 mg (n = 140), or linagliptin 5 mg (n = 132) as add-on to metformin for 52 weeks. The primary end point was change from baseline in HbA1c at week 24. RESULTS At week 24, reductions in HbA1c (mean baseline 7.90-8.02% [62.8-64.1 mmol/mol]) with empagliflozin/linagliptin were superior to those with empagliflozin or linagliptin alone as add-on to metformin; adjusted mean (SE) changes from baseline were -1.19% (0.06) (-13.1 mmol/mol [0.7]) with empagliflozin 25 mg/linagliptin 5 mg, -1.08% (0.06) (-11.8 mmol/mol [0.7]) with empagliflozin 10 mg/linagliptin 5 mg, -0.62% (0.06) (-6.8 mmol/mol [0.7]) with empagliflozin 25 mg, 20.66% (0.06) (-7.2 mmol/mol [0.7]) with empagliflozin 10 mg, and -0.70% (0.06) (27.6 mmol/mol [0.7]) with linagliptin 5 mg (P < 0.001 for all comparisons). In these groups, respectively, 61.8, 57.8, 32.6, 28.0, and 36.1% of subjects with baseline HbA1c S7% (S53 mmol/mol) had HbA1c <7% (<53 mmol/mol) at week 24. Efficacy was maintained at week 52. The proportion of subjects with adverse events (AEs) over 52 weeks was similar across treatment arms (68.6-73.0%), with no hypoglycemic AEs requiring assistance. CONCLUSIONS Combinations of empagliflozin/linagliptin as second-line therapy for 52 weeks significantly reduced HbA1c compared with the individual components and were well tolerated. [ABSTRACT FROM AUTHOR]

Abstract: The synthesis, antimycobacterial activity and 3D-QSAR study of two series of 4-(adamantan-1-yl) group containing quinolines conjugated to amino acids are described. The most potent analogs displayed in vitro antimycobacterial activity ranging between 1.00 and 3.125μg/mL. To understand the relationship between structure and activity, a 3D-QSAR analysis has been carried out by Comparative Molecular Field Analysis (CoMFA). The activities of molecules in the test sets were nicely predicted by the CoMFA model generated with field alignment. The best model was obtained using atom-fit alignment. Based on the molecular fields the relationships between structure and activity were easily rationalized. [Copyright &y& Elsevier]

Objective: The aim of this study was to discuss a case of malignant pleural mesothelioma (MPM) that presented to a chiropractic teaching clinic and review the pathophysiology of diseases associated with asbestos exposure. Clinical Features: An 86-year-old woman had right-sided back pain at the thoracolumbar junction for 3 months; this pain prevented her from exercising on a daily basis. She was alert and oriented but in obvious distress because of her back pain. Breath sounds were decreased on the right in the posterior and lower lobes, with dull percussion and increased tactile fremitus, A significant collection of pleural effusion was seen on the right side on plain film radiographs. A chest computed tomography with contrast showed a large right-sided pleural effusion with small consolidation at the right lung base suggestive of pleural or pulmonary malignancy and highly suspicious for MPM. Further questioning about asbestos exposure revealed that her husband was a maintenance worker. An extrapleural pneumonectomy was performed, and specimens of parietal and visceral pleura were sent for pathological, which revealed a definitive diagnosis of spindle cell mesothelioma. Intervention and Outcome: The patient was diagnosed with MPM, and a surgical therapy option was considered because of the aggressive nature of the lesion and her advanced age. An extrapleural pneumonectomy was performed with removal of parietal and visceral pleura, right lower lobe, and right hemidiaphragm. Conclusion: This is an unusual case of advanced MPM that is most likely from indirect asbestos exposure. [ABSTRACT FROM AUTHOR]

: PurposeTo determine changes in central epithelial and stromal thickness in human corneas in vivo after laser in situ keratomileusis (LASIK).: DesignProspective, nonrandomized, comparative trial.: ParticipantsEighteen eyes of 12 patients received LASIK (performed using the VISX Star laser [VISX, Santa Ana, CA]) with a planned 180-μm flap (created using an automated Hansatome microkeratome [Bausch & Lomb, Irvine, CA]) to correct refractive errors between −2.0 diopters (D) and −11.0 D.: MethodsCorneas were examined by using confocal microscopy in vivo before LASIK and at 1 week and 1, 3, 6, and 12 months after LASIK. Epithelial thickness was the distance between images of the surface epithelium and subbasal nerve plexus or, when nerves were not visible, the subbasal peak (if present in the light intensity profile). Total flap thickness was the distance between images of the surface epithelium and interface debris (or peak), and total stromal thickness was the distance between images of the most anterior keratocytes and endothelium.: Main outcome measuresCorneal epithelial and stromal thickness.: ResultsEpithelial thickness before LASIK was 46 ± 5 μm (mean ± standard deviation) and increased 22% by 1 month after LASIK (56 ± 5 μm; P = 0.01). Thereafter, epithelial thickness did not change, but remained thicker at 12 months after LASIK (54 ± 8 μm) than before LASIK (P = 0.02). Total flap thickness at 1 month after LASIK was 160 ±28 μm and did not change thereafter. Changes in total stromal thickness between 1 and 12 months after LASIK were not significant.: ConclusionsThe central corneal epithelium was thicker in the first year after LASIK than before LASIK. There was no change in central stromal thickness between 1 month and 12 months after LASIK. [Copyright &y& Elsevier]

The article focuses on the effectiveness of dipeptidyl peptidase-4 inhibitor linagliptin in treating moderate to severe renal impairment among patients with type 2 diabetes. Topics discussed include the methodology and population covered by the study conducted by the authors and the incidence of adverse effects following the treatment including incidence of cardiovascular events and hypoglecemia.

Wilms' tumor is one of the most common intraabdominal malignancies among children and treatment protocols have been well studied in this population. The clinical presentation differs between the pediatric and adult populations with adults presenting similar to patients with renal cell carcinoma. Diagnosis is usually made by surgical pathology as imaging cannot differentiate between Wilms' tumor and other kidney pathologies. In addition to surgical excision, treatment includes systemic chemotherapy and/or radiation. In this case report, we present a patient who underwent successful surgical resection of a 29x24x25 cm right-sided Wilms' tumor with subsequent chemotherapy and radiation. [ABSTRACT FROM AUTHOR]

Atherosclerosis is considered a chronic inflammatory disease of the arterial wall. Recently, compelling evidence has arisen for the role of monocytes and neutrophils and a particular protein complex that resides within these cells – the NLRP3 inflammasome – in atherosclerosis-associated inflammation. It is now also known that cholesterol crystals are present through all stages of atherosclerosis and can activate the NLRP3 inflammasome within these inflammatory cells to produce interleukin 1β and interleukin 18 – key mediators in the inflammatory cascade that drive plaque progression and instability. In this review, we describe the role of monocytes/macrophages and neutrophils in atherosclerosis, outline mechanisms of activation of the NLRP3 inflammasome in the setting of atherosclerosis-associated inflammation and discuss potential therapies that specifically target the NLRP3 inflammasome and/or its downstream mediators in atherosclerosis, with a particular focus on the emerging role of colchicine. [ABSTRACT FROM AUTHOR]

Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare long-term keratometric changes after penetrating keratoplasty (PK) for keratoconus and Fuchs endothelial dystrophy. Design: Retrospective, comparative case series. Methods: We retrospectively analyzed 168 corneas after PK for keratoconus (85 eyes of 63 subjects) and Fuchs dystrophy (83 eyes of 60 subjects). Patients were examined after final suture removal at 12 months after PK to 30 years after surgery. Operations were performed by one surgeon (W.M.B.) using the same suturing technique in all cases. Eyes were excluded from further analysis after regrafting or after relaxing incisions. Mean keratometric corneal power and astigmatism were measured by manual keratometry. Data were assessed by using generalized estimating equation models to determine change over time. Results: Mean keratometric corneal power and astigmatism increased through 30 years after PK for keratoconus (P < .001 and P < .001), but did not change through 20 years after PK for Fuchs dystrophy (P = .55 and P = .55) The change in keratometric corneal power and astigmatism after PK in keratoconus patients only differed from the change in Fuchs dystrophy patients 10 or more years after PK (P = .002 and P = .003). Conclusions: Corneal curvature and regular astigmatism increase progressively after PK for keratoconus, but remain stable after PK for Fuchs dystrophy. Our data suggest that keratometric instability after PK for keratoconus is attributable to delayed, progressive ectasia in the host corneal rim. [Copyright &y& Elsevier]

Fruit processing by-products, especially pomace, peels, rinds, and seeds, are underused and mostly discarded as waste. Such biowastes are rich in beneficial bioactive like carotenoids, enzymes, polyphenols, oils, vitamins, and other biomolecules possessing various health-promoting properties. Therefore, these bioactive substances from agro-waste can be recovered and recycled to create functional food items that may gain popularity. The opportunity to generate additional revenue for the industrial sector can be provided by the sustainable utilization of agri-food wastes and by-products to produce indispensable biomolecules and value-added products. This review combines a case study methodology with a selective analysis of the peer-reviewed research and review articles. The data has been collected from various research platforms, including Google Scholar and PubMed. Articles have been thoroughly studied and examined in the last five years to give the collated form of wholesome information. In addition, recent progress and possible therapeutic perspectives have been discussed for fruit waste-based bioactivity. Bioactives prevent diabetes, overweight, Alzheimer's, and Parkinson's diseases, and microbial inhibition. Due to broad therapeutic benefits and possible specialized uses, bioactive garners are increasing interest in their recovery from biowastes such as fruit-derived wastes. This review explores fruit biowaste-based bioactives and their bioavailability and potential therapeutic uses. This study's finding suggested that efficient biowaste/by-product valorisation can minimize environmental burdens and generate valuable bioactive, which have broad beneficial applications. Future exploring strategies for efficiently recovering fruit waste bioactives and their uses via a sustainable development approach can be more anticipated. • Fruit wastes are the potential source of various biologically active compounds. • Bioavailability of bioactive compounds is an essential factor for the accessibility of such compounds by the body. • Bioactive compounds derived from fruit waste are therapeutic and disease preventive. [ABSTRACT FROM AUTHOR]

Existing literature reports that colchicine inhibits inflammasome activation and downstream inflammatory cytokine production and stabilizes coronary plaque. However, colchicine's effect on chemokines, which orchestrate multiple atheroinflammatory pathways, is unknown. Patients with acute coronary syndrome (ACS) were randomly assigned to colchicine (1.5 mg PO) (n = 12; mean age, 65.2 years) or no treatment (n = 13; mean age, 62.2 years). Blood samples were collected during cardiac catheterization within 24 hours of colchicine administration from the coronary sinus, aortic root, and right atrium. Patients with colchicine-naive stable angina (SAP) (n = 13; mean age, 66.8 years) were additionally sampled. Serum chemokine levels were analyzed with ELISA. In parallel, monocytes from healthy donors were isolated and subjected to colchicine treatment. Transcoronary (TC) levels of chemokine ligand 2 (CCL2) and C-X3-C motif chemokine ligand 1 (CX3CL1) were significantly elevated in patients with ACS versus patients with SAP (P < 0.01). TC chemokine ligand 5 (CCL5) levels were not significantly (P = 0.084) elevated in patients with ACS versus patients with SAP. Colchicine treatment markedly reduced TC levels of CCL2, CCL5, and CX3CL1 in patients with ACS (P < 0.05). In vitro colchicine suppressed CCL2 gene expression in stimulated monocytes (P < 0.05). Colchicine treatment reduced the intracellular concentration of all 3 chemokines (P < 0.01) and impaired monocyte chemotaxis (P < 0.05). Here, we report for the first time that short-term colchicine therapy significantly reduces the local production of coronary chemokines, in part by attenuating production of these mediators by monocytes. These data provide further evidence of colchicine's beneficial role in patients with ACS. [ABSTRACT FROM AUTHOR]

[Display omitted] Atherosclerosis, a chronic cardiovascular disease caused by plaque development in arteries, remains a leading cause of morbidity and mortality. Atherosclerotic plaques are characterized by the expression and regulation of key molecules such as cell surface receptors, cytokines, and signaling pathway proteins, potentially facilitating precise diagnosis and treatment on a molecular level by specifically targeting the characteristic molecules. In this review, we highlight the recent progress in the past five years on developing molecularly targeted nanomedicine for imaging detection and treatment of atherosclerosis with the use of inorganic nanoparticles. Through targeted delivery of imaging contrast nanoparticles to specific molecules in atherogenesis, atherosclerotic plaque development at different stages could be identified and monitored via various molecular imaging modalities. We also review molecularly targeted therapeutic approaches that target and regulate molecules associated with lipid regulation, inflammation, and apoptosis. The review is concluded with discussion on current challenges and future development of nanomedicine for atherosclerotic diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose Suboptimal visual acuity after endothelial keratoplasty has been attributed to increased anterior corneal high-order aberrations (HOAs). In this study, we determined anterior and posterior corneal HOAs over a range of severity of Fuchs' endothelial corneal dystrophy (FECD). Design Cross-sectional study. Participants A total of 108 eyes (62 subjects) with a range of severity of FECD and 71 normal eyes (38 subjects). Methods All corneas were examined by using slit-lamp biomicroscopy to determine the severity of FECD versus normality. Fuchs' endothelial corneal dystrophy corneas were categorized as mild, moderate, or advanced according to the area and confluence of guttae and the presence of clinically visible edema. Normal corneas were devoid of any guttae. Wavefront errors from the anterior and posterior corneal surfaces were derived from Scheimpflug images and expressed as Zernike polynomials through the sixth order over a 6-mm diameter optical zone. Backscatter from the anterior 120 μm and posterior 60 μm of the cornea also was measured from Scheimpflug images and was standardized to a fixed scatter source. Variables were compared between FECD and control eyes by using generalized estimating equation models to adjust for age and correlation between fellow eyes. Main Outcome Measures High-order aberrations, expressed as root mean square of wavefront errors, and backscatter of the anterior and posterior cornea. Results Total anterior corneal HOAs were increased in moderate (0.61±0.27 μm, mean ± standard deviation; P = 0.01) and advanced (0.66±0.28 μm; P = 0.01) FECD compared with controls (0.47±0.16 μm). Total posterior corneal HOAs were increased in mild (0.22±0.09 μm; P = 0.017), moderate (0.22±0.08 μm; P < 0.001), and advanced (0.23±0.09 μm; P < 0.001) FECD compared with controls (0.16±0.03 μm). Anterior and posterior corneal backscatter were higher for all severities of FECD compared with controls ( P ≤ 0.02, anterior; P ≤ 0.001, posterior). Conclusions Anterior and posterior corneal HOAs and backscatter are higher than normal even in early stages of FECD. The early onset of HOAs in FECD might contribute to the persistence of HOAs and incomplete visual rehabilitation after endothelial keratoplasty. [ABSTRACT FROM AUTHOR]

Purpose: To determine whole-eye high-order aberrations (HOAs) in pseudophakic eyes after Descemet stripping endothelial keratoplasty (DSEK) for Fuchs dystrophy, and to establish relationships between graft thickness, HOAs, and visual acuity. Design: Cross-sectional study. Methods: Whole-eye HOAs were measured in pseudophakic eyes at intervals through 24 months after DSEK, and in otherwise healthy pseudophakic control eyes implanted with the same type of spherical intraocular lens. Wavefront errors were assessed by a Hartmann-Shack aberrometer over a 4-mm-diameter optical zone. In DSEK eyes, central graft thickness and stromal graft folds were measured using confocal microscopy in vivo, and best-corrected visual acuity (BCVA) was determined by the electronic Early Treatment of Diabetic Retinopathy Study method. Results: Total HOAs at 24 months after DSEK (0.28 ± 0.11 μm, mean ± SD, n = 17) were higher than those in pseudophakic controls (0.16 ± 0.07 μm, n = 25, P < .001); specifically, trefoil and quadrafoil were higher after DSEK. At 24 months, total HOAs (r = 0.69, P < .001) and graft folds (r = 0.41, P = .02) were correlated with central graft thickness, and BCVA was correlated with total HOAs (r = 0.39, P = .01) but not with graft thickness (r = −0.24, P = .20, n = 27). Conclusions: Whole-eye HOAs are higher after DSEK compared to untreated corneas. Thicker grafts are associated with increased HOAs and more graft folds, suggesting that the donor lenticule contributes, in part, to the wavefront errors. Although BCVA is weakly related to total HOAs after DSEK, it is not related to graft thickness. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease. Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st, 2010 and December 31st, 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management. Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6–12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability. [ABSTRACT FROM AUTHOR]

Purpose: To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping endothelial keratoplasty (DSEK). Design: Prospective, cohort study. Methods: Forty-four eyes with Fuchs endothelial dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. Results: Total corneal thickness was 610 ± 50 μm (mean ± standard deviation) before DSEK, increased to 680 ± 74 μm by 1 month after DSEK (P < .001), and stabilized at 660 ± 68 μm by 3 months after DSEK (P = .03 vs 1 month). Graft thickness was 170 ± 57 μm at 1 month, decreased to 157 ± 49 μm by 3 months (P = .004), and then remained stable through 12 months (156 ± 51 μm; P = .99 vs 3 months). BCVA was 0.44 ± 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 ± 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months (P < .001), and improved to 0.16 ± 0.16 logMAR units (Snellen equivalent, 20/29) at 12 months (P < .001 vs 3 months). BCVA and forward light scatter did not correlate with corneal or graft thickness after DSEK. Conclusions: Stromal edema resolves by 3 months after DSEK for Fuchs dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter. [ABSTRACT FROM AUTHOR]