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Abstract Antimicrobial resistance is one of the leading concerns in medical care. Here we study the mechanism of action of an antimicrobial cationic tripeptide, AMC-109, by combining high speed-atomic force microscopy, molecular dynamics, fluorescence assays, and lipidomic analysis. We show that AMC-109 activity on negatively charged membranes derived from Staphylococcus aureus consists of two crucial steps. First, AMC-109 self-assembles into stable aggregates consisting of a hydrophobic core and a cationic surface, with specificity for negatively charged membranes. Second, upon incorporation into the membrane, individual peptides insert into the outer monolayer, affecting lateral membrane organization and dissolving membrane nanodomains, without forming pores. We propose that membrane domain dissolution triggered by AMC-109 may affect crucial functions such as protein sorting and cell wall synthesis. Our results indicate that the AMC-109 mode of action resembles that of the disinfectant benzalkonium chloride (BAK), but with enhanced selectivity for bacterial membranes.

Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams. [ABSTRACT FROM AUTHOR]

Abstract Background Astigmatic keratotomy (AK) remains an accessible means to correct surgically induced or naturally occurring astigmatism. The advantages of femtosecond laser-assisted astigmatic keratotomy (FSAK) over conventional methods have been recognized recently. Main text This review evaluates the efficacy, complications, and different methods of FSAK for correction of astigmatism in native eyes and those that underwent previous penetrating keratoplasty (PKP). The penetrating and intrastromal FSAK (IFSAK) techniques can reduce post-keratoplasty astigmatism by 35.4% to 84.77% and 23.53% to 89.42%, respectively. In native eyes, the penetrating and IFSAK techniques reduce astigmatism by 26.8% to 58.62% and 36.3% to 58% respectively, implying that the magnitude of the astigmatic reduction is comparable between the two FSAK procedures. Nonetheless, IFSAK offers the additional advantages of almost no risk of infection, wound gape, and epithelial ingrowth. The use of nomograms, anterior-segment optical coherence tomography, and consideration of posterior cornea and corneal biomechanics are helpful to enhance the efficacy and safety of FSAK. The complications of FSAK in eyes that underwent PKP include overcorrection, visual loss, microperforations, infectious keratitis, allograft rejection, and endophthalmitis. The reported difficulties in native eyes include overcorrection, anterior gas breakthrough, and suction loss. Conclusions In eyes that underwent PKP, FSAK effectively reduces high regular or irregular astigmatism, with rare and manageable complications. Nevertheless, the drawbacks of the procedure include the potential loss of visual acuity and low predictability. For native eyes undergoing femtosecond laser-assisted cataract surgery, IFSAK is a good choice to correct low astigmatism (

Ventilatory equivalents for oxygen and carbon dioxide are physiological measures of breathing efficiency, and are known to be affected by the intensity and mode of exercise. We examined the effect of level running (gradient 0%) and muscle-damaging downhill running (−12%), matched for oxygen uptake, on the ventilatory equivalents for oxygen () and carbon dioxide (). Nine men (27 ± 9 years, 179 ± 7 cm, 75 ± 12 kg, : 52.0 ± 7.7 mL·kg−1·min−1) completed two 40-min running bouts (5 × 8-min with 2-min inter-bout rest), one level and one downhill. Running intensity was matched at 60% of maximal metabolic equivalent. Maximal isometric force of m.quadriceps femoris was measured before and after the running bouts. Data was analyzed with 2-way ANOVA or paired samples t-tests. Running speed (downhill: 13.5 ± 3.2, level: 9.6 ± 2.2 km·h−1) and isometric force deficits (downhill: 17.2 ± 7.6%, level: 2.0 ± 6.9%) were higher for downhill running. Running bouts for level and downhill gradients had , heart rates and respiratory exchange ratio values that were not different indicating matched intensity and metabolic demands. During downhill running, the , (downhill: 29.7 ± 3.3, level: 27.2 ± 1.6) and (downhill: 33.3 ± 2.7, level: 30.4 ± 1.9) were 7.1% and 8.3% higher (p < 0.05) than level running. In conclusion, breathing efficiency appears lower during downhill running (i.e., muscle-damaging exercise) compared to level running at a similar moderate intensity.

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); spectacle independence rate; and quality of life. Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13±0.15 (standard deviation), 0.22±0.15, and 0.16±0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00±0.10, 0.08±0.13, and 0.13±0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P>0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46±1.62, 1.85±1.69, 0.78±1.31, and 3.50±1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31±8.50 out of 100. Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.

Background Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID - 19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE—especially with increased COVID-19 hygiene regimes. Aims This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. Methods In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. Results Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. Conclusions Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE. [ABSTRACT FROM AUTHOR]

Background. The vision with diffractive toric multifocal intraocular lenses after cataract surgery in long eyes has not been studied previously. Objectives. To report visual performance after bilateral implantation of a diffractive toric multifocal intraocular lens in high myopes. Methods. Prospective, observational case series to include patients with axial length of ≥26 mm and corneal astigmatism of >1 dioptre who underwent bilateral AT LISA 909M implantation. Postoperative examinations included photopic and mesopic distance, intermediate, and near visual acuity; photopic contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); and spectacle independence rate. Results. Twenty-eight eyes (14 patients) were included. Postoperatively, mean photopic monocular uncorrected distance, intermediate, and near visual acuities (logMAR) were 0.12±0.20 (standard deviation), 0.24±0.16, and 0.29±0.21, respectively. Corresponding binocular values were -0.01±0.14, 0.13±0.12, and 0.20±0.19, respectively. One eye (4%) had one-line loss in vision. Under mesopic condition, intermediate vision and near vision decreased significantly (all P≤0.001). Contrast sensitivity at all spatial frequencies did not improve significantly under binocular condition (all P>0.05). Median scores for halos, night glare, starbursts, and satisfaction were 0.50, 0.00, 0.00, and 4.25, respectively. Ten patients (71%) reported complete spectacle independence. Conclusions. Bilateral implantation of the intraocular lens in high myopes appeared to be safe and achieved good visual performance and high satisfaction.