Update on Femtosecond Laser-Assisted Cataract Surgery: A Review.

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.

Pupil versus 1st Purkinje capsulotomy centration with femtosecond laser: Long term outcomes with a sinusoidal trifocal lens.

PURPOSE: To assess the role of femtosecond laser-assisted capsulotomy centration in the long-term intraocular positioning of a multifocal intraocular lens. DESIGN: Prospective comparative study. METHODS: A total of 60 eyes of 30 patients underwent femtosecond laser-assisted Refractive Lens Exchange (RLE). For every patient, capsulotomy centration was randomly performed according to pupil centre (PC) in one eye and first Purkinje reflex (FPR) in the other. The intraocular lens (IOL) positioning, visual acuities, spherical equivalent, internal aberrometry and quality of vision were assessed and compared at 3 years' follow-up between groups (PC and FPR). RESULTS: Intraocular lens positioning showed a statistically significant difference between groups, with a closer centration to the visual axis in the FPR patients (p < 0.001). Internal aberrometry showed higher values in the PC capsulotomy centration group (p < 0.01). CONCLUSIONS: FPR centered capsulotomy is associated to a closer centration of the IOL to the visual axis.

Renal transplant waiting list mortality in COVID era: is it advisable to halt transplant activity?

INTRODUCTION: Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Since March 2020, transplant activity in Mexico has been affected due to the COVID-19 pandemic. OBJECTIVE: The aim of the study was to determine the impact on mortality of patients on the waiting list (WL) for cadaveric donor kidney transplantation in a referral hospital in Yucatán, due to suspension of activities due to the pandemic. MATERIAL AND METHODS: Patients over 18 years of age on the waiting list for kidney transplantation at this hospital. In the event of a patient's death, the cause was investigated, especially if it was associated with COVID-19. A two-tailed p ≤ 0.05 was considered significant in all analyzes. RESULTS: The odds ratio (OR) of death from COVID-19 in a patient with ESRD in the WL in 2020 was OR = 5.04 (95% CI: 1.65-7.14, p = 0.023). The OR of dying with ESRD in the WL with a delay in the follow-up visits was OR = 6.59 (95% CI: 2.7-16.28, p = 0.008). CONCLUSION: The probability of death of a patient with ESRD with delayed follow-up visits and transplant retention is statistically higher than the probability of death from COVID-19.

INTRODUCCIÓN: El trasplante renal es el tratamiento de elección de la enfermedad renal en etapa terminal (ERT). Desde marzo de 2020, la actividad de trasplantes en México se ha visto afectada debido a la pandemia de COVID-19. OBJETIVO: Determinar el impacto en la mortalidad de pacientes en lista de espera (LE) para trasplante renal de donante cadavérico en un hospital de referencia en Yucatán, por suspensión de actividades debido a la pandemia. MATERIAL Y MÉTODOS: Pacientes > 18 años en LE para trasplante renal en este hospital. En caso de muerte de un paciente, se investigó la causa, especialmente si estaba asociada a COVID-19. Un valor de p de dos colas ≤ 0.05 se consideró significativo en todos los análisis. RESULTADOS: La razón de probabilidad de muerte por COVID-19 en un paciente con ERT en la LE en 2020 fue OR = 5.04 (IC 95%: 1.65-7.14, p = 0.023). La razón de probabilidad de morir con ERT en la LE con retraso en las consultas de seguimiento fue de OR = 6.59 (IC 95%: 2.7-16.28, p = 0.008). CONCLUSIÓN: La probabilidad de muerte de un paciente con ERT en la LE con retraso en las consultas de seguimiento y retención del trasplante es estadísticamente más alta que la probabilidad de muerte por COVID-19.

Cataract Grade and Pupil: Comparison Between Conventional Phacoemulsification and Low-Energy Femtosecond Laser Assisted Cataract Surgery.

Purpose: This study presents a comparison of pupil changes according to cataract grade between low-energy femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CP) in the same patient. Patients and Methods: Data from surgical records from patients submitted to cataract surgery with CP in one eye and FLACS in the other were retrospectively reviewed. The inclusion criterion was both eyes of the same patient having the same cataract grade in accordance with Lens Opacity Classification System (LOCS) III. Total pupil variation (TPV) was measured after recorded images, with intraindividual comparison between techniques, according to cataract grade (≤3 and >3), age and cumulative dissipated energy (CDE). Results: The study included a total of 124 eyes of 62 patients (mean age 72.65 ± 7.64 years). Analysis showed a statistically significant difference in TPV between techniques in the grade ≤3 cataract group (0.08 ± 0.22 mm²; p=0.034), with less pupil narrowing with FLACS, but not in the grade >3 group (0.01 ± 0.23 mm²; p=0.849). Regarding CDE, a significant difference (p<0.001) was found between techniques in both softer and harder cataracts, with lower values for FLACS. Correlation between CDE and TPV was significant for CP (p=0.021) but not for FLACS (p=0.922). TPV was significantly lower in older patients (age >74 years) for both techniques (p<0.001). Conclusion: There was a statistically significant difference between techniques (although of mild clinical relevance), with less reduction of pupil area with FLACS in softer cataracts (grade ≤3), as compared to CP. Higher levels of CDE are associated with more pupil narrowing in CP.

Pupil Status with Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification: An Intraindividual Comparative Study.

Purpose: To compare the pupil changes in low-energy femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CP) intraindividually. Patients and Methods: A retrospective review of registered surgical data from patients that undergone uncomplicated cataract surgery in a single centre, with randomly assigned femtosecond laser-assisted cataract surgery (FLACS) to one eye and conventional phacoemulsification (CP) to the other, was performed. The recorded pupil images were evaluated at pre and post laser treatment (after suction release) and at several surgical timepoints for both techniques (FLACS and CP). Pupil areas were calculated and compared in the same eye undergone FLACS (pre vs post laser treatment), between eyes (CP vs FLACS) in the same patient and between groups. Subgroups were built regarding age and ocular comorbidity. Results: This study involved a total of 164 eyes of 82 patients (55 female, 27 male). No statistical differences regarding the total duration of surgery (p=0.805) between FLACS and CP. Pupil measurements between pre and post laser treatment in the FLACS group showed no statistically significant differences (p=0.107). The mean change in pupil area from the beginning until the end of surgery (total variation) was 6.59±2.08 mm2 in the FLACS group and 6.67±2.13 mm2 in the CP group, associated to less narrowing of pupil area with FLACS, although not statistically significant (p=0.080). Comorbidity group analysis revealed less, but not significant, pupil narrowing with the FLACS technique (p=0.071). No statistically significant differences between FLACS and CP concerning age subgroups were registered. Conclusion: This study shows no significant pupil changes, namely myosis, after low-energy FLACS pre-treatment. Comparison between techniques showed less pupil variation in FLACS as compared to CP, more markedly in eyes with comorbidities (particularly with shallow anterior chamber), although non-statistically significant.

Total Ankle Replacement Versus Arthrodesis for End-Stage Ankle Osteoarthritis: A Randomized Controlled Trial.

BACKGROUND: End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR) and ankle fusion (AF). OBJECTIVE: To determine which treatment is superior in terms of clinical scores and adverse events. DESIGN: A multicenter, parallel-group, open-label randomized trial. (ISRCTN registry number: 60672307). SETTING: 17 National Health Service trusts across the United Kingdom. PATIENTS: Patients with end-stage ankle osteoarthritis, aged 50 to 85 years, and suitable for either procedure. INTERVENTION: Patients were randomly assigned to TAR or AF surgical treatment. MEASUREMENTS: The primary outcome was change in Manchester-Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. No blinding was possible. RESULTS: Between 6 March 2015 and 10 January 2019, a total of 303 patients were randomly assigned; mean age was 68 years, and 71% were men. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95% CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7%. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]). LIMITATION: Only 52-week data; pragmatic design creates heterogeneity of implants and surgical techniques. CONCLUSION: Both TAR and AF improve MOXFQ-W/S and had similar clinical scores and number of harms. Total ankle replacement had greater wound healing complications and nerve injuries, whereas AF had greater thromboembolism and nonunion, with a symptomatic nonunion rate of 7%. PRIMARY FUNDING SOURCE: National Institute for Health and Care Research Heath Technology Assessment Programme.

Torus mandibular e palatino predisponentes em um grupo familiar: fatores genéticos e ambientais, relato de uma série de casos / Mandibular and palatine torus predisposing in a family group: genetic and environmental factors, report of a series of cases / Torus mandibular y palatino predisponente en un grupo familiar: factores genéticos y ambientales, informe de una serie de casos

As exostoses mais conhecidas são o Torus palatino e mandibular, que se desenvolvem a partir do crescimento benigno da cortical óssea, localizadas respectivamente na linha média palatina e superfície lingual de caninos e pré-molares, podendo ser unilaterais ou bilaterais. Esse trabalho tem como objetivo o estudo de um grupo familiar que apresentaram o Torus como característica em comum, buscando confirmar a presença e prevalência das características clínicas multifatoriais listadas na literatura, possibilitando o diagnóstico da etiologia e assim traçando um plano de tratamento individual, se necessário. Como metodologia, foi realizada uma triagem com cada membro familiar na clínica Odontológica da Faculdade Sete Lagoas - FACSETE, descartando a participação no estudo os membros que não apresentaram o Torus. Os indivíduos que apresentaram indicação da remoção cirúrgica foram encaminhados para clínica de cirurgia da própria instituição. Concluímos, portanto, com este estudo que fatores genéticos e ambientais colaboram como fator etiológico mais predominantes para surgimento do Torus no grupo familiar estudado... (AU)

The best known exostosis are the palatine and mandibular Torus, which develop from the benign growth of the cortical bone, located respectively in the midpalatal line and lingual surface of canines and premolars, and maybe unilateral or bilateral. This work aims to study a family group that had Torus as a common feature, confirming the presence and prevalence of multifactorial clinical features listed in the literature, enabling the diagnosis of etiology and thus outlining an in dividual treatment plan, if necessary. As a methodology, a screening was performed by each family member at the Dental Clinic of Facul dade Sete Lagoas - FACSETE, discarding the participation in the study for members who did not present Torus. Individuals who indicated surgical removal were referred to the institution's own surgery clinic. Therefore, we conclude with this study that genetic and environmental factors collaborate as the most predominant etiological factor for the emergence of Torus in the studied family group... (AU)

Las exostosis más conocidas son el Torus palatino y el Torus mandibular, las cuales se desarrollan a partir del crecimiento benigno del hueso cortical y están ubicadas respectivamente en la línea medio palatina y en la cara lingual de los caninos y de los premolares que pueden ser unilaterales o bilaterales. Este proyecto tiene como objetivo el estudio de un grupo familiar que presentó en sus características comunes el Torus, buscando confirmar la presencia y el predominio de las características clínicas multifactoriales listadas en la literatura, lo que hizo posible el diagnóstico de la etiología y diseñar un plan de tratamiento individual, caso necesiten. Como la metodología fue hecho una selección con los miembros de la familia en la clínica odontologica de la Faculdade Sete Lagoas - FACSETE, quitando de los estudios las personas de la familia que no presentaron el Torus. Los individuos que presentaron indicación de extirpación quirúrgica fueron enviados a la clínica de cirugía de la escuela. Concluimos con este estudio que los factores genéticos y ambientales colaboraron como los factores etiológicos más predominantes para la aparición del Torus en la familia analizada... (AU)

Tratamento cirúrgico conservador de cisto radicular de grande extensão: relato de caso com acompanhamento / Conservative surgical treatment of large extension radicular cyst: case report with follow-up

Introdução: os cistos radiculares são as lesões císticas mais comuns nos maxilares. Eles surgem dos Restos Epiteliais de Malassez, presos no ligamento periodontal e podem ser ativados por um processo inflamatório na região pulpar. Geralmente são descobertos em exames radiográficos de rotina, apresentando-se como uma imagem radiolúcida, bem delimitada, envolvendo o periápice de um ou mais dentes. Objetivo: apresentar o tratamento de um extenso cisto radicular, em região de maxila, com acompanhamento de 18 meses. Relato do caso: Paciente do sexo feminino, 49 anos, foi encaminhada para avaliação e tratamento na Clínica Odontológica da Faculdade Sete Lagoas (FACSETE), apresentando lesão extensa em região maxilar anterior direita ao exame radiográfico. Ao exame clínico, observou-se leve assimetria facial e ausência de sintomas dolorosos. Tomografia computadorizada, punção aspirativa e biópsia incisional foram utilizadas para se chegar ao diagnóstico compatível com cisto radicular. Optou-se por uma técnica conservadora, em que foi realizada a descompressão da lesão. Após 05 meses de tratamento, um novo procedimento cirúrgico foi realizado para enuclear o restante da patologia. Conclusão: a descompressão, com utilização de cânula, é um tratamento auxiliar fácil, conservador, eficaz e reduz a morbidade causada por diferentes cistos odontogênicos(AU)

Introduction: root cysts are the most common cystic lesions in the jaw. They arise from the Epithelial Remains of Malassez, trapped in the periodontal ligament and can be activated by an inflammatory process in the pulp region. They are usually discovered in routine radiographic examinations, presenting as a well-defined radiolucent image involving the periapex of one or more teeth. Objective: to present the treatment of an extensive root cyst, in the maxillary region, with a follow-up of 18 months. Case report: A 49-year-old female patient was referred for evaluation and treatment at the Dental Clinic of Faculdade Sete Lagoas (FACSETE), with an extensive lesion in the right anterior maxillary region on radiographic examination. On clinical examination, mild facial asymmetry and absence of painful symptoms were observed. Computed tomography, aspiration puncture and incisional biopsy were used to reach a diagnosis compatible with radicular cyst. We opted for a conservative technique, in which the lesion was decompressed. After 05 months of treatment, a new surgical procedure was performed to enucleate the rest of the pathology. Conclusion: decompression, using a cannula, is an easy, conservative, effective auxiliary treatment and reduces the morbidity caused by different odontogenic cysts.

Effect of Novel Deep Eutectic Solvents on the Endo/Exo Ratio of Diels-Alder Reactions at Room Temperature.

The Diels-Alder reaction is a prototypical example of a thermally allowed [4 + 2] cycloaddition with good control over the regio- and stereochemical outcomes. Therefore, Diels-Alder reactions in which adjacent stereocenters are generated at the two ends of the newly formed single bonds imply two different possible stereochemical outcomes. In cases where the dienophile has a single electron-withdrawing substituent, the outcome can often be predicted by applying the known "endo rule". Furthermore, the use of chiral eutectic solvents in asymmetric synthesis has become a novel tool to maintain sustainability in organic synthesis. In the present work, a set of recyclable and sustainable bio-based deep eutectic solvents (DESs) was designed using hydrogen bond acceptors (HBAs) with a chiral center. These compounds were used in their racemic and enantiomerically enriched forms to prepare DESs with lactic acid (LA), glycerol (Gly), and ethylene glycol, which act as hydrogen bond donors (HBDs) in the corresponding eutectic mixture. These DESs were used as solvents to study the reaction between cyclopentadiene and ethyl acrylate or butyl acrylate in typical [4 + 2] cycloadditions. The best yields and endo-selectivity were achieved using LA as the HBD in the eutectic mixtures. The results and adduct ratios obtained show that these DESs were able to improve both reaction yields and selectivity when compared to those observed in organic solvents or ionic liquids. Moreover, the reaction products (adducts) were easily recovered with diethyl ether from the reaction mixture, where they appeared as an upper layer.

Effect of Four Novel Bio-Based DES (Deep Eutectic Solvents) on Hardwood Fractionation.

Using the basic principle of construction between a hydrogen bond acceptor (HBA) and a hydrogen bond donor (HBD), four bio-based deep eutectic solvents (DESs) were prepared in a 1:2 molar ratio of HBA:HBD. 2,3-Dihydroxypropyl-1-triethylammonium chloride ([C9H22N+O2]Cl-) was synthesized from raw glycerol and used as an HBA. Lactic acid, urea, pure glycerol, and ethylene glycol were selected as HBD. Attempts to prepare DESs, using citric acid and benzoic acid as HBDs, were unsuccessful. All these DESs were characterized using FTIR and NMR techniques. Besides, physicochemical parameters such as pH, viscosity, density, and melting point were determined. The behavior of these DES to fractionate olive pomace was studied. Lignin recovery yields spanned between 27% and 39% (w/w) of the available lignin in olive pomace. The best DES, in terms of lignin yield ([C9H22N+O2]Cl- -lactic acid), was selected to perform a scale-up lignin extraction using 40 g of olive pomace. Lignin recovery on the multigram scale was similar to the mg scale (38% w/w). Similarly, for the holocellulose-rich fractions, recovery yields were 34% and 45% for mg and multi-gram scale, respectively. Finally, this DES was used to fractionate four fruit pruning samples. These results show that our novel DESs are alternative approaches to the ionic liquid:triethylammonium hydrogen sulfate and the widely used DES: choline chloride:lactic acid (1:10 molar ratio) for biomass processing.

Novel kidney injury biomarkers in tropical infections: a review of the literature.

Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.

The Azorean edible abalone Haliotis tuberculata, an alternative heavy metal-free marine resource?

Abalones are considered a delicacy and exploited for food worldwide. In many places, overfishing has led to the decimation of wild stocks and many are now reared in aquaculture systems. In the Azores, there is no tradition of eating abalones and Haliotis tuberculata stocks are still virtually untouched. However, as tourism in the islands grows and the stocks of other shellfish diminish, there is an increasing pressure to find alternative edible resources, leading to a rising interest in abalones. According to previous studies performed in the region, other edible species, including the local highly appreciated limpets and the giant barnacle, present high concentration levels of some heavy metals, which has been attributed to the volcanic origin of the islands. Here we analysed the metal content in the edible tissue of Haliotis tuberculata from São Miguel Island, Azores. The potential human health risks due to its consumption was assessed by estimating the average daily intake (EDI) and target hazard quotient (THQ) of metals. Similarly to other organisms in the Azores, abalones have higher than normal levels of some heavy metals, particularly cadmium, reflecting a local natural source that should be closely monitored from a public health point of view.

Mid-Atlantic elasmobranchs: Suitable metal scouts?

Heavy metals are a hazard to marine fauna and human health. In this study we assess stable isotopes and metal content in Prionace glauca and Isurus oxyrinchus and analyse these results within and among other species and across regions and geographical areas. Also, we evaluate their suitability, together with Raja clavata and Galeorhinus galeus, as Mid-Atlantic bioindicators. Prionace glauca and I. oxyrinchus shared the same trophic level in a pelagic food web and did not present significant differences between genders or metals, except for As. Arsenic and Hg accumulated while Cd and Pb were not detected. One I. oxyrinchus presented Hg values above regulatory limits. A high Hg exposure was associated with I. oxyrinchus since its maximum weekly intake was exceeded. Elasmobranchs can be used as metal sentinels, each presenting different key features which defines a good marine bioindicator, allowing long-term monitoring at different temporal and spatial scales.

Peripapillary choroidal thickness by enhanced depth imaging optical coherence tomography: the impact of metabolic syndrome.

PURPOSE: To assess the impact of metabolic syndrome (MetS) on the peripapillary choroidal thickness (PPCT) and to characterize the PPCT in a Portuguese population. METHODS: This prospective study included 104 eyes. Detailed medical and ophthalmic examinations were performed; the PPCT was measured by spectral-domain optical coherence tomography (SD-OCT) using enhanced depth imaging (EDI) modality. The PPCT changes with MetS, as well as with other clinical and demographic factors, were investigated. RESULTS: The mean PPCT was 142.4 ± 54.0 µm (58-303 µm); it was thickest superiorly, followed by the temporal, nasal, and inferior sectors. The PPCT was significantly associated with axial length (p<0.001), age (p = 0.001), intraocular pressure (IOP) (p = 0.041), weight (p = 0.015), and arterial hypertension (p = 0.044). The presence of MetS was associated with thinner PPCT in all sectors, being statistically significant in the temporal (p = 0.032) and inferotemporal (p = 0.034) sectors. CONCLUSIONS: The choroidal thickness was significantly less in temporal and inferotemporal sectors in patients with MetS than in controls. This may suggest vascular insufficiency around the optic nerve head.

Bioaccumulation of metals and PCBs in Raja clavata.

The goal of this study was to assess stable isotopes profiles, metals concentration and PCBs in Raja clavata muscle and liver, according to sex and size, and to elucidate its suitability as a Mid-Atlantic biomonitor. The results reflected bioaccumulation and suggested biomagnification processes for As and Hg in muscle tissue. Cd, Cu and Zn were detected in high amounts in liver, Cr, Mn and Rb were relatively stable and low, Pb was not detected and Sr was present in muscle at high levels, decreasing with length. Hg and Se were strongly correlated, suggesting a mitigation role. Both tissues presented low concentrations of PCBs, especially the dioxin-like congeners, although always higher in liver and not correlated with size. None of these contaminants exceed EU legislated limits. However, they need to be monitored given study area's location, volcanic nature and the expected increase of anthropogenic activity related to future prospective mining activities and the establishment of the Transatlantic Trade and Investment Partnership (TTIP) between Europe and the USA.

Metal Concentrations in Two Commercial Tuna Species from an Active Volcanic Region in the Mid-Atlantic Ocean.

Concentrations of cadmium (Cd), mercury (Hg), and lead [Pb (µg g(-1) wet weight)] were determined in liver and muscle samples of 15 bigeye (Thunnus obesus) and 15 skipjack tunas (Katsuwonus pelamis) caught over an active volcanic region in the Mid-Atlantic Ocean (Azores, Portugal) and evaluated regarding consumption safety. None of the muscle samples (edible part) exceeded the European Union (EU) maximum limits (MLs) for Hg and Pb. Cd concentrations in muscle were much greater than EU MLs with 53 and 26 % of the bigeye tuna and skipjack tuna, respectively, in exceedance of the limits. Results obtained in this work, together with other studies in the same region, support the existence of an important volcanic source of Cd in waters of the Mid-Atlantic region, which should be carefully monitored given the importance of many commercial marine species for human consumption, mainly in Europe.

Ophthalmological manifestations in hereditary transthyretin (ATTR V30M) carriers: a review of 513 cases.

PURPOSE: Assessment of ocular involvement in transthyretin-related familial amyloidosis with polyneuropathy (FAP) in a large cohort of Portuguese patients. METHODS: We reviewed the medical records of 513 Portuguese FAP mutation carriers, at the Ophthalmology Service, Centro Hospitalar do Porto, between 1 January 2008 and 31 January 2013. Abnormal conjunctiva vessels (ACV), Schirmer test, tear break-up time (TBUT), amyloid deposition on the iris (DAI), scalloped iris, amyloid deposition on the anterior capsule of the lens (DAL), vitreous amyloidosis, retinal amyloid angiopathy and glaucoma were evaluated and registered. RESULTS: Of the 513 carriers, 477 (93%) had clinical systemic disease with a median duration of 9.3 (5.1-13.7) years and 247 were men. Of these, 343 (72%) had been liver transplanted, on median of 6.6 (3.3-10.8) years before inclusion in this study. No ocular abnormalities were identified in the asymptomatic carriers (7%). The abnormalities observed with decreasing frequency were abnormal TBUT (379 patients, 79.5%, 751 eyes), abnormal Schirmer test (320 patients, 67%, 635 eyes), DAI (183 patients, 38.4%, 350 eyes), DAL (157 patients, 32.9%, 308 eyes), scalloped iris (133 patients, 27.9%, 238 eyes), glaucoma (97 patients, 20%, 165 eyes), vitreous amyloidosis (83 patients, 17.4%, 139 eyes), ACV (68 patients, 14%, 136 eyes) and amyloidotic retinal angiopathy (21 patients, 4%, 32 eyes). Patients with abnormal Schirmer test (p < 0.001), scalloped iris (p = 0.006) and vitreous amyloidosis (p = 0.007) were significantly older than the others. According to their age of onset of systemic disease, the patients have been split into early-onset (<40 years old), intermediate-onset (40-50 years old), late onset (>50 years old) and asymptomatic carriers. We observed a statistically significant difference in the prevalence of ACV (p = 0.045) and of an abnormal Schirmer test (p = 0.004) between groups. Transplanted patients have a significantly higher prevalence of DAI (p = 0.001), DAL (p = 0.009) and vitreous amyloidosis (p = 0.025) than non-transplanted patients. Of the 165 eyes with glaucoma, 92.1% had scalloped iris (p < 0.001) and of 32 eyes with retinal amyloidotic angiopathy, 68.8% had vitreous amyloidosis (p < 0.001). All prevalences increased with time of disease. The earliest ocular manifestations were abnormal Schirmer test and abnormal TBUT (12% and 17% at 5 years of clinical disease) and the least prevalent was retinal amyloid angiopathy (8% at 15 years of clinical disease). CONCLUSION: Ocular disorders in FAP patients are common, and their prevalence increases with disease duration. Prevalence is influenced by several factors, such as the age at onset of FAP and liver transplantation.

Impact of liver transplantation on the natural history of oculopathy in Portuguese patients with transthyretin (V30M) amyloidosis.

PURPOSE: Evaluation of the impact of liver transplantation in the natural history of ocular disorders in familial amyloidotic polyneuropathy (FAP) amyloidosis TTR V30M related (ATTR V30M) patients. DESIGN: A clinical, retrospective and cross-sectional study of 64 Portuguese FAP ATTR V30M patients was carried out between January 2005 and December 2011. METHODS: Thirty-two liver transplanted patients (both eyes) aged 39.6-53.8 years old, 32/32 male/female, were paired with an equal number of non-transplanted patients, matching for age, gender, age at onset, disease duration and gender of transmitting parent. Intervention or observation procedure: Routine ophthalmological observation. MAIN OUTCOME MEASURES: Slit-lamp observation for abnormal conjunctival vessels (ACV), tears break-up time, iris, lens; fundus observation for vitreous, retina and optic disc; Schirmer test. RESULTS: Liver transplantation had no influence on tears break-up time, deposition of amyloid on the iris and retinal amyloid angiopathy. Slight, non-statistically significant protective effects of liver transplantation were noted in the first years for some ocular manifestations (ACV and scalloped iris), except for the abnormal Schirmer test, which was significantly more prevalent in non-transplanted patients' eyes (81% versus 56%, p = 0.002). On the other hand, deposition of amyloid on the lens, vitreous amyloidosis and glaucoma were apparently more common in transplanted patients. Those differences tended to disappear with time. CONCLUSIONS: Ocular manifestations of FAP were not influenced by liver transplantation in a meaningful way. Both transplanted and non-transplanted FAP patients need similar regular follow-up due to long-term risk of serious ocular disease.

Aqueous humor erythropoietin levels in open-angle glaucoma patients with and without TTR V30M familial amyloid polyneuropathy.

PURPOSE: Glaucoma is the leading cause of irreversible blindness in familial amyloidotic polyneuropathy (FAP) patients. Erythropoietin (EPO) is a cytokine that has been shown to play a role in neuroprotection and is endogenously produced in the eye. EPO levels in the aqueous humor are increased in eyes with glaucoma. In this study, we evaluated the EPO concentration in the aqueous humor of FAP and non-FAP patients, with and without glaucoma. METHODS: Undiluted aqueous humor samples were obtained from 42 eyes that underwent glaucoma surgery, phacoemulsification, or vitrectomy. EPO concentration in the aqueous humor and blood were measured using the Immulite 2000 Xpi using an automatic analyzer (Siemens Healthcare Diagnostics). RESULTS: The mean EPO concentration in the aqueous humor of non-FAP glaucoma eyes group 2 (75.73±13.25 mU/ml) was significantly higher than non-FAP cataract eyes (17.22±5.33 mU/ml; p<0.001), FAP glaucoma eyes (18.82±10.16 mU/ml; p<0.001), and FAP nonglaucoma eyes (20.62±6.22 mU/ml; p<0.001). There was no statistically significant difference between FAP nonglaucoma eyes versus non-FAP cataract eyes (p = 0.23) and FAP glaucoma eyes versus FAP nonglaucoma eyes (p = 0.29). In the glaucoma groups, there was no correlation between the aqueous humor EPO concentration and the ocular pressure (p = 0.95) and mean deviation (p = 0.41). There was no correlation between the EPO serum concentration and EPO aqueous humor concentration in our patients (p = 0.77). CONCLUSIONS: Unlike other glaucomatous patients, FAP patients with glaucoma do not show increased and potentially neuroprotective endocular EPO production in the aqueous humor and may need more aggressive glaucoma management.