Coyotes can do 'puppy dog eyes' too: comparing interspecific variation in Canis facial expression muscles.

Facial expressions are critical for non-verbal communication. The Canis genus epitomizes the interplay between behaviour and morphology in the evolution of non-verbal communication. Recent work suggests that the levator anguli oculi medialis (LAOM) muscle is unique to dogs (Canis familiaris) within the Canis genus and evolved due to domestication. The LAOM raises the inner eyebrows, resulting in the 'puppy dog eyes' expression. Here, we test whether the LAOM is a derived trait in dogs by (i) examining the facial expression muscles of a closely related and ancestral wild Canis species, the coyote (C. latrans) and (ii) comparing our results with other Canis and canid taxa. We discover that coyotes have a well-developed LAOM like dogs, which differs from the modified/absent LAOM in grey wolves. Our findings challenge the hypothesis that the LAOM developed due to domestication. We suggest that the LAOM is a basal trait that was lost in grey wolves. Additionally, we find inter- and intraspecific variations in the size of the muscles of the outer ear, forehead, lips and rostrum, indicating potential adaptations related to sensory perception, communication and individual-level functional variations within canids. Together, this research expands our knowledge of facial expressions, their evolution and their role in communication.

Cytoplasmic strings in human blastocysts: hypotheses of their role and implications for embryo selection.

STUDY QUESTION: What are the implications of the presence cytoplasmic strings (Cyt-S) and their quantity and dynamics for the pre-implantation development of human blastocysts? SUMMARY ANSWER: Cyt-S are common in human embryos and are associated with faster blastocyst development, larger expansion, and better morphological quality. WHAT IS KNOWN ALREADY: Cyt-S are dynamic cellular projections connecting inner cell mass and trophectoderm (TE) cells, that can be observed during blastocyst expansion. Their prevalence in human embryos has been estimated to be between 44% and 93%. Data relevant to their clinical implications and role in development are lacking, limited, or controversial. STUDY DESIGN, SIZE, DURATION: Retrospective study conducted at a single IVF center between May 2013 and November 2014 and involving 124 pre-implantation genetic testing for aneuploidy cycles in a time-lapse incubator with ≥1 blastocyst biopsied and vitrified (N = 370 embryos assessed). These cycles resulted in 87 vitrified-warmed single-euploid blastocyst transfers. PARTICIPANTS/MATERIALS, SETTING, METHODS: ICSI, continuous blastocyst culture (Days 5-7), TE biopsy of fully expanded blastocysts without Day 3 zona pellucida drilling, qPCR to assess uniform full-chromosome aneuploidies, and vitrification were all performed. Only vitrified-warmed euploid single-embryo-transfers were conducted. Blastocyst morphological quality was defined according to Gardner's criteria. The AI-based software CHLOE™ (Fairtility) automatically registered timings from time of starting blastulation (tSB) to biopsy (t-biopsy, i.e. blastocyst full-expansion) as hours-post-insemination (hpi), embryo area (including zona pellucida in µm2), and spontaneous blastocyst collapses. One senior embryologist manually annotated Cyt-S presence, quantity, timings, and type (thick cell-to-cell connections and/or threads). All significant associations were confirmed through regression analyses. All couples', cycles', and embryos' main features were also tested for associations with Cyt-S presence, quantity, and dynamics. MAIN RESULTS AND THE ROLE OF CHANCE: About 94.3% of the patients (N = 117/124) had ≥1 embryo with Cyt-S. Out of a total of 370 blastocysts, 55 degenerated between blastulation and full-expansion (N = 55/370, 14.9%). The degeneration rate among embryos with ≥1 Cyt-S was 10.8% (N = 33/304), significantly lower than that of embryos without Cyt-S (33.3%, N = 22/66, P < 0.01). Of the remaining 315 viable blastocysts analyzed, 86% (N = 271/315; P < 0.01) had ≥1 Cyt-S, on average 3.5 ± 2.1 per embryo ranging 1-13. The first Cyt-S per viable embryo appeared at 115.3 ± 12.5 hpi (85.7-157.7), corresponding to 10.5 ± 5.8 h (0.5-31) after tSB. Overall, we analyzed 937 Cyt-S showing a mean duration of 3.8 ± 2.7 h (0.3-20.9). Cyt-S were mostly threads (N = 508/937, 54.2%) or thick cell-to-cell connections becoming threads (N = 382/937, 40.8%) than thick bridges (N = 47/937, 5.0%). The presence and quantity of Cyt-S were significantly associated with developmentally faster (on average 6-12 h faster) and more expanded (on average 2700 µm2-larger blastocyst's area at t-biopsy) embryos. Also, the presence and duration of Cyt-S were associated with better morphology. Lastly, while euploidy rates were comparable between blastocysts with and without Cyt-S, all euploid blastocysts transferred from the latter group failed to implant (N = 10). LIMITATIONS, REASONS FOR CAUTION: Cyt-S presence and dynamics were assessed manually on seven focal planes from video frames recorded every 15 min. The patients included were mostly of advanced maternal age. Only associations could be reported, but no causations/consequences. Lastly, larger datasets are required to better assess Cyt-S associations with clinical outcomes. WIDER IMPLICATIONS OF THE FINDINGS: Cyt-S are common during human blastocyst expansion, suggesting their physiological implication in this process. Their presence, quantity and dynamics mirror embryo viability, and morphological quality, yet their role is still unknown. Future basic science studies are encouraged to finally describe Cyt-S molecular nature and biophysical properties, and Artificial Intelligence tools should aid these studies by incorporating Cyt-S assessment. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: N/A.

Analysis of Meis2 knockout mice reveals Sonic hedgehog-mediated patterning of the cochlear duct.

BACKGROUND: The mechanisms underlying the formation of complex structures such as during the outgrowth of the cochlear duct are still poorly understood. RESULTS: We have analyzed the morphological and molecular changes associated with cochlear development in mouse mutants for the transcription factor Meis2, which show defective coiling of the cochlea. These morphological abnormalities were accompanied by the formation of ectopic and extra rows of sensory hair cells. Gene profiling of otic vesicles from Meis2 mutants revealed a dysregulation of genes that are potentially involved in Sonic hedgehog (Shh)-mediated patterning of the cochlear duct. Like in Shh mutants, Meis2 defective mice showed a loss of genes that are expressed in the apical part of the cochlear duct. CONCLUSIONS: Taken together, these data reveal that the loss of Meis2 leads to a phenotype that resembles Shh mutants, suggesting that Meis2 is instrumental for cochlear Shh signaling. The modulation of the same subset of genes provides an interesting insight into which Shh responsive genes are essential for outgrowth and patterning of the cochlear duct.

The Effect of Rheumatoid Arthritis on Middle and Inner Ear Functions.

Objective: To investigate the middle and inner ear functions, and efferent auditory systems in patients with rheumatoid arthritis (RA). Methods: Thirty-five RA patients and 40 control subjects participated in the study. Pure-tone audiometry, high-frequency audiometry, multifrequency tympanometry, transient evoked otoacoustic emissions, and contralateral suppression tests were administered to all participants. Results: Pure-tone hearing thresholds of RA patients were significantly higher at all frequencies except for 2000 Hz, 14,000 Hz, and 16,000 Hz in the right ear and 16,000 Hz in the left ear (p<0.05). Resonance frequency values of RA patients were statistically significantly lower than those of the control group (p<0.001). Emission amplitudes obtained with contralateral acoustic stimulation were significantly lower at 1400 Hz frequency in both groups than without contralateral acoustic stimulation (p<0.05). While contralateral suppression was observed at all frequencies in the control group, no suppression occurred at 2800 Hz and 4000 Hz in RA patients. Conclusion: The results obtained in this study demonstrated the presence of hearing dysfunction in patients with RA. When a patient is diagnosed with RA, an audiological evaluation should be made, and the patient should be informed about the possibility of audiological involvement.

Commentary on "Structural characterization of SLYM - a 4th meningeal membrane".

For centuries, the meninges have been described as three membranes: the inner pia, middle arachnoid and outer dura. It was therefore sensational when in early 2023 Science magazine published a report of a previously unrecognized - 4th - meningeal membrane located between the pia and arachnoid. Multiple features were claimed for this new membrane: a single cell layer marked by the transcription factor Prox1 that formed a barrier to low molecular weight substances and separated the subarachnoid space (SAS) into two fluid-filled compartments, not one as previously described. These features were further claimed to facilitate unidirectional glymphatic cerebrospinal fluid transport. These claims were immediately questioned by several researchers as misinterpretations of the authors' own data. The critics argued that (i) the 4th meningeal membrane as claimed did not exist as a separate structure but was part of the arachnoid, (ii) the "outer SAS" compartment was likely an artifactual subdural space created by the experimental procedures, and (iii) the 4th membrane barrier property was confused with the arachnoid barrier. Subsequent publications in late 2023 indeed showed that Prox1 + cells are embedded within the arachnoid and located immediately inside of and firmly attached to the arachnoid barrier cells by adherens junctions and gap junctions. In a follow-up study, published in this journal, the lead authors of the Science paper Kjeld Møllgård and Maiken Nedergaard reported additional observations they claim support the existence of a 4th meningeal membrane and the compartmentalization of the SAS into two non-communicating spaces. Their minor modification to the original paper was the 4th meningeal membrane was better observable at the ventral side of the brain than at the dorsal side where it was originally reported. The authors also claimed support for the existence of a 4th meningeal membrane in classical literature. Here, we outline multiple concerns over the new data and interpretation and argue against the claim there is prior support in the literature for a 4th meningeal membrane.

EVA implants for controlled drug delivery to the inner ear.

This study evaluated the potential of poly(ethylene vinyl acetate) (EVA) copolymers as matrix formers in miniaturised implants, allowing to achieve controlled drug delivery into the inner ear. Due to the blood-cochlea barrier, it is impossible to reliably deliver a drug to this tiny and highly sensitive organ in clinical practice. To overcome this bottleneck, different EVA implants were prepared by hot melt extrusion, altering the vinyl acetate content and implant diameter. Dexamethasone was incorporated as a drug with anti-inflammatory and anti-fibrotic activity. Its release was measured into artificial perilymph, and the systems were thoroughly characterised before and after exposure to the medium by optical and scanning electron microscopy, SEM-EDX analysis, DSC, X-ray powder diffraction, X-ray microtomography and texture analysis. Notably, the resulting drug release rates were much higher than from silicone-based implants of similar size. Furthermore, varying the vinyl acetate content allowed for adjusting the desired release patterns effectively: With decreasing vinyl acetate content, the crystallinity of the copolymer increased, and the release rate decreased. Interestingly, the drug was homogeneously distributed as tiny crystals throughout the polymeric matrices. Upon contact with aqueous fluids, water penetrates the implants and dissolves the drug, which subsequently diffuses out of the device. Importantly, no noteworthy system swelling or shrinking was observed for up to 10 months upon exposure to the release medium, irrespective of the EVA grade. Also, the mechanical properties of the implants can be expected to allow for administration into the inner ear of a patient, being neither too flexible nor too rigid.

Enhancing brain tumor detection in MRI images using YOLO-NeuroBoost model.

Brain tumors are diseases characterized by abnormal cell growth within or around brain tissues, including various types such as benign and malignant tumors. However, there is currently a lack of early detection and precise localization of brain tumors in MRI images, posing challenges to diagnosis and treatment. In this context, achieving accurate target detection of brain tumors in MRI images becomes particularly important as it can improve the timeliness of diagnosis and the effectiveness of treatment. To address this challenge, we propose a novel approach-the YOLO-NeuroBoost model. This model combines the improved YOLOv8 algorithm with several innovative techniques, including dynamic convolution KernelWarehouse, attention mechanism CBAM (Convolutional Block Attention Module), and Inner-GIoU loss function. Our experimental results demonstrate that our method achieves mAP scores of 99.48 and 97.71 on the Br35H dataset and the open-source Roboflow dataset, respectively, indicating the high accuracy and efficiency of this method in detecting brain tumors in MRI images. This research holds significant importance for improving early diagnosis and treatment of brain tumors and provides new possibilities for the development of the medical image analysis field.

Training and validation of a deep learning U-net architecture general model for automated segmentation of inner ear from CT.

BACKGROUND: The intricate three-dimensional anatomy of the inner ear presents significant challenges in diagnostic procedures and critical surgical interventions. Recent advancements in deep learning (DL), particularly convolutional neural networks (CNN), have shown promise for segmenting specific structures in medical imaging. This study aimed to train and externally validate an open-source U-net DL general model for automated segmentation of the inner ear from computed tomography (CT) scans, using quantitative and qualitative assessments. METHODS: In this multicenter study, we retrospectively collected a dataset of 271 CT scans to train an open-source U-net CNN model. An external set of 70 CT scans was used to evaluate the performance of the trained model. The model's efficacy was quantitatively assessed using the Dice similarity coefficient (DSC) and qualitatively assessed using a 4-level Likert score. For comparative analysis, manual segmentation served as the reference standard, with assessments made on both training and validation datasets, as well as stratified analysis of normal and pathological subgroups. RESULTS: The optimized model yielded a mean DSC of 0.83 and achieved a Likert score of 1 in 42% of the cases, in conjunction with a significantly reduced processing time. Nevertheless, 27% of the patients received an indeterminate Likert score of 4. Overall, the mean DSCs were notably higher in the validation dataset than in the training dataset. CONCLUSION: This study supports the external validation of an open-source U-net model for the automated segmentation of the inner ear from CT scans. RELEVANCE STATEMENT: This study optimized and assessed an open-source general deep learning model for automated segmentation of the inner ear using temporal CT scans, offering perspectives for application in clinical routine. The model weights, study datasets, and baseline model are worldwide accessible. KEY POINTS: A general open-source deep learning model was trained for CT automated inner ear segmentation. The Dice similarity coefficient was 0.83 and a Likert score of 1 was attributed to 42% of automated segmentations. The influence of scanning protocols on the model performances remains to be assessed.

Prevalence of Fovea Plana in patients with rhegmatogenous retinal detachment.

PURPOSE: To assess the prevalence of fovea plana in patients with rhegmatogenous retinal detachment and compare characteristics of the detachment between patients with and without fovea plana. METHODS: This retrospective, cross-sectional, case-control study included individuals with rhegmatogenous retinal detachment. We collected demographics and data on the operated eye, spherical equivalent, best-corrected visual acuity, lens status, macula status, number of retinal holes or tears, and presence of intravitreal hemorrhage, macular hole, epiretinal membrane, posterior vitreous detachment and proliferative vitreoretinopathy. The type of surgery, the tamponade, and cataract surgery following retinal surgery were also recorded. Spectral-domain optical coherence tomography macular cubes were used to evaluate the fovea by using the Spectralis HRA-OCT device (Heidelberg Engineering, Germany). Images were graded by two different investigators and a third investigator in case of disagreement. RESULTS: We included 204 individuals; 35 (17.2%) had fovea plana, a proportion significantly higher than in the general population (p = 0.041). Individuals with and without fovea plana did not differ in any of the characteristics mentioned above apart from posterior vitreous detachment, which was more frequent in those with than without fovea plana (p = 0.038). CONCLUSION: The prevalence of fovea plana is higher in patients with rhegmatogenous retinal detachment, which suggests an association between fovea plana and potential vitreoretinal interface changes.

Microcystic Macular Edema Caused by Non-Glaucomatous Optic Atrophy: A Single-Center, Retrospective, Cohort Study in France.

Optic Atrophy (OA) can be associated with the development of microcystic macular edema (MME) in the perifoveal retinal inner nuclear layer (INL). We aimed here to retrospectively determine the prevalence of MME in patients with non-glaucomatous OA in our tertiary ophthalmology department between 2015 and 2020. We then examined how MME affected the thicknesses of the different retinal layers and the differences in demographic and clinical characteristics between those patients who developed MME and those who did not. A total of 643 eyes (429 patients) were included (mean age 45.9 ± 17.8 years, 52% female). MME developed in 95 (15%) eyes and across all etiologies of OA except for toxic/nutritional causes, but the prevalence of MME varied between the different etiologies. The development of MME was associated with thinning of the ganglion cell layer (11.0 vs. 9.6 µm; p = 0.001) and the retinal nerve fiber layer (10.1 vs. 9.15 µm; p = 0.024), with INL thickening in the 3- and 6-mm diameter areas of the central fovea. Patients developing MME had significantly worse distance best-corrected visual acuity than those not developing MME (0.62 vs. 0.38 logMAR; p = 0.002). Overall, the presence of MME in OA cannot be used to guide the diagnostic work-up of OA.

Exploring the application of stem cell technology in treating sensorineural hearing loss.

Sensorineural deafness mainly occurs due to damage to hair cells, and advances in stem cell technology, especially the application of induced pluripotent stem cells (iPSCs) and adult stem cells, provides new possibilities for hair cell regeneration. This review describes the basic knowledge of stem cells and their important applications in regenerative medicine, as well as recent progress in stem cell research in the field of hair cell regeneration, especially the induced differentiation of hair-like cells. At the same time, we also point out the challenges facing current research, including differentiation efficiency, cell stability issues, and treatment safety and long-term efficacy considerations. Finally, we look forward to the direction of future research, and emphasize the importance of the cell differentiation mechanism, simulation of the inner ear microenvironment, safety assessment, and personalized treatment strategies. In conclusion, despite many challenges, stem cell technology has shown great potential in the field of hearing research and is expected to bring revolutionary treatment options for patients with sensorineural hearing loss in the future.

Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation.

Acute dizziness and vertigo are common emergency department presentations (≈4% of annual visits) and sometimes, a life-threatening diagnosis like stroke is missed. Recent literature reviews the challenges in evaluation of these symptoms and offers guidelines for diagnostic approaches. Strong evidence indicates that when well-trained providers perform a high-quality bedside neurovestibular examination, accurate diagnosis of peripheral vestibular disorders and stroke increases. However, it is less clear who can and should be performing these assessments on a routine basis. This article offers a focused debate for and against routine specialty consultation for patients with acute dizziness or vertigo in the emergency department as well as a potential path forward utilizing new portable technologies to quantify eye movements.

Benign Lobular Inner Nuclear Layer Proliferations of the retina.

PURPOSE: Report the clinical and imaging findings of a patient with an intraretinal benign tumor that was documented as an unexpected clinical finding after an ischemic stroke in the context of mitral valve disease. This tumor must be distinguished from retinoblastoma and other malignant neoplasms. METHODS: A patient with intraretinal tumor of the inner nuclear layer (INL) underwent a combination of ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCT-A). RESULTS: A 64-year-old male patient with unilateral benign tumor lesions dependent on the internal retina, centered in the posterior pole, and multifocal. OCT showed that these lesions were centered within the INL at the edge of the inner plexiform layer and were not associated with other findings in the posterior pole. CONCLUSIONS: Benign Lobular Inner Nuclear Layer Proliferations (BLIP) of the Retina are recently described lesions that should be considered, given their distinctive characteristics that set them apart from other benign and malignant retinal lesions.

Development of Microcystoid Macular Degeneration in the Retina of Nonhuman Primates: Time-Course and Associated Pathologies.

PURPOSE: Microcystoid macular degeneration (MMD) is a condition where cystoid vacuoles develop within the inner nuclear layer of the retina in humans in a variety of disorders. Here we report the occurrence of MMD in non-human primates (NHPs) with various retinal ganglion cell (RGC) pathologies and evaluate the hypothesis that MMD does not precede RGC loss but follows it. METHODS: Morphological studies were performed of the retinas of NHPs, specifically both rhesus (Macaca mulatta) and cynomolgus macaques (Macaca fascicularis), in which MMD was identified after induction of experimental glaucoma (EG), hemiretinal endodiathermy axotomy (HEA), and spontaneous idiopathic bilateral optic atrophy. In vivo imaging analyses included fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT), adaptive optics scanning laser ophthalmoscopy (AOSLO), light microscopy, and electron microscopy. RESULTS: MMD, like that seen on OCT scans of humans, was found in both rhesus and cynomolgus macaques with EG. Of 13 cynomolgus macaques with chronic EG imaged once with OCT six of 13 animals were noted to have MMD. MMD was also evident in a cynomolgus macaque with bilateral optic atrophy. Following HEA, MMD did not develop until at least 2 weeks following the RNFL loss. CONCLUSION: These data suggest that MMD may be caused by a retrograde trans-synaptic process related to RGC loss. MMD is not associated with inflammation, nor would it be an independent indicator of drug toxicity per se in pre-clinical regulatory studies. Because of its inconsistent appearance and late development, MMD has limited use as a clinical biomarker.

The Role and Research Progress of Mitochondria in Sensorineural Hearing Loss.

Hearing loss is one of the most common human diseases, seriously affecting everyday lives. Mitochondria, as the energy metabolism center in cells, are also involved in regulating active oxygen metabolism and mediating the occurrence of inflammation and apoptosis. Mitochondrial defects are closely related to hearing diseases. Studies have shown that mitochondrial DNA mutations are one of the causes of hereditary hearing loss. In addition, changes in mitochondrial homeostasis are directly related to noise-induced hearing loss and presbycusis. This review mainly summarizes and discusses the effects of mitochondrial dysfunction and mitophagy on hearing loss. Subsequently, we introduce the recent research progress of targeted mitochondria therapy in the hearing system.

The relationship between endolymphatic hydrops features and hearing loss in Bilateral Meniere's disease.

BACKGROUND: This study aimed to investigate the relationship between the features of endolymphatic hydrops and hearing loss in patients with Bilateral Meniere's Disease. METHODS: A retrospective analysis was conducted on 77 patients diagnosed with Bilateral Meniere's Disease. The features of endolymphatic hydrops in the affected ear were evaluated through gadolinium-enhanced inner ear Magnetic resonance imaging. The Spearman correlation coefficient, paired t-tests, and Wilcoxon signed-rank tests were employed for data analysis. RESULTS: The analysis revealed a significant correlation between the degree of endolymphatic hydrops and hearing loss across all frequencies(0.125-8 kHz), including the cochlear, vestibular, and overall degree of endolymphatic hydrops. The strongest correlation between the overall degree of endolymphatic hydrops and hearing loss was observed at low frequencies (r = 0.571, p < 0.05), followed by mid-frequencies (r = 0.508, p < 0.05), and high-frequencies (r = 0.351, p < 0.05), with a correlation of r = 0.463, p < 0.05 for the staging of Meniere's disease. Affected Ears with endolymphatic hydrops both in the cochlea and vestibule exhibited more severe hearing loss and Meniere's disease staging compared to those with isolated endolymphatic hydrops within the same patient. CONCLUSIONS: The features of endolymphatic hydrops in patients with Bilateral Meniere's Disease were found to correlate with the severity of hearing loss and the staging of Meniere's disease.

Yellow Emissive Carbon Dots - A Robust Nanoprobe for Highly Sensitive Quantification of Jaundice Biomarker and Mitochondria Targeting in Cancer Cells.

The abnormally high level of bilirubin (BR) in biofluids (human serum and urine) indicates a high probability of jaundice and liver dysfunction. However, quantification of BR as the Jaundice biomarker is difficult due to the interference of various biomolecules in serum and urine. To address this issue, we developed a fluorescence-based detection strategy, for which yellow emissive carbon dots (YCDs) were produced from a one-step solvothermal process using phloroglucinol and thionin acetate as chemical precursors. The as-fabricated YCDs exhibited a strong fluorescence peak at the wavelength of 542 nm upon excitation at 390 nm. We used YCDs for detecting BR through the fluorescence turn-off mechanism, unveiling the excellent sensitivity in the linear range of 0.5-12.5 µM with a limit of detection (LOD) of 9.62 nM, which was far below the clinically relevant range. The analytical nanoprobe also offered excellent detection specificity for quantifying BR in real samples. Moreover, the biocompatible fluorescent nanoprobe was successfully employed to target mitochondria in live cancer cells. A colocalization study confirmed that YCDs possessed the ability to target mitochondria and overlapped completely with MitoTracker Red. The developed nanoprobe of YCDs turned out to be straightforward in their synthesis, noninvasive, and can be utilized for biomedical sensors to diagnose the onset of jaundice as well as for mitochondria targeting.

Acute Macular Neuroretinopathy Associated with COVID-19 Pandemic: A Real-World Observation Study.

PURPOSE: To evaluate the clinical and retinal imaging features of Chinese patients with acute macular neuroretinopathy (AMN) associated with COVID-19. DESIGN: A prospective observational study. METHODS: Retinal imaging, including color fundus photography, near-infrared imaging (NIR), swept-source optical coherence tomography (SS-OCT), optical coherence tomography angiography (OCTA), and Humphrey perimetry, were conducted for each case. RESULTS: All cases were included within the first three months following the pandemic outbreak. A total of 12 male patients (36.36%) and 21 female patients (63.64%) were prospectively recruited, and 29 cases (87.88%) were bilaterally affected. The median interval between the onset of fever and the appearance of ocular symptoms was two days (range, 0.5-5.0 days). Apart from the outer retinal changes typical of AMN, changes in the inner retinal layers were observed, including intraretinal hemorrhage (8.06%), cotton wool spots (9.68%), and paracentral acute middle maculopathy (PAMM) (8.06%). Smaller retinal inner nuclear layer hyperreflective speckles (RIHS) (41.94%) were identified as a distinguishing feature from typical PAMM. Voids of vessel signals were found in the superficial (11.54%), intermediate (82.69%), and deep capillary plexus (98.08%), and in the choriocapillaris (19.23%) on OCTA. Humphrey perimetry illustrated central, paracentral, and peripheral scotomas. The occult lesions associated with AMN, PAMM, and some of the RIHS illustrated by OCT were visualized topographically and further confirmed by OCTA as perfusion defects. CONCLUSION: An increase in AMN cases correlated with the SARS-CoV-2 outbreak. Additional features, including widespread inner retinal perfusion deficits, were observed and may serve as potential biomarkers for systemic microcirculation dysregulation in COVID-19.

Mediating role of inner strength in the relationship between medication literacy and medication adherence among kidney transplant patients. / å† åœ¨åŠ›é‡åœ¨è‚¾ç§»æ¤æ‚£è€ è¯ç‰©ç´ å »ä¸Žæœè¯ä¾ä»Žæ€§å ³ç³»ä¸­çš„ä¸­ä»‹ä½œç”¨ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Compared with long-term renal replacement therapy, kidney transplantation is the ideal treatment for end-stage renal disease (ESRD), significantly extending patient life and improving quality of life. Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens, but their medication adherence is generally poor compared with other organ transplant recipients. Medication adherence is closely related to medication literacy and psychological status, yet related studies are limited. This study aims to investigate the current status of medication adherence, inner strength, and medication literacy in kidney transplant patients, analyze the relationships among these 3 factors, and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence. METHODS: A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province. The inner strength, medication literacy, and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale (ISS), the Chinese version of the Medication Literacy Assessment in Spanish and English (MedLitRxSE), and the Chinese version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), respectively. Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence. Correlation analysis was conducted to explore the relationships among medication literacy, medication adherence, and inner strength. Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression, and the mediating effect of inner strength was explored. RESULTS: Among the 421 questionnaires collected, 408 were valid, with an effective rate of 96.91%. The scores of C-MMAS-8, MedLitRxSE, and ISS were 6.64±1.16, 100.63±14.67, and 8.47±4.03, respectively. Among the 408 patients, only 86 (21.08%) patients had a high level of medication adherence, whereas 230 (56.37%) patients had a medium level of medication adherence, and 92 (22.55%) patients had poor medication adherence. Univariate analysis indicated that the kidney transplant patients' age, marital status, education levels, years since their kidney transplant operation, number of hospitalizations after the kidney transplant, and adverse drug reactions showed significant differences in medication adherence (all P<0.05). Correlation analysis showed that inner strength positively correlated with both medication literacy (r=0.183, P<0.001) and medication adherence (r=0.201, P<0.001). Additionally, there was a positive correlation between medication adherence and medication literacy (r=0.236, P<0.001). Inner strength accounted for 13.22% of the total effect in the mediating role between medication literacy and medication adherence. CONCLUSIONS: The level of medication adherence among kidney transplant patients needs improvement, and targeted intervention measures are essential. Inner strength mediates the relationship between medication literacy and medication adherence in these patients. Healthcare professionals should focus on enhancing medication literacy and supporting patients' inner strength to improve medication adherence.

Pathogenesis and New Pharmacological Approaches to Noise-Induced Hearing Loss: A Systematic Review.

Noise-induced hearing loss (NIHL) is responsible for significant adverse effects on cognition, quality of life and work, social relationships, motor skills, and other psychological aspects. The severity of NIHL depends on individual patient characteristics, sound intensity, and mainly the duration of sound exposure. NIHL leads to the production of a reactive oxygen (ROS) inflammatory response and the activation of apoptotic pathways, DNA fragmentation, and cell death. In this situation, antioxidants can interact with free radicals as well as anti-apoptotics or anti-inflammatory substances and stop the reaction before vital molecules are damaged. Therefore, the aim of this study was to analyze the effects of different pharmacological treatments, focusing on exogenous antioxidants, anti-inflammatories, and anti-apoptotics to reduce the cellular damage caused by acoustic trauma in the inner ear. Experimental animal studies using these molecules have shown that they protect hair cells and reduce hearing loss due to acoustic trauma. However, there is a need for more conclusive evidence demonstrating the protective effects of antioxidant/anti-inflammatory or anti-apoptotic drugs' administration, the timeline in which they exert their pharmacological action, and the dose in which they should be used in order to consider them as therapeutic drugs. Further studies are needed to fully understand the potential of these drugs as they may be a promising option to prevent and treat noise-induced hearing loss.