Cigarette smoke-induced injury induces distinct sex-specific transcriptional signatures in mice tracheal epithelial cells.

The airway epithelial barrier is crucial for defending against respiratory insults and diseases. Disruption of epithelial integrity contributes to respiratory diseases, and sex-specific differences in susceptibility and severity have been observed. However, sex-specific differences in the context of respiratory diseases are often overlooked, especially in murine models. In this study, we investigated the in vitro transcriptomics of male and female murine tracheal epithelial cells (mTECs) in response to chronic cigarette smoke (CS) exposure using an International Organization for Standardization (ISO) puff regimen. Our findings reveal sex-specific differences in the baseline characteristics of airway epithelial cells. Female mTECs demonstrated stronger barrier function and higher ciliary function compared with males. The barrier function was disrupted in both males and females following chronic CS, but the difference was more significant in females due to their higher baseline. Female mice exhibited transcriptional signatures suggesting dedifferentiation with increased basal cells and markers of cellular senescence. Pathway analysis indicated potential protective roles of planar cell polarity (PCP) in preventing dedifferentiation in male mice exposed to CS. We also observed sex-specific differences in the DNA damage response and antioxidant levels, suggesting distinct mechanisms underlying cellular stress. Understanding these sex-specific mechanisms could facilitate the development of targeted therapeutic strategies for lung diseases associated with environmental insults. Recognizing sex-based differences in disease susceptibility and treatment response can lead to personalized care and improved outcomes. Clinical trials should consider sex as a biological variable to develop effective interventions that address the unique differences between men and women in respiratory diseases.NEW & NOTEWORTHY The study underscores the importance of considering sex-specific differences in the airway epithelium in respiratory diseases such as COPD. Differences in gene expression between males and females at baseline and in response to chronic injury in the airway epithelium could have implications on disease susceptibility, both in COPD and other respiratory diseases. Therefore, understanding these differences is crucial for developing targeted therapies to treat respiratory diseases based on a sex-specific manner.

Smartphone Applications for the Clinical Oncologist in UK Practice.

A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK. Applications aimed specifically at physician clinical oncologists were searched for on the major smartphone operating systems: Apple iOS; Google Android; Microsoft Windows OS; and Blackberry OS. All applications were installed and analysed. The applications were scrutinised to assess the following information: cost; whether the information included was referenced; when the information was last updated; and whether they made any reference to UK guidelines. A novel rating score based on these criteria was applied to each application. Fifty applications were identified: 24 for Apple's iOS; 23 for Google's Android; 2 for Blackberry OS; and 1 for Windows OS. The categories of applications available were: drug reference; journal reference; learning; clinical calculators; decision support; guidelines; and dictionaries. Journal reference and guideline applications scored highly on our rating system. Drug reference application costs were prohibitive. Learning tools were poorly referenced and not up-to-date. Smartphones provide easy access to information. There are numerous applications devoted to oncology physicians, many of which are free and contain referenced, up-to-date data. The cost and quality of drug reference and learning applications have significant scope for improvement. A regulatory body is needed to ensure the presence of peer-reviewed, validated applications to ensure their reliability.

Use of Gamma-Irradiated Cornea to Plug Sclerostomy Site During Tube Shunt Revision.

Tube shunt implantation is a common procedure for control of intraocular pressure (IOP). However, tube revision and repositioning must sometimes be performed, and this involves removing the tube from its sclerostomy site. This site is prone to leaking and this may cause postoperative hypotony. We describe a novel and cosmetically acceptable technique of plugging and covering the sclerostomy site with gamma-irradiated corneal tissue.

Short-duration transient visual evoked potentials and color reflectivity discretization analysis in glaucoma patients and suspects.

AIM: To evaluate the use of short-duration transient visual evoked potentials (VEP) and color reflectivity discretization analysis (CORDA) in glaucomatous eyes, eyes suspected of having glaucoma, and healthy eyes. METHODS: The study included 136 eyes from 136 subjects: 49 eyes with glaucoma, 45 glaucoma suspect eyes, and 42 healthy eyes. Subjects underwent Humphrey visual field (VF) testing, VEP testing, as well as peripapillary retinal nerve fiber layer optical coherence tomography imaging studies with post-acquisition CORDA applied. Statistical analysis was performed using means and ranges, ANOVA, post-hoc comparisons using Turkey's adjustment, Fisher's Exact test, area under the curve, and Spearman correlation coefficients. RESULTS: Parameters from VEP and CORDA correlated significantly with VF mean deviation (MD) (P<0.05). In distinguishing glaucomatous eyes from controls, VEP demonstrated area under the curve (AUC) values of 0.64-0.75 for amplitude and 0.67-0.81 for latency. The CORDA HR1 parameter was highly discriminative for glaucomatous eyes vs controls (AUC=0.94). CONCLUSION: Significant correlations are found between MD and parameters of short-duration transient VEP and CORDA, diagnostic modalities which warrant further consideration in identifying glaucoma characteristics.

Color Reflectivity Discretization Analysis of OCT Images in the Detection of Glaucomatous Nerve Fiber Layer Defects.

PURPOSE: To compare the ability of Cirrus retinal nerve fiber layer (RNFL) thickness and the Color Reflectivity Discretization Analysis (CORDA), a novel optical coherence tomography (OCT) analysis method, to differentiate between normal subjects, glaucoma suspects, and glaucoma patients. PATIENTS AND METHODS: Analysis of peripapillary OCT images using Cirrus SD-OCT (optic nerve head cube 200 × 200 protocol) and postacquisition CORDA analysis of peripapillary RNFL B-scan images was performed. In total, 291 eyes of 148 subjects (94 normal eyes, 100 primary open-angle glaucoma suspect eyes, and 97 eyes with primary open-angle glaucoma) were included. Area under the receiver operating characteristic curve was estimated for each region and method (Cirrus vs. CORDA) for differentiating eyes with glaucoma, and those that are glaucoma suspect, from normal eyes. RESULTS: CORDA HR1 parameter discriminated glaucoma patients from normal subjects more accurately than Cirrus RNFL thickness in nasal (P = 0.003) and temporal (P = 0.001) regions. HR1 showed greater area under the receiver operating characteristic curve than Cirrus RNFL thickness when discriminating glaucoma suspects from normal subjects in the superior (P = 0.02), nasal (P = 0.003), and temporal (P = 0.001) regions. Both were similar for mean and the inferior regions. CONCLUSIONS: In this study, the novel CORDA HR1 differentiated between normal subjects and glaucoma suspects more accurately than Cirrus RNFL, and in temporal and nasal regions when discriminating between normal and glaucomatous eyes. CORDA analysis may improve the diagnostic accuracy of Cirrus OCT for glaucoma and glaucoma suspects.

Evaluation of Nonmydriatic Hand-held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project.

PURPOSE: To determine the reproducibility of optic disc photograph grading obtained by a hand-held fundus camera and to determine the diagnostic value of these photographs in detecting patients with glaucoma in a community-based glaucoma-detection program. MATERIALS AND METHODS: Patients underwent slit-lamp examination by an ophthalmologist who graded each patient's optic discs using 2 methods: cup-to-disc ratio (CDR) and disc damage likelihood scale (DDLS). After a comprehensive glaucoma evaluation, patients were diagnosed as having "glaucoma," "glaucoma suspect," or "no glaucoma." Nonmydriatic, monoscopic optic disc photographs were then taken with a portable digital imaging device. On a different day, the same examiner and a second observer graded the disc photographs in a masked manner and determined a diagnostic impression based only on the disc photographs. RESULTS: Of the 1649 patients examined, 119 subjects were randomly selected according to 3 groups of diagnoses: "glaucoma" (n=36), "glaucoma suspect" (n=50), and "no glaucoma" (n=33). For CDR, the intraobserver agreement was 0.71 and the interobserver agreement was 0.69. For disc DDLS, the intraobserver agreement was 0.65 and the interobserver agreement was 0.67. The area under the receiver-operating characteristic distinguishing between normal and glaucoma was 0.88 and 0.86 for CDR and disc DDLS, respectively. CONCLUSIONS: Nonmydriatic, monoscopic disc photographs obtained by a hand-held camera had only moderate disc grading reproducibility. This could be due to a reduced quality of images, making interpretation more challenging, due to taking photographs through small pupils by a hand-held camera and the high percentage of patients with significant cataracts.

An adhesion-related small bowel obstruction occurring within 36 h of a total abdominal hysterectomy and bilateral salpingo-oophorectomy.

We present a case of adhesion-related small bowel obstruction occurring within only 36 h of a total abdominal hysterectomy and bilateral salpingo-oophorectomy. There has been no previously reported case where there has been such a short interval between surgery and adhesion-related small bowel obstruction. This is important to note, as it ensures that adhesion-related small bowel obstruction is on the list of differential diagnoses for patients who present very soon after surgery with symptoms such as abdominal pain and vomiting. It is also important as it allows the pathogenesis of adhesion formation to be reviewed in light of this rapid onset of adhesion formation and its complications.

Endogenous Serratia marcescens endophthalmitis.

PURPOSE: The purpose of this study was to describe a rare case of endogenous endophthalmitis associated with dental disease secondary to Serratia marcescens in an HIV-negative individual. METHODS: Retrospective case report. RESULTS: A 50-year-old white man with a history of intravenous drug use presented with pain and decreased vision in his right eye. Slit-lamp examination showed a hazy cornea, hypopyon with fibrin in the anterior chamber, and elevated intraocular pressure. B-scan ultrasound showed vitritis and choroidal thickening. Computed tomography showed gingival inflammation and lucencies of several teeth. Blood and urine cultures were negative, and HIV testing was negative. Echocardiography was negative for vegetations. Intravitreal culture revealed S. marcescens. Despite intravitreal and systemic antibiotics, the patient's clinical situation rapidly deteriorated, and the eye was eviscerated. The patient underwent dental extraction and was subsequently discharged in stable condition. CONCLUSION: The first case of endogenous endophthalmitis secondary to S. marcescens in an otherwise healthy, HIV-negative, intravenous drug user in association with severe dental disease is reported. Serratia may be found in oral biofilm, and this mechanism should be considered in cases where other etiologies have been ruled out.

Lower limb gangrene postcardiac surgery.

A 67-year-old gentleman presented with a 1-day history of left foot pain. He had recently been discharged following a coronary artery bypass graft; during the admission, he had received an intravenous heparin infusion. Examination revealed black-purple discolouration of the first and second digits of the left foot with pitting oedema to the level of the knee. The posterior tibial and dorsalis pedis pulses were both shown to be patent. A new thrombocytopenia was noted. Ultrasound imaging revealed multiple deep vein thrombosis. The history of recent heparin exposure coupled with venous gangrene secondary to deep vein thrombosis was consistent with heparin-induced thrombocytopenia. He was treated acutely with intravenous danaparoid and later with warfarin. There was complete resolution of the venous gangrene at 1 month follow-up.