Enhancing Post-Stroke Rehabilitation and Preventing Exo-Focal Dopaminergic Degeneration in Rats-A Role for Substance P.

Dopaminergic signaling is a prerequisite for motor learning. Delayed degeneration of dopaminergic neurons after stroke is linked to motor learning deficits impairing motor rehabilitation. This study investigates safety and efficacy of substance P (SP) treatment on post-stroke rehabilitation, as this neuropeptide combines neuroprotective and plasticity-promoting properties. Male Sprague Dawley rats received a photothrombotic stroke within the primary motor cortex (M1) after which a previously acquired skilled reaching task was rehabilitated. Rats were treated with intraperitoneal saline (control group, n = 7) or SP-injections (250 µg/kg) 30 min before (SP-pre; n = 7) or 16 h (SP-post; n = 6) after rehabilitation training. Dopaminergic neurodegeneration, microglial activation and substance P-immunoreactivity (IR) were analyzed immunohistochemically. Systemic SP significantly facilitated motor rehabilitation. This effect was more pronounced in SP-pre compared to SP-post animals. SP prevented dopaminergic cell loss after stroke, particularly in the SP-pre condition. Despite its proinflammatory propensity, SP administration did not increase stroke volumes, post-stroke deficits or activation of microglia in the midbrain. Finally, SP administration prevented ipsilesional hypertrophy of striatal SPergic innervation, particularly in the SP-post condition. Mechanistically, SP-pre likely involved plasticity-promoting effects in the early phase of rehabilitation, whereas preservation of dopaminergic signaling may have ameliorated rehabilitative success in both SP groups during later stages of training. Our results demonstrate the facilitating effect of SP treatment on motor rehabilitation after stroke, especially if administered prior to training. SP furthermore prevented delayed dopaminergic degeneration and preserved physiological endogenous SPergic innervation.

[Bilateral explantation of iris implants due to pigment dispersion syndrome (PDS) and corneal decompensation after cosmetic iris implantation (BrightOcular)]. / Bilaterale Irisimplantatexplantation bei Pigmentdispersionssyndrom (PDS) und Hornhautdekompensation nach kosmetischer Irisimplantation (BrightOcular).

This article reports the case of a 27-year-old female patient with pigment dispersion syndrome (PDS) and corneal edema in both eyes after cosmetic iris implantation (BrightOcular, Anaheim, CA, USA) in an Indian eye clinic in order to change the eye color. Explantation of the implants was recommended 3 years after implantation and after developing PDS due to the high risk of developing glaucoma and because of corneal decompensation due to loss of corneal endothelial tissue. Postoperatively, traumatic, middle wide and irregular pupils were present.

Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation.

INTRODUCTION: Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS: The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.

Tomographic analysis of anterior and posterior surgically induced astigmatism after 2.2 mm temporal clear corneal incisions in femtosecond laser-assisted cataract surgery.

PURPOSE: To evaluate surgically induced astigmatism (SIA) of temporal clear corneal incisions (CCIs) on anterior and posterior corneal curvature after femtosecond laser-assisted cataract surgery (FLACS) using Scheimpflug tomographic measurements. SETTING: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. DESIGN: Prospective interventional case series. METHODS: This study enrolled patients who underwent FLACS from June 2013 to July 2014. All eyes were measured with a Pentacam HR preoperatively and at 1 month and 3 months postoperatively, had preoperative total corneal refractive power (TCRP) astigmatism (CATCRP) of 0.50 diopters (D) or less, and received a temporal 2.2 mm incision at 0 degrees and 180 degrees. Vector analysis, using the Holladay-Cravy-Koch formula and the Alpins method, determined astigmatic changes in anterior corneal astigmatism (CAant), posterior corneal astigmatism (CApost), and CATCRP. Student t and Wilcoxon tests were performed. A P value less than 0.05 was considered statistically significant. RESULTS: This study comprised 53 eyes of 38 patients. At 3 months postoperatively, the CAant, CApost, and CATCRP were significantly higher compared with the preoperative values (P = .015, P = .007, P = .008, respectively); however, CApost and CATCRP were significantly lower compared with the limit of 0.50 D (P < .001, P = .01, respectively), whereas CAant was not (P = .11). The mean SIA of CAant, CApost, and CATCRP was 0.25 D ± 0.15 (SD), 0.16 ± 0.11 D, and 0.28 ± 0.17 D, respectively. The angle of error was high (-1.98 ± 52.95 degrees, 1.64 ± 51.27 degrees, and -1.72 ± 48.79 degrees, respectively). CONCLUSION: Femtosecond laser temporal CCIs induce minimal astigmatism in CAant, CApost, and CATCRP, but can be evaluated statistically as astigmatically neutral.

Tomographic Analysis of Anterior and Posterior and Total Corneal Refractive Power Changes After Femtosecond Laser-Assisted Keratotomy.

PURPOSE: To analyze the effect of penetrating femtosecond laser-assisted keratotomy (pFLAK) during laser lens surgery on anterior and posterior corneal astigmatism and total corneal refractive power (TCRP) astigmatism (CAant, CApost, CATCRP) measured with Scheimpflug tomography. DESIGN: Prospective, interventional case series. METHODS: This institutional study included 27 eyes of 23 patients (aged 65 ± 8 years) with low-to-moderate CATCRP determined with Scheimpflug tomography (Pentacam HR; Oculus, Wetzlar, Germany) after penetrating femtosecond laser-assisted keratotomy (pFLAK) and laser lens surgery. The CAant, CApost, and CATCRP were determined before and 1 and 3 months after surgery. Vector analysis according to the Alpins method was used to calculate surgically induced astigmatism (SIA). RESULTS: The mean preoperative CAant (0.97 ± 0.30 diopter [D]) was significantly reduced to 0.63 ± 0.34 D (P < .001). SIAant was 0.71 ± 0.37 D. The CApost showed no significant change, from preoperative 0.26 ± 0.12 D to 0.26 ± 0.10 D postoperatively (P = .625). In line with this finding, SIApost was low (0.12 ± 0.07 D). The CATCRP showed similar results as CAant. CONCLUSION: pFLAKs planned according to Scheimpflug-based CATCRP result in a significant reduction of the CAant and CATCRP, but do not affect the posterior corneal curvature significantly, as measured by Scheimpflug tomography. Further research is required to develop a new valid nomogram for laser-assisted lens surgery.