Accuracy of Intraocular lens power calculation in pediatric traumatic cataract.

PURPOSE: To evaluate the prediction error (PE) in pediatric traumatic cataract surgery involving primary or secondary intraocular lens implantation (IOL) and the factors affecting it. METHODS: Retrospective data of unilateral traumatic cataract eyes of children aged ≤16 years were collected between February 2019 and March 2022 at a tertiary eye care hospital. Absolute PE was calculated by deducting the target refraction from the observed refraction at 6 weeks postsurgery following suture removal. Simulated PE was calculated in eyes with corneal scar replacing the affected eye keratometry (K) with the K of the fellow eye and standard K (44D) and was then compared with absolute PE. RESULTS: Fifty children with a mean age of 9.5 years (2-16 years) were included. Mean absolute PE was 1.63 ± 1.8D (0 to 9D). Absolute PE was not affected by the age at surgery, method of biometry, duration of injury, type of cataract surgery, position of IOL, and preoperative keratometry. The absolute PE was affected by axial length (AXL) being <1.5D in AXL of 22.73 ± 0.84 mm, <1.5-2D in AXL of 22.07 ± 0.61 mm, and >2D in AXL of 22.01 ± 0.74 mm (P = 0.039) in univariate analysis. In multivariate analysis, none of the factors affected the absolute PE. In 34 eyes with corneal scar, higher variability in PE was observed. The standard K resulted in greater simulated PE as compared to the affected eye average K in eyes with scar involving the visual axis. CONCLUSION: Absolute PE following pediatric traumatic cataract was studied. It was higher in shorter AXLs. In corneal scar involving the visual axis, using the fellow eye K yielded lesser simulated PE as compared to standard K.

In-Situ-Generated Fluoride-Assisted Rapid Dissolution of Uranium Oxides by Ionic Liquids.

A quantitative, rapid, endothermic dissolution of U3O8 in C4mim·PF6 (1-alkyl-3-methyl imidazolium hexafluorophosphate) has been achieved within 2 h at 65 °C by in situ generated fluoride ions by pre-equilibrating the ionic liquid with suitable concentrations of nitric acid. The efficiency of the dissolution followed the trend: UO3 > UO2 > U3O8. The fluoride generation was found to increase with the concentration of nitric acid being equilibrated, the water content of the ionic liquid, and also the time of equilibration. The rate of dissolution of U3O8 followed the trend: C4mim·PF6> C6mim·PF6 > C8mim·PF6. The maximum loading observed for the present case was 200 mg mL-1 which is considered to be quite high with an ionic liquid. The effects of different acid pre-equilibration (HClO4, HCl) on F- generation and subsequent dissolution characteristics have also been investigated. The in situ F- generation, as well as U3O8 dissolution, were found to predominantly follow a pseudo-second-order rate kinetics, while the rate constants for U3O8 dissolution were found to be higher than that of F- generation. The dissolved uranium was successfully electrodeposited on a Cu plate, as confirmed by EDXRF, while the formation of UO2 was revealed from the XRD pattern of the deposit.

Remarkably High Separation of Neodymium from Praseodymium by Selective Dissolution from their Oxide Mixture using an Ionic Liquid Containing aß-Diketone.

A simple, efficient, direct and economical method for the mutual separation of Nd and Pr was developed by the selective dissolution of Nd2O3 from their oxide mixtures in an ionic liquid containing 2-thenoyltrifluoroacetone (HTTA) resulting in an unprecedented separation factor (ßNd/Pr)>500, which is 277 times more than the thus far reported ßNd/Pr values. The proposed mechanism was supported by DFT computations.

Experimental and Theoretical Insight into the Ionic Liquid-Mediated Complexation of Trivalent Lanthanides with ß-Diketone and Its Fluorinated Analogue.

A multitechnique approach with theoretical insights has been employed to understand the complexation of trivalent lanthanides with two ß-diketones, viz. 1-phenyl-1,3-butanedione (L1) and 4,4,4-trifluoro-1-phenyl-1,3-butanedione (L2), in an ionic liquid (C6mim·NTf2). UV-vis spectral analysis of complexation using Nd3+ revealed the predominance of ML2+ and ML4- species. The stability constants for the PB complexes were higher (ß2 ∼ 10.45 ± 0.05, ß4 ∼ 15.51 ± 0.05) than those for the TPB (ß2 ∼ 7.56 ± 0.05, ß4 ∼ 13.19 ± 0.06). The photoluminescence titration using Eu3+ corroborated the same observations with slightly higher stability constants, probably due to the higher ionic potential of Eu3+. The more asymmetric (AL2ML4 ∼ 5.2) Eu-L2 complex was found to contain one water molecule in the primary coordination sphere of Eu3+ with more covalency of the Eu3+-O bond (Ω2L1 = 8.5 × 10-20, Ω4L1 = 1.3 × 10-20) compared to the less asymmetric Eu-L1 complex (AL1ML4 ∼ 3.5) with two water molecules having less Eu-O covalency (Judd-Offelt parameters: Ω2L1 = 7.3 × 10-20, Ω4L1 = 1.0 × 10-20). Liquid-liquid extraction studies involving Nd3+ and Eu3+ revealed the formation of the ML4- complex following an 'anion exchange' mechanism. The shift of the enol peak from 1176 to 1138 cm-1 on the complexation of the ß-diketones with Eu3+ was confirmed from the FTIR spectra. 1H NMR titration of the ß-diketones with La(NTf2)3 evidenced the participation of α-H of the ß-diketones and protons at C2, C4, and C5 positions of the methylimidazolium ring. For the ML2 complex, 4 donor O atoms are suggested to coordinate to the trivalent lanthanides with bond distances of 2.3297-2.411 Å for La-O, 2.206-2.236 Å for Eu-O, and 2.217-2.268 Å for Nd-O, respectively, while for the ML4 complex, 8 donor O atoms were coordinated with bond lengths of 2.506-2.559 Å for La-O, 2.367-2.447 Å for Eu-O, and 2.408-2.476 Å for Nd-O. The Nd3+ ion was higher by 9.7 kcal·mol-1 than that of the La3+ ion for the 1:4 complex. The complexation energy with L1 was quite higher than that with L2 for both 1:2 and 1:4 complexes. Using cyclic voltammetry, the redox behavior of trivalent lanthanides Eu and Gd with ß-diketonate in ionic liquid medium was probed and their redox energetic and kinetic parameters were determined.

An 85-Year-Old Man with Fever, Dyspnea, and Dry Cough Diagnosed with Idiopathic Hypereosinophilic Syndrome, Successfully Treated with High-Dose Corticosteroids.

BACKGROUND Idiopathic hypereosinophilic syndrome (I-HES) is a rare disease diagnosed as absolute eosinophil count >1500 cells/µl and end-organ involvement attributable to tissue eosinophilia with no secondary cause of underlying eosinophilia. The mean age of presentation for I-HES is 44 years. The skin, lungs, and gastrointestinal (GI) system are most common sites of presenting manifestations, including fatigue, cough, dyspnea, myalgias, angioedema, rash, fever, nausea, and diarrhea. Although cardiac and neurologic symptoms are less common at presentation, they can be life-threatening. CASE REPORT We report the case of an 85-year-old man who presented with fever, malaise, and loss of appetite for 3 weeks, followed by dyspnea and dry cough for 2 weeks. His absolute eosinophil count was 9000 cells/µl, which was not responding to empirical antibiotic therapy, with worsening of symptoms, suggesting a non-infective origin. He was then extensively evaluated to establish underlying an etiology for specific treatment, which was negative for common causes like atypical infections, malignancy, and autoimmune disorders. He was then started on corticosteroid therapy to overcome an exaggerated immune response and reduce inflammation-related injury, to which he responded well. On follow-up, hypereosinophilia was fully cured, with reversal of end-organ involvement including myocarditis and pneumonitis. CONCLUSIONS This report shows that idiopathic HES can present with various clinical features and that accurate diagnosis, excluding known causes of eosinophilia, and early management are essential to prevent long-term organ damage. Our patient responded to prompt treatment with high-dose corticosteroids.

The Gut-Brain Axis in Autoimmune Diseases: Emerging Insights and Therapeutic Implications.

The gut-brain axis (GBA) is a two-way communication system that is influenced by signals from the nervous system, hormones, metabolism, the immune system, and microbes. The GBA may play a key role in gastrointestinal and neurological illnesses. Signaling events from the gut can regulate brain function. As a result, mounting data point to a connection between autoimmune disorders (AIDs), both neuroinflammatory and neurodegenerative diseases, and the GBA. Clinical, epidemiological, and experimental studies have shown that a variety of neurological illnesses are linked to alterations in the intestinal environment, which are suggestive of disease-mediated inter-organ communication between the gut and the brain. This review's objective is to draw attention to the clinical and biological relationship between the gut and the brain, as well as the clinical importance of this relationship for AIDs, neurodegeneration, and neuroinflammation. We also discuss the dysbiosis in the gut microbiota that has been linked to various AIDs, and we make some assumptions about how dietary changes such as prebiotics and probiotics may be able to prevent or treat AIDs by restoring the composition of the gut microbiota and regulating metabolites.

Evaluation of a Phosphinate Functionalized Ionic Liquid for the Separation of Nb and Ta from Nitric Acid Feed Conditions.

A 'green' single-step separation process, involving a phosphonium phosphinate functionalized ionic liquid (FIL) in C8mim·NTf2, has been developed for highly encouraging improvements in the mutual separation of Nb and Ta with a maximum separation factor of ∼48 at 2 M nitric acid. The separation factor in C4mim·NTf2 was found to be somewhat lower compared to that seen in C8mim·NTf2. In C8mim·NTf2, the extraction proceeded via the neutral NbOF3(R4P+)(R2POO-) and TaOF3(R4P+)(R2POO-) species predominated by a 'solvation' mechanism at 2 M HNO3, where both the cationic and anionic parts of the FIL took part in the metal ion extraction. However, in the case of C4mim·NTf2, the extraction proceeded via a cation exchange mechanism involving the mono-positive species viz. [NbO(R2POO-)2]+IL, [TaO(R2POO-)2]+IL. Only the phosphinate group of the FIL was directly involved in the binding to the metal ion. The charge neutrality was maintained by the exchange of the C4mim+ ion from the ionic liquid phase to the aqueous phase. The processes were spontaneous, exothermic involving outer sphere complexation. The radiolytic stabilities of the C8mim·NTf2-based solvent systems were poorer than those of the solvents based on C4mim·NTf2. Aqueous solutions of EDTA-guanidine carbonate or DTPA-guanidine carbonate showed promising back extraction ability though three contacts of these organic phases were required for more than 99.99% stripping of the metal ion. The reusability of these solvent systems was evaluated. After four consecutive cycles, a maximum of only 8% reduction in the extraction efficiency of Ta was noticed, while for Nb it was less than 4% for Nb.

A structure and knowledge-based combinatorial approach to engineering universal scFv antibodies against influenza M2 protein.

BACKGROUND: The influenza virus enters the host via hemagglutinin protein binding to cell surface sialic acid. Receptor-mediated endocytosis is followed by viral nucleocapsid uncoating for replication aided by the transmembrane viral M2 proton ion channel. M2 ectodomain (M2e) is a potential universal candidate for monoclonal antibody therapy owing to its conserved nature across influenza virus subtypes and its importance in viral propagation. METHODS: The phage-displayed naive human antibody libraries were screened against the short stretch of the N-terminal 10-mer peptide (SLLTEVETPI) of the M2e. ELISA, BLI, and flow cytometry assays were used to examine scFv binding to M2e epitopes. The scFv crystal structures were determined to examine the nature of the interactions. The potencies of the scFvs against the influenza virus were demonstrated by real-time PCR and confocal microscopy imaging. RESULTS: The four unique scFv clones were obtained from the scFv phage-display antibody libraries and shown to exhibit binding with the 10-mer conserved part of the M2e and with full-length M2 protein expressed on the HEK293T cells. The crystal structure of scFv AU1 with M2e peptide showed the peptide as a dimer in the parallel beta-sheet conformation bound at the interface of two scFv CDRs. The scFv AU1 significantly restricted the release of H1N1 virus progeny from the infected A549 cells. CONCLUSION: This structural and biochemical study showcased the binding of antibody scFv molecules with M2e peptide dimer, providing the structural insights for the function effect in terms of recognizing and restricting the release of new viral particles from an infected host cell.

Reprogramming of glucose metabolism in virus infected cells.

Viral infection is a kind of cellular stress that leads to the changes in cellular metabolism. Many metabolic pathways in a host cell such as glycolysis, amino acid and nucleotide synthesis are altered following virus infection. Both oncogenic and non-oncogenic viruses depend on host cell glycolysis for their survival and pathogenesis. Recent studies have shown that the rate of glycolysis plays an important role in oncolysis as well by oncolytic therapeutic viruses. During infection, viral proteins interact with various cellular glycolytic enzymes, and this interaction enhances the catalytic framework of the enzymes subsequently the glycolytic rate of the cell. Increased activity of glycolytic enzymes following their interaction with viral proteins is vital for replication and to counteract the inhibition of glycolysis caused by immune response. In this review, the importance of host cell glycolysis and the modulation of glycolysis by various viruses such as oncogenic, non-oncogenic and oncolytic viruses are presented.

Risk factors and predictors of violence: insights from the emergency department at a level 1 trauma center in the USA.

BACKGROUND: This study aimed to assess the risk factors and predictors of violence among patients admitted to a Level 1 trauma center in a single institution. METHODS: We conducted a retrospective analysis of patients who were admitted with a history of violence between 2012 and 2016. RESULTS: A total of 9855 trauma patients were admitted, of whom 746 (7.6%) had a history of violence prior to the index admission. Patients who had history of violence were younger and more likely to be males, Black, Hispanic and covered by low-income primary payer in comparison to non-assault trauma patients (P < 0.001 for all). Multivariate logistic regression analysis showed that covariate-adjusted predictors of violence were being Black, male having low-income primary payer, Asian, drug user, alcohol intoxicated and smoker. CONCLUSIONS: Violence is a major problem among young age subjects with certain demographic, social and ethnic characteristics. Trauma centers should establish violence injury prevention programs for youth and diverse communities.

Modified Nishida's procedure in a case of medial rectus hypoplasia.

Introduction: We report a case of large angle exotropia in a child with limitation of adduction in the left eye with a radiological finding of hypoplastic medial rectus. Methods: A 3- year- old male child presented with left eye large angle exotropia, left face turn, -4 adduction limitation and severe amblyopia. Orbital imaging revealed hypoplasia of the medial rectus and intraoperatively a thin medial rectus was noted. The surgical procedure planned was lateral rectus recession combined with Modified Nishida's technique in the left eye. In this technique the superior and inferior recti were transposed medially by inserting non-absorbable sutures in the sclera posteriorly, closer to the upper and lower borders of the medial rectus muscle. Result: There was improvement in adduction of left eye and reduction of original deviation following maximal lateral rectus recession and a modified Nishida's approach. The early and optimal correction of exotropia also improved the compliance to patching with subsequent gain in visual acuity of the amblyopic eye. Conclusion: Modified Nishida's technique has the advantage of no muscle splitting and no tenotomy, remains a less invasive surgical procedure to correct large deviations. The modification of placing the bellies closer to medial rectus augments the effect and further improves adduction in cases with severe limitation of adduction. This technique can thus be considered as a possible surgical approach in young children with large angle exotropia due to hypoplastic medial rectus.

Does Endovascular Repair for Blunt Traumatic Aortic Injuries Provide Better Outcomes Compared to Its Open Technique? A Systematic Review and Meta-analysis.

INTRODUCTION: Traumatic aortic injuries are devastating events in terms of high mortality and morbidity in most survivors. We aimed to compare the outcomes of endovascular repair (ER) vs. open repair (OR) in the treatment of traumatic aortic injuries. METHODS: PubMed, Embase, and Cochrane Library were systematically searched. Postoperative mortality was the primary endpoint. Secondary endpoints included intensive care unit (ICU) length of stay, hospital length of stay, operating time, paraplegia, stroke, acute renal failure, and reoperation rate. The Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95% CI)), and the inverse variance method with the mean difference (MD (95% CI)), were used to measure the effects of continuous and categorical variables, respectively. RESULTS: A total of 49 studies involving 12,857 patients were included. Postoperative mortality was not significantly different between the two groups (p=0.459). Among secondary outcomes, the paraplegia rate was significantly lower after ER (p=0.032). Other secondary endpoints such as ICU length of stay (p=0.329), hospital length of stay (p=0.192), operating time (p=0.973), stroke rate (p=0.121), ARF rate (p=0.928), and reoperation rate (p=0.643) did not significantly differ between the two groups. CONCLUSION: This meta-analysis found that ER was associated with a reduced paraplegia rate compared to OR for the management of traumatic aortic injury.

Experimental validation of influenza A virus matrix protein (M1) interaction with host cellular alpha enolase and pyruvate kinase.

Influenza A virus, a respiratory pathogen manipulates various host cellular processes to establish a successful infection in a host. We had reported earlier the interaction of influenza A virus nucleoprotein with host glycolytic enzymes; alpha enolase and pyruvate kinase in A549 cells. Matrix protein (M1), another multifunctional protein encoded by genome segment 7 forms the inner layer of the virion and interacts with the ribonucleoprotein complex. Nucleoprotein and matrix protein, major structural components of the virion together contribute to the stability of the capsid. Thus, we have investigated the interaction of viral matrix protein with host glycolytic enzymes; alpha enolase and pyruvate kinase. Results had demonstrated differential expression of these two glycolytic enzymes in response to matrix protein and their interaction with matrix protein by in vitro binding, co-immunoprecipitation and co-localization studies. Our results confirmed that viral matrix protein interacts with host glycolytic enzymes in association with viral nucleoprotein.

Focal Loss for Dense Object Detection.

The highest accuracy object detectors to date are based on a two-stage approach popularized by R-CNN, where a classifier is applied to a sparse set of candidate object locations. In contrast, one-stage detectors that are applied over a regular, dense sampling of possible object locations have the potential to be faster and simpler, but have trailed the accuracy of two-stage detectors thus far. In this paper, we investigate why this is the case. We discover that the extreme foreground-background class imbalance encountered during training of dense detectors is the central cause. We propose to address this class imbalance by reshaping the standard cross entropy loss such that it down-weights the loss assigned to well-classified examples. Our novel Focal Loss focuses training on a sparse set of hard examples and prevents the vast number of easy negatives from overwhelming the detector during training. To evaluate the effectiveness of our loss, we design and train a simple dense detector we call RetinaNet. Our results show that when trained with the focal loss, RetinaNet is able to match the speed of previous one-stage detectors while surpassing the accuracy of all existing state-of-the-art two-stage detectors. Code is at: https://github.com/facebookresearch/Detectron.

Recent Strategies and Paradigm Shift in Management of Hepatic Metastasis from Colorectal Cancer.

The liver is the most common site for metastasis from colorectal cancers (CRCs). There are so many new armamentarium, which have increased the life expectancy and progression-free survival. There are various available guidelines, such as NCCN, ESMO, and ASCO, which provide an insight into the latest modalities and new protocols. We have tried to elucidate into paradigm shift of the management.

The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma.

BACKGROUND: We aimed to evaluate the clinical utility of shock index (SI) to assess the need for blood transfusion and predict the outcomes in trauma. MATERIALS AND METHODS: We conducted a retrospective analysis for trauma patients between 2012 and 2016 in a level-1 trauma center. Data included patient demographics, vital signs, mechanism of injury, Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), blood transfusion, hospital length of stay (HLOS), and mortality. Patients were classified into group I (SI < 0.8) and group II (SI ≥ 0.8). RESULTS: Out of 8710 admitted patients, 1535 (22%) had SI ≥ 0.8 and 976 (12.5%) received blood transfusion (89 received massive transfusion, following massive blood transfusion protocol [MTP]). In comparison to lower SI, patients with SI ≥ 0.8 were mostly female patients, 8 y younger (43 ± 22 versus 51 ± 23), had greater ISS (15 ± 12 versus 10.5 ± 8), higher NISS (19 ± 15 versus 14 ± 11), lower pulse pressure (43 ± 14 versus 62 ± 18), lower TRISS (0.892 ± 0.20 versus 0.953 ± 0.11), and received more blood transfusion (28.6% versus 9.0%) or MTP (17.7% versus 3%), P = 0.001. Also, they had mostly exploratory laparotomy (13.3% versus 6.6%, P = 0.001), longer HLOS (11.3 versus 7.0 d, P = 0.001), and higher mortality (7.0% versus 3.1%, P = 0.001). SI was correlated with age (r = -0.188), pulse pressure (r = -0.51), HLOS (r = 0.168), ISS (r = 0.251), NISS (r = 0.211), amount of blood transfused (r = 0.27), Glasgow Coma Scale (r = -0.96), and TRISS (r = -0.230). After adjusting for age and sex, ISS, and Glasgow Coma Scale in two multivariable analyses, high SI was found to be an independent predictor for mortality (odd ratio, 2.553; 95% confidence intervals: 1.604-4.062) and blood transfusion (odd ratio, 3.57; 95% confidence intervals: 3.012-4.239). The cutoff point of SI for predicting MTP is 0.81 (sensitivity, 85%; specificity, 64%; positive predictive value, 16%; and negative predictive value, 98%). CONCLUSIONS: The SI after injury can be used early to predict the need for MTP and laparotomy and mortality. It correlates with other physiological and anatomical variables. However, its cutoff values for risk stratification and prognostication need further evaluation.