A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal.

PURPOSE: To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal. METHODS: A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces. RESULTS: Five cases were performed with this technique with improved visual acuity and no complications. CONCLUSION: The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.

Clinical and MRI phenotypes of sarcoidosis-associated myelopathy.

OBJECTIVE: To determine the characteristic clinical and spinal MRI phenotypes of sarcoidosis-associated myelopathy (SAM), we analyzed a large cohort of patients with this disorder. METHODS: Patients diagnosed with SAM at a single center between 2000 and 2018 who met the established criteria for definite and probable neurosarcoidosis were included in a retrospective analysis to identify clinical profiles, CSF characteristics, and MRI lesion morphology. RESULTS: Of 62 included patients, 33 (53%) were male, and 30 (48%) were African American. SAM was the first clinical presentation of sarcoidosis in 49 patients (79%). Temporal profile of symptom evolution was chronic in 81%, with sensory symptoms most frequently reported (87%). CSF studies showed pleocytosis in 79% and CSF-restricted oligoclonal bands in 23% of samples tested. Four discrete patterns of lesion morphology were identified on spine MRI: longitudinally extensive myelitis (n = 28, 45%), short tumefactive myelitis (n = 14, 23%), spinal meningitis/meningoradiculitis (n = 14, 23%), and anterior myelitis associated with areas of disc degeneration (n = 6, 10%). Postgadolinium enhancement was seen in all but 1 patient during the acute phase. The most frequent enhancement pattern was dorsal subpial enhancement (n = 40), followed by meningeal/radicular enhancement (n = 23) and ventral subpial enhancement (n = 12). In 26 cases (42%), enhancement occurred at locations with coexisting structural changes (e.g., spondylosis). CONCLUSIONS: Recognition of the clinical features (chronically evolving myelopathy) and distinct MRI phenotypes (with enhancement in a subpial and/or meningeal pattern) seen in SAM can aid diagnosis of this disorder. Enhancement patterns suggest that SAM may have a predilection for areas of the spinal cord susceptible to mechanical stress.

Human brain microvascular endothelial cell pairs model tissue-level blood-brain barrier function.

The blood-brain barrier plays a critical role in delivering oxygen and nutrients to the brain while preventing the transport of neurotoxins. Predicting the ability of potential therapeutics and neurotoxicants to modulate brain barrier function remains a challenge due to limited spatial resolution and geometric constraints offered by existing in vitro models. Using soft lithography to control the shape of microvascular tissues, we predicted blood-brain barrier permeability states based on structural changes in human brain endothelial cells. We quantified morphological differences in nuclear, junction, and cytoskeletal proteins that influence, or indicate, barrier permeability. We established a correlation between brain endothelial cell pair structure and permeability by treating cell pairs and tissues with known cytoskeleton-modulating agents, including a Rho activator, a Rho inhibitor, and a cyclic adenosine monophosphate analog. Using this approach, we found that high-permeability cell pairs showed nuclear elongation, loss of junction proteins, and increased actin stress fiber formation, which were indicative of increased contractility. We measured traction forces generated by high- and low-permeability pairs, finding that higher stress at the intercellular junction contributes to barrier leakiness. We further tested the applicability of this platform to predict modulations in brain endothelial permeability by exposing cell pairs to engineered nanomaterials, including gold, silver-silica, and cerium oxide nanoparticles, thereby uncovering new insights into the mechanism of nanoparticle-mediated barrier disruption. Overall, we confirm the utility of this platform to assess the multiscale impact of pharmacological agents or environmental toxicants on blood-brain barrier integrity.

Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy.

OBJECTIVE: To assess the predictive value of the initial clinical and paraclinical features in the differentiation of inflammatory myelopathies from other causes of myelopathy in patients with initial diagnosis of transverse myelitis (TM). METHODS: We analyzed the clinical presentation, spinal cord MRI, and CSF features in a cohort of 457 patients referred to a specialized myelopathy center with the presumptive diagnosis of TM. After evaluation, the myelopathies were classified as inflammatory, ischemic/stroke, arteriovenous malformations/fistulas, spondylotic, or other. A multivariable logistic regression model was used to determine characteristics associated with the final diagnosis and predictors that would improve classification accuracy. RESULTS: Out of 457 patients referred as TM, only 247 (54%) were confirmed as inflammatory; the remaining 46% were diagnosed as vascular (20%), spondylotic (8%), or other myelopathy (18%). Our predictive model identified the temporal profile of symptom presentation (hyperacute <6 hours, acute 6-48 hours, subacute 48 hours-21 days, chronic >21 days), initial motor examination, and MRI lesion distribution as characteristics that improve the correct classification rate of myelopathies from 67% to 87% (multinomial area under the curve increased from 0.32 to 0.67), compared to only considering CSF pleocytosis and MRI gadolinium enhancement. Of all predictors, the temporal profile of symptoms contributed the most to the increased discriminatory power. CONCLUSIONS: The temporal profile of symptoms serves as a clinical biomarker in the differential diagnosis of TM. The establishment of a definite diagnosis in TM requires a critical analysis of the MRI and CSF characteristics to rule out non-inflammatory causes of myelopathy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients presenting with myelopathy, temporal profile of symptoms, initial motor examination, and MRI lesion distribution distinguish those with inflammatory myelopathies from those with other causes of myelopathy.

Efecto del ejercicio en subpoblaciones de lipoproteínas de alta densidad y en la presión arterial / Effect of exercise on high density lipoprotein subpopulations and blood pressure

Objetivo Determinar la relación del ejercicio con los niveles séricos de la apoA-I y las subpoblaciones de HDL2 y HDL3, en personas hipertensas de la Ciudad de Armenia - Quindío. Métodos La intervención fueron dos meses de ejercicio. La presión arterial se tomó con las recomendaciones del Ministerio de Salud de Colombia. Las subpoblaciones de HDL se midieron con el método del precipitado ionico y la apoA-I se midió con la técnica de nefelometría de bindig site. Resultados Los datos se analizaron con estadística descriptiva e inferencial. Se captaron 160 pacientes de los cuales 125 permanecieron hasta el final del proyecto, es decir, hubo un 78,12 % de permanencia; el 28 % hicieron ejercicio. El análisis mostró una reducción altamente significativa de la tensión arterial sistólica y diastólica mayor en las personas que hicieron que en las que no hicieron ejercicio. Las cifras de HDL estaban por debajo de lo normal antes del ejercicio aumentaron significativamente con el ejercicio pero aún se mantuvieron por debajo de los valores de referencia, las HDL2 aumentaron significativamente, mientras las HDL3 descendieroncon niveles normales de apoA-I. Conclusiones Este trabajo muestra que el ejercicio aumenta las HDL totales, pero lo más importante es que modifica la subpoblaciones de HDL en una relación que favorece aquellas que parecen tener propiedades ateroprotectivas. Y la evidencia de la interrelación entre factores protectores, aporta nuevos argumentos para las acciones en salud pública, frente al riesgo cardiovascular y la hipertensión Arterial.

Objetive Determine the relationship of exercise with serum levels of apoA-I and HDL2 and HDL3, subpopulations in hypertensive individuals from the city of Armenia - Quindío. Methods The interventions were two months of exercise. Blood pressure was taken with the recommendations of the Ministry of Health of Colombia. HDL subpopulations were measured with the method of precipitate ionicand the apoA-I was measured using nephelometry of Bindig site. Results Descriptive and inferential statistics were used for data analysis. A total of 160 patients of whom 125 remained until the end of the project were gathered, that is, there was a 78.12 % retention, 28 % did the exercise. The analysis showed a highly significant reduction of systolic and diastolic blood pressure, higher in people who did exercise. The HDL were below normal before exercise, significantly increased with exercise but still remained below the reference values, the HDL2 increased significantly, while HDL3 decreased with normal levels of apoA-I. Conclusion This study shows that exercise increases the total HDL, but the most important is that exercise modified the HDL subpopulations in a relationship that favors those which seem to have ateroprotective properties. The evidence of the interrelationship between protective factors provides new arguments for public health actions against the cardiovascular risk and hypertension.

[Effect of exercise on high density lipoprotein subpopulations and blood pressure]. / Efecto del ejercicio en subpoblaciones de lipoproteínas de alta densidad y en la presión arterial.

OBJECTIVE: Determine the relationship of exercise with serum levels of apoA-I and HDL2 and HDL3, subpopulations in hypertensive individuals from the city of Armenia - Quindío. METHODS: The interventions were two months of exercise. Blood pressure was taken with the recommendations of the Ministry of Health of Colombia. HDL subpopulations were measured with the method of precipitate ionic and the apoA-I was measured using nephelometry of Bindig site. RESULTS: Descriptive and inferential statistics were used for data analysis. A total of 160 patients of whom 125 remained until the end of the project were gathered, that is, there was a 78.12 % retention, 28 % did the exercise. The analysis showed a highly significant reduction of systolic and diastolic blood pressure, higher in people who did exercise. The HDL were below normal before exercise, significantly increased with exercise but still remained below the reference values, the HDL2 increased significantly, while HDL3 decreased with normal levels of apoA-I. CONCLUSION: This study shows that exercise increases the total HDL, but the most important is that exercise modified the HDL subpopulations in a relationship that favors those which seem to have ateroprotective properties. The evidence of the interrelationship between protective factors provides new arguments for public health actions against the cardiovascular risk and hypertension.

Hybridization and introgression in New World red mangroves, Rhizophora (Rhizophoraceae).

PREMISE OF THE STUDY: Hybridization is common in both animals and plants and can lead to a diverse array of outcomes ranging from the generation of new ecotypes or species to the breakdown of morphological differences. Here, we explore the extent of hybridization in the three currently recognized New World Rhizophora species-R. mangle, R. racemosa, and the putative hybrid species R. harrisonii. • METHODS: We assayed variation across the three recognized Rhizophora species using two noncoding chloroplast (cpDNA), two flanking microsatellite regions (FMRs), and six microsatellite loci. • KEY RESULTS: Gene genealogies of cpDNA and FMRs showed a strong phylogeographic break across the Central American Isthmus, but little relationship to recognized species boundaries. Instead, individuals collected in the same ocean basin and classified as R. mangle and R. racemosa by morphological characteristics were more closely related to each other than with similar looking individuals collected in the other ocean basin. Nonetheless, there were low, yet significant differences at microsatellite loci among co-occurring populations of R. mangle and R. racemosa in both ocean basins, suggesting that two taxonomic groups coexist. However, we found no genetic evidence that R. harrisonii was a hybrid species. Rather, R. harrisonii appears to represent a morphotype produced by ongoing hybridization and backcrossing between R. mangle and R. racemosa. • CONCLUSIONS: Our data support ancient and persistent introgressive hybridization among new world Rhizophora and argue for a full revision of the systematic relationships of the group based on much finer morphological, ecological, and genetic analyses.