New Insights Into the Anatomy of the Eyelashes With Regard to Ethnic Differences Against a Clinical Background.

BACKGROUND: To investigate the root depth, root angle, and light and scanning electron microscopical anatomy of human eyelashes relevant to eyelash ablation. METHODS: Eyelash root depth, the angle between eyelash root and skin epithelium, spatial relationship, and scanning electron microscopical features of the eyelashes were studied on 4 upper and 4 lower eyelids of Caucasian (n = 4) and Indian (n = 4) cadaver heads according to a set protocol. RESULTS: There were significant differences in the mean eyelash root depth between Indians (2.3 ± 0.38 mm) and Caucasians (1.9 ± 0.26 mm; p = 0.007), as well as between upper eyelids and lower eyelids (1.9 ± 0.2 mm vs. 1.8 ± 0.1 mm). The mean angle between the lash follicle root and the skin epithelium was 75 ± 11 degrees and similar in both ethnic groups. The eyelash bulb was located close to the tarsal plate and meibomian glands and formed an angle of less than 15 degrees with the eyelash root. Scanning electron microscopy studies revealed that the eyelash bulb was 202 ± 12 µm wide in Indians and 170.6 ± 16.8 µm wide in Caucasian eyelids ( p = 0.08). The eyelashes were placed more closely in Indian eyelids than in Caucasian eyelids ( p = 0.03). The width of the cuticle layer varied between the hair shaft and the inner eyelid segment. CONCLUSIONS: There are differences in eyelash root depth, inter-eyelash distance, and cuticle thickness between Indian and Caucasian eyelids. The oblique orientation of the eyelash root and close proximity of the eyelash bulb to the tarsal plate should be kept in mind while doing the electroepilation procedure.

Impact of polishing system on surface roughness of different ceramic surfaces after various pretreatments and bracket debonding.

OBJECTIVE: Evaluating various polishing methods after bracket debonding and excessive attachment material removal for different ceramics and pretreatments. MATERIAL AND METHODS: Zirconia (ZrO2), leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with a) silica coated alumina particles (CoJet); LEU and LiSi additionally with b) hydrofluoric acid (HF), c) Monobond Etch&Prime (MEP), d) silicium carbide grinder (SiC) before bracket bonding, shearing off, ARI evaluation, excessive attachment material removal and polishing with i) Sof-Lex Discs (Soflex), ii) polishing paste (Paste), iii) polishing set (Set). Before/after polishing surface roughness (Ra) was measured with a profilometer. Martens hardness parameter were also assessed. RESULTS: Irrespective of pretreatment Ra of LEU increased the most, followed by LiSi and ZrO2 (p < 0.001, SiC: p = 0.012), in accordance with the measured Martens hardness parameter. CoJet/SiC caused greater roughness as HF/MEP (p < 0.001). The ZrO2 surface was rougher after polishing with Paste/Set (p < 0.001; p = 0.047). Ra improved in the LEU/CoJet, LEU/SiC and LiSi/SiC groups with Soflex/Set (p < 0.001), in the LiSi/CoJet and LEU/HF groups by Soflex (p = 0.003, p < 0.001) and worsened by Paste (p = 0.017, p < 0.001). Polishing of HF or MEP pretreated LiSi with Set increased Ra (p = 0.001, p < 0.001), so did Paste in the LEU/MEP group (p < 0.001). CONCLUSIONS: Paste couldn't improve the surfaces. Soflex was the only method decreasing Ra on rough surfaces and not causing roughness worsening. Polishing of LEU/LiSi after MEP, LEU after HF pretreatment doesn´t seem to have any benefit. CLINICAL RELEVANCE: To avoid long-term damage to ceramic restorations, special attention should be paid to the polishing method after orthodontic treatment.

Orthodontic bonding to silicate ceramics: impact of different pretreatment methods on shear bond strength between ceramic restorations and ceramic brackets.

OBJECTIVE: The study aims to investigate the shear bond strength (SBS) between silicate ceramic restorations and ceramic brackets after different pretreatments and aging methods. MATERIAL AND METHODS: Leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with (i) 4% hydrofluoric acid + silane (HF), (ii) Monobond Etch&Prime (MEP), (iii) silicatization + silane (CoJet), and (iv) SiC grinder + silane (SiC). Molars etched (phosphoric acid) and conditioned acted as comparison group. SBS was measured after 24 h (distilled water, 37 °C), 500 × thermocycling (5/55 °C), and 90 days (distilled water, 37 °C). Data was analyzed using Shapiro-Wilk, Kruskal-Wallis with Dunn's post hoc test and Bonferroni correction, Mann-Whitney U, and Chi2 test (p < 0.05). The adhesive remnant index (ARI) was determined. RESULTS: LEU pretreated with MEP showed lower SBS than pretreated with HF, CoJet, or SiC. LiSi pretreated with MEP resulted in lower initial SBS than pretreated with HF or SiC. After thermocycling, pretreatment using MEP led to lower SBS than with CoJet. Within LiSi group, after 90 days, the pretreatment using SiC resulted in lowest SBS values. After HF and MEP pretreatment, LEU showed lower initial SBS than LiSi. After 90 days of water storage, within specimens pretreated using CoJet or SiC showed LEU higher SBS than LiSi. Enamel presented higher or comparable SBS values to LEU and LiSi. With exception of MEP pretreatment, ARI 3 was predominantly observed, regardless the substrate, pretreatment, and aging level. CONCLUSIONS: MEP pretreatment presented the lowest SBS values, regardless the silicate ceramic and aging level. Further research is necessary. CLINICAL RELEVANCE: There is no need for intraoral application of HF for orthodontic treatment.

Neurocritical care complications and interventions influence the outcome in aneurysmal subarachnoid hemorrhage.

BACKGROUND: This observational study was performed to show the impact of complications and interventions during neurocritical care on the outcome after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We analyzed 203 cases treated for ruptured intracranial aneurysms, which were classified regarding clinical outcome after one year according to the modified Rankin Scale (mRS). We reviewed the data with reference to the occurrence of typical complications and interventions in neurocritical care units. RESULTS: Decompressive craniectomy (odds ratio 21.77 / 6.17 ; p < 0.0001 / p = 0.013), sepsis (odds ratio 14.67 / 6.08 ; p = 0.037 / 0.033) and hydrocephalus (odds ratio 3.71 / 6.46 ; p = 0.010 / 0.00095) were significant predictors for poor outcome and death after one year beside "World Federation of Neurosurgical Societies" (WFNS) grade (odds ratio 3.86 / 4.67 ; p < 0.0001 / p < 0.0001) and age (odds ratio 1.06 / 1.10 ; p = 0.0030 / p < 0.0001) in our multivariate analysis (binary logistic regression model). CONCLUSIONS: In summary, decompressive craniectomy, sepsis and hydrocephalus significantly influence the outcome and occurrence of death after aneurysmal SAH.

Teaching to Relax: Development of a Program to Potentiate Stress-Results of a Feasibility Study with Medical Undergraduate Students.

Medical students are a population at risk for the development of stress-related risk states (e.g. burnout) and manifest mental disorders (e.g. depression). Still the learning of coping mechanisms against stress is not an integral part of the medical curriculum. In a pilot study we developed an elective course for learning relaxation techniques (Relacs) which was geared to the clinical practice of autogenic training (AT) with psychiatric patients. The course focussed on an innovative and mostly communicative transfer of knowledge about AT, progressive muscle relaxation and medical hypnosis and stressed the principle of repeated and supervised exercises in small student groups alongside self-administered exercise. 42 students took part in this course and showed a very high acceptance for the topic and positive evaluation. Moreover, we found a distinct improvement of the participants' mental parameters (burnout, anxiety) and a good knowledge about the course's contents within the final exams at the end of the semester. The structure and realisation of the course is easily adaptable and very effective regarding the improvement of the students' mental health. Due to our results and the commonly known prevalence of stress-related disorders in medical students we postulate the integration of courses on relaxation strategies in the medical curriculum.

[Development and correlation of work-related behavior and experience patterns, burnout and quality of life in medical students from their freshmanship to the first state examination]. / Entwicklung und Zusammenhang von Arbeitsverhalten, Burnout-Beschwerden und Lebensqualität bei Studierenden der Humanmedizin vom Studienstart bis zum ersten Staatsexamen.

Symptoms of burnout are common among medical students. Although they usually start with a good health status, their condition deteriorates over the course of their studies. In our study ESTRELLAS we examined 530 medical students in the preclinical semesters with validated psychological questionnaires. The longer the students were studying, the more showed risky working habits. Cognitive and emotional burnout symptoms increased coincidentally in their intensity, whereas the mental quality of life continuously deteriorated. Medical students' cognitive and emotional burnout symptoms are constantly increasing from the beginning of their studies. Contemporaneously, the mental quality of life is deteriorating. This might be based on a drastic change towards risky working habits. We suggest to actively work against this process to keep our motivated students and prospective physicians productive and in good mental health.

Suitability of Slaughterhouse-Acquired Pig Eyes as Model Systems for Refractive Ultraviolet and Infrared Femtosecond Laser Research.

PURPOSE: To elucidate whether it is feasible to use porcine eyes from scalded, abattoir-acquired animals for refractive femtosecond laser research. METHODS: An infrared laser (FS 200) and an ultraviolet laser (prototype version) were tested for their applicability on scalded pig eyes. Fifty porcine eyes were divided into two equally-sized groups and assigned to either the infrared or the ultraviolet laser. Both laser groups were comprised of five subgroups of n = 5 eyes each. Group A: non-scalded eyes (negative control); group B: eyes taken from tunnel-scalded animals; group C1: eyes taken from tank-scalded animals without opaque corneal lesion; group C2: eyes taken from animals with opaque corneal lesion; group D: eyes scalded in toto in the laboratory (positive control). In each group the lasers were employed to create a stromal flap. The quality of the laser cuts and the resulting flap beds, as well as of the porcine corneas themselves, was examined by anterior segment optical coherence tomography and scanning electron microscopy. RESULTS: All scalded specimens exhibited substantial corneal swelling, most pronounced in group C2. After ultraviolet laser application, the tank- and tunnel-scalded samples displayed marked irregularities and an increased degree of surface roughness in the flap beds. After infrared laser application, this was only the case in the tank-scalded specimens. CONCLUSION: It is not recommended to use eyes taken from scalded pigs for ultraviolet femtosecond laser experiments. For infrared femtosecond lasers, eyes taken from tunnel-scalded animals may represent an acceptable alternative, if non-scalded eyes are not available.

Urea and ocular surface: Synthesis, secretion and its role in tear film homeostasis.

Urea has been detected in the tear film, aqueous humor, and vitreous of the eye. While most of the urea in the aqueous humor and vitreous is considered to be an ultrafiltrate from the blood vessels, the presence of urea transporters and urea-synthesizing enzymes in the lacrimal gland, meibomian glands, conjunctiva, and cornea suggests ureagenesis occurring at the ocular surface. This review summarizes the distribution and function of urea transporters, urea and its synthesizing enzymes at the ocular surface to analyze their role in the tear film homeostasis. Urea transporters (UT)-A- and UT-B-as well as the enzymes arginase I, II, and agmatinase are located at the ocular surface. Urea concentration on the ocular surface is influenced by blood urea concentration, the amount of urea released by the tear fluid, tear evaporation, and arginase concentration in the tears. There are conflicting reports on the relationship between tear and plasma urea levels though a linear correlation exists between their levels. Urea protects the ocular surface from osmotic stress and is thought to maintain a lipid-water interface in the lamellar phase of the tear film. The reduction of urea levels in the tears of patients with evaporative dry eye suggests its possible role in tear film stability. Other than mitigating osmotic stress, urea has hydrating properties as well. Animal studies have demonstrated the healing effects of urea on the corneal epithelium. Future studies examining the variations in urea content in tears from different ocular surfaces, at different times of day, and under different environmental conditions would further solidify the role of urea in tear film stability.

Impact of different pretreatments and attachment materials on shear bond strength of indirectly bonded brackets using CAD/CAM transfer trays to monolithic zirconia.

OBJECTIVE: Investigating the impact of different pretreatment methods, attachment materials and aging regimens on shear bond strength (SBS) between zirconia and indirectly bonded brackets using CAD/CAM transfer trays. METHODS: Zirconia substrates were conditioned with silica coated alumina (CoJet) and a) Clearfil Ceramic Primer Plus (CF), b) RelyX Ceramic Primer (RXP), c) Futurabond U (FU). Brackets were virtually placed, transfer tray designed (OnyxCeph) and 3D-printed for indirect bonding with a) Transbond LV (TBL), b) Nexus NX3 (NX3), c) Maximum Cure (MC). SBS testing was performed with a universal testing machine after 24 h, 500 thermal cycles, 90 d. Directly bonded brackets to human enamel using Transbond XT Adhesive served as control. The adhesive remnant index (ARI) was evaluated. Data was analyzed with Shapiro-Wilk, Kruskal-Wallis and Dunn's post-hoc test with Bonferroni correction, Chi2 test (p < 0.05), and the Weibull modulus was calculated. RESULTS: SBS ranged from 0.1 to 15.5 MPa and were influenced mostly by the attachment material. NX3 generally showed the highest values (9.5-15.8 MPa). Initially RXP/TBL and FU/TBL presented the lowest values (4.3/4.8 MPa). Aging regimens reduced SBS of MC irrespective of pretreatment, after 90 d values ranged from 0.1 to 0.9 MPa. ARI 1 was predominant in all MC groups and FU/NX3, 2 and 3 in the other groups. Weibull moduli ranged between 0.15 (MC/RXP/500 TC) and 6.24 (NX3/RXP/500 TC). SIGNIFICANCE: MC seems not to be suitable for indirect bonding using CAD/CAM transfer trays to zirconia. NX3 showed similar SBS values compared to the control, TBL lower.

LOXL1 deficiency in the lamina cribrosa as candidate susceptibility factor for a pseudoexfoliation-specific risk of glaucoma.

PURPOSE: To test the hypothesis that a primary disturbance in lysyl oxidase-like 1 (LOXL1) and elastin metabolism in the lamina cribrosa of eyes with pseudoexfoliation syndrome constitutes an independent risk factor for glaucoma development and progression. DESIGN: Observational, consecutive case series. PARTICIPANTS: Posterior segment tissues obtained from 37 donors with early and late stages of pseudoexfoliation syndrome without glaucoma, 37 normal age-matched control subjects, 5 eyes with pseudoexfoliation-associated open-angle glaucoma, and 5 eyes with primary open-angle glaucoma (POAG). METHODS: Protein and mRNA expression of major elastic fiber components (elastin, fibrillin-1, fibulin-4), collagens (types I, III, and IV), and lysyl oxidase crosslinking enzymes (LOX, LOXL1, LOXL2) were assessed in situ by quantitative real-time polymerase chain reaction, (immuno)histochemistry, and light and electron microscopy. Lysyl oxidase-dependent elastin fiber assembly was assessed by primary optic nerve head astrocytes in vitro. MAIN OUTCOME MEASURES: Expression levels of elastic proteins, collagens, and lysyl oxidases in the lamina cribrosa. RESULTS: Lysyl oxidase-like 1 proved to be the major lysyl oxidase isoform in the normal lamina cribrosa in association with a complex elastic fiber network. Compared with normal and POAG specimens, lamina cribrosa tissues obtained from early and late stages of pseudoexfoliation syndrome without and with glaucoma consistently revealed a significant coordinated downregulation of LOXL1 and elastic fiber constituents on mRNA and protein level. In contrast, expression levels of collagens and other lysyl oxidase isoforms were not affected. Dysregulated expression of LOXL1 and elastic proteins was associated with pronounced (ultra)structural alterations of the elastic fiber network in the laminar beams of pseudoexfoliation syndrome eyes. Inhibition of LOXL1 interfered with elastic fiber assembly by optic nerve head astrocytes in vitro. CONCLUSIONS: The findings provide evidence for a pseudoexfoliation-specific elastinopathy of the lamina cribrosa resulting from a primary disturbance in LOXL1 regulation and elastic fiber homeostasis, possibly rendering pseudoexfoliation syndrome eyes more vulnerable to pressure-induced optic nerve damage and glaucoma development and progression.

Urea transporter-B expression on the ocular surface and in the lacrimal glands.

OBJECTIVE: Urea is a component of tear fluid showing a significantly decreased concentration in dry eye disease. The urea content of tear fluid may depend on urea transporters. The purpose of this study was to examine the expression of urea transporter B (UT-B) at the ocular surface and in the lacrimal glands. METHODS: UT-B protein and mRNA expression was investigated in human, porcine, and murine samples. Immunohistochemical staining for UT-B was performed on paraffin sections of human, porcine, and murine corneas, eyelids, and lacrimal glands (n = 5 each). Reverse transcriptase polymerase chain reaction was conducted to detect UT-B mRNA in human and murine cornea, conjunctiva, Meibomian gland, and lacrimal gland (n = 5 each). RESULTS: UT-B protein expression was comparable in all three species. It was found in the corneal epithelium and endothelium, in the conjunctival epithelium, in the end pieces and excretory ducts of the lacrimal gland, Meibomian gland, and in the glands of Moll and Zeis. The glands of Zeis and the Meibomian glands showed intense UT-B signals in the basal layers of the alveolar epithelia and in the cells of the ductal epithelia. UT-B mRNA was detected in all samples analyzed. CONCLUSION: UT-B is expressed by the cells and tissues of the ocular surface and in the lacrimal glands. Potential changes in urea transporter expression might have implications for the pathogenesis of dry eye disease. Since comparable results were obtained for all species investigated, the presented findings may open the door for DED-relevant experimentation on porcine and murine model systems.

Immunohistochemical detection of urea transporter-A in the tear-producing part of the lacrimal system.

OBJECTIVE: Urea constitutes a physiological and presumably well-regulated constituent of tear fluid. Its lacrimal concentration is significantly decreased in dry eye disease. Urea homeostasis within the tear fluid may also depend on the expression of urea transporters. The present study reports on the expression patterns of urea transporter A (UT-A) in the cells and tissues of the ocular surface and the lacrimal glands. METHODS: UT-A immunohistochemistry was performed on 5 µm paraffin sections of paraformaldehyde-fixed human, porcine, and murine corneas, eyelids, and lacrimal glands (n = 5 each). RESULTS: UT-A immunostaining was largely comparable in all three species. UT-A signals were detected in the corneal epithelium and endothelium, in the conjunctival epithelium, in the acinar cells and excretory ducts of the lacrimal gland, Meibomian gland, and in the glands of Moll and Zeis. The Meibomian glands and the glands of Zeis exhibited a marked UT-A-positive staining in the basal cells of the alveolar epithelia and in the ductal epithelia. CONCLUSION: UT-A shows comparable expression patterns to UT-B (previous study) at the ocular surface and in the lacrimal glands, as determined by immunohistochemistry. The presence of both urea transporters in the lacrimal functional unit suggests that they are essential for the normal function of the lacrimal system and the integrity of the tear film. Potential alterations in urea transporter expression might be associated with the significant reduction of urea found in the tear fluid of dry eye patients. They may thus play an important role in the pathogenesis of dry eye disease.

Prevalence and characteristics of test anxiety in first year anatomy students.

BACKGROUND: Test anxiety is a common phenomenon at universities with the potential to impair academic performance and student well-being. This study was conducted to investigate prevalence, characteristics, and development of the test anxiety categories "emotionality", "worry", "interference", and "lack of confidence" among first year medical students. METHODS: Overall, 625 freshman medical students were enrolled. They were recruited from the participants of a first semester anatomy course. The participants were assessed four times with a validated psychological test anxiety questionnaire (Prüfungsangstfragebogen, PAF). The first assessment was conducted at the commencement of the first semester. All further assessments were performed two days prior to each of three mandatory oral anatomy tests in the course of one half year. Prevalence rates as well as mean global and subscale scores of the test anxiety dimensions "emotionality", "worry", "interference" and "lack of confidence" were determined and compared between assessments. RESULTS: Approximately 50% of the study participants showed pronounced test anxiety in at least one dimension over the observation period. Only about 10% were considered test anxiety-positive according to the global PAF scale. Worry showed the highest (up to 48%) and interference the lowest (≈5%) prevalence rates. Emotionality had a stable prevalence of approximately 17%, whereas lack of confidence showed a rising trend over the observation period from 15.2% up to 24.0%. CONCLUSION: Test anxiety is substantially more prevalent among medical students as commonly reported and deserves more detailed, dimension-specific exploration in future. Especially worry and lack of confidence give reason for concern, demanding further investigation.

Usability of abattoir-acquired pig eyes for refractive excimer laser research.

The purpose of this study was to elucidate, under which conditions abattoir-acquired pig eyes are suitable for refractive excimer laser experiments. Porcine eyes from tunnel-scalded (n = 5) and tank-scalded (n = 10) pigs were compared to unscalded eyes (n = 5) and to eyes scalded in the laboratory (n = 5). The corneal epithelium was removed before an excimer laser was used to perform a - 8.0 D photoablation. Corneal thickness was measured by optical coherence topography before and after photoablation. The ablation depth was determined with a contour measuring station, the morphology of the ablated areas was characterized by scanning electron microscopy and white-light profilometry. The scalded eyes showed an increase in corneal swelling which gained statistical significance in tank-scalded eyes showing a wedge-shaped opaque stromal lesion in the nasal corneal quadrant. A measurable deterioration of photoablation was only found in tank-scalded eyes that exhibited the opaque lesion. Ablated area morphology was smooth and regular in the unscalded and tunnel-scalded eyes. The tank-scalded eyes showed conspicuous wrinkles. While unscalded eyes should always be preferred for excimer laser laboratory experiments, the data suggest that the use of tunnel-scalded eyes may also be acceptable and should be chosen over tank-scalded eyes.

Curvature-dependent shear bond strength of different attachment materials for orthodontic lingual indirect bonding.

To evaluate the shear bond strength (SBS) of different attachment materials used for lingual bonding, the influence of artificial aging and the radii of curvature of the enamel surface on SBS, 192 third molars were photographed to determine the radius of curvature of the oral surface. After phosphoric acid etching a cylindrical test piece was bonded to the oral enamel using a mold that was filled with a chemically curing (Maximum Cure, Transbond IDB Premix) or a dual-curing (Nexus NX3, RelyX Unicem2) attachment material. SBS was tested after 24 h, 500 thermal cycles or 90 days at 37 °C with a universal testing machine. Computed tomography scans were performed to determine the bonded surface and calculate SBS. Values ranged from 8.3 to 20.9 MPa. RelyX Unicem2 showed the highest SBS values at baseline, 500 thermal cycles and after 90 days (p < 0.001). Ninety days of wet storage significantly reduced SBS of Maximum Cure (p = 0.028). The radius of curvature correlated positively with SBS (rs = 0.204, p = 0.005). The SBS of all attachment materials was sufficient for clinical use, even after artificial aging. RelyX Unicem2 showed almost twice as high SBS values as the other attachment materials.

Feasibility of Clinical Hypnosis for Test Anxiety in First-Year Medical Students.

The purpose of this pilot study was to characterize test anxiety among first-year medical students at the University of Erlangen-Nürnberg and to test clinical hypnosis as a possible intervention. The "Prüfungsangstfragebogen," a shortened and revised German version of the Test Anxiety Inventory, was used to estimate test anxiety. It was administered 3 times: at the commencement of winter term 2017/18 and 2 days prior to each of 2 mandatory oral anatomy exams. The test-anxiety categories emotionality, worry, interference, and lack of confidence were evaluated. The effect of clinical hypnosis on test anxiety was estimated. The global test anxiety and lack of confidence scores were reduced significantly over time in the group that underwent clinical hypnosis but not in the control group. Direct comparisons of hypnosis vs. control group yielded no statistically significant differences in the test anxiety scores.

Ansa cervicalis - A new classification approach.

Normally, the inferior root of Ansa cervicalis passes around the internal jugular vein and runs in an anterior direction to meet the superior root ventral to the common carotid artery. However, anatomical variants of the Ansa cervicalis are as yet not well investigated and understood. To close this gap the present study was undertaken. The Ansa cervicalis was examined in 54 human formalin-fixed cadavers and preparations of the head and neck by conventional dissection. In 66% of the specimens the Ansa cervicalis displayed the typical course that was classified as "internal type" (located medial to the internal jugular vein inside the carotid sheath). The remaining 34% pertained to the "external type" of the Ansa cervicalis (lateral to the internal jugular vein). The distance of the Ansa cervicalis relative to the superior margin of the thyroid cartilage was measured in every specimen. The external type Ansa cervicalis was located significantly lower than the internal type relative to the superior margin of thyroid cartilage. Regarding its location relative to the internal jugular vein four variants of combinations of the external and internal types of Ansa cervicalis on the right and left sides were distinguished. Based on their distance from the superior margin of the thyroid cartilage three types of Ansa cervicalis were defined.

Interface morphology and gas production by a refractive 347 nm ultraviolet femtosecond laser: Comparison with established laser systems.

PURPOSE: To evaluate gas production and interface quality after refractive lenticule creation. A new ultraviolet (UV) 347 nm femtosecond laser was compared with the FS200 and the Visumax lasers. SETTING: Department of Anatomy II, University of Erlangen-Nürnberg, Erlangen, Germany. DESIGN: Experimental study. METHODS: Refractive lenticules were created in 52 porcine corneas with the UV laser (n = 20), the Visumax laser (n = 20), and a modified FS200 laser (n = 12). Twelve corneas in each laser group were fixed immediately after lenticule creation to entrap the gas produced. Lenticule extraction was omitted. From 16 other corneas (UV and Visumax lasers; n = 8 each) -5.0 diopter (D) and -10.0 D lenticules were extracted. On lenticule extraction, a flap was created and lifted. In 12 additional corneas, a flap was cut using the FS200 laser and lifted afterward; laser in situ keratomileusis was performed on 8 of these samples. The corneas were processed for light microscopy (gas bubble 2-dimensional morphometry) and scanning electron microscopy (interface quality). RESULTS: The Visumax generated approximately one half as much gas as the FS200. The UV laser undercut the Visumax by another 50%. The interfaces created by the FS200 appeared smooth and without irregularities. The optical zone margin was always conspicuous in the Visumax samples but hardly discernible in the UV specimens. Slight irregularities and very small lenticule pieces were found occasionally in both groups. The UV interfaces appeared slightly rougher than the Visumax interfaces. CONCLUSIONS: Ultraviolet laser lenticule extraction seems promising. The interface quality was similar to that of the clinical Visumax system while gas production was reduced significantly.

Differentiation Patterns of Immortalized Human Meibomian Gland Epithelial Cells in Three-Dimensional Culture.

Purpose: To establish a simplified three-dimensional (3D) meibomian gland culture model using a meibomian gland epithelial cell (HMGEC) line that might be a useful tool to gain deeper insights into meibomian gland dysfunction. For this purpose, 3D differentiation patterns and growth characteristics of HMGECs were studied on various membranes/scaffolds as well as in hanging drops. Methods: Several types of inserts consisting of different materials (Millicell-HA, Millicell-PCF, ThinCert, and Alvetex) as well as hanging drop culture were analyzed. Culture conditions were optimized employing exposure to air (air-lift) and different cell culture media for a maximum of 28 days. To characterize cell differentiation in the developed 3D model, the expression pattern of cytokeratins was investigated by immunohistochemistry. Sudan III staining was performed for detection of lipid formation and transmission electron microscopy (TEM) was used for ultrastructural analysis. Results: Only Alvetex scaffolds and the hanging drop method revealed satisfactory results with regard to 3D culture. Continuous use of proliferation medium (serum-free keratinocyte medium containing epidermal growth factor and bovine pituitary extract) and air-lift were important steps for HMGEC differentiation in 3D culture. However, HMGECs only reached a differentiating state and never became mature or hypermature. When cultured in hanging drops, HMGECs showed serum-induced keratinization processes. Conclusions: HMGECs have the capability to differentiate in a long-term 3D culture, especially when adapted to an air-rich environment. However, even in the 3D format, HMGECs only reach a state of differentiating meibocytes.

Impact of Comorbidities and Smoking on the Outcome in Aneurysmal Subarachnoid Hemorrhage.

The intention of this observational study is to show the significant impact of comorbidities and smoking on the outcome in aneurysmal subarachnoid hemorrhage (SAH). During this observational study 203 cases of treatment of ruptured intracranial aneurysms were analyzed. We examined and classified prospectively the 12 month outcome according to the modified Rankin Scale (mRS) considering retrospectively a history of smoking and investigated prospectively the occurrence of early and delayed cerebral ischemia between 2012 and 2017. Using logistic regression methods, we revealed smoking (odds ratio 0.21; p = 0.0031) and hypertension (odds ratio 0.18; p = 0.0019) to be predictors for a good clinical outcome (mRS 0-2). Age (odds ratio 1.05; p = 0.0092), WFNS Grade (odds ratio 6.28; p < 0.0001), early cerebral ischemia (ECI) (odds ratio 10.06; p < 0.00032) and delayed cerebral ischemia (DCI) (odds ratio 4.03; p = 0.017) were detected as predictors for a poor clinical outcome. Significant associations of occurrence of death with hypertension (odds ratio 0.12; p < 0.0001), smoking (odds ratio 0.31; p = 0.048), WFNS grade (odds ratio 3.23; p < 0.0001) and age (odds ratio 1.09; p < 0.0001), but not with ECI (p = 0.29) and DCI (p = 0.62) were found. Smoking and hypertension seem to be predictors for a good clinical outcome after aneurysmal SAH.