Effects of exercise, physical activity, and sports on physical fitness in adults with Down syndrome: A systematic review.

This systematic review aimed to analyze the effects of exercise, physical activity, and sports on physical fitness in adults with Down syndrome (DS). A literature search was conducted across four databases EBSCO, Scopus, Web of Science, and PubMed. The PRISMA guidelines were followed. The PEDro scale and the Cochrane risk of bias tool were used to assess the quality and risk of the studies, respectively. The protocol was registered in PROSPERO (code: CRD42023449627). Of the 423 records initially found, 13 were finally included in the systematic review, in which 349 adults with DS participated. 92% of the articles declared at least one significant difference post-intervention. The available evidence indicates that exercise, physical activity, and sports have a positive effect on some variables of physical fitness, especially strength, balance, body composition, cardiorespiratory fitness, flexibility, and functional capacity. Furthermore, it should be considered as an additional treatment or complementary therapy to improve the functionality and quality of life of adults with DS.

Lobectomy in patients with differentiated thyroid cancer: experience of a Chilean tertiary center.

PURPOSE: Thyroid lobectomy (TL) is an appropriate treatment for up to 4 cm intrathyroidal differentiated thyroid cancer (DTC). There is scarce data regarding TL outside first-world centers. Our aim is to report a cohort of patients with DTC treated with TL in Chile. METHODS: We included DTC patients treated with TL, followed for at least 6 months, characterized their clinicopathological features and classified their risk of recurrence and response to treatment. RESULTS: Eighty-two patients followed for a median of 2.3 years (0.5-7.0). Seventy-three (89%) patients had papillary, 8 (9.8%) follicular and 1 (1.2%) high-grade DTC. The risk of recurrence was low in 56 (68.3%) and intermediate in 26 (31.7%). Eight (9.8%) patients required early completion thyroidectomy and radioiodine. At last follow-up, 52 (70.3%) had excellent, 19 (25.7%) had indeterminate, and 1 (1.4%) had structural incomplete response. CONCLUSION: In a developing country, TL is an adequate option for appropriately selected DTC patients.

Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis.

BACKGROUND: Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. METHODS AND FINDINGS: We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). RESULTS: Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%-58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%-48%) and blindness in 20% (95% CI 13%-30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72-8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59-6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. CONCLUSION: Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.

Effects of Physical Activity, Exercise and Sport on Executive Function in Young People with Attention Deficit Hyperactivity Disorder: A Systematic Review.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that negatively affects the inattention, disorganization, and/or hyperactivity-impulsivity in children and adolescents who suffer from it, included cases being reported that continue into adulthood. This disorder impairs social, academic, emotional, psychological, and health system functioning due to its high cost of treatment. The present systematic review aims to analyze the effects of physical activity, exercise, and sports on the executive function in children and adolescents diagnosed with ADHD through the scientific literature. The results show that the practice of physical activity, exercise, or sport produces improvements in executive function in children and adolescents diagnosed with ADHD, mainly through aerobic exercise. A 20 min session of physical activity, sport, or exercise leads to improvements in executive functions in children and adolescents with ADHD. It can be concluded that the practice of physical activity, exercise, and sport generate improvements on executive functions in children and adolescents with ADHD, mainly through aerobic exercise.

Actividad Física, Ejercicio Físico y Calidad de Vida en niños y adolescentes con Trastorno por déficit de atención y/o hiperactividad / Physical activity, exercise and quality of life in children and adolescents with Attention deficit hyperactivity disorder

Introducción: El Trastorno por déficit de atención y/o hiperactividad (TDAH) es un trastorno del neurodesarrollo que afecta la calidad de vida en niños y adolescentes, y se extiende hasta la edad adulta. La literatura señala que la práctica de actividad física y ejercicio físico establece beneficios positivos para el organismo del ser humano, a nivel físico, biológico y psicológico. Objetivo: Examinar los efectos de las intervenciones de actividad física o ejercicio físico sobre la calidad de vida en niños y adolescentes diagnosticados con TDAH. Material y Método: La búsqueda de las investigaciones fueron realizadas a través de Google Scholar, Scopus, Pubmed, Scielo, Web of Science, Dialnet y Redalyc, seleccionando solo investigaciones de libre acceso en idioma español. Se consideraron los últimos 5 años para el análisis de las investigaciones, se buscaron mediante las palabras utilizadas Actividad Física y Calidad de vida en niños y adolescentes con trastorno por déficit de atención e hiperactividad, Ejercicio Físico y Calidad de vida en niños y adolescentes con trastorno por déficit de atención e hiperactividad, Actividad Física y Calidad de vida en niños y adolescentes con TDAH, Ejercicio Físico y Calidad de vida en niños y adolescentes con TDAH. Desarrollo: Los 8 artículos seleccionados y extraídos de las bases de datos, concuerdan con los criterios de inclusión relacionados con los beneficios en la calidad de vida físicos, a nivel psicológicos, biológicos y sociales. Conclusiones: Intervenciones de actividad física y ejercicio físico con una duración de 15 min a 90 min en niños y adolescentes con TDAH pueden ser beneficiosas en la calidad de vida(AU)

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects quality of life in children and adolescents, extending into adulthood. The literature indicates that the practice of physical activity and physical exercise establishes positive benefits for the human body at a physical, biological and psychological level. Objective: To examine the effects of physical activity or physical exercise interventions on quality of life in children and adolescents diagnosed with ADHD. Material and Methods: The search for research was carried out through Google Scholar, Scopus, Pubmed, Scielo, Web of Science, Dialnet and Redalyc, selecting only open access research in Spanish. The last 5 years were considered for the analysis of the research; they were searched using the words: Physical Activity and Quality of life in children and adolescents with attention deficit and hyperactivity disorder, Physical Exercise and Quality of life in children and adolescents with attention deficit disorder with hyperactivity, Physical Activity and Quality of life in children and adolescents with ADHD, Physical Exercise and Quality of life in children and adolescents with ADHD. Development: The 8 articles selected and extracted from the databases agree with the inclusion criteria related to the physical, psychological, biological and social benefits on quality of life. Conclusions: Physical activity and physical exercise interventions with a duration of 15-90 minutes in children and adolescents with ADHD can be beneficial on quality of life(AU)

A plasmid encoding the extracellular domain of CD40 ligand and Montanide™ GEL01 as adjuvants enhance the immunogenicity and the protection induced by a DNA vaccine against BoHV-1.

DNA vaccines are capable of inducing humoral and cellular immunity, and are important to control bovine herpesvirus 1 (BoHV-1), an agent of the bovine respiratory disease complex. In previous work, a DNA plasmid that encodes a secreted form of BoHV-1 glycoprotein D (pCIgD) together with commercial adjuvants provided partial protection against viral challenge of bovines. In this work, we evaluate new molecules that could potentiate the DNA vaccine. We show that a plasmid encoding a soluble CD40 ligand (CD40L) and the adjuvant Montanide™ GEL01 (GEL01) activate in vitro bovine afferent lymph dendritic cells (ALDCs). CD40L is a co-stimulating molecule, expressed transiently on activated CD4+ T cells and, to a lesser extent, on activated B cells and platelets. The interaction with its receptor, CD40, exerts effects on the presenting cells, triggering responses in the immune system. GEL01 was designed to improve transfection of DNA vaccines. We vaccinated cattle with: pCIgD; pCIgD-GEL01; pCIgD with GEL01 and CD40L plasmid (named pCIgD-CD40L-GEL01) or with pCIneo vaccines. The results show that CD40L plasmid with GEL01 improved the pCIgD DNA vaccine, increasing anti-BoHV-1 total IgGs, IgG1, IgG2 subclasses, and neutralizing antibodies in serum. After viral challenge, bovines vaccinated with pCIgD-GEL01-CD40L showed a significant decrease in viral excretion and clinical score. On the other hand, 80% of animals in group pCIgD-GEL01-CD40L presented specific anti-BoHV-1 IgG1 antibodies in nasal swabs. In addition, PBMCs from pCIgD-CD40L-GEL01 had the highest percentage of animals with a positive lymphoproliferative response against the virus and significant differences in the secretion of IFNγ and IL-4 by mononuclear cells, indicating the stimulation of the cellular immune response. Overall, the results demonstrate that a plasmid expressing CD40L associated with the adjuvant GEL01 improves the efficacy of a DNA vaccine against BoHV-1.

MANα1-2MAN decorated liposomes enhance the immunogenicity induced by a DNA vaccine against BoHV-1.

New technologies in the field of vaccinology arise as a necessity for the treatment and control of many diseases. Whole virus inactivated vaccines and modified live virus ones used against Bovine Herpesvirus-1 (BoHV-1) infection have several disadvantages. Previous works on DNA vaccines against BoHV-1 have demonstrated the capability to induce humoral and cellular immune responses. Nevertheless, 'naked' DNA induces low immunogenic response. Thus, loading of antigen encoding DNA sequences in liposomal formulations targeting dendritic cell receptors could be a promising strategy to better activate these antigen-presenting cells (APC). In this work, a DNA-based vaccine encoding the truncated version of BoHV-1 glycoprotein D (pCIgD) was evaluated alone and encapsulated in a liposomal formulation containing LPS and decorated with MANα1-2MAN-PEG-DOPE (pCIgD-Man-L). The vaccinations were performed in mice and bovines. The results showed that the use of pCIgD-Man-L enhanced the immune response in both animal models. For humoral immunity, significant differences were achieved when total antibody titres and isotypes were assayed in sera. Regarding cellular immunity, a significant increase in the proliferative response against BoHV-1 was detected in animals vaccinated with pCIgD-Man-L when compared to the response induced in animals vaccinated with pCIgD. In addition, upregulation of CD40 molecules on the surface of bovine dendritic cells (DCs) was observed when cells were stimulated and activated with the vaccine formulations. When viral challenge was performed, bovines vaccinated with MANα1-2MAN-PEG-DOPE elicited better protection which was evidenced by a lower viral excretion. These results demonstrate that the dendritic cell targeting using MANα1-2MAN decorated liposomes can boost the immunogenicity resulting in a long-lasting immunity. Liposomes decorated with MANα1-2MAN-PEG-DOPE were tested for the first time as a DNA vaccine nanovehicle in cattle as a preventive treatment against BoHV-1. These results open new perspectives for the design of vaccines for the control of bovine rhinotracheitis.

Improvement of Leptospira spp. diagnosis in aborted bovine fetuses by qPCR.

Leptospirosis is a disease with major economic impact on livestock industry. The objective of this work was to determine the presence of Leptospira spp. DNA by qPCR in bovine fetuses with presumptive diagnosis of leptospirosis as the cause of abortion. Leptospira spp. DNA was detected by qPCR in 11 out of 34 fetuses. These specimens (10/11) had histopathological findings in hepatic and/or renal tissues compatible with leptospirosis. qPCR detection rate (32.4 %) was higher compared with direct immuno-fluorescence antibody test (DFAT) (11.8 %). The concordance coefficient between both techniques was 0.44. qPCR is a rapid and sensitive technique for the diagnosis of leptospirosis and improved the detection rate in fetal tissues compared with DFAT. Implementation of molecular techniques may increase the accurate detection of leptospirosis as a cause of bovine abortion allowing the application of rapid therapeutic and prophylactics measures in order to reduce the impact of this zoonotic disease.

Identificación y sensibilidad antimicrobiana de bacterias potencialmente responsables de infecciones nosocomiales en medicina veterinaria / Antimicrobial Identification and Sensitiveness of Bacteria Potentially Responsible for Nosocomial Infections in Veterinary Medicine

Resumen Las infecciones nosocomiales (IN) son definidas como aquellas infecciones que se presentan 48 a 72 horas después del ingreso a un hospital en Chile, causadas por bacterias con altos niveles de resistencia antibiótica. En Chile existen muy pocos estudios en medicina veterinaria, y se utilizan muchas veces los parámetros humanos. Por esto, la investigación tuvo como objetivo identificar y evaluar la sensibilidad antibiótica de la microbiota bacteriana, potencialmente causal de IN. Se realizó un estudio de corte transversal a 20 objetos en una clínica veterinaria durante el mes de junio del año 2012. Se evidenció desarrollo bacteriano en el 85 % de los elementos muestreados. Se logró aislar cepas de Staphylococcus epidermidis (50 %), Acinetobacter spp. (15 %), Enterococcus faecalis (15 %), Escherichia coli (10 %), Proteus mirabilis (5 %) y Bacillus subtilis (5 %). Se logró identificar especies bacterianas, con potencial para generar infecciones nosocomiales, con un grado medio de resistencia antimicrobiana.

Abstract Nosocomial infections (NI) are defined as those occurring within 48-72 hours after being admitted in a hospital, and caused by bacteria with high antibiotic resistance levels. In Chile there are very few studies in veterinary medicine on this issue and most of the times human parameters are used instead. Therefore, this research aimed to identify and evaluate the antibiotic sensitiveness of the bacterial microbiota potentially causing NI. A cross-sectional study was conducted using 20 objects from a veterinary clinic during June 2012. Bacterial growth was observed in 85% of the sampled objects. The isolated strains include Staphylococcus epidermidis (50%), Acinetobacter spp. (15%), Enterococcus faecalis (15%), Escherichia coli (10%), Proteus mirabilis (5%), and Bacillus subtilis (5%). Bacteria species were identified with a potential to cause nosocomial infections of medium-grade antimicrobial resistance.

Detection of a novel severe mutation affecting the CYP21A2 gene in a Chilean male with salt wasting congenital adrenal hyperplasia.

PURPOSE: 21-hydroxylase deficiency (21-OHD) is a congenital adrenal disease with more than 200 mutations published to date. The aim of this report is to describe a severe novel mutation of the CYP21A2 gene. METHOD: We describe a case of a 39-year-old male diagnosed with a salt wasting congenital adrenal hyperplasia (SWCAH) due to 21-OHD. The genetic testing was done using a combination of three methods (PCR XL, SALSA-MLPA, and bidirectional sequencing) and finally an in silico analysis. RESULTS: The genetic testing demonstrated three severe mutations of the CYP21A2 gene (p.Gln318*; c.290-13C>G; and p.Trp86*), being the last one a novel mutation not previously reported. The in silico modeling of the p.Trp86* (c.258G>A) showed a truncated CYP21A2 protein that loses all the main structural features required for activity, such as the HEM binding domain and the hormone binding site. CONCLUSION: We present an adult man with an SWCAH due to 21-OHD who carried three severe mutations of the CYP21A2 gene, one of them, p.Trp86* (c.258G>A) has not been previously described.

[Prognostic value of granular pattern of growth hormone secreting tumors]. / Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico.

BACKGROUND: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. AIM: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. MATERIAL AND METHODS: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. RESULTS: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. CONCLUSIONS: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico / Prognostic value of granular pattern of growth hormone secreting tumors

Background: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. Aim: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. Material and Methods: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Results: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. Conclusions: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up.

PURPOSE:: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. METHODS:: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. RESULTS:: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. CONCLUSIONS:: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.

Zone I of Tear Microdesiccates Is a Lipid-Containing Structure.

PURPOSE: Morphological features of tear microdesiccates on glass surfaces have been associated with tear fluid status. Tear-film lipids play a critical role in the pathophysiology of some ocular surface disorders. Tear microdesiccates display 4 distinctive morphological domains (zones I, II, III, and transition band). In this study, we investigated the lipid location in tear microdesiccates. METHODS: Tear from individual healthy eyes (assessed by symptoms, signs, and slit-lamp examination) was collected using absorbing minisponges. One-µL aliquots were allowed to dry under ambient conditions on microscope slides. Tear microdesiccates were examined by various transmitted light microscopy methods. Tear lipids were located both by partition experiments using 2 lipophilic dyes (Oil red O and Nile blue A) mixed with tear fluid under conditions preserving morphological features of microdesiccates and by assessing the effect of 2 solvents markedly differing in polarity (water and ethanol) on the morphology of particular domains of preformed microdesiccates. RESULTS: During desiccation, both Nile blue A and Oil red O became preferentially located in the outermost domain of tear microdesiccates (zone I) without affecting the formation of major fern-like crystalloids (zones II and III). Low volumes of water drastically affected fern-like crystalloids, whereas the gross morphology of zone I was maintained. Contrarily, ethanol, a less polar solvent, was a fixative for fern-like crystalloids, although it markedly affected the bulk of zone I by extracting liquid droplets out of microdesiccates and visibilizing some filamentous subcomponents. CONCLUSIONS: Zone I is a hydrophobic domain, whereas zones II and III are highly hydrophilic domains of tear microdesiccates. Zone I represents a lipid-rich structure.

Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up / Algoritmo de abordagem para cirurgia de revisão nas complicações da bolha de início tardio após trabeculectomia: acompanhamento de longo prazo

ABSTRACT Purpose: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. Methods: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. Results: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. Conclusions: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.

RESUMO Objetivo: Descrever um algoritmo reprodutível para o tratamento cirúrgico das complicações da bolha de início tardio (>2 meses) após trabeculectomia com mitomicina-C. Métodos: Revisão retrospectiva de olhos que foram submetidos a um algoritmo reprodutível para o tratamento cirúrgico das complicações da bolha de início tardio por um único cirurgião, de julho de 2006 a abril de 2014. Os critérios de exclusão foram revisão de bolha com menos de 3 meses de seguimento ou revisão de bolha combinado com outro procedimento antiglaucomatoso no momento da cirurgia. O sucesso foi avaliado pelo método de sobrevida de Kaplan-Meier e definidos como ter atingido todos os seguintes critérios: indicação de cirurgia primária resolvido, nenhuma cirurgia adicional necessária para diminuir a pressão intraocular (IOP), IOP ≥6 mmHg e ≤18 mmHg. Resultados: Vinte e três olhos de 20 pacientes foram incluídos. Indicações para revisão bolha foram maculopatia hipotônica (47,8%), extravasamento da bolha (30,4%) e bolha elevada (21,7%). A taxa de sucesso do resultado primário global calculada pelo método de sobrevivência de Kaplan-Meier foi de 65,2% aos 48 meses. Quando a IOP foi diminuída para ≤15mmHg, a taxa de sobrevivência bolha foi de 47,8% em 48 meses. Na visita pós-operatória mais recente, 95,7% dos olhos apresentavam PIO ≤15mmHg e 56,5% estavam sob tratamento com uma média de um medicamento por olho. Um olho (4,3%) necessitou de uma segunda revisão da bolha para hipotonia persistente e dois olhos necessitaram cirurgia de antiglaucomatosa para reduzir a IOP durante o seguimento. Conclusões: Um algoritmo de abordagem para o tratamento cirúrgico das complicações tardias da bolha com uma taxa de sucesso semelhante aos relatados na literatura especializada é proposto. Ensaios clínicos randomizados são necessários para confirmar a melhor abordagem cirúrgica.

Progress in tear microdesiccate analysis by combining various transmitted-light microscope techniques.

BACKGROUND: Tear desiccation on a glass surface followed by transmitted-light microscopy has served as diagnostic test for dry eye. Four distinctive morphological domains (zones I, II, III and transition band) have been recently recognized in tear microdesiccates. Physicochemical dissimilarities among those domains hamper comprehensive microscopic examination of tear microdesiccates. Optimal observation conditions of entire tear microdesiccates are now investigated. One-µl aliquots of tear collected from individual healthy eyes were dried at ambient conditions on microscope slides. Tear microdesiccates were examined by combining low-magnification objective lenses with transmitted-light microscopy (brightfield, phase contrasts Ph1,2,3 and darkfield). RESULTS: Fern-like structures (zones II and III) were visible with all illumination methods excepting brightfield. Zone I was the microdesiccate domain displaying the most noticeable illumination-dependent variations, namely transparent band delimited by an outer rim (Ph1, Ph2), homogeneous compactly built structure (brightfield) or invisible domain (darkfield, Ph3). Intermediate positions of the condenser (BF/Ph1, Ph1/Ph2) showed a structured roughly cylindrical zone I. The transition band also varied from invisibility (brightfield) to a well-defined domain comprising interwoven filamentous elements (phase contrasts, darkfield). CONCLUSIONS: Imaging of entire tear microdesiccates by transmitted-light microscopy depends upon illumination. A more comprehensive description of tear microdesiccates can be achieved by combining illumination methods.

Efficient and automated large-scale detection of structural relationships in proteins with a flexible aligner.

BACKGROUND: The total number of known three-dimensional protein structures is rapidly increasing. Consequently, the need for fast structural search against complete databases without a significant loss of accuracy is increasingly demanding. Recently, TopSearch, an ultra-fast method for finding rigid structural relationships between a query structure and the complete Protein Data Bank (PDB), at the multi-chain level, has been released. However, comparable accurate flexible structural aligners to perform efficient whole database searches of multi-domain proteins are not yet available. The availability of such a tool is critical for a sustainable boosting of biological discovery. RESULTS: Here we report on the development of a new method for the fast and flexible comparison of protein structure chains. The method relies on the calculation of 2D matrices containing a description of the three-dimensional arrangement of secondary structure elements (angles and distances). The comparison involves the matching of an ensemble of substructures through a nested-two-steps dynamic programming algorithm. The unique features of this new approach are the integration and trade-off balancing of the following: 1) speed, 2) accuracy and 3) global and semiglobal flexible structure alignment by integration of local substructure matching. The comparison, and matching with competitive accuracy, of one medium sized (250-aa) query structure against the complete PDB database (216,322 protein chains) takes about 8 min using an average desktop computer. The method is at least 2-3 orders of magnitude faster than other tested tools with similar accuracy. We validate the performance of the method for fold and superfamily assignment in a large benchmark set of protein structures. We finally provide a series of examples to illustrate the usefulness of this method and its application in biological discovery. CONCLUSIONS: The method is able to detect partial structure matching, rigid body shifts, conformational changes and tolerates substantial structural variation arising from insertions, deletions and sequence divergence, as well as structural convergence of unrelated proteins.

Progress in tear microdesiccate analysis by combining various transmitted-light microscope techniques

BACKGROUND: Tear desiccation on a glass surface followed by transmitted-light microscopy has served as diagnostic test for dry eye. Four distinctive morphological domains (zones I, II, III and transition band) have been recently recognized in tear microdesiccates. Physicochemical dissimilarities among those domains hamper comprehensive microscopic examination of tear microdesiccates. Optimal observation conditions of entire tear microdesiccates are now investigated. One-µl aliquots of tear collected from individual healthy eyes were dried at ambient conditions on microscope slides. Tear microdesiccates were examined by combining low-magnification objective lenses with transmitted-light microscopy (brightfield, phase contrasts Ph1,2,3 and darkfield. RESULTS: Fern-like structures (zones II and III) were visible with all illumination methods excepting brightfield. Zone I was the microdesiccate domain displaying the most noticeable illumination-dependent variations, namely transparent band delimited by an outer rim (Ph1, Ph2), homogeneous compactly built structure (brightfield) or invisible domain (darkfield, Ph3). Intermediate positions of the condenser (BF/Ph1, Ph1/Ph2) showed a structured roughly cylindrical zone I. The transition band also varied from invisibility (brightfield) to a well-defined domain comprising interwoven filamentous elements (phase contrasts, darkfield. CONCLUSIONS: Imaging of entire tear microdesiccates by transmitted-light microscopy depends upon illumination. A more comprehensive description of tear microdesiccates can be achieved by combining illumination methods.

Stratification of Tear Components During Tear Microdesiccation on Vertical Glass Surfaces: A Novel Approach in Tear Fluid Assessment.

PURPOSE: Tear desiccation on a horizontal glass surface followed by low-resolution light microscopy has been used as an expeditious diagnostic aid to evaluate patients suspected of dry eye. The presence of fern-like crystalloids in the dry specimen is the only feature taken into consideration. We demonstrate that different morphological domains of tear microdesiccates can be separated based on distinctive physicochemical properties. METHODS: Healthy subjects (Ocular Surface Disease Index questionnaire, laboratory tests, and slit-lamp examination) and 74 young adults from a random student population were recruited as volunteer tear donors. Single tear samples were taken from individual eyes (n = 154) using absorbing polyurethane minisponges. From each sample, aliquots were allowed to desiccate simultaneously on microscope slides positioned either horizontally or vertically followed by comparative dark-field microscopy. RESULTS: Vertical desiccation of each tear sample resulted in highly reproducible top-to-bottom stratification. Particular layers in any vertical microdesiccate represented morphological domains of the corresponding horizontal microdesiccate. Major fern-like crystalloids located at the center of Rolando type I horizontal microdesiccates became concentrated in a prominent layer at the bottom of vertical microdesiccates. Often, these fern-like crystalloids were more vigorous than those of the horizontal counterpart. A number of tear samples from the random population showed no ability to form fern-like crystalloids either by vertical or horizontal microdesiccation. Other prominent layers in vertical microdesiccates represented less noticeable circularly distributed morphological domains of the corresponding horizontal specimens. CONCLUSIONS: Microdesiccation of tear fluid on a vertical glass surface causes top-to-bottom stratification of diverse tear components. A more comprehensive expeditious tear assessment is feasible.

Delayed-onset postoperative endophthalmitis secondary to Exophiala.

Exophiala is a genus of slow-growing, melanin-producing, saprophytic fungi most commonly found in soil, faeces and decaying plant matter. It is an unusual fungal pathogen capable of causing a variety of ophthalmic manifestations, including keratitis, scleritis and endophthalmitis. In this report, we present a rare case of delayed-onset postoperative endophthalmitis confined to the anterior segment, secondary to Exophiala species. Previous reported cases of delayed-onset postoperative endophthalmitis have been treated medically, with suboptimal outcomes. Our experience supports the use of anterior segment surgery to clear the nidus of disease combined with intravitreal voriconazole to prevent recurrence of the infection.