Deciphering the Role of Microbial Extracellular and Intracellular Organic Matter in Antibiotic Photodissipation: Molecular and Fluorescent Profiling under Natural Radiation.

This study addresses existing gaps in understanding the specific involvement of dissolved organic matter (DOM) fractions in antibiotic photolysis, particularly under natural conditions and during DOM photobleaching. Employing fluorescent, chemical, and molecular analysis techniques, it explores the impact of extracellular and intracellular organic matter (EOM and IOM) on the photodissipation of multiclass antibiotics, coupled with DOM photobleaching under natural solar radiation. Key findings underscore the selective photobleaching of DOM fractions, propelled by distinct chemical profiles, influencing DOM-mediated antibiotic photolysis. Notably, lipid-like substances dominate in the IOM, while lignin-like substances prevail in the EOM, each uniquely responding to sunlight and exhibiting selective photobleaching. Sunlight primarily targets fulvic acid-like lignin components in EOM, contrasting the initial changes observed in tryptophan-like lipid substances in IOM. The lower photolability of EOM, attributed to its rich unsaturated compounds, contributes to an enhanced rate of indirect antibiotic photolysis (0.339-1.402 h-1) through reactive intermediates. Conversely, the abundance of aliphatic compounds in IOM, despite it being highly photolabile, exhibits a lower mediation of antibiotic photolysis (0.067-1.111 h-1). The triplet state excited 3DOM* plays a pivotal role in the phototransformation and toxicity decrease of antibiotics, highlighting microbial EOM's essential role as a natural aquatic photosensitizer for water self-purification. These findings enhance our understanding of DOM dynamics in aquatic systems, particularly in mitigating antibiotic risks, and introduce innovative strategies in environmental management and water treatment technologies.

Algal Extracellular Organic Matter Induced Photochemical Oxidation of Mn(II) to Solid Mn Oxide: Role of Mn(III)-EOM Complex and Its Ability to Remove 17α-Ethinylestradiol.

Photosensitizer-mediated abiotic oxidation of Mn(II) can yield soluble reactive Mn(III) and solid Mn oxides. In eutrophic water systems, the ubiquitous algal extracellular organic matter (EOM) is a potential photosensitizer and may have a substantial impact on the oxidation of Mn(II). Herein, we focused on investigating the photochemical oxidation process from Mn(II) to solid Mn oxide driven by EOM. The results of irradiation experiments demonstrated that the generation of Mn(III) intermediate was crucial for the successful photo oxidization of Mn(II) to solid Mn oxide mediated by EOM. EOM can serve as both a photosensitizer and a ligand, facilitating the formation of the Mn(III)-EOM complex. The complex exhibited excellent efficiency in removing 17α-ethinylestradiol. Furthermore, the complex underwent decomposition as a result of reactions with reactive intermediates, forming a solid Mn oxide. The presence of nitrate can enhance the photochemical oxidation process, facilitating the conversion of Mn(II) to Mn(III) and then to solid Mn oxide. This study deepens our grasp of Mn(II) geochemical processes in eutrophic water and its impact on organic micropollutant fate.

Compensatory growth of Microcystis aeruginosa after copper stress and the characteristics of algal extracellular organic matter (EOM).

Cyanobacterial blooms can impair drinking water quality due to the concomitant extracellular organic matter (EOM). As copper is often applied as an algicide, cyanobacteria may experience copper stress. However, it remains uncertain whether algal growth compensation occurs and how EOM characteristics change in response to copper stress. This study investigated the changes in growth conditions, photosynthetic capacity, and EOM characteristics of M. aeruginosa under copper stress. In all copper treatments, M. aeruginosa experienced a growth inhibition stage followed by a growth compensation stage. Notably, although chlorophyll-a fluorescence parameters dropped to zero immediately following high-intensity copper stress (0.2 and 0.5 mg/L), they later recovered to levels exceeding those of the control, indicating that photosystem II was not destroyed by copper stress. Copper stress influenced the dissolved organic carbon (DOC) content, polysaccharides, proteins, excitation-emission matrix spectra, hydrophobicity, and molecular weight (MW) distribution of EOM, with the effects varying based on stress intensity and growth stage. Principal component analysis revealed a correlation between the chlorophyll-a fluorescence parameters and EOM characteristics. These results imply that copper may not be an ideal algicide. Further research is needed to explore the dynamic response of EOM characteristics to environmental stress.

An Unusual Case of Eosinophilic Chronic Rhinosinusitis With Concurrent Eosinophilic Otitis Media: Limited Responsiveness to Multiple Antibody Therapies and Subsequent Cochlear Implantation.

Eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM) are debilitating inflammatory conditions that affect the paranasal sinuses and middle ear, respectively, and are characterized by eosinophilic infiltration. This study describes a rare and intricate case of a 65-year-old male patient concurrently afflicted with ECRS, EOM, and bronchial asthma. Despite the systematic administration of corticosteroids and various antibody drugs, the patient's condition remained unimproved, necessitating a cochlear implant for EOM, which is seldom an aggressive intervention. The patient had a history of symptoms dating back to 2005, with notable exacerbations and treatment resistance over the years. Multiple antibody drugs, including anti-IgE, anti-IL-5, and anti-IL-4α antibodies, failed to ameliorate the patient's condition, presenting a significant clinical challenge. Pathological examination revealed marked eosinophilic infiltration and severe fibrosis, suggesting a possible mechanism underlying the poor response to antibody therapy. Cochlear implantation significantly enhanced the patient's communicative abilities. This case highlights the limitations of the current antibody drugs in managing severely intertwined cases of ECRS, EOM, and bronchial asthma, highlighting the need for novel therapeutic strategies. This case also propounds cochlear implantation as an efficacious intervention for refractory EOM with severe sensorineural hearing impairment, extending the spectrum of treatment modalities for such challenging scenarios. This singular case contributes to the growing body of evidence regarding the management of ECRS and EOM, especially against the backdrop of treatment resistance, and can aid clinicians in identifying and navigating similar complex cases in clinical practice.

Prognostic value of extraocular muscles for intraocular pressure in thyroid-associated ophthalmopathy patients.

Background: Persistent increase in intraocular pressure (IOP) is often observed in eyes with thyroid-associated ophthalmopathy (TAO), which has irreversible effects on the visual function of patients. This retrospective cross-sectional study evaluated the value of magnetic resonance imaging (MRI) measurements of extraocular muscle (EOM) volume in prognosing IOP in patients with TAO. Methods: This single-center study was conducted in Beijing Friendship Hospital (Beijing, China), a tertiary hospital. From 35 participants, 70 eyes (normal IOP group: 50 eyes; high IOP group: 20 eyes; random samples) were enrolled in this study. Basic data from patients were collected and compared using 2-sample t-tests and chi-squared tests. The volume of the EOM, orbit fat, and whole orbit were measured by orbital MRI. Moreover, proptosis, optic nerve (ON) sheath diameter, optic nerve angle (ONA), and gaze angle were additionally measured with MRI. These parameters were compared between the two groups using 2-sample t-tests and chi-squared tests. Before and after post-methylprednisolone therapy, the MRI data of 20 eyes were obtained and compared with a paired t-test. Peripapillary retinal nerve fiber layer (RNFL) thickness was obtained using an optical coherence tomography (OCT) scan. Spearman rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves were performed to evaluate the role of these factors in IOP changes. Results: The EOM volume and axial and sagittal ONAs in the high-IOP group were significantly increased compared to the normal-IOP group (P<0.001, P=0.001, P=0.02, respectively). Logistic regression analysis indicate that the cutoff value for EOM volume for the diagnosis of high IOP was significantly larger than that of the other parameters except orbit volume (P=0.03, P=0.004, P=0.08, respectively). Spearman correlation analysis revealed a significant correlation between EOM volume and ON sheath diameter and average RNFL thickness (P=0.01, P=0.02, respectively). A paired t-test indicated a significant decrease of EOM volume and ON sheath diameter as well as a significant enlargement of the axial ONAs after methylprednisolone therapy (P=0.002, P=0.02, P=0.05, respectively). Conclusions: EOM volume was an effective diagnostic factor for tracking IOP changes and ON patterns in patients with TAO. Methylprednisolone therapy is recommended for patients with TAO with secondary glaucoma to quickly reduce the EOM volume.

Do Storage Conditions Affect Collected Cookstove Emission Samples? Implications for Field Studies.

Cookstove emissions are a significant source of indoor air pollution in developing countries and rural communities world-wide. Considering that many research sites for evaluating cookstove emissions and interventions are remote and require potentially lengthy periods of particulate matter (PM) filter sample storage in sub-optimal conditions (e.g., lack of cold storage), an important question is whether samples collected in the field are stable over time. To investigate this, red oak was burned in a natural-draft stove, and fine PM (PM2.5) was collected on polytetrafluoroethylene filters. Filters were stored at either ambient temperature or more optimal conditions (-20°C or -80°C) for up to 3 months and extracted. The effects of storage temperature and length on stability were evaluated for measurements of extractable organic matter (EOM), PM2.5, and polycyclic aromatic compound (PAC) levels in the filter extracts. A parallel, controlled laboratory condition was also evaluated to further explore sources of variability. In general, PM2.5 and EOM in both simulated field and laboratory samples were similar regardless of the storage condition or duration. The extracts were also analyzed by gas chromatography to quantify 22 PACs and determine similarities and/or differences between the conditions. PAC levels were a more sensitive stability measure in differentiating between storage conditions. The findings suggest that measurements are relatively consistent across storage duration/temperatures for filter samples with relatively low EOM levels. This study aims to inform protocols and filter storage procedures for exposure and intervention research conducted in low- and middle-income countries where studies may be budget- and infrastructure-limited.

Ab initio study on the singlet states of Zn-RG (RG = He, Ne, Ar, Kr, Xe, Rn) molecules.

The computations on the potential energy curves (PECs) oftheground state and low-lying singlet excited states for Zn-RG (RG = He, Ne, Ar, Kr, Xe, Rn) molecule have been carried out using coupled-cluster with single and double excitations (CCSD), coupled-cluster with single and double excitations and perturbative contribution of connected triple excitations (CCSD(T)) methods and the equation-of-motion coupled cluster method restricted to single and double excitations (EOM-CCSD). The spectroscopic constants of all the bound states of Zn-RG have been calculated, and comparisons with the available experimental and theoretical works have been made for the ground state and C1Π state of the Zn-RG complexes, reasonable agreement is found. The transition dipole moments (TDMs) functions of C1Π-X1Σ+ and D1Σ+-X1Σ+ transitions, the vibrational band origins, rotational constants and Franck-Condon factors of C1Π-X1Σ+ transition have also been reported, which would be of value to understand the transition properties of Zn-RG. Our study is expected to be helpful for deep understanding on the electronic structure and spectroscopy of Zn-RG van der Waals molecules.

A novel gravity sedimentation - Forward osmosis hybrid technology for microalgal dewatering.

A novel gravity sedimentation - forward osmosis (G-FO) hybrid reactor was built up for separating and concentrating the biomass from the algal-rich water (microalgal dewatering). The extracellular organic matter (EOM) from Chlorella vulgaris (C. vulgaris) was divided into dissolved EOM (dEOM) and bound EOM (bEOM). Water flux, flux recovery rate and moisture content (MC) were investigated. Through sedimentation rate, zeta potential and hydrophilicity/hydrophobicity to analyze the experimental results. Scanning electronic microscopy (SEM) was used to observe the different morphologies of accumulated algae cells and EOM on the surface of the membrane. The results showed that cell + bEOM solution had the fastest sedimentation rate and fewest negative charge, so the pollutants accumulated more easily on the membrane surface, resulting in the highest flux decline. Its algal cake layer was the densest from the view of SEM. Cell + bEOM + dEOM solution had the lowest flux decline and the cake layer was the loosest. Cell + bEOM solution had the most severe irreversible fouling and the lowest flux recovery rate (FRR). The membrane fouling of cell solution was lower than that of cell + bEOM + dEOM solution, and the FRR of cell solution was almost 100%. According to the nonionic macro-porous resin fraction results of EOM, cell + bEOM + dEOM solution contained more hydrophilic components, resulting in the lowest MC. On the contrary, cell + bEOM solution showed the highest MC, which contained more hydrophobic components. Effects of bEOM and dEOM on microalgae dewatering performance of a novel gravity sedimentation - forward osmosis (G-FO) hybrid system were investigated, which provided a theoretical basis for large-scale application of FO technology for microalgae dewatering.

Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case-control study.

BACKGROUND: Ear, nose, and throat involvement are common in eosinophilic granulomatosis with polyangiitis (EGPA). Among otologic manifestation, middle ear effusion (MEE) is less recognized but a problematic condition as it may progress to hearing impairment when left untreated. This study aimed to evaluate the characteristics, risk factors and clinical outcomes of MEE in EGPA patients. METHODS: This is a case-control study of patients who were diagnosed and treated for EGPA from January 1995 to November 2018. Patients with ear symptoms (ear fullness, ear discharge, tinnitus or hearing loss) were assessed by otologists and were included in the case group (n = 23) if clinically relevant. The other patients without MEE were included in the control group (n = 52). Risk of MEE was calculated using the Cox proportional-hazard model. RESULTS: During median follow-up of 9.9 years, 23 (30.7%) out of 75 patients had MEE. In MEE group, 12 (52.2%) patients had hearing loss; conductive type in 10 (10/12, 83.3%) and mixed type in two (2/12, 16.7%). In multivariable regression analysis, major organ involvement at diagnosis (adjusted hazard ratio [aHR] 65.4; 95% confidence interval [CI], 1.50-2838.39; P = 0.030] , early onset of ear symptom after systemic therapy (< 6 months) (aHR 40.0; 95% CI, 1.35-1183.43; P = 0.033) and continuing the maintenance steroid without cessation (aHR 8.59; 95% CI, 1.13-65.42; P = 0.038) were independently associated with a risk of MEE. To control MEE, 16 (69.6%) patients had to increase maintenance steroid dose and 9 (39.1%) patients experienced recurrent MEE whenever maintenance dose was tapered. CONCLUSIONS: MEE is a common but frequently neglected condition in EGPA which is often intractable. The maintenance steroid dose should be adequately adjusted to control MEE and to prevent from progressive hearing loss. Novel biologic agents possibly have a role in controlling MEE in EGPA.

Mitochondrial bioenergetics in ocular fibroblasts of two myasthenia gravis cases.

Myasthenia gravis (MG) is a rare, treatable, antibody-mediated disease characterized by fatigable muscle weakness of extraocular muscles (EOMs) and non-ocular skeletal muscles. The antibodies are directed against muscle-endplate proteins, most frequently the acetylcholine receptor (AChR) alpha-subunit. Although most MG patients respond to immunosuppressive treatment, some individuals, frequently with African-genetic ancestry, develop treatment-resistant ophthalmoplegia (OP-MG). Although the underlying pathogenetic mechanisms of OP-MG remain unknown, experimental rodent models of MG showed upregulation of genes involved in oxidative metabolism in muscles. EOMs are highly dependent on oxidative metabolism. We opportunistically sampled EOM-tendons of two rare OP-MG patients (and non-MG controls) undergoing re-alignment surgery, and established ocular fibroblast cultures. Metabolic assays were performed on these live cells to assess real-time differences in energy metabolism. To study the cellular bioenergetic profiles in the context of MG, we exposed the cultures to homologous 5% MG sera for 24 h, vs. growth media, from two independent MG patients (with circulating AChR-antibodies) and five controls without MG, and estimated the fold change in oxygen consumption rates in response to three compounds which inhibit different mitochondrial chain complexes. Quantitative PCR (qPCR) was performed in cells before and after MG sera exposure, to assess transcript levels of mitochondrial genes, PDK4, ANGPTL4 and UCP3, which were altered in experimental MG. In response to the mitochondrial stressors, basal oxidative metabolism parameters were similar between OP-MG and control fibroblasts (p = 0.81). However, after exposure to MG sera, bioenergetic parameters (oxygen consumption rate as an indicator of oxidative phosphorylation; extracellular acidification rate as an indicator of glycolysis), were induced to higher levels in OP-MG fibroblasts compared to controls (2.6-fold vs 1.5-fold; p = 0.031) without evidence of mitochondrial insufficiency in the OP-MG ocular fibroblasts. In support of the bioenergetic responses to the same MG sera, gene transcripts of PDK4 and ANGPLT4 in ocular fibroblasts also showed significant upregulation (p ≤ 0.041), but similarly in OP-MG and control cases. Taken together we showed similar basal and metabolic adaptive responses after exposure to mitochondrial inhibitors in ocular fibroblasts derived from OP-MG cases and controls, although the OP-MG cells showed greater activation in response to MG conditions. These pilot results in orbital-derived tissues provide support for myasthenic-induced changes in cellular metabolism and evidence that orbital fibroblasts may be useful for dynamic bioenergetic assessments.

TrkB signaling is correlated with muscular fatigue resistance and less vulnerability to neurodegeneration.

At the neuromuscular junction (NMJ), motor neurons and myocytes maintain a bidirectional communication that guarantees adequate functionality. Thus, motor neurons' firing pattern, which is influenced by retrograde muscle-derived neurotrophic factors, modulates myocyte contractibility. Myocytes can be fast-twitch fibers and become easily fatigued or slow-twitch fibers and resistant to fatigue. Extraocular muscles (EOM) show mixed properties that guarantee fast contraction speed and resistance to fatigue and the degeneration caused by Amyotrophic lateral sclerosis (ALS) disease. The TrkB signaling is an activity-dependent pathway implicated in the NMJ well-functioning. Therefore, it could mediate the differences between fast and slow myocytes' resistance to fatigue. The present study elucidates a specific protein expression profile concerning the TrkB signaling that correlates with higher resistance to fatigue and better neuroprotective capacity through time. The results unveil that Extra-ocular muscles (EOM) express lower levels of NT-4 that extend TrkB signaling, differential PKC expression, and a higher abundance of phosphorylated synaptic proteins that correlate with continuous neurotransmission requirements. Furthermore, common molecular features between EOM and slow soleus muscles including higher neurotrophic consumption and classic and novel PKC isoforms balance correlate with better preservation of these two muscles in ALS. Altogether, higher resistance of Soleus and EOM to fatigue and ALS seems to be associated with specific protein levels concerning the TrkB neurotrophic signaling.

Diatomite Dynamic Membrane Fouling Behaviour during Dewatering of Chlorella pyrenoidosa in Aquaculture Wastewater.

Combined microalgal and membrane filtration could effectively treat aquaculture wastewater; however, the membrane fouling induced by extracellular organic matter (EOM) during the dewatering process is an issue. This study investigated diatomite dynamic membrane (DDM) fouling behaviour during the dewatering of Chlorella pyrenoidosa under the influence of copper ions. The results indicate that copper ion heavy metals in aquaculture wastewater significantly affected purification and algae dewatering by DDM. Aquaculture wastewater with a high copper concentration (1 and 0.5 mg/L) could induce serious DDM fluxes and cake layer filtration resistance (Rc), whereas fewer filtration fluxes were induced when aquaculture wastewater had a low copper concentration, particularly that of 0.1 mg/L, at which the Rc was lowest and the concentration effect was highest. Macromolecular organics of EOM, such as biopolymers, polysaccharides, and proteins, were responsible for DDM fouling and accumulated mostly in the slime layer, whereas only a small amount of them accumulated in the diatomite layer. The DDM rejected more protein-like organics of EOM in the slime layer when dewatering algae at low copper concentrations (<0.1 mg/L); however, when using the DDM to dewater algae at high copper concentrations, more polysaccharides of EOM were rejected (0.5 < Cu2+ < 5 mg/L). This result has significant ramifications for aquaculture wastewater treatment as well as algae separation and concentration by the DDM.

Exploitation of extracellular organic matter from Micrococcus luteus to enhance ex situ bioremediation of soils polluted with used lubricants.

Chronic pollution by used lubricant oils (ULOs) poses a serious challenge to the environment. Under stress conditions, microorganisms, including potential degraders, can enter a viable but non-culturable (VBNC) state, complicating the bioremediation of ULO-polluted areas. Resuscitation-promoting factors (Rpfs) can reverse this transition and/or enhance the biodegradation performance of both native and augmented strains. Here, Rpf-containing extracellular organic matter (EOM) from Micrococcus luteus was used to enhance the ex situ ULO removal in biostimulated and bioaugmented (with Rhodococcus qingshengii KAG C, R. erythropolis PR4) soils. ULO bioconversion, microbial activity, and CFUs were significantly higher in EOM-treated soils compared to corresponding control soils. After 60 days, the initial ULO concentration (52,500 mg kg-1) was reduced by 37% and 45% with EOM-supplemented biostimulation and bioaugmentation, respectively. Based on high-throughput 16S rRNA analysis, the enhancement was attributable both to the reactivation of EOM-responsive hydrocarbonoclastic bacterial genera (e.g., Pseudomonas, Comamonas, Stenotrophomonas, Gordonia) and to the long-term positive effect of EOM on the degradative efficacy of the introduced rhodococci. Ecotoxicological responses revealed that reduced ULO concentration did not correlate with decreased soil toxicity. Our findings provide an insight into the applicability of EOM in bioremediation and its effects on the soil microbial activity and community composition.

A Proposed Sentiment Analysis Deep Learning Algorithm for Analyzing COVID-19 Tweets.

With the rise in cases of COVID-19, a bizarre situation of pressure was mounted on each country to make arrangements to control the population and utilize the available resources appropriately. The swiftly rising of positive cases globally created panic, anxiety and depression among people. The effect of this deadly disease was found to be directly proportional to the physical and mental health of the population. As of 28 October 2020, more than 40 million people are tested positive and more than 1 million deaths have been recorded. The most dominant tool that disturbed human life during this time is social media. The tweets regarding COVID-19, whether it was a number of positive cases or deaths, induced a wave of fear and anxiety among people living in different parts of the world. Nobody can deny the truth that social media is everywhere and everybody is connected with it directly or indirectly. This offers an opportunity for researchers and data scientists to access the data for academic and research use. The social media data contains many data that relate to real-life events like COVID-19. In this paper, an analysis of Twitter data has been done through the R programming language. We have collected the Twitter data based on hashtag keywords, including COVID-19, coronavirus, deaths, new case, recovered. In this study, we have designed an algorithm called Hybrid Heterogeneous Support Vector Machine (H-SVM) and performed the sentiment classification and classified them positive, negative and neutral sentiment scores. We have also compared the performance of the proposed algorithm on certain parameters like precision, recall, F1 score and accuracy with Recurrent Neural Network (RNN) and Support Vector Machine (SVM).

Intracellular organic matter from Chlorella vulgaris enhances the photodegradation of acetaminophen.

Algae is able to accelerate the photodegradation rate of contaminants under sunlight irradiation, and this process can be attributed to algal substances, namely, intracellular organic matter (IOM) and extracellular organic matter (EOM). This study aimed to investigate the efficiencies and mechanisms of the photodegradation of three pharmaceuticals - acetaminophen (ACE), codeine (COD) and cephradine (CFD) - in the presence of Chlorella vulgaris and its algal substances. The result shows that a much higher photodegradation rate of acetaminophen was obtained in the presence of IOM (kobs = 0.250 hr-1) than in the presence of EOM (kobs = 0.060 hr-1). The photodegradation mechanisms of acetaminophen were demonstrated and verified by scavenger experiments and probe tests. The major reactive species for acetaminophen photodegradation was triplet-state IOM (3IOM∗), which contributed 93.52% of the photodegradation, while ⋅OH was the secondary contributor (5.60%), with 1O2 contributing the least (0.88%). Chlorella vulgaris also effectively enhanced the photodegradation of codeine and cephradine. However, the photodegradation behaviors of codeine and cephradine in the presence of algal substances were different from those of acetaminophen, indicating that the photodegradation mechanisms might depend on the type of compound. This study not only demonstrates the effectiveness of algal substances in the photodegradation of acetaminophen, codeine and cephradine under sunlight irradiation but also provides a comprehensive study on the photodegradation mechanisms of acetaminophen in the presence of algal substances.

Rapid and remarkable effectiveness of benralizumab for treating severe bronchial asthma with intractable eosinophilic rhinosinusitis and eosinophilic otitis media: A case report.

Severe bronchial asthma is a challenging disorder to treat and can impair quality of life (QOL) under conventional therapeutic modalities. We report the case of a 52-year-old woman with severe asthma associated with eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM). Although the patient was treated with a full dose of inhaled corticosteroid, leukotriene receptor antagonist (LTRA), theophylline, burst use of oral corticosteroids (OCS), her asthmatic condition aggravated, disrupting her daily life. ECRS and EOM symptoms were also getting worse despite treatment with topical application of corticosteroids to the nose and ears, LTRA, and occasional use of OCS. In addition to asthmatic symptom, the patient always suffered from intractable nasal obstruction and hearing disturbance, which contributed to the heavily impaired QOL. However, the administration of benralizumab showed rapid and remarkable improvement not only in her asthmatic conditions but also in the symptoms of ECRS and EOM within a month. These results suggest that the use of benralizumab for the treatment of severe asthma with intractable ECRS and EOM should be considered when the patient's QOL is severely deteriorated.

Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic.

OBJECTIVE: To describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients. DESIGN: Retrospective. SETTING: Two acute care inpatient rehabilitation hospitals and 1 long-term acute care (LTAC) hospital. PARTICIPANTS: Records of inpatients seen by the vision service. INTERVENTIONS: Records from a 1-year telemedicine pilot performed at acute rehabilitation (AR) hospital 1 and then expanded to AR hospital 2 and LTAC hospital during coronavirus disease 2019 (COVID-19) were reviewed. In the virtual visits, an occupational therapist measured the patients' vision with the iPad applications and forwarded results to the off-site Doctor of Optometry (OD) for review prior to a video visit. The OD provided diagnosis and education, press-on prism application supervision, strategies and modifications, and follow-up recommendations. Providers completed the telehealth usability questionnaire (10-point scale). MAIN OUTCOME MEASURES: Vision examinations per month at AR hospital 1 before and with telemedicine. RESULTS: With telemedicine at AR hospital 1, mean visits per month significantly increased from 10.7±5 to 14.9±5 (P=.002). Prism was trialed in 40% of cases of which 83% were successful, similar to previously reported in-person success rates. COVID-19 caused only a marginal decrease in visits per month (P=.08) at AR1, whereas the site without an established program (AR hospital 2) had a 3-4 week gap in care while the program was initiated. Cases at the LTAC hospital tended to be more complex and difficult to manage virtually. The telehealth usability questionnaire median category scores were 7 for Ease of Use, 8 for Interface Quality, 6 for Reliability, and 9 for Satisfaction and Future Use. CONCLUSIONS: The virtual vision clinic process improved inpatient access to eye and visual neurorehabilitation assessment before and during the COVID-19 quarantine and was well accepted by providers and patients.

Double-bellied medial rectus muscle in a patient with Down syndrome and congenital esotropia.

A 13-year-old male with Down syndrome, pseudophakic secondary to congenital cataract presented with esotropia. During bilateral medial rectus recession, a unilateral two-bellied right medial rectus was identified and recessed successfully with complete resolution of the deviation. Clinicians facing a two-bellied medial rectus can consider continuing with their surgical plan.