LASER PROPHYLAXIS IN STICKLER SYNDROME: The Manchester Protocol.

PURPOSE: Patients with Stickler syndrome are at high risk of giant retinal tears (GRTs) and detachments. Vitreoretinal interventions can reduce this risk, but there is presently no consensus about the optimal prophylactic approach. The aim of our study was to determine whether 360° laser prophylaxis is a safe and effective procedure to prevent GRT detachments in patients with Stickler syndrome. METHODS: Study subjects were recruited retrospectively through the databases of the vitreoretinal and ophthalmic genetic tertiary services in Manchester, United Kingdom. Clinical data were collected including on prophylactic intervention, the occurrence of retinal detachment, and the presence/type of retinal breaks. RESULTS: One hundred thirteen eyes from 63 patients with Stickler syndrome were studied; 72.6% (82/113) of these eyes received 360° laser prophylaxis. Of these, 9% had a retinal detachment, but no GRTs occurred. Among the 27.4% (31/113) of eyes that had no prophylactic treatment, 23% suffered a retinal detachment and 42.9% of these were associated with a GRT. CONCLUSION: Patients who underwent laser prophylaxis had fewer retinal detachments and no GRTs during an average of 6.1 years of follow-up (median 5 years), suggesting that this is a safe and effective approach for individuals with Stickler syndrome.

Complexation of starch and phenolic compounds during food processing and impacts on the release of phenolic compounds.

Phenolic compounds can form complexes with starch during food processing, which can modulate the release of phenolic compounds in the gastrointestinal tract and regulate the bioaccessibility of phenolic compounds. The starch-phenolic complexation is determined by the structure of starch, phenolic compounds, and the food processing conditions. In this review, the complexation between starch and phenolic compounds during (hydro)thermal and nonthermal processing is reviewed. A hypothesis on the complexation kinetics is developed to elucidate the mechanism of complexation between starch and phenolic compounds considering the reaction time and the processing conditions. The subsequent effects of complexation on the physicochemical properties of starch, including gelatinization, retrogradation, and digestion, are critically articulated. Further, the release of phenolic substances and the bioaccessibility of different types of starch-phenolics complexes are discussed. The review emphasizes that the processing-induced structural changes of starch are the major determinant modulating the extent and manner of complexation with phenolic compounds. The controlled release of complexes formed between phenolic compounds and starch in the digestive tracts can modify the functionality of starch-based foods and, thus, can be used for both the modulation of glycemic response and the targeted delivery of phenolic compounds.

Impact of functional vegetable ingredients on the technical and nutritional quality of pasta.

Pasta is a popular staple food around world. This makes pasta a great vehicle for delivering functional ingredients. This article reviews the popular functional ingredients - cereals, pseudocereal, legumes and vegetables, that are used to enrich pasta. The influence of these functional ingredients, additives and cooking process on pasta's nutritional, technical and sensory properties is summarized. This article focusses on the effects of different forms of these ingredients on the quality of cereal foods. Such as carrot juice pasta has a superior technical quality than carrot flour pasta. As far as can be established there are very few articles examining the effects of different forms of ingredients on pasta. Puree or liquid form raw vegetable materials offfers a better option than conventional powder form to add to semolina to produce functional pasta with superior technical quality and improved nutritional value.

Factors influencing consistent use of bed nets for the control of malaria among children under 5 years in Soroti District, North Eastern Uganda.

BACKGROUND: The use of insecticide-treated bed nets has been proven to be effective in reducing malaria transmission in highly endemic areas. Use of long-lasting insecticidal nets (LLINs) has been embraced by many malaria endemic countries. LLINs are up to 95% effective in inhibiting blood feeding, when used consistently even after 7 years. The challenge, however, is enhancing their consistent use, especially by the most vulnerable groups (children under 5 years and pregnant women). The study established factors associated with consistent use of bed nets for malaria control among children under 5 years in Soroti district. METHODS: The study employed a cross-sectional design, with multi-stage sampling of households. A total of 400 households (HH) were sampled and the HH head in each household interviewed. Key informant interviews (KIIs) were conducted with 7 key informants who were knowledgeable on the subject matter. Data analysis was done using SPSS 17.0 at Univariate, Bivariate and Multivariable levels; after entry and cleaning. Key informants' data were summarized manually; verbatim quotes and text used to reinforce quantitative data in line with objectives. RESULTS: Only 56.8% of the 690 children under 5 years used bed nets consistently. The factors affecting consistent bed net use were age of the child, their use of bed nets the previous night, occupation of caretaker, respondents' perceived susceptibility, perceived risk of getting malaria, size and shape of the bed nets. Rectangular nets were difficult to hang daily in huts according to most key informants. CONCLUSION: Consistent bed net use among under fives is still below the RBM target of 85% by 2015 and can be enhanced by providing conical bed nets and setting aside a health education programme to emphasize the effectiveness of even one mosquito in spreading malaria at night to the entire household and ability of bed nets to stop transmission better than other methods.

STEP-WISE APPROACH TO THE MANAGEMENT OF SUBMACULAR HEMORRHAGE USING PNEUMATIC DISPLACEMENT AND VITRECTOMY: The Manchester Protocol.

PURPOSE: To evaluate a sequential approach of pneumatic displacement followed by vitrectomy (pars plana vitrectomy) in failed cases to deal with submacular hemorrhage (SMH) of various etiologies. METHODS: Retrospective, nonrandomized interventional case series of consecutive patients with SMH of up to 2 weeks' duration, who were treated with a stepwise approach. Step 1 involved intravitreal injection of 0.3 mL 100% C3F8 and recombinant tissue plasminogen activator 50 µg/0.1 mL. If unsuccessful, a prompt pars plana vitrectomy with subretinal recombinant tissue plasminogen activator 50 µg/0.1 mL and 20% SF6 gas tamponade was performed as a second attempt to displace the SMH. RESULTS: Thirty-one patients with SMH underwent pneumatic displacement; 24 (77.4%) had a successful outcome without further intervention. The mean presenting visual acuity of the "successful cohort" was 1.34 logMAR (20/440 Snellen), improving to 0.83 logMAR (20/135 Snellen) 1 month after treatment. Five of the seven patients with failed pneumatic displacement underwent pars plana vitrectomy with subretinal recombinant tissue plasminogen activator at an average of 5 days poststep 1, with successful SMH displacement in 3 patients, giving an overall success of 87.1% for this treatment protocol. CONCLUSION: A sequential approach of expansile gas injection followed by prompt pars plana vitrectomy, aided by recombinant tissue plasminogen activator at both steps, is a coherent, logical pathway to treat SMH with high anatomical and functional success.

Negative Food Effect of Danirixin: Use of PBPK Modelling to Explore the Effect of Formulation and Meal Type on Clinical PK.

PURPOSE: To use physiologically-based pharmacokinetic (PBPK) modelling to explore the food effect of different DNX hydrobromide (HBr) hemihydrate salt tablet formulations using biorelevant dissolution. METHODS: Compendial dissolution using a paddle method and TIM-1 biorelevant dissolution were performed and incorporated into a previously reported PBPK model. A two-part clinical study evaluated tablet formulations in the fasted/fed (high fat) state (Part A), and the impact of food (fasted/normal/high fat) and Proton Pump Inhibitor (PPI) co-administration for a selected formulation; as well as a formulation containing DNX HBr in the monohydrate state (Part B). RESULTS: TIM-1 data showed that the fed state bioaccessibility of DNX was significantly decreased compared to the fasted state with no significant differences between formulations. Dosed with normal/high fat food the selected formulation showed comparable exposure and a modest increase in DNX systemic PK was observed with PPI dependent on meal type. Under fed conditions DNX systemic exposure was comparable for the monohydrate and hemihydrate formulations. The integration of biorelevant TIM-1 data into the PBPK model led to the successful simulation of a DNX negative food effect. CONCLUSIONS: Interactions between DNX and food components are the likely the source of the negative food effect via micellar entrapment, ion pairing and/or meal induced viscosity changes.

Effects of temperature stress on the accumulation of ascorbic acid and folates in sweet corn (Zea mays L.) seedlings.

BACKGROUND: Extreme temperatures are among the primary abiotic stresses that affect plant growth and development. Ascorbic acid (AsA) is an efficient antioxidant for scavenging relative oxygen species accumulated under stress. Folates play a significant role in DNA synthesis and protect plants against oxidative stress. Sweet corn (Zea mays L.), a crop grown worldwide, is sensitive to extreme temperatures at seedling stage, which may cause yield loss. This study was conducted to explore the biosynthetic regulative mechanism of AsA and folates in sweet corn seedlings under temperature stress. RESULTS: The AsA and folate composition and relative gene expression in sweet corn seedlings grown under different temperature stresses (10, 25, and 40 °C) were evaluated. The imposition of temperature stress altered the AsA content mainly by modulating the expression of Zm DHAR, whose encoded enzyme dehydroascorbic reductase (DHAR) is essential in the AsA recycle pathway. Low temperature stress raised the expressions of relative genes, leading to folate accumulation. High temperature stress modulated the folate content by influencing the expression of the correspondence gene for aminodeoxychorismate synthase, Zm ADCS, as well as downstream genes that connected with DNA methylation. CONCLUSION: These results provided a theoretical basis, at a genetic level, for understanding the stress responses mechanism in sweet corn seedlings, offering guidance for sweet corn cultivation. © 2019 Society of Chemical Industry.

Improving the Performance Time and Accuracy of Ultrasound-Guided Interventions: A Randomized Controlled Double-Blind Trial of the Line-of-Sight Approach and the "APPLES" Mnemonic.

OBJECTIVES: To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure. METHODS: Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group. The procedure time was determined by 2 blinded reviewers. A survey was administered to determine which method participants preferred and whether they thought the APPLES mnemonic was helpful. A paired t test was used to compare the performance time, and the McNemar test was used to compare the accuracy of the methods. RESULTS: Among the 110 participants, the performance time with the line-of-sight approach (mean, 14.4 seconds; SD, 9.95 seconds) was significantly decreased compared to the side approach (mean, 18.6 seconds; SD, 10.1 seconds; P = .00029). Additionally, participants who only hit the target using one method were more likely to hit the target in 30 seconds using the line-of-sight approach (P = .035). In total, 72.7% of participants preferred the line-of-sight approach over the side approach, and 88.2% of participants thought that APPLES mnemonic was useful. CONCLUSIONS: This study highlights the finding that positioning of the operator is important in performing US-guided interventions, and the line-of-sight approach may improve the performance time and accuracy among novice operators. Furthermore, the APPLES mnemonic serves as a useful educational tool for teaching US-guided interventional procedures.

Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review.

PURPOSE: To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature. METHODS: An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents. RESULTS: The majority (93% for aspirin, 82% for clopidogrel) of respondents would not suspend antiplatelet administration, and 79% would not stop warfarin before vitreoretinal surgery. Regarding the novel anticoagulants (factor Xa inhibitors), 58% would not stop them, and 24% were unsure. Eighty-three percent of the surgeons were not confident regarding the management of factor Xa inhibitors preoperatively. Thirty-one percent of the respondents felt that anticoagulation cessation was independent of the type of vitreoretinal surgery, whereas 9% each felt that they would stop anticoagulation if possible for diabetic vitrectomy and retinectomy. Published evidence suggests that antiplatelet agents and warfarin do not confer a significantly greater risk of intra- or perioperative bleeding. Evidence regarding the novel anticoagulants is sparse. CONCLUSIONS: Further evaluation of novel anticoagulants in vitreoretinal surgery is required in order to provide evidence-based recommendations and address variations in practice.

Effect of Light- and Dark-Germination on the Phenolic Biosynthesis, Phytochemical Profiles, and Antioxidant Activities in Sweet Corn (Zea mays L.) Sprouts.

Sweet corn is one of the most widely planted crops in China. Sprouting of grains is a new processes to increase the nutritional value of grain products. The present study explores the effects of light on the nutritional quality of sweet corn sprouts. Gene expression of phenolic biosynthesis, phytochemical profiles and antioxidant activity were studied. Two treatments (light and dark) were selected and the morphological structure of sweet corn sprouts, as well as their biochemical composition were investigated to determine the effects of light on the regulation of genes responsible for nutritional compounds. Transcription analyses for three key-encoding genes in the biosynthesis of the precursors of phenolic were studied. Results revealed a negative regulation in the expression of ZmPAL with total phenolic content (TPC) in the light group. TPC and total flavonoid content (TFC) increased during germination and this was correlated with an increase in antioxidant activity (r = 0.95 and 1.0). The findings illustrate that the nutritional value of sweet corn for the consumer can be improved through germination to the euphylla stage.

EXTENT AND LOCATION OF INTRARETINAL AND SUBRETINAL FLUID AS PROGNOSTIC FACTORS FOR THE OUTCOME OF PATIENTS WITH OPTIC DISK PIT MACULOPATHY.

PURPOSE: To determine if baseline fundoscopic and optical coherence tomography (OCT) features influence the clinical course of optic disk pit maculopathy. METHODS: A multicenter retrospective case note review was undertaken, using standardized OCT and clinical data collection. Visual success was defined as at least a two-line visual acuity improvement, anatomical success as full resolution of OCT foveal fluid with restoration of the normal foveal contour, and partial anatomical success as incomplete resolution of the OCT foveal fluid. Outcomes were compared with a synthesis of the literature, using similar eligibility criteria. RESULTS: Of 36 patients (36 eyes), 2 spontaneously improved and 34 underwent surgery. Visual success was achieved in 64% of surgical cases, anatomical success in 36%, and partial anatomical success in 47%. Cases with multilayer intraretinal and subretinal fluid were less likely to have visual success (P = 0.003). Cases where the fluid did not extend to the macular arcade vessels also had better visual and anatomical outcomes (P = 0.004 and 0.005, respectively). CONCLUSION: Fundoscopic and OCT features can help predict surgical outcome in optic disk pit maculopathy.

Vitreous evaluation: a diagnostic challenge.

PURPOSE: To categorize vitrectomy cytologic diagnoses and ancillary tests to address appropriate processing of low-volume vitreous samples. DESIGN: Retrospective case series. PARTICIPANTS: Five thousand seven hundred thirty-six vitreous samples. METHODS: Cytologic diagnoses of therapeutic and diagnostic vitrectomy samples and their processing protocols from 3 teaching institutions were reviewed. MAIN OUTCOME MEASURES: Diagnostic results were categorized as negative for malignancy, suspicious for malignancy, and positive for malignancy. All ancillary studies performed were documented, including special stains, immunohistochemistry analysis, cytokine levels, and polymerase chain reaction (PCR) analysis. RESULTS: Of the 5736 vitreous samples analyzed, 4683 (81.64%) were from Tufts Medical Center (TMC), 955 (16.65%) were from Boston Medical Center (BMC), and 98 (1.70%) were from Massachusetts Eye Research and Surgery Institution (MERSI). Cases from TMC and BMC were therapeutic and diagnostic vitrectomies, and MERSI cases were diagnostic vitrectomies. Most vitrectomies showed negative results for malignancy: 99.47% of TMC cases, 99.89% of BMC cases, and 79.6% of MERSI cases. These included vitreous hemorrhage and inflammatory or infectious findings. Ancillary studies performed in this category included Periodic Acid-Schiff staining for fungi, PCR analysis for toxoplasmosis, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex virus I and II, and vitreous cultures for infections (coagulase-negative Staphylococcus, Candida, Fusarium, and Propionibacterium species). Interleukin (IL) 10-to-IL-6 ratios were performed on 38.7% of cases from MERSI. Fourteen cases from TMC were suspicious for malignancy based on cytologic evaluation. Eleven cases from TMC, 1 case from BMC, and 20 cases from MERSI showed positive results for malignancy and included B-cell lymphoma, retinoblastoma, melanoma, and metastatic adenocarcinoma. The ancillary testing included PCR for heavy chain immunoglobulin gene rearrangements, immunohistochemistry for EBV, in situ hybridization for κ and λ light chains, and cytogenetics. CONCLUSIONS: This is the largest data pool of reported cytologic diagnoses of diagnostic and therapeutic vitrectomy samples. Cytologic evaluation of therapeutic vitrectomy samples provides a valuable baseline of nonpathologic findings that assist in differentiation between malignancy, infections, and inflammatory conditions. Allocation of small-volume vitreous samples to select ancillary testing from the plethora of available diagnostic tests requires preoperative communication between surgeons and pathologists to ensure appropriate and timely treatment methods.

A minimalist legislative solution to the problem of euthanasia.

Intense debate has continued for many years about whether voluntary euthanasia or assisted suicide should be permitted by law. The community is bitterly divided and there has been vigorous opposition from medical practitioners and the Australian Medical Association. Despite differences of religious and philosophical convictions and ethical values, there is widespread community agreement that people with terminal illnesses are entitled to adequate treatment, and should also be allowed to make basic choices about when and how they die. A problem with the current law is that doctors who follow current best practice cannot be confident that they will be protected from criminal prosecution. We propose simple changes to Commonwealth and state legislation that recognise community concerns and protect doctors acting in accordance with best current practice. This minimalist solution should be widely acceptable to the community, including both the medical profession and those who object to euthanasia for religious reasons. Important areas of disagreement will persist that can be addressed in future debates.

Regenerative Food Innovation: The Role of Agro-Food Chain By-Products and Plant Origin Food to Obtain High-Value-Added Foods.

Food losses in the agri-food sector have been estimated as representing between 30 and 80% of overall yield. The agro-food sector has a responsibility to work towards achieving FAO sustainable goals and global initiatives on responding to many issues, including climate pressures from changes we are experiencing globally. Regenerative agriculture has been discussed for many years in terms of improving our land and water. What we now need is a focus on the ability to transform innovation within the food production and process systems to address the needs of society in the fundamental arenas of food, health and wellbeing in a sustainable world. Thus, regenerative food innovation presents an opportunity to evaluate by-products from the agriculture and food industries to utilise these waste streams to minimise the global effects of food waste. The mini-review article aims to illustrate advancements in the valorisation of foods from some of the most recent publications published by peer-reviewed journals during the last 4-5 years. The focus will be applied to plant-based valorised food products and how these can be utilised to improve food nutritional components, texture, sensory and consumer perception to develop the foods for the future.

Iatrogenic retinal breaks in 20-G versus 23-G pars plana vitrectomy.

BACKGROUND: The purpose of this study was to compare the incidence of iatrogenic anterior retinal breaks in 20-G vitrectomy (PPV) with transconjunctival 23-G PPV. METHODS: Retrospective, observational review study involving consecutive patients undergoing PPV in a single center in the UK during a 2-year period. RESULTS: Sclerotomy-related entry-site breaks (ESB) were found in 50/628 (7.9 %) 20-G PPV cases and 5/296 (1.7 %) 23-G PPV eyes (p<0.0001*). Anterior non-sclerotomy iatrogenic breaks (ANSB) were present in 55/628 (8.7 %) 20-G PPV cases and 18/296 (6.1 %) 23-G PPV eyes (p=0.19). The incidence of total anterior iatrogenic breaks (ANSB + ESB) was 105/628 (16.7 %) for 20-G PPV and 23/296 (7.8 %) for 23-G PPV (p=0.002*). Univariate analysis showed that posterior vitreous detachment induction was the only risk factor significantly associated with the development of anterior retinal breaks for both 20-G and 23-G PPV. Multivariate logistic model of risk factors for development of iatrogenic retinal breaks demonstrated that 23-G PPV was the most important factor reducing the risk of anterior breaks (p<0.0001*). CONCLUSIONS: We report the largest series of patients undergoing 20-G and 23-G vitrectomy, where 23-G vitrectomy was associated with a significantly lower incidence of anterior iatrogenic retinal breaks.

EEG-based BCI Dataset of Semantic Concepts for Imagination and Perception Tasks.

Electroencephalography (EEG) is a widely-used neuroimaging technique in Brain Computer Interfaces (BCIs) due to its non-invasive nature, accessibility and high temporal resolution. A range of input representations has been explored for BCIs. The same semantic meaning can be conveyed in different representations, such as visual (orthographic and pictorial) and auditory (spoken words). These stimuli representations can be either imagined or perceived by the BCI user. In particular, there is a scarcity of existing open source EEG datasets for imagined visual content, and to our knowledge there are no open source EEG datasets for semantics captured through multiple sensory modalities for both perceived and imagined content. Here we present an open source multisensory imagination and perception dataset, with twelve participants, acquired with a 124 EEG channel system. The aim is for the dataset to be open for purposes such as BCI related decoding and for better understanding the neural mechanisms behind perception, imagination and across the sensory modalities when the semantic category is held constant.

Appraisal of vitreous syphilis antibody as a novel biomarker for the diagnosis of syphilitic uveitis: a prospective case-control study.

PURPOSE: To determine the sensitivity and specificity of syphilis antibody tests in vitreous samples and to propose an algorithm using vitreous syphilis antibody as a supplementary test to confirm syphilitic uveitis (SU). METHODS: A prospective case-control study was conducted at the Retina and Uveitis Clinic from May 2017 to January 2020. Initially, patients were classified based on syphilis serology into group 1 (positive testing) and group 2 (negative testing). Group 1 was further divided into 2 subgroups (group 1A and 1B) depending on their relevant clinical manifestations and clinical improvement. Group 2 served as a control group. RESULTS: Thirty-eight patients were enrolled in the study: 14 in group 1A, 5 in group 1B, and 19 in group 2B. No patient was assigned to group 2A. All patients in group 1A, representing definite SU, completed syphilis test (rapid plasma reagin [RPR], enzyme immunoassay [EIA], and fluorescent treponemal antibody-absorption [FTA-ABS]) for vitreous, and all vitreous samples yielded positive results. Of the 5 subjects in group 1B, 3 cases were considered to be not SU with different conditions, and 2 were indeterminate for SU. They presented with different features not typical of SU, and they had variable and fewer positive syphilis antibody responses. The most sensitive test for detecting syphilis antibodies in vitreous was EIA (90.9%), followed by RPR (80.0%) and FTA-ABS IgG (78.9%). EIA and FTA-ABS had the highest specificity, detecting 100% of the syphilis antibody. CONCLUSIONS: Vitreous analysis of syphilis antibody can serve as a supplementary test to confirm SU in selected cases as the proposed algorithm.

Acidic polysaccharides from black ear and silver ear mushrooms modulated the release and transport of glucose from gelatinised sorghum starch during digestion.

This study investigated the ability of acidic polysaccharides from Auricularia auricula-judae (AAP) and Tremella fuciformis (TFP) mushrooms to modulate starch digestion and absorption. Gelatinised sorghum starch was used as starch-rich material, and its digestion and glucose transport were determined through in vitro digestion/Caco-2 cells model. Results showed that fortification with 0.6% AAP/TFP increased the proportion of high molecular weight α-dextrin and delayed glucose diffusion from digested starch gels. Gelatinisation of sorghum starch with AAP and TFP reduced the amount of transported glucose by 34.2% and 38.7%, respectively. This reduction was related to the inhibition of AAP/TFP on α-glucosidase and the difficulty in the hydrolysis of high molecular weight maltooligosaccharides. The potential bonding of AAP/TFP to glucose transporter (SGLT1) also impeded glucose transport. The findings suggest that AAP/TFP could act as natural hypoglycaemic agents used in starch-based foods and provide a better understanding of the hypoglycaemic mechanism of mushroom polysaccharides.