A simple method for gene expression in endo- and ectodermal cells in mouse embryos before neural tube closure.

The lack of a widely accessible method for expressing genes of interest in wild-type embryos is a fundamental obstacle to understanding genetic regulation during embryonic development. In particular, only a few methods are available for introducing gene expression vectors into cells prior to neural tube closure, which is a period of drastic development for many tissues. In this study, we present a simple technique for injecting vectors into the amniotic cavity and allowing them to reach the ectodermal cells and the epithelia of endodermal organs of mouse embryos at E8.0 via in utero injection, using only a widely used optical fiber with an illuminator. Using this technique, retroviruses can be introduced to facilitate the labeling of cells in various tissues, including the brain, spinal cord, epidermis, and digestive and respiratory organs. We also demonstrated in utero electroporation of plasmid DNA into E7.0 and E8.0 embryos. Taking advantage of this method, we reveal the association between Ldb1 and the activity of the Neurog2 transcription factor in the mouse neocortex. This technique can aid in analyzing the roles of genes of interest during endo- and ectodermal development prior to neural tube closure.

Filling an ARHGAP in our knowledge of human brain evolution.

The human cerebral cortex has tripled in size since our divergence from a common ancestor with chimpanzees. This cortical expansion is driven by the increased proliferative capacity of radial glia (RG), a neural progenitor cell (NPC) population that generates cortical neurons. RG along the ventricular zone (VZ) produce neurons and also give rise to basal progenitors (BPs), which migrate to the embryonic subventricular zone (SVZ). Comparative studies suggest that the increased proliferative capacity of human NPCs involves cell-intrinsic mechanisms (Otani et al, 2016), and a number of human-specific genetic changes have recently been linked to NPC proliferation. In particular, overexpression studies in model organisms indicate that the human-specific gene ARHGAP11B is sufficient to increase BP abundance when introduced into the developing brain of non-human model organisms (Florio et al, 2015; Kalebic et al, 2018; Heide et al, 2020). However, studying human-specific mutations in a hominid genetic and developmental context, rather than in more divergent model organisms, could provide further insight into the evolutionary consequences and effect size of human mutations. Fischer et al (2022) now developed a novel organoid electroporation technique to establish the necessity and sufficiency of ARHGAP11B for BP proliferation in cells from humans and our closest living relative, chimpanzees (Fig 1).

Investigating the biological relevance of measuring gastrointestinal cortisol metabolite levels to assess stress responses in Atlantic salmon (Salmo salar L.) after an acute stress.

Monitoring stress levels of farmed Atlantic salmon (Salmo salar) is important to ensure fish welfare and optimize farm operations. Feces could be a promising matrix for assessing stress responses in fish, based on their properties of low-invasive sampling and allowing repeated sampling over time. Meanwhile, elevated levels of cortisol metabolites (CMs) in feces indicate the increases in plasma cortisol levels (PLA) after exposure to acute stress. However, the dynamics of fecal CMs following acute stress in Atlantic salmon remain unclear. In this study, a confinement stress involving chasing and crowding was conducted to investigate the responses of gastrointestinal CMs to an acute stressor in Atlantic salmon. The post-smolts, with an average weight of 155.21 g, were sampled before and at 30 min, 1.5, 6, 12, 18, 24, 36, and 48 h after the onset of stress. Blood and gastrointestinal contents from the stomach, proximal intestine, and distal intestine of each fish were collected and subsequently analyzed, using competitive enzyme-linked immunosorbent assay (ELISA). The results demonstrated that the pre-stress level of PLA was low (4.28 ± 6.13 ng/ml) and reached a peak within 30 min following stress. The levels of CMs in gastrointestinal contents from stomach (SCMs), proximal intestine (PCMs), and distal intestine (DCMs) in pre-stress group were 0.82 ± 0.50, 18.31 ± 6.14 and 16.04 ± 6.69 ng/g, respectively. Gastrointestinal CMs increased significantly within 30 min and the peak levels of SCMs (3.51 ± 3.75 ng/g), PCMs (68.19 ± 23.71 ng/g) and DCMs (65.67 ± 23.37 ng/g) were found at 1.5 h post-stress. The significant increases in PCMs and DCMs post-stress validate the biological relevance of measuring intestinal CMs for assessing acute stress responses in Atlantic salmon. No significant difference was noted between PCMs and DCMs across all samples, suggesting that intestinal contents can serve as a suitable matrix compared with feces when measuring the responses of CMs to acute stress. The time lag between the peak of PLA levels and their reflection in the intestinal contents exceeded 1 h, indicating that using intestinal contents as a matrix to assess stress levels in fish can extend and delay the sampling window. This study highlights valuable guidance for determining the optimal times to utilize intestinal contents for measuring stress responses, providing further insights into the dynamics of fecal CM following acute stress.

Non-Covalent Assembly of Multiple Fluorophores in Edible Protein/Lipid Hydrogels for Applications in Multi-Step Light Harvesting and White-Light Emission.

The design and production of biodegradable and sustainable non-toxic materials for solar-energy harvesting and conversion is a significant challenge. Here, our goal was to report the preparation of novel protein/lipid hydrogels and demonstrate their utility in two orthogonal fundamental studies-light harvesting and white-light emission. Our hydrogels contained up to 90% water, while also being self-standing and injectable with a syringe. In one application, we loaded these hydrogels with suitable organic donor-acceptor dyes and demonstrated the energy-transfer cascade among four different dyes, with the most red-emitting dye as the energy destination. We hypothesized that the dyes were embedded in the protein/lipid phase away from the water pools as monomeric entities and that the excitation of any of the four dyes resulted in intense emission from the lowest-energy acceptor. In contrast to the energy-transfer cascade, we demonstrate the use of these gels to form a white-light-emitting hydrogel dye assembly, in which excitation migration is severely constrained. By restricting the dye-to-dye energy transfer, the blue, green, and red dyes emit at their respective wavelengths, thereby producing the composite white-light emission. The CIE color coordinates of the emission were 0.336 and 0.339-nearly pure white-light emission. Thus, two related studies with opposite requirements could be accommodated in the same hydrogel, which was made from edible ingredients by a simple method. These gels are biodegradable when released into the environment, sustainable, and may be of interest for energy applications.

Ovarian germ cell tumor/mastocytosis with KIT mutation: A unique clinicopathological entity.

Most tumors are sporadic and originated from somatic mutations. Some rare germline mutations cause familial tumors, often involving multiple tissues or organs. Tumors from somatic mosaicism during embryonic development are extremely rare. We describe here a pediatric patient who developed both an ovarian germ cell tumor and systemic mastocytosis. Targeted DNA next-generation sequencing analysis revealed similar genomic changes including the same KIT D816V mutation in both tissues, suggesting a common progenitor cancer cell. The KIT mutated cells are likely from early embryonic development during germ cell migration. A literature search found additional eight similar cases. These diseases are characterized by pediatric-onset, all-female, neoplastic proliferation in both gonad and bone marrow, and a common oncogenic cause, that is, KIT mutation, constituting a clinically and genetically homogenous disease entity. Importantly, the association of germ cell tumors with hematopoietic neoplasms suggests that the primordial germ cells are the primitive hematopoietic stem cells, a much-debated and unsettled question.

Eye-Preserving Therapies for Advanced Retinoblastoma: A Multicenter Cohort of 1678 Patients in China.

PURPOSE: This study attempted to estimate the impact of eye-preserving therapies for the long-term prognosis of patients with advanced retinoblastoma with regard to overall survival and ocular salvage. DESIGN: Retrospective cohort study covering all 31 provinces (38 retinoblastoma treating centers) of mainland China. PARTICIPANTS: One thousand six hundred seventy-eight patients diagnosed with group D or E retinoblastoma from January 2006 through May 2016. METHODS: Chart review was performed. The patients were divided into primary enucleation and eye-preserving groups, and they were followed up for survival status. The impact of initial treatment on survival was evaluated by Cox analyses. MAIN OUTCOME MEASURES: Overall survival and final eye preservation. RESULTS: After a median follow-up of 43.9 months, 196 patients (12%) died, and the 5-year overall survival was 86%. In total, the eyeball preservation rate was 48%. In this cohort, 1172 patients (70%) had unilateral retinoblastoma, whereas 506 patients (30%) had bilateral disease. For patients with unilateral disease, 570 eyes (49%) underwent primary enucleation, and 602 patients (51%) received eye-preserving therapies initially. During the follow-up (median, 45.6 months), 59 patients (10%) from the primary enucleation group and 56 patients (9.3%) from the eye-preserving group died. Multivariate Cox analyses indicated no significant difference in overall survival between the 2 groups (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.84; P = 0.250). For patients with bilateral disease, 95 eyes (19%) underwent primary enucleation, and 411 patients (81%) received eye-preserving therapies initially. During the follow-up (median, 40.1 months), 12 patients (13%) from the primary enucleation group and 69 patients (17%) from the eye-preserving group died. For bilateral retinoblastoma with the worse eye classified as group E, patients undergoing primary enucleation exhibited better overall survival (HR, 2.35; 95% CI, 1.10-5.01; P = 0.027); however, this survival advantage was not evident until passing 22.6 months after initial diagnosis. CONCLUSIONS: Eye-preserving therapies have been used widely for advanced retinoblastoma in China. Patients with bilateral disease whose worse eye was classified as group E and who initially underwent eye-preserving therapies exhibited a worse overall survival. The choice of primary treatment for advanced retinoblastoma should be weighed carefully.

De-Escalation Dual Antiplatelet Therapy Prevail over Potent P2Y12 Inhibitor Monotherapy in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: A Network Meta-Analysis.

Background: Dual antiplatelet therapy (DAPT) with potent P2Y12 inhibitor is the cornerstone of acute coronary syndrome (ACS) management. Balancing the effects of different strategies of antiplatelet therapy including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT is a hot topic. Methods: A systematic search was conducted from the MEDLINE, PubMed, and Embase through October 2021 to identify various DAPT strategies in randomized controlled trials (RCTs) for treatment of ACS patients after undergoing PCI with drug-eluting stent (DES). The network meta-analysis was performed to investigate the net clinic benefit of the DAPT de-escalation, potent P2Y12 inhibitor monotherapy, as well as conventional DAPT. The primary outcome was net adverse clinical events, defined as a composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization. The secondary outcomes include major adverse cardiac events and trial-defined major or minor bleeding. Results: A total of 14 RCTs with 63,982 patients were included. The DAPT de-escalation was associated with a lower risk of the primary outcome compared with potent P2Y12 inhibitor monotherapy (De-escalation vs monotherapy odds ratio (OR): 0.72 95% confidence interval (CI): 0.55-0.96), and other antiplatelet strategies (De-escalation vs clopidogrel + aspirin OR: 0.49 95% CI: 0.39-0.63; De-escalation vs prasugrel + aspirin OR: 0.76 95% CI: 0.59-0.98; De-escalation vs ticagrelor + aspirin OR: 0.76 95% CI: 0.55-0.90). There were no statistical differences in the incidence of bleeding (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.73 95% CI: 0.47-1.12) and major adverse cardiac events (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.79 95% CI: 0.59-1.08) between DAPT de-escalation and potent P2Y12 inhibitor monotherapy. Conclusions: This network meta-analysis showed that DAPT de-escalation would reduce the net adverse clinical events, compared with potent P2Y12 inhibitor monotherapy, for ACS patients undergone PCI treatment.

Lipid metabolism patterns and relevant clinical and molecular features of coronary artery disease patients: an integrated bioinformatic analysis.

BACKGROUND: Hyperlipidaemia is an important factor that induces coronary artery disease (CAD). This study aimed to explore the lipid metabolism patterns and relevant clinical and molecular features of coronary artery disease patients. METHODS: In the current study, datasets were fetched from the Gene Expression Omnibus (GEO) database and nonnegative matrix factorization clustering was used to establish a new CAD classification based on the gene expression profile of lipid metabolism genes. In addition, this study carried out bioinformatics analysis to explore intrinsic biological and clinical characteristics of the subgroups. RESULTS: Data for a total of 615 samples were extracted from the Gene Expression Omnibus database and were associated with clinical information. Then, this study used nonnegative matrix factorization clustering for RNA sequencing data of 581 lipid metabolism relevant genes, and the 296 patients with CAD were classified into three subgroups (NMF1, NMF2, and NMF3). Subjects in subgroup NMF2 tended to have an increased severity of CAD. The CAD index and age of group NMF1 were similar to those of group NMF3, but their intrinsic biological characteristics exhibited significant differences. In addition, weighted gene coexpression network analysis (WGCNA) was used to determine the most important modules and screen lipid metabolism related genes, followed by further analysis of the DEGs in which the significant genes were identified based on clinical information. The progression of coronary atherosclerosis may be influenced by genes such as PTGDS and DGKE. CONCLUSION: Different CAD subgroups have their own intrinsic biological characteristics, indicating that more personalized treatment should be provided to patients in each subgroup, and some lipid metabolism related genes (PDGTS, DGKE and so on) were related significantly with clinical characteristics.

Blepharochalasis: clinical and epidemiological characteristics, surgical strategy and prognosis-- a retrospective cohort study with 93 cases.

BACKGROUND: Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated. METHODS: This was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. RESULTS: A total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00-70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3-10) years before surgery, and 2.07 (range:1.54-4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5-16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2-192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. CONCLUSIONS: Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.

QTLs Associated with Resistance to Cardiomyopathy Syndrome in Atlantic Salmon.

Cardiomyopathy syndrome (CMS) caused by piscine myocarditis virus is a major disease affecting the Norwegian Atlantic salmon industry. Three different populations of Atlantic salmon from the Mowi breeding program were used in this study. The first 2 populations (population 1 and 2) were naturally infected in a field outbreak, while the third population (population 3) went through a controlled challenged test. The aim of the study was to estimate the heritability, the genetic correlation between populations and perform genome-wide association analysis for resistance to this disease. Survival data from population 1 and 2 and heart atrium histology score data from population 3 was analyzed. A total of 571, 4312, and 901 fish from population 1, 2, and 3, respectively were genotyped with a noncommercial 55,735 Affymetrix marker panel. Genomic heritability ranged from 0.12 to 0.46 and the highest estimate was obtained from the challenge test dataset. The genetic correlation between populations was moderate (0.51-0.61). Two chromosomal regions (SSA27 and SSA12) contained single nucleotide polymorphisms associated with resistance to CMS. The highest association signal (P = 6.9751 × 10-27) was found on chromosome 27. Four genes with functional roles affecting viral resistance (magi1, pi4kb, bnip2, and ha1f) were found to map closely to the identified quantitative trait loci (QTLs). In conclusion, genetic variation for resistance to CMS was observed in all 3 populations. Two important quantitative trait loci were detected which together explain half of the total genetic variance, suggesting strong potential application for marker-assisted selection and genomic predictions to improve CMS resistance.

Reconstruction strategy in isolated complete Cryptophthalmos: a case series.

BACKGROUND: The present study sought to introduce clinical characteristics and stepwise surgical strategies of isolated complete cryptophthalmos, a rare, congenital ocular anomaly. CASE PRESENTATION: Retrospective, noncomparative, clinical study. Six patients with isolated complete cryptophthalmos were diagnosed at the Beijing Tongren Hospital between 2010 to 2018. The presentation age of patients ranged from 1 month to 68 years. This study includes two males and four females, and involvement was noted to be bilateral in two cases and unilateral in four cases. According to orbital CT scan and ocular CDI results, two patients were combined with ocular cyst. Reconstruction surgeries were performed in three patients, involving the eyeball enucleation, creation of fornix, eyelid reconstruction with skin flaps/amniotic membrane, and implantation of prosthesis. Besides, implantation of hydroxyapatite was performed in one pediatric patient to promote orbit development. Good outcomes in terms of cosmetic satisfaction were achieved in all patients during follow-up. CONCLUSIONS: Surgical intervention could only improve the cosmetic appearance in isolated complete cryptophthalmos. The surgical strategies may be planned to use three-stage approaches described in this study. Meanwhile, orbital development must be taken into consideration in pediatric cases.

[Whether external dacryocystorhinostomy will be abandoned].

External dacryocystorhinostomy (DCR) has long been considered as the gold standard treatment for nasolacrimal duct obstruction or chronic dacryocystitis. Recently, however, endoscopic endonasal DCR is becoming increasingly popular with the development of endoscopic surgery technique in naso-orbit related diseases. Endoscopic DCR has the advantages of avoiding an external incision scar and simultaneously handling with nasal conditions. Nevertheless, the new method also has some disadvantages, for example, the lower long-term success rate, the high technical requirement, long learning curves, expensive equipment and the high cost of surgery. The choice of the surgical approaches should be based on the patient's condition, experience of the surgeon and available resources. After nearly a century of proven, external DCR still has incomparable superiority and should receive widespread attention and application.

[Repair of full-thickness lower eyelid defect following surgical excision of malignant tumor using Hughes technique].

OBJECTIVE: To evaluate surgical outcome of reconstruction of full-thickness lower eyelid defect resulting from tumor excision. METHODS: A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from June 2008 to May 2013 was made. The defect ranged from 50% to 80% of the lower eyelid after excision of tumor with frozen section control of the surgical margins. Hughes technique was used to reconstruct the posterior lamellar and local flap and free graft were fashioned to repair the anterior defect. The pedicle was divided at 1-3 months postoperatively. RESULTS: Of the 157 lower eyelid malignant tumors, the 3 most common types were basal cell carcinoma (107/157, 68.2%), sebaceous gland carcinoma (32/157, 20.4%), and malignant melanoma (10/157, 6.4%). Twenty-one eyelids of 21 patients (aged from 43 to 77 years old) were identified. No tumor recurred during follow-up period (8-60 months). There was only one case with squamous carcinoma metastasized to the parotid gland and then excised. The contour of all lower eyelids was satisfactory. No eyelid margin deformity or upper lid retraction was observed. Revision surgery was performed to treat lower lid entropion (3 patients), while mild lower lid retraction (2 patients) and temporary ectropion (one patient) required no management. CONCLUSION: Hughes flap, which is a posterior lamellar replacement for lower eyelid defect after removal of malignant tumor, achieves favorable functional and cosmetic results.

[Posture-induced intraocular pressure measurements].

OBJECTIVE: To measure the intraocular pressure (IOP) in different sleep positions and compare with IOP in the sitting position. METHODS: Perspective study. Thirty-two patients with primary open angle glaucoma (POAG) and 28 normal subjects had IOP measured in the sitting position and then again in the supine, right lateral decubitus (right-lateral) and left lateral decubitus (left-lateral) positions with a Perkins applanation tonometer. IOPs then were measured again in the sitting postion after 1, 5 and 10 minutes. Two-way ANOVA was used to compare IOP readings in the different positions among the two study groups. Data were shown as mean ± standard deviation. RESULTS: In normal subjects, the IOP values of the right eye were (17.5 ± 3.8) (sitting), (19.3 ± 3.1) (supine), (21.7 ± 3.7) (right-lateral) and (21.5 ± 3.7) mmHg (left lateral) (1 mmHg = 0.133 kPa). The IOP values of left eye were (18.4 ± 3.0) (sitting), (19.3 ± 3.1) (supine), (20.7 ± 2.9) (right-lateral) and (22.8 ± 4.0) mmHg (left lateral). In the POAG patients, the IOP values of the right eye were (17.9 ± 3.7) (sitting), (20.6 ± 4.6) (supine), (26.1 ± 7.1)(right-lateral) and (26.3 ± 5.9) mmHg (left-lateral). The IOP of the left eye in these positions were (18.2 ± 3.6),(20.0 ± 4.1), (25.6 ± 6.1) and (25.7 ± 6.0) mmHg, respectively. The IOP under the right- and left-lateral positions were higher than that in sitting and supine in both groups. The IOP increases in all positions for POAG patients were significant higher than in normal subjects. The IOP decreased rapidly after returning from the supine to the sitting position. The IOP values at 1 minute, 5 minutes and 10 minutes after returning to the sitting position were not significantly different than the original sitting. CONCLUSIONS: The IOP in lateral decubitus positions is significantly higher than the IOP in sitting and supine positions. These differences are greater in POAG.

Effective prime factorization via quantum annealing by modular locally-structured embedding.

This paper investigates novel techniques to solve prime factorization by quantum annealing (QA). First, we present a very-compact modular encoding of a multiplier circuit into the architecture of current D-Wave QA devices. The key contribution is a compact encoding of a controlled full-adder into an 8-qubit module in the Pegasus topology, which we synthesized using Optimization Modulo Theories. This allows us to encode up to a 21 × 12-bit multiplier (and a 22 × 8-bit one) into the Pegasus 5760-qubit topology of current annealers. To the best of our knowledge, these are the largest factorization problems ever encoded into a quantum annealer. Second, we investigated the problem of actually solving encoded PF problems by running an extensive experimental evaluation on a D-Wave Advantage 4.1 quantum annealer. In the experiments we introduced different approaches to initialize the multiplier qubits and adopted several performance enhancement techniques. Overall, 8,219,999 = 32,749 × 251 was the highest prime product we were able to factorize within the limits of our QPU resources. To the best of our knowledge, this is the largest number which was ever factorized by means of a quantum annealer; also, this is the largest number which was ever factorized by means of any quantum device without relying on external search or preprocessing procedures run on classical computers.

Highly stable, fluorescent, artificial lipoprotein nanoparticles.

Here, we report a novel kind of protein nanoparticles of 11 nm in size, which have a central protein core surrounded by two layers of lipid. One layer of the lipid was covalently attached to the protein, while the other layer has been physically assembled around the protein core. Particle synthesis is highly modular, while both the size and charge of the protein nanoparticles are controlled in a predictable manner. Circular dichroism studies of the conjugate showed that the protein secondary structure is retained, while biophysical characterizations indicated the particle purity, size, and charge. The conjugate had a high thermal stability to steam sterilization conditions at 121°C (17 psi). After labeling the protein core with few different fluorescent dyes, they were strongly fluorescent with the corresponding colors independent of their size, unlike quantum dots. They are readily digested by proteases, and these water-soluble, non-toxic, highly stable, biocompatible, and biodegradable conjugates are suitable for cell imaging and drug delivery applications.

Case Report: Thrombus aspiration and in situ thrombolysis via a Guidezilla guide extension catheter in a patient with high-risk pulmonary embolism.

Standard catheter-directed thrombolysis (CDT) and thrombus aspiration are considered potentially promising approaches for reopening the embolism-related pulmonary artery in patients with pulmonary embolism (PE) with high thrombotic burden and deteriorating hemodynamics, especially in those for whom systemic thrombolysis is contraindicated or has failed. However, the constrained accessibility of dedicated catheters has impeded the potential benefits of standard CDT in developing countries. The Guidezilla guide extension catheter (GEC) with a larger diameter and extended length is widely used in challenging coronary anatomy. Nevertheless, there have been few reports on the application of the Guidezilla GEC as a novel option for patients with massive PE when dedicated catheters and surgical thrombectomy are not available. In this case report, we demonstrated that thrombus aspiration and in situ thrombolysis through the Guidezilla GEC are applicable to patients with PE in whom systemic thrombolysis is contraindicated, resulting in successful reperfusion and positive clinical outcomes.

Cosmetic shell fitting over a sensitive cornea in mild phthisis bulbi using total conjunctival flap.

BACKGROUND: Cosmetic scleral shells provide a superior alternative to enucleation or evisceration in the setting of phthisis bulbi. However, corneal irritation often minimizes the wearing time of a scleral shell. This study aimed to evaluate the clinical effectiveness of a total conjunctival flap covering in the management of mild phthisis bulbi with a sensitive cornea. METHODS: The surgical technique involved a total conjunctival flap covering combined with superficial lamellar keratectomy to allow the fitting of a cosmetic scleral shell over a sensitive cornea. The records of patients with mild phthisis bulbi who underwent this technique from September 2003 through July 2011 were reviewed. Postoperative and long-term complications were noted. Outcome measures included cosmetic appearance, complications, and patient satisfaction. RESULTS: A total of 58 patients (58 eyes) were identified. The mean age at surgery was 28.5 years (range=2-65 years) and the mean follow-up period (follow-up rate=66%) was 42.6 months (range=6-98 months). Postoperative complications like epithelial inclusion cyst (one eye), intolerance of scleral shell wear (2 eyes), and deterioration of phthisis bulbi (3 eyes) were observed during the follow-up interval. Surgical success was achieved in 52 subjects (90%) with the desired prosthetic appearance and motility and no further intervention was required. CONCLUSION: The total conjunctival flap is an easy and effective globe-conserving alternative to enucleation or evisceration in the cosmetic rehabilitation of patients with mild phthisis bulbi. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Eyelid thickening and ptosis associated with pachydermoperiostosis: a case report and review of literature.

UNLABELLED: The case of a 27-year-old Chinese patient with bilateral eyelid thickening and ptosis secondary to the rare condition of pachydermoperiostosis is presented. Surgical treatment was performed by horizontal tightening via a full-thickness wedge resection combined with levator shortening and advancement. Satisfactory aesthetic and functional results were achieved. The histopathology of eyelid tissue showed sebaceous gland hyperplasia and chronic inflammatory response. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .