Sutureless intrascleral fixation using different three-piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.

Intraoperative high dose rate brachytherapy during breast-conserving surgery: A Prospective Pilot Study

PURPOSE

To evaluate feasibility, quality of life, toxicity, and cosmetic outcome for intraoperative breast cancer brachytherapy after breast-conserving surgery using high dose rate brachytherapy.

METHODS AND MATERIALS

Fifty-two consecutive women, ⩾50 years old, diagnosed with a unifocal non-lobular breast cancer ⩽3 cm, N0, underwent breast-conserving surgery and sentinel node biopsy. Twenty-five women received intraoperative brachytherapy pre-pathology at primary surgery and the others post-pathology, during a second procedure. An applicator, connected to a high dose rate afterloader, was used. Two of the women were excluded due to metastases found per-operatively at a frozen section from the sentinel node. Quality of life was evaluated using two validated health questionnaires. Treatment toxicity was documented according to the LENT-SOMA scale by two oncologists. The cosmetic result was evaluated using the validated freely available software BCCT.core 2.0.

RESULTS

The clinical procedure worked out well logistically. Seven women received supplementary external radiotherapy due to insufficient margins and, in one case, poor adaptation of the breast parenchyma to the applicator. No serious adverse effects from irradiation were registered. The results from the health questionnaires showed no major differences compared with reference groups from the Swedish population. Only two women were registered as having a "poor" cosmetic result while a majority of the women had a "good" outcome.

CONCLUSION

This pilot study shows that intraoperative brachytherapy is a feasible procedure and encourages further trials evaluating its role in treatment of early breast cancer.

Increased risk for hip fracture after death of a spouse-further support for bereavement frailty?

Death of a spouse is associated with poorer physical and mental health. We followed all married individuals, born from 1902 to 1942, during the period from 1987 to 2002, and found that widows and widowers had higher risk for hip fracture, compared with still married women and men.

INTRODUCTION

Spousal bereavement can lead to poorer physical and mental health. We aimed to determine whether married women and men had an elevated risk of hip fracture after death of a spouse.

METHODS

In a retrospective cohort study, we followed all Swedish married individuals aged 60 to 100 years (n = 1,783,035), from 1987 to 2002. Data are presented as mean with 95% confidence interval (CI).

RESULTS

During the follow-up period, 21,305 hip fractures among widows and 6538 hip fractures among widowers were noted. The hazard ratio (HR) for hip fracture in widows compared with married women was 1.34 (95% CI 1.31 to 1.37) and for widowers compared with married men 1.32 (95% CI 1.29 to 1.35). The HR for hip fracture in the first 6 months after death of a spouse was in widows compared with married women 1.62 (95% CI 1.53 to 1.71) and in widowers compared with married men 1.84 (95% CI 1.68 to 2.03). The elevated risk was especially prominent in young widowers in the age range 60-69 years. During the first 6 months they showed a HR of 2.76 (95% CI 1.66 to 4.58) for a hip fractvure compared with age matched married men. Widows aged 60-69 years showed a HR of 1.59 (95% CI 1.26 to 1.99) compared with age matched married women.

CONCLUSION

Our observation of a higher hip fracture risk in both genders in connection with the death of a spouse indicates a possible effect of bereavement on frailty.

Improved Wellbeing for Both Caretakers and Users from A Zoo-Related Nature Based Intervention-A Study at Nordens Ark Zoo, Sweden

Nature-based interventions have been proposed to promote physical and mental health and give stress reduction. Little attention has been given to the potential of zoos for human health and wellbeing. A disadvantaged group in Sweden regarding access to nature are individuals with disabilities who consequently do not have the same access to these health benefits as other groups. To increase awareness and knowledge regarding spending time in nature and with animals, courses directed at caretakers for persons with disabilities and their users were held at Nordens Ark, a zoo in Sweden. To explore if the courses had led to increased nature activities, and if participating in the courses had affected caretakers' and their users' health and wellbeing, questionnaires and interviews for evaluating the courses were used. The results showed improved quality in nature visits because of course participation as well as positive effects for the wellbeing, sustainability for the caregivers and users in their working lives, and relationships were positively affected. The conclusion from this study is that nature and animal-based education should be more frequent to provide opportunities for a disadvantaged group to have the positive effects of nature of which most other groups have obvious access to.

P1796Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects

Background

Peripheral muscle factors are presumed to be important contributors to the reduced exercise capacity in congenital heart disease (CHD), but the mechanisms are poorly understood.

Purpose

To investigate if muscle oxygenation in the calf muscle is impaired in adults with complex CHD in comparison to controls.

Method

Seventy-four adults with complex CHD (35.6±14.3 years, females n=22) were recruited from centers specialized in adult CHD. Seventy-four age and gender matched subjects were recruited as controls. Muscle oxygenation was successfully determined using near-infrared spectroscopy on the medial portion of m. gastrocnemiusin 63 patients and 67 controls. Measurements were made at rest, during venous occlusion to estimate blood flow (BF – indicated by the slope increase of total haemoglobin, HbT), at the start of isotonic unilateral heel-lifts to exhaustion, and immediately after exercise.

Results

In comparison to controls, patients had a lower muscle saturation (StO2) at rest, albeit not statistically significant, (66±17% vs. 60±19%, p=0.07), and a lower BF (0.38±0.21 vs. 0.31±0.21 HbTx3.5sec–1, p=0.07). For exercise, compared to the controls, patients had a slower desaturation rate at exercise onset (−11.7±5.8% vs. −7.7±4.3%. StO2x3.5sec–1, p<0.001), and both a slower resaturation rate (6.1±3.8% vs. 3.9±3.7% StO2x3.5sec–1, p=0.002) and a slower half recovery time (16.8±11.1 vs. 28.6±21.2 sec, p<0.001) post exercise.

Conclusion

The lower muscle oxygenation and blood flow at rest, and the slower oxygenation kinetics during exercise may give insight to the mechanism for the reduced exercise capacity commonly found in adults with complex CHD. This finding may also provide implications for design of rehabilitation programs for these patients.

Tachykinin upregulation in atopic dermatitis

Context: Atopic dermatitis (AD) is a chronic, inflammatory, itching skin disorder, which may worsen due to stress, depression and anxiety. Tachykinins may be involved in inflammation signaling as well as they may have a role in stress, depression and anxiety. Objective: This study aimed to measure the expression of tachykinin markers, in the skin of patients with AD, and the correlation of these tachykinins with clinical and psychodemographic parameters. Materials and methods: Twenty-eight adult patients with AD were investigated regarding tachykinin expression in skin biopsies, using an immunohistochemical technique. The patients were characterized with clinical and psychodemographic parameters. Results: The number of substance P and neurokinin (NK)A positive nerve fibers, as well as NKA positive mononuclear dermal cells, was increased in lesional compared to non-lesional skin. Interestingly, the depression score and the number of dermal NK-1 receptor (R) positive cells in lesional as well as in non-lesional skin showed a correlation. Conclusion: These findings indicate an upregulation of the tachykinergic system in the inflamed skin of AD.

Quantitative assessment of DNA damage in the industrial ethanol production strain Saccharomyces cerevisiae PE-2

Lignocellulosic hydrolysates remain one of the most abundantly used substrates for the sustainable production of second generation fuels and chemicals with Saccharomyces cerevisiae. Nevertheless, fermentation inhibitors such as acetic acid, furfural and hydroxymethylfurfural are formed during the process and can lead to slow or stuck fermentations and/or act as genotoxic agents leading to production strain genetic instability. We have developed a novel dominant deletion (DEL) cassette assay for quantification of DNA damage in both wild-type and industrial yeast strains. Using this assay, the ethanol production strain S. cerevisiae PE-2 was shown to be more resistant to hydrogen peroxide and furfural than the laboratory DEL strain RS112. Indeed, the PE-2 strain also showed a lower tendency for recombination, consistent with a more efficient DNA protection. The dominant DEL assay presented herein should prove to be a useful tool in the selection of robust yeast strains and process conditions for second generation feedstock fermentations.

A systematic review of working conditions and occupational health among immigrants in Europe and Canada

Background

A systematic attempt to summarize the literature that examines working conditions and occupational health among immigrant in Europe and Canada.

Methods

We established inclusion criteria, searched systematically for articles included in the Medline, Embase and Social Sciences Citation Index databases in the period 2000–2016 and checked the reference lists of all included papers.

Results

Eighty-two studies were included in this review; 90% were cross-sectional and 80% were based on self-report. Work injuries were consistently found to be more prevalent among immigrants in studies from different countries and in studies with different designs. The prevalence of perceived discrimination or bullying was found to be consistently higher among immigrant workers than among natives. In general, however, we found that the evidence that immigrant workers are more likely to be exposed to physical or chemical hazards and poor psychosocial working conditions is very limited. A few Scandinavian studies support the idea that occupational factors may partly contribute to the higher risk of sick leave or disability pension observed among immigrants. However, the evidence for working conditions as a potential mediator of the associations between immigrant status and poor general health and mental distress was very limited.

Conclusion

Some indicators suggest that immigrant workers in Europe and Canada experience poorer working conditions and occupational health than do native workers. However, the ability to draw conclusions is limited by the large gaps in the available data, heterogeneity of immigrant working populations, and the lack of prospectively designed cohort studies.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5703-3) contains supplementary material, which is available to authorized users.

Luminance and Color Contrast Sensitivity and Vep Latency in Subjects with Normal and Defective Binocularity

Luminance contrast sinusoidal gratings (spatial frequencies 1, 2 and 4 cycles/degree) were compared with the corresponding color contrasting patterns (along the protan, deutan and tritan axes) to see whether they demonstrated normal binocular function in humans, and distinguished between normals and persons with defective binocularity. Contrast sensitivity and transient pattern VEP latency (on-responses) were measured in normals (n = 11, median age 36, range 12-46 years) and subjects with no stereopsis (n = 6, median age 13, range 8-38 years). The normal group had significantly higher contrast sensitivity with binocular stimulation for all patterns except tritan contrast gratings of 2 and 4 c/deg. The stereo-deficient group showed no higher binocular contrast sensitivity for any pattern. Differences between groups were significant with all gratings of 4 c/deg, and also with protan and deutan contrast gratings of 2 c/deg. In the normal group, binocular VEP latency was significantly shorter than the monocular with protan contrast gratings of 2 c/deg and tritan contrast gratings of 1 and 2 c/deg. Differences between the normal and the stereo-deficient groups were significant for all color contrast patterns of 2 c/deg; and tritan contrast gratings of 1 c/deg. We conclude that color contrast sensitivity and VEP measurements are potentially useful for demonstrating binocular function, and for separating normals from stereo-blind subjects. Color contrast patterns however are less effective than the corresponding luminance contrast patterns in evoking cortical potentials.

Evaluation of clinical outcomes following implantation of a sub-2-mm hydrophilic acrylic MICS intraocular lens

PURPOSE

To evaluate clinical outcomes following sub-2-mm microincision cataract surgery (MICS) and intraocular lens (IOL) implantation.

SETTING

Five EU clinical sites.

DESIGN

Prospective, multicenter, open-label, single-arm, non-randomized.

METHODS

Preoperative assessment involved visual acuity (VA), intraocular pressure and biometry measurements. 1.4-mm wound-assisted or 1.8-mm MICS was performed. Follow-up visits were made 1 day, 1-2 weeks, 1-2 and 4-6 months after surgery. The incision size, corrected distance VA (CDVA), uncorrected distance VA, manifest refraction spherical equivalent (MRSE), refraction predictability/stability and IOL decentration were assessed. At 12-, 18-, and 24-month, long-term centration, posterior capsular opacification (PCO) and Nd:YAG capsulotomy rates were investigated.

RESULTS

A total of 103 eyes were implanted with the study IOL (INCISE, Bausch & Lomb), 96 of which were included in visual outcome analysis. A mean 6-month CDVA of - 0.02 logMAR (20/20 + 1) was observed and 75 eyes (79.8%) and 93 eyes (98.3%) achieved a visual acuity of at least 20/20 or 20/40. Mean MRSE was - 0.20 ± 0.60 D. Mean absolute predictive error was 0.44 ± 0.36 D, with 90.4% within 1.00 D of target. Mean total decentration was 0.35 ± 0.36 mm at 6 months and 0.32 ± 0.14 mm at 24 months (p > 0.05). 24-month evaluation of posterior capsular opacification score was 0.03 for the central area. A Nd:YAG rate of 3.4% was observed at 24 months.

CONCLUSIONS

The new MICS IOL provided excellent visual outcomes and was safe and effective for the sub-2-mm procedure. The MICS IOL demonstrated long-term centration, stability and a low rate of PCO development.

HAA1 and PRS3 overexpression boosts yeast tolerance towards acetic acid improving xylose or glucose consumption: unravelling the underlying mechanisms

Acetic acid tolerance and xylose consumption are desirable traits for yeast strains used in industrial biotechnological processes. In this work, overexpression of a weak acid stress transcriptional activator encoded by the gene HAA1 and a phosphoribosyl pyrophosphate synthetase encoded by PRS3 in a recombinant industrial Saccharomyces cerevisiae strain containing a xylose metabolic pathway was evaluated in the presence of acetic acid in xylose- or glucose-containing media. HAA1 or PRS3 overexpression resulted in superior yeast growth and higher sugar consumption capacities in the presence of 4 g/L acetic acid, and a positive synergistic effect resulted from the simultaneous overexpression of both genes. Overexpressing these genes also improved yeast adaptation to a non-detoxified hardwood hydrolysate with a high acetic acid content. Furthermore, the overexpression of HAA1 and/or PRS3 was found to increase the robustness of yeast cell wall when challenged with acetic acid stress, suggesting the involvement of the modulation of the cell wall integrity pathway. This study clearly shows HAA1 and/or, for the first time, PRS3 overexpression to play an important role in the improvement of industrial yeast tolerance towards acetic acid. The results expand the molecular toolbox and add to the current understanding of the mechanisms involved in higher acetic acid tolerance, paving the way for the further development of more efficient industrial processes.

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

Objective

This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics.

Methods

Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types.

Conclusions

PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.