Facial Rejuvenation Strategy in Asian Women with Autologous Fat Transplantation

OBJECTIVE

To explore the clinical strategy of autologous fat transplantation in facial rejuvenation.

METHODS

From September 2016 to May 2023, 2715 female patients with facial filling by autologous fat were retrospectively analysed. After treatment, they were followed up for 3-6 months to summarize the relationship between aesthetic design and treatment outcomes.

RESULTS

In total, 2306 patients were followed up and completed the questionnaires of satisfactory. Most patients (97%, 2237 cases) achieved satisfactory results after one operation, and about 3% (69 cases) achieved satisfactory results after secondary filling.

CONCLUSION

Autologous fat granule transplantation in the treatment of facial rejuvenation can achieve an excellent therapeutic outcome. Customized design according to the different lineaments, age, and other factors, and extensive use of various treatment methods can achieve better results.

LEVEL OF EVIDENCE III

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 .

Artificial intelligence and different image modalities in uveal melanoma diagnosis and prognosis: A narrative review

BACKGROUND

The most widespread primary intraocular tumor in adults is called uveal melanoma (UM), if detected early enough, it can be curable. Various methods are available to treat UM, but the most commonly used and effective approach is plaque radiotherapy using Iodine-125 and Ruthenium-106.

METHOD

The authors performed searches to distinguish relevant studies from 2017 to 2024 by three databases (PubMed, Scopus, and Google Scholar).

RESULTS

Imaging technologies such as ultrasound (US), fundus photography (FP), optical coherent tomography (OCT), fluorescein angiography (FA), and magnetic resonance images (MRI) play a vital role in the diagnosis and prognosis of UM. The present review assessed the power of different image modalities when integrated with artificial intelligence (AI) to diagnose and prognosis of patients affected by UM.

CONCLUSION

Finally, after reviewing the studies conducted, it was concluded that AI is a developing tool in image analysis and enhances workflows in diagnosis from data and image processing to clinical decisions, improving tailored treatment scenarios, response prediction, and prognostication.

A Systematic Review of Advances in AI-Assisted Analysis of Fundus Fluorescein Angiography (FFA) Images: From Detection to Report Generation

Fundus fluorescein angiography (FFA) serves as the current gold standard for visualizing retinal vasculature and detecting various fundus diseases, but its interpretation is labor-intensive and requires much expertise from ophthalmologists. The medical application of artificial intelligence (AI), especially deep learning and machine learning, has revolutionized the field of automatic FFA image analysis, leading to the rapid advancements in AI-assisted lesion detection, diagnosis, and report generation. This review examined studies in PubMed, Web of Science, and Google Scholar databases from January 2019 to August 2024, with a total of 23 articles incorporated. By integrating current research findings, this review highlights crucial breakthroughs in AI-assisted FFA analysis and explores their potential implications for ophthalmic clinical practice. These advances in AI-assisted FFA analysis have shown promising results in improving diagnostic accuracy and workflow efficiency. However, further research is needed to enhance model transparency and ensure robust performance across diverse populations. Challenges such as data privacy and technical infrastructure remain for broader clinical applications.

Molecular Mechanisms of Vitamin E in Ocular Neurodegenerative Disorders: An Update on the Emerging Evidence and Therapeutic Implications

Vitamin E is renowned for its potent antioxidant properties, crucial for shielding cells against oxidative stress and damage. Deficiency in this vitamin can lead to various health issues, including neurodegenerative diseases, due to its pivotal role in preserving cell membrane integrity and combating cellular oxidative damage. While its importance for overall health, including neurodegeneration, is acknowledged, the specific correlation between vitamin E deficiency and distinct ocular neurodegenerative disorders need to be further explored. This review delves into the molecular mechanisms of vitamin E in ocular neurodegenerative disorders; diabetic retinopathy, age-related macular degeneration, glaucoma, and cataracts, and emphasising the therapeutic implications drawn from existing evidence. Relationship between vitamin E and ocular neurodegenerative disorders is widely researched on, with its primary protective mechanisms attributed to its antioxidant and anti-inflammatory properties. However, studies on the supplementation of vitamin E among human subjects present mixed results, suggesting its complexities and variability depending on factors such as the specific disorder, disease stage, genetic differences, and form of vitamin E utilized. In conclusion, while vitamin E holds promise in mitigating ocular neurodegeneration through its antioxidant and anti-inflammatory properties, its supplementation's efficacy remains nuanced and context dependent. More research works are essential to elucidate its precise role and therapeutic potential in combating various ocular neurodegenerative disorders.

Advances in the Diagnosis and Management of Limbal Stem Cell Deficiency

ABSTRACT

This concise review focuses on the latest advancements in the diagnosis and management of limbal stem cell deficiency (LSCD). Ensuring the standard of care for individuals affected by LSCD involves the crucial task for physicians to meticulously and accurately diagnose the condition and determine its specific stage. A standardized diagnostic approach forms the foundation for formulating and delivering customized therapeutic interventions to maximize treatment outcomes for each patient. In this review, we introduce a systematic diagnostic algorithm to guide the assessment of LSCD. In addition, the current management algorithm and emerging therapies for LSCD are summarized.

Evaluation of macula ganglion cell analysis and retinal nerve fiber layer thickness in preperimetric glaucoma, early stage glaucoma and healthy individuals

PURPOSE

In this study, it was planned to compare the macular ganglion cell analysis (GCA) and peripapillary retinal nerve fiber layer (pRNFL) of the patients with preperimetric glaucoma (PPG), early stage glaucoma (EG) and the control group.

METHODS

This retrospective study included a total of 103 eyes: 38 from EG patients, 30 from PPG patients, and 35 from healthy individuals at Ankara Bilkent City Hospital Glaucoma Unit between January 2018 and September 2021. Eyes were categorized into control, PPG, and EG groups based on visual field (VF) classification. Topcon DRI Optical Coherence Tomography (OCT)-1, a Swept-Source OCT (SS-OCT), measured optic nerve head parameters, pRNFL, gangliyon cell inner plexiform layer (GCIPL), and ganglion cell complex (GCC) thickness. Glaucomatous defects were identified using also the SS-OCT SuperPixel map. Diagnostic efficacy of OCT parameters was assessed through area under the curve (AUC) values.

RESULTS

All pRNFL and ganglion cell parameters in OCT showed significant differences between the control-PPG and control-EG groups (p < 0.05). GCIPL, GCC, and pRNFL thicknesses in the PPG and EG groups were significantly lower than those in the control group (p < 0.05). The mean pRNFL thickness emerged as the most valuable diagnostic parameter for distinguishing between the control and EG groups (p < 0.05). In the wide-field SuperPixel map, the frequency of glaucomatous defect detection was higher in the EG group than in the PPG group (p < 0.05). Mean pRNFL and mean GCIPL thicknesses exhibited the highest sensitivity and specificity for differentiating glaucoma groups from controls.

CONCLUSION

OCT parameters were not significantly superior to each other in control-PPG and control-EG. The evaluation of pRNFL and GCA together is still considered to be the most valid diagnostic method.

Use of the radial forearm free flap in eyelid and orbit defect reconstruction: A systematic review and meta-analysis

BACKGROUND

The radial forearm free flap (RFFF) is widely used in head and neck reconstruction and serves as a versatile option for complex soft tissue eyelid and orbital socket reconstruction, particularly following orbital exenteration. This study evaluated the success and complication rates of RFFF in these contexts.

METHODS

A literature search of the PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal electronic databases was conducted (PROSPERO registration number CRD42024584536).

RESULTS

Twenty-two studies met the inclusion criteria, reporting 40 RFFF procedures in 40 patients (ages: 21-93, M:F 2.1:1). Of these, 65% (n=26) of the RFFFs were used for orbital socket reconstruction, with 75.7% (n=28) performed after cancer resection. The pooled success rate of the RFFFs in orbital and eyelid reconstruction was 92.8% (95% CI, 83.25 to 100, P = 0.39, I² = 5%) and the pooled complication rate was 8.62% (95% CI, 0% to 24.98%, P<0.01, I² = 78%). Flap failure occurred in 10% (n=4) of cases, primarily due to wound dehiscence (n=2).

CONCLUSIONS

RFFFs demonstrate success and complication rates comparable to traditional flaps used in eyelid and orbital reconstruction, such as the anterolateral thigh, rectus abdominis and latissimus dorsi flaps. It offers functional and cosmetic benefits, particularly for reconstruction after orbital exenteration. The RFFF is a reliable option for complex orbital and eyelid reconstructions and should be considered when local options are unavailable. Standardised reporting and further research are needed to validate long-term outcomes and minimise donor site complications.

Augmented Reality Navigation in Craniomaxillofacial/Head and Neck Surgery

Objective

This study aims to (1) develop an augmented reality (AR) navigation platform for craniomaxillofacial (CMF) and head and neck surgery; (2) apply it to a range of surgical cases; and (3) evaluate the advantages, disadvantages, and clinical opportunities for AR navigation.

Study Design

A multi-center retrospective case series.

Setting

Four tertiary care academic centers.

Methods

A novel AR navigation platform was collaboratively developed with Xironetic and deployed intraoperatively using only a head-mounted display (Microsoft HoloLens 2). Virtual surgical plans were generated from computed tomography/magnetic resonance imaging data and uploaded onto the AR platform. A reference array was mounted to the patient, and the virtual plan was registered to the patient intraoperatively. A retrospective review of all AR-navigated CMF cases since September 2023 was performed.

Results

Thirty-three cases were reviewed and classified as either trauma, orthognathic, tumor, or craniofacial. The AR platform had several advantages over traditional navigation including real-time 3D visualization of the surgical plan, identification of critical structures, and real-time tracking. Furthermore, this case series presents the first-known examples of (1) AR instrument tracking for midface osteotomies, (2) AR tracking of the zygomaticomaxillary complex during fracture reduction, (3) mandibular tracking in orthognathic surgery, (4) AR fibula cutting guides for mandibular reconstruction, and (5) integration of real-time infrared visualization in an AR headset for vasculature identification.

Conclusion

While still a developing technology, AR navigation provides several advantages over traditional navigation for CMF and head and neck surgery, including heads up, interactive 3D visualization of the surgical plan, identification of critical anatomy, and real-time tracking.

From molecular design to clinical translation: dual-targeted CAR-T strategies in cancer immunotherapy

The pathogenesis of tumors involves various abnormalities at both the cellular and genetic levels. Chimeric antigen receptor (CAR)-T cell immunotherapy has emerged as a transformative treatment strategy that effectively addresses these challenges. While CAR-T therapy has shown remarkable success in treating hematological malignancies, limitations have been identified, particularly in single antigen-targeting CAR-T therapies. These limitations include antigenic mutation or loss, reduced efficacy against leukemia, and poor results in solid tumors due to factors like low CAR-T cell persistence, limited tumor infiltration, rapid cell exhaustion, the suppressive tumor microenvironment, and heterogeneous tumor antigen expression. In recent years, multi-antigen targeted CAR-T therapies have garnered significant attention for their potential to prevent tumor relapse and progression. This review outlines the fundamental design of dual CAR structures and summarizes the major advancements in both preclinical studies and clinical trials of dual-targeted CAR-T cell therapy, categorized by cancer type. Additionally, it discusses the challenges associated with dual-targeted CAR-T therapy and the strategies to enhance its efficacy and applicability in treating both hematologic and solid tumors. In conclusion, the progress in dual-targeted CAR-T cell therapy presents a promising therapeutic avenue for multiple malignancies, offering insights into future modifications of immunotherapy to advance the field.

Diagnosis, management and outcomes of incarceration or intussusception of Fallopian tubes following uterine perforation after vacuum aspiration or dilatation and curettage of the uterine cavity: a systematic review of the literature

Background

Dilation and curettage and vacuum aspiration are frequently performed gynaecological procedures used to treat uterine pathology. This procedure carries a risk of uterine perforation, which can lead to injury of abdominal organs and, rarely, to fallopian tubes.

Objectives

To evaluate symptoms and diagnostic signs and to propose the most appropriate management for the intussusception and incarceration of fallopian tubes following uterine aspiration and curettage.

Methods

We screened three major databases (Medline, Scopus, Google Scholar) from 2000 to May 2024. Our review examined tubal incarceration, causes, management, symptoms, parity, diagnosis timelines, visceral injury, and surgical complications. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports.

Main Outcome Measures

Diagnostic methods, complications and management of tubal incarceration following uterine perforation.

Results

We identified 24 papers, all of which were case reports or case series. In our analysis, tubal incarceration was observed in 25 of 26 cases (96.2%) and in 2 of which (7.7%) it was associated with the entrapment of the infundibulopelvic ligament. In 1 of 26 cases (3.8%) intussusception of the fallopian tube was observed. The most frequently manifested symptoms were abdominopelvic pain, vaginal bleeding, vaginal discharge and amenorrhoea. The mean time to diagnosis was 15.4 months, with transvaginal ultrasound being the primary diagnostic tool, followed by hysteroscopy and diagnostic laparoscopy.

Conclusions

Diagnosing this condition should involve a detailed medical history, a comprehensive clinical examination, and imaging evaluations. If instrumental investigations are negative but suspicion remains, hysteroscopy and/or laparoscopy may be necessary.

What is New?

Tubal incarceration complicating uterine perforation can be managed using hysteroscopy and laparoscopy.

Fabrication of a 3D Corneal Model Using Collagen Bioink and Human Corneal Stromal Cells

Corneal transplantation remains a critical treatment option for individuals with corneal disorders, but it faces challenges such as rejection, high associated medical costs, and donor scarcity. A promising alternative for corneal replacement involves fabricating artificial cornea from a patient's own cells. Our study aimed to leverage bioprinting to develop a corneal model using human corneal stromal cells embedded in a collagen-based bioink. We generated both cellular and acellular collagen I (COL I) constructs. Cellular constructs were cultured for up to 4 weeks, and gene expression analysis was performed to assess extracellular matrix (ECM) remodeling and fibrotic markers. Our results demonstrated a significant decrease in the expression of COL I, collagen III (COL III), vimentin (VIM), and vinculin (VCL), indicating a dynamic remodeling process towards a more physiologically relevant corneal ECM. Overall, our study provides a foundational framework for developing customizable, corneal replacements using bioprinting technology. Further research is necessary to optimize the bioink composition and evaluate the functional and biomechanical properties of these bioengineered corneas.

Osteogenic function of BMP2-modified PEEK scaffolds for orbital fracture repair

This study aimed to investigate the osteogenic function of polyetheretherketone (PEEK) scaffolds modified with bone morphogenetic protein 2 (BMP2) and its possibility for orbital fracture repair. The 3D-printed PEEK sheets were combined with BMP2-loaded hyaluronic acid hydrogel (HAH) to fabricate PEEK-BMP2-HAH composite scaffolds. Bone marrow mesenchymal stem cells (BMSCs) were seeded onto PEEK or PEEK-BMP2-HAH scaffolds. Cell adhesion and cell proliferation were measured by transmission electron microscopy and CCK-8 assay. Alkaline phosphatase (ALP) chromogenic, alizarine red S staining, and PCR analysis of Runt-related transcription factor 2 (Runx2), collagen-I (Col-I), Osterix, and osteopontin (OPN) were performed to assess osteogenic activity. The rat orbital fracture defect model is proposed for evaluating the biocompatibility, osteogenic integration, and functional recovery of PEEK orbital implants. Compared with PEEK, cell adhesion and cell proliferation were increased in PEEK-BMP2-HAH scaffolds. ALP activity and mineralized nodule formation were increased in PEEK-BMP2-HAH scaffolds than that in PEEK the mRNA expression of Runx2, Osterix, Col-I and OPN was increased on PEEK-BMP2-HAH scaffolds than that on PEEK at 14 d of osteogenic induction. Besides, a bone defect animal model revealed that BMP2-HAH-modified PEEK scaffolds could effectively facilitate the repair of the orbital bone defect, with increased expression of OPN and Runx2. BMP2-loaded HAH effectively increased adhesion, proliferation, and osteogenic differentiation of BMSCs on PEEK. PEEK-BMP2-HAH scaffolds are expected to become new materials for orbital fracture repair.

Advances in Regenerative Medicine, Cell Therapy, and 3D Bioprinting for Corneal, Oculoplastic, and Orbital Surgery

Advances in regenerative medicine, cell therapy, and 3D bioprinting are reshaping the landscape of ocular surgery, offering innovative approaches to address complex conditions affecting the cornea, ocular adnexal structures, and the orbit. These technologies hold the potential to enhance treatment precision, improve functional outcomes, and address limitations in traditional surgical and therapeutic interventions.The cornea, as the eye's primary refractive and protective barrier, is particularly well-suited for regenerative approaches due to its avascular and immune-privileged nature. Cell-based therapies, including limbal stem cell transplantation as well as stromal keratocyte and corneal endothelial cell regeneration, are being investigated for their potential to restore corneal clarity and function in conditions such as limbal stem cell deficiency, keratoconus, and endothelial dysfunction. Simultaneously, 3D bioprinting technologies are enabling the development of biomimetic corneal constructs, potentially addressing the global shortage of donor tissues and facilitating personalized surgical solutions.In oculoplastic and orbital surgery, regenerative strategies and cell therapies are emerging as possible alternatives to conventional approaches for conditions such as eyelid defects, meibomian gland dysfunction, and Graves' orbitopathy. Stem cell-based therapies and bioengineered scaffolds are showing potential in restoring lacrimal glands' function as well as reconstructing complex ocular adnexal and orbital structures. Moreover, 3D-printed orbital implants and scaffolds offer innovative solutions for repairing traumatic, post-tumor resection, and congenital defects, with the potential for improved biocompatibility and precision.Molecular and gene-based therapies, including exosome delivery systems, nanoparticle-based interventions, and gene-editing techniques, are expanding the therapeutic arsenal for ophthalmic disorders. These approaches aim to enhance the efficacy of regenerative treatments by addressing underlying pathophysiological mechanisms of diseases. This chapter provides an overview of these advancements and the challenges of translating laboratory discoveries into effective therapies in clinical practice.

Challenging glaucoma with emerging therapies: an overview of advancements against the silent thief of sight

Glaucoma, a leading cause of irreversible blindness, represents a significant challenge in ophthalmology. This review examines recent advancements in glaucoma treatment, focusing on innovative medications and creative strategies. While new agents offer promising methods for lowering intraocular pressure (IOP), they also pose challenges related to efficacy and side effects. Alongside IOP reduction, emerging neuroprotective approaches are being explored to safeguard retinal ganglion cells (RGCs) from glaucoma-induced damage. The review also evaluates the potential of novel drug delivery systems, such as biodegradable implants and nanoparticles, to enhance treatment effectiveness and patient adherence. Additionally, it highlights the role of personalized medicine in identifying new biomarkers and customizing therapies based on individual genetic and environmental factors.

Complement updates in optic neuritis

Optic neuritis (ON) is an inflammatory condition of the optic nerve associated with demyelinating diseases like multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease. The complement system is crucial in ON pathogenesis, driving blood-optic nerve barrier disruption, inflammation, and tissue damage. This review explores the complement activation pathways-classical, alternative, and lectin-and their roles in ON progression. Key proteins such as C3, C5, and terminal pathway components are highlighted as central to disease mechanisms. Recent advances in complement-targeted therapies, including C1q blockers, C3 and C5 inhibitors, show promising results in clinical and preclinical studies. Novel therapies, like anaphylatoxin receptor blockers and recombinant factor H, expand the treatment landscape, while plasma exchange remains vital for severe, corticosteroid-resistant cases. Challenges remain, such as ON heterogeneity, the long-term safety of complement inhibition, and the need for personalized approaches. Future studies should focus on unraveling complement-mediated mechanisms, identifying biomarkers, and refining therapeutic strategies. This review highlights the critical role of complement in ON and the latest therapeutic advances to improve patient outcomes.

Bringing ophthalmology into the scientific world: Novel nanoparticle-based strategies for ocular drug delivery

The distinctive benefits and drawbacks of various drug delivery strategies to supply corneal tissue improvement for sense organs have been the attention of studies worldwide in recent decades. Static and dynamic barriers of ocular tissue prevent foreign chemicals from entering and inhibit the active absorption of therapeutic medicines. The distribution of different medications to ocular tissue is one of the most appealing and demanding tasks for investigators in pharmacology, biomaterials, and ophthalmology, and it is critical for cornea wound healing due to the controlled release rate and increased drug bioavailability. It should be mentioned that the transport of various types of medications into the different sections of the eye, particularly the cornea, is exceedingly challenging because of its distinctive structure and various barriers throughout the eye. Nanoparticles are being studied to improve medicine delivery strategies for ocular disease. Repetitive corneal drug delivery using biodegradable nanocarriers allows a medicine to remain in different parts of the cornea for extended periods of time and thus improve administration route effectiveness. In this review, we discussed eye anatomy, ocular delivery barriers, as well as the emphasis on the biodegradable nanomaterials ranging from organic nanostructures, such as nanomicelles, polymers, liposomes, niosomes, nanowafers, nanoemulsions, nanosuspensions, nanocrystals, cubosomes, olaminosomes, hybridized NPs, dendrimers, bilosomes, solid lipid NPs, nanostructured lipid carriers, and nanofiber to organic nanomaterials like silver, gold, and mesoporous silica nanoparticles. In addition, we describe the nanotechnology-based ophthalmic medications that are presently on the market or in clinical studies. Finally, drawing on current trends and therapeutic approaches, we discuss the challenges that innovative optical drug delivery systems confront and propose future research routes. We hope that this review will serve as a source of motivation and inspiration for developing innovative ophthalmic formulations.

Analysis of the Correlation Between Cardiac Markers in Post-Mortem Vitreous Humor and the Perimortem Agony Interval

Forensic biochemistry has often relied on the vitreous humor as a matrix for toxicological investigations due to its stability and isolation from post-mortem redistribution processes. Recently, the scope of research has expanded to explore the vitreous humor as a medium reflecting systemic and pathological changes, particularly in its protein composition. This study delves into the detection and quantification of cardiac damage markers such as CK-MB and myoglobin in vitreous humor samples from 45 autopsy cases. For the first time, it demonstrates a statistically significant correlation between these markers and the perimortem agony interval (PAI), defined as the survival time before death. This discovery paves the way for innovative forensic applications, including the estimation of the PAI, a critical parameter for judicial and compensatory assessments. The findings underscore the potential of the vitreous humor as a diagnostic medium, opening new avenues for understanding the systemic dynamics of cardiac markers and the role of the blood-retinal barrier in post-mortem scenarios.

Is there a link between choroidal and retinal parameters in patients with systemic sclerosis? A prospective study

PURPOSE

Systemic sclerosis (SSc) is an autoimmune connective tissue disease. It affects choroid causing reduction in its thickness and volume. The aim of this study has been to get a better insight into the pathogenesis of retinal and choroidal involvement in SSc.

METHODS

This prospective single-center cross-sectional study included 33 patients with SSc and 40 controls. A full ophthalmological and rheumatological assessment was performed. The patients underwent the spectral-domain optical coherence tomography. The thickness of the inner retinal and outer retinal layer (ORL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) was evaluated, as well as the central macular choroidal thickness and choroidal vascularity index (CVI).

RESULTS

The inner retinal thickness did not differ. In the outer retina, slight differences were observed in the thickness of the RPE and ORL within the inner temporal subfield, that were thinner in SSc patients, p<0.05. Choroidal parameters differed between the groups (luminal, stromal, and total choroidal areas; central choroidal thickness, p<0.05 for all). Correlations were found in the SSc patients (diffuse cutaneous systemic sclerosis group: the central macular ORL with the CVI rho=0.47, p=0.042; limited cutaneous systemic sclerosis group: the central macular RPE thickness with the total choroidal area rho=-0,7, p=0038, and with the luminal area: rho=-0,7, p=0036). The univariate regression analyses revealed only few significant associations with low fit of models to the data of the central macular ORL, ONL, RPE with the tested ocular and clinical parameters in the SSc and the controls.

CONCLUSION

It is plausible to assume that, although reduced in the SSc patients, the choroidal blood supply to the outer retina may still be sufficient to maintain its thickness.

H105A peptide eye drops promote photoreceptor survival in murine and human models of retinal degeneration

BACKGROUND

Photoreceptor death leads to inherited blinding retinal diseases, such as retinitis pigmentosa (RP). As disease progression often outpaces therapeutic advances, developing effective treatments is urgent. This study evaluates the efficacy of small peptides derived from pigment epithelium-derived factor (PEDF), which are known to restrict common cell death pathways associated with retinal diseases.

METHODS

We tested chemically synthesized peptides (17-mer and H105A) with affinity for the PEDF receptor, PEDF-R, delivered as eye drops to two RP mouse models: rd10 (phosphodiesterase 6b mutation) and RhoP23H/+ (rhodopsin P23H mutation). Additionally, we engineered AAV-H105A vectors for intravitreal delivery in RhoP23H/+ mice. To assess peptide effects in human tissue, we used retinal organoids exposed to cigarette smoke extract, a model of oxidative stress. Photoreceptor survival, morphology and function were evaluated.

RESULTS

Here we show that peptides 17-mer and H105A delivered via eye drops successfully reach the retina, promote photoreceptor survival, and improve retinal function in both RP mouse models. Intravitreal delivery of a AAV-H105A vector delays photoreceptor degeneration in RhoP23H/+ mice up to six months. In human retinal organoids, peptide H105A specifically prevents photoreceptor death induced by oxidative stress, a contributing factor to RP progression.

CONCLUSIONS

PEDF peptide-based eye drops offer a promising, minimally invasive therapy to prevent photoreceptor degeneration in retinal disorders, with a favorable safety profile.

[Brain and Meningeal Metastases of Lung Cancer Manifested as Brain Calcifications: A Case Report and Literature Review]

Lung cancer is still one of the most common malignant tumors in the world. With the increase of its incidence and the development of medical technology, the overall survival of lung cancer patients has significantly extended compared to before. The incidence of brain and meningeal metastases from lung cancer has also been rising year by year, but patients with brain and meningeal metastases from lung cancer have a poor prognosis and a very high mortality rate, and the diagnosis is mainly based on computed tomography (CT), magnetic resonance imaging (MRI) and other imaging examinations. However, the imaging features are diverse and the specificity is low, which makes it easy to be misdiagnosed and missed. Therefore, accurately identifying brain and meningeal metastases and timely targeted treatment is crucial for improving patient prognosis. This paper analyzed the diagnosis and treatment of a case of lung cancer with no obvious recurrence and metastasis in nearly 7-year long-term follow-up after radical lung cancer surgery, but the patient with abnormal behavior, impaired consciousness and epilepsy in the past 5 months, and multiple punctate calcifications in the brain found by head CT and MRI. This paper consider that the patient's mental and behavioral symptoms were caused by brain and meningeal metastasis of lung cancer after excluding infectious disease and ineffective treatment of autoimmune encephalitis, and further pathological biopsy and genetic detection confirmed the diagnosis of metastatic lung adenocarcinoma with epidermal growth factor receptor (EGFR) L858R gene mutation, and the patient's symptoms were significantly improved after targeted therapy by Osimertinib. This paper also searched the relevant literatures of brain calcifications in databases such as China National Knowledge Infrastructure (CNKI), Wanfang, UpToDate, PubMed, etc., and found that intracerebral calcifications exist in a variety of diseases, including infectious, genetic and neurodegenerative diseases, vascular diseases, metabolic diseases and tumors. However, brain calcification in brain and meningeal metastases are often underestimated, and the consequent risk is misdiagnosis and delayed treatment. Therefore, brain and meningeal metastases manifested as brain calcification should not be ignored in patients with a history of previous tumors.
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Mechanistic insights into CDCA gene family-mediated glioblastoma progression: implications for diagnosis, prognosis, and therapeutic targeting

BACKGROUND

Glioblastoma (GBM) is a highly aggressive brain tumor characterized by poor prognosis and limited therapeutic options. Understanding the molecular mechanisms driving GBM progression is essential for developing more effective diagnostic and therapeutic approaches. Specifically, investigating Cell Division Cycle-Associated (CDCA) genes offers new perspectives on cell cycle regulation and the proliferation of GBM cells, which are key factors in tumor growth and resistance to treatment. These genes have not been extensively studied in GBM, making them a promising area for targeted research and potential therapeutic interventions. This project was launched to elucidate the pathogenic, diagnostic, and therapeutic roles of CDCA genes in GBM.

METHODOLOGY

Total RNA was extracted from GBM cell lines followed by RT-qPCR to analyze the expression of CDCA genes. The expression validation, prognostic significance, and mutational analysis of CDCA genes were performed using various databases. Functional assays, including gene knockdown, colony formation, proliferation, and wound healing, were conducted in U87MG cells to assess the role of CDCA7 and CDCA8 in GBM.

RESULTS

The expression analysis of CDCA genes in 12 GBM cell lines and 6 normal brain cell lines revealed significant overexpression of these genes in GBM. ROC curve analysis demonstrated excellent diagnostic potential, with AUC values of 1 for most genes. This indicates that CDCA gene expression effectively distinguishes GBM cells from normal brain cells. Validation using additional TCGA data confirmed the upregulation of these genes in GBM tumors, with significant association to key cancer-related pathways. Survival analysis showed that higher expression of CDCA genes correlated with poor prognosis in GBM patients. Mutation, CNV, and methylation analyses revealed alterations in these genes, further supporting their role in GBM. Additionally, CDCA gene expression was linked to immune modulation and cell cycle-related functions, suggesting their involvement in immune evasion and tumor proliferation. Knockdown experiments of CDCA7 and CDCA8 in U87MG cells demonstrated a reduction in cell proliferation, colony formation, and migration, highlighting their potential as therapeutic targets.

CONCLUSION

Overall, our findings suggest that CDCA genes could serve as both diagnostic biomarkers and therapeutic targets for GBM.

Construction of a predictive model for the efficacy of anti-VEGF therapy in macular edema patients based on OCT imaging: a retrospective study

Background

Macular edema (ME) is an ophthalmic disease that poses a serious threat to human vision. Anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment for ME due to its safety and high efficacy. However, there are still cases of refractory macular edema and non-responding patients. Therefore, it is crucial to develop automated and efficient methods for predicting therapeutic outcomes.

Methods

We have developed a predictive model for the surgical efficacy in ME patients based on deep learning and optical coherence tomography (OCT) imaging, aimed at predicting the treatment outcomes at different time points. This model innovatively introduces group convolution and multiple convolutional kernels to handle multidimensional features based on traditional attention mechanisms for visual recognition tasks, while utilizing spatial pyramid pooling (SPP) to combine and extract the most useful features. Additionally, the model uses ResNet50 as a pre-trained model, integrating multiple knowledge through model fusion.

Results

Our proposed model demonstrated the best performance across various experiments. In the ablation study, the model achieved an F1 score of 0.9937, an MCC of 0.7653, an AUC of 0.9928, and an ACC of 0.9877 in the test conducted on the first day after surgery. In comparison experiments, the ACC of our model was 0.9930 and 0.9915 in the first and the third months post-surgery, respectively, with AUC values of 0.9998 and 0.9996, significantly outperforming other models. In conclusion, our model consistently exhibited superior performance in predicting outcomes at various time points, validating its excellence in processing OCT images and predicting postoperative efficacy.

Conclusion

Through precise prediction of the response to anti-VEGF therapy in ME patients, deep learning technology provides a revolutionary tool for the treatment of ophthalmic diseases, significantly enhancing treatment outcomes and improving patients' quality of life.

From virtual to reality: innovative practices of digital twins in tumor therapy

BACKGROUND

As global cancer incidence and mortality rise, digital twin technology in precision medicine offers new opportunities for cancer treatment.

OBJECTIVE

This study aims to systematically analyze the current applications, research trends, and challenges of digital twin technology in tumor therapy, while exploring future directions.

METHODS

Relevant literature up to 2024 was retrieved from PubMed, Web of Science, and other databases. Data visualization was performed using R and VOSviewer software. The analysis includes the research initiation and trends, funding models, global research distribution, sample size analysis, and data processing and artificial intelligence applications. Furthermore, the study investigates the specific applications and effectiveness of digital twin technology in tumor diagnosis, treatment decision-making, prognosis prediction, and personalized management.

RESULTS

Since 2020, research on digital twin technology in oncology has surged, with significant contributions from the United States, Germany, Switzerland, and China. Funding primarily comes from government agencies, particularly the National Institutes of Health in the U.S. Sample size analysis reveals that large-sample studies have greater clinical reliability, while small-sample studies emphasize technology validation. In data processing and artificial intelligence applications, the integration of medical imaging, multi-omics data, and AI algorithms is key. By combining multimodal data integration with dynamic modeling, the accuracy of digital twin models has been significantly improved. However, the integration of different data types still faces challenges related to tool interoperability and limited standardization. Specific applications of digital twin technology have shown significant advantages in diagnosis, treatment decision-making, prognosis prediction, and surgical planning.

CONCLUSION

Digital twin technology holds substantial promise in tumor therapy by optimizing personalized treatment plans through integrated multimodal data and dynamic modeling. However, the study is limited by factors such as language restrictions, potential selection bias, and the relatively small number of published studies in this emerging field, which may affect the comprehensiveness and generalizability of our findings. Moreover, issues related to data heterogeneity, technical integration, and data privacy and ethics continue to impede its broader clinical application. Future research should promote international collaboration, establish unified interdisciplinary standards, and strengthen ethical regulations to accelerate the clinical translation of digital twin technology in cancer treatment.

Lipid Nanocarriers as Precision Delivery Systems for Brain Tumors

Brain tumors, particularly glioblastomas, represent the most complicated cancers to treat and manage due to their highly invasive nature and the protective barriers of the brain, including the blood-brain barrier (BBB). The efficacy of currently available treatments, viz., radiotherapy, chemotherapy, and immunotherapy, are frequently limited by major side effects, drug resistance, and restricted drug penetration into the brain. Lipid nanoparticles (LNPs) have emerged as a promising and targeted delivery system for brain tumors. Lipid nanocarriers have gained tremendous attention for brain tumor therapeutics due to multiple drug encapsulation abilities, controlled release, better biocompatibility, and ability to cross the BBB. Herein, a detailed analysis of the design, mechanisms, and therapeutic benefits of LNPs in brain tumor treatment is discussed. Moreover, we also discuss the safety issues and clinical developments of LNPs and their current and future challenges. Further, we also focused on the clinical transformation of LNPs in brain tumor therapy by eliminating side effects and engineering the LNPs to overcome the related biological barriers, which provide personalized, affordable, and low-risk treatment options.

Global research trend of Herpes simplex keratitis: a bibliometric analysis and visualization from 1941 to 2024

Objective

Herpes simplex keratitis (HSK), caused by the herpes simplex virus (HSV), is a leading cause of infectious blindness worldwide. This study aims to explore the research trends, key contributors, and emerging areas of focus in HSK research through bibliometric analysis.

Methods

Publications related to HSK from 1941 to 2024 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric and visual analyses were conducted using VOSviewer, CiteSpace, and R 4.3.3.

Results

A total of 1,076 publications on HSK were identified. The top three contributing countries were the United States (267 papers), China (99), and Japan (64). Harvard University was the leading institution with 75 publications, while the American Journal of Ophthalmology emerged as the most influential journal, boasting an h-index of 29. Kaufman, HE, was the most cited author, with 1,988 citations. The top three keywords were "infection" (82), "stromal keratitis" (73), and "penetrating keratoplasty" (62). Burst keyword analysis indicated a growing interest in terms such as "outcome" and "ultraviolet A" since 2018.

Conclusion

This bibliometric analysis underscores two primary research areas in HSK: the clinical management of stromal keratitis and infection, as well as the mechanisms of HSK recurrence, which include strategies for preventing reactivation and managing immune rejection. Future research is anticipated to focus on innovative treatments, particularly ultraviolet A therapy.

A Comprehensive Exploration of the Biological Effects of Adipose-Derived Stem Cells in the Treatment of Systemic Sclerosis

Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vasculopathy and tissue fibrosis affecting the skin and internal organs. Genetic and environmental factors influence susceptibility, severity, and onset. Current treatments are limited and not always effective, leading researchers to investigate new approaches, such as the use of adipose-derived mesenchymal stem cells (ADSCs) through fat grafting. This review seeks to understand how ADSCs may impact the development and progression of SSc, with a particular focus on how these cells could alter immune responses and reduce fibrosis. ADSCs have been found to affect various immune cells, including T cells, B cells, macrophages, and dendritic cells, by releasing cytokines, chemokines, and growth factors. These interactions generally suppress inflammation and promote a regulatory immune environment. Additionally, ADSCs can influence the extracellular matrix, helping to prevent fibrosis through signaling molecules like exosomes. ADSCs show promise as a treatment for SSc due to their ability to modulate the immune system and reduce fibrosis. Early clinical studies are encouraging, but more research is needed to fully understand how they work and to develop effective treatment protocols.

Renal dysfunction associated with clinical response to intravitreal conbercept therapy for diabetic macular edema

AIM

To investigate the impact of renal dysfunction on clinical response to intravitreal conbercept injection (IVC) for diabetic macular edema (DME).

METHODS

This retrospective study included a total of 100 eyes from 100 patients with DME treated with IVC with 3+PRN regimen. Based on the estimated glomerular filtration rate (eGFR), the patients were divided into normal renal function group (n=37), impaired renal function group (n=27), and renal insufficiency group (n=36). The main outcome measures were best-corrected visual acuity (BCVA) and central subfield macular thickness (CST). Clinical parameters included blood urea nitrogen, serum creatinine, serum uric acid, glycosylated hemoglobin (HbA1c), and hemoglobin.

RESULTS

The mean follow-up time was 3.9mo. The mean number of IVCs was 2.07±1.22 in the three groups. Mean BCVA improved significantly from 0.81±0.49 logMAR at baseline to 0.72±0.52 logMAR in the three groups at the final visit (P<0.001). Mean CST decreased significantly from 427.85±148.99 µm at baseline to 275.31±108.31 µm at final visit (P<0.001). Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group (all P<0.001). Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group (all P<0.001). The three groups had no differences in baseline HbA1c levels (P>0.05). Good baseline BCVA (logMAR, P=0.001) and thicker baseline CST (P=0.041) were associated with visual acuity improvement. Higher eGFR (P<0.001), hemoglobin (P=0.032) and thicker baseline CST (P=0.017) were associated with macular edema retrogression in the conbercept-treated diabetic patients, which showed better anatomical response to IVC.

CONCLUSION

Our results indicate that the renal dysfunction is the risk factor associated with the efficacy of IVC for DME.

Timeframe to Keratoplasty After Ocular Surface Stem Cell Transplantation

PURPOSE

The aim of this study is to report the actual time delay between ocular surface stem cell transplantation (OSST) and keratoplasty at a high-volume center for limbal stem cell deficiency (LSCD). Understanding expected timelines and reasons for any delays or deferrals can allow for more accurate expectation-setting discussions with prospective patients.

METHODS

A retrospective chart review was performed on all patients having undergone OSST between January 2013 and December 2022. Charts were reviewed to determine whether the need for keratoplasty was specified at the time of OSST planning. Parameters for these cases were then collected including underlying diagnoses, type of OSST performed, and time delay between OSST and keratoplasty (if performed). Results were then aggregated, and subgroup analysis was conducted.

RESULTS

A total of 219 eyes were included, of which, 128 eyes had initial intent for keratoplasty. Of these, 48% had keratoplasty within 6 months of OSST, 17% between 6 and 24 months, 5% beyond 2 years, and, interestingly, 30% had no subsequent keratoplasty. Most eyes with no eventual keratoplasty experienced unanticipated stromal clearing after OSST obviating the need for keratoplasty.

CONCLUSIONS

This is the first study to report realized time delay between OSST and keratoplasty at a large LSCD practice. Prospective patients can be counselled that 76% of compliant cases with initial intent for keratoplasty either had keratoplasty within 6 months or exhibited unanticipated stromal clearing after OSST alone. Patients with congenital aniridia or contact lens-related LSCD are more likely to have unanticipated stromal clearing.

Optical Imaging of Cilia in the Head and Neck

Background/Objectives: Cilia are hair-like organelles with various mechanosensory and chemosensory functions. In particular, motile cilia generate directional fluid flow important for multiple processes. Motile ciliopathies have serious clinical implications, including developmental and respiratory disorders. Evaluating the most suitable imaging methods for studying ciliary structure and function has great clinical significance. Methods: Here, we provide an overview of ciliary function, imaging modalities, and applications in ciliopathic diseases. Results: Optical imaging has become a crucial tool for studying ciliary structure and function, providing high-resolution, non-invasive imaging capabilities that are valuable for in vivo applications. Optical coherence tomography (OCT) is well suited for the visualization of ciliary anatomy and quantitative studies of microfluidic flow. Conclusions: A deeper understanding of ciliary biology can lead to novel approaches in diagnosing, treating, and monitoring ciliopathies, contributing to more effective and individualized care.

Lamellar keratoplasty using acellular porcine corneal stroma for the treatment of corneal ulcers

Objective

The study aimed to investigate the efficacy and safety of acellular porcine corneal stroma (APCS) for lamellar keratoplasty in the treatment of corneal ulcers.

Methods

A total of 14 patients (14 eyes) diagnosed with corneal ulcers who underwent lamellar keratoplasty using acellular porcine corneal stroma at the Second Affiliated Hospital of Nanchang University between June 2016 and May 2017 were recruited and followed up for at least 12 months. Postoperative visual acuity, epithelial recovery, graft transparency, the recurrence rate of corneal ulcers, the rate of graft rejection, corneal neovascularization, graft infection, secondary glaucoma, and graft melting were examined and analyzed.

Results

All 14 patients (100%) who underwent lamellar keratoplasty using acellular porcine corneal stroma successfully preserved the structure of their eyeballs. The visual acuity improved in 11 patients (78.5%). Graft rejection occurred in one patient (7.1%), while two patients (14.3%) developed recurrent corneal ulcers. Corneal vessel ingrowth was observed in seven patients (50%), and one patient (7.1%) developed pseudopterygium. The average time for complete epithelial recovery was 3-7 days.

Conclusion

Lamellar keratoplasty using acellular porcine corneal stroma is an effective surgical alternative for the treatment of corneal ulcers.

Mitochondrial DNA Pathogenic Variants in Ophthalmic Diseases: A Review

Mitochondria are vital organelles responsible for ATP production and metabolic regulation, essential for energy-intensive cells such as retinal ganglion cells. Dysfunction in mitochondrial oxidative phosphorylation or mitochondrial DNA (mtDNA) pathogenic variants can disrupt ATP synthesis, cause oxidative stress, and lead to cell death. This has profound implications for tissues such as the retina, optic nerve, and retinal pigment epithelium, which are dependent on robust mitochondrial function. In this review, we provide a comprehensive compilation of pathogenic variants in the mtDNA associated with various ophthalmic diseases, including Leber's hereditary optic neuropathy, chronic progressive external ophthalmoplegia, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, among others. We highlight the genetic variants implicated in these conditions, their pathogenic roles, and the phenotypic consequences of mitochondrial dysfunction in ocular tissues. In addition to well-established mutations, we also discuss the emerging evidence of the role of mtDNA's variants in complex multifactorial diseases, such as non-arteritic anterior ischemic optic neuropathy, primary open-angle glaucoma, and age-related macular degeneration. The review aims to serve as a valuable resource for clinicians and researchers, providing a detailed overview of mtDNA pathogenic variants and their clinical significance in the context of mitochondrial-related eye diseases.

CAR T cell therapy for glioblastoma: A review of the first decade of clinical trials

Glioblastoma (GBM) is an aggressive primary brain tumor with a poor prognosis and few effective treatment options. Focus has shifted toward using immunotherapies, such as chimeric antigen receptor (CAR) T cells, to selectively target tumor antigens and mediate cytotoxic activity within an otherwise immunosuppressive tumor microenvironment. Between 2015 and 2024, the results of eight completed and two ongoing phase I clinical trials have been published. The majority of studies have treated recurrent GBM patients, although the inter- and intra-patient tumor heterogeneity has been historically challenging to overcome. Molecular targets have included EGFR, HER2, and IL13Rα2 and there has been continued development in improving receptor constructs, identifying novel targets, and adding adjuvant enhancers to increase efficacy. CAR T cells have been safely administered through both peripheral and locoregional routes but with variable clinical and radiographic efficacy. Most trials utilized autologous T cell products to avoid immune rejection yet were unable to consistently show robust engraftment and persistence within patients. Nonetheless, targeted immunotherapies such as CAR T cell therapy remain the next frontier for GBM treatment, and the popularity and complexity of this undertaking is evident in the past, present, and future landscape of clinical trials.

TMED9: a potential therapeutic target and prognostic marker in glioma and its implications across pan-cancer contexts

Background

The escalating global cancer burden, projected to reach 35 million new cases by 2050, underscores the urgent need for innovative cancer biomarkers to improve treatment efficacy and patient outcomes. The TMED family, particularly TMED9, has garnered attention for its involvement in cancer progression; however, its comprehensive role across various cancer types remains poorly understood.

Methods

Utilizing multi-omics data, we analyzed the expression pattern, prognostic significance, genomic alterations, and immunological features of TMED9 in various cancer types. Through in vitro experiments, we paid special attention to its role in glioma, especially its correlation with glioma cell migration and invasion behavior.

Results

Our findings reveal that TMED9 is significantly overexpressed in various tumor tissues and is associated with poor prognosis in cancers such as glioblastoma and lower-grade gliomas. Genetic analysis shows TMED9 mutations predominantly in kidney renal clear cell carcinoma, with its expression linked to chromosomal instability. Immunological analysis indicates that TMED9 correlates positively with immune cell infiltration, particularly macrophages, suggesting its role in promoting tumor immunity. Furthermore, TMED9 expression was negatively correlated with tumor stemness, indicating its potential influence on chemotherapy resistance. Knockdown of TMED9 led to reduced migration and invasion in glioma cell lines.

Conclusions

Our comprehensive analysis positions TMED9 as a critical player in cancer progression and immune modulation, especially in gliomas. Elevated TMED9 expression correlates with poorer outcomes and may serve as a prognostic marker and therapeutic target. Future research should focus on elucidating TMED9's mechanistic pathways and validating its role in clinical settings to enhance glioma treatment strategies.

Correlation of visual acuity changes and optical coherence tomography imaging in patients with central retinal artery occlusion post-arterial thrombolysis

This retrospective study investigates the correlation between visual acuity changes and structural modifications observed through optical coherence tomography (OCT) in patients with central retinal artery occlusion (CRAO) treated with urokinase. Conducted at the Neuro-Ophthalmology Center of Xi'an People's Hospital from January 2022 to May 2023, the study included 217 CRAO patients (217 eyes), comprising 157 males and 60 females, aged 18 to 83 years (mean age: 57.8 ± 13.3 years). Key data were collected on visual acuity, ocular motility, and various imaging techniques at admission and post-thrombolysis. Results showed a significant improvement in visual acuity from 2.4 ± 0.5 to 1.9 ± 0.7 (P < 0.001) after treatment. Notably, patients with severe retinal damage had poorer visual recovery compared to those with milder damage. OCT analysis revealed a decrease in macular foveal retinal thickness from 415.5 ± 107.7 μm to 362.1 ± 93.8 μm (P < 0.001). Correlation analysis confirmed an association between visual acuity and retinal thickness (P < 0.001). Inter-observer variability for OCT grading was assessed using Cohen's Kappa, which yielded a Kappa value of 0.873 (P < 0.001). This study underscores the relationship between visual recovery and retinal structural changes in CRAO patients, emphasizing the efficacy of urokinase treatment, particularly in mild to moderate cases, and the need for personalized therapeutic strategies based on condition severity.

Important role of endoscope in tuberculum sellae meningioma resection via supraorbital keyhole approach

BACKGROUND

Tuberculum sellae meningiomas pose a surgical challenge due to the tumor adhesion to vital structures. In many cases, tumor residue and dural tail sign may contribute to an opportunity for future recurrence.

METHODS

In this study, we introduced endoscopic technique in supraorbital keyhole approach to further resected residual tumor and dural attachments that are traditionally difficult to detect under microscopic surgery, and finally achieved Simpson Grade II resection.

CONCLUSION

The use of endoscopy offers enhanced visualization and ensures more reliable Simpson Grade II resection outcomes for tuberculum sellae meningiomas.

Diabetic Retinopathy (DR): Mechanisms, Current Therapies, and Emerging Strategies

Diabetic retinopathy (DR) is one of the most prevalent complications of diabetes, affecting nearly one-third of patients with diabetes mellitus and remaining a leading cause of blindness worldwide. Among the various diabetes-induced complications, DR is of particular importance due to its direct impact on vision and the irreversible damage to the retina. DR is characterized by multiple pathological processes, primarily a hyperglycemia-induced inflammatory response and oxidative stress. Current gold standard therapies, such as anti-VEGF injections and photocoagulation, have shown efficacy in slowing disease progression. However, challenges such as drug resistance, partial therapeutic responses, and the reliance on direct eye injections-which often result in low patient compliance-remain unresolved. This review provides a comprehensive overview of the underlying molecular mechanisms in DR, the current therapies, and their unmet needs for DR treatment. Additionally, emerging therapeutic strategies for improving DR treatment outcomes are discussed.

Treatment-induced ripple effect: a systematic review exploring the abscopal phenomenon in Glioblastoma multiforme

PURPOSE

This systematic review aimed to collate and synthesize the available literature on the abscopal effect in Glioblastoma multiforme (GBM) neoplasms, focusing on the reported biochemical mechanisms driving the abscopal effect.

METHODS

A systematic search was conducted in PubMed, Cochrane Database of Systematic Reviews, and Epistemonikos from inception to May 1, 2023. Studies exploring the abscopal effect in GBM were included. The Clinical Relevance Assessment of Animal Preclinical research (RAA) tool was used to assess methodological quality of preclinical studies. Data on preclinical models, biochemical mechanisms, and outcomes were extracted and synthesized systrmatically.

RESULTS

Out of a total of 7 studies, five preclinical studies met the inclusion criteria. The studies utilized various in vivo mouse models, including bilateral tumor models and immunohumanized mice. Key biochemical mechanisms identified included immunogenic cell death, danger-associated molecular pattern release, macrophage activation, and enhanced T cell responses. Combinatorial approaches involving oncolytic virotherapy, nanoparticle-based treatments, radiation therapy, and immune checkpoint inhibitors showed promise in inducing abscopal effects. Significant tumor growth inhibition and improved survival were reported in treated animals. However, the RAA analysis highlighted concerns regarding research transparency and internal validity across studies.

CONCLUSIONS

This systematic review highlighted the potential of the abscopal effect in GBM, demonstrating its ability to enhance anti-tumor immune responses both locally and systemically. The synergistic effects of combinatorial approaches showed promise for improving outcomes. However, the low methodological quality of existing studies underscored the need for more rigorous preclinical research. Future studies should focus on improving research transparency, exploring the abscopal effect in other primary CNS neoplasms, and translating these findings into clinical trials to assess safety and efficacy in humans.

Comparability analysis of the HNT-1P Huvitz non contact tonometer for the measurement of intraocular pressure

PURPOSE

To evaluate the diagnostic validity of the HNT-1P non-contact tonometer (Huvitz) as a tool for accurately measuring intraocular pressure (IOP) in patients with healthy eyes, compared to the Goldmann applanation tonometer (GAT), which is the Gold Standard method for measurement of IOP.

METHODS

Observational, descriptive, transversal study using 148 eyes of 74 healthy patients without a diagnosis of glaucoma or other ophthalmological diseases. Three measurements of IOP were taken in each eye, using three tonometers: HNT-1P, ICR100, and GAT. The median IOP (quartiles) and mean IOP (SD) its statistical significance were calculated, and comparisons were made between the mean and median IOP values found in three groups: GAT-HNT, GAT-ICR, and HNT-ICR. The difference in mean and median IOP was analyzed in each of the three study groups, and its statistical significance and concordance correlation coefficient (CCC) were calculated.

RESULTS

The median IOP with HNT-1P was statistically significantly lower than the median IOP with GAT, (1.1 mmHg, p < 0.001). The median IOP with HNT-1P was also lower than the median IOP with ICR100. As an additional result, the median IOP with GAT was lower than the median IOP with ICR. The CCC was moderate for HNT-ICR (0.72) and low for GAT-HNT and GAT-ICR (0.43 and 0.38, respectively).

CONCLUSIONS

HNT-1P (Huvitz) provides statistically significantly lower IOP values than those obtained with GAT. HNT-1P could be used for screening of ocular hypertension in postoperative patients. The IOP measurement obtained with HNT-1P should be confirmed with GAT. HNT-1P yields lower IOP values than those obtained with ICR.

Adverse Events in a Mobile Eye Health Outreach Program

This survey study describes the postprocedure conditions experienced by individuals who received eye screening from the mobile Casey Outreach Program clinics in Oregon.

Exploring miRNA therapies and gut microbiome-enhanced CAR-T cells: advancing frontiers in glioblastoma stem cell targeting

Glioblastoma multiforme (GBM) presents a formidable challenge in oncology due to its aggressive nature and resistance to conventional treatments. Recent advancements propose a novel therapeutic strategy combining microRNA-based therapies, chimeric antigen receptor-T (CAR-T) cells, and gut microbiome modulation to target GBM stem cells and transform cancer treatment. MicroRNA therapies show promise in regulating key signalling pathways implicated in GBM progression, offering the potential to disrupt GBM stem cell renewal. CAR-T cell therapy, initially successful in blood cancers, is being adapted to target GBM by genetically engineering T cells to recognise and eliminate GBM stem cell-specific antigens. Despite early successes, challenges like the immunosuppressive tumour microenvironment persist. Additionally, recent research has uncovered a link between the gut microbiome and GBM, suggesting that gut dysbiosis can influence systemic inflammation and immune responses. Novel strategies to modulate the gut microbiome are emerging, enhancing the efficacy of microRNA therapies and CAR-T cell treatments. This combined approach highlights the synergistic potential of these innovative therapies in GBM treatment, aiming to eradicate primary tumours and prevent recurrence, thereby improving patient prognosis and quality of life. Ongoing research and clinical trials are crucial to fully exploit this promising frontier in GBM therapy, offering hope to patients grappling with this devastating disease.

Latest trends & strategies in ocular drug delivery

Ocular drug delivery is one of the most challenging routes of administration, and this may be attributed to the complex interplay of ocular barriers and clearance mechanisms that restrict therapeutic payload residence. Most of the currently approved products that ameliorate ocular disease conditions are topical, i.e., delivering therapeutics to the outside anterior segment of the eye. This site of administration works well for certain conditions such as local infections but due to the presence of numerous ocular barriers, the permeation of therapeutics to the posterior segment of the eye is limited. Conditions such as age-related macular degeneration and diabetic retinopathy that contribute to an extreme deterioration of vision acuity require therapeutic interventions at the posterior segment of the eye. This necessitates development of intraocular delivery systems such as intravitreal injections, implants, and specialized devices that deliver therapeutics to the posterior segment of the eye. Frequent dosing regimens and high concentration formulations have been strategized and developed to achieve desired therapeutic outcomes by overcoming some of the challenges of drug clearance and efficacy. Correspondingly, development of suitable delivery platforms such as biodegradable and non-biodegradable implants, nano delivery systems, and implantable devices have been explored. This article provides an overview of the current trends in the development of suitable formulations & delivery systems for ocular drug delivery with an emphasis on late-stage clinical and approved product. Moreover, this work aims to summarize current challenges and highlights exciting pre-clinical developments, and future opportunities in cell and gene therapies that may be explored for effective ocular therapeutic outcomes.

The Properties and Applicability of Bioprinting in the Field of Maxillofacial Surgery

Perhaps the most innovative branch of medicine is represented by regenerative medicine. It deals with regenerating or replacing tissues damaged by disease or aging. The innovative frontier of this branch is represented by bioprinting. This technology aims to reconstruct tissues, organs, and anatomical structures, such as those in the head and neck region. This would mean revolutionizing therapeutic and surgical approaches in the management of multiple conditions in which a conspicuous amount of tissue is lost. The application of bioprinting for the reconstruction of anatomical areas removed due to the presence of malignancy would represent a revolutionary new step in personalized and precision medicine. This review aims to investigate recent advances in the use of biomaterials for the reconstruction of anatomical structures of the head-neck region, particularly those of the oral cavity. The characteristics and properties of each biomaterial currently available will be presented, as well as their potential applicability in the reconstruction of areas affected by neoplasia damaged after surgery. In addition, this study aims to examine the current limitations and challenges and to analyze the future prospects of this technology in maxillofacial surgery.

Enhancing Ophthalmic Diagnosis and Treatment with Artificial Intelligence

The integration of artificial intelligence (AI) in ophthalmology is transforming the field, offering new opportunities to enhance diagnostic accuracy, personalize treatment plans, and improve service delivery. This review provides a comprehensive overview of the current applications and future potential of AI in ophthalmology. AI algorithms, particularly those utilizing machine learning (ML) and deep learning (DL), have demonstrated remarkable success in diagnosing conditions such as diabetic retinopathy (DR), age-related macular degeneration, and glaucoma with precision comparable to, or exceeding, human experts. Furthermore, AI is being utilized to develop personalized treatment plans by analyzing large datasets to predict individual responses to therapies, thus optimizing patient outcomes and reducing healthcare costs. In surgical applications, AI-driven tools are enhancing the precision of procedures like cataract surgery, contributing to better recovery times and reduced complications. Additionally, AI-powered teleophthalmology services are expanding access to eye care in underserved and remote areas, addressing global disparities in healthcare availability. Despite these advancements, challenges remain, particularly concerning data privacy, security, and algorithmic bias. Ensuring robust data governance and ethical practices is crucial for the continued success of AI integration in ophthalmology. In conclusion, future research should focus on developing sophisticated AI models capable of handling multimodal data, including genetic information and patient histories, to provide deeper insights into disease mechanisms and treatment responses. Also, collaborative efforts among governments, non-governmental organizations (NGOs), and technology companies are essential to deploy AI solutions effectively, especially in low-resource settings.

The Modulatory Role of Bioactive Compounds in Functional Foods on Inflammation and Metabolic Pathways in Chronic Diseases

Chronic diseases are major contributors to global morbidity and mortality. More than 70% of deaths worldwide are caused by chronic diseases, including cardiovascular diseases (CVDs), obesity, type 2 diabetes, and cancer. These diseases are characterised by chronic low-grade inflammation and metabolic dysregulation. Incorporating functional foods into daily diet has been suggested as a complementary strategy to promote health and lower the risk of non-communicable diseases. Functional foods, known as foods that confer health benefits beyond basic nutrition, have been reported to exhibit preventive and therapeutic benefits such as anti-inflammatory properties for human health. Therefore, the aim of this state-of-the-art review will synthesise the findings from recent and high-quality studies that investigated the modulatory role of some commonly reported bioactive active compounds, such as polyphenols, omega-3 fatty acids, probiotics, and prebiotics, in inflammation and metabolic pathways.

Increased risk of chronic diseases and multimorbidity in middle-aged and elderly individuals with early vision, hearing, or dual sensory impairments: insights from prospective cohort studies and Mendelian randomization analysis

BACKGROUND

Sensory impairments (SI), including vision (VI), hearing (HI), and dual sensory impairments (DSI), are prevalent with aging, but their impact on disease risk remains unclear. This study investigates the epidemiological and genetic associations between SIs and 10 chronic disease categories and multimorbidity.

METHODS

Using the CHARLS study, participants were classified by their self-reported VI/HI/DSI status in 2011 and 2013 into groups: "new onset, remission, persistent, and no SI." Their chronic disease incidence was tracked until 2018 in sub-cohorts respectively. Mendelian randomization (MR) analyses used genetic instruments from UK Biobank GWAS data on 88,250/504,307 individuals for vision/hearing loss, with outcome datasets from consortia including FinnGen, DIAMANTE, CKDGen, PGC, GWAS Catalog, and International Parkinson's Disease Genomics Consortium.

RESULTS

The cohort study revealed that persistent HI significantly increased the risk of heart disease (P < 0.001, HR 1.63, 95% CI 1.31-2.03), stroke (P 0.004, HR 1.59, 95% CI 1.16-2.18), chronic lung disease (P 0.002, HR 1.53, 95% CI 1.17-1.99), and emotional, nervous, or psychiatric problems (P 0.016, HR 2.03, 95% CI 1.14-3.60). Persistent VI was significantly associated with diabetes or high blood sugar (DM/Hglu) (P 0.012, HR 1.63, 95% CI 1.11-2.38) and chronic lung disease (P 0.042, HR 1.53, 95% CI 1.02-2.31). MR confirmed these strong or suggestive associations, indicating that HI significantly increased the risk of cardiovascular and cerebrovascular events by 61-170%, bronchitis by 160%, and schizophrenia by 36%. In addition, VI significantly raised the risk of hyperglycemia or diabetes by 2-4% and the risk of lung function decline. Additionally, cohort studies confirmed that early DSI significantly raised the risk of multiple diseases, while MR identified genetic links between VI and hepatic failure, Parkinson's, and Alzheimer's disease, and between HI and hypertension, chronic kidney disease, and renal failure.

CONCLUSIONS

This study provides evidence from epidemiological or genetic perspectives demonstrates that early exposure to HI/VI/DSI increases the risk of developing chronic diseases. These findings underscore the need for continuous monitoring and timely intervention for SI to manage chronic disease risks in aging populations.

Preclinical Retinal Disease Models: Applications in Drug Development and Translational Research

Retinal models play a pivotal role in translational drug development, bridging preclinical research and therapeutic applications for both ocular and systemic diseases. This review highlights the retina as an ideal organ for studying advanced therapies, thanks to its immune privilege, vascular and neuronal networks, accessibility, and advanced imaging capabilities. Preclinical retinal disease models offer unparalleled insights into inflammation, angiogenesis, fibrosis, and hypoxia, utilizing clinically translatable bioimaging tools like fundoscopy, optical coherence tomography, confocal scanning laser ophthalmoscopy, fluorescein angiography, optokinetic tracking, and electroretinography. These models have driven innovations in anti-inflammatory, anti-angiogenic, and neuroprotective strategies, with broader implications for systemic diseases such as rheumatoid arthritis, Alzheimer's, and fibrosis-related conditions. By emphasizing the integration of the 3Rs principles and novel imaging modalities, this review highlights how retinal research not only enhances therapeutic precision but also minimizes ethical concerns, paving the way for more predictive and human-relevant approaches in drug development.

Targeting GDF15 to enhance immunotherapy efficacy in glioblastoma through tumor microenvironment-responsive CRISPR-Cas9 nanoparticles

Despite the outstanding clinical success of immunotherapy, its therapeutic efficacy in glioblastoma (GBM) is still limited. To identify critical regulators of GBM immunity, we constructed a mouse single-guide RNA (sgRNA) library corresponding to all disease-related immune genes, and performed an in vivo CRISPR knockout (KO) screen in syngeneic GBM mouse models. We demonstrated that the deletion of GDF15 in GBM cells ameliorated the immunosuppressive tumor microenvironment (TME) and enhanced the antitumor efficacy of immune checkpoint blockade (ICB) response. Moreover, we designed unique nanoparticles for efficient encapsulation of CRISPR-Cas9, noninvasive brain delivery and tumor cell targeting, demonstrating an effective and safe strategy for GDF15 gene therapy. The CRISPR-Cas9 nanoparticles, known as ANPSS (Cas9/sgRNA), are easily created by enclosing a single Cas9/sgRNA complex in a polymer shell that is sensitive to glutathione. This shell also contains a dual-action ligand that aids in crossing the blood‒brain barrier, targeting tumor cells, and selectively releasing Cas9/sgRNA. Our encapsulating nanoparticles demonstrated promising GBM targeting, resulting in high GDF15 gene editing efficiency within brain tumors while showing minimal off-target gene editing in high-risk tissues. Treatment with ANPSS (Cas9/sgGDF15) effectively halted tumor growth, reversed immune suppression, and enhanced the efficacy of ICB therapy. These results emphasize the potential role of GDF15 in modulating the immune microenvironment and enhancing the effectiveness of current immunotherapy strategies for GBM.

Progress in Drug Delivery Systems Based on Nanoparticles for Improved Glioblastoma Therapy: Addressing Challenges and Investigating Opportunities

Glioblastoma multiforme (GBM) is a highly malignant brain tumor that has a bleak outlook despite existing treatments such as surgery, radiation, and chemotherapy. The utilization of nanoparticles for drug delivery presents a promising method by which to improve the effectiveness of treatment while reducing the harmful effects on the entire body. This review examines the application of nanoparticles in the treatment of GBM, focusing on different types of nanoparticles, including lipid-based, polymeric, metallic, and those under development. Every variety is analyzed for its distinct characteristics and therapeutic capacity. Lipid-based nanoparticles, such as liposomes and solid lipid nanoparticles, enhance the transport of medicines that are not soluble in water and have shown considerable potential in preclinical investigations. Polymeric nanoparticles have benefits in terms of controlled release and targeted distribution, whereas metallic nanoparticles have potential in both therapy and imaging. In the current review we would like to emphasize the ways in which nanoparticles improve medicine delivery, specifically by enhancing penetration of the blood-brain barrier (BBB), targeting tumors, and enabling controlled release. Additionally, we also discuss current preclinical and clinical discoveries, highlighting both achievements and obstacles in the process of converting these technologies into effective treatments for GBM. This study offers a thorough examination of the present status and prospects of nanoparticles in the treatment of GBM.

Risk factors of developing non-arteric ischemic optic neuropathy in patients with type 2 diabetes mellitus: a single-center retrospective cohort study

AIM

To determine the risk factors and time to non-arteric ischemic optic neuropathy (NAION) occurrence among Thai type 2 diabetes mellitus (T2DM) patients.

METHODS

A retrospective review of 266 newly diagnosed T2DM cases at Rajavithi Hospital between 2007 and 2016 was conducted to determine time to occurrence of NAION and evaluate associated risk factors.

RESULTS

Hypertension and dyslipidemia were the most common pre-existing vascular diseases and there was a significant male predominance in the NAION group. The mean age of the NAION group was significantly higher than that of the group without NAION. A higher proportion of subjects in the NAION group had hypertension, dyslipidemia, high diastolic blood pressure, smokers, and had a small cup-to-disc ratio (CDR). Higher levels of triglycerides and low-density lipoprotein-cholesterol in the group with NAION. Fifty-five patients among 266 participants (20.68%) developed NAION during a mean follow-up time of 81.26±25.04mo. In a multivariable logistic regression analysis, dyslipidemia (OR=8.36, 95%CI, 3.447-20.273, P<0.001), high low density lipoprotein levels (OR=1.017, 95%CI, 1.004-1.029, P=0.009), and small CDR (OR=11.92, 95%CI, 4.477-31.741, P<0.001) were significant risk factors for NAION development. Smoking was the strongest predictive risk (OR=12.843, 95%CI, 3.959-41.659, P<0.001). Vascular complications of T2DM and aspirin were not associated with NAION.

CONCLUSION

T2DM patients with dyslipidemia or a small CDR should be carefully followed up as they are at increased risk of developing NAION.

Gas Plasma Technology and Immunogenic Cell Death: Implications for Chordoma Treatment

Cancer is the second-leading cause of death in developed societies. Specifically, cancers of the spine and brain come with significant therapeutic challenges. Chordomas are semi-malignant tumors that develop from embryonic residuals at the skull base (clival) or coccyx (sacral). Small tumor fragments can remain in the operation cavities during surgical resection, forming new tumor sites. This requires repeated surgeries or the application of proton-beam radiation and chemotherapy, which often do not lead to complete remission of the tumors. Hence, there is a need for novel therapeutic avenues that are not limited to killing visible tumors but can be applied after surgery to decrease chordoma recurrences. Reactive oxygen species (ROS) generated locally via novel medical gas plasma technologies are one potential approach to address this clinical problem. Previously, broad-spectrum free radicals generated by these cold physical plasmas operated at about body temperature were shown to oxidize cancer cells to the disadvantage of their growth and induce immunogenic cancer cell death (ICD), ultimately promoting anticancer immunity. This review outlines the clinical challenges of chordoma therapy, how medical gas plasma technology could serve as an adjuvant treatment modality, and potential immune-related mechanisms of action that could extend the longevity of gas plasma therapy beyond its acute local tissue effects.