Decoding the heterogeneous subpopulations of glioblastoma for prognostic stratification and uncovering the promalignant role of PSMC2

Glioblastoma (GBM), a highly heterogeneous and aggressive brain tumor, presents significant clinical challenges due to its frequent recurrence and poor prognosis. In this study, we employed high-dimensional weighted gene co-expression network analysis (hd-WGCNA) and single-cell transcriptomic analysis to investigate the molecular heterogeneity of GBM. We identified functional gene modules associated with tumor cell subpopulations exhibiting highly malignant traits, particularly linked to proteasome dysregulation. Intercellular communication analysis revealed extensive interactions between malignant tumor subpopulations and tumor microenvironment (TME), highlighting critical crosstalk with tumor-associated macrophages (TAMs) and T cells. Using machine learning, we developed risk scores based on these malignant gene modules, which effectively stratify GBM patients by prognosis and treatment response, particularly in relation to immunotherapy. Furthermore, we systematically evaluated pathway enrichment, genomic variations, and drug response differences across risk groups. Finally, we validated the oncogenic role of PSMC2, a key gene in the proteasome complex, demonstrating its role in promoting GBM progression through cell proliferation, invasion, and epithelial-mesenchymal transition (EMT). Our findings provide novel insights into GBM heterogeneity, prognosis, and therapeutic strategies, suggesting PSMC2 as a potential therapeutic target.

Revolutionizing diabetic retinopathy screening and management: The role of artificial intelligence and machine learning

Diabetic retinopathy (DR) remains a leading cause of vision impairment and blindness among individuals with diabetes, necessitating innovative approaches to screening and management. This editorial explores the transformative potential of artificial intelligence (AI) and machine learning (ML) in revolutionizing DR care. AI and ML technologies have demonstrated remarkable advancements in enhancing the accuracy, efficiency, and accessibility of DR screening, helping to overcome barriers to early detection. These technologies leverage vast datasets to identify patterns and predict disease progression with unprecedented precision, enabling clinicians to make more informed decisions. Furthermore, AI-driven solutions hold promise in personalizing management strategies for DR, incorporating predictive analytics to tailor interventions and optimize treatment pathways. By automating routine tasks, AI can reduce the burden on healthcare providers, allowing for a more focused allocation of resources towards complex patient care. This review aims to evaluate the current advancements and applications of AI and ML in DR screening, and to discuss the potential of these technologies in developing personalized management strategies, ultimately aiming to improve patient outcomes and reduce the global burden of DR. The integration of AI and ML in DR care represents a paradigm shift, offering a glimpse into the future of ophthalmic healthcare.

Angiotensin-(1-7) Provides Potent Long-Term Neurorepair/Neuroregeneration in a Rodent White Matter Stroke Model: Nonarteritic Ischemic Optic Neuropathy (rNAION)

Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic lesion of the anterior optic nerve (ON), currently untreatable due to the length of time from symptom onset until treatment. We evaluated angiotensin-(1-7) (Ang-(1-7)): the MAS1-receptor ligand, as a possible NAION treatment using the rodent NAION model (rNAION). Long-Evans rats were unilaterally rNAION-induced. One-day post-induction, lesion severity was quantified via optic nerve head (ONH) edema using spectral domain optical coherence tomography. Animals meeting rNAION induction criteria were randomized into (1) Subcutaneous Ang-(1-7) infusion for 28 days and (2) Vehicle. Visual function was assessed using both visual acuity and flash visual evoked potentials (fVEP). Tissues were collected >30d and RGC neurons were quantified by stereology. ONs were histologically examined for inflammation. Ang-(1-7) improved post-rNAION visual function. Ang-(1-7)-treated animals showed improved visual acuity (ANCOVA: p = 0.0084) and improved fVEP amplitudes (ANCOVA: p = 0.0378) vs vehicle controls. The relative degree of improvement correlated with ONH edema severity. Treated animals showed trends towards increased RGC survival, and reduced optic nerve inflammatory cell infiltration. Ang-(1-7) is the first agent effective ≥1 day after rNAION induction. Ang-(1-7) type agonists may be useful in improving long-term function and neuronal survival in clinical NAION and other forms of white matter ischemia.

Oxygenated Exosome-Based Nanoeyedrop for Mitigating Hypoxia in Corneal Wound Healing: Impact on Healing Properties of Human Corneal Epithelial Cells

The rapid and organized healing of the cornea, while maintaining optical clarity, is essential for patient health and quality of life following corneal injuries. Oxygen plays a critical role in regulating cell migration and proliferation during wound repair, and the application of stem cell-derived exosomes offers potential therapeutic benefits due to their antioxidant and antiscarring properties. In this study, we developed oxygenated exosome-coated hemoglobin nanoparticles (OExo NPs) designed for effective oxygen delivery to enhance corneal re-epithelialization, reduce inflammation, and mitigate scarring. These OExo NPs exhibit a uniform average diameter of 130 nm and demonstrate consistent oxygen release capabilities. In vitro assays using human corneal epithelial cells-transformed (HCE-T) revealed that OExo NPs significantly promote cell proliferation and accelerate migration in scratch wound assays. Fluorescence imaging confirmed the successful internalization of OExo NPs into HCE-T cells and increased intracellular oxygen levels under hypoxic conditions. Gene expression analyses indicated a downregulation of critical wound healing markers, including HIF-1α, VEGF, IL-8, and FAK, suggesting effective alleviation of hypoxia, inhibition of angiogenesis, suppression of inflammation, and reduction of scar formation. These results highlight the potential of OExo NPs as a promising therapeutic approach for topical treatment of corneal wounds.

In Vitro Evaluation of Genetically Unmodified Ligand-Armed Allogeneic Natural Killer Cells to Treat EGFR-Positive Glioblastoma

Glioblastomas (GBMs) are lethal brain tumors in which EGFR gene amplification or mutation is frequently detected and is associated with poor prognosis. The standard of care is maximal resection followed by chemotherapy and radiation. Over the last twenty years, marginal improvements in patient survival have been achieved mainly through surgical techniques and the more accurate use of radiation. In this study, umbilical cord blood-derived and expanded human allogeneic natural killer (eNK) cells were pre-complexed to an Fc-engineered anti-EGFR monoclonal antibody (Pin-EGFR) to create Pin-EGFR-armed eNK cells. Pin-EGFR-armed eNK cells showed in vitro persistence of mAb anchoring. This arming process mediated specific, rapid and potent NK cell-redirected cytotoxicity against GBM cell lines and patient-derived cells in models consistent with the pathophysiological conditions of GBM. These results demonstrate the potential of Pin-EGFR-armed eNK cells to be an effective therapy against GBM cell lines in vitro. This product represents a promising strategy to directly target residual tumor tissue remaining at and beyond the resection margins immediately following GBM surgery to improve patient care.

Evaluating the association between autoimmune disease and normal tension glaucoma: a retrospective case-control study

BACKGROUND

Limited population-based data as well as proposed mechanisms of retinal ganglion cell (RGC) loss suggest autoimmune disease may be a risk factor for glaucoma, the leading cause of irreversible blindness worldwide. Though intraocular pressure (IOP) is the leading risk factor for glaucoma onset and progression, a subset of glaucoma referred to as normal tension glaucoma (NTG) may be more likely to be associated with IOP-independent mechanisms of RGC injury including those of an inflammatory or immune nature.

METHODS

This retrospective case-control study enrolled 277 patients with NTG and the same number of age- and sex-matched controls to determine whether autoimmune disease diagnosis, treatment thereof, or relevant laboratory markers are associated with NTG.

RESULTS

There was no significant difference between the two groups in frequency of autoimmune disease overall, autoimmune disease catagorized by mechanism or organ involvement, or individual autoimmune disease including psoriasis (6% vs. 5%), rheumatoid arthritis (5% vs. 4%), inflammatory bowel disease (2% vs. 3%), Sjögren's syndrome (1% vs. 1%), sarcoidosis (1% vs. 1%), autoimmune thyroiditis (1% vs. 0%), type 1 diabetes (1% vs. 0%), or systemic lupus erythematosus (1% vs. 0%). There was also no significant difference in laboratory values or treatment of identified autoimmune conditions.

CONCLUSIONS

Our study found no significant association between autoimmune disease and NTG, suggesting that other factors may play a more significant role in the pathogenesis of NTG.

Combination of Apigenin and Melatonin with nanostructured lipid carriers as anti-inflammatory ocular treatment

Ocular inflammation is a complex pathology with limited treatment options. While traditional therapies have side effects, novel approaches, such as natural compounds like Apigenin (APG) and Melatonin (MEL) offer promising solutions. APG and MEL, in combination with nanostructured lipid carriers (NLC), may provide a synergistic effect in treating ocular inflammation, potentially improving patient outcomes and reducing adverse effects. NLC could provide chemical protection of these compounds, while offering a sustained release into the ocular surface. Optimized NLC exhibited suitable physicochemical parameters, physical stability, sustained release of APG and MEL, and were biocompatible in vitro with a corneal cell line, and in ovo by using hen's egg chorioallantoic membrane test. In vitro and in vivo studies confirmed the NLC' ability to attenuate inflammation by reducing interleukin-6 (IL-6), IL-8 and monocyte chemoattractant protein 1 (MCP-1) cytokine levels and by decreasing inflammation in a rabbit model. These findings suggest that the co-encapsulation of APG and MEL into NLC could represent a promising strategy for managing ocular inflammatory conditions.

Deep Learning in Glaucoma Detection and Progression Prediction: A Systematic Review and Meta-Analysis

Purpose: To evaluate the performance of deep learning (DL) in diagnosing glaucoma and predicting its progression using fundus photography and retinal optical coherence tomography (OCT) images. Materials and Methods: Relevant studies published up to 30 October 2024 were retrieved from PubMed, Medline, EMBASE, Cochrane Library, Web of Science, and ClinicalKey. A bivariate random-effects model was employed to calculate pooled sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC). Results: A total of 48 studies were included in the meta-analysis. DL algorithms demonstrated high diagnostic performance in glaucoma detection using fundus photography and OCT images. For fundus photography, the pooled sensitivity and specificity were 0.92 (95% CI: 0.89-0.94) and 0.93 (95% CI: 0.90-0.95), respectively, with an AUROC of 0.90 (95% CI: 0.88-0.92). For the OCT imaging, the pooled sensitivity and specificity were 0.90 (95% CI: 0.84-0.94) and 0.87 (95% CI: 0.81-0.91), respectively, with an AUROC of 0.86 (95% CI: 0.83-0.90). In predicting glaucoma progression, DL models generally showed less robust performance, with pooled sensitivities and specificities ranging lower than in diagnostic tasks. Internal validation datasets showed higher accuracy than external validation datasets. Conclusions: DL algorithms achieve excellent performance in diagnosing glaucoma using fundus photography and OCT imaging. To enhance the prediction of glaucoma progression, future DL models should integrate multimodal data, including functional assessments, such as visual field measurements, and undergo extensive validation in real-world clinical settings.

Advances in the Management of Craniopharyngioma: A Narrative Review of Recent Developments and Clinical Strategies

Craniopharyngiomas (CPs) are rare intracranial tumors arising from remnants of Rathke's pouch. Despite their benign histology, CPs present considerable clinical challenges due to their tendency to exert mass effect and adherence to critical neurovascular structures. There remains no clear consensus on the most effective management of CPs. We explore the latest developments in targeted treatment approaches, examining how innovations in surgery, radiation therapy, and emerging therapies are improving outcomes and management for these challenging tumors. In addition to providing our experience, we reviewed previously reported case series and reviews relevant to CPs. Studies show a bimodal age distribution for CP diagnosis, with peak incidence occurring in children aged 5-14 years and in adults aged 50-74 years. Surgical resection is the typical initial treatment for CPs, and adjuncts, including radiation therapy and intracavitary treatments, have been proven effective for tumor control. Additionally, genetic mutations associated with CPs offer an opportunity for novel strategies that address the underlying molecular mechanisms driving tumor growth through targeting the Wnt/β-catenin and/or MAPK/ERK pathways to disrupt the aberrant signaling that promotes tumor proliferation and survival. Survival rates for CPs are generally favorable (five-year survival of 80%), with recent studies showing improved outcomes and higher survival rates in children. CPs remain rare and challenging tumors. Although surgical resection is the main treatment, surgeons must weigh the benefits of achieving a gross total resection with the risks of iatrogenic injury. Adjuncts, including intracavitary and radiation treatments, may assist with subtotal resections and recurrences, as well as approved BRAF inhibitor therapy for the papillary variant. Many improvements in diagnostic and therapeutic methods were made after Dr. Cushing coined the term "craniopharyngioma". Ongoing experiments, investigations, and advances in radiation techniques and molecular targeted therapies will provide patients with promise for safer and more effective treatments.

Research trends in glioma chemoradiotherapy resistance: a bibliometric analysis (2003-2023)

Background

Glioma is the most aggressive primary malignant tumor of the central nervous system, characterized by high recurrence rates and resistance to chemoradiotherapy, making therapeutic resistance a major challenge in neuro-oncology. Recent research emphasizes the role of the tumor microenvironment (TME) and immune modulation in glioma progression and resistance. Despite these advances, a comprehensive bibliometric analysis of research trends in glioma chemoradiotherapy resistance over the past two decades is lacking. This study aims to systematically evaluate the research landscape, identify emerging hotspots, and provide guidance for future investigations.

Methods

Articles on glioma chemoradiotherapy resistance published between 2003 and 2023 were retrieved from the Web of Science Core Collection, resulting in 4,528 publications. Bibliometric tools, including VOSviewer, CiteSpace, and R packages such as bibliometrix and ggplot2, were used to analyze co-authorship networks, keyword evolution, and citation bursts to identify collaboration patterns, thematic developments, and influential contributions.

Results

Publication output increased significantly between 2013 and 2022, peaking at 650 articles in 2022. Over 1,000 institutions from 88 countries contributed to this research. The United States, Switzerland, and Germany showed the highest citation impact, while China led in publication volume but demonstrated relatively lower citation influence. The research focus has shifted from traditional topics such as the "MGMT gene" to emerging areas including the "tumor microenvironment," "immune infiltration," and "nanoparticles." The androgen receptor was identified as a promising but underexplored therapeutic target.

Conclusions

Research on glioma chemoradiotherapy resistance has seen substantial growth, with increasing emphasis on immune modulation, the tumor microenvironment, and novel therapeutic targets such as the androgen receptor. This study represents the first comprehensive bibliometric analysis of this field, providing a detailed overview of research trends and potential directions for future studies. The findings highlight the need for strengthened international collaboration and multidisciplinary approaches to address the challenges of therapeutic resistance in glioma.

Applications of Machine Learning-Driven Molecular Models for Advancing Ophthalmic Precision Medicine

Ophthalmic diseases such as glaucoma, age-related macular degeneration (ARMD), and optic neuritis involve complex molecular and cellular disruptions that challenge current diagnostic and therapeutic approaches. Advanced artificial intelligence (AI) and machine learning (ML) models offer a novel lens to analyze these diseases by integrating diverse datasets, identifying patterns, and enabling precision medicine strategies. Over the past decade, applications of AI in ophthalmology have expanded from imaging-based diagnostics to molecular-level modeling, bridging critical gaps in understanding disease mechanisms. This paper systematically reviews the application of AI-driven methods, including reinforcement learning (RL), graph neural networks (GNNs), Bayesian inference, and generative adversarial networks (GANs), in the context of these ophthalmic conditions. RL models simulate transcription factor dynamics in hypoxic or inflammatory environments, offering insights into disrupted molecular pathways. GNNs map intricate molecular networks within affected tissues, identifying key inflammatory or degenerative drivers. Bayesian inference provides probabilistic models for predicting disease progression and response to therapies, while GANs generate synthetic datasets to explore therapeutic interventions. By contextualizing these AI tools within the broader framework of ophthalmic disease management, this review highlights their potential to transform diagnostic precision and therapeutic outcomes. Ultimately, this work underscores the need for continued interdisciplinary collaboration to harness AI's potential in advancing the field of ophthalmology and improving patient care.

Looking to the Future of Viral Vectors in Ocular Gene Therapy: Clinical Review

Eye diseases can significantly affect the quality of life of patients due to decreased visual acuity. Although modern ophthalmological diagnostic methods exist, some diseases of the visual system are asymptomatic in the early stages. Most patients seek advice from an ophthalmologist as a result of rapidly progressive manifestation of symptoms. A number of inherited and acquired eye diseases have only supportive treatment without eliminating the etiologic factor. A promising solution to this problem may be gene therapy, which has proven efficacy and safety shown in a number of clinical studies. By directly altering or replacing defective genes, this therapeutic approach will stop as well as reverse the progression of eye diseases. This review examines the concept of gene therapy and its application in the field of ocular pathologies, emphasizing the most recent scientific advances and their potential impacts on visual function status.

Emerging strategies targeting genes and cells in glaucoma

Glaucoma comprises a heterogeneous set of eye conditions that cause progressive vision loss. Glaucoma has a complex etiology, with different genetic and non-genetic risk factors that differ across populations. Although difficult to diagnose in early stages, compromised cellular signaling, dysregulation of genes, and homeostatic imbalance are common precursors to injury and subsequent death of retinal ganglion cells (RGCs). Lowering intraocular pressure (IOP) remains the primary approach for managing glaucoma but IOP alone does not explain all glaucoma risks. Orthogonal approaches such as large-scale genetic screening, combined with studies of animal models have been instrumental in identifying genes and molecular pathways involved in glaucoma pathogenesis. Cell type dependent vulnerability among RGCs can reveal genetic basis for specific visual deficits. A growing body of knowledge and availability of modern tools to perform targeted assessments of cellular health in different animal models facilitate development of effective and timely interventions for vision rescue. This review highlights recent findings on genes, molecules, and cell types in the context of glaucoma pathophysiology and treatment.

GBMPurity: A Machine Learning Tool for Estimating Glioblastoma Tumour Purity from Bulk RNA-seq Data

BACKGROUND

Glioblastoma (GBM) presents a significant clinical challenge due to its aggressive nature and extensive heterogeneity. Tumour purity, the proportion of malignant cells within a tumour, is an important covariate for understanding the disease, having direct clinical relevance or obscuring signal of the malignant portion in molecular analyses of bulk samples. However, current methods for estimating tumour purity are non-specific and technically demanding. Therefore, we aimed to build a reliable and accessible purity estimator for GBM.

METHODS

We developed GBMPurity, a deep-learning model specifically designed to estimate the purity of IDH-wildtype primary GBM from bulk RNA-seq data. The model was trained using simulated pseudobulk tumours of known purity from labelled single-cell data acquired from the GBmap resource. The performance of GBMPurity was evaluated and compared to several existing tools using independent datasets.

RESULTS

GBMPurity outperformed existing tools, achieving a mean absolute error of 0.15 and a concordance correlation coefficient of 0.88 on validation datasets. We demonstrate the utility of GBMPurity through inference on bulk RNA-seq samples and observe reduced purity of the Proneural molecular subtype relative to the Classical, attributed to the increased presence of healthy brain cells.

CONCLUSIONS

GBMPurity provides a reliable and accessible tool for estimating tumour purity from bulk RNA-seq data, enhancing the interpretation of bulk RNA-seq data and offering valuable insights into GBM biology. To facilitate the use of this model by the wider research community, GBMPurity is available as a web-based tool at: https://gbmdeconvoluter.leeds.ac.uk/.

BRD4 promotes immune escape of glioma cells by upregulating PD-L1 expression

PURPOSE

Glioblastoma multiforme (GBM) poses significant challenges in treatment due to its aggressive nature and immune escape mechanisms. Despite recent advances in immune checkpoint blockade therapies, GBM prognosis remains poor. The role of bromodomain and extraterminal domain (BET) protein BRD4 in GBM, especially its interaction with immune checkpoints, is not well understood. Our study aimed to explore the role of BRD4 in GBM, especially the immune aspects.

METHODS

In this study, we performed bioinformatics gene expression and survival analysis of BRD4 using TCGA and CGGA databases. In addition, we investigated the effects of BRD4 on glioma cell proliferation, invasion and migration by clone formation assay, Transwell assay, CCK8 assay and wound healing assay. Chromatin immunoprecipitation (ChIP) assay was conducted to confirm BRD4 binding to the programmed death ligand 1 (PD-L1) promoter. GL261 cells with BRD4 shRNA and/or PD-L1 cDNA were intracranially injected into mice to investigate tumor growth and survival time. Tumor tissue characteristics were analyzed using H&E and IHC staining and immune cell infiltration were assessed by flow cytometry.

RESULTS

The results showed that elevated expression of BRD4 in high-grade gliomas was associated with poor patient survival. In addition, we validated the promotional effects of BRD4 on glioma cell proliferation, invasion and migration. The results of ChIP experiments showed that BRD4 is a regulator of PD-L1 at the transcriptional level, implying that it is involved in the immune escape mechanism of glioma cells. In vivo studies showed that BRD4 knockdown inhibited tumor growth and reduced immunosuppression, improving prognosis.

CONCLUSION

BRD4 has the capability to regulate the growth of glioblastoma and enhance immune suppression by promoting PD-L1 expression. Targeting BRD4 represents a promising direction for future research and treatment.

Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections

INTRODUCTION

Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections.

METHODS

This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group.

RESULTS

The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001.

CONCLUSION

Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion.

TRIAL REGISTRATION

TCTR20241005001, retrospectively registered.

A Novel Technique for Eye Rejuvenation: A Case Series of the Combined Use of CO2 Laser Blepharoplasty and Erbium: YAG Resurfacing and A Novel Artificial Intelligence Model to Quantify Laser Results

BACKGROUND

Consumers are searching for a solution to rejuvenate the eye area. Surgical blepharoplasties are a common solution, but they lack improvement in skin quality.

AIMS

To present a novel procedure of a laser upper blepharoplasty in combination with erbium laser resurfacing of the lower eyelid for optimal rejuvenation and minimal complications.

METHODS

The authors present a laser upper blepharoplasty with the CO2 laser performed at the same time as lower eyelid resurfacing using an erbium laser. The authors used an artificial intelligence large language model to assess the patient before and after photographs to quantify cosmetic improvement.

RESULTS

After this novel procedure, patients demonstrated significant improvements in upper eyelid contour, reduced skin laxity, and smoother lower eyelid texture. Patient satisfaction was high, with each patient reporting an overall rejuvenated appearance and a more "awake" and youthful look. The artificial intelligence algorithm showed cosmetic improvement in line with the clinical evaluations by the patient and physician.

CONCLUSIONS

The combination of CO2 laser blepharoplasty and Er:YAG laser resurfacing addresses both upper eyelid dermatochalasis and lower eyelid wrinkles effectively while minimizing recovery time and the potential for complications. Artificial intelligence models were used to enhance this study and corroborate evaluator cosmetic improvement.

Performance of Cementless Hip Arthroplasty Stem Types Based on Consolidated Large Registry Data

Background

Improvements in cementless total hip arthroplasty have been directed at optimizing osseointegration of the femoral implant to reduce aseptic loosening rates. Stem design plays a critical role in the performance of these implants. Given the increase in new stem designs and the creation of an updated classification system, improved understanding of the outcomes of each stem type is warranted. The purpose of this study was to determine overall revision rates based on stem design and proprietary model.

Methods

Joint registry data on the reported overall cases and revisions for each cementless stem brand were collected from the annual reports of the American Joint Replacement Registry (2021), United Kingdom National Joint Registry (2021), New Zealand Joint Registry (2020), and Australian Orthopaedic Association National Joint Replacement Registry (2021). Each individual stem brand was classified into a stem type derived from the classification system described by Radaelli et al.

Results

The most utilized stem types were (1) type B2 stems, (2) type A stems, and (3) type C1 stems. The most utilized stem models were the (1) Corail stem (B2), (2) Accolade II (type A), and (3) Taperloc 133 (type A). The highest and lowest overall revision rates observed were in the type B1 stems (8.09%) and type C3 stems (1.12%), respectively. The 3 stem models with the highest overall revision rates were the Synergy HA stem (9.04%), CBC stem (8.59%), and CLS stem (7.96%). The 3 stems with the lowest respective overall revision rates were the C2 stem (0.00%, 0 of 933 cases), Actis Duofix (0.59%), and VerSys stem (0.89%).

Conclusions

Based on consolidated large registry data, some cementless femoral stem types and models appear to perform better than others when compared on the basis of stem design.

Clinical Efficacy of 830 nm LED Photobiomodulation Therapy on Postoperative Blepharoplasty Complications

BACKGROUND

Blepharoplasty is the most prevalent cosmetic surgery procedure in Asia. There are three main types of blepharoplasty procedures: incision, threading, and spotting, with incision being the most common procedure. However, after incisional surgery, patients experience prolonged periorbital swelling, bruising, and scarring. In order to help patient reduce periorbital swelling and erythema and ease the discomfort. In this research, the authors introduce a photobiomodulation therapy and to investigate the efficacy and safety of 830 nm light-emitting diode (LED) phototherapy in improving complications after incisional blepharoplasty.

METHOD

Participants were randomly assigned 830 nm LED phototherapy (novel care model) or traditional care model for postoperative care. The efficacy of different care measures on postoperative complications after incisional blepharoplasty was assessed using swelling score, pain score (VAS), wound healing grading, and anxiety scale (SAS).

RESULTS

A total of 145 patients were included, including 73 in the novel care model group and 72 in the traditional care model group. The new care model based on 830 nm LED phototherapy could significantly improve the swelling, pain, wound healing, and anxiety self-assessment scale assessment of the patients compared with the traditional care model, and the difference was statistically significant (P<0.05).

CONCLUSION

Photobiomodulation using 830 nm LED can markedly reduce postoperative swelling and pain, promote effective wound healing, lessen postoperative patient anxiety, and have no negative side effects.

LEVEL OF EVIDENCE I

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 .

ALTERATION OF TREATMENT CHOICES AND THE VISUAL PROGNOSIS FOR DIABETIC MACULAR EDEMA IN THE ERA OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR DRUGS: Analysis of the STREAT-DME 2 Study

PURPOSE

To assess the real-world outcome of best-corrected visual acuity after 2-year intervention for treatment-naive diabetic macular edema since the approval of anti-vascular endothelial growth factor therapy.

METHODS

A total of 1,780 treatment-naive eyes with diabetic macular edema for which intervention was initiated between 2015 and 2019, and which were followed for 2 years, were extracted from the longitudinal medical records of 37 retinal disease institutions in Japan. Interventions included anti-VEGF therapy, topical corticosteroid therapy, macular photocoagulation, and vitrectomy. The baseline and final best-corrected visual acuity, and the number and timing of interventions were recorded. Eyes were classified according to the year in which intervention was initiated.

RESULTS

Over a 2-year period, best-corrected visual acuity improved annually, finally reaching seven letters. The proportion of eyes in which good vision was maintained (best-corrected visual acuity >20/40) increased to 73.3% in the latest period. The administration of anti-VEGF therapy remained stable, accounting for approximately 90% of eyes. Notably, the proportion of eyes receiving anti-VEGF drugs as first-line treatment increased dramatically to approximately 80%.

CONCLUSION

Anti-VEGF therapy has become the first-line treatment since the approval of anti-VEGF drugs for diabetic macular edema. These findings reflect the evolution of diabetic macular edema treatment and highlight the superiority of anti-VEGF therapy and its increased uptake over time.

Femtosecond Laser-Assisted Autologous Glueless Simple Limbal Epithelial Transplantation in Unilateral Limbal Stem Cell Deficiency: 12-Month Outcome of the First Clinical Cases

PURPOSE

Surgical treatment of unilateral limbal stem cell deficiency (LSCD) is based on limbal stem cell transplantation. Glueless simple limbal epithelial transplantation (G-SLET) technique implements several limbal micrografts harvested from the healthy eye of the same patient into the peripheral corneal tunnels without the use of fibrin glue and human amniotic membrane.

METHODS

A novel customized algorithm and software for a low-energy femtosecond laser (FSL) were developed and tested using 5 pairs of isolated porcine eyes. FSL-assisted G-SLET modification was assessed in 3 clinical cases of unilateral LSCD caused by chemical burns. Corneal epithelization efficacy, best-corrected visual acuity, corneal epithelial mapping, central corneal thickness, and impression cytology with immunohistochemical examination were evaluated. All patients were followed up for 12 months postoperatively.

RESULTS

The FSL set for 100% energy and the pattern of 8 nonpenetrating vertical cuts with oblique tunnel portions having variable incision depths and diameter of 8.5 mm and higher were selected for further clinical evaluation. Clinically, stable corneal epithelialization was achieved 2 to 3 weeks after intervention. At the 6-month follow-up, all patients had a healthy corneal epithelium with limbal micrografts visible inside the corneal tunnels. Best-corrected visual acuity markedly improved in 2 cases, but not in the third case with severe corneal stromal scarring. In addition, all patients noted a full-scale reduction in subjective complaints and substantial improvement in their quality of life.

CONCLUSIONS

The FSL-assisted G-SLET is a new technique for autologous limbal stem cell transplantation in patients with unilateral LSCD. It allows the standardization of corneal tunnel localization and dimensions, thereby increasing the safety of the surgical procedure.

Evaluation of the nutraceutical Palmitoylethanolamide in reducing intraocular pressure (IOP) in patients with glaucoma or ocular hypertension: a systematic review and meta-analysis

Intraocular pressure (IOP) positively correlates with both normal and high-tension glaucoma. To date, IOP targeting remains the validated pharmacological approach in counteracting glaucoma progression as well as in halting vision loss. Among the different adjuvant compounds, evidence highlighted the potential effectiveness of Palmitoylethanolamide (PEA), an endogenous fatty acid amide. Thus, a systematic review of the literature was conducted, thoroughly evaluating PEA treatment regimen in decreasing IOP in patients with eye disorders. We checked for articles across the scientific databases Pubmed (MEDLINE), Embase (OVID), and Web of Science from the inception to 30 August 2023, and a total of 828 articles were recovered. Six of these studies (199 patients) were included in the systematic review after the study selection process, and three studies for meta-analysia. Overall, PEA showed significant efficacy in reducing IOP in patients, this encourages its clinical use in glaucoma as well as across different forms of eye disorders.

Biportal Endoscopic TransOrbital and transMaxillary Approach to the Cranio-Orbital Region and Middle Cranial Fossa: A Preliminary Analysis of Maneuverability

BACKGROUND AND OBJECTIVES

Traditional and well-established transcranial approaches to the spheno-orbital region and middle cranial fossa guarantee optimal intracranial exposure, and additional orbital and zygomatic osteotomies provide further control over extracranial components to be resected; however, these techniques come at the cost of additional morbidity. The introduction of minimally invasive endoscopic approaches and the conceptualization of the so-called "multiportal" paradigm might provide an alternative route. This preliminary study investigates the feasibility of the combined Biportal Endoscopic TransOrbital and transMaxillary Approach (bETOMA) approach to the spheno-orbital and middle cranial fossa regions.

METHODS

Using 4 silicon-injected adult cadaver heads (8 sides; 16 approaches), we systematically dissected through superior eyelid ETOA and endoscopic TMA approaches. The analysis focused on pterygopalatine, infratemporal, anterior and middle cranial fossae, Meckel cave, and cavernous sinus access. We evaluated the feasibility of bETOMA using linear distances, angles of attack, and exposure areas. We also introduced volume of operative maneuverability, its standardized derivative (sVOM), target distance, visuo-operative angle, and working zone volume as novel metrics.

RESULTS

The analysis revealed comparable angles of attack between approaches. ETOA and TMA exposure areas were 918.38 ± 223.93 mm 2 and 257.07 ± 86.07 mm 2 , respectively. TMA showed a larger VOM in the greater sphenoid wing, but ETOA offered superior distal maneuverability (sVOM: 5.39 ± 1.94 vs 2.54 ± 0.79 cm 3 ) and closer intracranial space access (27.45 vs 50.83 mm). The combined approaches yielded a mean working zone volume of 13.75 ± 3.73 cm 3 in the spheno-orbital interface.

CONCLUSION

The bETOMA approach provides adequate neurovascular exposure and maneuverability to the spheno-orbital region, infratemporal, and anterior and middle cranial fossae, addressing significant limitations of previously investigated monoportal techniques (ie, optic nerve decompression, hyperostotic bone resection, and infratemporal exposure). This combined minimally invasive approach might help manage lesions harbored within the cranio-orbital interface region invading the extracranial space.

Comparison of macular retinal thickness measurements using spectral-domain and swept-source optical coherence tomography in healthy eyes

Aim

This study compares retinal thickness measurements in healthy eyes using one SD-OCT and two SS-OCT devices to assess differences and consistency for clinical application.

Methods

Forty-eight eyes with a mean age of 28.15 ± 8.85 years were enrolled. Retinal thickness was measured using Heidelberg Spectralis SD-OCT, Svision VG200 SS-OCT, and TowardPi En Face SS-OCT. Normally distributed data were presented as mean ± SD; non-normal data as median (P25-P75). Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess agreement, with a 7 μm error threshold.

Results

Significant differences were found between the three devices (p < 0.001). SD-OCT measurements were consistently lower than SS-OCT (p < 0.001), while the two SS-OCT devices showed no significant differences except in the nasal region (p = 0.006). ICC values between SD-OCT and SS-OCT devices were low (0.125-0.532), while SS-OCT devices showed better agreement (ICC: 0.369-0.922). Bland-Altman analysis found only 8.33% of SD-OCT and SS-OCT measurements within the 7 μm error range, compared to 81.25-83.33% for SS-OCT devices.

Conclusion

The measurements of macular retinal thickness using SD-OCT and SS-OCT devices showed poor consistency and cannot be used interchangeably. However, measurements obtained from different SS-OCT devices demonstrated good consistency. To enhance the accuracy of results, it is recommended to maintain consistency in the devices used for follow-up examinations in the same patient.

Long-term Safety and Performance of a Suprachoroidal Pressure Sensor System: Results of the EYEMATE-SC Trial Follow-up Study

PURPOSE

To evaluate the long-term safety and performance of the EYEMATE-SC sensor system, a suprachoroidal implantable diagnostic medical device designed for measuring intraocular pressure (IOP) in patients with glaucoma that offers direct digitized IOP readings in millimeters of mercury.

DESIGN

This study is part of the prospective, open-label, multicenter interventional EYEMATE-SC trial.

PARTICIPANTS

Twenty-two eyes of 22 patients with open-angle glaucoma who received the implant in conjunction with nonpenetrating glaucoma surgery (NPGS) were included in the study.

METHODS

This 3-year follow-up study analyzed the long-term safety of the EYEMATE-SC suprachoroidal sensor system (Implandata). The telemetric sensor system includes an implantable IOP sensor and a handheld reading device.

MAIN OUTCOME MEASURES

All patients underwent 5 follow-up visits over a 24-month follow-up period from month 12 to month 36 after implantation. Each visit consisted of a comprehensive examination including IOP measurement with the EYEMATE-SC system and Goldmann applanation tonometry (GAT). The agreement between GAT and the EYEMATE-SC was analyzed using Bland-Altman analysis. Adverse events (AEs) and device-related adverse events (ADEs) were recorded at all follow-up visits.

RESULTS

Of 24 eligible patients of the EYEMATE-SC trial, 22 patients (mean age 65.0 ± 10.6 years, 54.5% female) were enrolled. The overall mean follow-up was 2.7 ± 0.6 years (range, 1.0-3.4 years). Limits of agreement between GAT and EYEMATE-SC IOP were -6.2 to 5.7 mmHg (mean absolute difference of 2.3 mmHg), with greatest concordance at 12 months (concordance correlation coefficient [rccc] = 0.802, N = 22) and 18 months (rccc = 0.854, N = 19). A difference of < 5 mmHg was recorded in > 85% of the 86 paired measurements. No serious AEs and ADEs were recorded. Most common AEs were raised IOP in 5 patients, reduced visual acuity in 3 patients, and cataract in 3 patients.

CONCLUSIONS

This study demonstrates the long-term safety of the EYEMATE-SC system. No serious AEs related to the EYEMATE-SC were observed. The agreement between the EYEMATE-SC and GAT was within the standard range of IOP-measuring methods set by regulatory agencies. The EYEMATE-SC system is well tolerated and accurate for self- measurement of IOP throughout the day.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Targeted therapy for glioblastoma utilizing hyaluronic acid-engineered liposomes for adriamycin delivery

Glioblastoma (GBM) is a malignant tumor with highly heterogeneous and invasive characteristics leading to a poor prognosis. The CD44 molecule, which is highly expressed in GBM, has emerged as a highly sought-after biological marker. Therapeutic strategies targeting the cell membrane protein CD44 have emerged, demonstrating novel therapeutic potential. In this study, we constructed a nanodrug system (HA-Liposome@Dox) based on hyaluronic acid-engineered liposomes delivering adriamycin to target GBM. The system efficiently encapsulated Dox inside the liposomes through a hydrophilic-hydrophobic interaction mechanism, and the resulting HA-Liposome@Dox exhibited excellent loading efficacy, attributed to its uniform particle size distribution and negatively charged surface. Further evaluation revealed that HA-Liposome@Dox possessed excellent stability and safety and could promote the effective uptake of drug particles by CD44-overexpressing tumor cells, thus exerting a more potent cell-killing effect. Notably, in the treatment of GBM, HA-Liposome@Dox demonstrated significantly greater tumor growth inhibition compared to free Dox and prolonged the survival of tumor-bearing mice. Taken together, the present study not only verified the feasibility of HA-Liposome@Dox as an effective therapeutic tool against GBM and other CD44-positively expressing tumors, but also opened a promising new avenue for the clinical treatment of this type of refractory malignancies.

Immune Resistance in Glioblastoma: Understanding the Barriers to ICI and CAR-T Cell Therapy

BACKGROUND

Glioblastoma (GBM) is the most common primary malignant brain tumor, with fewer than 5% of patients surviving five years after diagnosis. The introduction of immune checkpoint inhibitors (ICIs), followed by chimeric antigen receptor (CAR) T-cell therapy, marked major advancements in oncology. Despite demonstrating efficacy in other blood and solid cancers, these therapies have yielded limited success in clinical trials for both newly diagnosed and recurrent GBM. A deeper understanding of GBM's resistance to immunotherapy is essential for enhancing treatment responses and translating results seen in other cancer models.

OBJECTIVES

In this review, we examine clinical trial outcomes involving ICIs and CAR-T for GBM patients and explore the evasive mechanisms of GBM and the tumor microenvironment.

FINDINGS AND DISCUSSION

Multiple clinical trials investigating ICIs in GBM have shown poor outcomes, with no significant improvement in progression-free survival (PFS) or overall survival (OS). Results from smaller case studies with CAR-T therapy have warranted further investigation. However, no large-scale trials or robust studies have yet established these immunotherapeutic approaches as definitive treatment strategies. Future research should shift focus from addressing the scarcity of functional T cells to exploiting the abundant myeloid-derived cells within the tumor microenvironment.

CONCLUSIONS

Translating these therapies into effective treatments for glioblastoma in humans remains a significant challenge. The highly immunosuppressive nature of GBM and its tumor microenvironment continue to hinder the success of these innovative immunotherapeutic approaches. Targeting the myeloid-derived compartment may lead to more robust and sustained immune responses.

Antioxidants in Age-Related Macular Degeneration: Lights and Shadows

Age-related macular degeneration (AMD) is a leading cause of vision impairment worldwide, primarily driven by oxidative stress and inflammation. This review examines the role of antioxidants in mitigating oxidative damage, emphasizing both their therapeutic potential and limitations in AMD management. Key findings underscore the efficacy of specific antioxidants, including vitamins C and E, lutein, zeaxanthin, and Coenzyme Q10, in slowing AMD progression. Landmark studies such as AREDS and AREDS2 have shaped current antioxidant formulations, although challenges persist, including patient variability and long-term safety concerns. Emerging therapies, such as mitochondrial-targeted antioxidants and novel compounds like saffron and resveratrol, offer promising avenues for AMD treatment. Complementary lifestyle interventions, including antioxidant-rich diets and physical activity, further support holistic management approaches. This review highlights the critical role of antioxidants in AMD therapy, advocating for personalized strategies to optimize patient outcomes.

Retinopathy in Parkinson's disease: A potential biomarker for early diagnosis and clinical assessment

Parkinson's disease (PD) is a prevalent neurodegenerative disorder caused by degeneration of dopaminergic neurons, originating from the substantia nigra pars compacta, and characterized by motor symptoms such as bradykinesia, muscle rigidity, resting tremor, and postural instability, as well as non-motor symptoms such as anxiety, depression, reduced sense of smell, cognitive impairment, and visual dysfunction. Emerging evidence highlights the retina as a promising site for non-invasive exploration of PD pathology, due to its shared embryonic origin with the central nervous system. In recent years, with the development of ophthalmic technology, the acquisition of retinal-related function and structure has gradually become mature. PD-related retinal changes have become a research hotspot for non-motor symptoms of PD. This review provides a comprehensive synthesis of retinal dysfunctions in PD, focusing on structural and functional changes as potential biomarkers for early diagnosis and clinical assessment. By integrating findings from advanced imaging and electrophysiological studies, this review introduces novel perspectives on the correlation between retinal changes and PD pathophysiology, offering innovative approaches for early detection, disease progression monitoring, and therapeutic stratification.

Contact Lenses in Therapeutic Care: A Comprehensive Review of Past Innovations, Present Applications, and Future Directions

Contact lenses have become integral tools in the realm of ocular therapeutics, extending beyond their primary function of refractive correction to encompass a diverse array of therapeutic applications. This review explores the evolving role of contact lenses in managing various ocular conditions, highlighting their efficacy in enhancing patient outcomes. Initially developed to correct refractive errors, contact lenses now serve as effective vehicles for delivering medications directly to the ocular surface, offering targeted treatment for conditions such as dry eye syndrome and corneal ulcers. Their ability to provide sustained moisture and facilitate drug absorption makes them indispensable in promoting corneal healing and managing chronic ocular surface diseases. Specialized contact lenses designed for irregular corneas, such as those affected by keratoconus, provide both optical correction and structural support, significantly improving visual acuity and patient comfort. Additionally, orthokeratology lenses have shown promise in controlling myopia progression in children by reshaping the cornea overnight, thereby reducing reliance on corrective eyewear during waking hours. In post-surgical settings, therapeutic contact lenses aid in epithelial regeneration and minimize discomfort, accelerating recovery and improving surgical outcomes. They also play a crucial role in protecting the cornea from external irritants and promoting a stable tear film, crucial for maintaining ocular health. Looking ahead, ongoing advancements in contact lens materials and designs promise further innovation in ocular therapeutics, paving the way for personalized treatment strategies and improved patient care. As such, contact lenses continue to evolve as essential therapeutic tools, offering tailored solutions for a spectrum of ocular conditions and contributing to enhanced quality of life for patients worldwide.

[Neurology in Bohemian Lights]

INTRODUCTION

Valle-Inclán's Bohemian Lights is the inaugural work of the esperpento, a literary genre that was born with the intention of offering distorted images of reality as a way of accessing it in a reflexive way.

MATERIAL AND METHODS

Critical reading of the editio princeps of the work to analyze its neurological content.

RESULTS

The character of Max Estrella, inspired by the figure of Alejandro Sawa, would not meet the criteria for encephalitis. The diagnoses of Charles Bonnet syndrome and death due to stroke are more likely. The characters at the wake discuss the differential diagnosis between death and catalepsy, and one of them suffers a non-epileptic event.

CONCLUSIONS

Bohemian Lights reflects different social, political and cultural aspects contemporary to the author. Health and disease are also addressed, with a preponderant role for neurology.

Computed Tomography-Image-Based Glioma Grading Using Radiomics and Machine Learning: A Proof-of-Principle Study

BACKGROUND/OBJECTIVES

In recent years, numerous studies have been published on determining the WHO grade of central nervous system (CNS) tumors using machine learning algorithms. These studies are usually based on magnetic resonance imaging (MRI) and sometimes also on positron emission tomography (PET) images. To date, however, there are virtually no corresponding studies based on routinely generated computed tomography (CT) images. The aim of our proof-of-concept study is to investigate whether machine learning-based tumor diagnosis is also possible using CT images.

METHODS

We investigate the differentiability of histologically confirmed low-grade and high-grade gliomas. Three conventional machine learning algorithms and a neural net are tested. In addition, we analyze which of the common imaging methods (MRI or CT) appears to be best suited for the diagnostic question under investigation when machine learning algorithms are used. For this purpose, we compare our results based on CT images with numerous studies based on MRI scans.

RESULTS

Our best-performing model includes six features and is obtained using univariate analysis for feature preselection and a Naive Bayes approach for model construction. Using independent test data, this model yields a mean AUC of 0.903, a mean accuracy of 0.839, a mean sensitivity of 0.807 and a mean specificity of 0.864.

CONCLUSIONS

Our results demonstrate that low-grade and high-grade gliomas can be differentiated with high accuracy using machine learning algorithms, not only based on the usual MRI scans, but also based on CT images. In the future, such CT-image-based models can help to further accelerate brain tumor diagnostics and to reduce the number of necessary biopsies.

Nanoparticle Interactions with the Blood Brain Barrier: Insights from Drosophila and Implications for Human Astrocyte Targeted Therapies

This review explores the intricate connections between Drosophila models and the human blood-brain barrier (BBB) with nanoparticle-based approaches for neurological treatment. Drosophila serves as a powerful model organism due to its evolutionary conservation of key biological processes, particularly in the context of the BBB, which is formed by glial cells that share structural and functional similarities with mammalian endothelial cells. Recent advancements in nanoparticle technology have highlighted their potential for effective drug delivery across the BBB, utilizing mechanisms such as passive diffusion, receptor-mediated transcytosis, and carrier-mediated transport. The ability to engineer nanoparticles with specific physicochemical properties-such as size, surface charge, and functionalization-enhances their targeting capabilities, particularly towards astrocytes, which play a crucial role in maintaining BBB integrity and responding to neuroinflammation. Insights gained from Drosophila studies have informed the design of personalized nanomedicine strategies aimed at treating neurodegenerative diseases, including Alzheimer's, Parkinson's disease etc. As research progresses, the integration of findings from Drosophila models with emerging humanized BBB systems will pave the way for innovative therapeutic approaches that improve drug delivery and patient outcomes in neurological disorders.

Artificial Intelligence and Neuroscience: Transformative Synergies in Brain Research and Clinical Applications

The convergence of Artificial Intelligence (AI) and neuroscience is redefining our understanding of the brain, unlocking new possibilities in research, diagnosis, and therapy. This review explores how AI's cutting-edge algorithms-ranging from deep learning to neuromorphic computing-are revolutionizing neuroscience by enabling the analysis of complex neural datasets, from neuroimaging and electrophysiology to genomic profiling. These advancements are transforming the early detection of neurological disorders, enhancing brain-computer interfaces, and driving personalized medicine, paving the way for more precise and adaptive treatments. Beyond applications, neuroscience itself has inspired AI innovations, with neural architectures and brain-like processes shaping advances in learning algorithms and explainable models. This bidirectional exchange has fueled breakthroughs such as dynamic connectivity mapping, real-time neural decoding, and closed-loop brain-computer systems that adaptively respond to neural states. However, challenges persist, including issues of data integration, ethical considerations, and the "black-box" nature of many AI systems, underscoring the need for transparent, equitable, and interdisciplinary approaches. By synthesizing the latest breakthroughs and identifying future opportunities, this review charts a path forward for the integration of AI and neuroscience. From harnessing multimodal data to enabling cognitive augmentation, the fusion of these fields is not just transforming brain science, it is reimagining human potential. This partnership promises a future where the mysteries of the brain are unlocked, offering unprecedented advancements in healthcare, technology, and beyond.

Biomedical Application of MSCs in Corneal Regeneration and Repair

The World Health Organization estimates that approximately 285 million people suffer from visual impairments, around 5% of which are caused by corneal pathologies. Currently, the most common clinical treatment consists of a corneal transplant (keratoplasty) from a human donor. However, worldwide demand for donor corneas amply exceeds the available supply. Lamellar keratoplasty (transplantation replacement of only one of the three layers of the cornea) is partially solving the problem of cornea undersupply. Obviously, cell therapy applied to every one of these layers will expand current therapeutic options, reducing the cost of ophthalmological interventions and increasing the effectiveness of surgery. Mesenchymal stem cells (MSCs) are adult stem cells with the capacity for self-renewal and differentiation into different cell lineages. They can be obtained from many human tissues, such as bone marrow, umbilical cord, adipose tissue, dental pulp, skin, and cornea. Their ease of collection and advantages over embryonic stem cells or induced pluripotent stem cells make them a very practical source for experimental and potential clinical applications. In this review, we focus on recent advances using MSCs from different sources to replace the damaged cells of the three corneal layers, at both the preclinical and clinical levels for specific corneal diseases.

A Journey into the Complexity of Temporo-Insular Gliomas: Case Report and Literature Review

INTRODUCTION

Temporo-insular gliomas, rare brain tumors originating from glial cells, comprise about 30% of brain tumors and vary in aggressiveness from grade I to IV. Despite advancements in neuroimaging and surgical techniques, their management remains complex due to their location near critical cognitive areas. Techniques like awake craniotomy have improved outcomes, but tumor heterogeneity and proximity to vital structures pose challenges. Radiotherapy and chemotherapy offer benefits post-surgery, though issues like resistance and side effects persist. This article discusses a case report and literature review to deepen understanding of temporo-insular gliomas, focusing on advanced diagnostic and treatment approaches.

MATERIALS AND METHODS

A systematic review was conducted using PubMed, Embase, and Google Scholar, covering studies from 2019 to July 2024. Keywords included 'brain tumor', 'neurosurgery', and 'treatment'. Articles on glioma diagnosis, management, and outcomes were selected, excluding non-English studies, irrelevant reports, non-glioma research, and inaccessible texts.

RESULTS

From 156 studies, 11 met inclusion criteria, highlighting advanced diagnostics, surgical strategies, and adjunct therapies for temporo-insular gliomas (TIGs). Gross total resection (GTR) was achieved in 39% of cases. Awake craniotomy enhanced functional outcomes, while temozolomide and radiotherapy improved survival. Challenges included ischemic complications and treatment resistance. Two patient cases underscored the complexity of TIG management and the importance of individualized approaches, achieving satisfactory resection with minimal deficits.

CONCLUSIONS

Temporo-insular gliomas (TIGs) necessitate a multidisciplinary strategy that integrates advanced imaging, meticulous surgical methods, and cutting-edge adjuvant therapies. Despite progress with techniques like awake craniotomy and the use of temozolomide improving patient outcomes, significant challenges persist in maintaining functional integrity and addressing treatment resistance. Ongoing research into targeted therapies, immunotherapies, and innovative technologies remains critical to advancing patient care and improving long-term prognosis.

Photopsias are associated with greater levels of depression and anxiety

CLINICAL RELEVANCE

Vitreous floaters have been associated with depressive and anxiety symptoms. However, there is a scarcity in the literature regarding the possible impact of vitreous flashes on the psychological status of the patients.

BACKGROUND

Photopsias and vitreous floaters frequently co-exist. Floaters have been accompanied by exacerbated levels of depression and anxiety. The aim of this study was to examine whether the presence of photopsias in patients suffering from vitreous floaters is accompanied by exacerbated levels of anxiety and depression.

METHODS

One hundred and four patients complaining of floaters were included in the study; 51 experienced also photopsias and 53 did not. A comprehensive ocular examination, including funduscopy and optical coherence tomography scans was performed to every patient, while their clinical and demographic data were also assessed. Every participant completed the PHQ-9, the Zung SDS, and the HADS anxiety and depression questionnaires.

RESULTS

The clinical and demographic data did not differ significantly between the study groups (p > 0.05).The scores of every questionnaire were significantly higher among the patients with vitreous flashes (p < 0.05 for all). After adjustment for several confounders, the values remained significantly impaired.

CONCLUSION

Photopsias negatively affect the psychological and mental well-being of the patients, by the terms of amplified levels of depression and anxiety. These findings underscore the necessity for a more holistic approach to managing patients presenting with vitreous flashes.

Toll-like receptor agonists promote the formation of tertiary lymphoid structure and improve anti-glioma immunity

BACKGROUND

Glioma, characterized by limited lymphocytic infiltration, constitutes an "immune-desert" tumor displaying insensitivity to various immunotherapies. This study aims to explore therapeutic strategies for inducing tertiary lymphoid structure (TLS) formation within the glioma microenvironment (GME) to transition it from an immune resistant to an activated state.

METHODS

TLS formation in GME was successfully induced by intracranial administration of Toll-like receptor (TLR) agonists (OK-432, TLR2/4/9 agonist) and glioma antigens (i.c. αTLR-mix). We employed staining analysis, antibody neutralization, single-cell RNA sequencing (scRNA-Seq), and BCR/TCR sequencing to investigate the underlying mechanisms of TLS formation and its role in anti-glioma immunity. Additionally, a preliminary translational clinical study was conducted.

RESULTS

TLS formation correlated with increased lymphocyte infiltration in GME and led to improved prognosis in glioma-bearing mice. In the study of TLS induction mechanisms, certain macrophages/microglia and Th17 displayed markers of "LTo" and "LTi" cells, respectively, interaction through LTα/β-LTβR promoted TLS induction. Post-TLS formation, CD4 + and CD8 + T cells but not CD19 + B cells contributed to anti-glioma immunity. Comparative analysis of B/T cells between brain and lymph node showed that brain B/T cells unveiled the switch from naïve to mature, some B cells highlighted an enrichment of class switch recombination (CSR)-associated genes, V gene usage, and clonotype bias were observed. In related clinical studies, i.c. αTLR-mix treatment exhibited tolerability, and chemokines/cytokines assay provided preliminary evidence supporting TLS formation in GME.

CONCLUSIONS

TLS induction in GME enhanced anti-glioma immunity, improved the immune microenvironment, and controlled glioma growth, suggesting potential therapeutic avenues for treating glioma in the future.

Unmasking Racial, Ethnic, and Socioeconomic Disparities in United States Chordoma Clinical Trials: Systematic Review

BACKGROUND

Chordoma is a rare bone cancer with limited treatment options. Clinical trials are crucial for developing effective therapies, but their success depends on including diverse patient populations. The objective of this study was to systematically evaluate the reporting of racial, ethnic, and socioeconomic diversity in United States clinical trials exploring treatment for chordoma.

METHODS

A literature search was conducted through PubMed/Medline, Cochrane, Epistemonikos, and ClinicalTrials.gov databases for published US chordoma trials up until 19 August 2024. The data collected included trial characteristics and racial and ethnic data, as well as socioeconomic indicators when available. Methodological Index for Non-Randomized Studies (MINORS) and Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) analyses were adopted to assess the methodological quality. The N-1 Chi-squared (χ2) test was implemented to compare the reported racial and ethnic data with the most recent US Census Bureau data.

RESULTS

Five trials involving 111 patients (median age: 63 years; 34% female) were included. Four studies (80%) were single-arm non-randomized studies with one study (25%) having a high methodological quality and three (75%) having a moderate quality based on the MINORS analysis. Most patients (91%, n = 82) were White/Caucasian, representing a proportion which was significantly higher than the reported 75% in the US population (p = 0.0005). Black/African American patients (2%, n = 2) were significantly underrepresented compared to the 14% in the US population (p = 0.0015). Regarding ethnicity, Hispanic/Latino patients (7%, n = 6) were significantly underrepresented compared to the 20% in the US population (p = 0.0021). No measures of socioeconomic status were reported.

CONCLUSIONS

This systematic review highlighted the need for improved racial and ethnic diversity in chordoma trials and the better reporting of socioeconomic data. The underrepresentation of minority groups may obscure potential disparities in disease incidence, treatment access, and clinical outcomes.

The importance of clinical experience in AI-assisted corneal diagnosis: verification using intentional AI misleading

We developed an AI system capable of automatically classifying anterior eye images as either normal or indicative of corneal diseases. This study aims to investigate the influence of AI's misleading guidance on ophthalmologists' responses. This cross-sectional study included 30 cases each of infectious and immunological keratitis. Responses regarding the presence of infection were collected from 7 corneal specialists and 16 non-corneal-specialist ophthalmologists, first based on the images alone and then after presenting the AI's classification results. The AI's diagnoses were deliberately altered to present a correct classification in 70% of the cases and incorrect in 30%. The overall accuracy of the ophthalmologists did not significantly change after AI assistance was introduced [75.2 ± 8.1%, 75.9 ± 7.2%, respectively (P = 0.59)]. In cases where the AI presented incorrect diagnoses, the accuracy of corneal specialists before and after AI assistance was showing no significant change [60.3 ± 35.2% and 53.2 ± 30.9%, respectively (P = 0.11)]. In contrast, the accuracy for non-corneal specialists dropped significantly from 54.5 ± 27.8% to 31.6 ± 29.3% (P < 0.001), especially in cases where the AI presented incorrect options. Less experienced ophthalmologists were misled due to incorrect AI guidance, but corneal specialists were not. Even with the introduction of AI diagnostic support systems, the importance of ophthalmologist's experience remains crucial.

Retinal Protection of New Nutraceutical Formulation

Background/Objectives: Retinal ganglion cell (RGC) protection represents an unmet need in glaucoma. This study assessed the neuroprotective, antioxidant, and anti-inflammatory effect of a new nutraceutical formulation named Epicolin, based on citicoline, homotaurine, epigallocatechin-3-gallate, forskolin, and vitamins, through in vitro and in vivo studies. Methods: The neuroprotective effect of Epicolin or its single components, and Epicolin compared to an untreated control and two marketed formulations [Formulation G (FG) and N (FN)], was evaluated in neuroblastoma cells (SH-SY5Y) challenged with staurosporine. The antioxidant potential and the scavenging activity of Epicolin compared to the untreated control, and FG and FN, was evaluated in SH-SY5Y cells and through oxygen radical absorbance capacity acellular assay, respectively. Moreover, the protective effect against hypoxic damage was evaluated in Muller cells (MIO-M1) subjected to hypoxia. The efficacy of Epicolin was also evaluated in DBA/2J glaucomatous mice through the use of a pattern electroretinogram (PERG), immunostaining, and real-time PCR. Results: Among the nutraceutical formulations tested, only Epicolin showed a significant neuroprotective effect on SH-SY5Y attributable to the synergistic action of its single ingredients. As for antioxidant and scavenging activity, Epicolin showed a higher efficacy compared to FG and FN. Furthermore, Epicolin showed the same protective effect on MIO-M1 cells reducing HIF-1α expression. Finally, Epicolin treatment on DBA/2J mice protected the RGCs from loss of function, as demonstrated by PERG analysis, and attenuated their death by enhancing brain-derived neurotrophic factor (BDNF) and reducing interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) expression. Conclusions: Epicolin, due to its neuroprotective, antioxidant, and anti-inflammatory properties, represents a promising potential treatment for glaucoma.

Impact of COVID-19 on Ocular Surface Health: Infection Mechanisms, Immune Modulation, and Inflammatory Responses

COVID-19, caused by SARS-CoV-2, has presented formidable challenges to global health since its emergence in late 2019. While primarily known for respiratory symptoms, it can also affect the ocular surface. This review summarizes the effects of SARS-CoV-2 on ocular surface immunity and inflammation, focusing on infection mechanisms, immune responses, and clinical manifestations. Ocular symptoms, though uncommon, include conjunctivitis, dry eye, and blurred vision. SARS-CoV-2 binds to ACE2 receptors in ocular surface epithelial cells, facilitating viral entry, replication, and local dissemination. The innate immune responses involving corneal epithelial cells and immune cells are discussed, alongside mechanisms of antigen presentation and adaptive immunity. The review also examines the roles of cytokines and chemokines in mediating ocular surface inflammation and explores the impact of cytokine storms and chronic inflammation on ocular health. Additionally, the interplay between systemic and ocular immune responses is highlighted, analyzing how systemic COVID-19 inflammation influences ocular surface health. These insights underscore the broader implications of COVID-19 beyond localized ocular infection. By consolidating current findings, this review aims to guide preventive and therapeutic strategies while identifying directions for future research to mitigate the ocular consequences of COVID-19.

Differences Between Amblyopic and Fellow Eyes in Optical Coherence Tomography: A Cohort from Jordanian Population

Background and Objectives: Amblyopia is a condition where children undergo unilateral or bilateral vision loss due to a variety of disorders that impact the visual pathway. The assessment of retinal nerve fiber layer (RNFL) thickness in amblyopia has made optical coherence tomography (OCT) a useful technique for studying the pathophysiology of this condition. This study was conducted to assess OCT results for various forms of amblyopia, including macular thickness and peripapillary RNFL thickness. It is the first of its kind in Jordan. Materials and Methods: Sixty-one individuals, aged 14 to 67, who had been diagnosed with unilateral amblyopia participated in a prospective study. Both eyes underwent spectral-domain OCT imaging, and clinical and demographic information was gathered. Relationships between different types of amblyopia and OCT measurements were investigated. Results: Compared to the contralateral fellow eyes, the amblyopic eyes showed thicker fovea, and there were differences in foveal and macular thickness observed between the sexes. Individuals with anisometropic amblyopia exhibited a greater central macular thickness. While nasal optic nerve thickness was adversely correlated with age, inferior optic nerve thickness was considerably lower in amblyopia. Conclusions: This research indicates unique OCT traits in amblyopic eyes, which may have a role in amblyopia diagnosis and treatment. The prevention of long-term visual impairment depends heavily on early detection and care. More studies using larger cohorts and longitudinal designs are necessary to improve our knowledge of the pathogenesis of amblyopia and to provide the best possible clinical management approaches.

Green extraction of prostaglandin analogs in cosmetics using deep eutectic solvents and detection via LC-MS/MS

Prostaglandin analogs (bimatoprost, travoprost, tafluprost, etc.) have similar effects to prostaglandins and are effective drugs for treating glaucoma. These compounds exhibit abnormal reactions such as causing eyelash growth, with several cases being reported of people purchasing them to increase eyelash growth; however, some cases have reported side effects such as pigmentation and dry eyes. In the Republic of Korea, cosmetics are not medicines for treating diseases; therefore, cosmetics cannot contain drugs or have labels that could mislead people. However, there are cases in which products claim to elongate and enrich eyelashes. Concerns about the abnormal reactions of these products are constantly growing, and the absence of analytical methods for illicit compounds (prostaglandins and their analogs) in cosmetics (eyelash growth serums) renders monitoring challenging. Accordingly, in this study, we sought to develop an LC-MS/MS method for facile and fast analysis of compounds illegally mixed into eyelash growth serums. Green analytical chemistry has recently emerged because of environmental concerns. In line with this trend, we developed an optimal method by comparing the methods mainly used in cosmetic pretreatment (solvent extraction, QuEChERS, and solid phase extraction) with a method using deep eutectic solvents (DESs), which is an eco-friendly solvent. As a result of validation according to the International Conference on Harmonization guidelines, the limit of detection was 0.20-9.34 ng/mL, and the limit of quantification was 0.60-28.31 ng/mL. Recovery, linearity, precision, and accuracy were within acceptable ranges. Additionally, using the Analytical GREEnness calculator and complex green analytical procedure index tools, we confirmed that the method using the DES was greener than the other methods. In this study, we developed an analytical method for illicit compounds contained in eyelash growth serums, offering an eco-friendly approach for the prevention of the distribution of illegal cosmetics.

Eye Movements and the Intraorbital Subarachnoid Space: Potential Contribution of Altered Cerebrospinal Fluid Pumping in Optic Neuropathies

Purpose

The optic nerve (ON) is mechanically perturbed by eye movements that shift cerebrospinal fluid (CSF) within its surrounding dural sheath. This study compared changes in ON length and CSF volume within the intraorbital ON sheath caused by eye movements in healthy subjects and patients with optic neuropathies.

Methods

Twenty-one healthy controls were compared with 11 patients having primary open angle glaucoma (POAG) at normal intraocular pressure (IOP), and 11 with chronic non-arteritic anterior ischemic optic neuropathy (NA-AION). High resolution magnetic resonance imaging (MRI) was performed in central and eccentric gazes, and analyzed to determine ON partial volume and gaze-related changes in ON path redundancy, ON elongation, and intrasheath CSF volume.

Results

ON volume was subnormal in both POAG and NA-AION. In all subjects, ON path redundancy decreased similarly from abduction to central gaze to adduction; in healthy subjects, the ON path was also significantly less redundant in infraduction and supraduction. The ON elongated significantly in adduction in controls and NA-AION but not in POAG. In all groups, CSF volume was 40 to 50 mm3 in central gaze, and significantly decreased in adduction, abduction, and supraduction in controls but subnormally in adduction only in POAG and NA-AION. The globe translated laterally more than normal in NA-AION but did not retract.

Conclusions

Horizontal gaze and supraduction change subarachnoid CSF volume around the retrobulbar ON. Eye movements might thus pump CSF to promote ON health, but this effect is subnormal in adduction in POAG and NA-AION, suggesting that retrobulbar CSF pumping is associated with chronic forms of these optic neuropathies.

Corrected Axial Length and Choroidal Thickness: A Correlation Analysis for Scientific Purposes

Purpose: Choroidal thickness (ChT) is an important measurement for evaluating eye and systemic disorders, but it is influenced by numerous elements, especially axial length (AL). It is known that the presence of a linear relationship between ChT and AL exists, but recently it has been shown that the AL measurement obtained with the current optical biometry is not very precise and needs to be corrected. This study aimed to verify if a similar correlation also persists with this corrected AL (ALc). Methods: All subjects underwent a complete eye examination, including spectral domain optical coherence tomography (OCT) with enhanced depth image (EDI) mode and AL measurement with IOLMaster. After a normality check of the data, the correlations between ChT with AL and ALc were investigated through the Pearson correlation coefficient. p values < 0.05 were considered statistically significant. Results: In total, 100 eyes of 50 healthy patients were evaluated. The mean AL was 24.36 ± 1.23 mm and mean ALc was 24.25 ± 1.22 mm. The mean nasal ChT, subfoveal ChT, and temporal ChT were, respectively, 250.57 ± 93.93 µm, 307.18 ± 101.66 µm, and 313.72 ± 88.86 µm. A significant negative linear correlation was found by comparing both AL and ALc to ChT (all r < -0.500, all p < 0.050). The negative linear correlation was stronger between nasal ChT and both AL and ALc (all r = -0.581). Conclusions: Through OCT and optical biometry, we confirmed that a statistically significant correlation persists between ALc and ChT, equal to the uncorrected AL. On these bases, in ChT studies or protocols, we recommend stratifying population according to ALc because linear correlation is still present; however, the cut-off values should be changed according to the systematic errors in optical biometry. In addition, both AL and ChT changes should be evaluated according to ALc.

Chimeric antigen receptor-macrophages: Emerging next-generation cell therapy for brain cancer

Adoptive cell-based therapy utilizing chimeric antigen receptor (CAR)-T technology holds promise in the field of neuro-oncology. Significant progress has been made in enhancing both the efficacy and safety of CAR-T-cell therapies. However, challenges such as the multifaceted immunosuppressive impact of the tumor microenvironment and insufficient CAR-T-cell infiltration into brain tumor sites remain a major hurdles. Emerging novel approaches utilizing CAR-macrophages (CAR-MACs) show potent results for brain tumor immunotherapy. CAR-MACs localize to tumor sites more readily, increase immune cell infiltrates, and demonstrate high antitumor efficacy by effectively eliminating tumor cells through mechanisms such as phagocytosis or efferocytosis. This review discusses the current advancements in CAR-MAC cell therapies for brain cancer, followed by an overview of research on manufacturing CAR-MACs for clinical application. We further highlight the potential future applications of CAR-MACs in combinatory therapies in the treatment of brain tumors.

Evaluating the Consistency of Online Circular Contrast Perimetry Across Different Computer Monitors: A Cross-sectional Study

Aim and background

The aim of this study is to evaluate the agreement between perimetric findings of a novel 24°, 52-loci online circular contrast perimetry (OCCP) application on three different computer monitors to determine its stability of testing across varying displays.

Materials and methods

Sixty-one participants (19 healthy controls, 42 with glaucoma) underwent SAP testing followed by OCCP testing on three uncalibrated computer monitors in randomized order: a large-screen (24-inch) desktop personal computer (DPC) (Dell, Texas, US), a 17-inch laptop (LPC) (Dell), and a 14-inch MacBook Pro (MP) (Apple, California, US).

Results

Agreement of mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)/visual index (VI) values between MP, DPC, and LPC OCCP were strong, with intraclass correlations and Deming's coefficients ranging from 0.96 to 1.00 and 0.93 to 1.03, respectively. When OCCP tests were compared to SAP, ICCs and Deming's coefficients were less strong, ranging from 0.89 to 0.95 and 0.72 to 0.89. Bland-Altman analyses revealed higher biases (2.90 to 3.59 dB) and wider limits of agreement when comparing OCCP to SAP than when comparing OCCP on different monitors. Bland-Altman bias of contrast sensitivities for each 24-2 testing location revealed stronger relationships between OCCP tests on different monitors (-0.82 to 0.78) than between OCCP and SAP tests (-1.53 to 1.32).

Conclusion

OCCP demonstrates strong levels of test-retest agreement when performed on computer monitors of varying display and moderate to strong levels of correlation to SAP perimetric indices.

Clinical significance

With further enhancements, OCCP could potentially be used on different personal computers, which could help address current challenges in glaucoma care, such as limited access to traditional perimetric testing. This has the potential to expand the scope of glaucoma detection and monitoring, particularly in remote and underserved areas of our community.

How to cite this article

Gong A, Busija L, Skalicky SE. Evaluating the Consistency of Online Circular Contrast Perimetry Across Different Computer Monitors: A Cross-sectional Study. J Curr Glaucoma Pract 2025;19(1):15-27.

Retinal Microstructural and Microvascular Changes in Alzheimer Disease: A Review

"The eyes are a window to the brain," prompting the investigation of whether retinal biomarkers can indicate Alzheimer disease (AD) and cognitive impairment. AD is a neurodegenerative condition with a lengthy preclinical phase where pathologic changes in the central nervous system (CNS) occur before clinical symptoms. Mild cognitive impairment (MCI) often precedes AD. As part of the CNS, the retina exhibits similar pathologic changes related to AD as those seen in the brains of patients with MCI. Noninvasive imaging technologies such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) allow high-resolution visualization of the retina, providing an opportunity to screen and monitor AD noninvasively. In this review, we summarize the relationship between AD and retinal pathology detected by OCT and OCTA. The most common findings in patients with AD include peripapillary retinal nerve fiber layer thinning, decreased macular thickness, an enlarged foveal avascular zone, and decreased vascular densities in the superficial and deep capillary plexuses. These retinal changes correlate with magnetic resonance imaging (MRI) findings of cerebral atrophy, positron emission tomography (PET) findings of increased amyloid load, and neuropsychological testing results suggesting cognitive dysfunction. We conclude that retinal microstructural and microvascular abnormalities may serve as biomarkers for the early detection and clinical monitoring of AD and as tools for evaluating potential treatment effects. Future studies should focus on standardizing protocols for in vivo ophthalmic imaging to measure retinal pathology in AD and MCI.

The Current Potential Pathogenesis of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease mainly characterized by the accumulation of ubiquitinated proteins in the affected motor neurons. At present, the accurate pathogenesis of ALS remains unclear and there are still no effective treatment measures for ALS. The potential pathogenesis of ALS mainly includes the misfolding of some pathogenic proteins, the genetic variation, mitochondrial dysfunction, autophagy disorders, neuroinflammation, the misregulation of RNA, the altered axonal transport, and gut microbial dysbiosis. Exploring the pathogenesis of ALS is a critical step in searching for the effective therapeutic approaches. The current studies suggested that the genetic variation, gut microbial dysbiosis, the activation of glial cells, and the transportation disorder of extracellular vesicles may play some important roles in the pathogenesis of ALS. This review conducts a systematic review of these current potential promising topics closely related to the pathogenesis of ALS; it aims to provide some new evidences and clues for searching the novel treatment measures of ALS.