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Survey of Ophthalmology 2024Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and... (Review)
Review
Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.
Topics: Humans; Trachoma; Trichiasis; Conjunctiva; Blindness; Vision, Low
PubMed: 36878359
DOI: 10.1016/j.survophthal.2023.02.008 -
JAMA Ophthalmology May 2024Effects of genetic variants on primary angle-closure disease remained uncertain. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Effects of genetic variants on primary angle-closure disease remained uncertain.
OBJECTIVE
To systematically review the associations of common single-nucleotide variants (SNVs) and rare coding variants with primary angle-closure disease, its subtypes (including primary angle-closure glaucoma, primary angle-closure suspect, and primary angle-closure) and progression.
DATA SOURCES
Eligible studies from PubMed, Embase, and Web of Science were retrieved up to April 3, 2023. SNV information was extracted from eligible reports and 2 genome-wide association studies summary statistics, UK BioBank and FinnGen.
STUDY SELECTION
Studies providing analyzable genotype or allele data in a case-control design for primary angle-closure disease association and longitudinal case-only design for primary angle-closure disease progression.
DATA EXTRACTION AND SYNTHESIS
PRISMA guidelines were used for literature screening and the Newcastle Ottawa Scale for data quality assessment. Pooled effect size with 95% CIs of SNV associations were calculated using fixed- or random-effect models according to I2 statistics.
MAIN OUTCOMES AND MEASURES
SNVs reported in 2 or more studies were meta-analyzed to generate pooled odds ratios and P values. Common and rare coding variants from single reports were summarized.
RESULTS
Sixty-nine citations were eligible for meta-analysis on overall primary angle-closure disease, involving 206 SNVs in 64 genes or loci. Seventeen SNVs in 15 genes or loci showed associations with primary angle-closure disease, and 15 SNVs in 13 genes or loci showed associations with primary angle-closure glaucoma. Two SNVs, ABCA1 rs2422493 and ZNRF3 rs3178915, were associated only with primary angle-closure disease. Two SNVs, PCMTD1-ST18 rs1015213 and COL11A1 rs3753841, were associated with primary angle-closure suspect, and 1 SNV, MMP9 rs3918249, was associated with primary angle-closure. This systematic review and meta-analysis newly confirmed 7 genes or loci associated with primary angle-closure glaucoma: ATOH7, CALCRL, FBN1, IL6, LOXL1, MMP19, and VAV3. Common and rare coding variants in 16 genes or loci that have been associated with primary angle-closure disease were cataloged. Stratification analysis revealed different primary angle-closure disease-associated genes in different ethnic populations. Only 1 study regarding the genetic association of primary angle-closure glaucoma progression was identified.
CONCLUSIONS AND RELEVANCE
This study revealed the genetic complexity of primary angle-closure disease, involving common SNVs and rare coding variants in more than 30 genes or loci, with ethnic and phenotypic diversities. Further replication, genotype-phenotype correlation, and pathway analyses are warranted.
Topics: Glaucoma, Angle-Closure; Humans; Polymorphism, Single Nucleotide; Genome-Wide Association Study; Genetic Predisposition to Disease; Intraocular Pressure
PubMed: 38546604
DOI: 10.1001/jamaophthalmol.2024.0363 -
Ophthalmology Feb 2023To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual... (Review)
Review
TOPIC
To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA).
CLINICAL RELEVANCE
Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear.
METHODS
A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies.
RESULTS
Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA.
CONCLUSIONS
Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
Topics: Adult; Humans; Retinal Perforations; Visual Acuity; Randomized Controlled Trials as Topic; Retina; Vitrectomy; Retrospective Studies; Basement Membrane; Tomography, Optical Coherence; Treatment Outcome
PubMed: 36058348
DOI: 10.1016/j.ophtha.2022.08.028 -
Child's Nervous System : ChNS :... Jun 2024Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to... (Review)
Review
OBJECTIVE
Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality.
METHODS
A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies.
RESULTS
A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated.
CONCLUSION
OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.
Topics: Child; Humans; Craniopharyngioma; Neurosurgical Procedures; Pituitary Neoplasms; Treatment Outcome; Vision Disorders
PubMed: 38416204
DOI: 10.1007/s00381-024-06328-5 -
Journal of Traditional Chinese Medicine... Feb 2024To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy.
METHODS
We comprehensively searched the available literature up to November 2021, including PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database, for randomized controlled trials (RCTs) on AM for the treatment of severe vomiting, insomnia, pharyngeal and pelvic pain, mood abnormalities, and dyspepsia during pregnancy.
RESULTS
Sixteen RCTs with a cumulative sample size of 1178 cases were included. Of these, 964 patients were included in the Meta-analysis. The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy [odds ratio () = 1.19, 95% confidence interval () (1.11, 1.28), 0.01]. AM was better than the control group in improving the visual analog scale scores [standard mean difference () = 0.62, 95% (0.53, 0.71), 0.01]. AM was superior to the control group in improving Numerical Rating Scale (NRS) symptom scores [ = 7.31, 95% (3.36, 15.94), 0.01]. There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group [ = 0.70, 95% (0.39, 1.28), = 0.25], but the treatment and control groups had mild adverse effects with a low incidence.
CONCLUSIONS
AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms, and is relatively safe. However, the quality of the included trials was rather poor, and high-quality studies are required to confirm our findings.
Topics: Female; Humans; Pregnancy; Acupuncture Therapy; China; Pelvic Pain; Sleep Initiation and Maintenance Disorders; Vomiting
PubMed: 38213235
DOI: 10.19852/j.cnki.jtcm.20231204.006 -
The British Journal of Radiology Jan 2018Lung cancer is the leading cause of cancer mortality worldwide. Treatment pathways include regular cross-sectional imaging, generating large data sets which present... (Review)
Review
Lung cancer is the leading cause of cancer mortality worldwide. Treatment pathways include regular cross-sectional imaging, generating large data sets which present intriguing possibilities for exploitation beyond standard visual interpretation. This additional data mining has been termed "radiomics" and includes semantic and agnostic approaches. Textural analysis (TA) is an example of the latter, and uses a range of mathematically derived features to describe an image or region of an image. Often TA is used to describe a suspected or known tumour. TA is an attractive tool as large existing image sets can be submitted to diverse techniques for data processing, presentation, interpretation and hypothesis testing with annotated clinical outcomes. There is a growing anthology of published data using different TA techniques to differentiate between benign and malignant lung nodules, differentiate tissue subtypes of lung cancer, prognosticate and predict outcome and treatment response, as well as predict treatment side effects and potentially aid radiotherapy planning. The aim of this systematic review is to summarize the current published data and understand the potential future role of TA in managing lung cancer.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Image Interpretation, Computer-Assisted; Lung Neoplasms; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 28869399
DOI: 10.1259/bjr.20170267 -
British Journal of Anaesthesia Jan 2022Development of a widely accepted standardised analgesic pathway for adult spine surgery has been hampered by the lack of quantitative analysis. We conducted a systematic... (Meta-Analysis)
Meta-Analysis
Efficacy of perioperative pharmacological and regional pain interventions in adult spine surgery: a network meta-analysis and systematic review of randomised controlled trials.
BACKGROUND
Development of a widely accepted standardised analgesic pathway for adult spine surgery has been hampered by the lack of quantitative analysis. We conducted a systematic review and network meta-analysis (NMA) to compare, rank, and grade all pharmacological and regional interventions used in adult spine surgery.
METHODS
A systematic search was performed in January 2021. We performed double study screening, selection, and data extraction. The co-primary outcomes were cumulative morphine consumption (mg) and visual analogue pain score (range 0-10) at postoperative 24 h. An NMA was performed using the Bayesian approach (random effects model). We also ranked and graded all analgesic interventions using the Grading of Recommendations Assessment, Development and Evaluation approach for NMA.
RESULTS
We screened 5908 studies and included 86 randomised controlled studies, which comprised 6284 participants. Of 20 pharmacological and 10 regional interventions, the most effective intervention was triple-drug therapy, consisting of paracetamol, nonsteroidal anti-inflammatory drugs, and adjunct. The pooled mean reduction in morphine consumption and pain score at postoperative 24 h were -26 (95% credible interval [CrI]: -39 to -12) mg and -2.3 (95% CrI: -3.1 to -1.4), respectively. Double-drug therapy was less effective, but showed moderate morphine reduction in a range of -15 to -17 mg and pain score reduction in a range of -1 to -1.6. Single-agent interventions were largely ineffective.
CONCLUSIONS
Triple-drug therapy is the most effective pain intervention in adult spine surgery with moderate-to-high certainty of evidence. We have also identified a graded analgesic effect, in which analgesic efficacy increased with the number of multimodal drugs used.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42020171326).
Topics: Adult; Analgesics; Analgesics, Opioid; Drug Therapy, Combination; Humans; Morphine; Network Meta-Analysis; Pain Measurement; Pain, Postoperative; Randomized Controlled Trials as Topic; Spine
PubMed: 34774296
DOI: 10.1016/j.bja.2021.08.034 -
Frontiers in Bioscience (Landmark... Oct 2023The retina, a component of the central nervous system, is composed of six distinct neuronal types and various types of glial cells. A technique for single-cell... (Review)
Review
The retina, a component of the central nervous system, is composed of six distinct neuronal types and various types of glial cells. A technique for single-cell transcriptome analysis called single-cell RNA sequencing (scRNA-seq) can be employed to study the complicated dynamics of several types of retinal cells. It meticulously examines how various cell types express their genes, shedding light on all biological processes. scRNA-seq is an alternative to regular RNA-seq, which cannot identify cellular heterogeneity. Understanding retinal diseases requires research on retinal cell heterogeneity. The identification of novel cell subpopulations can provide information about disease occurrence and progression as well as the specific biological functions of particular cells. We currently have a better understanding of the interactions among the brain, the retina, and its visual pathways thanks to the use of scRNA-seq to examine retinal development and disease pathogenesis. Additionally, this technology offers fresh perspectives on the sensitivity and molecular basis of cell subtypes linked to retinal diseases. Thanks to scRNA-seq technology, we now have a better understanding of the most recent developments and difficulties in retinal development and disorders. We believe that scRNA-seq is an important tool for developing cutting-edge treatments for retinal diseases. This paper presents a systematic review of the history of sRNA-seq technology development and provides an overview of the unique subtypes of retinal cells and the specific gene markers this technology identifies.
Topics: Humans; Retina; Neurons; Sequence Analysis, RNA; Retinal Diseases; Biology; Gene Expression Profiling
PubMed: 37919055
DOI: 10.31083/j.fbl2810247 -
Frontiers in Aging Neuroscience 2022Alzheimer's disease (AD) is a multifaceted neurodegenerative disorder with many complex pathways feeding into its pathogenesis and progression. Vitamin C, an essential...
PURPOSE
Alzheimer's disease (AD) is a multifaceted neurodegenerative disorder with many complex pathways feeding into its pathogenesis and progression. Vitamin C, an essential dietary antioxidant, is vital for proper neurological development and maintenance. This meta-analysis and systematic review attempted to define the relationship between vitamin C plasma levels and AD while highlighting the importance and involvement of vitamin C in the pathogenesis of AD.
MATERIALS AND METHODS
PRISMA guidelines were used to obtain studies quantifying the plasma levels of vitamin C in AD and control subjects. The literature was searched in the online databases PubMed, Google Scholar, and Web of Science. A total of 12 studies were included ( = 1,100) and analyzed using Comprehensive Meta-Analysis 3.0.
RESULTS
The results show that there is a significant decrease in the plasma vitamin C levels of AD patients as compared to healthy controls (pooled SMD with random-effect model: -1.164, with 95%CI: -1.720 to -0.608, = -4.102, = 0.00) with significant heterogeneity ( = 93.218). The sensitivity analysis showed directionally similar results. Egger's regression test ( = 0.11) and visual inspection of the funnel plot showed no publication bias.
CONCLUSION
Based on these studies, it can be deduced that the deficiency of vitamin C is involved in disease progression and supplementation is a plausible preventive and treatment strategy. However, clinical studies are warranted to elucidate its exact mechanistic role in AD pathophysiology and prevention.
PubMed: 36158537
DOI: 10.3389/fnagi.2022.970263 -
Expert Review of Clinical Immunology Feb 2014The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic... (Review)
Review
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
Topics: Animals; Anti-Inflammatory Agents; Complementary Therapies; Cryotherapy; Evidence-Based Medicine; Humans; Inflammation; Inflammation Mediators; Joints; Rheumatic Diseases
PubMed: 24345205
DOI: 10.1586/1744666X.2014.870036