This prospective cohort study aimed to assess the efficacy and safety of modified posterior scleral reinforcement (PSR) combined with comprehensive therapy versus conventional optical correction for controlling myopia progression in patients with high and pathologic myopia. A total of 203 patients aged 8-18 years were allocated, based on preference, to either the combination therapy group (n = 111; receiving modified PSR plus low-concentration atropine and/or peripheral defocus optical correction) or the conventional control group (n = 92; fitted with rigid gas-permeable contact lenses only). After accounting for 10 withdrawals during the study period, 193 patients completed the 24-month follow-up (combination group, n = 102; control group, n = 91) and were included in the final analysis. The primary outcomes were changes in axial length (AL) and spherical equivalent (SE). Secondary outcomes included best-corrected visual acuity (BCVA), posterior segment structural lesions, and adverse events. After 24 months, the combination therapy group showed significantly less AL elongation (0.33 ± 0.13 mm vs 0.70 ± 0.23 mm, p < 0.001) and SE progression (-0.75 ± 0.27 dioptres [D] vs -1.48 ± 0.57 D, p < 0.001) than the control group. The combination therapy group also demonstrated greater improvement in BCVA (p < 0.001) and lower rates of progression of myopic tractional maculopathy (2.9% vs 12.1%, p = 0.014) and aggravated tessellated fundus (6.9% vs 17.6%, p = 0.022) than the control group. The incidence of adverse events did not differ significantly between the groups (4.9% vs 4.4%, p = 1.000). In real-world clinical practice, personalized combination therapy centered on modified PSR is associated with slower axial elongation and refractive error progression and may help to stabilize posterior segment structures in patients with high and pathologic myopia, demonstrating more favorable clinical outcomes than conventional optical correction alone.

During general anesthesia in dogs, vasopressor-induced increases in mean arterial pressure (MAP) may be partly opposed by reflex sinus slowing. Subsequent administration of atropine or another antimuscarinic may cause an abrupt increase in sinus rate; when vascular tone is already elevated, this increase may in turn contribute to an abrupt or excessive MAP rise. This article examines cardiac vagal decoupling, defined as reduced vagally mediated muscarinic restraint at the sinoatrial node, as a physiological concept for graded vasopressor titration. The hypothesis is that reducing this restraint before substantial vasopressor escalation, followed by MAP-guided dose adjustments, may permit more graded pressure control: reaching and maintaining a specified MAP range with fewer abrupt or excessive pressure increases. Canine studies support muscarinic control of sinus rate, baroreflex responses during anesthesia, and modification of vasopressor responses by prior antimuscarinic administration. These findings support components of the proposed concept, but whether it improves graded MAP titration has not been directly tested. The article contrasts the two hemodynamic patterns, evaluates the supporting evidence, and considers the limits of the hypothesis. Effects of such titration on cardiac output, tissue perfusion, and clinical outcomes require separate evaluation.

Background/Objectives: Neural infiltration closely correlates with the progression and poor prognosis of gastrointestinal tumors. The vagus nerve regulates tumor cell proliferation and invasion through acetylcholine (ACh). Combining targeted neurotherapy with chemotherapy has recently emerged as a promising anticancer strategy. Methods: In this study, we designed a biodegradable temperature-sensitive hydrogel (PDLLA-PEG-PDLLA, PLEL) that co-delivers 5-fluorouracil (5-FU) and atropine (a vagal nerve blocker) for local gastric cancer chemotherapy. A key feature of this 5-FU + atropine/PLEL hydrogel system is its sol-gel phase transition in response to physiological temperature, enabling sustained drug release in vivo. Results: After intraperitoneal injection, this dual-drug-loaded hydrogel significantly reduced tumor growth in gastric cancer models, outperforming single-drug-loaded hydrogels and free 5-FU plus atropine combinations. This delivery system also reduced side effects. Conclusions: Therefore, this innovative dual-drug-loaded hydrogel shows strong potential for intratumoral gastric cancer chemotherapy and offers a clinically valuable option for postoperative management.

Objectives: To evaluate the 24-month efficacy of combining highly aspherical lenslet target (HALT) spectacle lenses with low-dose atropine (LDA) in children with poor response to atropine monotherapy. Methods: This prospective interventional cohort study included myopic children aged 6-11 years who continued to progress despite LDA (0.01-0.025%). Fifty children completed 12 months of follow-up and 48 completed 24 months. At 12 months, atropine dosage was maintained, reduced, or increased according to clinical discretion. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline, 12 months, and 24 months. Results: Myopia progression during the first year (SER: -0.07 ± 0.45 D; AL: 0.13 ± 0.14 mm) was markedly lower than during the 6 months before treatment (SER: -0.61 ± 0.39 D; AL: 0.24 ± 0.12 mm). During the second year, atropine dosage was reduced in 23%, maintained in 67%, and increased in 10% of participants. Mean second-year progression was -0.26 ± 0.41 D and 0.17 ± 0.17 mm, with no significant differences between treatment groups. Although second-year SER progression exceeded first-year progression (p = 0.003), both SER and AL progression remained significantly lower than pre-treatment rates (p = 0.004). Over 24 months, 73.9% of eyes progressed ≤ 0.50 D and 71.7% progressed ≤ 0.40 mm. Younger age and greater first-year progression independently predicted greater 24-month SER and AL progression. Conclusions: Myopia progression was relatively well sustained over 24 months after combination treatment was started in children previously progressing on LDA. Younger children and those with greater early progression may warrant closer monitoring.

Background/Objectives: Long-term tear-film and symptom data for compounded 0.025% atropine remain limited in European children. We assessed changes in first non-invasive tear-film break-up time (fNIBUT) and Ocular Surface Disease Index (OSDI) scores over 24 months. Methods: This secondary analysis of the ASPECT trial included 101 children completing 24 months, all assigned nightly compounded 0.025% atropine with Defocus Incorporated Multiple Segments or single-vision spectacles. Available fNIBUT, OSDI, and corneal endothelial cell density (ECD) measurements at baseline, 12 months, and 24 months were analysed using longitudinal mixed-effects models. The six pairwise contrasts across the primary outcomes of this secondary analysis used Holm-adjusted p-values and simultaneous Bonferroni 95% confidence intervals (CIs). No untreated comparator was available. Results: fNIBUT was numerically higher at 24 months than at baseline (16.9 vs. 14.3 s; mean difference [MD], 2.60 s; 95% CI, -0.37 to 5.57; p = 0.103). OSDI decreased from 14.7 to 9.6 (MD, -5.15 points; 95% CI, -9.93 to -0.36; p = 0.028). This reduction was not statistically significant in all examined missing-not-at-random scenarios or in an analysis restricted to children aged ≥8 years. ECD showed no statistically significant longitudinal changes. The exploratory combined criterion of OSDI ≥ 13 and fNIBUT < 10 s decreased numerically from 13/98 (13.3%) to 5/86 (5.8%). Conclusions: No deterioration was detected in the measured parameters among 24-month completers. Selection of completers, differential missingness, limited paediatric symptom assessment, and absence of a concurrent untreated comparator preclude firm conclusions about long-term ocular surface tolerability.

Comparative evidence for integrated ventilation-neuromuscular blockade-reversal strategies is limited in geriatric small dogs. This single-center retrospective cohort included 288 dogs aged ≥12 years and weighing ≤7 kg undergoing orthopedic surgery or thoracolumbar hemilaminectomy. Initially planned strategies were spontaneous ventilation without neuromuscular blockade (A), controlled ventilation without blockade (B), rocuronium-controlled ventilation-sugammadex (C), vecuronium-controlled ventilation-sugammadex (D), or vecuronium-controlled ventilation-neostigmine-atropine (E). The primary outcome was the percentage of the entire primary physiologic window with concurrent mean arterial pressure ≥ 60 mmHg and end-tidal carbon dioxide 35-55 mmHg. Adjusted means were A 58.9%, B 59.3%, C 86.6%, D 74.0%, and E 67.8%. Group C exceeded A, B, and D by 27.7 (95% confidence interval, 26.3-29.2), 27.3 (25.9-28.8), and 12.7 (11.2-14.1) percentage points; B and A differed by 0.4 points (-0.8-1.6). Ventilator asynchrony occurred in 3.4% of C versus 73.2% of B. Adjusted mean times to normalized train-of-four ratio ≥ 0.90 were 1.41, 2.31, and 7.43 min in Groups C-E, respectively. Observed early respiratory and hard 48 h event risks were 3.4% and 1.7% in C, 40.7% and 18.6% in A, and 44.6% and 17.9% in B. The rocuronium-facilitated strategy was associated with superior concurrent target attainment; nonrandomized strategy selection precludes causal safety conclusions.

Acute respiratory failure due to organophosphate (OP) poisoning is a life-threatening emergency caused by acetylcholinesterase inhibition and subsequent cholinergic overstimulation. The author reports a 36-year-old male who intentionally ingested 50% malathion and presented with blurred vision, excessive salivation, muscle fasciculations, altered consciousness, and acute respiratory distress. His laboratory tests showed reduced cholinesterase levels, and chest imaging showed mild bilateral infiltrates without evidence of aspiration pneumonia. Immediate management included securing the airway with mechanical ventilation and administering atropine according to the patient's clinical response. Pralidoxime was administered, and appropriate intravenous fluid resuscitation was provided for hypotension. Close monitoring allowed early differentiation between his primary respiratory failure due to OP toxicity and potential secondary complications. He was discharged on day nine after making a full recovery. This case highlights the critical importance of rapid recognition, early airway stabilization, and timely antidote administration in managing acute respiratory failure resulting from OP poisoning.

This review examines recent advances in the enantiomeric separation of tropane alkaloids (TAs), focusing on atropine, a racemic mixture of (+)- and (-)-hyoscyamine whose enantiomers differ significantly in pharmacological activity, with (-)-hyoscyamine being the more potent antimuscarinic agent. Enantiomeric purity and racemisation control are therefore essential in pharmaceutical formulations, biological samples, and food, where TAs are regulated contaminants due to their toxicological effects. The review covers analytical strategies reported from 2010 to 2026, with emphasis on high-performance liquid chromatography (HPLC), often coupled with tandem mass spectrometry (MS/MS) to improve sensitivity and selectivity. Polysaccharide-based chiral stationary phases operated in normal-phase or polar organic modes, usually with amine additives, represent the most widely employed approach. Protein-, cyclodextrin-, and antibiotic-based chiral selectors have also demonstrated successful enantiomeric resolution. Sample preparation is particularly challenging for food matrices, requiring efficient extraction and clean-up while preventing enantiomeric racemisation. Published strategies include solid-phase extraction (SPE), matrix solid-phase dispersion (MSPD), and QuEChERS protocols. Despite significant analytical advances, chiral analysis of TAs in foods remains underexplored. Recent studies have reported (-)-hyoscyamine concentrations exceeding regulatory limits in herbal infusions, underscoring the need for further research to support European Food Safety Authority (EFSA) recommendations and improve consumer risk assessment.

Social interaction and preference are essential parts of human and animal behavior. Zebrafish are rapidly emerging as a major model organism in neurobehavioral research and, as highly social animals, enable probing of their social preference and its pharmacological modulation. Neuroactive drug effects, however, can also be socially transmittable, thereby indirectly affecting drug-free animal behavior as well. Here, we examine this possibility in adult zebrafish by assessing their social preference for conspecifics treated using a wide range of neuroactive drugs with well established effects in zebrafish. Zebrafish were treated with acute or chronic neuroactive drugs (GBR-12909, fluoxetine, reserpine, caffeine, arecoline, nicotine, cuprizone, ethanol, and atropine), and exposed to target fish in the three-chamber social preference test, scoring time the latter spent in each zone. Overall, we found their overt social preference for conspecifics treated with acute nicotine and GBR-12909, and social avoidance of fish exposed to all other drugs used, except cuprizone and ethanol. These findings confirm altered social preference for central nervous system (CNS) drug-treated zebrafish, but suggest that this preference is nonlinear and does not correlate with anxiolytic or anxiogenic drug profiles. Further research is needed to explore why some CNS drug-evoked behavioral effects render conspecifics socially attractive or aversive to observer zebrafish, and to determine potential practical and translational implications of these findings for neuropharmacology and biological psychiatry.