- Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT). [Journal Article]Br J Radiol. 2023 Jan 12 [Online ahead of print]BJ
- CONCLUSIONS: Changes in blinking characteristics could serve as objective measures of reader fatigue and may prove useful in the development of DBT reading protocols.
- Effects of Botulinum Toxin Injection on Reducing Myogenic Artifacts during Video-EEG Monitoring: A Longitudinal Study. [Journal Article]Neurodiagn J. 2022 Dec; 62(4):222-238.NJ
- Medically refractory seizures affect one-third of patients with epilepsy (PwE), for whom epilepsy surgery is considered. Video electroencephalography (vEEG) monitoring is a fundamental tool for pre-operative seizure localization. Facial and cranial myogenic artifacts can obscure vEEG findings, thus interfering with seizure localization. Studies have shown the beneficial effects of botulinum toxin…
Medically refractory seizures affect one-third of patients with epilepsy (PwE), for whom epilepsy surgery is considered. Video electroencephalography (vEEG) monitoring is a fundamental tool for pre-operative seizure localization. Facial and cranial myogenic artifacts can obscure vEEG findings, thus interfering with seizure localization. Studies have shown the beneficial effects of botulinum toxin type A (BTX-A) injection into cranial muscles for reducing myogenic artifacts. This longitudinal study aimed to assess the effects of BTX-A injection on these artifacts. Twenty-two patients with medically refractory hypermotor seizures with daily seizure frequency and undetermined epilepsy localization were included in this study and underwent Dysport® injection (200 units) into the frontotemporal region. vEEG recordings were performed at baseline (one week before the injection), and at three days and six days post-injection. Before and after the injection, the amplitudes of myogenic artifacts were compared during various states (ictal, blinking, chewing, bruxism, head lateralization, scowling, talking, and yawning). BTX-A injection significantly reduced the amplitudes of EEG myogenic artifacts, except during blinking (day three) and talking (days three and six). On day six, significant reduction in EEG myogenic artifacts were noted during blinking, chewing, and bruxism for the greatest number of patients (95.5%, 90.9%, 81.8%), while significant reductions in EEG myogenic artifacts during talking, head lateralization, and ictal phase were associated with the least number of patients (22.7%, 36.3%, and 40.9%). Therefore, BTX-A injection could be a convenient method for filtering myogenic contamination, improving EEG interpretation, and facilitating seizure localization in patients with medically refractory seizures.
- StatPearls: Meibomian Gland Disease [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- The meibomian gland dysfunction (MGD) international workshop describes MGD as "chronic diffuse abnormality of the meibomian glands, characterized by terminal duct obstruction along with qualitative or quantitative changes in the glandular secretion." The obstruction of the terminal duct occurs because of hyperkeratinization of the duct epithelium and the viscous nature of the meibum. These can…
The meibomian gland dysfunction (MGD) international workshop describes MGD as "chronic diffuse abnormality of the meibomian glands, characterized by terminal duct obstruction along with qualitative or quantitative changes in the glandular secretion." The obstruction of the terminal duct occurs because of hyperkeratinization of the duct epithelium and the viscous nature of the meibum. These can result in atrophy and drop out of the meibomian glands, thus decreasing secretion. The sequelae of MGD can be observed in the forms of tear film abnormalities, ocular surface irritation, inflammation, or ocular surface disease. These meibomian glands are a type of sebaceous glands that are located in the eyelids. These are named after a German physician and anatomist 'Heinrich Meibom.' These glands lie parallelly in a single row within the tarsal plates of the upper and lower lids. The proximal ends of the meibomian glands extend towards the proximal margin of the tarsal plates. The distal end of the tarsus receives the secretion, i.e., meibum, through the excretory duct into the lid margin. It is estimated that the upper lid contains approximately 20 to 30 separate glands, and the lower lid has about 40 to 50 glands. Meibomian glands produce lipids, which are the major component of the superficial lipid layer of the tear film. This lipid layer is known to protect the excessive evaporation of the tear film's aqueous layer. It also helps by lowering the surface tension and thus stabilizing the tear film. It acts as a lubricant during blinking and provides an outer barrier that prevents bacteria from entering the tear film. The functional disorders caused by the meibomian gland dysfunction resulting in alterations in the meibomian gland secretions are also referred to as posterior blepharitis. MGD can broadly be classified based on onset into congenital and neoplastic. Based on the duration, it can be classified into acute or chronic. Based on underlying etiology, it can be divided into: Low delivery. High delivery. The low delivery type can be hyposecretory (meibomian sicca) and obstructive (cicatricial or non-cicatricial). Meibomian sicca results from atrophy of the meibomian glands or secondary to medications. MG atrophy results in an overall reduction in functional meibomian glands. The most common form of MGD is the obstructive type. This results from hypertrophy and keratinization of the ductal epithelium. This is further classified into cicatricial or non-cicatricial. The high delivery type is also called hypersecretory (meibomian seborrhea) and results from excessive secretion of the lipids. Meibomian seborrhea occurs secondary to underlying systemic conditions such as seborrheic or atopic dermatitis and acne rosacea.
- Moisture-Dependent Blinking of Individual CsPbBr3 Nanocrystals Revealed by Single-Particle Spectroscopy. [Journal Article]J Phys Chem Lett. 2022 Nov 24; 13(46):10751-10758.JP
- All-inorganic metal halide perovskite nanocrystals (NCs) have been exceptional candidates for high-performance solution-processed optoelectronic and photonic devices compared with organometal halide perovskite NCs due to their superior stability. However, the interactions between all-inorganic perovskite NCs and moisture, which is an acknowledged detrimental factor, are still under debate, and de…
All-inorganic metal halide perovskite nanocrystals (NCs) have been exceptional candidates for high-performance solution-processed optoelectronic and photonic devices compared with organometal halide perovskite NCs due to their superior stability. However, the interactions between all-inorganic perovskite NCs and moisture, which is an acknowledged detrimental factor, are still under debate, and detailed investigations to uncover such fundamentals remain to be performed. Herein, with wide-field fluorescence microscopy, the burst photoluminescence blinking responses of CsPbBr3 NCs were observed in ambient air, and moisture rather than oxygen was verified to be the key factor that leads to the enhanced PL intensity and reduced OFF duration. This behavior is rationalized through an effective passivation effect of the adsorbed water molecules on the surface halide vacancies on CsPbBr3 NCs. This work validates that ∼40% humidity atmospheres are helpful for better utilizing the all-inorganic perovskites, which is evidence of their promising prospect for application.
- StatPearls: Sexual Harassment And Prevention Training [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Even though sexual harassment policies and procedures are required within the medical field, surveys reveal that unwanted sexual and gender harassment is prevalent in healthcare workplaces. In the healthcare community, sexual harassment remains an issue for worker wellness and productivity, as well as the optimal delivery of patient care. Sexual harassment is a risk factor for various mental heal…
Even though sexual harassment policies and procedures are required within the medical field, surveys reveal that unwanted sexual and gender harassment is prevalent in healthcare workplaces. In the healthcare community, sexual harassment remains an issue for worker wellness and productivity, as well as the optimal delivery of patient care. Sexual harassment is a risk factor for various mental health conditions and can result in qualified personnel leaving the workplace. Efficient training and preventive measures improve recognition of potential sexually offensive behaviors and help to establish an inclusive and respectful workplace. Acknowledging the problem is the first step, and prevention is the cornerstone of an effective anti-harassment strategy. Changes in institutional and organizational approaches can prevent sexual harassment and covert retaliation. Helpful initiatives include enhanced senior faculty member training and encouragement of bystander complaints when they witness prohibited behaviors. All medical fields can benefit from reflecting on workplace culture, focusing on prevention, reviewing policies and strategies, and committing to change. Sexual harassment continues to be prevalent in medical training, a pressing concern for leadership. The adverse effects detract from the professional workforce. Definitions of Sexual Harassment According to the Equal Employment Opportunity Commission (EEOC), unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when submission to or rejection of this conduct explicitly or implicitly affects an individual’s employment; unreasonably interferes with an individual’s work performance; or creates an intimidating, hostile or offensive work environment. [See 29 CFR PART 1604] This unethical practice exploits inequalities in status and power, abuses the rights and trust of those affected, may influence or be perceived to influence professional advancement, harm working relationships, and is likely to jeopardize patient care. [See AMA Code of Medical Ethics Opinion 9.1.3] The United States EEOC enforces Title VII of the Civil Rights Act of 1964, which not only prohibits sexual discrimination, including pregnancy, sexual orientation, and gender identity but also makes sexual harassment or retaliation illegal. Sexual harassment in the workplace is a form of sex discrimination that violates Title VII. Since Title VII, cultural and legal changes include decreased tolerance for harassment, increased legal responsibility assigned to institutions, and a significant increase in women choosing careers in medicine. Unwelcome sexual behavior occurs when the victim does not invite the behavior or when the victim regards the conduct as undesirable or offensive. If behavior starts as welcome behavior and then crosses over to unwelcome behavior, consent can be revoked at any time. The individual should announce that the behavior needs to stop. The harasser cannot use a defense that the other person started the behavior or initially gave consent after the alleged victim announces that welcome behavior is now unwelcome behavior. The work environment or the workplace is not limited to the assigned physical location of the employee. The work environment includes all locations where work is performed, and work-related business is conducted. Medical conferences and training sessions, satellite clinics, business travel, work-related social activities, and work-related communications are all considered part of the work environment or workplace. A hostile work environment occurs when the harasser creates an uncomfortable or harsh atmosphere for the person subjected to unwelcome behavior. The harassment can be verbal, nonverbal, or physical and is sexual or based on someone's gender. Physical forms of sexual harassment may include intentionally touching, massaging, leaning over or cornering a person, caressing, pinching, kissing, and hugging, as well as sexual assault or rape. Verbal forms of sexual harassment include socially and culturally inappropriate and unwelcome comments or jokes with sexual overtones, persistent proposals, asking about sexual fantasies/preferences/history, spreading rumors or fabricating lies about one's personal sex life, inappropriate remarks about a woman's physical appearance, and unwelcome requests or persistent invitations to go out on a date. Referring to a woman by inappropriate names, such as doll, babe, honey, or similar, is unacceptable. Nonverbal forms of sexual harassment include unwelcome gestures, suggestive body language, indecent exposure, repeated winks, sexual gestures, whistling at someone, and unwelcome display of pornographic materials. Sending letters, phone calls, texts, emails, social media comments, blog posts, or other communications of a sexual nature may constitute harassment. In healthcare, verbal harassment is the most common form, primarily sexually suggestive statements or jokes, followed by meddling questions about one's intimate life or physical appearance. Occasional compliments that are socially and culturally appropriate and acceptable are not considered sexual harassment. Any consensual adult interaction of a sexual nature that is welcomed or reciprocated is also not harassment. The law does not prohibit simple teasing, offhand comments, or isolated incidents that are not serious. The behavior is illegal when it is more than a single incident and creates a hostile or offensive work environment, or when an individual’s employment is negatively affected. According to the EEOC, the two main types of sexual harassment claims are (1) quid pro quo and (2) hostile work environments. Quid pro quo, or “this for that,” sexual harassment implies that if “you do something for me, I’ll do something for you.” Quid pro quo sexual harassment involves demands for sexual favors in exchange for some benefit or to avoid some detriment in the workplace. This type of behavior occurs when an individual in an organization attempts to influence the process of recruitment, promotion, training, discipline, dismissal, pay increases, or other benefits of an employee or job applicant in exchange for sexual favors. Hostile work environment sexual harassment occurs when unwelcome sexual advances, requests for sexual favors, or any conduct of a sexual nature interfere with someone’s work performance or cause an intimidating, hostile, or demeaning work environment. Unlike quid pro quo harassment, the perpetrator could be anyone in the workplace, including a coworker, subordinate, contractor, consultant, patient, or supervisor. Examples of unwelcome conduct that could create a hostile work environment include sexual jokes or communications, offensive pictures, inappropriate touching, or repeated requests for dates. Forms of Sexual Harassment: The Tripartite Model A 3-part classification system divides sexual harassment into these distinct categories: gender harassment, unwanted sexual attention, and sexual coercion. Sexual harassment is not necessarily about sexual activity or sexual desire. Sexual harassment is also discrimination based on gender, which includes one's biological sex and cultural gender-based stereotypes. Gender harassment includes verbal or physical behavior that denigrates or shows aversion to one's gender, gender identity, or sexual orientation. For example, calling out a man for being a "sissy" or telling a woman she isn't fit for a senior position in a male-dominated leadership environment may constitute gender harassment. Gender harassment can include hatred, objectification, exclusion, or giving second-class status to members of a particular gender. Sexist or heterosexist language, jokes, or comments also fall under this category. Given the circumstances, gender harassment can have the same unfavorable outcomes as one instance of sexual coercion. Unwanted sexual attention includes making suggestive statements about a person's body, spreading sexual rumors, and electronically sharing sexualized images. Sexual coercion, or quid pro quo, happens the least frequently of the 3 categories of sexual harassment but is the most reported. Scope of the Problem A large national medical center with more than 65,000 employees, including more than 4000 physicians and scientists, serves as a contemporary snapshot of the scope of the problem. A 2-year survey of more than 6200 healthcare workers, including physicians in all specialties, residents, nurses, nurse practitioners, and physician assistants, was conducted. Among physicians who reported sexual harassment, 12% were women, and 4% were men. About half of the harassers were physicians, with 37% in a superior hierarchical position. Only 40% of those who stated that they did experience harassing behaviors reported the behaviors. Of importance, 40% of the investigations could not be substantiated. In just over 3% of the claims, the patients were the alleged harassers. However, in another study, sexual harassment from patient to clinician was common, with 67% reporting inappropriate behavior. Approximately 84% of female providers reported some form of sexual harassment by patients, while 40% of male providers reported the same. Of those female providers, 42% experienced multiple episodes of sexual harassment by patients during their medical careers. The most common occurrences of patient-to-provider harassment were in outpatient clinics, with Veterans Affairs outpatient clinics reporting the highest frequency. Few providers in an inpatient setting reported sexual harassment by patients. According to a National Academies of Sciences, Engineering, and Medicine (NASEM) report, high rates of sexual harassment in medicine compromise the integrity of education and research. Of concern to leaders of academic medical institutions, medical students experience sexual harassment considerably more often than their peers in sciences and engineering. About 45-50% of female medical students reported that they experienced sexually harassing behavior from faculty or staff members. A systematic review revealed that 33.1% of medical students, 36.2% of residents, and 30.4% of younger faculty encounter sexual harassment. Surgery and emergency medicine female residents experience eminently high estimates of sexual harassment; the leading reason is that those fields value a hierarchical and authoritative workplace. Pediatric residents reported the lowest incidence of harassment. Recently, several investigations found that medical trainee harassment is not limited to specific nations or education programs. Sexual harassment charges filed with the EEOC have increased after the #MeToo movement received international attention beginning in the fall of 2017. Between 2018 and 2021, sexual harassment charges accounted for 27.7% of all harassment charges compared to 24.7% of all harassment charges between 2014 and 2017. Of the sexual harassment charges filed between 2018 and 2021, 78.2% were filed by women, while men filed 21.8%. [See EEOC Sexual Harassment in Our Nation's Workplaces] Roughly 3 out of 4 individuals who experience harassment never report the unwelcome behavior to a supervisor or manager, usually because they fear disbelief of their claim, no corrective action will occur, blame, or social or professional retaliation. According to the EEOC Select Task Force on the Study of Sexual Harassment in the Workplace, anywhere from 25% to 85% of women report having experienced sexual harassment in their work environments. The discrepancy in numbers was dependent on the vocabulary used in the surveys. For example, when employees were asked if they had experienced sexual harassment, 25% answered that they had. However, when employees were asked if they experienced a specific sexually-based behavior, such as unwanted sexual attention or coercion, the rate rose to 60% answering affirmatively. Recent cross-sectional studies revealed that women younger than 55 were at increased risk of sexual harassment or violence in their current workplace compared to women aged 55–69. Women who belong to a sexual minority (lesbian, bisexual, or not defined) more frequently encounter unwanted behavior than heterosexual women. Harassment was more common among women who worked shifts and irregular hours than women who worked during the day. This may be because women who work nights more often work alone due to factors such as understaffing, and they might be in contact with third-party individuals (eg, patients, clients, or vendors). Factors such as a hierarchical structure with faculty and trainees, a male-dominated environment, and a culture that tolerates harassing behavior from those in power make an organization particularly prone to sexual harassment. Healthcare organizations, including hospitals, nursing homes, and clinics, have all these elements.
- Raw Data to Results: A Hands-On Introduction and Overview of Computational Analysis for Single-Molecule Localization Microscopy. [Journal Article]Front Bioinform. 2021; 1:817254.FB
- Single-molecule localization microscopy (SMLM) is an advanced microscopy method that uses the blinking of fluorescent molecules to determine the position of these molecules with a resolution below the diffraction limit (∼5-40 nm). While SMLM imaging itself is becoming more popular, the computational analysis surrounding the technique is still a specialized area and often remains a "black box" for…
Single-molecule localization microscopy (SMLM) is an advanced microscopy method that uses the blinking of fluorescent molecules to determine the position of these molecules with a resolution below the diffraction limit (∼5-40 nm). While SMLM imaging itself is becoming more popular, the computational analysis surrounding the technique is still a specialized area and often remains a "black box" for experimental researchers. Here, we provide an introduction to the required computational analysis of SMLM imaging, post-processing and typical data analysis. Importantly, user-friendly, ready-to-use and well-documented code in Python and MATLAB with exemplary data is provided as an interactive experience for the reader, as well as a starting point for further analysis. Our code is supplemented by descriptions of the computational problems and their implementation. We discuss the state of the art in computational methods and software suites used in SMLM imaging and data analysis. Finally, we give an outlook into further computational challenges in the field.
- Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review. [Journal Article]Dystonia. 2022; 1D
- CONCLUSIONS: This study provides a comprehensive summary of motor and non-motor features of blepharospasm, along with novel insights into factors that may be responsible for its poor diagnostic recognition and natural history.
- Sustained Activity of Hippocampal Parvalbumin-Expressing Interneurons Supports Trace Eyeblink Conditioning in Mice. [Journal Article]J Neurosci. 2022 11 02; 42(44):8343-8360.JN
- Although recent studies have revealed an involvement of hippocampal interneurons in learning the association among time-separated events, its underlying cellular mechanisms remained not fully clarified. Here, we combined multichannel recording and optogenetics to elucidate how the hippocampal parvalbumin-expressing interneurons (PV-INs) support associative learning. To address this issue, we trai…
Although recent studies have revealed an involvement of hippocampal interneurons in learning the association among time-separated events, its underlying cellular mechanisms remained not fully clarified. Here, we combined multichannel recording and optogenetics to elucidate how the hippocampal parvalbumin-expressing interneurons (PV-INs) support associative learning. To address this issue, we trained the mice (both sexes) to learn hippocampus-dependent trace eyeblink conditioning (tEBC) in which they associated a light flash conditioned stimulus (CS) with a corneal air puff unconditioned stimuli (US) separated by a 250 ms time interval. We found that the hippocampal PV-INs exhibited learning-associated sustained activity at the early stage of tEBC acquisition. Moreover, the PV-IN sustained activity was positively correlated with the occurrence of conditioned eyeblink responses at the early learning stage. Suppression of the PV-IN sustained activity impaired the acquisition of tEBC, whereas the PV-IN activity suppression had no effect on the acquisition of delay eyeblink conditioning, a hippocampus-independent learning task. Learning-associated augmentation in the excitatory pyramidal cell-to-PVIN drive may contribute to the formation of PV-IN sustained activity. Suppression of the PV-IN sustained activity disrupted hippocampal gamma but not theta band oscillation during the CS-US interval period. Gamma frequency (40 Hz) activation of the PV-INs during the CS-US interval period facilitated the acquisition of tEBC. Our current findings highlight the involvement of hippocampal PV-INs in tEBC acquisition and reveal insights into the PV-IN activity kinetics which are of key importance for the hippocampal involvement in associative learning.SIGNIFICANCE STATEMENT The cellular mechanisms underlying associative learning have not been fully clarified. Previous studies focused on the involvement of hippocampal pyramidal cells in associative learning, whereas the activity and function of hippocampal interneurons were largely neglected. We herein demonstrated the hippocampal PV-INs exhibited learning-associated sustained activity, which was required for the acquisition of tEBC. Furthermore, we showed evidence that the PV-IN sustained activity might have arisen from the learning-associated augmentation in excitatory pyramidal cell-to-PVIN drive and contributed to learning-associated augmentation in gamma band oscillation during tEBC acquisition. Our findings provide more mechanistic understanding of the cellular mechanisms underlying the hippocampal involvement in associative learning.
- Conscious agency vs. pre-conscious sensory filtering: Disparate suppression of trigeminal blink reflex by self-stimulation and by prepulses. [Journal Article]Psychophysiology. 2023 Mar; 60(3):e14190.P
- Modulation of the blink reflex (BR) to supraorbital nerve (SON) stimulation by a weak somatosensory prepulse (sPP) consists of inhibition of R2 and facilitation of R1. Similar BR changes occur with self-stimulation. Our aim was to compare neurophysiological processes underlying both effects. We assessed BR parameters in 18 healthy participants following right SON stimulation either performed by a…
Modulation of the blink reflex (BR) to supraorbital nerve (SON) stimulation by a weak somatosensory prepulse (sPP) consists of inhibition of R2 and facilitation of R1. Similar BR changes occur with self-stimulation. Our aim was to compare neurophysiological processes underlying both effects. We assessed BR parameters in 18 healthy participants following right SON stimulation either performed by an experimenter (experiment 1A) or following self-stimulation (experiments 1B, 1C). In experiments 1A and 1C, sPPs to digit 2 preceded SON stimuli by 40, 100, 200 and 500 ms. In experiment 1B: self-stimulation was delayed by 40, 100, 200, and 500 ms. In experiment 2, BRs were elicited by an experimenter randomly during a 2-s period before participants applied self-stimulation. In experiment 1, as expected, sPPs caused facilitation of R1 and inhibition of R2, which peaked at 100 ms ISI, similarly in experiments 1A and 1C. Self-stimulation caused a decrease of R2, which was evident in a broad range of time intervals. In experiment 2, R2 was already inhibited at the onset of the 2-s period, while R1 began to rise significantly 1.4 s before self-stimulation. Both effects progressively increased until self-triggering. The results concur with a time-locked gating mechanism of prepulses at brainstem level, whereas self-stimulation modulates BR in a tonic manner, reflecting a cognitive influence due to self-agency.
- Spintronic Eyeblink Gesture Sensor With Wearable Interface System. [Journal Article]IEEE Trans Biomed Circuits Syst. 2022 10; 16(5):779-792.IT
- This work presents an eyeblink system that detects magnets placed on the eyelid via integrated magnetic sensors and an analogue circuit on an eyewear frame (without a glass lens). The eyelid magnets were detected using tunnelling magnetoresistance (TMR) bridge sensors with a sensitivity of 14 mV/V/Oe and were positioned centre-right and centre-left of the eyewear frame. Each eye side has a single…
This work presents an eyeblink system that detects magnets placed on the eyelid via integrated magnetic sensors and an analogue circuit on an eyewear frame (without a glass lens). The eyelid magnets were detected using tunnelling magnetoresistance (TMR) bridge sensors with a sensitivity of 14 mV/V/Oe and were positioned centre-right and centre-left of the eyewear frame. Each eye side has a single TMR sensor wired to a single circuit, where the signal was filtered (<0.5 Hz and >30 Hz) and amplified to detect the weak magnetic field produced by the 3-millimetre (mm) diameter and 0.5 mm thickness N42 Neodymium magnets attached to a medical tape strip, for the adult-age demographic. Each eyeblink was repeated by a trigger command (right eyeblink) followed by the appropriate command, right, left or both eyeblinks. The eyeblink gesture system has shown repeatability, resulting in blinking classification based on the analogue signal amplitude threshold. As a result, the signal can be scaled and classified as well as, integrated with a Bluetooth module in real-time. This will enable end-users to connect to various other Bluetooth enabled devices for wireless assistive technologies. The eyeblink system was tested by 14 participants via a stimuli-based game. Within an average time of 185-seconds, the system demonstrated a group mean accuracy of 72% for 40 commands. Moreover, the maximum information transfer rate (ITR) of the participants was 35.95 Bits per minute.
- StatPearls: Complex Partial Seizure [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Complex partial seizures refer to focal seizures that start in one hemisphere of the brain and are associated with impairment in consciousness. Complex partial seizures are now preferably called "focal impaired awareness seizure" or "focal onset impaired awareness seizure." International League Against Epilepsy (ILAE) 2017 classification has categorized seizures based on three key features: the l…
Complex partial seizures refer to focal seizures that start in one hemisphere of the brain and are associated with impairment in consciousness. Complex partial seizures are now preferably called "focal impaired awareness seizure" or "focal onset impaired awareness seizure." International League Against Epilepsy (ILAE) 2017 classification has categorized seizures based on three key features: the location of seizure onset, level of awareness during a seizure, and other features of seizures. Focal seizures refer to epileptiform activity starting in one area on one side of the brain. If awareness is impaired or affected at any time during the seizure, it is called focal impaired awareness seizure. Focal seizures are further classified into motor onset (automatisms, atonic, clonic, myoclonic, tonic, epileptic spasms, hyperkinetic) and nonmotor onset (autonomic, emotional, sensory, cognitive, behavior arrest) types. A seizure that starts on one side or one part of the brain and then spreads to both sides, earlier referred to secondarily generalized seizures, is now preferably termed as "focal to bilateral seizure." Focal seizures with impaired consciousness can present with or without an aura. Auras can last from a few seconds to as long as 1 to 2 minutes before the consciousness is impaired. Consciousness is maximally impaired in the beginning typically. Most of the seizures with automatisms last longer than 30 seconds, up to 1 to 2 minutes, and sometimes can be as long as 10 minutes. Absence seizures can sometimes present with the same symptomatology however ictal EEG will show generalized 3-Hz spike-wave complexes. Symptoms of focal seizures with impaired awareness depend on the area of the brain it is arising from. Most of the complex partial seizures arise from the temporal lobe. Extratemporal origin has been reported in at least 10% to 30% of patients. Seizures of Temporal Lobe Origin These are the most common type of focal impaired awareness seizures. Stereotyped automatisms occur in about 40% to 80% of patients with temporal lobe epilepsies. Seizures with predominantly oral and manual automatisms in addition to some other motor manifestations are highly suggestive of temporal lobe origin. About 60% of temporal lobe seizures have a secondary generalization. Gradual recovery after several minutes of confusion occurs postictally in most patients, however, in some patients automatic behavior like running, walking about, the non-directed violent behavior may occur. Temporal lobe focal impaired seizures can have features similar to frontal seizures, but temporal lobe focal impaired seizures typically have slower onset and progression, and more pronounced confusion. Certain features can help in localizing the seizure onset to one hemisphere. Ictal vomiting, ictal speech, urinary urge, and automatisms with intact consciousness suggest seizure onset in the non-dominant hemisphere, and speech disturbance postictally is suggestive of seizure onset in the dominant hemisphere. Upper limb dystonia lateralizes seizure to the opposite hemisphere. In young children with focal seizures of temporal lobe onset, behavioral arrest and unresponsiveness are common. Oroalimentary automatisms tend to occur in children older than age 5. In younger children, the symmetric motor movement of the limbs and head nodding is typical. In infants, these seizures may be subtle with few automatisms. In very young infants, central apnea can occur. Temporal focal impaired seizures can be confused with absence seizures as both may have automatisms, but temporal seizures are usually longer in duration and are associated with postictal confusion. Seizures arising from the mesial temporal lobe are characterized by auras such as epigastric sensation, deja vu, a feeling of fear, and unpleasant smells. Autonomic features like tachycardia, flushing, and pallor are common. Auras may be followed by impaired awareness and manual and oroalimentary automatisms. Automatisms in the upper limb and /or pupillary dilatation unilaterally may lateralize seizure to the ipsilateral hemisphere. Dystonia in the upper limbs and head and eye version on the opposite side can occur. Lateral temporal seizures may have vertigo, auditory (buzzing, ringing), or visual symptoms as initial aura symptoms. Auditory aura in only one ear may lateralize seizure to the contralateral hemisphere. Initial aura is usually not prolonged, and impaired awareness is an early feature. Seizures are of shorter duration and progression to bilateral convulsions is more common than those arising from the mesial temporal lobe. Seizures of Frontal Lobe Origin Up to 30% of the patients with focal epilepsy have seizures arising from the frontal lobe. It is the most common extratemporal type. Seizures are accompanied by loss of consciousness in about half of the patients with frontal lobe epilepsy. Focal impaired awareness seizures can arise from various locations within the frontal lobe, except the rolandic strip. These seizures typically are brief, lasting about 30 seconds, occurring in clusters, multiple times a day, are often nocturnally occurring during sleep, and have minimal postictal confusion. Motor symptoms are predominant and range from hypermotor thrashing episodes like pelvic thrusting, bicycling movements to asymmetric tonic posturing. Sexual automatisms, bizarre behavior, and vocalizations are common. These seizures often have a stereotypical pattern for each patient. Nocturnal frontal lobe seizures may be mistaken for parasomnias. The ictal EEG may be difficult to interpret because of movement artifacts. Identification based on semiology alone and differentiating from mesial temporal lobe epilepsy may be difficult, however earliest signs and symptoms and their order of appearance may help in distinction. Seizures with hypermotor features are more likely to have an ictal focus in the orbitofrontal and frontopolar regions. Temporal lobe seizures have more oroalimentary automatisms, gesturing, and fumbling semiology. Epileptiform activity in frontal convexity can cause clonic seizures, and in the supplementary motor area can cause tonic seizures. Unique semiology of the supplementary sensorimotor cortex includes deviation of head and eye to the side contralateral to seizure onset, the asymmetrical posturing of upper limbs with an extension of arm contralateral to the side of seizure onset, and flexion of ipsilateral arm. Orbitofrontal region seizures are automotor type and manifest prominently with autonomic phenomena like flushing, vocalization, and automatisms. Anterior cingulate gyrus seizures have predominant motor manifestations like hypermotor seizures and complex motor seizures. Posterior cingulate cortex epilepsies predominantly have altered consciousness and automotor seizures as main clinical manifestations. Antero-lateral dorsal convexity seizures may manifest with auras such as dizziness, epigastric sensation, behavioral arrest, and speech arrest. Seizures of Parietal Lobe Region Seizures arising from the parietal lobe may be difficult to diagnose because of their subjective nature. Positive and /or negative sensory features are common. Sensorimotor phenomenon and vestibular hallucinations suggest onset in the parietal lobe. Paresthesias, visual hallucinations, visual illusions, somatic illusions, vertiginous features can occur. Seizures arising from the dominant hemisphere can cause receptive language impairment. Parietal lobe complex partial seizures can have auras like epigastric sensations, visual hallucinations, panic attacks, and behavioral arrest. Often there is an involvement of other lobes as the seizure spreads. When focal seizures from the parietal lobe spread and involve the temporal lobe, loss of consciousness and automatisms may occur. Seizures of occipital lobe origin Seizures with ictal origin in the occipital lobe are characterized by a visual aura and are difficult to diagnose especially in young children. Visual auras, typically of elementary sensations, ictal blindness, versions of the head and eyes to the opposite side, rapid and forced blinking, oculoclonic activity are some features suggesting occipital lobe as an origin of focal seizure with impaired consciousness. Seizures from the primary visual cortex can cause bilateral loss of vision in the form of white-out or black-out. A shorter duration of the visual aura (less than 2 minutes) can help to differentiate from migraine aura which is typically longer (5 to 15 minutes). Complex, formed visual hallucinations like pictures of people, animals, etc. are associated with seizure onset in the extra-striate cortex. Other symptoms may result from spread to the temporal or parietal lobes. Seizures of Insular Lobe Origin Seizures arising from the insula can mimic frontal, temporal, parietal lobe seizures. Origin from the insula is suspected when viscerosensitive symptoms (nausea, vomiting, salivation), motor symptoms (tonic, hypermotor, or generalized tonic-clonic movements), and/or sensory symptoms (numbness, tightness, vibration, pain, vertigo) occur at seizure onset.
- Development of a Self-Viscosity and Temperature-Compensated Technique for Highly Stable and Highly Sensitive Bead-Based Diffusometry. [Journal Article]Biosensors (Basel). 2022 May 25; 12(6)B
- Brownian motion, which is a natural phenomenon, has attracted numerous researchers and received extensive studies over the past decades. The effort contributes to the discovery of optical diffusometry, which is commonly used for micro/nano particle sizing. However, the analysis uncertainty caused by the coupling relationship among particle diameter, temperature, and fluid viscosity usually poses …
Brownian motion, which is a natural phenomenon, has attracted numerous researchers and received extensive studies over the past decades. The effort contributes to the discovery of optical diffusometry, which is commonly used for micro/nano particle sizing. However, the analysis uncertainty caused by the coupling relationship among particle diameter, temperature, and fluid viscosity usually poses a barrier to precise measurement. Preventing random background noise becomes the key to achieving a high level of accuracy in diffusometry detection. Recently, Janus particles have become known as an ideal tool for resolving the rotational Brownian motion. Followed by our previous study, the rotational Brownian motion and the translational Brownian motion can be separately measured using the Janus particles. Accordingly, a simple self-viscosity and temperature-compensated technique based on the delicate removal of temperature and fluid viscosity variations through particle tracking was first proposed in this study. Consequently, the translational Brownian motion was expressed in terms of particle trajectory, whereas the rotational Brownian motion was expressed in terms of the blinking signal from the Janus particles. The algorithm was verified simulatively and experimentally in temperature (10 °C to 40 °C) and viscosity-controlled (1 mPa·s to 5 mPa·s) fields. In an evaluation of biosensing for a target protein, IFN-γ, the limit of detection of the proposed self-compensated diffusometry reached 0.45 pg/mL, whereas its uncertainties of viscosity and temperature were 96 and 15-fold lower than the pure the rotational Brownian motion counterpart, respectively. The results indicated the low-uncertainty and high-accuracy biosensing capability resulting from the self-viscosity and temperature-compensated technique. This research will provide a potential alternative to future similar bead-based immunosensing, which requires ultra-high stability and sensitivity.
- Phase-Stable and Highly Luminescent CsPbI3 Perovskite Nanocrystals with Suppressed Photoluminescence Blinking. [Journal Article]J Phys Chem Lett. 2022 Jun 30; 13(25):5742-5750.JP
- Despite their low band gap, the utility of CsPbI3 nanocrystals (NCs) in solar photovoltaic and optoelectronic applications is rather limited because of their phase instability and photoluminescence (PL) intermittency. Herein we show that phase-pure, monodispersed, stable and highly luminescent CsPbI3 NCs can be obtained by tweaking the conventional hot-injection method employing NH4I as an additi…
Despite their low band gap, the utility of CsPbI3 nanocrystals (NCs) in solar photovoltaic and optoelectronic applications is rather limited because of their phase instability and photoluminescence (PL) intermittency. Herein we show that phase-pure, monodispersed, stable and highly luminescent CsPbI3 NCs can be obtained by tweaking the conventional hot-injection method employing NH4I as an additional precursor. Single-particle studies show a significant suppression of PL blinking. Among all NCs studied, 60% exhibit only high-intensity ON states with a narrow distribution of intensity. The remaining 40% of NCs exhibit a much wider distribution of PL intensity with a significant contribution of low-intensity OFF states. Excellent characteristics of these CsPbI3 NCs are shown to be the result of NH4+ replacing some surface Cs+ of an iodide-rich surface of the NCs. These phase-stable and highly luminescent CsPbI3 NCs with significantly suppressed PL blinking can be useful single-photon emitters and promising materials for optoelectronic and solar photovoltaic applications.
- Comparison of experiences and preferences following non-invasive cardiovascular risk procedures: a cross-sectional survey in participants with and without diabetes mellitus. [Journal Article]J Diabetes Metab Disord. 2022 Jun; 21(1):463-474.JD
- CONCLUSIONS: Participants with diabetes mellitus, especially with poorer self-rated health, had a more negative experience with the ECG-gated fundoscope than the EndoPAT2000 system. Difficulties experienced under examination by the ECG-gated fundoscope appear related to the procedural design, which requires amendments improving patient comfort and compliance.
- The undesirable wink. [Journal Article]Indian J Ophthalmol. 2022 06; 70(6):2211.IJ
- Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.
Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.
- Deficits in auditory and visual steady-state responses in adolescents with bipolar disorder. [Journal Article]J Psychiatr Res. 2022 07; 151:368-376.JP
- CONCLUSIONS: impairments in the production and preservation of SSVEP and ASSR are evident in BD, implicating abnormalities in visual and auditory pathways. Neurophysiological deficits and worse performance in BD adolescents may imply that visual and auditory pathways cannot well transfer the pertinent information from arriving sensory data to the visual and auditory cortices, and the frontal cortex cannot well integrate incoming signals into a unified and coherent perceptual action.
- A Flexible Wearable Electrooculogram System With Motion Artifacts Sensing and Reduction. [Journal Article]IEEE Trans Biomed Circuits Syst. 2022 04; 16(2):324-335.IT
- Electrooculogram (EOG) is a well-known physiological metric picked up by placing two or more electrodes around the eyeball. EOG signals are known to be extremely susceptible to motion artifacts. This paper presents a single channel, wireless, wearable flexible EOG monitoring system with motion artifacts sensing and reduction feature. The system uses two non-contact electrode pairs for EOG/motion …
Electrooculogram (EOG) is a well-known physiological metric picked up by placing two or more electrodes around the eyeball. EOG signals are known to be extremely susceptible to motion artifacts. This paper presents a single channel, wireless, wearable flexible EOG monitoring system with motion artifacts sensing and reduction feature. The system uses two non-contact electrode pairs for EOG/motion artifacts detection and motion artifacts reduction. It is implemented on a four-layer flexible polyimide substrate. It is light-weight (only 8.75 gram), battery operated, and uses a microcontroller and a BLE 5.0 transceiver for wireless EOG data transmission, while consuming only 56 mW of power. The system metrics such as gain around 37 dB, bandwidth from 1 Hz to 40 Hz, and noise are evaluated. The system is tested for different electrode configurations and it is demonstrated that horizontally parallel electrode pairs achieve an acceptable motion artifact reduction at the output, while preserving perfect EOG features (such as eye-blinking). The average sensitivity for horizontally parallel non-contact electrodes is found out to be more than 50 times with respect to commercial gold electrodes, whereas the average response time of the sensor is around 380 mS. The flexible EOG system is comfortable to wear and the use of non-contact electrode eliminates the need of skin preparation. Therefore, the system can be easily integrated with eye-masks and headbands, thus making it an excellent prototype for many smart applications.
- The winking sign is an indicator for increased femorotibial rotation in patients with recurrent patellar instability. [Journal Article]Knee Surg Sports Traumatol Arthrosc. 2022 Nov; 30(11):3651-3658.KS
- CONCLUSIONS: The winking sign reliably indicates an increased femorotibial rotation on a weight-bearing AP knee radiograph and could prove useful for day-by-day clinical work. Future research needs to investigate whether femorotibial rotation is not only a prognostic factor but a potential surgical target in patients with patellofemoral disorders.
- Water-dispersed CsPbBr3 nanocrystals for single molecule localization microscopy with high location accuracy for targeted bioimaging. [Journal Article]Nanoscale. 2022 May 05; 14(17):6392-6401.N
- Single-molecule localization microscopy (SMLM) is one of the most promising super-resolution imaging techniques for visualizing ultrasmall cellular structures. Here, water-dispersed perovskite CsPbBr3 nanocrystals (CsPbBr3 NCs) fabricated by a one-step mechanochemical method are explored as a SMLM fluorophore for bioimaging. Due to their ultrahigh photoluminescence quantum yield (PLQY), inherent …
Single-molecule localization microscopy (SMLM) is one of the most promising super-resolution imaging techniques for visualizing ultrasmall cellular structures. Here, water-dispersed perovskite CsPbBr3 nanocrystals (CsPbBr3 NCs) fabricated by a one-step mechanochemical method are explored as a SMLM fluorophore for bioimaging. Due to their ultrahigh photoluminescence quantum yield (PLQY), inherent frequent fluorescence blinking, proper duty cycle and long-term photostability, an extremely high location precision of ∼3 nm was achieved, a sixfold enhancement than those reported previously. In addition, the spatial resolution of a SMLM image depends on the size of CsPbBr3 NCs, which is approximately 23 nm. Two closely spaced CsPbBr3 NCs with a gap of 40 nm can be clearly distinguished in the SMLM image. More importantly, unlike most perovskite quantum dots (QDs), one-step mechanochemically prepared CsPbBr3 NCs can retain their excellent fluorescence characteristics even after surface biofunctionalization, greatly reducing the current limitations of perovskite QDs on bioimaging. As an example, cell-derived exosomes (30-150 nm in diameter) labeled with CsPbBr3 NCs were easily identified by SMLM. In addition, after being functionalized with biotin, targeted SMLM imaging of the nuclear lamina or cell membranes of cells was achieved with an enhanced resolution. This work may open up a promising avenue to expand the field of perovskite QD-based SMLM to bioimaging with a high location accuracy.
- A cross-sectional study on the use of near-visual display devices in the Middle-Eastern children population. [Journal Article]Saudi J Ophthalmol. 2021 Apr-Jun; 35(2):102-107.SJ
- CONCLUSIONS: Majority of the children (90%) were symptomatic when used NVDD excessively. Children are generally uneducated about healthy practices to prevent these symptoms. Spreading awareness among children and parents is important.
- An Acid-Regulated Self-Blinking Fluorescent Probe for Resolving Whole-Cell Lysosomes with Long-Term Nanoscopy. [Journal Article]Angew Chem Int Ed Engl. 2022 05 16; 61(21):e202202961.AC
- Long-term super-resolution imaging appears to be increasingly important for unraveling organelle dynamics at the nanoscale, but is challenging due to the need for highly photostable and environment-sensitive fluorescent probes. Here, we report a self-blinking fluorophore that achieved 12 nm spatial resolution and 20 ms time resolution under acidic lysosomal conditions. This fluorophore was succes…
Long-term super-resolution imaging appears to be increasingly important for unraveling organelle dynamics at the nanoscale, but is challenging due to the need for highly photostable and environment-sensitive fluorescent probes. Here, we report a self-blinking fluorophore that achieved 12 nm spatial resolution and 20 ms time resolution under acidic lysosomal conditions. This fluorophore was successfully applied in super-resolution imaging of lysosomal dynamics over 40 min. The pH dependence of the dye during blinking made the fluorophore sensitive to lysosomal pH. This probe enables simultaneous dynamic and pH recognition of all lysosomes in the entire cell at the single-lysosome-resolved level, which allowed us to resolve whole-cell lysosome subpopulations based on lysosomal distribution, size, and luminal pH. We also observed a variety of lysosome movement trajectories and different types of interactions modes between lysosomes.
- Nicotinamide Adenine Dinucleotide Phosphate Oxidase 2 Expression and Effects of Alpha Lipoic Acid on Recovery in a Rat Model of Facial Nerve Injury. [Journal Article]Biomedicines. 2022 Jan 27; 10(2)B
- CONCLUSIONS: Our study showed that NOX2 expression trended higher with facial nerve injury, exhibiting a significant increase with cutting-type injury. Furthermore, intraperitoneally injection with ALA may be an efficient strategy for accelerating peripheral facial nerve recovery after a crushing injury.
- Spatial probability maps of the segments of the postcentral sulcus in the human brain. [Journal Article]Cereb Cortex. 2022 08 22; 32(17):3651-3668.CC
- The postcentral sulcus is the posterior boundary of the postcentral gyrus where the somatosensory cortex is represented. In the human brain, the postcentral sulcus is composed of five distinct segments that are related to the somatosensory representation of different parts of the body. Segment 1 of the postcentral sulcus, located near the dorsomedial boundary of each hemisphere, is associated wit…
The postcentral sulcus is the posterior boundary of the postcentral gyrus where the somatosensory cortex is represented. In the human brain, the postcentral sulcus is composed of five distinct segments that are related to the somatosensory representation of different parts of the body. Segment 1 of the postcentral sulcus, located near the dorsomedial boundary of each hemisphere, is associated with toe/leg representations, segment 2 with arm/hand representations, segment 3 with blinking, and segments 4 and 5, which are near the lateral fissure and the parietal operculum, with the mouth and tongue representations. The variability in location and spatial extent of these five segments were quantified in 40 magnetic resonance imaging (MRI) anatomical brain scans registered to the stereotaxic space of the Montreal Neurological Institute (MNI space), in the form of volumetric (using MINC Toolkit) and surface (using FreeSurfer) spatial probability maps. These probability maps can be used by researchers and clinicians to improve the localization of the segments of the postcentral sulcus in MRI images of interest and also to improve the interpretation of the location of activation peaks generated in functional neuroimaging studies investigating somatosensory cortex.
- The Influence of Filters on EEG-ERP Testing: Analysis of Motor Cortex in Healthy Subjects. [Journal Article]Sensors (Basel). 2021 Nov 19; 21(22)S
- The raw EEG signal is always contaminated with many different artifacts, such as muscle movements (electromyographic artifacts), eye blinking (electrooculographic artifacts) or power line disturbances. All artifacts must be removed for correct data interpretation. However, various noise reduction methods significantly influence the final shape of the EEG signal and thus its characteristic values,…
The raw EEG signal is always contaminated with many different artifacts, such as muscle movements (electromyographic artifacts), eye blinking (electrooculographic artifacts) or power line disturbances. All artifacts must be removed for correct data interpretation. However, various noise reduction methods significantly influence the final shape of the EEG signal and thus its characteristic values, latency and amplitude. There are several types of filters to eliminate noise early in the processing of EEG data. However, there is no gold standard for their use. This article aims to verify and compare the influence of four various filters (FIR, IIR, FFT, NOTCH) on the latency and amplitude of the EEG signal. By presenting a comparison of selected filters, the authors intend to raise awareness among researchers as regards the effects of known filters on latency and amplitude in a selected area-the sensorimotor area.
- My experience on taeniasis and neurocysticercosis. [Journal Article]Trop Parasitol. 2021 Jul-Dec; 11(2):71-77.TP
- Taeniasis and neurocysticercosis (NCC) are major public health problems in developing countries. NCC is the leading cause of community-acquired active epilepsy. NCC may present as a medical emergency, especially when there is cysticercotic encephalitis or raised intracranial hypertension. Systematic community-based studies on taeniasis and NCC are lacking. We studied taeniasis and NCC-related act…
Taeniasis and neurocysticercosis (NCC) are major public health problems in developing countries. NCC is the leading cause of community-acquired active epilepsy. NCC may present as a medical emergency, especially when there is cysticercotic encephalitis or raised intracranial hypertension. Systematic community-based studies on taeniasis and NCC are lacking. We studied taeniasis and NCC-related active epilepsy disease burden in the pig farming community of Lucknow district, Uttar Pradesh, India. Based on the 30 cluster sampling approach as recommended by the World Health Organization, we estimated the prevalence of taeniasis, NCC-related active epilepsy, and silent NCC in the community. We also estimated the prevalence of swine cysticercosis. Taeniasis was detected in 18.6% of populations. Expulsions of tapeworm segments in stool, consumption of undercooked pork, age above 15 years, and handwash with clay or plain water after defecation were associated with taeniasis. On molecular analyses of positive stool samples, T. solium was identified in 40% and Taenia asiatica in 60% of cases. Active epilepsy was identified in 5.8% of subjects; 48% of them had NCC. On neuroimaging, NCC was detected in 15% of asymptomatic individuals. We observed that host genetic factors such as toll-like receptor-4, matrix metalloproteinase-9, intercellular adhesion molecule-1, and glutathione-S transferase gene polymorphisms were associated with seizure in NCC. When peripheral blood mononuclear cells (PBMCs) from NCC subjects were exposed to cysticerci fluid antigens in-vitro, PBMCs from symptomatic and asymptomatic subjects showed significantly higher Th 1 and Th 2 cytokines response respectively, symptomatic patients had significant Th-1 cytokines response, while asymptomatic individuals showed Th-2 response. Porcine cysticercosis was detected in 26% of swine; 38% of them had cysticerci in the brain. Swine with brain involvement showed clinical signs such as excessive salivation, excessive blinking and tearing, and subconjunctival nodule. On molecular analysis, 15% of cysticerci in swine were identified as T. asiatica. Infected swine when treated with albendazole plus/minus steroid, the response rate of cysticerci (either dead or resolved lesion) was 100% in albendazole-treated group and 71% in albendazole plus steroid-treated group. The above studies suggest that taeniasis and NCC are alarmingly high in the pig farming community of North India. Taeniasis in human and cysticercosis in swine due to T. asiatica call for further studies on this parasite.
- Ultrasound-Enhanced Transcorneal Drug Delivery for Treatment of Fungal Keratitis. [Journal Article]Cornea. 2022 Jul 01; 41(7):894-900.C
- CONCLUSIONS: This study suggests that ultrasound is a safe, effective, and minimally invasive treatment method for enhancing the transcorneal drug delivery of natamycin. Further research is needed into the long-term effects of ultrasound parameters used in this study on human ocular tissues.
- Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study. [Journal Article]PLoS One. 2021; 16(10):e0258233.Plos
- The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regre…
The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%-25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%-18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%-11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%-72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.
- Symmetrical Skin Lesions on the Gluteal Region in a Patient with Anti-Laminin-332 Mucous Membrane Pemphigoid. [Case Reports]Acta Dermatovenerol Croat. 2021 Jul; 29(2):105-107.AD
- Mucous membrane pemphigoid (MMP), previously called cicatricial pemphigoid, is a rare subepidermal immunobullous disorder that primarily affects the mucous membranes (1,2). MMP is divided into two major subtypes, anti-BP180-type MMP and anti-laminin-332 (previously called laminin 5 or epiligrin) MMP. Anti-laminin-332 MMP is known to be associated with malignant tumors (3), which may cause overexp…
Mucous membrane pemphigoid (MMP), previously called cicatricial pemphigoid, is a rare subepidermal immunobullous disorder that primarily affects the mucous membranes (1,2). MMP is divided into two major subtypes, anti-BP180-type MMP and anti-laminin-332 (previously called laminin 5 or epiligrin) MMP. Anti-laminin-332 MMP is known to be associated with malignant tumors (3), which may cause overexpression of autoantibodies and induce autoimmunity to laminin-332 (4). MMP primarily affects the mucous membranes, and widespread skin lesions are rare. In MMP, circumscribed skin lesions have been previously reported as occurring on the head, neck, and upper trunk (5). We report a case of anti-laminin-332 MMP presenting with symmetrical skin lesions characteristic of MMP on the weight-bearing areas of the gluteal region. A 66-year-old Japanese man presented with a month-long history of multiple erosions and blisters on the mucous membranes and skin, with conjunctival hyperemia, nasal obstruction, oral pain, and hoarseness of voice. Three days before the first visit, he was diagnosed with gastric cancer with liver metastasis by gastrointestinal endoscopy and abdominal ultrasound examination for tarry stool. Physical examination demonstrated erosions and tense bullae on the conjunctivae, tongue, and lips (Figure 1, a,b), as well as erosive erythematous skin lesions on the nape, right index finger, both legs, and symmetric lesions on the gluteal region (Figure 1, c). His body weight was 86 kg. Laboratory examinations showed slight liver dysfunction and elevation of C-reactive protein levels. Histopathologic examination of the skin lesions demonstrated subepidermal blisters with lymphocytic and eosinophilic infiltrates (Figure 1, d,e). Direct immunofluorescence (IF) revealed linear deposits of IgG and C3, but not IgA, along the basement membrane zone (BMZ) (Figure 1, f,g). An IgG subclass study showed IgG1 and IgG4 deposits. Indirect IF on normal human skin revealed weak positivity for IgA anti-keratinocyte cell surface antibodies and IgG anti-BMZ antibodies, which were bound to the dermal side of 1 mol/L NaCl-split skin (Figure 1, h). IgG immunoblot analyses of both normal human epidermal and dermal extracts showed negative results (including BP230, BP180, 290 kDa type VII collagen, and 200 kDa laminin-γ1). Immunoprecipitation using radio-labeled cultured keratinocyte lysate demonstrated positive reactivity with laminin-332 (Figure 1, i). We established the diagnosis of anti-laminin-332 MMP. We started treatment with oral minocycline (200 mg/day) and niacinamide (900 mg/day) with topical corticosteroids without any effect after 2 weeks of therapy. Administration of oral prednisolone (40 mg/day) with topical corticosteroids and alprostadil ointment on the skin lesions, as well as beclometasone dipropionate powder on the oral lesions resulted in significant improvement of mucocutaneous lesions within 10 days. Although the gastric cancer and liver metastasis initially responded to chemotherapy with fluorouracil and cisplatin, the patient succumbed to multiple organ failure 9 months after the initial visit. Anti-laminin-332 antibodies were originally detected by immunoprecipitation, as in our case. Immunoblotting of purified human laminin-332 have been subsequently developed, which detects the 165/145 kDa α3, 140 kDa β3, and 105 kDa γ2 subunits of laminin-332 in various patterns (6). Today, the ELISA system uses laminin-332 preparations as adjunct diagnostic tools in MMP (7). Occasionally, a wide spectrum of autoantibodies is detected in MMP, for example, MMP with IgG antibodies to both BP180 and laminin-332, which were considered to be developed via epitope spreading. Detection of circulating IgA autoantibodies against the skin have also been reported in MMP (8). However, the pathogenic significance and mechanisms of coexistence of IgG anti-laminin-332 antibodies and IgA anti-keratinocyte cell surface antibodies found in our case are currently unknown. It is generally considered that IgG1 antibodies activate complements and are pathogenic in MMP, while IgG4 antibodies behave as blocking antibodies and are protective. In our case, direct IF revealed IgG1 and IgG4 deposits; the same was reported in a previous case report (9). The pathogenic roles of autoantibodies with different IgG subclasses need to be analyzed in further studies. Conjunctival mucosal lesions in MMP may occur by rubbing of the eyes due to irritation. Blinking subjects the conjunctivae to repeated friction. Vocal cords vibrate during breathing and speaking. The tongue moves while eating and drinking; in particular, the tip of the tongue gets into frequent contact with the inner sides of the incisor teeth. In the present case, characteristic symmetrical skin lesions were seen on the weight-bearing areas of the gluteal region on bony prominences which receive mechanical stresses in the sitting position. These skin lesions were subjected to repeated stretch and pressure stresses, but no ischemic changes were observed, such as decubitus ulcers. Therefore, the symmetrical skin lesions in the gluteal region as well as the ocular and oral mucosal lesions seen in our patient might have resulted from the same mechanism of pathogenesis. We reported a case of anti-laminin-332 MMP presenting with symmetrical gluteal skin lesions, probably induced by mechanical stress. MMP primarily affects the mucous membranes, and widespread skin lesions are rare. Our case emphasizes that clinicians need to specifically check for the presence of skin lesions on weight-bearing parts of the body during examination of patients with suspected MMP.
- Intraocular Scattering, Blinking Rate, and Tear Film Osmolarity After Exposure to Environmental Stress. [Journal Article]Transl Vis Sci Technol. 2021 08 02; 10(9):12.TV
- CONCLUSIONS: Exposure to dry environment increased light scatter in older subjects. Although more blinks were triggered in both younger and older groups to prevent corneal dehydration, there was no difference between the groups. Blink rate and osmolarity are not associated with the difference in light scatter.
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- Impact of femtosecond laser-assisted in situ keratomileusis on retinal ganglion cell function. [Journal Article]Eur J Ophthalmol. 2022 May; 32(3):1441-1447.EJ
- CONCLUSIONS: FS-LASIK seems to induce a mild and transitory defect in retinal ganglion cell function. Only a mild decrease was detected in the magnitude value for low-contrast stimuli when pERG was performed 16 h postoperatively, and it returned to normal 1 month after surgery.