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Infrared (IR) emitters have drawn considerable attention for applications in deep-tissue imaging, optical communication, and thermal sensing. While III-V and II-VI semiconductors are traditionally used in these emitters, their reliance on complex epitaxial growth to overcome lattice mismatch and thermal expansion challenges leads to intricate device structures and limits their integrability. In contrast, 2D materials provide a more flexible solution, offering diverse optical bandgaps and the ability to be vertically restacked in arbitrary crystal orientations to form complex van der Waals (vdW) heterostructures, which can be further integrated onto diverse device platforms. This review highlights recent advancements in 2D-based IR emitters, focusing on the NIR, SWIR, and MWIR regions. It discusses the photoluminescence properties of 2D materials and innovative vdW engineering techniques used to develop IR light-emitting diodes (LEDs). The review also explores how external stimuli, such as electric fields and strain, can enable tunable emission wavelengths and examines the integration of 2D-based emitters with photonic structures, like cavities and waveguides, to create hybrid photonic devices. Finally, the review addresses the challenges and prospects of 2D-based IR technologies, highlighting their potential to transform IR light sources across various applications., (© 2024 Wiley‐VCH GmbH.)

Particle plasmon resonance (PPR), or localized surface plasmon resonance (LSPR), utilizes intrinsic resonance in metal nanoparticles for sensor fabrication. While diffraction grating waveguides monitor bioaffinity adsorption with out-of-plane illumination, integrating them with PPR for biomolecular detection schemes remains underexplored. This study introduces a label-free biosensing platform integrating PPR with a diffraction grating waveguide. Gold nanoparticles are immobilized on a glass slide in contact with a sample, while a UV-assisted embossed diffraction grating is positioned opposite. The setup utilizes diffraction in reflection to detect changes in the environment's refractive index, indicating biomolecular binding at the gold nanoparticle surface. The positional shift of the diffracted beam, measured with varying refractive indices of sucrose solutions, shows a sensitivity of 0.97 mm/RIU at 8 cm from a position-sensitive detector, highlighting enhanced sensitivity due to PPR-diffraction coupling near the gold nanoparticle surface. Furthermore, the sensor achieved a resolution of 3.1 × 10 -4 refractive index unit and a detection limit of 4.4 pM for detection of anti-DNP. The sensitivity of the diffracted spot was confirmed using finite element method (FEM) simulations in COMSOL Multiphysics. This study presents a significant advancement in biosensing technology, offering practical solutions for sensitive, rapid, and label-free biomolecule detection.

Strawberry is a popular fruit with valuable nutrition and an attractive fragrance, but its production and propagation are limited by various diseases, including anthracnose and gray mold. For disease management, biological control measures are environmentally friendly and good alternatives to fungicides to avoid crop losses, reduce carbon emissions, and improve food safety. In this study, Paenibacillus polymyxa TP3, which originated from the strawberry phyllosphere, was shown to antagonize the anthracnose fungal pathogen Colletotrichum siamense and reduce leaf symptoms on strawberry plants. Several mass spectra corresponding to fusaricidin were detected in the confrontation assay of P. polymyxa TP3 and C. siamense by image mass spectrometry . The transcription of fusA and fusG in the fusaricidin biosynthesis gene cluster increased while P. polymyxa TP3 was cultured in the medium containing the culture filtrate of C. siamense , as detected by reverse-transcription polymerase chain reaction, indicating the involvement of fusaricidins in P. polymyxa TP3 antagonism against the anthracnose pathogen. Further disease control assays demonstrated the time frame and spatial mode of P. polymyxa TP3-induced systemic resistance of strawberry against C. siamense . The transcript level of the marker gene FaPDF1.2 of the jasmonic acid pathway increased in strawberry leaves after drenching treatment with P. polymyxa TP3, and the callose deposition was enhanced by further flg22 treatment. In addition, P. polymyxa TP3 treatments of the strawberry mother plants reduced C. siamense infection in the daughter plants, which would be a potent feature for the application of P. polymyxa TP3 in strawberry nurseries and fields to reduce the impact of diseases, especially anthracnose., Competing Interests: The author(s) declare no conflict of interest.

Graphene possesses an exotic band structure that spans a wide range of important technological wavelength regimes for photodetection, all within a single material. Conventional methods aimed at enhancing detection efficiency often suffer from an extended response time when the light is switched off. The task of achieving ultrafast broad-band photodetection with a high gain remains challenging. Here, we propose a devised architecture that combines graphene with a photosensitizer composed of an alternating strip superstructure of WS 2 -WSe 2 . Upon illumination, n + -WS 2 and p + -WSe 2 strips create alternating electron- and hole-conduction channels in graphene, effectively overcoming the tradeoff between the responsivity and switch time. This configuration allows for achieving a responsivity of 1.7 × 10 7 mA/W, with an extrinsic response time of 3-4 μs. The inclusion of the superstructure booster enables photodetection across a wide range from the near-ultraviolet to mid-infrared regime and offers a distinctive photogating route for high responsivity and fast temporal response in the pursuit of broad-band detection.

Modern infrared (IR) microscopy, communication, and sensing systems demand control of the spectral characteristics and polarization states of light. Typically, these systems require the cascading of multiple filters, polarization optics, and rotating components to manipulate light, inevitably increasing their sizes and complexities. Here, we report two-terminal mid-infrared (mid-IR) emitters, in which tuning the polarity of the applied bias can switch their emission peak wavelengths and linear polarization states along two orthogonal orientations. Our devices are composed of two back-to-back p-n junctions formed by stacking anisotropic light-emitting materials, black phosphorus and black arsenic-phosphorus with MoS 2 . By controlling the crystallographic orientations and engineering the band profile of heterostructures, the emissions of two junctions exhibit distinct spectral ranges and polarization directions; more importantly, these two electroluminescence (EL) units can be independently activated, depending on the polarity of the applied bias. Furthermore, we show that when operating our emitter under the polarity-switched pulse mode, the time-averaged EL exhibits the characteristics of broad spectral coverage, encompassing the entire first mid-IR atmospheric window (λ: 3-5 μm), and electrically tunable spectral shapes.

In this study, AlGaN/GaN light-emitting HEMTs (LE-HEMT) with a single quantum well inserted in different locations in the epitaxy layers are fabricated and analyzed. For both structures, light-emitting originated from electrons in the 2DEG and holes from the p-GaN for radiative recombination is located in the quantum well. To investigate the importance of the location of single quantum well, optical characteristics are compared by simulation and experimental results. The experimental results show that the main light-emitting wavelength is shifted from 365 nm in the UV range to 525 nm in the visible range when the radiative recombination is confined in the quantum well and dominates among other mechanisms. Epi B, which has a quantum well above the AlGaN barrier layer in contrast to Epi A which has a quantum well underneath the barrier, shows better intensity and uniformity in light-emitting. According to the simulation results showing the radiative distribution and electron concentrations for both structures, the lower quantum efficiency is due to the diverse current paths in Epi A. On the other hand, Epi B shows better quantum confinement and therefore better luminescence in the same bias condition, which is consistent with experimental observations. These findings are critical for advancing the performance of LE-HEMTs.

Background: Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults., Materials/methods: A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed., Results: Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p = 0.03 and 33% versus 13%, p = 0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR): 4.28, 95% CI: 1.46-12.58, p = 0.01 and HR: 2.80, 95% CI: 1.28-6.15, p = 0.01, respectively), whereas the detection of influenza did not., Conclusions: Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians., (Copyright © 2022. Published by Elsevier B.V.)

A bias-selectable photodetector, which can sense the wavelength of interest by tuning the polarity of applied bias, is useful for target discrimination and identification applications. So far, those detectors are generally based on the back-to-back photodiode configuration via exploiting epitaxial semiconductors as optoelectronic materials, which inevitably lead to high fabrication costs and complex device architectures. Here, we demonstrate that our band-engineered van der Waals heterostructures can be applied as bias-selectable photodetectors. Our first prototypical device is mainly composed of black phosphorus (BP) and MoTe 2 light absorbers sandwiching a thin MoS 2 hole blocking layer. By varying the bias polarity, its spectral photoresponse can be switched between near-infrared and short-wave infrared bands, and our optoelectronic characterizations indicate that the detector can exhibit high external quantum efficiency (EQE) and fast operation speed. With this framework, we further demonstrate the detector with bias-selectable photoresponses within the mid-wave infrared band using BP/MoS 2 /arsenic-doped BP heterostructures and show that our developed detectors can be integrated into a single-pixel imaging system to capture dual-band infrared imaging.

Electrical manipulation of the valley degree of freedom in transition metal dichalcogenides is central to developing valleytronics. Towards this end, ferromagnetic contacts, such as Ga(Mn)As and permalloy, have been exploited to inject spin-polarized carriers into transition metal dichalcogenides to realize valley-dependent polarization. However, these materials require either a high external magnetic field or complicated epitaxial growth steps, limiting their practical applications. Here we report van der Waals heterostructures based on a monolayer WSe 2 and an Fe 3 GeTe 2 /hexagonal boron nitride ferromagnetic tunnelling contact that under a bias voltage can effectively inject spin-polarized holes into WSe 2 , leading to a population imbalance between ±K valleys, as confirmed by density functional theory calculations and helicity-dependent electroluminescence measurements. Under an external magnetic field, we observe that the helicity of electroluminescence flips its sign and exhibits a hysteresis loop in agreement with the magnetic hysteresis loop obtained from reflective magnetic circular dichroism characterizations on Fe 3 GeTe 2 . Our results could address key challenges of valleytronics and prove promising for van der Waals magnets for magneto-optoelectronics applications., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Extending the operation wavelength of silicon photonics to the mid-infrared (mid-IR) band will significantly benefit critical application areas, including health care, astronomy, and chemical sensing. However, a major hurdle for mid-IR silicon photonics has been the lack of high-speed, high-responsivity, and low noise-equivalent power (NEP) photodetectors. Here, we demonstrate a van der Waals (vdW) heterostructure mid-IR photodetector integrated on a silicon-on-insulator (SOI) waveguide. The detector is composed of vertically stacked black phosphorus (BP)/molybdenum ditelluride (MoTe 2 ). We measured high responsivity (up to 0.85 A/W) over a 3-4 μm spectral range, indicating that waveguide-confined light could strongly interact with vdW heterostructures on top. In addition, the waveguide-integrated detector could be modulated at high speed (>10 MHz) and its switching performance shows excellent stability. These results, together with the noise analysis, indicate that the NEP of the detector is as low as 8.2 pW/Hz 1/2 . This reported critical missing piece in the silicon photonic toolbox will enable the wide-spread adoption of mid-IR integrated photonic circuits.

Recently, low-concentration atropine (0.01%) has gained increased attention in controlling myopia progression with satisfying effects and minimal side effects. However, studies concerning responders to 0.01% atropine are limited. This retrospective observational cohort study aimed to determine the responder characteristics of 0.01% atropine in Asian children. One hundred forty children (aged between 3 and 15 years) receiving 0.01% atropine were analyzed for the factors influencing annual spherical equivalent changes (SE). The mean age was 9.13 (2.6) years, the mean baseline SE was - 1.56 (1.52) diopters (D), and the mean annual SE change was - 0.52 (0.49) D. A 58.63% responder rate (146/249) of myopic control was achieved with 0.01% atropine in our entire cohort under the criteria of less than 0.5 D of myopic progression annually. The subjects were stratified into 4 subgroups based on a cut-off point of baseline SE of - 1.5 D and baseline age of 9 years. The responder rate differed significantly with the highest being the youngest with the lowest myopia subgroups. Our results demonstrated that children with myopia better than - 1.5 D and younger than 9 years had the highest potential to achieve successful myopic control under 0.01% atropine therapy., (© 2022. The Author(s).)

Purpose: Pediatric strabismus surgery has low success rates and high reoperation rates because of difficult alignment measurements and the nature of different strabismus types. Furthermore, adjustable sutures are not easily employed in children on an OPD basis., Methods: This was a retrospective comparative case study of children less than 12 years old who underwent strabismus surgery and were followed up at least 6 months postoperatively. We proposed a novel method that combines adjustable sutures and corneal light reflexes in regular strabismus surgery to improve surgical results. Efficacy and safety were evaluated and compared with those in a regular fixed-suture group., Results: In total, 128 children (88: exotropia and 41: esotropia) in the novel method group (Group 1) and 109 (71: exotropia and 38: esotropia) in the regular fixed-suture group (Group 2) were enrolled. The primary outcome was the immediate target angle (for esotropia within 4 PD of orthotropia and exotropia within 8 PD of esotropia within the first week postoperatively); the secondary outcome was success at the 6-month visit (angle of deviation < 10 PD). Consequently, there was a significantly higher proportion of achieving the immediate target range and success rate in both exotropic and esotropic patients in Group 1 than in Group 2. A significantly lower reoperation rate was also demonstrated in Group 1. No complications were noted in either group. Conclusions: The novel method enabled a higher proportion of subjects to achieve an immediate target range and success rate and a lower chance of reoperation among both esotropic and exotropic patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fu, Hsieh, Lee, Chen, Wen, Chen and Chien.)

Background: Since December 2019, a number of cases and deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have been reported worldwide. In spite of clinical manifestations similar to the SARS-CoV epidemic in 2003, affected organs and severity are yet to be defined. Moreover, viral load alterations and viral shielding among different specimens remained scarce. Therefore, clarifying clinical presentations and correlations among viral loads, disease severity, and viral shielding of SARS-CoV-2 infection is crucial in the disease prevention., Methods: The clinical courses of SARS-CoV-2 cases were presented through Gantt charts. Laboratory examinations and reverse-transcriptase quantitative polymerase chain reactions (RT-qPCR) among different specimens were tested periodically. Cycle thresholds (CT) were recorded and presented as viral loads., Results: From March 2020 to April 2020, 4 SARS-CoV-2 cases were presented, of which, cases 1 and 2 manifested the symptoms severer than cases 3 and 4, along with higher serum lactate dehydrogenase levels and graded for lymphocytopenia. Case 4 initially exhibited anosmia but recovered within a short period. Curves of the CT of all the cases, except case 2, concaved upward after prescribing hydroxychloroquine (HCQ) and azithromycin. Except for case 4, the CT in most stool specimens remained undetectable; however, none of the cases presented gastrointestinal symptoms. Surprisingly, the CT values of the saliva specimens were inconsistent with those of the nasopharyngeal swabs and sputum., Conclusion: SARS-CoV-2 manifests various symptoms. Sudden onset of central nervous system symptoms should be considered. The timing of HCQ and azithromycin administration might be a key factor in the viral load reduction. Positive prediction values of RT-qPCR of different specimens should be tested carefully to prevent false-negative results., Competing Interests: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2020, the Chinese Medical Association.)

Light-emitting diodes (LEDs) based on III-V/II-VI materials have delivered a compelling performance in the mid-infrared (mid-IR) region, which enabled wide-ranging applications in sensing, including environmental monitoring, defense, and medical diagnostics. Continued efforts are underway to realize on-chip sensors via heterogeneous integration of mid-IR emitters on a silicon photonic chip, but the uptake of such an approach is limited by the high costs and interfacial strains, associated with the processes of heterogeneous integrations. Here, the black phosphorus (BP)-based van der Waals (vdW) heterostructures are exploited as room-temperature LEDs. The demonstrated devices emit linearly polarized light, and the spectra cover the technologically important mid-IR atmospheric window. Additionally, the BP LEDs exhibit fast modulation speed and exceptional operation stability. The measured peak extrinsic quantum efficiency is comparable to the III-V/II-VI mid-IR LEDs. By leveraging the integrability of vdW heterostructures, we further demonstrate a silicon photonic waveguide-integrated BP LED.

Black phosphorus (BP), a narrow band gap semiconductor without out-of-plane dangling bonds, has shown promise for broadband and integrable photodetector applications. Simultaneously exhibiting high speed and high-efficiency operation, however, remains a critical challenge for current BP-based photodetectors. Here, we demonstrate a photodetector based on the BP-based van der Waals heterostructures. The developed photodetector enables broadband responses in the visible to mid-infrared range with external quantum efficiency ranging from 20 to 52% at room temperature. These results together with noise measurements indicate that the photodetector can detect light in the picowatt range. Furthermore, the demonstrated BP detector has ultrafast rise (1.8 ns) and fall (1.68 ns) times, and its photoresponse exhibits reproducible switching behavior even under consecutive and rapid light intensity modulations (2100 cycles, 200 MHz), as indicated by the eye-diagram measurement. By leveraging these features, we show our BP heterostructures can be configured as a point-like detector in a scanning confocal microscopy, useful for mid-infrared imaging applications.

Purpose: To compare the effects of oblique astigmatism on refractive amblyopia in children aged 3-7 years with those having orthogonal astigmatism., Design: A retrospective review of medical records., Methods: The medical records of patients attending Tri-Service General Hospital in Taiwan from January 2003 to December 2010 were reviewed and summarized. Seventy-two children with oblique astigmatism-related refractive amblyopia (Group 1) and 82 children with orthogonal astigmatism (Group 2) were chosen. Characteristics such as baseline visual acuity (VA), the time course of VA improvement, refractive error, and family history were assessed., Results: Group 1 showed a worse baseline mean VA (±SD) of 0.61 (0.13) vs 0.52 (0.16) logMAR (P = .01), a slower rate of amblyopia improvement, and higher prevalence of parental oblique astigmatism (29% vs 5.5%; P < .01) than did Group 2. The cylinder power of astigmatism (in D) causing amblyopia in Group 1 of 2.48 (0.82) was lower than that in Group 2: 2.93 (0.71) (P = .006). However, Group 1 achieved a noninferior resolution of amblyopia (mean final VA 0.18 vs 0.16 logMAR) after longer treatment of 6.45 (2.44) vs 5.86 (2.92) months (P = .039)., Conclusions: A smaller degree of initial oblique astigmatism caused amblyopia than did orthogonal astigmatism. Although the children with oblique astigmatism achieved equal resolution rates after treatment, this took longer. Therefore, we should pay more attention to children with mild oblique astigmatism, as they are more likely to develop oblique astigmatism-related amblyopia. Moreover, early diagnosis and prompt treatment might help visual improvement., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aim: To evaluate the efficacy of a new modality for improving visual acuity (VA) in pediatric patients with anisometropic amblyopia., Methods: Retrospective and interventional case series. Medical records of 360 children with anisometropic amblyopia treated with a modality that included rotated prisms, lenses, and near activities from January 2008 to January 2012 were analyzed. Characteristics such as improvement of VA and contrast sensitivity in amblyopic eyes and resolution of amblyopia (VA ≤0.1logMAR or a difference of ≤2 lines in logMAR between the eyes) were assessed., Results: Among the patients, the mean VA of the amblyopic eyes improved from 0.48logMAR (SD=0.16) to 0.12logMAR (SD=0.16) and the mean VA improvement was 0.36logMAR (SD=0.10, P<0.001). Resolution of amblyopia was achieved in 233 of 360 patients (64.72%). The mean time for resolution of amblyopia was 8.05 weeks (SD=4.83) or 14.14 sessions (SD=8.76). Among the study group, refraction error did not change significantly after treatment (P=0.437). We found that better baseline VA may be related to success and shorten the time to amblyopic resolution., Conclusion: VA and contrast sensitivity improved with rotated prisms, correcting lenses, and near activities in children with anisometropic amblyopia. The VA improvement by this modality was comparable to other methods. However, the time to resolution of amblyopia was shorter with this method than with other modalities. Rotated prisms combined with near acuity could provide an alternative treatment in children with anisometropic amblyopia who can't tolerant traditional therapy method like patching.

A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. Laboratory evaluation revealed a d-dimer level of 35.2 mg/L (FEU) on the day of the test and 1.2 mg/L one and a half months ago (normal level, <0.55). These findings were suggestive of a recent-onset peripheral arterial occlusive disorder. Computed tomography of the aorta showed bilateral popliteal arterial dissection with arterial intimal flap. Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery.

Introduction: We report the effective use of dexmedetomidine in the treatment of a patient with a history of chronic alcohol abuse and an acute traumatic brain injury who developed agitation that was unresolved if from traumatic brain injury, or alcohol withdrawal or the combination of both. Treatment with benzodiazepines failed; lorazepam therapy obscured our ability to do reliable neurological testing to follow his brain injury and nearly resulted in intubation of the patient secondary to respiratory suppression. Upon admission to hospital, the patient was first treated with intermittent, prophylactic doses of lorazepam for potential alcohol withdrawal based upon our institution's standard of care. His neurological examinations including a motor score of 6 (obeying commands) on his Glasgow Coma Scale testing, laboratory studies, and repeat CT head imaging remained stable. For lack of published literature in diagnosing symptoms of patients with a history of both alcohol withdrawal and traumatic brain injury, a diagnosis of agitation secondary to presumed alcohol withdrawal was made when the patient developed acute onset of tachycardia, confusion, and extreme anxiety with tremor and attempts to climb out of bed requiring him to be restrained. Additional lorazepam doses were administered following a hospital-approved protocol for titration of benzodiazepine therapy for alcohol withdrawal. The patient's mental status and respiratory function deteriorated with the frequent lorazepam dosing needed to control his agitation. Dexmedetomidine IV infusion at a rate of 0.5 mcg/kg/h was then administered and was titrated ultimately to 1.5 mcg/kg/h. After 8 days of therapy with dexmedetomidine, the patient was transferred from the ICU to a step-down unit with an intact neurological examination and no evidence of alcohol withdrawal. Airway intubation was avoided during the patient's entire hospitalization. This case report highlights the intricate balance between the side effects of benzodiazepine sedation for treatment of agitation and the difficulties of monitoring the neurological status of non-intubated patients with traumatic brain injury., Conclusion: Given the large numbers of alcohol-dependent patients who suffer a traumatic brain injury and subsequently develop agitation and alcohol withdrawal in hospital, dexmedetomidine offers a novel strategy to facilitate sedation without neurological or respiratory depression. As this case report demonstrates, dexmedetomidine is an emerging treatment option for agitation in patients who require reliable, serial neurological testing to monitor the course of their traumatic brain injury.

Background: Our primary objective was to detect malignant hyperthermia (MH)-susceptible persons and thereby prevent MH episodes. We identified variants in the ryanodine receptor isoform 1 using molecular pedigree analysis., Methods: Nineteen exons covering major hotspots were chosen for the primary screening by polymerase chain reaction, denaturing high performance liquid chromatography, and confirmed by direct sequencing., Results: Three novel variants involving amino acid changes were identified in two unrelated families as Met2698Arg, Glu2724Lys in exon 51 and Leu2785Val in exon 53., Conclusions: Three novel ryanodine receptor isoform 1 variants located either near or within the central domain might predispose carriers to MH.

Purpose: To evaluate the improvement in visual acuity (VA) in children 3 to 7 years old with hypermetropic amblyopia after full or partial hypermetropic correction., Design: Retrospective interventional case series., Methods: Medical records of 182 children with hypermetropic amblyopia treated with partial or full hypermetropic correction from January 1, 2001 to July 31, 2007 were evaluated. Improvement in the VA of the amblyopic eye, changes in the power of glasses, and the reduction in hypermetropia were assessed., Results: Ninety-three children underwent full hypermetropic correction and the mean VA of their amblyopic eyes improved by 0.46 logarithm of minimal angle of resolution (logMAR). Eighty-one children underwent partial hypermetropic correction and the mean VA of their amblyopic eyes improved by 0.48 logMAR. The reduction in hypermetropia was 0.44 diopters (D)/year and 0.43 D/year, respectively. Changes in glasses at four to eight weeks of follow-up were noted in 11 children receiving full correction, all of whom were older than 5 years. Ten children, aged 3 to 5 years, with hypermetropia of more than 3 D and receiving partial correction, required a change of glasses and most (seven children) had underdiagnosed accommodative esotropia., Conclusions: Both full correction and partial correction of hypermetropic errors improved the VA of 3 to 7-year-old children with hypermetropic amblyopia. The reduction in hypermetropia was similar after full and partial hypermetropic correction. However, for children older than 5 years, full correction should be undertaken with care because the accompanying blur at distance can hinder compliance. For younger children, especially with a high degree of hypermetropia, full correction might be required to avoid strabismus, which would cancel the effects of spectacle correction.

Purpose: Glucosamine sulfate (GS) is a naturally occurring sugar that exerts immunosuppressive effects in vitro and in vivo. The authors investigated whether GS modulates the inflammatory reaction in endotoxin-induced uveitis (EIU) of rats and the mechanisms by which it exerts its effects., Methods: Two-hundred micrograms of lipopolysaccharide (LPS) was injected subcutaneously into Lewis rats to induce EIU. Doses of GS (10, 100, or 1000 mg/kg) were divided into three aliquots and administered intraperitoneally 30 minutes before LPS injection, concurrently with LPS injection, and 30 minutes after LPS injection. Twenty-four hours after LPS injection, aqueous humor was collected for cell counting and measurement of protein concentration. Immunohistochemical staining of the iris-ciliary body was performed to evaluate the effects of GS on intercellular adhesion molecule (ICAM)-1 and nuclear factor (NF)-kappaB activation and to demonstrate macrophage infiltration. The effects of various doses of GS pretreatment were also examined using a mouse macrophage cell line (RAW264.7 cells) and LPS stimulation. Levels of prostaglandin (PG)-E2 and nitric oxide (NO) were determined. Expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 were measured using Western blot analysis. The effect of GS on LPS-induced NF-kappaB activation in RAW cells was also examined., Results: Cell counting and analysis of protein concentration in aqueous humor revealed that GS suppressed EIU in rats treated with a high dose of GS (1000 mg/kg). Immunohistochemistry showed that treatment with GS reduced ICAM-1 expression and suppressed activation of NF-kappaB in the iris-ciliary body. The main inflammatory cells in the iris-ciliary body during EIU were macrophages. In LPS-stimulated macrophage RAW cell culture, GS inhibited the production of NO and PG-E2, the expression of iNOS and COX-2, and the activation of NF-kappaB., Conclusions: GS suppresses EIU in rats by blockading the NF-kappaB-dependent signaling pathway and the subsequent production of ICAM-1 and proinflammatory mediators. This study has extended the authors' previous observation that GS is a potentially important compound for reducing ICAM-1-mediated inflammatory effects in the eye.

Background: To compare the effects of perceptual learning or patching on improving visual acuity and contrast sensitivity in patients with anisometropic amblyopia., Methods: Patients with anisometropic amblyopia received either patching or perceptual learning treatment. Corrected amblyopic logMAR visual acuity and contrast sensitivity function were measured at four-weekly intervals until visual acuity stabilized or amblyopia resolved. Improvements in visual acuity, contrast sensitivity and resolution of amblyopia were compared between the two groups., Results: The mean visual acuities of the amblyopic eyes improved by 0.34 logMAR (95% CI: 0.22-0.47 logMAR) with patching and 0.25 logMAR (95% CI: 0.16-0.35 logMAR) with perceptual learning (p=0.125). Resolution of amblyopia was achieved in 10 of 26 patients (38%) in the perceptual learning group and 17 of 27 patients (63%) in the patching group (p=0.809). Amblyopia improved by two or more lines in 20 of 26 (76%) patients in the perceptual learning group and 26 of 27 (96%) patients in the patching group (p=0.0001). The mean time for patching was 37.3 weeks (522.2 h) and the average number of training sessions in the perceptual learning group was 48 (29.5 h) (p=0.0001)., Conclusions: Visual acuity can be improved with perceptual learning and patching in older children and adult patients with anisometropic amblyopia. The improvements in visual acuity achieved with patching were one line better than those achieved with perceptual learning. Perceptual learning might provide an alternative treatment in patients with anisometropic amblyopia.

Background: Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU)., Methods: In this observational study, 308 patients who received general anesthesia with NMBAs were enrolled. Residual curarization was evaluated using the TOF-Watch acceleromyograph upon arrival in the PACU. Three consecutive TOF stimulations were applied and recorded at 15-second intervals. Two thresholds of TOF ratios (0.9 and 0.7) were used to assess the presence of residual curarization., Results: TOF ratios less than 0.7 and 0.9 were observed in 15 (5%), and 97 (31%) patients, respectively. The differences of the TOF ratios between the male and female patients were significant (p = 0.014). In terms of weight, the differences between the patients with ratios > 0.9 and < or = 0.9 were significant (p = 0.013). There were 67, 49, 15, and three patients who received reversal medication in the > 0.9 group, < or = 0.9 and > 0.7 group, and < or = 0.7 group, respectively. The differences of the TOF ratios between the patients who received and those who did not receive reversal medication were not significant (p = 0.91)., Conclusion: PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.

Malignant hyperthermia (MH) is a rare condition consisting of increased temperature and rigidity with mild to fulminant manifestation during anesthesia. Sevoflurane was thought to be a less potent triggering agent of MH; however, in literature review, the onset of MH after exposure to sevoflurane may be associated with calcium release from the sarcoplasmic reticulum. We present here a case of rarely-seen delayed MH induced by an inhalation agent of low-inducing probability, sevoflurane, after the second exposure to which within a short period of time. The patient was a five years old boy who received sevoflurane anesthesia for repeat orthopedic surgery within two days. Gradual elevation in heart rate, abrupt hypercarbia and hyperthermia were observed 90 min after induction. Dantrolene was administrated immediately with effective therapeutic response. Eventually, the patient recovered without any complication as an aftermath. Gradually elevated heart rate during the second exposure to sevoflurane was the atypical sign in the episode of MH in this case. One plausible explanation for the development of delayed onset of MH is the latent effect of the volatile anesthetic on the skeletal muscles. Therefore, it is worth noting for the anesthesiologists to recognize the possibility of an atypical MH and be alert for the possible occurrence of MH during routine anesthetic practice.

Purpose: To evaluate factors predicting resolution of amblyopia and the time course of improvement in VA in children 3 to 7 years old with anisometropic amblyopia treated with spectacles alone., Design: Prospective, noncomparative intervention., Methods: Measurement of corrected amblyopic logMAR visual acuity (VA) in newly diagnosed children at four-weekly intervals until VA stabilized or amblyopia resolved. The time course of improvement in VA and the factors related to amblyopia resolution were assessed., Results: Sixty children with a mean age of 5.3 years and mean anisometropia of 2.95 diopters (D) were included. Amblyopia improved by 2 or more logMAR lines in 56 patients (93%) and resolved in 27 patients (45%), with a mean improvement in VA of 0.38 logMAR. The improvement in VA in the amblyopic eye was considerable at four to 12 weeks then reached a plateau, after which it improved only slowly. Resolution of amblyopia was related to better initial VA (0.2 to 0.6 logMAR) and lesser amounts of anisometropia (<4 D). The time to resolution ranged from four to 40 weeks, but no patient with residual amblyopia showed an improvement in VA of more than 0.1 logMAR over four consecutive visits., Conclusions: With spectacle correction alone, 3- to 7-year-old children with previously untreated anisometropic amblyopia achieved approximately four-line improvement and resolved nearly in half. The nearly two-month plateau periods during improvement of VA should be noticed. After four months with no improvement in VA, occlusion therapy or atropine penalization may be considered.

Purpose: We investigated whether glucosamine sulfate modulates the production of ICAM-1 induced by proinflammatory cytokines and whether glucosamine sulfate inhibits leukocyte adhesion to a monolayer of human conjunctival epithelial cells stimulated with proinflammatory cytokines., Methods: We used flow cytometry and either primary cultured human conjunctival cells or the Chang conjunctival cell model to determine the effects of glucosamine sulfate on the production of ICAM-1 in response to tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-6, TNF-alpha plus IFN-gamma, or TNF-alpha plus IL-1beta. The effects of glucosamine sulfate on the expression of the ICAM-1 gene, upregulated by various cytokines, were determined by semiquantitative reverse transcription-polymerase chain reaction. The activation and nuclear translocation of the nuclear factors NF-kappaB and STAT1 were evaluated by the transient transfection of reporter gene systems and immunocytochemistry. The influence of glucosamine-sulfate-modulated ICAM-1 on neutrophil adhesion was demonstrated in a model that measures the adherence of conjunctival cells and neutrophils., Results: TNF-alpha, IFN-gamma, and IL-1beta significantly increased the production of ICAM-1 by both primary cultured human conjunctival cells and Chang conjunctival cells. Glucosamine sulfate effectively downregulated the production of ICAM-1 induced by TNF-alpha, IFN-gamma, IL-1beta, TNF-alpha plus IFN-gamma, or TNF-alpha plus IL-1beta. This downregulation occurred through the interferon-stimulated response element, IFN-gamma activation sequence, and binding sequence of NF-kappaB at the mRNA and protein levels. Glucosamine sulfate further inhibited the nuclear translocation of p65 protein in TNF-alpha- and IL-1beta-stimulated Chang conjunctival cells and phosphorylated STAT1 in IFN-gamma-stimulated Chang conjunctival cells. Glucosamine sulfate also significantly reduced the number of neutrophils adhering to a conjunctival monolayer in response to TNF-alpha, IFN-gamma, or IL-1beta., Conclusions: Our results suggest that glucosamine sulfate inhibits ICAM-1 production in conjunctival epithelial cells in vitro. Therefore, glucosamine sulfate might be valuable in the treatment of inflammatory ocular-surface conditions.

Glucosamine is an amine-containing sugar that exhibits immunosuppressive effects in vitro and in vivo, although its mechanism of action is unknown. We investigated whether glucosamine sulfate (GS) modulates the proinflammatory cytokine interleukin (IL)-1beta-induced expression and production of intercellular adhesion molecule (ICAM)-1, the mechanism responsible for this effect, and whether GS inhibits leukocyte adhesion to the monolayer of retinal pigment epithelial (RPE) cells stimulated with various cytokines. We used flow cytometry and an ARPE-19 cell model to determine the effect of GS on the production of ICAM-1 in response to IL-1beta, IL-6, tumor necrosis factor (TNF)-alpha plus IL-1beta, TNF-alpha plus IL-6, and TNF-alpha plus interferon (IFN)-gamma. We also used semiquantitative RT-PCR to determine the effect of GS on IL-1beta-induced expression of the ICAM-1 gene, and immunocytochemistry and western blotting to measure the effect of GS on the activation and nuclear translocation of the nuclear factor NF-kappaB and the degradation of cytoplasmic IkappaB. The functionality of GS-modulated ICAM-1 on leukocyte adhesion was demonstrated in an RPE cell-neutrophil adherence assay. IL-1beta increased the expression of ICAM-1 at the mRNA and protein levels in ARPE-19 cells. GS downregulated the production of ICAM-1 induced by IL-1beta, IL-6, TNF-alpha, and IFN-gamma at the protein level in a dose-dependent manner. GS also inhibited the nuclear translocation of NF-kappaB subunit p65 and partially prevented the degradation of cytoplasmic IkappaB in IL-1beta-stimulated ARPE-19 cells. GS significantly decreased the number of neutrophils adhering to the RPE monolayer in response to cytokines IL-1beta, IL-6, TNF-alpha, and IFN-gamma. GS inhibits the expression of the ICAM-1 gene in ARPE-19 cells stimulated with IL-1beta by blocking NF-kappaB subunit p65 translocation and by partially preventing IkappaB degradation. GS also decreases leukocyte adhesion to the monolayer of ARPE-19 cells stimulated with various cytokines by decreasing ICAM-1 production. Our study demonstrates a potentially important property of GS in reducing ICAM-1-mediated inflammatory mechanisms in the eye.

Purpose: To evaluate the efficacy and safety of apraclonidine 0.5% in the diagnosis of Horner syndrome in pediatric patients., Design: Prospective, interventional case series., Methods: Ten pediatric patients with a diagnosis of Horner syndrome and 10 age-matched controls with physiologic anisocoria underwent pharmacological testing with apraclonidine. The difference between the pupil diameters of both eyes under low (room light off) and high (room light on) ambient illumination before and one hour after apraclonidine was instilled was recorded. Any adverse effects during the examination or reported by the patient's parents were recorded., Results: The mean differences in pupil diameters before and after apraclonidine testing in the Horner syndrome group were -2.05 mm and 0.97 mm, respectively, under low illumination (P = .0049) and -1.48 mm and 1.1 mm, respectively, under high illumination (P = .0051). Three patients with Horner syndrome showed positive values (reversal of anisocoria) only under high ambient illumination, but not under low illumination. There was no statistical difference in the mean differences in pupil diameter before and after apraclonidine testing in the control group. Conjunctival hyperemia was noted in two patients with Horner syndrome and in three patients in the control group. No systemic adverse effects were noted during the examination or were reported by patients' parents., Conclusions: The application of apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner syndrome. The reversal of anisocoria was more obvious under high (room light on) ambient illumination.

Background: To study the effect of hyperbaric oxygen (HBO) therapy on diabetic retinopathy in a streptozotocin-induced diabetic rat model., Methods: Sprague-Dawley albino male rats were divided into three groups. The three groups were as follow: (i) non-diabetic control group (non-DM control); (ii) diabetic control group (DM control); and (iii) diabetic rats receiving hyperbaric oxygen therapy (DM HBO). Rats in DM HBO group were incubated in an oxygen monoplace chamber. The HBO condition was set at 2.5 atmospheres and 100% oxygen. The duration of a single HBO treatment was 90 min. Rats in DM HBO groups received HBO three times per week for 3 months. Retinal vascular permeability was assessed by measuring fluorescein isothiocyanate-labelled bovine albumin and retinal Evans blue leakage into the retina., Results: We found that the retinal parenchyma showed prominent thickening but not statistically significant in rats with DM, corresponding to the retinal oedema, compared with the control and DM HBO groups. fluorescein isothiocyanate relative fluorescence intensity (Mean+/-SE) in normal control animals, diabetic animals, and HBO-treated diabetic animals was 356+/-47, 865+/-78, and 518+/-49, respectively, demonstrating significant difference between the means of diabetic and HBO-treated diabetic animals, and between means of control and diabetic animals (n=8, P<0.05). Retinal Evans blue leakage in control animals, diabetic animals, and HBO-treated diabetic animals was 7.6+/-2.9, 18.5+/-4.2 and 10.2+/-3.1 microL plasma/g retinal dry weight/h, respectively, demonstrating significant difference between the means of diabetic and HBO-treated diabetic animals, and between means of control and diabetic animals (n=8, P<0.05)., Conclusion: HBO therapy may diminish the extent of the increased blood-retinal barrier breakdown in diabetic animals.

Purpose: The aim of this study was to compare the efficacy of 0.5% apraclonidine with that of 4% cocaine and to evaluate its safety in the diagnosis of Horner syndrome in pediatric patients., Methods: This was a randomized, crossover study, wherein 10 patients with a probable diagnosis of Horner syndrome were assigned to undergo pharmacological testing with 4% cocaine and 0.5% apaconidine. The difference in the pupil diameters of each eye was recorded under dim light before and 1 h after 0.5% apraclonidine or 4% cocaine was instilled. Any adverse effects were noted during examination or reported by the patients' parents were recorded., Results: The mean differences in pupil diameter before and after 4% cocaine testing were -2.08 and -2.97 mm, respectively (P = 0.0047). All patients had an anisocoria greater than 1 mm after 4% cocaine testing. The mean difference in pupil diameter before and after 0.5% apraclonidine was instilled were -2.04 and +1.08 mm, respectively (P = 0.005). All patients showed a reversal of anisocoria after 0.5% apraclonidine testing. Conjunctival hyperemia was noted in 2 patients, but systemic adverse effects were not noted during examination nor reported by the patients' parents., Conclusions: The application of 0.5% apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner syndrome.

Purpose: To report the outcomes of balloon dacryocystoplasty of the lacrimal duct with inferior turbinate infracture as a primary treatment of congenital nasolacrimal duct obstruction in children 18 months of age or older., Materials and Methods: This study was a 3-year, prospective, interventional case series, consisting of 83 consecutive patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty as their primary treatment modality. Outcome evaluations included an ophthalmologic examination and a dye disappearance test at 3 weeks and 6 months postoperatively. We analyzed the different age groups and the types of obstruction noted at surgery to determine their respective influences on patient outcomes. We used the chi-square test for statistical analysis., Results: Seventy-two patients aged 18 to 112 months (mean 30 months) were included. Overall, 57 patients (79%) had good outcomes from balloon dacryocystoplasty. When analyzed by type of obstruction, 34/42 patients (81%) with simple membranous obstruction at the valve of Hasner had good outcomes and 23/30 patients (77%) with stenosis that extended along the length of the distal NLD had good outcomes (P = 0.60, power 0.62). Age did not significantly affect outcomes (P = 0.66, power 0.72)., Conclusions: Balloon dacryocystoplasty is probably more effective than simple probing in older children with stenosis extending along the distal nasolacrimal duct obstruction.

Aims: The aim of this study was to evaluate the efficacy of mitomycin C in reducing postoperative adhesions following strabismus surgery., Methods: This study was a prospective, single-center, interventional case series. We randomized 14 patients with restrictive strabismus to the mitomycin C group (7 patients) or to the control group (7 patients). We used mitomycin C intraoperatively for 5 min at a concentration of 0.2 mg/mL in the mitomycin group after adhesion release. We compared postoperative results using the forced duction test., Results: Compared to the control group, the mitomycin C group exhibited a better range of passive duction at all postoperative follow-up times; however, mitomycin C did not completely eliminate the problem of postoperative adhesions. Patients receiving mitomycin C did not report any complications during this study., Conclusions: The intraoperative application of mitomycin C is a safe and effective adjunct to surgery in the treatment of restrictive strabismus.

Purpose: To investigate the clinical efficacy of a new patient-operated intraocular pressure tool, the Proview eye pressure monitor (PEPM; Bausch & Lomb, Inc., Rochester, NY), for monitoring intraocular pressure (IOP) in patients with glaucoma or ocular hypertension., Patients and Methods: One hundred and forty eyes of 70 Taiwanese patients from the Tri-Service General Hospital (Taiwan, Republic of China) who had been diagnosed with ocular hypertension or glaucoma were studied. After being fully trained during an initial clinic visit, patients measured their own IOP with the PEPM at home. The IOPs were measured again using a Haag-StreitBern Goldmann tonometer (GT; Haag-Streit, Köniz, Switzerland) during subsequent outpatient visits. The training time, assessment of the patients' ease of PEPM use, and accuracy of measured PEPM IOPs in relation to GT IOPs were recorded and analyzed., Results: Relative to GT readings, PEPM readings tended to be overestimated at lower pressure (<10 mmHg) and underestimated at higher pressure (>20 mmHg). Between 10 to 20 mmHg, PEPM measurements did not significantly differ from GT measurements. Up to 80% of the PEPM measurements fell within +/- 3 mmHg of the corresponding GT readings. When consideration was limited to GT readings of > or =21 mmHg, PEPM measured IOPs of > or =21 mmHg with a sensitivity of 80% and a specificity of 90%. The mean satisfaction rating of PEPM use was 88.3 +/- 2.0 (maximum, 100). The mean training time for appropriate use of PEPM was 17.9 +/- 4.0 minutes. The older the patients, the longer the training time that was required., Conclusion: Our data suggest that after appropriate training: (1) PEPM and GT measurements correspond well between 10 mmHg and 20 mmHg and (2) PEPM could offer patients with glaucoma or ocular hypertension an easy-to-use, substantially reliable means of selfmonitoring IOP.

Background: To report the clinical experience and success rate with Ritleng intubation system in patients with congenital nasolacrimal duct obstruction., Methods: Twenty-four patients (32 eyes) with congenital nasolacrimal duct obstruction treated with the Ritleng intubation system were enrolled in this study. The mean age was 20.1+/-9.6 months. The technique involved introduction of a Prolene monofilament guide thread, securely fastened to silicone tubing, into a tubular metal probe that opened into the inferior meatus. Success was defined as complete resolution of previous symptoms and a normal result of dye disappearance test in cooperative patients. To establish relationship of success rate with patients' ages, these data were compared and analyzed., Results: All eyes were successfully intubated with the Ritleng system. The Prolene monofilament spontaneously emerged from the nose in 19 (60%) of 32 eyes, making retrieval simple and uncomplicated. The overall success rate (of all aged groups) was 90%. In the group over 24 months of age, there was no significant decrease in the success rate (p > 0.1), but obvious difficulty in intubation and lengthy operation time were noted., Conclusions: Silicone intubation with the Ritleng system is an effective treatment for patients with congenital nasolacrimal duct obstruction, especially at young age. Comparing with conventional metal probe system, there was minimal nasal bleeding and trauma to the nasal mucosa with Ritleng intubation system. With the advantage of easy retrieval, operation time can be shortened, thereby improving patient care and decreasing potential morbidity.

Pre-Descemet's dystrophy is a symmetrical bilateral comeal dystrophy consisting of multiple small discrete opacities of lipid-like material in the deep stroma just anterior to the pre-Descemet's membrane. We presented a case of a 46-year-old male who visited our hospital on account of acute conjunctivitis. On routine examination, we found multiple fine gray dots in the pre-Descemet's area and large, dark, scaly skin lesions over extensor surfaces of the extremities. After consultation with a dermatologist, X-linked recessive ichthyosis was diagnosed.