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Peripheral facial paralysis (PFP) is a common condition where oxidative stress (OS) is involved in the pathophysiology of facial paralysis, inhibiting peripheral nerve regeneration, which can be featured in Bell's palsy, Ramsay Hunt syndrome and Lyme disease. The current standard care treatments lack consensus and clear guidelines. Hence, the utilization of the antioxidant immunomodulator photobiomodulation (PBM) can optimize clinical outcomes in patients who are unresponsive to standard care treatments. Our study describes three unique cases of chronic PFP of various origins that were unresponsive to standard care treatments, but achieved a significant and complete recovery of facial paralysis following PBM therapy. Case presentations: Case #1: a 30-year-old male who presented with a history of 12 years of left-side facial paralysis and tingling as a result of Bell's palsy, where all the standard care treatments failed to restore the facial muscles' paralysis. Eleven trigger and affected points were irradiated with 1064 nm with an irradiance of ~0.5 W/cm2 delivered with a collimated prototype flat-top (6 cm2) in a pulsed mode, with a 100 µs pulse duration at a frequency of 10 Hz for 60 s (s) per point. Each point received a fluence of 30 J/cm2 according to the following treatment protocol: three times a week for the first three months, then twice a week for another three weeks, and finally once a week for the following three months. The results showed an improvement in facial muscles' functionality (FMF) by week two, whereas significant improvement was observed after 11 weeks of PBM, after which the House–Brackmann grading scale (HBGS) of facial nerve palsy dropped to 8 from 13 prior to the treatment. Six months after PBM commencement, electromyography (EMG) showed sustainability of the FMF. Case #2: A five-year-old female who presented with a 6-month history of severe facial paralysis due to Lyme disease. The same PBM parameters were utilized, but the treatment protocol was as follows: three times a week for one month (12 consecutive treatment sessions), then the patient received seven more sessions twice a week. During the same time period, the physiotherapy of the face muscles was also delivered intensively twice a week (10 consecutive treatments in five weeks). Significant improvements in FMF and sustainability over a 6-month follow-up were observed. Case #3: A 52-year-old male who presented with severe facial palsy (Grade 6 on HBGS) and was diagnosed with Ramsay Hunt syndrome. The same laser parameters were employed, but the treatment protocol was as follows: three times a week for three weeks, then reduced to twice a week for another three weeks, then weekly for the next three months. By week 12, the patient showed a significant FMF improvement, and by week 20, complete FMF had been restored. Our results, for the first time, showed pulsed 1064 nm PBM delivered with a flat-top handpiece protocol is a valid and its treatment protocol modified, depending on the origin and severity of the condition, which is fundamental in optimizing facial paralysis recovery and alleviating neurological symptoms. Further extensive studies with large data are warranted to validate our PBM dosimetry and treatment protocols. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation between ocular surface disease (OSD) and functional status among elderly population over 60 years old in Hong Kong. Methods: Chinese subjects above 60 years old were recruited from the Ophthalmology clinic in Hong Kong West Cluster. Subjects demographic and questionnaires to evaluate the functional status were used to correlate with OSD objectively with clinical examination to assess the meibomian gland dysfunction (MGD), corneal staining, Schirmer's test and tear break-up time (TBUT); and subjectively with ocular surface disease index (OSDI). Results: Twenty-eight patients were recruited, with a mean age of 71.5 ± 6.8 years. There was good correlation between the findings of the two eyes for bilateral measurements. Corneal staining was present in 75% of the subjects, while 92.9% of them had positive MGD grading. TBUT was reduced in 85.7% of the subjects. There is a negative association between MGD grading and Barthel index (r = −0.55, p<.01), indicating worse activities of daily living is related to worse MGD. OSDI is negatively associated with Schirmer's test (r = −0.49, p<.01). A negative correlation is also found between TBUT value and corneal staining (r = −0.58, p<.01). Conclusions: There is a high prevalence of OSD among our subjects. Lower Barthel index (indicating worse Lawton's instrumental activities of daily living) is associated with worse MGD grading. In elderly with poor functional status, care should be taken to manage their OSD. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state. Methods: We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed. Results: Patients in the Texas cohort (n = 296) were younger (57 vs. 63 years, p value <0.001), they had a higher BMI (30.3 kg/m2 vs. 28.5 kg/m2, p = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; p = 0.014). In contrast, patients in the New York state cohort (n = 218) had higher rates of coronary artery disease (19 vs. 10%, p = 0.005) and atrial fibrillation (11 vs. 5%, p = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, p = 0.020; 30 vs. 12%, p < 0.001; and 11 vs. 5%, p = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, p = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both p < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, p = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, p = 0.741). Conclusions: Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources. [ABSTRACT FROM AUTHOR]

Objectives. To identify the risk factors for poor eye drop application technique in treatment-naïve subjects and to assess if patient education can benefit these subjects. Methods. Chinese subjects above 60 years were recruited. Questionnaires, including Barthel index; Lawton's instrumental activities of daily living (ADL); Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale; and Montreal Cognitive Assessment (MoCA), were used to correlate with eye drop application technique (before and after patient education) using Spearman correlation analysis. A multiple linear regression was conducted to determine the predictors of successful administration technique and the improvement of technique after education. Results. The data from 26 subjects (mean age 72) were analyzed. Eye drop instillation technique score improved from 5.42 at baseline to 7.33 after clear instructions. FRAIL score was an independent predictor of baseline score (p=0.003), as well as the improvement after patient education (p=0.012). Age, sex, education level, visual acuity, Barthel index, MoCA, and ADL score were not correlated with eye drop instillation technique, before nor after patient education. Discussion. In patients with poor functional status as reflected by FRAIL score, eye drop application is prone to be ineffective. Education with step-by-step instructions could effectively improve the success of eye drop application. [ABSTRACT FROM AUTHOR]

A new beam-to-column connection has been developed for assembling precast concrete bridge bents in regions of high seismicity. The connection is made with a small number of large column bars, which are grouted into large corrugated-metal ducts embedded in the cap beam. Bents built with these connections can be erected quickly and permit generous construction tolerances. To evaluate the seismic performance of the proposed connection, lateral-load tests were performed on three manifestations of the connection, as well as on a comparable cast-in-place connection. The tests demonstrated that the force-displacement response and damage progression in the precast connection are similar to those of typical cast-in-place concrete connections. Deliberate partial debonding of the longitudinal reinforcement only slightly affected the force-displacement response and observed damage. [ABSTRACT FROM AUTHOR]

Background and Objective: Earlier studies have shown increased production of reactive oxygen species (ROS) and upregulation of ROS-generating enzyme, nicotinamide adenine dinucleotide (phosphate) oxidase, in the kidney of spontaneously hypertensive rats (SHR). This study aimed to examine the activities and protein abundance of the main antioxidant enzymes [i.e. superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX)] in the kidney of SHR fed a regular or an antioxidant-rich diet., Methods: Pregnant SHR and their offspring were fed either a regular diet or an antioxidant-rich diet (alpha-tocopherol, ascorbic acid, zinc and selenium) and observed for 6 months. Wistar-Kyoto (WKY) rats fed a regular or antioxidant-fortified diet served as controls., Results: The untreated SHR showed severe hypertension and significant increases in plasma hydrogen peroxide and renal tissue nitrotyrosine abundance, indicating the presence of oxidative/nitrosative stress. Despite oxidative stress, Cu Zn SOD, CAT and GPX activities were unchanged in the cortex and medulla of untreated SHR. Immunodetectable Mn SOD was reduced in the medulla and elevated in the cortex, whereas, Cu Zn SOD protein was unchanged in the cortex and reduced in the medulla. By contrast, CAT protein abundance was increased in both cortex and medulla while GPX protein was elevated in the cortex and unchanged in the medulla. Comparison of protein abundance and activities of the antioxidant enzymes revealed significant discordance in the untreated SHR. Lifelong antioxidant therapy diminished the severity of hypertension, improved oxidative stress and ameliorated or reversed abnormalities of antioxidant enzyme expressions and activities. By contrast, antioxidant therapy had no effect on the measured parameters in the WKY rat controls., Conclusions: Oxidative stress in SHR was associated with a lack of coordinate upregulation of the antioxidant enzymes and discordance between their protein abundance and enzymatic activity. These findings suggest an impaired antioxidant defense system and the presence of functionally abnormal enzymes in the SHR kidney. Lifelong antioxidant therapy improved expression, activity and activity-to-mass relationship of the measured enzymes. The latter suggests oxidative and nitrosative modification of these molecules in the SHR kidney.