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Purpose: To investigate the influence of glomerular filtration rate in renal disease decline and its association with diabetic retinopathy (DR) and age‑related macular degeneration (ARMD) in patients in South India. Methods: A population‑based cross‑sectional study was conducted including participants with DR and ARMD recruited from urban and rural populations. The data collection included medical history, anthropometric measurements, and ophthalmic work‑up. The estimated glomerular filtration rate (eGFR) was calculated using the equation of chronic kidney disease‑epidemiology collaboration (CKD‑EPI). The grading of AMD was done by a single experienced (more than 5 years) vitreoretinal surgeon as per the International ARM Epidemiological Study Group and it was staged based on grading in the worsened eye. Results: A decline in eGFR was observed as the severity of DR increased (P < 0.001). Baseline characteristics such as age (P < 0.001), duration of diabetes (P < 0.001), gender (P < 0.001), creatinine (P < 0.001), albumin to creatinine ratio (ACR; P < 0.001), albuminuria (P = 0.023), blood urea (P < 0.001), and high‑density lipoprotein (HDL; P = 0.003) were found to be statistically significant. The risk for developing DR with CKD was found to be 5 times higher in male patients compared to female patients. Age and high blood urea level, diastolic blood pressure, mild and moderate DR were the risk factors associated with CKD. A decline in eGFR was observed as the severity of ARMD increased (P < 0.001). The risk factors associated with CKD were age, gender, smoking, alcohol consumed, presence of hypertension, duration of diabetes, systolic and diastolic blood pressure, history of diabetes, body mass index (BMI), serum triglycerides, and serum HDL cholesterol. Conclusion: Reduced eGFR values were associated with an increase in the severity of DR and ARMD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of glomerular filtration rate in renal disease decline and its association with diabetic retinopathy (DR) and age-related macular degeneration (ARMD) in patients in South India. Methods: A population-based cross-sectional study was conducted including participants with DR and ARMD recruited from urban and rural populations. The data collection included medical history, anthropometric measurements, and ophthalmic work-up. The estimated glomerular filtration rate (eGFR) was calculated using the equation of chronic kidney disease-epidemiology collaboration (CKD-EPI). The grading of AMD was done by a single experienced (more than 5 years) vitreoretinal surgeon as per the International ARM Epidemiological Study Group and it was staged based on grading in the worsened eye. Results: A decline in eGFR was observed as the severity of DR increased (P < 0.001). Baseline characteristics such as age (P < 0.001), duration of diabetes (P < 0.001), gender (P < 0.001), creatinine (P < 0.001), albumin to creatinine ratio (ACR; P < 0.001), albuminuria (P = 0.023), blood urea (P < 0.001), and high-density lipoprotein (HDL; P = 0.003) were found to be statistically significant. The risk for developing DR with CKD was found to be 5 times higher in male patients compared to female patients. Age and high blood urea level, diastolic blood pressure, mild and moderate DR were the risk factors associated with CKD. A decline in eGFR was observed as the severity of ARMD increased (P < 0.001). The risk factors associated with CKD were age, gender, smoking, alcohol consumed, presence of hypertension, duration of diabetes, systolic and diastolic blood pressure, history of diabetes, body mass index (BMI), serum triglycerides, and serum HDL cholesterol. Conclusion: Reduced eGFR values were associated with an increase in the severity of DR and ARMD.

Introduction: Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions. Methods: Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure. Results: MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months–14.5 years). Conclusions: Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD. [ABSTRACT FROM AUTHOR]

Age related macular degeneration is an acquired degeneration of the retina that causes signicant central visual impairment through a combination non-neovascular (Drusen and retinal pigment epithelium abnormalities) and neovascular derangement (choroidal neovascular membrane). AMD is the most common cause of irreversible, visual loss, in individuals over 50 years of age and it is the leading cause of blindness in elderly people. Globally the projected number of people with ARMD in 2020 is 196 millions, increasing to 288 millions in 2040. In Ayurvedic text there is a detailed description of Netragatvyadhi according to various sites. In this study an approach has been made to understand the pathology of ARMD, its sign and symptoms through Ayurvedic point of view and co-relation between patalgatvyadhi mentioned in Ayurveda. [ABSTRACT FROM AUTHOR]

Despite being one of the most reliable procedures in orthopedic surgery, complications can occur after total hip arthroplasty, and radiology plays an essential role in their evaluation. This article will review the various types of hip arthroplasty and their normal appearances on imaging, followed by mechanisms and imaging appearances of component wear and fracture. • Hip arthroplasties vary in component design, bearing surfaces, and fixation, each with its unique set of complications. • Imaging evaluation of complications associated with hip arthroplasties requires a multi-modality approach. • All bearing surfaces are susceptible to wear, and polyethylene wear can incite an inflammatory reaction causing osteolysis. • Metal-on-metal arthroplasties are associated with adverse reaction to metal debris. • Fractures associated with arthroplasties can involve the periprosthetic bone or the components themselves. [ABSTRACT FROM AUTHOR]

Aims: To establish the survivorship, function, and metal ion levels in an unselected series of metal-on-metal hip resurfacing arthroplasties (HRAs) performed by a non-designer surgeon. Methods: We reviewed 105 consecutive HRAs in 83 patients, performed by a single surgeon, at a mean follow-up of 14.9 years (9.3 to 19.1). The cohort included 45 male and 38 female patients, with a mean age of 49.5 years (SD 12.5) Results: At the time of review 13 patients with 15 hips had died from causes unrelated to the hip operation, and 14 hips had undergone revision surgery, giving an overall survival rate of rate of 86.7% (95% confidence interval (CI) 84.2 to 89.1). The survival rate in men was 97.7% (95% CI 96.3 to 98.9) and in women was 73.4% (95% CI 70.6 to 75.1). The median head size of the failed group was 42 mm (interquartile range (IQR) 42 to 44), and in the surviving group was 50 mm (IQR 46 to 50). In all, 13 of the 14 revised hips had a femoral component measuring ≤ 46 mm. The mean blood levels of cobalt and chromium ions were 26.6 nmol/l (SD 24.5) and 30.6 nmol/l (SD 15.3), respectively. No metal ion levels exceeded the safe limit. The mean Oxford Hip Score was 41.5 (SD 8.9) and Harris Hip Score was 89.9 (14.8). In the surviving group, four patients had radiolucent lines around the stem of the femoral component, and one had lysis around the acetabular component; eight hips demonstrated heterotopic ossification. Conclusion: Our results confirm the existing understanding that HRA provides good long-term survival and function in patients with adequate-sized femoral heads. This is evidenced by a 97.7% survival rate among men (larger heads) in our series at a mean follow-up of 14.9 years. Failure is closely related to head sizes ≤ 46 cm. Cite this article: Bone Jt Open 2022;3(1):68–76.

Purpose: Patients with age-related macular degeneration (ARMD) are required to follow a treatment protocol that requires regular follow-ups. The COVID-19 pandemic has created an additional burden for patients with ARMD under treatment with anti-vascular endothelial growth factor (anti-VEGF) injections, since patients face a congestion of the health system and closing of the outpatient services. This study examines the impact of the uncertainty regarding patients' treatment on their sense of well-being. Methods: This is a longitudinal cohort study of eighty patients who were followed during the year following the outbreak of the COVID pandemic. Patients reported their sense of well-being with the WHO-5 questionnaire and their perception and fears for the impact of the pandemic on their ongoing ARMD treatment. Results: There was a significant drop in mental well-being during the pandemic that paralleled the self-reported impact of the pandemic on ARMD treatment. Patients who reported a higher impact of COVID-19 on their treatment had experienced a higher drop in mental wellbeing compared to those who hadn't, with female gender being an additional risk factor. Objective measurements of visual acuity did not factor in the drop of sense of well-being. Conclusions: The high initial level of uncertainty regarding ARMD patients' long-term course was further exacerbated when exposed to additional uncertainties during the pandemic regarding their standard of care. Planning ahead for continuation of services and close contact with patients during similar health emergencies is of paramount importance. [ABSTRACT FROM AUTHOR]

Background:Age related macular degeneration (ARMD) is a leading cause of irreversible blindness and adversely affects activities of daily living especially in elderly individuals and one of the manifestations of advanced ARMD is choroidal neovascular membrane (CNVM). Objective: To analyze the causes of CNVM and to establish the different clinical presentations and systemic associations of CNVM.Material and Methods:This prospective study conductedat retina clinic, RIOGOH, Egmore, Chennai for a period of 1 year. A detailed history of the patient including that of systemic illness, unaided visual acuity, best corrected visual acuity, slit lamp examination for anterior segment evaluation, fundus examination for posterior segment evaluation and fundus fluorescein angiography(FFA)were done at the time of presentation and followed up during the study period. Results:Maximum number of patients in our study belonged to 61-75 years age groupwith slightly morepreponderance for females and rural population. Majority of patients presented within 6 months with blurred vision beingthe most common complaint except for myopic, inflammatory and angiod cnvm where it is scotoma .31 % of the patients were diabetic, 25 % were having uncontrolled systemic hypertension, 34 % were smokers and 11 % had dyslipidemia. Among the patients who presented to us earlier (i.e., within 6 months) a greater percentage of patients hadbest corrected visual acuity (BCVA> 6/60). Most of the CNVM cases in our study were due to ARMD Among the patients, all myopic CNVM cases had better presenting visual acuity compared to other CNVM causes. The most common pattern on FFA was the classic CNVM pattern and while the least common pattern was late leakage from undetermined source. There were no retinal angiomatosis proliferation (RAP )cases.Conclusion:CNVM is a potentially disabling disease that hinders the quality of life of thoseaffected. It is commoner as age advances and its most common cause in our study was due to ARMD. Early presentation and treatment are essential to slow down disease progression and prevent conversion to scarred CNVM. In our study patients who presented earlier to the hospital showed improvement in BCVA after treatment. In our study no correlation was found with factors like smoking, lipidemic status, other systemic comorbid conditions with regards to improvement in vision. Early presentation to the hospital and thereby early diagnosis of the disease per se may be a factor in visual prognosis. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration(ARMD)is a multifactorial disease, genetic factors play important roles in the pathogenesis of the disease. To date, intraocular injection of anti-vascular endothelial growth factor drugs is the first choice for the treatment of wet ARMD, but the response is variable. This review summarizes vascular endothelial growth factor(VEGF)gene, complement factor H(CFH)gene, age-related maculopathy susceptibility 2(ARMS2)gene and high-temperature requirement A-1(HTRA1)gene single-nucleotide polymorphisms(SNP)in the study of pharmacological genetics of wet ARMD. It is still worthy of further investigations that the genetic mechanism of the disease, so that we can provide individualized treatment sequences and predict the response to anti-VEGF therapy.

Background and purpose — Data regarding long-term behavior of metal ion levels in metal-on-metal total hip arthroplasty (MoM THA) patients is scarce. Therefore, we assessed whether there is any change in whole blood (WB) chromium (Cr), and cobalt (Co) ion measurements in Durom and MMC MoM THA patients over time. The secondary aim was to report the clinical outcomes using these devices in a single district. Patients and methods — Durom and MMC cups were used in 249 MoM THAs from 2005 to 2011 in our district. Median follow-up time was 12 years for Durom THA (interquartile range [IQR] = 3) and 9 years for MMC THA (IQR = 1). A random coefficient model was used to compare individual differences in repeated WB Cr and Co ion measurements. The Kaplan–Meier estimator was used to analyze implant survival with any reason for revision as the endpoint. Results — Geometric means of Cr in Durom THA and MMC THA patients decreased from 2.2 ppb (geometric standard deviation [SD] = 1.9) to 1.5 ppb (geometric SD = 2.5, p< 0.001) and from 1.8 ppb (geometric SD = 1.8) to 1.1 ppb (geometric SD = 2.8, p = 0.01) respectively. The geometric means of Co values remained unchanged. The 10-year survival of Durom THA was 82%, and that of MMC THA 89% for any revision reason as endpoint. Interpretation — WB Cr levels decreased over time, and Co levels remained unchanged at long-term follow-up. Despite this we recommend continuing the follow-up of these devices due to relatively low implant survival.

Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis. [ABSTRACT FROM AUTHOR]

Abstract Background Adverse Reaction to Metal Debris (ARMD) is a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. Most failures are related to excessively wearing implant producing harmful metal debris (extrinsic factor). As ARMD may also occur in patients with low-wearing implants, it has been suggested that there are differences in host-specific intrinsic factors contributing to the development of ARMD. However, there are no studies that have directly assessed whether the development of ARMD is actually affected by these intrinsic factors. Methods We included all 29 patients (out of 33 patients) with sufficient data who had undergone bilateral revision of ASR MoM hips (58 hips) at our institution. Samples of the inflamed synovia and/or pseudotumour were obtained perioperatively and sent to histopathological analysis. Total wear volumes of the implants were assessed. Patients underwent MARS-MRI imaging of the hips preoperatively. Histological findings, imaging findings and total wear volumes between the hips of each patient were compared. Results The difference in wear volume between the hips was clinically and statistically significant (median difference 15.35 mm3, range 1 to 39 mm3, IQR 6 to 23 mm3) (p 0.05 for all comparisons). These features included macrophage sheet thickness, perivascular lymphocyte cuff thickness, presence of plasma cells, presence of diffuse lymphocytic infiltration and presence of germinal centers. Conclusions Despite the significantly differing amounts of wear (extrinsic factor) seen between the sides, majority of the histological findings were similar in both hips and the presence of pseudotumour was symmetrical in most hips. As a direct consequence, it follows that there must be intrinsic factors which contribute to the symmetry of the findings, ie. the pathogenesis of ARMD, on individual level. This has been hypothesized in the literature but no studies have been conducted to confirm the hypothesis. Further, as the threshold of metal debris needed to develop ARMD appears to be largely variable based on the previous literature, it is likely that there are between-patient differences in these intrinsic factors, ie. the host response to metal debris is individual.

Background: To our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear.Methods: All Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis.Results: In total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation.Conclusion: We observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended. [ABSTRACT FROM AUTHOR]

Vision impairment remains an important cause of disability with the leading being age-related cataract (ARC) and age-related macular degeneration (ARMD) with depression symptoms often reported in vision impairment. This is a cross-sectional survey of two groups of fifty patients with ARC and ARMD and no prior psychiatric history on depressive symptomatology. Results indicate that ARMD patients scored higher on the BDI-II than ARC patients, in line with their poorer prognosis. Female patients with ARMD, living alone, with a higher number of other comorbid health issues, are more likely to have more depressive symptomatology. ARMD patients scored higher in the items related to pessimism for the future, feelings of past failure and feelings of self-dislike. There is a need for liaison psychiatry services to be readily available in patients with suspected ARC and ARMD coming forward with substantial vision loss. ARMD patients in particular tend to be more pessimistic and blame themselves for the progression of their disease. This should be taken into consideration with patient education on the causes of the disease and more effort should be undertaken to instill hope. The impact of vision loss on psychic status is related to disease prognosis and not only current state. [ABSTRACT FROM AUTHOR]

Age-Related Macular Degeneration (ARMD) is a progressive eye disease that slowly causes patients to go blind. For several years now, it has been an important research field to try to understand how the disease progresses and find effective medical treatments. Researchers have been mostly interested in studying the evolution of the lesions using different techniques ranging from manual annotation to mathematical models of the disease. However, artificial intelligence for ARMD image analysis has become one of the main research focuses to study the progression of the disease, as accurate manual annotation of its evolution has proved difficult using traditional methods even for experienced practicians. In this paper, we propose a deep learning architecture that can detect changes in the eye fundus images and assess the progression of the disease. Our method is based on joint autoencoders and is fully unsupervised. Our algorithm has been applied to pairs of images from different eye fundus images time series of 24 ARMD patients. Our method has been shown to be quite effective when compared with other methods from the literature, including non-neural network based algorithms that still are the current standard to follow the disease progression and change detection methods from other fields. [ABSTRACT FROM AUTHOR]

Abstract Background Adverse Reaction to Metal Debris (ARMD) is still a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. ARMD consists of a wide range of alterations in periprosthetic tissues, most important of which are metallosis, inflammation, pseudotumors and necrosis. Studies investigating histopathological findings and their association to implant wear or indirect measures of wear have yielded inconsistent results. Therefore, we aimed to investigate bearing surface wear volume, whole blood and synovial fluid metal ion concentrations, histopathological findings in periprosthetic tissues and their associations. Methods Seventy-eight patients with 85 hips revised for ARMD were included in the study. Prior to revision surgery, all patients had whole blood chromium and cobalt ion levels assessed. In revision surgery, a synovial fluid sample was taken and analyzed for chromium and cobalt. Periprosthetic tissue samples were taken and analyzed for histopathological findings. Explanted implants were analyzed for bearing wear volume of both acetabular cup and femoral head components. Results Volumetric wear of the failed components was highly variable. The total wear volume of the head and cup had a strong correlation with whole blood chromium and cobalt ion concentrations (Cr: ρ = 0.80, p

An ovine total hip arthroplasty model was developed to evaluate metal ion release, wear, the biological response and adverse tissue reaction to metal‐on‐metal (MoM) bearing materials. The performance of an advanced superlattice ceramic coating (SLC) was evaluated as a bearing surface and experimental groups divided into; (1) MoM articulating surfaces coated with a SLC coating (SLC‐MoM), (2) uncoated MoM surfaces (MoM), and (3) metal on polyethylene (MoP) surfaces. Implants remained in vivo for 13 months and blood chromium (Cr) and cobalt (Co) metal ion levels were measured pre and postoperatively. Synovial tissue was graded using an ALVAL scoring system. When compared with the MoM group, sheep with SLC‐MoM implants showed significantly lower levels of chromium and cobalt metal ions within blood over the 13‐month period. Evidence of gray tissue staining was observed in the synovium of implants in the MOM group. A significantly lower ALVAL score was measured in the SLC‐MoM group (3.88) when compared with MoM components (6.67) (p = 0.010). ALVAL results showed no significant difference when SLC‐MOM components were compared to MoP (5.25). This model was able to distinguish wear and the effect of released debris between different bearing combinations and demonstrated the effect of a SLC coating when applied onto the bearing surface. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1760–1771, 2019. [ABSTRACT FROM AUTHOR]

Background: Adverse Reaction to Metal Debris (ARMD) is a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. Most failures are related to excessively wearing implant producing harmful metal debris (extrinsic factor). As ARMD may also occur in patients with low-wearing implants, it has been suggested that there are differences in host-specific intrinsic factors contributing to the development of ARMD. However, there are no studies that have directly assessed whether the development of ARMD is actually affected by these intrinsic factors.Methods: We included all 29 patients (out of 33 patients) with sufficient data who had undergone bilateral revision of ASR MoM hips (58 hips) at our institution. Samples of the inflamed synovia and/or pseudotumour were obtained perioperatively and sent to histopathological analysis. Total wear volumes of the implants were assessed. Patients underwent MARS-MRI imaging of the hips preoperatively. Histological findings, imaging findings and total wear volumes between the hips of each patient were compared.Results: The difference in wear volume between the hips was clinically and statistically significant (median difference 15.35 mm3, range 1 to 39 mm3, IQR 6 to 23 mm3) (p < 0.001). The median ratio of total wear volume between the hips was 2.0 (range 1.09 to 10.0, IQR 1.67 to 3.72). In majority of the histological features and in presence of pseudotumour, there were no differences between the left and right hip of each patient (p > 0.05 for all comparisons). These features included macrophage sheet thickness, perivascular lymphocyte cuff thickness, presence of plasma cells, presence of diffuse lymphocytic infiltration and presence of germinal centers.Conclusions: Despite the significantly differing amounts of wear (extrinsic factor) seen between the sides, majority of the histological findings were similar in both hips and the presence of pseudotumour was symmetrical in most hips. As a direct consequence, it follows that there must be intrinsic factors which contribute to the symmetry of the findings, ie. the pathogenesis of ARMD, on individual level. This has been hypothesized in the literature but no studies have been conducted to confirm the hypothesis. Further, as the threshold of metal debris needed to develop ARMD appears to be largely variable based on the previous literature, it is likely that there are between-patient differences in these intrinsic factors, ie. the host response to metal debris is individual. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the biological effects of metal debris from hip arthroplasties which characterize a polymorphic clinical spectrum of local and remote manifestation.Methods: Retrospective study. Patient, implant, and surgical characteristics were collected, including implant survival, clinical manifestations, cause of arthroplasty revision or implant failure, and peri- and intra-operative complications. The primary endpoint was implant survivorship. Hip revision arthroplasty was decided considering clinical signs and symptoms, abnormal imaging (XR, MR, TC, echotomography, scintigraphy), and blood metal ion level. An ad hoc electronic form was used to collect demographic, epidemiological, and clinical variables. In-between group comparisons of quantitative variables were performed with the Student t test and the Mann-Whitney for parametric and non-parametric variables, respectively. Logistic regression analyses were carried out to assess the relationship between clinical and radiographic characteristics and stem and cup revision. Radiographic measurements of implant positioning validity and reliability were assessed using Krippendorff's alpha reliability coefficient. The statistical software STATA version 15 (StatsCorp, TX) was used to perform statistical computations.Results: In this MoM THA series, the most incident cause of implant failure was ARMD in 11 out of 14 (78.6%) patients. All clinical failure manifestations, revision surgery highlights, and intra-operative findings are reported.Conclusions: The local adverse reactions include lesions of different clinical relevance from small asymptomatic soft tissue lesions to dramatic osteolysis, necrosis, effusion, and growing masses which can cause secondary pathological effects. Symptoms of systemic toxicity are rarely described but may have been largely unreported in literature. Despite the extensive literature on the topic, the patient's management is still uncertain and challenging. Every metallic implant (e.g., screws, plates, spinal instrumentations) has a potential local or systemic adverse effect. Organizing a national registry of arthroplasty should be mandatory, in order to collect data about the patients, the surgery, the implanted device (with a careful post-marketing tracking), and the follow-up for all the procedures performed at a national level. The data collected in the registry will allow to analyze the implant survival and to better recognize the undesirable and sometimes unexpected effects of different biomaterials on the whole body. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A new treatment option for cataracts and advanced ARMD: the simultaneous intravitreal injection of anti‐vascular endothelial growth factor and implantation of a high‐add IOL. We believe major opportunities arise from a new subcategory in cataract surgery—called magnifying surgery (MAGS). Our case proves the potential of this brand‐new technology. A new treatment option for cataracts and advanced ARMD: the simultaneous intravitreal injection of anti‐vascular endothelial growth factor and implantation of a high‐add IOL. We believe major opportunities arise from a new subcategory in cataract surgery—called magnifying surgery (MAGS). Our case proves the potential of this brand‐new technology. [ABSTRACT FROM AUTHOR]

Oral pathogens have been identified in bioptic specimens from Age-Related Macular Degeneration (ARMD) patients, and alveolar bone loss has been related to ARMD. Therefore, the possible association between ARMD and periodontal disease was investigated in the present case-control study, evaluating clinical and radiographic periodontal parameters, primarily, in cases vs. controls and, secondarily, in relation to ARMD risk factors, in cases, to highlight a possible pathogenic link between the disorders. Forty ARMD cases and 40 non-ARMD controls, matched for age (±3 years) and gender and homogeneous for ARMD risk factors, therefore comparable, underwent full-mouth periodontal charting, panoramic radiograph, and medical data, including ARMD risk factors, collection. Statistical analysis was conducted using the language R. Comparisons between groups were made using both traditional t-tests and Yuen’s test with bootstrap calibration. Enrolled subjects were ≥55 years old, and 50 females and 30 males were equally distributed among the two groups. No statistically significant difference was found in clinical and radiographic periodontal parameters in cases vs. controls. In the case group, no differences were found when relating the periodontal parameters to ARMD risk factors, except for Clinical Attachment Level values that were statistically significantly higher in hypertensive ARMD subjects. A possible association between periodontal disease and ARMD may be hypothesized in hypertensive ARMD subjects, with hypertension as a possible pathogenic link between the disorders.

Age-Related Macular Degeneration (ARMD) is a progressive eye disease that slowly causes patients to go blind. For several years now, it has been an important research field to try to understand how the disease progresses and find effective medical treatments. Researchers have been mostly interested in studying the evolution of the lesions using different techniques ranging from manual annotation to mathematical models of the disease. However, artificial intelligence for ARMD image analysis has become one of the main research focuses to study the progression of the disease, as accurate manual annotation of its evolution has proved difficult using traditional methods even for experienced practicians. In this paper, we propose a deep learning architecture that can detect changes in the eye fundus images and assess the progression of the disease. Our method is based on joint autoencoders and is fully unsupervised. Our algorithm has been applied to pairs of images from different eye fundus images time series of 24 ARMD patients. Our method has been shown to be quite effective when compared with other methods from the literature, including non-neural network based algorithms that still are the current standard to follow the disease progression and change detection methods from other fields.

Background: Adverse Reaction to Metal Debris (ARMD) is still a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. ARMD consists of a wide range of alterations in periprosthetic tissues, most important of which are metallosis, inflammation, pseudotumors and necrosis. Studies investigating histopathological findings and their association to implant wear or indirect measures of wear have yielded inconsistent results. Therefore, we aimed to investigate bearing surface wear volume, whole blood and synovial fluid metal ion concentrations, histopathological findings in periprosthetic tissues and their associations.Methods: Seventy-eight patients with 85 hips revised for ARMD were included in the study. Prior to revision surgery, all patients had whole blood chromium and cobalt ion levels assessed. In revision surgery, a synovial fluid sample was taken and analyzed for chromium and cobalt. Periprosthetic tissue samples were taken and analyzed for histopathological findings. Explanted implants were analyzed for bearing wear volume of both acetabular cup and femoral head components.Results: Volumetric wear of the failed components was highly variable. The total wear volume of the head and cup had a strong correlation with whole blood chromium and cobalt ion concentrations (Cr: ρ = 0.80, p < 0.001 and Co: ρ = 0.84, p < 0.001) and a bit weaker correlation with fluid chromium and cobalt ion concentrations (Cr: ρ = 0.50, p < 0.01 and Co: ρ = 0.41, p = 0.027). Most tissues displayed only low-to-moderate amounts of macrophages and lymphocytes. Total wear volume correlated with macrophage sheet thickness (ρ = 0.25, p = 0.020) and necrosis (ρ = 0.35, p < 0.01). Whole blood chromium and cobalt ion concentrations had similar correlations. Lymphocyte cuff thickness did not correlate with either total wear volume or whole blood metal ion concentrations, but correlated with the grade of necrosis.Conclusions: Bearing wear volume correlated with blood metal ion levels and the degree of necrosis and macrophage infiltration in periprosthetic tissues suggesting a dose-response relationship. Whole blood metal ion levels are a useful tool for clinician to estimate bearing wear and subsequent tissue response. [ABSTRACT FROM AUTHOR]

Background: Metal-on-metal-hip-resurfacing arthroplasties (MoMHRAs) have been associated with an increased failure rates due to an adverse-response-to-metal-debris (ARMD) associated with a spectrum of pathological features. Serum levels of cobalt (Co) and chromium (Cr) are used to assess MoMHRAs, with regard to ARMD, but it is not certain whether ion levels correlate with pathological changes in periprosthetic tissues.Methods: Serum Co and Cr levels were correlated with histological findings in 38 revised MoMHRAs (29 pseudotumour cases and 9 non-pseudotumour cases revised for pain). The extent of necrosis and macrophage infiltrate as well as the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) response was assessed semi-quantitatively; the prosthesis linear wear rate (PLWR) was also determined in ten cases.Results: Cr levels were elevated in 82% and Co levels elevated in 53% of cases; the PLWR correlated with Cr level (rho = 0.8, p = 0.006). Tissue necrosis and macrophage infiltration were noted in all, most of which also exhibited significant ALVAL. Although a discrete correlation was not seen between Co and/or Cr ion levels and the extent of necrosis, degree of macrophage infiltration, or ALVAL score, it was noted that cases with acceptable metal ions levels had high ALVAL score.Conclusion: Histological features of both innate and adaptive immune response to metal wear are seen in periprosthetic tissues in cases with both elevated and non-elevated metal ion levels. MoMHRA failures with acceptable ion levels exhibited a pronounced ALVAL response. Although metal ion levels are elevated in most cases of MoMHRA failure due to ARMD, the finding of a normal metal ion level does not exclude this diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the incidence of adverse reactions to metal debris (ARMD) in a consecutive series of DUROM¿ Hip Resurfacing Arthroplasty (HRA) at mid-term follow-up.~Introduction~Background~Between October 2003 and March 2007 a total of 134 consecutive DUROM¿ HRA in 121 patients were performed at our institution. Follow-up could be obtained in 101 unrevised patients (83%) at a mean time of 8.51 ± 0.97 years postoperatively and included patient-related outcome measurement, plain radiographs, MARS-MRI as well as whole blood metal ion assessment.~Methods~Methods~17 (16.5%) out of 103 hips revealed pseudotumour occurrence in MRI investigation, 1 (10.6%) with a diameter of ¿2 cm. Higher incidence of pseudotumours was found patients with femoral component size <50 mm. 38 patients had elevated cobalt levels, 36 of them (35%) in the range of 2-7 ¿g/l and 2 patients (1.9%) at a rate of >7 ¿g/l. In contrast to cobalt determination, only elevated chromium values showed a positive association with pseudotumour occurrence and size.~Results~Results~A significant proportion of patients developed pseudotumours and metal ion elevation in a consecutive cohort of DUROM¿ HRA after mid-term follow-up. The incidence, however, seems not to differ from results of other well performing resurfacing brands; clinical relevance of our findings is unclear. Regarding potential local as well as systemic effects of metal particle release, close follow-up of patients is essential, even with clinically well-performing implants.~Discussion~Conclusions [ABSTRACT FROM AUTHOR]

Background: We conducted a retrospective study to assess the clinical outcome, failure rate, and reason for failure of a large consecutive series of 36 mm MoM Corail/Pinnacle total hip replacements (THRs). Methods: Between 2006 and 2011, 601 consecutive 36 mm MoM THRs were performed (585 patients). Patients were followed according to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. All patients were accounted for and 469 patients (78%) were clinically and radiographically assessed. 328 females and 141 males with a median age of 73 (range 36-94 years) and a median follow up of 7.2 years (range 5.2-9.7 years) were followed. Clinical data included blood cobalt and chromium, Oxford Hip Score (OHS), plain radiograph, ultrasound of hip and intra-operative findings in those patients who had revision surgery. Results: 56 patients died of causes unrelated to their hip replacement. The mean survivorship of the implant was 92.8% (range 91.6-94%, 95% CI) at a median time to follow up of 84 months (62-113 months). The functional outcome was good with a median OHS of 38 out of 48 (23-44). The dislocation rate was 0.99%, with all these 6 cases requiring revision. 476 patients had blood tests. 100 patients (21%) had elevated levels of either cobalt above MHRA guidelines of 7 parts per billion (120 and 135 nmol/L respectively for cobalt and chromium). Cobalt was elevated independently of chromium in 75% of the cases (but never vice versa). The mean cup inclination angle was 428. Each incremental stem size increase resulted in a decrease in cobalt by 11 nmol/L. The most common reason for revision was adverse reaction to metal debris (ARMD) (12 cases). Conclusion: This paper is the largest and longest follow up of 36 mm MoM THRs. Using the MHRA guidelines for follow up, the revision rates of this cohort has remained low compared to other studies, but unacceptably higher than that of other bearing surfaces. Level of evidence: III. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess whether there is a disparity in distance and near best-corrected visual acuity (BCVA) in cataract eyes. 102 patients with cataract ( N = 121 eyes) were seen in clinic between January and November 2013 at the Wilmer Eye Institute Comprehensive Eye Service. An age-related macular degeneration (ARMD) group ( N = 27 eyes) was also identified for comparison. Distance and near BCVA were measured as part of the standard ophthalmic evaluation. Snellen measurements were converted to their LogMAR equivalents for statistical analysis. Near was better than distance BCVA with mean difference of 1.38 lines ( P < 0.001) in the cataract eyes. This disparity was not seen in the ARMD eyes. Near-distance BCVA disparity is a statistically significant finding seen with cataracts. This may have further implications in patients with both cataract and ARMD as the presence of disparity may suggest a cataract etiology playing a greater role in vision loss. This comparison may be useful for surgical prognostication and as a quick triage tool in conjunction with, or in place of, a potential acuity meter and dilated near-pinhole test. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is a disease that worsens the central vision of numerous individuals across the globe. Ensuring that patients are diagnosed accurately and that their symptoms are carefully monitored is essential to ensure that adequate care is delivered. To accomplish this objective, retinal imaging technology is necessary to assess the pathophysiology that is required to give an accurate diagnosis of AMD. The purpose of this review is to assess the ability of various retinal imaging technologies such as optical coherence tomography (OCT), color fundus retinal photography, fluorescein angiography, and fundus photography. The statistical methods that were conducted yielded results that suggested that using OCT in conjunction with other imaging technologies results in a higher detection of symptoms among patients that have AMD. Further investigation should be conducted to ascertain the validity of the conclusions that were stated within the review., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Riazi Esfahani et al.)

Haploinsufficiency of the short stature homeobox contaning SHOX gene has been shown to result in a spectrum of phenotypes ranging from Leri-Weill dyschondrosteosis (LWD) at the more severe end to SHOX-related short stature at the milder end of the spectrum. Most alterations are whole gene deletions, point mutations within the coding region, or microdeletions in its flanking sequences. Here, we present the clinical and molecular data as well as the potential molecular mechanism underlying a novel microdeletion, causing a variable SHOX-related haploinsufficiency disorder in a three-generation family. The phenotype resembles that of LWD in females, in males, however, the phenotypic expression is milder. The 15523-bp SHOX intragenic deletion, encompassing exons 3-6, was initially detected by array-CGH, followed by MLPA analysis. Sequencing of the breakpoints indicated an Alu recombination-mediated deletion (ARMD) as the potential causative mechanism. [ABSTRACT FROM AUTHOR]

Introduction: Age-related Macular Degeneration (ARMD) patients often describe complaints from neck and scapula area muscles and a decreased postural control. In clinical assessment, these complaints are considered to be due to old age. Purpose: This study focuses on low-vision patients with ARMD, comparing them to age-matched controls without any eye disease, in order to evaluate if the linkage between self-rated visual complaints and musculoskeletal complaints is more prominent when low vision is present. Methods: In a cross-sectional study, 24 ARMD patients, aged 65 to 85, were compared to a group of 24 controls without visual problems having a similar age distribution. Visual acuity, the need for magnification plus other optical and visual parameters were assessed. Visual, musculoskeletal and balance/proprioceptive complaints were collected by means of a self-rating questionnaire. The Visual Functioning Questionnaire - Near Activities Subscale (VFQ–NAS) was used to evaluate visual function and related complaints. Results: The correlation between visual complaints and musculoskeletal complaints yielded significant values of the correlation coefficient when performed separately within each group, as well as when calculated on the entire data set [ARMD, Spearman's rho (ρ)=0.60, P=0.002; control group ρ=0.59, P=0.004; both groups together ρ=0.50 P

Purpose: To identify the prevalence of extramacular drusen and their role in the progression of age-related macular degeneration (AMD)., Design: Retrospective analysis of a prospective cohort study., Participants: The study was conducted in 4168 eyes (2998 participants) with intermediate AMD in one or both eyes enrolled in the Age-Related Eye Disease Study 2 (AREDS2), a 5-year multicenter study of nutritional supplements., Methods: Baseline 3-field 30-degree color photographs were evaluated for drusen characteristics outside the macular grid, including size, area, and location. The characteristics of extramacular drusen were compared with those of drusen within the macula., Main Outcome Measures: Progression rates to late AMD., Results: Although extramacular drusen were observed in 3624 (86.9%) eyes, they represented a small area (< 0.5 mm 2 ) in 50.3% of eyes, with only 17.5% exhibiting an area of > 1 disc area. Eyes with extramacular drusen exhibited larger macular drusen size and area than eyes without extramacular drusen (P < 0.001). Extramacular drusen were not associated with progression to late AMD. The hazard ratio adjusted for baseline age, sex, smoking, AMD severity level, and reticular pseudodrusen for 4043 eyes at risk of developing late AMD over 5 years was 1.17 (95% confidence interval [CI], 0.88-1.54; P = 0.27) for geographic atrophy and 0.96 (95% CI, 0.76-1.2; P = 0.7) for neovascular AMD., Conclusions: Extramacular drusen are commonly observed in eyes with AMD and are more frequent with an increasing drusen burden within the macula. In eyes with intermediate AMD, extramacular drusen do not confer additional risk to previously identified risk factors in progression to late AMD., (Copyright © 2022 American Academy of Ophthalmology. All rights reserved.)

Background: Adverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (<50 mm) Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA). The aims of the present study were to analyze whether these previously established risk factors also apply to patients who have received a large-headed (>50 mm) ASR™ XL THR. Methods: Large-headed ASR total hip replacements were used in 225 operations (196 patients) at our institution. 176 patients (203 hips) attended a screening programme, consisting of a clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging. Results: Revision surgery was performed on 84 hips (37%) in 75 patients. ARMD was diagnosed in the majority (n = 73 [87%]) of these revisions. Cumulative 8-year survivorship was 52%. The previously established risk factors for ARMD were not applicable. Interestingly, increasing femoral diameter and stem type were identified as independent risk factors for ARMD but reduced cup coverage had no significant association with ARMD. Conclusions: Stem type and increasing femoral size as independent risk factors for ARMD in the cohort of ASR XL THR patients, support the importance of taper failure in the development of ARMD. The present results suggest that the degree of taper failure may be variable and dependent on the taper design. [ABSTRACT FROM AUTHOR]

Introduction Adverse reaction to metal debris (ARMD) can be caused by metal-on-metal total hip arthoplasty. We treated a case of ARMD in a 61-year-old patient by limited prosthetic revision, replacing the metal head with a polyethylene one. Presentation of case Two years after metal-on-metal total arthoplasty of the left hip, radiographic control showed osteolysis of the patient’s greater trochanter. He underwent surgical curettage and the application of demineralized bone matrix. After a few months, blood Co and Cr increased, and at clinical evaluation, the patient had worsening paresthesias. He agreed to prosthetic revision after 14 months. Discussion During surgery, the acetabular cup and femoral stem appeared correctly osteointegrated; therefore, the cup was maintained, while the prosthetic femoral head was removed and replaced with a 50 mm polyethylene head. Conclusion Blood Cr and urinary Cr and Co decreased and normalized 3 months after surgery, and the patient no longer suffered paresthesias. Blood Co normalized 7 months after revision. Radiographic follow-up showed no change after 30 months post-operatively. We believe this case report could be a starting point for a future randomized clinical trial to test the efficacy of the procedure used compared with complete implant revision. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to analyse our painful metal-on-metal (MoM) hip resurfacing revisions with evidence of ‘adverse reactions to metal debris' (ARMD). In our series of 35 revisions the median whole blood Cobalt levels were 58 nmols/l (range 12-1407 nmols/l), and whole blood Chromium levels were 73 nmols/l (range 2-353 nmols/l). Thirty-four of our 35 patients had abnormal imaging on Ultrasound scanning (USS). The mean histological Campbell grading of ARMD was 4, and ranged from 0-9. The mean Oxford Hip Score (OHS) increased from 19 pre-revision (range 4-46) to 33 post-revision surgery (range 23-47). We found no correlation between the preoperative metal ion levels, and the severity of the disease or the outcome. Pain following hip resurfacing may arise from a number of causes and when groin pain arises in conjunction with abnormal cross sectional imaging we have offered our patients revision surgery regardless of raised metal ions or grossly abnormal imaging, with good results. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) has been identified as a major promoter of the development of choroidal neovascularization in age-related macular degeneration. The development of choroidal neovascularization can be slowed by preventing the binding of vascular endothelial growth factor to cellular VEGF receptor-2 present on vascular endothelial cells, which represents the major proangiogenic stimulus. Advances in the development of anti-VEGF therapy have led to significant improvement in visual acuity outcomes in recent years that neovascular age-related macular degeneration can no longer be considered an incurable disease. Despite its many advantages, the current standard of care, which is the frequent application of VEGF blockers to the vitreous, is a significant burden on both the patient and the healthcare system. This review is aim on a new brolucizumab molecule (also known as RTH 258 or formerly ESBA 1008). The article focuses on the molecular aspects of the drug and an overview of the basic preclinical and clinical studies that were performed during drug development. Brolucizumab is a single chain fragment of a humanized monoclonal antibody with a molecular weight of 26 kDa that inhibits VEGF-A. Preclinical animal studies have shown good penetration of the molecule through the retina with minimal systemic exposure. The SEE study (phase 1/2) demonstrated safety and tolerability after drug administration. The OSPREY (phase 2) study demonstrated the same efficacy of brolucizumab on visual acuity in the 8-week dosing regimen compared to aflibercept. In the same study, patients were also pilot tested in a 12-week dosing regimen. The HAWK and HARRIER studies (phase 3) demonstrated the efficacy of the drug at a dose of 6 mg in a 12-week dosing schedule in 55.6 % and 51 % of patients, respectively.

According to the traditional explanations ('old paradigm'), aging is due to the progressive accumulation of heterogeneous damages that are insufficiently contrasted by natural selection. An opposite interpretation ('new paradigm') sees aging as selectively advantageous in terms of supra-individual natural selection, and this implies the indispensable existence of genetically controlled specific mechanisms that determine it. The aim of this work is to expound synthetically the progressive alterations that mark the aging by showing how these changes are clearly defined and regulated by genes. The possibility of such a description, based on sound evidence, is an essential element for the plausibility of the new paradigm, and a fundamental argument against the tenability of the old paradigm. [ABSTRACT FROM AUTHOR]

Purpose To investigate the clinical efficacy and safety of an additional core vitrectomy to the standard therapy in patients with exudative age-related macular degeneration ( ARMD). Methods In this prospective, controlled, single-centre study, 50 eyes of 50 patients (mean age: 74.1 ± 7.1; median 74 (69/78)) with ARMD were enrolled and randomized 1:1 to group 1 - core vitrectomy additional to three times injections of ranibizumab (3x Rbz) and Group 2 - 3x Rbz (control). 1 16 of 25 eyes in Group 1(64%) and 12 of 25 (48%) in Group 2 had a posterior vitreous detachment ( PVD) prior to start of the study. Changes in best-corrected visual acuity ( BCVA) using ETDRS charts, central macular thickness and macular volume ( OCT) as well as the rate of reinjection with an OCT-based pro renata ( PRN) protocol were monitored prospectively over 48 weeks. Forty-seven eyes completed follow-up at week 48. Results In Group 1, 4 of 24 lost 1 line of BCVA (16.7%) and 3 of 24 lost 2 lines (12.5%), whereas 17 of 24 gained more than 1 line (70.8%) and improved in average by 9.8 letters. In Group 2, 3 of 23 remained stable and 20 of 23 gained more than or exactly 1 line (78.3%), resulting in 14.3 letters, with no loss of lines. Central macular thickness decreased by 85.58 μm (28.8%) in Group 1 and by 121.43 μm (32.68%) in Group 2 compared with baseline. In Group 1, four patients received three additional and two patients, two additional Rbz injections. In Group 2, three patients received three additional, three patients two and 12 patients one additional Rbz injections. This yielded in an average injection rate of 3.66 in Group 1 and 4.17 in Group 2 over 48 weeks. Posterior vitreous detachment ( PVD) was identified in Group 1 in 16 of 24 (66.7%) and in Group 2 in 12 of 23 (52.2%) patients at baseline. At week 48, 6 of 8 (75%) of the patients in Group 1 with initial attached vitreous showed a vitreal detachment, whereas only 1 of 11 (9%) in Group 2 had a new occurred detachment of the vitreous. No systemic or ocular adverse events were noticed. Conclusion An initial core vitrectomy combined with a conventional ranibizumab injection regimen for exudative AMD patients was safe and lead to similar functional results with less intravitreal ranibizumab injections over 48 weeks. [ABSTRACT FROM AUTHOR]