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Abhimanyu S Ahuja,1,* Alfredo A Paredes III,2,* Mallory LS Eisel,3,* Sejal Kodwani,4 Isabella V Wagner,5 Darby D Miller,5 Syril Dorairaj5 1Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 3College of Medicine, Florida State University, Tallahassee, FL, USA; 4Windsor University School of Medicine, Cayon, St. Kitts, KN; 5Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA*These authors contributed equally to this workCorrespondence: Abhimanyu S Ahuja, Casey Eye Institute, Oregon Health and Science University, 515 SW Campus Drive, Portland, Oregon, 97239, USA, Email ahujaa@ohsu.eduAbstract: Cataract surgery is one of the most performed procedures worldwide, and cataracts are rising in prevalence in our aging population. With the increasing utilization of artificial intelligence (AI) in the medical field, we aimed to understand the extent of present AI applications in ophthalmic microsurgery, specifically cataract surgery. We conducted a literature search on PubMed and Google Scholar using keywords related to the application of AI in cataract surgery and included relevant articles published since 2010 in our review. The literature search yielded information on AI mechanisms such as machine learning (ML), deep learning (DL), and convolutional neural networks (CNN) as they are being incorporated into pre-operative, intraoperative, and post-operative stages of cataract surgery. AI is currently integrated in the pre-operative stage of cataract surgery to calculate intraocular lens (IOL) power and diagnose cataracts with slit-lamp microscopy and retinal imaging. During the intraoperative stage, AI has been applied to risk calculation, tracking surgical workflow, multimodal imaging data analysis, and instrument location via the use of “smart instruments”. AI is also involved in predicting post-operative complications, such as posterior capsular opacification and intraocular lens dislocation, and organizing follow-up patient care. Challenges such as limited imaging dataset availability, unstandardized deep learning analysis metrics, and lack of generalizability to novel datasets currently present obstacles to the enhanced application of AI in cataract surgery. Upon addressing these barriers in upcoming research, AI stands to improve cataract screening accessibility, junior physician training, and identification of surgical complications through future applications of AI in cataract surgery.Plain language summary: Although barriers remain for the generalizability and standardization of artificial intelligence in cataract surgery, there are growing applications improving efficiency, data analysis, safety, training, and patient outcomes in pre-operative, intraoperative, and post-operative stages.Keywords: cataract surgery, artificial intelligence, deep learning, convolutional neural networks

Nithya Boopathiraj,1 Isabella V Wagner,1 Paul Connor Lentz,2 Christian Draper,3 Chelsey Krambeer,1 Yazan S Abubaker,1 Bryan Chin Hou Ang,1,4,5 Darby D Miller,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA; 3Department of Ophthalmology, Eye Consultants, Spokane, WA, USA; 4Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; 5Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, SingaporeCorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1-904-953-2377, Fax +1-904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG).Methods: A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student’s t-tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded.Results: Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, − 23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, − 22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (− 30.8%; p=0.0005) and 2.2 ± 1.4 (− 25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP.Conclusion: Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery.Keywords: kahook dual blade, micro-invasive glaucoma surgery, open angle glaucoma, xen gel stent

Nithya Boopathiraj,1 Isabella V Wagner,1 Paul Connor Lentz,1,2 Leticia Checo,1 Emily Aashna Dorairaj,3 Abhimanyu S Ahuja,4 Darby D Miller,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA; 3Department of Medicine, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA; 4Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USACorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1 904-953-2377, Fax +1 904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To evaluate the safety and effectiveness of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG).Patients and Methods: This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed.Results: Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (− 61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (− 71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥ 20%. No vision threatening complications were observed.Conclusion: To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.Keywords: primary open angle glaucoma, intraocular pressure, glaucoma drainage device

Isabella V Wagner,1 Nithya Boopathiraj,1 Connor Lentz,1 Emily Aashna Dorairaj,2 Christian Draper,3 Devesh Kumar,4 Leticia Checo,1 Darby D Miller,1 Chelsey Krambeer,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 3Department of Ophthalmology, Eye Consultants, Spokane, WA, USA; 4Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, WI, USACorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA, Tel +1 904-953-2377, Fax +1 904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months.Patients and methods: This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years.Results: Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3– 8.0 mmHg (34.7– 38.3%; p < 0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2– 1.4 medications (66– 75.5%; p < 0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001).Conclusion: In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥ 1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.Keywords: glaucoma, goniotomy, intraocular pressure, IOP-lowering medications, phacoemulsification, minimally invasive glaucoma surgery

Isabella V Wagner,1 Bryan Ang,2 Leticia Checo,1 Derya Simsek,3 Christian Draper,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Ophthalmology, Tan Tock Seng Hospital, Singapore; 3Department of Ophthalmology, Baskent University Medical School, Ankara, TurkeyCorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA, Tel +1 904-953-2377, Fax +1 904-953-7040, Email dorairaj.syril@mayo.eduAbstract: Minimally invasive glaucoma surgery (MIGS) has revolutionized glaucoma care with its favorable safety profile and ability to delay or minimize the need for traditional, bleb-based procedures. Microstent device implantation is a type of angle-based MIGS, which reduces intraocular pressure (IOP) through bypass of the juxtacanalicular trabecular meshwork (TM) and facilitation of aqueous outflow into the Schlemm’s canal. Although there are limited microstent devices on the market, multiple studies have evaluated the safety and efficacy of iStent® (Glaukos Corp.), iStent Inject® (Glaukos Corp.), and Hydrus® Microstent (Alcon) in the treatment of mild-to-moderate open-angle glaucoma, with and without concurrent phacoemulsification. This review attempts to provide a comprehensive evaluation of injectable angle-based microstent MIGS devices in the treatment of glaucoma.Keywords: microstent injection, Schlemm’s canal, Hydrus microstent, iStent, glaucoma, aqueous outflow

Syril Dorairaj,1 Leticia A Checo,1 Isabella V Wagner,1 Richard D Ten Hulzen,1 Abhimanyu S Ahuja2 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USACorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA, Tel +1 904-953-2377, Fax +1 904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To describe the safety and efficacy of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in the treatment of refractory primary open-angle glaucoma (POAG).Patients and methods: This was a retrospective, noncomparative, single-surgeon, interventional case series of adult patients with medically ± surgically refractory POAG undergoing ACP implantation. Intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded over 24 months of follow-up. Primary outcomes included mean reductions in both IOP and medication use through 24 months, and secondary outcomes included the proportion of eyes achieving an IOP between 6 and 19 mmHg, IOP reduction by ≥ 20%, and reduction by ≥ 1 medication at last mean follow-up.Results: Twelve eyes of 11 patients (mean age 71.3 ± 14.1 years) fit inclusion criteria and were enrolled. Most patients were Caucasian (n = 8), female (n = 10), and all had severe POAG (n = 11). The mean last follow-up was 18 months, at which time the mean (standard deviation) baseline IOP of 29.0 (7.6) mmHg was reduced to 12.2 (4.0) mmHg (58% reduction). 91.7% of eyes achieved an IOP between 6 and 19 mmHg, and 100% of eyes met an IOP reduction of ≥ 20%. Mean baseline number of glaucoma medications was 3.0 (0.9) and was reduced to 0.5 (0.7) at last mean follow-up (83.3% reduction), with 91.7% of eyes using ≥ 1 fewer medications. No long-term complications were observed, and short-term complications (mild hyphema, inflammation, and pain) were resolved by month 3.Conclusion: To our knowledge, this is the second long-term study evaluating the efficacy of the Ahmed ClearPath drainage device in adult patients, and the first study with 24-months follow-up. The ACP device is safe and effective at reducing both IOP and medication burdens in patients with severe POAG. Additionally, minimal short-term complications were noted with no long-term adverse effects, increasing comfort for both the surgeon and the patient.Keywords: primary open angle glaucoma, intraocular pressure, IOP-lowering medications, valved drainage devices

Syril Dorairaj,1 Mai Dang Tam,2 Goundappa K Balasubramani3 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Glaucoma Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam; 3University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USACorrespondence: Syril DorairajDepartment of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USATel +1 201 704 7896Email syrildorairajmd@gmail.comPurpose: To characterize clinical outcomes following Kahook Dual Blade (KDB)-assisted goniosynechialysis and excisional goniotomy combined with phacoemulsification in eyes with angle-closure glaucoma and cataract.Setting: Two clinical practices.Methods: In this retrospective analysis of existing health records, data were collected from 42 eyes of 24 subjects from preoperative, operative, and postoperative encounters through 12 months of follow-up. Outcomes included changes in mean IOP, IOP-lowering medications, and logMAR best-corrected visual acuity (BCVA), as well as the proportions of patients achieving IOP reductions ≥20%, IOP ≤18 mmHg, and a reduction of ≥1 medication.Results: Preoperative, mean (standard error) IOP was 25.5 (0.7) mmHg and at Month 12 was reduced by 12.3 (0.73) mmHg (−47.2%; p

Daniela M Junqueira,1 Flavio S Lopes,1,2 Fabiola C de Souza,1 Syril Dorairaj,3 Tiago S Prata1,21Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; 2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; 3Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USAObjective: This study evaluated the efficacy and safety of a new device (Eyedrop®) designed for eye drop instillation in patients with and without glaucoma.Methods: This prospective study included consecutive patients with glaucoma and healthy participants. After a complete eye examination and determination of baseline intraocular pressure (IOP), topical hypotensive medication was introduced in both eyes, and the Eyedrop® delivery device (a plastic device in which the bottle with eye drops is inserted) was made available to all participants (with video and written instructions) for use in one eye, randomly chosen. In the second phase, all patients were evaluated by an experienced examiner for IOP determination, investigation of possible associated side effects, and ease of instilling eye drops (by a visual analog scale [VAS]; 0–10).Results: Thirty two participants (mean age 42.3±16.2 years) were evaluated. Of these, 44% had glaucoma. There was no significant difference in mean IOP variation when comparing the eye using (-3.9±2.9 mmHg) or not using the device (-3.3±2.6 mmHg; P=0.36). The subjective rating of the facility of drops instillation was significantly higher with the Eyedrop® applicator (VAS =7.6±1.6) than without it (VAS =6.2±1.8; P5) among participants without prior experience with eye drop instillation (78.6% [11/14]) versus those already experienced (66.7% [12/18]). No difference in the frequency of side effects or in the distribution pattern of fluorescein between eyes was observed (P≥0.63).Conclusion: Eyedrop® received a better subjective response regarding the ease of instillation of hypotensive eye drops compared to traditional instillation, especially in patients with no previous experience with eye drops. Using the device did not result in any loss of hypotensive effect or increase in the frequency of side effects.Keywords: glaucoma, eye drops, applicator, therapy adherence

Verônica Castro Lima,1,2 Richard B Rosen,1,3 Tiago Santos Prata,2 Syril Dorairaj,4 Leigh Spielberg,1 Mauricio Maia,2 Juliana M Sallum21Retina Service, Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY, 2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; 3New York Medical College, New York, NY, 4Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USABackground: Several lines of evidence suggest that macular pigment may play a protective role against age-related macular degeneration, but the influence of age on macular pigment density levels remains unclear. This study was designed to investigate the relationship between age and the normal distribution of macular pigment optical density (MPOD) values surrounding the fovea.Methods: Consecutive healthy subjects with no evidence of ocular disease were enrolled in this study. After inclusion, MPOD values were measured at specific eccentricities (0.5, 1, and 2 degrees) from the foveal center using a dual-wavelength autofluorescence method employing a modified confocal scanning laser ophthalmoscope. Whenever both eyes were eligible, one was randomly selected for analysis. The correlation between age and MPOD values was investigated using regression analysis.Results: Thirty subjects (30 eyes) were included (mean age 48.6 ± 16.4 [range 23–77] years). Significant differences were found between MPOD values measured at 0.5, 1, and 2 degrees from the center of the fovea (0.49 ± 0.12 density units, 0.37 ± 0.11 density units, and 0.13 ± 0.05 density units, respectively, P < 0.05). Significant correlations between age and MPOD values at 0.5 and 1 degree were found (P ≤ 0.02). Values measured at 2 degrees did not correlate significantly with age (P = 0.06).Conclusion: In healthy subjects, MPOD values were highest near the foveal center. These values appeared to increase during adulthood (peak at 45–50 years), followed by a gradual reduction after 60 years of age.Keywords: age, macular pigment optical density, dual-wavelength autofluorescence imaging, association

Mohammed K ElMallah,1 John P Berdahl,2 Blake K Williamson,3 Syril K Dorairaj,4 Malik Y Kahook,5 Mark J Gallardo,6 Ahad Mahootchi,7 Sanjay N Smith,8 Leonard A Rappaport,9 Daniela Diaz-Robles,10 Gabriel S Lazcano-Gomez11 1Ocala Eye, Ocala, FL, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Williamson Eye Center, Baton Rouge, LA, USA; 4Mayo Clinic, Jacksonville, FL, USA; 5University of Colorado, Aurora, CO, USA; 6El Paso Eye Surgeons, El Paso, TX, USA; 7The Eye Clinic of Florida, Zephyrhills, FL, USA; 8Medical Eye Associates, South Miami, FL, USA; 9Tidewater Eye Centers, Portsmouth, VA, USA; 10Clinica Santa Lucia, Guadalajara, Mexico; 11Asociacion Para Evitar Le Ceguera (APEC), Mexico City, MexicoCorrespondence: Mohammed K ElMallah Email elmallah@ocalaeye.comPurpose: To describe 12-month intraocular pressure (IOP) and medication use outcomes following excisional goniotomy (EG) as a stand-alone procedure in eyes with medically uncontrolled glaucoma.Methods: This was a retrospective analysis of data from surgeons at 8 centers (6 US, 2 Mexico). Eyes with glaucoma undergoing standalone EG with a specialized instrument (Kahook Dual Blade, New World Medical, Rancho Cucamonga, CA) for IOP reduction and followed for 12 months postoperatively were included. Data were collected preoperatively, intraoperatively, and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. The primary outcome was reduction from baseline in IOP, and key secondary outcomes included IOP-lowering medication reduction as well as adverse events.Results: A total of 42 eyes were analyzed, of which 36 (85.7%) had mild to severe primary open-angle glaucoma (POAG). Mean (standard error) IOP at baseline was 21.6 (0.8) mmHg, and mean number of medications used at baseline was 2.6 (0.2). At 3, 6, and 12 months postoperatively, mean IOP reductions from baseline were 4.6 mmHg (22.3%), 5.6 mmHg (27.7%), and 3.9 mmHg (19.3%) (p≤ 0.001 at each time point). At the same time points, mean medications reductions of 0.7 (25.8%), 0.9 (32.6%), and 0.3 (12.5%) medications were seen (p< 0.05 at months 3 and 6, not significant at month 12). Six eyes (14.3%) underwent additional glaucoma surgery during the 12-month follow-up period.Discussion: Standalone EG with KDB can reduce IOP, and in many cases reduce medication use, through up to 12 months in eyes with mild to severe glaucoma. Statistically significant and clinically relevant reductions in IOP were seen at every time point. While the goal of surgery was not to reduce medication burden, mean medication use was significantly reduced at all but the last time point. In the majority of eyes, the need for a bleb-based glaucoma procedure was delayed or prevented for at least 12 months.Keywords: glaucoma, standalone, Kahook dual blade, goniotomy

Industrial wastes are capable of polluting the soil and groundwater. The tanning industry is considered as a potential environmental polluting agent through out the world. Chromium (Cr), a toxic heavy metal, is a major constituent of tannery waste, and its accumulation in soil and water causes serious environmental issues of increasing public concern in India particularly in Tamil Nadu. The present study deals with isolation and identification of chromium reducing bacteria isolated from tannery effluent collected from Crompet, Chennai, Tamil Nadu (latitude 12°57′51.8″N and longitude 80°07′58.1″E). Two chromium reducing bacteria were isolated; and the identification of the isolates were done by 16 s rRNA sequencing followed by BLAST results as Klebsiella pneumoniae and Mangrovibacter yixingensis. Furthermore the presence of chromium reductase gene in the isolated bacteria was confirmed by PCR techniques. Bioremediation using bacteria may provide an alternative or aid conventional methods of metal removal/metal recovery. The newly identified chromium reducing bacteria would be useful for the detoxification of heavy metal contaminated tannery effluent and metal recovery in mining process. Keywords: Klebsiella pneumoniae, Mangrovibacter yixingensis, Bioremediation, Reductase gene, Heavy metal

The present study, deal about the antibiosis activity of soil bacteria, isolated from 10 different locations of rhizosphere and diverse cultivation at Kochi, Kerala, India. The bacteria were isolated by standard serial dilution plate techniques. Morphological characterization of the isolate was done by Gram’s staining and found that all of them gram positive. Isolated bacteria were tested against 6 human pathogens viz., Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter sp. Primary screening was carried out by perpendicular streaking and seed overlay method. Based on the result of primary screening most potential isolates of S1A1 and S7A3 were selected for secondary screening. Both the isolates showed positive results against Enterococcus sp. and S.aureus. The maximum antagonistic activity of 20.98 and 27.08 mm zone of inhibition was recorded at S1A1 against Enterococcus sp. and S. aureus respectively, at 180 µl concentration. Molecular identification was carried out by 16S rRNA sequence. The 16S rRNA was amplified from the DNA samples by using PCR. The amplified 16S rRNA PCR products were purified and sequenced. The sequences were subjected to NCBI BLAST. The isolates S1A1 and S7A3 BLAST results showed 99% and 95% respectively, similarity with the available database sequence of Bacillus amyloliquefaciens. The sequences were deposited in GenBank and the accession numbers KY864390 (S1A1) and KY880975 (S7A3) were obtained. Keywords: Soil bacteria, Isolates, 16S rRNA, PCR

Syril K Dorairaj,1 Malik Y Kahook,2 Blake K Williamson,3 Leonard K Seibold,4 Mohammed K ElMallah,5 Inder P Singh6 On behalf of the KDB Goniotomy Study Group 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, 2School of Medicine, University of Colorado, Denver, CO, 3Williamson Eye Center, Baton Rouge, LA, 4School of Medicine, University of Colorado, Aurora, CO, 5Ocala Eye, Ocala, FL, 6The Eye Center of Racine and Kenosha, Kenosha, WI, USA Purpose: The aim of this study was to compare intraocular pressure (IOP) outcomes in eyes with cataract and glaucoma undergoing phacoemulsification (phaco) in combination with goniotomy using the Kahook Dual Blade (KDB) or implantation of a single iStent trabecular bypass device.Methods: Retrospective analysis of IOP and IOP-lowering medication reduction in eyes undergoing phaco-goniotomy with KDB (n=237) or phaco-iStent (n=198). Preoperative, intraoperative, and postoperative data were collected through 6 months of follow-up. Outcome measures included mean IOP reduction, mean reduction in IOP-lowering medications, and the proportion of eyes achieving ≥20% IOP reduction or ≥1 medication reduction from baseline.Results: Mean IOP in the phaco-goniotomy with KDB group decreased from 17.9±4.4 mmHg at baseline to 13.6±2.7 mmHg at Month 6 (P

Introduction: The cranial capacity indirectly reflects the volume of the brain, hence may predict the mental ability of an individual. Aim: To estimate the cranial capacity and correlate it with Body Mass Index (BMI) and academic performance of first-year students of a Medical College in Chennai, Tamil Nadu, india. Materials and Methods: A total of hundred first year MBBS students aged between 17 and 19 years were selected for the present study from Sree Balaji Medical College and Hospital, Chrompet, Chennai, India. Cranial capacity and BMI were calculated by standard methods. The average academic performance during the year was obtained by calculating the average of the total marks secured in the academic year. All the above data were tabulated and analysed statistically by using Pearson’s correlation test and Paired Student t-test. Results: The cranial capacity had no significant correlation with the academic performance in the present study. However, the BMI had a significant correlation with cranial capacity; this may be because larger cranial capacity is required for controlling larger muscular body mass. Conclusion: The present study showed a larger cranial capacity was related with increased BMI and hence may be helpful in the medicolegal and anthropological examination to find the relations between cranial capacity and age, height, body weight and BMI. There was no significant correlation between academic abilities with cranial capacity.

Fabio N Kanadani,1 Paulo AA Mello,1 Syril K Dorairaj,2 Tereza CM Kanadani31Federal University of Sao Paulo, Sao Paulo, Brazil; 2Mayo Clinic, Department of Ophthalmology, Jacksonville, Florida, USA; 3Sao Jose University Hospital, Belo Horizonte, BrazilIntroduction: The gold standard in functional glaucoma evaluation is standard automated perimetry (SAP). However, SAP depends on the reliability of the patients’ responses and other external factors; therefore, other technologies have been developed for earlier detection of visual field changes in glaucoma patients. The frequency-doubling perimetry (FDT) is believed to detect glaucoma earlier than SAP. The multifocal visual evoked potential (mfVEP) is an objective test for functional evaluation.Objective: To evaluate the sensitivity and specificity of FDT and mfVEP tests in normal, suspect, and glaucomatous eyes and compare the monocular and interocuar mf VEP.Methods: Ninety-five eyes from 95 individuals (23 controls, 33 glaucoma suspects, 39 glaucomatous) were enrolled. All participants underwent a full ophthalmic examination, followed by SAP, FDT, and mfVEP tests. Results: The area under the curve for mean deviation and pattern standard deviation were 0.756 and 0.761, respectively, for FDT, 0.564 and 0.512 for signal and alpha for interocular mfVEP, and 0.568 and 0.538 for signal and alpha for monocular mfVEP. This difference between monocular and interocular mfVEP was not significant. Conclusion: The FDT matrix was superior to mfVEP in glaucoma detection. The difference between monocular and interocular mfVEP in the diagnosis of glaucoma was not significant. Keywords: standard automated perimetry, electrophysiology, glaucomatous eyes

A letter to the editor is presented which discusses the clinicopathologic correlation of a subconjunctival foreign body utilizing ultrasound biomicroscopy and anterior segment ocular coherence tomography.

The tRNA structure contains conserved modifications that are responsible for its stability and are involved in the initiation and accuracy of the translation process. tRNA modification enzymes are prevalent in bacteria, archaea, and eukaryotes. tRNA Gm18 methyltransferase (TrmH) and tRNA m1G37 methyltransferase (TrmD) are prevalent and essential enzymes in bacterial populations. TrmH involves itself in methylation process at the 2'-OH group of ribose at the 18th position of guanosine (G) in tRNAs. TrmD methylates the G residue next to the anticodon in selected tRNA subsets. Initially, m1G37 modification was reported to take place on three conserved tRNA subsets (tRNAArg, tRNALeu, tRNAPro); later on, few archaea and eukaryotes organisms revealed that other tRNAs also have the m1G37 modification. The present study reveals Gm18, m1G37 modification, and positions of m1G that take place next to the anticodon in tRNA sequences. We selected extremophile organisms and attempted to retrieve the m1G and Gm18 modification bases in tRNA sequences. Results showed that the Gm18 modification G residue occurs in all tRNA subsets except three tRNAs (tRNAMet, tRNAPro, tRNAVal). Whereas the m1G37 modification base G is formed only on tRNAArg, tRNALeu, tRNAPro, and tRNAHis, the rest of the tRNAs contain adenine (A) next to the anticodon. Thus, we hypothesize that Gm18 modification and m1G modification occur irrespective of a G residue in tRNAs.

Purpose: To evaluate racial/ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States., Design: Retrospective cohort study., Participants: Patients with a diagnosis of mild or moderate POAG, as defined by current procedural terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients and the control group consisted of patients without an AA designation in the TriNetX database., Methods: Propensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, Body Mass Index, and weight. Outcome was incidence of MIGS over 1 year of follow up. Odds ratios were calculated between cohorts MAIN OUTCOME MEASURE: Incidence of MIGS over 1 year of follow-up post-POAG diagnosis., Results: 63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared to non-AA patients (1,508 of 31,709) (OR 0.834, 95% CI: 0.773 - 0.900)., Conclusion: Although POAG is understood to be more prevalent among African Americans, these patients display lower utilization of MIGS, suggesting a possible nationwide racial disparity in the management of POAG., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: This study aims to evaluate the long-term clinical outcomes of excisional goniotomy with the Kahook Dual Blade (KDB) in the management of various types of glaucoma., Methods: This was a retrospective, noncomparative chart review of 90 eyes of 53 patients with glaucoma that underwent standalone KDB goniotomy (KDB-alone group) or KDB goniotomy with concomitant phacoemulsification (KDB-phaco group) between October 2015 and October 2017. Surgical success was defined as an intraocular pressure (IOP) reduction by ≥ 20% at the last follow-up with no surgical reinterventions required and a final IOP ≥ 4 mmHg and ≤ 21 mmHg. We also report on changes from baseline in IOP, number of glaucoma medications, best-corrected visual acuity (BCVA), and visual field parameters, for up to 72 months., Results: At 72 months, mean (standard deviation [SD]) IOP was reduced from 17.5 (5.7) to 13.6 (3.0) mmHg (P < 0.0001) in the KDB-phaco group and from 23.3 (5.9) to 15.1 (6.2) mmHg (P = 0.0593) in the KDB-alone group. The mean (SD) number of glaucoma medications was reduced from 1.3 (1.0) to 0.8 (0.9) (P < 0.0001) in the KDB-phaco group and from 1.2 (1.0) to 0.7 (0.8) (P = 0.3409) in the KDB-alone group. During the 72-month follow-up, surgical success was achieved in 24 of the 52 available eyes (46.2%). Four eyes underwent a glaucoma surgical reintervention by 72 months., Conclusions: Excisional goniotomy with the KDB effectively lowered the IOP (by an average of 28.0% from baseline) and maintained or further reduced glaucoma medication burdens (by an average of 30.8% from baseline) under an excellent safety profile, independent of phacoemulsification status. The procedure exhibited favorable success for up to 6 years, providing valuable insights into its long-term efficacy as a glaucoma treatment., (© 2024. The Author(s).)

Purpose XEN45 Gel Stent and glaucoma drainage device (GDD) implantation is safe and effective for glaucoma treatment and should be taught during glaucoma fellowship training. However, complications may still occur, with potentially sight-threatening consequences. The purpose of this study is to describe the management of complications following a series of XEN45 Gel Stent and GDD surgeries performed over the course of glaucoma fellowship training. Methods This is a retrospective case series of XEN45 Gel Stent surgeries performed on 16 eyes and GDD surgeries performed on seven eyes. Patient demographics, disease characteristics, and complications are reviewed. The intra- and postoperative course of five select cases with complications are described in detail. Results The most frequent complications following XEN45 implantation were transient hypotony (10 eyes, 63%), reduced visual acuity (VA) (five eyes, 31%), choroidal effusion (three eyes, 19%), hyphema (two eyes, 13%), and intraocular pressure (IOP) spike (two eyes, 13%). Thirteen eyes (81%) required bleb needling, and three eyes (19%) required XEN45 replacement. Complications following GDD implantation included hypotony (three eyes, 43%), reduced VA (two eyes, 29%), choroidal effusion (two eyes, 29%), IOP spike (two eyes, 29%), implant exposure (two eyes, 29%), and shallow anterior chamber (one eye, 14%). Three eyes (43%) required revision or explantation with a secondary glaucoma surgery. One choroidal effusion following XEN45 surgery and one following GDD surgery were hemorrhagic choroidal effusions requiring surgical drainage. Conclusion Significant and potentially sight-threatening complications may occur following XEN45 Gel Stent and GDD implantation performed over the course of fellowship training. Glaucoma fellows should be ably equipped to recognize, diagnose, and manage these complications both intra- and postoperatively., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Mayo Clinic Institutional Review Board issued approval 18-000006. This retrospective study was performed in accordance with the tenets of the Declaration of Helsinki and was approved by the Mayo Clinic IRB on February 28, 2018. There is no personal identifying information within this work. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lentz et al.)

Topic: To investigate differences in peripapillary choroidal thickness (PPCT) between primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and healthy eyes, additionally comparing differences between POAG and NTG eyes., Clinical Relevance: Peripapillary choroidal thickness is a well-established OCT parameter in eyes with glaucoma and other ocular pathologies. The relationship between PPCT and glaucoma, if better understood, may facilitate the development of PPCT as a potential diagnostic and monitoring metric for glaucoma. In particular, there has yet to be a synthesis that directly compares PPCT between POAG eyes and NTG eyes., Methods: A comprehensive literature search was performed on PubMed, EMBASE, and Cochrane Library, identifying studies from inception to December 2022. We included studies that measured PPCT using OCT in POAG, NTG, and healthy eyes. Mean difference (MD) among groups was calculated. Statistical analysis was performed using R version 4.2.0. Risk of bias of included studies was assessed using the Newcastle Ottawa Scale (NOS)., Results: Eighteen studies were included in this meta-analysis, with a pooled total of 935 healthy control eyes, 446 NTG eyes, and 934 POAG eyes. There was a significant reduction of PPCT in POAG eyes compared with healthy eyes [MD = -16.32; 95% confidence interval (CI) (-27.55 to -5.09)]. Reduction in PPCT was also significant in NTG eyes compared with healthy eyes [MD = -34.96; 95% CI (-49.97 to -19.95)]. NTG eyes had significantly reduced PPCT compared with POAG eyes [MD = -26.64; 95% CI (-49.00 to -4.28)]., Conclusions: Glaucomatous eyes appear to have significantly reduced PPCT compared with normal healthy eyes. In addition, PPCT in NTG eyes appear significantly thinner compared with that in POAG eyes., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and effectiveness of the Ahmed ClearPath ® (ACP) 250 mm 2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG)., Patients and Methods: This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed., Results: Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed., Conclusion: To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models., Competing Interests: All authors report no conflicts of interest in this work., (© 2024 Boopathiraj et al.)

Aim: To review the published literature evaluating the safety and efficacy outcomes of canaloplasty performed in the treatment of glaucoma., Background: Canaloplasty is a nonpenetrating glaucoma procedure involving combined 360° circumnavigation and viscodilation of Schlemm's canal. The procedure may be performed under an ab externo (with tensioning suture) or ab-interno (conjunctiva-sparing) approach. Given the wide variety of glaucoma procedure types and approaches, further investigation into the role of canaloplasty in ophthalmological practice is warranted. The objectives of this narrative review are to synthesize the existing literature in order to investigate indications, safety and efficacy outcomes, and the optimal place of canaloplasty in glaucoma treatment and management., Review of Results: A total of 60 articles were included in this review. Both ab externo and ab-interno canaloplasty (ABiC) were found to be significantly effective at reducing intraocular pressure (IOP) and glaucoma medication burdens in patients with mild-to-moderate open-angle glaucoma (OAG). These findings remained consistent regardless of phacoemulsification status. ABiC was found to exhibit a safety profile favorable compared to trabeculectomy and comparable to minimally invasive trabecular bypass implants., Conclusion: Canaloplasty is a nonpenetrating surgical intervention that is highly effective in treating patients with mild-to-moderate OAG across a large variety of clinical scenarios., Clinical Significance: These findings support the clinical use of canaloplasty in ophthalmological practice, clarify its patient profile, and compare procedural outcomes to other minimally invasive glaucoma surgery (MIGS) devices on the market., How to Cite This Article: Wagner IV, Towne C, Saade MC, et al. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024;18(2):79-85., Competing Interests: Source of support: Nil Conflict of interest: Dr Syril Dorairaj is associated as the Associate Managing Editor of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of this editorial board member and his research group.Conflict of interest: Dr Syril Dorairaj is associated as the Associate Managing Editor of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of this editorial board member and his research group., (Copyright © 2024; The Author(s).)

Aim: To evaluate the success and safety of MicroPulse transscleral laser therapy (TLT) on intraocular pressure (IOP) reduction in adults with uncontrolled glaucoma using different total treatment durations, sweep velocities, and a number of sweeps utilizing the revised MicroPulse P3 delivery device., Materials and Methods: A single-center Institutional Review Board (IRB) approved multiple cohort studies of MicroPulse TLT with the revised MicroPulse P3 delivery device, which was conducted in 61 eyes from 40 adults with uncontrolled glaucoma. Eyes that received 50-second (GI, GII, and GIII) and 60-second (GIV, GV, and GVI) treatment applications between May and October 2020 were reviewed. Each hemisphere received a total of five, four, or three sweeps. The patient's IOP and glaucoma medications were monitored over 12 months follow-up. Qualified success was defined as an IOP of ≤21 mm Hg and/or reduction of ≥20% from baseline at 12 months, with no secondary glaucoma reinterventions. Complete success was defined as meeting the above criteria with no increase in glaucoma medications at 12 months. All eyes requiring a glaucoma surgical intervention were considered a failure., Results: Qualified success was achieved in 83.6% of eyes, while complete success was achieved in 75.4% of eyes. In eyes receiving 50-second applications of five, four, or three sweeps (GI, GII, and GIII), 70, 90, and 91% achieved qualified success, respectively; in eyes receiving 60-second applications of five, four, or three sweeps (GIV, GV, and GVI), 78, 82, and 90% achieved qualified success, respectively. Within each subgroup, mean IOP reductions ranged from 32.8 to 49.4% and were statistically significant ( p < 0.008). The failure rate was 16.4%, and at least one eye failed in each subgroup., Conclusions: MicroPulse TLT with the revised MicroPulse P3 delivery device and relatively low total energy levels is safe and effective at lowering IOP. Efficacy appears to increase with longer treatment durations and slower sweep velocities, but statistical differences between age and clinical differences between baseline IOP measurements limit comparison between subgroups., Clinical Significance: There is a lack of literature evaluating the safety and IOP-lowering success of the revised MicroPulse P3 delivery device using different total treatment durations, sweep velocities, and number of sweeps., How to Cite This Article: Checo LA, Dorairaj S, Wagner IV, et al. Clinical Outcomes of MicroPulse Transscleral Laser Therapy with the Revised P3 Delivery Device. J Curr Glaucoma Pract 2024;18(1):10-15., Competing Interests: Source of support: Nil Conflict of interest: Dr Syril Dorairaj is associated as the Associate Editorial Board member of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of this editorial board member and his research group., (Copyright © 2024; The Author(s).)

Surgery has long been an important treatment for limiting optic nerve damage and minimising visual loss in patients with glaucoma. Numerous improvements, modifications, and innovations in glaucoma surgery over recent decades have improved surgical safety, and have led to earlier and more frequent surgical intervention in glaucoma patients at risk of vision loss. This review summarises the latest advancements in trabeculectomy surgery, glaucoma drainage device (GDD) implantation, and minimally invasive glaucoma surgery (MIGS). A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases, alongside subsequent hand searches-limited to the past 10 years for trabeculectomy and GDDs, and the past 5 years for MIGS-yielded 2283 results, 58 of which were included in the final review (8 trabeculectomy, 27 GDD, and 23 MIGS). Advancements in trabeculectomy are described in terms of adjunctive incisions, Tenon's layer management, and novel suturing techniques. Advancements in GDD implantation pertain to modifications of surgical techniques and devices, novel methods to deal with postoperative complications and surgical failure, and the invention of new GDDs. Finally, the popularity of MIGS has recently promoted modifications to current surgical techniques and the development of novel MIGS devices.

The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments.

A 69-year-old woman with bilateral primary open-angle glaucoma who underwent cataract extraction with intraocular lens implantation and excisional goniotomy with the Kahook Dual Blade (KDB; New World Medical, Rancho Cucamonga, CA, USA) in both eyes one year prior was referred for evaluation of significant visual acuity loss and pain in the left eye. On initial examination, intraocular pressure in the left eye was 3 mmHg and slit lamp examination revealed normal anterior chamber depth. Gonioscopy revealed a cyclodialysis cleft that was confirmed by anterior segment optical coherence tomography. Prominent chorioretinal folds suggestive of long-standing hypotony maculopathy were observed during fundoscopic examination. The cyclodialysis cleft, thought to be created inadvertently during the KDB goniotomy, resolved after three sessions of argon laser photocoagulation and the patient's symptoms and visual acuity partially improved., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by the Turkish Ophthalmological Association / Turkish Journal of Ophthalmology published by Galenos Publishing House.)

This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were classified as LTDH or HTDH if they presented at the time of DH detection an intraocular pressure (IOP) < 16 mmHg or ≥ 16 mmHg, respectively. Demographic and ophthalmological data, ET-1 concentrations, LDI (before and 1, 10, and 20 min after cold stimulation), and nailfold capillaroscopy findings were evaluated. The ET-1 blood level was 65% higher in the LTDH (2.27 ± 1.46 pg/ml) than in the HTDH (1.37 ± 0.57 pg/ml; p = 0.03) group. Moreover, there was a statistically significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45, p = 0.02). Blood flow measurements 10 and 20 min after cold stimulation were lower in the LTDH group than in the HTDH group (p < 0.01). Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction as estimated by LDI than those with higher IOPs. These findings suggest that distinct underlying mechanisms may be involved in patients developing DH within different IOP ranges., (© 2023. The Author(s).)

Background: The exact mechanism by which fungal strains sense insoluble cellulose is unknown, but research points to the importance of transglycosylation products generated by fungi during cellulose breakdown. Here, we used multi-omics approach to identify the transglycosylation metabolites and determine their function in cellulase induction in a model strain, Talaromyces cellulolyticus MTCC25456., Results: Talaromyces sp. is a novel hypercellulolytic fungal strain. Based on genome scrutiny and biochemical analysis, we predicted the presence of cellulases on the surface of its spores. We performed metabolome analysis to show that these membrane-bound cellulases act on polysaccharides to form a mixture of disaccharides and their transglycosylated derivatives. Inevitably, a high correlation existed between metabolite data and the KEGG enrichment analysis of differentially expressed genes in the carbohydrate metabolic pathway. Analysis of the contribution of the transglycosylation product mixtures to cellulase induction revealed a 57% increase in total cellulase. Further research into the metabolites, using in vitro induction tests and response surface methodology, revealed that Talaromyces sp. produces cell wall-breaking enzymes in response to cellobiose and gentiobiose as a stimulant. Precisely, a 2.5:1 stoichiometric ratio of cellobiose to gentiobiose led to a 2.4-fold increase in cellulase synthesis. The application of the optimized inducers in cre knockout strain significantly increased the enzyme output., Conclusion: This is the first study on the objective evaluation and enhancement of cellulase production using optimized inducers. Inducer identification and genetic engineering boosted the cellulase production in the cellulolytic fungus Talaromyces sp., (© 2023. The Author(s).)

Background: Mammosphere formation assay has become a versatile tool to quantify the activity of putative breast cancer stem cells in non-adherent in vitro cultures. However, optimizing the suspension culture system is crucial to establish mammosphere cultures from primary breast tumors., Methods: This study aimed at determining the self-renewal and sphere-forming potential of breast cancer stem-like cells derived from human primary invasive ductal carcinoma and normal breast tissue samples, and MCF-7 breast cancer cell line using an optimal suspension culture system. Mammosphere-forming efficiency of the mammospheres generated from the tissue samples and cell line were compared. We evaluated the expression of CD44 + /CD24 - / low and CD49f + /EpCAM - / low phenotypes in the stem-like cells by flow cytometry. CK-18, CK-19, α-SMA, and EpCAM marker expression was assessed using immunohistochemical staining., Results: Breast epithelial cells isolated from the three samples formed two-dimensional spheroids in suspension cultures. Interestingly, mammospheres formed from patient-derived primary breast tumors were enriched in breast cancer stem-like cells with the phenotype CD44 + /CD24 - / low and exhibited a relatively more number of large spheres when compared to the normal breast stem cells. MCF-7-derived SCs were more aggressive and resulted in the formation of a significantly higher number of spheroids. The expression of CK-18/CK-19 and α-SMA/EpCAM proteins was confirmed in breast cancer tissues., Conclusions: Thus, the use of primary tumor specimens and breast cancer cell lines as suitable models for elucidating the breast cancer stem cell activity was validated using mammosphere culture system., (© 2022. The Author(s).)

Competing Interests: The authors have no conflict of interests to declare.