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Background To evaluate the effect of lanosterol on cataractous lens of cynomolgus monkeys using a subconjunctival drug release system. Methods Nine elder cynomolgus monkeys were used, consisting of three monkeys without cataract as controls, three monkeys with naturally occurring cortical cataract, and three monkeys with nuclear cataract as intervention groups. Nanoparticulated thermogel with lanosterol and fluorescein was administered by subconjunctival injection in the monkeys with cataract. Fluorescence changes of injected thermogel and cataract progression were observed. Lanosterol concentration in aqueous humor, solubility changes in lens proteins, and oxidative stress levels were analyzed in the lenses of the control and intervention groups. Results Injected thermogel showed decreased fluorescence during follow up. Lanosterol concentration in aqueous humor increased in the first 2 weeks and then gradually decreased, which was in accordance with the changes in cortical lens clarity. However, lenses with nuclear opacification showed little change. In the cortical region of lenses with cortical cataract, solubility of α-crystallin was significantly increased after administration of lanosterol, as well as the reduction of oxidative stress. Conclusions We demonstrated the effect of lanosterol on cataract progression based on in vivo models of primates. Lanosterol showed a short-term and reliable reversal effect on reducing cataract severity in cortical cataract in the early stages, possibly due to the increase in the solubility of lens proteins and changes in the oxidative stress status. Lanosterol administration using subconjunctival drug release system could be a promising nonsurgical approach for future clinical studies of cataract prevention and treatment.

Treatment of hepatitis C virus (HCV) infection with direct-acting antiviral agents (DAAs) in hemodialysis patients requires extensive consideration. At present, studies regarding DAAs for acute HCV infection in such patients are limited. The present study aims to evaluate the efficacy and safety of grazoprevir (GZR) plus elbasvir (EBR) treatment in acute hepatitis C (AHC) patients undergoing hemodialysis. Patients undergoing hemodialysis who had a nosocomial acute HCV infection were enrolled. All patients received GZR 100 mg/EBR 50 mg once daily for 12 weeks and were followed up for 12 weeks. Serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and HCV RNA levels were monitored during treatment and follow-up periods. Sustained virologic response (SVR) at 12 weeks after treatment cessation and treatment emergent adverse events (AEs) were assessed. A total of 68 AHC patients were enrolled. All patients were infected with HCV genotype 1b and achieved SVR12. Decreasing ALT, AST, and TBIL were observed over time in the first four weeks and became steady thereafter. Forty-eight (70.59%) patients reported at least one AEs. The most common AEs were fatigue, headache, and nausea. Two AHC patients discontinued treatment due to serious but drug-unrelated AEs. In conclusion, GZR/EBR has a high efficacy and safety profile in hemodialysis-dependent patients with genotype 1b AHC. This article is protected by copyright. All rights reserved.

The rapid and early detection of foodborne pathogens in contaminated food is important for ensuring food safety and quality. In this study, a highly sensitive fluorescent immunosensor was developed to detect Escherichia coli O157:H7 in milk, by using microspheres labeled with carbon dots (CDs). The CDs-microspheres were prepared with Staphylococcus aureus cells as the carrier to incorporate CDs particles. Characterization of the microsphere revealed strong intensity, good stability and high uniformity in fluorescence. With Staphylococcal Protein A (SPA) on the surface of S. aureus cells, the microsphere could be easily coupled with various antibodies (e.g., immunoglobulin G). In combination with the immunomagnetic beads technique, a CDs-microsphere immunosensor was established for the specific detection of E. coli O157:H7 in milk. The limit of detection for E. coli O157:H7 is 2.4 × 102 colony-forming unit (CFU)/mL, comparable to that of real-time PCR methods. Milk samples spiked with E. coli O157:H7 at concentrations from 2.4 × 102 to 2.4 × 107 CFU/mL could be detected within 30 min. The coefficients of variation of the intra-assay tests were less than 10%, indicating a good repeatability. Moreover, the method was able to detect trace amounts of E. coli O157:H7 (

We report a case of a leak in the curved suction contact glass of a VisuMax femtosecond laser that occurred during small-incision lenticule extraction (SMILE). As a result, creation of the anterior surface of the lenticule was not complete. One month later, a cap was created using the flap mode; the flap side cut was manually stopped after the flap cut was made. After laser in situ keratomileusis flap creation, the refractive lenticule was manually removed using microforceps, similar to the uneventful SMILE procedure. To our knowledge, this is the first report of a leak in the curved suction contact glass during SMILE that was successfully treated.

To evaluate the surface characteristics of lenticules created by small-incision lenticule extraction (SMILE) with different cap thicknesses.This prospective study included 20 consecutive patients who underwent bilateral SMILE. Surface regularity of the extracted corneal lenticule was analyzed using scanning electron microscopy (SEM) combined with 2 methods: qualitative and quantitative regularity. Qualitative regularity of SEM images was graded by masked observers using an established scoring system. Quantitative regularity of SEM images was assessed by counting the total number and areas of tissue bridges using Image-Pro Plus software. Four different cap thickness of 120, 130, 140, and 150 μm were compared. Refractive outcomes of patients were measured at baseline and 1 month after surgery.As 10 specimens were not analyzable, only 30 eyes were included. Postoperatively, all eyes had postoperative uncorrected distance visual acuity of 20/20 or better; 43% had an unchanged corrected distance visual acuity; 43% gained 1 line; 10% lost 1 line. Ultrastructurally, surface irregularity was primarily caused by tissue bridges. The average surface regularity score obtained was 10.87 ± 2.40 for 120 μm, 10.78 ± 2.60 for 130 μm, 8.76 ± 2.16 for 140 μm, and 8.70 ± 2.66 for 150 μm (P0.001). The total number and areas of tissue bridges of 120 to 130 μm were significantly less than 140 to 150 μm (P0.05). Surface regularity decreased as cap thickness increased (P0.05).There is smoother appearance of the lenticular surface as seen through SEM when a thin cap is created compared with a thick cap qualitatively and quantitatively.

PURPOSE To evaluate clinical outcomes after small incision lenticule extraction (SMILE) with different cap thicknesses in thick corneas. METHODS Forty patients with central corneal thickness of more than 560 μm were recruited in this prospective, randomized, masked, paired-eye study. Patients were randomized to receive SMILE with a 120-μm cap thickness in 1 eye and 140-μm cap thickness in the other. Uncorrected and corrected distance visual acuity (CDVA), contrast sensitivity (CS), higher-order aberrations (HOAs), and morphologic modifications of corneal architecture were measured during the 3-month follow-up period. RESULTS Postoperative refractive outcomes, visual outcomes, CS, and the changes in HOAs were similar between both groups. The persistence of brightly reflective particles in the corneal interface layer was 1388.6 ± 219.5/mm in eyes with 120-μm cap thickness and 54.7 ± 8.6/mm in eyes with 140-μm cap thickness (P < 0.001). The hyperreflectivity line at the interface layer almost disappeared in all eyes with 140-μm cap thickness, and it still persisted in 43% of the fellow eyes at 3 months postoperatively. The anterior surfaces of lenticules in the 140-μm cap thickness group exhibited more smoothness than in the 120-μm cap thickness group. CONCLUSIONS There was a lower level corneal wound-healing response after SMILE with a 140-μm cap thickness than with a 120-μm cap thickness, although the thickness of cap creation did not affect visual outcomes by 3 months postoperatively.

PURPOSE: To evaluate the clinical results of suction loss in eyes during small incision lenticule extraction (SMILE). METHODS: This prospective paired-eye case study enrolled 8,490 eyes of 4,296 patients, of which 35 eyes experienced suction loss during the SMILE procedure while being treated for myopia or myopic astigmatism. The eyes with suction loss were re-treated with SMILE, femtosecond laser-assisted LASIK (FS-LASIK), or pseudo SMILE, and the fellow eyes were treated with SMILE. Patients were examined before surgery and at 1 day, 1 week, and 1 and 3 months postoperatively. Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, higher order aberrations (HOAs), and morphologic modifications of corneal architecture were evaluated. At 3 months, patients were asked if they preferred the vision in either eye. RESULTS: High-contrast CDVA was worse in the eyes that suffered loss of suction than in the fellow eyes at 1 week postoperatively (two-tailed paired t tests, P = .04), but not at 1 and 3 months. There was no statistical significance between the two treatments in the safety and efficacy indices or the 3rd and 4th order aberrations at 3 months postoperatively (two-tailed paired t tests, all P > .05). No apparent abnormalities were observed in the corneas by frequency-domain optical coherence tomography. CONCLUSIONS: Re-treatment with femtosecond laser for incomplete SMILE was safe, predictable, and effective, and the patients did not perceive a difference in vision. [ J Refract Surg. 2016;32(10):686–692.]

To compare the clinical outcomes of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK) for the correction of myopia and myopic astigmatism.In this prospective, randomized, comparative study, SMILE surgery was performed in 113 eyes with a mean spherical equivalent (MSE) of -5.22 ± 1.70 diopters (D) and FS-LASIK was performed in 84 eyes with an MSE of -5.18 ± 1.93 D. Contrast sensitivity and uncorrected and corrected distance visual acuities were measured preoperatively and 1 day, 1 week, 1, 3, and 6 months postoperatively. Higher-order aberrations were evaluated preoperatively and 6 months postoperatively.At postoperative day 1, the uncorrected distance visual acuity in the FS-LASIK group was better (P0.05), whereas no statistically significant difference was found at 6 months postoperatively (P = 0.9). There was no significant difference in terms of logMAR corrected distance visual acuity and MSE during the 6 months of follow-up between the SMILE and FS-LASIK groups (all P0.05). The contrast sensitivity in the SMILE group was lower at 1 day and 1 week postoperatively (all P0.05). The spherical aberration at 6 mm diameter at 6 months postoperatively was lower (P0.05) in the SMILE group (0.12 ± 0.22 μm) than in the FS-LASIK group (0.28 ± 0.26 μm).Both FS-LASIK and SMILE procedures achieved good visual outcomes in the correction of myopia and myopic astigmatism. SMILE had a lower induction rate of spherical aberration at 6 months postoperatively in the analysis of 6 mm diameter than that of FS-LASIK.

Artificial intelligence (AI)-based methods have emerged as powerful tools to transform medical care. Although machine learning classifiers (MLCs) have already demonstrated strong performance in image-based diagnoses, analysis of diverse and massive electronic health record (EHR) data remains challenging. Here, we show that MLCs can query EHRs in a manner similar to the hypothetico-deductive reasoning used by physicians and unearth associations that previous statistical methods have not found. Our model applies an automated natural language processing system using deep learning techniques to extract clinically relevant information from EHRs. In total, 101.6 million data points from 1,362,559 pediatric patient visits presenting to a major referral center were analyzed to train and validate the framework. Our model demonstrates high diagnostic accuracy across multiple organ systems and is comparable to experienced pediatricians in diagnosing common childhood diseases. Our study provides a proof of concept for implementing an AI-based system as a means to aid physicians in tackling large amounts of data, augmenting diagnostic evaluations, and to provide clinical decision support in cases of diagnostic uncertainty or complexity. Although this impact may be most evident in areas where healthcare providers are in relative shortage, the benefits of such an AI system are likely to be universal.

Purpose To evaluate decentration from pupil center and corneal vertex normal following femtosecond laser small incision lenticule extraction (SMILE) for the treatment of myopia and myopic astigmatism. Methods This study evaluated 101 eyes of 101 patients with a spherical equivalent (SE) of -5.30 ± 1.72 diopters (D). Decentration was measured in the pupil-centered group (PC group) by video capture images and in the vertex normal-centered group (VNC group) using the WaveLight Oculyzer II (Alcon). The PC and VNC groups were further divided into 4 subgroups (1 PC, 2 PC and 1 VNC, 2 VNC) based on the displacement of the lenticule center. Uncorrected and corrected distance visual acuities, manifest refraction, and wavefront errors were measured preoperatively, and at 1 day, 1 week, 1 month, and 3 and 6 months postoperatively. Results Regarding efficacy and safety, at 6 months postoperatively, 65, 71, 83, and 53% of eyes had unchanged corrected distance visual acuity in 1 PC, 1 VNC, 2 PC and 2 VNC groups, respectively. Also, 97, 98, 100, and 97% of treated eyes had a postoperative uncorrected distance visual acuity 20/20 or better in the subgroups, respectively. In the groups mentioned above, 96, 100, 100, and 95% of eyes, respectively, were within ±0.5 D of the targeted SE. In terms of total higher-order aberrations, the 1 PC group was significantly higher than the 1 VNC group (P = 0.04), whereas the 2 VNC group was significantly higher than the 2 PC group (P = 0.02). Conclusions Our results demonstrate that better refractive outcomes will be achieved when the lenticule center is closer to the corneal vertex normal.

To evaluate the microstructural modifications and safety of small incision lenticule extraction combined with accelerated cross-linking (SMILE Xtra) in high myopia and thin corneas by means of in vivo confocal microscopy (IVCM) and 3D–OCT after a 6-month follow-up. Forty-three eyes with high myopia and thin corneas were enrolled. All eyes underwent SMILE procedure. After the lenticule was extracted, 0.25% riboflavin was injected into the interface and allowed to diffuse for 60 s. The eye was irradiated with UVA radiation of 30 mW/cm2 for 90 s through the cap. The total energy delivered was 2.7 J/cm2. Morphologic modifications of corneal architecture were evaluated prior to SMILE Xtra and 7 days, 1, 3, and 6 months after SMILE by in vivo confocal microscopy (IVCM) and 3D–OCT. The corneal epithelial cells showed slight damage until 3 months postoperatively. The subepithelial nerve plexus decreased but no absence within the treatment zone at the first week after treatment, recolonized at 3 months postoperatively, and had mostly recovered at the 6 months postoperative but remained less than its normal baseline state. Keratocytes were absent in the surgical interface area, and the presence of strong reflective particles and cicatricial reaction in the anterior stroma were observed during the entire 6-month examination period. Increased hyperreflectivity was observed from the cap side at a depth of 60 µm to stroma bed at a depth of 388 µm through 6 months. The depth of the demarcation line in 40 eyes (93.0%) was at a mean depth of 296.12 ± 47.86 μm (range, 211–388 μm). No particular change between preoperative and postoperative corneal endothelium was observed. Confocal microscopy showed increased hyperreflectivity in the SMILE Xtra eyes, and no changes in corneal endothelium. We confirmed the safety of the SMILE Xtra but recognize that larger and longer-term studies of SMILE Xtra are necessary.

Ferroelectric Ba0.55Sr0.4Ca0.05TiO3 (BSCT) ceramics with nano-MgO additive have been prepared by typical electrical ceramic technology sintered at 950°C for 2 h. The influence of the additive content on the sintering behaviors of BSCT ceramics is investigated. The results show that the interactions of MgO with BSCT and B2O3-Li2O liquid sintering additive help to form wetting boundaries for accelerating densification process, promote the grain growth of BSCT ceramic. The BSCT ceramic with 20 wt% nano-MgO possesses uniform microstructure, high densification, and superior dielectric properties. The modification mechanism of nano-MgO on BSCT ceramic is summarized as “MgO assisted wetting sintering model.”

PURPOSE: To analyze early clinical outcomes of aspheric micro-monovision LASIK for correction of presbyopia and myopia with or without astigmatism. METHODS: Prospective, non-comparative case series of 80 eyes of 40 patients with a mean age of 43.4 ± 4.9 years (range: 38 to 63 years) treated bilaterally using an aspheric micro-monovision protocol. The target refraction was plano for the distance eye and between −0.75 and −2.25 diopters (D) for the near eye. Visual acuity, ocular aberrations, contrast sensitivity, corneal topography, amplitude of accommodation, binocular sensorial function, and satisfaction score questionnaires were evaluated at 3 months after surgery. RESULTS: Three months after surgery, the mean spherical equivalent (SE) refraction in the distance eye was −0.08 ± 0.27 D, whereas the attempted and achieved SE in the near eye were −1.41 ± 0.28 and −1.32 ± 0.35 D, respectively. Ninety-three percent of eyes were within ±0.50 D of target correction of SE. The uncorrected distance visual acuity (UDVA) after surgery was −0.10 ± 0.06 logMAR (20/15.5), 0.22 ± 0.12 logMAR (20/34), and −0.11 ± 0.06 logMAR (20/15), for distance eyes, near eyes, and binocularly, respectively. Ninety-five percent of patients achieved simultaneously uncorrected distance visual acuity 0.0 logMAR (20/20) or better and uncorrected near visual acuity J2 (20/25) or better. Stability was achieved from 1 week of follow-up. The overall satisfaction score for surgery was 92 ± 6. CONCLUSIONS: The aspheric micro-monovision protocol provided a well-tolerated and effective means for treating myopic astigmatism and alleviating presbyopic symptoms simultaneously. [ J Refract Surg. 2016;32(10):680–685.]

Objective To explore and compare the genetic polymorphisms of the sortase A (srtA) gene found in Streptococcus mutans ( S. mutans ) infecting two-year-old children suffering early childhood caries to those found in caries-free children through molecular identification methods. Methods Clinical S. mutans strains were isolated from the dental plaques of two-year-old children. Fifteen strains of S. mutans from the caries-active group and 15 strains of S. mutans from the caries-free group were collected. Genomic DNA was extracted from the S. mutans isolates. DNA fragments, including the srtA gene, were amplified by PCR. The PCR products were purified, sequenced and analyzed. A chi-square test and BioEdit software were used to analyze the sequencing results. Results All 30 clinically isolated S. mutans strains had a 741 base pair (bp) srtA gene. There were no nucleotide sequence insertions or deletions observed in the srtA genes. Twenty mutations were identified in the srtA genes that taken from the 30 clinical strains. There were 10 silent point mutations at the 78, 99, 150, 165, 186, 222, 249, 261, 312, and 636 bp positions. The other 10 mutations were point mutations resulting in a missense mutation at the 23, 34, 36, 47, 112, 114, 168, 176, 470, and 671 bp positions. None of the positions were enzyme-activity sites of srt A. The missense mutation rates of the two groups did not exhibit statistically significant differences. Conclusion There were no genetic polymorphisms of the sortase A gene associated with early childhood caries in two-year-old children.

PURPOSE: To evaluate outcomes, reversibility, and wound healing response after the femtosecond laser-assisted endokeratophakia procedure in a rabbit model. METHODS: Allogeneic rabbit corneal lenticules were cryopreserved in liquid nitrogen for 3 months. Twenty rabbits underwent the monocular endokeratophakia procedure and were divided into four groups according to the follow-up periods. The first three groups were killed at 3 days, 2 weeks, and 6 months after endokeratophakia, respectively. The rabbits in the fourth group received re-extraction of implanted lenticules at 6 months after endokeratophakia and were killed at 1 month after re-extraction. The rabbits were monitored by slit-lamp microscopy, ultrasonic pachymetry, in vivo confocal microscopy, optical coherence tomography (OCT), Corvis ST tonometry (Oculus Optikgeräte, Wetzlar, Germany), and Ocular Response Analyzer (Reichert Ophthalmic Instruments, Depew, NY). The tissue responses were analyzed by immunohistochemistry and transmission electron microscopy. RESULTS: After endokeratophakia, corneal clarity improved continually with time. The changes in the refraction and corneal thickness were stable after implantation and could be reversed after re-extracting the lenticules. The interfaces were clearly visible on confocal microscopy and transmission electron microscopy images over the entire follow-up period. There were significant numbers of TUNEL-positive keratocytes in lenticules after endokeratophakia. CD11b-positive cells and deposition of fibronectin and tenascin were observed at earlier follow-up times. No alpha-smooth muscle actin-positive fibroblasts could be detected. In addition, the corneal biomechanics parameters were not significantly increased after endokeratophakia. CONCLUSIONS: The endokeratophakia procedure using allogeneic cryopreserved lenticules was clinically stable and could be reversed. The wound healing response was mild, limited, and produced no scars. [ J Refract Surg. 2016;32(8):569–576.]

The Ba0.55Sr0.4Ca0.05TiO3–MgO (BSCT–MgO) composite powders possessing core-shell structure, small particle size and high specific surface area were prepared by the novel two-step sol–gel method which was based on the citric acid (CA)–ethylene glycol (EG) system. In this experiment, the Ba0.55Sr0.40Ca0.05TiO3 (BSCT) powders were firstly synthesized by chemical co-precipitation method. MgO [(MgO/BSCT)mass = 1] and MnO2 [(MnO2/BSCT)mole = 0.01] were added into the BSCT powders in the first sol–gel step. 1.5 wt% B2O3–Li2O as sintering aids was added into the composite powders during the second sol–gel step. The BSCT–MgO composite powders were detected to have a perfect core-shell structure which was detected by the transmission electron microscope. Perovskite BSCT and periclase MgO were confirmed to exist in the BSCT–MgO composite powders according to the X-ray diffraction patterns. The Ba0.55Sr0.4Ca0.05TiO3–MgO (BSCT–MgO) composite ceramics that synthesized with the core-shell powders were sintered at 1,000 °C for 2 h. According to the scanning electron microscope images, the grain sizes of BSCT and MgO in the BSCT–MgO composite ceramics were in the range of 0.5–2.0 μm and 1.0–2.5 μm, respectively. The dielectric constant of the BSCT–MgO composite ceramics was 210 and the dielectric loss was 0.0012 when tested at 1 MHz, room temperature. The BSCT–MgO composite ceramics were expected to be a promising candidate for applying as phase shifters or tunable components, etc, in the microwave field.

Streptococcus mutans (S. mutans) is the major aetiological agent of dental caries, and the transpeptidase Sortase A (SrtA) plays a major role in cariogenicity. The T168G and G470A missense mutations in the srtA gene may be linked to caries susceptibility, as demonstrated in our previous studies. This study aimed to investigate the effects of these missense mutations of the srtA gene on SrtA enzyme activity in S. mutans. The point mutated recombinant S.mutans T168G and G470A sortases were expressed in expression plasmid pET32a. S. mutans UA159 sortase coding gene srtA was used as the template for point mutation. Enzymatic activity was assessed by quantifying increases in the fluorescence intensity generated when a substrate Dabcyl-QALPNTGEE-Edans was cleaved by SrtA. The kinetic constants were calculated based on the curve fit for the Michaelis-Menten equation. SrtA△N40(UA159) and the mutant enzymes, SrtA△N40(D56E) and SrtA△N40(R157H), were expressed and purified. A kinetic analysis showed that the affinity of SrtA△N40(D56E) and SrtA△N40(R157H) remained approximately equal to the affinity of SrtA△N40(UA159), as determined by the Michaelis constant (K m ). However, the catalytic rate constant (k cat ) and catalytic efficiency (k cat /K m ) of SrtA△N40(D56E) were reduced compared with those of SrtA△N40(R157H) and SrtA△N40(UA159), whereas the k cat and k cat /K m values of SrtA△N40(R157H) were slightly lower than those of SrtA△N40(UA159). The findings of this study indicate that the T168G missense mutation of the srtA gene results in a significant reduction in enzymatic activity compared with S. mutans UA159, suggesting that the T168G missense mutation of the srtA gene may be related to low cariogenicity.

PURPOSE: To investigate the feasibility of allogeneic corneal lenticule implantation using the femtosecond laser as a method for cornea remodeling. METHODS: Small incision lenticule extraction was performed on the right eyes of 15 New Zealand white rabbits. Corneal intrastromal pockets were created with a femtosecond laser on the left eyes. Allogeneic corneal lenticule implantation was performed on the left eye immediately after the lenticule was extracted from the right eye. All animals had preoperative and postoperative slit-lamp photography, ultrasonic pachymetry, corneal endothelial cell count, anterior segment optical coherence tomography, in vivo confocal microscopy, and retinoscopy refraction during the observation period of 8 weeks. The rabbits were killed 8 weeks after surgery. Corneal wound healing response was analyzed by transmission electron microscopy, hematoxylin–eosin staining, TUNEL assay, and immunofluorescent staining. RESULTS: Mild corneal edema and decreased clarity were noted the first few days after implantation, improving to normal 8 weeks after surgery. The corneal thickness and retinoscopy refraction were stable during the observation period. Viable keratocytes could be detected within the lenticule lamellae by ultrastructural analysis 8 weeks after surgery. The anterior and posterior border of the lenticule showed acellular layers with highly irregular collagen arrangement on transmission electron microscope images. Proliferating Ki-67 positive cells were present only in the epithelium layer. CONCLUSION: Femtosecond laser-assisted endokeratophakia using allogeneic corneal lenticule may be feasible for reshaping cornea, providing a new possibility in refractive surgery and keratoconus treatment. [ J Refract Surg. 2015;31(11):775–782.]

In this paper, we study the bifurcations of an epidemic model with non-monotonic incidence rate of saturated mass action, which describes the psychological effects of the community on certain serious diseases when the number of infective is getting larger. By carrying out the bifurcation analysis of the model, we show that there exist some values of the model parameters such that numerous kinds of bifurcation occur for the model, such as Hopf bifurcation, Bogdanov-Takens bifurcation.

Purpose To evaluate the morphologic changes of corneal after small incision lenticule extraction (SMILE) using the Heidelberg Retina Tomograph III (HRT III)/Rostock Cornea Module confocal microscope and three-dimensional optical coherence tomography (3D-OCT). Methods Thirty eyes of 30 patients who underwent SMILE for the correction of myopia and myopic astigmatism in this study. Morphologic modifications of corneal architecture and the density of corneal subbasal nerve were evaluated prior to SMILEand7days,1,3,and6monthsafter SMILEbyin-vivo confocal microscopy (IVCM) and 3D-OCT. Results The corneal epithelium morphology showed no particular changes during the entire 6-month examination period. Subbasal nerve density recovered to preoperative levels within 3 months after SMILE (P>0.05). On the interface layer, intense keratocyte activity was noted in all eyes after SMIL E. The corneal fibrotic tissues on the interface layer diminished with time, but the persistence of brightly reflective particles still existed. No particular change between preoperative and postoperative corneal endothelium. The incision margin of SMILE had the appearance of a less clearly identified fibrotic scar with epithelial plug. Conclusions IVCM and 3D-OCT analysis showed that there is a low-level corneal wound-healing response after SMILE procedure in the early postoperative period. Subbasal nerve regeneration is recovered at the third month, but the reflective particles elevated up to the sixth month.

Background The factors involved in Streptococcus mutans colonization in young children are not clear. The aim of this study was to determine the factors associated with S. mutans colonization in 8- to 32-month-old children. Methods A group of 225 caries-free 8-month-old children was recruited for the study. They were examined every six months until they were 32 months old to investigate their environmental factors, host factors and bacterial transmission factors. At baseline and during each examination, their teeth were checked for the presence of dental plaque and developmental defects of enamel, and S. mutans plaque status was assessed using a real-time PCR test. Results Eight children (3.6%) showed S. mutans colonization by the age of 8 months. The percentages of colonization were 6.0% at 14 months, 16.2% at 20 months, 26.7% at 26 months, and 33.5% at 32 months. The results showed that females (p = 0.006), children with enamel hypoplasia (p = 0.024), children with low birth weights (p = 0.005), those who consume more sweets (p