The objective was to map the stages and costs of processing donated corneal tissue for transplantation in Eye Banks. The method followed the JBI Institute Reviewer's Manual, and the PRISMA-ScR guidelines were adopted for reporting, to answer the question: "What are the stages and costs of processing donated corneal tissue for transplantation in Eye Banks?" Studies considered for inclusion comprised qualitative, quantitative, mixed-method, observational, experimental, quasi-experimental studies, reviews, institutional documents, manuals, theses, and dissertations, all available in full text and open access, with no restrictions on language or publication period. Information sources included PubMed, Embase, Cochrane Library, Scopus, Web of Science, ScienceDirect, CINAHL (EBSCOhost), the Virtual Health Library, and gray literature databases. The systematic search resulted in the final inclusion of seven studies. The results identified an operational workflow comprising three main phases: corneal selection and recovery, processing and evaluation, and the pre-surgical stage. The review revealed extensive variation in evaluation and discard/disqualification protocols across institutions and countries, especially in those with decentralized regulation. A lack of cost analyses and economic data was identified. In conclusion, although the processing workflow was mapped, the lack of protocol uniformity and, above all, the absence of cost data limit the understanding of financial impact and the sustainability of Eye Banks, reinforcing the need for future research with an economic focus and the development of standardized indicators.
Visual attention to emotional faces provides a useful framework for investigating orienting, visual exploration, and attentional engagement across development. The present study aimed to characterize the visuospatial organization of attention in neurotypical children and to examine how this pattern is modulated by social and emotional factors. Twenty children (aged 8-12 years) participated in a passive viewing paradigm of facial expressions while their eye movements were recorded using eye tracking (120 Hz). Oculomotor metrics based on areas of interest (eyes, mouth, nose, face, and non-social regions) were analyzed, including time to first fixation (TTFF), number of fixations (NF), and total fixation duration (TFD), as well as total saccade count as a global index of visual scanning. Results indicated statistically significant AOI-dependent interactions involving emotional expression, observer sex, stimulus sex, and stimulus race/ethnicity, revealing region-specific modulation of visual attention. Consistently, prioritization of the eye region was observed, particularly for angry expressions, and was associated with greater fixation recurrence and duration, whereas happy and surprised expressions were associated with increased attentional allocation to the mouth. Differences related to observer sex and stimulus characteristics reflected region-specific modulations. In contrast, global saccadic dynamics remained relatively stable across experimental conditions and showed no significant effects of observer sex, stimulus sex, race/ethnicity, or emotional expression. Taken together, these findings suggest that visual attention to emotional faces in childhood follows a relatively stable spatial organization characterized by preferential processing of the eye region and region-specific modulation associated with emotional expression and stimulus characteristics.
Nature exposure has been associated with improvements in physiological, emotional, and cognitive functioning. However, workplace research has primarily focused on visual access to nature, despite nature being inherently a multisensory experience. Drawing on Attention Restoration Theory (ART), Stress Reduction Theory (SRT), and emerging work on olfactory environments ("smellscapes"), this study examines how visual and olfactory nature stimuli independently and jointly influence cognitive and behavioral outcomes in workplace settings. A between-subjects experiment (N = 256) employed a 2 × 2 design (visual: present vs. absent × olfactory: present vs. absent). Participants completed tasks assessing attention, memory recall, abstract reasoning, risk aversion, and dishonest behavior. Outcomes were analyzed using two-way factorial ANOVA to evaluate the independent and combined effects of exposures, with supplementary one-way ANOVA conducted across the four conditions. Blink rate was also recorded via continuous eye-tracking as a physiological indicator of cognitive load, alongside facial expression data to contextualize affective responses. Effects varied by sensory condition and outcome. Visual exposure was associated with improvements in attention and abstract reasoning, whereas olfactory exposure was associated with memory performance and dishonest responding. Significant interactions were observed for several outcomes, including attention, memory, risk-taking, and dishonest responding. Blink rates were generally lower under nature exposure conditions than in the control condition. Physiological measures indicated reduced blink rates under nature exposure conditions relative to control environments, suggesting differences in visual attention and task engagement across experimental conditions. These findings suggest that multisensory nature exposure differentially influences cognitive and behavioral processes in workplace environments rather than producing uniform benefits. By demonstrating that low-cost, passive interventions such as visual and olfactory cues can shape attention, decision-making, and mental overload, this study advances environmental psychology and supports the integration of multisensory design strategies to enhance workplace functioning and overall productivity.
The sleep monitoring terminal display (SMTD) designated for sleep cabins provides data visualizations of sleep profiles, yet poses challenges concerning visually informed interfaces. Given the scarcity of research on the SMTD interface, this study aims to evaluate the influence of SMTD-related factors, including stimulus areas of interest (AOIs), user experiences and tasks, on user visual perceptions while interacting with the SMTD system. Eye-tracking experimental contexts drawn from authentic settings are used to examine how the SMTD interfaces affect visual perceptions under varying tasks. Forty valid samples were collected, and pupil sizes (PSs), task performances, satisfaction, and usability were statistically compared and evaluated. The findings indicated that tasks had no significant effects, but user experiences and stimuli AOIs had significant main effects on PSs. In addition, task completion time ratio and tracking ratio between the two tasks varied; physical demand exceeded mental demand in task 1, whereas it was the opposite in task 2. The effectiveness of post-optimized interfaces was additionally substantiated through combining subjective ratings and objective metrics. The SMTD study provides novel insights for digital interface development and helps enhance users' integrated visual perception.
Current treatment for type 1 retinopathy of prematurity (ROP), including laser photocoagulation and intravitreal anti-vascular endothelial growth factor therapy, is invasive but necessary to prevent blindness. Experimental evidence and limited clinical experience suggest that topical steroids may reduce disease progression and the need for invasive treatment. To evaluate whether dexamethasone eye drops reduce the proportion of preterm infants with prethreshold ROP progressing to treatment-requiring type 1 ROP. The DROPROP trial was a double-masked randomized clinical trial at 6 university hospitals and 8 county hospitals in Sweden. It evaluated infants born before 30 weeks' gestational age (GA), from 2022 to 2025, with severe ROP. Data analysis was performed from November 2025 to January 2026. Infants were randomized to receive dexamethasone eye drops (1 mg/mL) or placebo (saline). One eye drop was administered every day or every other day for up to 12 weeks. The primary outcome was progression to type 1 ROP requiring invasive treatment. Logistic regression adjusted for GA and site was used for the primary analysis. Intention-to-treat analysis was performed. Adverse events were monitored as safety outcomes. Among 100 infants, the mean (SD) GA at birth was 25.1 (1.4) weeks, 42 (42.0%) were female, and the mean (SD) birth weight was 712.9 (202.1) g. In the intention-to-treat population, type 1 ROP occurred in 10 of 50 infants (20.0%) in the dexamethasone group and 19 of 50 infants (38.0%) in the placebo group (adjusted odds ratio, 0.44; 95% CI, 0.17-1.12; P = .08), corresponding to a relative risk reduction of 47%. In the per-protocol population, type 1 ROP occurred in 9 of 48 infants (18.8%) in the dexamethasone group vs 19 of 49 infants (38.8%) in the placebo group (adjusted odds ratio, 0.40; 95% CI 0.15-1.05). No clinically significant differences in adverse events were observed between groups. Timely administration of topical dexamethasone numerically reduced the risk of prethreshold ROP progressing to treatment-requiring type 1 ROP. Although the analysis did not reach statistical significance, these findings suggest that topical dexamethasone may be a safe, noninvasive strategy to reduce the need for invasive treatment. euclinicaltrials.eu Identifier: 2023-505318-97-00.
Social determinants of health (SDOH) screenings have identified disproportionate inequities in Hispanic populations that increase diabetes risk, yet they rarely lead to interventions. Churches are trusted community hubs with the potential to address health needs; however, partnerships with Hispanic churches remain largely unexplored. To assess the feasibility of a church-based, community health worker (CHW)-led program to identify and address SDOH inequities in a Hispanic community. Pilot quasi-experimental feasibility study PARTICIPANTS: Forty-seven Hispanic adults, predominantly women (74.5%), with a mean age of 51 years INTERVENTIONS: Five church congregants obtained CHW state certification (160-h course) and received training in teaching skills, diabetes self-management, and SDOH. With ongoing mentoring, CHWs led a 6-month diabetes prevention and self-management program with monthly in-person education and weekly mHealth coaching focused on addressing SDOH inequities in the healthcare access and quality domain. Feasibility was assessed across eight pre-established variables (integration, expansion, demand, implementation, limited efficacy, acceptability, practicality, and adaptation), including CHWs' ability to address SDOH inequities such as insurance coverage, established medical home, primary care utilization, eye exams, medication access, and glucose monitoring. CHWs completed 97.3% of planned weekly mHealth contacts, identified and addressed 92.8% of participant concerns, and conducted all in-person education sessions per protocol. Healthcare access improved significantly: insurance coverage/clinic eligibility (66.0 to 85.1%; p = 0.025), established medical home (61.7 to 91.5%; p < 0.0001), time since last primary care visit (16.2 to 1.4 months; p = 0.017), and annual eye exams (25.0 to 64.3%; p < 0.0001). On a 5-point Likert scale, participants increased access to medications (Δ = 0.54; p = 0.03), medical care (Δ = 0.67; p = 0.012), and a primary care provider (Δ = 0.79; p = 0.009). Among participants with diabetes, glucose monitoring increased from 0.5 to 1.4 times daily (p = 0.017). Findings support the feasibility of partnering with Hispanic churches to both identify and address healthcare access SDOH inequities.
Eye movement desensitisation and reprocessing (EMDR) is a guideline-recommended treatment for post-traumatic stress disorder (PTSD), but evidence in survivors of critical illness remains limited. We assessed the feasibility, acceptability, and safety of EMDR for critical care survivors with clinically significant post-traumatic stress symptoms, and generated exploratory clinical outcome estimates to inform a future definitive trial. We conducted a mixed-methods, randomised, single-blind, parallel group-controlled, feasibility trial at three UK National Health Service hospitals. Adults (≥18 years) with an intensive care stay >24 h were approached before hospital discharge and followed within an observational cohort. At 2-3 months, participants were screened for post-traumatic stress symptoms (Impact of Event Scale-Revised); those scoring ≥22 were invited and randomly assigned (1:1) to EMDR plus treatment as usual (TAU) or TAU. EMDR comprised up to 16 sessions delivered face-to-face or online by accredited therapists. Primary outcomes were feasibility (recruitment, retention, intervention uptake, fidelity) and safety. Symptoms were assessed using Clinician-administered PTSD Scale for Diagnostic and Statistical Manual-5 (CAPS-5) at 3 and 12 months. Analyses followed intention-to-treat principles. The trial was registered on ClinicalTrials.gov (NCT05591625) and is closed to recruitment. Between Feb 20, 2023, and May 13, 2024, 160 patients were recruited to the observational cohort; 40 were randomised, with 20 allocated to EMDR plus TAU and 20 to TAU. Median age was 59.5 years (IQR 52.0-66.0); 21 participants (53%) were female and 19 (48%) were male. At 12 months, 39 (98%, 95% CI 86.8-99.9) of 40 randomised participants completed CAPS-5 follow-up. In the EMDR plus TAU group, 18 (90%, 95% CI 68.3-98.8) of 20 participants initiated treatment; mean sessions attended was 10.4 (SD 7.0), and 15 (75%) of 20 completed a full therapeutic course. Mean CAPS-5 score change was -15.6 (SD 12.5) in the EMDR plus TAU group and -1.6 (SD 11.8) in the TAU group, giving an exploratory unadjusted between-group difference of -14.1 points (95% CI -22.0 to -6.2). No treatment-related serious adverse events were identified. A staged trial pathway of symptom screening, clinician-rated PTSD assessment, randomisation, and EMDR delivery was feasible and broadly acceptable in survivors of critical illness with clinically significant post-traumatic stress symptoms. Exploratory clinician-rated PTSD outcome estimates were hypothesis-generating and support progression to a definitive multicentre trial, but should not be interpreted as evidence of treatment effectiveness. Andrew Bates was funded by National Institute for Health and Care Research Clinical Doctoral Research fellowship (grant number: NIHR302160).
Glaucoma is a leading cause of irreversible blindness worldwide, yet available treatments fail to prevent disease progression for all patients. It is characterized by a progressive dysfunction and loss of retinal ganglion cells. Neuroinflammation has been recognized as an underlying neurodegenerative mechanism of glaucoma in animal models and human post-mortem samples, and targeting neuroinflammation may provide additional means to neuroprotection. Galectin-3, a pro-inflammatory mediator encoded by the LGALS3 gene in humans, holds promise as a treatable target as its pharmacological and genetic inhibition is neuroprotective in multiple models of experimental glaucoma. However, the role of Galectin-3 in glaucoma remains unclear, particularly whether its emergence is a consequence of degeneration, or occurs at earlier time points. To address these knowledge gaps, we labeled IBA1, GFAP, and Galectin-3 in retina sections at early glaucoma stages in the rat bead glaucoma model, and in human retina from glaucoma donors. In the rat, IBA1 volume, but not GFAP, increased at an early, pre-degenerative timepoint. Accompanying this, we identified a significant increase of Galectin-3/IBA1 colocalization compared to control at the same timepoint, supporting the upregulation of Galectin-3 in early inflammation, preceding retinal ganglion cell degeneration in experimental glaucoma. However, a significant increase in Galectin-3/GFAP colocalization compared to control at the same timepoint in the rat additionally associates Galectin-3 production with astrocytes and Müller glia. This Galectin-3 to Müller glia relationship was significantly pronounced in human glaucomatous retina, predominating over microglia co-labelling. We further demonstarted that human MIO-M1 Müller glia in vitro express Galectin-3, but this is not altered in response to glaucoma relevant stimuli (TNF-α or mild-metabolic stress from rotenone). Instead, Galectin-3 expression was altered in phagocytosing states from exposure to E. coli particles, brain synaptosomes, or apoptotic neuronal debris. These findings provide further insight into Galectin-3 and gross inflammatory responses in glaucoma pathology.
Preloaded Descemet membrane endothelial keratoplasty (plDMEK), in which eye-bank validated donor tissues are prepared, folded, and loaded into delivery devices prior to shipment, has emerged as a promising strategy to standardize and expand access to endothelial keratoplasty. Protocols developed with both endothelium-in (endo-in) and endothelium-out (endo-out) loading configurations have shown to improve surgical efficiency, reproducibility, and tissue utilization while lowering procedural barriers. We compiled current laboratory and clinical evidence on plDMEK and compared endo-in versus endo-out techniques to inform best practices. Following PRISMA guidelines, studies published between June, 2016, and August, 2025, were identified through PubMed, Scopus, Web of Science, and Google Scholar. Thirty-nine studies met inclusion criteria (19 clinical, 20 laboratory). Across 1420 clinical eyes, the overall sample size-weighted rebubbling rate was 25.5%; with rates of 30.4% for endo-in and 19.3% for endo-out grafts. Both configurations produced meaningful visual improvement from baseline (0.18 logMAR for endo-in, 0.12 logMAR for endo-out; p = 0.31) with endothelial cell loss (ECL) of 38% (endo-in) and 32% (endo-out) (p = 0.33) at 12 months. Laboratory studies showed a pooled ECL of 10.2% (9.4% endo-in, 11% endo-out; p = 0.4112) after storing in the delivery device for up to five days. Both approaches appear to be reliable, safe, and clinically acceptable methods for graft preparation and delivery. While endo-out technique shows a trend toward lower post operative rebubbling compared to endo-in, study heterogeneity underscores the need for standardized reporting, longer follow-up, and direct comparative trials to guide global clinical adoption.
The ongoing evolution of SARS-CoV-2, particularly Omicron sublineages harboring extensive RBD mutations, compromises the effectiveness of many existing neutralizing nanobodies. Here, we present an integrated computational-experimental framework to prioritize nanobodies with favorable predicted interaction profiles across mutated RBD backgrounds and to explore their potential for biparatopic engineering. Thirty-two nanobody-RBD complexes from the Protein Data Bank were computationally screened across eight Omicron sublineages (BA.1-XBB.1.5). Selected nanobodies were then further evaluated against the Wuhan reference strain and XBB.1.5-the predominant sublineage at the onset of laboratory testing-using molecular simulations and conventional virus neutralization tests (cVNTs) performed in three biological replicates. These analyses led to the prioritization of MR17 and Sb14. In subsequent cVNT assays, MR17 showed a significantly higher neutralization titer against XBB.1.5 than against the Wuhan reference strain, whereas Sb14 showed comparable titers against both targets. A biparatopic Sb14-MR17 construct exhibited a significantly higher neutralization titer against XBB.1.5 than either monomeric nanobody. In addition, the interaction profiles of selected candidates with the emerging NB.1.8.1 RBD were evaluated computationally. Collectively, these results highlight multi-sublineage computational triage, together with targeted experimental validation, as a practical strategy for prioritizing nanobody candidates under ongoing SARS-CoV-2 antigenic drift.
Hair follicle regeneration depends on coordinated interactions between different cells and signaling pathways controlling proliferation. Biologically derived injectable formulations, including human secretomes, plant exosomes, and hybrids, are emerging as potential therapeutics, yet their efficacy in intact skin is not understood. The aim of this research was to evaluate and compare the effects of human adipose-derived secretomes, plant-derived exosomes, and a hybrid exosome formulation on hair regeneration in intact skin. A randomized, blinded, controlled study was conducted in healthy hamsters. Each animal received two intradermal injections of human secretomes, plant exosomes, hybrid secretomes, or saline with untreated animals as baseline controls. Skin biopsies were collected at baseline, 73 days, and 93 days. Histology (H&E) assessed follicular morphology, and immunohistochemistry for Ki67, β catenin, and CD34 quantified proliferation, Wnt activation, and stem cell involvement. Ki67-positive cells were highest in hybrid secretomes, followed by plant exosomes and human secretomes, with the lowest levels in controls. Nuclear β catenin localization was most pronounced in human secretome-treated follicles, followed by plant exosomes and hybrid secretomes, whereas controls were largely negative. CD34 expression was highest in hybrid secretomes, followed by human secretomes and plant exosomes, with minimal staining in controls. The hybrid secretomes most effectively stimulated proliferative and stem cell-associated markers, whereas human secretomes showed strong Wnt/β catenin activation, highlighting differential mechanistic effects of these formulations.
To evaluate the effectiveness of combining patching with active vision therapy, compared to patching with placebo training on contrast sensitivity (CS) in pediatric participants with bilateral refractive amblyopia. In this double-blind, clinical trial, 43 participants aged 5-8 with bilateral refractive amblyopia, unresponsive to spectacles, were randomly assigned to either the experimental group (active vision therapy plus patching) or the control group (placebo treatment with patching) for four months. Active therapy included anti-suppression, accommodative, vergence, and visual memory exercises. CS was measured at baseline and after four months, serving as key outcome measures. Forty participants (20 in each group) completed the study. The mean age for the experimental group (5 males) was 6.10±0.84y, and 6.50±1.15y for the control group (11 males). CS in the experimental group improved by 0.10 log (right eye), 0.14 log (left eye), and 0.07 log binocularly (P≤0.03). The control group showed no statistically significant enhancements in monocular or binocular CS (P≥0.07). Compared to the control group, the experimental group demonstrated a rate of change in monocular CS of 0.05 during follow-up time. Active vision therapy leads to significant and accelerates improvements in CS among children with bilateral refractive amblyopia.
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To evaluate the mid-term impact of Hydrus Microstent implantation on refractive and corneal astigmatism. Eyes undergoing Hydrus Microstent implantation were retrospectively collected. Subjective refraction was required at baseline and at 3 and 12 months postoperatively. Corneal tomography was optional (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany). Astigmatism was analyzed using three-dimensional power vector analysis. Forty-two eyes of 35 patients were implanted with a Hydrus Microstent, including 15 eyes treated as a stand-alone procedure and 27 eyes combined with phacoemulsification. In the overall cohort, mean refractive cylinder remained stable from baseline (CD0 = -1.27 ± 0.94 D) to 3 months (CD90 = -1.33 ± 1.29 D, p = 0.6) and 12 months (CD360 = -1.48 ± 1.33 D, p = 0.08). Blurring strength vector B was stable between 3 and 12 months (p = 0.8; pPhacoemulsification = 0.7; pStand-alone >0.9). None of the power vector components J0 and J45 showed significant effects of time, group, or their interaction in any cohort. Tomography data were available for 20 eyes of 18 patients, with half undergoing stand-alone implantation. J0, J45, and B of both anterior and posterior surface astigmatism remained stable over time, with no significant effects of surgical group or of the interaction between group and time. Hydrus Microstent implantation does not affect corneal and refractive astigmatism after 12 months.
To investigate the associations of a one-year intermittent, high-illuminance crystal pure full-spectrum lighting scheme on refractive development, axial length growth, and choroidal thickness in school-aged children (6-10 years), and to assess the persistence of these associations after withdrawal. A total of 198 primary school students are randomly assigned into an experimental group (n=102) receiving high-illuminance crystal pure full-spectrum lighting and a control group (n=96) receiving conventional LED lighting. The intervention involves 4 hours of daily exposure during school hours for one year. Axial length, axial curvature ratio, and macular choroidal thickness are measured bilaterally at five time points. The experimental group demonstrates a significantly smaller increase in axial length and a more pronounced increase in choroidal thickness compared to the control group. The axial curvature ratio improves significantly in the experimental group (3.02 ± 0.07) versus the control group (p<0.001). Refractive changes show clear improvement post-intervention and maintain a regular pattern afterward. Furthermore, changes in choroidal vascular index are significantly higher in the experimental group during both autumn (1.38 ± 0.79%) and spring (1.52 ± 0.86%) intervention periods (p<0.001). The density of choriocapillaris flow deficit also decreases significantly in the experimental group (13.11 ± 3.80%) compared to controls. Intermittent high-illuminance crystal pure full-spectrum lighting was associated with choroidal thickening and slower axial elongation in children, offering a promising, evidence-based strategy for myopia prevention and control within school environments.
Synesthesia describes cross-over processes that can generate 'extra' conscious percepts, such as seeing additional color when reading numbers. While existing research focuses on the mechanisms and effects of synesthetic associations, it often overlooks its most distinctive feature: unique sensory phenomenology. Here, we introduce pupillometry as an objective physiological measure of synesthetic color phenomenology. Across 16 grapheme-color synesthetes and two matched control groups, pupil responses tracked the brightness of synesthetic colors under constant physical visual input, scaling with self-reported strength. Synesthetic colors elicited pupil dynamics comparable to real colors, dissociating synesthetes from non-synesthetes. These responses emerged too rapidly to reflect imagery and scaled with reported color brightness, revealing cross-over caused genuine perceptual processing. Controls required to generate color associations showed greater effort-linked pupil dilation than synesthetes or controls who did not report colors, providing evidence for the effortless nature of synesthesia. Synesthesia thus provides a tractable human model for studying physiologically measurable phenomenology. Perception feels like a window onto the world, but it never is. What we see is built from what reaches the eye and from what the brain adds. In synesthesia, that second part is easy to spot. People with synesthesia involuntarily experience additional sensations triggered by ordinary stimuli, for example, seeing the number 5 as always appearing red, or hearing a trumpet and perceiving it as bright yellow. This is not imagination or a choice; the experience simply happens. The most common form is grapheme-color synesthesia, where letters and numbers reliably evoke specific colors. Synesthesia is not a 'disease', most synesthetes enjoy the additional sensations and find them useful (e.g., the additional colors help to remember a telephone number). Although synesthesia has been studied for decades, measuring it objectively has proven difficult because researchers have had to rely largely on self-report. Strauch, Leenaars and Rouw studied what happens to the eyes when people experience the colours. They tested 16 grapheme-color synesthetes and two matched control groups of 16 participants each, measuring pupil sizes while the participants viewed gray digits. Synesthetes' pupils became smaller for digits evoking brighter synesthetic colors and became larger for darker ones despite identical physical stimulation of the digits on the screen. Pupil responses were also stronger for digits for which synesthetes had reported a strong color association. Synesthetes did not seem to use visual imagery to evoke their colors, as their pupil responses were too fast for deliberate imagery. The control group, who had to report a random color with digits, did not show effects in their pupil size related to color brightness. Furthermore, controls needed more effort to perform the task. I.e., their pupils widened more than those of synesthetes doing the same task, and more than in controls with no color task. Pupillometry offers researchers a low-cost, objective tool for identifying synesthesia. Objective measurement helps demonstrate that synesthetic experiences are 'real' and offers a method to objectively map out (variations in) synesthetic experiences. This is particularly important for synesthetic children, who are often misunderstood when they report their experiences during schoolwork involving letters or digits. Pupillometry makes synesthesia usable as a model for a larger question. Because the sensory extra (the color) has no physical counterpart on the screen, the method opens a way to study how the brain builds conscious perception.
The ocular surface is a sensory-rich mucosal barrier in which trigeminal input, autonomic output, tear composition, epithelial stress, glandular secretion, goblet-cell function and local immunity are closely coupled. This review uses the sensory-secretory mucosal immune unit as a tissue-level map across four measurable output domains: secretory function, neural state, immune activity and barrier integrity. The term is not proposed as a new anatomical compartment or as a renamed lacrimal functional unit or eye-associated lymphoid tissue. Direct ocular evidence is distinguished from ocular-adjacent observations and cross-barrier analogies, particularly for cytokine-neuron, microbiome-neuron and mucosal-drainage pathways. Dry eye disease, allergic conjunctivitis and neurotrophic keratopathy are compared as overlapping but distinct patterns of circuit failure, with dry eye disease framed as sensory-autonomic dysfunction, allergic conjunctivitis as type 2 neuroimmune amplification and neurotrophic keratopathy as sensory denervation with impaired epithelial repair. The review also considers lacrimal drainage, nasal mucosal continuity and regional eye-draining lymph nodes as conditional antigen-handling routes. Emphasis is placed on paired secretory, neural, immune and barrier readouts that may help define the dominant failing process and guide intervention studies.
The recent pilot simulation study by Greenberg and colleagues introduced a proof-of-concept audio-visual support system for anesthesiology professional management of perioperative patient deterioration. The results demonstrated that real-time decision support for providers may enhance diagnostic accuracy/efficiency. In collaboration with Greenberg and colleagues, the authors from Massachusetts General Brigham (MGB) similarly developed a realistic operating room simulation environment at Massachusetts General Hospital (MGH) Learning Center. Here, the ability of anesthesiology trainees to accurately diagnose and treat using audio-visual cues was measured. This study is a prospective, randomized controlled pilot trial adapted from a recent study further investigating the impact of audio-visual decision support on anesthesiology resident and student nurse anesthetist diagnostic accuracy and efficiency. This study took place entirely at Massachusetts General Hospital Center for Simulation and Innovation. Twenty-one anesthesiology trainees were randomized into 2 groups: (1) standard of care (control) versus (2) audio-visual cue group (experimental). The experimental group received audio-visual cues such as a choice of possible diagnoses from an experienced anesthesiologist and subsequent recommended interventions from the Stanford emergency manual and based on changes in the simulated patient's vitals. Each participant underwent 3 experimental simulations where patient deterioration occurs. These included: anaphylaxis, amniotic fluid embolism (AFE), and pulseless electrical activity (PEA) arrest during a pediatric dental case. Key time points and accuracy of diagnoses and treatment steps were recorded. The simulation scenario recordings for 10 anesthesiology residents and 11 student nurse anesthetists of various training years were investigated. For the anaphylaxis scenario, there was a statistically significant increase in the number of participants who correctly executed intervention 1 in the intervention group compared with the control group (P=0.0015). For the AFE scenario, there was a statistically significant increase in the median time to intervention 1 for SRNAs in the intervention group compared with the control group (P=0.01). However, there was a statistically significant decrease in the median time to intervention 1 for residents in the intervention group compared with the control group (P=0.01). For the pediatric dental scenario, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 2 (P=0.005). In addition, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 3 (P=0.023). The results indicate that real-time audio and visual cues in a simulated operative environment may improve time to diagnosis and treatment. This effect has now been investigated across the training spectrum from resident trainees to attendings. On the basis of observations from these simulations, this mode of simulation can be an effective educational tool for simulation-based learning exercises. In education or real-time practice, additional dedicated research and development of decision support technology could be beneficial in improving safety during periprocedural care by guiding best training practices.
In endemic countries, people remain at risk of contracting both malaria and typhoid concurrently. Though experimental animal models are very reliable for understanding human diseases, the rat model for Plasmodium-Salmonella coinfection remains underresearched. The present study was performed to characterize the rat model of malaria-typhoid coinfection focusing on physical, hematological, and biochemical parameters. Thirty-four Wistar rats were distributed into five groups including normal control, immunosuppressed, Salmonella-infected, Plasmodium-infected, and Salmonella-Plasmodium-coinfected. Physical signs, mobility, and the fecal appearance of animals were observed. Plasmodium load was monitored through microscopic Giemsa-staining thin blood smears. Concurrently, Salmonella load was evaluated after feces culture in Shigella-Salmonella agar medium based on the McFarland turbidity to determine the number of colony-forming units. Hematological and biochemical parameters were assessed using an automatic hematology analyzer and a spectrophotometer, respectively. All the infected animals exhibited at least one clinical sign including piloerection, eye depigmentation, or hyperthermia. Coinfected animals showed severe anemia, leukocytosis, and thrombocytosis compared with monoinfected animals. A significant (p < 0.001) drop in total blood proteins and cholesterol levels was observed in infected rats, with a remarkable decrease in Salmonella-Plasmodium-coinfected rats, whereas transaminase levels significantly (p < 0.001) increased in the same coinfected group. This model provides many important features of Salmonella and Plasmodium sequential coinfection and therefore may be used as a tool to better understand, diagnose, and care for human malaria and/or typhoid pathogenesis.
Retinal vein occlusion (RVO), a common retinal vascular disease, is frequently treated with anti-vascular endothelial growth factor (anti-VEGF) agents as first-line therapy. However, anti-VEGF monotherapy lacks neuroprotective effects, primarily targets vascular leakage and neovascularisation, and requires frequent long-term injections that impose substantial economic burdens. Therefore, combined therapeutic strategies that address both vascular pathology and neural damage are being explored. This article describes the protocol for evaluating mecobalamin (a widely used neuroprotective drug) in combination with anti-VEGF for the treatment of macular edema (ME). The study is a randomised, double-blind, placebo-controlled clinical trial that will enrol 120 patients with RVO from the First Affiliated Hospital of Chongqing Medical University. Participants will be randomly assigned (1:1) to an experimental group and a control group. The experimental group will receive intravitreal injections of conbercept plus oral mecobalamin for 6 months, while the control group will receive the same conbercept regimen plus a placebo for 6 months. All patients will undergo 1 year of follow-up after initial treatment, with visits at 1, 3, 6, 9 and 12 months. The primary outcome is the change in central subfield thickness from baseline to 1 year post initial treatment. Secondary outcomes consist of change in the best-corrected visual acuity from baseline over time, capillary density, cone photoreceptor distribution characteristics, mean light sensitivity and fixation stability, serum vitamin B12 levels, the number of treatments, frequency of injection (times per year), interval time, incidence and severity of adverse events (AEs) and serious AEs. Statistical analyses will use appropriate parametric and non-parametric tests for group comparisons, correlation analyses, and multivariate modelling. This study has been approved by the Research Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (No. 2025-387-01). The results will be disseminated through conference presentations and publication in peer-reviewed international journals. NCT07133438.