There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

Prospective Cohort Study

https://ebmt.co.uk/wp-content/uploads/2013/08/GVHD1.pdf

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report

The aim of the DEWS Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. These guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.

The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international Dry Eye WorkShop (2007)

Reactive oxygen species, antioxidants, and the mammalian thioredoxin system.

Aim: To determine the efficacy of using albumin tear supplements in the treatment of ocular surface disorders as a substitute for serum eye drops. Methods: The effects of albumin on the viability of serum deprived conjunctival cell were observed in vitro. The ability for albumin to compensate for serum was demonstrated by measuring the activity of the apoptosis related enzyme, caspase-3. In an animal study, corneal erosions were inflicted in 40 Japanese white rabbits. Rabbits were treated with 5% or 10% solutions of human albumin, and the decrease in epithelial defect size was compared with saline control and 0.3% sodium hyaluronate. A clinical case series trial of 5% albumin drops was conducted in nine patients with Sjogren's syndrome with severe dry eye. The addition of albumin to serum deprived conjunctival cells inhibited caspase activity and increased cell viability, showing that albumin can compensate for some of the physiological properties of serum. Corneal erosions in rabbits healed significantly faster (p,0.05) in eyes treated with 10% albumin compared with control and sodium hyaluronate. Patients with Sjogren's syndrome used albumin drops showed statistically significant improvement in fluorescein and rose bengal scores, but not in tear break up time and subjective symptoms. No adverse effects of albumin were observed during the study. Conclusions: The use of albumin as a protein supplement in artificial tear solutions is a viable approach in the treatment of ocular surface disorders associated with tear deficiency.

https://bjo.bmj.com/content/bjophthalmol/87/10/1279.full.pdf

Albumin as a tear supplement in the treatment of severe dry eye.

The corneal epithelia of phakic control (n=13), aphakic control (n=10), diabetic phakic (n=10), and diabetic aphakic patients (n=13) were surveyed under a widefield specular microscope with a special contact lens. In control patients, the corneal epithelium showed relatively hexagonal cells, which w

Corneal epithelium in diabetic patients.

Objective—To examine the hypothesis that fetal microchimerism plays a part in the pathogenic process of Sjogren’s syndrome (SS). Methods—Genomic DNA samples were extracted from peripheral blood whole nucleated cells and the CD34+ cell enriched fraction of patients with SS and healthy women who had male oVspring as well as nulliparous women. A Y chromosome-specific sequence was detected as a marker for fetal cells by a nested polymerase chain reaction (PCR) and by DNA hybridisation combined with PCR using specific primers and probes. All procedures were performed with great care to avoid the contamination of male DNA. Results—A nested PCR and DNA hybridisation combined with PCR was established that can detect a single male cell out of 1.67×10 5 female cells. It was not possible to increase the sensitivity further because the amount of template DNA held in the PCR was limited. When these methods were used, no fetal cells were detected in any samples from patients with SS, though they were detected in whole nucleated cells from two healthy women who had delivered sons previously. Conclusions—The findings indicate that circulating fetal cells in patients with SS are uncommon (<1 in 1.67×10 5 ), if they exist. With the conventional PCR based methods that were used, it is diYcult to evaluate the quantitative diVerence in circulating fetal cells between patients with SS and healthy women. (Ann Rheum Dis 2001;60:248‐253)

https://ard.bmj.com/content/annrheumdis/60/3/248.full.pdf

Lack of evidence for an increased microchimerism in the circulation of patients with Sjögren's syndrome

Vitamin A, B9, C, E, and uric acid are well-known antioxidants and may prevent age-related eye disorders. The aim of the present study was to investigate the levels of antioxidant vitamins, A, B9, C, E, and antioxidative substance, uric acid in the serum of Japanese patients with normal-tension glaucoma and compare the results with normal controls. All subjects with suspicion of primary open-angle glaucoma who came to the glaucoma subspeciality clinic of Keio University Hospital were enrolled in this study. Sixty patients (28 males, 32 females; mean age ± standard deviation: 59.9 ± 9.8 years) with newly diagnosed primary open-angle glaucoma patients were consecutively enrolled in this study. After the diagnosis of primary open-angle glaucoma, the patients underwent 24-h IOP measurements. Forty-seven newly diagnosed consecutive normal-tension glaucoma patients (18 males, 29 females; mean age ± standard deviation: 59.5 ± 10.2 years) were enrolled in this study. The control subjects were recruited from subjects who came to the clinic for annual refractive check-up. The 44 consecutive control subjects of the current study, (16 males, 28 females; 62.7 ± 14.8 years) did not have any ocular diseases. The serum levels of vitamins A, B9, C, E, and uric acid were measured. The values were compared between the normal-tension glaucoma and control groups by the Mann-Whitney U test. Serum levels of vitamin C were significantly lower in normal-tension glaucoma patients than in normal healthy controls (P = 0.04; normal-tension glaucoma; 4.6 ± 4.0 μg/ml control; 6.3 ± 3.9 μg/ml). Uric acid level was significantly higher in normal-tension glaucoma patients than in controls (P = 0.01; normal-tension glaucoma; 5.8 ± 1.5 mg/dl control; 4.9 ± 1.4 mg/dl). No statistically significant difference was seen in vitamin A (P = 0.41; normal-tension glaucoma; 82.1 ± 26.7 μg/dl control; 77.1 ± 30.1 μg/dl), B9 (P = 0.37; normal-tension glaucoma; 8.7 ± 4.3 ng/ml control; 8.0 ± 3.1 ng/ml)and E (P = 0.83; normal-tension glaucoma; 1.5 ± 0.6 control; 1.5 ± 0.6) levels between normal-tension glaucoma and control groups. Normal-tension glaucoma patients had lower serum levels of vitamin C and increased levels of uric acid. These observations may pave the way for possible alternative treatment for normal-tension glaucoma.

Reduced-serum vitamin C and increased uric acid levels in normal-tension glaucoma

BACKGROUND AND OBJECTIVE: This study was conducted to examine the usefulness of limbal autograft transplantation in the treatment of recurrent and advanced pterygia. PATIENTS AND METHODS: Eleven patients with recurrent and 16 with advanced pterygia (a total of 27 pterygia) were treated with limbal autograft transplantation. Once a pterygium had been excised, superior limbal tissue was taken with conjunctival flap and transferred to the excised area. RESULTS: All the grafts were planted promptly, and donor sites were re-epithelialized with no excessive scar tissue formation. Although slight recurrence was noted in 2 eyes (7.4%), subconjunctival tissue invasions were limited to less than 1 mm, and no further surgical interventions were needed. CONCLUSION: These results indicate that limbal autograft transplantation may be effective for the treatment of recurrent and advanced pterygia.

Kazuo Tsubota

Papers

Albumin as a tear supplement in the treatment of severe dry eye.

Corneal epithelium in diabetic patients.

Lack of evidence for an increased microchimerism in the circulation of patients with Sjögren's syndrome

Reduced-serum vitamin C and increased uric acid levels in normal-tension glaucoma

Limbal Autograft Transplantation for Recurrent and Advanced Pterygia