Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Progress in corneal wound healing

Surrogate markers of diabetic neuropathy are being actively sought to facilitate the diagnosis, measure the progression, and assess the benefits of therapeutic intervention in patients with diabetic neuropathy. We have quantified small nerve fiber pathological changes using the technique of intraepidermal nerve fiber (IENF) assessment and the novel in vivo technique of corneal confocal microscopy (CCM). Fifty-four diabetic patients stratified for neuropathy, using neurological evaluation, neurophysiology, and quantitative sensory testing, and 15 control subjects were studied. They underwent a punch skin biopsy to quantify IENFs and CCM to quantify corneal nerve fibers. IENF density (IENFD), branch density, and branch length showed a progressive reduction with increasing severity of neuropathy, which was significant in patients with mild, moderate, and severe neuropathy. CCM also showed a progressive reduction in corneal nerve fiber density (CNFD) and branch density, but the latter was significantly reduced even in diabetic patients without neuropathy. Both IENFD and CNFD correlated significantly with cold detection and heat as pain thresholds. Intraepidermal and corneal nerve fiber lengths were reduced in patients with painful compared with painless diabetic neuropathy. Both IENF and CCM assessment accurately quantify small nerve fiber damage in diabetic patients. However, CCM quantifies small fiber damage rapidly and noninvasively and detects earlier stages of nerve damage compared with IENF pathology. This may make it an ideal technique to accurately diagnose and assess progression of human diabetic neuropathy.

https://diabetes.diabetesjournals.org/content/diabetes/56/8/2148.full.pdf

Surrogate Markers of Small Fiber Damage in Human Diabetic Neuropathy

Purpose:To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia.Methods:Patients who had a corneal scraping for culture over a 5-year period wer

Risk factors and causative organisms in microbial keratitis.

Acanthamoeba keratitis: diagnosis and treatment update 2009.

Clinical characteristics of microbial keratitis in a university hospital in Taiwan.

Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001

Decreased Density of Corneal Basal Epithelium and Subbasal Corneal Nerve Bundle Changes in Patients with Diabetic Retinopathy

Purpose. To determine the leading indications for penetrating keratoplasty and to identify changing trends in these indications during the past 12 years. Methods. We retrospectively performed a chart review of the hospital records of all patients undergoing penetrating keratoplasty at the National Taiwan University Hospital during a 12-year period (1987–1999). When possible, the clinical indication was corroborated by the pathologic report. Results. A total of 770 corneal transplants were performed. The leading indications for penetrating keratoplasty, in order of decreasing frequency, were corneal scars (27.9%), regraft (21.0%), acute necrotizing and ulcerative keratitis (17.9%), pseudophakic or aphakic bullous keratopathy (17.6%), Fuchs' dystrophy (4.5%), and keratoconus (2.5%). A trend of increasing frequency of regraft and acute necrotizing and ulcerative keratitis, a decreasing frequency of corneal scar, and an initially decreasing then increasing frequency of pseudophakic and aphakic bullous keratopathy were found during the 12-year study period. Acute necrotizing and ulcerative keratitis was found to be the most frequent indication for regraft. Conclusion. In this series, corneal scars, regraft, and acute necrotizing and ulcerative keratitis were the leading indications for penetrating keratoplasty. A changing incidence of pseudophakic and aphakic bullous keratopathy noted during the study period was related to the type of intraocular lens implanted and the method of cataract surgery performed. This study found a comparatively high frequency of acute necrotizing and ulcerative keratitis and an extremely low frequency of keratoconus compared with previous reports.

Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999.

Lumican, a small leucine-rich proteoglycan (SLRP), is one of the major extracellular components in interstitial collagenous matrices of the corneal stroma, aorta, skin, skeletal muscle, lung, kidney, bone, cartilage, and intervertebral discs.1–8 In the cornea, lumican contains keratan sulfate chains. However, it is present as a low or nonsulfated glycoprotein (50 –57 kDa) in noncorneal tissues.1,2,9–11 Its wide distribution implies that it has multiple functions in tissue morphogenesis and maintenance of tissue homeostasis. This is best illustrated by the multiple clinical manifestations observed in Lumican-knockout (lum−/−) mice that exhibit corneal opacity, skin and tendon fragility, delayed wound healing, and low fertility. Indeed, lumican has been shown to play essential roles in corneal transparency by regulating collagen fibrillogenesis8 in wound healing, by modulating epithelial cell migration,12 and in the epithelium–mesenchyme transition of the injured lens.13 These results have led to the speculation that lumican may play an active role in corneal epithelial wound healing.

Transplantation of human AM as a temporary or permanent graft has become a popular surgical procedure for ocular surface reconstruction.14,15 Besides the observation that cryopreserved AM reduces inflammation,16–21 scarring,22,23 and neovascularization,24 many clinical studies25–28 have shown that human AM as a graft promotes corneal epithelial wound healing. Furthermore, human AM can help preserve corneal limbal epithelial progenitor cells and maintain the keratocyte phenotype during ex vivo expansion.29–32 Nevertheless, the exact molecular mechanism of the aforementioned effects remains unknown.

The present study revealed that human AM is a rich source of soluble lumican glycoprotein and that purified soluble lumican glycoprotein can facilitate proliferation and migration of corneal epithelial cells during wound healing in both wild-type and lum−/− mice.

/pdf/soluble-lumican-glycoprotein-purified-from-human-amniotic-tmx49f9a0d.pdf

Wei-Li Chen

Papers

Clinical characteristics of microbial keratitis in a university hospital in Taiwan.

Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001

Decreased Density of Corneal Basal Epithelium and Subbasal Corneal Nerve Bundle Changes in Patients with Diabetic Retinopathy

Changing indications for penetrating keratoplasty in Taiwan from 1987 to 1999.

Soluble lumican glycoprotein purified from human amniotic membrane promotes corneal epithelial wound healing.