Hayashi Eye Hospital

Abstract Background Mechanical ventilation, a crucial intervention for acute respiratory distress syndrome (ARDS), can lead to ventilator-induced lung injury (VILI). This study focuses on individualizing mechanical power (MP) in mechanically ventilated patients to minimize VILI and reduce ICU mortality. Methods A retrospective analysis was conducted using the Amsterdam University Medical Centers Database (AmsterdamUMCdb) data. The study included patients aged 18 and older who needed at least 48 hours of pressure-controlled mechanical ventilation. Patients who died or were extubated within 48 hours and those with inadequate data were excluded. Patients were categorized into hypoxemia groups based on their PaO2/FiO2 ratio. MP was calculated using a surrogate formula and normalized to ideal body weight (IBW). Statistical analyses and machine learning models, including logistic regression and random forest, were used to predict ICU mortality and establish safe upper limits for IBW-adjusted MP. Results Out of 23,106 admissions, 2,338 met the criteria. Nonsurvivors had a significantly higher time-weighted average MP (TWA-MP) than survivors. Safe upper limits for IBW-adjusted MP varied across hypoxemia groups. The XGBoost model showed the highest predictive accuracy for ICU mortality. An individualization method for mechanical ventilation settings, based on real-time physiological variables, demonstrated reduced predicted mortality in a subset of patients. Discussion Elevated TWA-MP is associated with increased ICU mortality, underscoring the need for personalized mechanical ventilation strategies. The study highlights the complexity of VILI and the multifactorial nature of ICU mortality. Further studies to define a safe upper limit for IBW-adjusted MP may help clinicians optimize mechanical ventilation settings and decrease the risk of VILI and mortality. Conclusions Despite the fact that the study's retrospective design and reliance on a single-center database may limit the generalizability of findings, this study offers valuable insights into the relationship between mechanical power and ICU mortality, emphasizing the need for individualized mechanical ventilation strategies. The findings suggest a potential for more personalized, data-driven approaches in managing mechanically ventilated patients, which could improve patient outcomes in critical care settings.

We present the first record of Dixella aliciae (Johannsen) in Mexico, collected in the locality of Lagunas de Zempoala National Park, Morelos state. Additionally, a new species of the genus Dixella Dyar & Shannon, Dixella machiotla sp. nov., is described and illustrated; specimens were collected in a cloud forest at an altitude of 1750 meters, in the Municipality of Tlanchinol, Hidalgo state. This new species is characterized by the shape of the gonostylus, with its distinctive digitiform mesially directed process, and dark brown katepisternum, with a small pale spot in the middle of the posterior margin.

The concept of women human rights defenders is not as an attempt to exclude women from the role of human rights defenders in general, but because their involvement in human rights defense efforts is often underrecognized and invisible. Inequality in the relationship between men and women is still a marginal discussion due to the inferiority of women. The idea that women's human rights are part of human rights (women's rights are human rights), including defenders of their human rights, needs to be fought for. Local social, religious and cultural values ​​are problematic for women's human rights defenders. State responsibility and legal protection for women human rights defenders is a common concern. Reflecting on the Declaration of Human Rights Defenders shows that the world community has guaranteed the rights of every human being. The approach used is a normative juridical approach with Statute Approach. This research approach is approach. Issues of human rights, state responsibility, and legal protection for women human rights defenders are not taken seriously by the state. The lack of provisions to protect women human rights defenders places them in a vulnerable and dangerous situation. There is a legal vacuum to protect women human rights defenders. This can be used as a reference in developing security protection for women human rights defenders and their institutions because they are vulnerable to violence and criminalization by various groups. Keywords: Responsibility, Protection, Human Rights Defenders, Women

To examine the incidence and characteristics of eyes with oblique astigmatism stratified by meridian, age, sex, and eye side (left to right). One thousand eyes of 1000 patients with oblique corneal astigmatism underwent videokeratographic examination and was classified into 4 meridian categories: (1) 31°-45°, (2) 46°-59°, (3) 121°-135°, and (4) 136°-149°. Amounts of regular and irregular astigmatism, and the vertical/horizontal (Rx) and oblique astigmatism components (Ry) decomposed using vector analysis were compared among the 4 categories and age groups, and between sexes and eye sides. Incidences of the 4 meridian categories were similar and did not differ significantly among age groups or between sexes. The incidence was significantly greater in eyes in meridian categories 1 and 2 in the left eye and categories 3 and 4 in the right eye, and significantly greater in men in their 40 s and 50 s and in women in their 70 s and 80 s (P < 0.0001). The mean regular astigmatism, asymmetry and higher-order irregularity components, and Rx and absolute Ry significantly increased with age (P ≤ 0.0372). The mean regular and irregular astigmatism, and absolute Rx and Ry did not differ significantly among the 4 categories, or between sexes or left and right eyes. The incidence of oblique astigmatism was significantly greater in the temporal side meridians, and the incidence in women increased with age. The degree of oblique astigmatism increased with age, with an increase in irregular astigmatism.

Abstract OBJECTIVE: To examine the incidence and characteristics of eyes with oblique astigmatism stratified by meridian, age, sex, and eye side (left to right). METHODS: One thousand eyes of 1000 patients with oblique corneal astigmatism underwent videokeratographic examination, and was classified into 4 meridian categories: 1) 31°-45°, 2) 46°-59°, 3) 121°-135°, and 4) 136°-149°. Amounts of regular and irregular astigmatism, and the vertical/horizontal (Rx) and oblique astigmatism components (Ry) decomposed using vector analysis were compared among the 4 categories and age groups, and between sexes and eye sides. RESULTS: Incidences of the 4 meridian categories were similar, and did not differ significantly among age groups or between sexes. The incidence was significantly greater in eyes in meridian categories 1 and 2 in the left eye and categories 3 and 4 in the right eye, and significantly greater in men in their 40s and 50s and in women in their 70s and 80s (P &lt; 0.001). The mean regular astigmatism, asymmetry and higher-order irregularity components, and Rx and absolute Ry significantly increased with age (P ≤ 0.037). The mean regular and irregular astigmatism, and absolute Rx and Ry did not differ significantly among the 4 categories, or between sexes or left and right eyes. CONCLUSIONS: The incidence of oblique astigmatism was significantly greater in the temporal side meridians, and the incidence in women increased with age. The degree of oblique astigmatism increased with age, with an increase in irregular astigmatism.

Background: The aim of this study was to evaluate the most common underlying genetic and clinical etiologies of retinitis pigmentosa (RP) disease in our geographical area. Material and Method: In our archive, there are about 3000 patients who applied to our clinic between the years 2015-2021. The files of approximately 700 patients with a definitive genetic diagnosis were retrospectively scanned. A definitive genetic diagnosis was made in 22 of these patients. During our research, we collected some clinical parameters including the prenatal, natal, and postnatal history of the patients, history of surgery and seizures, and family history. In family history, we did a detailed pedigree with at least 3 generational analyses, questioned parental kinship, looked for similar members in families, and identified inheritance patterns of their disorder. We draw 3 generations pedigree and we collected peripheral venous blood samples from patients and sent them to a commercial lab for gene panels or WES. After obtaining the definitive genetic diagnosis of all patients, we compiled a table with the other parameters we questioned. Results: As a result of our WES analysis in patients 1 and 2, homozygous c.1331_1332 dupAG/p. Thr445ArgfsTer10 Class 2 variant was detected in the POC1B gene of patient #2.In the RP panel 1 reports of patients 3 and 4, the genomic alteration of c.2254dupA (p.Ser752Lysfs*14) was detected in exon 15 of the ABCA4 (NM_000350) gene. Patient 5, EYS c.4964T&gt;C heterozygous. Patient 6. SEMA4A C.1168A&gt;G (heterozygous). Patient 7, SEMA4A C.1168A&gt;G (heterozygous), RP1 c.5402C&gt;T (heterozygous), CGNB1 c.1382C&gt;T (heterozygous).Patient #8, . Heterozygous variation of p.Thr390Ala (c.1168A&gt;G) in the SEMA4A gene is present.As a result of our WES analysis, a homozygous c.2021C&gt;A/p.Pro674His Class 2 variant was detected in the RPGRIP1 gene of patient #9. Heterozygous c.119-2A&gt;C Class 1 mutation was detected in the NR2E3 gene of patient 10. Homozygous c.271C&gt;T/p.Gln91* Class 1 mutation was detected in the MFRP gene in patient 11. Patient #12 was diagnosed at the age of 7-8 years. When we look at the exome sequencing results, a homozygous mutation in the CNGB1 gene c.413-1G&gt; of patient 13 was detected. Heterozygous p.Ser361Tyr (c.1082C&gt;A) change detected in the ABCA4 gene of patient #14 was detected. The heterozygous p.Glu150Lys (c.448G&gt;A) change detected in the RHO gene of patient #15 was pathogenic according to ClinVar database and in silico analysis. rated as. Prediagnosis was Bardet-Biedle Syndrome in patient 16. P.Gly244Asp change was detected in RPE65 gene of patients 17 and 18. Automated DNA sequencing of patient #19 and patient #20 results in a homozygous sequence variation in the coding sequence of the NR2E3 genes, a homozygous CGG&gt;CAG nucleotide substitution, and an amino acid replacement of Arg311Gln. Heterozygous mutation was detected in the same gene region in patient 21 (fathers). Variation in NR2E3 is the most likely cause of these patients' eye condition, as it is a complete genotype and is strongly associated with RP in many published families. Genetic results on an allele of the BBS1 gene of patient 22 (chr11:66.278.121-66.291.364 (13.2kb)/ISCN: seq [GRCH37]11q13.2(66.278).121-66.291.364)x1). The other allele has a heterozygous point mutation (c.1424dupT p.Ser476fs-rs886039798). Conclusıons: As determined in our study, the disease can be encountered with many different genetic etiologies. In this regard, patients undergoing genetic testing should be carefully examined for both SNP (single nucleotide polymorphism) and CNV (copy number variation).In addition, before genetic tests are performed, it should be well determined whether there is an isolated RP or an accompanying RP. In this respect, patients should be evaluated by making a detailed anamnesis and physical examination and drawing a pedigree containing at least 3 generations. Therefore, it was concluded that accompanying abnormalities should also be examined in the evaluation of retinitis pigmentosa anomalies.