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Cataract Surgery

Capt. Joseph Pasternak, an ophthalmology surgeon at National Naval Medical Center Bethesda, lines up the laser on Marine Corps Lt. Col. Lawrence Ryder’s eye before beginning LASIK VISX surgery. The actual procedure can take only seconds, while most of the patient’s time is spent preparing for the procedure.  Photo credit: U.S. Navy photo by Mass Communication Specialist 1st Class Brien Aho; Public Domain, Wikipedia

 

 

A cataract is an opacification or cloudiness of the eye’s crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the 1) ___. If visual loss is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic intraocular lens (IOL). Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended. The clouding of the lens leads to a decrease in 2) ___. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry vision, halos around light, trouble with bright lights, and trouble seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause half of all cases of blindness and 33% of visual impairment worldwide. Cataracts are most commonly due to 3) ___ but may also occur due to trauma or radiation exposure, be present from birth, or occur following eye surgery for other problems. Risk factors include diabetes, smoking tobacco, prolonged exposure to sunlight, and alcohol. Either clumps of protein or yellow-brown pigment may be deposited in the lens reducing the transmission of light to the retina at the back of the eye. Diagnosis is by an eye examination. The genetic component is strong in the development of cataracts, most commonly through mechanisms that protect and maintain the lens.

 

Prevention includes wearing sunglasses and not smoking. Early on the symptoms may be improved with 4) ___. If this does not help, surgery to remove the cloudy lens and replace it with an artificial lens is the only effective treatment. Surgery is needed only if the cataracts are causing problems and generally results in an improved quality of life. Cataract surgery is not readily available in many countries, which is especially true for women, those living in rural areas, and those who do not know how to read. About 20 million people are blind due to cataracts. It is the cause of approximately 5% of blindness in the United States and nearly 60% of blindness in parts of Africa and South America. 5) ___ from cataracts occurs in about 10 to 40 per 100,000 children in the developing world, and 1 to 4 per 100,000 children in the developed world. Cataracts become more common with age. More than half the people in the United States had cataracts by the age of 80.

 

Blunt trauma causes swelling, thickening, and whitening of the lens fibers. While the swelling normally resolves with time, the white color may remain. In severe blunt trauma, or in injuries that penetrate the eye, the capsule in which the lens sits can be damaged. This damage allows fluid from other parts of the eye to rapidly enter the lens leading to swelling and then whitening, obstructing light from reaching the retina at the back of the eye. Cataracts may develop in 0.7 to 8.0% of cases following electrical injuries. Blunt trauma can also result in star- or petal-shaped cataracts.

 

Femtosecond laser-assisted cataract surgery (FLACS) has gained popularity in recent years with the new technology suggesting potential improvements in clinical and safety outcomes over conventional phacoemulsification cataract surgery (PCS). A decade since the advent of FLACS has given time and experience for laser technology to develop in maturity, and better quality evidence to become available.

 

Just behind the iris and pupil lies the lens, which helps focus light on the back of your eye. Most of the eye is filled with a clear gel called the vitreous. Light projects through your pupil and lens to the back of the eye. The inside lining of the eye is covered by special light-sensing cells that are collectively called the retina. It converts light into electrical impulses. Behind the eye, your optic 6) ___ carries these impulses to the brain. The macula is a small extra-sensitive area in the retina that gives you central vision.

 

In most cases, waiting to have cataract surgery won’t harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever. Complications after cataract surgery are uncommon, and most can be treated successfully.

 

Undergoing Tests: A week or so before your surgery, a painless ultrasound test is performed to measure the size and shape of the eye. This helps determine the right type of lens implant (intraocular lens, or IOL). The eye surgeon advises the patient to temporarily stop taking any medication that could increase risk of 7) ___ during the procedure. Use eyedrops to reduce infection risk. Antibiotic eyedrops may be prescribed for use one or two days before the surgery.

 

Fast before surgery. You may be instructed not to eat or drink anything 12 hours before the procedure.

 

Prepare for your recovery. Normally you can go home on the same day as your surgery, but you won’t be able to drive, so arrange for a ride home. Also arrange for help around home, if necessary, because your doctor may limit activities, such as bending and lifting, for about a week after your surgery.

 

Nearly everyone who has cataract surgery will be given an 8) ___ lens called an intraocular lens (IOL). These lenses improve your vision by focusing light on the back of your eye. You won’t be able to see or feel the lens. It requires no care and becomes a permanent part of your eye. A variety of IOLs with different features are available. Before surgery, you and your eye doctor will discuss which type of intraocular lens (IOL) might work best for you and your lifestyle. Cost may also be a factor, as insurance companies may not pay for all types of lenses. IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires few or no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.

 

Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. First, your doctor will place eyedrops in your eye to dilate your pupil. You’ll receive local anesthetics to numb the area, and you may be given a sedative to help you relax. If you’re given a sedative, you may remain awake, but groggy, during surgery. During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens. A laser or an ultrasound probe, will be used to break up the lens for removal. During a procedure called phacoemulsification, your surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed, to suction out the fragments of the lens. Using an advanced laser technique to remove the cloudy lens. In laser-assisted cataract surgery, the surgeon uses a laser to make all incisions and soften the cataract for removal. Once the cataract pieces have been removed the artificial lens is implanted into the empty lens capsule. After surgery, expect your vision to begin improving within a few days. Your vision may be blurry at first as your eye heals and adjusts. Colors may seem brighter after your surgery because you are looking through a new, clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting the look of colors. You’ll usually see your eye doctor a day or two after your surgery, the following week, and then again after about a month to monitor healing. It’s normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pushing on your eye. The surgeon will cover the healing eye with an eye patch or protective shield the day of surgery; and may also recommend wearing the eye patch for a few days after surgery along with the protective shield when you sleep during the recovery period. Doctor usually prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure. Sometimes, steroid medications can be injected into the eye at the time of surgery to keep inflammation at bay. After a couple of days, most of the discomfort should disappear. Often, complete healing occurs within eight weeks. Most people need glasses, at least some of the time, after cataract surgery. The doctor will inform whether the eye has healed enough to get a final prescription for eyeglasses. This is usually between one and three months after surgery.

 

Ophthalmology surgeons prefer to use the laser because it is simpler and quicker. While the laser avoids certain sources of human error and automates multiple steps of cataract surgery, users must still pay careful attention to what the laser will be doing. The precision benefits of the laser make surgeons very trusting of its performance. However, surgeons must be mindful to not flash quickly through all of the screens, assuming that the OCT pick-up of the lens capsule position is always correct. Results of a randomized controlled, real-world study in which the ophthalmologists-in-training were doing the surgery showed that FLACS significantly reduced the average total time spent in the OR compared with conventional phacoemulsifcation. The FS laser pretreatment reduces the duration of the operation. Most eye surgeons see the potential for laser surgery, offering a huge change in a world where cataract surgery will become even more automated and performed by a dedicated subspecialty group of surgeons. After the procedure, you usually stay in the doctor’s office for about an hour to make sure your eye pressure doesn’t rise. Other complications are rare but can include increased eye pressure and retinal detachment. The Johns Hopkins Medicine website reports that cataract surgery is among the 9) ___ (and pain free) surgeries performed today. For most people, cataract surgery is an outpatient procedure. After 10) ___, you’ll probably spend one or two hours in the post-op room with a protective eye covering. You should arrange for someone to drive you home and pick up any prescriptions, as you may not be able to drive right away

 

According to an AARP telephone survey of 250 people who had cataract surgery, 2 out of 3 said they were less dependent on glasses for distance vision after surgery. Additionally, two-thirds said they could read better (with or without glasses) after surgery, and 82% said cataract surgery made it easier to drive.

 

Sources: Mayo ClinicOphthalmology Times ; Wikipedia;

 

Click to see a short video describing cataract surgery.

 

ANSWERS: 1) retina; 2) vision; 3) aging; 4) glasses; 5) Blindness; 6) nerve; 7) bleeding; 8) artificial; 9) safest; 10) surgery

 

Cataract Surgery

A cataract surgery. Dictionnaire Universel de Medecine (1746-1748).

Graphic credit: Robert James (1703-1776); Wikipedia Commons; This work is in the public domain in its country of origin and other countries and areas where the copyright term is the author’s life plus 100 years or less. This file has been identified as being free of known restrictions under copyright law, including all related and neighboring rights.

 

 

Cataract surgery is one of the most frequently performed operations in the world. Recent advances in techniques and instrumentation have resulted in earlier intervention, improved surgical outcomes, and reduced dependence on spectacles.

 

The first record of cataract being surgically treated is by Susruta, who carried out the procedure in 600 BCE. Cataracts were treated using a technique known as couching, in which the opaque lens is pushed into the vitreous cavity to remove it from the visual axis. Couching is still performed in some parts of Africa and the Middle East. In 1753, Samuel Sharp performed the first intracapsular cataract extraction (ICCE) through a limbal incision. He used pressure from his thumb to extract the lens. In 1961, Polish surgeon Tadeusz Krwawicz developed a cryoprobe which could be used to grasp and extract cataracts during ICCE surgery. However, an aphakic spectacle correction was still required. When the first edition of the Community Eye Health Journal was published, ICCE was still the most widely practiced method of cataract extraction in low- and middle-income countries. However, in high-income countries, ICCE had been superseded by extracapsular surgery with an IOL implant.

 

Modern extracapsular cataract extraction (ECCE) gained acceptance in high-income countries after the introduction of operating microscopes during the 1970s and 1980s made it possible to perform microsurgery. The microscopes offered better intraocular visibility and the ability to safely place multiple corneal sutures. ECCE has the advantage of leaving the posterior capsule intact; this reduces the risk of potentially blinding complications and makes it possible to implant a lens in the posterior chamber. Phacoemulsification was introduced in 1967 by Dr Charles Kelman. Since then, there have been significant improvements in the fluidics, energy delivery, efficiency and safety of this procedure. Advantages include small incision size, faster recovery and a reduced risk of complications.

 

Manual small-incision cataract surgery (MSICS) is a small-incision form of ECCE with a self-sealing wound which is mainly used in low-resource settings. MSICS has several advantages over phacoemulsification, including shorter operative time, less need for technology and a lower cost. It is also very effective in dealing with advanced and hard cataracts. As with modern ECCE techniques, MSICS also allows for a lens to be implanted. A recent introduction is femtosecond laser-assisted cataract surgery, during which a laser is used to dissect tissue at a microscopic level. Initial results from the recent FEMCAT trial suggest little or no improvement in safety and accuracy compared to standard phacoemulsification, and the procedure brings with it new clinical and financial challenges. Today, although phacoemulsification is considered the gold standard for cataract removal in high-income countries, MSICS is hugely popular and practiced widely in many countries of the world because of its universal applicability, efficiency and low cost.

 

Over the three decades since the first issue of the Community Eye Health Journal was published, the availability of microsurgery and high-quality intraocular lenses (IOLs), at an acceptable cost, have made a positive global impact on visual results after cataract surgery. IOLs can be placed in the anterior chamber or posterior chamber, or be supported by the iris. The preferred location is the posterior chamber, where the posterior chamber IOL (or PCIOL) is supported by the residual lens capsule. Sir Harold Ridley is credited with the first intraocular lens implantation in 1949, using a material known as PMMA. Since then, numerous design and material modifications have been developed to make IOLs safer and more effective, and they have been in routine use in high-income countries since the 1980s. However, when the first edition of the CEHJ was published in 1988, an IOL cost approximately $200 and was far too expensive for widespread use in low- and middle-income countries. Thankfully, owing to the foresight and innovation of organizations such as the Fred Hollows Foundation and Aravind Eye Hospitals, IOLs are now produced at low cost in low- and middle-income countries and have become available to even the most disadvantaged patients.

 

With the introduction of the first multifocal and toric IOLs, the focus of IOL development has shifted toward improving refractive outcomes and reducing spectacle dependence. Toric lenses correct postoperative astigmatism, and multifocal lenses reduce dependency on spectacles for near vision. However, multifocal lenses may cause glare and reduced contrast sensitivity after surgery and should only be used in carefully selected patients. The accommodating lenses that are in current use are limited by their low and varied amplitude of accommodation. The light-adjustable lens is made of a photosensitive silicone material. Within two weeks of surgery, the residual refractive error (sphero-cylindrical errors as well as presbyopia) can be corrected by shining an ultraviolet light on the IOL through a dilated pupil to change the shape of the lens. Development of an intraocular lens (IOL) as a drug delivery device has been pursued for many years. Common postoperative conditions such as posterior capsular opacification (PCO), intraocular inflammation or endophthalmitis are potential therapeutic targets for a drug-eluting IOL.

Sources: British Council For Prevention of Blindness; Community Eye Health Journal is published by the International Centre for Eye Health, a research and education group based at the London School of Hygiene and Tropical Medicine (LSHTM), one of the leading Public Health training institutions in the world. Unless otherwise stated, all content is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 

Brain Size and Thinking at a Cost

 

According to an article published in Science, First Release Online (31 May 2018), it was found that some human brains are nearly twice the size of others, and that these differences in size are related to the brain’s shape and the way it is organized. Interestingly, it was observed that the bigger the brain, the more its additional area is accounted for by growth in thinking areas of the cortex, or outer mantle; however, at the expense of relatively slower growth in lower order emotional, sensory, and motor areas. According to the authors, this mirrors the pattern of brain changes seen in evolution and individual development — with higher-order areas showing greatest expansion. The authors also found evidence linking the high-expanding regions to higher connectivity between neurons and higher energy consumption.

 

For the study, the authors analyzed magnetic resonance imaging brain scans of more than 3,000 youth from the Philadelphia Neurodevelopmental Cohort, a NIMH IRP sample, and the Human Connectome Project. Results showed that cortex areas showing relatively more expansion in larger brains sit at the top of a network hierarchy and are specialized functionally, microstructurally and molecularly at integrating information from lower order systems. Since this theme holds up across evolution, development and inter-individual variation, the authors suggested that it appears to be a deeply ingrained biological signature. The authors added that since not all cortex regions are created equal, the high-expanding regions seem to exact a higher biological cost, and that these regions seem to be greedier in consuming energy and that they use relatively more oxygenated blood than low-expanding regions. Gene expression related to energy metabolism is also higher in these regions.

 

Since people with certain mental disorders show alterations in brain size related to genetic influences, the new cortex maps may improve understanding of altered brain organization in disorders. The higher expanding regions are also implicated across diverse neurodevelopmental disorders, so the new insights may hold clues to understanding how genetic and environmental changes can impact higher mental functions. The authors concluded that the study shows there are consistent organizational changes between large brains and small brains, and that observing that the brain needs to consistently configure itself differently as a function of its size is important for understanding how the brain functions in health and disease states.

 

Shark’s Electrical “Sixth Sense“ May Be Tuned To Attack

 

In both sharks and rays, networks of organs, called ampullae of Lorenzini, constantly survey the electric fields they swim through. Electricity enters the organs through pores that surround the animals’ mouths and form intricate patterns on the bottom of their snouts. Once inside, the electrical current is carried via a special gel through a grapevine of canals, ending in bunches of spherical cells that can sense the fields, called electroreceptors. Finally, the cells relay this information onto the nervous system by releasing packets of chemical messengers, called neurotransmitters, into communication points, or synapses, made with neighboring neurons. For decades scientists knew that minute changes in electric fields stimulated a graded range of wavy currents in skate cells, much like the way our ears react to sounds. Larger fields stimulated bigger currents while smaller fields induced smaller responses.

 

The following is the hypothetical from the NIH: “Imagine having superhuman hearing. You’re at a noisy, cocktail party and yet your ears can detect normally inaudible sounds made by your friends’ muscles as they lean in to dish the latest gossip. But, unlike normal hearing, each of these sounds causes your ears to react in the same way. There is no difference between the quietest and loudest movements. To your superhuman ears, they all sound loud, like honking horns.“

 

According to a study published in Nature (30 May 2018), that may be how a shark’s electrosensing organ reacts when it detects teensy, tiny electrical fields emanating from nearby prey. This same team studies the cells and molecules behind pain and other sensations. Their research has helped to understand why chili peppers feel hot and menthol feels cool. According to the authors, since sharks have this incredible ability to pick up nanoscopic currents while swimming through a blizzard of electric noise, the study results suggest that a shark’s electrosensing organ is tuned to react to any of these changes in a sudden, all-or-none manner, as if to say, “attack now.“ The authors showed that the shark’s responses may be very different from the way the same organ reacts in skates, the flat, winged, evolutionary cousins of sharks and sting rays, and this may help explain why sharks appear to use electric fields strictly to locate prey while skates use them to find food, friends, and mates. The authors also showed how genes that encode for proteins called ion channels, may control the shark’s unique “sixth sense.“

 

According to the NIH, ion channels essentially make the nervous system tick in that they play a major role in controlling how information flows through a nervous system. Mutations in ion channels can be devastating and have been linked to a variety of disorders, including cystic fibrosis and some forms of epilepsy, migraines, paralysis, blindness and deafness. In addition, studies like this highlight the role a single ion channel can play in any nervous system, shark, skate, or human.“

 

For the study, the authors compared currents recorded from little skate electroreceptor cells with those from the chain catshark. Results showed that although both cells were sensitive to the same narrow range of voltage zaps, the responses were very different. Shark currents were much bigger than skate currents and they were the same size and waviness for each zap. In contrast, the skate cells responded with currents that varied in both size and waviness to each zap. Further experiments suggested that these contrasting responses may be due to different ion channels genes, which encode proteins that form tunnels in a cell’s membrane, or skin. When activated the tunnels open and create electrical currents by allowing ions, or charged molecules, to flow in and out of the cell. The authors showed that while both shark and skate electroceptors may have used the same type of voltage sensitive, calcium conducting ion channels to sense the zaps, they appeared to use very different types of potassium conducting ion channels to shape the responses. Their results suggested that shark cells used a special voltage activated channel that supported large repetitive responses while the skate cells used a calcium activated channel that tended to dampen the initial currents. In addition, they suggested that the voltages at which the cells electrically rested may also have contributed to the responses. The shark’s voltage was slightly lower than the skate’s and in a range that could have primed the calcium ion channels to respond with stronger currents. These differences also affected how the electroreceptors relayed information to the rest of the nervous system. The results suggested that shark electroreceptors basically released the same number of neurotransmitter packets, regardless of the size of the voltage zaps. In contrast, bigger zaps caused skate cells to send more messages and smaller zaps less. Ultimately, these differences affected how sharks and skates reacted to electric fields that mimicked those produced by prey. To test this, the authors exposed sharks and skates swimming alone in tanks to a wide range of low voltage electric field frequencies and then measured their breathing rates. As anticipated, the skates had a variety of reactions. Some frequencies caused their breathing rates to rise above rest while others produced minimal changes. The results may help explain why a previous study found that skates may use their electrosensory perceptions to detect both prey and mates. The sharks, however, had one simple reaction. Almost every field raised their breathing rates to a level seen when they smelled food, suggesting their system is tuned for one thing: catching prey.

 

FDA Approves First Artificial Iris

 

Patients with iris defects may experience severe vision problems, as well as dissatisfaction with the appearance of their eye. Congenital aniridia is a rare genetic disorder in which the iris is completely or partially absent. This disorder affects approximately 1 in 50,000 to 100,000 people in the U.S. The iris controls the amount of light entering the eye, and those with aniridia have sensitivity to light and other severe vision problems.

 

The FDA has approved the CustomFlex Artificial Iris, the first stand-alone prosthetic iris in the United States. The CustomFlex Artificial Iris is a surgically implanted device to treat adults and children with aniridia or other damage to the eye. According to the FDA, this first artificial iris provides a novel method to treat iris defects that reduces sensitivity to bright light and glare, and also improves the cosmetic appearance of the eye. In addition to congenital aniridia, the CustomFlex Artificial Iris is indicated to treat iris defects due to other reasons or conditions, such as albinism, traumatic injury or surgical removal due to melanoma

 

The CustomFlex Artificial Iris is made of thin, foldable medical-grade silicone and is custom-sized and colored for each individual patient. A surgeon makes a small incision, inserts the device under the incision, unfolds it and smooths out the edges using surgical instruments. The prosthetic iris is held in place by the anatomical structures of the eye or, if needed, by sutures.

 

The safety and effectiveness of the CustomFlex Artificial Iris was demonstrated primarily in a non-randomized clinical trial of 389 adult and pediatric patients with aniridia or other iris defects. The study measured patients’ self-reported decrease in severe sensitivity to light and glare post-procedure, health-related quality of life, and satisfaction with the cosmetic improvement or appearance of the prosthesis. More than 70% of patients reported significant decreases in light sensitivity and glare as well as an improvement in health-related quality of life following the procedure. In addition, 94% of patients were satisfied with the artificial iris’ appearance.

 

The study found low rates of adverse events associated with the device or the surgical procedure. In the study, complications associated with the use of the CustomFlex Artificial Iris device included: device movement or dislocation, strands of device fiber in the eye, increased intraocular pressure, inflammation of the iris (iritis), adhesion of the iris to the cornea or lens (synechiae) and the need for secondary surgery to reposition, remove or replace the device. Complications associated with the surgical procedure included: increased intraocular pressure, blood leakage in the eye, swelling of the center of the retina (cystoid macular edema), secondary surgery, corneal swelling, iritis, and retinal detachment.

 

The CustomFlex Artificial Iris is contraindicated, or should not be used, in eyes with any of the following conditions: uncontrolled or severe chronic inflammation (uveitis), abnormally small eye size (microphthalmus), untreated retinal detachment, untreated chronic glaucoma, cataract caused by rubella virus, abnormal blood vessels on the iris (rubeosis), certain kinds of damaged blood vessels in the retina, and intraocular infections. It is also contraindicated for patients who are pregnant.

 

The CustomFlex Artificial Iris was approved through a premarket approval application (PMA), which is the most stringent type of device marketing application and generally required for high-risk devices. A PMA approval is primarily based on a determination by the FDA that the PMA contains sufficient valid scientific evidence that provides reasonable assurance that the device is safe and effective for its intended uses. CustomFlex Artificial Iris was granted Breakthrough Device designation, meaning the FDA provided intensive interaction and guidance to the company on efficient device development, to expedite evidence generation and the agency’s review of the device. To qualify for such designation, a device must provide for more effective treatment or diagnosis of a life-threatening or irreversibly debilitating disease or condition, and meet one of the following criteria: the device must represent a breakthrough technology; there must be no approved or cleared alternatives; the device must offer significant advantages over existing approved or cleared alternatives; or the availability of the device is in the best interest of patients.

 

The FDA granted approval of the CustomFlex Artificial Iris to Clinical Research Consultants, Inc.

 

Summer Shrimp Cakes, Beyond Delicious

On Their Own with Mango Garnish

With Dipping Sauce

With Avocado/Mango Salsa

With my Jackson Pollack Salad

Oh Lordy, are you lucky! There’s a secret here, with a trail of memos to back it up, plus more than one witness. ©Joyce Hays, Target Health Inc.

 

These shrimp cakes are unbelievably good! ©Joyce Hays, Target Health Inc.

Just cook on your outdoor grill, grab one out of the bowl and you have a world-class snack! ©Joyce Hays, Target Health Inc.

 

Morning, Noon and Night! ©Joyce Hays, Target Health Inc.

 

Roll in your hands a smaller appetizer size and serve to your guests, with a dipping sauce. They’ll be gone in 5 minutes, so make double the recipe. ©Joyce Hays, Target Health Inc.

 

To the right is my Jackson Pollack salad. To the left is the avocado/mango salsa. On top is the dipping sauce. ©Joyce Hays, Target Health Inc.

 

Venture a bite and you won’t be able to stop. ©Joyce Hays, Target Health Inc.

 

Double the Yum Factor! ©Joyce Hays, Target Health Inc.

 

OMG! ©Joyce Hays, Target Health Inc.

 

My Jackson Pollack Salad! ©Joyce Hays, Target Health Inc.

 

Avocado/Mango Salsa. ©Joyce Hays, Target Health Inc.

 

Serve with Tacos and Salsa. What’s really good is to add a little salad to the warm taco with shrimp cake and then dribble dipping sauce over the taco. Um um! ©Joyce Hays, Target Health Inc.

 

We’ve been eating shrimp cakes all week, as I experimented with the herbs and seasoning. Jules, who doesn’t usually like shrimp that much, gives this dish five stars! I happen to love shrimp (low in calories) and I agree with him! ©Joyce Hays, Target Health Inc.

 

Ingredients

2 pounds shrimp

10 fresh garlic cloves, large slices

4 Tablespoons chopped scallions

1 teaspoon curry powder

6 Tablespoons diced celery

Pinch chili flakes

4 Tablespoons chopped parsley

3 teaspoons lemon zest

6 Tablespoons Kraft mayonnaise

2 cups Panko

2 eggs, beaten

3 anchovy fillets, instead of salt

Pinch black pepper

Tabasco sauce to taste

2 Tablespoons, vegetable oil like peanut oil

 

The umami secret is in the little glass jar, behind the egg. ©Joyce Hays, Target Health Inc.

 

Directions

1. Do all your chopping, peeling, cutting first, and do it all on the same cutting board.

2. Beat the eggs

 

Getting the chopping done. ©Joyce Hays, Target Health Inc.

 

Beat the eggs with a fork or whisk, before you add them. ©Joyce Hays, Target Health Inc.

 

3. Clean, peel, devein shrimp. Divide the shrimp in half. Hand chop 1/2 of the raw shrimp and put into a large bowl.

 

Chop by hand, 1/2 of the shrimp. ©Joyce Hays, Target Health Inc.

 

4. Put the other half of the shrimp, in food processor, with the sliced garlic, the anchovies, black pepper, chili flakes and slowly pulse until you get a more finely chopped raw shrimp than the hand chopped, but DON’T LET IT TURN INTO PASTE. With a small spatula, scrape every last bit of the shrimp mixture, out of the food processor and into the large bowl with the other shrimp.

 

The umami secret: the 3 anchovy fillets, went into the food processor first. ©Joyce Hays, Target Health Inc.

 

On top of the anchovies, put 1/2 of the shrimp, into the food processor. ©Joyce Hays, Target Health Inc.

 

5. Into the bowl add the scallions, celery, parsley and lemon zest. Stir in mayonnaise, Panko and the eggs, and beat with a whisk or wooden spoon until everything is evenly distributed.

 

Chopped veggies go into a large mixing bowl.  ©Joyce Hays, Target Health Inc.

 

All the shrimp and anchovies go into the mixing bowl.  ©Joyce Hays, Target Health Inc.

 

Add the beaten eggs, all the spices and seasonings, don’t forget the tobacco. ©Joyce Hays, Target Health Inc.

 

Panko and mayo are added last. Stir well with a wooden spoon. However, mixing with your hands works very well also. Consider wearing thin clear plastic gloves. ©Joyce Hays, Target Health Inc.

 

Ready to get this mixture into shape. ©Joyce Hays, Target Health Inc.

 

6. Make shrimp balls with your hands that you slightly flatten after you put them into a large skillet.

7. Heat the peanut oil, then cook the shrimp until both sides are nicely browned. Drain on paper towels. Serve on a green leaf, like romaine, spinach, etc, with fresh pineapple chunks or circles, grapes, thin apple slices (skin on) and tartar sauce.

 

Cook over medium high heat. ©Joyce Hays, Target Health Inc.

 

Flip over and cook until they’re all golden brown. Don’t try to squeeze all of the cakes into the skillet at the same time. Cook in batches. ©Joyce Hays, Target Health Inc.

 

8. When the second sides have been cooked and are a golden brown, put the shrimp cakes on a double layer of paper towels to drain off the cooking oil.

9. Make the shrimp small for appetizers or large for an entree.

10. Serve warm with dipping sauce, salsa, salad, warm tacos and an icy white wine, like chardonnay, sauvignon blanc, Pouilly-Fuisse.

 

Shrimp cake on a bed of Jackson Pollack salad. ©Joyce Hays, Target Health Inc.

 

Icy Chardonnay was perfect with the shrimp cakes and all that went with them. ©Joyce Hays, Target Health Inc.

 

Have a great week everyone!

From Our Table to Yours

Bon Appetit!

 

Fundamental process by which brains are built

Date:
May 30, 2018

Source:
King’s College London

Summary:
Researchers have discovered a fundamental process by which brains are built, which may have profound implications for understanding neurodevelopmental conditions like autism and epilepsy. The study also answers an evolutionary mystery about how the delicate balance between different types of brain cells might be maintained across species with vastly different brain sizes.

 

Researchers at King’s College London have discovered a fundamental process behind development of the cerebral cortex.
Credit: King’s College London

 

 

Researchers at King’s College London have discovered a fundamental process by which brains are built, which may have profound implications for understanding neurodevelopmental conditions like autism and epilepsy.

The study, published in Nature and funded by the Wellcome Trust, also answers an evolutionary mystery about how the delicate balance between different types of brain cells might be maintained across species with vastly different brain sizes.

The cerebral cortex is the largest region of the human brain and is responsible for many of our advanced abilities such as learning, memory and our ability to plan future actions. The cerebral cortex contains two main types of brain cells: excitatory and inhibitory neurons, which can be more simply defined as ‘go’ and ‘no-go’ neurons.

Excitatory ‘go’ neurons process information and provide orders telling other neurons what to do. Inhibitory ‘no-go’ neurons restrict the activity of excitatory neurons so that they don’t all go at the same time. Too much ‘go’ leads to the over-firing of neurons seen in epilepsy, while too much ‘no-go’ causes cognitive problems.

The researchers have discovered how the correct balance is achieved in the number of ‘go’ and ‘no-go’ neurons by studying the brains of developing mice. Since the ratio of the two cell types in all mammals is remarkably similar, the findings are likely to apply to humans.

‘Like many fundamental things in nature, the process we have uncovered is elegant and likely very important,’ says senior author Professor Oscar Marín, from the Centre for Developmental Neurobiology at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN).

‘This study fills a big gap in our understanding of how the brain is built, explaining quite simply how the balance of excitatory and inhibitory neurons in the cerebral cortex has remained constant as mammals have evolved. It is probable that this process has been critical in allowing human brains to expand.’

By manipulating brain cells in mice during a critical period of embryonic development, the researchers demonstrated that the number of ‘no-go’ neurons is adjusted once the number of ‘go’ neurons is established.

Co-lead author Dr Kinga Bercsenyi from the Marín laboratory at the IoPPN explains: ‘If we imagine brain activity as a conversation, neurons have to be connected to each other in order to talk. During the first two weeks after birth, ‘no-go’ neurons can sense if they are alone and are programmed to die if they cannot find ‘go’ neurons that are willing to talk to them.’

The researchers found that ‘go’ neurons rescue their ‘no-go’ cousins from death by blocking the function of a protein called PTEN. Mutations in the gene coding for PTEN have been strongly linked to autism, suggesting that when PTEN is not functioning properly not enough ‘no-go’ neurons die, tipping the balance of cell types and causing problems in information processing in some autistic people.

Co-lead author Dr Fong Kuan Wong the Marín laboratory at the IoPPN says: ‘As well as finding a biological process that is fundamental to brain development, our findings suggest that disruptions to this process may be fundamental to neurodevelopmental disorders. Understanding how the balance of cell types in the cerebral cortex is disrupted in conditions like autism and epilepsy could potentially lead to new treatments.’

The researchers are now investigating the consequences of having too many ‘no-go’ neurons in mice, and how this might relate to human conditions like autism.

Story Source:

Materials provided by King’s College LondonNote: Content may be edited for style and length.


Journal Reference:

  1. Fong Kuan Wong, Kinga Bercsenyi, Varun Sreenivasan, Adrián Portalés, Marian Fernández-Otero, Oscar Marín. Pyramidal cell regulation of interneuron survival sculpts cortical networksNature, 2018; 557 (7707): 668 DOI: 10.1038/s41586-018-0139-6

 

Source: King’s College London. “How to build a brain: Discovery answers evolutionary mystery: Fundamental process by which brains are built.” ScienceDaily. ScienceDaily, 30 May 2018. <www.sciencedaily.com/releases/2018/05/180530133030.htm>.

Geologic evidence supports a coastal theory of early settlement

Date:
May 30, 2018

Source:
University at Buffalo

Summary:
A geological study provides compelling evidence to support the hypothesis that ancient humans migrated into the Americas via a coastal route. By analyzing boulders and bedrock, a team shows that part of a coastal migration route became accessible to humans 17,000 years ago. During this period, ancient glaciers receded, exposing islands of southern Alaska’s Alexander Archipelago to air and sun — and, possibly, to human migration.

 

University at Buffalo Ph.D. candidate Alia Lesnek works at Suemez Island.
Credit: Jason Briner

 

 

When and how did the first people come to the Americas?

The conventional story says that the earliest settlers came via Siberia, crossing the now-defunct Bering land bridge on foot and trekking through Canada when an ice-free corridor opened up between massive ice sheets toward the end of the last ice age.

But with recent archaeological evidence casting doubt on this thinking, scientists are seeking new explanations. One dominant, new theory: The first Americans took a coastal route along Alaska’s Pacific border to enter the continent.

A new geological study provides compelling evidence to support this hypothesis.

By analyzing boulders and bedrock, a research team led by the University at Buffalo shows that part of a coastal migration route became accessible to humans 17,000 years ago. During this period, ancient glaciers receded, exposing islands of southern Alaska’s Alexander Archipelago to air and sun — and, possibly, to human migration.

The timing of these events is key: Recent genetic and archaeological estimates suggest that settlers may have begun traveling deeper into the Americas some 16,000 years ago, soon after the coastal gateway opened up.

The research will be published online on May 30 in the journal Science Advances.

“People are fascinated by these questions of where they come from and how they got there,” says lead scientist Jason Briner, PhD, professor of geology in UB’s College of Arts and Sciences. “Our research contributes to the debate about how humans came to the Americas. It’s potentially adding to what we know about our ancestry and how we colonized our planet.”

“Our study provides some of the first geologic evidence that a coastal migration route was available for early humans as they colonized the New World,” says UB geology PhD candidate Alia Lesnek, the study’s first author. “There was a coastal route available, and the appearance of this newly ice-free terrain may have spurred early humans to migrate southward.”

The findings do not mean that early settlers definitely traversed Alaska’s southern coast to spread into the Americas: The project examined just one section of the coast, and scientists would need to study multiple locations up and down the coastline to draw firmer conclusions.

Still, the work is exciting because it hints that the seafaring theory of migration is viable.

The bones of an ancient ringed seal — previously discovered in a nearby cave by other researchers — provide further, tantalizing clues. They hint that the area was capable of supporting human life at the time that early settlers may have been passing through, Briner says. The new study calculates that the seal bones are about 17,000 years old. This indicates that the region was ecologically vibrant soon after the ice retreated, with resources including food becoming available.

Co-authors on the research included Briner; Lesnek; Charlotte Lindqvist, PhD, an associate professor of biological sciences at UB and a visiting associate professor at Nanyang Technological University; James Baichtal of Tongass National Forest; and Timothy Heaton, PhD, of the University of South Dakota.

A landscape, touched by ice, that tells a story

To conduct their study, the scientists journeyed to four islands within the Alexander Archipelago that lie about 200 miles south/southeast of Juneau.

The team traveled by helicopter to reach these remote destinations. As soon as the researchers arrived, Briner knew that the islands had once been covered by ice.

“The landscape is glacial,” he says. “The rock surfaces are smooth and scratched from when the ice moved over it, and there are erratic boulders everywhere. When you are a geologist, it hits you in the face. You know it immediately: The glacier was here.”

To pinpoint when the ice receded from the region, the team collected bits of rock from the surfaces of boulders and bedrock. Later, the scientists ran tests to figure out how long the samples — and thus the islands as a whole — had been free of ice.

The researchers used a method called surface exposure dating. As Lesnek explains, “When land is covered by a glacier, the bedrock in the area is hidden under ice. As soon as the ice disappears, however, the bedrock is exposed to cosmic radiation from space, which causes it to accumulate certain chemicals on their surface. The longer the surface has been exposed, the more of these chemicals you get. By testing for these chemicals, we were able to determine when our rock surfaces were exposed, which tells us when the ice retreated.

“We use the same dating method for huge boulders called erratics. These are big rocks that are plucked from the Earth and carried to new locations by glaciers, which actually consist of moving ice. When glaciers melt and disappear from a specific region, they leave these erratics behind, and surface exposure dating can tell us when the ice retreated.”

For the region that was studied, this happened roughly 17,000 years ago.

The case for a coastal migration route

In recent years, evidence has mounted against the conventional thinking that humans populated North America by taking an inland route through Canada. To do so, they would have needed to walk through a narrow, ice-free ribbon of terrain that appeared when two major ice sheets started to separate. But recent research suggests that while this path may have opened up more than 14,000 years ago, it did not develop enough biological diversity to support human life until about 13,000 years ago, Briner says.

That clashes with archaeological findings that suggest humans were already living in Chile about 15,000 years ago or more and in Florida 14,500 years ago.

The coastal migration theory provides an alternative narrative, and the new study may mark a step toward solving the mystery of how humans came to the Americas.

“Where we looked at it, the coastal route was not only open — it opened at just the right time,” Lindqvist says. “The timing coincides almost exactly with the time in human history that the migration into the Americas is thought to have occurred.”

The research was funded by a UB IMPACT award, and Lesnek’s work on the project, which will contribute to her dissertation, was supported by the National Science Foundation.

Story Source:

Materials provided by University at Buffalo. Original written by Charlotte Hsu. Note: Content may be edited for style and length.


Journal Reference:

  1. Alia J. Lesnek, Jason P. Briner, Charlotte Lindqvist, James F. Baichtal, Timothy H. Heaton. Deglaciation of the Pacific coastal corridor directly preceded the human colonization of the AmericasScience Advances, 2018; 4 (5): eaar5040 DOI: 10.1126/sciadv.aar5040

 

Source: University at Buffalo. “In ancient boulders, new clues about the story of human migration to the Americas: Geologic evidence supports a coastal theory of early settlement.” ScienceDaily. ScienceDaily, 30 May 2018. <www.sciencedaily.com/releases/2018/05/180530144144.htm>.

Date:
May 29, 2018

Source:
Newcastle University

Summary:
The first human corneas have been 3D printed by scientists.

 

Dr. Steve Swioklo and Professor Che Connon with a dyed cornea.
Credit: Newcastle University, UK

 

 

The first human corneas have been 3D printed by scientists at Newcastle University, UK.

It means the technique could be used in the future to ensure an unlimited supply of corneas.

As the outermost layer of the human eye, the cornea has an important role in focusing vision.

Yet there is a significant shortage of corneas available to transplant, with 10 million people worldwide requiring surgery to prevent corneal blindness as a result of diseases such as trachoma, an infectious eye disorder.

In addition, almost 5 million people suffer total blindness due to corneal scarring caused by burns, lacerations, abrasion or disease.

The proof-of-concept research, published today in Experimental Eye Research, reports how stem cells (human corneal stromal cells) from a healthy donor cornea were mixed together with alginate and collagen to create a solution that could be printed, a ‘bio-ink’.

Using a simple low-cost 3D bio-printer, the bio-ink was successfully extruded in concentric circles to form the shape of a human cornea. It took less than 10 minutes to print.

The stem cells were then shown to culture — or grow.

Che Connon, Professor of Tissue Engineering at Newcastle University, who led the work, said: “Many teams across the world have been chasing the ideal bio-ink to make this process feasible.

“Our unique gel — a combination of alginate and collagen — keeps the stem cells alive whilst producing a material which is stiff enough to hold its shape but soft enough to be squeezed out the nozzle of a 3D printer.

“This builds upon our previous work in which we kept cells alive for weeks at room temperature within a similar hydrogel. Now we have a ready to use bio-ink containing stem cells allowing users to start printing tissues without having to worry about growing the cells separately.”

The scientists, including first author and PhD student Ms Abigail Isaacson from the Institute of Genetic Medicine, Newcastle University, also demonstrated that they could build a cornea to match a patient’s unique specifications.

The dimensions of the printed tissue were originally taken from an actual cornea. By scanning a patient’s eye, they could use the data to rapidly print a cornea which matched the size and shape.

Professor Connon added: “Our 3D printed corneas will now have to undergo further testing and it will be several years before we could be in the position where we are using them for transplants.

“However, what we have shown is that it is feasible to print corneas using coordinates taken from a patient eye and that this approach has potential to combat the world-wide shortage.”

Reference:

3D Bioprinting of a Corneal Stroma Equivalent. Abigail Isaacson, Stephen Swioklo, Che J. Connon. Experimental Eye Research.

Story Source:

Materials provided by Newcastle UniversityNote: Content may be edited for style and length.


Journal Reference:

  1. Isaacson A, Swioklo S, Connon C. 3D bioprinting of a corneal stroma equivalentExperimental Eye Research, 2018 DOI: 10.1016/j.exer.2018.05.010

 

Source: Newcastle University. “First 3D-printed human corneas.” ScienceDaily. ScienceDaily, 29 May 2018. <www.sciencedaily.com/releases/2018/05/180529223312.htm>.

Memorial Day Weekend

 

On this Memorial Day weekend, we salute the brave men and women who respond to the call and join the military, dedicating their lives to the protection of this great country. Nothing is more precious than life; therefore, nothing is a greater gift, or more heroic, than offering one’s life to defend one of mankind’s great social experiments, America, the beautiful.

 

Springtime in NYC

 

This past Friday was a beautiful day, so we decided to stroll through Central Park. The rhododendrons were flowering and if you look closely, you will see 5th Avenue in the background

 

Springtime in NYC – ©Target Health Inc.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

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