The average concentrations of PM2.5, PM10 and TSP were 20.4, 27.2 and 50.3 μg/m3, respectively. Σ15PBDEs mean concentrations in PM2.5, PM10, TSP and gas phase were 51.8, 110.7, 148 and 59.6 pg/m3, respectively. Much more PBDEs distributed in fine fractions than coarse ones. PBDEs congener profiles found in PM2.5, PM10 and TSP (dominated by BDE-209) were different from that in gas phase (dominated by the tri- to penta-BDEs). Approximately 3.20 pg/kg/d PM2.5 bound PBDEs can be inhaled into the lung; 3.62 pg/kg/d PM10-PM2.5(particles with aerodynamic diameter of 2.5-10 μm) bound PBDEs tended to be deposited in the upper part of respiratory system, and the intake of PBDEs via gas-phase was 2.74 pg/kg/d. The exposure of PBDEs was far below the minimal risk levels (MRLs), indicating lower risk from PBDEs via inhalation in the studied office in Shanghai.To evaluate risk via inhalation exposure of polybrominated diphenyl ethers (PBDEs) in office environment, thirty-six pairs air samples including PM In recent years, some studies have shown that some brominated flame retardants, especially polybrominated diphenyl ethers (PBDEs), are potentially toxic, bio-accumulative, ubiquitous and persistent in the environment . Human e2.5 (particles with aerodynamic diameter less than 2.5 μm) has caused a great deal of attention [2.5 bound PAHs is particularly worrisome for both children and adults who spend over 10 h home every day. Ni et al.[Like other semi-volatile organic compounds (SVOCs), PBDEs partition between the gaseous and the particulate phase in the atmosphere . These Pttention . Ohura ettention  reportedNi et al. measured2.5, PM10 (particles with aerodynamic diameter less than 10 μm), TSP  and PBDEs levels in PM2.5, PM10, TSP and gas phase in a representative office in Shanghai, China; to assess the risk of PBDEs exposure via inhalation in office environment.The objectives of this study were to investigate mass concentrations of PMNo specific permissions were required for the described field studies in Shanghai and the field studies did not involve endangered or protected species. The specific location of our study is located at 31°30’N, 121°51’E in Shanghai, China.Nineteen PBDEs congeners  (purity >99%) were purchased from Accu Standards . BDE-50 and BDE-172 used as surrogate standards and BDE-118 (purity >99%) and BDE-128 (purity >99%) used as internal standards were also purchased from Accu Standards.etc. The selected office building is located in downtown Shanghai which was not adjacent to any industrial activity; it is somehow representative of a white-collar working office. The studied office located on the third floor covers an area of 1450 m2 with the height of 3 m. The offices were equipped with common office furniture and electronic products. There is about 350 staff; each of them has a computer and a desktop phone. A printer is shared between 14 staff members. There are also a lot of humidifiers, water dispensers and other electrical and electronic equipment. The office was occupied all the day with a few occupants on duty during the night, so the central air conditioner operated all day. The indoor temperature was 21–25°C and the humility was 45%–70%. The windows of the whole building are completely closed all the time. There are automatic controls for entrance doors of offices. The ventilation rate in this study is significantly lower than others with windows opened . Central air conditioners are used to recirculate indoor air, with more than 90% of the supply-air typically being recirculated.The study was conducted in Shanghai in the Eastern China. The representative office was selected using the following criteria: location, scale, electronic and electrical equipment, flooring, building age and ventilation pattern, 2.5, PM10, TSP and gas phase samples were collected using two high volume air samplers .Six sampling events were conducted in June, July, August, December 2012 and January, February 2013, respectively. During sampling, particles and gas phase samples were isolated from the atmosphere by drawing air through a quartz fiber filter  and polyurethane foam at a flow rate of about 0.2 m3/min. PM2.5 and PM10 were collected using PM2.5 and PM10 cyclones, respectively. To avoid disturbing most staff during the day, the sampler was operated from midnight to the early morning and the sampling process was repeated for 3 days until 300 m3 of air was sampled. The time interval for collecting PM2.5, PM10 and TSP with matching gas phase samples was 7 days. To obtain duplicate samples, two air samplers were operated simultaneously. All samples were collected from the atmosphere at a height of 1.5 m above ground.PM2.5, PM10 and TSP were determined by weighing the filters after conditioning the filter at 33% relative humidity and 22°C before and after sampling.Before being used, QFFs were baked at 450°C for 4 h and PUF plugs were Soxhlet extracted for 48 h with methanol and for another 48 h with an acetone and hexane mixture (1:1) to remove any organic containment. After sampling, the QFFs were wrapped with aluminum foils and sealed in double-layer polyethylene bags, and PUFs were placed in solvent rinsed glass cartridges with PTEE covers, and then transported to the laboratory and stored at -20°C until extraction. The concentrations of PM2 stream. Internal standards were added before instrumental analysis.The QFFs and PUF plugs spiked with surrogate standards were extracted with a Soxhlet extractor using 150 ml dichloromethane for 48 h. The extract was rotary-evaporated to about 2 ml and solvent-exchanged to hexane, and then 4 ml concentrated sulfuric acid was added. Each extract was subsequently cleaned with a gel permeation chromatography column (40 g Bio-Beads SX-3). The final extract volume was evaporated to 100 μL under a gentle NPBDEs congeners were quantified with a Shimadzu GCMS-QP 2010 plus instrument with the selective ion monitoring (SIM) mode. A DB-5 column  was employed. The analysis of PBDEs congeners using the isotope internal standard method followed our previous study.Breakthrough of gas-phase chemicals was tested by using a second PUF plug in series with the first one. The PBDEs contents in the second plug were less than 7% of those in the first plug for all congeners.2.5, PM10, TSP and gas samples, a procedural blank, spiked blank and drift tests were processed. All targets were lower than the limit of detection (LOD) in procedural blanks, so they were not subtracted from the sample measurement. The surrogate recovery of BDE-50 and BDE-172 was 79.3 ± 4.5% and 86.5 ± 6.5%, respectively. The quantification was performed with a seven-point calibration curve with 20 μg/L 13C-BDE-118 and 13C-BDE-128 as internal standards (R2 >0.999) for both lower and higher BDE congeners. Both external calibration and internal standard (BDE-118) calibration were applied in the quantification of BDE-209, while internal standard calibration was used for other congeners. To check drift, standards were run after every 6 samples, and the results were unacceptable unless the relative standard deviation for individual PBDEs congener in standards was less than 10%. Recoveries of targets ranged from 81.5% to 89.7%, and relative standard deviations ranged from 3.2% to 7.9% in spiked blank samples. Reported concentrations were not surrogate recovery corrected.For each batch of PMHEC values , the MRL  is derived as follows:Based on the NOAELHEC was calculated from the duration-adjusted NOAEL (NOAELADJ) using EPA RfDs methodology as follows:The NOAELThe regional deposited dose ratio (RDDR) (2.7) for the extrathoracic (ET) region was used to extrapolate deposited doses in species studied to deposited doses in human .3;HEC by UF of 30 (3 for species to species extrapolation with dosimetric adjustments and 10 for human variability) and MF of 3 (for an incomplete database reflecting a single study in one species).For the lower brominated PBDEs: NOAEL was 1.1 mg/m3/h = 12.96 m3/day [3.For higher brominated PBDEs: The MRL was estimated by dividing the NOAEL (1000 mg/kg/day) by UF of 100 . It has been suggested that deca-BDE is very poorly absorbed via inhalation  and rapidly eliminated (≈ 99% of the dose within 72 hours) . Then 0.6 m3/day ), the fip<0.05 level. The measured PBDE data followed the normal distribution with the average and standard deviations. Data were not transformed during the analysis. All statistical analyses were performed with SPSS software .The experimental data were expressed as mean ± standard deviation (SD).One-way ANOVA was performed to assess the significance of differences. Statistical significance was evaluated at 2.5, PM10 and TSP in this study and previous studies. The average concentrations of PM2.5, PM10 and TSP were 20.4, 27.2 and 50.3 μg/m3, respectively. Higher concentrations of indoor PM were generally found in developing countries than developed countries [2.5 in this study was comparable to those reported in offices in Beijing (China) [3 for annual mean)and U.S. annual health standard (12 μg/m3)[2.5 level in this study was slightly higher. In the European Union, the Air Quality Directive (Directive 1999/30/EC) established the limit values for PM10, to be accomplished by 2010 [10 in this study was higher than this directive. Those regulations were established for ambient air pollution. It is inappropriate to compare the indoor measurements with them, however, there is no any other regulations for indoor air quality. The ambient standard is considered to be a reasonably conservative benchmark for occupational exposure since it represents an effective maximum allowable concentration for the general population. The indoor air quality regulation is still required, so further work is needed to do to get more information to support more definitive occupational exposure.Because there was no significant difference between the mass concentrations of suspended particles in summer and winter in the office the average concentrations of these particles were applied . Table 1ountries . The off (China) , but muc (China) and Greec (China) , 25. Com12 μg/m3), the PM22.5, PM10, and TSP in indoor air. It is generally thought that indoor concentrations of particles derive from indoor and outdoor sources, determined by several variables: air-exchange rate, outdoor air quality, indoor activities, aerodynamic diameter of PM emitted. etc. [-1)in this study is significantly lower than others with windows opened [Except for the offices in Belgium, the concentrations in this study were obviously lower compared to others , 28–31. ed. etc. . Becausetilation). The filtilation). As expetilation).2.5/PM10 mass concentrations was calculated as presented in 2.5/PM10 ratio in the studied office was significantly higher than previous studies [2.5/PM10 ratio of 0.5 is typical of developing country urban areas and is at the bottom of the range found in developed country urban areas (0.5–0.8) [2.5 /PM10 ratio may also be explained by the release of ultrafine particles from office equipment such as printers and copiers. There were about twenty-six printers and copiers in the studied office. Reports have identified ultrafine aerosol particle formation during operation of laser printer and copiers [8 s-1, and emitted mainly ultrafine particles (diameter less than 100 nm). Printer-emitted particles increased 6-h averaged particle concentration over eleven times compared to the background particle concentration. Toner and paper dust from printing devices may become airborne, generating respirable particles (PM2.5) [The ratio of PM studies , 35. A P0.5–0.8) . The res copiers , 38. In  copiers , they pr (PM2.5) .15PBDEs as the sum of all these congeners. Concentrations of PBDEs in PM2.5, PM10, TSP and gas phase in summer and winter are presented in Among 19 target PBDE congeners, only those detected in at least 60% of the samples were quantified, including BDE-28, 33, 47, 66, 99,138, 153, 154, 183, 190, 196,203, 206,207 and 209. Here we defined Σ2.5/TSP ratio of BDE-209 concentration was 26% in winter and 24% in summer suggesting higher brominated PBDEs existed mainly in coarse particles. BDE-209 concentrations in particles 2.5–10 μm in diameter were 64% and 54% in summer and winter, respectively. It was also found that BDE-209 was mainly associated with particles 3–10 μm in diameter [Octa-, nona- and deca-BDE were only found in the particulate phase, whereas the tri-BDE BDE-28/33) and BDE-47 were almost exclusively present in the gas phase (89–93% and 86–91%). The tetra- to hepta-BDEs were both found in the particulate and gas phase. PBDEs distributed disproportionally between the fine and coarse fractions. Much more PBDEs distributed in fine fractions than coarse ones, especially for lower brominated PBDEs. Fine fractions contain more PBDEs, indicating higher accumulative effect. This was consistent with the result found by Wang et al. /33 and B were assdiameter .2.5 and PM10 in office air were available. PBDEs bound to different size of dust in the central air conditioner filter of an office building in Shenzhen, China [2.5 and PM10 in this study were slightly higher than that in dust in conditioner filter due to the different sample types and sources[No publication data on PBDEs concentrations in PMn, China were seled sources.15PBDEs in TSP  were 1 order of magnitude lower than America [15PBDEs in gas phase  in this study were lower than those reported in Greece [Concentrations of Σ America  and Swed America . BDE-209 America , 49. BDE America , 51. The America . This ma America . The Σ15n Greece , and Amen Greece , but slin Greece . This ma2.5, PM10, TSP and the gas phase during summer and winter. The exposed persons were all adults. The daily exposure dose by air inhalation (DEDair) of PBDEs in gas phase can be estimated as:3), IR is inhalation rate (m3/d), T is exposure time (h), fr is the alveolar fraction retained in the lungs [The office exposure can occur from air inhalation, dust ingestion and dermal contact. The exposure was assessed only via inhalation pathways to address inhalation exposure in office environment . In thiswas used ) and bw  (adults), T is thair) of Σ15PBDEs in different sizes of particulate matter was estimated using the following equation.PM (pg/m3) is the PBDEs concentration in PM. Human exposure via inhalation of PM-bound and gas-phase PBDEs were calculated and presented in The daily exposure dose by air inhalation  was far below the lowest observed adverse effect level of 1 mg/kg/d recommended by Darnerud et al.[As shown in problems . The valproblems . Meanwhiud et al.. The USEud et al.. Obviousud et al.. Therefo3 has been derived for intermediate-duration inhalation exposure (15–364 days) to lower brominated BDEs [3 was derived for intermediate-duration inhalation exposure to deca-BDE. We divided the targets 15 PBDE congeners into two categories: the lower brominated BDEs  and higher brominated BDEs . As shown in 3), indicating much lower risk for higher brominated BDE in the surrounding air. Exposure to lower brominated BDEs was 22.32, 35.79 and 70.98pg/m3 for PM2.5, PM10 and gas phase respectively. The exposure to lower brominated BDEs did not exceed the value of MRLs (0.006 mg/m3), indicating lower risk of adverse health effects for inhalation exposure during working time. The present study provides useful information about PBDEs exposure and the risk of adverse health effects for office occupation population during working time. However, the MRLs in this study were derived for intermediate-duration (15–364 days) inhalation exposure. No MRLs were derived for chronic-duration inhalation exposure to PBDEs due to a lack of inhalation studies. Further study on chronic-duration inhalation exposure to PBDEs was required.People are exposed to environmental PBDE mixtures of different congeners rather than the original commercial PBDE products. However, the toxicity data based on MRLs for environmental PBDEs are insufficient. Hence data from commercial PBDE mixtures are used to develop MRLs from environmental concentrations to PBDEs, owing to the following factors: (1) multiple mechanisms may be involved in health effects induced by PBDEs; (2) different PBDE congeners may produce effects by different mechanisms; (3) humans are exposed to complex mixtures of interacting PBDEs with differing biological activities, as well as to the lack of a suitable approach for quantitatively evaluating joint toxic action from concurrent exposures to PBDEs in the environment . An MRL ted BDEs . Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.S4 Table(DOCX)Click here for additional data file.S5 Table(DOCX)Click here for additional data file.S6 Table(DOCX)Click here for additional data file.S7 Table(DOCX)Click here for additional data file.


Aim. To determine the impact of gene polymorphisms on detrusor contraction-relaxation harmony in children with lower urinary tract symptoms (LUTS). Materials and Methods. Toilet trained children older than 5 years of age with LUTS and normal neurological examination underwent videourodynamic study. The control group was composed of age matched children with no voiding complaints. The study group who filled out the voiding dysfunction symptom score before and after the treatment received standard oxybutynin treatment and was reevaluated 1 year after treatment. Genomic DNA was isolated from all patients and subjected to PCR for amplification. Genotyping of ARGHEF10, ROCK2, ADRB3, and CYP3A4 was carried out with Polymerase Chain Reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) method. Results. 34 (45%) and 42 (55%) patients were enrolled in the study and control group, respectively. ARGEF10 GG, ADRB3 TC, and CYP3A4 AG genotype patients displayed insignificant difference between pre- and posttreatment voiding dysfunction symptom score and bladder volumes. Conclusions. The polymorphism of genes in the cholinergic pathway did not significantly differ clinical parameters. On the other hand, polymorphic patients in the adrenergic pathway seemed to suffer from clinical disappointment. For this reason, we think that the neglected adrenergic pathway could be a new therapeutic target for the treatment of anticholinergic resistant LUTS in children. Lower urinary tract symptoms (LUTS) are the most commonly encountered voiding dysfunction in children and are generally seen between 5 and 7 years of age . Delay iStimulation of M3 receptor in detrusor muscle by acetylcholine results in activation of RhoA pathway leading to contraction and actin cytoskeletal reorganization . There aβ-adrenergic receptors (AR) results in relaxation of detrusor muscle leading to the deposition of urine in bladder [β1,  β2, and β3 [β3 AR mRNA is highly expressed in detrusor muscle [β3 AR agonists [β3 AR encoded by ADRB3 gene is thought to be mainstay of detrusor relaxation in human bladder and it might be considered as a new therapeutic target in the treatment of OAB [On the other hand, activation of adrenergic pathway in detrusor muscle through  bladder . AR have and β3 . Among tr muscle , 8. The agonists . For thit of OAB –12.Oxybutynin is mainly metabolized by P450-bound microsomal enzyme system in liver . The cytIn our study, we aimed to determine the polymorphisms of the genes participating in detrusor contraction-relaxation harmony in kids with OAB and evaluate the impact of these polymorphisms on the clinical response to the medical treatment.Toilet trained children older than 5 years of age with urgency, frequency, urge incontinence, and normal neurological examination underwent videourodynamic study. Patients with vesicoureteral reflux, dysfunctional voiding pattern, constipation, and residual urine were excluded from the study. The control group was composed of age matched children with no voiding complaints who received treatment in our pediatric urology unit due to other urological pathologies.In urodynamic evaluation before the treatment, bladder capacity, peak detrusor pressure, voiding pattern, and uroflowmetric parameters were recorded. All patients filled out the voiding dysfunction symptom score (VDSS)  before aμL, containing 3 μL genomic DNA, 1.5 mM MgCl2, 0.2 mM dNTP, 50 pmol/mL of each primer, and 1.0 U/mL Taq DNA polymerase. Thermal cycling conditions were settled as 94°C for 30 seconds, 62°C for 60 seconds for 30 cycles, and then 72°C for 1 minute. After the incubation time, the fragments were separated on a 2%–4% agarose gel that was stained with ethidium bromide and visualized by Gel Logic 100 image system .Genomic DNA was collected from peripheral blood samples using the Heliosis Kit , following the manufacturer's instructions. ARGEF10, ROCK2, ADRB3, and CYP3A4 polymorphisms were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) methods. Amplifications were performed with Mastercycler gradient  thermal cycler. The gene-specific primer sequences, PCR products, and restriction endonucleases (REs) are shown in t-test, Mann-Whitney U test, and Fisher's exact test. Using the χ2 test, polymorphisms were tested for deviation from Hardy-Weinberg equilibrium (HWE). The relative association between patients and controls for genotype and allele frequencies was assessed by Pearson's χ2 test. The corresponding odds ratios (ORs) and confidence intervals (95% CIs) were calculated with SPSS version 15.0. Multivariate unconditional logistic regression analysis with adjustment for clinical and biochemical characteristics and genotype distribution was performed to calculate adjusted ORs and 95% CIs. All p values are two sided; p values <0.05 were considered statistically significant.Differences between the means of two continuous variables were evaluated by Student's p = 0.063).34 (45%) and 42 (55%) patients were enrolled in the study and control group, respectively. The demographic and clinical characteristics of responder and nonresponder patients treated with oxybutynin are summarized in p < 0.001). When we evaluated our patients according to filling and voiding phase symptoms after treatment, responders had significantly less bothering symptoms in both phases when compared to the nonresponder group . In addition, there was no significant difference in terms of uroflowmetric bladder volume before and after the treatment between the responder and nonresponder groups .On the other hand, VDSS after the treatment was significantly lower in the responder group 2.28 (0–8) when compared with the nonresponder group 14.11 (8–20) .All four SNP genotype frequencies in both study and control group were in agreement with Hardy-Weinberg equilibrium (n = 26) of the 34 patients, 20 patients had the CC genotype (76.9%), 4 patients had the CG genotype (15.4%), and 2 patients had the GG genotype. Of the nonresponder group (n = 8), 6 cases were type CC (75%) and 2 cases were CG (25%). Of the 42 healthy control cases, 29 (69%) cases were type CC, 12 (28.6%) cases were CG (2.4%), and only one case was type GG. The frequencies of C alleles were 85.3% in both responder and nonresponder patients and 83.3% in control group. The frequencies of G alleles were 16.7% in both responder and nonresponder patients and in control group. We found no statistically significant difference in the genotype and allele frequencies between the patients and controls.As for ARGEF10 (rs4376531) genotypes, responder group (p > 0.05).As for ROCK2 (rs2230774) genotypes, of the responder patients, 12 patients had the AA genotype (48%), 9 patients had the AC genotype (36%), and 4 patients had the CC genotype (16%). Of the nonresponder patients, 3 patients had the AA genotype (33.3%), 3 patients had the AC genotype (33.3%), and 3 patients had the CC genotype (33.3%). Of the healthy control cases, 13 cases were type AA (31.7%), 17 cases were AC (41.5%), and 11 cases were type CC (26.8%). The frequencies of A alleles were 61.8% in all patients and 52.4% in control group. The frequencies of C alleles were 38.2% in all patients and 47.6% in control group. Genotype and allele frequencies were not significantly different between the patients and the control group (n = 26) of the 34 patients, 23 patients had the TT genotype (88.5%) and 3 patients had the TC genotype (11.5%). Of the nonresponder group (n = 8), 7 cases were type TT (87.5%) and only one case was TC (12.5%). Of the 42 healthy control cases, 37 (88.1%) cases were type TT and 5 (11.9%) cases were TC. CC genotype was observed neither in patients nor in healthy controls group. The frequencies of T alleles were 94.1% in both responder and nonresponder patients and 94% in control group. The frequencies of C alleles were 5.92% in both responder and nonresponder patients and 6% in control group. We found no statistically significant difference in the genotype and allele frequencies between the patients and controls.As for ADRB3 rs4994 T/C genotypes, responder group (∗1B (rs2740574) genotypes, of the responder patients, 23 patients had the AA genotype (92%) and 2 patients had the AG genotype (8%); of the nonresponder patients, 8 patients had the AA genotype (88.9%) and only one patient had the AG genotype (11.1%). Of the healthy control cases, 36 cases were type AA (87.8%) and 5 cases were AG (12.2%). The frequencies of A alleles were 95.6% in all patients and 93.9% in control group. The frequencies of G alleles were 4.4% in all patients and 6.1% in control group. Genotype and allele frequencies were not significantly different between the patients and the control group (p > 0.05).As for CYP3A4p = 0.033). In our study, although we could not detect significant impact of our genotypes on VDSS when evaluated together, CC and CG allele of ARGHEF10 displayed significant impact on VDSS. In contradiction to Matsushita et al. [Humans are believed to carry over a million distinct single nucleotide polymorphisms (SNPs). The determination of SNPs is a new means to study the etiology of polygenetic disorders with complex inheritance patterns, like OAB. Polymorphism of ARGEF10 gene was studied in numerous pathologies and special focus was directed on systemic hypertension because of the aforementioned effect of this gene on smooth muscle contraction. Matsushita et al.  compareda et al. , these pROCK2 has important functions in smooth muscle contraction. Kandabashi et al.  studied β3 AR subtype in the bladder. In animal studies, it was found that certain β3 AR agonists  could significantly improve bladder capacity and prolong voiding intervals without interference of voiding pressure [β3 AR agonists (BRL37344A and CL316243) could not display significant relaxative effects on human detrusor muscle cell in contradiction to rat detrusor [Oxybutynin has been prescribed enormously and displayed significant side-effects due to the nonselective anticholinergic activity. After that, intravesical application of the medication has begun in order to bypass the side-effects . Due to pressure , 28. No detrusor .p < 0.05). We could not reach similar distributional significance between the study and control groups probably due to small sample size.The frequency of the polymorphism that we studied (ADRB3 Trp64Arg (rs4994) T/C) was found to be 20% and 40% in Japanese and Alaskan Eskimos, respectively . These rOxybutynin is excreted through metabolism of the drug to N-deethyloxybutynin by liver . CytochrAnticholinergic medication is contemporarily considered as the first treatment of choice for children with OAB. Although this method is very efficient, a significant portion of the patients suffer from unsatisfactory clinical improvement and side-effects. We studied certain genes in the molecular pathway of detrusor contraction-relaxation harmony and drug metabolism. We did not detect significant impact of these polymorphisms on clinical parameters as a whole probably due to small sample size. The polymorphism of genes in the cholinergic pathway could not significantly differ clinical parameters. On the other hand, polymorphic patients in the adrenergic pathway seemed to suffer from clinical disappointment. For this reason, we think that the neglected adrenergic pathway could be a new therapeutic target for the treatment of anticholinergic resistant OAB in children.


Daily concentrations of PM2.5 components were measured over five years in Denver to investigate whether specific PM2.5 components are associated with daily mortality.Associations of short-term exposure to fine particulate matter , organic carbon (OC), sulfate and nitrate were measured at a central residential monitoring site. Using generalized additive models, we estimated relative risks (RRs) of daily death counts for daily PM2.5 and four PM2.5 component concentrations at single and distributed lags between the current and three previous days, while controlling for longer-term time trend and meteorology.Daily counts of total and cause-specific deaths were obtained for the 5-county Denver metropolitan region from 2003 through 2007. Daily 24-hour concentrations of PM3 in PM2.5 distributed over 4 days was 1.012 ; RRs for EC and OC were larger  than those for sulfate and nitrate. We generally did not observe associations with cardiovascular and respiratory mortality except for associations with ischemic heart disease mortality at lags 3 and 0–3 depending on the component. In addition, there were associations with cancer mortality, particularly for EC and OC, possibly reflecting advanced deaths of a frail population.RR of total non-accidental mortality for an inter-quartile increase of 4.55 μg/m2.5 components possibly from combustion-related sources are more strongly associated with daily mortality than are secondary inorganic aerosols.PMThe online version of this article (doi:10.1186/s12940-015-0037-4) contains supplementary material, which is available to authorized users. Most of these studies investigated the short-term association of exposures to PM2.5 components on a given day and counts of deaths or hospital admissions on the current or a few following day. Increases in daily concentrations of combustion-related components such as elemental and organic carbon were associated with increased cardiovascular mortality within a few days in California, New York City, and Phoenix [Recent observational epidemiologic studies have focused on the adverse health effects of outdoor fine particulate matter  with daily mortality attributed to the most common causes of death in the 5-county Denver metropolitan area over the 5 years of the study.The Denver Aerosol Sources and Health (DASH) study was designed to enable investigation of the health effects of short-term exposure to chemical components of PMexposure . Here we2.5 chemical speciation data , elemental and organic carbon (EC and OC). Gravitational mass measurements were made using a microbalance housed in a temperature and humidity controlled chamber. Filters were collected from the field within 72 hours of sampling and post-weighed within 2 weeks of collection. Inorganic ionic compounds were quantified using an ion chromatograph following standard methodology for airborne particulate matter. EC and OC concentrations were determined by the National Institute for Occupational Safety and Health Method 5040.PM2, and NO2 were collected at one EPA site 5.7 kilometer away from the DASH site, whereas O3 was measured at another site 9.2 kilometer away. Daily maximum of 1-hour averages for CO, SO2, and NO2, and daily maximum of 8-hour averages for O3 were computed.Meteorological measurements were collected at the Buckley Air Force Base about 14 kilometer away from the DASH monitoring site. We computed daily averages of temperature, relative humidity, and barometric pressure. Hourly measurements of gaseous pollutants at the two U.S. Environmental Protection Agency (EPA) monitoring stations in Denver were extracted from the U.S. EPA Air Quality System database. CO, SO2.5 [Human subjects study approval was obtained from the Human Subjects Division, University of Washington. Daily mortality counts for metropolitan Denver were computed from the Colorado Health Information Dataset compiled by the Colorado Department of Public Health and Environment. Data included underlying cause of death by the International Classification of Diseases 10th Revision (ICD-10) code, residence zip code, gender and age at death. Deaths were restricted to the five-county Denver metropolitan region that includes Adams, Arapahoe, Denver, Douglas and Jefferson counties  and 95 % confidence intervals (CIs) for inter-quartile (IQR) increases in pollutant concentrations.The associations between the daily PMe models . In these models . Estimat2.5 components, PM2.5, and gaseous pollutants including CO, SO2, NO2, and O3. For PM2.5, we used residuals from the regression of PM2.5 on each PM2.5 component [Several sensitivity analyses were carried out to assess the robustness of the findings to modeling choices. We examined smaller or larger df  for long-term temporal trend, matching lags of meteorology to those of pollutants, and a squared term and moving averages of extended days  for temperature. We additionally adjusted for barometric pressure, the other PMomponent . To asseomponent , 19. The2.5 and PM2.5 components from 2003 through 2007 are shown in Table 2.5, EC, OC, sulfate, and nitrate were 7.98, 0.47, 3.09, 1.08, and 1.03 μg/m3, respectively. Nitrate and EC showed the most clear seasonal cyclical pattern with both having higher winter concentrations  at lag 0–3. The estimated RRs of EC and OC were generally larger, particularly at lags 1, 2 and 0–3 than those of the other PM2.5 components and of PM2.5. There was little evidence of associations of PM2.5 or PM2.5 components on cardiovascular and respiratory mortality. However, PM2.5 and all four PM2.5 components were associated with IHD mortality at lag 3 or lags distributed over days 0–3. RRs for IHD were higher than those of any other cause-specific mortality, but with much wider CIs. Estimated RRs of cancer mortality were higher than those of cardiovascular or respiratory mortality. PM2.5 as well as all four PM2.5 components were associated with cancer mortality at lags 0, 1, or 0–3 with larger effect estimates for EC and OC.Estimated RRs of non-accidental total, cardiovascular, IHD, respiratory, and cancer mortality for IQR increases in PM2.5 residuals and gaseous pollutants, and restriction of the study area to 10 and 20 kilometer buffers  rather than an effect of one day in isolation. Findings show suggestive associations with total mortality, especially for EC and OC, but little evidence of associations specifically with cardiovascular or respiratory mortality; the clearest associations were seen for cancer mortality particularly for EC and OC with possibly mortality displacement. PM2.5, EC and OC associations distributed over several days were somewhat larger than those at any single day lag.The DASH study features daily PM2.5 or the PM2.5 components, whereas total mortality was associated with EC and OC. For PM2.5, no associations of cardiovascular mortality were commonly found in single-city time-series studies performed in the U.S [2.5, a few recent time-series studies focusing on PM2.5 components found higher effect estimates for cardiovascular mortality than total mortality. Ostro et al. (2007) found generally higher effect estimates of PM2.5, EC, OC and nitrate in California on cardiovascular mortality than total mortality at lag 0 through 3 [2.5 and EC than for total mortality in the cold season [2.5 components for 5 years actually resulted in comparable or better power in the DASH study compared to those studies which used regulatory monitoring data measured every 3rd or 6th day for 4 and 3 years, respectively. It is possible that there is still insufficient power in single city studies, however, in light of the evidence of associations for PM2.5 from multi-city studies [2.5 component with cause-specific mortality.We found no evidence for associations between cardiovascular mortality and PM the U.S . A meta- the U.S . Another the U.S . As oppohrough 3 . In Seatd season . While t studies . We did 2.5 and the four PM2.5 components than for any other cause-specific mortality, with the exception of IHD mortality, as noted above. Higher effect estimates of total mortality than those of cardiovascular and respiratory mortality may indicate stronger associations with other common causes of mortality, such as cancer mortality. Higher effect estimates of cancer mortality than of non-cancer mortality  across the four sites [2.5 component concentrations were highly correlated (0.70-0.86) over time with those at an EPA Chemical Speciation Network site located 13 kilometers away (Fig. This study has some limitations and implications for future studies. Because air pollution concentrations were measured at only one site in the Denver metropolitan region, it is likely that these population exposures to ambient air pollution were estimated with some degree of error. Measurement error might be expected to be greater for those PMur sites , 35. We 2.5 species. A detailed set of speciated organic compounds was also measured daily at the DASH monitoring site [Here we report mortality findings relating to the bulk PMing site , 36. In ing site , 33.2.5 components was associated with increased daily mortality. Associations were stronger for EC and OC than for sulfate and nitrate, secondary inorganic aerosols, especially in those with cancer as an underlying cause of death. Individuals with cancer may represent a very frail subpopulation whose deaths could be advanced given high exposures to PM2.5 component air pollution. Future studies are needed to identify the specific sources of air pollution, such as traffic emissions, for example, that are more responsible for producing these adverse effects.Short-term exposure to increased concentrations of some PM


To evaluate the long-term outcomes of Argon laser photocoagulation compared to surgical direct cyclopexy in small-size cyclodialysis cleft patients.This is a retrospective study. Small-size cyclodialysis cleft patients who underwent Argon laser photocoagulation and surgical direct cyclopexy were reviewed. The mean follow-up period were 82.4  months and 99.9  months in both groups. The comparison of best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative peak IOP and time to normalization of IOP before and after the treatment.p = 0.38). Preoperatively, the mean logMAR BCVA  was 0.7 (0.2) and 1.1 (0.9) and mean IOP was 4.4 (2.4) mmHg and 3.0 (1.5) mmHg in Argon laser group and surgical direct cyclopexy group . The extension of cyclodialysis and duration of cyclodialysis cleft were not significantly different between the two groups . The mean follow-up period were 82.4  months and 99.9  months in both groups (p = 0.41). Postoperatively, the mean logMAR BCVA was 0.0 (0.1) and 0.2 (0.3) and mean IOP was 14.5 (3.1) mmHg and 16.8 (2.5) mmHg . Postoperative peak IOP and time to normalization of IOP were not different between the two groups .The causes of all included 15 cyclodialysis cleft cases were blunt trauma. seven patients underwent Argon laser photocoagulation and eight patients underwent surgical direct cyclopexy. The mean age of included patients was not significantly different (It is necessary to use invasive treatment such as cryotherapy or surgical direct cyclopexy in cyclodialysis cleft with hypotonic maculopathy. In the present study, Argon laser photocoagulation showed good prognosis in a small-size cyclodialysis cleft below 1.5 clock-hours. Considering possible complications and cost of surgical direct cyclopexy, Argon laser can be more beneficial than surgical direct cyclopexy in small-size cyclodialysis cleft below 1.5 clock-hours.The clinical ourcome of Argon laser photocoagulation seems to be as good as surgical direct cyclopexy in small-size cyclodialysis cleft below 1.5 clock-hours. Cyclodialysis cleft occurs when the ciliary body is detached from the scleral spur. This is usually related to blunt trauma or iatrogenic injury due to ophthalmic surgery. The communication between the anterior chamber and the suprachoroidal space can result in clinically significant hypotony and its complications such as cataract or macular edema . ClinicaLaser photocoagulation using Argon laser has been used as one of the treatment of choice for repair of cyclodialysis cleft to avoid major intraocular surgeries . PreviouThe present study was retrospective study approved by the Institutional Review Board of Samsung Medical Center and adhered to the tenets of the Declaration of Helsinki. The medical charts of the traumatic cyclodialysis cleft patients who visited Samsung Medical Center and underwent Argon laser photocoagulation from January 1999 to December 2008 were reviewed.We included the patients with small-size cyclodialysis cleft below the extent of 2 clock-hours. A single surgeon (CK) performed all the Argon laser treatment and surgical direct cyclopexy. All included patients with small-size cyclodialysis cleft used atropine at least for 2 months at first. In case the patients had no improvement of the symptoms of cyclodialysis cleft such as persistent ocular hypotony with decreased visual acuity or macula edema with medical treatment, they underwent Argon laser photocoagulation or surgical direct cyclopexy. The decision which methods the patient would undergo was made by the patient after explaining the strength and weakness of the each treatment. We only included the cases with medical records over five years after the treatment. The cases with severe ocular complications such as scleral laceration and choroidal rupture were excluded. The treatments were fully explained to each patient, and each provided written informed consent.All patients underwent routine ophthalmologic examinations including best-corrected visual acuity (BCVA), slit-lamp examination, Goldmann applanation tonometry and fundus photo. Gonioscopic examination and ultrasound biomicroscopy (UBM) Fig.  and b weThe procedure was performed on the outpatient clinic. Retrobulbar anesthesia using 2 % lidocaine was used. If the anterior chamber is too shallow, it was deepend with ophthalmic viscosurgical device (OVD), Hyal 2000® . The location and extent of cyclodialysis cleft was confirmed by gonioscopy and Argon laser was applied to the full extent of the cleft. The protocol of Argon laser photocoagulation  in our clinic was as follows: at first, the laser targeted for bare sclera detached from ciliary body. The recommended spot size was 300 to 500 μm, duration of 0.3 to 0.5 s and the power ranged between 800 and 1000 mW. The green color of laser (532 nm) was used. The number of burns was approximately 40 to 50 shots. And then, the target of laser changed into the area that contains iris root and detached ciliary body. The spot size also changed into 100 μm with a duration of 0.1 to 0.2 s and the power ranged between 600 and 800 mW. The number of burns was approximately 40 to 50 shots. The laser power was titrated based on the tissue response. We regarded bubble formation around tissue as the proper tissue response of an effective laser treatment. If pop sound with bubble formation occurred, the power was decreased. The number of burns was usually totally 80 to 100 shots. After the procedure, patients used 1 % atropine for one month. Because of temporary IOP increase, a topical β-blocker, an oral carbonic anhydrase inhibitor, or an intravenous hyperosmotic agent was used. If the IOP was still low at 1 week, additional Argon laser photocoagulation was performed as the same method mentioned above.A conjunctival flap was made and the sclera was exposed at the site of the cyclodialysis cleft. A partial-thickness scleral flap was made approximately 4 mm posterior to the limbus. After elevating the scleral flap, the sclera was incised 1.5 mm posterior and parallel to the limbus. Aqueous humor was released, and the cyclodialysis cleft was visualized. The detached ciliary body was attached to the sclera with an interrupted suture through the anterior sclera, the ciliary body, and the posterior scleral lip using 10–0 nylon sutures. The scleral flap and conjunctiva were closed. After the surgery, 1 % atropine was used in eyes. Because of temporary IOP increase, a topical β-blocker, an oral carbonic anhydrase inhibitor, or an intravenous hyperosmotic agent was used.t-test or Mann–Whitney U-test was used for comparison of the clinical characteristics between Argon laser photocoagulation group and surgical direct cyclopexy group. Clinical characteristics that were compared between the two groups were as follows: Age, extent of cyclodialysis cleft, DOC, preoperative and postoperative final BCVA and IOP, postoperative maximum IOP, TNP, and follow-up period. Statistical analyses were performed using 18.0 . The results were considered significant at p-values < 0.05.Independent p = 0.38). All the included patients were men except one case in surgical direct cyclopexy group.Twenty-one patients with a small-size cyclodialysis cleft were investigated. Five cases were excluded because they were accompanied by ocular problems such as scleral laceration and choroidal rupture. Among 16 patients, one case was recovered from hypotony only using 1 % atropine for a month. Argon laser photocoagulation for cyclodialysis repair was performed in seven eyes of seven patients. Surgical direct cyclopexy were performed in eight eyes of eight patients. The cause of all cyclodialysis cleft cases treated by Argon laser or surgical cyclopexy was blunt trauma. The mean  age of included patients was 33.3 (15.2) years  and 40.8 (16.3) years  in Argon laser group and surgical direct cyclopexy group . The mean extent of cyclodialysis cleft were 1.2 (0.3) clock-hours  and 1.6 (0.4) clock-hours  and the duration of cyclodialysis before laser treatment were 6.1 (8.4) months  and 2.0 (0.5) months  in both groups . All patients except one patient (Case A7) had hypotonic maculopathy before the treatment.Preoperatively, the mean (SD) log minimum angle of resolution (logMAR) BCVA were 0.7 (0.2) and 1.1 (0.9) and mean (SD) IOP were 4.4 (2.4) mmHg  and 3.0 (1.5) mmHg  in both groups . The mean (SD) postoperative maximum IOP were 30.4 (13.4) mmHg  and 32.8 (13.8) mmHg  in both groups (p = 0.75). The mean (SD) time to normalization of IOP were 9.6 (15.8) days  and 8.9 (6.9) days  in both groups (p = 0.91). The mean (SD) follow-up period were 82.4 (29.0) months  and 99.9 (47.1) months  in both groups (p = 0.41). There were no complications during the laser treatments or surgeries. One patient (Case A3) in Argon laser group had an additional Argon laser photocoagulation at 1 week after the first Argon laser treatment due to persistent hypotony. Recurrence of hypotony, secondary glaucoma were not found during follow-up period. The preoperative and postoperative demographics of the cyclodialysis cleft patients are summarized in Table Postoperatively, the mean (SD) final logMAR BCVA were 0.0 0.1) and 0.2 (0.3) and mean (SD) final IOP were 14.5 (3.1) mmHg and 16.8 (2.5) mmHg in both groups  in Argon laser group underwent the treatment because of persistent hypotony associated with cyclodialysis cleft. However, cyclodialysis cleft was sealed by additional Argon laser photocoagulation and IOP have been maintained over 10 years.Surgical treatment can burden the surgeons and patients. Surgical treatment has substantial severe complications such as endophthalmitis or suprachoroidal hemorrhage. Furthermore, the conventional surgical direct cyclopexy takes much longer time to be performed than Argon laser photocoagulation. Even though there was no treatment failure case when using direct cyclopexy in the present study, several reports showed failure cases of direct cyclopexy previously , 17. TheIn conclusion, the clinical ourcome of Argon laser photocoagulation seems to be as good as surgical direct cyclopexy. Considering cost, time and possible complications of surgical direct cyclopexy, Argon laser can be more beneficial than surgical direct cyclopexy in small-size cyclodialysis cleft below 1.5 clock-hours.Written informed consent was obtained from the patients (Case A2) for publication.


A balanced nutrition schedule provides the essential substances for proper oral health.The aim of this study was to investigate the association between dental caries and body mass index in 6-11 year-old children in Zahedan.In this cross-sectional study 1213 children  were included. Body mass index (BMI) and clinical examination for determination of DFT (decay filling teeth) index (based on WHO criteria) were taken. Collected data were analyzed using the t-test, chi-square and ANOVA.Among children, 20.8% had low weight, 66.3% normal weight, 7.8% were overweight and 5.1% obese. In the low weight, normal weight, overweight, and obese groups, the mean ± SD values for DFT were: 0.63 ± 1.1, 0.88 ± 1.36, 1.16 ± 1.33, and 0.87 ± 1.31, respectively. There was a significant association between BMI and DFT (P = 0.005). The overweight group had higher DFT compared to the low and normal weight groups. 13.5% of low weight, 12.2% of normal weight, 14.7% of overweight and 22.6% of obese children had DFT = 0. There was no statistical association between BMI and being caries free (P = 0.4).The mean DFT in the overweight group was higher than low and normal weight groups. There was a statistically significant association between BMI and DFT. Dental caries is one of the major health problems in the world . Its impAn association between weight and oral health in children has had controversial results. On one hand, consumption of soft drinks and fast food as well as lack of activity and exercise contributed to the increasing number of overweight individuals around the world . OverweiAlthough surveys on Iranians show improvements in oral health education and dental services, various regions of a country may have different dental caries frequencies compared to other parts due to different conditions and access to dental care. No information on the association of BMI and dental caries is available from Zahedan. The purpose of this study was to determine the relationship between BMI-for-age and dental status of primary school children in Zahedan, Iran.This cross-sectional study was conducted on 1213 primary school children  aged 6-11 years, in Zahedan. Using a random cluster sampling, 12 girls and boys primary schools (classes I-V for children aged 6-11 years) in the study area with different social backgrounds were screened. From a total of 1233 children at the beginning of the study, 20 children had chronic problems and were excluded.The body weights were recorded to the nearest 100 g using a standard beam balance scale (Seca). Subjects had light dresses. The scale was calibrated at the beginning of each working day and at frequent intervals throughout the day. The body heights were recorded to the nearest 0.5 cm without shoes.BMI-for-age [(weight in kilograms)/(height in meters) ²] was calculated. Underweight was defined as BMI-for-age < 5th percentile, “normal” was defined as 5th percentile < BMI-for-age < 85th percentile, “at risk of overweight” was defined as 85th percentile < BMI-for-age < 95th percentile, and “Obese” was defined as BMI-for-age > 95th percentile . The DMFThe study was confirmed by the research committee of the Faculty of Dentistry, Zahedan University of Medical Sciences.Means and standard deviations were calculated to express the DFT values. The t-test was applied to study the association of the dental caries prevalence with gender and age. ANOVA test was used for the relationship between DFT and BMI. P ≤ 0.05 was considered statistically significant.A total of 1213 children were present in this study (670 (55.2%) girls and 543 (44.8%) boys). Thirteen cases (1 boy and 12 girls) were 6, 223 children (86 boys and 137 girls) were 7, 271 children (127 boys and 144 girls) were 8, 206 children (105 boys and 101 girls) were 9, 238 children (102 boys and 136 girls) were 10, and 261 children (121 boys and 140 girls) were 11 years old.Five percent of the children in the study  were obese, 7.8%  were overweight, 66%  had normal weight, and 20%  were underweight. There was a statistically significant association between BMI-for-age and gender (P = 0.01).There were more obese and overweight girls than boys in the study (P = 0.01). The gender differences of the carious lesions frequencies in relation with the BMI values resulted in a slightly higher occurrence of carious lesions in girls. The boys and girls had a mean of 0.7 ± 1.24 and 0.9 ± 1.36 for carious lesions  in their permanent dentition, respectively (P = 0.05).Distribution of the children according to the DFT index and BMI is given in Daily consumption of sweet products did not have any relationship with dental caries and BMI. Watching TV was more frequent in girls than boys (P = 0.0001). DFT decreased with increased tooth brushing (P = 0.0001).There have been no oral epidemiological studies determining the association between BMI and DFT in Zahedan. Considering this issue, the present study intended to provide such information. The studied subjects were 13% obese and overweight, 66% had normal weight, and 20% were underweight. Our results showed a significant association between BMI-for-age and gender . There was a slightly higher occurrence of carious lesions in girls. This research also revealed that only 37% children in overweight and obese groups were caries free. Caries prevalence was substantially lower in children with increased tooth brushing (P = 0.0001).In a study by Hilgers KK et al. on 178 children aged 8 to 11 years, caries severity averages were analyzed. The results showed that the mean caries for permanent molars significantly increased with increased BMI, which is similar to our results .In an Iranian survey, the percentages of caries-free children (deciduous and permanent teeth) among 6 and 9 years old were reported as 13.8 and 11.5 respectively, and more than 50% of 12-year-old children had caries experience, with the decay component being the greatest cause. Although improvement in DFT index was shown as marked decline in dental caries from DFT of 4 to 1.5 in 12-year-old children, the authors emphasized that the general level of oral health is still not satisfactory especially among children and recommended that interventions should be taken . In addiThe results of our study showed that the number of tooth brushing sessions in a day could affect the DFT. Brushing three times was more effective than never in one day (1.09 ± 0.5 vs. 1.4 ± 1.3 respectively). Daily tooth brushing behaviors and age of brushing initiation with parental supervision have been reported by several studies as strong caries prevention methods , 17. In Finally, we analyzed the caries prevalence rates using DFT, but there were other factors such as cultural and hygienic habits  that we The results of this study indicate a possible association between high weight and caries. Besides numerous other risk factors, high weight can also be responsible for increased number of carious lesions. In future preventive programs, strategies should aim at nutrition control to avoid high weight as well as carries.


Our study aimed to investigate which echo time (TE) on single-echo susceptibility is the optimal echo for visualizing AMV and to compare the ability in detecting AMV in stroke patients between SWIs and multi-echo susceptibility weighted imaging (SWIc).Asymmetric medullary veins (AMV) are frequently observed in stroke patients and single-echo susceptibility weighted imaging (SWIs including SWIs1 (TE = 23.144 ms), SWIs2 (TE = 29.192 ms) and SWIs3 (TE = 35.240 ms) were reconstructed. SWIc was averaged using the three echoes of SWIs. Image quality and venous contrast of medullary veins were compared between SWIs and SWIc using peak signal-to-noise ratio (PSNR), mean opinion score (MOS), contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). The presence of AMV was evaluated in each SWIs (1–3) and SWIc.Twenty patients with middle cerebral artery stroke were included. SWI was acquired by using a multi-echo gradient-echo sequence with six echoes ranging from 5 ms to 35.240 ms. Three different echoes of SWIs2 had the highest PSNR, MOS and CNR and SWIs1 had the highest SNR among three different echoes of SWIs. No significant difference was found in SNR between SWIs1 and SWIs2. PSNR, MOS and CNR in SWIc were significantly increased by 27.9%, 28.2% and 17.2% compared with SWIs2 and SNR in SWIc was significantly increased by 32.4% compared with SWIs1. 55% of patients with AMV were detected in SWIs2, SWIs3 and SWIc, while 50% AMV were found in SWIs1.SWIs using TE around 29ms was optimal in visualizing AMV. SWIc could improve image quality and venous contrast, but was equal to SWIs using a relative long TE in evaluating AMV. These results provide the technique basis for further research of AMV in stroke.SWI The significant differences in PSNR, CNR and SNR  among the four types of SWI images were analyzed using one-way ANOVA followed by least significant difference (LSD) post-hoc analysis for multiple comparisons. The significant difference in MOS  among the four types of SWI images was analyzed using Kruskal-Wallis test followed by all pairwise multiple comparisons. The correlation between PSNR and MOS was performed using Spearman's correlation analysis. A two-tailed value of P < 0.05 was considered significant.The mean patient age was 56.2 ± 11.5 years  with 14/20 (70%) being male patients. The time between MR examination and symptom onset was 4.6 ± 1.3 days . NIHSS on admission was 9.1 ± 3.7 . The detail information of stroke patients was shown in s2 had the highest PSNR value among the three different echoes of SWIs . There were no significant differences in PSNR value between SWIs1 and SWIs3 (P = 0.964). PSNR value of SWIc was 130.9 ± 10.9 dB, increasing by 27.9% compared with PSNR value of SWIs2 (P < 0.001). SWI s1, SWIs2 and SWIs3 were 3 , 4  and 4 , respectively. No significant differences were found between SWIs1 and SWIs2 (P = 0.097), SWIs1 and SWIs3 (P = 0.746) and SWIs2 and SWIs3 (P = 1.000). The median values of MOS in SWIc was 5 , which was much higher than MOS of SWIs2 (P < 0.001). Inter-rater reliability for MOS was excellent with an ICC of 0.90 . The median values of MOS in SWIs2 and SWIs3 were 2.9 ± 0.7 dB, which were significantly higher than that in SWIs1 (P = 0.018). CNR values of SWIc was 3.4 ± 0.7 dB, increasing by 17.2% compared with CNR value of SWIs2 or SWIs3 (P = 0.013). With TE increasing, the SNR decreased. SWIs1 had the highest SNR value compared with SWIs2 and SWIs3 . SNR value of SWIc was 47.4 ± 15.8 dB, increasing by 32.4% compared with SNR value of SWIs1 (P = 0.002). Both values of CNR in SWIThe raw data of PSNR, MOS, CNR and SNR are within s2, SWIs3 and SWIc, but in 10 patients (50%) in SWIs1. The Kappa value of AMV was 0.80 for SWIs1, 0.90 for SWIs2, SWIs3 and SWIc. AMV were much more conspicuous in SWIc images, but were inconspicuous in SWIs1. The case without obvious AMV in SWIs1 was shown in The presence of AMV was found in 11 patients (55%) in SWIs. Compared with SWIs images, SWIc images can effectively improve both image quality and venous contrast. For qualitative evaluation of AMV, SWIs (except TE = 23.144 ms) had the same capability as SWIc.Our study showed that TE = 29.192 ms was the optimal echo in visualizing DMV among the three different echoes of SWIAMV is considered to be caused by an increase of oxygen extraction within veins, due to the elevated ratio of deoxyhemoglobin to oxyhemoglobin in ischemic brain regions , 27. T2*0 field, venous orientation of DMV with θ = 90° would be mainly influenced by an additional extravascular field around the vessel which brings additional dephasing [0 is in accordance with an in vivo and simulation study that showed maximum contrast of venous orientation of θ = 90° was close to that of venous orientation of θ = 0° when using a comparable TE [SWI images using longer echoes can produce higher venous contrast. Thus, we used the latter three echoes from multi-echo SWI sequence including TE = 23.144 ms, TE = 29.192 ms and TE = 35.240 ms to reconstruct different single echoes of SWI images and found that SNR decreased when TE was prolonged. In other words, it was not the longest TE that had the best venous contrast. This result is consistent with previous finding that a longer TE has a higher venous contrast but contains severe artifacts caused by the off-resonance effect . Unlike ephasing . We founephasing , 16. Therable TE . It suggs images acquired at different echo times, venous contrast would be improved because different contrasts of veins and susceptibility artifacts in the same zone of interest are weighted [c had a more desirable balance between contrast of small DMV and image quality and quantitative image analysis showed that image quality and venous contrast were significantly increased on SWIc. As far as we known, no studies have quantitatively investigated these small veins in SWI images. The main reason is that it is difficult to segment DMV because of low local contrasts and high noise levels of DMV in current MR technique. Venous contrast could be improved by using complex post-processing techniques, which has been reported in recent studies [By combining SWIweighted . In our  studies , 35. Thec showed superior contrast compared to SWIs, our data showed that the detection ratio of AMV in SWIc images was the same as that in SWIs images when using TE = 29.192 ms or 35.240 ms. The requirement for image quality in detecting the presence of AMV is not such rigorous as that in quantitative measurement of DMV because only the asymmetric performance of DMV is needed to be identified. Thus, for hyperacute or acute stage of stroke with limited scanning time or for some institutions without multi-echo SWI technique, SWIs can be recommended to evaluate the presence of AMV. Based on our finding that best image quality and venous contrast of DMV was achieved at TE = 29.192 ms, a SWIs with a relative long TE (around 29 ms) seems to be sufficient. However, using a shorter TE in SWIs should be cautious because it may underestimate the presence of AMV. Small vessels at shorter TE have a lower venous contrast, and therefore, DMV may be difficult to be differentiated from adjacent image noise.Although SWIImage resolution is also an important issue in delineating intracranial small veins. Due to the normal caliber of DMV ranging from 100 μm to 250 μm , a high s images derived from a multi-echo sequence has its own advantage that all parameters are the same besides TE. In fact, it is difficult to obtain the same sequence parameters between a reference SWIs image and a SWIc image because some parameters have to be adjusted to allocate time for the sampling of multiple echoes. Secondly, the maximum TE was only 35.240 ms. It is unknown whether combined with other TEs of longer than 35.240 ms would produce a better image quality and venous contrast. However, a too long TE will increase the total scan time, which is not practicable in the clinical setting of hyperacute stroke when “time is brain” [There are some limitations in our study. Firstly, an additional single-echo sequence was not acquired for comparison. Different echoes of SWIs brain” .s using TE around 29 ms was the optimal echo for visualizing AMV in stroke patients. SWIc could improve visibility of AMV, but was equal to SWIs using a relative long TE in qualitative assessment of AMV. These results will provide the technique basis for choosing the optimal echo for visualizing AMV and pave the way for further research of AMV in stroke.In summary, SWIS1 Dataset(XLSX)Click here for additional data file.


Mushroom was added in both biscuits. Biscuits were analyzed for chemical and sensory parameters. Protein content of soy flour-supplemented biscuits increased from 11.07% to 17.86% as compared to control along with a significant increased in fat (17.36–20.89%), fiber (0.48–0.92%), iron (1.56–1.99 mg/100 g), and energy value . Ash content also increased but not significantly. Results from chemical analyses and organoleptic evaluation indicate that good quality biscuits can be prepared by substituting wheat flour with 15% soy flour and addition of mushroom powders may affect the backing quality. Protein Energy Malnutrition (PEM) of the Bangladeshi population can be reduced through the development of biscuits in this way.The research study was conducted to evaluate the quality characteristics of soy-mushroom-enriched biscuits which could be used as a protein supplemented cereal snack food. In this study, wheat flour was replaced with soy flour at different levels that is 20% (T3), 15% (T2), and 10% (T1) and without soy flour was kept as control (T Protein Malnutrition is widely recognized as a major health problem in Bangladesh due to cereal-based dietary pattern. The protein quality of the cereal-based diet can be improved by fortifications. According to FAO standards FAO , suggestNowadays, bakery food products, especially biscuits are becoming very popular in Bangladesh in rural as well as urban areas among all the age groups due to its several attractive features, including wider consumption, low cost among other processed foods, varied taste, easy availability and good eating quality, and relatively long shelf life , a species of legume, a miracle bean, is an excellent health food and it contains 43.2% good quality protein but only minimal saturated fat, 21% carbohydrates , Vitamins (Vitamin B- complex), and minerals , Bangladesh Council of Scientific and Industrial Research (BCSIR), Bangladesh.Pleurotus ostreatus) was collected from the National Mushroom Development and Extension Center, Savar, Bangladesh. Other ingredients were collected from the local market.Soybean was collected from the Bangladesh Agricultural Research Institute. Oyster mushroom  was kept as control. Fixed amount of mushroom (5%) was added in all the treatments and control. The formulation and preparation of biscuits is shown in TableWheat flour was replaced with soy flour in three proportions 10, 15, and 20% and designed as T1, T2, and T3, respectively, whereas TThe organoleptic test of the products was done by the 9-point hedonic scale scorecard, especially prepared for the purpose. A 10-member trained panelist was selected from the staff members of the Institute of Food Science and Technology (IFST), Bangladesh Council of Scientific and Industrial Research (BCSIR), Bangladesh. Each attribute was scored based on its intensity scaled on a 9-point hedonic scale  for color, flavor, texture, and taste.The proximate composition  and total energy of soya-mushroom biscuits were determined according to the standard analytical methods AOAC .Moisture content was determined by drying a sample in an oven at 100°C for 12 h, the weight loss incurred was calculated as: Crude protein content of the samples was determined using the Kjeldahl method. The method consists of three basic steps: (1) digestion of the sample in sulfuric acid with a catalyst, which results in conversion of nitrogen to ammonia; (2) distillation of the ammonia into a trapping solution; and (3) quantification of the ammonia by titration with a standard solution.According to this method, percentage of crude protein content of the samples = % nitrogen × 6.25.Crucibles were first dried for about 2 h at 100°C in an oven and placed in a desiccator. They were cooled and about 2.0 g of sample was weighed into the crucible. The samples were then placed in a furnace at 600°C for 4 h. Percentage ash content was determined by weighing the resulting inorganic residue. Fat content was determined using the Soxhlet extraction method. In this method, fat was determined by extracting the dried materials (food samples) with a light petroleum fraction in a continuous extraction apparatus. The solvent was distilled off and the extract was dried and weighed.2SO4 and 0.313N NaOH, consecutively, for 30 min under a reflux condenser and each time the sample was washed well with boiling water to remove acid and alkali residues. The sample was then transferred into a crucible, dried overnight at 100°C and weighed (W1) in an analytical balance. The crucible was heated in a muffle furnace at 600°C for 20 min, cooled, and weighed again (W2). The difference in the weights (W1 – W2) represents the weight of crude fiber. The moisture and fat-free sample was boiled with 0.255N HThe content of the available carbohydrate was determined by the following equation: Estimation of Iron by WONG's Method Wong .Metabolizable energy was calculated following the formula below: t-test.Data analysis was performed using Statistical Package for the Social Sciences . Values were expressed as percentage and mean ± SD. One way ANOVA was used for determining the significance/nonsignificance of results. Means were separated using The nutritional compositions of dehulled soy flour were moisture 1.4%, protein 49.3%, fat 24.9%, ash 2.8%, fiber 3.0%, and total carbohydrate 18.6% in dry weight. The protein and fat content is slightly higher than the results of Gopalan et al.  on a dryPleurotus ostreatus) powder were moisture 4.0%, protein 31.8%, fat 2.5%, ash 7.0%, fiber 12.5% and total carbohydrate 42.2% in dry weight. The protein, ash, fiber, and fat content were almost similar to the study of Michael et al. .In the present study, the moisture content (3.97%) was found to be the highest in control (To) biscuit. The results showed that the moisture content gradually decreased from 3.97 to 2.19% with the increase in soy flour Table. This maThe highest ash content (1.75%) was found in treatments T3 20%) and lowest value (1.50%) was recorded in control (To) biscuit. In treatments T2 (15%) and T1 (10%), the ash content was found to be 1.68% and 1.59%, respectively The result showed that the ash content gradually increased from 1.50% to 1.76% with an increase in the percentage of soy flour as shown in Table0% and loIn the present study, the protein content was found to increase from 11.07% to 17.86%. The highest protein content (17.86%) was found in treatment T3 20%) and lowest (11.07%) was recorded for control (To) biscuit. In treatment groups T2 (15%) and T1 (10%), protein content was found to be 14.87% and 13.46%, respectively  was found in treatment T3 (20%) and lowest (17.36%) was recorded for control (To) biscuit. In treatments T2 (15%) and T1 (10%), the fat content was found to be 18.97% and 18.57%, respectively Table, but oppThe fiber content of the biscuit increased from 0.48% to 0.92% with the increase in supplementation of soy flour. The highest fiber content (0.92%) was found in treatment T3 (20%) and lowest (0.48%) was recorded for control (To) biscuit. In treatments T2 (15%) and T1 (10%), the fiber content was found to be 0.76% and 0.64%, respectively Table on the sCarbohydrate content was gradually decreased with the increase in supplementation of soy flour. Highest carbohydrate content was observed in control (To) 65.62%) and lowest was reported in treatment T3 (56.38%)  was found in treatment T3 20%) and lowest (1.56%) was recorded for control (To) biscuit. In treatment T2 (15%) and T1 (10%), iron content was found as 1.83% and 1.68%, respectively  is obtained from oxidation of fats while proteins and most carbohydrates have about 4 kcal/g. In the present study, the calorie content of the biscuits has been increased from 463.00 to 484.97 kcal with the addition of soy flour Table. A similIn the present study, sensory scores of biscuit enriched with 10% (T1), 15% (T2), and 20% T3) soy flour keeping the mushroom content fixed (5%), showed that with regard to flavor, taste, body texture, color and appearance, and overall acceptability, the sensory characteristics of T1 (10%) were found to be the best and T2 (15%) was closer T1 (10%). Other treatments T3 (20%) and control (To) were also found acceptable  was rated poorest in taste (7.2). The control (To) has the highest mean score (8.5). The mean scores for color of the biscuits change from 7.6 to 8.6. The highest score (8.6) was obtained for treatment T1. In treatment T2, the mean score for color was 8.2. On the other hand, for control (To) it was 7.9. As increase in soy flour, mean score for color was also decreasing. A similar trend was also reported by Banureka and Mahendran .The texture of the crust was related to the external appearance of the biscuit top which implies smoothness or roughness of the crust. With the increase in substitution of soy flour to the biscuits, the texture of crust was decreased from 7.8 to 6.9. The control (To) had the highest mean value and 20% soy flour (T3) added biscuit had the least mean value. In the case of flavor of the biscuit, it was decreased from 7.9 to 7.2 with an increase in the substitution of soy flour. This could be due to the beany flavour of soy flour  of the Bangladeshi population can therefore be reduced through the development of these biscuits..None declared.


To describe the outcomes of cataract surgery in the United Kingdom.Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Outcome measures included intraoperative and postoperative complication rates, and preoperative and postoperative visual acuities.Median age at first eye surgery was 77.1 years, 36.9% cases had ocular co-pathology and 41.0% patients underwent cataract surgery on both eyes. Preoperative visual acuity was 0.30 logMAR or better in 32.0% first eyes and 47.7% second eyes. Postoperative best-measured visual acuity was 0.00 and 0.30 logMAR or better in 50.8 and 94.6% eyes without ocular co-pathology, and 32.5 and 79.9% in eyes with co-pathology. For eyes without co-pathology, postoperative uncorrected distance visual acuity was 0.00 and 0.30 logMAR or better in 27.3 and 80.9% eyes. Posterior capsule rupture or vitreous loss or both occurred in 1.95% cases, and was associated with a 42 times higher risk of retinal detachment surgery within 3 months and an eight times higher risk of endophthalmitis.These results provide updated data for the benchmarking of cataract surgery. Visual outcomes, and the rate of posterior capsule rupture or vitreous loss or both appear stable over the past decade. Robust data are critical for the benchmarking of surgical outcomes, as a quality improvement tool, and for commissioners and patients to make informed choices.Cataract is the leading cause of blindness in the worldad hoc collaboration that resulted in the Cataract National Dataset publications.6 The RCOphth NOD covers a range of conditions and operations10 and collates pseudoanonymized data collected during routine clinical care using electronic medical record systems (EMRs).The Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD) was established to provide national audit and research data, and to provide an evidence base for revalidation standards allowing Ophthalmologists to compare their surgical outcomes with those of their anonymised peers. The RCOphth NOD is the formalised successor to the 6 All data were recorded using a single EMR system . The lead clinician and Caldicott Guardian (responsible nominee for data protection) at each NHS Trust gave written approval for anonymised data extraction. Anonymized database analyses of this type do not require ethical permission as they are viewed as audit or service evaluation (see http://www.hra.nhs.uk/research-community/before-you-apply/determine-whether-your-study-is-research/) and this was confirmed by a Research Ethics Committee. This study was conducted in accordance with the declaration of Helsinki, and the UK's Data Protection Act.Data were extracted from 31 UK NHS Trusts of which 28 had recorded data for cataract surgery, as detailed in the acknowledgements section. All cataract operations were performed between August 2006 and November 2010 and this time frame was specifically chosen to exclude data used in previous analyses of cataract surgery outcomes in the Cataract National Dataset publications.Eligible cataract operations were those performed on patients aged 18 years or older using phacoemulsification and where the primary intention was cataract surgery, not combined ‘cataract+other' operations where the cataract component may not have been the primary reason for surgery. Surgeon grades were categorised as: Consultant surgeons, independent non-consultant surgeons  and trainee surgeons  Owing to progression through training an individual surgeon can have data recorded at more than one grade. Ocular co-pathology was a compulsory question with responses of none, a list of common categories and a free text field for rare options.In all centres the EMR software mandated the collection of the presence or absence of surgical complications. If the surgeon indicated that a complication occurred, then they had to select from a pre-populated list of complications specific to that operation, or select ‘other' and record the complication using free text.‘Posterior Capsular Rupture or vitreous loss or both' (abbreviated as PCR) was defined as unintentional communication with the posterior segment from the occurrence of any of the following intraoperative complications: PCR with or without vitreous loss, zonule rupture with vitreous loss, vitreous loss, vitreous to the section at the end of surgery, IOL into the vitreous or nuclear/epinuclear fragment into the vitreous or the performing of any of an automated anterior vitrectomy, ‘sponge and scissors vitrectomy,' secondary IOL or scleral fixed IOL during surgery; or if either of vitreous to the section or anterior chamber were recorded within 2 months of cataract surgery, or an operation for a dropped nucleus was recorded within 3 months of cataract surgery.Owing to varying availability of postoperative complication data, the results for post cataract retinal detachment surgery and endophthalmitis treatment were confined to centres where this could be cross-checked with other RCOphth NOD treatment data. Data on retinal detachment surgery were available from 15 centres providing 139 537 (77.5%) of all cataract operations and results are reported for within 3 months, 6 months and 1 year of cataract surgery. For endophthalmitis data from 19 centres providing 145 868 (81.0%) cataract operations were available and results are reported within 3 months of cataract surgery.Preoperative visual acuity data was defined as the better value of uncorrected distance visual acuity (UDVA) or corrected distance visual acuity (CDVA). Eligible VA measurements were recorded within 3 months prior to cataract surgery where the VA measurement closest to the date of cataract surgery was used in the analysis.Postoperative ‘best-measured' visual acuity was defined as the best CDVA measurement within 2 weeks and 4 months of cataract surgery when present and the best measurement of UDVA or pinhole VA within the time period when CDVA was absent.For postoperative UDVA only analysis, data was used for eyes where the predicted postoperative refraction was ±0.5 dioptres spherical equivalent.Visual acuity values were recorded as Snellen or logMAR, and Snellen values were converted to logMAR for analyses. LogMAR values corresponding to count fingers (CF), hand movements (HM), perception of light (PL) and no PL (NPL) were substituted with 2.10, 2.40, 2.70 and 3.00 logMAR, respectively, in keeping with previous publications from this group.4 between preoperative and postoperative measures.Significant visual loss was defined as visual acuity deteriorating by ≥0.30 logMAR units 2 test were used as appropriate and all analysis was conducted using STATA version 11  except for the calculation of confidence intervals which were calculated using Confidence Interval Analysis version 2.1.2.11Fishers exact test or Pearson's χThere were 180 114 cataract operations performed on 127 685 patients eligible for analysis. These were performed by 995 surgeons at 27 NHS Trusts in England and 1 in Scotland. Median patient age at first eye cataract surgery was 77.1 years (IQR: 69.7–82.8); where 51 838 (40.6%) patients were male, 75 465 (59.1%) female and 382 (0.3%) gender not specified.In 67.3% cases the operation was on the patient's first eye to undergo cataract surgery. For those who had surgery on both eyes , the median time between operations was 3.7 months . 436 (0.3%) patients underwent immediate sequential bilateral surgery performed by 120 surgeons.Of the 995 surgeons, 285 were Consultant surgeons, 451 independent non-consultant surgeons and 325 trainee surgeons. Sixty-six surgeons performed surgery while at more than one grade of surgeon.Local anaesthesia was used for 96.2% operations, general anaesthesia for 3.5% operations and not known for 0.3% operations. Pupil size at the time of surgery was considered to be ‘small,' ‘medium,' or ‘large' in 3.0, 10.7, and 86.2% eyes, respectively, and was not recorded for 0.1% of eyes. The intraocular lens was placed in the capsular bag in 98.6% eyes, in the sulcus or partly in the bag for 1.0% eyes, and in the anterior chamber for 0.1% eyes. In 0.2% eyes, no intraocular lens was placed (aphakic) and in 0.2% of the intraocular lens position was not recorded.P=0.000).Ocular co-pathology was present in 66,504 (36.9%) cases, with age-related macular degeneration (10.0%), glaucoma (8.0%), and diabetic retinopathy (4.7%) being the most frequently recorded . ConsultP=0.000) and PCR .Overall 4.2% (95% CI: 4.1–4.3%) cases had an intraoperative complication, the most common being PCR , see Intraoperative complication rates were lower for consultant surgeons than other surgeon grades (P=0.000) in eyes that had PCR than those without. Within 6 months of cataract surgery 73 eyes and within 1 year 108 eyes had surgery for retinal detachment. For both time points, higher proportions of eyes that had PCR underwent retinal detachment surgery, OR 23.98 (95% CI: 14.60–39.37) and 18.28 (95% CI: 11.86–28.17) respectively.The rate of retinal detachment surgery within 3 months of cataract surgery was 0.03% , and this was ∼42 times higher  in cases with PCR than those without.The rate of endophthalmitis within 3 months of cataract surgery was 0.03% . The rate of endophthalmitis was approximately eight times higher  eyes, of which 100 473 (67.9%) were CDVA measurements, 43 537 (29.4%) were UDVA measurements and in 3952 (2.7%) cases the CDVA equalled the UDVA. The median VA was 0.50 logMAR (IQR: 0.30–0.80), and mean 0.63 logMAR (including 6905 (4.7%) eyes with CF, 2973 (2.0%) with HM, 819 (0.6%) with PL, and 50 (<0.1%) with NPL).n=108 086); and 5.1, 7.4, and 47.7% of second eyes (n=39 876).For all eyes, 3.2, 4.6, and 36.2% had a preoperative visual acuity of 0.00, 0.18, or 0.30 logMAR or better. For those without ocular co-pathology the corresponding values were 3.7, 5.2, 40.7% respectively. Preoperative visual acuity was 0.00, 0.18, or 0.30 logMAR or better in 2.5, 3.5, and 32.0% of first eyes  had postoperative visual acuity data between 2 weeks and 4 months after surgery (median 61 days). Of the 95 561 postoperative VA measurements, 64 421 (67.4%) were CDVA measurements, 20 617 (21.6%) were UDVA measurements and 10 523 (11.0%) were pinhole measurements. The median postoperative best-measured visual acuity was 0.10 logMAR (IQR: 0.00–0.20) and the mean was 0.16 logMAR  eyes with CF, 232 (0.2%) with HM, 54 (<0.1%) with PL, and 6 (<0.1%) with NPL). For the 62 848 eyes with no ocular co-pathology, the median postoperative visual acuity was 0.00 logMAR (IQR: 0.00–0.20). The mean and standard deviation were 0.10 and 0.21 logMAR, respectively.P<0.001). The rate of visual loss did not differ across surgeons grade, 1.5% for consultant surgeons, 1.5% for independent non-consultant surgeons, and 1.7% for trainee surgeons (P=0.184).Significant visual loss occurred in 1455 (1.5%) eyes, 2This study provides pragmatic data on current cataract surgery outcomes using data collated from a large multi-centre database over 4 years. Overall, we found the median visual acuity improved from 0.50 before surgery to 0.10 logMAR after surgery. Comparison with the Cataract National Dataset analysis reporting on outcomes between 2001 and 2006 in the UK, suggests the rate of PCR and proportions achieving good postoperative visual acuities have stabilised.12 In 1990, 8.3% cases in England had a preoperative visual acuity of 0.30 logMAR or better,13 in 1997 this had increased to 31%,14 and in Cataract National Dataset analysis for 2001–2006 was 43%.2 In this series, 36% had a preoperative visual acuity of 0.30 logMAR or better. We found 32% first eyes and 48% second eyes had a preoperative visual acuity of 0.30 logMAR or better compared with 35 and 55%, respectively in the Cataract National Dataset papers.2 Thus suggesting there is no longer a trend towards performing cataract surgery at lower levels of visual impairment in the UK, and if anything this may have reversed slightly. This may be owing to cataract surgery rationing in recent years.15Over the past 20 years there has been a dramatic change in practice to operating on eyes with cataract at lower levels of visual impairment. The reasons for this are multifactorial and include better surgical techniques and outcomes, patients' visual expectations and a need for higher visual function to maintain independence, including that for driving.vs 29% in the Cataract National Dataset). Part of this may be explained by a change in the EMR definition of co-pathology from conditions likely to be a cause of a guarded visual prognosis in the years contributing to Cataract National Dataset publications, to presence or absence of co-pathology in the years covered by this analysis. For those without ocular co-pathology, we found 50 and 94% were 0.00 and 0.30 logMAR or better, respectively compared with 51 and 95% in the Cataract National Dataset papers. We used slightly different definitions for pre and postoperative visual acuity measures than those in the Cataract National Dataset .2 Repeat analyses using the earlier definitions made no clinically meaningful difference to our results. In comparison with the outcomes from the recent European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) sub-analysis16 on 274 000 eyes without ocular co-pathology, our results appear slightly less favourable with EUREQUO reporting 70 and 98% had a postoperative CDVA of 0.00 and 0.30 logMAR or better. However, these are CDVAs only, so each case has undergone a formal refraction.The analyses of postoperative visual acuity showed 44 and 89% all eyes achieved 0.00 and 0.30 logMAR or better. These results are similar to those reported in the Cataract National Dataset paper where 46 and 91% were 0.00 logMAR and 0.30 logMAR or better, however immediate comparison is complicated by differing proportions of those with ocular co-pathology  on 602 553 operations performed between 2002 and 2009 reported an overall rate of a capsule complication (similar to our definition of PCR) of 2.1%,17 with a consistent decline until 2006 and stabilisation thereafter with rates of 1.6–1.9%.The PCR rate in our series was 1.95% and as seen in 18 The 28 sites providing data for these analyses represent ∼15% of the annual number of cataract surgeries in England and Scotland as although there is encouragement to collect data to nationally agreed standards, each NHS Trust is independent resulting in variable adoption of EMR systems. All data used in these analyses were from a single EMR platform  and were from Trusts that have agreed to contribute data to the NOD and were able to provide this. The recording of intraoperative complications is mandatory on the EMR and accuracy depends on surgeons recording their complications faithfully. It is not possible to confirm how reliably a surgeon records these, and surgeons may have a natural reluctance to record complications even though their results were anonymized. Data on possible under-reporting rates may be partly inferred by the <0.1% operations that had an unplanned anterior vitrectomy without PCR having been reported to have occurred. Another limitation of our study is incompleteness of particularly postoperative data, with for example, only 53.1% of eyes being eligible for the postoperative visual acuity analyses.A strength of this study is that the data were non-selective, pooled, and anonymized, so they may be more generalisable than data obtained from randomized controlled trials, and less subject to publication bias than single-centre case series.19 and was the intraoperative factor with most contribution to endophthalmitis risk.19 Although the association of PCR with a higher risk of retinal detachment is well known, our findings of 42, 24, and 18 times higher likelihoods of retinal detachment surgery within 3, 6, and 12 months, respectively, of cataract surgery if PCR occurred are higher than previously reported, but do suggest the difference in risk decreases with time. Our results are comparable with the Swedish NCR where a 15 times higher odds of retinal detachment surgery within 3 years was found if a capsule complication occurred.20 The rates for retinal detachment and endophthalmitis after cataract surgery (both 0.03%), must be interpreted with caution as they are likely to represent minimum values owing to the possibility that cases with these complications may have been treated at other NHS Trusts not contributing to this data set.The finding of an eight times higher risk of endophthalmitis if PCR occurred is consistent with data from a recent meta-analysis that found PCR was associated with a six times higher risk of endophthalmitis,Overall, this analysis reports pragmatic data from a national database of cataract surgery outcomes allowing benchmarking of surgical units and individual surgeons, and gives an overview of the results that may be anticipated in the UK NHS. Our findings suggest that the trend of operating at lower levels of visual impairment has stopped or even reversed, and that visual outcomes and surgical complication rates have been stable over the past decade.