Background Previous research has demonstrated a correlation between hand grip strength (HGS) and muscle strength. This study aims to determine the relationship between HGS and muscle mass in older Asian adults. Methods We retrospectively reviewed the dual-energy X-ray absorptiometry (DXA) records of 907 older adults (239 (26.4%) men and 668 (73.6%) women) at one medical institution in Taipei, Taiwan, from January 2019, to December 2020. Average age was 74.80 ± 9.43 and 72.93 ± 9.09 for the males and females respectively. The inclusion criteria were: 1) aged 60 and older, 2) underwent a full-body DXA scan, and 3) performed hand grip measurements. Patients with duplicate results, incomplete records, stroke history, and other neurological diseases were excluded. Regional skeletal muscle mass was measured using DXA. HGS was measured using a Jamar handheld dynamometer. Results Total lean muscle mass (kg) averaged 43.63 ± 5.81 and 33.16 ± 4.32 for the males and females respectively. Average HGS (kg) was 28.81 ± 9.87 and 19.19 ± 6.17 for the males and females respectively. In both sexes, HGS and regional muscle mass consistently declined after 60 years of age. The rates of decline per decade in upper and lower extremity muscle mass and HGS were 7.06, 4.95, and 12.30%, respectively, for the males, and 3.36, 4.44, and 12.48%, respectively, for the females. In men, HGS significantly correlated with upper (r = 0.576, p < 0.001) and lower extremity muscle mass (r = 0.532, p < 0.001). In women, the correlations between HGS and upper extremity muscle mass (r = 0.262, p < 0.001) and lower extremity muscle mass (r = 0.364, p < 0.001) were less strong, though also statistically significant. Conclusion Muscle mass and HGS decline with advancing age in both sexes, though the correlation is stronger in men. HGS measurements are an accurate proxy for muscle mass in older Asian adults, particularly in males.

We quantified episcleral drug clearance of sodium fluorescein (NaFl) in rats to examine the hypothesis that there is rapid clearance of episcleral water soluble drugs, and that this rapid clearance may limit the amount of drug that is able to reach the posterior segment from an episcleral location. 2 mm implants containing either 12 or 22 ug of NaFl were manufactured and in vitro release rates were determined. Implants were placed in the sub-Tenon's space and the amount of drug remaining in the conjunctiva/sclera/choroid complex (CSCC) at various time points was quantified following tissue solubilization and fluorescence quantification using a spectrofluorometer. Kinetics of NaFl clearance was determined in live animals, following euthanasia and in animals in which choroidal non-perfusion had been achieved with indocyanine green-enhanced 810 nm diode laser thrombosis of the choroidal vasculature. Choroidal non-perfusion in these laser-treated rats was verified with Concavalin-A staining of choroidal flatmounts. In vitro, >99% of drug was released by 25 minutes for the low dose implants, and by 60 minutes for the high dose implants. In vivo, both implant doses were >99% cleared from the episcleral tissue by 3 hrs. By 7 hrs, an average of only 0.14 ± 0.131 ng of NaFl per mg of wet tissue weight (mean ± SD) remained in the CSCC with the low dose implant, and 0.29 ± 0.428 ng of NaFl per mg of wet tissue weight remained in animals with the high dose implant. By comparison, in euthanized animals at 7 hrs following sub-Tenon's implantation, 432.0 ± 181.40 ng of NaFl per mg of wet tissue weight was in the episcleral tissue of animals with the low dose implant, and of 787.8 ± 409.89 ng of NaFl per mg of wet tissue weight remained in the animals with the high dose implant. In live animals with selective thrombosis of the choroidal vasculature, the difference in the amount of drug remaining in the episcleral tissue as compared to control live animals was not significant at all time points for both implant doses. In conclusion, there is rapid clearance of episcleral NaFl delivered from a bioerodible subtenon's implant. The clearance mechanisms are dramatically reduced following euthanasia, suggesting that elimination is occurring via active physiologic mechanisms, rather than by passive diffusion clearance (CL(diff)) (Pfister et al. 2003). Interestingly, the choroid does not appear to play a prominent role as clearance of episcleral NaFl was not affected by elimination of choroidal blood flow. Further work is needed to delineate the pathways of episcleral drug clearance.

Trabeculectomy has been the traditional primary surgical therapy for open-angle glaucoma. While trabeculectomy is effective in lowering intraocular pressure, complications associated with the procedure have motivated the development of alternative techniques and devices, including the EX-PRESS Glaucoma Filtration Device. This review describes the efficacy, safety, complication rates, and potential advantages and disadvantages of the EX-PRESS Glaucoma Filtration Device. EX-PRESS implantation is technically simpler compared with that of trabeculectomy, with fewer surgical steps. Vision recovery has been more rapid after EX-PRESS implantation compared with trabeculectomy. Intraocular pressure variation is lower during the early postoperative period, indicating a more predictable procedure. While efficacy of the EX-PRESS implant has been comparable to trabeculectomy, postoperative complications appear less common after EX-PRESS implantation compared with trabeculectomy. The EX-PRESS Glaucoma Filtration Device appears to be safe and effective in the surgical management of open-angle glaucoma.

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'Facial naevus flammeus with choroidal haemangioma and without intracranial involvement' SIR-We would like to report a male patient who was noted at birth to have left-sided facial naevus flammeus (port wine stain) involving the left side of the scalp, upper eyelid, and the left side of the nose. Follow-up in the next 6 years did not show any developmental problems, focal neurological deficit, nor seizures. His left eye was found to be hyperaemic over the bulbar conjunctiva. He also had anisometropic hyperoptic astigmatism of the left eye. Fundal examination confirmed the presence of left choroidal haemangioma, mainly in the upper half and posterior pole of the choroid. It was a well circumscribed lesion, slightly raised, bright red in colour, and affecting the left foveal region. The child had no evidence of raised intraocular pressure. The latest follow-up assessment at 6 years recorded visual acuity of 6/5(right eye) and 6/9 (left eye) with glasses correction. He is currently undergoing treatment for left amblyopia.At 18 months of age the child had brain CT which was normal. To clarify the diagnosis further, and to be in a position to give the parents an accurate diagnosis and prognosis, MRI was performed at the age of 6 years. Brain imaging enhanced by gadalinium -DTPA was performed. This showed diffuse enhancement of the choroid with choroidal angioma of the left eye. There was no intracranial abnormality.Naevus flammeus can be an isolated birthmark or it can be associated with ophthalmological and/or neurological abnormalities. When neurological abnormalities are present the diagnosis of Sturge-Weber syndrome (SWS) is highly likely. Stevenson and colleagues reported ocular findings in 50 patients with naevus flammeus. 1,2 Only one patient was found to have clinical evidence of choroidal haemangioma and this patient did not have intracranial abnormalities. Sullivan and coworkers reported the ocular manifestations of SWS in 51 patients. Of these, 28 had choroidal haemangiomas. 3 Choroidal haemangiomas in SWS patients are usually diffuse, primarily related to the posterior pole, and usually seen as red, flat to moderately elevated masses. This is in contrast to choroidal haemangiomas not associated with SWS which are usually discreet raised structures arising from the choroid. 4 In our patient, the naevus flammeus involves the ophthalmic and maxillary divisions of the trigeminal nerve and the choroidal haemangioma has the characteristics of those seen in SWS. However, the child does not have any neurological deficit.We feel it is appropriate in these cases to clarify the possibility of intracranial involvement with neuroimaging to be able to give parents an accurate prognosis. 'Salivary cortisol in children with cognitive impairment' SIR-Cortisol plays an essential role in stress-regulation in humans. 1 It is produced in a well-defined circadian rhythm which is under the influence of an individual's sleep-wake activity. Under basal conditions, cortisol levels are highest in the early morning and subsequent...

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In the late 1990s, the National Railroad Passenger Corporation (Amtrak) faced a rude awakening as Congress stipulated that it eliminate its reliance on federal subsidies by 2002. In response, Amtrak drew up a plan for self-sufficiency, the centerpiece of which was a new high-speed passenger service that, it was hoped, would boost revenue enough to make Amtrak self-sufficient by 2002. To run this new service, Amtrak needed to purchase $750 million worth of new locomotives and train sets in 1999. Three alternatives were available for funding the purchase: debt financing, lease financing, or reliance on federal sources. The case opens with Amtrak's CFO instructing her staff in April 1999 to review a leveraged-lease proposal that has just been submitted by BNY Capital Funding LLC. The objectives of the case are to introduce students to financial leases as a financing alternative, explore the lease-versus-buy decision and the conditions under which financial lease arrangements make sense, and exercise skills in the valuation of financial leases.