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In vivo confocal microscopy appears to be a valuable tool in evaluating the dynamic change of DCs at the conjunctiva and cornea. DCs play an essential role in VKC and therefore may constitute a target for therapeutic intervention for VKC.

Proton radiography enables proton range verification in addition to the anatomical alignment verification currently obtained with x-ray radiography. Design specifications require that a clinical system be simple, lightweight, easily scaled to large field sizes, operate at high speed to maximize patient throughput, and expose the patient to the minimum possible radiation dose for a given resolution. We are developing a system to produce images of proton stopping power by tracking individual protons proximal and distal to the patient and then measuring the proton residual range after traversing the patient. Due to multiple scattering effects, each proton deviates randomly from its projected trajectory. To achieve optimal spatial resolution, an image reconstruction algorithm must fully exploit the individual three-dimensional proton position information. Materials/Methods: We have developed an iterative algorithm for radiography that fully exploits proton path information to produce projective radiographs with no blurring from multiple scattering. Simulations of our detector design, with and without multiple scattering effects included, determine the expected accuracy of our proton path reconstruction, and the impact on the spatial resolution of the reconstructed image. Tests of our detector components with proton beams demonstrate the performance needed to validate our simulations. Results: Protons typically scatter transversely from the projected path by 4 mm after 20 cm of water. Our simulations demonstrate path reconstruction of individual protons to better than 1 mm. Our iterative algorithm successfully produces images with 1 mm sharpness. The iterative process necessarily increases pixel noise compared to estimates neglecting multiple scattering and additional protons will be needed to achieve a given contrast. Operation of our detector components in a test beam demonstrates the required proton tracking resolution and efficiency to optimize resolution and minimize dose to the patient. Conclusion: A proton radiography system optimizing image sharpness and dose to the patient will individually track protons before and after the patient. An iterative algorithm produces images with spatial resolution given by the tracking accuracy, at the price of increased pixel noise. We are in the process of integrating the necessary components into a fully functional system.

Background:  Chinese Hypertension Intervention Efficacy (CHIEF) study is a large-scale randomised clinical trial across China, which compares the efficacy of two combination regimens in reducing cardiovascular events associated with hypertension. Methods:  We reported the 48-week efficacy and tolerability of the two antihypertensive regimens in participants from Shandong Province, China. Eligible patients aged 50-79 years were randomised to receive amlodipine plus amiloride/hydrochlorothiazide (Group A) or amlodipine plus telmisartan (Group B). The doses of both regimens were titrated and other antihypertensive agents were added subsequently to achieve a blood pressure (BP) goal (<140/90 mmHg for general population, <130/80 mmHg for diabetics and <150/90 mmHg for elderly). Efficacy variables included the changes of BP, control rates (the proportion of patients achieving a BP goal), and response rates (the proportion of patients achieving a BP goal or a reduction of BP ≥20/10 mmHg). Safety was assessed by monitoring the incidence of adverse events (AEs). Results:  Of the 349 patients enrolled, 314 were randomised and 291 completed the study (141 in Group A and 150 in Group B). At week 48, the BP was reduced by 28.77/15.55 mmHg in Group A and by 31.38/16.07 mmHg in Group B (p> 0.05 for comparisons between Group A and Group B). The control rates (71.79% vs. 77.22%; p = 0.270) and response rates (79.49% vs. 84.81%; p = 0.218) were also similar. For both regimens, the control rates in diabetic patients were relatively lower (31.91% and 32.50%), while those in elderly patients were pretty higher (90.74% and 97.62%). AEs were mild to moderate in severity (17.95% vs. 12.66%, p = 0.193). Conclusion:  Both combination regimens, amlodipine plus amiloride/hydrochlorothiazide and amlodipine plus telmisartan, were effective and safe for the high-risk hypertensive patients.