Purpose To evaluate the safety and efficacy of manual limbal astigmatic keratotomy (AK) compared to femtosecond laser-guided limbal astigmatic keratotomy (FLAK) to correct corneal astigmatism more than 3 diopters (D) after phacoemulsification. Study design Prospective, comparative, randomized, interventional study. Patients and methods This prospective study included 35 patients (40 eyes) divided into two groups. Group A included 16 patients (20 eyes) who had received FLAK and group B included 19 patients (20 eyes) who had received manual limbal AK using a diamond knife. All patients were suffering from corneal astigmatism after conventional phacoemulsification. This study was conducted from April 2024 to January 2025. Corneal astigmatism was measured by corneal tomography and Scheimpflug imaging (pentacam). Results The mean topographic corneal astigmatism was reduced from 4.78±1.4 to 1.78±1.31 D 3 months postoperatively in the FLAK group with a statistically highly significant difference (P<0.001) and from 4.93±1.03 to 1.98±1.31 D in the manual limbal AK group with a statistically highly significant difference (P<0.001). The mean topographic corneal astigmatism 3 months postoperatively showed a statistically nonsignificant difference between the two groups (P=0.608). Although there was no statistically significant difference between the two groups, the mean arithmetic reduction of astigmatism was 3 D in the femtosecond AK group, which was higher than the mean arithmetic reduction of astigmatism in the manual AK group, which was 2.95 D. The surgery was uneventful in both groups with no adverse events. Conclusion FLAK and manual limbal AK are safe, predictable, and effective methods for correcting preexisting or surgically induced high degrees of corneal astigmatism after phacoemulsification, with the possibility to correct up to 4 D of corneal astigmatism.

Mice were fed ad libitum with a normal diet (25% protein) or low-protein diets (0–12.5% protein) for a wk and then infected with a nonlethal or lethal strain of Plasmodium yoelii, that is, blood stage infection. The same diet was continued until recovery. Mice fed with a normal diet showed severe parasitemia during nonlethal infection, but survived the infection. They died within 2 wk in the case of lethal infection. However, all mice fed with low-protein diets survived without apparent parasitemia (there were small peaks of parasitemia) in cases of both nonlethal and lethal strains. These surviving mice were found to have acquired potent innate immunity, showing the expansion of NK1.1!TCRint cells and the production of autoantibodies during malarial infection. Severe combined immunodeficiency (scid) mice, which lack TCRint cells as well as TCRhigh cells, did not survive after malarial infection of lethal strain of P. yoelii, even when low-protein diets were given. These results suggest that low-protein diets enhanced innate immunity and inversely decreased conventional immunity, and that these immunological deviations rendered mice resistant against malaria. The present outcome also reminds us of our experience in the field study of malaria, in which some inhabitants eventually avoided contracting malaria even after apparent malarial infection

Mice were fed ad libitum with a normal diet (25% protein) or low-protein diets (0–12.5% protein) for a wk and then infected with a nonlethal or lethal strain of Plasmodium yoelii, that is, blood stage infection. The same diet was continued until recovery. Mice fed with a normal diet showed severe parasitemia during nonlethal infection, but survived the infection. They died within 2 wk in the case of lethal infection. However, all mice fed with low-protein diets survived without apparent parasitemia (there were small peaks of parasitemia) in cases of both nonlethal and lethal strains. These surviving mice were found to have acquired potent innate immunity, showing the expansion of NK1.1!TCRint cells and the production of autoantibodies during malarial infection. Severe combined immunodeficiency (scid) mice, which lack TCRint cells as well as TCRhigh cells, did not survive after malarial infection of lethal strain of P. yoelii, even when low-protein diets were given. These results suggest that low-protein diets enhanced innate immunity and inversely decreased conventional immunity, and that these immunological deviations rendered mice resistant against malaria. The present outcome also reminds us of our experience in the field study of malaria, in which some inhabitants eventually avoided contracting malaria even after apparent malarial infection

Balance between inflammatory and anti-inflammatory cytokines may be important in malaria presentation and outcome. To clarify cytokine interactions that produce pathology of malaria and control infection, C57BL/6 mice were infected with 10(4) parasitized RBCs from a non-lethal strain of Plasmodium yoelii. Kinetics was monitored showing the course of parasitemia, and cytokines were determined by RT-PCR from liver and spleen tissues. Inflammatory cytokines such as interferon-γ (IFNγ), interleukin (IL)-12, IL-6, tumor necrosis factor-α (TNFα) and anti-inflammatory cytokines, including IL-4 and IL-10, were investigated as key molecules that interact with immune cells in the activation of the immune responses. The production of IFNγ mRNA was found to be higher on day 7 than on day 21 after infection, and IL-12 and IL-6 showed higher expression in the liver than in the spleen. Though TNFα was highly expressed on day 14 after infection and on day 21 in the liver, such expression was decreased on day 21 in the spleen. Anti-inflammatory cytokines showed high expression in both the liver and spleen. The results suggest that a relative balance between inflammatory and anti-inflammatory cytokines is crucial and that the increase of inflammatory cytokine levels during the acute phase of malaria may reflect an early and effective immune response.The counteraction effect of anti-inflammatory cytokines is thought to play a role in limiting progression from uncomplicated malaria to severe life-threatening complications.