Editors Choice Articles

Rotavirus (RV) is an agent of gastroenteritis and, to a lesser extent, neurological manifestations including seizures and epilepsy. Before the development of effective vaccines, rotavirus was among the leading global drivers of life-threatening diarrhea in neonates and children less than five years of age.

In early 2020, the contagious and deadly virus, SARS-CoV-2, was identified. The virus spread rapidly worldwide and was declared a pandemic by the World Health Organization (WHO) in March of 2020 [1]. While many who became infected remained asymptomatic, an alarming number of infected individuals developed severe symptoms, often requiring hospitalization and intensive care, or resulting in death.

While other countries have begun to see a flattening of the Severe Acute Respiratory Syndrome – Coronavirus-2 (SARS-CoV-2) curve, the United States continues to see a rise in cases, with approximately 7.4 million confirmed cases to date. Even more worrisome, various news articles have begun to shed light on the healthcare inequities that have become increasingly more transparent during this crisis.

The PI3K/Akt signaling pathway is frequently hyperactivated in different types of breast cancer. In the past two decades, major efforts have been made to develop inhibitors of this pathway to treat cancer patients. 

Kindlin-1 (K1, FERMT1), Kindlin-2 (K2, FERMT2), and Kindlin-3 (K3, FERMT3) are the three members of the kindlin family of adapter proteins found in mammals. One or more kindlins are found in most cell types, K1 primarily in epithelial cells, K3 in primarily hematopoietic cells and also endothelial cells, and K2 is very broadly distributed. The kindlins consist primarily of a 4.1-erzin-radixin-moiesin (FERM) domain, which is transected by a lipid-binding plextrin-homology (PH) domain. Deficiencies of each kindlin in mice and/or humans have profound pathogenic consequences.

New stool DNA panels and blood-based assays offer non-invasive options for early CRC detection, though require further validation. Immuno- and targeted therapies matched to tumor molecular profiles have transformed metastatic CRC treatment. Pembrolizumab elicits durable responses in mismatch repair-deficient tumors, and anti-EGFR antibodies cetuximab/panitumumab improve outcomes for left-sided RAS/RAF wild-type CRC. Larotrectinib and entrectinib are highly active in NTRK fusion-positive CRC. Research focusing on new immunotherapies, leveraging the microbiome, and combining multi-omics data to enable precision medicine holds promise. Disparities across groups remain a challenge.

Non-alcoholic fatty liver disease (NAFLD) is an increasing health problem when left untreated. NAFLD is defined as accumulation of fat in 5% of the hepatocytes. NAFLD can convert into non-alcoholic steatohepatitis (NASH) which is defined as inflammatory NAFLD. Both NAFLD and NASH are observed in individuals suffering from metabolic syndrome and type 2 diabetes (T2D).

A tumor marker is a chemical that acts as a tumor indication. Tumor biomarkers are undefined in origin, but they indicate the existence of a certain tumor. The detection of a specific tumor is aided by an increase or decrease in the concentration of marker concentrations. Gene expression arrays, proteomic technologies, and high-throughput sequencing are some of the current methods for detecting cancer.

In normal cells, homologous recombination (HR) is strictly regulated and precise and plays an important role in preserving genomic integrity by accurately repairing DNA damage. RAD51 is the recombinase which mediates homologous base pairing and strand exchange during DNA repair by HR. We have previously reported that HR is spontaneously elevated (or dysregulated) in esophageal adenocarcinoma (EAC) and contributes to ongoing genomic changes and instability. The purpose of this study was to evaluate the impact of RAD51 inhibitor on genomic toxicity caused by etoposide, a chemotherapeutic agent.

Vitamin B12 is one of the most complex non-protein compounds as described by Dorothy Hodgkin, a Nobel Prize-winning chemist, who discovered the molecular crystal structure of B12. Cobalamins (vitamin B12 derivatives) contain the rare transition metal, cobalt (Co), positioned in the center of a corrin ring and weakly bound to carbon.  While cobalamins are synthesized only in certain bacteria and archaea, not in mice or humans, they are co-enzymes essential for all life except for plants. For example, in higher vertebrates, methyl-cobalamin and 5’-deoxyadenosyl-cobalamin are essential for the function of methionine synthase and methylmalonyl CoA mutase, respectively.

Discovered in a large-scale screening of natural plant chemicals, Taxol/paclitaxel and the taxane family of compounds are surprisingly successful anti-cancer drugs, used in treatment of the majority of solid tumors, and especially suitable for metastatic and recurrent cancer. Paclitaxel is often used in combination with platinum agents and is administrated in a dose dense regimen to treat recurrent cancer.

Cancer care has been greatly impacted during the COVID-19 pandemic. The number of cases and deaths caused by the COVID-19 pandemic continues to escalate throughout the United States and the world. Worldwide, over 150 million people have been diagnosed with the coronavirus and more than 3 million have died.

The relative safety of E-cigarette (E-cig) has been an emerging topic in the public domain as well as the medical and scientific communities as vaping associated health problems arose. While there were  significant amounts of intelligent discussions and opinions on the benefits and deleterious effects of E-cig vaping, there is a lack of solid evidence of the fundamental biochemical and biological effects of E-cig aerosol and nicotine.

The nucleosome, consisting of ~150bp of DNA wrapped around a core histone octamer, is a regulator of nuclear events that contributes to gene expression and cell fate. Nucleosome organization at promoters and their associated remodeling events are important regulators of access to the genome. Occupancy alone, however, is not the only nucleosomal characteristic that plays a role in genome regulation. Nucleosomes at the transcription start sites (TSSs) of genes show differential sensitivity to micrococcal nuclease (MNase) and this differential sensitivity is linked to transcription and regulatory factor binding events. 

The identification of new mutations in SARS-CoV-2 and their roles in the viral fitness towards evolution and survival to face the selective pressure imposed by the human host immune response have become the target of great attention recently. As result, concerns related to the emergence of novel variants with more transmissibility and pathogenic potential have led many countries to apply more restrictive measures to avoid increase in the number of infections and collapse of healthcare systems.

The complexity of the tumor microenvironment has been a challenge for understanding the mechanisms of therapy resistance. The development of improved animal models that closely mimic human disease is key for understanding and treating diseases. Recently, a new humanized mouse model has been developed that enables the study of human immune cells in tumor host-cell interactions

Prostate cancer (Pca) is one of the most common cancers among men worldwide. The current screening methods lack effectiveness such as prostate-specific antigen (PSA) and Magnetic resonance imaging (MRI), and some others come with pain such as biopsy. Understanding the genomic behavior of the disease may play a key part in designing more effective, accurate, and less invasive diagnosis measures. Pca has many clinical features to describe the spread and the aggressiveness of the tumor including Gleason score, TNM staging system, and the location of the tumor in the prostate gland which is known as laterality.

In the United States, lung and bronchus cancers are the second most common types of cancer and are responsible for the largest number of deaths from cancer, with African Americans suffering disproportionately from lung and bronchus cancers. This disparity likely results from a complex interplay among social, psycho-social, lifestyle, environmental, health system, and biological determinants of health.

In medical diagnostics, complex physical techniques are state of the art and everyday clinical practice would be unthinkable without them. But also, in the field of therapeutic interventions there are several physical procedures. For example, ionizing radiation is used in oncology and non-ionizing radiation in dermatological (UV light) and photodynamic therapies (laser). Similarly, electrosurgical and laser procedures are well established in surgery.

This study examines differences between patients with and without cancer in patient demographic and clinical characteristics and COVID-19 mortality and discusses the implications of these differences in relation to existing cancer disparities and COVID-19 vulnerabilities. Data was collected as a part of a retrospective study on a cohort of COVID-19 positive patients across Mount Sinai Health System from March 28, 2020 to April 26, 2020. Descriptive, comparative, and regression analyses were applied to examine differences between patients with and without cancer in demographic and clinical characteristics and COVID-19 mortality and whether cancer status predicts COVID-19 mortality controlling for these covariates using SAS 9.4. Results showed that, of 4641 patients who tested positive for COVID-19, 5.1% (N=236) had cancer.

Cryoablation of breast cancer offers an alternative to surgery for women who are not ideal surgical candidates. It is a minimally invasive procedure that has already had success in fibroadenoma treatment with good tumor reduction and cosmesis. The findings of cryoablation as treatment for early-stage, low-risk breast cancer has been previously discussed in the recently published article ‘Cryoablation: A promising non-operative therapy for low-risk breast cancer’.

Nicotinamide (Nam, amide form of niacin acid or nicotinate), a precursor for nicotinamide adenine dinucleotide (NAD+), is important for normal physiological function of organisms. Nam also suppresses mobilization of Ca2+ from sarcoplasmic reticulum into cytoplasm through inhibiting ADP-ribose cyclase. Previously, we have demonstrated that a pharmacological dose of Nam normalizes maternal blood pressure in mouse models of preeclampsia, a pregnancy related hypertensive disorder.

Lung cancer is the leading cause of cancer death among both men and women in the United States. Because lung cancer is genetically heterogeneous, tailored therapy alone or in combination with chemotherapy would increase patient overall survival as compared with the one-size-fits-all chemotherapy. TP53-mutant lung cancer accounts for more than half of all lung cancer cases and is oftentimes more aggressive and resistant to chemotherapy. Directly targeting mutant p53 has not yet been successful, so identification of novel therapy targets and biomarkers in the TP53-mutant lung cancer is urgently needed to increase the overall survival in this subgroup.

Background: In a recent study, it was shown that patients with pT1 adenocarcinoma of the esophagus or stomach have a shorter survival time compared to an age- and gender-matched group from the normal population despite curative therapy. The reasons for the loss of expected life years (YLL) can only be discussed. The aim of the present evaluation is to analyze the influence of the patients' gender on the results.

The continuous increase in the elderly population and chronic health conditions present significant challenges to healthcare systems, particularly in developing countries. Among these conditions, dementia, particularly Alzheimer's disease (AD), is one of the most concerning, causing cognitive decline, behavioral changes, and progressive dependence on family caregivers.

In ongoing efforts to bring innovation to healthcare, technology and patient self-management are at an important intersection. Our study, "A Mobile App for Chronic Disease Self-Management for Individuals with Low Health Literacy: A Multisite Randomized Controlled Clinical Trial” [1], serves as a potentially useful contribution to this intersection by addressing the challenges faced by older adults with chronic conditions and low health literacy in managing chronic health conditions. 

H3K9 demethylases can remove the repressive H3K9 methylation marks on histones to alter chromatin structure, gene transcription and epigenetic state of cells. By counteracting the function of H3K9 methyltransferases, H3K9 demethylases have been shown to play an important role in numerous biological processes, including diseases such as cancer. 

In the early phases of the pandemic caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) the emphasis of diagnosis and treatment was on acute respiratory distress syndrome (ARDS).

Arrestins were discovered as key players in the conserved two-step homologous desensitization of G protein-coupled receptors (GPCRs): they specifically bind active phosphorylated GPCRs, precluding their coupling to cognate G proteins, thereby stopping (“arresting”) G protein-mediated receptor signaling [1]. 

The management of anxiety and distress in patients with cancer is stressful for the oncology clinicians who treat them. Unfortunately, psychosocial care for patients with cancer is not universally available or standardized. Referrals from oncology services to psychological serves are often not initiated early enough, may not be encouraged from medicine or surgical services, and are subsequently foregone or patients do not follow up beyond a single appointment.

Nationally, patients experience multiple barriers to receiving mental health care. In many parts of the US, access to mental health providers is limited. For many patients, getting an appointment with a psychiatrist is difficult and often takes weeks. When patients are able to schedule appointments with a psychiatrist, the visits are usually short and aimed mostly at prescribing medications. For patients with serious conditions like schizophrenia or major depression, the consequences of unattended emergence or worsening of symptoms during those time intervals can be severe.

In prior work, we analyzed gene expression profiles of mouse, rat and human gastrocnemius muscles to identify conserved regulators of muscle aging processes. By further comparing data obtained from different muscles we found stronger conservation of aging-related factors at the level of molecular pathways than at the level of individual genes.

Third Age adults are able to engage in society in ways inaccessible to previous generations of older adults, ways facilitated by today’s unique cultural context of late modernity. The combination of myriad personal strengths and specific cultural context raises the challenge of whether and how these adults want to and can play a role in their societies.

Objectives: Physical function impairment can cause great stress to older adults. The purpose of the study is to investigate the association between self-reported and directly-observed physical function on perceived stress among U.S. Chinese older adults. 

Histological analysis of fluorescently labeled tissues has been a critical tool to understand molecular organization in situ. However, assessing molecular structures within large cells and in the context of human organ anatomy has been challenging because it requires penetration of staining reagents and light deep into opaque tissues, while also conforming to the spatial constraints of high-resolution objective lenses.

Gating of voltage-dependent sodium channels involves coordinated movements of the voltage sensors in the voltage-sensing modules (VSMs) of the four domains (DI-DIV) in response to membrane depolarization. Zhu et al. have recently examined the effects of charge reversal substitutions at the VSM of domain III on the action of scorpion alpha- and beta-toxins that intercept the voltage sensors in domains IV and II, respectively. The increased activity of both toxin types on the mutant channels has suggested that the VSM module at domain III interacts allosterically with the VSM modules in domains IV and II during channel gating thus affecting indirectly the action of both scorpion toxin classes.

Although essential metal ions are required in the body, neurotoxicity occurs when exposed to a concentration of metal that the body cannot accommodate. In the case of non-essential metals which are important in industry, these elements have the property of causing neurotoxicity even at small concentrations. When such neurotoxicity progresses chronically, it can contribute to various neurodegenerative disorders, such as Alzheimer’s disease and Parkinson’s disease. Therefore, research on the relationships between neurotoxicity and metal metabolism are being actively conducted, and some recent research has suggested that the mechanisms of metal-induced neurotoxicity critically involve endoplasmic reticulum (ER) stress and mitochondrial dysfunction. Hence, this mini-review is to summarize some examples of such evidence and raise new questions in attempting to address metal-induced neurotoxicity with ER stress and mitochondria dysfunctions, two important topics for the effects of metals in neurodegenerative diseases.

Aside its function in locomotion, posture maintenance and respiration, the hSKM is reported to be a critical metabolic regulator [1]. The hSKM is acknowledged as the primary site of glucose metabolism and storage [1]. Additionally, it serves as a reserve for amino acids [1,2]. In recently times, the hSKM has also been described as an endocrine organ.

Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus, solid organ, or stem cell transplantation, underlying hematologic malignancy, and major trauma. 

Pediatric Functional Gastrointestinal Disorders (p-FGID) comprise one of the most common chronic conditions impacting global health. Conceptualized as gut-brain communication disorders, p-FGID are often exacerbated by and contribute to significant anxiety as well as functional impairment. Cognitive behavioral therapy is the gold standard psychosocial treatment for anxiety spectrum disorders. 

Individuals with spinal cord injury (SCI) have a significantly increased risk for cognitive impairment that is associated with cerebrovascular remodeling and endothelial dysfunction. The sub-acute stage following high thoracic SCI is characterized by increased fibrosis and stiffness of cerebral arteries. However, a more prolonged duration after SCI exacerbates cerebrovascular injury by damaging endothelium. Endothelial dysfunction is associated with reduced expression of transient receptor potential cation channel 4 that mediates the production of nitric oxide and epoxyeicosatrienoic acids following shear stress and the response to carbachol and other endothelium-dependent vasodilators.

Mother-to-child transmission (MTCT) through breastfeeding remains a major source of pediatric HIV-1 infection worldwide. To characterize plasma HIV-1 subtype C populations from infected mothers during pregnancy that related to subsequent breast milk transmission, an exploratory study was designed to apply next generation sequencing and a custom bioinformatics pipeline for HIV-1 gp41 extending from heptad repeat region 2 (HR2) through the membrane proximal external region (MPER) and the membrane spanning domain (MSD).

Ischemic colitis (IC) is a common cause of severe lower gastrointestinal bleeding (LGIB) in the elderly. There are very few studies of patients with IC as a cause of severe LGIB in the literature. This article aims to review diagnosis, colonoscopic findings, medical treatment, and outcomes of patients with IC as a cause of severe hematochezia.

Alzheimer’s disease (AD) is a global health crisis currently afflicting ~6 million Americans (and ~40 million people worldwide). By the middle of the century, these numbers will stagger by ~16 million Americans (and ~152 million people worldwide) suffering from AD, if breakthrough disease-modifying treatments are not discovered.

Diabetic Retinopathy (DR) is a leading cause of blindness in the U.S. However, not much is known of underlying molecular mechanism and how oxidative stress contributes to its development. In the present study, we investigated the involvement of TGFβ signaling pathway on the effect of oxidative stress on VEGF secretion and viability of retinal cells. VEGF is the hallmark that exacerbates DR progression in prolonged diabetes. Some major concerns that have arisen are the underlying effects of antioxidants in elevating VEGF secretion in diabetes.

Since the publication of our previous paper, Visual cycle proteins: Structure, function, and roles in human retinal disease (Tsin, et.al, JBC 293:13016, 2018) there has been significant progress on multiple topics discussed in this paper. In the present communication, we further explore research advances on two visual cycle proteins: DES1 and IRBP.

Acute myeloid leukemia (AML) is characterized by multiple molecular and cytogenetic abnormalities, with increasing data to support clinical and prognostic implications to guide clinical decision making. One of the most well described mutations involves fms-like tyrosine kinase 3 (FLT3) that results in a constitutively active tyrosine kinase and is generally associated with poor prognosis involving shorter overall survival and higher rates of relapse.

Sanfilippo Syndrome Type-B remains an untreatable childhood neurodegenerative disease with great burden for both patient and caregiver. Very few clinical trials have been undertaken to treat the disease, and none of these have yet yielded clinically obtainable products for patients. Caused by a simple enzyme function deficiency, Sanfilippo Syndrome Type-B has been considered a great prospect for gene-therapy interventions.

Diabetes is a complex, multi-symptomatic disease whose complications drives increases in healthcare costs as the diabetes prevalence grows rapidly world-wide. Real-world electronic health records (EHRs) coupled with patient biospecimens, biological understanding, and technologies can characterize emerging diagnostic autoimmune markers resulting from proteomic discoveries.

While opioids remain our most potent analgesics in the management of pain, the many potential harms of prescription opioids have become increasingly clear. Despite the analgesic benefits for people with acute and chronic pain [1], opioid therapy (especially long-term opioid treatment) can result in significant problems such as opioid misuse, the development of opioid use disorder, and overdose. Some authors report that up to 20-30% of patients in primary and tertiary care settings who are maintained on long-term opioid therapy misuse opioids (i.e., use them in a manner other than how the opioids are prescribed) [2,3]. Misuse of opioids can cause or exacerbate additional health problems in people with chronic pain [1,4], and in fact, roughly 10% of patients prescribed long-term opioid therapy may develop an opioid use disorder (OUD), although prevalence varies between studies depending on differences in methodology and operational definitions [3]. 

The protein hormone adiponectin regulates glucose and fatty acid metabolism by binding to two PAQR-family receptors (AdipoR1 and AdipoR2). Both receptors feature a C-terminal segment which is released by proteolysis to form a freely circulating C-terminal fragment (CTF) found in the plasma of normal individuals but not in some undefined diabetes patients. The AdipoR1-CTF_344-376 is a competitive inhibitor of tumor necrosis factor α cleavage enzyme (TACE) but it contains a shorter peptide domain (AdipoR1 CTF_351-362) that is a strong non-competitive inhibitor of insulin-degrading enzyme (IDE).

The mini-review is an update of the original article: Do bachelor assignments in Danish midwifery- and nursing educations reflect evidence-based practice? A document study [1]. We will summarize the findings from the original article, add an analysis of 140 recent bachelor assignments and present the result of a new search of literature to see recent developments in the field. Our aim is to see if the bachelor assignments present evidence-based nursing. 

The recent pandemic of SARS-CoV-2 has emerged as a health emergency to develop effective therapeutic strategies for restricting deadly disease, COVID-19. SARS-CoV-2 infects cells by the endocytosis process via receptor-mediated binding and priming by cellular proteases.

Aspirin (acetylsalicylic acid), a non-steroidal anti-inflammatory drug, inhibits cyclooxygenases (COX-1 and COX-2), which catalyze the conversion of arachidonic acid to prostaglandins [1-3]. In control environments, low-dose aspirin (75 mg or 81 mg) inhibits COX-1 and disrupts the production of thromboxane, reducing platelet aggregation

Liver masses account for 5 to 6% of pediatric cancer, which includes hepatoblastoma (HBL) along with rare cases of hepatocellular carcinoma (HCC). The most dangerous form of pediatric liver cancer is aggressive HBL, which can be characterized by chemo-resistance and multiple nodules or metastases at diagnosis, all correlating with worse clinical prognosis. Despite intensive studies and a significant improvement in overall outcomes, very little is known about the key molecular pathways which determine the aggressiveness of pediatric liver cancer.

Depression is one of the most common comorbidities of chronic diseases including diabetes and obstructive lung diseases (emphysema, chronic bronchitis, and asthma). Obstructive lung diseases and depression have few symptoms in common. However, they are both common in adults and associated with chronic inflammation. It is not clear if their coappearance in diabetic patients is coincidental or associated beyond that expected by chance.

Primary myelofibrosis (PMF) is a type of myeloproliferative neoplasm (MPN) that portends a poor prognosis and has limited options for treatment. PMF is often driven by clonal mutations in one of three genes that regulate the JAK-STAT signaling pathway, leading to hyperactivation of this signaling pathway and over-proliferation of megakaryocytes (MKs) and their precursors. PMF presents with debilitating symptoms such as splenomegaly and weight loss.

The action potential (AP) in cardiac tissue is important for initiating and coordinating contractions in the heart. In addition, the long refractory period minimizes the potential for developing extrasystoles and arrhythmias. The AP is generated by coordinate changes in different ionic currents. In human (or canine) adult ventricular cells, the depolarization phase of the AP is mainly through the influx of Na+ and Ca2+ through specific voltage gated channels.

Geophagy is described in most countries of the world as a practice observed in pregnant women. In industrialized countries, it results from migrant populations who carry with them their cultural habits and practices. This is the case in France and more particularly in Guiana, an overseas territory. Originally used to treat the ills of pregnancy, it is today considered to be dangerous for the woman and her unborn child.
A survey involving 788 pregnant women examining substance use during pregnancy was conducted in three maternity wards in Guiana in 2017-2018. This survey on the Pemba (clay in local language) issue also performed interviews and observations with a dozen women and a dozen health professionals in 2019.

It has long been clear that cigarette smoking is causally linked to many diseases, particularly lung cancer, chronic obstructive pulmonary disease and various forms of cardiovascular disease. For lung cancer, for example, a meta-analysis my colleagues and I conducted, based on epidemiological evidence published in the 1900s [1], estimated that current smoker/never smoker relative risks, were around 10 in North America and Europe, though lower (around three) in Asia. They were higher for squamous cell carcinoma than for adenocarcinoma, were very strongly related to amount smoked, and declined with increasing years of cessation of smoking.

In recent years, various types of synthetic cannabinoids have become widely distributed and are causing social and health problems in most parts of the world. Synthetic cannabinoids are currently the largest group of new psychoactive substances. Those that have been subjected to legal control are replaced by newer controlled and uncontrolled substances. Some of the most recent synthetic cannabinoids that have distributed on the market among youth are FUB-AMB and AB-FUBINACA.

Focused ultrasound has emerged as a key tool for neurologic disorders. In this focused review, we discuss the utility in disrupting the blood brain barrier to maximize treatment. This can facilitate creating direct coagulative lesions and aid in the administration of chemotherapy. Furthermore, it can facilitate neuromodulation when used in pulse sequencing.

Few studies have been conducted on the relationship between “outside-residing” resilience characteristics and the risk of developing drug use disorder later in life. These characteristics include responsive and caring parenting, household routines involving regular family meals and bedtime routines, social support from peers, participation in organized activities, and religious service attendance. We quantified the association between these resilience promotion factors during childhood and the risk of developing criteria for drug use disorder during adulthood using data from a retrospective cohort study of 618 adults born in Massachusetts during 1969-1983, including those with adverse childhood experiences (ACEs). Self-administered questionnaires gathered information on criteria for drug use disorder, ACEs, and family and community resilience promotion factors.

Manual small-incision cataract surgery (MSICS) is a sutureless cataract surgery that has multiple advantages over traditional phacoemulsification and extracapsular cataract extraction (ECCE) procedures. SICS became the procedure of choice for international ophthalmology, where the microscopes and operating room can be more challenging, in addition to the more advanced pathology often seen.

The last two decades were especially fruitful for the refractive surgeons and for the industry who have been showing tremendous development in both understanding and meeting patients’ desire for spectacle independence. Ever since the first trials from Dr. Kenneth Hoffer with his early 1980’s effort in producing a multifocal IOL to the latest achievements from different companies in putting trifocals and EDOF optics to the market.