Posterolateral fusion (PLF) with autogenous iliac bone graft is one of the most common surgical procedures for lumbar spinal disease. However, its limited success demands new biologically competent graft enhancers or substitutes. Although the use of direct current (DC) electrical stimulation has been shown to increase rate of successful spinal fusions, little is known about the effect of the type of current in DC stimulation.
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Σάββατο 22 Δεκεμβρίου 2018
Effect of the type of electrical stimulation on spinal fusion in a rat posterolateral spinal fusion model
Foramen ovale blood flow and cardiac function after main pulmonary artery occlusion in fetal sheep
New Findings
What is the central question of this study? At near term gestation, foramen ovale blood flow accounts for a significant proportion of fetal left ventricular output. Can foramen ovale increase its volume blood flow, when right ventricular afterload is increased by main pulmonary artery occlusion? What is the main finding and its importance? Foramen ovale volume blood flow increased during main pulmonary artery occlusion. However, this increase was attributable to a rise in fetal heart rate, because left ventricular stroke volume remained unchanged. These findings suggest that foramen ovale has a limited capacity to increase its volume blood flow.
Abstract
Foramen ovale (FO) accounts for the majority of fetal left ventricular (LV) output. Increased right ventricular (RV) afterload can cause a redistribution of combined cardiac output between the ventricles. To understand the capability of FO to increase its volume blood flow and thus LV output, we mechanically occluded the main pulmonary artery in seven chronically instrumented near term sheep fetuses. We hypothesised that FO volume blood flow and LV output would increase during main pulmonary artery occlusion. Fetal cardiac function and haemodynamics were assessed by pulsed and tissue Doppler at baseline, 15 and 60 min after occlusion of the main pulmonary artery and 15 min after occlusion was released. Fetal ascending aorta and central venous pressures, and blood gas values were monitored. Main pulmonary artery occlusion initially increased fetal heart rate (p < 0.05) from 158(7) to 188(23) bpm and LVCO (p < 0.0001) from 629(198) to 776(283) ml/min. Combined cardiac output fell (p < 0.0001) from 1524(341) to 720(273) ml/min. During main pulmonary artery occlusion, FO volume blood flow increased (p < 0.001) from 507(181) to 776(ml/min). This increase was related to fetal tachycardia, because LV stroke volume did not change. Fetal ascending aorta blood pressure remained stable. Central venous pressure was higher (p < 0.05) during the occlusion than after it was released. During the occlusion fetal pH decreased and pCO2 increased. LV systolic dysfunction developed while LV diastolic function was preserved. RV systolic and diastolic function deteriorated following the occlusion. In conclusion, FO has a limited capacity to increase its volume blood flow at near term gestation.
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Decrement in resting and insulin‐stimulated soleus muscle mitochondrial respiration is an early event in diet‐induced obesity in mice
New Findings
What is the central question of this study? What are the temporal responses on mitochondrial respiration, and insulin mitochondrial responsivity in soleus muscle‐fibres from mice during the development of obesity and insulin resistance? What are the main finding and its importance? Short‐ and long‐term exposition of high‐fat diet (HFD) markedly reduced soleus mitochondrial respiration and mitochondrial insulin responsivity prior any change in glycogen synthesis. Muscle glycogen synthesis and whole‐body insulin resistance were present after 14 and 28 days, respectively. Our findings highlight the plasticity of mitochondria during the development of obesity and insulin resistance.
Abstract
Recently, significant attention has been given to the role of muscle mitochondrial function in the development of insulin resistance associated with obesity. Our aim was to investigate temporal alterations in mitochondrial respiration, H2O2 emission, and mitochondrial responsivity to insulin in permeabilized skeletal muscle‐fibres during the development of obesity in mice. Swiss male mice (5‐6 weeks old) were fed with a high‐fat diet (60% calories from fat) or standard diet for 7, 14 and 28 days to induce obesity and insulin resistance. Diet‐induced obese (DIO) mice presented reduced glucose tolerance and hyperinsulinemia after 7 days of HFD. After 14 days, the expected increase in muscle glycogen content after systemic injection of glucose and insulin was not observed in DIO mice. At 28 days, blood glucose decay after insulin injection was significantly impaired. Complex I (pyruvate + malate) and II (succinate) linked respiration, and oxidative phosphorylation (ADP) were decreased after 7 days of HFD and remained low in DIO mice after 14 and 28 days of treatment. Moreover, mitochondria from DIO mice were incapable of increasing respiratory coupling and ADP responsivity after insulin‐stimulation in all observed periods. Mitochondrial content markers were reduced only after 28 days of treatment. Mitochondrial H2O2 emission profile varied during the time course of DIO, with a reduction of H2O2 emission in the early stages of DIO and an increased emission after 28 days of treatment. Our data demonstrate that DIO promotes transitory alterations in mitochondrial physiology during the early and late stages of insulin‐resistance related to obesity.
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Ischaemia‐induced muscle metabolic abnormalities are poorly alleviated by endurance training in a mouse model of sickle cell disease
New Findings
The aim of this study was to evaluate the potential beneficial effects of endurance training during an ischemia/reperfusion paradigm in sickle cell disease mice. Endurance training would not reverse the metabolic defects induced by a simulated vaso‐occlusive crisis in sickle cell mice, whether it is with regard to intramuscular acidosis, mitochondrial dysfunction or anatomical properties. Our results suggest that endurance training would reduce vaso‐occlusive crisis number rather than the complications related to vaso‐occlusive crisis.
Abstract
The aim of this study was to investigate whether endurance training could limit the abnormalities described in sickle cell disease (SCD) mice in response to an ischemia/reperfusion (I/R) paradigm. Ten sedentary (HbSS‐SED) and 9 endurance trained (HbSS‐END) SCD mice were submitted to a standardized protocol of I/R of the leg during which ATP, phosphocreatine and inorganic phosphate concentrations as well as intramuscular pH were measured using magnetic resonance spectroscopy. Forty‐eight hours later, skeletal muscles were harvested. Oxidative stress markers were then measured. While the time‐course of intramuscular pH was slightly different between trained and sedentary mice (p < 0.05), the extent of acidosis was similar at the end of the ischemic period. The initial rate of phosphocreatine resynthesis measured at blood flow restoration, illustrating mitochondrial function, was not altered in trained mice compared to sedentary mice. Although several oxidative stress markers were not different between groups (p > 0.05), the I/R‐related increase of uric acid concentration observed in sedentary SCD mice (p < 0.05) was not present in the trained group. The spleen weight, generally used as a marker of the severity of the disease, was not different between groups (p > 0.05). In conclusion, endurance training did not limit the metabolic consequences of an I/R paradigm in skeletal muscle of SCD mice, suggesting that the reduction in the severity of the disease previously demonstrated at the basal state would be attributable to a reduction of vaso‐occlusive crisis (VOC) occurrence rather than a decrease of the deleterious effects of VOC.
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Sex differences in the circulatory responses to an isocapnic cold pressor test
New Findings
What is the central question of this study?
To determine whether sex differences exist in the cardiorespiratory responses to an isocapnic cold pressor test (CPT).
What is the main finding and its importance?
During the CPT, there were no sex differences in the respiratory response; however, females demonstrated a reduced mean arterial pressure and reduced dilation of the common carotid artery. Since the CPT is predictive of future cardiovascular events, these data have clinical implications for improving the utility of the CPT to determine cardiovascular health risk. Sex differences should be taken into consideration when conducting and interpreting a CPT.
Abstract
The cold pressor test (CPT) elicits a transient increase in sympathetic nervous activity, minute ventilation (VE), mean arterial pressure (MAP), and common carotid artery (CCA) diameter in healthy individuals. Although the extent of dilation of the CCA in response to the CPT has been used as a clinical indicator of cardiovascular health status, the potential sex differences have yet to be explored. In response to a CPT, we hypothesized that elevations in VE, MAP and dilation of the CCA would be attenuated in females compared to males. In 20 young healthy participants (10 females), we measured the respiratory, cardiovascular, and CCA responses during a CPT, which consisted of a three‐minute right foot immersion into 0–1 °C water. Blood pressure (via finger photo plethysmography), heart rate (via electrocardiogram), and CCA diameter and velocity (via Duplex ultrasound) were simultaneously recorded immediately before and during the CPT. During the CPT, while controlling end‐tidal gases to baseline values, the main findings were: 1) no sex differences were present in absolute or relative changes in VE (P = 0.801 and P = 0.179, respectively); 2) the relative MAP and CCA diameter response were reduced in females by 51% and 55%, respectively (P = 0.008 and P = 0.029 vs. males, respectively); and 3) the relative MAP responses was positively correlated to the dilation of the CCA in males (r = 0.42, P = 0.019), females (r = 0.43, P = 0.019), and in males and females combined (r = 0.55, P < 0.001). Since the CPT is used as a clinical tool to assess cardiovascular health status, sex differences should be considered in future studies.
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μ‐Opioid receptors in primary sensory neurons are essential for opioid analgesic effect on acute and inflammatory pain and opioid‐induced hyperalgesia
Key points
μ‐Opioid receptors (MORs) are expressed peripherally and centrally, but the loci of MORs responsible for clinically relevant opioid analgesia are uncertain. Crossing Oprm1flox/flox and AdvillinCre/+ mice completely ablates MORs in dorsal root ganglion neurons and reduces the MOR expression level in the spinal cord. Presynaptic MORs expressed at primary afferent central terminals are essential for synaptic inhibition and potentiation of sensory input by opioids. MOR ablation in primary sensory neurons diminishes analgesic effects produced by systemic and intrathecal opioid agonists and abolishes chronic opioid treatment‐induced hyperalgesia. These findings demonstrate a critical role of MORs expressed in primary sensory neurons in opioid analgesia and suggest new strategies to increase the efficacy and reduce adverse effects of opioids.
ABSTRACT
The pain and analgesic systems are complex, and the actions of systemically administered opioids may be mediated by simultaneous activation of μ‐opioid receptors (MORs, encoded by the Oprm1 gene) at multiple, interacting sites. The loci of MORs and circuits responsible for systemic opioid‐induced analgesia and hyperalgesia remain unclear. Previous studies using mice in which MORs are removed from Nav1.8‐ or TRPV1‐expressing neurons provided only an incomplete and biased view about the role of peripheral MORs in opioid actions in vivo. In the present study, we determine the specific role of MORs expressed in primary sensory neurons in the analgesic and hyperalgesic effects produced by systemic opioid administration. We generated Oprm1 conditional knockout (Oprm1‐cKO) mice in which MOR expression is completely deleted from dorsal root ganglion neurons and substantially reduced in the spinal cord, which are confirmed by immunoblotting and immunocytochemical labeling. Both opioid‐induced inhibition and potentiation of primary sensory input were abrogated in Oprm1‐cKO mice. Remarkably, systemically administered morphine potently inhibited acute thermal and mechanical nociception and persistent inflammatory pain in control mice but had little effect in Oprm1‐cKO mice. The analgesic effect of intrathecally administered morphine was also profoundly reduced in Oprm1‐cKO mice. Additionally, chronic morphine treatment–induced hyperalgesia was absent in Oprm1‐cKO mice. Our findings directly challenge the notion that clinically relevant opioid analgesia is mediated mostly by centrally expressed MORs. MORs in primary sensory neurons, particularly those expressed presynaptically at the first sensory synapse in the spinal cord, are crucial for both opioid analgesia and opioid‐induced hyperalgesia.
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Manipulation of mechanical ventilatory constraint during moderate intensity exercise does not influence dyspnoea in healthy older men and women
Key Point Summary
The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly due to sex‐difference respiratory system morphology. During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea. Using a single‐blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate‐intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults. When older men and women perform submaximal exercise at a moderate intensity, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. We sought to determine the effect of manipulating mechanical ventilatory constraint during submaximal exercise on dyspnoea in older men and women. Methods: Eighteen healthy subjects (60‐80 y; 9 men, 9 women) completed two days of testing. On Day 1, subjects performed pulmonary function testing and a maximal incremental cycle exercise test. On Day 2, subjects performed three 6‐min bouts of cycling at ventilatory threshold, in a single‐blind randomized manner, while breathing: i) normoxic helium‐oxygen (HEL) to reduce the work of breathing (Wb) and alleviate expiratory flow limitation (EFL); ii) through an inspiratory resistance (RES) of ∼5 cmH2O·l−1·s−1 to increase Wb; and iii) ambient air as a control (CON). Oesophageal pressure, diaphragm electromyography, and sensory responses (using the category‐ratio 10 Borg scale) were monitored throughout exercise. Results: During the HEL condition, there was a significant decrease in Wb (men: –21 ± 6%, women: –17 ± 10%) relative to CON (both p < 0.01). Moreover, if EFL was present during CON (4 men, 5 women), it was alleviated during HEL. Conversely, during the RES condition, Wb (men: 42 ± 19%, women: 50 ± 16%) significantly increased relative to CON (both p < 0.01). There was no main effect of sex on Wb (p = 0.59). Across conditions, women reported significantly higher dyspnoea intensity than men (2.9 ± 0.9 vs. 1.9 ± 0.8 Borg scale units, p < 0.05). Despite significant differences in the degree of mechanical ventilatory constraint between conditions, dyspnoea intensity was unaffected, independent of sex (p = 0.46). Conclusion: When older men and women perform submaximal exercise at a moderate intensity, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea.
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Intermittent sprint performance in the heat is not altered by augmenting thermal perception via L-menthol or capsaicin mouth rinses
Abstract
Purpose
Cooling sensations elicited by mouth rinsing with L-menthol have been reported as ergogenic. Presently, responses to L-menthol mouth rinsing during intermittent sprint performance (ISP) in the heat are unknown and the impact of increased thermal perception on ISP via capsaicin has also not been quantified. This experiment aimed to identify whether eliciting cooling/warming sensations via L-menthol/capsaicin would alter ISP in the heat.
Method
Fourteen participants (mass = 72 ± 9 kg, \(\dot {V}_{2{\text{peak}}}}\) = 3.30 ± 0.90 L min−1), undertook four experimental trials, involving 40 min of ISP in hot conditions (40.2 ± 0.6 °C, 42 ± 2% R.H.) with mouth rinsing (25 mL, 6 s) at the protocol onset, and every 10 min thereafter. Cooling (0.01% L-menthol; MEN), warming (0.2% capsaicin; CAP), placebo (0.3 sham-CHO; PLA), and control (water; CON) mouth rinses were utilized. Performance was quantified via power (PP) and work done (WD) during sprints. Heart rate (HR), core (Trec) and skin (Tskin) temperature, perceived exertion (RPE), thermal sensation (Tsens), and comfort (Tcom) were measured at 10 min intervals. Sweat rate (whole-body sweat rate) was calculated from ∆mass.
Result
PP reduced over time (P < 0.05); however, no change was observed between trials for PP or WD (P > 0.05). Tcom increased over time and was lower in MEN (2.7 ± 1.1; P < 0.05) with no difference between CAP (3.1 ± 1.2), PLA (3.2 ± 1.3) and CON (3.1 ± 1.3). RPE, Tsens HR, Trec, and Tskin increased over time (P < 0.05) with no between trial differences (P > 0.05).
Conclusion
Despite improved thermal comfort via L-menthol, ISP did not improve. Capsaicin did not alter thermal perception or ISP. The reduction in ISP over time in hot conditions is not influenced by thermal perception.
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An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso
Abstract
Objectives Increasing financial access to healthcare is proposed to being essential for improving child health outcomes, but the available evidence on the relationship between increased access and health remains scarce. Four years after its launch, we evaluated the contextual effect of user fee removal intervention on the probability of an illness occurring and the likelihood of using health services among children under 5. We also explored the potential effect on the inequality in healthcare access. Methods We used a comparative cross-sectional design based upon household survey data collected years after the intervention onset in one intervention and one comparison district. Propensity scores weighting was used to achieve balance on covariates between the two districts, which was followed by logistic multilevel modelling to estimate average marginal effects (AME). Results We estimated that there was not a significant difference in the reduced probability of an illness occurring in the intervention district compared to the non-intervention district [AME 4.4; 95% CI 1.0–9.8)]. However, the probability of using health services was 17.2% (95% CI 15.0–26.6) higher among children living in the intervention district relative to the comparison district, which rose to 20.7% (95% CI 9.9–31.5) for severe illness episodes. We detected no significant differences in the probability of health services use according to socio-economic status [χ2 (5) = 12.90, p = 0.61]. Conclusions for Practice In our study, we found that user fee removal led to a significant increase in the use of health services in the longer term, but it is not adequate by itself to reduce the risk of illness occurrence and socioeconomic inequities in the use of health services.
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Robot helps health workers train for emergencies
Hal is one of the most advanced human simulators and can replicate many human vital signs — heartbeat, blood pressure, pulse, blood oxygen levels and breathing
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Measurement of uranium distribution coefficient and 235U/238U ratio in soils affected by Fukushima dai-ichi nuclear power plant accident
Publication date: March 2019
Source: Journal of Environmental Radioactivity, Volume 198
Author(s): S. Mishra, S. Kasar, A. Takamasa, N. Veerasamy, S.K. Sahoo
Abstract
Fukushima Daiichi Nuclear Power Plant (FDNPP) accident resulted radioactive contamination in soil due to deposition of mainly radiocesium as well as many long-lived radionuclides surrounding a large area around FDNPP. Depending upon environmental conditions, radionuclides in soil can be mobilized in aquatic systems. Therefore, the fate and transfer of these radionuclides in the soil water system is very important for radiation protection and dose assessment. In the present study, soil and water samples were collected from contaminated areas around FDNPP. Inductively coupled plasma mass spectrometry (ICP-MS) is used for total uranium concentration. Emphasis has been given on isotope ratio measurement of 235U/238U ratio using thermal ionization mass spectrometry (TIMS) that gives us the idea about its contamination during accident. For the migration behavior, its distribution coefficient (Kd) has been determined using laboratory batch method. Chemical characterization of soil with respect to different parameters has been carried out. The effect of these soil parameters on distribution coefficient of uranium has been studied in order to explain the radionuclide mobility in this particular area. The distribution coefficient values for uranium are found to vary from 30 to 36000 L/kg. A large variation in the distribution coefficient values shows the retention or mobility of uranium is highly dependent on soil characteristics in the particular area. This variation is explained with respect to soil pH, Fe, Mn, CaCO3 and organic content. There is a very good correlation of uranium Kd obtained with Fe content. There is no enrichment of 235U has been noticed in the studied area.
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Development of the Measure of Experiential Aspects of Participation for People With Physical Disabilities
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Jeffrey G. Caron, Kathleen A. Martin Ginis, Meredith Rocchi, Shane N. Sweet
Abstract
Objectives
To create a parsimonious, psychometrically sound measure of experiential aspects of participation (MeEAP) for people with physical disabilities.
Design
Cross-sectional.
Setting
Online survey.
Participants
Respondents were a purposive sample of adults (N=228, n=118 female, mean age=49.66±14.71, range=19-83). Each respondent indicated having a physical disability and participating in employment, mobility, sport, and/or exercise life domains.
Interventions
None.
Main Outcome Measures
The MeEAP was designed to be conceptually aligned with 6 experiential aspects of participation among people with physical disabilities: autonomy, belongingness, challenge, engagement, mastery, and meaning.1 The measure was also designed to be relevant across employment, mobility, sport, and exercise life domains. Higher scores on MeEAP items were hypothesized to be associated with higher levels of life satisfaction.
Results
The final 12-item scale (2 items per subscale) had strong model fit (Satorra-Bentler scaled χ2(39)=58.26, P<.001, comparative fit index=.98, Tucker-Lewis index=.96, root mean square error of approximation=.05, standardized root mean square residual=.03) and good reliability and validity estimates. Results of regression analyses indicated that the MeEAP explained 10%-29% of the variance in life satisfaction.
Conclusions
The MeEAP is the first measure to capture all 6 experiential aspects of participation for individuals with physical disabilities across 4 major life domains. The MeEAP can be used as an outcome measure or as a mediator to help explain broader outcomes (eg, life satisfaction). The MeEAP could also be used for program evaluation to provide insights about the types of interventions needed to promote full participation.
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Information/Education Pages (I/EPs)
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s):
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Extraordinary Contributions to Disability and Rehabilitation Research and Unwavering Leadership: A Tribute to Ruth Brannon
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Stephanie A. Kolakowsky-Hayner, Wayne A. Gordon, National Institute on Disability, Independent Living, and Rehabilitation Research Staff
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A Theory-Driven System for the Specification of Rehabilitation Treatments
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Tessa Hart, Marcel P. Dijkers, John Whyte, Lyn S. Turkstra, Jeanne M. Zanca, Andrew Packel, Jarrad H. Van Stan, Mary Ferraro, Christine Chen
Abstract
The field of rehabilitation remains captive to the black-box problem: our inability to characterize treatments in a systematic fashion across diagnoses, settings, and disciplines, so as to identify and disseminate the active ingredients of those treatments. In this article, we describe the Rehabilitation Treatment Specification System (RTSS), by which any treatment employed in rehabilitation may be characterized, and ultimately classified according to shared properties, via the 3 elements of treatment theory: targets, ingredients, and (hypothesized) mechanisms of action. We discuss important concepts in the RTSS such as the distinction between treatments and treatment components, which consist of 1 target and its associated ingredients; and the distinction between targets, which are the direct effects of treatment, and aims, which are downstream or distal effects. The RTSS includes 3 groups of mutually exclusive treatment components: Organ Functions, Skills and Habits, and Representations. The last of these comprises not only thoughts and feelings, but also internal representations underlying volitional action; the RTSS addresses the concept of volition (effort) as a critical element for many rehabilitation treatments. We have developed an algorithm for treatment specification which is illustrated and described in brief. The RTSS stands to benefit the field in numerous ways by supplying a coherent, theory-based framework encompassing all rehabilitation treatments. Using a common framework, researchers will be able to test systematically the effects of specific ingredients on specific targets; and their work will be more readily replicated and translated into clinical practice.
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Advancing Rehabilitation Practice Through Improved Specification of Interventions
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Jeanne M. Zanca, Lyn S. Turkstra, Christine Chen, Andrew Packel, Mary Ferraro, Tessa Hart, Jarrad H. Van Stan, John Whyte, Marcel P. Dijkers
Abstract
Rehabilitation clinicians strive to provide cost-effective, patient-centered care that optimizes outcomes. A barrier to this ideal is the lack of a universal system for describing, or specifying, rehabilitation interventions. Current methods of description vary across disciplines and settings, creating barriers to collaboration, and tend to focus mostly on functional deficits and anticipated outcomes, obscuring connections between clinician behaviors and changes in functioning. The Rehabilitation Treatment Specification System (RTSS) is the result of more than a decade of effort by a multidisciplinary group of rehabilitation clinicians and researchers to develop a theory-based framework to specify rehabilitation interventions. The RTSS describes interventions for treatment components, which consist of a target (functional change brought about as a direct result of treatment), ingredients (actions taken by clinicians to change the target), and a hypothesized mechanism of action, as stated in a treatment theory. The RTSS makes explicit the connections between functional change and clinician behavior, and recognizes the role of patient effort in treatment implementation. In so doing, the RTSS supports clinicians' efforts to work with their patients to set achievable goals, select appropriate treatments, adjust treatment plans as needed, encourage patient participation in the treatment process, communicate with team members, and translate research findings to clinical care. The RTSS may help both expert and novice clinicians articulate their clinical reasoning processes in ways that benefit treatment planning and clinical education, and may improve the design of clinical documentation systems, leading to more effective justification and reimbursement for services. Interested clinicians are invited to apply the RTSS in their local settings.
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The Importance of Voluntary Behavior in Rehabilitation Treatment and Outcomes
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): John Whyte, Marcel P. Dijkers, Tessa Hart, Jarrad H. Van Stan, Andrew Packel, Lyn S. Turkstra, Jeanne M. Zanca, Christine Chen, Mary Ferraro
Abstract
Most rehabilitation treatments are volitional in nature, meaning that they require the patient's active engagement and effort. Volitional treatments are particularly challenging to define in a standardized fashion, because the clinician is not in complete control of the patient's role in enacting these treatments. Current recommendations for describing treatments in research reports fail to distinguish between 2 fundamentally different aspects of treatment design: the selection of treatment ingredients to produce the desired functional change and the selection of ingredients that will ensure the patient's volitional performance. The Rehabilitation Treatment Specification System (RTSS) is a conceptual scheme for standardizing the way that rehabilitation treatments are defined by all disciplines across all areas of rehabilitation. The RTSS highlights the importance of volitional behavior in many treatment areas and provides specific guidance for how volitional treatments should be specified. In doing so, it suggests important crosscutting research questions about the nature of volitional behavior, factors that make it more or less likely to occur, and ingredients that are most effective in ensuring that patients perform desired treatment activities.
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The Rehabilitation Treatment Specification System: Implications for Improvements in Research Design, Reporting, Replication, and Synthesis
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Jarrad H. Van Stan, Marcel P. Dijkers, John Whyte, Tessa Hart, Lyn S. Turkstra, Jeanne M. Zanca, Christine Chen
Abstract
Despite significant advances in measuring the outcomes of rehabilitation interventions, little progress has been made in specifying the therapeutic ingredients and processes that cause measured changes in patient functioning. The general approach to better clarifying the process of treatment has been to develop reporting checklists and guidelines that increase the amount of detail reported. However, without a framework instructing researchers in how to describe their treatment protocols in a manner useful to or even interpretable by others, requests for more detail will fail to improve our understanding of the therapeutic process. In this article, we describe how the Rehabilitation Treatment Specification System (RTSS) provides a theoretical framework that can improve research intervention reporting and enable testing and refinement of a protocol's underlying treatment theories. The RTSS framework provides guidance for researchers to explicitly state their hypothesized active ingredients and targets of treatment as well as for how the individual ingredients in their doses directly affect the treatment targets. We explain how theory-based treatment specification has advantages over checklist approaches for intervention design, reporting, replication, and synthesis of evidence in rehabilitation research. A complex rehabilitation intervention is used as a concrete example of the differences between an RTSS-based specification and the Template for Intervention Description and Replication checklist. The RTSS's potential to advance the rehabilitation field can be empirically tested through efforts to use the framework with existing and newly developed treatment protocols.
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An End to the Black Box of Rehabilitation?
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Marcel P. Dijkers
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Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s): Jasmine Heath Hearn, Imogen Cotter, Katherine Anne Finlay
Abstract
Objectives
To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI).
Design
Randomized controlled feasibility study with 3-month follow-up.
Setting
Community setting.
Participants
Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27).
Interventions
An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks.
Main Outcome Measure
Depression severity.
Results
Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= −.891; 95% confidence interval,−1.48 to −.30) and T3 (mean difference=−1.96; 95% confidence interval, −2.94 to −.97). Mindfulness training also reduced anxiety at T2 (mean difference=−.888; 95% confidence interval, −1.40 to −.38) and T3 (mean difference=−2.44; 95% confidence interval, −3.20 to −1.69).
Conclusions
Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.
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Editors' Selections From This Issue: Volume 100 / Number 1 / January 2019
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s):
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Table of Contents
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s):
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Editorial Board
Publication date: January 2019
Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 1
Author(s):
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The Effectiveness of the Proprioceptive Neuromuscular Facilitation Method on Gait Parameters in Patients with Stroke: A Systematic Review
Publication date: Available online 22 December 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Emer Gunning, Marcin Kacper Uszynski
Abstract
Objective
The aim of this paper is to review the current evidence on the effectiveness of PNF techniques on gait parameters in patients with stroke.
Data Sources
The electronic platforms of CINAHL, MEDLINE, PubMed, and PEDro were searched using the relevant search terms.
Study Selection
Intervention studies that had gait parameters as an outcome and, in which PNF techniques were used in a post stroke population, were reviewed. The studies were reviewed by both authors and a consensus was reached. The literature search identified 84 studies. Following screening, there were 5 studies which met the inclusion criteria for this review.
Data extraction
Data was extracted from the studies by both authors and independently reviewed. Methodological quality of randomised controlled trials (RCTs) was assessed with the Physiotherapy Evidence Database (PEDro) scale and for non-RCTs with the Quality Assessment Tool for Quantitative Studies.
Data Synthesis
It was found that treatment using the PNF method led to a statistically significant improvement in gait outcome measures in patients with stroke in all the studies. Three of the studies also found that groups treated with PNF techniques had a significantly greater improvement in outcome measures than groups that received routine physiotherapy treatment.
Conclusions
Although some limitations were identified in the methodological quality of the studies, current research suggests that PNF is an effective treatment for the improvement of gait parameters in patients with stroke. Further research is needed to build a robust evidence base in this area.
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Self-Report of Outpatient Therapy Dose at 6 and 12 Months After Severe Traumatic Brain Injury
Publication date: Available online 22 December 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Tessa Hart, John Whyte, Monica Vaccaro, Amanda R. Rabinowitz
Abstract
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient Physical, Occupational, and Speech Therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported healthcare utilization in this population.
Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.
Setting
Rehabilitation center providing outpatient TBI therapies.
Participants
65 people with severe TBI living in the community provided 6-month data; 54 provided 12-month data.
Interventions
Not applicable.
Main Outcome Measure
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation (ICC), with linear regression used to predict accuracy from demographic variables and cognitive status.
Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower Cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.
Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs. scheduled) sessions.
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Goal setting and achievement in individualized rehabilitation of younger total and unicondylar knee arthroplasty patients - a cohort study
Publication date: Available online 22 December 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Suzanne Witjes, Alexander Hoorntje, P.Paul F.M. Kuijer, Koen L.M. Koenraadt, Leendert Blankevoort, Gino M.M.J. Kerkhoffs, Rutger C.I. van Geenen
Abstract
Objective
To investigate activity goals, intensity and achievement of these activity goals in younger Knee Arthroplasty (KA) patients, and to identify the differences between Total Knee Arthroplasty (TKA) and Unicondylar Knee Arthroplasty (UKA) patients.
Design
Prospective cohort study.
Setting
Department of orthopedic surgery and physical therapy practices.
Participants
48 patients aged 65 years or younger, who underwent KA.
Intervention
Rehabilitation with Goal Attainment Scaling (GAS).
Main outcome measures
GAS goals for daily life activity, work and leisure time, corresponding metabolic equivalent of task (MET) values, corrected MET values, and GAS scores at three and six months.
Results
The intensity levels of all 144 formulated activity goals were light in 16% of cases, moderate in 63% and vigorous in 21%. Intensity levels did not differ between TKA and UKA patients. Following rehabilitation using GAS, 54% of daily life activity goals, 65% of work activity goals, and 46% of leisure time activities were attained after three months. After six months, 91% of daily life activity goals, 93% of work activity goals, and 89% of leisure time activity goals were attained. Goal attainment did not differ between MET intensity levels. Higher goal attainment was achieved in the UKA group (100%) compared to the TKA patients (82%) after six months (p<0.001).
Conclusions
Younger patients aim to perform many different activities of varying metabolic intensity levels following KA. After six months of rehabilitation using GAS, in total these patients attain 91% of their preoperatively formulated activity goals, independent of the MET intensity level. After six months, UKA patients attain significantly more activity goals than TKA patients. GAS might be a useful objective outcome measure in evaluating clinical outcomes of individual KA patients.
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The regulation of skeletal muscle fatigability and mitochondrial function by chronically elevated IL‐6
New Findings
What is the central question of this study?
Interleukin‐6 has been associated with muscle mass and metabolism with both physiological and pathological conditions. A causal role for IL‐6 to induce fatigue and disrupt mitochondrial function has not been determined.
What is the main finding and its importance?
We demonstrate that chronically elevated IL‐6 increased skeletal muscle fatigability and disrupted mitochondrial content and function independent of fiber‐type and mass changes.
Abstract
Background
Interleukin‐6 (IL‐6) can initiate intracellular signaling in skeletal muscle through binding to the IL‐6‐receptor and interaction with the transmembrane gp130 protein. Circulating IL‐6 has established effects on skeletal muscle mass and metabolism in both physiological and pathological conditions. However, the effects of circulating IL‐6 on skeletal muscle function are not well understood. The purpose of this study was to determine if chronically elevated systemic IL‐6 was sufficient to disrupt skeletal muscle force, fatigue, and mitochondrial function. Additionally, we examined the role of muscle gp130 signaling during IL‐6 over‐expression.
Methods
Systemic IL‐6 overexpression for 2‐weeks was achieved by electroporation of an IL‐6 over‐expression plasmid or empty vector into the quadriceps of either C57BL/6 (WT) or skeletal muscle gp130 knockout (KO) male mice. Tibialis anterior muscle in situ functional properties and mitochondrial respiration were determined.
Results
IL‐6 accelerated in situ skeletal muscle fatigue in the WT; a 18.5% reduction in force within 90s of repeated submaximal contractions and a 7% reduction in maximal tetanic force following 5 minutes. There was no difference between KO and KO+IL‐6 fatigue. IL‐6 reduced WT muscle mitochondrial respiratory control ratio (RCR) 36% and COX activity 42%. IL‐6 had no effect on either KO RCR or COX activity. IL‐6 also had no effect on body weight, muscle mass, or tetanic force in either genotype.
Conclusions
These results provide evidence that 2 weeks of elevated systemic IL‐6 is sufficient to increase skeletal muscle fatigability and decrease muscle mitochondrial content and function and these effects require muscle gp130 signaling.
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Urotensin II in the development and progression of chronic kidney disease following 5/6 nephrectomy in the rat
New Findings
What is the central question of this study? Urotensin II is upregulated in patients in the later stages of chronic kidney disease (CKD), particularly in individuals requiring dialysis. However, studies in animals have been limited to the early stages of CKD. What is the main finding and its importance? Expression of urotensin II and its receptor increased, extending into cortical structures as CKD progressed towards end‐stage renal failure in the rat. Sub‐chronic treatment with a urotensin receptor antagonist slowed but did not prevent progression of CKD. This suggests that urotensin II contributes to the decline in renal function in CKD.
Abstract
Elevated serum and urine urotensin II (UII) concentrations have been reported in end‐stage patients with chronic kidney disease (CKD). Similar increases in UII and its receptor, UT, have been reported in animal models of CKD, but only at much earlier stages of renal dysfunction. The aim of this study was to characterise urotensin system expression as renal disease progresses to end‐stage failure in a 5/6 sub‐total nephrectomy (SNx) rat model. Male Sprague‐Dawley rats underwent SNx or sham surgery and were killed at 8 weeks post‐surgery (early – E) or immediately prior to end‐stage renal failure (30 ± 3 weeks post‐surgery, late – L). Systolic blood pressure (SBP), urinary albumin:creatinine ratio (uACR) and glomerulosclerosis index were all increased in SNx‐E rats compared with sham‐E by 8 weeks post‐surgery. These changes were associated with an increase in renal immunoreactive UII‐staining but little change in UT expression. As CKD progressed to end‐stage disease in the SNx‐L group markers of renal function deteriorated further, in association with a marked increase in immunoreactive UII and UT staining. Sub‐chronic administration of a UT antagonist, SB‐611812, at 30 mg kg−1 day−1 for 13 weeks in a separate group of SNx rats resulted in a two week delay in the increase in both SBP and uACR observed in vehicle‐treated SNx, but did not prevent the progression of renal dysfunction. The urotensin system is up‐regulated as renal function deteriorates in the rat; UT antagonism can slow but not prevent disease progression, suggesting that UII plays a role in CKD.
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Recovery of blood flow regulation in microvascular resistance networks during regeneration of mouse gluteus maximus muscle
Key points
Skeletal muscle regenerates following injury but the recovery of its microvascular supply is poorly understood. We injured the gluteus maximus muscle in mice to study the recovery of blood flow regulation in microvascular resistance networks. We hypothesized that blood flow regulation recovers in concert with myofiber regeneration. Microvascular perfusion ceased within 1d post injury and was restored at 5d coincident with the appearance of new myofibers, however the resistance network was dilated and unresponsive to vasoactive agents. Spontaneous vasomotor tone, endothelium‐dependent dilatation and adrenergic vasoconstriction increased at 10d in concert with myofiber regeneration. Vasomotor control recovered at 21d, when regenerated myofibers matured and active force production stabilized. Functional vasodilatation in response to muscle contraction recovered at 35d. Physiological integrity of microvascular smooth muscle and endothelium recovers in parallel with myofiber regeneration. Additional time is required to restore the efficacy of signaling between myofibers and microvascular networks controlling their oxygen supply.
Abstract
Myofiber regeneration following skeletal muscle injury is well‐studied but little is known of how microvascular perfusion is restored. Our goal was to evaluate the recovery of blood flow regulation during skeletal muscle regeneration. In anesthetized male C57BL/6J mice (age, 4 months), the gluteus maximus muscle (GM) was injured by local injection of barium chloride solution (1.2%, 75 μl). Functional integrity of the resistance network was evaluated at 5, 10, 21 and 35 days post‐injury versus Control by measuring internal diameter of feed arteries (FA), first‐ (1A), second‐ (2A) and third‐order (3A) arterioles supplying the GM using intravital microscopy. Resting diameters of all branch orders were significantly greater (P<0.05) than Control at 5d and 10d and recovered to Control by 21d, as did spontaneous vasomotor tone. Vasodilatation to acetylcholine and vasoconstriction to phenylephrine (10−9 to 10−5 M) were absent at 5d, increased at 10d and recovered to Control by 21d; reactivity improved in a distal‐to‐proximal gradient. Across branch orders, functional vasodilatation to single tetanic contraction (100 Hz,500 ms) and to rhythmic twitch contractions (4 Hz,30s) were impaired at 5d, improved through 21d and were not different from Control at 35d. Peak force development (g) was 60% of Control at 10d and recovered by 21d. Diminished vasomotor tone during initial stages of regeneration promotes tissue perfusion as myofiber recovery begins. Recovery of tone and vasomotor responses to agonists occur in concert with myofiber regeneration. Delayed recovery of functional vasodilatation indicates that additional time is required to restore signalling between contracting myofibers and their vascular supply.
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Patients with SATB2‐associated syndrome exhibiting multiple odontomas
Abstract
Special AT‐rich sequence‐binding protein 2 (SATB2)‐associated syndrome (SAS) is characterized by alterations of SATB2. Its clinical features include intellectual disability and craniofacial abnormalities, such as cleft palate, dysmorphic features, and dental abnormalities. Here, we describe three previously undiagnosed, unrelated patients with SAS who exhibited dental abnormalities, including multiple odontomas. Although isolated odontomas are common, multiple odontomas are rare. Individuals in families 1 and 3 underwent whole‐exome sequencing. Patient 2 and her parents underwent targeted amplicon sequencing after uncovering the candidate SATB2 . On the basis of the hg19/GRCh37 reference and the RefSeq mRNA NM_001172517, respective heterozygous mutations were found and validated in Patients 1, 2, and 3: a splice‐site mutation (chr2:g.200137396C > T, c.1741‐1G > A), a nonsense mutation (chr2:g.200213750G > A, c.847C > T, p.R283*), and a frame‐shift mutations (chr2:g.200188589_200188590del, c.1478_1479del, p.Q493fs*19). All mutations occurred de novo. The mutations in Patients 1 and 3 were novel; the mutation in Patient 2 has been described previously. Tooth mesenchymal cells derived from Patient 2 showed diminished SATB2 expression. Multiple odontomas were evident in the patients in this report; however, this has not been recognized previously as a SAS‐associated phenotype. We propose that multiple odontomas be considered as an occasional manifestation of SAS.
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GAPO syndrome in seven new patients: Identification of five novel ANTXR1 mutations including the first large intragenic deletion
GAPO syndrome is a very rare disorder characterized by growth retardation, alopecia, pseudoanodontia and progressive optic atrophy. It is caused by biallelic mutations in the ANTXR1 gene. Herein, we describe the clinical and molecular findings of seven new patients with GAPO syndrome. Our patients presented with the characteristic clinical features of the syndrome except for one patient who did not display total alopecia till the age of two years. Strikingly, optic atrophy and glaucoma were observed in all patients and one patient showed keratopathy in addition. Moreover, craniosynstosis was an unusual associated finding in one patient. Mutational analysis of ANTXR1 gene identified five novel homozygous mutations including two frameshift, two splice site and a large intragenic deletion of exon 3. Our results reinforce the clinical characteristics of the syndrome, expand the mutational spectrum and provide more insights into the role of the ANTXR1 protein in the regulation of extracellular matrix.
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Comparison of Aberrant Behavior Checklist profiles across Prader–Willi syndrome, Down syndrome, and autism spectrum disorder
Abstract
Prader–Willi syndrome (PWS, OMIM # 176270) and Down syndrome (DS, OMIM #190685) are neurodevelopmental genetic disorders with higher rates of autism spectrum disorder (ASD). The Aberrant Behavior Checklist (ABC) is a caregiver rating scale that assesses maladaptive behaviors. Overlapping symptoms exist between PWS, DS, and ASD, including maladaptive behaviors. We aimed to evaluate ABC profiles between PWS, DS, and ASD alone (without known genetic syndrome). In addition, we hypothesized PWS and DS with a comorbid ASD positive screen or diagnosis would have similar ABC profiles to ASD alone. ABC data from the following cohorts were analyzed: PWS (Seattle Children's Hospital, n = 28, mean age = 12.8 ± 4.9 years; University of Florida, n = 35, mean age = 9.3 ± 7.1 years), DS (Johns Hopkins, n = 406, mean age = 8.1 ± 2.4 years), and ASD (University of Florida, n = 102, mean age = 10.8 ± 3.5 years). ASD alone had significantly higher ABC scores. Subgroups of PWS and DS with a comorbid ASD positive screen or diagnosis had similarities in scores with the ASD only group, with subscale patterns unique to each syndrome. The ABC indicated worse maladaptive behaviors in children with ASD, including those with genetic syndromes. Although more studies are needed to evaluate the utility and the accuracy of the ABC as a tool to screen for ASD in special populations, it may be a useful adjunct in screening those children with PWS or DS who need more in depth ASD evaluation.
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The Genetic Pathogenesis, Diagnosis and Therapeutic insight of Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes chronic inflammation of the joints. RA is a heterogeneous disorder caused by an abnormal autoimmune response triggered by the complex interactions of genetics and environmental factors that contribute to RA aetiology. However, its underlying pathogenic mechanisms are yet to be fully understood. In this review, I provide an overview of the pathogenesis, diagnosis and therapeutic insight in the clinical management of RA in light of the recent updates to classification criteria and recent discoveries of genetic loci associated with susceptibility for RA.
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Management of Juvenile Polyposis Syndromes in Children and Adolescents: A Position Paper from the ESPGHAN Polyposis Working Group
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Polyposis Working Group developed recommendations to assist clinicians and health care providers with appropriate management of patients with juvenile polyposis. This is the first juvenile polyposis Position Paper published by ESPGHAN with invited experts. Many of the published studies were descriptive and/or retrospective in nature, consequently after incorporating a modified version of the GRADE system many of the recommendations are based on expert opinion. This ESPGHAN Position Paper provides a guide for diagnosis, assessment and management of Juvenile polyposis syndrome (JPS) in children and adolescents, and will be helpful in the appropriate management and timing of procedures in children and adolescents. The formation of international collaboration and consortia is proposed in order to monitor patients prospectively to advance our understanding of juvenile polyposis conditions. Address correspondence and reprint requests to Shlomi Cohen, MD, Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel 6423906 (e-mail: shlomico@tlvmc.gov.il). Accepted 12 July, 2018 Conflict of interest: None of the authors nor the ESPGHAN Polyposis Working group have any conflicts of interest to declare. Support and financial interest: None to declare. SC and WH received support in training in EBM learning by ESPGHAN 2016. CD supported by the Zane Cohen Centre for Digestive Diseases. No external funding sought nor obtained © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Management of Familial Adenomatous Polyposis in Children and Adolescents: Position Paper from the ESPGHAN Polyposis Working Group
Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, characterised by the development of hundreds to thousands of adenomas in the colorectum, with implications in children and adolescents. Almost all adult patients will develop colorectal cancer (CRC) if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (EPGHAN) position paper provides a guide for diagnosis, assessment and management of familial adenomatous polyposis in children and adolescents. This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP. Address correspondence and reprint requests to Warren Hyer, Dr, Consultant Paediatric Gastroenterologist, St Mark's Hospital Polyposis Registry, St Mark's Hospital, Watford Road, Harrow HA1 3UJ (e-mail: polyposiswg@drhyer.co.uk). Accepted 12 July, 2018 © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Management of Peutz-Jeghers syndromes in children and adolescents: A Position Paper from the ESPGHAN Polyposis Working Group
Peutz-jeghers syndrome (PJS) is a well-described inherited syndrome, characterised by the development of gastrointestinal polyps and characteristic mucocutaneous freckling. Development of small bowel intestinal polyps may lead to intussusception in children may require emergency laparotomy with potential loss of bowel. Gastrointestinal (GI) polyps may lead to bleeding and anaemia. This ESPGHAN position paper provides a guide for diagnosis, assessment and management of PJS in children and adolescents and guidance on avoiding complications from PJS or from the endoscopic procedures performed on these patients. This is the first position paper regarding PJS published by ESPGHAN. Literature from PubMed, Medline and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, some of the recommendations are based on expert opinion. This position paper will be helpful in the appropriate management and timing of procedures in children and adolescents with PJS. Address correspondence and reprint requests to Dr Warren Hyer, Consultant Paediatric Gastroenterologist, St Mark's Hospital Polyposis Registry, St Mark's Hospital, Watford Road, Harrow HA1 3UJ (e-mail: polyposiswg@drhyer). Received 12 July, 2018 Accepted 21 November, 2018 Support and financial interest: None to declare. No external funding sought nor obtained DISCLAIMER ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians". Role in submitted paper: Andrew Latchford: Created answers, researched answers, editing, expertise Shlomi Cohen: researched answers, editing, expertise Marcus Auth: researched answers, editing, expertise Michele Scaillon: Created answers, researched answers Richard Daniels: Created answers, researched answers Cecile Talbotec: Created answers, researched answers Thomas Attard: researched answers, editing, expertise Jerome Viala: Created answers, researched answers Warren Hyer: Created answers, researched answers, editing, expertise, prepared manuscript. Conflict of interest: None of the authors nor the ESPGHAN Polyposis Working group have any conflicts of interest to declare. Conflict of interest: Andrew Latchford: None to declare Shlomi Cohen: None to declare Marcus Auth: None to declare Michele Scaillon: None to declare Richard Daniels: None to declare Cecile Talbotec: None to declare Thomas Attard: None to declare Jerome Viala: None to declare Warren Hyer: None to declare © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Microbial keratitis: Significant increase in Gram-positive bacterial infection
Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Giant cell arteritis related arteritic anterior ischemic optic neuropathy
http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_1_142_248176_f1.jpg
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
: Clinico-pathological correlation
Mohit Dogra, Ramandeep Singh, Mangat R Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence Address:
Dr. Mohit Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
DOI: 10.4103/ijo.IJO_881_18
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
 | Figure 1: (a) showing pale disc edema (blue arrows) with an inferotemporal branch retinal artery occlusion, (b and c) showing "wedge shaped" equatorial choroidal infarcts on fluorescein angiogram, and (d) right side temporal artery biopsy at 200× magnification showing intimal proliferation with breaks in the internal elastic lamina (yellow arrows) with extravasation of red blood cells in the tunica media (black arrow) with minimal inflammatory cells, suggestive of vasculitis Click here to view |
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References |  |
| 1. | Hayreh SS, Podhasky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.  |
| 2. | Wayand CM, Bartley GB. Giant cell arteritis: New concepts inpathogenesis and implications of management. Am J Ophthalmol1997;123:392-5. |
| 3. | Guevara M, Kollipara CS. Recent advances ingiant cell arteritis. CurrRheumatol Rep 2018;20:25. |
| 4. | HayrehSS. Management of ischaemic optic neuropathy. Indian J Ophthalmol 2011;59:123-36. |
| 5. | Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D. Anterior ischemic optic neuropathydue tobiopsy-provengiant cell arteritisin Thai patients. ClinOphthalmol 2015;9:1071-5. |
Ophthalmology
http://www.ijo.in/currentissue.asp?sabs=y
| Indian Journal of Ophthalmology – On the right path Santosh G Honavar Indian Journal of Ophthalmology 2019 67(1):1-2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required? Jatinder Bali, Rohit Garg, Renu T Bali Indian Journal of Ophthalmology 2019 67(1):3-6 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypopigmented fundus in a young male Nawazish Fatma Shaikh, Vinod Kumar Indian Journal of Ophthalmology 2019 67(1):7-7 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Current concepts in crosslinking thin corneas Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev Indian Journal of Ophthalmology 2019 67(1):8-15 Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Management of Duane retraction syndrome: A simplified approach Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):16-22 Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement Manca Tekavcic Pompe, Alki Liasis, Richard Hertle Indian Journal of Ophthalmology 2019 67(1):23-30 Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: "Current" consensus: Electrodiagnostics in eye Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):30-31 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu Indian Journal of Ophthalmology 2019 67(1):32-36 Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: Assessment of limbal ischemia in ocular burns Naveen Radhakrishnan, N Venkatesh Prajna Indian Journal of Ophthalmology 2019 67(1):37-37 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dopamine levels in human tear fluid Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu Indian Journal of Ophthalmology 2019 67(1):38-41 Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer's strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 ± 11.80 pg/ml (mean ± SEM), 279 ± 14.8 pg/ml (mean ± SEM), and 470.4 ± 37.64 pg/ml (mean ± SEM) in the plasma and in the tears collected using Schirmer's strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels.
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