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Wavefront-optimized surface retreatments of refractive error following previous laser refractive surgery: a retrospective study. - Eye and vision (London, England)
Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery. Many different combinations of primary treatment methods and retreatment techniques have been studied, however, few studies have investigated wavefront-optimized (WFO) technology for retreatment following primary refractive surgery. This study aimed to report the outcomes of WFO photorefractive keratectomy (PRK) retreatments of refractive error following previous laser refractive surgery with PRK, laser in situ keratomileusis (LASIK), or laser-assisted subepithelial keratectomy (LASEK).We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400Â Hz Excimer Laser System (Alcon Surgical) between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center. Outcomes were recorded in terms of uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), corrected distance visual acuity (CDVA), and complications at 1Â month (M), 3Â M, and 6Â M post-op.Seventy-eight patients (120 eyes) underwent WFO PRK retreatment during the study period. Primary surgery was surface ablation in 87 eyes (78 PRK, 9 LASEK) and LASIK in 33 eyes. The mean spherical equivalent before retreatment was -0.79â€‰Â±â€‰0.94 D (-3.00 to 1.88 D). UDVA wasâ€‰â‰¥â€‰20/20 in 69 eyes (60.0Â %) at 1Â M, 54 eyes (71.1Â %) at 3Â M, and 27 eyes (73.0Â %) at 6Â M follow-up. MRSE was within Â±0.50 D of emmetropia in 78 eyes (67.8Â %) at 1Â M, 59 eyes (77.6Â %) at 3Â M, and 25 eyes (67.6Â %) at 6Â M follow-up. CDVA was maintained within Â±1 line of pre-op in 113 of 115 eyes (98.3Â %) at 1Â M, 74 of 76 eyes (97.4Â %) at 3Â M, and 37 eyes (100Â %) at 6Â M follow-up.Although follow-up was limited beyond 3Â M, WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure. Further studies are necessary to determine the long-term safety and stability of outcomes.
Crystal structures of tris-[1-oxo-pyridine-2-olato(1-)]silicon(IV) chloride chloro-form-d 1 disolvate, tris-[1-oxo-pyridine-2-olato(1-)]silicon(IV) chloride aceto-nitrile unqu-anti-fied solvate, and fac-tris-[1-oxo-pyridine-2-thiol-ato(1-)]silicon(IV) chl - Acta crystallographica. Section E, Crystallographic communications
The cations in the title salts, [Si(OPO)3]ClÂ·2CDCl3, (I), [Si(OPO)3]ClÂ·xCH3CN, (II), and fac-[Si(OPTO)3]ClÂ·2CDCl3, (III) (OPO = 1-oxo-2-pyridin-one, C5H4NO2, and OPTO = 1-oxo-2-pyridine-thione, C5H4NOS), have distorted octa-hedral coordination spheres. The first two structures contain the same cation and anion, but different solvents of crystallization led to different solvates and packing arrangements. In structures (I) and (III), the silicon complex cations and chloride anions are well separated, while in (II), there are two C-Hâ‹¯Cl distances that fall just within the sum of the van der Waals radii of the C and Cl atoms. The pyridine portions of the OPO ligands in (I) and (II) are modeled as disordered with the planar flips of themselves [(I): 0.574â€…(15):0.426â€…(15), 0.696â€…(15):0.304â€…(15), and 0.621â€…(15):0.379â€…(15); (II): 0.555â€…(13):0.445â€…(13), 0.604â€…(14):0.396â€…(14) and 0.611â€…(13):0.389â€…(13)], demonstrating that both fac and mer isomers are co-crystallized. In (II), highly disordered solvent, located in two independent channels along , was unable to be modeled. Reflection contributions from this solvent were fixed and added to the calculated structure factors using the SQUEEZE [Spek (2015 â–¸). Acta Cryst. C71, 9-18] function of program PLATON, which determined there to be 54 electrons in 225â€…Ã…(3) accounted for per unit cell (25 electrons in 109â€…Ã…(3) in one channel, and 29 electrons in 115â€…Ã…(3) in the other). In (I) and (II), all species lie on general positions. In (III), all species are located along crystallographic threefold axes.
Whole body and local muscle vibration immediately improves quadriceps function in individuals with anterior cruciate ligament reconstruction. - Archives of physical medicine and rehabilitation
To determine the immediate effects of a single session of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function in individuals with anterior cruciate ligament reconstruction (ACLR).Singe-blind randomized crossover trial.Research Laboratory.20 population-based sample of individuals with ACLR (age=21.1 (1.2) years, mass=77.2 (17.1) kg, time since ACLR=50.7 (21.3) months; 14 females, 16 patellar tendon autograft, 3 hamstring autograft, 1 allograft).Participants performed isometric squats while being exposed to WBV, LMV, or no vibration (control). Interventions were delivered in a randomized order during separate visits separated by 1-week. Quadriceps active motor threshold (AMT), motor evoked potential (MEP) amplitude, H-reflex amplitude, peak torque (PT), rate of torque development (RTD), Electromygraphy (EMG) amplitude, and central activation (CAR) ratio was assessed prior to and immediately following a WBV, LMV, or control intervention.There was an increase in CAR (+4.9%, p=0.001), and EMG amplitude (+16.2%, p=0.002), and a reduction in AMT (-3.1%, p<0.001) following WBV, and an increase in CAR (+2.7%, p=0.001) and reduction in AMT (-2.9%, p<0.001) following LMV. No effect was observed following WBV or LMV in H-reflex, RTD, or MEP amplitude. AMT (-3.7%, p<0.001), CAR (+5.7%, p=0.005), PT (+0.31 Nm/kg, p=0.004) and EMG amplitude (p=0.002) in the WBV condition differed from the control condition post application. AMT (-3.0% p=0.002), CAR (+3.6% p=0.005), and PT (+0.30 Nm/kg, p=0.002) in the LMV condition differed from the control condition post application. No differences were observed between WBV and LMV post application in any measurement.WBV and LMV acutely improved quadriceps function, and could be useful modalities for restoring quadriceps strength in individuals with knee pathologies.Copyright Â© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Management of obesity. - Lancet (London, England)
A modern approach to obesity acknowledges the multifactorial determinants of weight gain and the health benefits to be derived from weight loss. Foundational to any weight loss effort is lifestyle change, diet, and increased physical activity. The approach should be a high quality diet to which patients will adhere accompanied by an exercise prescription describing frequency, intensity, type, and time with a minimum of 150 min moderate weekly activity. For patients who struggle with weight loss and who would receive health benefit from weight loss, management of medications that are contributing to weight gain and use of approved medications for chronic weight management along with lifestyle changes are appropriate. Medications approved in the USA or European Union are orlistat, naltrexone/bupropion, and liraglutide; in the USA, lorcaserin and phentermine/topiramate are also available. Surgical management (gastric banding, sleeve gastrectomy, and Roux-en Y gastric bypass) can produce remarkable health improvement and reduce mortality for patients with severe obesity.Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Enhancing Physical Function in HIV-Infected Older Adults: A Randomized Controlled Clinical Trial. - Health psychology : official journal of the Division of Health Psychology, American Psychological Association
HIV-infected older adults (HOA) are at risk of functional decline. Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority. We conducted a randomized, controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory (SDT) improves physical function, autonomous motivation, depression and the quality of life (QOL) in HOA.In total, 67 community-dwelling HOA with mild-to-moderate functional limitations were randomized to 1 of 2 groups: a physical activity counseling group or the usual care control group. We used SDT to guide the development of the experimental intervention. Outcome measures that were collected at baseline and final study visits included a battery of physical function tests, levels of physical activity, autonomous motivation, depression, and QOL.The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups. Overall physical performance, gait speed, measures of endurance and strength, and levels of physical activity improved in the treatment group compared to the control group (p < .05). Measures of autonomous regulation such as identified regulation, and measures of depression and QOL improved significantly in the treatment group compared with the control group (p < .05). Across the groups, improvement in intrinsic regulation and QOL correlated with an improvement in physical function (p < .05).Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function, autonomous motivation, depression, and QOL in HOA with functional limitations. (PsycINFO Database Record(c) 2016 APA, all rights reserved).
Drug Discovery Approaches Utilizing Three-Dimensional Cell Culture. - Assay and drug development technologies
Historically, two-dimensional (2D) cell culture has been the preferred method of producing disease models in vitro. Recently, there has been a move away from 2D culture in favor of generating three-dimensional (3D) multicellular structures, which are thought to be more representative of the in vivo environment. This transition has brought with it an influx of technologies capable of producing these structures in various ways. However, it is becoming evident that many of these technologies do not perform well in automated in vitro drug discovery units. We believe that this is a result of their incompatibility with high-throughput screening (HTS). In this study, we review a number of technologies, which are currently available for producing in vitro 3D disease models. We assess their amenability with high-content screening and HTS and highlight our own work in attempting to address many of the practical problems that are hampering the successful deployment of 3D cell systems in mainstream research.
Moving Toward Integrating Gene Expression Profiling into High-throughput Testing: A Gene Expression Biomarker Accurately Predicts Estrogen Receptor Î± Modulation in a Microarray Compendium. - Toxicological sciences : an official journal of the Society of Toxicology
Microarray profiling of chemical-induced effects is being increasingly used in medium- and high-throughput formats. Computational methods are described here to identify molecular targets from whole-genome microarray data using as an example the estrogen receptor Î± (ERÎ±), often modulated by potential endocrine disrupting chemicals. ERÎ± biomarker genes were identified by their consistent expression after exposure to 7 structurally-diverse ERÎ± agonists and 3 ERÎ± antagonists in ERÎ±-positive MCF-7 cells. Most of the biomarker genes were shown to be directly regulated by ERÎ± as determined by ESR1 gene knockdown using siRNA as well as through ChIP-Seq analysis of ERÎ±-DNA interactions. The biomarker was evaluated as a predictive tool using the fold-change rank-based Running Fisher algorithm by comparison to annotated gene expression data sets from experiments using MCF-7 cells, including those evaluating the transcriptional effects of hormones and chemicals. Using 141 comparisons from chemical- and hormone-treated cells, the biomarker gave a balanced accuracy for prediction of ERÎ± activation or suppression of 94% and 93%, respectively. The biomarker was able to correctly classify 18 out of 21 (86%) ER reference chemicals including "very weak" agonists. Importantly, the biomarker predictions accurately replicated predictions based on 18 in vitro high-throughput screening assays that queried different steps in ERÎ± signaling. For 114 chemicals, the balanced accuracies were 95% and 98% for activation or suppression, respectively. These results demonstrate that the ERÎ± gene expression biomarker can accurately identify ERÎ± modulators in large collections of microarray data derived from MCF-7 cells.Published by Oxford University Press on behalf of the Society of Toxicology 2016. This work is written by US Government employees and is in the public domain in the US.
HbA1c Assessment in Diabetic Patients with Acute Coronary Syndromes. - Internal medicine journal
Guidelines for the management of Acute Coronary Syndromes (ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. HbA1c measurement is commonly used to monitor long-term glycaemic control in diabetes.To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge.This registry based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic Generalised Estimating Equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis.714 (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7% to 87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs. urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, STEMI, cardiac catheterisation and CABG Surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence based medicines but not with mortality during six months following discharge (HR 0.48, 95% CI 0.19-1.18).Frequency of HbA1c assessment varies markedly between hospitals and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.This article is protected by copyright. All rights reserved.
Integration of Hybrid and Single-Ventricle Rehabilitation Techniques to Treat a Neonate After Iatrogenic Mitral Injury. - World journal for pediatric & congenital heart surgery
Neonatal critical aortic stenosis is life threatening and requires intervention shortly after birth. Early percutaneous aortic valvuloplasty is an effective way to obtain reliable prograde flow. We describe the integrated use of hybrid, open surgical, and single-ventricle rehabilitation techniques to successfully treat a neonate with borderline left-sided cardiac structures, who sustained a complication from balloon aortic valvuloplasty.Â© The Author(s) 2016.
Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial. - The American journal of clinical nutrition
The utility of dairy ingredients in the supplementary foods used in the treatment of childhood moderate acute malnutrition (MAM) remains unsettled.We evaluated the effectiveness of a peanut-based ready-to-use supplementary food (RUSF) with soy protein compared with a novel RUSF containing dairy ingredients in the form of whey permeate and whey protein concentrate in the treatment of children with MAM.We conducted a randomized, double-blind clinical effectiveness trial involving rural Malawian and Mozambican children 6-59 mo of age with MAM treated with either soy RUSF or a novel whey RUSF treatment of âˆ¼75 kcal Â· kg(-1) Â· d(-1) for up to 12 wk.The proportion of children that recovered from MAM was significantly higher in the group that received whey RUSF (960 of 1144; 83.9%) than in the group that received soy RUSF (874 of 1086; 80.5%; P < 0.04; risk difference 3.4%, 95% CI: 0.3%, 6.6%). Children who consumed whey RUSF also demonstrated better growth markers, with a higher mean midupper arm circumference (MUAC) at the time of discharge (P < 0.009), greater MUAC gain during the course of treatment (P < 0.003), higher mean weight-for-height z score at discharge (P < 0.008), and greater weight gain (P < 0.05). No significant differences were identified in length gain or time to recovery between the 2 groups.This study highlights the importance of milk protein in the treatment of MAM, because the use of a novel whey RUSF resulted in higher recovery rates and improved growth than did soy RUSF, although the whey RUSF supplement provided less total protein and energy than the soy RUSF. This study was registered at clinicaltrials.gov as NCT01790048.Â© 2016 American Society for Nutrition.
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