Raffinose family oligosaccharides (RFOs) are non-structural, water-soluble carbohydrates widely distributed in the plant kingdom, and include the trisaccharide raffinose, the tetrasaccharide stachyose and the pentasaccharide verbascose. RFOs have been suggested to play a major role in storing carbohydrates in seeds and vegetative tissues, and in conferring osmoprotection against abiotic stresses, such as high salinity and drought. However, the high polarity nature of RFOs makes their analysis with typical reversed phase liquid chromatography (RP-LC) generally difficult, with these compounds eluting very close to the void volume with minimal retention. Moreover, carbohydrate-related compounds lack an inherent chromophore in the ultraviolet-visible (UV) region to make them suitable for UV detection. To overcome these issues, alternative analytical methods based on LC coupled to mass spectrometry (MS) have been developed and porous graphitic carbon (PGC) stationary phases described in the literature as good alternative to typical RP columns for retaining these highly polar compounds were used. In addition, PGC stationary phases allow the use of MS-compatible mobile phases for efficient on-line coupling with electrospray ionization (ESI), and when coupled to tandem MS (MSn) techniques, powerful structural information can be obtained. The present work focuses on the application of a PGC-ESI-QIT-MSn method for the quantitative analysis of RFOs in Casuariana glauca plant tissues under salt stress conditions. In addition, we describe the structural characterization of RFOs through collision induced dissociation (CID) and MSn experiments using a quadrupole ion trap mass spectrometer (QIT-MS) in the ESI positive ion mode.
This randomized controlled trial examined serum and macular (in vivo measured macular pigment optical density [MPOD]) responses to supplemental lutein and zeaxanthin in Chinese subjects with early age-related macular degeneration.One hundred and eight patients with early age-related macular degeneration older than 50 y were randomized to low lutein (LL; 10 mg/d), high lutein (HL; 20 mg/d), lutein plus zeaxanthin (LZ; each 10 mg/d), or placebo during a 48-wk intervention. Serum concentrations were quantified by C30 high-performance liquid chromatography (at baseline and 4, 12, 24, and 48 wk), and MPOD was measured by analysis of autofluorescence images (at baseline and 24 and 48 wk).Serum lutein levels in the LL, LZ, and HL groups increased significantly in the first 4 wk and then increased 4.24-, 4.66-, and 6.23-fold during the trial, respectively (all P < 0.001). The serum lutein level in the HL group was significantly higher than that in the LL or LZ group at 48 wk (P < 0.05). Similarly, the serum zeaxanthin concentration in the LZ group increased 3.11-fold at 48 wk. MPOD increased smoothly in all treated groups, and the increase from baseline was greatest in the HL group at 24 and 48 wk (both P < 0.05). MPOD and serum lutein levels increased linearly with the dosage and their increasing rates were statistically correlated (all P < 0.05). No notable changes were detected in the placebo group for MPOD and serum concentrations.Xanthophyll supplementation significantly increased serum concentrations and MPOD in patients with early age-related macular degeneration, and a higher lutein supplementation (20 mg/d) might be more effective in increasing these two biochemical markers in Chinese patients without significant side effects.
Many high-flexible structures with circular sections (chimneys, etc.) tend to be damaged by vortex-induced vibration (VIV in short). As the direct guidance of wind-resistant design of circular high structures, the wind load code is responsible for wind-induced damage. In view of so many failure cases of circular high structures, it is necessary to study the applicability of current wind load codes. In this paper, the VIV displacements of six chimneys are calculated using European (approach 1, 2), Chinese, Japanese, Canadian, and American wind load codes/recommendations, respectively, and the calculated displacements are compared with the full-scale measured results. The comparison shows that for steel chimneys, the displacements calculated by Japanese recommendation and Chinese code are about only 30% of the full-scale measured value, and those calculated by Canadian code and approach 1 of European code are about 70% of the measured value. For reinforced concrete (RC) chimneys, the calculated displacements of Chinese codes are smaller than the full-scale measured values, while the calculated values of other codes are far greater than the full-scale measured results, with the difference between them even more than ten times. On the whole, there is a significant difference between the results of the VIV displacement calculated by the wind load codes/recommendations and the actual measured value, and the calculated results of current codes/recommendations are differ from one another, thus giving rise to a contradictory phenomenon of “the same structure, but different design wind load” and making the wind-resistant design of circular high structure kind of blind. The purpose of this discussion is to clarify the objective problems of current wind load codes of circular tall structures, which can provide a reference for further research.
Disclosure of personal substance use often places people who use drugs (PWUD) at risk, both personally and professionally. Yet disclosure can positively influence governmental and organizational policies as well as improve programs meant to serve PWUD. Through numerous autobiographical conversations, six researchers and professionals in their thirties and forties who live in the Appalachian region of the United States examined what it meant for us to discuss our illicit substance use publicly. We examined the limitations of the term “lived experience” and detailed our non-problematic use. Most of us have, at times, experienced negative consequences of substance use, but these consequences are as tied to society's negative responses to substance use as to use itself. When disclosing use, we have often found that others are keen to portray PWUD as resilient, but are less willing to highlight the contributions of PWUD while they are using. We agree that making disclosure more acceptable as well as acknowledging the positive aspects of drug use would alter societal responses to use to be more effective at preventing harm. We conclude by highlighting societal and institutional policy changes that will increase the ability of PWUD to openly disclose use.
BACKGROUND: This literature review analyzes the scientific evidence available regarding corneal collagen cross-linking (CXL) as a treatment option for progressive keratectasia.METHODS: A literature search was performed using dates from 1990 to August 2010 regarding CXL Specific areas of focus for the literature review include safety and efficacy of the procedure as a stand-alone treatment or when used in conjunction with Intacs (R) corneal implants (Addition Technology (TM)) or photorefractive keratectomy (PRK).RESULTS: A total of 50 clinical trials and studies were identified. 20 of which met the inclusion criteria. Results of the included literature support the conclusion that CXL is a safe and efficacious treatment for progressive keratectasia. The results of CXL alone have shown stabilization or improvement in the maximum keratometry readings, best-corrected visual acuity, uncorrected visual acuity, and spherical and cylinder refractive measurements. CXL has been shown to enhance the effects of Intacs and has been proven successful when used in conjunction with PRK.CONCLUSION: CXL is an effective treatment for limiting the progression of keratectasia, thus reducing the need for penetrating keratoplasty. CXL has a similar side-effect profile and similar risk level as PRK. Optometry 2012;83:33-42
BACKGROUND:Clinically isolated syndrome (CIS) describes a single, first-occurrence attack caused by inflammation/demyelination in 1 or more locations in the central nervous system. The optic nerve is a frequent site affected by this neurologic event. As the name implies, CIS is an isolated condition but is often considered a precursor to multiple sclerosis (MS). When distinctive brain lesions detected by magnetic resonance imaging (MRI) accompany CIS, the person is considered at a high risk for MS. Treatment is aimed at delaying the onset of a second neurologic episode, reducing the accumulation of MRI-detected brain lesions and delaying the development of definite MS. CASE REPORT:This article describes a 40-year-old woman who experienced a sudden loss of vision in the right eye. Testing ultimately found a normal MRI, demyelination of the optic nerve, and progressive thinning of the retinal nerve fiber layer, leading to a diagnosis of CIS.
BACKGROUND: Intermittent central suppression (ICS) is a repetitive intermittent ("on-and-off") loss of central visual sensation without strabismus or amblyopia. These repetitive seconds-long suppressions have been suggested to create visual confusion and instability that would cause vision symptoms, contribute to reading complaints, and even impair reading.METHODS: Teacher-identified Job Corps students were diagnosed with ICS and then treated with 5-Hz electronic liquid crystal shutter alternate occlusion.RESULTS: Twenty-six young adult students (19.7 +/- 1.6 y) had their ICS treated over 5.9 +/- 3.7 months. Suppression periods decreased in length (P < 0.0001) and "binocular" nonsuppressed periods increased in length (P < 0.0001). Overall, College of Optometrists in Vision Development (COVD) quality-of-life (QOL) scores improved (P < 0.0001), 16 reading behavior COVD QOL questions improved (P < 0.0001), and individual QOL questions improved. Posttherapy reading scores (N = 18) improved 3.7 (+/- 2.6) years (P < 0.0001).CONCLUSIONS: Treating ICS with electronic alternate occlusion reduced suppression periods, increased binocular periods, and improved symptoms as measured in the COVD QOL questionnaire. Positive changes also occurred in reading scores. These data suggest ICS should be considered a probable cause for symptoms of reading problems. Optometry 2012;83:19-26
BACKGROUND: A study was completed to assess the academic and state-level professional optometry leadership views regarding optometry professionals as surge responders in the event of a catastrophic event.METHODS: A cross-sectional survey was conducted using a 21-question, self-administered, structured questionnaire. All U.S. optometry school deans and state optometric association presidents were mailed a questionnaire and instructions to return it by mail on completion; 2 repeated mailings were made. Descriptive statistics were produced and differences between deans and association presidents were tested by Fisher exact test.RESULTS: The questionnaire response rate was 50% (25 returned/50 sent) for the state association presidents and 65% (11/17) for the deans. There were no statistically significant differences between the leadership-groups for any survey questions. All agreed that optometrists have the skills, are ethically obligated to help, and that optometrists should receive additional training for participation in disaster response. There was general agreement that optometrists should provide first-aid, obtain medical histories, triage, maintain infection control, manage a point of distribution, prescribe medications, and counsel the "worried well." Starting intravenous lines, interpreting radiographs, and suturing were less favorably supported. There was some response variability between the 2 leadership groups regarding potential sources for training.CONCLUSIONS: The overall opinion of optometry professional leadership is that with additional training, optometrists can and should provide an important reserve pool of catastrophic event responders. Optometry 2012;83:27-32
PURPOSE: The aim of this analysis was to describe characteristics and trends of malpractice payments by optometrists since the inception of the National Provider Data Bank (NPDB) as they assumed increasing prescriptive authority.METHODS: NPDB data files were analyzed for details of optometrist malpractice payments from 1991 through 2008. Payment amounts, sources, and allegations were all identified and summarized, along with geographic and demographic data.RESULTS: Between 1991 and 2008, a total of 609 optometrist malpractice payments were reported nationally, ranging from $50 to $2,050,000 (median, $57,500; mean, $156,055 +/- 246,556), with 603 (99%) less than $1,000,000. Annual inflation-adjusted mean dollars and frequency of payments increased only nominally over the 18-year interval, from $154,573 to $155,151, and 30 to 40, respectively. More than half of all cases originated in 11 states. Alleged errors in diagnosis accounted for 55% of all cases.CONCLUSION: Malpractice payments on behalf of optometrists are relatively infrequent (on average, less than 34 nationally each year) and usually relatively small (almost half less than $50,000). The frequency of payments and mean payments have increased little over the last 2 decades.Optometry 2011;82:32-37
Cryopreservation consists of preserving living cells or tissues generally at −80 °C or below and has many current applications in cell and tissue banking, and future potential for organ banking. Cryoprotective agents such as ethylene glycol (EG) are required for successful cryopreservation of most living systems, but have toxic side effects whose mechanisms remain largely unknown. In this work, we investigated the mechanisms of toxicity of ethylene glycol in human umbilical vein endothelial cells (HUVECs) as a model of the vascular endothelium in perfused organs. Exposing cells to 60% v/v EG for 2 h at 4 °C resulted in only a slight decrease in subsequent cell growth, suggesting only modest toxicity of EG for this cell type. Gene expression analysis with whole genome microarrays revealed signatures indicative of a generalized stress response at 24 h after EG exposure and a trend toward partial recovery at 72 h. The observed changes involved signalling pathways, glycoproteins, and genes involved in extracellular and transmembrane functions, the latter suggesting potential effects of ethylene glycol on membranes. These results continue to develop a new paradigm for understanding cryoprotectant toxicity and reveal molecular signatures helpful for future experiments in more completely elucidating the toxic effects of ethylene glycol in vascular endothelial cells and other cell types.
To compare onset times of glaucoma progression among different glaucoma tests: disc photography (DP), visual field (VF) testing, 2-dimensional (2D) retinal nerve fiber layer (RNFL) thickness, and 3-dimensional (3D) spectral-domain (SD) OCT neuroretinal rim measurements.Prospective, longitudinal cohort study.One hundred twenty-four eyes of 124 patients with open-angle glaucoma.Over a 5-year period, 124 patients with open-angle glaucoma underwent yearly DP, VF testing, SD OCT RNFL thickness scans, and optic nerve volume scans (Spectralis; Heidelberg Engineering), all performed on the same day. From high-density optic nerve volume scans, custom-built software calculated the minimum distance band (MDB) thickness, a 3D neuroretinal rim parameter. Patients were classified as glaucoma progressors or nonglaucoma progressors using event-based analysis. Progression by DP and VF testing occurred when 3 masked glaucoma specialists unanimously concurred. Progression by RNFL and MDB thickness occurred if change of more than test–retest variability was observed. Kaplan-Meier curves were constructed to analyze time-to-progression data. Kappa Coefficients were used to measure agreement of progressing eyes among methods.Time to glaucoma progression among all 4 methods.Global MDB thickness detected glaucoma progression in the highest percentage of eyes (52.4%) compared with DP (16.1%; P < 0.001) and global RNFL thickness (15.3%; P < 0.001). Global MDB thickness detected glaucoma progression earlier than either DP (23 months vs. 44 months; P < 0.001) or global RNFL thickness (23 months vs. 33 months; P < 0.001). Among MDB progressing eyes, 46.2% were confirmed simultaneously or later by other conventional methods. Agreement of glaucoma-progressing eyes for all 4 methods in paired fashion were slight to fair (κ = 0.095–0.300).High-density 3D SD OCT neuroretinal rim measurements detected glaucoma progression approximately 1 to 2 years earlier compared with current clinically available structural tests (i.e., DP and 2D RNFL thickness measurements).
The incidence of pulmonary complications in heart transplant recipients has not been extensively studied. We report pulmonary complications in 159 consecutive adult orthotopic heart transplantations (OHTs) performed in 157 patients.Retrospective review of medical records.Forty-seven of 159 recipients (29.9%) had 81 pulmonary complications. Pneumonia was the most common (n = 27), followed by bronchitis (n = 15), pleural effusion (n = 10), pneumothorax (n = 7), prolonged respiratory failure requiring tracheotomy (n = 7), and obstructive sleep apnea syndrome (n = 6). All patients with late-onset (> 6 months after transplantation) community-acquired bacterial pneumonia presented with fever, cough, and a new lobar consolidation on the chest radiograph, and responded promptly to empiric antibiotics without undergoing an invasive diagnostic procedure. In contrast, early-onset nosocomial bacterial pneumonias carried a 33.3% mortality rate. A positive tuberculin skin test result was associated with a significantly higher rate of pulmonary complications (62.5% vs 26.8%, p = 0.007). Lung cancer and posttransplant lymphoproliferative disorder (PTLD) developed exclusively in 6 of the 61 patients (8.1%) who received induction immunosuppression with murine monoclonal antibody (OKT3).Pulmonary complications are common following heart transplantation, occurring in 29.9% of recipients, and are attributed to pneumonia of primarily bacterial origin in one half of cases. Late-onset community-acquired pneumonia carried an excellent prognosis following empiric antibiotic therapy, suggesting that in the appropriate clinical setting invasive diagnostic procedures are unnecessary. Analogous to reports in other solid-organ transplant recipients, induction therapy with OKT3 was associated with an increased incidence of lung cancer and PTLD. Overall, the development of pulmonary complications after OHT has prognostic significance given the higher mortality in this subset of patients.
To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.One-year follow-up of a population-based inception cohort.The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.Not applicable.We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.A total of 1716 adults suffered MTBI after a motor vehicle collision over the 2-year inception period. Six weeks after the collision, 75% reported having more than 3 symptoms and 30% had clinically significant pain in more than 3 body sites. Over time, the prevalence of symptoms and pain decreased but they were still common after 1 year. Almost all participants sought care for their symptoms at all time points, most commonly from a physician. Care-seeking from physiotherapists, chiropractors, and massage therapists was also very common, and most participants sought care from 2 or 3 providers at all follow-up points.Up to 1 year after sustaining an MTBI during a motor vehicle collision, multiple symptoms and pain in several anatomical sites are common. Care-seeking from multiple providers continues throughout the first year postinjury.
This study sought to define the nature and frequency of complications present 1 week after cataract surgery, to determine whether these complications are predictable, and to ascertain if patients undergoing cataract surgery require routine review at this time.Retrospective, noncomparative case series.One thousand consecutive patients undergoing cataract removal by either phacoemulsification or extracapsular extraction at a large teaching hospital between January 1996 and May 1998. Patients with both complicated and uncomplicated histories and surgeries were included.Nature and frequency of complications present 1 week after cataract surgery.At the routine 1-week visit, postoperative complications were observed in 41 of 1000 patients (4.1%). Twenty-one (51%) of these patients had a completely unremarkable history to that point, and whereas only four (19%) were symptomatic, 20 (95%) required a change to their postoperative management. The most significant unexpected complications were uveitis (seven cases), cystoid macular edema (four cases), and vitreous to the wound, exposed knots, and loose suture (one case of each). Complications were present in 20 of 257 (7.8%) patients with a preoperative or surgical risk factor, and there was a significant relationship between preoperative (P = 0.02), and combined preoperative and intraoperative risk factors (P = 0.001), and complications present at the 1-week review. The relationship between surgical risk factors and 1-week complications was not significant (P = 0.07). There were coexistent pathologic features in 19% of all eyes. Registrars performed 38% of surgeries, and 96% of cataracts were removed by phacoemulsification. Operative complications occurred in 6.7% of patients, most commonly a posterior capsule tear (4.4% of all cases). Complications were observed in 10% of eyes on the first postoperative day. Raised intraocular pressure was the complication in 88% of these patients.This study provides an overview of modern cataract surgery in a large teaching hospital and indicates that abandonment of routine 1-week review may result in the failure to detect significant postoperative complications.
While the progression of acute rhinosinusitis to orbital infections has decreased in the modern antibiotic era, they still occur, particularly in the pediatric population. Infection may spread from the nasal cavity and sinuses via direct extension into the orbit through the thin lamina papyracea or through the valveless veins in the bony orbital wall. Congenital dehiscence and trauma also allow for direct extension of the infection to the orbit. Most of these orbital infections originate in the ethmoid sinuses and subperiosteal abscesses most commonly occur along the medial orbital wall. However, the frontal sinus is implicated in superior abscesses in older children and adults. Postseptal orbital infections require prompt diagnosis and treatment as they may impact vision and progress centrally, manifesting as cavernous sinus and intracranial infections associated with significant morbidity and mortality. This article describes endoscopic surgical management of medial and superior subperiosteal abscess.
