Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema.

PURPOSE: To compare standard and frequent topical steroids for postsurgical macular edema (ME). DESIGN: Randomized clinical trial. METHODS: Subjects with postsurgical ME stratified into post-cataract surgery ME (PCSME) and post-other surgery ME (POSME) were randomized to ketorolac 4 times a day (qid) + 1% prednisolone acetate (PA) every hour while awake (q1hWA, Group 1) or qid (Group 2). Mean change from baseline best-corrected visual acuity (BCVA) was determined at week 12, after which group 2 subjects with persistent edema were crossed over to PA q1hWA. RESULTS: Twenty-two subjects (13 PCSME and 9 POSME) were randomized to Group 1 and 20 (12 PCSME and 8 POSME) to Group 2. At week 12, change from baseline BCVA (ETDRS letters) in Group 1 vs 2 was +11.6 vs +8.5 (P = .32) and for subgroups was +10.6 vs +7.8 (P = .23) for PCSME and +13.1 vs +9.4 (P = .47) for POSME. Mean change from baseline central subfield thickness (CST, µm) at week 12 in Group 1 vs 2 was -100.8 vs -63.9 (P = .30). Mean change from baseline intraocular pressure was +2.6 vs +1.7 mm Hg (P = .52). Eight subjects in Group 2 with residual ME at week 12 were switched to PA q1hWA and at week 24, the mean changes from week 12 BCVA and CST were +7.0 letters (P = .01) and -108.25 µm (P = .04). CONCLUSIONS: Our data suggest that patients with postsurgical ME should initially be treated with ketorolac and PA qid, but if edema does not resolve after 12 weeks, a switch to ketorolac qid and PA q1hWA may provide benefit.

Visual recovery following open globe injury with initial no light perception.

BACKGROUND: The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery. METHODS: The records of consecutive patients with at least 6 months of follow-up presenting with OGI and NLP to a single institution between January 1, 2003 and December 31, 2013 were reviewed for demographics, ophthalmic history, context and characteristics of injury, ocular examination findings, surgical interventions, and follow-up visual acuity. Unpaired t-tests and Fisher's Exact tests were used for statistical analysis. RESULTS: Twenty-five patients met our inclusion criteria. The mean age was 50.4±25.5 (range 8-91) years. Four patients (16%) regained vision (hand motion in three patients and light perception in one patient) while 21 patients (84%) remained with NLP or had a prosthesis at final follow-up. Fourteen eyes (56%) were enucleated; nine (36%) were secondary enucleations. Although the sample sizes were small, neither ocular trauma score nor wound size was found to predict visual recovery. CONCLUSION: Four patients regained some vision after presenting with NLP due to OGI. These findings suggest that, in select cases, physicians should discuss the possibility of regaining some vision.

Variability in delivery of care and echocardiogram surveillance of Kawasaki disease.

OBJECTIVE: The objective of this study is to characterize variability in the acute management of Kawasaki disease and compliance of echocardiogram surveillance with published American Heart Association recommendations. DESIGN: Retrospective review. SETTING: Tertiary care children's hospital. PATIENTS: All patients discharged from our institution with Kawasaki Disease between 1999 and 2007 were identified. Patients meeting any of the following were excluded: presence of a comorbidity that necessitated echocardiogram follow-up independent of Kawasaki disease diagnosis, previous history of Kawasaki disease, or magnetic resonance imaging of the coronary arteries performed in place of echocardiography. Preexisting or comorbid conditions resulting in study exclusion included structural heart disease, arrhythmia, and concomitant severe multiorgan disease at presentation (e.g., sepsis). OUTCOME MEASURES: The time course of echocardiogram surveillance among those with a normal echocardiogram at diagnosis was evaluated for compliance with published American Heart Association recommendations. Coronary artery involvement at presentation was characterized using standardized values. Additional characterization of national care practices for children with Kawasaki disease was obtained via distribution of an internet-based survey to pediatric hospitalists. RESULTS: Overall, only 11 (4%) of 302 patients with a normal study at diagnosis received a total of three studies at recommended intervals. Using standardized values for coronary artery dimensions in place of Japanese Ministry of Health aneurysm criteria, 59 (13%) of patients with Kawasaki disease experienced coronary artery involvement at diagnosis. The majority of the early coronary artery abnormalities detected in these patients using standardized definitions persisted on short-term follow-up. Pediatric hospitalist survey results revealed significant interinstitutional variability in the management of these patients. CONCLUSIONS: Lack of optimal surveillance after a diagnosis of Kawasaki disease may result in the underdiagnosis of coronary artery pathology or other complications. Considerable variability in surveillance and acute management exists, and additional research is needed to determine optimal screening and care delivery models for this population.

A membrane protein/signaling protein interaction network for Arabidopsis version AMPv2.

Interactions between membrane proteins and the soluble fraction are essential for signal transduction and for regulating nutrient transport. To gain insights into the membrane-based interactome, 3,852 open reading frames (ORFs) out of a target list of 8,383 representing membrane and signaling proteins from Arabidopsis thaliana were cloned into a Gateway-compatible vector. The mating-based split ubiquitin system was used to screen for potential protein-protein interactions (pPPIs) among 490 Arabidopsis ORFs. A binary robotic screen between 142 receptor-like kinases (RLKs), 72 transporters, 57 soluble protein kinases and phosphatases, 40 glycosyltransferases, 95 proteins of various functions, and 89 proteins with unknown function detected 387 out of 90,370 possible PPIs. A secondary screen confirmed 343 (of 386) pPPIs between 179 proteins, yielding a scale-free network (r(2) = 0.863). Eighty of 142 transmembrane RLKs tested positive, identifying 3 homomers, 63 heteromers, and 80 pPPIs with other proteins. Thirty-one out of 142 RLK interactors (including RLKs) had previously been found to be phosphorylated; thus interactors may be substrates for respective RLKs. None of the pPPIs described here had been reported in the major interactome databases, including potential interactors of G-protein-coupled receptors, phospholipase C, and AMT ammonium transporters. Two RLKs found as putative interactors of AMT1;1 were independently confirmed using a split luciferase assay in Arabidopsis protoplasts. These RLKs may be involved in ammonium-dependent phosphorylation of the C-terminus and regulation of ammonium uptake activity. The robotic screening method established here will enable a systematic analysis of membrane protein interactions in fungi, plants and metazoa.