The stability of the monofixation syndrome.

PURPOSE: To determine etiology, characteristics, and stability of the monofixation syndrome (MFS) in a chart review of 63 consecutive patients in a private practice of pediatric ophthalmology. DESIGN: Retrospective, consecutive chart review. METHODS: The charts of 63 consecutive patients with MFS, encountered from 2007-2012 followed for a minimum of 3 years were included. Best visual acuity, motor angle deviation at near, fusion, and stereoacuity as recorded on the most recent visit during the follow-up period were examined. Stability of the MFS was determined by comparing the dates of diagnosis with the last examination for those patients who remained stable. Decompensated patients were also studied for characteristics and results of secondary surgery. RESULTS: The etiology of the MFS was esotropia in 58 (92.1%), anisometropia in 2 (3.2%), and exotropia in 3 patients (4.8%). The majority of patients, 57 of 63 (92%), had stable MFS for a mean of 13.9 years. Six esotropic patients decompensated after a mean of 6 years; 5 of these patients were restored to MFS by secondary surgery and 1 spontaneously recovered. Five patients were found to have improved stereoacuity to 60 arc seconds or better by the end of the study. CONCLUSIONS: The MFS is a relatively stable binocular status during the first 2 decades of follow-up. A small percentage of patients decompensated, requiring secondary surgery to restore the MFS binocular status. A similar small percentage of MFS patients developed a higher grade of stereoacuity when followed for a sufficient interval of time.

Routine assessment of social difficulties in cancer patients: are we opening Pandora's box?

GOALS OF WORK: Living with cancer impacts on the social aspects of the lives of the patient and their families, causing problems that can remain undetected. The Social Difficulties Inventory (SDI) has been shown as an effective screening tool, but concerns exist that detecting more problems may increase the workload for clinic staff and related services. The aim of this analysis is to assess the level of unmet need for social difficulties and to identify any potential increase in required interventions that may occur as a result of detailed assessment. PATIENTS AND METHODS: A previous cross-sectional interview study was conducted to establish the clinical utility of the SDI. Adult patients were recruited from oncology, haematology and chest medicine clinics. They completed the SDI and a semi-structured interview by a social worker, who was blind to the SDI results. With participant agreement, interventions were made for the detected problems. This paper reports on a secondary descriptive analysis of intervention data, which was performed to examine the details of the interventions and referral patterns. MAIN RESULTS: No intervention was necessary for 108 (59%) of patients, 42 (23%) received information, 33 (15%) were referred to another service and five (3%) received both information and a referral. Most information was provided about holiday insurance. The majority of referrals were made to Social Work (55% of all referrals) with the main reason being related to benefits or finances. CONCLUSIONS: Increased referral rate was observed following a social work interview, when comparing with local audit data. However, the majority of needs could be met by increasing accessibility of information.

Toileting concerns, parenting stress, and behavior problems in children with special health care needs.

This study examined the relationship between toileting concerns, behavior problems, and parenting stress in parents of children with special health care needs (CSHCN). Participants included parents of 99 males and 71 females aged 4 to 12 years with neural tube defects (NTD), developmental-behavioral disabilities (DBD), or history of perinatal intraventricular hemorrhage (IVH). Parents completed the Achenbach Child Behavior Checklist (CBCL) and the Parenting Stress Index-Short Form (PSI-SF). Parents expressing toileting concerns on the CBCL reported significantly more personal distress and more externalizing problems versus those with continent children. Variation within subsamples suggested that expectations based on nature of disability may be a factor in parent adjustment. Direct assessment and intervention of toileting issues should be a high priority in secondary stress prevention with CSHCN and their families.

Methods for inducing apoptosis.

Apoptotic cells are sources of tolerogenic material during tissue homeostasis; abnormalities in apoptosis or in the clearance of apoptotic material generate a novel source of antigens against which an autoimmune response may be initiated. In our laboratory, we study the biochemistry and cell biology of systemic autoimmune disease autoantigens during different forms of cell death. Several different methods for inducing apoptosis, and for assaying the induction of this cellular process, are routinely performed. This chapter describes methods for inducing apoptosis via ultraviolet B irradiation, small molecule drug treatments, death receptor ligation, and exposure to granule components of cytotoxic lymphocytes. Assays to confirm the induction of apoptosis by quantifying changes in mitochondrial membrane potential, phosphatidylserine membrane localization, DNA content, and autoantigen cleavage are also detailed.