LONG-TERM OUTCOMES OF INTRAVITREAL BEVACIZUMAB THERAPY FOR SUBRETINAL NEOVASCULARIZATION SECONDARY TO IDIOPATHIC MACULAR TELANGIECTASIA TYPE 2.

PURPOSE: To assess the long-term visual acuity results for intravitreal bevacizumab therapy in the treatment of subretinal neovascular membrane (SRNVM) secondary to idiopathic macular telangiectasia (Mactel) Type 2. METHODS: This retrospective review of a consecutive, interventional case series includes patients with SRNVM secondary to Mactel Type 2 who were seen at Cincinnati Eye Institute from February 2006 to December 2014. Best-corrected visual acuity, fluorescein angiography, and optical coherence tomography measurements were performed. Exclusion criteria were the following: Mactel Type 2 patients without SRNVM, Mactel Type 1 patients, patients who had SRNVM or macular edema related to other maculopathies, and patients who had pars plana vitrectomy or laser treatment to the macula during the course of care or before their first visit. RESULTS: Twenty-five eyes of 20 patients with SRNVM secondary to Mactel Type 2 were included in the study. The mean baseline best-corrected visual acuity was 20/91 (median: 20/69) and the mean final best-corrected visual acuity was 20/62 (median: 20/60) at the last visit (P < 0.0001). The mean number of injections was 8.4 ± 11.1 (range: 2-53, median: 4). The mean pretreatment central macular thickness of 254 µm improved to 205 µm at the final visit (P = 0.011). No complications related to intravitreal bevacizumab injection were noted during the mean follow-up time of 40.8 ± 33.7 months (range: 4-108 months, median: 24 months). CONCLUSION: Intravitreal bevacizumab therapy is an effective long-term treatment modality for SRNVM secondary to Mactel Type 2 based on improvement in best-corrected visual acuity and associated reduction in central macular thickness.

Skin-interfacing wearable biosensors for smart health monitoring of infants and neonates.

Health monitoring of infant patients in intensive care can be especially strenuous for both the patient and their caregiver, as testing setups involve a tangle of electrodes, probes, and catheters that keep the patient bedridden. This has typically involved expensive and imposing machines, to track physiological metrics such as heart rate, respiration rate, temperature, blood oxygen saturation, blood pressure, and ion concentrations. However, in the past couple of decades, research advancements have propelled a world of soft, wearable, and non-invasive systems to supersede current practices. This paper summarizes the latest advancements in neonatal wearable systems and the different approaches to each branch of physiological monitoring, with an emphasis on smart skin-interfaced wearables. Weaknesses and shortfalls are also addressed, with some guidelines provided to help drive the further research needed.

Continuous real-time assessment of acute cognitive stress from cardiac mechanical signals captured by a skin-like patch.

The inability to objectively quantify cognitive stress in real-time with wearable devices is a crucial unsolved problem with serious negative consequences for dementia and mental disability patients and those seeking to improve their quality of life. Here, we introduce a skin-like, wireless sternal patch that captures changes in cardiac mechanics due to stress manifesting in the seismocardiogram (SCG) signals. Judicious optimization of the device's micro-structured interconnections and elastomer integration yields a device that sufficiently matches the skin's mechanics, robustly yet gently adheres to the skin without aggressive tapes, and captures planar and longitudinal SCG waves well. The device transmits SCG beats in real-time to a user's device, where derived features relate to the heartbeat's mechanical morphology. The signals are assessed by a series of features in a support vector machine regressor. Controlled studies, compared to gold standard cortisol and following the validated imaging test, show an R-squared correlation of 0.79 between the stress prediction and cortisol change, significantly improving over prior works. Likewise, the system demonstrates excellent robustness to external temperature and physical recovery status while showing excellent accuracy and wearability in full-day use.

Flexible Thermoelectric Wearable Architecture for Wireless Continuous Physiological Monitoring.

Continuous monitoring of physiological signals from the human body is critical in health monitoring, disease diagnosis, and therapeutics. Despite the needs, the existing wearable medical devices rely on either bulky wired systems or battery-powered devices needing frequent recharging. Here, we introduce a wearable, self-powered, thermoelectric flexible system architecture for wireless portable monitoring of physiological signals without recharging batteries. This system harvests an exceptionally high open circuit voltage of 175-180 mV from the human body, powering the wireless wearable bioelectronics to detect electrophysiological signals on the skin continuously. The thermoelectric system shows long-term stability in performance for 7 days with stable power management. Integrating screen printing, laser micromachining, and soft packaging technologies enables a multilayered, soft, wearable device to be mounted on any body part. The demonstration of the self-sustainable wearable system for detecting electromyograms and electrocardiograms captures the potential of the platform technology to offer various opportunities for continuous monitoring of biosignals, remote health monitoring, and automated disease diagnosis.

Soft wireless sternal patch to detect systemic vasoconstriction using photoplethysmography.

Vasoconstriction is a crucial physiological process that serves as the body's primary blood pressure regulation mechanism and a key marker of numerous harmful health conditions. The ability to detect vasoconstriction in real time would be crucial for detecting blood pressure, identifying sympathetic arousals, characterizing patient wellbeing, detecting sickle cell anemia attacks early, and identifying complications caused by hypertension medications. However, vasoconstriction manifests weakly in traditional photoplethysmogram (PPG) measurement locations, like the finger, toe, and ear. Here, we report a wireless, fully integrated, soft sternal patch to capture PPG signals from the sternum, an anatomical region that exhibits a robust vasoconstrictive response. With healthy controls, the device is highly capable of detecting vasoconstriction induced endogenously and exogenously. Furthermore, in overnight trials with patients with sleep apnea, the device shows a high agreement (r2 = 0.74) in vasoconstriction detection with a commercial system, demonstrating its potential use in portable, continuous, long-term vasoconstriction monitoring.

Recent Advances in Materials and Flexible Sensors for Arrhythmia Detection.

Arrhythmias are one of the leading causes of death in the United States, and their early detection is essential for patient wellness. However, traditional arrhythmia diagnosis by expert evaluation from intermittent clinical examinations is time-consuming and often lacks quantitative data. Modern wearable sensors and machine learning algorithms have attempted to alleviate this problem by providing continuous monitoring and real-time arrhythmia detection. However, current devices are still largely limited by the fundamental mismatch between skin and sensor, giving way to motion artifacts. Additionally, the desirable qualities of flexibility, robustness, breathability, adhesiveness, stretchability, and durability cannot all be met at once. Flexible sensors have improved upon the current clinical arrhythmia detection methods by following the topography of skin and reducing the natural interface mismatch between cardiac monitoring sensors and human skin. Flexible bioelectric, optoelectronic, ultrasonic, and mechanoelectrical sensors have been demonstrated to provide essential information about heart-rate variability, which is crucial in detecting and classifying arrhythmias. In this review, we analyze the current trends in flexible wearable sensors for cardiac monitoring and the efficacy of these devices for arrhythmia detection.

Force-Time Waveform Shape Reveals Countermovement Jump Strategies of Collegiate Athletes.

The purpose of this study was to relate the shape of countermovement jump (CMJ) vertical ground reaction force waveforms to discrete parameters and determine if waveform shape could enhance CMJ analysis. Vertical ground reaction forces during CMJs were collected for 394 male and female collegiate athletes competing at the National Collegiate Athletic Association (NCAA) Division 1 and National Association of Intercollegiate Athletics (NAIA) levels. Jump parameters were calculated for each athlete and principal component analysis (PCA) was performed on normalized force-time waveforms consisting of the eccentric braking and concentric phases. A K-means clustering of PCA scores placed athletes into three groups based on their waveform shape. The overall average waveforms of all athletes in each cluster produced three distinct vertical ground reaction force waveform patterns. There were significant differences across clusters for all calculated jump parameters. Athletes with a rounded single hump shape jumped highest and quickest. Athletes with a plateau at the transition between the eccentric braking and concentric phase (amortization) followed by a peak in force near the end of the concentric phase had the lowest jump height and slowest jump time. Analysis of force-time waveform shape can identify differences in CMJ strategies in collegiate athletes.

Intravitreal bevacizumab for choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome.

PURPOSE: The purpose of this study was to assess the efficacy of intravitreal bevacizumab for choroidal neovascularization resulting from presumed ocular histoplasmosis syndrome. METHODS: This is a chart review of retrospective consecutive case series in which intravitreal bevacizumab (1.25 mg) was injected into 24 eyes with choroidal neovascularization resulting from presumed ocular histoplasmosis syndrome. Visual acuity was measured in all patients. Optical coherence tomography and/or fluorescein angiography was performed before and after treatment. The minimum follow-up time was 3 months. Retreatment criteria included failure to improve visual acuity and/or persistent leakage as determined by optical coherence tomography or fluorescein angiography. RESULTS: Patients' mean age was 43.08 years (standard deviation, 13.58 years) and mean follow-up was 31.8 weeks (standard deviation, 20.79 weeks). The average number of bevacizumab injections was 6.8 injections/year. After 3 months, visual acuity improved from mean logMAR 0.76 +/- 0.48 (Snellen equivalent of 20/114) to mean logMAR 0.45 +/- 0.47 (Snellen equivalent of 20/55) (P < 0.001, paired t test; n = 24). After 12 months, visual acuity improved from mean logMAR 0.86 +/- 0.35 (Snellen equivalent of 20/150) to mean logMAR 0.34 +/- 0.33 (Snellen equivalent of 20/45) (P = 0.006, paired t test; n = 9). Fourteen (58.3%) eyes had final visual acuity of 20/40 or better compared with 5 (20.8%) eyes at baseline (P = 0.003, McNemar test). Ten patients (41.6%) had visual acuity of 20/200 or worse at baseline compared with 5 (20.8%) eyes at the final visit (P = 0.059, McNemar test). CONCLUSION: Intravitreal injection of bevacizumab seems to be an effective treatment for choroidal neovascularization resulting from presumed ocular histoplasmosis syndrome.

Reverse amblyopia with atropine treatment.

INTRODUCTION: Occlusion, pharmacologic pernalization and combined therapy have been documented in controlled studies to effectively treat amblyopia with few complications. However, there remain concerns about the effectiveness and complications when, as in this case, there are not standardized treatment protocols. METHODS: A retrospective chart review of 133 consecutive patients in one community based ophthalmology practice treated for amblyopia was performed. Treatments evaluated were occlusion only, atropine penalization, and combination of occlusion and atropine. Reverse amblyopia was defined as having occured when the visual acuity of the sound eye was 3 LogMar units worse than visual acuity of the amblyopia eye after treatment. RESULTS: Improvement in vision after 6 months and 1 year of amblyopia therapy was similar among all three groups: 0.26 LogMar lines and 0.30 in the atropine group, 0.32 and 0.34 in the occlusion group, and 0.24 and 0.32 in the combined group. Eight (6%) patients demonstrated reverse amblyopia. The mean age of those who developed reverse amblyopia was 3.5 years, 1.5 years younger than the mean age of the study population, 7/8 had strabismic amblyopia, 6/8 were on daily atropine and had a mean refractive error of +4.77 diopters in the amblyopic eye and +5.06 diopters in the sound eye. Reverse amblyopia did not occur with occlusion only therapy. CONCLUSIONS: In this community based ophthalmology practice, atropine, patching, and combination therapy appear to be equally effective modalities to treat ambyopia. Highly hyperopic patients under 4 years of age with dense, strabismic amblyopia and on daily atropine appeared to be most at risk for development of reverse amblyopia.

Emergency Department and Primary Care Use by Refugees Compared to Non-refugee Controls.

The U.S. grants asylum to 60,000-70,000 refugees yearly. However, little is known about their healthcare utilization practices. We examined data from emergency department (ED) and primary care (PC) visits of 694 refugees and 738 non-refugee controls over a 3 years period at a large academic medical center, comparing visit frequencies, Emergency Severity Index (ESI) scores, diagnoses, and dispositions. Refugees used emergency care services less frequently than the non-refugee controls (1.19 vs. 2.31, p < 0.0001) while there was no difference in their use of primary care services (8.45 vs. 9.07, p = 0.18). Non-English-speaking refugees were more likely to use the ED than English-speaking refugees (mean ED use in study period 1.50 visits vs. 0.73, p < 0.0001). Refugee patients utilized emergency services less often compared to controls. These results differ from previously studied refugee populations. Refugee-specific primary care services in this study population may reduce unnecessary ED use.

Perioperative treatment of patients with diabetes having eye surgery with local anesthesia in an ambulatory facility.

BACKGROUND AND OBJECTIVE: To evaluate the incidence of hyperglycemia and hypoglycemia in diabetic patients on the morning of eye surgery scheduled under local anesthesia in an ambulatory surgery facility. PATIENTS AND METHODS: A retrospective analysis of fasting blood glucose levels in 216 diabetic patients on 326 admissions. RESULTS: The fasting blood glucose level was 80 mg/dL or lower in 10 patient admissions (3%). Hyperglycemia (fasting blood glucose level of greater than 300 mg/dL) was present on 8 admissions (2.4%). CONCLUSIONS: Blood glucose levels need to be monitored in diabetic patients undergoing even short surgical procedures. The dosage of long-acting insulins or oral hypoglycemics given the night prior to surgery may have to be reduced to prevent hypoglycemia on the morning of surgery.