Biomechanical Comparison of the Roof Step Cut Technique with the Bulk Bone Graft Technique During Total Hip Arthroplasty for Hip Dysplasia: a Finite Element Analysis.

PURPOSE OF THE STUDY Different techniques have been reported to reconstruct the defi cient acetabulum during total hip arthroplasty (THA). The purpose of this study was to compare the biomechanical features of the bulk bone graft (BBG) technique (Harris acetabular plasty) and the Roof Step Cut (RSC) technique using fi nite element analysis. MATERIAL AND METHODS Based on a female patient's dysplastic hip CT scan, 3D models were assembled according to the two techniques. For the Harris technique, an irregular BBG was sculpted from a solid sphere, while for the RSC technique, the graft was sculpted into a step-cut shape with a similar size. Each graft was fi xed with two compression screws at two different angles (0° and 45°). Four fi nite element models were used to compare the von Mises stress distribution and total deformation of the grafts and the screws. The pressure and sliding distances of the contacts between the bone graft, metal cup and acetabular host bone were also analyzed. RESULTS For both of the bone grafts and the screws, compared to the Harris models, the maximum stress of the RSC models was signifi cantly lower (16.56 MPa, 25.50 MPa vs 97.13 MPa, 112.72 MPa) and the total deformation was signifi cantly smaller (0.0096 mm, 0.0089 mm vs 0.022 mm, 0.018 mm). 45° inserted screws generated higher stress at the end of the screws and on the outside of the bone graft. In case of 0° inserted screws, the maximum value was mainly located in the middle of the screws, inside the screw channel as well as at the contact area between the graft and the host bone. At all analyzed contacts, the RSC technique shows signifi cantly lower pressure and sliding distances, irrelevant to the screw's insertion angle. In comparison, the model of BBG with 45° screws showed a signifi cant sliding effect and higher contact pressure. CONCLUSIONS Compared with the BBG technique, the step-shaped graft of the RSC technique could signifi cantly reduce the maximum stress and deformation of the graft and the screws, and decrease the pressure and sliding distance between the bone graft, metal cup and the acetabular host bone. The angle of screw placement affects the location of stress and deformation. Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabular reconstruction, bone graft, fi nite element analysis.

Influence of using history of immune checkpoint inhibitor therapy for neutropenia caused by combination therapy of ramucirumab and docetaxel.

Recently, pretreatment with immune checkpoint inhibitors (ICIs) has been shown to enhance the therapeutic effects of the combination therapy of ramucirumab (RAM) and docetaxel (DTX); however, its influence on the drug's side effects remains unclear. This study investigated the influence of pretreatment with ICIs on the incidence of neutropenia caused by RAM + DTX therapy in patients with non-small cell lung cancer (NSCLC). Patients with NSCLC who received RAM + DTX therapy at Gifu Prefectural General Medical Center between April 2016 and December 2020 were enrolled. Retrospective data regarding age, sex, performance status and detailed treatment history, among others, at treatment initiation were collected from the patients' electronic medical records. Additionally, data on the course number of RAM + DTX therapy, supportive therapy and blood biochemical parameters, including leukocyte and neutrocyte counts, during the treatment period were collected. We identified 41 patients receiving RAM + DTX therapy. Among the more than grade 3 adverse events caused by this therapy, neutropenia was the most common (78.1%). Despite the fact that all previous risk factors influencing this incidence rate had corresponded, the only factor influencing the incidence rate of neutropenia more than grade 3 was ICI treatment history. A difference in the incidence of neutropenia more than grade 3 in the Kaplan-Meier curve was observed between patients with and without ICI pretreatment history (p = 0.037). The pretreatment history of ICI therapy affects the incidence of neutropenia caused by RAM + DTX therapy in patients with NSCLC.

Validation of an electronic algorithm for Hodgkin and non-Hodgkin lymphoma in ICD-10-CM.

PURPOSE: Lymphoma is a health outcome of interest for drug safety studies. Studies using administrative claims data require the accurate identification of lymphoma cases. We developed and validated an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)-based algorithm to identify lymphoma in healthcare claims data. METHODS: We developed a three-component algorithm to identify patients aged ≥15 years who were newly diagnosed with Hodgkin (HL) or non-Hodgkin (NHL) lymphoma from January 2016 through July 2018 among members of four Data Partners within the FDA's Sentinel System. The algorithm identified potential cases as patients with ≥2 ICD-10-CM lymphoma diagnosis codes on different dates within 183 days; ≥1 procedure code for a diagnostic procedure (e.g., biopsy, flow cytometry) and ≥1 procedure code for a relevant imaging study within 90 days of the first lymphoma diagnosis code. Cases identified by the algorithm were adjudicated via chart review and a positive predictive value (PPV) was calculated. RESULTS: We identified 8723 potential lymphoma cases via the algorithm and randomly sampled 213 for validation. We retrieved 138 charts (65%) and adjudicated 134 (63%). The overall PPV was 77% (95% confidence interval: 69%-84%). Most cases also had subtype information available, with 88% of cases identified as NHL and 11% as HL. CONCLUSIONS: Seventy-seven percent of lymphoma cases identified by an algorithm based on ICD-10-CM diagnosis and procedure codes and applied to claims data were true cases. This novel algorithm represents an efficient, cost-effective way to target an important health outcome of interest for large-scale drug safety and public health surveillance studies.

Prospective influenza vaccine safety surveillance using fresh data in the Sentinel System.

PURPOSE: To develop the infrastructure to conduct timely active surveillance for safety of influenza vaccines and other medical countermeasures in the Sentinel System (formerly the Mini-Sentinel Pilot), a Food and Drug Administration-sponsored national surveillance system that typically relies on data that are mature, settled, and updated quarterly. METHODS: Three Data Partners provided their earliest available ("fresh") cumulative claims data on influenza vaccination and health outcomes 3-4 times on a staggered basis during the 2013-2014 influenza season, collectively producing 10 data updates. We monitored anaphylaxis in the entire population using a cohort design and seizures in children ≤4 years of age using both a self-controlled risk interval design (primary) and a cohort design (secondary). After each data update, we conducted sequential analysis for inactivated (IIV) and live (LAIV) influenza vaccines using the Maximized Sequential Probability Ratio Test, adjusting for data-lag. RESULTS: Most of the 10 sequential analyses were conducted within 6 weeks of the last care-date in the cumulative dataset. A total of 6 682 336 doses of IIV and 782 125 doses of LAIV were captured. The primary analyses did not identify any statistical signals following IIV or LAIV. In secondary analysis, the risk of seizures was higher following concomitant IIV and PCV13 than historically after IIV in 6- to 23-month-olds (relative risk = 2.7), which requires further investigation. CONCLUSIONS: The Sentinel System can implement a sequential analysis system that uses fresh data for medical product safety surveillance. Active surveillance using sequential analysis of fresh data holds promise for detecting clinically significant health risks early. Limitations of employing fresh data for surveillance include cost and the need for careful scrutiny of signals. © 2015 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

The effect of carbon dioxide on the shelf life of ready-to-eat shredded chicken breast stored under refrigeration.

The objective of the present study was to determine the shelf life of ready-to-eat cooked chicken breast fillets (shredded) stored in atmospheres that were modified with different concentrations of CO2 and to establish a relationship between the concentration of this gas and bacterial growth. The samples were divided into 7 groups with different packaging conditions: aerobiosis, vacuum, and 10, 30, 50, 70, and 90% CO2 (with the remaining volume filled with N2). All of the samples were stored at 4 ± 2°C for 28 d. During this period, pH tests and counts of aerobic heterotrophic mesophyll bacteria (AHMB), aerobic heterotrophic psychotropic bacteria (AHPB), Enterobacteriaceae, and lactic acid bacteria (LAB) were performed, and the gas compositions of the packaging atmospheres were verified. The pH of the aerobic packages increased during storage. However, the other treatments resulted in the opposite trend, with the CO2 concentration decreasing over the first 24 h and then remaining constant until the end of experiment. A gradual increase in the AHMB, AHPB, Enterobacteriaceae, and LAB counts was observed during storage; this increase was faster in the meat that was packed under aerobiosis conditions than in the other treatments. The treatments with a CO2 concentration above 10% exhibited lower Enterobacteriaceae growth, whereas LAB growth was discrete in all of the treatments, independent of the CO2 concentration. The shelf life of the samples packed with 90% CO2 was 28 d. Based on the AHMB and AHPB counts, the shelf life was 3 times longer than for the samples packed under aerobiosis conditions (9 d). The increased package CO2 concentration caused a reduction in the growth rate of the examined bacteria (r = 0.99), and treatment with 90% CO2 appears promising as a method with which to increase the product's shelf life.

Microbiological quality and biogenic amines in ready-to-eat grilled chicken fillets under vacuum packing, freezing, and high-dose irradiation.

The combined effects of cooking, vacuum packing, freezing, and high-dose gamma irradiation in the microbiological conservation and in biogenic amine (BA) contents of ready-to-eat grilled breast chicken fillets are investigated in this work. After seasoning, cooking, and vacuum packing, one-third of the samples were stored at -25°C (T1). The remaining two-thirds were treated with 48 kGy, one-third being stored at -25°C (T2) and the other one-third kept at room temperature (T3). All samples were periodically analyzed to determine growth of heterotrophic aerobic mesophilic bacteria (HAMB) and levels of BA (tyramine, TYM; putrescine, PUT; cadaverine, CAD; spermidine, SPD; histamine, HYM; and spermine, SPM). Variance analysis was performed to determine significant changes in the measured data. Grilling caused HAMB counts in seasoned samples to drop from 5.3 log cfu/g to zero. In addition, no viable HAMB cells were detected in the samples throughout the 12-mo storage time. Regarding the BA analyses, the highest mean levels were measured for SPM and CAD with significantly higher levels (P < 0.05) being determined in nonirradiated samples (T1). Furthermore, significantly lower mean levels for the total content of BA were observed in the irradiated samples. Relative to T1 (7.5 ± 1.5 mg/kg), the figures were 47 ± 23% for T2 and 60 ± 25% for T3, mostly due to loss of CAD by radiolysis. Therefore, it can be concluded that the combination of grilling, vacuum packing, freezing, and high-dose gamma irradiation efficiently eliminated HAMB, while sustaining acceptable levels of BA in ready-to-eat chicken breast fillets throughout the 12 mo of storage at room temperature.

Effect of high-dose irradiation on quality characteristics of ready-to-eat broiler breast fillets stored at room temperature.

The effect of high-dose irradiation on the physical, chemical, and bacteriological parameters of ready-to-eat vacuum-packed broiler breast meat after 430 d of storage at room temperature was investigated. Ready-to-eat broiler breast fillets were immersed in brine with garlic powder and then drained, grilled, and vacuum-packed (primary packaging). The high-dose irradiation used was approximately 48 kGy. The treatments were designated as A (irradiated samples stored at room temperature), B (irradiated samples stored at -25°C), and C (nonirradiated samples stored at -25°C). All samples were packaged in polyethylene bags containing aluminum to exclude light (secondary packaging). Proximate composition, pH, 2-thiobarbituric acid reactive substance (TBARS), and heterotrophic aerobic mesophilic bacteria were analyzed during 430 d of storage. Results were analyzed using 1-way ANOVA and the Tukey test. Linear regression was used to analyze the correlation between the results for each parameter and storage time of the different treatments. The gamma radiation caused slight changes (P < 0.05) in the moisture and fat content, regardless of storage temperature. After storage d 110, TBARS values remained stable (P > 0.05) in all the treatments. The preservation methods used were effective in maintaining the mesophilic counts below the detection level during the entire storage period. We concluded that, among the treatments studied, high-dose irradiation with storage at room temperature showed potential for the preservation of ready-to-eat products made from poultry meat, to provide foods safe for consumption.

Effects of ultraviolet light on biogenic amines and other quality indicators of chicken meat during refrigerated storage.

Radiation from UV-C has been demonstrated as a potential surface decontamination method in addition to several advantages over regular sanitation methods. However, UV-C radiation possibly affects the physicochemical properties of meat products. To determine the optimum exposure time for bacterial reduction, 39 chicken breasts, inoculated with a pool of Salmonella spp., were submitted to 3 levels of UV-C intensities (0.62, 1.13, and 1.95 mW/cm²) for up to 120 s. After the optimum exposure time of 90 s was determined, changes in the biogenic amines, total aerobic mesophilic bacteria, Enterobacteriaceae, lipid oxidation, pH, and instrumental color were evaluated in 84 chicken breasts that were irradiated (0.62, 1.13, and 1.95 mW/cm²) and stored at 4°C for 9 d. The groups treated with UV-C radiation exhibited an increase in tyramine, cadaverine, and putrescine contents (P < 0.05). The highest UV-C intensity (1.95 mW/cm²) promoted a decrease in the initial bacterial load, and extended the lag phase and the shelf life. The groups irradiated with 1.13 and 1.95 mW/cm² exhibited a more stable b* value than the other groups; similar trends for L*, a*, pH, and TBA reactive substance values were observed among all groups. The UV-C light was demonstrated to be an efficient alternative technology to improve the bacteriological quality of chicken meat without negatively affecting the physical and chemical parameters of chicken breast meat. Nonetheless, the increases on the biogenic amines content should be considered as an effect of the UV processing and not as an indicator of bacterial growth.

Intraosseous structural graft technique: a new surgical concept in the treatment of superolateral defects in case of dysplastic acetabulum, during hip replacement surgery biomechanical and cadaver experimentations.

PURPOSE: The replacement of the dysplastic hip, despite the numerous available surgical techniques, is not entirely solved. One of the reasons for this is the relative lack of bone in the acetabulum. In this study, we present a new concept (intraosseous structural graft technique), with the aim to improve the primary stability and biological environment of the graft. METHODS: During the procedure in the cranial quadrant of the acetabulum, a proximally hinged cortico-spongious plate is fashioned that is opened laterally and a wedge-shaped graft made from the femoral head is impacted. The precisely fitted graft has good primary rotational and cranial stability which is further improved by a bicortical screw. RESULTS: The hypothesis is supported by examination on 3D models. Cadaver experimentations were performed on 19 hips of 10 cadavers, and stability testing was done on a further 20 hips of 10 cadavers with a material testing apparatus. Also the analysis of the biological and mechanical properties of the graft and the implant were examined. CONCLUSION: Based on our results, it can be concluded that our technique provides good primary stability with a more favorable biological condition for bony incorporation compared to other bulk bone graft techniques.

Validation of anaphylaxis in the Food and Drug Administration's Mini-Sentinel.

PURPOSE: We aim to develop and validate the positive predictive value (PPV) of an algorithm to identify anaphylaxis using health plan administrative and claims data. Previously published PPVs for anaphylaxis using International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) codes range from 52% to 57%. METHODS: We conducted a retrospective study using administrative and claims data from eight health plans. Using diagnosis and procedure codes, we developed an algorithm to identify potential cases of anaphylaxis from the Mini-Sentinel Distributed Database between January 2009 and December 2010. A random sample of medical charts (n = 150) was identified for chart abstraction. Two physician adjudicators reviewed each potential case. Using physician adjudicator judgments on whether the case met diagnostic criteria for anaphylaxis, we calculated a PPV for the algorithm. RESULTS: Of the 122 patients for whom complete charts were received, 77 were judged by physician adjudicators to have anaphylaxis. The PPV for the algorithm was 63.1% (95%CI: 53.9-71.7%), using the clinical criteria by Sampson as the gold standard. The PPV was highest for inpatient encounters with ICD-9-CM codes of 995.0 or 999.4. By combining only the top performing ICD-9-CM codes, we identified an algorithm with a PPV of 75.0%, but only 66% of cases of anaphylaxis were identified using this modified algorithm. CONCLUSIONS: The PPV for the ICD-9-CM-based algorithm for anaphylaxis was slightly higher than PPV estimates reported in prior studies, but remained low. We were able to identify an algorithm that optimized the PPV but demonstrated lower sensitivity for anaphylactic events.

Validity of diagnostic codes to identify cases of severe acute liver injury in the US Food and Drug Administration's Mini-Sentinel Distributed Database.

PURPOSE: The validity of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify diagnoses of severe acute liver injury (SALI) is not well known. We examined the positive predictive values (PPVs) of hospital ICD-9-CM diagnoses in identifying SALI among health plan members in the Mini-Sentinel Distributed Database (MSDD) for patients without liver/biliary disease and for those with chronic liver disease (CLD). METHODS: We selected random samples of members (149 without liver/biliary disease; 75 with CLD) with a principal hospital diagnosis suggestive of SALI (ICD-9-CM 570, 572.2, 572.4, 572.8, 573.3, 573.8, or V42.7) in the MSDD (2009-2010). Medical records were reviewed by hepatologists to confirm SALI events. PPVs of codes and code combinations for confirmed SALI were determined by CLD status. RESULTS: Among 105 members with available records and no liver/biliary disease, SALI was confirmed in 26 (PPV, 24.7%; 95%CI, 16.9-34.1%). Combined hospital diagnoses of acute hepatic necrosis (570) and liver disease sequelae (572.8) had high PPV (100%; 95%CI, 59.0-100%) and identified 7/26 (26.9%) events. Among 46 CLD members with available records, SALI was confirmed in 19 (PPV, 41.3%; 95%CI, 27.0-56.8%). Acute hepatic necrosis (570) or hepatorenal syndrome (572.4) plus any other SALI code had a PPV of 83.3% (95%CI, 51.6-97.9%) and identified 10/19 (52.6%) events. CONCLUSIONS: Most individual hospital ICD-9-CM diagnoses had low PPV for confirmed SALI events. Select code combinations had high PPV but did not capture all events.

High-intensity ultrasound improves color and oxidative stability of beef from grain-fed and pasture-fed Nellore cattle.

This research aimed to evaluate the influence of high-intensity ultrasound (HIU) levels (control: 0; high: 747.79; ultra-high: 1344.17 Wcm-2) on pH, instrumental color (redness, R630/580, hue angle and chroma) and oxidative stability (lipid and protein oxidation) of Psoas major (PM) muscle from Nellore cattle raised in two feeding systems: grain and pasture. Using a structural equation modeling (SEM) approach, the relations (P > 0.05) between exogenous (HIU levels) and endogenous (pH, color, lipid and protein oxidation) variables were observed. In beef from grain-fed animals the pH was directly and negatively related to lipid oxidation (γ = -0.321), hue angle (γ = -0.847) and chroma (γ = -0.442) and protein oxidation (γ = -0.752). In PM from pasture-fed HIU exhibited a negative relation with lipid (γ = -0.144) and protein (γ = -0.743) oxidation, suggesting a possible positive influence on the oxidative stability of meat and a positive relation with redness (γ = 0.197) and R630/580 (γ = 0.379). The HIU positively influenced the color and oxidative stability of beef from Bos indicus cattle, and a synergistic effect of HIU and feeding system on beef from pasture-fed animals.

Effect of different feeding systems on color of longissimus muscle from Bos cattle: A systematic review and meta-analysis.

Considering the relevance of meat discoloration for meat production chain and the conflicting results regarding the influence of feeding regimes on color of fresh beef and the lack of meta-analytic studies on this subject we investigated the effect of grain-fed and pasture-fed regimes on color of beef longissimus from Bos cattle through a systematic review with meta-analysis. A systematic search from 2001 to 2021 was performed in two databases and 126 papers were eligible for meta-analysis. Pasture-fed longissimus beef exhibited higher a* (8.21%) and C* (8.61%) values, and lower h* values (17.18%) than grain-fed counterparts, indicating a greater color for longissimus beef from pasture-fed animals. Among the pasture-fed regimes, those containing alfalfa, bermudagrass, cowpea and pearl millet were the most effective for color improvements. Our findings indicate potential feeding regimes to mitigate global economic losses from meat discoloration and suggest the necessity to develop suitable processing strategies to improve the color of beef from grain-fed Bos cattle.

Ocular Flutter Following Adenoviral Conjunctivitis in an Adult.

A 37-year-old female presented with ocular flutter and a transient rhombo-encephalitis following acute adenoviral kerato-conjunctivitis. Clinicians are made aware of the possibility of a transient encephalitic illness following adenoviral conjunctivitis.

Retrograde stem removal in revision hip surgery: removing a loose or broken femoral component with a retrograde nail.

INTRODUCTION: Removal of a cemented femoral stem during revision total hip arthroplasty is a technically demanding procedure that requires a multitude of surgical techniques and tools. To gain full access to the cement and the stem, distal fenestration or a transfemoral approach is often required. This paper presents a technique of retrograde removal of femoral stems and cement from the distal femur. MATERIALS AND METHODS: The authors present five clinical cases. In two cases the femoral component and the surrounding cement was removed using this technique. In the other three cases, due to femoral component fracture, the distal fragment of the femoral component with its cement mantle was removed using the same technique. In an experimental study, we simulated the above technique and compared it with a windowing technique on six, paired cadaveric femora (12 femurs in all). RESULTS: In all of the clinical cases the stem and the cement were removed completely without any complications. The cadaveric experiments clearly showed that the biomechanical resistance of the femur against compression and torsion forces is greatly decreased by using a window to access the proximal femur, compared with the retrograde technique, which shows no significant change. CONCLUSION: Retrograde component removal provides a simple, rapid, and less invasive technique for stem and cement extraction in elective revision hip arthroplasty.

The risk of febrile seizures following influenza and 13-valent pneumococcal conjugate vaccines.

BACKGROUND: Evidence on the risk of febrile seizures after inactivated influenza vaccine (IIV) and 13-valent pneumococcal conjugate vaccine (PCV13) is mixed. In the FDA-sponsored Sentinel Initiative, we examined risk of febrile seizures after IIV and PCV13 in children 6-23 months of age during the 2013-14 and 2014-15 influenza seasons. METHODS: Using claims data and a self-controlled risk interval design, we compared the febrile seizure rate in a risk interval (0-1 days) versus control interval (14-20 days). In exploratory analyses, we assessed whether the effect of IIV was modified by concomitant PCV13 administration. RESULTS: Adjusted for age, calendar time and concomitant administration of the other vaccine, the incidence rate ratio (IRR) for risk of febrile seizures following IIV was 1.12 (95% CI 0.80, 1.56) and following PCV13 was 1.80 (95% CI 1.29, 2.52). The attributable risk for febrile seizures following PCV13 ranged from 0.33 to 5.16 per 100,000 doses by week of age. The age and calendar-time adjusted IRR comparing exposed to unexposed time was numerically larger for concomitant IIV and PCV13 (IRR 2.80, 95% CI 1.63, 4.83), as compared to PCV13 without concomitant IIV (IRR 1.54, 95% CI 1.04, 2.28), and the IRR for IIV without concomitant PCV13 suggested no independent effects of IIV (IRR 0.94, 95% CI 0.63, 1.42). Taken together, this suggests a possible interaction between IIV and PCV13, though our study was not sufficiently powered to provide a precise estimate of the interaction. CONCLUSIONS: We found an elevated risk of febrile seizures after PCV13 vaccine but not after IIV. The risk of febrile seizures after PCV13 is low compared to the overall risk in this population of children, and the risk should be interpreted in the context of the importance of preventing pneumococcal infections.

Emission of methyl bromide from biomass burning.

Bromine is, per atom, far more efficient than chlorine in destroying stratospheric ozone, and methyl bromide is the single largest source of stratospheric bromine. The two main previously known sources of this compound are emissions from the ocean and from the compound's use as an agricultural pesticide. Laboratory biomass combustion experiments showed that methyl bromide was emitted in the smoke from various fuels tested. Methyl bromide was also found in smoke plumes from wildfires in savannas, chaparral, and boreal forest. Global emissions of methyl bromide from biomass burning are estimated to be in the range of 10 to 50 gigagrams per year, which is comparable to the amount produced by ocean emission and pesticide use and represents a major contribution ( approximately 30 percent) to the stratospheric bromine budget.

Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery.

PURPOSE: Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. METHODS: Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. RESULTS: All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P < 0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P < 0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). CONCLUSIONS: In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

Evaluation of the risk of venous thromboembolism after quadrivalent human papillomavirus vaccination among US females.

After the Food and Drug Administration (FDA) licensed quadrivalent human papillomavirus vaccine (HPV4) in 2006, reports suggesting a possible association with venous thromboembolism (VTE) emerged from the Vaccine Adverse Event Reporting System and the Vaccine Safety Datalink. Our objective was to determine whether HPV4 increased VTE risk. The subjects were 9-26-year-old female members of five data partners in the FDA's Mini-Sentinel pilot project receiving HPV4 during 2006-2013. The outcome was radiologically confirmed first-ever VTE among potential cases identified by diagnosis codes in administrative data during Days 1-77 after HPV4 vaccination. With a self-controlled risk interval design, we compared counts of first-ever VTE in risk intervals (Days 1-28 and Days 1-7 post-vaccination) and control intervals (Days 36-56 for Dose 1 and Days 36-63 for Doses 2 and 3). Combined hormonal contraceptive use was treated as a potential confounder. The main analyses were: (1) unadjusted for time-varying VTE risk from contraceptive use, (2) unadjusted but restricted to cases without such time-varying risk, and (3) adjusted by incorporating the modeled risk of VTE by week of contraceptive use in the analysis. Of 279 potential VTE cases identified following 1,423,399 HPV4 doses administered, 225 had obtainable charts, and 53 were confirmed first-ever VTE. All 30 with onsets in risk or control intervals had known risk factors for VTE. VTE risk was not elevated in the first 7 or 28 days following any dose of HPV in any analysis (e.g. relative risk estimate (95% CI) from both unrestricted analyses, for all-doses, 28-day risk interval: 0.7 (0.3-1.4)). Temporal scan statistics found no clustering of VTE onsets after any dose. Thus, we found no evidence of an increased risk of VTE associated with HPV4 among 9-26-year-old females. A particular strength of this evaluation was its control for both time-invariant and contraceptive-related time-varying potential confounding.

Inhibitors of Protein Phosphatases 1 and 2A Block the Sugar-Inducible Gene Expression in Plants.

Genes coding for two major proteins of the tuberous root of sweet potato (Ipomoea batatas), namely, sporamin and [beta]-amylase, are inducible in leaves and petioles when they are supplied with high concentrations of sucrose or other metabolizable sugars, such as glucose and fructose, and the accumulation of a large amount of starch accompanies this induction. Three inhibitors of protein phosphatases 1 (PP1) and 2A (PP2A), namely, okadaic acid, microcystin-LR, and calyculin A, strongly inhibited the sucrose-inducible accumulation of mRNAs for sporamin, [beta]-amylase, and the small subunit of ADP-glucose pyrophosphorylase in petioles. However, these inhibitors did not have any major effect on the steady-state levels of mRNAs for catalase and glyceraldehyde-3-phosphate dehydrogenase, and the sucrose-inducible increase in the level of sucrose synthase mRNA was enhanced by okadaic acid. Inhibitors of PP1 and PP2A also inhibited sucrose-inducible expression of a fusion gene, consisting of the promoter of the sweet potato gene for [beta]-amylase and the coding sequence for [beta]-glucuronidase (GUS), in leaves of transgenic tobacco (Nicotiana tabacum). The inhibition was not due to inhibition of uptake and cleavage of sucrose, since okadaic acid also inhibited induction of the fusion gene by glucose or fructose. Addition of okadaic acid to leaves that had been treated with sucrose for 6 h inhibited further increases in GUS activity. These results suggest that the continuous dephosphorylation of proteins is required in the transduction of carbohydrate metabolic signals to the transcriptional activation of at least some sugar-inducible genes in plant.