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1.
Ophthalmic Physiol Opt ; 44(5): 917-924, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38572814

RESUMEN

PURPOSE: The Beer-Lambert law suggests that visual pigment optical density (OD) should be linearly related to the length of photoreceptor outer segments (POSs). Mammalian studies indicate that visual pigment concentration increases with POS length, but the nature of this relationship may vary due to factors such as visual pigment packing density or retinal eccentricity, and may not necessarily be linearly related. The purpose of this study was to establish the relationship between OD and POS length in humans. METHODS: Spectral domain optical coherence tomography (OCT) was used to image POS, and imaging retinal densitometry (IRD) was used to measure OD at corresponding locations in 19 healthy participants (age range 25-82 years). POS length and OD measurements were extracted from OCT and IRD images at 23 discrete locations spanning the central 9° of the retina. The averaged data from all participants were fitted with models based on the Beer-Lambert law to establish the relationship between OD and POS length. RESULTS: Visual pigment OD increased monotonically with POS length, but the relationship was non-linear, and a straight-line fit, based on a simple interpretation of the Beer-Lambert law, provided a poor description. A model allowing for different rod and cone visual pigment concentrations provided a superior fit. Specifically, the data were well described by a model where the molar concentration of visual pigment in cones and rods were 3.8 × 10-3 mol/L and 1.8 × 10-3mol/L, respectively. CONCLUSIONS: In accordance with the Beer-Lambert law, the results indicate that OD increases monotonically with POS length in humans, but the precise relationship is dependent on photoreceptor type. These results suggest that visual pigment concentration in rods is only about 48% of that found in cones. This may be due to the ubiquitous nature of artificial light that works to reduce the concentration of rhodopsin in rod photoreceptors.


Asunto(s)
Segmento Externo de las Células Fotorreceptoras Retinianas , Pigmentos Retinianos , Tomografía de Coherencia Óptica , Humanos , Anciano , Tomografía de Coherencia Óptica/métodos , Persona de Mediana Edad , Adulto , Masculino , Femenino , Anciano de 80 o más Años , Segmento Externo de las Células Fotorreceptoras Retinianas/metabolismo , Pigmentos Retinianos/análisis , Pigmentos Retinianos/metabolismo , Retina/diagnóstico por imagen , Retina/metabolismo
2.
Retina ; 40(8): 1549-1557, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31584557

RESUMEN

PURPOSE: To evaluate Pegasus optical coherence tomography (OCT), a clinical decision support software for the identification of features of retinal disease from macula OCT scans, across heterogenous populations involving varying patient demographics, device manufacturers, acquisition sites, and operators. METHODS: Five thousand five hundred and eighty-eight normal and anomalous macular OCT volumes (162,721 B-scans), acquired at independent centers in five countries, were processed using the software. Results were evaluated against ground truth provided by the data set owners. RESULTS: Pegasus-OCT performed with areas under the curve of the receiver operating characteristic of at least 98% for all data sets in the detection of general macular anomalies. For scans of sufficient quality, the areas under the curve of the receiver operating characteristic for general age-related macular degeneration and diabetic macular edema detection were found to be at least 99% and 98%, respectively. CONCLUSION: The ability of a clinical decision support system to cater for different populations is key to its adoption. Pegasus-OCT was shown to be able to detect age-related macular degeneration, diabetic macular edema, and general anomalies in OCT volumes acquired across multiple independent sites with high performance. Its use thus offers substantial promise, with the potential to alleviate the burden of growing demand in eye care services caused by retinal disease.


Asunto(s)
Retinopatía Diabética/clasificación , Diagnóstico por Computador/clasificación , Degeneración Macular/clasificación , Edema Macular/clasificación , Tomografía de Coherencia Óptica/clasificación , Área Bajo la Curva , Toma de Decisiones Clínicas , Aprendizaje Profundo , Retinopatía Diabética/diagnóstico por imagen , Humanos , Degeneración Macular/diagnóstico por imagen , Edema Macular/diagnóstico por imagen , Curva ROC , Programas Informáticos
3.
Mol Cell ; 44(1): 29-38, 2011 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-21981916

RESUMEN

Insulators are multiprotein-DNA complexes thought to affect gene expression by mediating inter- and intrachromosomal interactions. Drosophila insulators contain specific DNA-binding proteins plus common components, such as CP190, that facilitate these interactions. Here, we examine changes in the distribution of Drosophila insulator proteins during the heat-shock and ecdysone responses. We find that CP190 recruitment to insulator sites is the main regulatable step in controlling insulator function during heat shock. In contrast, both CP190 and DNA-binding protein recruitment are regulated during the ecdysone response. CP190 is necessary to stabilize specific chromatin loops and for proper activation of transcription of genes regulated by this hormone. These findings suggest that cells may regulate recruitment of insulator proteins to DNA to activate insulator activity at specific sites and create distinct patterns of nuclear organization that are necessary to achieve proper gene expression in response to different stimuli.


Asunto(s)
Cromatina/metabolismo , Regulación del Desarrollo de la Expresión Génica , Animales , Cromosomas/química , ADN/química , Proteínas de Unión al ADN/metabolismo , Drosophila , Proteínas de Drosophila/metabolismo , Ecdisona/farmacología , Perfilación de la Expresión Génica , Genoma , Proteínas de Choque Térmico/metabolismo , Microscopía Fluorescente/métodos , Proteínas Asociadas a Microtúbulos/metabolismo , Proteínas Nucleares/metabolismo , Unión Proteica , Transcripción Genética
4.
Int J Gynecol Cancer ; 28(3): 479-485, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29324546

RESUMEN

OBJECTIVES: The objectives of this study were to assess if targeted investigation for tumor-specific mutations by ultradeep DNA sequencing of peritoneal washes of ovarian cancer patients after primary surgical debulking and chemotherapy, and clinically diagnosed as disease free, provides a more sensitive and specific method to assess actual treatment response and tailor future therapy and to compare this "molecular second look" with conventional cytology and histopathology-based findings. METHODS/MATERIALS: We identified 10 patients with advanced-stage, high-grade serous ovarian cancer who had undergone second-look laparoscopy and for whom DNA could be isolated from biobanked paired blood, primary and recurrent tumor, and second-look peritoneal washes. A targeted 56 gene cancer-relevant panel was used for next-generation sequencing (average coverage, >6500×). Mutations were validated using either digital droplet polymerase chain reaction (ddPCR) or Sanger sequencing. RESULTS: A total of 25 tumor-specific mutations were identified (median, 2/patient; range, 1-8). TP53 mutations were identified in at least 1 sample from all patients. All 5 pathology-based second-look positive patients were confirmed positive by molecular second look. Genetic analysis revealed that 3 of the 5 pathology-based negative second looks were actually positive. In the 2 patients, the second-look mutations were present in either the original primary or recurrent tumors. In the third, 2 high-frequency, novel frameshift mutations in MSH6 and HNF1A were identified. CONCLUSIONS: The molecular second look detects tumor-specific evidence of residual disease and provides genetic insight into tumor evolution and future recurrences beyond standard pathology. In the precision medicine era, detecting and genetically characterizing residual disease after standard treatment will be invaluable for improving patient outcomes.


Asunto(s)
Cistadenocarcinoma Seroso/genética , Neoplasias Ováricas/genética , Anciano , Alelos , Cistadenocarcinoma Seroso/patología , Análisis Mutacional de ADN , ADN de Neoplasias/genética , ADN de Neoplasias/aislamiento & purificación , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Persona de Mediana Edad , Mutación , Neoplasias Ováricas/patología , Medicina de Precisión/métodos , Prueba de Estudio Conceptual
5.
Health Care Manag (Frederick) ; 37(2): 129-135, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29521892

RESUMEN

Decreasing health care expenditures has been one of the main objectives of the Affordable Care Act. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the Affordable Care Act on physician reimbursement rates from CMS to determine the most cost-effective method of delivering health care services. The CMS has experimented with payment methods in an attempt to increase cost-effectiveness. Medicare has offered shared cost-savings incentives to reward quality care to both primary care providers and preventative services. The CMS has determined fee-for-service payments obsolete, opting instead for a value-based purchasing method of payment. Although a universal payment method has yet to be adopted, it has been evident that a value-based purchasing model and preventative care can be used to decrease health care expenditure.


Asunto(s)
Medicare , Patient Protection and Affordable Care Act , Calidad de la Atención de Salud , Compra Basada en Calidad , Gastos en Salud , Estados Unidos
6.
Biochim Biophys Acta ; 1839(3): 178-90, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24412853

RESUMEN

The spatial organization of the nucleus results in a compartmentalized structure that affects all aspects of nuclear function. This compartmentalization involves genome organization as well as the formation of nuclear bodies and plays a role in many functions, including gene regulation, genome stability, replication, and RNA processing. Here we review the recent findings associated with the spatial organization of the nucleus and reveal that a common theme for nuclear proteins is their ability to participate in a variety of functions and pathways. We consider this multiplicity of function in terms of Crowdsourcing, a recent phenomenon in the world of information technology, and suggest that this model provides a novel way to synthesize the many intersections between nuclear organization and function. This article is part of a Special Issue entitled: Chromatin and epigenetic regulation of animal development.


Asunto(s)
Núcleo Celular/metabolismo , Replicación del ADN/fisiología , Regulación de la Expresión Génica/fisiología , Inestabilidad Genómica/fisiología , Procesamiento Postranscripcional del ARN/fisiología , Animales , Núcleo Celular/genética , Humanos
7.
JAMA Neurol ; 81(6): 619-629, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38619853

RESUMEN

Importance: Factors associated with clinical heterogeneity in Alzheimer disease (AD) lay along a continuum hypothesized to associate with tangle distribution and are relevant for understanding glial activation considerations in therapeutic advancement. Objectives: To examine clinicopathologic and neuroimaging characteristics of disease heterogeneity in AD along a quantitative continuum using the corticolimbic index (CLix) to account for individuality of spatially distributed tangles found at autopsy. Design, Setting, and Participants: This cross-sectional study was a retrospective medical record review performed on the Florida Autopsied Multiethnic (FLAME) cohort accessioned from 1991 to 2020. Data were analyzed from December 2022 to December 2023. Structural magnetic resonance imaging (MRI) and tau positron emission tomography (PET) were evaluated in an independent neuroimaging group. The FLAME cohort includes 2809 autopsied individuals; included in this study were neuropathologically diagnosed AD cases (FLAME-AD). A digital pathology subgroup of FLAME-AD cases was derived for glial activation analyses. Main Outcomes and Measures: Clinicopathologic factors of heterogeneity that inform patient history and neuropathologic evaluation of AD; CLix score (lower, relative cortical predominance/hippocampal sparing vs higher, relative cortical sparing/limbic predominant cases); neuroimaging measures (ie, structural MRI and tau-PET). Results: Of the 2809 autopsied individuals in the FLAME cohort, 1361 neuropathologically diagnosed AD cases were evaluated. A digital pathology subgroup included 60 FLAME-AD cases. The independent neuroimaging group included 93 cases. Among the 1361 FLAME-AD cases, 633 were male (47%; median [range] age at death, 81 [54-96] years) and 728 were female (53%; median [range] age at death, 81 [53-102] years). A younger symptomatic onset (Spearman ρ = 0.39, P < .001) and faster decline on the Mini-Mental State Examination (Spearman ρ = 0.27; P < .001) correlated with a lower CLix score in FLAME-AD series. Cases with a nonamnestic syndrome had lower CLix scores (median [IQR], 13 [9-18]) vs not (median [IQR], 21 [15-27]; P < .001). Hippocampal MRI volume (Spearman ρ = -0.45; P < .001) and flortaucipir tau-PET uptake in posterior cingulate and precuneus cortex (Spearman ρ = -0.74; P < .001) inversely correlated with CLix score. Although AD cases with a CLix score less than 10 had higher cortical tangle count, we found lower percentage of CD68-activated microglia/macrophage burden (median [IQR], 0.46% [0.32%-0.75%]) compared with cases with a CLix score of 10 to 30 (median [IQR], 0.75% [0.51%-0.98%]) and on par with a CLix score of 30 or greater (median [IQR], 0.40% [0.32%-0.57%]; P = .02). Conclusions and Relevance: Findings show that AD heterogeneity exists along a continuum of corticolimbic tangle distribution. Reduced CD68 burden may signify an underappreciated association between tau accumulation and microglia/macrophages activation that should be considered in personalized therapy for immune dysregulation.


Asunto(s)
Enfermedad de Alzheimer , Imagen por Resonancia Magnética , Neuroglía , Tomografía de Emisión de Positrones , Humanos , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/patología , Enfermedad de Alzheimer/metabolismo , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Neuroglía/patología , Neuroglía/metabolismo , Estudios Transversales , Estudios Retrospectivos , Ovillos Neurofibrilares/patología , Proteínas tau/metabolismo , Persona de Mediana Edad , Neuroimagen , Estudios de Cohortes , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Encéfalo/metabolismo , Autopsia
8.
BMJ Open ; 13(8): e069625, 2023 08 16.
Artículo en Inglés | MEDLINE | ID: mdl-37586867

RESUMEN

OBJECTIVES: Ocular pain is a commonly reported finding in the intravitreal injection procedure, but post-injection experiences and patient adherence to treatment remain underexplored. We therefore aimed to identify key variations in the intravitreal injection procedure that may influence pain, and to gain insights into the post-injection experience and treatment adherence from the perspective of patients and practitioners. DESIGN: Qualitative semistructured interview study using reflexive thematic analysis of transcripts. SETTING: Hospital Eye Clinic in Wales, UK. Interviews were conducted between May and September 2019. PARTICIPANTS: Purposive sample of patients aged ≥50 years with neovascular age-related macular degeneration and no other retinal pathology who had received at least six intravitreal injections, and practitioners including ophthalmologists, registered nurses and optometrists who performed intravitreal injections at the research site. RESULTS: Data saturation was reached with 21 interviews: 14 patients and 7 practitioners. Three main themes were identified from the analysis: fear of losing eyesight and treatment anxiety influence patient adherence to treatment, variability in pain experience during treatment, and post-injection experience and impact on patient recovery. To reassure patients feeling apprehensive about the injections, practitioners promoted safety and trust, and used techniques to manage anxiety. Key variations that may influence pain identified were application of antiseptic or anaesthetic, injecting methods and communication. During injection, patients reported a dull-aching and sharp pain, contrary to practitioners' perspective of feeling a 'pressure'. Patients described prolonged soreness and irritation of up to 36 hours post-injection affecting their sleep and recovery. CONCLUSION: Establishing rapport supported patients to recognise the necessity of ongoing treatment to prevent sight loss; however, inadequate pain management led to undesirable outcomes. Practitioners should use pain assessment tools during and immediately after injection and provide ongoing consistent information to help patients manage pain at home.


Asunto(s)
Degeneración Macular , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Dolor/tratamiento farmacológico , Dolor/etiología , Ansiedad/etiología , Emociones
9.
Methods Mol Biol ; 2709: 131-147, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37572277

RESUMEN

Silver and gold nanoparticle-aptamer conjugates have been extensively utilized as biosensors and microscopic vehicles that deliver a therapeutic cargo to cells. Here, we describe facile procedures to attach nucleic acid aptamers with a free thiol group to silver or gold nanoparticles. Methods to purify the nanoparticle-aptamer conjugates, verify aptamer attachment, and quantify aptamer-nanoparticle ratios are also discussed and compared. Additionally, a simple protocol that describes the aqueous synthesis of gold nanoparticles (~10 nm) is included.


Asunto(s)
Aptámeros de Nucleótidos , Técnicas Biosensibles , Nanopartículas del Metal , Ácidos Nucleicos , Oligonucleótidos , Oro , Plata , Compuestos de Sulfhidrilo
10.
Graefes Arch Clin Exp Ophthalmol ; 249(9): 1359-65, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21287189

RESUMEN

BACKGROUND: The ERG photostress test assesses the recovery of the focal 41 Hz ERG following exposure to a bright light that bleaches a significant proportion of photopigment. The aims of this study were: 1) to compare the repeatability of the ERG photostress test recovery time constant following long and short duration light exposure, and 2) to determine the effect of age on the ERG photostress test recovery time constant. METHODS: Focal 41 Hz ERGs were recorded from 23 participants (age range 20-71 years) at 20-second intervals for 5 minutes following either a short-duration (photoflash) or long-duration (equilibrium) light exposure. After a 5-minute wash-out period, the procedure was repeated using the second bleach modality. The time constant of cone recovery was determined by fitting an exponential model to the amplitude recovery data. The whole procedure was repeated on a second occasion. The co-efficient of repeatability (CoR) was calculated for each bleaching technique. The relationship between the time constant of recovery and age was investigated (Pearson's correlation coefficient). RESULTS: The time constant of recovery following an equilibrium bleach was more repeatable than recovery following a photoflash (CoR = 85s and 184s respectively). Eight trials (from seven participants) failed to show a reduction in amplitude following the photoflash, suggesting that a blink or fixation loss had occurred. All participants were reliably light-adapted by the equilibrium bleach. For the equilibrium bleach data, the time constant of recovery increased with age at a rate of 27 seconds per decade. CONCLUSIONS: The equilibrium bleach was more reliable and repeatable than the photoflash. Increasing participant age was shown to result in a lengthening of the recovery time constant, of a magnitude comparable to previously published psychophysical data.


Asunto(s)
Adaptación Ocular/fisiología , Envejecimiento/fisiología , Electrorretinografía/métodos , Electrorretinografía/normas , Estimulación Luminosa/métodos , Visión Ocular/fisiología , Adulto , Anciano , Humanos , Persona de Mediana Edad , Modelos Neurológicos , Reproducibilidad de los Resultados , Células Fotorreceptoras Retinianas Conos/fisiología , Pigmentos Retinianos/fisiología , Factores de Tiempo , Adulto Joven
11.
Ren Fail ; 33(8): 785-8, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21777171

RESUMEN

There is a paucity of outcome data for critically ill patients with combined acute liver and kidney injury secondary to paracetamol overdose (POD) requiring renal replacement therapy (RRT). We retrospectively reviewed all admissions over a 6-year period to the intensive care unit (ICU) at a university teaching hospital which supports an active liver transplant program. Of the 5582 admissions over this period, 73 patients were admitted with combined liver and kidney injury requiring RRT, and of these 10 patients went on to receive a liver transplant. Overall mortality was 58%, being lower at 20% for transplant recipients. Transplant recipients were younger than non-transplanted patients with similar global disease severity scores [Model for End-Stage Liver Disease (MELD) and Acute Physiology and Chronic Health Evaluation II (APACHE II)]. Patients with a higher MELD or APACHE II score fared worse and patients fulfilling the King's College Hospital transplant criteria on admission had an odds ratio (OR) for death of 3.8 (1.3-10.6). Logistic regression modeling found that only a higher admission bilirubin OR 1.6 (1.1-2.3) mg/dL and a lower creatinine OR 0.52 (0.3-0.9) mg/dL were predictive of mortality. Of the ICU survivors, 41% remained RRT dependant at the time of ICU discharge; all regained independent renal function by 1 month. Combined severe acute liver and kidney injury secondary to POD requiring RRT is associated with a high mortality. The majority of survivors recover independent kidney function by 1 month. Standard disease severity scores appear to reflect prognosis in these patients.


Asunto(s)
Acetaminofén/toxicidad , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/terapia , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Terapia de Reemplazo Renal , Lesión Renal Aguda/complicaciones , Adulto , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Crítica , Femenino , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
12.
Fish Physiol Biochem ; 37(4): 809-19, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21461903

RESUMEN

Atlantic sturgeon (Acipenser oxyrhynchus), which are bottom dwelling and migratory fish, experience environmental hypoxia in their natural environment. Atlantic sturgeon, acclimated to either 5 or 15°C, were subjected to a 1 h severe (<10 mm Hg) hypoxia challenge in order to document their physiological responses. We measured hematological parameters, including O(2) transport (hemoglobin, hematocrit), ionic (chloride, osmolality), and metabolic (glucose, lactate) variables under normoxic conditions (~160 mm Hg), immediately following a 1 h exposure to hypoxic water, and following a further 2 h of recovery from this challenge in normoxic water. In a second experiment, we assessed the opercular beat frequency before, during, and after hypoxic exposure. Hemoglobin concentrations and hematocrit were significantly different between fish held at 5°C vs. 15°C and also significantly different between normoxia prior to hypoxia and following recovery. Plasma lactate concentrations increased following hypoxia at both temperatures, indicative of an increase in anaerobic metabolism. In contrast, a significant increase in plasma glucose concentrations in response to hypoxia only occurred at 5°C, suggesting different fuel demands under different temperatures. Changes in opercular beat frequency (OBF) were dependent on temperature. At 5°C, OBF increased upon exposure to hypoxia, but returned to pre-exposure levels within 35 min for the remainder of the experiment. During hypoxia at 15°C, OBF increased very briefly, but then rapidly (within 20 min) decreased to levels below control values. Following a return to normoxia, OBF quickly increased to control levels. Overall, these findings suggest that Atlantic sturgeons are relatively tolerant to short-term and severe hypoxic stress, and the strategies for hypoxia tolerance may be temperature dependent.


Asunto(s)
Peces/fisiología , Hipoxia/fisiopatología , Oxígeno/fisiología , Temperatura , Aclimatación , Animales , Glucemia/metabolismo , Cloruros/metabolismo , Ácido Láctico/metabolismo , Concentración Osmolar
13.
Transl Vis Sci Technol ; 10(1): 27, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-34008019

RESUMEN

Purpose: To evaluate the performance of the Pegasus-OCT (Visulytix Ltd) multiclass automated fluid segmentation algorithms on independent spectral domain optical coherence tomography data sets. Methods: The Pegasus automated fluid segmentation algorithms were applied to three data sets with edematous pathology, comprising 750, 600, and 110 b-scans, respectively. Intraretinal fluid (IRF), sub-retinal fluid (SRF), and pigment epithelial detachment (PED) were automatically segmented by Pegasus-OCT for each b-scan where ground truth from data set owners was available. Detection performance was assessed by calculating sensitivities and specificities, while Dice coefficients were used to assess agreement between the segmentation methods. Results: For two data sets, IRF detection yielded promising sensitivities (0.98 and 0.94, respectively) and specificities (1.00 and 0.98) but less consistent agreement with the ground truth (dice coefficients 0.81 and 0.59); likewise, SRF detection showed high sensitivity (0.86 and 0.98) and specificity (0.83 and 0.89) but less consistent agreement (0.59 and 0.78). PED detection on the first data set showed moderate agreement (0.66) with high sensitivity (0.97) and specificity (0.98). IRF detection in a third data set yielded less favorable agreement (0.46-0.57) and sensitivity (0.59-0.68), attributed to image quality and ground truth grader discordance. Conclusions: The Pegasus automated fluid segmentation algorithms were able to detect IRF, SRF, and PED in SD-OCT b-scans acquired across multiple independent data sets. Dice coefficients and sensitivity and specificity values indicate the potential for application to automated detection and monitoring of retinal diseases such as age-related macular degeneration and diabetic macular edema. Translational Relevance: The potential of Pegasus-OCT for automated fluid quantification and differentiation of IRF, SRF, and PED in OCT images has application to both clinical practice and research.


Asunto(s)
Retinopatía Diabética , Edema Macular , Algoritmos , Retinopatía Diabética/diagnóstico por imagen , Humanos , Líquido Subretiniano/diagnóstico por imagen , Tomografía de Coherencia Óptica
14.
Ann Thorac Surg ; 111(1): 62-68, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32585202

RESUMEN

BACKGROUND: Decompensation of liver function after cardiac surgery in patients with cirrhosis has resulted in high morbidity and mortality. A treatment strategy, for which there is a scarcity of data in the literature, encompasses combined liver transplantation and cardiac surgery. METHODS: We performed a retrospective analysis of prospectively collected data on 15 patients who underwent combined liver transplantation and cardiac surgery between 2005 to 2017 at our institution. RESULTS: Between 2005 and 2017, 15 patients with cirrhosis and coronary artery disease or valve disease were identified who underwent combined liver transplantation and cardiac surgery. The cardiac disease was considered severe enough to preclude liver transplantation alone. Likewise, the advanced cirrhosis precluded cardiac surgery alone. Eighty percent of the patients were male and average age was 60 years. Six patients had coronary artery disease, 2 patients had severe aortic stenosis and coronary artery disease, 1 patient had severe mitral regurgitation and coronary artery disease, 2 patients had severe aortic stenosis, 1 patient had mitral valve prolapse, and 3 patients had severe aortic insufficiency. The mean model for end-stage liver disease score was 24. Four subjects were Child-Pugh class B, and 11 were class C. One-year survival was 73.3%. CONCLUSIONS: Combined liver transplant and cardiac surgery is feasible in this selected, otherwise inoperable, patient population with an acceptable early and midterm survival when performed in high volume centers with a cohesive multidisciplinary team.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Trasplante de Hígado , Adulto , Anciano , Puente de Arteria Coronaria/efectos adversos , Femenino , Humanos , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
15.
Clin Liver Dis (Hoboken) ; 15(2): 81-84, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32226622

RESUMEN

http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-reading-wood a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-interview-lindenmeyer an interview with the author.

16.
Sci Rep ; 10(1): 4494, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32161284

RESUMEN

We describe a new technique, high fidelity Imaging Retinal Densitometry (IRD), which probes the functional integrity of the outer retinal complex. We demonstrate the ability of the technique to map visual pigment optical density and synthesis rates in eyes with and without macular disease. A multispectral retinal imaging device obtained precise measurements of retinal reflectance over space and time. Data obtained from healthy controls and 5 patients with intermediate AMD, before and after photopigment bleaching, were used to quantify visual pigment metrics. Heat maps were plotted to summarise the topography of rod and cone pigment kinetics and descriptive statistics conducted to highlight differences between those with and without AMD. Rod and cone visual pigment synthesis rates in those with AMD (v = 0.043 SD 0.019 min-1 and v = 0.119 SD 0.046 min-1, respectively) were approximately half those observed in healthy controls (v = 0.079 SD 0.024 min-1 for rods and v = 0.206 SD 0.069 min-1 for cones). By mapping visual pigment kinetics across the central retina, high fidelity IRD provides a unique insight into outer retinal complex function. This new technique will improve the phenotypic characterisation, diagnosis and treatment monitoring of various ocular pathologies, including AMD.


Asunto(s)
Densitometría/métodos , Imagen Óptica/métodos , Retina/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Densitometría/normas , Humanos , Imagenología Tridimensional , Rayos Infrarrojos , Degeneración Macular/diagnóstico por imagen , Degeneración Macular/patología , Imagen Óptica/normas , Retina/patología , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Epitelio Pigmentado de la Retina/patología
17.
Am J Ophthalmol ; 206: 87-93, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30905725

RESUMEN

PURPOSE: To test the hypothesis that refractive errors such as myopia and hyperopia cause an increased risk of age-related macular degeneration (AMD) and to quantify the degree of risk. DESIGN: Two-sample Mendelian randomization analysis of data from a genome-wide association study. PARTICIPANTS: As instrumental variables for refractive error, 126 genome-wide significant genetic variants identified by the Consortium for Refractive Error and Myopia and 23andMe Inc. were chosen. The association with refractive error for the 126 variants was obtained from a published study for a sample of 95,505 European ancestry participants from UK Biobank. Association with AMD for the 126 genetic variants was determined from a genome-wide association study (GWAS) published by the International Age-related Macular Degeneration Genomics consortium of 33,526 (16,144 cases and 17,832 controls) European ancestry participants. METHODS: Two-sample Mendelian randomization (MR) analysis was used to assess the causal role of refractive error on AMD risk, using the 126 genetic variants associated with refractive error as instrumental variables, under the assumption that the relationship between refractive error and AMD risk is linear. MAIN OUTCOME MEASUREMENT: the risk AMD was caused by a 1-diopter (D) change in refractive error. RESULTS: MR analysis suggested that refractive error had very limited influence on the risk of AMD. Specifically, 1 D more hyperopic refractive error was associated with an odds ratio (OR) of 1.080 (95% confidence interval [CI], 1.021-1.142; P = 0.007) increased risk of AMD. MR-Egger, MR pleiotropy residual sum and outlier, weighted median, and Phenoscanner-based sensitivity analyses detected minimal evidence to suggest that this result was biased by horizontal pleiotropy. CONCLUSIONS: Under the assumption of a linear relationship between refractive error and the risk of AMD, myopia and hyperopia only minimally influence the causal risk for AMD. Thus, inconsistently reported strong associations between refractive error and AMD are likely to be the result of noncausal factors such as stochastic variation, confounding, or selection bias.


Asunto(s)
Proteínas del Ojo/genética , Degeneración Macular/genética , Análisis de la Aleatorización Mendeliana/métodos , Polimorfismo de Nucleótido Simple , Errores de Refracción/genética , Medición de Riesgo/métodos , Adulto , Femenino , Humanos , Degeneración Macular/epidemiología , Degeneración Macular/etiología , Masculino , Prevalencia , Errores de Refracción/complicaciones , Errores de Refracción/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología
18.
Artículo en Inglés | MEDLINE | ID: mdl-18577462

RESUMEN

Acid-soluble collagen (ASC) and pepsin solubilized collagen (PSC) isolated and purified from alligator (Alligator mississippiensis) bone were studied for molecular size, amino acid profile, secondary structure, and denaturation temperature by SDS-PAGE, HPLC, circular dichroism, and viscometry. Two collagen subunits, alpha1 and alpha2 were identified by SDS-PAGE. The molecular masses for alpha1 and alpha2 chains of ASC were 124 kDa and 111 kDa, respectively. The molecular masses were 123 kDa for alpha1 and 110 kDa for alpha2 chains of the PSC preparation. The molecular masses for ([alpha1](2) alpha2) of ASC and PSC were 359 kDa and 356 kDa, respectively. The major composition of alligator bone ASC and PSC was found to be typical type I collagen. The amino acid profiles of alligator ASC and PSC were similar to amino acid profile of subtropical fish black drum (Pogonias cromis, Sciaenidae) bone. Comparison of amino acid profiles with shark cartilage PSC, showed differences in alanine, hydroxylysine, lysine, and histidine contents. The denaturation temperatures (T(d)) of alligator ASC and PSC collagen measured by viscometry were 38.1 and 38.2 degrees C, respectively. Thermal denaturation temperatures, measured by melting point using circular dichroism, were 37.6 and 37.9 degrees C, respectively. Taken together, these results suggest that alligator bone collagen may find a wide range of applications in biological research, functional foods and nutraceuticals, and biomedical and pharmaceutical research.


Asunto(s)
Caimanes y Cocodrilos/metabolismo , Huesos/química , Colágeno/química , Animales , Colágeno/aislamiento & purificación , Colágeno/metabolismo , Estructura Secundaria de Proteína
19.
Acad Med ; 93(11): 1707-1712, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29596083

RESUMEN

PURPOSE: Academic scientists work in competitive environments, and many institutions invest in career development supports. These investments may be imperiled when extraprofessional demands challenge a faculty member's reserve capacity. This research assessed prevalence of caregiving challenges and estimated incidence of stressful life events. METHOD: In 2015-2016, the authors surveyed recipients of career development awards supporting ≥ 75% effort and individuals within the funding period of their first National Institutes of Health R01 or equivalent at Vanderbilt University Medical Center. Domains included family structure, hospitalizations of family members, responsibility for coordination of caregiving, and an inventory of stressful life events. RESULTS: Seventy-two percent (152 of 210) of early career researchers responded. Over half endorsed experiencing one or more substantial caregiving challenges in the prior year. This included 35 (23%) having a child or adult in the household hospitalized in the prior year and 36 (24%) being responsible for health care needs for a child or adult in the household, or for coordinating elder care, assisted living, or hospice care. The majority experienced one or more caregiving challenges. Stressful life events increased relative risk of "thinking about leaving academics" by 70% (risk ratio: 1.7; 95% confidence interval: 1.2, 2.4). Prevalence and incidence of caregiving demands did not differ by gender. CONCLUSIONS: Leaders, administrators, mentors, and faculty should anticipate that most women and men early career researchers will experience substantial caregiving challenges and life events in any given year. Sufficient need exists to warrant investigation of institutional programs to address caregiving challenges.


Asunto(s)
Docentes Médicos/psicología , Estrés Laboral/epidemiología , Centros Médicos Académicos , Adulto , Investigación Biomédica , Movilidad Laboral , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Laboral/psicología , Encuestas y Cuestionarios , Estados Unidos
20.
PLoS One ; 11(9): e0162001, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27588683

RESUMEN

Retinal and intra-retinal layer thicknesses are routinely generated from optical coherence tomography (OCT) images, but on-board software capabilities and image scaling assumptions are not consistent across devices. This study evaluates the device-independent Iowa Reference Algorithms (Iowa Institute for Biomedical Imaging) for automated intra-retinal layer segmentation and image scaling for three OCT systems. Healthy participants (n = 25) underwent macular volume scans using a Cirrus HD-OCT (Zeiss), 3D-OCT 1000 (Topcon), and a non-commercial long-wavelength (1040nm) OCT on two occasions. Mean thickness of 10 intra-retinal layers was measured in three ETDRS subfields (fovea, inner ring and outer ring) using the Iowa Reference Algorithms. Where available, total retinal thicknesses were measured using on-board software. Measured axial eye length (AEL)-dependent scaling was used throughout, with a comparison made to the system-specific fixed-AEL scaling. Inter-session repeatability and agreement between OCT systems and segmentation methods was assessed. Inter-session coefficient of repeatability (CoR) for the foveal subfield total retinal thickness was 3.43µm, 4.76µm, and 5.98µm for the Zeiss, Topcon, and long-wavelength images respectively. For the commercial software, CoR was 4.63µm (Zeiss) and 7.63µm (Topcon). The Iowa Reference Algorithms demonstrated higher repeatability than the on-board software and, in addition, reliably segmented all 10 intra-retinal layers. With fixed-AEL scaling, the algorithm produced significantly different thickness values for the three OCT devices (P<0.05), with these discrepancies generally characterized by an overall offset (bias) and correlations with axial eye length for the foveal subfield and outer ring (P<0.05). This correlation was reduced to an insignificant level in all cases when AEL-dependent scaling was used. Overall, the Iowa Reference Algorithms are viable for clinical and research use in healthy eyes imaged with these devices, however ocular biometry is required for accurate quantification of OCT images.


Asunto(s)
Retina/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Adulto , Algoritmos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Retina/anatomía & histología , Programas Informáticos , Adulto Joven
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