Do Patients Seek Women-Centered Cardiac Care? Patient Experience of an All-Female Multidisciplinary Heart Center for Women.

Purpose: Cardiovascular disease in women is frequently under-diagnosed and under-treated. Numerous heart centers for women have opened throughout the world to address these disparities; however, there is a paucity of data regarding participants' perspectives. The current study assesses motivation to participate and perceived benefits in attending a heart center for women (HCW) in Jerusalem, Israel. Methods: This study utilized qualitative methods to assess patients' motivation and perceived benefits to attending a women's heart center, particularly as they relate to gender medicine and single-sex staffing. A random sample of 42 clinic patients were asked to participate in interviews. Inclusionary criteria consisted of previous cardiovascular event, active cardiac symptom or three or more cardiovascular disease risk factors. Exclusionary criteria consisted of pregnancy, type 1 diabetes requiring insulin, psychiatric diagnosis that precluded participation, dementia, or other multidisciplinary clinic participation. Interviews were audio recorded and transcribed verbatim. Qualitative data analysis followed Braun and Clarke's methodology of thematic analysis. Results: The single-sex and gender medicine aspects did not motivate women to attend the HCW, although some participants perceived this as beneficial in retrospect. Women reported that the clinic visit enhanced their knowledge and awareness of issues related to heart disease in women as well as personal health benefits. They reported benefitting from the holistic approach, consideration of their lifestyle, the staff's expression of concern, personalized attention, common language, and feeling understood. Conclusion: This study describes the patient experience in an all-female HCW, highlighting their motivation for attendance and perceived benefits. While they did not actively seek women-centered care, women reported educational and care provision benefits to their attendance. The care attributes that women identified as beneficial typify the person-centered approach to care. These findings may inform both the design and evaluation of medical care facilities that aim to address the sex and gender disparities in cardiology as well as other medical specialties.

Deep Intrastromal Arcuate Keratotomy With In Situ Keratomileusis (DIAKIK) for the Treatment of High Astigmatism After Keratoplasty: 2-Year Follow-up.

PURPOSE: To describe 2-year results of deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) for the treatment of high astigmatism after keratoplasty. METHODS: This prospective study included 20 eyes from 20 patients presenting with high astigmatism after keratoplasty. All were treated by two-step femtosecond laser surgery, with two intrastromal arcuate keratotomies and a corneal flap, followed a few months later by excimer photoablation after reopening of the flap. RESULTS: At 24 months, both uncorrected (UDVA) and corrected (CDVA) distance visual acuity had improved from 1.12 ± 0.42 logMAR (20/200 Snellen) before surgery to 0.58 ± 0.23 logMAR (20/80 Snellen) (P < .001) and from 0.31 ± 0.26 logMAR (20/40 Snellen) to 0.20 ± 0.20 logMAR (20/32 Snellen) (P = .04), respectively. The mean spherical equivalent improved from -5.01 ± 4.35 to -1.54 ± 2.42 diopters. The mean efficacy index was 0.63. The mean correction index was 0.93 ± 0.32. The mean flattening index was 1.09 ± 0.75 and the mean safety index was 1.39. No graft rejection or epithelial ingrowth was observed. CONCLUSIONS: This two-step procedure was an effective treatment for high astigmatism after keratoplasty. The use of both femtosecond and excimer lasers helped to avoid some complications that would have jeopardized the grafts. Refractive and topographic stability was good 2 years after surgery. [J Refract Surg. 2019;35(4):239-246.].

Corneal Neurotization With a Great Auricular Nerve Graft: Effective Reinnervation Demonstrated by In Vivo Confocal Microscopy.

PURPOSE: We describe the first case of minimally invasive corneal neurotization with the great auricular nerve (GAN) to treat unilateral neurotrophic keratopathy. We assessed corneal sensation and reinnervation by esthesiometry and confocal microscopy over 12 months of follow-up, and we provide a detailed description of the surgical technique. METHODS: Corneal neurotization was successfully achieved with the ipsilateral GAN in a 58-year-old woman. Cochet-Bonnet esthesiometry and in vivo confocal microscopy were performed before and after corneal neurotization, to monitor the recovery of corneal sensation and corneal reinnervation by subbasal nerve fibers. RESULTS: Neurotrophic keratopathy was a complication of the surgical treatment of meningioma. Before surgery, the patient had no corneal sensation or corneal innervation. Six months after surgery, confocal microscopy confirmed regrowth of a large number of nerve fibers in the subepithelial space of the cornea. Nine months after surgery, a central esthesiometry score of 10-mm was attained. CONCLUSIONS: Corneal neurotization leads to reinnervation of the cornea and recovery of ocular sensation in adults. The GAN is suitable for use in corneal neurotization because of its anatomical proximity and the low level of associated morbidity. Confocal microscopy demonstrated the occurrence of corneal reinnervation, which preceded the recovery of corneal sensation.

Increased corneal sub-basal nerve density in patients with Sjögren syndrome treated with topical cyclosporine A.

BACKGROUND: To evaluate quantitative and qualitative changes in sub-basal corneal nerves (SBN) via in vivo confocal microscopy in patients with Sjögren syndrome dry eye (SSDE) treated with topical cyclosporine A (CsA). DESIGN: Prospective, observational, non-randomized study. PARTICIPANTS: Thirty eyes of 30 patients with SSDE refractory to conventional treatment treated with CsA 0.05% twice daily for 6 months. Fifteen eyes of 15 healthy, age and gender matched, volunteers constituted the control group at baseline. METHODS: A clinical evaluation of dry eye, corneal sensation using Cochet-Bonnet esthesiometry and in vivo confocal microscopy analysis of the central cornea were performed prospectively at baseline for all patients, and after 6 months of treatment with CsA. MAIN OUTCOME MEASURES: Density, number, reflectivity and tortuosity of SBN, dendritic cell (DC) density, esthesiometry, and dry eye signs and symptoms. RESULTS: Topical CsA 0.05% improved clinical signs and symptoms, and increased corneal sensitivity. Following treatment, SBN density was significantly increased (P < 0.0001) associated with a decreased in DC density (P < 0.0001). The increase in SBN density after treatment was positively correlated with baseline SBN density (R2  = 0.33; P = 0.0008) and negatively correlated with baseline Ocular Surface Disease Index (R2  = 0.28; P = 0.002), Oxford score (R2  = 0.31; P = 0.002), and DC density (R2  = 0.37; P = 0.0003). CONCLUSIONS: Topical CsA led to an increase in corneal SBN density, improving clinical signs and symptoms of SSDE. Our results also suggest an improved response to treatment in patients with less initial nerve damage.

Derivation of xeno-free and GMP-grade human embryonic stem cells--platforms for future clinical applications.

Clinically compliant human embryonic stem cells (hESCs) should be developed in adherence to ethical standards, without risk of contamination by adventitious agents. Here we developed for the first time animal-component free and good manufacturing practice (GMP)-compliant hESCs. After vendor and raw material qualification, we derived xeno-free, GMP-grade feeders from umbilical cord tissue, and utilized them within a novel, xeno-free hESC culture system. We derived and characterized three hESC lines in adherence to regulations for embryo procurement, and good tissue, manufacturing and laboratory practices. To minimize freezing and thawing, we continuously expanded the lines from initial outgrowths and samples were cryopreserved as early stocks and banks. Batch release criteria included DNA-fingerprinting and HLA-typing for identity, characterization of pluripotency-associated marker expression, proliferation, karyotyping and differentiation in-vitro and in-vivo. These hESCs may be valuable for regenerative therapy. The ethical, scientific and regulatory methodology presented here may serve for development of additional clinical-grade hESCs.