POSTERIOR TRACTIONAL MEMBRANES FOLLOWING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR RETINOPATHY OF PREMATURITY.

PURPOSE: To report two cases of tractional membrane formation following treatment with anti-vascular endothelial growth factor therapy in infants with Stage-3 retinopathy of prematurity. METHODS: Retrospective review of electronic medical record for historical information, clinical examination documentation, and imaging from fundus photography, retinal ultrasonography, and fluorescein angiography. RESULTS: Two patients with Stage-3 retinopathy of prematurity, previously treated with laser therapy and intravitreal bevacizumab, were referred to our institution for tractional membranes. The first case is of a male infant with Zone-II disease that progressed to Stage 4A with evidence of inferotemporal tractional retinal detachment only in the left eye. The second case is of a male infant with stable Zone-I disease with an epiretinal membrane in the left eye.Pars plicata vitrectomy and membranectomy were required for both cases because of the concern for subsequent tractional retinal detachment. CONCLUSION: Formation of tractional retinal membranes has been associated with anti-vascular endothelial growth factor therapy. These cases describe the formation of posterior tractional membranes after anti-vascular endothelial growth factor therapy. This potential ocular outcome should be considered when determining treatment plans for retinopathy of prematurity.

Assessment of blood lead level declines in an area of historical mining with a holistic remediation and abatement program.

UNLABELLED: Lead exposure and blood lead levels (BLLs) in the United States have declined dramatically since the 1970s as many widespread lead uses have been discontinued. Large scale mining and mineral processing represents an additional localized source of potential lead exposure in many historical mining communities, such as Butte, Montana. After 25 years of ongoing remediation efforts and a residential metals abatement program that includes blood lead monitoring of Butte children, examination of blood lead trends offers a unique opportunity to assess the effectiveness of Butte's lead source and exposure reduction measures. This study examined BLL trends in Butte children ages 1-5 (n= 2796) from 2003-2010 as compared to a reference dataset matched for similar demographic characteristics over the same period. Blood lead differences across Butte during the same period are also examined. Findings are interpreted with respect to effectiveness of remediation and other factors potentially contributing to ongoing exposure concerns. REFERENCE POPULATION COMPARISON: BLLs from Butte were compared with a reference dataset (n=2937) derived from the National Health and Nutrition Examination Survey. The reference dataset was initially matched for child age and sample dates. Additional demographic factors associated with higher BLLs were then evaluated. Weights were applied to make the reference dataset more consistent with the Butte dataset for the three factors that were most disparate (poverty-to-income ratio, house age, and race/ethnicity). A weighted linear mixed regression model showed Butte geometric mean BLLs were higher than reference BLLs for 2003-2004 (3.48vs. 2.05µg/dL), 2005-2006 (2.65vs. 1.80µg/dL), and 2007-2008 (2.2vs. 1.72µg/dL), but comparable for 2009-2010 (1.53vs. 1.51µg/dL). This trend suggests that, over time, the impact of other factors that may be associated with Butte BLLs has been reduced. COMPARISON ACROSS BUTTE: Neighborhood differences were examined by dividing the Butte dataset into the older area called "Uptown", located at higher elevation atop historical mine workings, and "the Flats", at lower elevation and more recently developed. Significant declines in BLLs were observed over time in both areas, though Uptown had slightly higher BLLs than the Flats (2003-2004: 3.57vs. 3.45µg/dL, p=0.7; 2005-2006: 2.84vs. 2.52µg/dL, p=0.1; 2007-2008: 2.58vs. 1.99µg/dL, p=0.001; 2009-2010: 1.71vs. 1.44µg/dL, p=0.02). BLLs were higher when tested in summer/fall than in winter/spring for both neighborhoods, and statistically higher BLLs were found for children in Uptown living in properties built before 1940. Neighborhood differences and the persistence of a greater percentage of high BLLs (>5µg/dL) in Butte vs. the reference dataset support continuation of the home lead abatement program. CONCLUSIONS: Butte BLL declines likely reflect the cumulative effectiveness of screening efforts, community-wide remediation, and the ongoing metals abatement program in Butte in addition to other factors not accounted for by this study. As evidenced in Butte, abatement programs that include home evaluations and assistance in addressing multiple sources of lead exposure can be an important complement to community-wide soil remediation activities.

Improving patient safety via automated laboratory-based adverse event grading.

The identification and grading of adverse events (AEs) during the conduct of clinical trials is a labor-intensive and error-prone process. This paper describes and evaluates a software tool developed by City of Hope to automate complex algorithms to assess laboratory results and identify and grade AEs. We compared AEs identified by the automated system with those previously assessed manually, to evaluate missed/misgraded AEs. We also conducted a prospective paired time assessment of automated versus manual AE assessment. We found a substantial improvement in accuracy/completeness with the automated grading tool, which identified an additional 17% of severe grade 3-4 AEs that had been missed/misgraded manually. The automated system also provided an average time saving of 5.5 min per treatment course. With 400 ongoing treatment trials at City of Hope and an average of 1800 laboratory results requiring assessment per study, the implications of these findings for patient safety are enormous.