A Retrospective Study of Visual Outcomes When Using a Cloud-Based Surgical Planning Platform and the Barrett Universal II Formula.

Purpose: To evaluate the efficacy of a cloud-based surgical planning platform with regards to refractive target accuracy. Methods: This was a retrospective chart review of consecutive cases from January 2022 through December 2023. Surgical planning was performed using the SMARTCataract platform, eyes were implanted with Clareon monofocal IOLs, and power calculations were done using the Barrett Universal II formula. Data were collected for the percentage of eyes within ±0.5 D of target refraction, mean absolute error (MAE), and postoperative visual acuity. Results: A total of 148 eyes were identified that met the inclusion/exclusion criteria. The percentage of eyes within ±0.5 D of the planned target was 94%. The MAE was 0.25 ± 0.17 D. In addition, 57%, 93%, 98%, and 100% of eyes had MAE ≤ 0.25 D, ≤ 0.5 D, ≤ 0.75 D, and ≤ 1.0 D, respectively. Conclusion: The results of this study suggest high refractive accuracy when using the SMARTCataract planning platform with the Barrett Universal II formula and excellent distance visual acuity.

When the natural lens inside the eye develops a cataract (becomes opaque) it can be replaced with a clear artificial intraocular lens (IOL). Good visual outcomes after surgery are heavily reliant on implanting the optimal lens power. A new cloud-based surgical planning tool (SMARTCataract) aims to automatically use patient data, surgeon preferences, favored IOL power calculation formulas, and desired IOL type to guide surgical planning. However, to date there are no data on the refractive outcomes when using the SMARTCataract platform. The purpose of this study was to evaluate the efficacy of the SMARTCataract platform with regards to refractive target accuracy. The results of this study suggest high refractive accuracy when using the SMARTCataract platform with the Barrett Universal II formula and excellent distance visual acuity.

Short-term outcomes in premature neonates adhering to the philosophy of supportive care allowing for weight gain and organ maturation prior to cardiac surgery.

BACKGROUND: Prematurity is a recognized risk factor for morbidity and mortality following cardiac surgery. The purpose of this study was to examine short-term outcomes following cardiac surgery in premature neonates adhering to our institutional philosophy of supportive care allowing for weight gain and organ maturation. METHODS: Retrospective review of all neonates undergoing cardiac surgery from January 2002 to May 2008. A total of 810 neonates (<30 days of age) were identified. Prematurity defined as less than 36 weeks of gestation. Neonates undergoing ductus arteriosus ligation alone were excluded. In all, 63 neonates comprised the premature group. Term group comprised 244 randomly selected term neonates in a 1:4 ratio. Outcome variables were compared between the 2 groups. RESULTS: Median gestation 34 weeks, range 24 to 35 weeks. Defects: 2 ventricle, normal arch (41% premature vs 44% term; P = .7), 2 ventricle, abnormal arch (24% vs 22%; P = .8), single ventricle, normal arch (21% vs 15%; P = .2), single ventricle, abnormal arch (14% vs 19%; P = .4). Premature neonates were older and smaller at surgery. Cardiopulmonary bypass procedures were performed less frequently in premature neonates (49% vs 69%; P = .004). Length of mechanical ventilation at our institution (6 days [0.5-54) vs 4 days [0.5-49); P = .06); postoperative hospital stay at our institution (17 days [1-161) vs 15 days [0-153); P = .06); and mortality (16% vs 11%; P = .2) was not different between the 2 groups. CONCLUSION: Early outcome seems independent of weight, prematurity, cardiopulmonary bypass, and type of first intervention. Importantly, there was no statistical difference in mortality between the 2 groups, regardless of how they were treated. Further long-term follow-up is needed in this patient population.

Second report of a Nocardia beijingensis infection in the United States: nodular scleritis with in vitro imipenem resistance.

We describe the case of a 52-year-old woman with scleritis caused by an imipenem-resistant strain of Nocardia beijingensis. The patient presented with pain, redness, and nodules on the sclera of 8 weeks' duration. A Gram stain from a nodule on the superonasal aspect of the globe was initially negative. After empiric treatment for an autoimmune etiology, cytopathology confirmed filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made, and medical management was based on a literature review on treatments for Nocardia infections. Cultures returned confirming Nocardia beijingensis. Antibiotic sensitivity testing confirmed the correct initial management. The patient's scleritis resolved with a good visual outcome.

Using lesson study to integrate information literacy throughout the curriculum.

To develop evidence-based practice skills, students need to be capable of retrieving various levels of scholarly information, evaluating its usefulness, and applying it to clinical practice. The authors discuss the process of developing an information literacy curriculum for a cohort of students over a 5-semester nursing program using lesson study.

GPR109A as an anti-inflammatory receptor in retinal pigment epithelial cells and its relevance to diabetic retinopathy.

PURPOSE: Retinal pigment epithelium (RPE) expresses GPR109A, a receptor for the vitamin niacin and the ketone body ß-hydroxybutyrate (ß-HB). Because diabetes results in elevated levels of ß-HB, here we studied expression of the receptor in diabetic retina. We also investigated its functional relevance in RPE. METHODS: Retinal expression of GPR109A in diabetic mice and postmortem human eyes was evaluated by quantitative PCR (qPCR). ARPE-19 cells and primary wild-type and Gpr109a(-/-) mouse RPE cells were exposed to TNF-α in the presence or absence of niacin or ß-HB, followed by analysis of IL-6 and Ccl2 expression via real-time qPCR and ELISA. RESULTS: GPR109A expression was increased in diabetic mouse and human retina. TNF-α increased the expression and secretion of IL-6 and Ccl2 in ARPE-19 cells. Niacin and ß-HB suppressed these effects, implicating GPR109A as the target responsible for mediation of the observed effects. Primary RPE cells from wild-type mice behaved similarly. In contrast, GPR109A ligands failed to suppress TNF-α-induced expression and secretion of IL-6 and Ccl2 in primary RPE cells from Gpr109a(-/-) mice, confirming that the observed anti-inflammatory effects were mediated specifically by Gpr109a. CONCLUSIONS: GPR109A plays an anti-inflammatory role in RPE and its expression is upregulated in diabetes. Inflammation is a key causative factor in the pathogenesis of diabetic retinopathy. We speculate that the increased expression of GPR109A and elevation of its ligand ß-HB in diabetes are mechanisms by which the tissue attempts to fight inflammation in this disease. Pharmacological activation of GPR109A may therefore have therapeutic potential in clinical management of diabetic retinopathy.

Curing the colonizers: highland hydrotherapy in Guadeloupe.

This article explores attempts by French colonial doctors in Guadeloupe to treat tropical pathologies with water and altitude cures, between the seventeenth and twentieth centuries. Assuming that high morbidity rates in the Caribbean were caused by the area's inherent 'toxicity', Europeans turned to mineral water and high-altitude spas, both for the reinvigoration of settlers and to 'season' new arrivals. Guadeloupean spas, though utilized by indigenous, black, creole, and white Guadeloupeans alike, soon emerged as replicas of France in the tropics, and served the socio-medical function of immersing the colonial body in familiar waters. The French obsession with 'healthful space' led to the creation of an 'administrative' quarter precisely in the region of Guadeloupe's spas around Basse- Terre (actually the highest part of the island). The arrival of germ theory in the nineteenth century did not fundamentally alter the rationale for water and altitude cures in Guadeloupe. Tracing the history of these 'folk-cures'--often admonished by colonial doctors as 'common sense', but in reality an integral part of the tropical medical canon--sheds light on some of the underlying dynamics, tensions, and continuities of French imperial medicine.

Curing the colonizers: highland hydrotherapy in Guadeloupe

It explores attempts by French colonial doctors in Guadeloupe to treat tropical pathologies with water and altitude cures, between the seventeenth and twentieth centuries. Assuming that high morbidity rates in the Caribbean were caused by the area`s inherent "toxicity", Europeans turned to mineral water and high-altitude spas, both for the reinvigoration of settlers and to "season" new arrivals. Guadeloupean spas, though utilized by indigenous, black, creole, and white Guadeloupeans alike, soon emerged as replicas of France in the tropics, and served the socio-medical function of immersing the colonial body in familiar waters. The French obsession with "healthful space" led to the creation of an "administrative" quarter precisely in the region of Guadeloupe s spas around Basse-Terre (actually the highest part of the island). The arrival of germ theory in the nineteenth century did not fundamentally alter the rationale for water and altitude cures in Guadeloupe. Tracing the history of these "folk-cures" - often admonished by colonial doctors as "common sense", but in reality an integral part of the tropical medical canon - sheds light on some of the underlying dynamics, tensions, and continuities of French imperial medicine. (AU)