Diabetes Management in Detention Facilities: A Statement of the American Diabetes Association

This statement provides guidance for diabetes care in detention facilities. It focuses on areas where the processes for delivery of care to people with diabetes in detention facilities may differ from those in the community, and key points are made at the end of each section. Areas of emphasis, which inform multiple aspects discussed in this statement, include 1) timely identification or diagnosis of diabetes treatment needs and continuity of care (at reception/intake, during transfers, and upon discharge), 2) nutrition and physical activity, 3) timely access to diabetes management tools (insulin, blood glucose monitoring, tracking data, current diabetes management technologies, etc.), and 4) treatment of the whole person with diabetes (self-management education, mental health support, monitoring and addressing long-term complications, specialty care, etc.).

Care of Young Children With Diabetes in the Childcare and Community Setting: A Statement of the American Diabetes Association

Diabetes management in children extends from the home to other settings where children spend a significant portion of their waking hours. For young children (generally, aged <5 years) with diabetes, this includes childcare centers. Given their age and developmental stage, young children require a carefully thought-out, proactive diabetes care plan for the childcare setting, developed jointly by the health care provider and parents/guardians, and implemented by childcare staff. In the U.S., federal laws and some state laws protect the rights of children with diabetes in childcare and other settings to ensure they receive appropriate assistance with the diabetes management and care. This American Diabetes Association (ADA) Statement addresses the legal rights of children in the childcare setting, outlines the current best practices for diabetes care, and provides resources and responsibilities for parents/guardians, childcare providers, and health care providers. The ADA intends for these tools and information to support the health and well-being of young children with diabetes and offer helpful guidance to those caring for them.

Esophageal cooling during ablation of persistent atrial fibrillation is associated with improved freedom from arrhythmia at one-year follow up

Background

Various factors influence successful freedom from atrial arrhythmia after pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). Lesion transmurality and continuity (as measured by the Continuity Index) are two important factors, and these can be worsened by pauses in RF energy application due to esophageal overheating. Proactive esophageal cooling precludes the need for premature cessation of power, avoiding partially-formed lesions and the need to “hop-scotch” in the left atrium. The resulting improvement in lesion continuity may improve long-term freedom from atrial arrhythmia after PVI, particularly in patients with persistent AF, where more posterior wall ablation is often necessary.

Purpose

Determine differences in freedom from arrhythmia at one year between patients receiving LET monitoring and those receiving esophageal cooling during PVI for persistent AF.

Methods

We reviewed data from two healthcare systems for patient rhythm status at one-year follow up after PVI for the treatment of persistent or long-standing persistent AF. We then determined Kaplan-Meier estimates of freedom from arrhythmia (AF, atrial flutter, and atrial tachycardia), and compared these between patients receiving esophageal cooling and those treated with traditional LET monitoring.

Results

A total of 252 patients received PVI for persistent or long-standing persistent AF and had data available for review. Of these, 148 received LET monitoring (with either a single or multi-sensor temperature probe), and 104 received active cooling with a dedicated esophageal cooling device. Mean age and gender for each group was similar (67.2, range 21 to 88 years, 36% female for LET monitoring, and 67.8, range 32 to 89 years, 30% female for esophageal cooling). KM estimates for freedom from AF at the one-year follow-up were 44.2% for LET monitored patients and 79.3% for actively cooled patients (P=0.01).

Conclusions

Freedom from atrial arrhythmia at one-year after PVI for persistent AF is associated with significant improvement when using active esophageal cooling rather than LET monitoring.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Attune Medical

Arrhythmia recurrence reduction with an active esophageal cooling device during radiofrequency ablation

Funding Acknowledgements

Type of funding sources: None.

Background

As the burden of atrial fibrillation continues to rise with an aging population, there have been contrasting positions on the efficacy of left atrial ablation. While ablation techniques have continued to improve over the past decades, arrhythmia recurrence rates must be further reduced given the burden of ablation on patients. Since continuity of lesion sets has been associated with greater lesion durability, it has been theorized that the use of active esophageal cooling may facilitate greater freedom from arrhythmia.

Purpose

In order to investigate the association between use of active esophageal cooling and arrhythmia recurrence, we performed a multicenter retrospective study of arrhythmia recurrence rates in patients that received active cooling and compared them to those that received luminal esophageal temperature (LET) monitoring.

Methods

In this study, follow up data were collected from patients that underwent pulmonary vein isolation (PVI) at three separate large medical centers. Data were contained in a prospective hospital registry, a prospective physician registry, or the electronic health record, depending on the center. For each patient included, we recorded whether their ablation utilized LET monitoring or active esophageal cooling, along with their rhythm status at 1-year follow up. Rhythm status at follow-up was determined by either electrocardiogram, Holter monitor, or wearable heart rate monitor. Kaplan-Meier (KM) curves were created for freedom-from-arrhythmia at one year comparing those in the LET monitoring group to those in the active cooling group.

Results

Follow up data were collected from 1035 patients. There were 560 patients that received LET monitoring during their original ablation, and 475 patients that underwent active esophageal cooling. KM estimates for freedom-from-arrhythmia at one year were 42% in the LET monitored group and 65% in the actively cooled group (P&lt;.001).

Conclusion

In this large multicenter study, there is a significant increase in freedom-from-arrhythmia at one year follow-up among patients that received active esophageal cooling as compared to those that underwent LET monitoring.

Effect of a proactive esophageal cooling device on procedure length - a multicenter comparison of persistent and paroxysmal atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

During left atrial ablation for the treatment of atrial fibrillation (AF), effective esophageal protection is essential for reducing or preventing thermal injury. Traditional methods include luminal esophageal temperature (LET) monitoring that lead to frequent pauses in the procedure when temperature alarms alert operators to dangerous temperature levels. While there have been recent studies that demonstrate an association between active esophageal cooling and a reduction in procedure duration regardless of AF type, these retrospective studies have been conducted at single or joint centers which may lead to confounding from other time-saving variables that have changed over time.

Purpose

Consequently, we sought to perform a large-scale multicenter comparison to better elucidate the association between procedure length and the use of active cooling in patients with persistent and paroxysmal atrial fibrillation.

Methods

In this study, we collected data from three large hospital centers, one hospital-maintained registry, one physician-maintained registry, and one through EHR data review and aggregated in groups separated by AF type as well as whether the patients received active cooling or LET monitoring. We then compared median procedure durations in each group.

Results

There were a total of 753 patients included in this study. Of the 360 patients with paroxysmal AF, 179 received active esophageal cooling while 181 underwent LET monitoring. In the persistent AF group with 393 patients, 157 received active esophageal cooling and 236 underwent LET monitoring. Among patients with paroxysmal AF, the median mean procedure duration was 137 minutes in the LET monitored group, and 90 minutes in the actively cooled group with an overall reduction of 47 minutes (P&lt;.001). In patients with persistent AF, the median procedure duration was 148 minutes in the LET monitored group and 94 minutes in the actively cooled group with an overall reduction of 54 minutes (P&lt;.001). The relative reduction as a percent of total procedure time was 34%, and 36%, for paroxysmal and persistent AF cases, respectively.

Conclusion

In this large multicenter review, there is a significant reduction in procedure length when using active esophageal cooling, regardless of AF type.

Radio-Pathomic Maps of Cell Density Identify Brain Tumor Invasion beyond Traditional MRI-Defined Margins

BACKGROUND AND PURPOSE

Currently, contrast-enhancing margins on T1WI are used to guide treatment of gliomas, yet tumor invasion beyond the contrast-enhancing region is a known confounding factor. Therefore, this study used postmortem tissue samples aligned with clinically acquired MRIs to quantify the relationship between intensity values and cellularity as well as to develop a radio-pathomic model to predict cellularity using MR imaging data.

MATERIALS AND METHODS

This single-institution study used 93 samples collected at postmortem examination from 44 patients with brain cancer. Tissue samples were processed, stained with H&E, and digitized for nuclei segmentation and cell density calculation. Pre- and postgadolinium contrast T1WI, T2 FLAIR, and ADC images were collected from each patient's final acquisition before death. In-house software was used to align tissue samples to the FLAIR image via manually defined control points. Mixed-effects models were used to assess the relationship between single-image intensity and cellularity for each image. An ensemble learner was trained to predict cellularity using 5 × 5 voxel tiles from each image, with a two-thirds to one-third train-test split for validation.

RESULTS

Single-image analyses found subtle associations between image intensity and cellularity, with a less pronounced relationship in patients with glioblastoma. The radio-pathomic model accurately predicted cellularity in the test set (root mean squared error = 1015 cells/mm²) and identified regions of hypercellularity beyond the contrast-enhancing region.

CONCLUSIONS

A radio-pathomic model for cellularity trained with tissue samples acquired at postmortem examination is able to identify regions of hypercellular tumor beyond traditional imaging signatures.

Falling for the Ones That Were Abusive: Cycles of Violence in Low-Income Women's Intimate Relationships

This study examines low-income women's cycles of lifelong violence victimization. A qualitative analysis of in-depth interviews with 24 low-income women living in Eastern Washington State illustrates the complexity of abusive interpersonal relationships, and the decision-making processes that abused women utilize to escape violence. The data illustrate patterns of a discursive process of normalization, wherein early experiences of violence socialized women to treat abuse as a normal and expected component of adult intimate unions. The normalization of abuse also set the stage for later abuse within intimate relationships to be downplayed. The participants' narratives demonstrate victims' efforts to interrupt cycles of violence by identifying protection of children and partners' other problematic behaviors as motivators in terminating their relationships. Abuse itself, however, is rarely stated as a main reason for victims to leave their abusers. The study's findings also highlight the importance of utilizing alternative sampling strategies, as the sample of domestic violence victims was not recruited via victim support services, but rather for a study of economic strain. The patterns elucidate the multiple ways in which abuse goes unrecognized and unreported within marginalized communities. These findings also provide insight for those within the victim advocacy network and researchers of domestic violence by showcasing the experiences of victims who are often excluded from studies of domestic violence. To those who work actively in the field, this study serves as a call to action to widen sampling strategies and examine abuse in ways that better fit victims' understandings and experiences of intimate partner and domestic violence.

Sustainability in Dentistry: A Multifaceted Approach Needed

This article provides an introduction to environmentally sustainable dentistry and offers perspectives on managing drivers to reduce carbon emissions and make dentistry more environmentally sustainable. A sustainable world must meet the needs of the present without compromising the ability of future generations to meet their own needs. Global commitment to sustainability and demands for a sustainable world are growing. Within dentistry, travel creates the highest carbon emissions and also contributes to human health damage. Internally, there are a number of ways to reduce impact by decreasing travel and energy use, as well as carefully considering the types of items purchased (and how they are disposed of). Larger dental organizations can influence their suppliers and industry by choosing to purchase from sustainable companies with environmentally friendly products. From an external driver perspective policy, guidance and research are essential. Governments need to reevaluate decontamination policy from an environmental perspective. Decontamination documents need revision to consider both planetary and public health. Dental organizations need to support dental teams in this area. Insurance providers and health care purchasers should review policies to influence the sustainability of dental providers. Sustainability education needs to be considered as part of the curriculum of undergraduate and postgraduate students. Guidance could also be developed for the dental industry to produce sustainable products. Research needs to be prioritized. Identifying hot spots or areas of high environmental contributions using other assessments such as life cycle analysis (LCA) would allow dentistry to identify products or practices that have a disproportionate adverse impact on the environment and might be prioritized for change. This should include an analysis of single-use instruments, chemicals, and products. Building research capacity by training students and creating virtual or physical centers for sustainability is essential. Financial support is needed for priority areas of research.

Cooperation and Coordination in Plant Disease Management

Scaling of management efforts beyond the boundaries of individual farms may require that individuals act collectively. Such approaches have been suggested several times in plant pathology contexts but rarely have been implemented, in part because the institutional structures that enable successful collective action are poorly understood. In this research, we conducted in-depth interviews with hop producers in Oregon and Washington State to identify their motivations for and barriers to collective action regarding communication of disease levels, coordination of management practices, and sharing of best management practices and other data for powdery mildew (caused by Podosphaera macularis). Growers were generally open to and engaged in communication with neighbors and others on disease status in their hop yards and some evidence of higher levels of information sharing on management practices was found. However, growers who had developed extensive knowledge and databases were reluctant to share information viewed as proprietary. Relationships, trust, and reciprocity were facilitating factors for communication and information sharing, whereas lack of these factors and social norms of independence and pride in portions of the grower community were identified as impediments. Given the heterogeneity of trust, lack of confidence in reciprocity, and weak shared norms, communication of disease risk and coordinated management may be most successful if directed at a smaller scale as a series of neighborhood-based partnerships of growers and their immediate neighbors. Developing a disease reporting system and coordinated disease management efforts with more producers and at larger spatial extents would require formalized structures and rules that would provide assurance that there is consistency in disease data collection and reporting, reciprocation, and sanctions for those who use the information for marketing purposes against other growers. Given the analyses presented here, we believe there is potential for collective action in disease management but with limitations on the scope and nature of the actions.

Temporary mechanical support of left ventricular failure following open heart surgery

Patients coming to open heart surgery with advanced cardiac dysfunction may require mechanical cardiac support to avoid life-threatening low cardiac output in the postoperative period. 15 patients who could not be withdrawn from cardiopulmonary bypass because of low cardiac output were supported with a left heart bypass system (left atrium to ascending aorta). Ten were ultimately separated from the device, 6 were dismissed from the hospital and 4 remain well (the longest 2.6 years postoperative). A major asset of the device is that thoracic reentry is not required when support is discontinued.

Concepts of Sustainability, Motivations for Pest Management Approaches, and Implications for Communicating Change

Impact and relevance are valued by both plant pathologists and the supporters of research and extension. Impact has been characterized as the "So what?" of research results, and in applied research in agriculture typically involves some change in human behavior. This might involve, for instance, avoidance of broad spectrum pesticides, use of economic thresholds, or adoption of a new cultural practice in disease management. Changes in human behavior often are slow and difficult, even when the potential benefits of change seem clear. Research and extension personnel working with farmers have discussed for decades the apparent slow pace of adoption of integrated pest management (IPM) and other less-pesticide-intensive management practices. The reasons why change is slow are numerous, but one aspect that warrants consideration is how changes in farm practices are communicated to farmers. Effectively communicating changes in pest management practices at the farm level requires a system of research and extension management that differs from that to which most biological scientists are accustomed. What is the motivation for farmers to deviate from historical practices? How persuasive are concepts of environmental sustainability, integrated pest management, risk management, and economic gain in communicating the needs for change? In addressing these questions, it is useful to understand some of the basic determinants of farmers' decision processes and motivations to adopt practices. This article discusses these issues.

Observing signs of pain in relation to self-injurious behaviour among individuals with intellectual and developmental disabilities

BACKGROUND

Self-injurious behaviour is a chronic condition among people with intellectual and developmental disabilities for which there is no known cure. The pain hypothesis suggests that individuals who engage in self-injury have altered or diminished pain perception. The purpose of the present study was to assess how frequently individuals diagnosed with an intellectual and developmental disability who engage in chronic self-injury displayed non-verbal signs of pain in relation to their self-injury.

METHODS

We videotaped four participants (aged 28-50 years) in their homes during times when they were likely to engage in self-injury. Using continuous recording measures, we coded videotapes for the frequency and duration of self-injury and expressions of non-verbal pain-related behaviours. Sequential analyses were conducted to identify temporal relations between pain-related behaviours and self-injury.

RESULTS

Our data suggest that the existing measures of pain may be systematically related to instances of self-injury. The relationships, however, appear to vary depending on the person who engages in self-injury, the environmental contexts in which the self-injury occurs, and perhaps, the type of self-injury in which the person engages.

CONCLUSIONS

These results support some of the findings of Symons et al. and they raise questions about the blunted nociception hypothesis of self-injury.

How to dig deeper? Improved enrichment methods for mucin core-1 type glycopeptides

Two different workflows were tested in order to develop methods that provide deeper insight into the secreted O-glycoproteome. Bovine serum samples were subjected to lectin affinity-chromatography both at the protein- and peptide-level in order to selectively isolate glycopeptides with the most common, mucin core-1 sugar. This enrichment step was implemented with either protein-level mixed-bed ion-exchange chromatography or with peptide-level electrostatic repulsion hydrophilic interaction chromatography. Both methods led to at least 65% of the identified products being glycopeptides, in comparison to ≈ 25% without the additional chromatography steps [Darula, Z., and Medzihradszky, K. F. (2009) Affinity enrichment and characterization of mucin core-1 type glycopeptides from bovine serum. Mol. Cell. Proteomics 8, 2515-2526]. In order to improve not only the isolation but also the characterization of the glycopeptides exoglycosidases were used to eliminate carbohydrate extensions from the directly peptide-bound GalNAc units. Consequent tandem MS analysis of the mixtures using higher-energy collision-dissociation and electron-transfer dissociation led to the identification of 124 glycosylation sites in 51 proteins. While the electron-transfer dissociation data provided the bulk of the information for both modified sequence and modification site assignment, the higher-energy collision-dissociation data frequently yielded confirmation of the peptide identity, and revealed the presence of some core-2 or core-3 oligosaccharides. More than two-thirds of the sites as well as the proteins have never been reported modified.

A rapid two-step method for isolation of functional primary mouse hepatocytes: cell characterization and asialoglycoprotein receptor based assay development

Primary mouse hepatocytes are an important tool in the biomedical research field for the assessment of hepatocyte function. Several methods for hepatocyte isolation have been published; however, many of these methods require extensive handling and can therefore compromise the viability and function of the isolated cells. Since one advantage of utilizing freshly isolated cells is to maintain an environment in which the cells are more comparable to their in vivo state, it is important to have robust methods that produce cells with high viability, good purity and that function in a similar manner to that in their in vivo state. Here we describe a modified two-step method for the rapid isolation and characterization of mouse primary hepatocytes that results in high yields of viable cells. The asialoglycoprotein receptor (ASGPR), which is one of the most abundant cell surface receptors on hepatocytes, was used to monitor the function of the isolated hepatocytes by demonstrating specific binding of its ligand using a newly developed flow cytometry based ligand-receptor binding assay. Also, an in vitro screening method for siRNA drug candidates was successfully developed utilizing freshly isolated hepatocytes with minimum culture time.

Complication Rates for Radiologically Inserted Gastrostomy in Head and Neck Cancer Inpatients

Objective: Identify complications of Radiologically Inserted Gastrostomy (RIG) insertion and factors contributing to complication rates, including the grade of radiologist, forms of treatment, and time from RIG insertion to onset of complications.

Method: A retrospective audit was performed on head and neck cancer inpatients undergoing RIG insertion between 2007 and 2008. A case note review analyzed the type and timing of complications. A change in clinical practice was introduced by delaying RIG suture removal from 3 to 7 days. Complication rates were re-audited from 2009 to 2010.

Results: A total of 63 RIG insertions were performed on 56 inpatients (13 surgical and 50 oncological). Major and minor complication rates were 7.9% (n = 5) and 63.4% (n = 40), respectively. Minor complications in surgical patients were significantly higher ( P = .02) than oncological cases (92.3% vs 56%). Average time onset for major complications was 2 ±1 days (±SD) and for minor complications was 27 ±35 days. There were no deaths. Tube dislodgement was the most common minor complication, and preliminary data from re-audit demonstrates improved rates following the change in timing of suture removal.

Conclusion: We report no differences in major complications. High rates of minor complications were noted. This may be due to the tube type or size utilized. Subgroup differences may be accounted for by timings in RIG placement. The rates of tube dislodgement were reduced by leaving stay sutures in for longer.

Two-generation reproductive toxicity study of inhaled acrylonitrile vapors in Crl:CD(SD) rats

To assess the effects of acrylonitrile (AN) exposure on reproduction, Sprague-Dawley rats (25/sex/group) were exposed to vapor atmospheres of AN via whole-body inhalation at concentrations of 0, 5, 15, 45 (two offspring generations) and 90 ppm (one offspring generation), 6 h daily, 1 litter/generation, through F2 weanlings on postnatal day 28. After approximately 3 weeks of direct exposure following weaning, exposure of the F1 animals at 90 ppm was terminated due to excessive systemic toxicity in the males. There were no exposure-related mortalities in adult animals, no functional effects on reproduction or effects on reproductive organs, and no evidence of cumulative toxicity or of enhanced toxicity in pregnant and lactating dams or in developing animals. Adult systemic toxicity was limited to body weight and/or food consumption deficits in both sexes and generations (greater in males) at 45 and 90 ppm and increased liver weights in the 90 ppm F0 males and females and 45 ppm F1 males. Neonatal toxicity was expressed by F1 offspring weight decrements at 90 ppm. Clinical signs of local irritation during and immediately following exposure were observed at 90 ppm. Microscopic lesions of the rostral nasal epithelium, representing local site-of-contact irritation, were observed in some animals at 5 to 45 ppm. The no-observed-adverse-effect level (NOAEL) for reproductive toxicity over two generations and neonatal toxicity of AN administered to rats via whole-body inhalation was 45 ppm. The NOAEL for reproduction was 90 ppm for the first generation. The NOAEL for parental systemic toxicity was 15 ppm.

Robotic system for prostate brachytherapy

In contemporary brachytherapy procedures, needle placement at the desired target is challenging for a variety of reasons. A robot-assisted brachytherapy system can potentially improve needle placement and seed delivery, resulting in enhanced therapeutic outcome. In this paper we present a robotic system with 16 degrees of freedom (DOF) (9 DOF for the positioning module and 7 DOF for the surgery module) that has been developed and fabricated for prostate brachytherapy. Strategies to reduce needle deflection and target movement were incorporated after extensive experimental validation. Provision for needle motion and force feedback was included in the system to improve robot control and seed delivery. Preliminary experimental results reveal that the prototype system is sufficiently accurate in placing brachytherapy needles.

Needle insertion force estimation model using procedure-specific and patient-specific criteria

Placement accuracy of different types of surgical needles in soft biological tissues depends on a variety of factors. The needles used for prostate brachytherapy procedures are typically about 200 mm in length and 1.27-1.47 mm in diameter. These needles are prone to deflection and thereby depositing the seeds at a location other than the planned one. Thus tumorous tissues may not receive the planned dose whereas the critical organs may be over-dosed. A significant amount of needle deflection and target movement is related to some procedure-specific criteria and some patient-specific criteria. In this paper we have developed needle insertion force models taking both procedure-specific criteria and patient-specific criteria. These statistical models can be used to estimate the force that the needle will experience during insertion and thereby control the needle to reduce the needle deflection and enhance seed delivery accuracy.

Spatial random tree grammars for modeling hierarchal structure in images with regions of arbitrary shape

We present a novel probabilistic model for the hierarchal structure of an image and its regions. We call this model spatial random tree grammars (SRTGs). We develop algorithms for exact computation of likelihoods and MAP estimates and exact EM updates for model-parameter estimation. We collectively call these algorithms the center-surround algorithm. We use the center-surround algorithm to automatically estimate the ML parameters of SRTGs, classify images based on their likelihood and based on the MAP estimate of the associated hierarchal structure. We apply our method to the task of classifying natural images and demonstrate that the addition of hierarchal structure significantly improves upon the performance of a baseline model that lacks such structure.

Arsenic in Oregon community water systems: demography matters

Recently, the maximum contaminate level (MCL) for arsenic was lowered to 10 microg/L in community water systems (CWS) throughout the United States. In this study, CWS in Oregon were assessed for the occurrence and magnitude of arsenic >10 microg/L between the effective and compliance dates for the new MCL. Ten CWS, with a combined population of 49,395, met the criteria for this study. Arsenic levels above the new MCL ranged from 11-25 microg/L. The demographic characteristics of these systems were queried and considered in the context of risk, exposure and outreach. A disproportionate percent of residents in affected CWS were of Hispanic origin (35%) compared to the statewide average (8%). Residents in these CWS had a lower median household income (20% less than the statewide average), a lower median age (32.5 vs. 36.3) and a higher percent of a second language spoken in the home besides English (34.6% vs. 12.1%) compared to the statewide census. These community characteristics have implications for exposure, risk and outreach associated with the occurrence of arsenic in drinking water. Consequently, demographic parameters are informative for risk management and communication and ultimately, beneficial to the affected public.

Effects of velocity modulation during surgical needle insertion

Precise interstitial intervention is essential for many medical diagnostic and therapeutic procedures. But accurate insertion and placement of surgical needle in soft tissue is quite challenging. The understanding of the interaction between surgical needle and soft tissue is very important to develop new devices and systems to achieve better accuracy and to deliver quality treatment. In this paper we present the effects of velocity (linear, rotational, and oscillatory) modulation on needle force and target deflection. We have experimentally verified our hypothesis that needle insertion with continuous rotation reduces target movement and needle force significantly. We have observed little changes in force and target deflection in rotational oscillation (at least at lower frequency) of the needle.

Colour vision defects in asymptomatic carriers of the Leber's hereditary optic neuropathy (LHON) mtDNA 11778 mutation from a large Brazilian LHON pedigree: a case-control study

AIMS

To determine if asymptomatic carriers from a previously identified large pedigree of the Leber's hereditary optic neuropathy (LHON) 11778 mtDNA mutation have colour vision deficits.

METHODS

As part of a comprehensive analysis of over 200 members of a large Brazilian LHON pedigree spanning seven generations, colour vision tests were obtained from 91 members. Colour vision was tested one eye at a time using the Farnsworth-Munsell 100 (FM-100) hue colour vision test. The test was administered under uniform conditions, taking into account: ambient light levels, daylight colour temperature of 6700 kelvin, and neutral uniform background. Tests were scored using the FM-100 MS-Excel computer scoring program. Defects were determined and categorised as tritan, deutan, or protan. Categorisation of each dyschromatopsia was based on review of demonstrated axis computer generated plots and age adjusted error scores which coincided with Verriest 95% confidence intervals. Only the axis with the greatest magnitude error score was used to classify the defect. 55 of the 91 test subjects were LHON mtDNA 11778 J haplotype mutation carriers, proved by mtDNA analysis. The remaining 36 subjects were age matched non-blood relatives (off pedigree), who served as controls.

RESULTS

27 of 55 carriers (49.10%) were shown to have colour vision defects in one or both eyes. 13 of the 27 (48%) abnormal tests in the carrier group were tritan defects and the remaining 14 (52%) were deutan defects. Nine of the 27 (33%) abnormals in the carrier group were identified as having bilateral defects. Six of these were deutan, and the remaining three were tritan dyschromatopsias. Only six of the 36 (16.66%) age matched controls were found to have any type of dyschromatopsia. Five (83.3%) of these were deutan defects. The remaining one was a tritan defect. The difference between the two groups using a chi(2) test with one degree of freedom was statistically significant with a p value less that 0.001.

CONCLUSIONS

Until now, LHON has always been characterised by a sudden, devastating vision loss. Asymptomatic carriers, those without vision loss, were considered unaffected by the disease. It now appears that asymptomatic carriers of the LHON mutation are affected by colour vision defects and may manifest other subtle, yet chronic, changes.

Efficacy of prostate stabilizing techniques during brachytherapy procedure

During the prostate brachytherapy procedure, multiple needles are inserted into the prostate and radioactive seeds are deposited. Stabilizing needles are first inserted to provide some rigidity and support to the prostate, ideally this will provide better seed placement and an overall improved treatment. However, there is much speculation regarding the effectiveness of using regular brachytherapy needles as stabilizers. In this study, we explored the efficacy of (1) two types of needles--18 gauge brachytherapy needle vs. 18 gauge hooked needle; and (2) parallel vs. angulated needle configurations to stabilize the prostate. Prostate phantom movement and needle insertion progression were imaged using ultrasound (US). The recorded images were analyzed and prostate displacement was computed from images using implanted artifacts. Experimentation allowed us to further understand the mechanics behind prostate stabilization. We observed superior stabilization by the hooked needles compared to the regular brachytherapy needles (more than 40% for parallel stabilization). Prostate movement was also reduced significantly when regular brachytherapy needles were in an angulated configuration as compared to the parallel configuration (approximately 40%). When the hooked needles were angled for stabilization, further improvement in decreased displacement was observed. In general, for convenience of dosimetric planning, all needles are desired to be in parallel and in this case, hooked needles are better suited to improve stabilization of the prostate. On the other hand, both regular and hooked needles appear to be equally effective in reducing prostate movement when they are in angulated configurations, which will be useful in robotic permanent seed implantation (PSI).