Dry eye in the upper blepharoplasty patient: a study comparing orbicularis-sparing versus orbicularis-excising techniques

PURPOSE

To compare subjective and objective dry eye syndrome (DES) metrics preoperatively and postoperatively in patients undergoing bilateral upper eyelid blepharoplasty (ULB) using orbicularis-sparing versus orbicularis-excising techniques.

METHODS

A double-blind, randomized clinical trial was conducted on patients without prior DES or other severe conditions who presented to our institution between 2017 and 2019 for routine functional ULB. Patients were randomized into two treatment arms: bilateral ULB using the orbicularis-sparing technique or bilateral ULB using the orbicularis-excising technique. One subjective and seven objective DES assessments were performed on all patients preoperatively and 1 month and 1 year after surgery.

RESULTS

A total of 63 patients were recruited for the study. Standard Patient Evaluation of Eye Dryness (SPEED) scores decreased in both treatment groups at 1 month and 1 year postoperatively. This change did not significantly vary based on surgical technique. Objective DES assessments were not significantly changed at both postoperative time points for either group. There was a correlation between the severity of preoperative DES symptoms and the subjective improvement of DES symptoms postoperatively in both groups.

CONCLUSIONS

ULB with an orbicularis-sparing or orbicularis-excising technique does not worsen subjective or objective DES metrics and so, surgeons may confidently use either surgical technique. These findings may impact postoperative expectations for surgeons and patients alike.

An Efficacy Study of Voice Quality Using Cepstral Analyses of Phonation in Parkinson's Disease before and after SPEAK-OUT!®

INTRODUCTION

SPEAK-OUT!® is a behavioral treatment for hypokinetic dysarthria in persons with Parkinson's disease (PD) that has become an alternative to the gold-standard Lee Silverman Voice Treatment (LSVT) in recent years. Acoustic evaluation of the efficacy of SPEAK-OUT!® therapy has focused on prosody. The purpose of this study was to investigate SPEAK-OUT!® efficacy in terms of vocal quality and its impact on quality of life. Vocal quality was measured acoustically using cepstral peak prominence (CPP) analysis and the Acoustic Voice Quality Index (AVQI) and perceptually using clinical ratings of speech performance. Impact on quality of life was measured with the Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL). An additional goal of this study was to investigate whether dysarthria severity and disease duration were predictive of changes in voice quality due to SPEAK-OUT!®.

METHODS

Pre- and post-therapy data included PD participants' acoustic and perceptual ratings of audio recordings. Demographic data included age, sex, diagnosis, duration of PD, and severity of dysarthria.

RESULTS

Participants achieved significant improvement in the vowel and sentence CPP smoothed (CPPS) mean score as well as in their AVQI score post SPEAK-OUT!® treatment. Improvements in AVQI correlated negatively with disease duration and positively with dysarthria severity.

DISCUSSION/CONCLUSION

SPEAK-OUT!® is effective in improving voice quality in patients with hypokinetic dysarthria due to idiopathic PD. Patients with more severe dysarthria and with a shorter disease duration may benefit the most, supporting earlier intervention. As for the type of measurement, AVQI combines acoustics from both vowel and sentence contexts and may therefore be the measure of choice over CPPS (vowel) or CPPS (sentence).

Reading Warm-Up, Reading Skill, and Reading Prosody When Reading the My Grandfather Passage: An Exploratory Study Born Out of the Motor Planning Theory of Prosody and Reading Prosody Research

PURPOSE

The Motor Planning Theory of Prosody and reading prosody research indicate that "out of the blue" oral reading, as practiced in clinical and research settings, invokes surface rather than covert prosody, particularly when readers are recorded, less skilled, and/or speech impaired. Warm-up is not considered in passage reading for motor-speech assessment. We report on a preliminary study aimed to investigate the effect of warm-up on reading prosody in two conditions: silent reading alone and reading "out of the blue" followed by silent reading. A secondary aim of the study was to examine the effect of reading skill on reading prosody.

METHOD

Twenty-one monolingual, English-speaking volunteers were recorded reading the My Grandfather Passage (GP) while their eye movements were tracked. Participants were randomly assigned to one of two reading conditions: (a) silent-oral (SO) and (b) oral-silent-oral (OSO). In the SO condition, participants read the GP silently as a warm-up for the subsequent oral reading. In the OSO condition, participants first read the GP aloud ("out of the blue") and then read the same passage silently with the instruction to do this in preparation for a second oral reading. Reading skill was quantified using eye-voice span and Wide Range Achievement Test-Fourth Edition testing. Reading prosody was evaluated using pause indexes, the Acoustic Multidimensional Prosody Index, and speech rate.

CONCLUSIONS

One oral reading before a silent reading but not a silent reading alone before oral reading was shown to affect reading prosody. In terms of reading skill, results indicate that predictive associations patterned differently in the reading conditions explored, suggesting different underlying skill sets.

Refractive and keratometric outcomes of supervised novice surgeon-performed limbal relaxing incisions: 1-year results

PURPOSE

To report refractive and keratometric astigmatism outcomes of resident-performed limbal relaxing incisions (LRIs) during cataract surgery.

SETTING

Tertiary care academic teaching hospital.

DESIGN

Retrospective case series.

METHODS

The length, location, and number of LRIs were determined preoperatively using an online calculator. Variables studied were preoperative keratometry and postoperative uncorrected and corrected distance visual acuity, refraction, and keratometry at 1-month, 3-month, and 12-month visits (POM1, POM3, and POM12, respectively). Subgroup analysis was performed on amount and type of astigmatism. The astigmatism double-angle plot tool and analysis of with-the-wound (WtW) and against-the-wound (AtW) changes were used to assess the effect of astigmatism correction at POM1, POM3, and POM12 visits.

RESULTS

In 118 eyes, a higher percentage of eyes demonstrated refractive astigmatism 0.25 diopter (D) or less, 0.50 D or less, 0.75D or less, and 1.0 D or less at POM1 and POM12 (all P < .05) compared with preoperative keratometric astigmatism. Subgroup analysis showed improvement in all groups and types of astigmatism (P < .01). Patients achieved a statistically significant reduction of keratometric astigmatism at POM1, POM3, and POM12 (all P ≤ .0001) relative to baseline, and changes differed significantly based on the preoperative amount of astigmatism (all P ≤ .0001, with greater reductions associated with higher baseline astigmatism) but not by location of the steep meridian. There were significant WtW-AtW changes at POM1, POM3, and POM12. Regression of effect after 1 month was approximately 0.11 D.

CONCLUSIONS

Resident-performed LRIs achieved effective and sustained reduction of both refractive and keratometric astigmatism regardless of meridian or magnitude of astigmatism for at least 1 year postoperatively.

Recurrence risk of occult micrometastases and isolated tumor cells in early stage endometrial cancer: A case control study

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Ultra-staging INCREASED the identification of low volume lymph node metastasis in EC.

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Occult ITC were not associated with increased odds of recurrent EC.

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Occult ITC were closely associated with known risk factors in early-stage EC.

Objectives

To determine whether previously undetected occult micrometastasis (MM) or isolated tumor cells (ITC) is associated with increased recurrence odds in stage I-II endometrioid adenocarcinoma.

Methods

Women with recurrent stage I/II EC who had complete pelvic and para-aortic were identified as the outcome of interest. A case-control study was designed with the exposure defined as occult MM/ITC not seen on original nodal pathology. Controls were found by frequency-matching in a 1:2 case control ratio. Original nodal slides were re-reviewed, stained and tested with immunohistochemical to detect occult MM/ITC and the odds of associated recurrence was calculated.

Results

Of 153 included, 50 with and 103 without recurrence, there was no difference in age (p = 0.46), race (p = 0.24), stage (p = 0.75), FIGO grade (p = 0.64), lymphovascular space invasion (LVSI); p = 1.00, or GOG 99 high-intermediate risk (HIR) criteria (p = 0.35). A total of 18 ITC (11.8%) and 3 MM (2.0%) not previously identified were found in 19 patients. Finding occult MM/ITC was not associated with more lymph nodes (LN) removed (p = 0.67) or tumor grade (p = 0.48) but was significantly associated with stage (p < 0.01). LVSI (p = 0.09) and meeting high-intermediate risk criteria (p = 0.09), were closely associated but not statistically significant. Isolated ITC were not associated with increased odds for recurrence (OR 0.71, CL: 0.20 – 2.22, p = 0.57), recurrence free survival (RFS) (p = 0.85) or overall survival (OS) (p = 0.92).

Conclusions

In early-stage EC, identification of occult MM or ITC is uncommon and associated with stage. The presence of ITC was not associated with increased odds of recurrence. Adjusting stage or treatment may avoided based on ITC alone. Isolated MM were rare in our population, and further investigation is warranted.

Abstract PR01: Factors associated with dual use of electronic cigarettes among adult American Indians who smoke: A Cherokee Nation cohort study

Significance: American Indians (AI) have a higher prevalence of smoking, higher prevalence of electronic cigarette (EC) use, and higher cancer mortality than most other racial groups, particularly in Oklahoma. However, AI are rarely included in studies of EC use among smokers. As many individuals who smoke also use ECs to reduce harms from cigarettes, understanding correlates of using both products by AI merits greater attention.

Methods: In Oklahoma in 2016, 375 AI who smoke and were ages 18 years and older completed a survey collecting demographic information, personal and family history of cancer, perceptions of EC harm and benefits, measures of smoking and dependence, other tobacco use, and EC use by spouse or partner. We defined dual users as using EC within 30 days and every day or some days (n = 44; 12%) and compared dual users to EC never users (n = 137; 37%).

Results: Dual users were younger than never users (median 36 vs. 46 years, respectively; p = .01) but did not differ significantly by sex, education, or income. Dual users did not differ significantly from never users in self-reported general health status, personal history of cancer, or other smoking-related medical conditions. Dual users more often reported history of depression (56% vs. 29%; p &lt; .01) and a family history of cancer (lung, head, neck, other) marginally more often than did never users (58% vs. 41%, p = 0.05). While no significant differences were noted for perceived harms of smoking or secondhand smoke, low perceived harm of ECs was more frequent among dual users than never users (64% vs. 24%; p &lt; .01) as well as secondhand vapor (77% vs. 29%; p &lt; .01). Dual users agreed more often that ECs help to quit smoking (75% vs. 16%; p &lt; .01) and are less harmful than smoking (70% vs. 17%; p &lt; .01). Only 9% of dual users did not know or were uncertain about EC harms or benefits, compared to 29% of never users for harms (p &lt; .01) and 38% for benefits (p &lt; .01). Differences between groups were not significant for cigarette consumption, salivary cotinine levels, or smoking dependence scales, but dual users reported a likelihood to quit smoking more often than never users (86% vs. 65%; p = .01), and more often tried to quit in past 12 months (55% vs. 32%; p = .01). Dual users significantly (p ≤ .01) more often ever tried snus (36% vs. 10%), cigars (68% vs. 46%), cigarillos (82% vs. 56%), and hookah (50% vs. 14%) but no differences in ever use of other smokeless tobacco. Among those living with a spouse/partner, dual and never users did not differ in spouse/partner smoking, but dual users much more frequently lived with a spouse/partner who uses ECs (45% vs. 6%; p &lt; .01).

Conclusions: EC use is a potential, albeit unproven, harm reduction strategy for people who smoke. The American Cancer Society strongly discourages dual use of EC and cigarettes. This exploratory study of AI found several significant associations with dual EC and cigarette use, but cigarette consumption was similar between groups. It remains to be determined whether ECs will have a role in smoking cessation or reducing cancer health disparities among AI.

This abstract is also being presented as Poster A004.

Citation Format: Dorothy A. Rhoades, Ashley L. Comiford, Justin D. Dvorak, Kai Ding, Leslie Driskill, Michelle Hopkins, Theodore L. Wagener, Paul Spicer, Mark P. Doescher. Factors associated with dual use of electronic cigarettes among adult American Indians who smoke: A Cherokee Nation cohort study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR01.

Use of Potentially Reduced Exposure Tobacco Products Among American Indian Smokeless Tobacco Users: Associations With Cessation Behaviors and Cotinine Levels

OBJECTIVES

American Indian/Alaska Native (AI/AN) adults use smokeless tobacco products (eg, chewing and dip tobacco) more often than other racial/ethnic groups do. Although US adults increasingly use potentially reduced exposure tobacco products (PREPs), such as electronic cigarettes and snus, no studies have examined the use of PREPs among AI/AN smokeless tobacco users. We examined associations between current PREPs use and smokeless tobacco-related measures, including cessation attempts and cotinine levels, in a sample of American Indian adults who currently use smokeless tobacco.

METHODS

We collected survey and tobacco biomarker data from 299 adult American Indian smokeless tobacco users at Cherokee Nation health care facilities and events in 2016 and 2017. We used multivariable analyses to determine associations between current PREPs use and smokeless tobacco-related characteristics.

RESULTS

Current PREPs users were younger, less likely to be married or living with a partner, less likely to report a chronic medical condition, and more likely to report other tobacco use than PREPs nonusers. Among participants with annual household incomes ≤$30 000, current PREPs users were less likely than PREPs nonusers to report a definite desire to quit smokeless tobacco (P = .02). PREPs use was not associated with planning to quit smokeless tobacco, past 12-month smokeless tobacco quit attempts, amount of smokeless tobacco used per week, cotinine levels, or scores on the Fagerström Test for Nicotine Dependence-Smokeless Tobacco.

CONCLUSIONS

Our study suggests that American Indian smokeless tobacco users may not be using PREPs as a smokeless tobacco cessation aid. Future studies should take this finding into consideration when evaluating the role of PREPs use in smokeless tobacco cessation and in total tobacco cessation in this population.

Impact of e-cigarette use among a cohort of American Indian cigarette smokers: associations with cigarette smoking cessation and cigarette consumption

INTRODUCTION

Despite American Indian/Alaska Native (AI/AN) people having the highest prevalence of cigarette smoking nationwide, few studies have evaluated e-cigarette use among AI/AN adults who smoke. The primary objective of this observational pilot cohort study was to determine if e-cigarette use is associated with cigarette smoking cessation or reduction among adult AI individuals who smoke.

METHODS

In 2016, we collected baseline survey and biomarker data among AI adults who smoke. The survey included questions about cigarette consumption and use of e-cigarettes and biomarkers, such as salivary cotinine markers and exhaled carbon monoxide. After 18 months, we repeated data collection, and asked about changes in cigarette smoking status and cigarettes per day (CPD). Comparisons between groups were performed using the χ² test, Fisher's exact test or Wilcoxon rank-sum test.

RESULTS

Of 375 baseline participants, 214 (57.07%) returned for follow-up and were included in analyses. Of these, 20 (9.3%) reported having stopped cigarette smoking and had biochemical verification of cigarette smoking abstinence. Among those who quit smoking, 15% were baseline e-cigarette users; while among those who continued to smoke at follow-up, about 11% were baseline e-cigarette users. This difference was not statistically significant (p=0.48). Among all those who continued to smoke at follow-up, there was no overall decrease in CPD, nor a significant difference in change in CPD between baseline e-cigarette users and non-users (p=0.98).

CONCLUSIONS

E-cigarette use at baseline was not associated with smoking cessation or a change in CPD in this cohort of AI adults who smoke after an 18-month follow-up period.

PD-1+ melanocortin receptor dependent-Treg cells prevent autoimmune disease

Experimental autoimmune uveoretinitis (EAU) is a mouse model of human autoimmune uveitis marked by ocular autoantigen-specific regulatory immunity in the spleen. The melanocortin 5 receptor (MC5r) and adenosine 2 A receptor (A2Ar) are required for induction of post-EAU regulatory T cells (Tregs) which provide resistance to EAU. We show that blocking the PD-1/PD-L1 pathway prevented suppression of EAU by post-EAU Tregs. A2Ar induction of PD-1⁺FoxP3⁺ Tregs in uveitis patients was similar compared to healthy controls, but was significantly reduced with melanocortin stimulation. Further, lower body mass index correlated with responsiveness to stimulation of this pathway. These observations indicate an importance of the PD-1/PD-L1 pathway to provide resistance to relapsing uveitis and shows a reduced capacity of uveitis patients to induce Tregs when stimulated through melanocortin receptors, but that it is possible to bypass this part of the pathway through direct stimulation of A2Ar.

Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

BACKGROUND

The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities.

METHODS

In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days.

RESULTS

About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.

CONCLUSIONS

Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.

E-cigarettes and Tobacco Exposure Biomarkers among American Indian Smokers

Objective We assessed associations between electronic cigarette (e-cigarette) use and smoking-related measures among American Indians (AIs) who smoke. MethodsWe collected baseline survey and smoking biomarker data in a cohort of 375 adult AI smokers at a Cherokee Nation healthcare facility in Oklahoma. We used multivariate logistic and linear regression analyses to determine associations between e-cigarette use and smoking-related characteristics, including biomarkers. ResultsCurrent e-cigarette users were more likely than never users to report a quit attempt in the past 12 months (current vs never adjusted odds ratio (AOR) = 2.24 [95% CI 1.20-4.16]). Current and past e-cigarette users were more likely than never users to report a likelihood to quit smoking (current vs never AOR = 2.97 [95% CI 1.34-6.56]; past vs never AOR = 1.77 [95% CI 1.08-2.91]). E-cigarette use was not significantly associated with confidence to quit smoking, cigarette packs smoked per day, or cotinine levels. ConclusionsE-cigarette use was associated with previous and future quit attempts, but not with reductions in cigarette smoking or confidence in quitting. This suggests that many dual users might benefit from the addition of evidence-based smoking cessation treatments.

Global public awareness about atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) is an important cause of ischemic stroke that often remains undetected until stroke occurs. Awareness of the risk factors and symptoms is important so that AF can be diagnosed and thromboprophylaxis given. However, the extent of public awareness of AF is uncertain. We assessed public awareness of AF across six continents and compared it with that of other thrombotic and non-thrombotic disorders.

METHODS

In collaboration with Ipsos-Reid, we conducted an internet-based, cross-sectional survey between September and October of 2016 in 10 countries: Argentina, Australia, Canada, Germany, Japan, Thailand, the Netherlands, Uganda, United Kingdom, and United States. Participants were selected from survey panels in weighted, age-stratified categories (40-60, 61-74, and ≥75 years). The survey included 11 questions about demographics and assessed awareness about AF, as well as that of other thrombotic and non-thrombotic disorders. Proportions and 95% confidence intervals (CI) were calculated.

RESULTS

Of a total of 6312 respondents, overall awareness of AF was 48% (95% CI, 46-50%), which was lower than awareness about other thrombotic and non-thrombotic disorders except for deep vein thrombosis (awareness 43%, 95% CI, 41-45%). Awareness about AF ranged from 25% to 69% across countries, while awareness of the risk factors for AF ranged from 8% to 52%, and awareness that AF leads to stroke ranged from 36% to 46%. Among those reporting awareness of AF, 82% correctly identified palpitations as an AF symptom.

CONCLUSIONS

Global public awareness of AF is low. Improving awareness may empower patients to seek timelier stroke preventive care.

Altered saccadic targets when processing facial expressions under different attentional and stimulus conditions

Depending on a subject's attentional bias, robust changes in emotional perception occur when facial blends (different emotions expressed on upper/lower face) are presented tachistoscopically. If no instructions are given, subjects overwhelmingly identify the lower facial expression when blends are presented to either visual field. If asked to attend to the upper face, subjects overwhelmingly identify the upper facial expression in the left visual field but remain slightly biased to the lower facial expression in the right visual field. The current investigation sought to determine whether differences in initial saccadic targets could help explain the perceptual biases described above. Ten subjects were presented with full and blend facial expressions under different attentional conditions. No saccadic differences were found for left versus right visual field presentations or for full facial versus blend stimuli. When asked to identify the presented emotion, saccades were directed to the lower face. When asked to attend to the upper face, saccades were directed to the upper face. When asked to attend to the upper face and try to identify the emotion, saccades were directed to the upper face but to a lesser degree. Thus, saccadic behavior supports the concept that there are cognitive-attentional pre-attunements when subjects visually process facial expressions. However, these pre-attunements do not fully explain the perceptual superiority of the left visual field for identifying the upper facial expression when facial blends are presented tachistoscopically. Hence other perceptual factors must be in play, such as the phenomenon of virtual scanning.

Prosody and Spoken Word Recognition in Early and Late Spanish-English Bilingual Individuals

PURPOSE

This study was conducted to compare the influence of word properties on gated single-word recognition in monolingual and bilingual individuals under conditions of native and nonnative accent and to determine whether word-form prosody facilitates recognition in bilingual individuals.

METHOD

Word recognition was assessed in monolingual and bilingual participants when English words were presented with English and Spanish accents in 3 gating conditions: onset only, onset plus prosody/word length only, and onset plus prosody. Word properties were quantified to assess their influence on word recognition in the onset-only condition.

RESULTS

Word recognition speed was proportional to language experience. In the onset-only condition, only word frequency facilitated word recognition across groups. Addition of duration information or prosodic word form did not facilitate word recognition in bilingual individuals the way it did in monolingual individuals. For the bilingual groups, Spanish accent significantly facilitated recognition in the presence of prosodic information. Word attributes were far more consequential in the English accent than in the Spanish accent condition.

CONCLUSIONS

Word rhyme information, word properties, and accent affect gated word recognition differently in monolingual and bilingual individuals. Top-down strategies emanating from word properties that may facilitate single-word recognition are experience and context dependent and become less available in the presence of a nonnative accent.