1
|
Liao Q, Fielding R, Lam WWT, Yang L, Tian L, Lee TC. Climate change beliefs, perceptions of climate change-related health risk, and responses to heat-related risks among Hong Kong adults: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 4:16-17. [PMID: 37690801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- Q Liao
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - R Fielding
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - W W T Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - L Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - L Tian
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - T C Lee
- Climate Information Services and Tropical Cyclone, Hong Kong Observatory, Hong Kong SAR, China
| |
Collapse
|
2
|
Chong KC, Chan PKS, Lee TC, Goggins WB, Wu P, Lai CKC, Fung KSC. Meteorologically favourable zones for seasonal influenza A and B in Hong Kong: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 3:19-22. [PMID: 37357586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- K C Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T C Lee
- Hong Kong Observatory, Hong Kong SAR, China
| | - W B Goggins
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P Wu
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C K C Lai
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K S C Fung
- Department of Pathology, United Christian Hospital, Hong Kong SAR, China
| |
Collapse
|
3
|
Stachelek K, Harutyunyan N, Lee S, Beck A, Kim J, Xu L, Berry JL, Nagiel A, Reynolds CP, Murphree AL, Lee TC, Aparicio JG, Cobrinik D. Non-synonymous, synonymous, and non-coding nucleotide variants contribute to recurrently altered biological processes during retinoblastoma progression. Genes Chromosomes Cancer 2023; 62:275-289. [PMID: 36550020 PMCID: PMC10006380 DOI: 10.1002/gcc.23120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Retinoblastomas form in response to biallelic RB1 mutations or MYCN amplification and progress to more aggressive and therapy-resistant phenotypes through accumulation of secondary genomic changes. Progression-related changes include recurrent somatic copy number alterations and typically non-recurrent nucleotide variants, including synonymous and non-coding variants, whose significance has been unclear. To determine if nucleotide variants recurrently affect specific biological processes, we identified altered genes and over-represented variant gene ontologies in 168 exome or whole-genome-sequenced retinoblastomas and 12 tumor-matched cell lines. In addition to RB1 mutations, MYCN amplification, and established retinoblastoma somatic copy number alterations, the analyses revealed enrichment of variant genes related to diverse biological processes including histone monoubiquitination, mRNA processing (P) body assembly, and mitotic sister chromatid segregation and cytokinesis. Importantly, non-coding and synonymous variants increased the enrichment significance of each over-represented biological process term. To assess the effects of such mutations, we examined the consequences of a 3' UTR variant of PCGF3 (a BCOR-binding component of Polycomb repressive complex I), dual 3' UTR variants of CDC14B (a regulator of sister chromatid segregation), and a synonymous variant of DYNC1H1 (a regulator of P-body assembly). One PCGF3 and one of two CDC14B 3' UTR variants impaired gene expression whereas a base-edited DYNC1H1 synonymous variant altered protease sensitivity and stability. Retinoblastoma cell lines retained only ~50% of variants detected in tumors and enriched for new variants affecting p53 signaling. These findings reveal potentially important differences in retinoblastoma cell lines and tumors and implicate synonymous and non-coding variants, along with non-synonymous variants, in retinoblastoma oncogenesis.
Collapse
Affiliation(s)
- Kevin Stachelek
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Cancer Biology and Genomics Program, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Narine Harutyunyan
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Susan Lee
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Assaf Beck
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Jonathan Kim
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Liya Xu
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jesse L. Berry
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Aaron Nagiel
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - C. Patrick Reynolds
- Department of Pediatrics and Cancer Center, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX
| | - A. Linn Murphree
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Thomas C. Lee
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer G. Aparicio
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - David Cobrinik
- The Vision Center and Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Ophthalmology and Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Biochemistry & Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
4
|
Lopez J, Borchert M, Lee TC, Nagiel A. Subretinal deposits in young patients treated with voretigene neparvovec-rzyl for RPE65-mediated retinal dystrophy. Br J Ophthalmol 2023; 107:299-301. [PMID: 35835501 PMCID: PMC9839889 DOI: 10.1136/bjo-2022-321488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/05/2022] [Indexed: 01/17/2023]
Abstract
We report a series of three young patients (ages: 22 months, 2 years, and 5 years) who developed subretinal deposits at post-operative week one following subretinal voretigene neparvovec-rzyl treatment for RPE65-mediated retinal dystrophy. In the 5-year-old, subretinal deposits were also observed in the inferior periphery of both eyes. All three patients experienced improved visual function with treatment, and both the macular and inferior subretinal deposits have improved or resolved over the follow-up period. These findings may inform the delivery parameters and safety profile of AAV-based gene therapy as the number of retinal gene therapy trials continues to grow.
Collapse
Affiliation(s)
- Jennifer Lopez
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, Los Angeles, California, USA
| | - Mark Borchert
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, Los Angeles, California, USA
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, Los Angeles, California, USA
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA .,Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
5
|
Stingl K, Stingl K, Schwartz H, Reid MW, Kempf M, Dimopoulos S, Kortuem F, Borchert MS, Lee TC, Nagiel A. Full-field scotopic threshold improvement following voretigene neparvovec-rzyl treatment correlates with chorioretinal atrophy. Ophthalmology 2023:S0161-6420(23)00126-4. [PMID: 36822437 DOI: 10.1016/j.ophtha.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To analyze demographic and ophthalmologic data in patients with and without chorioretinal atrophy after voretigene neparvovec-rzyl (VN) in order to identify possible causes for this phenomenon. DESIGN Retrospective cohort study with longitudinal follow-up. SUBJECTS 71 eyes of 38 patients aged 2 to 44 years with RPE65-mediated retinal dystrophy treated with VN across two large gene therapy centers in the USA and Germany. METHODS VN-treated patients who developed atrophy were compared to those who did not. MAIN OUTCOME MEASURES Gender, age, surgical center, spherical equivalent refraction, BCVA, baseline FST, and post-treatment change in full-field scotopic threshold testing (FST). RESULTS 20 eyes of 12 patients developed atrophy following treatment with VN (28% of all eyes). There was no significant difference in gender, age, surgical center, or spherical equivalent refraction between the Atrophy group and the No Atrophy group. However, patients between school age and young adulthood were predominantly affected, whereas the youngest and the oldest patients did not develop atrophy. Baseline BCVA was better in patients who developed atrophy than those who did not (P=0.006). The postoperative improvement in FST at 1 month was significantly higher in the Atrophy than the No Atrophy group (P=0.0005), and this difference remained statistically significant at 1 year (P=0.0001). There was no correlation to baseline FST, to inflammation, or to which eye was treated first. CONCLUSIONS The degree of FST improvement following VN appears to be strongly correlated with the development of VN-related chorioretinal atrophy. This finding raises the possibility that atrophy may develop as a toxic or metabolic sequela of vector-mediated RPE65 expression. In light of the expanding number of retinal gene therapy clinical trials, this complication warrants further study as it may not be limited to VN.
Collapse
Affiliation(s)
- Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany; Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Krunoslav Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany; Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Hillary Schwartz
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Mark W Reid
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Melanie Kempf
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany; Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Spyridon Dimopoulos
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Friederike Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Mark S Borchert
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| |
Collapse
|
6
|
Jung EE, Lee TC, Nagiel A. Initial Experience With Biosimilar Bevacizumab-bvzr For Intravitreal Use in Children: A Case Series and Literature Review. Ophthalmic Surg Lasers Imaging Retina 2023; 54:84-88. [PMID: 36780635 PMCID: PMC10874225 DOI: 10.3928/23258160-20230130-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE We report our initial experience with intravitreal bevacizumab-bvzr, a bevacizumab biosimilar approved by the US Food and Drug Administration in 2019 and recently introduced by our institution for off-label ophthalmologic use in children. PATIENTS AND METHODS This was an Institutional Review Board-approved single-institution retrospective case series of pediatric patients 21 years or younger who received at least one intravitreal injection of biosimilar bevacizumab-bvzr. RESULTS Twelve eyes of 9 patients were identified as having received intravitreal bevacizumab-bvzr, with a total of 13 injections performed. Indications for injection included retinopathy of prematurity (7/13), choroidal neovascularization (3/13), retinal vein occlusion (2/13), and Coats disease (1/13). Following injection of bevacizumab-bvzr, all patients experienced a positive clinical response. No occurrences of postinjection inflammation, intraocular pressure anomalies, or endophthalmitis were observed with a median follow-up of 18 weeks. CONCLUSION In the absence of controlled studies, this case series supports the use of intravitreal bevacizumab-bvzr as an anti-vascular endothelial growth factor therapy option, including in the pediatric population and resource-poor settings. [Ophthalmic Surg Lasers Imaging Retina 2023;54:84-88.].
Collapse
|
7
|
Cole ED, Park SH, Kim SJ, Kang KB, Valikodath NG, Al-Khaled T, Patel SN, Jonas KE, Ostmo S, Coyner A, Berrocal A, Drenser KA, Nagiel A, Horowitz JD, Lee TC, Kalpathy-Cramer J, Chiang MF, Campbell JP, Chan RVP. Variability in Plus Disease Diagnosis using Single and Serial Images. Ophthalmol Retina 2022; 6:1122-1129. [PMID: 35659941 DOI: 10.1016/j.oret.2022.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To assess changes in retinopathy of prematurity (ROP) diagnosis in single and serial retinal images. DESIGN Cohort study. PARTICIPANTS Cases of ROP recruited from the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) consortium evaluated by 7 graders. METHODS Seven ophthalmologists reviewed both single and 3 consecutive serial retinal images from 15 cases with ROP, and severity was assigned as plus, preplus, or none. Imaging data were acquired during routine ROP screening from 2011 to 2015, and a reference standard diagnosis was established for each image. A secondary analysis was performed using the i-ROP deep learning system to assign a vascular severity score (VSS) to each image, ranging from 1 to 9, with 9 being the most severe disease. This score has been previously demonstrated to correlate with the International Classification of ROP. Mean plus disease severity was calculated by averaging 14 labels per image in serial and single images to decrease noise. MAIN OUTCOME MEASURES Grading severity of ROP as defined by plus, preplus, or no ROP. RESULTS Assessment of serial retinal images changed the grading severity for > 50% of the graders, although there was wide variability. Cohen's kappa ranged from 0.29 to 1.0, which showed a wide range of agreement from slight to perfect by each grader. Changes in the grading of serial retinal images were noted more commonly in cases of preplus disease. The mean severity in cases with a diagnosis of plus disease and no disease did not change between single and serial images. The ROP VSS demonstrated good correlation with the range of expert classifications of plus disease and overall agreement with the mode class (P = 0.001). The VSS correlated with mean plus disease severity by expert diagnosis (correlation coefficient, 0.89). The more aggressive graders tended to be influenced by serial images to increase the severity of their grading. The VSS also demonstrated agreement with disease progression across serial images, which progressed to preplus and plus disease. CONCLUSIONS Clinicians demonstrated variability in ROP diagnosis when presented with both single and serial images. The use of deep learning as a quantitative assessment of plus disease has the potential to standardize ROP diagnosis and treatment.
Collapse
Affiliation(s)
- Emily D Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Shin Hae Park
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kai B Kang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Nita G Valikodath
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Tala Al-Khaled
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | | | - Karyn E Jonas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Aaron Coyner
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Audina Berrocal
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Kimberly A Drenser
- Department of Ophthalmology, Beaumont Eye Institute, Royal Oak, Michigan
| | - Aaron Nagiel
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University, New York, New York
| | - Thomas C Lee
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois.
| | | |
Collapse
|
8
|
Li J, Nguyen AM, Kolin T, Chang MY, Reid MW, Lee TC, Nallasamy S. Evaluation of Streamed Hardware-to-Software Telemedicine Strabismus Consultations Utilizing Video Glasses. Clin Ophthalmol 2022; 16:3927-3933. [PMID: 36471728 PMCID: PMC9719262 DOI: 10.2147/opth.s392862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background While video glasses have been shown to be an effective tool for real-time pediatric strabismus telemedicine consultations, the high cost of the hardware-to-hardware conferencing system and bandwidth limitations may present barriers to accessibility and widespread adoption. This study evaluates the use of video glasses with a more affordable hardware-to-software video conferencing system for real-time strabismus consultations across multiple graders. Methods A pediatric ophthalmologist (Grader 1) wearing video glasses simultaneously performed and recorded strabismus examinations in primary gaze, with and without correction, both at distance and near. Recorded parameters included strabismus category, angle measurements, and ocular motility. Three years later, four pediatric ophthalmologists (Graders 1-4) reviewed and graded streamed video feed transmitted at 1 megabit per second (Mbps) from a hard-wired codec to software. Agreement between streamed and gold standard in-person findings was determined by weighted kappa (κ) for categorical variables, intraclass correlation coefficient (ICC) for continuous variables, and percent agreement. Results Eighteen patients aged 4-11 years (median, 7 years) were included. Agreement in strabismus category between in-person and streamed examinations was perfect for both horizontal and vertical deviations (κ=1.0). Almost perfect agreement was found for degree manifest (tropia vs intermittent tropia vs phoria) across graders (κ=0.91, range 0.86-0.97). Agreement for angle measurements was excellent across graders (ICC = 0.97, range 0.97-0.98). Extraocular motility agreement was 90% for all graders combined, with Grader 1 having 100% agreement between her in-person and streamed examinations. Conclusion Feed obtained from video glasses streamed through a hardware-to-software video conferencing system at 1 Mbps is a reliable tool for pediatric strabismus telemedicine evaluations.
Collapse
Affiliation(s)
- Joy Li
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Angeline M Nguyen
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Talia Kolin
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Veterans Affairs Los Angeles Ambulatory Care Center, Los Angeles, CA, USA
| | - Melinda Y Chang
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mark W Reid
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Thomas C Lee
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sudha Nallasamy
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Correspondence: Sudha Nallasamy, The Vision Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS #88, Los Angeles, CA, 90027, USA, Tel +1 323 361 4510, Fax +1 323 361 7993, Email
| |
Collapse
|
9
|
Stewart C, Coffey-Sandoval J, Souverein EA, Ho TC, Lee TC, Nallasamy S. Patient and Provider Experience in Real-Time Telemedicine Consultations for Pediatric Ophthalmology. Clin Ophthalmol 2022; 16:2943-2953. [PMID: 36071727 PMCID: PMC9444028 DOI: 10.2147/opth.s374811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Telemedicine adoption hinges on positive experiences for patients and providers. We report participants’ experience from our prospective study. Patients and Methods Ophthalmic examinations for children 0–17 years of age were conducted by an optometrist using digital exam instruments and streamed to an ophthalmologist. The ophthalmologist, optometrist, parent, and patient (≥10 years) completed surveys capturing patient and provider experience outcomes. Results Three hundred forty-eight examinations were conducted with 210 patients in a hospital-based pediatric ophthalmology clinic. About 99% of parents were comfortable with exam quality, and 97% indicated they would have another telemedicine examination. Fifty-four of 55 consented for surgery during the initial telemedicine examination. Thirty-seven percent of families traveled ≥2 hours round-trip to their appointment; 1/3 of parents and patients missed a full day of work/school. Video glasses were by far the most useful instrument, while technical proficiency was most challenging with the digital indirect ophthalmoscope. Problem-focused examinations took 33 minutes of the ophthalmologist’s time on average. Equipment challenges caused delays in 40/348 (11.5%) of visits, with the majority lasting 5–10 minutes. In a few cases, a backup device was used. Despite seeing significantly fewer patients on telemedicine days, the ophthalmologist’s surgical volume increased 25%. Conclusion All participants were satisfied with telemedicine visits despite longer durations and learning curve. Results indicate an opportunity for telemedicine in community settings to improve access to specialized care. Telemedicine enabled the optometrist to manage or co-manage more complex patients with a pipeline to the ophthalmologist for surgical cases. In the right setting, collaborative telemedicine consultations may be beneficial to one’s practice.
Collapse
Affiliation(s)
- Carly Stewart
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Erik A Souverein
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Tiffany C Ho
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Thomas C Lee
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Sudha Nallasamy
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Correspondence: Sudha Nallasamy, The Vision Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS #88, Los Angeles, CA, 90027, USA, Tel +1 323 361 4510, Fax +1 323 361 7993, Email
| |
Collapse
|
10
|
Jrbashyan N, Yeghiazaryan N, Sikder A, Nallasamy S, Reid MW, Ohanesian R, Lee TC, Espinoza J. Pattern and prevalence of eye disorders and diseases in school-aged children: findings from the Nationwide School Sight Sampling Survey in Armenia. BMJ Open Ophthalmol 2022; 7:e000899. [PMID: 35265749 PMCID: PMC8860128 DOI: 10.1136/bmjophth-2021-000899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThis study aims to identify the prevalence of eye disorders and their causes among secondary schoolchildren aged 6–15 years old in Armenia, based on analysis of the Nationwide School Sight Sampling Survey.Methods and AnalysisA two-stage proportionate stratified cluster sample was designed for the survey. 22 600 students were screened for visual acuity in schools; 5944 of them were selected for analysis as a nationally representative sample. Those with 20/40 or worse vision were referred to photoscreening and rapid ophthalmic assessment in schools and then were provided with vouchers for free comprehensive eye examination in eye clinics. Data were collected through data collection forms and analysed using SPSS V.23.ResultsWhile majority of the children (85%) had normal vision, 15% had a visual acuity ≤20/40. The prevalence of vision impairment (VI) in at least one eye was 9.7% and blindness in at least one eye was 0.05%. The prevalence of abnormal vision and VI was higher among girls and older children. VI was more prevalent in urban areas. The most common diagnoses were myopia (60%), astigmatism (33.7%), hyperopia (29.5%) and strabismus (3.8%).ConclusionMajority of the vision abnormalities and VI among schoolchildren are a result of refractive error and are treatable. Our results highlight the importance of regular eye examinations for schoolchildren to detect and prevent VI. Raising awareness among parents, school staff and children about eye health is vital.
Collapse
Affiliation(s)
- Nairuhi Jrbashyan
- Armenian EyeCare Project, Yerevan, Armenia
- Yerevan State University, Yerevan, Armenia
| | | | - Abu Sikder
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Sudha Nallasamy
- Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Mark W Reid
- Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Roger Ohanesian
- Armenian EyeCare Project, Yerevan, Armenia
- Department of Ophthalmology, UC Irvine, Irvine, California, USA
| | - Thomas C Lee
- Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
- Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | - Juan Espinoza
- Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
- Pediatrics, USC Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
11
|
Gange WS, Sisk RA, Besirli CG, Lee TC, Havunjian M, Schwartz H, Borchert M, Sengillo JD, Mendoza C, Berrocal AM, Nagiel A. Perifoveal Chorioretinal Atrophy after Subretinal Voretigene Neparvovec-rzyl for RPE65-Mediated Leber Congenital Amaurosis. Ophthalmol Retina 2022; 6:58-64. [PMID: 33838313 PMCID: PMC8497635 DOI: 10.1016/j.oret.2021.03.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To report an anatomic change following subretinal injection of voretigene neparvovec-rzyl (VN) for RPE65-mediated Leber congenital amaurosis. DESIGN Multicenter, retrospective chart review. PARTICIPANTS Patients who underwent subretinal VN injection at each of 4 participating institutions. METHODS Patients were identified as having perifoveal chorioretinal atrophy if (1) the areas of atrophy were not directly related to the touch-down site of the subretinal cannula; and (2) the area of atrophy progressively enlarged over time. Demographic data, visual acuity, refractive error, fundus photographs, OCT, visual fields, and full-field stimulus threshold (FST) were analyzed. MAIN OUTCOME MEASURES Outcome measures included change in visual acuity, FST, visual fields, and location of atrophy relative to subretinal bleb position. RESULTS A total of 18 eyes of 10 patients who underwent subretinal injection of VN were identified as having developed perifoveal chorioretinal atrophy. Eight of 10 patients (80%) developed bilateral atrophy. The mean age was 11.6 years (range, 5-20 years), and 6 patients (60%) were male. Baseline mean logarithm of the minimum angle of resolution visual acuity and FST were 0.82 (standard deviation [SD], 0.51) and -1.3 log cd.s/m2 (SD, 0.44), respectively. The mean spherical equivalent was -5.7 diopters (D) (range, -11.50 to +1.75 D). Atrophy was identifiable at an average of 4.7 months (SD, 4.3) after surgery and progressively enlarged in all cases up to a mean follow-up period of 11.3 months (range, 4-18 months). Atrophy developed within and outside the area of the subretinal bleb in 10 eyes (55.5%), exclusively within the area of the bleb in 7 eyes (38.9%), and exclusively outside the bleb in 1 eye (5.5%). There was no significant change in visual acuity (P = 0.45). There was a consistent improvement in FST with a mean improvement of -3.21 log cd.s/m2 (P < 0.0001). Additionally, all 13 eyes with reliable Goldmann visual fields demonstrated improvement, but 3 eyes (23.1%) demonstrated paracentral scotomas related to the atrophy. CONCLUSIONS A subset of patients undergoing subretinal VN injection developed progressive perifoveal chorioretinal atrophy after surgery. Further study is necessary to determine what ocular, surgical delivery, and vector-related factors predispose to this complication.
Collapse
Affiliation(s)
- William S. Gange
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA,Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert A. Sisk
- Cincinnati Eye Institute, Cincinnati, OH,University of Cincinnati Department of Ophthalmology, Cincinnati, OH,Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cagri G. Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Thomas C. Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA,Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Margaret Havunjian
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Hillary Schwartz
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Mark Borchert
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA,Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Carlos Mendoza
- Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | | | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA,Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
12
|
Stewart C, Coffey-Sandoval J, Souverein EA, Lee TC, Nallasamy S. Provider-to-provider synchronous telemedical consultations in ophthalmology: Advice for implementation. Digit Health 2022; 8:20552076221117744. [PMID: 35935712 PMCID: PMC9350499 DOI: 10.1177/20552076221117744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
We previously demonstrated the non-inferiority of a synchronous (real-time) telemedicine model (compared to gold standard in-person examination) for pediatric ophthalmology consultations using a Polycom conferencing system, smart glasses, digital slit lamp, and digital indirect ophthalmoscope. Although we acknowledge there is a learning curve associated with becoming proficient with this system, we believe implementation of a synchronous telemedicine model is advantageous to both patient and provider in the right care setting. In conducting 348 such examinations over the course of our study and dozens of subsequent examinations after the implementation of our model in the community, we have gleaned many insights into optimizing the experience and efficiency. We wish to share these insights to help guide those interested in adopting such a model to expand access to specialists for underserved patients or improve efficiencies in their practice.
Collapse
Affiliation(s)
- Carly Stewart
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Erik A. Souverein
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thomas C. Lee
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Sudha Nallasamy
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Rodighiero J, McDonald EG, Lee TC, Piazza N, Martucci G, Langlois Y, Morin JF, Bendayan M, Piancova P, Lantagne S, Ouimet MC, Mantzanis H, Afilalo J. Polypharmacy in older adults after transcatheter or surgical aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Polypharmacy is associated with higher rates of adverse drug events and unplanned hospital visits in medical patients. Little is known about polypharmacy in frail older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.
Purpose
To determine the prevalence and prognostic implications of polypharmacy and potentially inappropriate medications (PIM) following TAVR or SAVR.
Methods
A post hoc analysis of the McGill Frailty Registry was conducted. Patients 70 years of age or older who were discharged alive after TAVR or SAVR at two university hospitals were included. Discharge prescriptions were codified and analyzed using the MedSafer electronic tool that has been validated to flag drug interactions and PIMs considering patient-specific comorbidities. Associations with the primary outcome of 30-day all-cause readmission were examined by logistic regression after adjusting for age, sex, Charlson Comorbidity Index, and procedure type.
Results
The cohort consisted of 495 patients (52% TAVR, 21% isolated SAVR, 27% combined SAVR). The mean age was 80.1±5.5 years with 52% females. The mean number of medications was 10.2±3.7 with 90% having 5 or more medications. A total of 55 patients were readmitted within 30 days. While the total number of medications was not predictive, three specific PIMs were found to be harmful and one PIM was found to be protective for readmission: clopidogrel with warfarin or heparin (OR 3.99; 95% CI 1.47, 10.82), diltiazem with heart failure (OR 3.16; 95% CI 1.04, 36.41), doxazosin or terazosin with hypertension (OR 6.21; 95% CI 0.99, 38.88), and any proton pump inhibitor (OR 0.47; 95% CI 0.26, 0.86). Of note, the combination of clopidogrel with direct oral anticoagulants was not found to be harmful for readmission.
Conclusion
The prevalence of polypharmacy is elevated in older patients undergoing TAVR or SAVR. Specific PIMs, but not total number of medications prescribed, were found to be associated with potentially preventable readmissions.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- J Rodighiero
- Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology, Montreal, Canada
| | - E G McDonald
- McGill University Health Centre, Division of Internal Medicine, Montreal, Canada
| | - T C Lee
- Mcgill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Canada
| | - N Piazza
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - G Martucci
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - Y Langlois
- Jewish General Hospital, Division of Cardiac Surgery, Montreal, Canada
| | - J F Morin
- Jewish General Hospital, Division of Cardiac Surgery, Montreal, Canada
| | - M Bendayan
- Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology, Montreal, Canada
| | - P Piancova
- Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology, Montreal, Canada
| | - S Lantagne
- Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology, Montreal, Canada
| | - M C Ouimet
- McGill University Health Centre, Research Institute, Montreal, Canada
| | - H Mantzanis
- Jewish General Hospital, Pharmacy Department, Montreal, Canada
| | - J Afilalo
- Jewish General Hospital, Division of Cardiology, Montreal, Canada
| |
Collapse
|
14
|
Quondamatteo F, Corzo-Leon DE, Brassett C, Colquhoun I, Davies DC, Dockery P, Grenham S, Guild S, Hunter A, Jones J, Lee TC, Tracey C, Wilkinson T, Munro CA, Gillingwater TH, Parson SH. Neutralisation of SARS-CoV-2 by anatomical embalming solutions. J Anat 2021; 239:1221-1225. [PMID: 34633083 PMCID: PMC8546517 DOI: 10.1111/joa.13549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/18/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Teaching and learning anatomy by using human cadaveric specimens has been a foundation of medical and biomedical teaching for hundreds of years. Therefore, the majority of institutions that teach topographical anatomy rely on body donation programmes to provide specimens for both undergraduate and postgraduate teaching of gross anatomy. The COVID‐19 pandemic has posed an unprecedented challenge to anatomy teaching because of the suspension of donor acceptance at most institutions. This was largely due to concerns about the potential transmissibility of the SARS‐CoV‐2 virus and the absence of data about the ability of embalming solutions to neutralise the virus. Twenty embalming solutions commonly used in institutions in the United Kingdom and Ireland were tested for their ability to neutralise SARS‐CoV‐2, using an established cytotoxicity assay. All embalming solutions tested neutralised SARS‐CoV‐2, with the majority of solutions being effective at high‐working dilutions. These results suggest that successful embalming with the tested solutions can neutralise the SARS‐CoV‐2 virus, thereby facilitating the safe resumption of body donation programmes and cadaveric anatomy teaching.
Collapse
Affiliation(s)
- Fabio Quondamatteo
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dora E Corzo-Leon
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Ian Colquhoun
- Royal College of Physicians and Surgeons of Glasgow, Glasgow, UK
| | - David C Davies
- Human Anatomy Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Dockery
- Anatomy, School of Medicine NUI Galway, Galway, Ireland
| | - Sue Grenham
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Simon Guild
- School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Amanda Hunter
- Anatomy Centre, ARU Medical School, Anglia Ruskin University, Chelmsford, UK
| | - James Jones
- Biomedical Section, School of Medicine, University College Dublin, Dublin, Ireland
| | - Thomas C Lee
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris Tracey
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Carol A Munro
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Thomas H Gillingwater
- Anatomy, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Simon H Parson
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
15
|
Chong KC, Chan E, Lee TC, Kwok KL, Lau SYF, Wang P, Lam HCY, Goggins W, Mohammad K, Leung SY, Chan PKS. 91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene.
Methods
Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis.
Results
Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%.
Conclusions
Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses.
Key messages
Weather plays a minor role in food and water contamination in affluent societies.
Low temperature and humidity extremes might improve survival of enteric viruses.
Collapse
Affiliation(s)
- Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, Shenzhen, China
| | - Emily Chan
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - TC Lee
- Hong Kong Observatory, Hong Kong
| | - KL Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - SYF Lau
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - P Wang
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - HCY Lam
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - W Goggins
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - K Mohammad
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - SY Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - PKS Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
16
|
Miskin N, Gaviola GC, Huang RY, Kim CJ, Lee TC, Small KM, Wieschhoff GG, Mandell JC. Standardized Classification of Lumbar Spine Degeneration on Magnetic Resonance Imaging Reduces Intra- and Inter-subspecialty Variability. Curr Probl Diagn Radiol 2021; 51:491-496. [PMID: 34556373 DOI: 10.1067/j.cpradiol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE To determine the efficacy of standardized definitions of degenerative change in reducing variability in interpretation of lumbar spine magnetic resonance imaging within and between groups of subspecialty-trained neuroradiologists (NR) and musculoskeletal radiologists (MSK). MATERIALS AND METHODS Six radiologists, three from both NR and MSK groups were trained on a standardized classification system of degenerative change. After an 11-month washout period, they independently re-interpreted fifty exams at the L4-L5 and L5-S1 levels. Responses were converted to a six-point ordinal scale for the assessment of neural foraminal stenosis and spinal canal stenosis (SCS), three-point scale for lateral recess stenosis, and four-point scale for facet osteoarthritis (FO). Intra-subspecialty and inter-subspecialty analysis was performed using the weighted Cohen's kappa with a binary matrix of all reader pairs. RESULTS Inter-subspecialty agreement improved from k=0.527 (moderate) to k=0.602 (substantial) for neural foraminal stenosis, from k=0.540 (moderate) to k=0.652 (substantial) for SCS, from k=0.0818 (slight) to k=0.337 (fair) for lateral recess stenosis, and from k=0.176 (slight) to k=0.495 (moderate) for FO. The NR group demonstrated improved intra-subspecialty agreement for the assessment of SCS, from k=0.368 (fair) to k=0.638 (substantial). The MSK group demonstrated improved intra-subspecialty agreement for the assessment of FO, from k=0.134 (slight) to k=0.413 (moderate). Intra-subspecialty agreement was similar for other parameters before and after training. CONCLUSIONS As result of the standardized definitions training, the NR and MSK groups each improved in one of the four parameters, while inter-subspecialty variability improved in all four parameters. These definitions may be useful in clinical practice across radiology subspecialties.
Collapse
Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christine J Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
17
|
Yang U, Gentleman S, Gai X, Gorin MB, Borchert MS, Lee TC, Villanueva A, Koenekoop R, Maguire AM, Bennett J, Redmond TM, Nagiel A. Utility of In Vitro Mutagenesis of RPE65 Protein for Verification of Mutational Pathogenicity Before Gene Therapy. JAMA Ophthalmol 2021; 137:1381-1388. [PMID: 31580392 DOI: 10.1001/jamaophthalmol.2019.3914] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Next-generation sequencing can detect variants of uncertain significance (VUSs), for some of which gene therapy would not be advantageous. Therefore, the pathogenicity of compound heterozygous or homozygous variants should be confirmed before bilateral vitrectomy and administration of voretigene neparvovec-rzyl. Objective To describe an in vitro mutagenesis assay for assessing the pathogenicity of variants in the RPE65 gene. Design, Setting, and Participants This case series was conducted at 2 tertiary referral centers. Clinical history, imaging, and electrophysiologic testing results were reviewed from September 5, 2008, to December 31, 2019. Participants were 4 pediatric patients with Leber congenital amaurosis who were evaluated for or met the inclusion criteria for phase 1 to 3 clinical trials or were referred for voretigene neparvovec-rzyl treatment. Main Outcomes and Measures A functional assay was used to confirm the pathogenicity of novel RPE65 VUSs in 4 patients with Leber congenital amaurosis. Results Four patients with Leber congenital amaurosis had VUSs in RPE65. Patients 1 and 2 were siblings with the homozygous VUS c.311G>T p.(G104V). Patient 3 was a compound heterozygote with 1 known pathogenic allele, c.1202_1203insCTGG p.(Glu404AlafsTer4), and 1 VUS, c.311G>T p.(G104V), which segregated to separate alleles. Patient 4 was also a compound heterozygote with 1 pathogenic variant, c.11 + 5G>A, and 1 variant in trans, c.1399C>T p.(P467S). In vitro mutagenesis revealed that the G104V and P467S RPE65 proteins were catalytically inactive (0% isomerase activity). Patients 1 and 2 were excluded from participation in a phase 1 trial owing to high Adeno-associated virus 2 capsid-neutralizing antibodies. Patients 3 (G104V) and 4 (P467S) underwent successful surgical gene therapy with voretigene neparvovec-rzyl, and their response to lower white light intensity and visual field increased in fewer than 30 days after gene therapy intervention. Conclusions and Relevance Findings from this study suggest that, in patients with missense mutations in RPE65, functional assays of protein function can be performed to assess the pathogenicity of variants in both compound heterozygous and homozygous cases. Given the potential risks of gene therapy operations, in vitro RPE65 activity testing should be considered to avoid the possibility of treating a false genotype.
Collapse
Affiliation(s)
- Unikora Yang
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Susan Gentleman
- Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, Bethesda, Maryland
| | - Xiaowu Gai
- Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Michael B Gorin
- Division of Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles)
| | - Mark S Borchert
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Adda Villanueva
- Retina Department Genomics Institute, Mejora Vision MD/Virtual Eye Care MD, Mérida, Yucatán, México.,Laboratoire de Diagnostic Moleculaire, Hôpital Maisonneuve Rosemont, Montreal, Quebec, Canada
| | - Robert Koenekoop
- Department of Paediatric Surgery, Montreal Children's Hospital, McGill University and McGill University Health Centre Research Institute, Montreal, Quebec, Canada.,Department of Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University and McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Albert M Maguire
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia
| | - Jean Bennett
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia
| | - T Michael Redmond
- Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, Bethesda, Maryland
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles
| |
Collapse
|
18
|
Ho TC, Kolin T, Stewart C, Reid MW, Lee TC, Nallasamy S. Evaluation of high-definition video smart glasses for real-time telemedicine strabismus consultations. J AAPOS 2021; 25:74.e1-74.e6. [PMID: 33901673 DOI: 10.1016/j.jaapos.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the use of high-definition, wireless video recording Pivothead glasses in streamed strabismus examinations. METHODS A pediatric ophthalmologist wearing Pivothead glasses simultaneously performed and recorded strabismus examinations, which were completed in primary gaze, with and without correction, and at distance and near. Parameters included category of strabismus, angle measurements, and ocular motility. Another pediatric ophthalmologist, masked to clinical findings, reviewed and graded live video feed. At least 3 months later, both pediatric ophthalmologists graded the stored videos. Agreement was determined by unweighted kappa for categorical variables, intraclass coefficient for continuous variables, and percent agreement. RESULTS A total of 100 videos were recorded for 37 enrolled patients aged 4-16 years. Agreement between streamed and in-person examinations was perfect for both horizontal and vertical (κ = 1.0) deviations. Agreement for degree manifest (tropia vs intermittent tropia vs phoria) was almost perfect for all deviations (κ = 0.94). Agreement was excellent for angle measurements of both horizontal (ICC = 0.95) and vertical (ICC = 0.91) deviations. Inferior and superior oblique agreement was 93% and 98%, respectively. Similar agreement was also observed between store-and-forward versus gold standard examinations. CONCLUSIONS Real-time video feed obtained with video glasses can be read with a high degree of reliability for detecting strabismus category, angle, and extraocular motility.
Collapse
Affiliation(s)
- Tiffany C Ho
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Talia Kolin
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles; Veterans Affairs Los Angeles Ambulatory Care Center, Los Angeles, California
| | - Carly Stewart
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Sudha Nallasamy
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California; USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles.
| |
Collapse
|
19
|
Stewart C, Coffey-Sandoval J, Reid MW, Ho TC, Lee TC, Nallasamy S. Reliability of telemedicine for real-time paediatric ophthalmology consultations. Br J Ophthalmol 2021; 106:1157-1163. [PMID: 33722800 PMCID: PMC9340009 DOI: 10.1136/bjophthalmol-2020-318385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/30/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions. Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies. Results 210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%). Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
Collapse
Affiliation(s)
- Carly Stewart
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Mark W Reid
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Tiffany C Ho
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Thomas C Lee
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA .,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| |
Collapse
|
20
|
Sarin-Gulian L, Espinoza J, Lee TC, Choe JYU, Fichera S. Development and Evaluation of a Tele-Education Program for Neonatal ICU Nurses in Armenia. J Pediatr Nurs 2021; 57:e9-e14. [PMID: 32981807 DOI: 10.1016/j.pedn.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Neonatal mortality currently accounts for more than 60% of all infant mortality in Armenia. The majority of health professionals in Neonatal Intensive Care Units (NICU) however, have had no specialized training in neonatology. Local and global agencies have emphasized the need for improvement in the education and skills of NICU health professionals. The objective of this study was to design, implement, and evaluate an innovative tele-education program for NICU nurses in Armenia. DESIGN AND METHODS Seven online tele-education courses were designed on various neonatal nursing topics using Final Cut Pro and translated professionally to Armenian. The videos were uploaded to YouTube. All NICU nurses employed in two hospitals (n = 35) in Yerevan, Armenia, completed a diagnostic pretest, course viewing, a posttest, and a satisfaction survey for each topic. A difference in knowledge was defined as the number of correct test answers obtained before and after the course. Participant satisfaction was measured using a Likert scale. RESULTS The combined average for completed pre-tests for all courses was 45% and 71% for post-tests, which was statistically significant for each course (p < 0.05). A majority of the nurses either agreed or strongly agreed with all of the satisfaction parameters of the course. CONCLUSIONS These results support a tele-education model for effectively providing continuing education to NICU nurses in Armenia. A similar platform could be used to establish nationwide certification programs for neonatal nurses. PRACTICE IMPLICATIONS Tele-education technology can be used effectively by nursing educators working in global health as part of international learning collaboratives.
Collapse
Affiliation(s)
| | - Juan Espinoza
- Children's Hospital Los Angeles, Los Angeles, CA, United States.
| | - Thomas C Lee
- Children's Hospital Los Angeles, Los Angeles, CA, United States.
| | | | - Sharon Fichera
- Children's Hospital Los Angeles, Los Angeles, CA, United States.
| |
Collapse
|
21
|
Mulchandani D, Reiser BJ, Ho TC, Reid MW, Stewart C, Lee TC, Nallasamy S. Evaluation of digital slit-lamp videos for paediatric anterior segment telemedicine consultations. J Telemed Telecare 2021:1357633X21990991. [PMID: 33535917 DOI: 10.1177/1357633x21990991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study aimed to assess the validity of telemedicine consultations using digital slit-lamp videos to detect anterior segment pathology in a paediatric population. METHODS A paediatric anterior segment specialist simultaneously performed and recorded anterior segment examinations using the Topcon digital-ready slit lamp. Components of the examination included the eyelids/eyelashes, conjunctiva/sclera, cornea, anterior chamber, iris and lens. Masked to clinical findings, a paediatric ophthalmologist reviewed and graded the live video feed transmitted at 4 Mbps. At least three months later, both ophthalmologists graded the stored videos. We compared the sensitivity, specificity, percent agreement and weighted kappa (κ) of diagnosing anterior segment pathologies via live-streamed and store-and-forward video clips compared to the in-person standard examination. RESULTS Examinations of 89 eyes from 45 children (5-17 years old) with known anterior segment pathology were included. Agreement between live-streamed and in-person standard examinations for conjunctiva/sclera, anterior chamber, iris and lens findings was almost perfect (sensitivity 89-96%, specificity 95-100%, κ = 0.87-0.97). Substantial agreement was found for cornea pathology (sensitivity 88%, specificity 90%, κ = 0.72), and moderate agreement was found for eyelids/eyelashes pathology (sensitivity 54%, specificity 92%, κ = 0.46). Store-and-forward results were similar, though slightly better for eyelids/eyelashes and slightly worse for conjunctiva/sclera. DISCUSSION Digital slit-lamp videos hold promise for synchronous and asynchronous telemedicine in diagnosing paediatric anterior segment pathologies.
Collapse
Affiliation(s)
| | - Bibiana J Reiser
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | - Tiffany C Ho
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Carly Stewart
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | - Sudha Nallasamy
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| |
Collapse
|
22
|
Souverein EA, Kim JW, Loudin NN, Johnston J, Stewart C, Reid MW, Lee TC, Nallasamy S. Feasibility of asynchronous video-based telemedicine in the diagnosis and management of paediatric blepharoptosis. J Telemed Telecare 2021:1357633X20985394. [PMID: 33470165 DOI: 10.1177/1357633x20985394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the validity of using video glasses as part of an asynchronous telemedicine screening protocol for paediatric blepharoptosis. METHODS A physician assistant wearing Pivothead SMART Series glasses recorded videos of paediatric patients referred for blepharoptosis in primary, down and upgaze while holding a ruler next to the eyes. An oculoplastic surgeon viewed the stored videos and recorded margin-reflex distance 1 and levator function. Using these measurements, the surgeon determined whether surgical intervention was recommended and, if so, which procedure was recommended. The surgeon recorded the same parameters for each patient based on an in-person examination performed later that day. Videos were reviewed eight months later and the same parameters were recorded. RESULTS Twenty-nine children (n = 58 eyes) were enrolled. Margin-reflex distance 1 and levator function measurements based on same-day video review agreed with in-person examination 94.8% (intraclass correlation coefficient = 0.82) and 98.3% (intraclass correlation coefficient = 0.96) of the time, respectively. Margin-reflex distance 1 and levator function measurements based on later video review agreed with in-person examination 93.1% (intraclass correlation coefficient = 0.85) and 94.8% (intraclass correlation coefficient = 0.93) of the time, respectively. Agreement in identifying surgical candidates was almost perfect (= = 0.93) for same-day video review and substantial (= = 0.73) for later video review. Sensitivity of identifying surgical patients was 100% for both same-day video review and later video review; though specificity was lower at 94.1% for same-day video review and 76.5% for later video review. DISCUSSION Asynchronous telemedicine encounters employing video glasses are a useful screening modality for identifying surgical paediatric blepharoptosis patients.
Collapse
Affiliation(s)
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | | | - Julia Johnston
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Carly Stewart
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | - Sudha Nallasamy
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| |
Collapse
|
23
|
Lai FHP, Wong EWN, Lam WC, Lee TC, Wong SC, Nagiel A, Lam RF. Endoscopic vitreoretinal surgery: Review of current applications and future trends. Surv Ophthalmol 2020; 66:198-212. [PMID: 33278403 DOI: 10.1016/j.survophthal.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Endoscopy provides unique optical properties to circumvent anterior segment opacities and visualize difficult-to-access anatomical regions, including retroirideal, retrolental, ciliary body, and anterior retinal structures. We summarize the basic principles and utilization of endoscopic vitreoretinal surgery, along with recent technological advances in the field base on a structured literature search in Pubmed, Embase, and Google Scholar database up to February, 2020. Endoscopy has been used in the management of retinal detachment, ischemic retinopathies with neovascular glaucoma, severe ocular trauma, endophthalmitis, lens-related disorders in the posterior segment, pediatric vitreoretinal diseases, and implantation of retinal prostheses. Ongoing development of endoscopic technology aims to provide higher resolution images with endoscopes of smaller diameter. New surgical techniques supported by the adoption of endoscopy are available to manage challenging surgical scenarios. Endoscopy can be a useful adjunct to microscope wide-angle viewing systems in the management of complex vitreoretinal diseases.
Collapse
Affiliation(s)
| | | | - Wai Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; Department of Ophthalmology and Vision Science, University of Toronto, Ontario, Canada
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sui Chien Wong
- Great Ormond Street Hospital for Children, London, England; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England; Royal Free Hospital, London, England
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Fung Lam
- Department of Ophthalmology, Caritas Medical Centre, Hong Kong
| |
Collapse
|
24
|
Kuo AH, Cho CH, Huang RY, Kim CJ, Lee TC. Target-specific yield rate and clinical utility of percutaneous tissue sampling in spinal infection. Clin Imaging 2020; 68:257-262. [DOI: 10.1016/j.clinimag.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
|
25
|
Schaefer PM, Guenette JP, Lee TC. Intraprocedural MRI monitoring during percutaneous cryoablation procedures of the head and neck, and spine: a single institution experience. Clin Imaging 2020; 73:6-12. [PMID: 33246275 DOI: 10.1016/j.clinimag.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES Evaluate whether intraprocedural MRI monitoring of percutaneous cryoablation procedures of head and neck, and spine lesions is effective for avoiding iatrogenic neurovascular and mucosal injury. MATERIALS AND METHODS We retrospectively reviewed 64 consecutive percutaneous head and neck, and spine cryoablation procedures with intraprocedural MRI monitoring performed on 45 patients (mean age 55 years, range 17-91 years). Ablation goals were either complete local control of primary or metastatic lesions or pain relief. RESULTS The technical success rate was 100%. The complication rate was 13% with only 2 complications (3%) requiring further intervention. There were no deaths or persistent neurological or vascular complications. Subsequent cryoablation in the same location was performed in 12 patients (27%). Subsequent surgical intervention in the same location was performed in 7 patients (16%) for progressive disease or worsening symptoms. CONCLUSIONS MRI provides excellent visualization of the ice ball margin during percutaneous cryoablation procedures. Accurate intraprocedural visualization of the ice ball allows for adjustment of cryoablation parameters to avoid damage to adjacent vital neurovascular structures or mucosal surfaces. Intraprocedural MRI monitoring is thus a novel and highly effective method that allows a high rate of technical success for cryoablation in the head and neck, and spine while avoiding iatrogenic injury.
Collapse
Affiliation(s)
- Peter M Schaefer
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States of America.
| |
Collapse
|
26
|
Belfort MA, Whitehead WE, Shamshirsaz AA, Espinoza J, Nassr AA, Lee TC, Olutoye OO, Keswani SG, Sanz Cortes M. Comparison of two fetoscopic open neural tube defect repair techniques: single- vs three-layer closure. Ultrasound Obstet Gynecol 2020; 56:532-540. [PMID: 31709658 DOI: 10.1002/uog.21915] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We reported previously on an exteriorized-uterus fetoscopic repair for open neural tube defect (ONTD) using a single-layer closure (SLC) technique. However, because SLC was associated with a high rate of cerebrospinal fluid (CSF) leakage at birth, we developed a three-layer closure (3LC) technique comprising a bovine collagen patch, a myofascial layer and a skin layer. The aims of this study were to compare SLC and 3LC in terms of intraoperative, postoperative and obstetric outcomes, as well as short-term neonatal neurologic and non-neurologic outcomes. METHODS This was a retrospective analysis of prospectively collected data, from 32 consecutive SLC controls and 18 consecutive 3LC cases, that underwent exteriorized-uterus two-port fetoscopic repair of ONTD at our center, between April 2014 and December 2018. All patients satisfied the Management of Myelomeningocele Study (MOMS) criteria. Obstetric, maternal, fetal and early neonatal outcomes were compared between the SLC and 3LC groups. RESULTS Maternal demographics and mean gestational age (GA) at fetal surgery (25.0 ± 0.7 vs 25.0 ± 0.5 weeks' gestation; P = 0.96), and at delivery (36.5 ± 3.5 vs 37.6 ± 3.0 weeks; P = 0.14), were similar between the SLC and 3LC groups, respectively. The rate of preterm prelabor rupture of membranes (PPROM) < 37 weeks (28% vs 29%; P = 0.9), mean GA at PPROM (32.3 ± 3.4 vs 32.7 ± 1.9 weeks; P = 0.83) and rate of vaginal delivery (50% vs 47%; P = 0.84) were similar for the SLC vs 3LC groups, respectively. In pregnancies that had SLC compared with those that had 3LC, there was a significantly higher incidence of CSF leakage at birth (8/32 (25%) vs 0/17 (0%); P = 0.02) and a significantly lower rate of reversal of hindbrain herniation at 6 weeks postoperatively (18/30 (60%) vs 14/15 (93%); P = 0.02). The rate of infants that met the MOMS criteria for shunt placement or died before 12 months of age (23/31 (74%) vs 7/12 (58%); P = 0.31) and those that required treatment for hydrocephalus by 12 months (15/32 (47%) vs 4/12 (33%); P = 0.42) were similar between the SLC and 3LC groups, respectively. CONCLUSIONS Compared to SLC, 3LC preserves the fetal and obstetric benefits of fetoscopic repair and shows improved rates of CSF leakage and reversal of hindbrain herniation at 6 weeks postoperatively. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - W E Whitehead
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Department of Surgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - O O Olutoye
- Department of Surgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - S G Keswani
- Department of Surgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
27
|
Lee TC, Guenette JP, Moses ZB, Lee JW, Annino DJ, Chi JH. MRI and CT Guided Cryoablation for Intracranial Extension of Malignancies along the Trigeminal Nerve. Skull Base Surg 2020; 81:511-514. [DOI: 10.1055/s-0039-1692640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
Objectives To describe the technical aspects and early clinical outcomes of patients undergoing percutaneous magnetic resonance imaging (MRI)-guided tumor cryoablation along the intracranial trigeminal nerve.
Design This study is a retrospective case review.
Setting Large academic tertiary care hospital.
Participants Patients who underwent MRI-guided cryoablation of perineural tumor along the intracranial trigeminal nerve.
Main Outcome Measures Technical success, pain relief, local control.
Results Percutaneous MRI-guided cryoablation of tumor spread along the intracranial portion of the trigeminal nerve was performed in two patients without complication, with subsequent pain relief, and with local control in the patient with follow-up imaging.
Conclusions Percutaneous MRI-guided cryoablation is a feasible treatment option for malignancies tracking intracranially along the trigeminal nerve.
Collapse
Affiliation(s)
- Thomas C. Lee
- Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ziev B. Moses
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Donald J. Annino
- Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - John H. Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
28
|
Ho T, Lee TC, Choe JY, Nallasamy S. Evaluation of real-time video from the digital indirect ophthalmoscope for telemedicine consultations in retinopathy of prematurity. J Telemed Telecare 2020; 28:502-507. [DOI: 10.1177/1357633x20958240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction This study aimed to evaluate the validity of using real-time video indirect ophthalmoscopy for telemedicine consultations for paediatric retinal findings, using retinopathy of prematurity (ROP) as a model disease. Methods An ophthalmologist simultaneously performed and recorded routine ROP screenings on enrolled premature infants (aged ≤30 weeks and weighing <1500 g) using the Keeler digital indirect ophthalmoscope. Examinations were graded as no ROP, mild, type 1 or type 2. Masked to clinical findings, another ophthalmologist reviewed and graded streamed video feed transmitted at 4096 kbps. We compared the sensitivity and specificity of diagnosing ROP via streamed and stored-and-forwarded video clips to the gold-standard in-person examination. Results A total of 150 examinations of individual eyes from 34 babies were included. The median postmenstrual age (PMA) at delivery was 24 weeks (range 23–34 weeks), the median birth weight was 630 g (range 455–1530 g) and the median PMA at examination was 37 weeks (range 31–54 weeks). Of those infants with any ROP, the sensitivity and specificity of streamed examinations were 100% and 70.6%, respectively. For type 2 or worse ROP, the sensitivity and specificity were 92.5% and 86.1%, respectively. For type 1 ROP, the sensitivity and specificity were 100% and 99.3%, respectively. Sensitivities (unless already 100%) and specificities were slightly higher for store-and-forward evaluations. Discussion Streamed video feed from the digital indirect ophthalmoscope can be utilised to diagnose clinically significant ROP accurately, though store-and-forward video review yielded slightly better results.
Collapse
Affiliation(s)
- Tiffany Ho
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
| | - Thomas C Lee
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
- Keck School of Medicine, University of Southern California, USA
| | - Ja-Yoon Choe
- Keck School of Medicine, University of Southern California, USA
| | - Sudha Nallasamy
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
- Keck School of Medicine, University of Southern California, USA
| |
Collapse
|
29
|
Wang R, Wang Y, Edrington TC, Liu Z, Lee TC, Silvanovich A, Moon HS, Liu ZL, Li B. Presence of small resistant peptides from new in vitro digestion assays detected by liquid chromatography tandem mass spectrometry: An implication of allergenicity prediction of novel proteins? PLoS One 2020; 15:e0233745. [PMID: 32542029 PMCID: PMC7295189 DOI: 10.1371/journal.pone.0233745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
The susceptibility of newly expressed proteins to digestion by gastrointestinal proteases (e.g., pepsin) has long been regarded as one of the important endpoints in the weight-of-evidence (WOE) approach to assess the allergenic risk of genetically modified (GM) crops. The European Food Safety Authority (EFSA) has suggested that current digestion study protocols used for this assessment should be modified to more accurately reflect the diverse physiological conditions encountered in human populations and that the post-digestion analysis should include analytical methods to detect small peptide digestion products.The susceptibility of two allergens (beta-lactoglobin (β-Lg) and alpha-lactalbumin (α-La)) and two non-allergens (hemoglobin (Hb) and phosphofructokinase (PFK)) to proteolytic degradation was investigated under two pepsin digestion conditions (optimal pepsin digestion condition: pH 1.2, 10 U pepsin/μg test protein; sub-optimal pepsin digestion condition: pH 5.0, 1 U pepsin/10 mg test protein), followed by 34.5 U trypsin/mg test protein and 0.4 U chymotrypsin/mg test protein digestion in the absence or presence of bile salts. All samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in conjunction with Coomassie Blue staining and, in parallel, liquid chromatography tandem mass spectrometry (LC-MS) detection. The results provide following insights: 1) LC-MS methodology does provide the detection of small peptides; 2) Peptides are detected in both allergens and non-allergens from all digestion conditions; 3) No clear differences among the peptides detected from allergen and non-allergens; 4) The differences observed in SDS-PAGE between the optimal and sub-optimal pepsin digestion conditions are expected and align with kinetics and properties of the specific enzymes; 5) The new methodology with new digestion conditions and LC-MS detection does not provide any differentiating information for prediction whether a protein is an allergen. The classic pepsin resistance assay remains the most useful assessment of the potential exposure of an intact newly expressed protein as part of product safety assessment within a WOE approach.
Collapse
Affiliation(s)
- Rong Wang
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | - Yanfei Wang
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | | | - Zhenjiu Liu
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | - Thomas C. Lee
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | | | - Hong S. Moon
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | - Zi L. Liu
- Bayer CropScience, Chesterfield, Missouri, United States of America
| | - Bin Li
- Bayer CropScience, Chesterfield, Missouri, United States of America
| |
Collapse
|
30
|
Hamad AE, Moinuddin O, Blair MP, Schechet SA, Shapiro MJ, Quiram PA, Mammo DA, Berrocal AM, Prakhunhungsit S, Cernichiaro-Espinosa LA, Mukai S, Yonekawa Y, Ung C, Holz ER, Harper CA, Young RC, Besirli CG, Nagiel A, Lee TC, Gupta MP, Walsh MK, Khawly JA, Campbell JP, Kychenthal A, Nudleman ED, Robinson JE, Hartnett ME, Calvo CM, Chang EY. Late-Onset Retinal Findings and Complications in Untreated Retinopathy of Prematurity. Ophthalmol Retina 2020; 4:602-612. [PMID: 32059986 PMCID: PMC7282927 DOI: 10.1016/j.oret.2019.12.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/01/2019] [Accepted: 12/17/2019] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy. DESIGN Retrospective, nonconsecutive, noncomparative, multicenter case series. PARTICIPANTS Three hundred sixty-three eyes of 186 patients. METHODS Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings. MAIN OUTCOME MEASURES Rate of RDs and factors conferring a higher risk of RDs. RESULTS The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009). CONCLUSIONS Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.
Collapse
Affiliation(s)
- Abdualrahman E Hamad
- Retina and Vitreous of Texas, Houston, Texas; Henry Ford Health System, Detroit, Michigan
| | - Omar Moinuddin
- Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Michael P Blair
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Retina Consultants, Ltd, Chicago, Illinois
| | - Sidney A Schechet
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Michael J Shapiro
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Retina Consultants, Ltd, Chicago, Illinois
| | - Polly A Quiram
- VitreoRetinal Surgery, PA, Minneapolis, Minnesota; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Danny A Mammo
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Shizuo Mukai
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Pediatric Retina Surgery Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yoshihiro Yonekawa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Pediatric Retina Surgery Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cindy Ung
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Eric R Holz
- Retina and Vitreous of Texas, Houston, Texas
| | | | | | - Cagri G Besirli
- Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Aaron Nagiel
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Mrinali P Gupta
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | | | | | - J Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Eric D Nudleman
- Shiley Eye Institute, University of California San Diego School of Medicine, San Diego, California
| | | | | | - Charles M Calvo
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah
| | | |
Collapse
|
31
|
Moses ZB, Lee TC, Huang KT, Guenette JP, Chi JH. MRI-guided cryoablation for metastatic spine disease: intermediate-term clinical outcomes in 14 consecutive patients. J Neurosurg Spine 2020; 32:1-6. [PMID: 31952035 DOI: 10.3171/2019.11.spine19808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal access ablative techniques have emerged as a less invasive option for spinal metastatic disease reduction and separation from neural tissue. Compared with heat-based ablation modalities, percutaneous image-guided cryoablation allows for more distinct visualization of treatment margins. The authors report on a series of patients undergoing MRI-guided cryoablation as a feasible method for treating spinal metastatic disease. METHODS A total of 14 patients with metastatic spine disease undergoing MR-monitored cryoablation were prospectively enrolled. Procedures were performed in an advanced imaging operating suite with the use of both CT and MRI to gain access to the spinal canal and monitor real-time cryoablation. RESULTS The average age was 54.5 years (range 35-81 years). The mean preoperative Karnofsky Performance Status score was 79.3 (range 35-90). The average radiographic follow-up was 7.1 months (range 25-772 days), and the average clinical follow-up was 9.8 months (range 7-943 days). In 10 patients with epidural disease, 7 patients underwent postprocedural imaging, and of these 71% (5/7) had stable or reduced radiographic disease burden. Bone regrowth was observed in 63% (5/8) of patients with bone ablation during the treatment who had postoperative imaging. Pre- and postoperative visual analog scale scores were obtained, and a significant reduction in these scores was found following ablation. There were no complications. CONCLUSIONS MR-guided cryoablation is a minimally invasive treatment option for metastatic spine disease. In patients with epidural disease, the majority experienced tumor reduction or arrest at follow-up. In addition, pain was significantly improved following ablation. The average hospital stay was short, and the procedure was safe in a range of patients who are otherwise not ideal candidates for standard treatment.
Collapse
Affiliation(s)
| | - Thomas C Lee
- 2Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey P Guenette
- 2Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
32
|
Shamshirsaz AA, Lee TC, Hair AB, Erfani H, Espinoza J, Shamshirsaz AA, Fox KA, Gandhi M, Nassr AA, Abrams SA, Mccullough LB, Chervenak FA, Olutoye OO, Belfort MA. Elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis: randomized controlled trial. Ultrasound Obstet Gynecol 2020; 55:15-19. [PMID: 31503365 DOI: 10.1002/uog.21871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate whether elective preterm delivery (ED) at 34 weeks is of postnatal benefit to infants with isolated gastroschisis compared with routine obstetric care (RC). METHODS Between May 2013 and September 2015, all women with a sonographic diagnosis of fetal gastroschisis referred to a single tertiary center, before 34 weeks' gestation, were invited to participate in this study. Eligible patients were randomized to ED (induction of labor at 34 weeks) or RC (spontaneous labor or delivery by 37-38 weeks, based on standard obstetric indications). The primary outcome measure was length of time on total parenteral nutrition (TPN). Secondary outcomes were time to closure of gastroschisis and length of stay in hospital. Outcome variables were compared using appropriate statistical methods. Analysis was based on intention-to-treat. RESULTS Twenty-five women were assessed for eligibility, of whom 21 (84%; 95% CI, 63.9-95.5%) agreed to participate in the study; of these, 10 were randomized to ED and 11 to RC. The trial was stopped at the first planned interim analysis due to patient safety concerns and for futility; thus, only 21 of the expected 86 patients (24.4%; 95% CI, 15.8-34.9%) were enrolled. Median gestational age at delivery was 34.3 (range, 34-36) weeks in the ED group and 36.7 (range, 27-38) weeks in the RC group. One patient in the ED group delivered at 36 weeks following unsuccessful induction at 34 weeks. Neonates of women who underwent ED, compared to those in the RC group, showed no difference in the median number of days on TPN (54 (range, 17-248) vs 21 (range, 9-465) days; P = 0.08), number of days to closure of gastroschisis (7 (range, 0-15) vs 5 (range, 0-8) days; P = 0.28) and length of stay in hospital (70.5 (range, 22-137) vs 31 (range, 19-186) days; P = 0.15). However, neonates in the ED group were significantly more likely to experience late-onset sepsis compared with those in the RC group (40% (95% CI, 12.2-73.8%) vs 0%; P = 0.03). CONCLUSION This study demonstrates no benefit of ED of fetuses with gastroschisis when postnatal gastroschisis management is similar to that used in routine care. Rather, the data suggest that ED is detrimental to infants with gastroschisis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A B Hair
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - H Erfani
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K A Fox
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - M Gandhi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A A Nassr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - S A Abrams
- University of Texas at Austin, Austin, TX, USA
| | - L B Mccullough
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, USA
| | - F A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, USA
| | - O O Olutoye
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
33
|
Zhang Y, Danesh J, Green KM, Schmidt RJ, Biegel J, Gai X, Lee TC, Kashani AH, Nagiel A. Bilateral Choroidal Neovascularization and Chorioretinal Anastomosis in Autosomal Recessive Bestrophinopathy. Journal of VitreoRetinal Diseases 2020; 4:69-74. [PMID: 37009563 PMCID: PMC9976081 DOI: 10.1177/2474126419880383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This case report discusses a case of bilateral chorioretinal anastomoses in autosomal recessive bestrophinopathy (ARB) unresponsive to antivascular endothelial growth factor therapy and its associated optical coherence tomography angiography (OCTA) findings. Methods: An observational case report is presented. Results: An 8-year-old girl initially presented at age 2 years with multifocal midperipheral yellow subretinal deposits with intraretinal and subretinal fluid. She was treated with intravitreal injections of bevacizumab in both eyes with minimal response. OCTA revealed the presence of choroidal neovascularization and chorioretinal anastomoses. Molecular diagnosis of ARB was achieved with the identification of compound heterozygous mutations in BEST1, including a silent exonic splicing mutation. Conclusions: Subretinal or intraretinal fluid in ARB may be exacerbated by the presence of chorioretinal anastomosis detected on OCTA. Silent exonic mutations that cause no amino acid change can be overlooked but are pathogenic in ARB.
Collapse
Affiliation(s)
- Youning Zhang
- Department of Surgery, The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Danesh
- Department of Surgery, The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kyle M. Green
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan J. Schmidt
- Department of Pathology and Laboratory Medicine, Center for Personalized Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn Biegel
- Department of Pathology and Laboratory Medicine, Center for Personalized Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Xiaowu Gai
- Department of Pathology and Laboratory Medicine, Center for Personalized Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Thomas C. Lee
- Department of Surgery, The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amir H. Kashani
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aaron Nagiel
- Department of Surgery, The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
34
|
Abstract
Anatomy played a significant role in the establishment of academies in art, initially in Italy and France, and then more widely in Europe and the Americas. This paper considers the role of anatomy in two such academies, the Royal Academy of Arts in London, and the Royal Hibernian Academy of Arts in Dublin. In both cases, anatomy teaching for art students was formalised by the appointment of a Professor of Anatomy, positions that continue to this day. The first Professor of Anatomy in the RA, William Hunter, set the standard by delivering lectures, carrying out dissections and producing écorchés. Some of his successors have published anatomy books specifically for artists, but their enthusiasm has varied. Unlike the continuity of the RA, the RHA has only had bespoke premises from 1826 to 1916, and from 1985 onwards, and its Schools or School have operated from 1826 to 1942, and from 2008 onwards. Anatomy teaching was a casualty of the decline of the formal art academy in the 20th century, but the fortunes of both are reviving in the early 21st century.
Collapse
Affiliation(s)
- T C Lee
- Royal Hibernian Academy of Arts, Dublin, Ireland.,Department of History of Art & Architecture, Trinity College, Dublin, Ireland.,St John's College, Oxford, UK.,Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
35
|
Abstract
The structure of the human body and its parts is of obvious relevance in medicine, but it has also played a role in art. Accurate observation of surface or external anatomy is essential in both disciplines, and its understanding has been enhanced by knowledge of what is found beneath the skin, the internal anatomy, usually based on dissection. The role of anatomy in art in general, and in academies of art in particular, is the theme of this paper. The revival of dissection in 14th-century Italy was, if not causative, at least coincidental with the Renaissance. In 1563, Vasari founded the Accademia del Disegno in Florence, with una Anatomia included in its regulations. As a liberal art taught by university graduates, anatomy helped raise the status of painters and sculptors from artisans to artists and from guild to academy. Anatomy teaching was required in subsequent academies in Rome (1593) and Paris (1648), where the pattern of drawing from drawings, from casts, and from life was established and a Professor of Anatomy appointed in 1777. Anatomy was central to two of the Academy's most important genres, history painting and portraiture. The Academy system, with its emphasis on anatomy, spread to other European cities and to the Caribbean and the Americas from the 17th to the 19th centuries. This paper is concerned with the role of anatomy in the founding of art academies in general, while its companion paper, 'A Tale of Two Cities', considers the cases of the academies in London and Dublin in particular.
Collapse
Affiliation(s)
- U Sealy
- Royal Hibernian Academy of Arts, Dublin, Ireland.,Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T C Lee
- Royal Hibernian Academy of Arts, Dublin, Ireland.,Department of History of Art & Architecture, Trinity College, Dublin, Ireland.,St John's College, Oxford, UK.,Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
36
|
Style CC, Olutoye OO, Belfort MA, Ayres NA, Cruz SM, Lau PE, Shamshirsaz AA, Lee TC, Olutoye OA, Fernandes CJ, Cortes MS, Keswani SG, Espinoza J. Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2019; 54:752-758. [PMID: 30640410 DOI: 10.1002/uog.20216] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/19/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Fetal endoscopic tracheal occlusion (FETO) is associated with increased perinatal survival and reduced need for extracorporeal membrane oxygenation (ECMO) in fetuses with severe congenital diaphragmatic hernia (CDH). This study evaluates the impact of FETO on the resolution of pulmonary hypertension (PH) in fetuses with isolated CDH. METHODS We reviewed retrospectively the medical records of all fetuses evaluated for CDH between January 2004 and July 2017 at a single institution. Fetuses with additional major structural or chromosomal abnormalities were excluded. CDH cases were classified retrospectively into mild, moderate and severe groups based on prenatal magnetic resonance imaging indices (observed-to-expected total fetal lung volume and percentage of intrathoracic liver herniation). Presence of PH was determined based on postnatal echocardiograms. Logistic regression analyses were performed to evaluate the relationship between FETO and resolution of PH by 1 year of age while controlling for side of the CDH, use of ECMO, gestational age at diagnosis, gestational age at delivery, fetal gender, sildenafil use at discharge and CDH severity. Resolution of PH by 1 year of age was compared between a cohort of fetuses with severe CDH that underwent FETO and a cohort that did not have the procedure (non-FETO). A subanalysis was performed restricting the analysis to isolated left CDH. Parametric and non-parametric tests were used for comparisons. RESULTS Of 257 CDH cases evaluated, 72% (n = 184) had no major structural or chromosomal anomalies of which 58% (n = 107) met the study inclusion criteria. The FETO cohort consisted of 19 CDH cases and the non-FETO cohort (n = 88) consisted of 31 (35%) mild, 32 (36%) moderate and 25 (28%) severe CDH cases. All infants with severe CDH, regardless of whether they underwent FETO, had evidence of neonatal PH. FETO (OR, 3.57; 95% CI, 1.05-12.10; P = 0.041) and ECMO (OR, 5.01; 95% CI, 2.10-11.96; P < 0.001) were independent predictors of resolution of PH by 1 year of age. A higher proportion of infants with severe CDH that underwent FETO had resolution of PH by 1 year after birth compared with infants with severe CDH in the non-FETO cohort (69% (11/16) vs 28% (7/25); P = 0.017). Similar results were observed when the analysis was restricted to cases with left-sided CDH (PH resolution in 69% (11/16) vs 28% (5/18); P = 0.032). CONCLUSION In infants with severe CDH, FETO and ECMO are independently associated with increased resolution of PH by 1 year of age. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- C C Style
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - N A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine, Houston, TX, USA
| | - S M Cruz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - P E Lau
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O A Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - C J Fernandes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Newborn Section, Baylor College of Medicine, Houston, TX, USA
| | - M Sanz Cortes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - S G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
37
|
Guenette JP, Cho CH, Huang RY, Miskin N, Ghazikhanian V, Lee TC. CT-Guided Percutaneous Spine Biopsy Specimen Adequacy, Pathology Concordance, and Negative Predictive Value with Battery-Powered Drill and Manual Approaches. Curr Probl Diagn Radiol 2019; 48:558-562. [DOI: 10.1067/j.cpradiol.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/22/2022]
|
38
|
Guenette JP, Ben-Shlomo N, Jayender J, Seethamraju RT, Kimbrell V, Tran NA, Huang RY, Kim CJ, Kass JI, Corrales CE, Lee TC. MR Imaging of the Extracranial Facial Nerve with the CISS Sequence. AJNR Am J Neuroradiol 2019; 40:1954-1959. [PMID: 31624121 DOI: 10.3174/ajnr.a6261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging is not routinely used to image the extracranial facial nerve. The purpose of this study was to determine the extent to which this nerve can be visualized with a CISS sequence and to determine the feasibility of using that sequence for locating the nerve relative to tumor. MATERIALS AND METHODS Thirty-two facial nerves in 16 healthy subjects and 4 facial nerves in 4 subjects with parotid gland tumors were imaged with an axial CISS sequence protocol that included 0.8-mm isotropic voxels on a 3T MR imaging system with a 64-channel head/neck coil. Four observers independently segmented the 32 healthy subject nerves. Segmentations were compared by calculating average Hausdorff distance values and Dice similarity coefficients. RESULTS The primary bifurcation of the extracranial facial nerve into the superior temporofacial and inferior cervicofacial trunks was visible on all 128 segmentations. The mean of the average Hausdorff distances was 1.2 mm (range, 0.3-4.6 mm). Dice coefficients ranged from 0.40 to 0.82. The relative position of the facial nerve to the tumor could be inferred in all 4 tumor cases. CONCLUSIONS The facial nerve can be seen on CISS images from the stylomastoid foramen to the temporofacial and cervicofacial trunks, proximal to the parotid plexus. Use of a CISS protocol is feasible in the clinical setting to determine the location of the facial nerve relative to tumor.
Collapse
Affiliation(s)
- J P Guenette
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - N Ben-Shlomo
- Otolaryngology-Head and Neck Surgery (N.B.-S., J.I.K., C.E.C), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Jayender
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - R T Seethamraju
- Siemens Medical Solutions USA (R.T.S.), Boston, Massachusetts
| | - V Kimbrell
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - N-A Tran
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - R Y Huang
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - C J Kim
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| | - J I Kass
- Otolaryngology-Head and Neck Surgery (N.B.-S., J.I.K., C.E.C), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - C E Corrales
- Otolaryngology-Head and Neck Surgery (N.B.-S., J.I.K., C.E.C), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - T C Lee
- From the Divisions of Neuroradiology (J.P.G., J.J., V.K., N.-A.T., R.Y.H., C.J.K., T.C.L.)
| |
Collapse
|
39
|
Xu L, Berry JL, Kooi I, Murphree AL, Prabakar RK, Reid MW, Stachelek K, Le BHA, Welter L, Jubran R, Lee TC, Kim JW, Kuhn P, Cobrinik D, Hicks JB. Abstract 2877: Genomic cfDNA analysis of aqueous humor in retinoblastoma (RB) predicts eye salvage. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Retinoblastoma (RB) was one of the first tumors to demonstrate a genetic basis to the development of cancer. However, unlike other cancers, RB cannot be directly biopsied due to the high risk of extraocular cancer spread. Therefore, unless the eye is enucleated, tumor tissue is not evaluated for genetic and genomic changes and these alterations are not used to inform diagnosis or prognosis for this disease. However, in a 2017 publication in JAMA Ophthalmology, we demonstrated that tumor-derived cell-free DNA can be extracted from the aqueous humor (AH) of RB eyes, which is safe to remove even with active intraocular disease. The purpose of this current study (Berry JL, Xu L et al. Molec Canc Res 2018) was to identify somatic chromosomal copy number alterations (SCNA) in tumor-derived cell-free DNA in the AH of RB eyes and to correlate with clinical outcomes particularly tumor relapse requiring enucleation.
Methods: AH was extracted via paracentesis from RB eyes during intravitreal injection of chemotherapy or post enucleation. Shallow whole genome sequencing was performed to assess for cell-free tumor DNA fractions and highly-recurrent SCNAs in RB which include gain of 1q, 2p, 6p and loss of 13q and 16q. Globe salvage was recorded.
Results: 26 patients were included; 3 patients had both eyes included for 29 eyes. From these, 63 samples of AH were analyzed; 5 post-enucleations and 58 during intravitreal chemotherapy injection. Ultimately 13 eyes required enucleation and 16 eyes were salvaged. Follow-up ranged from 8-43 months (median 17 months).
The presence of any detectable SCNA was 92% in enucleated eyes versus 38% in salvaged eyes (p=0.006). 6p gain was the most common SCNA found in 77% of enucleated eyes versus 25% of salvaged eyes (p=0.0092). 6p gain was associated with a ten-fold increased odds of enucleation (OR=10, 95% CI:1.8-55.6). The mean amplitude of 6p gain was 1.47 in enucleated eyes versus 1.07 in salvaged eyes (p=0.001). The probability of ocular survival was higher in eyes without detectable SCNAs in the AH (p=0.0028).
Serum testing was positive for a germline mutation in 17 eyes of 14 patients with the following incidence of RB SCNAs 1q (35%); 2p (18%); 6p (47%); 13q (18%) and 16q (35%) versus 12 eyes of 12 patients without germline disease with 1q (33%); 2p (8%); 6p (50%); 13q (17%) and 16q (33%) (p=0.71).
Conclusions: This is the first study to show that clinical outcomes correlate with highly-recurrent SCNAs in the AH from RB eyes. This study suggests that the AH can reliably serve as a surrogate to tumor biopsy and improves upon current clinical staging to predict tumor response to therapy and the ability to salvage the eye. Unlike previous studies that suggest a greater incidence of RB SCNAs in patients with non-germline disease, this was not seen in this evaluation which may be because all previous work was done on tumor from enucleated eyes instead of salvaged eyes.
Citation Format: Liya Xu, Jesse L. Berry, Irsan Kooi, A Linn Murphree, Rishvanth K. Prabakar, Mark W. Reid, Kevin Stachelek, Bao Han A. Le, Lisa Welter, Rima Jubran, Thomas C. Lee, Jonathan W. Kim, Peter Kuhn, David Cobrinik, James B. Hicks. Genomic cfDNA analysis of aqueous humor in retinoblastoma (RB) predicts eye salvage [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2877.
Collapse
Affiliation(s)
- Liya Xu
- 1University of Southern California, Los Angeles, CA
| | - Jesse L. Berry
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | - Irsan Kooi
- 3Leiden, the Netherlands, Leiden, Netherlands
| | - A Linn Murphree
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | | | - Mark W. Reid
- 4Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Bao Han A. Le
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | - Lisa Welter
- 1University of Southern California, Los Angeles, CA
| | - Rima Jubran
- 4Children's Hospital Los Angeles, Los Angeles, CA
| | - Thomas C. Lee
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | - Jonathan W. Kim
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | - Peter Kuhn
- 1University of Southern California, Los Angeles, CA
| | - David Cobrinik
- 2Children's Hospital Los Angeles and the USC Roski Eye Institute, Los Angeles, CA
| | | |
Collapse
|
40
|
Miskin N, Gaviola GC, Huang RY, Kim CJ, Lee TC, Small KM, Wieschhoff GG, Mandell JC. Intra- and Intersubspecialty Variability in Lumbar Spine MRI Interpretation: A Multireader Study Comparing Musculoskeletal Radiologists and Neuroradiologists. Curr Probl Diagn Radiol 2019; 49:182-187. [PMID: 31133459 DOI: 10.1067/j.cpradiol.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/09/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to assess the differences in degenerative spine MRI reporting between subspecialty-trained attending neuroradiologists and musculoskeletal radiologists (MSK) at a single institution, academic medical center. MATERIALS AND METHODS Fifty consecutive outpatient noncontrast lumbar spine examinations were selected from the Picture Archiving and Communication System. Three MSK and 3 neuroradiologists (NR) independently reviewed and interpreted the exams at the L4-L5 and L5-S1 levels in the same manner as in clinical practice. The assessment of neural foraminal stenosis (NFS) and spinal canal stenosis (SCS) was converted to a 5-point ordinal scale. The assessment of lateral recess stenosis (LRS) and facet osteoarthritis (FO) was recorded as present/absent. Intersubspecialty and intrasubspecialty analysis was performed using Cohen's kappa coefficient with a binary matrix of all reader pairs. RESULTS There was moderate intersubspecialty agreement (k = 0.527) for NFS and SCS (k = 0.540). Intersubspecialty agreement was slight for LRS (k = 0.0818) and FO (k = 0.176). The MSK group demonstrated greater intrasubspecialty agreement in assessment of NFS and SCS compared to the NR group, with nonoverlapping confidence intervals. The NR group demonstrated greater nominal intrasubspecialty agreement in the assessment of both LRS and FO, although with nonoverlapping confidence intervals. CONCLUSION There is moderate intersubspecialty agreement between MSK radiologists and neuroradiologists in reporting the severity of NFS and SCS, although MSK radiologists demonstrated greater intrasubspecialty agreement. There is slight intersubspecialty agreement for LRS and FO. The demonstration of differences in inter-reader agreement is a crucial first step to attempt to ameliorate these variabilities.
Collapse
Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christine J Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
41
|
Lee TC, Edrington TC, Bell E, Burzio LA, Glenn KC. Effect of common processing of soybeans on the enzymatic activity and detectability of the protein, Dicamba Mono-Oxygenase (DMO), introduced into dicamba-tolerant MON 87708. Regul Toxicol Pharmacol 2019; 102:98-107. [PMID: 30562601 DOI: 10.1016/j.yrtph.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/29/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022]
Abstract
Assessing the safety of genetically engineered crops includes evaluating the risk (hazard and exposure) of consuming their newly expressed proteins. The dicamba monooxygenase (DMO) protein, introduced into soybeans to confer tolerance (DT) to dicamba herbicide, was previously characterized and identified to pose no food or feed safety hazards. Most agricultural commodities (e.g., soybeans, maize) enter the food supply after processing methods that can include exposure to high temperatures, harsh solvents or pH extremes that can adversely impact the structure and function of proteins. To understand the likelihood of exposure to DMO in foods from DT soy, enzymatically active and/or immunodetectable forms of DMO were measured in pilot-scale productions of two soy foods (soymilk and tofu), and eight processed fractions (full fat flour, inactivated full fat flour, defatted flour, toasted meal, protein isolate, protein concentrate, crude lecithin, and refined, bleached and deodorized oil). Western blot analysis detected DMO in tofu and in five of the eight processed fractions. DMO activity was not detected in either soymilk or tofu, nor in six of the eight processed fractions. Therefore, many commercial soy processing methods can denature and/or degrade introduced proteins, like DMO. Although the DMO protein has shown no evidence of hazard, this study demonstrates that processing further reduces any food or feed risk by limiting dietary exposure to intact DMO protein.
Collapse
Affiliation(s)
- Thomas C Lee
- Bayer U.S. - Crop Science, 700 Chesterfield Parkway West., St. Louis, MO, 63017, USA.
| | - Thomas C Edrington
- Bayer U.S. - Crop Science, 700 Chesterfield Parkway West., St. Louis, MO, 63017, USA
| | - Erin Bell
- Bayer U.S. - Crop Science, 700 Chesterfield Parkway West., St. Louis, MO, 63017, USA
| | - Luis A Burzio
- Bayer U.S. - Crop Science, 700 Chesterfield Parkway West., St. Louis, MO, 63017, USA
| | - Kevin C Glenn
- Bayer U.S. - Crop Science, 700 Chesterfield Parkway West., St. Louis, MO, 63017, USA
| |
Collapse
|
42
|
Wang C, Li W, Kessenich CR, Petrick JS, Rydel TJ, Sturman EJ, Lee TC, Glenn KC, Edrington TC. Safety of the Bacillus thuringiensis-derived Cry1A.105 protein: Evidence that domain exchange preserves mode of action and safety. Regul Toxicol Pharmacol 2018; 99:50-60. [DOI: 10.1016/j.yrtph.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022]
|
43
|
Guenette JP, Seethamraju RT, Jayender J, Corrales CE, Lee TC. MR Imaging of the Facial Nerve through the Temporal Bone at 3T with a Noncontrast Ultrashort Echo Time Sequence. AJNR Am J Neuroradiol 2018; 39:1903-1906. [PMID: 30139756 DOI: 10.3174/ajnr.a5754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/03/2018] [Indexed: 11/07/2022]
Abstract
The pointwise encoding time reduction with radial acquisition (PETRA) ultrashort echo time MR imaging sequence at 3T enables visualization of the facial nerve from the brain stem, through the temporal bone, to the stylomastoid foramen without intravenous contrast. Use of the PETRA sequence, or other ultrashort echo time sequences, should be considered in the MR imaging evaluation of certain skull base tumors and perhaps other facial nerve and temporal bone pathologies.
Collapse
Affiliation(s)
- J P Guenette
- From the Division of Neuroradiology (J.P.G., J.J., T.C.L.)
| | - R T Seethamraju
- Siemens Medical Solutions USA, Inc. (R.T.S.), Boston, Massachusetts
| | - J Jayender
- From the Division of Neuroradiology (J.P.G., J.J., T.C.L.)
| | - C E Corrales
- Division of Otolaryngology-Head and Neck Surgery (C.E.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - T C Lee
- From the Division of Neuroradiology (J.P.G., J.J., T.C.L.)
| |
Collapse
|
44
|
Berry JL, Xu L, Kooi I, Murphree AL, Prabakar RK, Reid M, Stachelek K, Le BHA, Welter L, Reiser BJ, Chévez-Barrios P, Jubran R, Lee TC, Kim JW, Kuhn P, Cobrinik D, Hicks J. Genomic cfDNA Analysis of Aqueous Humor in Retinoblastoma Predicts Eye Salvage: The Surrogate Tumor Biopsy for Retinoblastoma. Mol Cancer Res 2018; 16:1701-1712. [PMID: 30061186 DOI: 10.1158/1541-7786.mcr-18-0369] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 01/29/2023]
Abstract
Tumor-derived cell-free DNA (cfDNA) has biomarker potential; therefore, this study aimed to identify cfDNA in the aqueous humor (AH) of retinoblastoma eyes and correlate somatic chromosomal copy-number alterations (SCNA) with clinical outcomes, specifically eye salvage. AH was extracted via paracentesis during intravitreal injection of chemotherapy or enucleation. Shallow whole-genome sequencing was performed using isolated cfDNA to assess for highly recurrent SCNAs in retinoblastoma including gain of 1q, 2p, 6p, loss of 13q, 16q, and focal MYCN amplification. Sixty-three clinical specimens of AH from 29 eyes of 26 patients were evaluated; 13 eyes were enucleated and 16 were salvaged (e.g., saved). The presence of detectable SCNAs was 92% in enucleated eyes versus 38% in salvaged eyes (P = 0.006). Gain of chromosome 6p was the most common SCNA found in 77% of enucleated eyes, compared with 25% of salvaged eyes (P = 0.0092), and associated with a 10-fold increased odds of enucleation (OR, 10; 95% CI, 1.8-55.6). The median amplitude of 6p gain was 1.47 in enucleated versus 1.07 in salvaged eyes (P = 0.001). The presence of AH SCNAs was correlated retrospectively with eye salvage. The probability of ocular salvage was higher in eyes without detectable SCNAs in the AH (P = 0.0028), specifically 6p gain. This is the first study to correlate clinical outcomes with SCNAs in the AH from retinoblastoma eyes, as such these findings indicate that 6p gain in the aqueous humor is a potential prognostic biomarker for poor clinical response to therapy.Implications: The correlation of clinical outcomes and SCNAs in the AH identified in the current study requires prospective studies to validate these finding before SCNAs, like 6p gain, can be used to predict clinical outcomes at diagnosis. Mol Cancer Res; 16(11); 1701-12. ©2018 AACR.
Collapse
Affiliation(s)
- Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California. .,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Liya Xu
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
| | | | - A Linn Murphree
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, California
| | - Mark Reid
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Kevin Stachelek
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Bao Han A Le
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Lisa Welter
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
| | - Bibiana J Reiser
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Patricia Chévez-Barrios
- Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist, Weill Cornell Medical College, Houston, Texas
| | - Rima Jubran
- The Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California.,Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck Medical School of the University of Southern CA, Los Angeles, California.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
45
|
Abstract
Endoscopic vitrectomy is a useful and unique adjunct to microincision vitreoretinal surgery. The optical properties of endoscopy allow for some clinically advantageous approaches that are not possible with regular microscope viewing systems, namely, the ability to both bypass optically signficant anterior segment opacities and directly visualize dificult-to-access retroirideal, retrolental, and anterior retinal structures in their natural anatomical configuration. The surgical benefits include improved surgical access to the pars plana, pars plicata, ciliary sulcus, ciliary body, and peripheral lens, along with unique access to anterior traction in complex pediatric anterior detachments, particularly in retinopathy of prematurity. This review will focus on the development and surgical utility of intraocular endoscopy, provide an update on its current uses in the era of microincision vitreoretinal surgery, and highligh its role in pediatric vitreoretinal diseases.
Collapse
Affiliation(s)
- Damien C M Yeo
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, England
| | - Aaron Nagiel
- Children's Hospital Los Angeles, Los Angeles, California
| | - Unikora Yang
- Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- Children's Hospital Los Angeles, Los Angeles, California
| | - Sui Chien Wong
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, England
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England
- Royal Free Hospital, London, England
| |
Collapse
|
46
|
Abstract
Primary care physicians are often tasked with evaluating neurologic symptoms, and imaging plays a critical role in neurologic diagnoses. Neuroradiology routinely employs advanced imaging modalities, and hence, determination of the appropriate imaging test and interpretation of findings in the clinical context can understandably be overwhelming. In this review article, we introduce resources that can guide physicians in the selection of neuroimaging tests and summarize guidelines on contrast agent administration. Key concepts on imaging techniques and terminology are reviewed, as is relevant for the primary care physician. We then present an overview of the typical imaging manifestations of brain pathologies, including stroke, traumatic injuries, infections, demyelinating and neurodegenerative processes, and neoplasms. Spine imaging is often considered for the evaluation of degenerative, infectious, or neoplastic etiologies, and the typical imaging findings in these scenarios are also summarized.
Collapse
Affiliation(s)
- Elizabeth George
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass.
| | | | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass
| |
Collapse
|
47
|
Groden PJ, Lee TC, Bhattacharyya S, Connors J, Lorch J. Lenvatinib-Associated Cervical Artery Dissections in a Patient with Radioiodine-Refractory Metastatic Papillary Thyroid Carcinoma. Front Med (Lausanne) 2018. [PMID: 29527527 PMCID: PMC5829091 DOI: 10.3389/fmed.2017.00220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lenvatinib is a tyrosine kinase inhibitor (TKI) approved by the FDA for the treatment of radioiodine-refractory (RAIR) thyroid cancers. Side effects can be severe, however, and include headaches, hypertension, arterial and venous thromboembolic events, and fatalities. Cervical artery dissections (CADs) are leading contributors of cerebral ischemia in young adults, yet the pathophysiology is poorly understood. Here, we describe a case of a 34-year-old female with recurrent, metastatic, RAIR papillary thyroid cancer who, following her second week of lenvatinib treatment, developed significant CAD which resolved following the termination of the TKI therapy. Given the lack of risk factors for the disorder in the patient’s history, the known cardiovascular events associated with the drug, previously described cases of arterial dissections linked to VEGF inhibitors, and the temporal relationship between the onset of symptoms and the treatment start date, a causal relationship between the CAD and lenvatinib is suggested.
Collapse
Affiliation(s)
- Phillip J Groden
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Jean Connors
- Hematology Division, Brigham and Women's Hospital, Boston, MA, United States
| | - Jochen Lorch
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| |
Collapse
|
48
|
Jiang B, Gao W, Kacher D, Nevo E, Fetics B, Lee TC, Jayender J. Kalman filter-based EM-optical sensor fusion for needle deflection estimation. Int J Comput Assist Radiol Surg 2018; 13:573-583. [PMID: 29417355 DOI: 10.1007/s11548-018-1708-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE In many clinical procedures such as cryoablation that involves needle insertion, accurate placement of the needle's tip at the desired target is the major issue for optimizing the treatment and minimizing damage to the neighboring anatomy. However, due to the interaction force between the needle and tissue, considerable error in intraoperative tracking of the needle tip can be observed as needle deflects. METHODS In this paper, measurements data from an optical sensor at the needle base and a magnetic resonance (MR) gradient field-driven electromagnetic (EM) sensor placed 10 cm from the needle tip are used within a model-integrated Kalman filter-based sensor fusion scheme. Bending model-based estimations and EM-based direct estimation are used as the measurement vectors in the Kalman filter, thus establishing an online estimation approach. RESULTS Static tip bending experiments show that the fusion method can reduce the mean error of the tip position estimation from 29.23 mm of the optical sensor-based approach to 3.15 mm of the fusion-based approach and from 39.96 to 6.90 mm, at the MRI isocenter and the MRI entrance, respectively. CONCLUSION This work established a novel sensor fusion scheme that incorporates model information, which enables real-time tracking of needle deflection with MRI compatibility, in a free-hand operating setup.
Collapse
Affiliation(s)
- Baichuan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300072, China.
| | - Wenpeng Gao
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150001, China
| | - Daniel Kacher
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Erez Nevo
- Robin Medical Inc., Baltimore, MD, 21203, USA
| | | | - Thomas C Lee
- Department of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jagadeesan Jayender
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
49
|
Costa e Silva Souza LM, Leung KJ, O'Neill A, Jayender J, Lee TC. Jugulodigastric lymph node size by age on CT in an adult cancer-free population. Clin Imaging 2018; 47:30-33. [DOI: 10.1016/j.clinimag.2017.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 11/15/2022]
|
50
|
Berry JL, Lewis L, Zolfaghari E, Green S, Le BHA, Lee TC, Murphree AL, Kim JW, Jubran R. Lack of correlation between age at diagnosis and RB1 mutations for unilateral retinoblastoma: the importance of genetic testing. Ophthalmic Genet 2017; 39:407-409. [PMID: 29286867 DOI: 10.1080/13816810.2017.1420807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jesse L Berry
- a Department of Ophthalmology, The Vision Center, Children's Hospital Los Angeles , Los Angeles , USA.,b Department of Ophthalmology , USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles , USA
| | - Laura Lewis
- c Department of Pediatrics , Children's Hospital Los Angeles , Los Angeles , USA
| | - Emily Zolfaghari
- a Department of Ophthalmology, The Vision Center, Children's Hospital Los Angeles , Los Angeles , USA
| | - Sarah Green
- c Department of Pediatrics , Children's Hospital Los Angeles , Los Angeles , USA
| | - Bao Han A Le
- b Department of Ophthalmology , USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles , USA.,d Department of Medicine , John A. Burns School of Medicine at the University of Hawaii , Honolulu , USA
| | - Thomas C Lee
- a Department of Ophthalmology, The Vision Center, Children's Hospital Los Angeles , Los Angeles , USA.,b Department of Ophthalmology , USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles , USA
| | - A Linn Murphree
- a Department of Ophthalmology, The Vision Center, Children's Hospital Los Angeles , Los Angeles , USA.,b Department of Ophthalmology , USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles , USA
| | - Jonathan W Kim
- a Department of Ophthalmology, The Vision Center, Children's Hospital Los Angeles , Los Angeles , USA.,b Department of Ophthalmology , USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles , USA
| | - Rima Jubran
- c Department of Pediatrics , Children's Hospital Los Angeles , Los Angeles , USA
| |
Collapse
|