Euthyroid graves' ophthalmopathy in a Chinese population: A cross-sectional follow-up study

OBJECTIVES

A subtype of patients with thyroid eye disease (TED) were found to be euthyroid without prior thyroid dysfunction or treatment, known as Euthyroid Graves' Ophthalmopathy (EGO). We report the prevalence, clinical and serological phenotypes of EGO in a Chinese population.

METHODS

A cross-sectional follow-up study. Ethnic Chinese TED patients were managed at the Thyroid Eye Clinic(TEC), Prince of Wales Hospital and TEC, the Chinese University of Hong Kong between September 2007 and July 2021.

RESULTS

A total of 66 (5%) patients among the 1266 ethnic Han Chinese TED cohort were diagnosed as EGO, and 6 (9%)of them become dysthyroid over an average of 74-month follow-up. EGO patients were associated with a longer duration between onset of the symptoms to our first consultation (P < 0.0001), a higher male-to-female ratio (P = 0.0045) and a higher age of disease onset (P = 0.0092). Family history of thyroid disease was more common in TED patients (P = 0.0216) than in EGO patients. EGO patients were more likely to present unilaterally (P < 0.0001), and they have a larger difference in MRD1 (P < 0.0001), and extraocular motility (P < 0.0001) between the 2 eyes when compared to the TED patients. Notably, the extraocular motility restriction of the worst eye was more affected in EGO patients (P = 0.0113). The percentages of patients who received IVMP, ORT and emergency or elective surgeries(decompression or squint operation) between EGO and TED were similar.

CONCLUSIONS

Understanding the important clinical phenotypes of EGO may help the clinician to make the correct diagnosis. Further study to compare EGO and TED is warranted.

Survey of ptosis practice patterns among surgeons in Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)

OBJECTIVE

To characterize the preferred ptosis practice patterns and variations among oculoplastic surgeons in the Asia-Pacific region.

METHODS

A web-based questionnaire was sent to both members and non-members registered under the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)'s email database. The survey included preoperative testing practices, surgical preferences for adult aponeurotic and congenital ptosis, various surgical techniques (anterior and posterior approach ptosis procedures, and frontalis sling procedures) and postoperative practices.

RESULTS

A total of 386 survey invitations were sent. There was a response rate of 68.7% from respondents from 20 countries in the Asia-Pacific region. There was variation in the preoperative evaluation and management of ptosis. Anterior approach ptosis surgery (96.6%) and frontalis sling procedures (86.8%) were performed by more surgeons than posterior approach ptosis surgery (47.2%). There was a deviation from the traditional frontalis sling procedures for patients with poor levator function.

CONCLUSIONS

Our survey results provide insight into the variation in the assessment and management of ptosis amongst oculoplastic surgeons in the Asia-Pacific region. It also demonstrates some differences between practice patterns in Asia-Pacific and America.

Indocyanine Green-Assisted Endoscopic Transorbital Excision of Lateral Orbital Apex Cavernous Hemangioma

Orbital apex lesions posed operative difficulties to neurosurgeons and ophthalmologists due to limited surgical corridor and close vicinity to cranial nerves and arteries. Lateral orbital apex lesions were traditionally operated via the transcranial route by neurosurgeons. Recently, only a handful of reports have described the use of endoscope alone for excision of lateral orbital apex lesion. Our group, with both endoscopic skull base neurosurgeons and oculoplastic surgeons, has adopted the endoscopic transorbital approach for orbital apex lesions. We also used an indocyanine green (ICG) endoscope to aid identification and dissection of orbital apex cavernous hemangioma, which otherwise can be difficult to differentiate from surrounding intraconal recti muscles. Video 1 captured the first reported case of excision of lateral orbital apex cavernous hemangioma via endoscopic transorbital approach, using a zero-degree ICG endoscope. This was a 64-year-old Chinese woman who presented with right eye painless blurring of vision with visual acuity of 0.6 and right relative afferent pupillary defect. Fundoscopic examination showed absence of right optic disc swelling, and automated visual field testing confirmed a superior and infratemporal visual field defect in the right eye. On magnetic resonance imaging, there was a 1-cm oval mass that was hypointense on T1-weighted and hyperintense on T2-weighted images, with slow enhancement, suggestive of cavernous hemangioma. Optical coherence tomography of the retinal nerve fiber layer showed evidence of subtle right nerve fiber layer thinning. Right endoscopic transorbital excision of the tumor was performed with an ICG-assisted endoscope. Lateral skin crease incision was followed by crescent-shaped superolateral orbital rim removal. Superior and inferior orbital fissures were identified after stripping off the periorbita. The meningoorbital band was divided to release the orbital apex from the middle fossa dura. The greater wing of sphenoid bone was drilled with a 3-mm high-speed diamond burr under irrigation to create space for dissection. Injection of ICG resulted in delayed enhancement of the lesion at around 1 minute and 30 seconds, in contrast to rapid enhancement of surrounding recti muscles at around 30 seconds. Incision of periorbita was guided by ICG enhancement of lesion. The tumor was dissected from the lateral rectus and superior division of oculomotor nerve and was excised en bloc. The supraorbital rim was reconstructed with 2 miniplates. Pathology confirmed the diagnosis of cavernous hemangioma. Postoperatively, the patient had good recovery, with right eye visual acuity of 0.8 and resolution of the relative afferent pupillary defect.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.

Factors associated with oral hygiene practices among adults with systemic sclerosis

OBJECTIVE

To identify factors associated with oral hygiene practices in adults with systemic sclerosis (SSc).

METHODS

In this cross-sectional study, 178 dentate adults with SSc received an oral examination which included measurement of oral aperture, assessment of manual dexterity to perform oral hygiene, as well as completion of the Center of Epidemiological Studies Depression (CES-D) Scale and an oral health-related questionnaire.

RESULTS

Multivariable logistic regression modelling showed male, minority and high CES-D scores (i.e. clinically significant symptoms of depression) were associated with less likelihood of participants brushing teeth at least twice daily, but the presence of self-reported dry mouth symptoms increased the likelihood of toothbrushing. Having a dental visit in the past 12 months and use of an adapted flossing or interdental cleaning device were significantly associated with daily dental flossing; however, having difficulty flossing teeth reduced the likelihood of daily flossing.

CONCLUSIONS

Overall, demographic variables were strongly associated with toothbrushing frequency, whereas flossing self-efficacy and barriers were strongly associated with dental flossing frequency in adults with SSc. The results suggest that dental health professionals should take mental health into consideration when educating patients with SSc to improve their oral hygiene and consider making referrals for patients exhibiting suspected clinically significant depressive symptoms to mental health professionals for further evaluation and treatment. In addition, an appropriate adapted flossing or interdental cleaning device should be recommended to increase dental flossing practices in this patient population.

Factors associated with gingival inflammation among adults with systemic sclerosis

OBJECTIVE

To identify factors associated with increased gingival inflammation in adults with systemic sclerosis (SSc, scleroderma).

METHODS

In this cross-sectional study, forty-eight adults with SSc received assessment of gingival inflammation using Löe and Silness gingival index (LSGI), measurement of oral aperture and evaluation of manual dexterity to perform oral hygiene using the Toothbrushing Ability Test, as well as completion of an oral health-related questionnaire.

RESULTS

Three explanatory variables in the final multiple predictor models for the LSGI outcome were statistically significant--manual dexterity to perform oral hygiene, flossing in the evening and SSc subtype, with higher (i.e., worse) LSGI score among those with impaired manual dexterity, not flossing in the evening and diffuse form of SSc. In addition, posterior teeth had higher LSGI scores compared with that of the anterior teeth after adjusting for other variables.

CONCLUSIONS

Results suggest that dental health professionals take manual dexterity into consideration when educating patients with SSc to improve their oral hygiene and educate them on paying more attention on cleaning their posterior teeth and the importance of flossing in the evening--especially those who only floss once a day or less often.

Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: a pilot study

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p = 0.002), and body weight and waist circumference were significantly reduced (p = 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.

Activities of daily living performance in dementia

OBJECTIVE

To explore the activities of daily living ADL performance profile of community-living people with dementia and to investigate its relationship with dementia severity.

MATERIALS & METHODS

ADL performance of 86 subjects were evaluated using Barthel Index (BI), Lawton and Brody's Instrumental Activities Daily Living (IADL) and Assessment of Motor and Process Skills (AMPS). Dementia severity was measured by Clinical Dementia Rating (CDR).

RESULTS

Subjects were able to perform most basic ADL (BI mean = 16.4) and some IADL (Lawton and Brody's IADL mean = 4.3). The AMPS process ability measure and the Lawton and Brody's IADL were significantly correlated with CDR (P < 0.01).

CONCLUSIONS

Subjects with mild dementia were able to perform mostly all basic ADL and some IADL. The AMPS process ability measure and the Lawton and Brody's IADL could provide useful information on their ability to live independently in the community.

Comparison of three wheelchair cushions for effectiveness of pressure relief

OBJECTIVE

Previous studies have suggested that no single wheelchair pressure-relieving cushion material was optimal for all persons with spinal cord injury (SCI). The purpose of this study was to compare the effectiveness of the short-term pressure-relieving ability of the three most commonly prescribed wheelchair cushions (Roho, Jay, Pindot) for a person with SCI.

METHOD

The number of pressure sensors registering at the buttock-cushion interface during wheelchair sitting was measured by the Xsensor Pressure Mapping System after 5 min of sitting. An alternating treatments research design, with an initial baseline and a final treatment phase ending with the most effective cushion for relieving pressure, was used for the clinical evaluation. Measurements were compared using visual inspection and a Wilcoxon signed ranks test.

RESULTS

Data analyses indicated that the number of pressure sensors that registered potential harmful levels of pressure at the buttock-cushion interface for the Roho cushion was significantly less than those of the Jay and Pindot cushions.

CONCLUSION

The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.

The effect of sports on level of community integration as reported by persons with spinal cord injury

OBJECTIVE

The purpose of this study was to determine whether participation in sports by persons with spinal cord injuries (SCIs) affected level of community integration as defined by the World Health Organization and as measured by the Craig Handicap Assessment and Reporting Technique (CHART).

METHOD

Forty-eight participants were recruited from a camp for persons with physical disabilities as well as from SCI support groups. Participants were divided into groups of athletes (n = 30) and nonathletes (n = 18) on the basis of their self-reported level of sports participation.

RESULTS

Athletes scored significantly higher on four of five subsections of the CHART (physical independence, mobility, occupation, social integration), indicating greater levels of community integration than nonathletes.

CONCLUSION

These findings extend the literature outlining the physical and psychological benefits of sports. Occupational therapists have a unique opportunity to use the occupation of sports to integrate the roots of the profession with the cultural demands of society.

Deriving directions through procedural task analysis

Task analysis is one of the essential components of activity analysis. Procedural task analysis involves breaking down an activity into a sequence of steps. Directions are the sequence of steps resulting from the task analysis (i.e., the product of the task analysis). Directions become a guide for caregivers or trainers use in teaching clients a specific skill. However, occupational therapy students often have difficulty in writing directions that are clear enough for caregivers or trainers to carry out. Books on activity analysis only provide examples of directions without giving guidelines on how to perform the writing process. The purposes of this paper are to describe the process of procedural task analysis and to provide a guideline for writing steps of directions.

Positive talk training in an adult with traumatic brain injury

Social skills often create a barrier to placement in less restrictive environments for persons with TBI. This case study illustrated the use of a positive talk program in the treatment of a person with long-standing social skill deficits. Occupational therapy intervention with speech-language consultation began with an evaluation of the cognitive barriers that influenced the client's social behavior. Work with the client's concrete concept formation, decreased memory, and poor generalization skills led to the development of the positive talk training program described. Through an understanding of the underlying cognitive deficits that influenced the client's behavior, the clinical team was able to develop an individual treatment plan. The intervention resulted in modification of behavior that would have required placing the client in a restricted environment. In the final analysis, the client's social skills improved to a level where he could be discharged to a less restrictive environment.

An EPSP synthase inhibitor joining shikimate 3-phosphate with glyphosate: synthesis and ligand binding studies

A novel EPSP synthase inhibitor 4 has been designed and synthesized to probe the configurational details of glyphosate recognition in its herbicidal ternary complex with enzyme and shikimate 3-phosphate (S3P). A kinetic evaluation of the new 3-dephospho analog 12, as well as calorimetric and (31)P NMR spectroscopic studies of enzyme-bound 4, now provides a more precise quantitative definition for the molecular interactions of 4 with this enzyme. The very poor binding, relative to 4, displayed by the 3-dephospho analog 12 is indicative that 4 has a specific interaction with the S3P site. A comparison of Ki(calc) for 12 versus the Ki(app) for 4 indicates that the 3-phosphate group in 4 contributes about 4.8 kcal/mol to binding. This compares well with the 5.2 kcal/mol which the 3-phosphate group in S3P contributes to binding. Isothermal titration calorimetry demonstrates that 4 binds to free enzyme with an observed Kd of 0.53 +/- 0.04 microM. As such, 4 binds only 3-fold weaker than glyphosate and about 150-fold better than N-methylglyphosate. Consequently, 4 represents the most potent N-alkylglyphosate derivative identified to date. However, the resulting thermodynamic binding parameters clearly demonstrate that the formation of EPSPS x 4 is entropy driven like S3P. The binding characteristics of 4 are fully consistent with a primary interaction localized at the S3P subsite. Furthermore, (31)P NMR studies of enzyme-bound 4 confirm the expected interaction at the shikimate 3-phosphate site. However, the chemical shift observed for the phosphonate signal of EPSPS x 4 is in the opposite direction than that observed previously when glyphosate binds with enzyme and S3P. Therefore, when 4 occupies the S3P binding site, there is incomplete overlap at the glyphosate phosphonate subsite. As a glyphosate analog inhibitor, the potency of 4 most likely arises from predominant interactions which occur outside the normal glyphosate binding site. Consequently, 4 is best described as an S3P-based substrate-analog inhibitor. These combined results corroborate the previous kinetic model [Gruys, K. J., Marzabadi, M. R., Pansegrau, P. D., & Sikorski, J. A. (1993) Arch. Biochem. Biophys. 304, 345-351], which suggested that 4 interacts well with the S3P subsite but has little, if any, interaction at the expected glyphosate phosphonate or phosphoenolpyruvate-Pi subsites.

Treatment methodology. Guiding of behaviour through redirection in brain injury rehabilitation

Confusion, agitation, and non-compliance are some of the most common behaviours exhibited by individuals with brain injury. The presence of these behaviours affects their daily functioning and social interactions with others. Management of these behaviours ranges from prevention and total ignoring to restraint, with the strategy of redirection cited most often in the literature. However, few guidelines exist on how to use redirection to manage clients who exhibit confusion and agitation beyond the acute phase of rehabilitation. This paper describes some of the intervention strategies that use guidance and redirection for individuals with brain injury in post-acute rehabilitation. Case examples are used to illustrate the various interventions.

Prosthesis training as a context for studying occupational forms and motoric adaptation

OBJECTIVES

Occupational therapy authors frequently emphasize the importance of the use of objects in the development of motor skill. This study investigated the use of object-produced visual input in learning control of flexion and extension of an above-elbow training prosthesis.

METHOD

Fifty-two male college students were randomly assigned to two training procedures: (a) two 1.5-min periods in which they used a flashlight attached to the hook of the prosthesis to connect dots on paper with light, or (b) the same time periods in which they had the opportunity to practice moving an equally weighted prosthesis, but without the light or dots. To assess motoric adaptation after training under one of the two conditions, each subject traced a continuous line through a maze with a pen attached to the hook. Deviations from the line were measured reliably.

RESULTS

Data analysis with a Mann-Whitney test revealed that subjects in the group that trained with added materials traced with significantly more skill than subjects in the other group (one-tailed U = 225.5, p = .02).

CONCLUSION

As predicted by occupational therapy theory, the object-produced visual input enhanced the learning of a motor skill relevant to rehabilitation. Although there is a need for more study across different occupations and populations, clinicians are urged to consider the possible benefits of the use of objects in the development of motor skills, as opposed to objectless exercise. Prosthetic training provides a useful context for future research addressing theoretical issues in motor learning.

Self-feeding system for an adult with head injury and severe ataxia

This report describes a customized self-feeding system designed to increase the independence of a person with a head injury who is unable to use his arm for self-feeding. The client has spastic hemiparesis in the right upper extremity and profound ataxia in the left upper extremity. Due to the severity of these disabilities, the client required total assistance at every meal since his injury 6.5 years ago. The self-feeding system described consists of an adapted spoon, a spoon holder, a scoop dish, and a dish stand. The client scoops food from the scoop dish with the adapted spoon held in his mouth and then transfers the spoon to a magnetic holder for positioning. This adaptation allows the client to position the spoon with his chin without demanding fine motor coordination. The self-feeding system is evaluated with a BAB single case research withdrawal design. Results indicate that this self-feeding system provides a viable alternative to assisting independence in self-feeding as measured by the cost-benefit ratio and nutrition intake. The client used the self-feeding system for 12 months at the rehabilitation center and has continued using the equipment at his nursing home.

Differential scanning calorimetric study of 5-enolpyruvoyl shikimate-3-phosphate synthase and its complexes with shikimate-3-phosphate and glyphosate: irreversible thermal transitions

The thermal denaturation of native Escherichia coli 5-enolpyruvoyl shikimate-3-phosphate (EPSP) synthase, its binary complex with shikimate-3-phosphate (S3P) and its ternary complex with S3P and glyphosate have been studied using highly-sensitive differential scanning calorimetry (DSC). All observed transitions are strongly scanning-rate-dependent and irreversible. Consistent with these observations, the data were better fit by a simple irreversible model than by the controversial reversible model more commonly employed. The results obtained provide additional support for the application of irreversible models to the thermal denaturation of proteins. The calculated parameters, activation energy (Ea), enthalpy of denaturation (delta H) and transition temperature (Tm), obtained from fitting to an irreversible model agree well with values obtained from approximation techniques. Further, the results show that the formation of the ternary complex greatly enhances the thermal stability of the enzyme (delta Tm = 10.6 degrees C), while the binding of S3P alone increases the transition temperature only slightly (delta Tm = 3 degrees C). The heat of binding calculated at the transition temperature also demonstrates the greater stability of the ternary complex (delta H = -70 kcal/mol) versus the binary complex (delta H = -10 kcal/mol).

Improved productivity through purposeful use of additional template for a woman with cortical blindness

A single-subject study with an ABAB design investigated an adaptation of a work activity through the purposeful use of an additional template to improve productivity for a woman with cortical blindness resulting from anoxic brain damage. The activity required the subject to outline brackets (as parts of a handi-rack woodwork project) by tracing a template on a piece of pine board. During the baseline phase of the study, the subject used one template to outline the brackets. During the intervention phase, the subject used an additional template after receiving a brief training in its use. Productivity was measured by the number of potentially usable outlined brackets. Data analysis revealed that in the intervention phases, productivity improved significantly and accuracy increased. The application of tapping the subjects' intact sensory system was valuable for determining her vocational potential. The rationale of using an additional template to improve productivity was explained by the theory of affordance.

EPSP synthase: binding studies using isothermal titration microcalorimetry and equilibrium dialysis and their implications for ligand recognition and kinetic mechanism

Isothermal titration calorimetry measurements are reported which give important new binding constant (Kd) information for various substrate and inhibitor complexes of Escherichia coli EPSP synthase (EPSPS). The validity of this technique was first verified by determining Kd's for the known binary complex with the substrate, shikimate 3-phosphate (S3P), as well as the herbicidal ternary complex with S3P and glyphosate (EPSPS.S3P.glyphosate). The observed Kd's agreed very well with those from previous independently determined kinetic and fluorescence binding measurements. Further applications unequivocally demonstrate for the first time a fairly tight interaction between phosphoenolpyruvate (PEP) and free enzyme (Kd = 390 microM) as well as a correspondingly weak affinity for glyphosate (Kd = 12 mM) alone with enzyme. The formation of the EPSPS.PEP binary complex was independently corroborated using equilibrium dialysis. These results strongly suggest that S3P synergizes glyphosate binding much more effectively than it does PEP binding. These observations add important new evidence to support the hypothesis that glyphosate acts as a transition-state analogue of PEP. However, the formation of a catalytically productive PEP binary complex is inconsistent with the previously reported compulsory binding order process required for catalysis and has led to new studies which completely revise the overall EPSPS kinetic mechanism. A previously postulated ternary complex between S3P and inorganic phosphate (EPSPS.S3P.Pi, Kd = 4 mM) was also detected for the first time. Quantitative binding enthalpies and entropies were also determined for each ligand complex from the microcalorimetry data. These values demonstrate a clear difference in thermodynamic parameters for recognition at the S3P site versus those observed for the PEP, Pi, and glyphosate sites.

Differential scanning calorimetry of plant cell walls

High-sensitivity differential scanning calorimetry has been used to study the phase transition of cell wall preparations of the elongating and mature regions of soybean hypocotyls and of celery epidermis and collenchyma strands. A step-like transition believed to be glass transition was observed in walls isolated from the elongating region of soybean hypocotyls at 52.9 degrees C. Addition of 1 mM CaCl2 to the cell wall preparation increased the transition temperature to 60.8 degrees C and greatly reduced the transition magnitude. In walls from the mature region, the transition was small and occurred at a higher temperature (60.1 degrees C). Addition of calcium to the mature region cell wall had little effect on the transition. Based on the known interactions between calcium and pectin, we propose that calcium affects the glass transition by binding to the polygalacturonate backbone of wall pectin, resulting in a more rigid wall with a smaller transition at a higher temperature. The mature region either has more calcium in the wall or has more methyl-esterified pectin, making it less responsive to added calcium.

Fieldwork students under stress

Many times there are no ideal answers to any of the interpersonal conflicts addressed. Often the solutions to these situations may depend on an individual's characteristics or personality. By analyzing the situation and the supervisor's attitude and then changing his or her way of responding to that situation, however, the student may improve his or her problem-solving skills. The student can modify the strategies taught in these seminars to suit his or her individual needs and particular situations. A seminar like this can provide students, and thus future therapists and student supervisors, with a solid background in dealing more tactfully with a variety of conflict-ridden situations in the workplace.