Bacterial endophthalmitis following 25-gauge transconjunctival sutureless vitrectomy

Drew N Sommerville, Dean P HainsworthThe Mason Eye Institute, University of Missouri, Columbia, Missouri, USAPurpose: To report a case of endophthalmitis following 25-gauge transconjunctival sutureless vitrectomy.Design: Observational case report.Methods: An 87-year-old male who underwent sutureless 25-gauge vitrectomy developed unilateral endophthalmitis. Vitreous culture revealed Staphylococcus coagulase-negative bacteria. He was subsequently treated with intravitreal antibiotics and oral prednisone.Results: The endophthalmitis resolved with a best corrected visual acuity of 6/200 with the presence of an epiretinal membrane.Conclusions: Possible contributing factors to endophthalmitis following sutureless vitrectomy include decreased vitreous irrigation/lavage, lack of a watertight wound, and/or vitreous wicking, all of which may promote intraocular bacterial entrance. A sutureless vitrectomy system may increase the risk of vitrectomy-associated endophthalmitis.Keywords: endophthalmitis, 25-gauge vitrectomy, vitreous wick, sutureless, high flow lavag

Nanomedicine approach for sustained release delivery of Avastin : treatment for PXE and AMD [abstract]

Gold nanoparticles possess unique properties including preferential binding to leaky blood vessels, ability to bind to a variety of ligands, with no evidence of cellular toxicity, making them an excellent platform for targeted sustained release of drugs. Avastin (Bevacizumab) is a humanized monoclonal antibody specifically targeting vascular endothelial growth factor (VEGF) that has found widespread use in inhibiting intraocular neovascularization manifested in macular degeneration and proliferative diabetic retinopathy. The conjugation of gold nanoparticles (AuNP) with Avastin (Av) yields AvAuNP nanoconjugates. Avastin conjugated gold nanoparticles (AvAuNP) can be used as therapeutic agents in the treatment of ophthalmic neovascular disorders, such as macular degeneration, PXE and proliferative diabetic retinopathy. AvAuNP nanoconjugate is a potential clinical therapeutic agent and has demonstrated excellent ability to deliver Avastin for sustained release of therapeutic dose within the eye. The design and development of AvAuNP conjugate would help in the initiation and completion of preclinical evaluations aimed at determining the ability to achieve long-term suppression of intraocular neovascularization in large animals. INVENTOR(S): Ravi Shukla; Kavita K. Katti; Raghuraman Kannan; Dean Hainsworth and Kattesh V. Katti CONTACT INFO: Paul Hippenmeyer, Ph.D., M.B.A.; [email protected]; (573)-882-047

The GCC repeat length in the 5'UTR of MRP1 gene is polymorphic: a functional characterization of its relevance for cystic fibrosis

BACKGROUND: Among the members of the ATP binding cassette transporter superfamily, MRPs share the closest homology with the CFTR protein, which is defective in CF disease. MRP1 has been proposed as a potential modifier gene and/or as novel target for pharmacotherapy of CF to explain the clinical benefits observed in some CF patients treated with the macrolide AZM. The 5'UTR of the MRP1 gene contains a GCC triplet repeat that could represent a polymorphic site and affect the activity of the promoter. METHODS: The MRP1 5' flanking region was amplified by PCR from 36 CF patients and 100 non-CF subjects and the number of GCC triplets of each allele was determined by sequence and electrophoretic analysis. We performed gene reporter studies in CF airway epithelial cells 16HBE14o-AS3, in basal conditions and in the presence of AZM. RESULTS: We found that the GCC repeat is polymorphic, ranging from 7 to 14 triplets either in CF or in non-CF subjects. Our data are preliminary and have to be confirmed on a larger population of CF subjects. The transcriptional activity of the proximal MRP1 5' regulatory region revealed no statistically significant correlations between the number of repeats and treatment with AZM. CONCLUSION: We identified a novel polymorphism in the 5'UTR of MRP1 gene that provides multiple alleles in a gene relevant for multidrug resistance as well as for CF, determining that this region is transcriptionally active and that this activity does not appear to be influenced by AZM treatment

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Creation of 'Super Avastin': A New Nanomedicine Approach for the Treatment of PXE and AMD [abstract]

Nanoscience Poster SessionNanomedicine is an emerging medical area that utilizes nanoparticles for the detection and treatment of diseases. The ubiquitous place of gold in Nanomedicine stems from its chemical ability to serve in an unoxidized state at the nano size level when most surfaces of other metals get oxidized. In addition to our ongoing interest on the development of hybrid gold nanoparticles for use in imaging and therapy of human cancers, we are also actively interested in the fabrication of biocompatible gold nanoparticles conjugated to Avastin for use in the treatment of choroidal neaovascularization associated with Pseudoxanthoma elasticum (PXE) and age related macular degeneration (AMD) ophthalmic diseases. Herein, we report design and development of Avastin conjugated Gold nanoparticles (Super Avastin) for the treatment of PXE and AMD

National Guidelines for Digital Modelling

These National Guidelines and Case Studies for Digital Modelling are the outcomes from one of a number of Building Information Modelling (BIM)-related projects undertaken by the CRC for Construction Innovation. Since the CRC opened its doors in 2001, the industry has seen a rapid increase in interest in BIM, and widening adoption. These guidelines and case studies are thus very timely, as the industry moves to model-based working and starts to share models in a new context called integrated practice. Governments, both federal and state, and in New Zealand are starting to outline the role they might take, so that in contrast to the adoption of 2D CAD in the early 90s, we ensure that a national, industry-wide benefit results from this new paradigm of working. Section 1 of the guidelines give us an overview of BIM: how it affects our current mode of working, what we need to do to move to fully collaborative model-based facility development. The role of open standards such as IFC is described as a mechanism to support new processes, and make the extensive design and construction information available to asset operators and managers. Digital collaboration modes, types of models, levels of detail, object properties and model management complete this section. It will be relevant for owners, managers and project leaders as well as direct users of BIM. Section 2 provides recommendations and guides for key areas of model creation and development, and the move to simulation and performance measurement. These are the more practical parts of the guidelines developed for design professionals, BIM managers, technical staff and ‘in the field’ workers. The guidelines are supported by six case studies including a summary of lessons learnt about implementing BIM in Australian building projects. A key aspect of these publications is the identification of a number of important industry actions: the need for BIM-compatible product information and a national context for classifying product data; the need for an industry agreement and setting process-for-process definition; and finally, the need to ensure a national standard for sharing data between all of the participants in the facility-development process

Brief of Amici Curiae GLBTQ Legal Advocates & Defenders et al. in Support of Respondent in Gloucester County School Board v. G.G., SJC 16-273

Amici brief submitted by the GLBTQ Legal Advocates & Defenders, the National Center for Lesbian Rights, and Foley Hoag, LLP. to the Supreme Court of the United States in the case of Gloucester County School Board v. G.G., by His Next Friend and Mother, Deirdre Grimm. The brief argues that the Court should reject the school board’s claim that privacy interests justify its discriminatory policy for three reasons. First, there is no basis for the creation of a new privacy right that justifies excluding transgender students from shared restrooms. Second, nothing in Title IX or its regulations supports the School Board’s claim that Congress created an unwritten privacy exception to Title IX. Finally, although not required by Title IX or its regulations, schools that wish to enhance students’ privacy in restrooms can use readily available non-discriminatory means to do so that do not violate Title IX