Correlation of retinal nerve fibre layer thickness and spontaneous retinal venous pulsations in glaucoma and normal controls

© 2015 Golzan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Purpose: To study the relationship between amplitude of spontaneous retinal venous pulsatility (SRVP) and retinal nerve fibre layer (RNFL) thickness in glaucomatous eyes, and to determine if this parameter may be a potential marker for glaucoma severity. Method: 85 subjects including 50 glaucoma (21 males, 67±10 yrs) and 35 normals (16 males, 62±11 yrs) were studied. SRVP amplitude was measured using the Dynamic Vessel Analyser (DVA, Imedos, Germany) at four regions of the retina simultaneously within one disc diameter from the optic disc - temporal-superior (TS), nasal-superior (NS), temporal-inferior (TI) and nasal-inferior (NI)). This was followed by RNFL thickness measurement using spectral domain optical coherence tomography (Spectralis OCT). The correlation between SRVP amplitude and corresponding sectoral RNFL thickness was assessed by means of non-linear regression (i.e. logarithmic). Linear regression was also applied and slopes were compared using analysis of covariance (ANCOVA). Results: Greater SRVP amplitude was associated with thicker RNFL. Global SRVP amplitude was significantly lower in glaucoma eyes compared with normals (p0.05). Since the slopes are not significantly different, it is possible to calculate one slope for all the data. The pooled slope equals 10.8 (i.e. RNFL = 10.8SRVP+41)

The Tamar Trough revisited: correlations berween sedimentary beds, basalts, their ages and valley evolution, North Tasmania

The Tamar Trough, an Early Palaeogene fault structure, contains sedimentaty beds and interleaved basaltic flows that infill the structure along its 70 km length. These infills represent a complex interplay between sedimentation, channel erosion, eruptive dislocations, and even 'out of trough' diyersions of the ancestral Tamar drainage. Several areas of resistant basalt flows remain in the south, upper, middle and lower Tamar reaches. Although some palynological control was known, radiometric dating of previously untested basalts now allows close integration and age-pegging for observed palynological biozones. The K-Ar and Ar-Ar ages of the basalt bodies indicate eruptive events at 47, 33-37 and 25 Ma, correlating with Proteacidites asperopolus-Malvacipollis diversus, Nothofagites asperus and Proteacidites tuberculatus biozone age sedimentary beds respectively. Basanite, alkali basalt and hawaiite flows dominate basalt lithology with lesser olivine nephelinite, transitional olivine basalt, olivine tholeiite and quartz tholeiite. Basalt geochemistry suggests derivation from different degrees of partial mande melting (from 7 to 35%), with alkaline and tholeiitic basalts being derived from separate source regions. Most alkaline basalts have high-jl (HIMU) related trace element signatures, which are absent in the tholeiitic rocks. A basalt plug on the trough margin at Loira gave a Jurassic age and has Jurassic dolerite-like geochemistry. The Tamar sequence suggests that the initial fluvio-Iacustrine and later channel-fill sedimentation from 65(?) to 24(?) Ma was then punctuated in places by periods of alkaline volcanism between 47 to 33(?) Ma, and alkaline and tholeiitic volcanism between 33 to 24(?) Ma. No Neogene fossils are known, so this later period was probably one of net erosion. These contrasting quiet sedimentary and more volcanic intervals are related here to a tectonic model that involves northerly drift of Victorian and Tasmanian lithosphere over several former Tasman metasomatised mantle plume sources

Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

BackgroundBEIT CURE International Hospital (BCIH) opened in 2002 providingorthopaedic surgical services to children in Malawi. This study reviews thehospital’s progress 10 years after establishment of operational services. Inaddition we assess the impact of the hospital’s Malawi national clubfootprogramme (MNCP) and influence on orthopaedic training.MethodsAll operative paediatric procedures performed by BCIH services in the10th operative year were included. Data on clubfoot clinic locations andnumber of patients treated were obtained from the MNCP. BCIH recordswere reviewed to identify the number of healthcare professionals whohave received training at the BCIH.Results609 new patients were operated on in the 10th year of hospital service.Patients were treated from all regions; however 60% came fromSouthern regions compared with the 48% in the 5th year. Clubfoot,burn contracture and angular lower limb deformities were the three mostcommon pathologies treated surgically. In total BCIH managed 9,842patients surgically over a 10-year period. BCIH helped to establish andco-ordinate the MNCP since 2007. At present the program has a totalof 29 clinics, which have treated 5748 patients. Furthermore, BCIH hasoverseen the full or partial training of 5 orthopaedic surgeons and 82orthopaedic clinical officers in Malawi.ConclusionThe BCIH has improved the care of paediatric patients in a country thatprior to its establishment had no dedicated paediatric orthopaedic service,treating almost 10,000 patients surgically and 6,000 patients in the MNCP.This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training  commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation

On the unification of dwarf and giant elliptical galaxies

The near orthogonal distributions of dwarf elliptical (dE) and giant elliptical (E) galaxies in the mu_e-Mag and mu_e-log(R_e) diagrams have been interpreted as evidence for two distinct galaxy formation processes. However, continuous, linear relationships across the alleged dE/E boundary at M_B = -18 mag - such as those between central surface brightness (mu_0) and (i) galaxy magnitude and (ii) light-profile shape (n) - suggest a similar, governing formation mechanism. Here we explain how these latter two linear trends necessitate a different behavior for dE and E galaxies, exactly as observed, in diagrams involving mu_e (and also _e). A natural consequence is that the distribution of dEs and Es in Fundamental Plane type analyses that use the associated intensity I_e, or _e, are expected to appear different. Together with other linear trends across the alleged dE/E boundary, such as those between luminosity and color, metallicity, and velocity dispersion, it appears that the dEs form a continuous extension to the E galaxies. The presence of partially depleted cores in luminous (M_B < -20.5 mag) Es does however signify the action of a different physical process at the centers (< ~300 pc) of these galaxies.Comment: 5 pages from the proceedings of the 2004 conference "Penetrating bars through masks of cosmic dust: the Hubble tuning fork strikes a new note". Edited by D. L. Block, I. Puerari, K. C. Freeman, R. Groess, and E. K. Bloc

Predicting the emergence of drug-resistant HSV-2: new predictions

BACKGROUND: Mathematical models can be used to predict the emergence and transmission of antiviral resistance. Previously it has been predicted that high usage of antivirals (in immunocompetent populations) to treat Herpes Simplex Virus type 2 (HSV-2) would only lead to fairly low levels of antiviral resistance. The HSV-2 predictions were based upon the assumption that drug-resistant strains of HSV-2 would be less infectious than drug-sensitive strains but that the drug-resistant strains would not be impaired in their ability to reactivate. Recent data suggest that some drug-resistant strains of HSV-2 are likely to be impaired in their ability to reactivate. Objectives: (1) To predict the effect of a high usage of antivirals on the prevalence of drug-resistant HSV-2 under the assumption that drug-resistant strains will be less infectious than drug-sensitive strains of HSV-2 and also have an impaired ability to reactivate. (2) To compare predictions with previous published predictions. METHODS: We generated theoretical drug-resistant HSV-2 strains that were attenuated (in comparison with drug-sensitive strains) in both infectivity and ability to reactivate. We then used a transmission model to predict the emergence and transmission of drug-resistant HSV-2 in the immunocompetent population assuming a high usage of antivirals. RESULTS: Our predictions are an order of magnitude lower than previous predictions; we predict that even after 25 years of high antiviral usage only 5 out of 10,000 immunocompetent individuals will be shedding drug-resistant virus. Furthermore, after 25 years, 52 cases of HSV-2 would have been prevented for each prevalent case of drug-resistant HSV-2. CONCLUSIONS: The predicted levels of drug-resistant HSV-2 for the immunocompetent population are so low that it seems unlikely that cases of drug-resistant HSV-2 will be detected

Dementia and osteoporosis in a geriatric population: Is there a common link?

AIM To determine the existence of a common pathological link between dementia and osteoporosis through reviewing the current evidence base. METHODS This paper reviews the current literature on osteoporosis and dementia in order to ascertain evidence of a common predisposing aetiology. A literature search of Ovid MEDLINE (1950 to June 2016) was conducted. The keywords “osteoporosis”, “osteoporotic fracture”, “dementia” and “Alzheimer’s disease” (AD) were used to determine the theoretical links with the most significant evidence base behind them. The key links were found to be vitamins D and K, calcium, thyroid disease, statins, alcohol and sex steroids. These subjects were then searched in combination with the previous terms and the resulting papers manually examined. Theoretical, in vitro and in vivo research were all used to inform this review which focuses on the most well developed theoretical common causes for dementia (predominantly Alzheimer’s type) and osteoporosis. RESULTS Dementia and osteoporosis are multifaceted disease processes with similar epidemiology and a marked increase in prevalence in elderly populations. The existence of a common link between the two has been suggested despite a lack of clear pathological overlap in our current understanding. Research to date has tended to be fragmented and relatively weak in nature with multiple confounding factors reflecting the difficulties of in vivo experimentation in the population of interest. Despite exploration of various possible mechanisms in search for a link between the two pathologies, this paper found that it is possible that these associations are coincidental due to the nature of the evidence available. One finding in this review is that prior investigation into common aetiologies has found raised amyloid beta peptide levels in osteoporotic bone tissue, with a hypothesis that amyloid beta disorders are systemic disorders resulting in differing tissue manifestations. However, our findings were that the most compelling evidence of a common yet independent aetiology lies in the APOE4 allele, which is a well-established risk for AD but also carries an independent association with fracture risk. The mechanism behind this is thought to be the reduced plasma vitamin K levels in individuals exhibiting the APOE4 allele which may be amplified by the nutritional deficiencies associated with dementia, which are known to include vitamins K and D. The vitamin theory postulates that malnutrition and reduced exposure to sunlight in patients with AD leads to vitamin deficiencies. CONCLUSION Robust evidence remains to be produced regarding potential links and regarding the exact aetiology of these diseases and remains relevant given the burden of dementia and osteoporosis in our ageing population. Future research into amyloid beta, APOE4 and vitamins K and D as the most promising aetiological links should be welcomed

Delayed reperfusion deficits after experimental stroke account for increased pathophysiology.

Cerebral blood flow and oxygenation in the first few hours after reperfusion following ischemic stroke are critical for therapeutic interventions but are not well understood. We investigate changes in oxyhemoglobin (HbO(2)) concentration in the cortex during and after ischemic stroke, using multispectral optical imaging in anesthetized mice, a remote filament to induce either 30 minute middle cerebral artery occlusion (MCAo), sham surgery or anesthesia alone. Immunohistochemistry establishes cortical injury and correlates the severity of damage with the change of oxygen perfusion. All groups were imaged for 6 hours after MCAo or sham surgery. Oxygenation maps were calculated using a pathlength scaling algorithm. The MCAo group shows a significant drop in HbO(2) during occlusion and an initial increase after reperfusion. Over the subsequent 6 hours HbO(2) concentrations decline to levels below those observed during stroke. Platelets, activated microglia, interleukin-1α, evidence of BBB breakdown and neuronal stress increase within the stroked hemisphere and correlate with the severity of the delayed reperfusion deficit but not with the ΔHbO(2) during stroke. Despite initial restoration of HbO(2) after 30 min MCAo there is a delayed compromise that coincides with inflammation and could be a target for improved stroke outcome after thrombolysis

Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial

Background: In sub-Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. Methods: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped-wedge trial of opt-out delivery of point-of-care (POC) HIV-1 nucleic acid testing (NAAT), compared with standard provider-initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log-binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. Results: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt-out intervention had a two-fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39–3.51) after adjustment for factors imbalanced across study periods. Conclusions: Among symptomatic adults aged 18–39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt-out testing could diagnose twice as many patients as an approach relying on provider discretion