Notes

Neurological age within wholesome aged forecasts aging-related ailments including dementia.
PURPOSE To characterize and compare clinical productivity and payments between female and male oral and maxillofacial surgeons (OMSs) serving Medicare beneficiaries in 2017. MATERIALS AND METHODS This cross-sectional study was composed of Medicare Provider Utilization and Payment Data from 2017. Providers were included if they were labeled as maxillofacial surgeons. The primary outcome variable was Medicare payment. Secondary outcome variables included clinical productivity (number of charges), unique billing codes, mean payment per charge, and beneficiary hierarchical condition category. Descriptive statistics and pair-wise comparisons were computed at an α level of .05. RESULTS The analysis cohort was composed of 737 distinct OMSs, of whom 58 were women. Although female surgeons recorded higher mean clinical productivity, total Medicare payments, and number of unique Healthcare Common Procedure Coding System billing codes relative to male surgeons in both the facility and office settings, the differences were not statistically different. Payment per charge did not differ significantly between genders in the office setting. In the facility setting, women were reimbursed $63.74 per charge whereas men were reimbursed $109.69 per charge (P less then .02). Female OMSs treated more medically complex patients relative to male OMSs (P less then .02). CONCLUSIONS Clinical productivity and total Medicare payments were similar between genders in both the facility and office settings, disputing prior surveys that illustrated bias about the productivity and ability of female OMSs. Female OMSs earned, on average, less per submitted charge in facility settings, which may be due to differences in documentation. The reason for this difference warrants further study. PURPOSE Methods for digital dental alignment are not readily available to automatically articulate the upper and lower jaw models. The purpose of the present study was to assess the accuracy of our newly developed 3-stage automatic digital articulation approach by comparing it with the reference standard of orthodontist-articulated occlusion. MATERIALS AND METHODS Thirty pairs of stone dental models from double-jaw orthognathic surgery patients who had undergone 1-piece Le Fort I osteotomy were used. Two experienced orthodontists manually articulated the models to their perceived final occlusion for surgery. Each pair of models was then scanned twice-while in the orthodontist-determined occlusion and again with the upper and lower models separated and positioned randomly. The separately scanned models were automatically articulated to the final occlusion using our 3-stage algorithm, resulting in an algorithm-articulated occlusion (experimental group). The models scanned together represented the manually artic, reliably, and automatically articulated using our 3-stage algorithm approach, meeting the reference standard of orthodontist-articulated occlusion. PURPOSE To describe the ocular manifestations of neuroblastoma in a large cohort of children. DESIGN Retrospective cohort study. METHODS The medical records of patients diagnosed with neuroblastoma between 1989 and 2017 at a tertiary-care pediatric hospital were analyzed. The main outcome measures were the incidence and prognostic role of ocular findings. RESULTS There were 523 patients with neuroblastoma in the study cohort. Median age at diagnosis was 1.9 years, median follow-up was 4.0 years, and 57.2% were male. At last follow-up, 55.3% were in disease remission, 5.0% had stable disease, 28.1% were deceased, and 11.7% were on active or palliative treatment. A total of 86 patients (16.4%) had ocular manifestations of neuroblastoma, 58 at presentation and 29 during the disease course. The most common findings were orbital involvement in 37 (43.0%), opsoclonus in 20 (23.3%) and Horner syndrome in 24 (27.9%). In 16 patients (3.1%), there were only ocular findings at presentation, including 8 (1.5%) with orbital involvement, 7 (1.3%) with Horner syndrome, and 1 (0.2%) with orbital involvement and a cranial nerve palsy. On survival analysis, a favorable prognosis was associated with opsoclonus, female sex, and diagnosis before 12 months of age, while a worse prognosis was associated with orbital involvement. CONCLUSIONS In this cohort, approximately 1 in 6 patients with neuroblastoma had ocular manifestations, but only 3% presented with only ocular findings. Orbital involvement was common and associated with a poor prognosis, while opsoclonus, female sex, and younger age at diagnosis were associated with a favorable prognosis. PURPOSE To report the baseline characteristics of participants enrolled in the Treatment of Advanced Glaucoma Study (TAGS) DESIGN Pragmatic randomised control trial (RCT). PARTICIPANTS Patients with open angle glaucoma presenting with advanced glaucoma in at least one eye as defined by the Hodapp-Parrish-Anderson (HPA) criteria of severe defect. METHODS Participants with newly diagnosed advanced glaucoma in at least one eye were recruited. Participants were randomly allocated to receive either primary augmented trabeculectomy or primary medical management. When both eyes were eligible, the same intervention was undertaken in both eyes and the index eye for analysis was the eye with the less severe visual field mean deviation (MD). MAIN OUTCOME MEASURES Visual field profile defined by the HPA classification, clinical characteristics, Quality of life measured by the National Eye Institute Visual Function Questionnaire 25 (VFQ-25), EuroQual-5 Dimension (EQ-5D 5L), Health Utility Index-3 (HUI-3) and Glaucoma Profile Instrument (GPI) RESULTS Four hundred and fifty-three patients were recruited. The mean visual field MD was -15.0dB (SD 6.3) in the index eye and -6.2dB in the non-index eye. Of index eyes (HPA 'severe' classification) at baseline, over 70% had a mean deviation less then -12.00dB and nearly 90% had more than 20 points defective at the 1% level. The mean LogMAR visual acuity of the index eye was 0.2 (SD 0.3), CONCLUSIONS TAGS is the first RCT to compare medical and surgical treatments for patients presenting with advanced open angle glaucoma in a publicly funded health service. It will provide clinical, health related quality of life and economic outcomes to inform future treatment choices for those presenting with advanced glaucoma. PURPOSE To investigate an enlarged dacryoadenotic lacrimal gland and normal lacrimal glands for the presence of goblet cells (mucocytes). DESIGN Retrospective clinicopathologic series. METHODS An enlarged lacrimal gland (dacryoadenosis) without obvious histopathologic alterations was extensively evaluated histochemically, immunohistochemically, and ultrastructurally to detect the presence of goblet cells and to compare the findings with those in five normal lacrimal glands. RESULTS Granular, zymogen-rich pyramidal acinar cells in normal glands predominated over a previously Not reported subpopulation of non-granular, pale staining cells in both dacryadenotic and normal lacrimal glands. These cells histochemically stained positively with mucicarmine and Alcian blue. Immunohistochemical and electron microscopic evaluations established that there was a displacement or replacement of cytoplasmic gross cystic disease fluid protein-15 and CK 7-positive tonofilaments in the pale acinar cells by myriad mucus granules. Goblet cells constituted approximately 2 % of the normal acinar cells and 5% of dacryoadenotic acinar cells. A depletion of myoepithelial cells and ectopic intra-acinar ductular cells were also observed in dacryoadenosis. CONCLUSION Dacryodenosis is caused by an increase in the number of acini without individual acinar cell hyperplasia. A normal cytologic feature of the lacrimal gland is the presence of acinar goblet cells that had been long overlooked; they are increased in number in dacryoadenosis. Intra-acinar ductular cells and the scattered loss of myoepithelial cells are other abnormalities in dacryoadenosis. The presence of lacrimal gland goblet cells may have physiologic implications for the pre-corneal tear film and its derangements as well as for the histogenesis of mucus-producing carcinomas. PURPOSE Determine the ocular complications in school-age children and adolescents surviving at least one year following allogeneic bone marrow transplantation. DESIGN Retrospective cohort study METHODS In our institutional study, 162 (7-18 years old) patients met our inclusion criteria with a mean age of 13.4 years at bone marrow transplantation. Follow up ranged from 13 months to 12 years (mean 4 years, median 3.2 years). Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment disease. RESULTS Cataract formation was noted in 57 patients. Univariate analysis showed that fractionated total body irradiation, race, and use of cytarabine significantly increased the incidence of cataracts forming (P less then 0.05). Multivariate analysis of significant variables showed that total body irradiation was a risk factor for cataract formation. Of the 57 (97 eyes) that developed cataracts after bone marrow transplantation, 4 (6 eyes) required cataract surgery. After surgery, all patients had visual acuities of 20/20-20/25. Of the 162 patients, 51 developed dry eyes. Univariate analysis showed that age at transplantation, steroid use, chronic graft-versus-host disease, fludarabine use, melphalan use, thiotepa use, and receiving no pre-transplant conditioning regimen prior to bone marrow transplant significantly increased the risk of dry eye syndrome (p less then 0.05). click here In multivariate analysis, chronic graft-versus-host disease was a significant risk factor for dry eye syndrome. CONCLUSION Due to the high incidence of cataract formation and dry eye disease in this population, we propose screening exams by a pediatric or general ophthalmologist at least every year. PURPOSE Wide field swept source OCT angiography (WF SS-OCTA) imaging was compared with ultrawide-field (UWF) fluorescein angiography (FA) imaging to better understand changes in retinal non-perfusion before and after panretinal photocoagulation (PRP) in treatment-naïve eyes with proliferative diabetic retinopathy (PDR). DESIGN Prospective, observational, consecutive case series. PARTICIPANTS Patients with treatment-naïve PDR. METHODS Patients were imaged using the SS-OCTA 12x12mm scan pattern at baseline and 1 week, 1 month, and 3 months after PRP. UWF FA was obtained at baseline and 3 months after PRP. Selected eyes were imaged using five SS-OCTA 12x12mm scans to create a posterior pole montage, and 5 eyes also underwent SS-OCTA imaging at 6 months and 1 year. Areas of retinal non-perfusion (RNP) were drawn independently by two masked graders, and analysis of variance (ANOVA) tests were used to compare areas of RNP over time. MAIN OUTCOME MEASURES Area and boundaries of RNP visualized using WF SS-OCTA and UWF FA RESULTS From January 2018 through January 2019, WF SS-OCTA was performed on 20 eyes with treatment-naïve PDR from 15 patients. Areas of RNP identified on UWF FA images co-localized with RNP areas visualized on WF SS-OCTA images. There were no statistically significant changes in RNP area on WF SS-OCTA images through 3 months after PRP. Even eyes that were severely ischemic at baseline had no significant changes in RNP area one year after PRP. CONCLUSIONS RNP in PDR can be identified at baseline and imaged serially after PRP using WF SS-OCTA. Retinal perfusion in PDR does not change significantly after PRP. The ability of WF SS-OCTA to longitudinally evaluate RNP areas provides additional justification for adopting WF SS-OCTA as the sole imaging modality for clinical management of PDR.
My Website: https://www.selleckchem.com/products/thal-sns-032.html